August 2006

News from Attorneys General Offices

BULLETIN: On Wednesday, September 6, 2006, the Drug Enforcement Administration (DEA) published two documents in the Federal Register:

“Dispensing Controlled Substances for the Treatment of Pain” [Statement of Policy]; and “Issuance of Multiple Prescriptions for Schedule II Controlled Substances” [Notice of Proposed Rulemaking]. Both documents can be viewed at the Federal Register's web site: then click on the “Browse the Table of Contents from today's issue in HTML” link. Once the table of contents appears, find “Drug Enforcement Administration” in the list of agencies. The documents will appear under DEA.

Legislative Developments

  1. Several articles in local Texas papers have focused on families’ unhappiness at the Texas futile-care law. The Texas House Committee on Public Health took testimony from the public and experts on both sides of the issue. Some families have taken hospitals to court to stop them from taking loved ones off life support. According to the Houston Chronicle, the calls for change are likely to produce contentious debate in the legislature and the issue has become part of the gubernatorial race. In early August, a court ordered a hospital to refrain from withdrawing life-sustaining treatment from 67-year old Daisy M. Conner. Another family is fighting a Dallas hospital’s decision to discontinue life-saving treatments for their 61-year old mother.

  2. Responding to an increase in inter-family battles over guardianship of infirm adults, the Uniform Law Commissioners is working on creating a model law dealing with interstate guardian disputes. Last year, fifteen states passed adult-guardianship laws.

  3. California legislators are working out differences between two versions of a bill passed earlier that would offer end-of-life hospice care to children. The bill would authorize the state to apply for a federal waiver of a law that prohibits public funding of hospice care for children. The bill would allow hospice care for children even if they were still undergoing treatment, such as chemotherapy.

  4. Spurred by the fight in Virginia courts this summer over the care of Starchild Abraham Cherrix (see paragraph 4, under Judicial Developments, below), a Virginia legislator has introduced a bill to strengthen families’ rights to manage the health care of their ill children.

  5. West Virginia, Arizona, Hawaii, and New Hampshire are considering legislation to ban pharmaceutical company access to doctors’ prescription records. (See story on California program, paragraph 5, under Pain Management below.)

  6. The Mental Capacity Act of 2005, to come into force in April 2007, will, for the first time, allow individuals to appoint a health care proxy to make medical decisions for them when they are not able to do so.

Judicial Developments

  1. The Fourth Circuit overturned the conviction of William Hurwitz for drug trafficking in United States v. William Eliot Hurwitz, No. 05-4474 (4th Cir. Aug. 22, 2006). The court held that the trial court should have given a “good faith” instruction to the jury on the drug trafficking charge.

  2. The family of 104-year old philanthropist Brooke Astor is feuding over her care in a New York courtroom. Her grandson, Philip Marshall, is asking the court to remove his father as guardian, alleging that he is not taking proper care of her. A side issue in this case is whether the media should be barred from hearings. The court sealed proceedings in July, but several New York newspapers have filed asking that the court file be opened.

  3. According to the Wall Street Journal, another guardianship fight is being fought over who will be the personal-care guardian of 86-year old Lillian Glasser, whose personal worth is estimated to be around $25 million. Her daughter, who lives in Texas, has asked to be appointed guardian of her mother who lives in New Jersey. Mrs. Glasser’s son is supporting the petition of a family friend.

  4. A compromise was reached by the parties in the case of a child in Virginia whose parents were ordered to continue his chemotherapy sessions. Under the settlement, Starchild Abraham Cherrix will be permitted to see a new oncologist who uses alternative therapies emphasizing nutrition and will also continue the therapy from Mexico whose use triggered the original court order.

Pain Management

  1. Edward Dehaas, M.D., the owner and operator of the former Professional Pain Management of Ohio Clinic in New Philadelphia, recently pled guilty to distributing hydrocodone.

  2. Ghassan Haj-Hamed pled guilty in U.S. District Court in Kentucky to federal drug charges. He will be sentenced on January 5. Haj-Haned was a co-owner of a chain of urgent care centers across northern Kentucky and in the Cincinnati, Ohio, area.

  3. According to an article in the Ionia, Michigan, Sentinel-Standard, Dr. John Hildebrandt was sentenced in August to probation and ordered to repay more than $190,000 in restitution after he pled guilty to one count of mail fraud in April. Hildebrandt was ordered to prepare a public announcement that must include the following phrases: “I harmed my patients; here’s how I did it. I contributed to the death of four patients. In fact, I was warned by pharmacists, family members, other doctors, and the State Board of Medicine, and I did nothing about those warnings.”

