The Salt Lake Tribune
Date: 07/10/2000
Weitzel -- Murderer or Trailblazer?
Study suggests morphine-based comfort care administered by the
doctor-defendant is underutilized;
Study Suggests Weitzel May Be
Ahead of His Time
BY STEPHEN HUNT
THE SALT LAKE TRIBUNE
FARMINGTON -- For a month, psychiatrist Robert Allen Weitzel
has been standing trial on charges that he murdered five elderly and
demented patients with lethal doses of morphine.
But a study published last week in the Journal of the American
Medical Association suggests Weitzel may be ahead of his time --
perhaps a medical pioneer who has been misunderstood.
The AMA article claimed doctors often withhold morphine from
demented patients in the mistaken assumption they are not in pain.
Because senile dementia robs its victims of speech, demented
patients in the study got half the morphine doses as did elderly
patients who could ask for pain medication.
Weitzel testified last week that he prescribed morphine to the
five patients in hopes of keeping them comfortable and pain-free
while they were dying from complications of old age.
Acknowledging he was "flying by the seat of his pants," Weitzel
said he often relied upon nonverbal signs and intuition when
prescribing drugs for the demented.
And he said he preferred giving more morphine, rather than too
little, to insure the patients remained free of pain.
Weitzel, 44, is charged with five counts of first-degree murder
in the deaths of Ennis Alldredge, 85; Ellen Anderson, 91; Mary
Crane, 72; Judith Larsen, 93; and Lydia Smith, 90.
All five died during a 16-day period in December 1995 and January
1996 at Weitzel's geriatric/psychiatric unit at the Davis Hospital
and Medical Center in Layton.
Whether the patients really were in pain has been a major
contention during the four weeks of trial testimony.
Defense experts interpreted every groan and moan as a sign of
severe pain.
But prosecution witnesses claimed most of the patients' apparent
agonies were byproducts of mental anxiety. Prosecution experts
claimed none of the five had medical conditions requiring any pain
medication stronger than over-the-counter Tylenol.
According to the AMA study, doctors also often failed to
acknowledge the final stages of Alzheimer's disease and other forms
of dementia as a terminal illness.
Coincidentally, the expected longevity of Weitzel's alleged
victims was also a disputed issue at trial.
Medical complications aside, and based only upon the progression
of the five patients' senile dementia, a defense witness testified
all patients had less than six months to live and would qualify for
end-of-life care under Medicare's hospice guidelines. But a
prosecution expert claimed the patients might have lived another
seven years.
The experts also clashed over the severity of the patients'
varied medical conditions.
A defense expert claimed the patients were "at death's door" or
"living on borrowed time," even before they were admitted to
Weitzel's unit.
Prosecution experts claimed the patients were basically healthy
until Weitzel weakened them with sedatives that caused them to stop
eating and drinking and become comatose.
Prosecutors criticized Weitzel for failing to get second opinions
from other doctors or to request follow-up tests to confirm that the
patients truly were dying. They also claimed Weitzel failed to push
for medical procedures that might have extended the patients' lives.
But Weitzel claimed family members -- and the patients, as stated
in their living wills and medical directives -- did not want
medical heroics. Instead, Weitzel offered "comfort care," something
that demented patients get too little of, according to the AMA
article.
More often, the AMA article asserted, demented patients are
subjected to aggressive life-saving treatments -- an oversight that
adversely affects the quality of their final months of life.
The study compared treatment given to dementia-free elderly
patients and those with end-stage dementia (patients who have
reached the point where they cannot talk or recognize family
members, and who frequently cannot walk and must depend on others
for daily care).
Alzheimer's disease, which affects more than 4 million Americans,
is the leading cause of dementia.
Researchers looked at 97 patients age 70 and older with hip
fractures, and 119 patients with pneumonia.
About half in each group had end-stage dementia.
Among the hip-fracture patients, those without dementia got more
than twice the morphine doses as did the demented, according to the
article. Only 24 percent of patients with dementia even had standing
orders for minor painkillers such as acetaminophen, found in
Tylenol, the authors wrote.
Weitzel's defense attorney, Peter Stirba, referred to the AMA
article while cross-examining a prosecution expert last Thursday.
But pharmacologist and pain management specialist Bradford Hare
declined to comment, saying he had not yet seen the study, which was
published only Wednesday.
Closing arguments to wrap up the month long trial are set for
today.
Jurors will have the option of convicting Weitzel of first-degree
felony murder, the lesser crime of second-degree felony
manslaughter, or the even lesser crime of misdemeanor negligent
homicide.
The jury also has the option of acquitting Weitzel under Utah's
"Personal Choice and Living Will Act." The act allows physicians to
withhold medical care from terminally ill patients, yet still
alleviate their pain, without fear of criminal prosecution. However,
the act only applies to doctors who act in "good faith."
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