February 2006

REMINDER: Register now for the Hospice Foundation of America’s live teleconference on April 5, 2006, dealing with pain management at the end of life. The teleconference will be moderated by Frank Sesno, Professor of Public Policy and Communication at George Mason University and Special Correspondent with CNN, and will feature as one of the panelists Oklahoma Attorney General Drew Edmondson. Participants may register or locate a host site on the Foundation’s website.

NEWS FROM ATTORNEYS GENERAL OFFICES

  1. Alabama Attorney General Troy King announced the conviction of a former bookkeeper at the Atmore Nursing Care Center for stealing $18,905 from the nursing home’s patient trust fund. The Office’s Medicaid Fraud Control Unit prosecuted the case.
  2. Drug-pricing websites are maintained by the following Attorneys General: Arizona Attorney General Terry Goddard; Florida Attorney General Charlie Frist; Indiana Attorney General Steve Carter; Maryland Attorney General J. Joseph Curran Jr.; and New York Attorney General Eliot Spitzer. These websites give consumers the ability to check the cost of popularly prescribed medications across their respective states.
  3. Connecticut Attorney General Richard Blumenthal announced that his office has reached an agreement with the owners of two residential homes for the elderly on charges that monies intended to pay for car for clients assigned to the homes were diverted to personal use. Under the agreement, the owners will pay the state $1.2 million and will sell the homes.
  4. Maryland Attorney General J. Joseph Curran Jr. announced that he would ask Maryland’s General Assembly to change the state’s suggested advance directive form to make it easier to understand and use.

COURT DECISIONS

The October 2005 EOL Update reported on the case in the United Kingdom of Charlotte Wyatt. In October the High Court had determined that the profoundly disabled child had improved sufficiently that the “do not ventilate” order should be lifted. However, lawyers for Portsmouth Hospital went back to court reporting that the child was suffering from an aggressive viral infection and the judge determined that the best interests of Charlotte would require that there be no intubation or ventilation should she stop breathing.

LEGISLATIVE DEVELOPMENTS

  1. Section 6012 of the Deficit Reduction Omnibus Reconciliation Act of 2005, S. 1932, signed this month by the President, extends the Long Term Care Partnership from Connecticut, California, Indiana, and New York, which pioneered the program, to all states. The act is also designed to curb Medicaid planning abuse.
  2. Various state legislatures have considered bills involving end-of-life and/or pain management issues. S.B. 102 is being considered by the Colorado legislature. It would allow physicians and nurses to help terminally ill patients manage heir pain without the threat of facing manslaughter charges. The Kansas House has passed H.2649, designed to address patient access, assessment, and treatment of pain. A bill has passed the New Hampshire House adopting changes to state law that would clarify the rules for living wills. A key committee in the West Virginia House of Delegates has voted not to send HB4022 to the full House for consideration. HB 4022 would allow doctors to refuse to perform cardiopulmonary resuscitation on patients they deem too ill for the procedure.
  3. According to a January 30 article in the Washington Post, more than twelve states are considering legislative measures that would allow doctors, pharmacists, nurses and others to refuse to take part in procedures to which they object on religious or moral grounds.

