Wed, Nov 20, 2002 (10:59 a.m.)

A national study has given Nevada -- and the nation -- low marks in health care for terminally ill and dying patients.

The report "Means to a Better End: A Report on Dying in American Today," by Last Acts, a Robert Woods Johnson Foundation-funded group, gave Nevada hospitals a failing grade.

"Hospitals in Nevada earned the lowest possible grade because they offer few pain management, hospice and palliative care services," the report said.

"Only 11 percent of hospitals reported offering pain management programs and 5 percent of hospitals reported offering hospice or palliative care, the 'gold standard' of end-of-life care."

Nevada officials said the report's findings were not unexpected, given that families don't like to talk about death and that doctors and hospitals are motivated more by saving lives than by preparing patients for the inevitable.

Nevada Attorney General Frankie Sue Del Papa said progress has been made in heightening awareness of end-of-life care statewide since she initiated a 1996 task force to address the needs of dying Nevadans.

Those advancements include holding 400 seminars for health-care professionals during the last three years on subjects including living wills, pain management and bereavement support; improved prescription tracking to avoid accidental overdose; and free public advance care planning presentations in 13 counties. The creation of the Nevada Center of Ethics and Health Policy also resulted from that task force to coordinate institutional policies.

"As a culture in the United States we are denying and defying death -- we push death away when we should embrace death as part of life and try to take away the fears surrounding it," said Noel Tiano, director the Center of Ethics and Health Policy.

"We have a medical model which is centered on curing. We need to change it to address healing more than curing. Death can no longer be perceived by the health-care provider as a failure on his part."

Tiano, whose coalition involves 70 health organizations, says that while life expectancy has increased because of doctors' never-say-die attitude, the Life Acts report sends a message that health-care professionals also must better address end-of-life issues as part of quality of life.

The national report said Nevada "also has relatively few nurses and physicians who are trained to provide palliative care," which focuses on controlling pain and symptoms and providing emotional and spiritual support to the patient and family, respecting cultural traditions. The state got a D grade for that shortfall.

Last Acts, of which former first lady Rosalynn Carter is honorary chairwoman, relied on data collected from 1997 through 2002 for the eight criteria for which grades were given.

Nursing homes got a D grade for having 51 percent of residents in persistent pain in 1999.

However, Paul Boyar, who runs a local nursing home and is president of the Nevada Healthcare Association, says the figures used by the study do not reflect what currently is going on in the state nursing home industry.

"The numbers from 1999 are dated because in 2001 Medicare on a national basis and Medicaid on a state basis began funding the use of hospice personnel in Nevada nursing homes," Boyar said.

"They augment my staff and are professionally trained in end-of-life care. They do wonderful work with pain management and other services and our staff watches them and learns their techniques."

The state also got a D for a lack of state policies that support good advance care planning. The report said Nevada laws do not support living wills and medical powers of attorney that designate a health care decision-maker should the patient become unable to communicate.

Nevada, however, got a B for state policies that encourage good pain control because it allows "physicians to treat pain at the end of life without undue scrutiny."

Nevada got C grades for having conditions where less than 32 percent of residents died at home in 1997, for having conditions where less than 29 percent died under hospice care in 2000 and for having nearly 11 percent of residents over 65 with seven or more intensive care unit days during the last six months of life in 2000.

Pam Dalinis, a nurse and a certified bio-ethicist with the Center for Ethics and Health Policy's Las Vegas office, said health-care professionals should look at this report as more of a guideline than a condemnation.

"This report should not be used to question what has been done but to demonstrate that we have so much more to do," Dalinis said. "We never before have had this information from which to work."

As a bio-ethicist, Dalinas helps patients by looking at what is the best path they should take with health-care treatment given their situations. That, she said, is something more health-care professionals, hospitals and people in general must do.

"The pressure and uncertainty of the future for the entire family escalates if you do not discuss death," she said. "All of a sudden dad has a heart attack and that increases the stress for the person who is uncertain what the patient's wishes are, but must make a decision at a critical time."

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