June 2007

News from Attorneys General Offices

  1. Appearing before the Maricopa Elder Abuse Prevention Alliance to help kick off the Break the Silence campaign, an effort to increase awareness of elder abuse, Arizona Attorney General Terry Goddard spoke on the work done by his office to prevent and prosecute elder abuse and financial exploitation.
  2. Massachusetts Attorney General Martha Coakley announced that a national nursing home corporation, Life Care Centers of America, Inc., was recently indicted by a Middlesex Grand Jury in connection with the 2004 death of an elderly patient in its care.
  3. Michigan Attorney General Mike Cox urged Michigan lawmakers to support legislation that would create a broad-based, user friendly, drug cost website. In testimony, he noted that the legislation would help Michigan seniors and others to save money on their drugs.
  4. New Mexico Attorney General Gary King has added an elder abuse focus to his Medicaid Unit. In announcing the appointment of Elizabeth Staley as the new Director of the Medicaid Elder Abuse and Fraud Division, General King announced that the division will recruit investigators trained in investigating elder abuse, conduct outreach and training for other law enforcement agencies that investigate senior facilities, and take a more active approach in referring gross misconduct to medical boards.
  5. Oklahoma Attorney General Drew Edmondson announced that a Tulsa, Oklahoma, doctor pled guilty to allegations of fraud and distributing prescription drugs without a medical basis. Addressing attendees of the DEA-sponsored National Conference on Drug and Chemical Diversion in Ft. Lauderdale in June, General Edmondson used this case as an illustration of how prosecutors can help to achieve a balance between vigorous enforcement against doctors who are in violation of controlled substance laws and ensuring that those in pain receive appropriate medical interventions.
  6. Pennsylvania Attorney General Tom Corbett announced the arrest of several Pennsylvania doctors this month for criminal violations of controlled substances laws. Dermatologist Jennifer C. Zampogna and her husband were charged with illegally possessing prescription narcotics for their own consumption. Two Phillipsburg doctors, Lawrence G. Adams and Michael A. Fuentes, were charged with prescribing narcotics in exchange for a profit from the street sale of the drug.
  7. Vermont Attorney General William H. Sorrell announced that his office has charged a registered nurse with diverting narcotics from an operating room. According to the charges, James Erwin removed a syringe of Fentanyl from the anesthesia cart and replaced it with a syringe of tap water.

Judicial Developments

  1. A Maricopa County, Arizona, Superior Court Judge ordered that doctors reconnect Jesse Ramirez to a feeding tube. Ramirez suffered severe head injuries in an automobile accident the end of May. On the advice of his doctors, his wife chose to move him to a hospice and stop nutrition and medical intervention. However, because Ramirez did not have an advance directive, Ramirez’s sister petitioned the court to reconnect the tube, arguing that Mrs. Ramirez was not acting in the best interest of Mr. Ramirez. Ramirez has now regained consciousness and has recovered to the extent that he can interact with visitors.
  2. St Anthony’s Hospital in Oklahoma City had petitioned a district judge to order a do-not-resuscitate order for David Kubanov who had been pronounced brain dead last November. The sixteen-year old Russian youth slipped into a coma several days after complex brain surgery in October. The hospital sought the order so that it could transfer the teen-ager to a long-term care center. A hearing, scheduled for July on the hospital’s petition, has been cancelled. Kubanov died at St. Anthony’s on June 20.

Legislative Developments

  1. The Nevada legislature passed AB 158, a law to create a voluntary online registry for advance directives in the Secretary of State’s office. It was signed into law on June 13 by Governor Jim Gibbons.
  2. Texas Congressman Kevin Brady held a roundtable discussion on the growing number of pain clinics in Southeast Texas, with participants examining various bills aimed at dealing with the clinics. A new Texas law, S.B. 1879, sponsored by Senator Tommy Williams, expands prescription tracking that will red-flag doctors, pharmacies, and patients with excessive prescriptions. Some advocates, such as Calcasieu Parish District Attorney John Derosier, are pushing for a bill to take the next legislative step and make doctor shopping illegal.

