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Cancer patients at Modesto hospital pressured to choose end-of-life care, lawsuit claims

Modesto Bee - 2/6/2020

Feb. 6--Colleen Ursini didn't give up on her 58-year-old husband and the doctor who treats him for cancer.

A year ago, her husband Nicholas was at Doctors Medical Center in Modesto for treatment of pneumonia when hospital staff told him death was near and they pushed for end of life care, Ursini says in a declaration for a lawsuit.

The Ripon woman said the staff surreptitiously gave him the hopeless prognosis after she went home to take a shower. When she returned, a "do not resuscitate" bracelet had been placed on his hand and Nicholas said they "told me I am going to die any time now," Ursini says in a sworn statement.

Her tearful husband had taken off his oxygen mask. Colleen put it back on, called for the head nurse and demanded treatment for his pneumonia.

A year later, cancer treatment has greatly shrunk the tumor in her husband's lung and he breathes on his own, Ursini says.

"You can live for four or five years if you continue with the treatment," says Ursini, who's willing to testify on behalf of Modesto oncologist Robert Williams, who filed a blistering lawsuit last week against DMC and other defendants.

The lawsuit cites numerous cases in which in-house doctors at the hospital pressured cancer patients to opt for end-of-life care. In some instances, cancer treatment or other procedures needed by patients were not provided, the suit alleges.

Ursini says an in-house doctor or "hospitalist" did not consult with Williams about her husband's condition.

Other patients and their families are vouching for the skills and knowledge of Williams, who is facing disciplinary action over his disagreements with hospital policies and conflicts with fellow staff members at Doctors.

Williams, whose education included Harvard Medical School and a research fellowship at Yale University, claims that officials with Stanislaus County health services, where he previously worked, and Doctors tried to stop him from opening his private practice in October 2011. He also claims that hospital officials want to revoke his privileges at Doctors, first awarded in 2003.

"He feels they are retaliating against him for speaking up for the way patients are treated," said Bay Area attorney Sunena Sabharwal, who's representing the cancer specialist. "He wants justice for his patients and wants his patients in the future to be treated with the care and dignity they deserve."

The attorney is seeking an injunction to stop any hospital disciplinary action against Williams, who is 73. A hearing is set for March 19 in Stanislaus Superior Court.

Citing violations of the business and professional code, interference with his right to practice medicine and infliction of emotional distress, the suit seeks an unspecified amount of general, special and punitive damages.

Williams charges that in the past several years he complained about patient care at Doctors and especially about policies "that were instituted to pressure cancer patients to choose hospice and end-of-life care while ignoring other medical conditions that could have been treated to extend their lives."

It's a serious charge as hospitals grapple with rising health care costs, and newer treatments offer more options for cancer patients to extend their lives, further complicating end-of-life decisions.

The lawsuit claims that nurses and hospitalists retaliated against Williams, telling patients he was incompetent, "stupid" or crazy, and hospital staff didn't follow his treatment orders.

In 2012, Williams made headlines after filing what one news service called a "scorching" lawsuit against the Stanislaus Health Services Agency, claiming fraudulent billing and dumping of indigent adult cancer patients on the Medi-Cal program. Williams also dialed up the heat for his lawsuit against Doctors.

It details six or more instances of postponed surgery, misdiagnoses or delayed cancer treatments alleged to have resulted in patient deaths. In some cases, hospital staff recommended hospice care for cancer patients who were in remission or were not terminally ill, the lawsuit claims.

The suit also cites cases of family members or Williams resisting hospital staff referrals for hospice care. The complaint says those patients are still alive today.

The suit suggests that part of the reason for the alleged actions was an attempt to increase profits by removing patients with inferior insurance from hospital beds.

Hospital statement

Doctors issued a short statement Wednesday in response to the lawsuit: "While we don't comment on pending litigation, at Doctors Medical Center, decisions on end-of-life care are made by the patient, the family or its representative and the treating physician."

Cancer is considered the second most costly disease in terms of health care spending, and studies have looked at the costs of health care for cancer patients near the end of life. A 2012 study in the Journal of Oncology Practice said the annual cost of cancer care in the United States was expected to be $173 billion in 2020, up from $104 billion in 2006.

The research cited older Medicare studies on cancer-related end-of-life care, showing that 5% of Medicare patients who died each year accounted for almost 30% of program payments. Most of the payments were for life-sustaining care, the study said; almost 80% of those costs stemmed from hospital inpatient care in the final month of life.

Williams' oncology practice on Florida Avenue, near Doctors Medical Center, would frequently bring sick patients in need of inpatient care to the hospital.

Health insurance was not an issue in Ursini's case. Colleen said her husband's insurance covers 100% of hospitalization.

Ursini said Tuesday she did witness the disrespectful behavior of hospital staff toward Williams. As he approached her husband's room, she said, nurses and others said quietly, "There he comes," and told the couple "He needs to understand you are our patient now" and "He is crazy."

"They were rude to him," Ursini said. "The man is so kind. He does not give up on his patients."

Restricted privileges

According to the suit, Williams was informed his hospital privileges were restricted in a July 2018 meeting with doctors Arun Manoharan, Rex Adamson and Erik Lacy and medical staff services director Karen Larson. Williams was told not to speak with his patients when they are admitted to the hospital or to just say "Hi" and discuss the weather if he visits patient rooms, the suit alleges.

Williams says the action to restrict his privileges contradicts hospital bylaws and was done without the peer review typically conducted in hospitals. Williams was notified by the hospital's medical executive committee Jan. 9 that he's being investigated concerning "his behavior creating (a) hostile work environment."

Williams says in a declaration that the alleged misconduct is related to his complaints on behalf of patients.

Mark Fahlen, chief of the hospital's medical staff and an executive committee member, said no action has been taken against the oncologist.

"As chief of staff, I want Dr. Williams to know his concerns are taken seriously and I really hope he will cooperate with the process," Fahlen said this week. "In the meantime, we will make sure patients get the highest quality of care possible at Doctors Medical Center."

For Fahlen, the shoe is on the other foot. The Modesto kidney specialist waged a court battle for years contesting an action to revoke his privileges at Memorial Medical Center and eventually won a large settlement.

In the lawsuit against Doctors, Williams tells of a number of conflicts with Manoharan, a hospitalist. Contacted at the hospital Tuesday, Manoharan declined to talk about the allegations in the suit.

One document in the civil case suggests Doctors has been trying to change a culture of "backstabbing" among hospital staff.

Stanislaus County officials said Williams' lawsuit in 2012, following a damage claim seeking upward of $30 million, did not go anywhere and they did not think the county was served with legal papers. In 2009, the oncologist's annual pay of $570,600 made him by far the highest-paid county employee.

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