September 2006

Legislative Developments

  1. The Senate unanimously passed the Older Americans Act prior to adjourning for the November elections. According to a press release, the act will help ensure that the nation’s older Americans, including 78.2 million aging Baby Boomers, are healthy, fed, housed, able to get where they need to go, and safe from abuse and scams.

  2. Congress is considering HR 4993, the Elder Justice Act of 2006. The act would create the first nationwide database on elder abuse. It would also assign a federal official to coordinate projects and technical assistance. One county, Orange County, California, has established an elder abuse forensic center, a model for other locations. At the Orange County center, public health and law enforcement techniques are used to diagnose elder abuse and neglect. The New York Times reported that there are programs being developed around the country to focus on ensuring appropriate care for the elderly. For instance, bank tellers at Wachovia banks are being trained to detect irregular transactions in the accounts of elderly customers.

  3. Governor Arnold Schwarzenegger signed legislation in September that makes California one of the first states in the country where children will be able to receive hospice and palliative care through public funding without foregoing other treatment.

  4. Efforts by the Nebraskans for Humane Care to place an initiative on this November’s ballot have evidently been unsuccessful. Secretary of State John Gale announced that the group had not obtained sufficient valid signatures. The “Humane Care Initiative” would have changed state law to presume that patients wanted food and water in cases where there is no advanced directive.

Judicial Developments

  1. In the continuing New York saga concerning care of 104-year old philanthropist Brooke Astor, the court has appointed the J.P. Morgan chase bank and designer Oscar de la Renta’s wife, Annette de la Renta, to become Astor’s guardian. Guardianship by Astor’s son, Anthony D. Marshall, was terminated after Marshall’s son, Philip, filed a petition alleging that his father was negligent in the treatment of Mrs. Astor. The judge rejected a request by the bank to have its powers expanded to include an investigation as to whether there has been mishandling of $18 million of her assets. The court will hold a competency hearing on October 13.

  2. A civil rights lawsuit has been filed against doctors at the Medical University of South Carolina who allegedly removed a two-month-old child from life support. In Hernandez v. Abel et al, No. 2:06-cv-02582-DCN (D.S.C. filed Sept. 18, 2006), Ramon Hernandez, charged with homicide of his daughter, Judith Hernandez, claims that he was deprived of his constitutional rights after the child was removed from life support on September 5. In late August, a hearing was held in Family Court to determine whether the South Carolina Department of social Services should be appointed guardian for the child. At that time, a doctor testified that the child had shown no signs of life since she had been brought into the hospital more than thirty days earlier. Prior to the court issuing a ruling, the child died. Both Hernandez and the child’s mother, Yuribel Najara, have been indicted on charges that their actions led to their daughter’s death.

  3. The issue of guardianship of mentally infirm adults has been raised in a recent case filed in a Pennsylvania state court. Mary Connors is fighting to have the durable power of attorney given by her mother to her be recognized. Guardianship of Mary’s mother was given to the Family Service Association by a county court judge. That decision is on appeal to Superior Court. The National Alliance for the Mentally Ill’s Wilkes-Barre chapter’s president, in commenting on the Connors case and another involving a sister who has a durable power of attorney from her brothers whose guardianship has also been given to an agency, commented that it seemed the courts are ignoring a guardianship law that puts families “first in line.”

Pain Management

  1. The University of Wisconsin Pail & Policy Studies Group (PPSG) has released its new report, “Achieving Balance in State Pain Policy: A Progress Report Card (Second Edition).” The report, funded by the American Cancer Society, the Lance Armstrong Foundation, and the Susan G. Komen Breast Cancer Foundation, found that states are making steady progress in adopting effective policies that help alleviating pain in their citizens. Two states, Virginia and Michigan, achieved an “A” grade. The complete report, along with an accompanying “Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (Third Edition),” are available on the PPSG’s website.

  2. The June 2006 issue of Pain Medicine reported the result of a study of patients receiving opioid medications for chronic pain; the study found that a number of warning signs may appear in the medication pre-screening process that will help clinicians determine which patient may be susceptible to medication abuse and the effectiveness of long-term treatment. Using the Pain Medication Questionnaire (PMQ), researchers determined that patients scoring high on the test would demonstrate higher levels of physical impairment and psychosocial distress.

  3. A local television news station reported that Dr. Emad Mikhall of Great Lakes Pain Management in Ohio is using a synthetic version of snail venom to help treat patients with chronic pain. The medication, known as Prialt, was recently approved by the Food and Drug Administration. Another relatively new procedure for treating pain was highlighted in the Sun News. This treatment using a type of laser, CuraeLase, which, according to the FDA, is used to ‘provide topical heating for the purpose of elevating tissue temperatures for the temporary relief of pain.

