June 2006

News from Attorneys General Offices

  1. Maine Attorney General Steven Rowe applauded a recent U.S. Supreme Court decision that rejected a challenge to Maine’s Unfair Prescription Drug Practices Act law. The law requires more disclosure of prescription drug deals. In denying the write of certiorari in Pharmaceutical Care Management Association v. Rowe, 429 F.3d 294 (1st Cir. 2005), the court let stand the First Circuit’s holding that Maine’s law was not preempted by federal law.

Judicial Developments

  1. The Maine Supreme Judicial Court issued its ruling in In re Matthew W., 2006 ME 67 (June 12, 2006). The court held that the parents’ right to due process was violated when a lower court authorized the state Department of Health and Human Services (HHS) to issue a “do not resuscitate” order for Matthew. Since the issuance of a DNR over the parents’ objections in effect terminates parental rights, the standard for a parental rights termination hearing must apply. Therefore, the court must provide reasonable notice for a hearing, hold a hearing, and determine, by clear and convincing evidence, whether it is in the best interest of the child in question to give the HHS the authority to issue a DNR.

Legislative Developments

  1. New Hampshire Governor John Lynch signed the bill that updates New Hampshire laws regarding advance directives for health care.

  2. The Western Australian parliament is considering the Advanced Health Care Planning Bill that will allow people over 18 to make Advance Health Directives. The proposed law will also give appointed guardians the power to make health decisions for their wards.

  3. According to a report in Medical News Today, drug laws that previously restricted the availability of pain medicines are to be relaxed in Romania. A three-year effort by Romanian pain and palliative care experts to identify regulatory barriers to pain relief was assisted by the University of Wisconsin Comprehensive Cancer Center’s Pain & Policy Studies Group, headed by David Joranson.

Pain Management

  1. On June 13, 2006, a Congressional Briefing on Pain was held on Capitol Hill, attended by over 100 congressional staffers and pain advocates. Testifying in support of H.R. 1020 were Howard A. Heit, M.D., who opined that the balance between preventing abuse and diversion and ensuring the availability of pain medication for sufferers had been lost; Rollin M. Gallagher, M.D., who spoke movingly about the impact of blast injuries on veterans and their need for adequate pain care in order to resume their lives; and Mary Vargas, J.D., a disability rights attorney, who suffers from chronic pain and who detailed her own struggle to receive the care she needs.

  2. The June 13th issue of The Arizona Republic carried an article reporting on the “Politics of Pain” conference held in Phoenix. The article pointed out that a patient’s race and sex often affect pain care.

  3. An article published on the June 8th issue of the Sidney Morning Herald noted that a group of pain management experts in Melbourne, Australia, has started a research project to determine if pain management might be achievable by modifying genes, particularly those involved in pain response.

  4. The Canadian Chronicle Herald carried an article in its June 8th issue that noted the waiting list for the pain management unit at the Queen Elizabeth II Health Sciences Centre is over five years. One doctor at the clinic calls it the “forever list.” Both parties have recognized that the wait lists for pain clinics in Canada are seriously affecting quality of life for chronic pain sufferers and have pledged money to tackle the problem.

  5. A study published in the June issue of Mayo Clinic Proceedings showed that people experiencing withdrawal from high-dose opioids or cocaine use increase their risk of a cardiac event, dubbed the “broken heart syndrome.” The article describes the treatment in the Mayo Clinic in Rochester, Minnesota, of a 61-year old woman who had abruptly discontinued use of OxyContin.

Other Developments

  1. More people who are reaching the end of their lives are taking advantage of “life tapes” by which they can leave a record for their family and loved ones of what mattered to them in life. This is an aspect of end-of-life care that some experts deem as important as other aspects of end-of-life care. An article about these tapes was included in the June 8 issue of The Oregonian.

  2. The death of Peggy Anne Nilon in Bunbury, Australia, has highlighted the need in Western Australia for legislation clarifying patients’ rights. Mrs. Nilon had been treated for lung cancer; the cancer was in remission. However, when visiting with family, she suffered severe side pain. The hospital to which she was admitted treated her as a terminal cancer patient instead of treating her pneumonia with antibiotics. A do-not-resuscitate order was signed without the family’s consent. The June 7th issue of the Bunbury Mail reported that her death in 2003 also led to the appointment at the hospital of a director of palliative care.

  3. The Susan G. Komen Breast Cancer Foundation, the Lance Armstrong Foundation, and the American Cancer Society recently announced the joint funding of a nationwide project to evaluate pain management policies in the states. They are funding a three-year grant to the Pain & Policy Studies Group (PPSG) at the University of Wisconsin Cancer Center to examine policies that govern pain management practices for cancer patients in the 50 states and the District of Columbia. During the course of the study, PPSG will issue three report cards. The first one is due in September.

  4. The June issue of the Journal of Palliative Medicine has numerous articles of interest to those in the end of life field. In a later issue, the results of a study at the Oregon Health and Science University (OHSU) will be published. The study showed that only 5 percent of discharged patients who had consulted with the OHSU Hospital’s palliative care team had to be readmitted to an acute care hospital to die. Instead, the team was able to develop treatment plans that allowed patients to spend their last days in the setting of their choosing.

  5. The May issue (volume 83, issue 10) of Medical Economics has, as its cover story, an article titled “Doctor: The New Target in the War on Drugs?” In addition to the historical review of prosecutions involving physicians for diversion, the article contains tips for physicians on how to lower their risk factors for investigation and prosecution.

  6. Aetna and the Aetna Foundation recently awarded over $800,00 in grants to various groups to study end of life care. The grants include $145,000 to expand the Initiative for Pediatric Palliate Care and $239,000 to the Texas Partnership for End-of-Life Care.

  7. An essay in the June 21st issue of the Journal of the American Medical Association comments on the seemingly abrupt division between treatment-oriented care and end-of-life care. Writing after experiencing the death of a close friend from metastatic breast cancer, the author queried why there is not a more seamless transition so that treating doctors and nurses might help patients through the dying process when living is no longer an option.

  8. In a study of Irish pediatricians, three out of the four responding doctors admitted to withdrawing or withholding life-saving treatment from “hopeless” newborn babies. The results of the survey will be published in a forthcoming issue of the Irish Medical Journal.

  9. The July issue of the European Journal of Pain includes an article detailing the results of a British study of 260 chronic pain patients. The results of the study suggest that doctors could help reduce disability in female patients with arthritis and back pain by targeting depression.

  10. Michigan State University offers a web site and a CD-Rom that teaches patients and families about the practical, emotional, spiritual, and medical issues faced by those dealing with advanced illness. The resource, called “Completing a Life,” contains three main areas: taking charge, finding comfort, and reaching closure.

  11. The Charleston, West Virginia, Daily Mail, in its June 22d issue, included an article detailing the results of a survey conducted by the West Virginia Center for End-of-Life Care. The survey whose that 39 percent of West Virginian have completed a living will, medical power of attorney, or a combined document. This is about double the rate of most states’ residents.

  12. The Missouri Bar has posted on its website a durable power of attorney for health care form and a health care directive form in both English and Spanish.

  13. The Department of Health and Aging in Australia has issued a new document, “Guidelines for a Palliative Approach in Residential Aged Care.” The guidelines cover all major aspects of providing a palliative approach for residents in nursing homes.

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