April 2006

News from Attorneys General Offices

  1. Florida Attorney General Charlie Crist, a candidate for governor, noted in an appearance in Palm Beach that, had he been governor, he would not have entered the debate concerning the withdrawal of life support from Terry Schiavo.

  2. Michigan Attorney General Mike Cox announced a third round of charges from his Nursing Home Initiative, which includes an ongoing series of investigations into nursing home employee criminal backgrounds. On April 1, Michigan’s new nursing home criminal background check law went into effect. It expands the number of crimes that can disqualify an applicant from employment with a nursing home and mandates fingerprint checks for employees.

  3. Oklahoma Attorney General Drew Edmondson recently issued an advisory opinion that found that Oklahoma’s Rights of the Terminally Ill or Persistently Unconscious Act is unconstitutional because it denies due process. Oklahoma’s law allowing patients to sign an advance health care directive applies only in “instances in which an individual has a terminal condition or is persistently unconscious.” According to the opinion, recent U.S. Supreme Court decisions do not place limits on the right to refuse medical treatment. The opinion also stated that the “Five Wishes” advanced health care form may be used in Oklahoma. In a press conference announcing Palliative Care Week in Oklahoma, General Edmondson also urged Oklahomans to put their health care wishes in writing and announced that he was extending the task force to improve end-of-life health care for another year.

Court Decisions

  1. A probate court judge in Michigan has rejected the petition of a doctor who requested the right to end life support for 97-year old Hazel Wagner. Probate Judge Frank Willis wrote that a doctor “should not place himself up as an advocate for the withdrawal of a life-saving apparatus” and also noted that the public could question the motives of the hospital, “ . . . whether the request to withdraw life-sustaining treatment is based upon the best interests of the patient or based upon a financial and time saving for the hospital and the physician.” The patient has only one living relative, a nephew through marriage, and has no health directive. Her legal guardian has now moved Wagner to another facility. An editorial in the Kalamazoo Gazette notes that Ms. Wagner’s case illustrates the need for Michigan to make living wills legally binding. Michigan is only one of two states in which living wills are not legally enforceable.

Legislative Developments

  1. A summary of the various state bills being considered regarding the provision of nutrition and hydration to incapacitated person can be found at http://www.abcd-caring.org/tools/advance_legislation.htm. According to the Sun Sentinel, Florida Governor Jeb Bush has given up on efforts to change the law in Florida to distinguish between artificial hydration and nutrition delivered through a medically implanted feeding tube and other life-prolonging medical interventions. Under the proposed law, there would have been a presumption towards continuation of hydration and nutrition unless an individual had specified another preference in an advance directive or had appointed another to make health decisions for him.

Pain Management

  1. The Hospice Foundation of America's videoconference, “Pain Management at the End of Life: Bridging the Gap between Knowledge and Practice” on April 5 focused on the barriers to pain management, assessing pain at the end of life, managing pain, and the importance of a team effort in managing pain. A book expanding on these issues is available from the Foundation’s website.

  2. Howard Heit, M.D., a pain specialist and the author of one of the articles in the January 2006 issue of Pain highlighted in the March EOL Update, was recently featured in an article in the Washington Post. The article briefly reviewed the controversy regarding recent DEA enforcement activities and the tension between vigorous enforcement and the assurance of adequate pain relief for sufferers.

  3. The May 2006 issue of Pain includes an article reporting the results of a study that demonstrates that premature babies consciously feel pain. According to one of the authors, Kanwaljeet Anand, M.D., director of the Pain neurobiology Laboratory at Arkansas children’s Hospital Research Institute, it is hoped that the findings will lead to better pain management for premature babies.

  4. A local ABC news affiliate reported in April that a new technique that uses ultrasound images to thread a needle close to a nerve during surgery is providing pain relief to patients undergoing painful procedures. The nerve is soaked with an anesthetic and a catheter and balloon pump pain relief to the nerve for two days as the patient recovers at home. The catheter works best for shoulder, knee, foot, and ankle procedures.

  5. A Guamanian doctor, Davina Lujan, was sentenced to five years’ probation and a fine of $10,000 and ordered to perform 300 hours of community service as a result of her pleading guilty to prescribing Percocet to patients without examining them. Prosecutors argued that she prescribed the medication knowing that the end user would be then-Governor Carl Gutierrez. The judge rejected Lujan’s recently filed motions to reverse her guilty plea, arguing that her earlier attorneys were incompetent. The judge noted that the motions were filed when she realized that her DEA license was going to be taken away.

  6. A St. Petersburg pain clinic’s marketing campaign is raising eyebrows among the state’s medical community and state officials. The Doctors Urgent Care Walk-in Clinic’s “Need Painkillers?” ads, which list drugs such as Vicodin, Percocet, OxyContin, and Xanax, and offers a $25 discount coupon for new patients, are finding a response among area patients. A second clinic is scheduled to open soon.

  7. Two doctors in Hawaii were recently indicted in separate cases by a federal grand jury for prescribing painkillers “outside the course of professional medical practice and not for a legitimate medical purpose.” The doctors, Kachen Clement Yeung and Barry N. Odegaard, were also charged with Medicaid fraud. The investigation included the use of DEA agents posing as patients.

  8. A Texas doctor has been indicted by a state grand jury for overcharging pain management services. The Shanti Pain & Wellness Clinic provides medical services to injured workers in Texas. The indictment alleges that Ihsan Shanti and his clinic billed for services in excess of the hours actually used by patients.

