December 2008

News from Attorneys General Offices

  1. Florida Attorney General Bill McCollum announced the arrest of a Broward County woman on charges she abused an elderly nursing home resident under her care. Videotape captured the accused dragging the elderly woman, who suffered from dementia, by the collar.
  2. Illinois Attorney General Lisa Madigan announced the sentencing of an Illinois physician for prescribing a controlled substance without determining a medical need. Dr. Irving Bush, 74, pled guilty, surrendered his medical license, and was sentenced to 30 months’ probation.
  3. Kentucky Attorney General Jack Conway announced the arrest of a former nurse’s aide at a Kentucky nursing home for allegedly neglecting a resident of the home.
  4. Montana Attorney General Mike McGrath announced that the state had filed a motion asking that the court postpone the effect of a recently-decided case in which a Montana state judge held that competent, terminally ill patients have the right to physician-assisted suicide. Baxter et al. v. Montana, No. ADV 2007-787. The plaintiff bringing the action died the day the court’s opinion was issued. The state will appeal the decision, arguing that it is the legislature, not the court, which should decide whether terminally ill patients have the right to take their own lives.
  5. New York Attorney General Andrew M. Cuomo announced the arrests of three western New York nursing home employees and the conviction of a fourth for abusing elderly and ill patients. The arrests are part of General Cuomo’s ongoing state-wide initiative to protect vulnerable nursing home residents.
  6. Oklahoma Attorney General Drew Edmondson announced the arrest of a Tulsa doctor who has been charged with dispensing controlled substances without medical need.
  7. Vermont Attorney General William H. Sorrell announced the arrest of two licensed registered nurses who have been charged with diverting narcotics from patients at the Fletcher Allen Health Center in Burlington, Vermont.

Judicial Developments

  1. The Fifth Circuit Court of Appeals, in United States v. Armstrong, No. 07-30286 (Nov. 21, 2008), affirmed the convictions of Dr. Suzette Cullins and Cherlyn Armstrong of violations of the Controlled Substances Act. Armstrong owned and operated several pain management clinics in Louisiana. Cullins was one of the physicians hired to work at the clinics. Cullins and Armstrong challenged their convictions because the government had not presented expert testimony on the professional standard of care for chronic pain patients. The court held that it is not required that an expert witness testify in order for a jury to reasonably find that a doctor prescribed controlled substances for other than a legitimate medical purpose. The defendants also challenged the jury instructions, arguing that they allowed a conviction based on a civil negligence standard. The court rejected that contention. The court also upheld Dr. Cullins’ sentence of 60 months’ incarceration.
  2. The Sixth Circuit Court of Appeals affirmed the sentence of 27 months imprisonment for Dr. Haj-Hamed. Dr. Haj-Hamed had pled guilty to one count of a twenty-two count indictment for distributing prescription drugs without a legitimate medical purpose. United States v. Ghassan Haj-Hamed, No. 07-6201 (Dec. 3, 2008).
  3. A transplant surgeon, Dr. Hootan Roozrokh, has been acquitted on charges that he tried to speed a potential donor’s death. In acquitting Dr. Roozrokh, the jury said that the case highlights the need for well-defined ethical standards in donation after cardiac death cases. (See the February 2008 Update.)

Pain Management

  1. The November 15 issue of American Family Physician reviewed recommendations on evaluating, diagnosing, and treating chronic nonmalignant pain in a primary care setting. The article notes that the challenges posed by opioids may be overcome by adherence to the Federation of State Medical Boards guidelines, random urine drug screening, monitoring for aberrant behaviors, and anticipating adverse effects.
  2. The Family Medicine Digital Resources Library has added resources in pain management that were developed for a chronic pain management program in a family medicine residency program.
  3. The Utah Department of Health has published a set of proposed guidelines for doctors who prescribe opioids for long-term treatment of chronic, non-cancer-related pain. The public comment period ended in the middle of the month.

