May 2009

News from Attorneys General Offices

  1. Florida Attorney General Bill McCollum announced that a case worker for the Bayview Center for Mental Health was charged with stealing more than $3700 from a patient under her care.
  2. Kansas Attorney General Steve Six announced that the pharmacist in charge of Hogan’s Pharmacy in Lyons was found guilty in an Internet pill mill scheme.
  3. Maine Attorney General Janet Mills was a speaker at a conference on “Prescription Drug Diversion: When Health Becomes Hazard.” The conferees agreed that the complex prescription drug diversion problem requires attention from a broad cross-section of expertise.
  4. Michigan Attorney General Mike Cox announced a website that provides a one-stop site to help Michigan seniors find information on health care, finances, veterans’ benefits, and consumer protection.
  5. Mississippi Jim Hood announced that a hospice nurse pled guilty to two misdemeanor charges of practicing medicine without a license. Evidence in the case demonstrated that the 67,000 dosage units given to a patient was so high that it caused death. She was sentenced to pay a $300 fine. A co-indictee in the case, physician Dr. Paul White, pled guilty last June to six counts of aiding and abetting the practice of medicine without a license.
  6. New Jersey Attorney General Anne Milgram announced that a licensed pharmacist was convicted of creating false telephone prescriptions for hydrocodone and filling the prescriptions for two friends who then sold the pills, splitting the profits with the pharmacist. General Milgram also announced that New York resident Edward Polanco pled guilty to racketeering charges involving his part in a prescription drug ring that illegally distributed millions of dollars of controlled substances in New York and New Jersey.
  7. Vermont Attorney General William Sorrell announced that a licensed registered nurse was convicted for unlawfully possessing a controlled substance. She was sentenced to nine to twelve months, all suspended, one year’s probation, and forty hours of community service.
  8. Wisconsin Attorney General J.B. Van Hollen participated in a prescription drug abuse roundtable this month. General Van Hollen’s office also announced the arrest of fifteen individuals accused of being participants in a drug trafficking scheme that dealt in controlled substances.

Judicial Developments

  1. A Minnesota judge has ruled that a 13-year old boy with Hodgkin’s lymphoma has been “medically neglected” because of his parents’ decision to use natural remedies instead of chemotherapy to treat his illness. The judge acknowledged that Daniel Hauser’s wishes are to use nutritional supplements and other alternative treatments favored by a Missouri-based religious group, the Nemenhah Band. However, the judge held that Daniel has only a “rudimentary understanding at best of the risks and benefits of chemotherapy. . . . He does not believe he is ill currently. The fact is that he is very ill.” The judge, thus, ruled that there is a “compelling state interest sufficient to override the minor’s genuine opposition.” Subsequent to the ruling, Daniel left the state with his mother, returning to Minnesota the end of the month. The parents have now announced that they will comply with the court’s order.
  2. Nevada’s Clark County is prosecuting a mother for withholding medical care from her 15-year old son. Lena Anderson has been charged with murder by child abuse of her son Patrick, who had a chronic kidney disorder requiring the use of a catheter which needed to be changed four times a day. The defense argues that the murder charge should be dismissed because refusing to submit to life-sustaining medical treatment is not murder.
  3. Disability Rights Wisconsin is suing the University of Wisconsin, alleging that doctors at the hospital broke the law by withholding treatment from two developmentally disabled patients with pneumonia. In Disability Rights Wisconsin v. University of Wisconsin Hospital and Clinics et al., No. 2009CV002340 (Cir. Ct. Dane County, filed May 15, 2009), the plaintiff alleges that state law prevents parents and others from withholding treatment from patients who cannot make such decisions for themselves unless these patients are in a “persistent vegetative state.”

Legislative Developments

  1. A panel of Iowa state legislators has requested that the Iowa Board of Medicine delay implementation of a proposed policy change that would allow only doctors to provide certain pain management treatments for patients. Currently, certified registered nurse anesthetists provide chronic pain care in 91 of Iowa’s 117 hospitals.
  2. The New York legislature is considering A07729, the Family Health Care Decisions Act, which would give family members the authority to make decisions for incapacitated patients who do not have a written health designee or treatment instructions.
  3. North Dakota Governor John Hoeven signed into law SB2236, which calls for the development of a health care directive registry within the Secretary of State’s office.
  4. Virginia has enacted new legislation which expands the types of decisions a person may make with an advance directive. These include preferences about mental health care, health care facility admission, and maintenance treatments. The new law also addresses issues such as decision-making capacity, revocation of advance directive documents, and the protection of agents and providers who act in good faith in carrying out a patient’s instructions.

