October 2007

News from Attorneys General Offices

  1. California Attorney General Edmund G. Brown Jr. issued a press release discussing the serving of search warrants at various doctors’ offices, billing locations, and residences in Los Angeles and Orange Counties related to the death of Anna Nicole Smith. His statement noted that an investigation was begun in March 2007 and that the locations of the search were related to doctors who provided medical treatment or prescribed drugs for Ms. Smith or her associates.
  2. Florida Attorney General Bill McCollum announced that a hospice nurse was arrested on charges of fraudulently obtaining controlled substances.
  3. Kentucky Attorney General Greg Stumbo filed a lawsuit against Purdue Pharma, alleging that the company misrepresented the risks of using OxyContin. The lawsuit seeks damages suffered by state and county governments related to the addiction caused by the drug.
  4. Maryland Attorney General Douglas F. Gansler announced that his office was charging a Columbia, Maryland, man with three counts of neglect of a vulnerable adult. He is accused of leaving three developmentally disabled men alone and unattended. General Gansler’s office has also charged Naimah Tarze Butler with abuse of a vulnerable adult and second degree assault. She is accused of assaulting a nursing home resident who was under her care.
  5. Massachusetts Attorney General Martha Coakley announced that Dr. Michael L. Mavroidis, a Lowell psychiatrist, was sentenced to one year’s incarceration and a $10,000 fine after having been found guilty of illegally prescribing drugs in connection with four former patients.
  6. Oklahoma Attorney General Drew Edmondson announced that the owner of a nursing home in Sulphur has been accused of stealing more than $300,000 from a mentally-ill woman in his care.
  7. Vermont Attorney General William H. Sorrell announced the convictions of three licensed registered nurses on charges of possessing narcotics. They used their positions at nursing homes and medical centers to divert controlled substances to their own use. In addition, a licensed registered nurse has been charged with diverting narcotics, falsifying records, and endangering patients when she allegedly diverted morphine to her own use. Also in Vermont, its public radio station aired an interview with Linda Purdy, Assistant Attorney General in the Vermont Attorney General’s Office regarding the rising number of complaints and arrests for prescription drug diversion.

Judicial Developments

  1. The mother of a profoundly mentally retarded and physically disabled 37-year old man won a court order to allow her to issue a do-not-resuscitate order for him. The Allegheny Valley School, where he lives, opposed the order because the man is neither unconscious nor in an “end-of-life” state. Judge Thomas Doerr of the Butler County Court in Pennsylvania ruled that the testimony of the mother, his legal guardian, was compelling as to what was the best for her son.
  2. A court hearing concerning the guardianship of Sam Webster, who has progressive dementia, will be held in Milwaukee County Circuit Court in December. After he was admitted to a hospital with pneumonia, he was transferred to a hospice on the recommendation of his physician who says he has less than six months to live. A guardian was appointed for him with no notice to his nephew, Abdulla Shabazz, who objected to his being placed in the hospice. Shabazz claims his uncle wants to be aggressively treated and not simply given pain medication. He also wants his uncle- transferred to a VA Hospital. After being sent back to the hospital and then to a nursing home, Shabazz called 911, concerned that his uncle was not receiving necessary medical care. The District Attorney’s Office is also looking into issues regarding Webster’s care.

Legislative Developments

  1. S. 2085, the Patient and Pharmacy Protection Act of 2007, which would delay the requirement to use tamper-resistant prescription pads under the Medicaid program for six months, passed the Senate by Unanimous Consent the end of September. The House has not yet acted upon it.
  2. S. 980, the Online Pharmacy Consumer Protection Act, was reported out of the Judiciary Committee in late September.
  3. Georgia’s House Resolution 663 created the House Study Committee on Pain Management which had its first meeting the end of September. The Committee will hold discussions with the Georgia Attorney General’s Office, regulatory boards, and interested parties on procedures and techniques for the management of pain. After a study is completed, the Committee will report to the General Assembly on issues involving medical, pharmaceutical, and patient care relating to the treatment of pain, including the use of Schedule II controlled substances.
  4. The South Carolina legislature overrode the Governor’s veto on a bill authorizing the establishment of a prescription monitoring program in the state. The system should be on-line as of January.

