April 2008

News from Attorneys General Offices

  1. Arizona Attorney General Terry Goddard announced his plans to celebrate Older American’s Month in May. The plans include making presentations to seniors to help protect themselves from consumer fraud.
  2. Connecticut Attorney General Richard Blumenthal has filed a lawsuit in federal court against the U.S. Food and Drug Administration (FDA). The agency has failed to act on General Blumenthal’s four-year-old citizen petition that seeks stronger warnings related to OxyContin. General Blumenthal also recently announced that Connecticut was seeking receivership over six Marathon Healthcare Center nursing homes throughout the state.
  3. Florida Attorney General Bill McCollum recently announced the arrest of a licensed practical nurse on charges that she stole narcotics prescribed to one of the patients under her care.
  4. Hawaii Attorney General Mark Bennett announced the sentencing of a Kauai man for the neglect of an elderly resident in an unlicensed care home which he operated. Jason Craig was sentenced to five years for assault and one year for the unlicensed operation of the care home.
  5. Maine Attorney General Steven Rowe has been working through the fall with the Maine Hospice Council and Center for End-of-Life Care to hold public meetings across the state. In April, comments were elicited so that others could share their experiences.
  6. New Hampshire Attorney General Kelly A. Ayotte announced the convictions of two nursing home workers in separate cases of stealing narcotic pain medications. In one case, Tammy Tura, a licensed medication nursing assistant, pled guilty to stealing a surplus vial of liquid morphine that was due for destruction. In the other case, Stephanie Wood, a licensed practical nurse pled guilty to stealing narcotic pain medications from a nursing home resident and replacing them with non-prescribed over-the-counter pain relievers.
  7. Vermont Attorney General William H. Sorrell announced that a licensed registered nurse had pled guilty to one count of Obtaining a Regulated Drug by Deceit and one count of Recklessly Endangering Another Person. She admitted to removing morphine from a computerized narcotic security system and injecting herself while on duty at Gifford Medical Center. She was sentenced to eighteen months to three years’ incarceration, all suspended except for ninety days, had her nursing licenses suspended, and is likely to be excluded from working in any Medicare- or Medicaid-funded facilities for up to five years.

Judicial Developments

  1. Dr. David Wexler, a dermatologist in New York City, was sentenced in 2006 on being found guilty on seventeen counts of an indictment involving the illegal distribution of controlled substances and health care fraud. On appeal, the U.S. Court of Appeals for the Second Circuit, in a two to one decision, reversed the judgment as to the charge of conspiracy to distribute a controlled substance that resulted in death. United States v. David E. Wexler, No. 06-1571-cr (Apr. 3, 2008).
  2. A federal judge held that the Pain Relief Network did not have standing to sue when it sought a temporary restraining order preventing the federal government from taking any action against a doctor who has been charged with unlawful distribution of a controlled substance resulting in death. The group also had asked for an order to the Kansas State Board of Healing Arts to restore the doctor’s license. The group has withdrawn its lawsuit for now.

Legislative Developments

  1. On March 12, the Senate Judiciary Subcommittee on Crime & Drugs and Caucus on International Narcotics Control held a joint hearing titled “Generation RX: The Abuse of Prescription and Over-the-Counter Drugs.” The witnesses included Dr. Len Paulozzi, medical epidemiologist at the Centers for Disease Control and Prevention and Dr. Nora Volkow, Director of the National Institute on Drug Abuse.
  2. Kansas Governor Kathleen Sebelius signed into law H.B. 2416, which creates a system to track prescriptions as a way to identify prescription drug abuse.
  3. Governor Mitch Daniels of Indiana recently signed S.B. 157, which strengthens the requirements for methadone clinics throughout the state.

