Reporter explains how he turned a troubling hospice death into an investigative series Date: 09/21/15
By Charles Piller
“An Unquiet Death,” my five-part investigative narrative that appeared in August in The Sacramento Bee, looked into the death of Jerome Lackner, former maverick leader of California’s Department of Health, one-time personal physician to Cesar Chavez, and a savior of countless addicts. Jerome passed away in 2010 during hospice care in his Davis, Calif., home. His primary caregivers had been his second wife, Rebecca, then 72, from whom he was legally separated; and Joseph Poirier, a 51-year-old recovering addict who friends and family would claim later was having a clandestine affair with Rebecca.
The stories, reported and written over 10 months, recount the troubled final weeks of Jerome’s life and raise questions about the actions of his caregivers, doctors, hospice nurses, and the coroner who would spend more than a year examining the circumstances of his death. The series addressed a basic question: Did Jerome succumb to serious illness amid sadly typical family disputes and human frailties, or did he fall victim to a malign conspiracy? In the process, I examined larger questions about abuse of the elderly and the sometimes-ambiguous responsibilities of hospital and hospice professionals to protect them.
The story initially came to me from one of Jerome’s daughters, who was deeply concerned that his death might have been due to foul play. Family disputes after the death of a beloved patriarch often lead to bitterness, so I approached the story with skepticism.
Normally, HIPAA rules make it impossible to see the hospice and medical records necessary to tell such a story fairly and well. But in this case there was a coroner’s report, a lengthy murder investigation by police and a probate dispute that made available thousands of pages of records normally inaccessible to a journalist. I got other records, such as audio of 911 calls and certain police records, under the California Public Records Act.
The documents raised questions about actions by caregivers, physicians, nurses, the coroner and others that might have had contributed to a profound tragedy even if no crime had been committed. The paper trail allowed me to measure the credibility of the central characters (including many who would only speak off the record) by matching their claims against knowable facts. Dozens of interviews with Jerome’s friends, patients and family members, and thousands of pages of documents made it possible to triangulate opposing accounts in an effort to find truth.
Some of those who lived this story were emotionally fragile, and some had a vested interest in a seeing my story reach particular conclusions. I had to be mindful of their vulnerabilities while being absolutely clear with myself and them that my job was to be tenacious in painting the most vivid and clear picture of a big, complicated life and a messy, controversial death – wherever the facts led.
I wrestled with how to sift the evidence fairly, and to make sure that the story of those implicated in a possible crime was described fully and well even when they refused to tell it themselves. Long before my series was published, I took special care to inform Becky and Joseph about how my series was developing and to encourage them to reconsider their several refusals to sit for formal interviews. (They ultimately refused to answer many questions.) My goal was “no surprises” – no reason for any of the main characters in the drama to feel they hadn’t been given a chance to understand what I was planning and to give their perspectives in their own words.
I also interviewed dozens of experts on hospice, palliative care, elder abuse about the myriad legal and ethical issues facing Jerome’s caregivers and family members. They proved crucial to helping me create a subtext about the broad challenges of hospice care beyond this case.
But my editor Deborah Anderluh and I decided against making this a technical story of dueling experts. We chose to let the story tell itself – to let readers draw their own conclusions after reading a narrative about a big life and a difficult death. Many people have had an experience with messy and complicated hospice deaths. Reader responses showed that doubts about the emotionally fraught process are common, even among those who support hospice as a profoundly important tool to humanize and ease the dying process.
Charles Piller is West Coast editor for STAT, a Boston Globe Media national publication covering life sciences, which will launch this fall at www.statnews.com. He writes watchdog reports and in-depth projects from his base in the San Francisco Bay Area. Piller previously worked as an investigative journalist for The Sacramento Bee and Los Angeles Times, and has reported on public health, science, and technology from Africa, Asia, Europe and Central America. He has won numerous journalism awards, authored two investigative books about science, and reported extensively on prison conditions and bridge engineering. Piller can be reached at Charles.Piller@statnews.com or @cpiller.