Protests putting spotlight on hospice

PINELLAS PARK, Fla. -- A narrow path, lined by wooden benches, flowering fuchsia bushes and hand-painted birdhouses, winds through the lawn and gardens of the Woodside Hospice, part of a $10 million renovation intended to create a tranquil home-like ambiance for the patients near death inside.

But for the past few weeks, and two other occasions since 2001, the political maelstrom around one patient, Terri Schiavo, has resulted in around-the-clock police presence, protests out front, and a sizable media encampment across the street. Everyone visiting patients at Woodside now go through identification checks and pat-down searches. Armed police stand guard inside. The situation has created a tense atmosphere precisely opposite of what hospices strive for, according to end-of-life specialists. Several families have complained to local police officials that the Schiavo case has disrupted their visits to their dying loved ones.

Woodside officials have said little about the Schiavo case, but have been aware of the need to balance the free speech rights being exercised outside the hospice with the delicate needs of the patients and families inside, according to local police officials, who have coordinated security and access with the hospice. Schiavo entered her 11th day with out food or water yesterday, as family members under police guard filed in and out throughout the day.

But the hospice is also aware that the Schiavo case has focused international attention on the right to die. Woodside is run by Hospice of the Florida Suncoast, a nonprofit chain that is part of a political movement that champions humane care at the end of life and the right to die. Officials there have kept in touch with the national hospice lobby, reviewing press statements by a trade group during the last few weeks of the Schiavo case, which many in the right-to-die movement consider a watershed moment.

''The [Woodside] hospice has conferred with us about message," said Jon Radulovic, vice president of communications at the National Hospice and Palliative Care Organization, based in Alexandria, Va., the nation's oldest and largest hospice organization.

Though international attention has focused on the hospice in this central Florida city of 46,000, most hospice care in the country occurs at home. For instance, about 95 percent of Boston-area hospice patients get end-of-life care in their homes, with hospice nurses or hospice workers visiting regularly, according to Dr. Muriel Gillick, a palliative care specilist with Harvard Vanguard Medical Associates.

Gillick said hospices strive to be ''home-like," and expressed sympathy with those who must run the gantlet in front of the Woodside. ''I hope that as much of the protest and noise is kept outside the building as possible," she said.

Those in facilities such as Woodside tend to be elderly patients lacking family members to help them out or severely disabled people requiring constant monitoring. Most hospice patients die within weeks or months. Schiavo has been at Woodside for five years. When she first arrived, her husband, Michael, planned to have her feeding tube removed, allowing her to die. The practice is not uncommon at hospices. Her tube was removed in April 2001, then reinserted two days later on a Florida judge's orders. It was again removed in October 2003, but inserted again six days later after the Florida Legislature passed and Governor Jeb Bush signed a law requiring it. It was removed a third time on March 18. Each instance drew protest and police, though the last few weeks have been by far the most intense of the Schiavo saga, said local police.

Yesterday, a crowd of about 90 people gathered in front of the Woodside. In this most recent round of protest, 39 people, mostly from out of state, have been arrested for trespassing, with many symbolically trying to carry water to Schiavo, according to Captain Sanfield Forseth of the Pinellas Park police. The small department has stationed officers intermittently around the Woodside's perimeter.

''We've had a couple of complaints [from visiting families] on the inconvenience of having to go through these checkpoints," said Forseth, who added that the hospice's design minimized the noise heard inside.

Typically, hospices have minimal security, said specialists. The Hospice of the Florida Suncoast's website touts ''around-the-clock care in a home-like setting" at Woodside, a 72-bed facility with one-story brick buildings.

Radulovic said the chain's executives are aware the Schiavo case is crucial for the hospice movement. ''They are aware there is considerable interest in this case," he said, adding that his group has gotten thousands of requests in recent weeks for living will forms.

With the failure of nearly all legal and political attempts to reinsert Terri Schiavo's feeding tube, her father, Robert Schindler, yesterday urged intervention by someone in power to save the life of a daughter he maintained was trying to communicate, an act medical specialists have said is impossible for someone in a persistent vegetative state.

''She's still communicating, still responsive. She's emaciated, but she's responsive and she's responding to me and she's begging for help," he said after a visit to her bedside yesterday. ''Don't give up on her."

However, Michael Schiavo's lawyer said yesterday that she had not passed urine since Sunday night, an indication her kidney could soon fail and death could soon follow.

Raja Mishra can be reached at rmishra@globe.com.