Pain Management

  1. A pain “boot camp,” run by the Rehabilitation Institute of Chicago’s Center for Pain Management, was featured in an article posted on CNN.com.
  2. A number of news outlets has discussed a clinical trial being conducted by Dr. Charles Birbara of the Clinical Pharmacology Study Group in Worcester, Massachusetts. Dr. Birbara, a rheumatologist, is using adlea, an ultra-purified form of capsaicin, to inject in the knees of patients who have painful osteoarthritis.
  3. Aaron M. Gilson, PhD, of the Pain and Policy Studies Group (PPSG), at the University of Wisconsin, presented an overview of state pain policies at the annual meeting of the Academy of Pain Medicine. His presentation, including a discussion of the PPSG’s methodology for evaluation these pain policies in the context of balance between legitimate treatment of patients in pain and ensuring that controlled substances are not illegally diverted, is available on-line.
  4. The Maine Hospice Council held a day-long meeting on Pain Management in April. The program included information on ethics and pain management, living pain free at the end of life, and pain management in critically ill pediatric patients.
  5. BMC Pediatrics published the results of a study that demonstrated that premature newborns suffered less if they experienced skin-to-skin contact with their mothers during a painful medical procedure.
  6. The results of a study conducted at Ohio State University was shared with attendees at the Society for General Internal Medicine. The study demonstrated how a busy clinic might more easily identify which patients are misusing opioid medications and assist them in finding treatment. Non-cancer patients receiving opioid medications were carefully logged and screened, contracts were signed between physicians and patients, and urine screening conducted. Thirty-five percent of the 167 patients were found to be in violation through use of illegal street drugs or doctor shopping. Patients receiving Oxycontin or another medicine that contained oxycodone were twice as likely as other opioid registry patients to violate the clinic policy.
  7. Dr. Volker Neugebauer of the Department of Neuroscience and Cell Biology, University of Texas Medical Branch in Galveston, Texas, recently received a $1.2 million grant from the National Institute of Neurological Disorders and Stroke to investigate how pain impairs decision making. An interview with him was published in the Galveston Daily News.
  8. The FDA has given 510K clearance to manufacture and market a hand-held biomedical device that was developed jointly by students at Stevens Institute of Technology and pain-management expert Dr. Norman Marcus. The device, which began life as a Stevens undergraduate Senior Design Team project in 2004, spawned a start-up company, SPOC, whose mission is to develop a proprietary point-of-care medical diagnostic system that consists of a medical device and methodology that pinpoint the specific muscle trigger points causing pain. The device was displayed and discussed on a March 20, 2008, edition of NBC’s “Today.”
  9. The El Dorado Telegraph and other local newspapers carried an article discussing reports that pain patients are not receiving appropriate care because of DEA enforcement activities and the Oxycontin abuse issue. However, the article also quotes a local physician as noting that physicians have generally always been reluctant to prescribe opium-derived painkillers because of state medical board oversight. Other local physicians did not wish to comment on the issue, according to the article’s author.

Prescription Drug Diversion

  1. The Baltimore Sun continued its reporting on buprenorphine abuse in April, noting that, in Baltimore, police officials examined more buprenorphine cases last year than they did methadone cases.
  2. The April 2 issue of The Seattle Times reported that the rate of OxyContin abuse has soared in the area. The U.S. Attorney’s office recently convicted a man who led almost two dozen people in breaking into pharmacies across California, Idaho, Oregon, and Washington between 2004 and 2006 to steal OxyContin and other scheduled narcotics.
  3. The website rxpatrol.com, a collaboration between the pharmaceutical industry and law enforcement, publicizes details about robberies at pharmacies as well as tips for safeguarding pharmacies.
  4. As the rate of prescription drug diversion among young people has continued to rise, more educational programs are being presented. In Marlboro, New Jersey, for instance, school administrators, township police, the municipal drug abuse prevention alliance, and the U.S. DEA joined together for a program aimed at parents. One of the purposes of the program was to alert parents and grandparents that the primary source of drugs for youth continues to be home medicine cabinets.
  5. A home-based hair follicle drug test kit called Hair Confirm Prescription is being marketed to parents of teen-agers. The hair testing kit gives a drug profile for the last ninety days and includes 12 types of legal and illegal drugs.
  6. A 2007 issue of the American Prosecutors Research Institute’s “Informant” deals with the role of local law enforcement in preventing pharmaceutical diversion.
  7. Dr. Joan Jaszczult of Bloomfield, New Jersey, was sentenced to 11 years in federal prison and fined $12,500 after having been found guilty of writing illegal prescriptions for controlled substances.
  8. Dr. Alexander Theodore of Sandy, Utah, has been sentenced to one year’s incarceration and six years’ probation as a result of his pleading guilty to four second-degree felony counts of drug distribution. He was also ordered to pay $22,000 in restitution to insurance companies and has paid the state $50,000 for investigative costs. The federal charges that were originally filed were dismissed in favor of the state action.
  9. An Owosso, Michigan doctor, Patrick Wegman, has been arraigned on drug charges. He has been charged with four counts of obtaining a controlled substance by fraud.
  10. A former Florida physician, Harsh Sharma, whose license had been revoked by state authorities last year, has been arrested by federal officials for possessing controlled substances with the intent to distribute unlawfully. He allegedly ordered controlled substances through the mail by presenting himself as a doctor with a valid DEA license.
  11. Dr. Adolfo Hernandez, Broad Ripple, Indiana, was recently indicted on eight counts of unlawfully dispensing oxycodone. The indictment also contains a forfeiture allegation, asking that all property acquired as a result of the unlawful distribution of controlled substances be forfeited to the government.
  12. A Highland Park, Illinois, orthopedic surgeon has been charged by state officials with seven counts of unlawful delivery of controlled substances. It is alleged that Gerald S. Kane’s prescriptions contributed to the fatal overdose deaths of three patients.