PAIN MANAGEMENT

  1. An article in February issue of the Mayo Clinic Proceedings reports the result of a survey of patients from Olmstead County, Minnesota to evaluate whether there were unmet pain care needs. The study concluded that more than one in five people with chronic pain did not seek physician care for their pain.
  2. A paper published in the January 25 issue of the Journal of the American Medical Association (JAMA), urges medical school faculty to set an example by distancing themselves from drug companies’ marketing efforts. Coincidentally, Yale University’s medical school had already decided to institute new conflict-of-interest guidelines that are in sync with the suggestions made in the JAMA article.
  3. The BBC News reported in its February 5 on-line edition that researchers at the Pain Clinical Research Hub, based at King’s College Hospital and the Institute of Psychiatry, London, are using imaging techniques to measure the brain activity of people in pain. They hope to obtain a more objective measurement of pain intensity to help them prescribe the appropriate amount of medications.
  4. Some physical therapists are using a relatively new pain management technique called Primal Reflex Release Technique. Developed several years ago by California physical therapist John Iams, it involves gentle tapping and tissue manipulation. An article in the Helena, Montana, Independent Record, reports on the positive results among patients of a physical therapist using the technique.
  5. A study by researchers at the University of Bath found that there was a difference in how men and women thought about pain. They also found that women have a lower pain threshold and tolerance. Dr. Ed Keogh, a psychologist from the university’s Pain Management Unit, has published a number of papers concerning gender differences in cooping with pain. He notes that genetic and hormonal differences play a role in pain perception but that social and psychological facts are also important.
  6. A resource for pain professionals in managing cancer pain is the Hypermedia Assistant for Cancer Pain Management (HACPM). Among other things, the website provides interactive tools for healthcare providers, multimedia instructional tools, and the complete text of Current and Emerging Issues in Cancer Pain: Research and Practice.
  7. The February 5 issue of the Boston Globe contained an editorial noting the tensions between law enforcement and the medical community regarding treatment of pain patients.
  8. According to a February 18th article in the South Florida Sun-Sentinel, Dr. Andrew Weiss of Boca Raton, Florida, recently entered a guilty plea to four counts of illegally distributing a controlled substance. Weiss admitted that he had prescribed pills to non-patients. Weiss’ medical license is under emergency suspension.
  9. The American Academy of Pain Management has accepted the resignation of Nelson Hendler, a Maryland physician, from the presidency of the Academy. Dr. Hendler is facing a suspension of his medical license for allegedly giving pain pills to female patients in exchange for sex.
  10. According to a February 4 article in the Arkansas Democrat Gazette, the Arkansas State Medical Board has suspended the medical license of Todd Simpson, M.D., for improperly giving a prescription for Ritalin to an undercover law enforcement agent. The revocation has been stayed contingent on his completing courses on proper prescribing and on maintaining proper doctor-patient boundaries.