  4. Former doctor Gregory Schulte has been granted early release after serving ten months of his four-year sentence. He pled guilty in July 2005 to stealing morphine from his patients suffering from severe back pain and replacing it with salt water.

  5. According to a story in the August 6 issue of the San Francisco Chronicle, after a three-year debate in California over pharmaceutical companies’ access to prescription records, a pilot program is being introduced that will give California physicians some choices about whether their prescription records may be accessed. Critics charge that access to these records by pharmaceutical representatives unduly influence doctors’ prescription writing. Under the California proposal, a physician may choose not to allow such access. If a doctor does not choose to opt out, he will receive the same data package containing their personal prescription profiles that drug companies receive. The primary source for this information comes from the American Medical Association, which claims the information is used for research.

  6. The British Journal, Archives of Disease in Childhood, reported that television soothes a child better than mothers. Children whose blood was being drawn while they watched television reported one-third less pain than did those being solely soothed by their mothers.

  7. Researchers have published a report in Current Biology that people suffering from chronic pain may be relieved by being given icilin. The chemical activates a protein, TRPM8, which prompts a feeling of coolness and acts as a pain reliever for chronic pain.

  8. The American Pain Foundation, with support from Merck & Company, is seeking to raise awareness and understanding about shingles. The “Spotlight on Shingles” website will inform users about the disease and its potential complications. Shingles can affect anyone who has had chickenpox and can be quite painful.

  9. An article in the recent issue of Pain Physician have found that inradiscal electrothermal therapy will spare up to 65 percent of patients with chronic lower back pain from spinal surgery. The same issue contains an article, titled “Medicare in Interventional Pain Management: A Critical Analysis.”

  10. An article in a local Tennessee newspaper quoted local law enforcement personnel as stating that prescription drug abuse is the most frequently encountered drug problem in the upper northeast portion of the state. One prosecutor noted that, already this year, thirty-two defendants have been indicted in connection with prescription fraud. A recently released survey from the American Prosecutors Research Institute showed that the Southeast is abusing prescription medication at a rate higher than other areas of the country.

  11. The August issue of Pain Medicine contains the results of two research studies on treating pain in veterans from Afghanistan and Iraq. One study reported significant success with advanced regional anesthetic techniques in treating soldiers suffering from battlefield wounds. The other study reviewed medical records from 100 randomly selected veterans of Operation Enduring Freedom and Iraqi Freedom, finding that a significant number experienced clinically significant pain following their military service. The study authors noted that early identification and treatment of pain is important to reduce the incidence and severity of chronic pain conditions.

  12. Physicians at Phoenix Children’s Hospital conducted a study using a color analogue scale for children to describe the severity of their pain. The results of the study were reported in the February issue of Academic Emergency Medicine. The study found that use of the white to red chart helped to triage children by ensuring that those children in the most pain were seen quickly in the emergency room.

  13. Ellen Hahn of the University of Kentucky College of Nursing researched smoking among chronic pain sufferers and found that they smoke at a higher than average rate than those who are not in pain. The results of her study were published in the June issue of Nicotine & Tobacco Research. The researches suggest that smoking cessation programs incorporate pain management into their protocols.

  14. An NIH-sponsored study to be reported in NeuroReport has found that transcendental meditation may reduce the brain’s reaction to pain.

  15. 15. In Nova Scotia, the health minister has committed $2 million over two years for the pilot phase of a plan to set up four multi-disciplinary pain centers for patients with chronic pain. According to an article in the Halifax Chronicle Herald, this is part of the response to a report that found that many of the 180,000 Nova Scotians living with chronic pain can not find appropriate treatment.

  16. A BBC News poll of general practitioners found that many are reluctant to prescribe pain relieving drugs to terminally ill patients after the conviction of Dr. Harold Shipman for murdering elderly patients with opioid drugs. It is feared that the “Shipman Effect” is harming patient care. One in three of the respondents also feared that increasing regulation of the use and movement of narcotics will hinder their ability to treat terminally ill patients adequately. One of the proposed regulations is that doctors will have to prove their fitness to practice every five years.

Other Developments of Interest

  1. NPR carried an article by Dr. Chris Feudtner, a pediatric palliative care physician. It is a highly personalized account of his day-to-day interactions with his small charges and their families. This article was a part of its series on end-of-life care for children.

  2. An article in the August 13 issue of the New York Times, titled “The Fuzzy Gray Place in the Killing Zone,” notes the spirited discussions that are being held by ethicists and physicians in regard to the charges lodged against a doctor and two nurses in Louisiana whose patients died during the period following Hurricane Katrina. Whether the sedatives were given to relieve pain and suffering or whether they were given to hasten their death will be an issue when the cases come to trial.

