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Medicine, money and Terri Schiavo

By LISA GREENE
Published March 26, 2005


If doctors put Terri Schiavo's feeding tube back in, will she have suffered permanent harm?

It's possible to reinsert a feeding tube at any time with no permanent damage to a patient, said Dr. Ronald Schonwetter, executive vice president and chief medical officer at LifePath Hospice and Palliative Care in Tampa. Schonwetter said he could not speak specifically about Schiavo's condition.

But while the tube is removed, the person might suffer permanent kidney damage, or brain damage because blood pressure drops so much that not enough oxygen gets to the brain.

How long before that might happen?

There's no time frame on when a person might sustain such damage, Schonwetter said. It could take as little as a few days, or as long as three weeks for the person to die after the tube is removed.

Do patients get pain medication when a feeding tube is removed?

Dying patients generally don't need pain medication for dehydration, Schonwetter said. As a patient's kidneys shut down, toxins build up in the body. Those chemicals make the patient sleepier and eventually comatose. Most patients who need pain medications during this time usually suffer pain because of cancer or some other disease, Schonwetter said. Paul O'Donnell, a Franciscan friar who has been by the Schindler family's side in recent days, said Friday that Schiavo had been prescribed morphine, but he did not know if she was receiving it.

What else happens to a person whose feeding tube is removed?

Patients' mouths and lips often become dry, and caregivers generally give ice chips, moist washcloths or swabs to make them comfortable. The circulation system would start to slow, and the person's hands and feet might look blue as blood was diverted to vital organs. Near the end, the person's breathing might become erratic before it finally stops.

Who else uses feeding tubes?

Some people with feeding tubes are in comas or coma-like states, and some have terminal diseases. One study found that about 40 percent of Florida nursing home patients with dementia use feeding tubes. Also, some people use them temporarily while recovering from surgeries or other conditions, and some people who have survived cancer or certain digestive problems use them permanently.

How can I make clear whether I would want a feeding tube inserted under certain circumstances?

Fill out a living will form, or an advance directive, that says what you want. You can find more information about living wills at www.agingwithdignity.org or www.p-grace.org Once you've filled out a form, make sure family members know about it.

Who is paying for Schiavo's care?

The Hospice of the Florida Suncoast has been paying for most of Schiavo's care for about two years, said Deborah Bushnell, one of Michael Schiavo's lawyers. Terri Schiavo also is enrolled in the state Medicaid medically needy program, which pays roughly $200 a month in medication costs, Bushnell said. Two years ago, lawyers set up a Medicaid disability trust fund with about $50,000, the remaining money from Schiavo's malpractice judgment, Bushnell said. It pays for certain medical expenses and legal costs, not including lawyers' fees, and will pay for funeral bills and any other medical expenses after she dies.

"I cannot imagine, in my wildest dreams, that there will be anything left" after those expenses are paid, Bushnell said.

The Hospice of the Florida Suncoast spent more than $9-million last year for all unreimbursed care, said spokesman Mike Bell.

[Last modified March 26, 2005, 01:09:10]


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