As retired dairy farmer Walter Morse lay dying, bedridden at his home in Barre, his family sought to make him comfortable in his final hours.
The 81-year-old, who owned hundreds of acres in Central Vermont, was one of the first organic dairy farmers in the state. He milked 150 cows up until 11 years ago. In his spare time, Morse loved to jawbone with neighbors and other farmers. His family describes him as “an old-school family man who believed a handshake was the honest law.”
Morse wanted to die peacefully in the place he had called home since 1958, surrounded by his three children and five grandchildren.
“He was adamant about living out the rest of his life at home and did not wish to be taken to the hospital when his time came,” the Morse family wrote in a letter to state officials.
But Morse’s health rapidly declined on March 20, at the height of uncertainty about Covid-19. When his two daughters sought to fulfill his wish, they could not get the help they needed.
They say their pleas for help from Central Vermont Home Health and Hospice were ignored on Friday and Monday. In desperation Judi Rossi and Wendy Dickinson took care of their father in isolation, doing their best to follow advice from their family doctor.
That meant that instead of saying good-bye to their father with support from home health or a hospice nurse, Rossi and Dickinson, who have no medical training, spent four agonizing days consumed by worry about whether they were providing Morse, who was in intense pain, with the proper amount of fentanyl to ease his suffering.
Family members say they were traumatized by the “harrowing experience” of watching their patriarch endure “a drawn out and painful death because hospice facilities in the area refused to support him for end of life care due to the current Covid-19 pandemic.”
When their father’s physician, Dr. Roger Kellogg, initiated a hospice care request on that Friday in March, the family was told they would need to somehow get the 260-pound Morse, who was immobilized, to a Covid-19 testing facility. Rossi also called directly and was told they would need to wait five days for results before Central Vermont Home Health and Hospice would order at-home services. Morse would die four days after the call was made.
Rossi and Dickinson say those requirements were impossible for them to fulfill. Their father couldn’t leave his bed, and they didn’t want to request an ambulance for fear that he would end up in the hospital.
“So we were then left with only one option; to care for him as best we could on our own without any professional medical support present,” they wrote in a formal letter to the governor’s office and the Vermont Department of Health.
Kellogg prescribed fentanyl patches, and the sisters did their best to try to keep their father’s pain under control. They barely slept for four days and at one point, in the middle of the night, they saw that he was in distress, but they had run out of fentanyl because the pharmacy would only give them two patches. An emergency order was placed the next morning.
By Monday, the sisters say he was “barely responsive” and started to suffer organ failure. While Kellogg offered to come to the house, they followed his orders over the phone, knowing that the 75-year-old physician was considered high-risk himself for contracting Covid-19.
Deprived of basic end-of-life care from trained nurses, the family says they did not receive the support they needed to ease his suffering, and they were exposed to the alarming physical changes to his body associated with organ failure.
In horror, the family witnessed his final hours. Josh Dickinson, Morse’s grandson, said his grandfather’s body was “grotesquely swollen, and his skin was taking on a dark, black hue that was slowly rising to his face.
“For over 2 hours, he made a harsh gargling noise as his lungs strained to keep going,” Josh Dickinson wrote. “These small signs of dying are usually taken care of by hospice so that the family does not see the ‘ugly’ parts of their loved one’s departure from Earth; but we did not have that luxury. We were alone. At 5:55 p.m. on Tuesday, March 24th, my grandfather took his last breath.”
The family’s trauma, however, didn’t end there. They also witnessed the gruesome aftermath of his death — the stiffening of his body as rigor mortis set in and dark bloody fluids flowing out of his mouth.
In time, as they reeled from shock and grief, they realized they needed to notify the authorities of Morse’s death. An EMT came to formally pronounce Walter Morse dead. That visit was followed by a brief inquiry from the Barre Police Department, in which the home was treated like a crime scene — statements were collected and photos were taken.
