November 2007

News from Attorneys General Offices

  1. Arizona Attorney General Terry Goddard’s office sponsored a “Life Care Planning for Everyone” workshop in November. Participants were given a video by General Goddard and a packet of life care planning information and documents. The Arizona Republic carried an article, quoting General Goddard, which noted the availability of documents on the Attorney General’s website.
  2. Connecticut Attorney General Richard Blumenthal filed a motion in federal bankruptcy court seeking the appointment of a Chapter 11 trustee to take over Haven Eldercare, LLC, and its 44 entities, including 15 Connecticut nursing homes. Haven Eldercare filed for bankruptcy on November 20. The bankruptcy filings cover nursing homes in Massachusetts, New Hampshire, Rhode, Island, and Vermont as well as Connecticut.
  3. Florida Attorney General Bill McCollum announced the arrest of a woman on charges of neglect of two disabled adults under her care at a group home. She allegedly failed to provide two of her patients with the appropriate medical attention, including medications. General McCollum and Colonel Bill Janes, Director of the Florida Office of Drug Control, have announced that they will jointly host a December presentation on the current state of drug trade in Florida and the significance of the drug quantities seen today. The presentation will be made to the Governor and members of the Florida Cabinet to provide them with information and insight into the growing threat of illegal drugs in the state. Among the presentations will be one on the explosion of prescription medications in the illegal drug market.
  4. Hawaii Attorney General Mark J. Bennett announced the conviction of an unlicensed care home operator who arranged for the care of an elderly man for $4000 a month. Doctors found that the gentleman had not been receiving his medications and had been badly neglected; he had lost weight, had bed sores and other ulcers, was dehydrated and extremely weak.
  5. Indiana Attorney General Steve Carter announced the arrest of a nurse for coercing one of her patient to save prescribed pain medications and give them to the nurse for her personal use.
  6. Massachusetts Attorney General Martha Coakley announced that her office has reached a settlement with the owner of a local nursing care facility that was not properly taking care of its residents. Pennsylvania-based Genesis HealthCare Corporation, which operates a facility in Gardner, Massachusetts, will pay $75,000 to the state to settle allegations of Massachusetts statutes and regulations.
  7. New Hampshire Attorney General Kelly A. Ayotte has announced that New Hampshire has finalized its share of a national Medicaid settlement with The Purdue Frederick Company and Purdue Pharma. New Hampshire’s share of the settlement is $1,053,000.
  8. Oklahoma Attorney General Drew Edmondson recently presented Oklahoma’s first guide on planning end-of-life health care during a bioethics conference at the University of Oklahoma. The guide, “Your Right to Decide,” outlines medical choices, planning options, steps for choosing a guardian, and a four-page form for the state’s new Advanced Directives for Health Care. Written by Annette Prince, director of the Oklahoma Palliative Care Resource Center, the guide notes an unusual feature of Oklahoma legislation. There is a presumption, if no contrary directive has been signed, that patients want to be kept alive by extraordinary medical means.
  9. Pennsylvania Attorney General Tom Corbett recently announced that a Bradford, Pennsylvania, woman was sentenced to a prison term of one to three years for using a power of attorney to financially victimize her elderly mother. General Corbett also announced that a Berks County podiatrist has been arrested on charges that he was fraudulently writing and obtaining prescriptions for his personal use.
  10. The week of November 26-30 has been proclaimed Advance Care Planning Awareness Week in the State of Rhode Island. The resolution to proclaim such a week was requested by Attorney General Patrick C. Lynch and passed by the General Assembly earlier this year.
  11. Vermont Attorney General William H. Sorrell announced that a licensed nursing assistant has been arraigned on two felony counts of diverting narcotics and two misdemeanor counts of abuse of a vulnerable adult. She is accused of removing duragesic Fentanyl patches from two elderly residents at a nursing home and using them herself.

Judicial Developments

  1. A Canadian court ordered a hospital to rescind a “do not resuscitate” order that had been issued for a Calgary, Alberta, man after a fall. Family members urged doctors to reinstate all life-sustaining treatments after the hospital had issued a DNR order, but the request was refused. Although the court heard expert testimony that the patient would likely exist in a persistent vegetative state, he is now talking with family members and doing exercises aimed at recovering his ability to walk. Alberta has no statute which addresses the issue of who decides on a DNR order for an incapacitated patient. The hospital has appealed the court ruling in an attempt to resolve a legal debate over medical care for the gravely ill.
  2. A district court in Colorado is dealing with the case of a critically injured 2-year old boy who has been on life support for over month in a Colorado Springs hospital. The boy’s guardian has asked that a “do not resuscitate” order be entered and life support withdrawn. The child’s 4-year old brother has been taken into protective custody. Police have executed search warrants and questioned the boys’ mother’s boyfriend to determine if child abuse was the cause of the child’s injury.