Other Developments

  1. According to local television station report, the ethics committee at St. Luke’s Hospital in Houston, Texas, has recommended removing Andrea Clark from life support. Family members argued that the Clark is not brain dead, can communicate by moving her lips and blinking her eyes, and wishes to fight to get better. Although she has no advance directive, family members contend she wants to utilize all medical alternatives to maintain life. Under Texas law, hospitals have the authority to remove patients from life support by giving a family ten days’ notice to find another facility to care for its loved one. An editorial in the on-line National Review, titled “Death by Ethics Committee,” calls Ms. Clarke an early victim of “one of the biggest agendas in bioethics: Futile-care theory, a.k.a., medical futility.” The Houston Chronicle reports that Clark’s life support was scheduled to be terminated on April 30. However, a facility in Chicago, Illinois, has agreed to accept her as a patient and St. Luke’s has agreed to pay for Clark’s transport.

  2. Australia’s only music-thanatologist, harpist Peter Roberts, is the subject of a recently concluded study by Deakin University researchers. The study followed six dying patients over eight months and recommended that music thanatology be included as part of end-of-life care. A key tool of the music thanatologist is “entrainment,” where the harpist matches the patient’s breathing, drawing them into the harps’ rhythm. Roberts is currently on a global speaking circuit discussing his work and the results of the study.

  3. The April 24 issue of Archives of Internal Medicine reports on a study conducted in Connecticut regarding whether health care preferences change as health declines. The study concluded that, as a person’s health declines, he is more likely to accept treatments that would result in functional disability. The authors conclude that, as a result, advance care planning cannot be looked at as a one-time event but must be conducted as an on-going process as an individual ages and experiences different health complications.

  4. A report issued by the Department of Health of the District of Columbia offered strategies for reversing D.C.’s high cancer rate. It criticized what it characterized as the District’s inequitable distribution of early detection programs, treatment, and end-of-life aid and its failure to spend any tobacco settlement funds on health care and cancer services.

  5. A Macon, Georgia, jury awarded the family of a patient who died in a nursing home $1.16 million in compensatory damage after James Davis died from an infection stemming from falls and negligent care. During the trial, the defense attorney criticized the family’s decision to let Mr. Davis die instead of undergoing amputation and putting in a permanent feeding tube.

  6. The inaugural speaker of the Carmelita Lawlor Memorial Lecture in Toronto, Canada, was Faith Mwangi-Powell, one of Africa’s pioneers in end-of-life care. The lecture is named after a former nun and nurse who died in 1989. The bulk of her estate went to funding an annual lecture on end-of-life care. Mwangi-Powell, executive director of the African Palliative Care Association, noted that some countries in Africa have no palliative care and that funding for the HIV/AIDS crisis in Africa contains no money for end-of-life care for sufferers.

  7. The inaugural speaker for the John and Valerie Rowe Lecture Series, which brings medical scholars to the University of Connecticut campus to speak about topics in health care, also focused on end-of-life issues. Joseph Civetta, M.D., noted that two principles of medicine — to preserve life and alleviate suffering — are not always compatible. He suggested that a good death should be focused on the patient’s needs, not on a family’s needs or on the protocols of a health insurance company.

  8. A researcher in Canada has been awarded a grant from the Canadian Institutes of Health Research to study the delivery of culturally appropriate end-of-life care to aboriginal families. The research will continue earlier studies conducted by Mary Hampton that revealed misunderstanding that prevented aboriginals from accessing care and services when a loved one is dying in a health-care setting.

  9. Deaconness Medical Center in Spokane, Washington, has launched the Pathways palliative-care consulting service. Another Spokane-are hospital, Sacred Heart Medical Center, has both palliative-care services and a perinatal hospice which cares for pregnant women whose fetuses have life-limiting conditions. Dr. Stacie Bering, the director of PathWays, noted that palliative care is not yet recognized as a specialty yet by the American Board of Medical Specialties. However, the Board’s website notes that it might be recognized as such by 2008.

  10. Preliminary government figures released this month showed a two percent decrease in the annual number of deaths. This is the biggest decline in nearly 70 years. The U.S. life expectancy is now at 77.9 years. Some experts reserved comment, noting that the report is based on preliminary data.

  11. China has established the Chinese Association for Life Care to act as a nationwide organization addressing end-of-life care issues. The association will focus on end-of-life care, palliative care, gerontology research, and healthcare for the elderly.

  12. In the current issue of Health Psychology, there is an article reporting research into patients’ decisions to end kidney dialysis. The research shows that patients with high scores on depression assessment were 42.6 percent more likely to withdraw from dialysis treatment. The authors recommend that patients considering ending a life-sustaining treatment be evaluated for depression and that doctors encourage patients found to be depressed to first be treated for the psychological condition before ending treatment for medical conditions.

  13. The Mayo Clinic offers an emergency medical form for those who are caring for elderly parents that includes such information as a list of medications being taken, insurance information, advance directives, and a list of allergies.

  14. An article in the March 2006 issue of Research on Aging discloses the results of research regarding how elderly adults’ attitudes towards religion affects their attitudes towards death. Researchers reported that fear of dying is increased in those that are “extrinsically” religious (even over those with no religious orientation) over those with an “intrinsic religious” orientation who have dedicated their life to a higher power.

  15. In “A Time to Die,” the author discusses eight ways to bring comfort and hope to a dying loved one. Although published in a magazine with a religious orientation, most of the suggestions are applicable to all.

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