March 2009

Headline News

News from Attorneys General Offices

  1. Arizona Attorney General Terry Goddard is sponsoring a contest among the state’s high school juniors that focuses attention on elder abuse. Participants are asked to submit original posters, poems, or essays that address the question, “Why should I care about elder abuse?” The winning entries will be featured as part of a statewide Elder Abuse Awareness Day that will be held on June 15 to coincide with World Elder Abuse Awareness Day.
  2. California Attorney General Edmund G. Brown Jr. announced that two doctors, Khristine Eroshevich and Sandeep Kapoor, have been charged with illegally furnishing controlled substances to Anna Nicole Smith. The doctors are accused of falsifying prescriptions and prescribing medications for no medical purpose.
  3. Kansas Attorney General Steve Six announced that an administrative judge in Topeka had revoked the licenses of the owner and technicians of Hogan’s Pharmacy in Lyons. It was found that the owners had entered into an agreement with two Internet websites to fill prescriptions for customers who simply filled out a questionnaire but who never saw a physician.
  4. Kentucky Attorney General Jack Conway announced that a plea agreement had been reached with two Kentucky caregivers that were arrested on charges relating to the abuse and death of a patient at a care facility. One of the two defendants will service eight years’ imprisonment; the other will serve five years’.
  5. Massachusetts Attorney General Martha Coakley announced that her office had obtained a consent judgment against a company that owned a nursing home for their roles in the mismanagement of the facility that eventually led to the emergency appointment of a temporary receiver. The consent judgment requires that the defendants pay more than $280,000 in receiver costs and civil penalties. The company is also prohibited from operating nursing homes in the Commonwealth for ten years.
  6. Minnesota Attorney General Lori Swanson announced the filing of a criminal complaint charging a woman with nine felony counts of theft by swindle and five felony counts of financial exploitation of a vulnerable adult. Connie Ruth Rott is accused of diverting over $1.1 from a trust to benefit her mother. Medicaid is now paying for her mother’s care.
  7. Mississippi Attorney General Jim Hood announced that a fourth caregiver at a New Albany care center has been arrested following an indictment for acquiring or obtaining possession of a controlled substance or prescription by misrepresentation. Wendy Gray, a licensed practical nurse, allegedly removed duragesic patches from residents to consumer the medications. Gray is the fourth nurse from the Graceland Care Center to be arrested by the Attorney General’s Medicaid Fraud Division in the past four months. General Hood also announced that two former workers at different nursing homes in the state have been sentenced after they pled guilty to felony abuse or exploitation of a vulnerable adult. Erica Haymer was sentenced to one year’s house arrest on her plea to exploiting over $4,000 in cash, Internet services, and a cell phone from a vulnerable adult living at the Mississippi State Veteran’s Home. Nicole Williams was sentenced to five years’ supervised probation, a $1,000 fine, and a five year suspension of her certified nurse’s assistant license. She admitted to striking a resident of the Manhattan Nursing Home in the face.
  8. New Jersey Attorney General Anne Milgram announced that a physician’s assistant, Alison Kinlaw, pled guilty to fraudulently obtaining controlled prescription drugs.
  9. Washington Attorney General Rob McKenna spoke at two events this month about the growing problem of prescription drug abuse by young people. He participated in a special roundtable discussion about the new efforts to mobilize families to tackle this public health threat and gave the keynote address at a law enforcement conference on prescription drug abuse.
  10. Wisconsin Attorney General J.B. Van Hollen announced that Eric Larrabee was convicted and sentenced on three counts of battery against an elderly female patient at Larrabee’s place of work, the Skaalen Nursing Home. He was sentenced to six months’ incarceration followed by eighteen months’ probation.

Judicial Developments

  1. A Union County, New Jersey, superior court judge has restrained Trinitas Regional Medical Hospital from taking it upon itself to discontinue life-sustaining treatment for Ruben Betancourt, who has been comatose for over a year and is dependent upon dialysis, a ventilator, and a feeding tube. Adjudicating on the merits, the judge rejected the hospital’s position that its doctors should not be forced to provide medical treatment that they believe is inhumane and contrary to standards of care. Betancourt v. Trinitas Regional Medical Hospital, UNN-C-12-09 (Super. Ct. Union County) (made available by Thaddeus Pope who writes the medical futility blog). The court concluded that it was the responsibility of the guardian to determine the course of action and appointed Betancourt’s daughter, who had brought the lawsuit, as his guardian.
  2. The parents of an 18-year old boy have filed a $5 million lawsuit in the U.S. District Court for the Western District of Pennsylvania claiming that the doctors at Hamot Medical Center caused their son’s death by administering medication and removing his breathing tube so that they could harvest his organs. Gregory Jacobs was injured in a snowboarding accident. His parents claim that their son had not been formally declared brain dead when surgeons began the transplant procedure. A copy of the complaint in Jacobs v. The Center for Oregon Recovery and Education is available through the medical futility blog.
  3. The Baby OT case has been reported widely this month in both the British and the U.S. press. The parents of a gravely ill 9-month old boy went to court to stop doctors from removing life support. Both the trial court and the appellate court granted doctors the right to take the child off life support. He died just hours after life support was removed. The parents are now considering suing the hospital and doctors responsible.
  4. Parents of a 16-month old baby with cerebral palsy and severe development delays are suing a Montreal hospital, alleging that they were pressured into a decision by its ethics committee to put their child back on life support.