And finally, Douglas Jasman, a medical examiner from the health department, arrived to assess the death. The family says Jasman proceeded to insult the sisters by criticizing the way they had administered the fentanyl patches, and, under questioning, scolded them for not knowing which type of diabetes their father had.
“The tone he used was unsympathetic, lacked compassion, and was downright insulting,” they wrote.
The family says they don’t believe their experience is unique, and to prevent a similar situation from happening to others, they submitted a formal letter of complaint to Sen. Bernie Sanders, I-Vt., Gov. Phil Scott, the Vermont Department of Health, and Central Vermont Home Health and Hospice.
In response, they received a letter of condolence and formal apology from the Chief Medical Examiner’s Office.
After VTDigger made inquiries, Joe Nusbaum, director of the state Division of Licensing and Protection, which regulates home health agencies, issued a letter to the family effectively absolving Central Vermont Home Health and Hospice of responsibility for its handling of the case. The agency reviewed home health records, policies and procedures. The investigation did not include an interview with Rossi and Dickinson.
“Based on the information they received from Dr. Kellogg and the intake, they did not process this as request for Hospice services and end of life care,” Nusbaum wrote. “Since that was the case, in this instance, there were no regulatory deficiencies cited.”
Nusbaum also disputed the family’s assertion that Morse was denied care because of Covid-19.
“We also confirmed that in no instance would Hospice care be predicated on a test for Covid-19; that would not and could not be a reason to deny care,” Nusbaum wrote.
In an interview the day before the letter was issued, Sandy Rousse, president and CEO of CVHHH, said she did not know why her agency did not provide Morse with home health care. Rousse said CVHHH is conducting an internal investigation into the matter. She would not confirm the family’s assertion that Morse was refused care because he was not tested for Covid-19.
“To hear something like this is just really heartbreaking and upsetting,” Rousse said in an interview. “Investigating the situation to understand what happened is really key.”
Rousse said she couldn’t talk about Morse’s case, but she said from the beginning of the pandemic, home health has screened patients before making visits in order to make sure proper precautions have been taken, but there is no Covid-19 test requirement.
Tender Loving Home Care in Barre, which was also contacted by Kellogg for hospice care, could not respond without an order from CVHHH, according to owner Rosalyn Haldane. The company, which independently secured personal protective equipment prior to the outbreak in Vermont, was fully prepared to provide services to Morse, but was not contacted by Central Vermont Home Health and Hospice officials, Haldane said.
Kellogg wouldn’t comment on CVHHH and the hospice center’s response. “Bad things happen that nobody likes,” he said. “But we don’t point fingers (in the profession).”
The physician, whose offices are located at Central Vermont Medical Center in Berlin, says his first suggestion was to get Morse to the hospital, but he wanted to be home. Kellogg, who did not have personal protective equipment, says he feels “ashamed” that he didn’t visit Morse as he was dying.
“I feel badly that I was intimidated by this virus,” Kellogg said. He worried about becoming a spreader and bringing the virus home to his family. “All I could do was offer as much support as I could.”
Wendy Dickinson says if CVHHH had provided services on the Friday before her father died, he would have been referred to hospice care right away. Instead, the home health agency insisted on a Covid-19 test. Three days later, as his death was imminent, CVHHH and Tender Loving Care Home did not come to provide hospice care, she said.
The TLCH owner Haldane says she was not contacted by the family, and the company was not allowed dispense hospice medication without an order from CVHHH. She said her company can only assist and was ready to provide care, but her hands were tied because the company is non-medical, she said.
Dickinson takes issue with the state’s version of events.
“Don’t tell us Kellogg and my sister didn’t put a request in, because they did,” Wendy Dickinson said.
The family feels lied to and is outraged by the Division of Licensing and Protection’s response.
“We were shocked that they didn’t come,” Josh Dickinson said. “It was a big breakdown of who really was making these [decisions]. We couldn’t get any help at all, and no one is accepting fault for it.”
Clarification: Tender Loving Home Care could not assist with hospice care medications without an order from CVHHH.
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