NAAG Issues and Research
NEWS FROM ATTORNEYS GENERAL OFFICES
California Attorney General Bill Lockyer?s office announced the arrest of a couple who are accused of defrauding elderly and sick homeowners of $5 million. The couple would look for homes for which back taxes were owed. They then conducted surveillance to see if they were occupied. If unoccupied, they paid the delinquent taxes and then filed fraudulent quitclaim deeds that purpoted to transfer the property to them.
Missouri Attorney General Jay Nixon has ordered that a nursing home pay a $5,000 fine after it was found guilty of neglect that led to the death of a patient in 2002.
North Carolina Attorney General Roy Cooper?s lawsuit against two companies that sold estate planning documents to North Carolina citizens has resulted in the issuance of an injunction against the companies. The companies encourage seniors to use their investments to purchase unneeded annuities that garner large commissions for the sellers and fail to explain the downside of these investments. Pennsylvania and California have filed lawsuits against the same companies for using similar tactics against senior citizens in their states.
Vermont Attorney General William Sorrell, appearing at the release of a training film produced by his office, noted the growing problem in Vermont regarding drug diversion by health care providers. Financed by a federal grant, the film depicts the stories of four Vermont caregivers convicted of drug diversion. The film will be used by law enforcement and by the health care community to assist in early detection and prevention. Attorneys General offices interested in obtaining a copy of the film may contact Rey Garofano at (802) 241-4440.
The Kenner County, Louisiana, council has imposed s six-month moratorium on permits for new pain management clinics and has requested a study from the city to determine what zoning or licensing regulations could be applied to these clinics. According to one councilman, the clinics were a ?scourge on families and a drain on law enforcement, abetting addiction by churning out prescriptions without rigorous diagnosis of a patient?s ailments.?
A letter to the editor of The American Journal of Psychiatry argues that sustained high dosage opioid pain medication is not continuously effective for chronic pain. The authors noted an article in the New England Journal of Medicine concluded that opioids given chronically, at least in high doses, are neither safe nor effective.
The Eighth Annual Josefina Mao Conference, ?The Many Faces of Pain in Palliative Care? was held in Falls Church, Virginia, the end of October. One critical issue identified at the conference was the need to educate medical professionals to properly assess a patient?s pain through asking the right questions of a patient. The conference concluded with action plans to bring better management of pain and symptoms directly to the bedside of Americans in pain from chronic, life-limiting illness.
The American Academy of Family Physicians Annual Scientific Assembly?s meeting included a two-hour seminar on pain and patients. Susan Center of Integrative Health Care in Mission, Kansas, noted that treatment for effective pain management must be carefully individualized and involve both pharmacologic and nonpharmacologic approaches. She emphasized that less than one percent of patients who need an opioid for pain become addicted. She also stressed the importance of appropriate nutrition, recommending essential fatty acids and the use of olive oil in cooking.
Mississippi State University?s Social Science Research Center recently released a study titled "Social and Cultural Dimensions of Pain: An Overview of the Southern Pain Prevalence Study 2004." This study looked at 3,600 adults in Mississippi, Alabama, Arkansas, Kentucky, Louisiana, and Tennessee. Conduced in partnership with the Mid-South Division of the American Cancer Society, the research found that pain was pervasive among the Southern adults surveyed. The study demonstrated that there are a number of widely held beliefs and attitudes that seem to create barriers in reducing or eliminating pain. Sixty-two percent of the individuals surveyed responded that pain is a normal part of life and, presumably, must thus be endured.
The West Virginia Center for End-of-Life Care conducted its second West Virginia Pain Summit early this month. The summits were begun after it was discovered in 2005 that seventy percent of West Virginians suffer moderate to severe pain each month and many do not know where to go to find relief.
The American Society of Pain Educators has announced a partnership with the Western Pain Society for PAINWeek 2007, to be held on September 6-9 at the Red Rock Casino in Las Vegas, Nevada. This meeting will be the first one open to healthcare professionals from all disciplines needing pain education.
A report published in the British Medical Journal found that, while arthritis self-management did not reduce patients? pains, it did improve confidence in managing their symptoms.
The New Orleans paper reported on the medical and law enforcement concern with the increase in online drug sales. Some estimate that there are more than 1,000 Internet pharmacies; however, they are difficult to track because they vanish as quickly as they appear. Most states have adopted laws or regulations that invalidate prescriptions resulting from electronic questionnaires without physical examinations by doctor.
A paper presented at the Annual Meeting of the American Society of Anesthesiologists demonstrated that patients who received optimum pain management before, during, and after surgery for lower extremity amputation are unlikely to experience prolonged phantom limb pain. Lead author Menelaos Karanikolas, M.D., also reported that epidural analgesia seemed somewhat better than intravenous analgesia.
A survey commissioned by the publication About-Pain-Management.com found that most people do not stop taking pain medication even when studies reveal potential negative side effects of the medication.
A survey of caregivers of the elderly with chronic pain, commissioned by Great Britain?s Patients Association, found that nearly one-third said that their patient?s chronic pain was managed poorly or very poorly and 39% said that their patient?s doctor never or only occasionally reviewed pain level.
