PORTLAND, OREGON. Physicians for Compassionate Care, 17-August-2002- In an electronic memorandum dated August 6, 2002, Kaiser Permanente NW, an HMO in Oregon where assisted suicide has been legalized, claimed it is difficult to find doctors to give lethal overdoses to patients. So Janet P. Price, representing Northwest Permanente, sent a memorandum to 829 recipients requesting that all doctors willing to overdose patients give their name to Doctor Robert Richardson of the Ethics Service or to another Kaiser administrator.

The memorandum complained that Richardson's Ethics Service could not find a doctor to give deadly drugs to a patient who was "suffering" and dying for three weeks. The communication did not explain why the patient's suffering was not adequately treated and relieved for three weeks or what Kaiser Permanente proposes to do to improve its pain treatment and palliative care. Doctor Richardson is the same doctor-administrator who approved the overdosing of HMO patient Kate Cheney, despite the fact that Mrs. Cheney had been determined to be demented, under pressure from her family, and therefore not eligible for assisted suicide. Some individuals have speculated that cost savings could be one motivating factor stimulating HMO administrators to provide so much support for assisted suicide. The entire contents of the original memorandum follow:

"Kaiser Permanente Northwest Division, ELECTRONIC MEMORANDUM

Sent: 06-Aug-2002 01:21pm PDT
From: Janet P. Price
PRICEJANETP
Dept: Northwest Permanente
Tel No: 49-2657
TO: See Below

Subject: Oregon Death with Dignity Act: Physician Participation

IF YOU ARE NOT INTERESTED IN PARTICIPATING PLEASE DISREGARD THIS E-MAIL

OREGON DEATH WITH DIGNITY ACT: PHYSICIAN PARTICIPATION
KPNW has complied with implementation of the Oregon Death with Dignity Act (for Oregon residents ONLY) since it became law. The use of this law by KPNW patients and physicians has been administered by our Regional Ethics Service. Recently our Ethics Service had a situation where no attending MD could be found to assist an eligible member in implementing the law for three weeks, during which time this person was suffering and actively dying. Participation by physicians is completely voluntary. At times a member's primary care or specialist physician is unwilling to participate in this process. If this happens, the Ethics Service approaches the Chief of the primary or specialty care service involved with this member, to identify another physician willing to participate. Significant time is often lost because some Chiefs do not know which of their physicians are willing to volunteer. This can be very distressing to critically ill patients and their families.

THE RESPONSIBILITIES OF AN ATTENDING PHYSICIAN:

1. Using questions required by the law, interview the patient to determine whether he or she is appropriate to proceed with a request for medication to end life (a clinic or home visit is usually necessary for this) . There must be a second discussion with the patient in person or by phone a minimum of 15 days after first request confirming this request.
   
2. If the attending physician agrees to support the request, the Ethics Service will arrange an appointment with a non Kaiser physician to independently evaluate the patient and his or her request.
   
3. If the attending and the consulting physician agree that the request is reasonable, the Ethics Service will arrange for a designated Kaiser Pharmacist to assist the attending physician in writing the prescription for appropriate medications. The pharmacist will dispense and explain their use to the patient and caregiver.
   
4. A representative of the Oregon Health Division will contact by phone the attending physician after the patient's death to confirm the process and the manner of the patient's death. This takes about 10 minutes.
   
5. The Ethics Service guides Physicians through this process and makes all necessary arrangements for other requirements of the law.

QUESTIONS TO PHYSICIANS:

1. Are you willing to act as the Attending Physician under the law for YOUR patient?
2. Are you willing to act as the Attending Physician under the law for members who ARE NOT your patients?

IF YOU ARE WILLING TO PARTICIPATE IN EITHER # 1 AND/OR #2, Please e-mail or call Marcia L. Liberson, MPH (LIBERSONMA, 49-3781) or Robert H. Richardson, MD (503-904-7978), KPNW Ethics Service. For questions please contact either Marcia or Robert.

Thank you.

IF YOU ARE NOT INTERESTED IN PARTICIPATING PLEASE DISREGARD THIS E-MAIL.

TO: 829 addressees

CC: 2 addressees"

NewsMax.com Wires. CHICAGO – A 67-year-old man died of West Nile encephalitis in August, the state public health director reported Friday. It is the first fatality from the virus this year outside of the South. Also, a Louisiana man died, raising the nationwide death toll to 11. Federal authorities predicted more than 1,000 human cases nationwide. Four new human cases of West Nile virus have been confirmed in Illinois.

