Kenneth L. Zeri


POSTED: Friday, August 21, 2009

Perhaps the most incendiary element of the health care debate centers on the debunked but persistent claim that the Obama administration wants to kill off elderly patients draining the Medicare system by rationing care.

None of the bills emerging from various congressional committees includes any so-called “;death panel,”; yet the disinformation persists, despite no less than the AARP—the national group representing people 50 and older—trying to dispel it.

The distortions especially dismay people devoted to caring for terminally ill patients, as the increasingly acrimonious debate threatens to demonize hospice care, the end-of-life therapy that recognizes a peaceful and comfortable death as essential when a cure is no longer possible.

Hospice programs provide state-of-the-art pain management and other physical, social, spiritual and emotional care to dying patients and their families, in private homes or facilities.

More than 2,500 patients a year receive hospice care in Hawaii, including 700 served by the nonprofit Hospice Hawaii, whose president and chief professional officer, Kenneth L. Zeri, shed light on some of the issues.

“;There's plenty of room to debate health care reform, but let's get the crazy fears out of the way and really talk honestly,”; said Zeri, a registered nurse with 23 years experience in hospice care. “;This fear strategy ... is wrong.”;

Zeri, 52, sits on the public policy committee of the National Hospice and Palliative Care Organization. He has lived in Hawaii for 14 years; his wife is a retired Navy physician. Their daughter, a Sacred Hearts Academy alum, is a Cordon Bleu-trained chef in New Hampshire who inherited her passion for cooking from dad, who also spends his free time immersed in music, as the choir director of Joy of Christ Lutheran Church in Pearl City.

QUESTION: Advance directives, living wills, power of attorney, all of those are very familiar subjects to anyone who has ever been hospitalized, or had a family member hospitalized. Why do you think these subjects are suddenly so controversial? ANSWER: Perhaps opponents of the broader health care overhaul are trying to whip up a little bit of fear and scare people into not supporting reform. When you strip away the disinformation, this is actually a very sensible proposal.

Q: What does the House bill actually say about end-of-life care?

A: It's Section 1233, Advance Care Planning Consultation. It's intended to offer Medicare beneficiaries the opportunity to engage in an informed discussion about future treatment. ... What's most important is that this is indeed a voluntary conversation. There's no mandate ... Congress is saying that we know that having these conversations is good, it benefits the patients and it benefits their families. And because it is good, we want Medicare to pay for it. ... It's similar to POLST, which Hawaii just passed.

Q: What's POLST?

A: It stands for Physician Orders for Life-Sustaining Treatment. It improves quality of care ... by helping patients communicate their wishes and making sure health care professionals honor those wishes. (About 25 states, including Hawaii, are developing or have enacted POLST laws.) There's a section in the bill that talks about explaining and paying for POLST.

Q: What are these “;death panels”; we're hearing so much about?

A: There is no panel! I think they made it up. I haven't seen anything in the bill that says anything about a panel.

Q: So the consultation is with the patient's own doctor?

A: Yes, their doctor, or their nurse practitioner, or physician assistant. It's with someone who knows them, who's involved with their care. And again, this is all totally voluntary and totally in keeping with the best medical practices that already exist today.

Q: Would this bill legalize euthanasia?

A: Absolutely not. Under no circumstances.

Q: Would it encourage any entity, whether a hospital, individual doctor, or government agency to hasten a patient's death? Does it contain a financial incentive to withhold treatment?

A: No. This bill is not about limiting care, it's not about hastening death ... (the end-of-life care) section is simply about making sure that patients have the tools to make our wishes known and to assist the health care providers in honoring those wishes.

Q: Do you worry that the misinformation could end up demonizing hospice care?

A: So many people don't understand what hospice care is to begin with so with so much misinformation about end-of-life care, there is in fact a significant risk that people will be misinformed about what hospice really can do for them ... It creates a huge barrier to even having that discussion. Ultimately that may mean some (terminally ill patients) ... end up being in pain and suffering in an ICU unit, versus being comfortable at home, surrounded by loved ones. That's not to malign our colleagues in ICU; they do a tremendous job, but it's a hard place to be, for the patient and their families.

Q: How would health care reform affect hospice care?

A: In terms of the very bottom line we're expecting to take cuts in our reimbursement ... we don't see avoiding cuts in Medicare, which is unfortunate.

Q: So Medicare covers hospice care?

A: Yes; so do most private insurers.

Q: How many people get hospice care?

A: About 1.3 million people get hospice care each year and there is a tremendously high level of satisfaction with the care among patients and their families.

Q: How many of those patients are in Hawaii?

A: More than 2,500 a year and the number is increasing ... We know that hospice provides exceptional care to patients and their families and saves Medicare tons of money.

Q: How does it save money?

A: So often (patients and their families) don't have these discussions until the very last moments and then the panicked response from the family is “;do everything”; and the person ends up in intensive care (and dies anyway) ... If they had these discussions a few months earlier, they could have gone home, been comfortable, surrounded by family. The thing is, you still get to choose. If you want to be in the ICU, then fine, you can ... But a lot of terminally ill people would not choose that if they knew about hospice.

Myths about health care reform debunked

The AARP, a national association of people 50 and older, supports the health care overhaul. Here is its take on two key issues.

Myth: Health care reform means rationed care.

Fact: None of the health reform proposals being considered would stand between individuals and their doctors or prevent any American from choosing the best possible care.

Fact: Health care reform will help ensure doctors are paid fairly so they will continue to treat Medicare patients.

Bottom line: Health reform isn't about rationing; it's about giving people the peace of mind of knowing that they will be able to keep their doctors and that they will have a choice of affordable health plans.


Myth: Health care reform means the government can make life-and-death decisions for you.

Fact: Health care reform will not give the government the power to make life-and-death decisions for anyone regardless of their age. Those decisions will be made by individuals, their doctor and their family.

Fact: No one, including the government or an insurance company, will be given power to make life-and-death decisions for you.

Bottom line: Health care reform isn't about putting the government in charge of difficult end-of-life decisions. It's about giving individuals and families the option to talk with their doctors in advance about difficult choices every family faces when loved ones near the end of their lives.

Source: AARP's Health Action Now campaign,