Brief Answer:
Can be treated for c-diff if you remove hospice

Detailed Answer:
Good morning XXXX. My name is Dr. Saghafi and I'd like to answer your questions for you. First, very good news that your is doing better than anticipated so they could get the respiratory support off from her.

The direct answer to your question of treating the c-diff is this:

1. She likely would not be authorized to be treated for the c-diff infection so long as she is on hospice care because they only treat conditions which in their estimation have to do directly with PATIENT COMFORT. This means that they will treat PAIN to the extent necessary or breathing discomfort to the extent necessary (without intubating her) but they will not allow new treatments to be initiated for things such as infections or other "life threatening" circumstances such as heart attacks, etc. That is what the hospice paradigm is all about in theory. It provides for terminal care without delving into medical treatments or measures which would tend to be considered either heroic, life saving, or life EXTENDING. Nature is to take its course with comfort support as I've described.

2. Having said that she is under NO OBLIGATION to remain on hospice and thereby be denied treatment for her C-diff if you would like to have her treated so that you can take her home and feel more comfortable. HOWEVER, YOU HAVE to initiate that she taken off hospice for the purpose of treating her condition and then, decide whether or not you would like to return her to the status hospice once you take her home.

Another less complicated route to take (though unlikely successful) would be to speak with her hospice nurse and see if they wouldn't consider allowing her doctor to treat her c-diff so that you may take care home in a "safer" condition since it is potentially contagious to yourself and others. If you put it in that light you MIGHT stir someone's compassion to see the logic of not letting her go on with the infection, still have it covered by insurance, and then, allow her to go home with you. But, as I said, that type of argument goes with a wing and a prayer most of the time. So if they say NO, be prepared to simply DISCONTINUE HOSPICE ON YOUR ORDER or on her physician's order with the understanding that she may be returned at a later date.

Do not allow people to make you believe that being on or off hospice is a decision that does not involve your input. It is absolutely up to you (now)....(I'm assuming you are her durable medical power of attorney) if you wish her to be treated for medical conditions or not. It's simply the case that while on hospice services they will not authorize insurance payments for things that do not involve strict COMFORT MEASURES only.

I have had many patients get taken to the hospital and placed on hospice only to have family members pull them off so that I and other specialists could see them to treat and stabilize them before bringing them home more comfortable for everyone and then, to reinstitute the hospice status. By doing it this way you get her into a more comfortable and safer position for homegoing and still retain some advantages in terms of occasional home visits by nurses, certain durable items covered at no cost to you such as DEPENDS, equipment, perhaps a hospital bed if you'd like one ordered for the home, etc.

A social worker at the hospital or nursing home can go over your options. Speak to your primary doctor now that you have more knowledge about what hospice offers and what it does not offer.

Be confident that YOU HAVE LEGAL AUTHORITY and power to exercise care as you see fit for your wife and see what else can be done to make both you and she more comfortable as far as this C-diff infection is concerned. You are under no obligation to follow ORDERS by hospice or the primary doctor, or the hospital for making her follow a certain path if you don't agree or think it's to her best interest. Lots of people out there will certainly make you feel that way but you just push back a little if necessary and you will see how much they will change their tune.

Many patients feel entrapped in this system and that are somehow legally bound by whatever the doctor, the hospice nurse, or the hospital says is best. Simply untrue.

And in addition, YES, treatment of c-diff is entirely possible (and I feel appropriate and necessary) in patients with PARKINSON'S disease. No contraindication to the treatment of this entity and no significant side effects to worry about between her parkinson's meds and the antibiotics used to treat the infection.

I wish you and your wife well. I am happy to answer any other question you may have had if the information I've provided still requires clarification. Otherwise, if you are satisfied with what I've shared with you can you do me the favor of submitting a review of our transaction and rating it as well as CLOSING THE QUERY so that the service can see your question has been satisfactorily addressed and completed. My thanks and best wishes for a comfortable outcome for you and your wife.

This case required 30 minutes of physician specific time for review, research, final draft documentation and envoy.

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