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Terminally ill Puebloans have few end-of-life options

March 31, 2018

In this March 23, 2018 photo, Dr. Alonso Pacheco, left, and Dr. Travis Archuleta pose for a photo in Pueblo, Colo. They have prescribed the aid-in-dying medication. (John Jaques/The Pueblo Chieftain via AP)

PUEBLO, Colo. (AP) — Despite Colorado voters passing the End-of-Life Options Act in 2016 to allow those with terminal diseases to secure medical aid-in-dying, there are still few or no options for those seeking the service in Pueblo or southern Colorado.

Only two local doctors are known to have prescribed the aid-in-dying medication to their patients since the law went into effect in December 2016, and the pair have written fewer than 10 prescriptions combined.

Drs. Travis Archuleta and Alonso Pacheco of Rocky Mountain Cancer Center are the only local physicians known to have prescribed the medication, and have done so only for inquiring patients with diagnoses of terminal cancer.

“I kind of knew prior to Colorado passing the bill that it would be something I would be willing to offer if I had a patient who I felt was suffering needlessly when I couldn’t do anything else to help them,” Archuleta said. “I have been a cancer doctor for about 15 years, and there are some cancers that we really can’t treat at a certain point.

“Some cancers may just involve places like the bones or the gut, where patients aren’t actively dying from the process but are in a lot of pain and are suffering a lot. And we don’t have a way to fix the disease, so they wind up having to stay on long-term narcotics. And sometimes they’re completely disabled from a disease that is killing them very slowly and causing a lot of suffering and pain.”

The final tallies for the Act, posed to the voters as Proposition 106, showed Coloradans supported the measure by nearly a 2-1 margin, with 65 percent voting in favor.

But despite voters resoundingly supporting the measure — including Colorado doctors, 56 percent of whom supported the law, according to the Colorado Medical Society — the religious and moral implications of medical aid-in-dying has seemingly deterred most southern Colorado doctors and pharmacies from participating.

The law allows — but does not require — hospitals and physicians to participate, and both of Pueblo’s major medical centers, Parkview and St. Mary-Corwin, have opted out and barred their physicians from performing any such services on hospital grounds.

Parkview’s policy details that medical staff are not prohibited from engaging in aid-in-dying activities off hospital premises, but the policy of St. Mary-Corwin’s Catholic parent company Centura Health makes no such distinction, stating simply that because of the company’s “long tradition of believing in the sanctity of life,” it has opted out of participating.

Archuleta said he has not heard of any local doctors outside of Rocky Mountain Cancer Center prescribing the medication, and since he and Pacheco only prescribe to their patients with a terminal cancer diagnosis, those with diagnoses unrelated to cancer have virtually no local resources to obtain it.

But it isn’t just health care providers who have shied away from participating, as many Pueblo pharmacies also have chosen to opt out from participating.

Only one local pharmacy is known to have prescribed the end-of-life medication, and two corporate pharmacies in Pueblo, Walgreens and King Soopers, have not.

A statement released by a Walgreens spokesman noted the company is evaluating the new regulations that allow for the prescriptions, while a statement by King Soopers spokesman Adam Williamson detailed the company’s pharmacists are able to opt in or out, as the law allows.

Locally owned JB Pharmacy, which works with area hospices on a consistent basis, has not previously and does not currently stock the medication. However, owner Jeanette Burns said that should any individuals or hospices request the prescription, JB Pharmacy would fill it.

“We can get it whenever my hospices need it,” she said. “We’d probably do the same for a patient if they were serious about doing that, but it’s very costly, so I’d highly doubt any pharmacy is going to stock that.”

The end-of-life prescription typically consists of the drug secobarbital, commonly sold under the brand name Seconal, or a cocktail of other drugs that, when combined, perform the same function.

Archuleta said that because of the high cost of Seconal, which can be upward of $3,000, many of the patients to whom he’s prescribed the medication have opted for the drug cocktail, which tends to cost between $300 and $500.

Archuleta said he is unaware of any health insurance providers who cover the medications, so the cost of Seconal is another barrier for those without the funds to afford it, as the prescription for the cocktail Archuleta uses can be filled only by a compounding pharmacy such as JB Pharmacy that can create it in-house.

The moral and religious implications of prescribing an end-of-life medication likely have played the primary role in why many local medical providers and pharmacies have opted out of participating, as well as concerns that angering the local religious community might hurt business.

Additionally, Archuleta identified a lack of knowledge as another obstacle keeping many local doctors from participating.

“There are a lot of steps involved in going through the system, and I think they don’t really know how to do it and they don’t know what drugs to prescribe,” Archuleta said. “So I think it’s mostly a lack of knowledge.”

“Another thing you have to be able to do is to reliably say a patient is going to live less than six months, and I think some doctors don’t feel comfortable making that prediction. That’s why I limit myself to cancer patients — because that’s my area of expertise, and they are mostly patients that I already have relationships with that are in this practice.”

For local doctors who may wish to opt in to providing aid-in-dying services but may be unsure where to begin, Archuleta said he would encourage them to contact him for more information.

“I would encourage any doctors who are interested to contact me or Dr. (Marlow) Sloan if they want to participate but don’t know how,” Archuleta said.

“I really think the doctor who prescribes this should have a relationship with the patient already and not somebody you can just refer to so that they can get the drug.”

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Information from: The Pueblo Chieftain, http://www.chieftain.com

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