Pain Management

  1. The fall issue of Practical Bioethics, a publication of the Center for Practical Bioethics, is devoted to pain management. The lead article is written by Dr. Richard Payne and titled “Medical Professionalism and Responsibility in Pain Management.” A case study highlights the barrier that opiophobia erects to deny appropriate pain relief.
  2. The FDA issued a public health advisory warning regarding a pain drug for cancer patients, Fentora. Several patient deaths have been reported due to inappropriate prescribing of the drug.
  3. The October issue of the Annals of Internal Medicine published new guidelines for the management of low back pain. Emphasizing a conservative approach to diagnosis and treatment, the guidelines discourage routine use of imaging and emphasize patient education and the use of nondrug therapies and over-the-counter medications as first-line treatment.
  4. The October issue of the Southern Medical Journal features an article discussing the prescribing of opioids by primary care clinicians for chronic noncancer pain. The article cautions that clinicians must identify patients who may have difficulties in managing opioids before starting patients on long-term opioid therapy. For those patients who are identified at risk, focused monitoring and case management are crucial. Thorough documentation of patient care is mandatory. The article details aberrant drug-taking behaviors that the doctor should look for.
  5. The NIH reported that a combination of two drugs can selectively block pain-sensing neurons in rats without impairing movement or other sensations such as touch. The study used a combination of capsaicin and a drug called QX-314. According to researchers, this may lead to future breakthroughs for treating chronic pain.
  6. According to the results of a recent study presented at the American Society of Anesthesiologists 2007 Annual Meeting in San Francisco, pediatric pain management strategies that focus on improving and restoring a child and their family’s quality of life are proven to be the most effective and realistic.
  7. Researchers at the University of Iowa are developing a system to help children better cope with pain during difficult medical procedures. The research team developed software that advises nurses as to the best way to distract children from the procedures that cause pain.
  8. Among the panelists at the American Academy of Pain Management’s 18th Annual Meeting was Myra Christopher, President and CEO of the Center for Practical Bioethics. Her panel discussed the ethical issues in the treatment of nonmalignant pain, including the apparent discrimination among groups in treating pain as well as the legal side of treating pain and the responsibility of the physician. Fellow panelists included Jennifer Bolen, former Assistant U.S. Attorney with the Department of Justice, and Dr. Doug Gourley, anesthesiologist at Wasser Pain Management Centere at Mount Sinai Hospital in Toronto.
  9. The October issue of the Journal of General Internal Medicine published a study evaluating the accuracy of the numerical rating scale (NRS) as a screening tool for pain in primary care patients. Researchers found that the tool demonstrated only modest accuracy and suggested that it might be necessary to structure questions that rate a patients’ pain for a full day or week rather than limiting it to the current experience.
  10. The Los Angeles Chronicle published an article titled “Pain - The Myth of the Weaker Sex.” The article discussed the research showing that some drugs produce greater pain relief in women than in men, but that common pain relievers do not work as well for women.
  11. Duke University’s Dr. T.J. Gan presented a paper at the American Society of Anesthesiology that reviewed multiple studies of the effectiveness of acupuncture. Although determining that most of the studies were not well conducted, he and his colleagues did find that acupuncture reduces the need for opiates, the incidence of nausea and vomiting, and respiratory depression in post-operative patients.
  12. Researchers at the University of Utah are studying physiological measures related to stress and emotion to better understand pain and how it is experienced differently among patients.

Prescription Drug Diversion

  1. This month, the FDA announced a new initiative to protect the U.S. drug supply by using radiofrequency identification technology. Purdue Pharma also plans to use the technology on bottles of OxyContin to make it easier to authenticate as well as track and trace. The company also plans to tag bottles of Palladone.
  2. As an aid to cracking down on prescription drug diversion, the Waterville, Maine, Police Department will mail a list of people who have been summoned, arrested, or convicted for possession, distribution, and/or sale of prescription and illegal drugs to health professionals in the area. The District Attorney’s office and area police departments will regularly update the list which will include photographs, age, and crime information.
  3. Denver, Colorado, DEA agents are asking for more local police officers to assist them in investigating prescription drug diversion cases. With Colorado ranking second nationally for prescription painkiller abuse, the Denver DEA recently added two more agents to its task force.
  4. The DEA is hosting the first national symposium on prescription drug abuse. The event, “Good Medicine, Bad Behavior: Drug Diversion in America,” will take place on November 2, 2007. A companion exhibit, opening on November 13, 2007, explores the history of prescription drug diversion in the United States and efforts to combat the problem.
  5. The Bucks County, Pennsylvania, Council on Alcoholism and Drug Dependence heard speakers discuss the issue of prescription drug diversion. Speakers noted that about half of controlled substance abusers get the drugs from friends while 20% rely on “pill mills.”
  6. A New Jersey physician, Philip B. Eatough, has been indicted by a federal grand jury on an 11-count indictment charging him with prescribing controlled substances without a legitimate medical purpose and outside the usual course of professional practice. His office manager was also charged.
  7. The Arkansas Democrat Gazette carried an article about the abuse of codeine cough syrup. Mixed with other ingredients, it becomes the street drug sometimes called “purple drank” or “sizzurp.” In 2006, the medicine was the target of at least 13 pharmacy break-ins in Arkansas. An Arkansas doctor, James Miller, has been charged by the Arkansas State Medical Board of prescribing excessive amounts of codeine cough syrup to six patients.
  8. The News and Tribune reported that the theft of prescription drugs from private residences is becoming a significant problem in New Albany, Indiana. According to a spokesman from the New Albany Police Department, it is the fastest growing crime in the town
  9. The grant announcement for developing and enhancing a prescription drug monitoring program has been posted.

