September 2007

News from Attorneys General Offices

  1. Florida Attorney General Bill McCollum announced the sentencing of a Florida man to five years? imprisonment for operating an illegal Internet pharmacy. The unlicensed operation dispensed hydrocodone without a prescription. He also announced the arrest of a former staffer at the Glades Health Care Center on charges that she abused an elderly resident at the nursing home.
  2. Indiana Attorney General Steve Carter announced the temporary suspension of the license of Dr. Mohamed Mekawy. He is alleged to have prescribed controlled substances via an Internet pharmacy without first examining patients. He does not hold an Indiana Controlled Substance Registration nor does he have a valid DEA number. Mekawy resides in Canada.
  3. Massachusetts Attorney General Martha Coakley announced the indictment of a Marlborough woman on charges that she obtained numerous fraudulent prescriptions for stimulants and painkillers in the names of her ex-husband and young children. She has been charged with identity fraud, insurance fraud, false health care claims, larceny, and fraudulently obtaining a controlled substance. She also announced that her office had reached a settlement with a nursing home and its owner that prohibits them from owing or operating a long term care facility in Massachusetts for ten years. A lawsuit had alleged that residents of the home were subject to physical and sexual abuse by other residents.
  4. Maine Attorney General Steve Rowe has partnered with the Maine Hospice Council and Center for End-of-Life Care to host a series of Town Hall Meetings to engage citizens in a dialogue concerning end-of-life care in Maine.
  5. Missouri Attorney General Jay Nixon was a sponsor of the third annual Missouri End-of-Life conference, held on September 14, which brought policymakers, healthcare experts, and consumer advocates together to discuss ways to improve quality of life for Missourians.
  6. New Jersey Attorney General Anne Milgram has convened a task force to study the possible effect that gifts from drug firms and medical device makers have on doctors? practices. The Task Force will consider whether the state should require firms to report gifts they give to physicians. Four states ? Maine, Minnesota, Vermont, and West Virginia ? as well as the District of Columbia already have such legislation.
  7. Nevada Attorney General Catherine Cortez Masto announced the arrest of a woman wanted in Texas for allegedly stealing money from financial accounts of residents in group homes.
  8. Pennsylvania Attorney General Tom Corbett announced the arrest of a New Cumberland doctor on charges that he allegedly prescribed and filled prescription pain medication for his own use.
  9. Rhode Island Attorney General Patrick C. Lynch, president-elect of NAAG, attended a meeting with top officials of the federal Drug Enforcement Agency and other stakeholders regarding prescription drug diversion.
  10. Vermont Attorney General William H. Sorrell announced the arraignment of a licensed practical nurse for allegedly diverting narcotics prescribed for resident of a nursing home to her own use.
  11. Wisconsin Attorney General J.B.Van Hollen announced the conviction of a registered nurse for diverting prescription Demerol from a nursing home resident for his own use. He will be sentenced as a ?habitual criminal? because of five prior convictions in the last three years for similar offenses.

Legislative Developments

No further action has been scheduled on S.980 since the Senate hearings in May on Rogue Online Pharmacies. One of the interesting aspects of the proposed legislation is that it would give state attorneys general authority to apply for injunctions or obtain damages and other civil remedies against an online pharmacy that poses a threat to state residents.