Prescription Drug Diversion

  1. In a report issued in mid-December, National Results on Adolescent Drug Use, the National Institute on Drug Abuse researchers found that teen drug abuse includes primarily prescription drugs or over-the-counter medications such as cough syrup. Among high school seniors, 15.4% reported that they used prescription drugs for non-medical reasons. Ten percent reported using Vicodin; 4.7% reported they had used OxyContin.
  2. A West Virginia television station aired a piece regarding pill traffickers using airplanes to fly in and out of Florida to obtain prescription drugs. According to this report, traffickers are particularly using the Columbus and Cincinnati, Ohio, airports and the Lexington, Kentucky, airport.
  3. An article in the December 10 issue of JAMA, the Journal of the American Medical Association, reported the results of a study of unintentional drug overdoses in West Virginia. The study found that the majority of these deaths in 2006 were associated with nonmedical use and diversion of prescription drugs, primarily opioid analgesics.
  4. The Ashville, North Carolina, Citizen Times published an article regarding the steep increase in prescription drug fraud. It quoted one law enforcement official as stating that the number of arrest warrants issued in the county for prescription drug fraud has increased by nearly 300 percent over 2006. A similar article regarding the increase in Vermont of prescription drug diversion, particularly regarding Methadone, OxyContin, and Suboxone, was published in the Burlington Free Press.
  5. The Florida Department of Law Enforcement (FLDE) has issued its report regarding deaths in the first six months of 2008. In that report, the FLDE stated that 4,055 Florida residents died with drugs in their system. Methadone was found in 75 percent of all those who died and oxycodone, in 60 percent.
  6. A Detroit, Michigan, doctor, pharmacist, and business owner have been charged in a healthcare fraud scheme that cost taxpayers nearly $500,000. According to the federal complaint, the defendants, including Dr. Milagros Ebreo, illegally obtained more than 20,000 units of OxyContin and then sold the pills on the street.
  7. A physician from Cleveland, Tennessee, Dr. James Sego, has been arrested on four felony prescription drug charges. A Cleveland police officer, one of his patients, has also been indicted and is suspected of reselling painkillers.
  8. A Billings, Montana, physician has pled guilty to one count of prescription fraud. A Billings pharmacy alerted federal prosecutors to suspicious prescriptions. Dr. Michael Metzger forged prescriptions so he could obtain painkillers and stimulants.
  9. A Golden, Colorado, doctor, Christine Connolly, pled guilty to writing prescriptions for a controlled substance for no medically legitimate reason. Dr. Connolly wrote a prescription for over 2,000 oxycodone pills for an undercover agent who told her that he was not in pain, but liked the way the pills made him feel. She was sentenced to one year’s probation.

Other Items of Interest

  1. The American Bar Association Commission on Law and Aging awarded Oklahoma Attorney General Drew Edmondson its National Aging and Law Award, co-sponsored by the AARP Foundation, at a dinner in early December. General Edmondson was honored for his role in advocating for those at the end of their lives and for working nationally for a balanced pain policy.
  2. The Wichita Eagle carried a provocative editorial, written by former member of Congress and retired physician Bill Roy, querying whether society can afford the cost of care for severely premature babies and those at the end of life.
  3. An article in the Las Vegas Review-Journal illustrates the importance of health care powers of attorney. Joe John Sorce had no authority to keep his companion of 18 years, Mary Clark, on life support because he had no legal status to do so. Instead, hospital officials contacted Clark’s estranged daughter who had had no relationship with her mother since she was a small child. However, the daughter gave permission to remove her mother from life support when a doctor told her that her mom was terminal.
  4. This month, the Dallas Morning News ran a five-part series exploring efforts to improve end-of-life medical care. The journalists involved with the story spent months with the palliative care team at Baylor University Medical Center.
  5. Parents are purchasing kits that will test for seven illicit drugs and five of the most popular prescription pills taken by teens. Available for $89.99, the kits require the clipping and shipping off of 70 to 80 strands of a child’s hair. Results are delivered within a couple of business days.
  6. The New York Times, in its “new old age” blog, carried a personal story regarding a daughter’s dealing with her mother who had opted for V.S.E.D., voluntarily stopping eating and drinking.

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