Other News of Interest

  1. Newspapers and media outlets around the country ran articles in connection with National Healthcare Decision Day, including this one from Mississippi’s Sun Herald.
  2. A New York panel that has been charged with developing guidelines on pain management and end-of-life care has held its first meeting. It is to submit a report to the governor and the legislature by February 1, 2010.
  3. A case study published in the January-February issue of the Hastings Report was the impetus for a front-page news story in the Washington Post in April. The article concerns medical devices called left ventricular assist devices (LVADs). These devices are implanted near the heart and attached to one of the main pumping chambers and the aorta. An ethical dilemma occurs when a patient decides he wants the device turned off. The article demonstrates how new medical technologies, such as LVADs, are used before society has a chance to resolve issues that they raise. Are these devices more akin to forms of life support or are they, rather, part of the body which, when removed, will cause death?
  4. A new article has been posted on Columbia University Law School’s National State Attorneys General Program’s website. It is titled “The Role of State Attorneys General in Improving End-of-Life Healthcare: Holding Hospitals and Nursing Homes Accountable for Undertreatment of Pain.”
  5. The Intercultural Cancer Council’s (ICC) 11th Biennial Symposium on Minorities, the Medically Underserved, & Cancer was held this month. In connection with that event the ICC’S Caucus released a new report, “From Awareness to Action: A Renewed Call to Eliminate the Unequal Burden of Cancer.” The report notes that poverty is the major factor contributing to higher cancer incidence and mortality rates among the medically underserved. Also addressed in the report is access to pain management and palliative care. The ICC Caucus has created a 12-point action plan to provide vulnerable populations with more access to programs that will prevent, detect, and treat cancer at its earliest stages.
  6. Spectrum.com carried an article regarding the he variance from state to state on what is provided or expected of assisted living facilities. The article quotes a report by Professor Catherine Hawes of Texas A&M University.
  7. Dr. Darryl S. Inaba, clinical manager of Genesis of Asante Health System, Central Point, Oregon, told a conference of substance abuse professionals that, in terms of percentage of the population, Oregon ranks close to first in prescription and over the counter drug abuse.
  8. Wisconsin authorities have charged the parents of an 11-year old girl who died of diabetic ketoacidosis with second degree reckless homicide. They did not seek medical help for their daughter but, instead, prayed for her recovery.
  9. In conjunction with National Healthcare Decisions Day, held on April 16, a survey was released indicating that Americans are more likely to talk with their children about drug use or sex than with a seriously ill parent about their end-of-life wishes.
  10. Also on April 16, Caring Connections hosted a free, interactive webinar to demonstrate a new Internet-based technology which provides a convenient way for people to create living wills and durable powers of attorney for healthcare.
  11. A nurse’s aide in Prince William County, Virginia, was recently sentenced to serve one year of a four-year prison sentence after her conviction for abuse and neglect of an incapacitated adult. She had been employed to care for a 55-year old man with Lou Gehrig’s disease. When a registered nurse visited, the patient was found covered in his own urine and crawling with maggots. He died three weeks later.
  12. The National Hospice and Palliative Care Organization (NHPCO) and the Alliance for Care at the End of Life have collaborated to create a powerful, web-based advocacy tool, Cap Wiz. Cap Wiz creates an easy way to send advocacy messages, containing either prepared messages or one’s own comments, to a person’s congressman and senator.
  13. Law students from McGeorge School of Law joined 90 third-year medical students from the University of California to exchange ideas and concerns on how to deal with the rights of patients at the end of their lives.
  14. The latest edition of the Dartmouth Atlas of Health Care calls for overhauling how the United States manages chronic illness. Researchers found that lower utilization of acute care hospitals and physician visits could actually lead to better results for patients and prolong the solvency of the Medicare program. The report demonstrated that hospitals that treat patients more intensively and spent more Medicare dollars did not get better results. The report also noted that Utah provides the most conservative medical care to elderly patients in their last six months of life; more of that state’s elderly are likely to die at home.
  15. John Hardin’s op-ed in the Chetek Alert chronicled his family’s decisions regarding the care for his wife, Nancy, who entered a nursing home at the age of 45 with dementia. He suggests that, in addition to a DNR order, families be asked if they wish to have a DNM order (do not medicate with new drugs) or a PCO (palliative care only).
  16. According to the results of a study published in the Journal of Clinical Nursing, humor plays an important role in healthcare even when patients are terminally ill. The authors concluded that humor offers a humanizing dimension in healthcare when combined with scientific skill and compassion.
  17. The National Institute on Aging, National Institutes of Health, has awarded a $969,089 to Leap of Faith Technologies to further development on eMedeonline(R). This system uses smartphone technology to remind patients to take their medications. It also helps them monitor their symptoms and side effects using a cellphone.
  18. MayoClinic.com published an article by Chaplain Mary E. Johnson on interacting with a terminally ill loved one. Her insightful comments include dealing with denial, the value of just “being there,” and encouraging a loved one to talk about his or her life.
  19. The results of a study published in the April 1 issue of the Journal of Clinical Oncology demonstrated that children dying of cancer are currently receiving care that is more consistent with optimal palliative care and, according to parents, are experiencing less suffering.
  20. A survey conducted by Excellus BlueCross BlueShield demonstrated that only 42 percent of upstate New York residents have designed a health care proxy although 90 percent said it was important to do so.
  21. News outlets covered the seemingly miraculous story of Zack Dunlap, a young man who was involved in what doctors thought was a fatal all terrain vehicle accident. Brain scans showed no activity and his parents had made the decision to remove him from life support once the organ donation team was in place. He has now made a nearly complete recovery from his injuries.

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