March 2007

NEWS FROM ATTORNEYS GENERAL OFFICES

  1. Alabama Attorney General Troy King announced that a former Chilton County Commissioner was sentenced on three counts of felony exploitation of an elderly man. Glenda Strength was charged with taking $1,270 from an 86-year old illiterate man, in poor health, who she purported to befriend. She was sentenced to three years? imprisonment.
  2. Florida Attorney General Bill McCollum has announced the arrest of two Miami-Dade women on charges they neglected an elderly victim under their care. They allegedly failed to provide care to a nursing home resident after she suffered a severe fall. The injuries contributed to the resident?s death a month later.
  3. Under an agreement reached with Illinois Attorney General Lisa Madigan, the township of Lenox will refurbish several units in its senior housing complex to ensure that it meets the requirements of accessibility.
  4. Massachusetts Attorney General Martha Coakley announced recently that a long term care facility located in Worcester will be required to educate its staff on readmittance regulations and pay $12,500 to the Commonwealth. State laws and regulation require readmission of a former resident to the next available bed after medical treatment and rehabilitation.
  5. Michigan Attorney General Mike Cox reported that Parkridge Associates and Kathryn Gills, the former Director of Nursing at the nursing home owned by Parkridge, were sentenced for their responsibity in the heat-related deaths of four patients at the nursing home in 2001. Parkridge Associates was barred from engaging in the nursing home business in the future and Gillis was sentenced to five years? probation and 167 hours of community service as well as being ordered to forfeit her nursing license.
  6. New Jersey Attorney General Stuart Rabner announced the guilty plea of Dr. Mario Comesanas to first-degree racketeering and second-degree distribution of narcotics. He admitted to writing thousands of fraudulent prescriptions for controlled substances.
  7. New York Attorney General Andrew M. Cuomo announced that his office has charged Dr. Michael Chait of Amagansett with writing hundreds of medically unnecessary prescriptions for controlled substances. Many of the prescriptions were written for Medicaid patients, costing the taxpayers thousands of dollars in medically unnecessary Medicaid billings.

JUDICIAL DEVELOPMENTS

  1. The importance of carefully reading all documents before signing them was highlighted in a recent California appellate court case, Hogan v. Country Villa Health Services, 148 Cal. App.4th 259 (2007). An elderly woman's daughter signed admission papers that included an arbitration clause when her mother entered a skilled nursing facility. When the family decided to sue for wrongful death, elder abuse, and violation of patient rights after the woman's death, the nursing home argued that any claim must be brought in arbitration. The court found that the mother?s Healthcare Power of Attorney to the daughter gave the daughter the right to waive her mother?s right to a jury trial; thus arbitration was the family?s only recourse.
  2. In West Palm Beach, Florida, a jury awarded the family of a woman who had lived at a nursing home $150,000 in damages for the home?s failure to honor the woman?s living will and advance directive. The patient had signed an advance directive indicating that she did not want to be kept alive by artificial means. When she fell unconscious, the nursing home called emergency workers who revived her and sent her to the hospital where she was kept alive for six days with a breathing tube and other life-saving measures before dying. The medical director of the home, who had also been named as a defendant, was found not to have been negligent in the case.
  3. The mother of 16-month old Emilio Gonzales went to court in Texas to challenge the decision of doctors at Austin Children?s Hospital, under the state?s Futile Care law, to remove the child from life support. Emilio has Leigh?s Disease, a neurometabolic disorder characterized by degeneration of the central nervous system. After the hearing, the hospital has given the family until April 10 to find another facility that will take him.

LEGISLATIVE DEVELOPMENTS

  1. Islamic law prohibits embalming and cosmetic work on a body. To address this issue, Maryland legislators are considering a bill that would allow the Board of Morticians to issue a permit to religious leaders to take care of a body from death to burial instead of licensed morticians. This would allow Muslims and Orthodox Jews to practice their faith in handling the remains of loved ones.
  2. South Dakota Governor Mike Rounds signed SB74 into law. SB74 provides that, where an incapacitated person has not otherwise indicated, a doctor may consult adult cousins or a patient?s close friend to make decisions about health care.
  3. Wyoming has passed the Wyoming Cancer Control Act. It contains provisions designed to reduce cancer in the state. It also authorizes the Department of Health to establish an acute and chronic pain management advisory committee.
  4. Several states? legislatures are considering bills which would make Salvia divinorum a controlled substance. When users chew the leaves of the Salvia plant, they may experience hallucinations and other mind-altering events. Five U.S. states ? Delaware, Louisiana, Missouri, Oklahoma, and Tennessee ? have already passed laws regarding the plant. Alaska, California, Georgia, Illinois, Maine, New Jersey, New York, North Dakota, Oregon, and Utah are among the states considering similar legislation. Federal legislation introduced in 2002 did not pass. Australia is among the foreign countries to prohibit Salvia divinorum. In the meantime, according to a Reuters report, scientists are studying its potential therapeutic effects including whether it can help cocaine addicts break the habit. Researchers indicate that they have found little evidence that Salvia is physically addictive.