Legislative/Regulatory Developments

  1. DEA issued its final ruling in November on “Issuance of Multiple Prescriptions for Schedule II Controlled Substances.” The regulation, which goes into effect on December 19, allows physicians to write three separate prescriptions with staggered fill dates when medically appropriate.
  2. S. 2160, the Veterans Pain Care Act of 2007, was introduced in October. Sponsored by Sen. Daniel Akaka (D-HI) and Sen. Sherrod Brown (D-OH), the bill would establish a pain care initiative in health care facilities of the Department of Veterans Affairs.
  3. A hearing was held on November 8 regarding H.R. 2994, the National Pain Care Policy Act of 2007. Sponsored by Rep. Lois Capps (D-CA) and Rep. Mike Rogers (R-MI), the bill would coordinate and improve pain research at the National Institutes of Health and educate professionals on how to best diagnose and treat pain safely.
  4. Idaho’s new POST (Physician’s Order for Scope of Treatment) law took effect this year. It incorporates language crafted by the Idaho Attorney General’s Office and the Department of Health and Welfare, drafted at the request of the legislature.
  5. Utah has a new law, that takes effect in January, that allows citizens to fill out a single form to designate who makes medical decisions when they are unable to, what medical treatment they want, and when care should be withdrawn. The law also strengthens a patient’s right, when capable, to make medical decisions that cannot be overridden.
  6. The New Hampshire legislature is scheduled to consider HB 630, a bill that would set up an electronic database for certain classes of prescription drugs. The measure was passed out of the House Health, Human Services and Elderly Affairs Committee this month. Sponsors note that privacy and confidentiality are the main concerns of those opposed to the bill.
  7. A Virginia state delegate and a Commonwealth attorney are drafting legislation to make it more difficult for individuals to fraudulently obtain prescription medications from the Internet. Modeled after a Kentucky law, the legislation would require that Internet companies be licensed by the Virginia Board of Pharmacy and would make it a crime to ship illegally obtained drugs into Virginia.

Pain Management

  1. The November 15 issue of Nature reported that researchers from Oxford University believe that they have discovered a signal from the brain that objectively correlates with the amount of pain a person is experiencing. The signal is identified as low frequency brain waves emanating from two regions deep in the brain. The more pain being experienced, the longer the waves last.
  2. The New York Times’ November 13 issue published an article by Jane Brody titled “Chronic Pain: A Burden Often Shared.” The article stresses that chronic pain is a family problem and references research from the University of Washington that found that family members were up to four times more depressed than the patients. The article includes ideas from the American Chronic Pain Association’s Family Manual as to how family members and friends can help to relieve some of the burdens carried by loved ones of chronic pain patients. Another article by Ms. Brody in the New York Times’ November 6 issue reviews the issue of chronic pain and the problem of undertreatment.
  3. A promising development in pain management was reported in the Journal of Clinical Investigation. Researchers at St. Louis University have discovered that there is a substance, peroxynitrite, that interferes with the delivery of morphine and repeated doses of morphine cause a build-up of peroxynitrite in the spinal cord. Working with animals, the researchers found that morphine given with a drug that prevents the buildup of peroxynitrite may stop the cycle of a patient's needing increasing larger doses of pain medication in order to function.
  4. The Centers for Disease Control and Prevention have announced that a study will be undertaken next year on both prescription drug misuse fatality rates and prescription drug monitoring programs.
  5. The January 2008 issue of Cancer published research from the University of North Carolina that found that nonwhite women with metastatic breast cancer are more likely than white women to suffer severe pain associated with their disease. The study did not address the specific reasons for differences in pain management, but the researchers surmise that a combination of disparities at system, provider, and patient levels are responsible.
  6. A revealing Canadian study demonstrated that graduates from Canadian medical schools receive an average of 16 hours’ education in pain management. In contrast, graduates of veterinary schools in Canada receive an average of 98 hours of designated pain education.
  7. An article regarding how anesthesiologists are managing non-combat pain problems in troops in Iraq so that they are able return to duty appears in the current issue of Anesthesiology.
  8. A guide for the use of urine toxicology in chronic pain patients on opioid therapy was published in the December issue of Pain Management Nursing. Readers are encouraged to consider urine toxicology analysis as an integral component in care plans for those on chronic opioid therapy.

