Hospice Turns Months-to-Live Patient Into Addict

Suffering from painful nerve damage in his feet, Charles Groomes was prescribed a daily dose of 205 milligrams of Oxycontin and oxycodone in 2007. His doctor wrote that it was the most he was comfortable prescribing — more, he said, than anyone without cancer should take.

After he was admitted to hospice care 11 months later, his painkillers were eventually increased to 2,880 milligrams, 14 times the pre-hospice levels. The hospice doctor forecast he had six months to live at most. He was wrong.

Groomes was discharged from Horizons Hospice LLC in Pittsburgh last year after 32 months. The legacy of the stay was debilitating, according to his family and doctors who examined him. He was depressed, addicted to narcotics and desperate. He turned to four doctors and three hospices begging for more drugs.

“This is a hospice case that spiraled out of control,” said Aaron Smuckler, one of the doctors who saw him. Groomes, who had a history of drug abuse, “clearly wasn’t dying” when he was on hospice; he needed drug rehabilitation and cardiac care, not more narcotics, Smuckler said.

Mary Stewart, Horizons Hospice’s director of operations, declined to comment on Groomes’s care and didn’t respond to a list of detailed questions.

Groomes died in his sleep at the age of 52 last August, 10 months after Horizons released him. It was also more than five years after he was first told he had six months to live — in an earlier hospice admission in 2006.

Surviving Hospice

His story shows how lax admissions practices combined with narcotics dispensing may add up to harmful side effects for hospice patients, especially among those who survive their stays. About 1.1 million people are enrolled in hospice care.

Although hospices are supposed to enroll only people who they believe will be dead within 180 days, they often miss the mark. About 21 percent of patients stay longer, the U.S. inspector general responsible for Medicare reported in July, and more than 200,000 are discharged alive each year. Some providers are boosting revenue by flouting eligibility rules, federal prosecutors say.

At the same time, the use of narcotics is central to the mission of hospice care, which is to ease the pain of dying patients.

“It’s the exceptional hospice patient who doesn’t see any opioids,” said Mark Sullivan, a psychiatrist at the University of Washington in Seattle, referring to the powerful class of narcotics that includes morphine, Oxycontin and oxycodone.

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