"Unfortunately, it is my duty to report the first fatality in our state due to West Nile virus illness," said Dr. John Lumpkin, state public health director. "The man, who had slipped into a coma after being admitted to the hospital, died on Aug. 10."

The 67-year-old man was admitted to a suburban Chicago hospital Aug. 4 complaining of fever, stiff neck, and change in mental status and fell into a coma. He also had other health problems. The next day, a 42-year-old Will County woman reported similar symptoms. She and an 80-year-old Cook County man who fell ill on Aug. 8 remain hospitalized for West Nile encephalitis. A 39-year-old Chicago woman also is hospitalized with the virus. Lumpkin, who heads the statewide West Nile Task Force, said Illinois was doing all it can to monitor West Nile virus activity and urged communities to launch aggressive efforts to control mosquitoes.

The death of a 78-year-old Livingston Parish man was the eighth in Louisiana, where the mosquito-borne disease has hit hardest. The state also reported 62 new human cases, bringing the total this year to 147 in easily the worst outbreak in U.S. history. The federal Centers for Disease Control and Prevention in Atlanta confirmed at least 160 cases nationwide and nine additional deaths in Louisiana and Mississippi. Public health officials in Colorado, Wyoming, Wisconsin, Minnesota and Iowa and anxiously waited Friday for the first human cases of West Nile to appear in their states after the mosquito-borne virus infected horses.

An 84-year-old New York man remained hospitalized in critical condition after developing encephalitis from the West Nile virus, the first human case in New York City this year. The virus first appeared in North American in New York three years ago. New York, Maryland, Massachusetts, Missouri and Ohio were added to the CDC's list of states with confirmed and suspected human virus cases this week.

"We can expect more cases, and potentially a lot more cases," said Dr. Lyle Petersen, an epidemiologist with the CDC. "We're still on the upslope of the epidemic curve ... the bottom line is we'll be seeing a lot more cases in the coming weeks."

States that have no suspected human cases are monitoring animals. West Nile virus has sickened 67 horses in Minnesota, three in Colorado, two in Iowa and two in Wisconsin and has now killed one horse in Wyoming. The Wisconsin Department of Health and Family Services was investigating the possible death of a 10-year-old quarter horse on a farm near Newburg from West Nile virus.

"Finding this disease in a horse tells us that there are mammal-biting mosquitoes in the area and that some are infected with West Nile virus," communicable disease expert Linda Glaser told the Milwaukee Journal-Sentinel. "These same mosquitoes could bite people."

Mosquitoes can spread the virus from infected birds to horses, people and other mammals. There is a vaccine for horses but not people.
Crows, ravens and blue jays are the most susceptible to the virus. Most people infected show mild flu-like symptoms such as headache, tiredness and nausea, for three to six days. Only about one in 150 infected humans develop potentially fatal encephalitis or meningitis after a mosquito bite. People over 50 are more susceptible. The virus has been found in every state east of the Rocky Mountains, plus Colorado and Wyoming. Copyright 2002 by United Press International. All rights reserved. Reprinted with permission from [NewsMax.com ]  posted at 8/21/2002 08:45:43 PM by Tom Heston, MD   comment on this article

In a recent "Statement of Conscience", the Unitarian Universalist Association of Congregations called for an end to the war on drugs as a matter of conscience. Some exerpts:

• For United States taxpayers, the price tag on the drug offensive has soared from $66 million in 1968 to almost $20 billion in 2000, an increase of over 30,000 percent. In practice the drug war disproportionately targets people of color and people who are poverty-stricken. Coercive measures have not reduced drug use, but they have clogged our criminal justice system with non-violent offenders. It is time to explore alternative approaches and to end this costly war.
• The war on drugs has blurred the distinction between drug use and drug abuse...Yet many people who use both legal and illegal drugs live productive, functional lives and do no harm to society.
• Legal prohibition of drugs leads to inflated street value, which in turn incites violent turf wars among distributors. The whole pattern is reminiscent of the proliferation of organized crime at the time of alcohol prohibition in the early twentieth century. That policy also failed.
• Instead of the current war on drugs, we offer the following policies for study, debate, and implementation...Establish a legal, regulated, and taxed market for marijuana. Treat marijuana as we treat alcohol.