Pain Management

  1. The June 17 New York Times cover story was titled “Doctor or Drug Pusher.” Centered on the trial and conviction of Dr. Ronald McIver, the article sympathetically reviews the concerns of physicians and pain management advocates concerning criminal prosecutions of physicians. The author concludes that no prosecution should be pursued on mere recklessness in prescribing of opioids.
  2. In the July issue of Anesthesia & Analegesia, Dr. Frank Brennen of New South Wales and colleagues, argue that pain management should be treated as a global human right. The authors call on the United Nations to consider declaring an International Year of Pain Management and on the World Health Organization (WHO) and other international bodies to create a single organization unifying all aspects of obligation on national governments in the area of pain control. An accompanying editorial summarizes WHO’s efforts in creating the Access to Controlled Medications Program.
  3. The June issue of Journal of Rehabilitation Research and Development is devoted entirely to the issue of pain and pain management. A publication of the Department of Veteran Affairs, it is available on-line. The issue includes articles on medical residents’ beliefs about using opioids, the efficacy of selected complementary and alternative interventions for chronic pain, and dealing with cognitive impairment and pain management.
  4. A web-based resource on pain management for professionals and consumers is www.pain-topics.org. A recent addition to the site is a special peer-reviewed report that provides guidance on the safe prescribing of immediate release and controlled release oxycodone.
  5. The journal Clinical Pharmacology & Therapeutics, in its June issue, featured an article titled “Prosecution of Physicians for Prescribing Opioids to Patients.” The authors discussed the results of a research project in which they reviewed newspaper accounts regarding 47 criminal cases involving 53 doctors. The same issue included a commentary on prosecuting physicians and an article querying whether medical boards are able to adequately respond in the case of physicians who inappropriately prescribe scheduled pain relievers.
  6. WebMD interviewed experts about OxyContin and its use as a medication for pain, the dangers of abuse, and the issue of addiction. The article notes the diverse views among experts in the pain management and addiction fields.
  7. The results of a study looking at whether hypnosis can alter the perception of acute pain were presented at the meeting of the European Neurological Society. The study demonstrated that perception of intense pain was significantly altered while participants were under hypnosis.
  8. Nearly 500 participants from around the world convened in New York to attend the 7th International Conference on Pain and Chemical Dependency. Four lectures presented at the conference are available on webcast. They are “Opioid Treatment in Chemically Dependent Patients;” “Pain, Chemical Dependency, and Addiction: New Definitions;” “Opioids for Nonmalignant Pain: Predicting Problem Patients;” and “Opioid Prescribing to Patients with and Without Chemical Dependency.”
  9. A review of several studies on pain relief and addiction, published in the June issue of Pain, concluded that the initial idea that addiction is rare among patients with chronic pain is incorrect and that problematic and attention-seeking behaviors can and do occur in a sub-group of patients with chronic pain. The authors urged that more research be done to find a better way of identifying patients with chronic pain at risk of becoming addicted and to develop medications that would offer adequate pain relief without the addictive qualities.
  10. A survey of nearly 5,000 cancer patients across Europe found that 57 % are enduring moderate to severe levels of pain and that one in five are not receiving any treatment for the management of pain. The research was conducted in 11 European countries. The results of the survey were highlighted at the European Association of Palliative Care Congress Meeting in Budapest.
  11. Newsweek’s June 4 issue carried a story titled, “The Changing Science of Pain.”

Prescription Drug Diversion

  1. David Joranson, Director of the Pain & Policy Studies Group at the University of Wisconsin School of Medicine and Public Health, has made available a 15-slide presentation titled “Diversion of Prescription Opioids.” The slides cover what diversion is, how it occurs, and key research and policy questions in connection with diversion. Also available on the Pain Policy Studies Group website is an editorial submitted for publication to Pain Medicine, titled “A Much-Needed Window on Opioid Diversion.”
  2. The June 19 issue of Annals of Internal Medicine features an article titled, “Strategies to Stop Abuse of Prescribed Opioid Drugs.” The article reviews the current debate regarding prescribing appropriate pain medication while addressing the concerns regarding the diversion of prescription drugs. Several developing approaches to stopping misuse include developing oxycodone in a viscous gel form and formulating hospital-strength opioid sufentanil that dissolves instantly when placed under the tongue, contained in a computerized, remote control-sized dispense programmed with the patient’s dose schedule and recording how much is used and how often.
  3. AP carried a story from Charleston, West Virginia, reporting that more people are seeking help from a local clinic for hydrocodone drug abuse. The article notes that hydrocodone is the most often prescribed opiate painkiller on the market and the highest per capita distribution of the drug is in Appalachia — West Virginia, Tennessee, Kentucky, and Alabama.
  4. Dr. Paul Maynard, who was convicted by a federal jury in February 2007 on four counts over-prescribing pain medication outside the course of professional medical practice, was sentenced to seven months’ imprisonment and a $5,000 fine.

