During our visit with Dr. Gabriela Sauder at UCLA Health, I requested home health services for my…read more80-year-old father, who is several years post-hemorrhagic stroke (intracerebral). I explained his clinical picture in detail: he remains ambulatory but requires assistance with ambulation, maintains relatively good overall health for his age with minimal polypharmacy, and experiences significant post-stroke agitation that precludes leaving the home for exercise or routine medical appointments. We have canceled numerous visits because coercion elevates his blood pressure and introduces greater physiologic risk. Home health support would facilitate safe mobility, monitoring, and provision of essential supplies such as absorbent pads and adult diapers--standard interventions for maintaining function in elderly stroke survivors who are homebound.
Dr. Sauder's immediate and unqualified response was that he would not qualify for home health. She inquired whether he had Medi-Cal; upon learning he did not, she asserted it would provide no benefit and that such services do not include the requested support. When I corrected this misunderstanding--home health agencies routinely assess and provide skilled nursing, therapy, and durable medical equipment for qualifying patients--she retreated to "I haven't evaluated him in over a year." I noted the obvious: she was conducting the evaluation in that moment. Her tone was curt, dismissive, and wholly unreceptive to reasoned dialogue, revealing a troubling lack of clinical curiosity or flexibility.
We then reconciled his medication list, which is appropriately sparse: daily finasteride and as-needed low-dose metoprolol, given his consistently low-normal systolic pressures (110-112 mmHg). When statin use was raised, I clarified that we had discontinued it due to intolerable myalgias. Rather than engaging collaboratively, Dr. Sauder questioned the decision with skepticism--"Was that your decision or someone else's?"--implying poor judgment on my part as his healthcare proxy. I emphasized that, at age 80 with a history of hemorrhagic stroke, quality of life must take precedence over aggressive secondary prevention, particularly when statins carry well-documented risks of muscle toxicity. I asked directly whether she believed he should endure ongoing pain. She persisted with lectures on cholesterol reduction and proposed alternative agents, ignoring the nuance that statin use post-hemorrhagic stroke remains controversial in the literature due to potential risks outweighing benefits in frail elderly patients.
Her culminating remark was: "Well, if your goal is quality of life, then we should look at END OF LIFE CARE."
This statement was not only medically premature and clinically inappropriate for a stable patient managing well at home, but profoundly unprofessional, callous, and indicative of deeper incompetence. In one breath, she dismissed practical, evidence-based supportive care options while pivoting to palliative end-of-life discussions without any preceding assessment of decline, goals-of-care conversation, or palliative care referral. It exposed a disturbing readiness to write off an elderly patient rather than address modifiable barriers to his well-being. This is not patient-centered medicine; it is bureaucratic expediency dressed in a white coat--lazy, arrogant, and beneath the standards expected of a UCLA geriatrician. Such indifference erodes trust and actively harms vulnerable families navigating complex post-stroke care.