OTHER DEVELOPMENTS

  1. The Center for Practical Bioethics has launched a project with the Centers for Disease Control (CDC) under which the Center will develop or identify a comprehensive end-of-life curriculum for the public health community. The Center will also develop an end-of-life resource manual for state health departments, a legislative tip sheet and a list of key end-of-life contacts in each state, and a template for an end-of-life web page along with a dissemination plan. In announcing the project, the CDC noted the Center’s extensive experience in creating training programs and materials focusing on end-of-life issues.
  2. The proceedings of the National Institutes of Health’s “State-of-the-Science on Improving End-of-Life Care” have been published in a special supplement of the Journal of Palliative Medicine. The conference, held in December 2004, brought together prominent professionals with expertise in a broad range of topics related to end-of-life care.
  3. National Public Radio conducted an interview on February 23 with John George, the subject of a PBS documentary, Almost Home. The documentary tells the story of how George is trying to improve the nursing home experience in the fifty-bed St. John’s on the Lake home in Milwaukee, Wisconsin.
  4. An article in the January 29 issue of the Hartford Courant spoke of the apparent gap between African Americans and white Americans in talking about end-of-life options, noting particularly the reluctance of many African Americans to choose hospice care.
  5. A training guide is now available to accompany the DVD, “Journey of Loss . . . Discovery of Hope.” The guide was written by a leading authority on hospice nursing practices, Dr. Sara A. Wilson. The DVD features survivors describing how they dealt with the death of a spouse, a child, a parent, a sibling, or a close friend. Wilson developed the guide to help healthcare professionals provide meaningful support for bereaved families.
  6. The Office of Drug Control Policy has issued its annual report. Chapter III contains a section on prescription drug abuse and calls for states to create prescription drug registries.
  7. The Mayday Fund, a New York City foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain has announced that it is accepting applications for the 2006 Mayday Pain and Society Fellowship. This program is designed to equip professionals with the necessary skills to become effective advocates and spokespeople about pain issues in the United States and Canada.
  8. The federal government’s Center for Substance Abuse Prevention offers several on-line courses earning social workers and other professionals continuing education credits. Among the offerings are “Substance Abuse and Older Adults,” “Alcohol, Medication, and Older Adults,” and “Uncovering Substance Use and Elder Abuse.”
  9. The current issue of the Journal of Law, Medicine, & Ethics (not yet available on-line) examines the bioethical and legal issues surrounding birth and death in its symposium, “Defining the Beginning and the End of Human Life: Implication for Ethics, Policy, and Law.”
  10. In an article in the current issue of the British Medical Journal, Dr. Simon Conroy, clinical lecturer in geriatrics, and his colleagues question the policy of automatically trying to resuscitate a heart attack victim in an elderly care home. They argue that a cost-benefit analysis might show that resources would be better spent elsewhere.
  11. Two nurses offer their top tips for palliative care nurses in Medical News Today. These are: 1) Set up routine processes and algorithms so nurses can more easily make decisions about treating immediate patient needs; 2) Create a culture of flexibility and responsiveness to patient needs; 3) Think beyond hospital walls to the broader continuum of care; and 4) Build in a support structure of nursing staff to prevent burnout.
  12. The National Hospice Foundation has announced that its Art of Caring National Hospice Gala will be held on Friday, April 7, 2006, at the Hilton Washington in Washington, D.C. The benefit’s honorary chairs are all of the living First Ladies of the United States. Along with an annual awards presentation, the evening will include dinner, dancing, and a silent auction.
  13. The February 16 issue of the New England Journal of Medicine contains an article reporting the results of a study conducted by Dr. Nicholas Christakis, a professor at Harvard Medical School. The study found that, when an older person falls seriously ill, the spouse faces a heightened risk of death. In the first thirty days after a wife’s hospitalization, a husband’s risk of dying rises thirty-five percent. During the first month after a husband’s hospitalization, a wife’s risk of dying goes to forty-four percent.
  14. An article in the February 19 issue of Louisville, Kentucky, Courier-Journal emphasizes that honesty is imperative when a family must tell a child and his siblings that he is dying of cancer.
  15. Dr. Jerry Griffin, a hospice director who served as a military doctor in Desert Storm and Operation Iraqi Freedom, and Pam Umann, a social worker specializing in cancer and AID patients, have joined together to write a book titled The Last Day of Winter: Secrets from the Seasons of Dying. The book is a combination of stories collected from California residents the two have treated at Saint Louise Regional Hospital and memorial Hospital in Salinas.
  16. The National Senior Citizens Law Center has published a booklet, “20 Common Nursing Homes Problems — and How to Resolve Them.” The booklet suggests that “residents and their families develop a healthy sense of entitlement to high-quality nursing home care.”
  17. A January 29 article in the Washington Post quoted Senator Majority leader Bill Frist on NBC’s “Meet the Press” as saying he learned from the Terry Schiavo case that Americans generally do not want the government involved in end-of-life decisions.
  18. Resources for various faith groups in writing advance directives and dealing with other end-of-life issues are available on beliefnet.com.

red logo

SAVE THE DATE

2014 Fall Consumer Protection Seminar

October 20 - 22, 2014
Providence, RI
Contact: Rupalee Rashatwar

Intellectual Property Theft Training Seminar: Springfield, MO

October 20, 2014
Mid States Organized Crime Information Center (MOCIC)
Contact: Judy McKee

E-Discovery for OAG-GA

October 21, 2014
Atlanta, GA
Contact: Hedda Litwin

Motions Practice for OAG-OH

October 30 - 31, 2014
Columbus, OH
Contact: Bill Malloy

Intellectual Property Theft Training Seminar: Honolulu, HI

October 31, 2014

Contact: Judy McKee

Management for OAG-OK

November 4 - 5, 2014
Oklahoma City, OK
Contact: Bill Malloy