  4. A recent issue of the journal Pain Management Nursing reported the results of a study conducted with 44 patients undergoing treatment for chronic pain. Patients in one group listened to a seven-minute audio tape that helped them to relax, focus on sensory images their pain evoked, and then guided them to change the sensory images. The patients in the group that was exposed to this “guided imagery” described their pain as more tolerable or easier to control.

  5. September was Pain Awareness Month. Numerous articles appeared in newspapers across the company regarding chronic pain, approaches to treating it, and new developments in the field. A lengthy article about pain management for chronic pain sufferers appeared in California’s North County Times in September. Pain physicians discussed the multi-modal approach that must be taken in order to treat chronic pain patients. Dr. Joseph Shurman, interviewed for the article, admitted that he practices defensive medicine in his treatment of medicine — defensive against drug authorities who, he says, has placed a chilling effect on pain care because they have investigated seventeen percent of pain physicians. He also noted that use of opiates should be the last resort after everything else has been tried. Dr. Erik Westerlund opined that a danger for patients in pain is undergoing unnecessary back surgery. He noted that such surgery should not be considered until the patient has been in pain at least six months and other, less invasive, treatments are tried. The Dallas Morning News carried an article in its September 11 issue detailing alternative methods of pain relief proved effective in a number of patients. These include relaxation techniques, meditation, guided imagery, and biofeedback. The Southwestern Medical Center in Texas published an article quoting Dr. Leland Lou who commented that techniques beyond medication which help patients deal with chronic pain include acupuncture, anesthetics, and electrical stimulation.

  6. The August 2006 on-line issue of Officer contained an article concerning tackling online prescription drug diversion. It advocates that police officers be aware and informed about the epidemic of prescription drug abuse when undertaking normal policing activities.

  7. The Journal Brain published an article detailing research conducted in Australia among patients suffering from dementia. It showed that Alzheimer’s sufferers feel pain like everyone else but are given fewer pain killing drugs because they are not likely to report pain.

Other Developments of Interest

  1. The National Association of Area Agencies on the Agency has published on its website a report titled “The Maturing of America — Getting Communities on Track for an Aging Population.” The report demonstrates that less than half of the nation’s communities have begun to prepare to deal with the needs of the elderly.

  2. The September 20 issue of the Journal of American Medical Association contains two articles that are of interest. One involves the terminal withdrawal of life-sustaining supplemental oxygen and the other examines spiritual issues in the care of dying patients.

  3. In the September 8 issue of Science, doctors reported that a patient, thought to be in a persistent vegetative state, showed evidence of awareness of herself and her environment. While using function MRI to examine the patient, investigators asked the patient to do tasks such as imagining herself playing tennis and walking through the rooms of her house. The patient’s brain areas governing visuospatial and motor function showed similar patterns to those seen in normal volunteers.

  4. The September issue of Pediatrics contains an article titled “Matters of Spirituality at the End of Life in the Pediatric Intensive Care Unit.” Examining the answers to a survey of families whose children had died in pediatric ICUs, the researchers noticed that four explicitly religious themes emerged. These were prayer, faith, access to and care from clergy, and belief in the transcendent quality of the parent-child relationship that endures beyond death. The research also noted that parents may be reluctant to share their faith perspective with health care providers for fear that their spirituality may be misunderstood or judged.

  5. In a recent issue of Clinical Journal of the American Society of Nephrology, researchers reported that 60 percent of nephrologists feel unprepared to withhold or withdraw dialysis in patients with kidney disease nearing the end of life.

  6. At its 21st annual Management and Leadership Conference in New York City, the National Hospice and Palliative Care Organization presented awards, on behalf of the national Council of Hospice and Palliative Professionals and the Foundation for Hospices in Sub-Saharan Africa, to colleagues who have led the way in end-of-life care delivery. They included a first-time International Person of the Year award to Bishop Kevin Dowling, founder of Tapologo Hospice and human rights advocate.

  7. USA Today reported a concern raised in a symposium this summer sponsored by the Army’s Wounded Warrior Program as to whether emergency physicians acting as initial responders should have access to living wills or DNR orders. Wounded soldiers and families of casualties noted that at least 250 soldiers have returned from Afghanistan and Iraq with severe head wounds that left them, at least initially, comatose or unable to respond to people.

  8. The International Council on Active Aging (ICAA) has announced its collaboration with Philips Medical systems to work with member facilities in deploying HeartStart Defibrillators.

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