“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
As everyone knows, we are in the midst of a horrific opioid addiction epidemic. Physicians are prescribing opiates for pain relief, and patients are becoming addicted to them.
One-fifth of patients who receive an initial 10-day prescription for opioids will still be using opiates a year later.
That is simply extraordinary.
Physicians are prescribing opiate formulations that are highly addictive. But they do not need to do that.
There are several newer formulations that relieve pain and are far less addictive than older agents. But they are prescribed uncommonly. Why is that?
It is not because physicians are uninformed.
It is because payers will not pay for the alternatives. The less-addictive opiates are more expensive, so payers have declined to support them. Patients get addicted because paying for highly addictive opiates saves the payers money.
The New York Times also noted that the treatment of opiate addiction is expensive. It is far cheaper for payers if physicians continue to prescribe opiates than if physicians enrolled a person into a drug addiction program.
What does that look like? Patients get more prescriptions for opiates instead of getting the help they need.
The Payers Are in Charge
If you are looking for someone to blame for the opioid epidemic, you can certainly blame physicians. You can blame pharmaceutical companies. But while you are at it, don’t forget to include payers.
This conclusion should not be surprising. We live in a world where payers — not physicians — determine what drugs and treatments patients receive.
If patients have a life-threatening condition, it is not unusual for a payer to demand that a physician first prescribe a cheaper and less effective alternative. Physicians know that the drugs they are allowed to use may not work very well, but frequently, payers demand that they be tried first anyway.
What happens if the patient doesn’t respond to the cheap drug?
Often, the physician continues to prescribe it, because — to gain access to the more effective drug — physicians need to go through a painful process of preauthorization. For many practitioners, it isn’t worth it.
Don’t patients eventually get the drugs that they need?
No. All too often, physicians stop trying. Or patients get frustrated and give up. Often, payers says “No!” no matter how many times they are asked. And if the drug is for a life-threatening illness and enough time passes by, then the patient may no longer be alive to demand that they get the right drug.
So we spend more for healthcare than any other country in the world, but Americans do not get the care they need. There is a simple reason. Treatment decisions are not being driven based on a physician’s knowledge or judgment. They are being driven by what payers are willing to pay for.
How many people are affected by all of this?
Everyone.
That includes me and my family. That includes everyone that I know.
Medicine has made incredible progress in the last 20-30 years. But you are not likely to benefit from it.
Do you want to blame the high cost of drugs? You can do that, but if you do, you will be missing the point. We should expect better drugs to be more expensive than less effective ones. But we do not expect to have a company decide that we will get the inferior drug simply because they want to make a profit.
Are payers the leading cause of death in the United States? If you think this is a crazy question, please think again.
I wonder why no ones does a survey on people who are diagnosed with other chronic conditions (high blood pressure, A-Fib, Diabetes, High Cholesterol and started on medication and they are still taking that same, similar or more medication a year later ?
Should those people treating those conditions with medications a year later be considered “addicted” to those medications ?
They claim that there are 250,000 – 400,000 /yr deaths from medical mistakes… how many end up being chronic pain pts from a medical mistake that does not cause a death.
Not everyone moves from being pain free to dealing with acute pain that can be healed and resolved.. all too many make a quantum leap from being relatively pain free to being in 24/7 intractable chronic pain.
Those that have an AGENDA about the use/abuse of opiates seems to omit or overlook certain FACTS that doesn’t serve their AGENDA..
Mississippi’s proposed regulations intended to curb the opioid crisis aren’t final, but some doctors have already started drug testing patients — the cost of which can fall on the patient.
And it’s not just patients on opioids being tested. The proposed regs also cover benzodiazepines like Xanax, Klonopon, Valium and Ativan, used to treat anxiety disorders, insomnia and seizures.
Benzodiazepines are present in roughly one-third of opioid overdoses, which are killing nearly 100 Americans a day, and the combination of the two is particularly dangerous.
While the medical community grapples with shifting attitudes surrounding the prescription of benzodiazepines, some question the burden new regulations might pose for the 264,895 Mississippians currently prescribed these addictive drugs.
Before prescribing routine medication, MEA Medical Clinic in Jackson charged a patient $57 out of pocket for a drug test conducted by a contract diagnostic company, LabCorp, in January.
This is despite the fact the State Board of Medical Licensure is still drafting the new regulations.
As proposed, the new regulations only require physicians any time they write a benzodiazepine prescription to conduct a point-of-service urine drug test — which does not require diagnostics from an outside lab like LabCorp.
The latest draft of the regulations would also require patients prescribed benzodiazepines to visit their doctor every four months (at first it was every 90 days), at which point staff must check the Mississippi Prescription Monitoring Program.
MEA Primary Care Plus Medical Director Gene Loper told the Clarion Ledger that MEA headquarters has not given physicians any directive to begin drug testing patients on benzodiazepines, so individual physicians doing so have chosen to do so on their own.
The $57 the patient was charged for the drug test in January is in line with what MEA has estimated it will cost to comply with new regulations, Loper said.
“I don’t think that’s what the licensure board intended for this to be, but that’s the consequence of it,” Loper said. “It’s a monetary expense to the patient. We don’t want our patients to incur that but we don’t have any direction on this.”
Licensure board member Dr. Randy Easterling said the drug test is necessary because the prescription monitoring system only goes so far. Someone could be getting drugs from the street, which wouldn’t show up as a prescription.
“If they’re on benzos chronically, you don’t know that they’re not on opioids unless they’re tested in some way,” Easterling said.
A September report from QuestDiagnostic, a contract laboratory and diagnostic service, shows over half of Americans misused their prescription medications between 2011 and 2016, according to an analysis of 3.4 million prescription monitoring lab tests.
