April 2007

News from Attorneys General Offices

Michigan Attorney General Mike Cox announced that a $100,000 penalty has been levied against Metron Integrated Health Systems for quality of care deficiencies at its Greenville, Michigan, nursing home. The penalty was levied by an independent monitor, appointed in June 2006, under the terms of a groundbreaking agreement made last year between Metron and Attorney General Cox. This is the fourth assessment levied since the monitor was appointed last June.

Legislative Developments

  1. The April 4th issue of the Washington Post reported that four states have adopted a model law, the Revised Uniform Anatomical Gift Act, designed to make organ donation easier. At the time of the article, the measure had also passed in Arkansas, Indiana, Iowa, and New Mexico and was awaiting governors’ signatures. A controversial provision in the revised model law requires medical staff to keep an organ donor on life support even if she or he has signed a document expressing a contrary end of life wish. There is alternative language to the model act, which a state may adopt, that would call for family members to be consulted in such situations to determine what the donor would have wanted. Another provision in the model law would give precedence to an individual’s expressed wish to be an organ donor over family objections. Another concern of some ethicists and medical practitioners is that there might be a reluctance to prescribe pain-relieving medication to a dying individual to ensure that organs are amenable to transplant.
  2. According to a Boston.com article, the Massachusetts legislators are looking at ways to overhaul how the Department of Social Services deals with the impending death of its charges. Some of the new initiatives being considered are making end-of-life hearings public and codifying end-of-life protocols into law.
  3. The Texas Senate recently passed SB 1879 and reported it to the House for consideration. The proposed bill would extend prescription monitoring to Schedule III through V drugs and makes several changes to the current monitoring program. The Texas legislature is also still debating the future of the Texas “Futile Care” law. The Texas medical community has evidently shifted its position and now embraces a compromise bill that would extend from two to seven days the notification a family would receive prior to an ethics committee reviewing an attending doctor’s determination that it would be inhumane to continue treatment. It would also extend the time from ten to twenty-one days that a patient’s family has to find another facility that would continue to treat a patient. The debate has been heightened by the case of seventeen-month-old Emilio Gonzales at Children’s Hospital of Austin. (See the March EOL Update.)

Pain Management

  1. The retrial of Dr. William Hurwitz in federal district court in Alexandria, Virginia, resulted in his being found guilty of sixteen counts of drug trafficking. The jury acquitted him on seventeen other trafficking charges. The judge dismissed the remaining twelve counts because the jurors would have had to come back to continue deliberation after the second of May. The most serious charges, which involved a patient who died and two who were seriously injured, were dismissed by the judge after the defense rested. Dr. Hurwitz's original conviction on fifty counts was overturned by the U.S. Court of Appeals for the Fourth Circuit. Sentencing is scheduled for July 13.
  2. The third edition of The Massachusetts General Hospital Handbook of Pain Management is now available for downloading. The booklet contains the latest evidence-based information and coverage of fibromyalgia, psychosomatic complaints, headaches, and opioid cautions have been expanded.
  3. An editorial in the British Medical Journal opines that over-regulation compromises doctors’ ability to treat pain.
  4. A former prosecutor, John P. Flannery, has written a book titled Pain in America and How Our Government Makes It Worse. In it, the author opines that the federal government “seems to have as its objective controlling the relationship between the physician and the chronic pain patient by criminalizing the prescription of narcotics and discouraging the existence of any physician-patient relationship by which to heal the chronic pain.”
  5. PAINWeek 2007 will be held in Las Vegas on September 6 through 9, 2007. There will be sixty sessions presented by a number of organizations, including the National Stroke Association, the American Headache Society, the National Fibromyalgia Research Association, the American Society of Pain Educators, and the American Osteopathic Academy of Addiction Medicine. One of the course concentrations will be “Fundamental in Pain Management,” which was developed specifically to help clinicians from California and Oregon meet their state mandates for pain management and end-of-life continuing medical education.
  6. According to a television report, a pharmacy in Orange, Texas, has announced that it will no longer fill new prescriptions that come from pain management clinics except those for its long-term customers. Walgreens, CVS, and Orange Pharmacy had already announced they would not fill such prescriptions. Despite the projected loss of more than half of its revenue from this decision, Sholar’s Pharmacy noted that its established customers were becoming afraid to go to the pharmacy because of the large number of drug-seeking

Prescription Drug Diversion

  1. Attorney General Alberto Gonzales’s prepared testimony for the April 15 Senate Judiciary Committee hearing included a statement regarding DOJ’s continued concern regarding the non-medical use of controlled substance prescription drugs while recognizing the critical need for individuals with a legitimate need to have access to such drugs.
  2. According to an article in the Tennessean, the number of deaths from prescription drugs in the state in 2005 closely rivaled the number of citizens murdered. The statistics were compiled from a review of the state’s medical examiner’s records. More than half of these deaths resulted from a lethal combination of two or more prescription drugs. A similar article regarding deaths in Oregon appeared in the April 2d issue of the Statesman Journal.

Other Developments of Interest

  1. The Hospice Foundation of America’s book, Living with Grief: Before and After Death, is now available, as is the DVD of the recent teleconference. The topic of the 2008 Conference will be Living with Grief: Children and Adolescents.
  2. According to a report released this month by the inspector general’s office of the U.S. Department of Health and Human Services, eighty-six percent of Medicare hospice programs have been certified within the six-year time frame. However, fourteen percent averaged past due dates of three years. Of the hospices surveyed, forty-six percent were cited for at least one health deficiency.
  3. The British Medical Association issued new guidance on how to treat terminally ill patients. The guidance covers a range of potential situations and emphasizes that advance directives must be given effect.
  4. The Japanese government is compiling its first guideline on end-of-life medical care. The proposal states that a team of medical caregivers should decide when to end treatment for terminally ill patients, but does not define “terminally ill.” The proposed guidelines give primary importance to a patient’s preferences.

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