Other News of Interest

  1. The June 18 issue of Newsweek carried an article addressing the issue that many baby boomers are facing, becoming a caregiver for an elderly parent or other close relative. The article covers medical issues, finances, legal issues, housing, and family dynamics and includes resources available for adults facing these issues. An additional article urges potential caregivers to have a frank conversation with elderly relatives about the future, expectations, and the importance of making plans. In addition, ABC news has featured the issues surrounding caring for elderly relatives in its nightly newscast the last week of June.
  2. Officials from the Central Massachusetts Partnership to Improve Care at the End of Life presented the results of a survey they had conducted at the 7th Clinical Team Conference and Scientific Symposium in San Diego in April. Survey questions were sent out to those who had been listed as next of kin on Worcester, Massachusetts, death certificates from 2004. Only 80 percent of those responding stated that they felt their loved one’s pain and symptoms had been managed adequately. The Partnership, better known as Better Ending Partnership, is developing projects to improve palliative care at the end of life in hospitals and nursing homes. Its brochure, “A Guide to a Better Ending,” is available in English, Spanish, and Vietnamese on its website. The website also features a brochure for African Americans, titled “The Last Miles Home.”
  3. Dr. Ira Byock, Director of Palliative Medicine at Dartmouth-Hitchock Medical Center in New Hampshire, is touring the state gathering information from families who are currently dealing with end-of-life issues involving loved ones. Dr. Byock wants to galvanize discussion around end-of-life issues and make it one of the focuses of debate in the upcoming presidential primaries.
  4. The Journal of Palliative Medicine had an article in its June 2007 issue titled, “Recognizing Depression in Palliative Care Patients.” Along with discussing the challenges in making such a diagnosis and describing the most common assessment tools that have been used, the authors highlight how to differentiate depression from normal grief.
  5. The issue of advance directives for disabled school children has arisen in California. The Clovis Unified School District has a written policy forbidding schools from following do-not-resuscitate orders. The policy means that the order written for nine-year old Gage Thornton by his doctor and his grandmother, his legal guardian, will not be enforced. Gage has Lennox-Gastaut Syndrome, which causes daily seizures that have severely affected his body and brain.
  6. The June 2007 issue of Critical Care Medicine includes an article reporting the results of a study that examined the effect of proactive palliative care consultation on length of stay for high-risk patients in the medical intensive care unit. The study found that such consultation was associated with a significantly shorter length of stay in intensive care without any significant differences in mortality rates.
  7. JAMA, in its June 26th issue, published an article titled, “Shifting Place of Death Among Children with Complex Chronic Conditions in the United States, 1989–2003.” In the article, researchers report that the number of such children dying at home increased significantly over that time span. Of concern, however, is that the changes are largely confined to white children. Black and Hispanic children of all ages were half as likely to die at home than were whites. Whether this reflects different preferences among these groups or whether the disparities are linked to poorer economic or social resources or to reduced health care services is not yet known.
  8. Writing in the June issue of Journal of Health and Social Behavior, researchers at the University of Madison and Rutgers University reported that education, religious attitudes, and experience with a loved one’s death are powerful influences on the decision as to whom to appoint as a health care proxy. Although the overwhelming choice among survey participants was a spouse or a child, the authors recorded twenty-five different choices, including siblings, co-workers, clergy, and physicians.
  9. Researchers conducted a survey to determine whether the regional variation in end-of-life treatment intensity was associated with regional differences in patient preferences. The survey of approximately 2,500 Medicare beneficiaries found that they generally preferred treatment focused on palliation rather than life extension. The research found that differences in preferences are not likely to explain regional variations in spending for end-of-life care. The results of the study was published in the May issue of Medical Care.
  10. A new study, published in the Journal of Pain and Symptom Management, found that one in ten U.S. hospice patients are referred too late to obtain needed hospice services, such as pain relief or emotional support.
  11. Franciscan University’s Institute of Bioethics will host a conference in October, titled “Human Life: Its Beginning and End,” that will provide guidance from the Catholic perspective on issues including stem cell research, assisted suicide, and the withholding or withdrawing of life-sustaining treatment.
  12. According to a recent study in the Journal of Clinical Oncology, there appears to be no reason not to integrate palliative care with standard care for patients newly diagnosed with terminal lung cancer. Fifty patients received integrated palliative and oncology care in an ambulatory setting. The problem is that many have felt that focusing on palliative care or symptom management is not compatible with aggressive treatment. The researchers found that discussing palliative care does not take away patients’ hope or drive and probably provides better care for them.
  13. A new resource for healthcare professionals has debuted online. It is called VIA and will provide short summaries of the latest journal findings on hospice, palliative care, and related topics.

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