Pain Management

  1. The Federation of State Medical Boards (FSMB) has published Responsible Opioid Prescribing: A Handbook for Physicians, written by Scott Fishman. The FSMB plans to distribute the book to all practicing physicians in the United States. New Mexico physicians will be the first to receive the book. Other states will receive it as soon as their medical boards approve the idea and funding becomes available.
  2. Florida Governor Charlie Crist and his Cabinet granted a full pardon to chronic pain sufferer Richard Paey who had been convicted of trafficking and sentenced to twenty-five years? imprisonment.
  3. A guidance paper, ?Commonsense Opioid-Risk Management in Chronic Noncancer Pain,? has been posted on the website, Pain Topics, for download. It applies the Federation of State Medical Boards Model Policy for the Use of Controlled Substances for the Treatment of Pain to provide a practical clinical framework helping to minimize risks when prescribing opioids.
  4. The challenges of appropriate pain management, for both patients and physicians, were the focus of an article in Delaware?s News Journal.
  5. The Archives of Internal Medicine had an interesting article reporting the results of a study by researchers at Ruhr-University Bochum in Germany. They found that nearly twice as many patients responded to acupuncture therapy for low-back pain as compared to conventional therapy. They also found that sham acupuncture worked just as well as true acupuncture.
  6. The New York Times published an article noting the lack of the availability and use of opioid medications in third world countries. As an example, the article noted that, in 2004, consumption of morphine per person in the United States was about 17,000 times that in Sierra Leone. Citizens in six countries ― the United States, Canada , France, Germany, Britain and Australia ― consume 79% of the world?s morphine, according to a 2004 estimate. The primary reason for the disparity is that doctors in developing countries have out-dated beliefs that narcotics are inevitably addictive and carry high risks of killing patients. A companion article wrote of the changing attitudes in Japan regarding opioid relief for pain.
  7. Harvey Silverglate wrote an article for The Phoenix, surrounding the saga of Dr. Joseph Zolot, whose license has been revoked by the Massachusetts Board of Medicine. In it, he decries the ?DEA?s bad-faith war on pain doctors.?
  8. A national conference on pain for frontline practitioners, PAINWeek 2007, was held in Las Vegas this month. Panelists emphasized that physicians need more practical knowledge when it comes time to prescribing opioids and that it is essential to pay more attention to elderly patients who oftentimes give up on treating their pain. During the meeting, 200 health care professional were surveyed. Close to half of those said the threat of regulation had ?significant? or ?high? impact on their practices. According to 43% of those surveyed, lack of adequate pain management education during their professional training had a high-impact on their abilities to provide pain care for their patients.

Prescription Drug Diversion

  1. One hundred forty New Jersey law enforcement personnel completed a three-day Pharmaceutical Diversion Investigative Training course held recently in New Jersey. It was hosted by DEA?s New Jersey Division.
  2. The DEA is inspecting health clinics on Montana?s Indian reservations, responding to tribal officials? concerns that there is a rampant problem with prescription drug abuse.
  3. An article in the Boston Globe reviewed the tension between appropriate pain management and the problem of prescription drug abuse and diversion in an article reviewing the suspension of a Needham, Massachusetts, physician?s license.
  4. An article in the Denver Post discusses Colorado?s Prescription Drug Monitoring Program that will allow physicians to look up drugs their patients have been prescribed from other physicians. It will be available in December or January and will contain six months worth of compiled data.
  5. Fifteen individuals were arrested in Puerto Rico recently and charged with violations of the federal Controlled Substance Act. According to the indictment, multiple prescriptions for controlled substances were written under different names. The prescriptions were sold at three pharmacies and all transactions were conducted in cash. Dr. Jose Victor Vazquez-Senti allegedly wrote 29,904 or more prescriptions for Oxycodone and approximately 26,904 prescriptions for Alprazolam in less than a three-year period.
  6. A Kentucky physician recently pled guilty to conspiracy for his part in an Internet pharmacy business. Dr. Subramanya K. Prasad admitted that, in a four-month period, he approved more than 30,790 orders for controlled substances, sometimes writing 1,000 prescriptions in one day. He admitted he had no physician-patient relationship with the clients of Affpower, an Internet pharmacy organization. Prasad will forfeit the $94,994 he earned. The owner of a Florida pharmacy also pled guilty to conspiracy and money laundering in connection with the Internet scheme. He will forfeit $831,560. Sixteen other defendants have been charged, including two other physicians.
  7. A New York doctor, Harry Black, and his wife have been charged in federal district court with controlled substances violations. Dr. Black is alleged to have written prescriptions for controlled substances for patients with the understanding that a portion of the drugs would be given to him for his and his wife?s use.

