November 2008

News from Attorneys General Offices

  1. Illinois Attorney General Lisa Madigan has announced that a company that owning a nursing home pled guilty to Gross Neglect of a Long Term Care Facility Resident. The company was ordered to pay a $25,000 fine and $75,000 for the costs of investigation and prosecution. The company was indicted, along with the former medical director, for gross neglect of a resident who died in the facility in September 2002.
  2. New York Attorney General Andrew M. Cuomo announced in November the arrests of a former nursing home employee who allegedly stole and forged personal checks from a resident. The certified nurse aide was charged with stealing personal checks from a nursing home patient and then cashing them by forging the patient’s name. General Cuomo also announced the arrests of two other nursing home employees in Rome, New York, for stealing and then pawning an engagement ring belonging to an 89-year-old resident.
  3. Oklahoma Attorney General Drew Edmondson announced the sentencing of a former admissions coordinator at a Bartlesville Care Center for exploiting a resident in her care. Edmondson’s Patient Abuse and Medicaid Fraud Control Unit brought the charges against Bobbie Joe Wilhelm. She stole royalty checks from a patient’s account. She was ordered to pay $7617.18 in restitution, a $1,000 fine and investigative costs. She will also serve a two-year deferred sentence.
  4. According to an article in the Burlington Free Press, Vermont Attorney General Bill Sorrell will be convening an all-day seminar in early December to address the criminal side of the prescription drug abuse problem. Vermont ranks among the top four states in three prescription drug categories; it ranks first in the nation in sales of buprenorphine; third in hydromorphone and fourth in methylphenidate. The Health Department is in the process of setting up a prescription drug monitoring program.

Judicial Developments

  1. The National Hospice and Palliative Care Organization filed a lawsuit in September challenging a new Medicare rule that cuts Medicare reimbursement rates. The court recently dismissed the lawsuit, holding that it did not have subject matter jurisdiction over the case.
  2. For the first time in the Republic of Korea, a court has approved the cessation of life support for a comatose 76-year old patient. The court found a constitutional right for a patient to demand the end of life support when it imposes physical and/or mental pain and harms a person’s dignity and individual values. The court cautioned, however, that the right belongs to the patient alone.

Legislative Developments

  1. Washington voters passed Initiative 1000, an “Aid in Dying” Act, which will provide doctor-assisted suicide to Washington residents.
  2. The Ohio General Assembly is considering a bill (H.B. 253) that would enhance the ability of advanced practice nurses (APNs) to prescribe Schedule II controlled medications. If passed, Ohio would join thirty-one other states that allow APNs to prescribe these medications. Currently, they can prescribe only a 24-hour supply for terminally ill patients after an initial prescription has been written by a physician.

Pain Management

  1. The Federation of State Medical Boards hosted a live webcast on November 15, sponsored by the Virginia Prescription Monitoring Program, the Virginia Board of Medicine, and Inova Health Care System. Aimed at prescribers and pharmacists, the webcast presented best practices and risk management perspectives in the prescribing of controlled substances.
  2. The Journal of Clinical Oncology is the latest journal to publish results of a study that demonstrated that elderly patients (in this case, cancer patients) do not receive appropriate pain relief at the end of life.
  3. The September issue of BMC Musculoskeletal Disorders included an article that reported positive effects of hypnosis for the treatment of chronic muscular pain.

Prescription Drug Diversion

  1. An article in the Des Moines Register noted that Iowa state drug agents have reported a 79 percent increase in pharmaceutical diversion cases. One Iowa high school principal noted that he had seen “a rash” of prescription pills in his school. The director of the Governor’s Office of Drug Control Policy is advocating an extension of Iowa’s Prescription Drug Monitoring Program. The law expires on June 30.
  2. West Virginia has adopted a new approach to countering prescription drug abuse. It has formed the Controlled Substance Advisory Board which is coordinating efforts among all the groups in the state that is addressing the issue. The board brings together police agencies, physicians, politicians and other stakeholders. As a first step in addressing the issue in the state’s most affected counties, the board plans to focus first on patients, warning them of the dangers of diversion.
  3. A Palm Cost, Florida doctor has been convicted of conspiracy to distribute controlled substances and conspiracy to commit money laundering after a week-long trial. Gerardo Klug, 65, had been employed as a prescribing physician at the Chronic Pain Management Clinic.
  4. A four-year joint investigation by the North Florida Health care Fraud Task Force has led to the conviction of Dr. Robert L. Ignasiak Jr. on 43 counts that included healthcare fraud and dispensing controlled substances illegally. He will be sentenced in January.
  5. A Galion, Ohio, doctor, Dr. Narenda Agrawai, was recently arrested and charged with one count of trafficking in prescription drugs.
  6. A Winchester, Tennessee, doctor, Elizabeth Reimers, has been indicted by a federal grand jury on 130 counts of illegally dispensing controlled substances.
  7. The Nevada State Medical Examiners Board, after an emergency meeting, has suspended Dr. Kevin Buckwalter’s license to prescribe controlled substances. This came after articles in the Las Vegas Sun detailing concerns about the deaths of three of Buckwalter’s patients and numerous other allegations concerning Buckwalter’s prescribing practices.