PAIN MANAGEMENT

  1. The National Institute of Drug Abuse conference in early March featured presentations on many issues, including the neurobiology of opioids, the epidemiology of opioid addiction and pain, the genetic intersections of pain and addiction, and balancing pain relief and risk for addiction. Although the conference was strongly criticized by the Pain Relief Network, researchers and attendees repeatedly stressed the need to address the under-treatment of chronic pain while also focusing on the increased threat of prescription drug diversion and addiction. Scientists told conference attendees that only a tiny fraction of patients who are appropriately prescribed powerful painkillers become dependent on them and those who are vulnerable tend to suffer psychiatric disorders as depression and anxiety. Doctors can closely monitor those patients who exhibit such symptoms. A webcast of the conference is available on the NIDA website.
  2. A commentary by Dr. Scott Gottlieb, ?Prescription for Trouble,? published in the March 6 issue of the Wall Street Journal, decried the increasing federal regulation of medical practice by the federal government. In the article, he stated that DEA had sought legislative authority to give it a role in approving new pain products and commenting that the agency has no ability to appreciate the need for better drugs to treat serious pain. Those statements elicited a strong response from DEA?s Administrator, Karen Tandy, who countered that DEA has ?neither sought nor obtained legislative authority to limit the approval of new pain products? and affirmed that DEA appreciates the need for effective, accessible pain relief to prevent needless suffering.
  3. The Pain and Policy Study Group at the University of Wisconsin submitted comments to DEA on its proposed regulation to allow ?do not fill until? prescriptions for Schedule II controlled substances. The comments pose questions about how the regulation will be interpreted by law enforcement and practitioners.
  4. Last summer, the journal Pharmacopidemiology and Drug Safety, published an article reporting the increase in drug poisoning deaths involving opioid analgesics and linking those findings with the increasing medical use of opioid analgesics in pain management. An accompanying commentary by David Joranson and Aaron Gilson of the Pain and Policy Study Group at the University of Wisconsin cautions against using correlations to make causal statements that implicate pain management. They note that much of the abuse of opioid analgesics is by recreational and street users and individuals with psychiatric conditions rather than pain patients. Another commentary accompanying the article by Scott Fishman, Professor of Anesthesiology and Pain Medicine at University of California, concludes that drug abuse and under treated pain are both public health crises, but the solution to one need not undermine the other.
  5. Two articles in the March issue of Palliative Medicine attempt to dispel the persisting fallacy in the medical community and among the public that morphine hastens death in sick patients or otherwise alters their survival. Professor Bassam Estfan and colleagues from the Taussic Cancer Center write that morphine, when prescribed properly in patients suffering with pain, does not cause respiratory depression. Dr. Rob George and Dr. Claud Regnard from the United Kingdom, highlighted the erroneous linkage between morphine and the so-called Double Effect, writing that morphine is well tolerated, does not cloud the mind, does not shorten life, and wears off quickly.
  6. A guest editorial in the March 26 issue of the Salida, Colorado, Mountain Mail, opined that the victims of drug war are pain sufferers. The editorial reported the experience of the author?s elderly father whose pain prescriptions for a compression fracture of the spine are not sufficient to address his pain while standing or sitting.
  7. The retrial of Dr. William Hurwitz, which began in federal court in Alexandria, Virginia, on March 27, prompted an article by John Tierney in the New York Times. Mr. Tierney has written extensively on the problems of pain patients receiving inadequate medication. The International Herald Tribune reported the beginning of the trial and related the pros and cons of the case.
  8. The U.K.?s Patient Association released a report it had commissioned concerning chronic pain in nursing home residents. Interviews with 77 people revealed that 57% had never been asked about their pain by nursing home staff and 85% said no doctor or nurse had ever talked to them about how their pain could be treated. The Registered Nursing Home Association criticized the report as being based on too few patients to draw generalizations or to permit statistical analysis.
  9. The Mayday Fund, a New York City-based foundation dedicated to alleviating pain, is accepting applications for the 2007 Mayday Pain & Society Fellowship. Applications are due by June 1. The program trains leaders to become proficient at working with the media and policymakers in issues dealing with pain treatment and management.
  10. Boston Scientific Corporation, a developer, manufacturer, and marketer of medical devices, has announced a Race Against Pain campaign designed to educate chronic pain sufferers about the importance of pain specialists and provide them with peer-to-peer support. Mike Roman, a Formula race car driver and chronic pain patient, will act as campaign spokesperson.
  11. The results of a study conducted at the U.K.?s University of Manchester Rheumatic Diseases Center, published in the April issue of Arthritis and Rheumatism, demonstrated that arthritis pain is processed in the areas of the brain concerned with emotions and fear. Researchers hope that this finding will help target pain-relieving therapies.
  12. WebMD had an article about chronic pain, noting it is the number one reason for disability in the United States and stressing the importance of treatment for the pain itself, not just for the underlying cause.