Legislative/Regulatory Developments

  1. The House Committee on Energy and Commerce has sent to the full House of Representatives HR 756, the National Pain Care Policy At of 2009. Among other things, the act would expand research on the causes and treatments for pain, provide education and training for healthcare professionals, and authorize an Institute of Medicine conference on pain management.
  2. The Florida legislature is considering HB 143 and SB 614 that would require dispensers to use inexpensive biometric scanning devices ─ fingerprints or retinal scans, for example ─ to biologically identify people attempting to fill prescriptions for Class II, III or IV controlled substances.
  3. The Illinois legislature is considering HB 3695, which amends the state’s Controlled Substances Act and portions of its prescription monitoring program. The bill is designed to eliminate the state drug classification system and replace it with the federal system. However, state regulators could “upgrade” the classification of a specific drug under certain circumstances. It also would allow more access, upon a showing of probable cause, to the state’s Prescription Monitoring Program.
  4. The New Jersey legislature is considering AB 2173, the Starvation and Dehydration of Persons with Disabilities Prevention Act. The bill establishes a presumption that every person legally incapable of making health care decisions has directed that person's health care provider to provide the person with nutrition and hydration to a degree that is sufficient to sustain life. The introduction of the legislation came immediately after the court decision in the New Jersey case of Betancourt v. Trinitas Regional Medical Hospital (see above).
  5. The West Virginia legislature is considering HB 3007, which would require random drug testing for recipients of federal-state assistance, state assistance, and unemployment compensation. If a recipient of such assistance were to test positive a second time two months’ after the initial positive test, he or she would be ineligible for public assistance. Addiction professionals are opposing the bill because it does not include treatment for those who test positive for drugs.
  6. The Utah Department of Health (DOH) has released its final draft of clinical guidelines to assist providers in safely prescribing prescription drugs. The guidelines were developed in partnership with two multi-disciplinary panels of physicians as part of the DOH’s campaign to reduce the amount of prescription drug overdose deaths in the state. Utah is the second state, after Washington, to develop such guidelines.

Prescription Drug Diversion

  1. Federal officials have arrested a Tampa, Florida doctor, 83-year old John Rew, for prescribing controlled substances for no valid medical reason. Upon being released from custody on $50,000 bail, the federal magistrate ordered him to stop practicing medicine until the case is resolved.
  2. Dr. Roger Browne, a Florida physician, was sentenced to two and one-half years in prison after he pled guilty to writing illegal prescriptions to more than 500 eastern Kentuckians. He was one of a dozen people who were part of an organized crime network that sold oxycodone pills in Kentucky, Ohio, and West Virginia.
  3. A North Carolina paper reported that the chairman of a local Child Protection Team expressed frustration that physicians and pharmacists are not accessing the prescription monitoring program that was initiated last November in the state.
  4. Tulsa World carried an article in its March 17 issue detailing information about prescription drug abuse in Oklahoma. According to the article, an estimated 87,000 citizens in the state abuse prescription drugs. After April 1, pharmacists will be required to enter data into the prescription monitoring program every 24 hours.
  5. The executive director of the Louisiana Board of Pharmacy announced recently that the state’s prescription monitoring program has been accessed more than 27,000 times by doctors and pharmacists since the beginning of the year.
  6. New Orleans Channel 4 reported the results of its investigation into prescription drug vendors on the Internet. The report quoted the DEA as estimating that more than 1,000 websites sell drugs without a valid doctor’s prescription.

Other Items of Interest

  1. The March 9 issue of the Archives of Internal Medicine has several articles involving end-of-life care. One report notes that better communication between dying cancer patients and their physicians leads to lower costs and better care at the end of life. In another study dealing with end-of-life cost issues, researchers at the National Institutes of Health found that black and Hispanic patients account for substantially higher treatment costs than whites. More than half of the cost differences are related to geographic, sociodemographic, and morbidity differences. The rest result from a greater use of life-sustaining interventions. The third article report families’ feelings of abandonment by their doctors after a patient’s death. The authors suggest that physicians should offer assurances that, as the end of life approaches, they will still be available and maintain contact with the patient and caregiver.
  2. In the March 11 issue of the Journal of the American Medical Association (JAMA), there is an article regarding palliative care for Latino patients and their families. It examines the communication and cultural barriers Hispanics face when seeking end-of-life care in the United States. An article discussing the JAMA paper appeared in The March 18 issue of JAMA reported that terminally ill cancer patients were almost three times more likely to receive invasive treatments if religion were an important part of their decisionmaking. An article on discussed the possible reasons behind the researchers’ findings. In that same issue of JAMA, there is an article discussing compassion fatigue in physicians caring for patients at the end of their life. JAMA’s March 25 issue reported on the efforts of professional organizations and government agencies in seeking a balance between pain management and the diversion of pain medications.

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