Other News of Interest

  1. An article about Colorado’s Butterfly program was the focus of an article published in Stateline.org. Colorado was one of the first states to win a waiver from Medicaid to pay for services outside a traditional hospice program for care for very ill children. Florida also has such a waiver. Supporters of better care for dying children are calling for “concurrent care,” a blend of aggressive treatment aimed at curing disease alongside palliative care. Advocates in Ohio are working towards adopting the program being tried in California that will allow children with a life-threatening illness to receive supporting services through Medicaid without giving up their curative treatments. Actress Melissa Gilbert, president of the board of the Children’s Hospice and Palliative Care Coalition, was the keynote speaker at a three-day conference of the Ohio Pediatric Palliative & End-of-life Care Network. Some are calling for a federal solution instead of requiring all 50 states going through a waiver process.
  2. The current issue of Pediatric Clinics of North America is dedicated to the topic of palliative care for children
  3. The World Health organization has released a guide to help caregivers ease the suffering of people in the advanced states of cancer. The guide is titled, “Palliative Care: Cancer Control Knowledge into Action, WHO Guide for Effective Programmes.” It was launched on the occasion of World Hospice and Palliative Care Day (6 October).
  4. An op-ed in the October 14 issue of the Washington Post has sparked a conversation among bloggers and a responding editorial. Titled “Back Off! I’m Not Dead Yet,” the author complained about the push by hospitals to ask each patient about a living will. The author worries that “dying well” is starting to mean “dying more quickly to save money.”
  5. In “Dignified Death for Severely Impaired Infants: Beyond the Best-Interest Standard,” published in the Journal of Child Neurology, Dr. Pedro Weislader uses the case of a 34 week pre-term infant who had severe and multiple malformations to highlight the issues surrounding determining treatment for such patients. Although the “Baby Doe” federal rules are supposedly the standard, ethicists have argued that the “best interest” standard be used to determine treatment. However, the “best interest” standard is dependent on the values of others and is, thus, prone to bias. Dr. Weislader discussing advocating for ethical treatment based on other standards, such as the right to avoid futile treatment, the right to a natural death, and the right to a life worth living.
  6. A study by the AARP, Valuing the Invaluable: A New Look at the Economic Value of Family Caregiving, found that the contributions of family caregivers are the backbone of the nation’s long-term care system with an estimated economic value, in 2006, of $350 billion.
  7. An article in the New York Times notes that prejudice against elderly gay and lesbian patients exists in nursing homes, assisted living facilities, and among home health care workers. The Journal of Social Work in End-of-Life & Palliative Care’s most recent issue featured an article regarding long-term planning and decision-making among midlife and older gay men and lesbians.
  8. Dr. Ira Byock, a nationally-known author and pioneer in the field of hospice and palliative care, was the speaker at the “Promise of Hope” program, funded by an endowed gift from Jean and Mary Jane Souweine. Dr. Byock’s topic was “The Four Things that Matter the Most,” which is also the title of his latest book.
  9. Newsweek contributing editor and McLaughlin Group panelist Eleanor Clift spoke at the University of Missouri in Kansas City recently. Her speech was part of a partnership between the Carolyn Benton Cockefair Chair in Continuing Education and the Center for Practical Bioethics. Clift spoke about the Terry Schiavo case which she covered while at the same time dealing with her husband’s dying from metastatic kidney cancer.
  10. The Center for Demography and Ecology at the University of Wisconsin has published a working paper titled “Do Older Adults Know Their Spouses’ End-of-Life Treatment Preferences?” The researchers found that spouses often picked their marital partners’ preferences incorrectly, projecting their own preferences onto their spouses.
  11. Several news outlets reported the findings of new research in the Journal of Pain and Symptom Management which reported a racial gap among patients who are suffering from non-cancer illnesses in choosing hospice care. MSNBC carried a story about the research findings as did Scientific American and the Detroit Free Press.
  12. An AP report noted that hospices are a growing venue for drug trials. There is a growing interest in clinic research for dying patients who have unique medical needs; however, there is little information as to how to best meet these needs. The article includes a discussion of the ethical considerations at play in using the sickest of patients as test subjects for experimental drugs.
  13. Two physicians were recently recognized for their work in pain and symptom management. Dr. Kathleen Foley of Memorial Sloan-Kettering Cancer Center and Dr. Perry Fine of the University of Utah School of Medicine received the Josefina Magno Excellence in Education and Leadership Award. The award recognizes contributors to the advancement of palliative care, the science of pain, and symptom management.
  14. The October 10 issue of the Journal of the American Medical Association contains a review of a new book, Choices in Palliative Care: Issues in health Care Delivery.

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