Pain Management

  1. The Center for Practical Bioethics has announced the establishment of the Kathleen M. Foley Chair for Pain and Palliative Care, which will be funded by a $3 million endowment. The new chair will amplify and continue the Center’s involvement in overcoming barriers to care for those in pain, including increasing standards for pain education research and policy.
  2. An expert panel of the American Geriatrics Society has suggested that adults ages 75 are better off taking opiates than non-steroidal anti-inflammatory drugs for chronic pain that cannot be relieved through alternatives such as acetaminophen.
  3. The Food and Drug Administration held a two-day public hearing to get input from physicians and others to decide what factors the agency should consider in drafting a Risk Evaluation and Mitigation Strategy (REMS) to reduce opioid-caused adverse affects. A major concern is that, with more regulation, physicians will not prescribe needed opioids to patients. The American Academy of Pain Medicine submitted comments on REMS, noting that the priorities should be the establishment of prescription monitoring programs with accurate and real-time data, monitoring of all opioids, not only slow release opioids, and education for physicians, pharmacists, and patients about medicines and monitoring.
  4. A University of Michigan study, published in The Journal of Pain and Symptom Management, found that minorities reported much more consistent and more breathrough pain in cancer patients. Non-white participants also reported a higher incidence of pain interfering with general activity, mood, and walking ability.

Prescription Drug Diversion

  1. The National Prescription Drug Threat Assessment, prepared by the National Drug Intelligence Center in conjunction with the Drug Enforcement Administration, was released this month. The report finds that unintentional deaths involving prescription opioids increased 114 percent from 2001 to 2005.
  2. Gil Kerlikowske took office as director of the White House Office of National Drug Control Policy this month. He announced as one of his top priorities curtailing abuse of prescription drugs.
  3. An investigative report in the Florida Sun-Sentinel noted that one in five of the doctors who work in pain clinics in South Florida has a history of professional discipline or criminal convictions.
  4. The State of Connecticut has asked for more than $620,000 in federal stimulus grants to combat “doctor shopping” by identifying individuals dealing with addiction and offering rehabilitation instead of criminal prosecution.
  5. After a lengthy investigation, Michigan state officials have arrested four doctors and charged them with various counts involving insurance fraud, falsified medical records, and prescribing controlled substances outside normal medical practice. All four doctors are family practitioners. Doctors Richard Neely and James Park face eighteen felony counts each; Dr. Peter Cotey faces two felony counts; and Dr. David Huff faces three felony counts. A fifth doctor was charged but has not yet been taken into custody.
  6. A Tennessee doctor and his patient were arrested by state officials and charged with 14 counts of fraud. According to investigators, during the five years that there was a doctor-patient relationship between the two individuals, Dr. James Durkin gave Regina Duff prescriptions for controlled substances that were not medically necessary.
  7. Dr. Masoud Bamdad, who operated a medical clinic in San Fernando, California, was found guilty on 13 felony counts for writing prescriptions for controlled substances outside of the usual course of professional practice and without a legitimate medical purpose.
  8. Murray, Utah, physician Warren R. Stack pled guilty to one count of conspiracy and two counts of health care fraud. He had originally been indicted on one count of conspiracy; five counts of dispensing drugs outside the bounds of medical practice, resulting in death; seven counts of unlawful distribution of a controlled substance; and five counts of health care fraud. Federal prosecutors will recommend eight years’ incarceration when he is sentenced in July.
  9. Carrollton, Georgia, physician Dr. Phil Astin III has been sentenced to serve ten years’ in federal prison. He pled guilty last January to illegally dispensing prescription drugs from 2002 until he was arrested in 2007. Astin was the physician for professional wrestler Chris Benoit.

Other Items of Interest

  1. President Obama discussed the death of his grandmother in an interview with the New York Times Magazine. During the interview, he discussed the human cost of denying surgery and other medical benefits to those who have terminal conditions.
  2. A study at Massachusetts General Hospital, published in the British Medical Journal, found that seniors who watched a video showing a patient with advanced dementia were able to make more informed decisions about their end-of-life care.
  3. Dr. Pauline Chen, who has written and spoken extensively encouraging doctors to discuss end of life care issues with their patients, wrote an article for the New York Times on her own experience with this issue when her mother-in-law recently died.
  4. A new Harvard Medical School study, published in the Archives of Internal Medicine, found that only about half of the patients with advanced lung cancer discussed hospice care with their physicians. The study suggests that doctors aren’t well-trained in end-of-life care discussions and choose, instead, aggressive treatment.
  5. An interesting article regarding ethical dilemmas that nurses face when choosing between conformance with hospital rules and regulations and doing what is best for the patient and the family appeared on-line in Nurseweek.
  6. Researchers at Children’s Hospital Boston published an article in the Proceedings of the National Academy of Sciences on work they conducted under a grant from the National Institutes of Health. They reported developing a new slow-release anesthetic drug-delivery system that holds promise for the treatment of pain during and after surgery as well as for chronic pain management.
  7. An article prompted by the trial in New York City of the son of Brooke Astor for financial exploitation of his mother notes that financial exploitation of the elderly is difficult to detect and that, often, family members are involved.
  8. An article in the New York Times explored how hospitals treat same-sex couples. The author concluded that couples must plan ahead and have documentation available to prove one’s right to visit and make decisions.
  9. Virginia’s prescription monitoring program was hacked this month and the site’s homepage was replaced with a ransom note demanding $10 million for the return of the records. The FBI is investigating.

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