A national, for-profit hospice chain has just sent its lawyers into court to fight over who gets the patients of a non-profit hospice that’s going bankrupt.

In their filing, Gentiva Health Services Inc. objects to the plans the failing San Diego Hospice has made to transition all willing patients to another local provider in a way that can keep patients, some existing employees, and hospice facilities together as much as possible, thereby causing the least disruption for those dying in their care.

Instead, they want the bankruptcy judge to break up the parts and, in essence, sell off the patients (referred to as the “business” in legalese) separately from the real estate. They’ve made a $1 million bid for the “business” and their filing language basically reduces these 450 rare, luminous, and achingly vulnerable human beings to the status of “valuable assets.”

This is a hospice.  Referring coldly and deliberately to dying people as so much business property. You’d think that was bad enough. It’s not.

They did it in open court.  A public forum with media coverage.  They either didn’t realize or didn’t care how these patients might feel to read a news article and hear themselves described in such demeaning and dehumanizing terms.

From the article Creditors decry Scripps hospice deal:

Gentiva Health Services Inc., the Atlanta-based company that made the $1 million offer, objects…saying that doing so amounts to handing over the hospice’s business for free, a move that would not maximize value for creditors who want to get paid.

In court papers, Gentiva states that San Diego Hospice’s “relationship with its 450 patients”** is a “valuable asset” of its estate.

(**see note below)

“Gentiva is ready, willing and able to pay Debtor the sum of $1 million for an orderly transition of the hospice business,” the filing states.

How in the world can people who run a hospice talk about dying people like that?

Look, I think we all understand that there’s a business dimension to hospice care.  Nobody can keep the doors open for long if they’re not financially responsible enough to obey the laws and pay their bills.

But that should never be construed to mean that profit can be shamelessly embraced as the bottom line like this. The mission of the hospice movement has always been to serve the dying, not monetize them. Whoever doesn’t understand that difference really shouldn’t be working in the field.

** Obviously, no one can legally buy, sell, or award patients themselves to any hospice company.  Theoretically, patients are always free to choose whomever they want, including the freedom to change hospices at any time, for any reason.  Any of these 450 people, if they so chose, could go back to the drawing board, start the process all over again, and interview as many hospices as they wanted.

Theoretically.

In reality though, that almost never happens.  The vast majority of patients never interview hospices at all.  Neither do they themselves choose one.  They’re almost always referred to the specific hospice favored by their personal doctor or the hospital they’re using and then they stay with that hospice for the duration of their life.  

Furthermore, as a patient’s condition deteriorates and they get closer to death, the risks of disruption of care associated with a change in hospice provider rise geometrically and it usually becomes unwise to change, even if they still had the energy to do so.  

So even though theoretically these 450 patients get to choose whichever hospice they’d like next, realistically speaking almost all of them will go to whichever one their records are legally transferred to.  They’ll probably be informed in some obscure way that they don’t HAVE to go with that hospice, but they either won’t understand or they won’t care.  They’ll be far too overwhelmed with the daily tasks of dying to deal with it and they’ll just want to know who’s going to take care of them next.

When Gentiva says it wants to buy “San Diego Hospice’s relationship with it’s 450 patients”, what they’re saying is they want to buy access to patient records, contact information, and most importantly, patients’ expectations that Gentiva will be the hospice assuming their care going forward.

So even though theoretically dying people can’t actually be bought and sold, for all practical purposes they most certainly can.

copyright Dia Osborn 2013