Prescription Drug Diversion

  1. The National Drug Intelligence Center has released the National Drug Threat Assessment 2008. Among the findings is that pharmaceutical drug abusers are having more difficulty acquiring drugs in states where there are prescription monitoring programs.
  2. An article in the Pennsylvania Cumberland County News (no longer available on-line) discussed the problem of doctors who are addicted to prescription pain medications and how the Medical Board handles accusations of this type. The article notes that a Pennsylvania law, the Criminal History Records Information Act, prevents law enforcement agencies, such as the Attorney General’s office, from sharing full details of investigations with agencies such as the Medical Board.
  3. A Macomb County, Michigan, doctor pled guilty to federal charges of distributing pain medications without a legitimate medical purpose and outside the course of professional practice. Information presented to the court indicated that Dr. Larry White unlawfully prescribed over 90,000 dosage units including Oxycodone, Vicodin, Xanax, and Valium. He will be sentenced on February 5.
  4. Dr. David Maurer of Jacksonville, Florida, was arrested by Florida officials and faces 29 counts of illegally prescribing painkillers, including hydrocodone, Xanax, and Soma.
  5. DEA is hosting an exhibit, “Good Medicine, Bad Behavior: Drug Diversion in America.” The program was created at the University of Utah and features seven cartoon mice in an interactive computer program to help visitors learn about drugs’ effects on the brain.
  6. According to an analysis of data from the West Virginia Medical Examiner’s Office, overdose has become the leading cause of death for West Virginia adults younger than 45. Seven of the top 10 drugs that helped to kill the 460 West Virginians that died of overdose in 2006 were prescription drugs.
  7. The Argus Leader had an article regarding the rise of abuse of OxyContin in South Dakota.
  8. CBS News with Katie Couric featured a news report on prescription drug diversion, focusing on the burgeoning problem in Florida.
  9. Channel 2 in Houston, Texas, is running a series on alleged “pill mills” in the Houston, Texas, area.

Other News of Interest

  1. A redesigned, simplified advance directive, written at a fifth-grade reading level, with graphics that reinforce the text, was the overwhelming choice of patients at all literacy levels compared with a commonly available standard form written at a twelfth-grade level. This was the finding of researchers at the San Francisco VA Medical Center and the University of California, San Francisco. The research was reported in the December issue of Patient Education and Counseling.
  2. The American Academy of Hospice and Palliative Medicine will hold its annual conference the end of January in Tampa Bay, Florida.
  3. A Bethel University candidate for a Master of Arts degree in gerontology has recently published a workbook titled My Life, My Care, My Way. It is intended to give caregivers a reference to provide their loved ones more personalized care at the end of life.
  4. A Duke University research study has found that hospice care saves Medicare $2,300 a patient in the last year of life. The results of the study were published in the October issue of Social Science and Medicine.
  5. Advocates in Connecticut are lobbying the Connecticut legislature to pass a law requiring the state’s Medicaid plan to cover the full complement of hospice care in all setting, including at home and in nursing homes. Connecticut is one of three states without a hospice benefit in its Medicaid program.
  6. Several news outlets carried stories concerning hospices that are millions of dollars in debt to Medicare. The major reason is that hospice providers are being penalized because too many patients are living longer than six months.
  7. A new website designed to help caretakers of aging parents has been unveiled. The site covers everything from what to ask when a patient receives an Alzheimer’s disease diagnosis to how to assess driving skills to tips for dealing with a difficult sibling.
  8. Samaritan Hospice of Marlton, New Jersey, has created a veterans’ program to deal with end-of-life issues specific to those who have served in our nation’s military and its conflicts.
  9. A Connecticut hospital is using puppets to help hospice and palliative care patients with depression and dementia.
  10. The Grieving Center, a television-based website by Continuum Hospice Care, in cooperation with the VA New York Harbor Healthcare System, has produced a series of videos about the staff who provide palliative and hospice care to veterans at the end of life.

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