Posted on Sun, May. 11, 2008

JACKSON, Miss. -- After 66-year-old Ersel Allen was diagnosed with pancreatic cancer and admitted to a hospice, she was dead within weeks.

The problem is, according to autopsy results and attorneys for her family, Allen never had cancer. She died of an overdose.

Allen's family won a $4.5 million award in 2006 after suing Dr. William Causey and Hospice Ministries in Ridgeland. The hospice settled. Causey, who is in prison for child molestation, is appealing the verdict.

"This woman was not terminally ill. She was put to sleep," said Philadelphia attorney Dan Mars, who is representing Allen's family.

Ray McNamara, Causey's attorney, acknowledges that Allen did not have cancer, but said she suffered from other ailments.

The Mississippi Supreme Court was scheduled to hear the case Tuesday, but that was postponed when a faulty sprinkler system flooded the court building.

A former district attorney investigated Allen's death, but apparently abandoned the investigation when Causey was charged in Louisiana with molesting a 13-year-old boy.

"They didn't do anything because (the doctor) would never get out of prison, anyway," said Allen's daughter, Reitha Sanders.

Causey was convicted in 2005 and sentenced to 25 years for molesting the boy.

Hospice experts agree that Allen's case is different.

"Certainly a case like this garners sensational headlines, but it's not the norm," said Todd Sitzman, past president of the American Academy of Pain Medicine and the director of advanced pain therapy at Forrest General Cancer Center in Hattiesburg.

"Unfortunately a case like this makes palliative care suspect," he said.

Accusations that hospices or their employees have given overdoses to patients date back years. Most of the allegations were determined to be unfounded.

Two employees of Sanctuary Hospice House in Tupelo were indicted last month on misdemeanor charges related to neglect and practicing medicine without a license. The relatives of several people claim their loved ones were given lethal does of morphine. Dr. Paul White, the hospice medical director, and clinical director Margaret Lehman, say they are innocent and will be vindicated along with the facility.

In 1998, a panel of doctors found there was no evidence to support claims by a medical examiner in Volusia County, Fla., that at least five patients from two hospices were killed with lethal doses of morphine. A grand jury in Oregon declined to indict a nurse accused of giving lethal doses of morphine to four patients at a nursing home who died from 1987-1998.

In Allen's case, autopsy results say she died of an overdose of Dilaudid after being admitted to the Ridgeland hospice in 2001. The story began months earlier when Allen was diagnosed with gallstones and sent to the University of Mississippi Medical Center in Jackson for treatment.

UMC physicians allegedly diagnosed Allen with terminal pancreatic cancer.

"They verified she had some kind of tumor but they never were able to confirm it microscopically," McNamara said. "They considered exploratory surgery but because of the weakened condition due to emphysema and cardiac problems, they discussed it with the family, and a decision was made not to operate."

UMC officials declined to comment on Allen's case.

That Allen never had cancer was discovered when her life insurance company asked for an autopsy before paying benefits, Mars said. Allen's family sued Causey, the hospice and the hospital.

"UMC was a party to the case and settled for a very nominal amount," said McNamara, adding that the hospice settled, too, but only because its insurance company "paid to get the hospice out."

Mars said the case has far-reaching implications, because, he claims, hospice physicians routinely overmedicate patients, sometimes with dire consequences. He points to Causey's own defense to bolster the claim.

"While there are recommended dosages for the use of Dilaudid, morphine and other opiates in an acute-care settings such as a hospital, there is no upper limit on an amount that a person can take in the hospice pain-care situation," according to testimony included in court documents from Causey's expert witness.

Other hospice specialists agree that there are no maximum limits to the amount of opiates that can be given to comfort the dying, but they say hospices aren't in the business of accelerating anyone's death.

Dying patients build tolerances and need larger doses over time, hospice specialists say.

"As long as the dose is calibrated against their pain severity, even at very large doses patients can remain awake and alert," said Dr. David Casarett, a professor with the University of Pennsylvania and a former board member for the National Hospice and Palliative Care Organization.

"So please don't get the idea that those patients who receive very large doses are choosing something like euthanasia."

That sentiment is lost on Allen's daughter.

"I lost a very important part of my life," Sanders said. "It's hard everyday when you wake up knowing that she would be here if it wasn't for that doctor."

Causey's attorney says the doctor should not have been held liable because he worked for the hospice and it wasn't the facility's role to re-diagnose Allen's condition.

"She'd been treated by a dozen specialists at UMC and they believed in good faith she was terminal," McNamara said. "She had a number of conditions that would have brought about her death."