An article to be published in an upcoming issue of Nature Medicine reports the results of research that indicates genes may affect how pain is felt. Studies in human volunteers showed that about a quarter of them had the genetic variant that protects them somewhat from pain while 3% carried two mutated copies that made them exceptionally insensitive to pain.
The fall issue of The Pain Community News, the newsletter of the American Pain Foundation, focused on the disease of shingles and the often-debilitating pain that can result.
An article in Newsweek?s series ?Fixing America?s Hospitals? reported on the focus on pain management at Virginia Mason Medical Center in Seattle, Washington. The article also noted that other institutions, such as the Cleveland Clinic and the Veterans Health Administration, have won accolades for their pain management practices.
OTHER DEVELOPMENTS OF INTEREST
Aging With Dignity?s popular advance care directive, Five Wishes, has been translated into Chinese, Arabic, Haitian Creole, Portuguese, Somali, Hmong, Korean, French, Polish, Russian, Vietnamese, Albanian, Bengali, Hindi, Urdu, Spanish, Japanese, Gujarati, and Croatian. Supported by funding from the United Health Foundation?s Evercare Hospice Foundation, 100,000 language-specific versions will be provided free of charge to individuals and community organizations. Five Wishes meets the legal requirements for an advance directive in 38 states.
Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania has concluded that Hawaii?s law governing removal of feeding tubs from an incapacitated or brain-dead patient is unconstitutional. When there is no documentation reflecting a patient?s wishes, Hawaii law requires the attending physician to gather all interested persons, defined as a spouse, adult children or grandchildren, siblings, and close friends to select a surrogate by consensus. Any person in the group who disagrees with the selection or the surrogate?s decision may then go to court to initiate a guardianship proceeding. The surrogate can make all decisions except whether artificial nutritional and hydration can be withheld or withdrawn. According to Caplan, this conflicts with the U.S. Supreme Court decision in Cruzan v. Director, 497 U.S. 201 (1990).
The Boise State Center for the Study of Aging released the result of an end-of-life survey that found that 63 percent of respondents considered ?living with great pain? to be ?worse than death.? However, only one-third of those had taken the steps necessary to create a living will and even fewer had prepared a power of attorney for health care.
The Washington Post carried an article that examined the phenomena of patients? leaving hospice, prompted by the remarkable saga of humorist Art Buchwald. Buchwald was in residence in a Washington, D.C., area hospice for five months after decided to stop undergoing dialysis. He checked out this summer to continue a long-standing tradition of vacationing at Martha?s Vineyard and has not returned. About 13 percent of the approximately 900,000 Americans who enter hospice each year are discharged.
Another article in the Washington Post gave tips on broaching the subject of death to one?s parents. One of the suggestions was to use a holiday family dinner to explore the subject by stating your own preferences for end of life care.
The question as to who gets the last work on using CPR on a patient was the subject of an informative article in the October 10 issue of Salt Lake City?s Deseret News. The article pointed out that New York is one of the few states with a law that directly addresses resuscitation orders. Even when a doctor believes that CPR would be medically futile, if there has been no indication by the patient and the designated representative insists it be performed, the physician must go to court to prevail. Hawaii law gives weight to a patient?s ?comfort care,? document but a physician may override that document if his professional opinion so dictates. According to the article, fourteen states have either endorsed or are developing programs using a document developed in Oregon. Called, the Physician Orders for Life-Sustaining Treatment, the form has physician orders that follow patients? wishes and treatment intentions.
Manitoba?s College of Physicians and Surgeons has promulgated a draft policy that details the process that doctors must follow when deciding whether to withhold or withdraw respirators, breathing tubes, and feeding tubes. The proposed policy worries some patient advocates who argue that such decisions should rest with the patients and their families.
A new durable power of attorney for health care and a health care directive has been developed by Compassion & Choices, a Seattle, Washington nonprofit that supports, educates, and advocates for improved care and expanded choice at the end of life. These forms are available on the organization?s website.
Mercy Health Center in Oklahoma was the first U.S. hospital to survey its nurses? attitudes about caring for the dying patient. The results of the survey, presented at an international conference on palliative care in Hanzhou, China, and published in the Journal of Palliative Care, revealed that an overwhelming number of nurses felt stress and apprehension caring for patients who are at the end of their lives. As a result of the survey, the hospital increased its palliative care education for its nursing staff.
A survey of doctors in the United Kingdom found that about two-thirds help withhold treatment or give their terminally ill patients painkillers that will shorten their lives. Such action, however, is taken only when they believe death is a few days away and after consulting with patients, relatives, or other doctors. The survey results were published in Palliative Medicine.
Vermont is participating in a new federal program that offers home care as an option equal to nursing home care under Medicaid. Under Vermont?s ?Choices for Care? program, Medicaid sets a budget limit for the state to care for seniors and people with disabilities. Vermont then uses a combination of federal and state money to reimburse in-home caregivers.
In the current issue of Ethnicity and Disease, an article reporting the results of a study shows that preferences for life-sustaining treatment often divides along racial lines. Dr. William Bayer found that many black patients say they would want life-extending therapy even if they suffered from an incurable condition.
Another article in the series ?Fixing America?s Hospitals,? in Newsweek featured the end of life care given at Mount Sinai Medical Center.
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