  3. Another family is feuding over the care a loved one. Karl Bernstein, 76 years old, is a retired nuclear engineer who is suffering from Parkinson’s and Alzheimer’s diseases. He has not spoken to anyone in four years. Her stepson, Scot, an attorney, won the right to control medical decisions for his father when he went to court to challenge the step-mother’s “do not resuscitate” order at the nursing home. Mrs. Bernstein gave up a challenge to the change in guardianship when she ran out of money and emotional energy to fight it.

  4. An article in the Charlotte Observer on August 27 reported the disagreement among hospice providers in North Carolina over the need for more hospices. During the last half of 2005, 130 new hospices were open in the state, prior to a December 31 deadline that required hospice providers to receive a certificate of need before opening.

  5. A new program called Better Together is being offered in Bradford, U.K. This provides palliative care to people with advanced heart failure, enabling them to stay at home if they wish. York University will be monitoring the program to evaluate whether it benefits patients and caregivers’ quality of life and the economic consequence of the program.

  6. Two articles in the September issue of the Journal of General Internal Medicine will be of interest to those involved in palliative health care. An article, authored by Amy Sullivan and others, evaluates the long-term impact of a faculty development program in palliative care education and practice. The article is titled “Creating Enduring Change: Demonstrating the Long-Term Impact of a Faculty Development Program in Palliative Care.” A companion article, by James Hallenbeck, is titled “Palliative Care Training for the Generalist: A Luxury or a Necessity?”

  7. The on-line issue of Medical Economics, on August 18, carried an article, which will be the first in a series on medical ethics, asking readers to respond to various vignettes on common ethical dilemmas. Some of these queries involve end-of-life care.

  8. Bill Colby, a fellow of the Center for Practical Bioethics, has authored a book titled Unplugged: Reclaiming Our Right to Die in America. Colby’s earlier book was written about his experience representing Nancy Cruzan’s family.

  9. Houston, Texas, doctor Liza Leal, has written a book titled Live Well with Chronic Pain. Dr. Leal herself is afflicted with rheumatoid arthritis. She wrote the book to help readers with chronic pain to become proactive in managing their pain.

  10. An article in the August 16 issue of the The Frederick News-Post noted that deaths of military members create unique grieving challenges. A book, written by a graduate of Hood College’s thanatology program, has been written to help children understand the death of a military parent. It is titled The Hero in My Pocket.

  11. The National Hospice and Palliative Care Organization, partnering with the National Alliance for Hispanic Health, is offering a toll-free phone line that offers information and resources in Spanish for people living with or caring for someone with a serious illness.

  12. An on-line issue of Health Services reports the results of a study that found that nursing-home residents in hospice care will be admitted to a hospital only half as many times as their nursing home peers who do not have hospice care. The study was funded by a grant from the U.S. Department of Health and Human Services.

  13. The August 1 issue of the Hospice News Network features information from an article that appeared in The Baltimore Sun regarding the SPIKES protocol. This is a protocol that can be used by a physician when delivering bad news to a patient. It stands for “Setting, Perception, Invitation, Knowledge, Empathy, and Strategy/Empathy.” These are the components of importance when sharing diagnosis with patients. Students at the University of Maryland School of Medicine encounter end-of-life issues in their first two years and begin visiting hospices in their junior year. They also receive formal training in protocols such as SPIKES when they become residents.

  14. A story in the August 14 issue of The Sacramento Bee featured a non-profit program called Talking, Listening, and Caring that uses volunteers to regularly call seniors living alone at home to check up on them. One hundred twenty volunteers regularly call 500 elderly people in the Sacramento area. During the recent heat wave in Sacramento, a volunteer, who came to a client’s home when the telephone was not answered, found the elderly woman lying unconscious on the floor, having succumbed to the heat when her air conditioner malfunctioned.

  15. A study to be published in the September issue of Journal of Epidemiology and Community Health found that single people who never marry have an increased risk of dying earlier than those who were divorced, separated, or widowed. Those who remain married have the greatest chance of surviving longer.

  16. The lack of a palliative care facility in the Yukon is becoming a campaign issue in the upcoming Canadian elections. The Yukon is the only territory in Canada that does not have such a facility.

  17. An article in the recent issue of the journal Chest reports that patients facing end-of-life care do not have adequate knowledge about cardiopulmonary resuscitation and that many show little interest in discussing EOL preferences.

  18. Santa Cruz, California, Spanish students at Soquel High translated the Children’s Hospice and Palliative Care Coalition’s online national support network,, into Spanish. The web site was recently featured in the PBS documentary “Lion in the House,” a five-part series on children with cancer.

  19. The National Cancer Institute contains a fact sheet for caregivers on end-of-life care, answering questions such as when an at-home caregiver should call for medical help and what the signs of approaching death are.

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