PRESCRIPTION DRUG DIVERSION

  1. With support from the National Institute on Drug Abuse, Inflexxion, Inc., of Newton, Massachusetts, has developed NAVIPPRO (National Addictions Vigilance Intervention & Prevention Program), which is designed to be a real-time national drug abuse monitoring system for prescription opioid medications.
  2. The Journal of the American Medical Association (JAMA) has an article in its March 28 issue that discusses the 2006 report of the International Narcotics Control Board. The report found that worldwide abuse of prescription drugs will soon exceed illicit drug use.
  3. A number of newspapers ran articles this month about the increasing rate of deaths from methadone. Typical is an article from the Redding, California, newspaper which quotes the Shasta County forensic pathologist, Dr. Susan Comfort. Dr. Comfort notes that one-third of the thirty-six overdose deaths recorded in Shasta County in 2006 were due to methadone overdose or use with a mixture of other drugs.
  4. Columbia University?s National Center on Addiction and Substance Abuse released a study titled, ?Wasting the Best and the Brightest: Substance Abuse at America?s Colleges and Universities.? The study found that, between 1993 and 2005, the proportion of students abusing prescription drugs increased 343 percent for opioids, 93 percent for stimulants, 450 percent for tranquilizers, and 225 percent for sedatives. The center offered ten ways that colleges and universities can address the substance abuse problem on their campuses.

OTHER DEVELOPMENTS OF INTEREST

  1. Caring Connections, a program of the National Hospice and Palliative Care Organization, has teamed with the National Endowment for Financial Education to produce an educational booklet for families facing the death of a loved one ? End-of-Life Financial Issues. The booklet is available on the Caring Connections web site.
  2. An article in the March 12 issue of the Washington Post highlighted the findings of an on-going research project, funded by the National Cancer Institute, that African Americans are two to three times as likely as whites to want life-prolonging care. The disparities may be explained in various ways, such as distrust of the medical system stemming from historical maltreatment, religious beliefs regarding suffering, and cultural expectations. The article emphasizes that practitioners must realize that end-of-life care is a very individual choice and what one person may think is appropriate may not be the solution another person would select.
  1. The Mayo Clinic website posted an article titled ?Anticipating End-of-Life Needs of People with Alzheimer?s Disease.? Giving helpful information to family members and loved ones of those suffering from Alzheimer?s, the article stress that caregivers can offer those with end-stage disease reassurance and love through touch, smell, sight and hearing even when the patient doesn?t recognize you and can?t communicate verbally.
  2. The March 25 issue of the Washington Post featured an article in its Business section focusing on the vital documents needed to deal with end-of-life issues. The article stated that only 24% of adults have put their end-of-life care wishes in writing.
  3. New research reported in the March issue of the Journal of Pain and Symptom Management has found that hospice care may prolong the lives of some terminally ill patients. Among the patient populations studied, the average survival was 29 days longer for hospice patients than for non-hospice patients.
  4. The Nebraska Hospice and Palliative Care Partnership (NHPCP) has released its findings from the Nebraska End-of-Life Survey, noting that there are differences between veterans and non-veterans when it comes to end-of-life issues. More than 90 percent of veterans, like their fellow Nebraskans, wanted certain non-medical issues addressed, but, as a group, they express less fear of dying from long-term illness and of dying alone and are more likely to pre-plan their funeral.
  5. The March 12, 2007, issue of the Archives of Internal Medicine included two articles involving end-of-life care and decision-making. A study in 2002 investigated shared decision making at the end of life in intensive care units. The author found that shared decision making about end-of-life treatment choices was often incomplete, especially among less educated families. Higher levels of shared decision making were associated with greater family satisfaction. The other article focused on a residential communication skills workshop for oncology fellows, Oncotalk. The research demonstrated that the workshop was successful in improving communication skills for doctors who must discuss transitions to palliative care and give other bad news to patients and family members.
  6. An interesting article in the March Plos Medicine posits the theory that computer models might be able predict wishes of incapacitated patients better than family or loved ones. David Wendler and colleagues at the NIH devised the decision tool, called a ?population-based treatment indicator.? They found that the tool accurately predict patients? treatment preferences with the same accuracy as surrogates and opined that improved decision tools would be more accurate than surrogates.
  7. A study conducted by Dr. John Song of the University of Minnesota, published in the April issue of the Journal of General Internal Medicine, found that homeless individuals worried about dying in a place were no one would find them and dying in anonymity, with no memorialization. Homeless individuals also were concerned they would not be treated compassionately or adequately by healthcare providers because of their homeless status.
  8. Reuters reported on a recent article in the Journal of the American Geriatrics Socieity by Joan M. Teno, M.D., of the Brown Medical School in Rhode Island. Her research shows that families of patients who completed advance directives tend to feel their loved ones received better end-of-life care. Nonetheless, the findings also indicated that families commonly felt the dying patient did not receive enough care for pain or breathing problems or enough emotional support.
  9. An article in the March 20 issue of Annals of Internal Medicine offers strategies for discussing the hospice and palliative care option with patients.

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