Other Items of Interest

  1. Dr. Scott Fishman’s Responsible Opioid Prescribing: A Physician’s Guide, can now be ordered through the Federation of State Medical Boards’ website. The book is an excellent guide to help physicians manage their patients’ acute and chronic pain.
  2. President George Bush proclaimed November National Hospice Month to honor the “dedicated health care professionals and volunteers who help the terminally ill spend their final days in comfort and with dignity.”
  3. Children’s National Medical Center in Washington, D.C., filed a lawsuit to obtain a court order to allow it to cease life support for 12-year-old Motl Brady suffering from brain cancer. Doctors had declared him legally dead. The parents opposed the hospital because, as Orthodox Jews, they do not believe that death is the cessation of brain function alone. Before the court could rule, Motl’s heart stopped beating.
  4. A team of researchers at Wake Forest University Baptist Medical Center, University of Rochester Medical Center and Unity Health System report in the October issue of Mayo Clinic Proceedings that a lack of understanding about the laws governing end-of-life care may leave some practitioners to subject their dying patients to pain that could be avoided. Physicians are likely to refuse to deactivate an implantable cardioverter-defibrillator (ICDs) in patients who are terminal results in physicians, even though their patients request it. Researchers also noted that there are no clear-cut recommendations on deactivation. ICDs are placed in a patient to give an electrical shock when it detects cardiac arrhythmia. There needs to be clarity as to how to handle these devices when a patient is close to death ─ and likely to receive more ICD shocks due to electrolyte disturbances, hypoxia, and heart failure.
  5. Stephen Kiernan, author of Last Rights ─ Rescuing the End of Life from the Medical System, was the keynote speaker at the National Academy of Elder Law Attorney’s Advanced Elder Law Institute, held in Kansas City in October. He noted that physicians receive inadequate training in death, dying, and palliative care because the focus of medical education is to save lives. Dying is perceived as a failure. Kiernan urged elder law attorneys to ensure that their clients know their choices and rights and have the appropriate documents in place.
  6. In two articles, the Carlsbad, New Mexico, Current Argus, detailed Christy Box’s fight with cancer and the palliative care team that enabled her to keep involved in her family’s activities until two weeks before her death.
  7. The British newspapers are discussing the case of 13-year old Hannah Jones’ decision to forego a heart transplant that could save her life. After years of being treated for acute myeloid leukemia, she has decided that she wants to have time with her family and die at home. The medical community has backed off an earlier effort to remove Hannah’s parents as her guardians in an effort to pursue the transplant. The question that has been raised is when is a child old enough to understand and give consent to, or to withhold consent from, complex medical treatments. Last February, 16-year old Josie Grove, who also had acute myeloid leukemia, made the decision to forego further treatments.
  8. The parents of Lauren Richardson have resolved their disagreements concerning the treatment of their brain-damaged daughter Lauren. Her dad had appealed the awarding of sole guardianship to Lauren’s mom who intended to withdraw life-sustaining support from her in accordance with Lauren’s wishes. Lauren will now go to her father’s home to be cared for.
  9. The President’s Council on Bioethics held a meeting on November 20 on medical futility. It was evident from both the presentations and the discussions that this is a topic on which it is difficult to find consensus and that there are many unresolved issues. The transcripts of the meeting should be available shortly on the Council’s website.
  10. A family who suffered through the death of 32-year-old Rosaria Vandenberg launched an initiative titled Engage with Grace. It encourages families to use traditional holiday gatherings to discuss end of life issues with one another. The family has started a website and has initiated a “blogger’s rally” to get the message out to as many people as possible.
  11. Florence Wald, the former dean of Yale’s School of Nursing and the founder of the American hospice movement passed away early in November. Her commitment to the compassionate care of those who are dying led to the establishment in 1974 of Connecticut Hospice in Branford. Thirty-eight years later, there are 3,200 hospice programs caring for over 900,000 patients annually.

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