Other News of Interest

  1. The Michigan Department of Community Health has launched a new website addressing the issues of pain and symptom management. The site has sections for both consumers and health care professionals.
  2. A new network, the Social Work Hospice & Palliative Care Network, has been formed. It will join together social work professionals, consumers, and stakeholder organizations in the field of hospice, palliative, and end-of-life care.
  3. October 6 is World Hospice and Palliative Care Day. 500 concerts will be held around the world to raise funds to support and develop hospice and palliative care services world-wide.
  4. Dr. Sandeep Jauhar wrote an article, published in the New York Times, regarding the dilemma a doctor faces when treating a dying patient.
  5. The September 20 issue of the Journal of the American Medical Association (JAMA) included a brief article discussing the adoption of palliative care by hospitals. The September 26 issue published an article titled ?When It Is No Longer Safe to Live Alone,? outlining the problem of self-neglect by the elderly.
  6. A study in the September/October issue of Health Affairs found that 60% of black Americans end up in just 10% of nursing home facilities, typically ones that have been cited for quality problems. The study also found that nursing homes in the Midwest were the most likely to be racially segregated; nursing homes in the South were the lease likely to have an unequal distribution of minorities.
  7. Nebraska has initiated a pilot program called the ?Ticket to Work Palliative Care Program,? that gives individuals with disabilities access to experts who help keep pain and other symptoms from getting in the way of daily activities, such as holding a job.
  8. Vermont Governor Jim Douglas signed a proclamation underscoring the importance of advance directives. Vermont?s on-line registry of advance directives, run by the Vermont Health Department, has been available since February. To date, about 700 people have registered their directories on-line.
  9. A new study, published in the September 2007 issue of the Journal of Pain and Symptom Management, examines which diseases are bringing people into hospice care. It also identifies hospice utilization by geographic region. Hospice use was highest for people with cancer, followed by kidney disease/nephritis, Alzheimer?s disease, and chronic obstructive pulmonary disease.
  10. The eighth international conference on Death, Dying & Disposal, organized by the Centre for Death & Society and ICIA at the University of Bath was held this month. More than 200 academics and practitioners from around the world gathered to discuss the latest research on issues relating to the social aspects of death and dying. Dr. Elizabeth Kasket presented a talk on the benefit of supporting doctors to help them cope with the trauma associated with a patient?s dying. Another presentation at the conference dealt with the disconnect between the medical diagnosis of brain death and the traditional view that death occurs when the heart stops beating.
  11. ?The Last Goodbye: Comforting Your Dying Patient? urges doctors not to distance themselves from patients who are facing death.
  12. The Vatican issued a statement in September reiterating that it is a moral obligation to provide food and water to patients in a vegetative state except in certain exceptional situations. Ethicists in Great Britain are concerned that the document will place health workers in a serious dilemma because the Mental Capacity Act, which takes effect on October 1, requires that the instructions in living wills be given effect and also instructs doctors to follow the directions of a friend or relative who has been given a health power of attorney.
  13. Stateline.org, an online publication that highlights state government matters, published an article discussing Wisconsin?s lead in establishing Aging and Disability Resource Centers. These are ?storefronts? that provide information and advice on home care services for the elderly and disabled. Forty-two states, assisted by funding from the federal government, now have set up or are beginning to set up such information centers to assist clients to obtain care in their own homes rather than in nursing homes.
  14. The Dodge Correctional Institution in Waupun, Wisconsin, has opened a hospice to care for dying inmates. Other inmates volunteer to care for the terminally ill inmates. In a newspaper article, those volunteer inmates shared their stories about how working with the terminally ill has affected their attitudes.
  15. The New York Times analyzed trends in nursing homes purchased by private investment groups and reported its finding in a September 23 article. The survey found that the typical number of serious health deficiencies cited by regulators last year was nearly 19 percent higher at homes owned by large investment companies than the national average.
  16. Christianity Today published a review of Stephen Kiernan?s book, Last Rights: Rescuing the End of Life from the Medical System.
  17. An article reviewing the literature regarding measures used in looking at end-of-life care has been published in the October issue of Health Services Research.

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