Of 33,000 samples tested for opioids and benzodiazepines in 2016, over one in five tested positive for the risky combination.
But the cost of the drug test, and who’s responsible for paying, illustrates the complexity of the current health care landscape. Add in each doctor’s interpretation of rules and how they implement them, and the impact on the patient can vary greatly.
Cost variation
The clinic where Easterling practices pays $3.85 for a point-of-service urine test that screens for 10 to 12 drugs. But the clinic charges insurance companies $50, and Blue Cross Blue Shield, for example, agrees to pay $14.
“This is routine in medicine,” Easterling said of overcharging insurance companies only to accept a much lower payment. “It doesn’t make any sense.”
There is some overhead considering the time it might take a patient to take the test and the staffing required to read it, but even at the $14 insurance rate, the clinic takes in 73 percent.
Even if patients paid $15 for each test, amounting to an extra $45 a year, Easterling said it would be a small price “if doing this helps prevent some people from dying.”
QuestDiagnostic charges $250 for a nine-panel, point-of-service drug test. The cost of “confirmatory” drug testing, not required by the proposed regulations, is significantly more expensive because it requires additional diagnostics. At Quest, the cost shoots up to $769.
Medicaid pays for medically necessary drug tests at rates ranging from $72 to $228. It does not cover over-the-counter drug tests like the ones that would be required under the proposed regulations.
The proposed regulations do not include specific directions on which urine drug test to use, but require they test for, “at a minimum, for opioids, benzodiazepines, amphetamines, cocaine and cannabis.” Inpatient and hospice treatment is exempt from the drug test requirement.
Loper said MEA is still trying to determine whether an in-house drug test will satisfy proposed regulations or if they will have to send it off to a lab at a greater cost.
“Those are things that, quite frankly, I think need to be worked through that have not been worked through with some of these proposals out there right now,” Loper said.
For anyone charged significantly above the cost of the $5 drug test, licensure board President Dr. Charles Miles said: “I would encourage them to ask why it’s so much.”
Questions about the variations in health care costs aside, some private practice psychiatrists are concerned their offices are not equipped to conduct urine testing.
Miles said the point-of-service test amounts to “putting some urine in a cup, shaking it around and writing down what it tells you.”
Beyond logistical issues, others are worried folks seeking psychiatric treatment might be deterred from seeing a doctor if they know they will be drug tested.
Confusion, misinformation
The proposed regulation changes have caused anxiety among the medical community and prompted what some call an overreaction from physicians.
“I’ve had people come to me — they have been to other doctors — because all of a sudden they’ve been cut back on their ADHD medicine because of what’s coming down,” said Jackson psychiatrist Dr. Richard Rhoden. “People are worried about their licenses — that’s their career, their livelihood. So what’s going to happen is some doctors are not even going to take these patients.”
But the proposed regulations don’t make any changes to the prescribing of amphetamines or other types of ADHD medication — that’s just another misconception.
Lawmakers did introduce House Bill 131 and Senate Bill 2817 this session requiring doctors to check the Mississippi Prescription Monitoring Program before prescribing a large swath of medication, including cough suppressants like codeine. The bills died without any fanfare.
The board has said repeatedly that it is not trying to prohibit opioid or benzodiazepine prescriptions, as long as they’re prescribed appropriately and in a way that identifies if they’re being abused.
What’s more, nothing in the proposed regulations requires doctors to cut off patients using these medications.
Much of the public controversy surrounding the licensure board’s action is less about attempts to curb overprescribing and more a result of widespread confusion and misinformation about the state’s approach to addressing the opioid crisis — like conflation between the regulations and state statute.
Mississippi law enforcement agencies have been involved in addressing the epidemic, but regulations by the Medical Licensure Board are not laws. They are rules physicians must follow or risk losing their license. The rules only apply to physicians licensed by the board, not other prescribers like dentists.
No bills to change the state statute regarding the prescription of painkillers or anxiety medication remain alive this session.
Cousin Xanax
Dr. William Rosenblatt, who called Xanax the “first cousin” of opioids, said when he came to Mississippi from New Hampshire, he was surprised at how often doctors here prescribe benzodiazapines — 1,312,976 prescriptions written in 2017.
“The question people don’t seem to be asking is why is this number of people on benzodiazepines?” he said. “Let’s not forget that benzos are not first-line drugs for anxiety or insomnia.”
Rosenblatt said he sees patients everyday who have been taking Xanax and were never told of its addictive nature or even about alternatives.
“They often greet me with open arms when I tell them there are other options,” he said.
If the new regulations should accomplish anything, Rosenblatt said, it’s to get doctors to think twice when prescribing benzodiazepines and consider alternatives like anti-depressants.
Of course, Rosenblatt said, some people with severe anxiety and panic disorders will benefit from remaining on drugs like Xanax, but those make up a small percentage of the more than 250,000 Mississippians on them now.
Rosenblatt also said the proposed regulations present no more of an inconvenience than what many ADHD patients currently face. (Some doctors choose to drug test patients prescribed Adderall or other amphetamines to ensure they’re taking their medication, though it’s not required by the regulations).
“Until we get rid of that (overprescribing) situation and figure out how to appropriately treat anxiety disorder, I don’t think we can then talk seriously about the inconvenience of a drug test,” he said.
The proposed regulations don’t specify how doctors are to move forward if a patient’s drug test comes back positive for other potentially harmful medications, to much consternation from doctors. Miles said it’s supposed to prompt a conversation.
“I can sit down with someone if the drug screening shows a combination of drugs in their urine that could be lethal. I’d say what have you been on that I haven’t known about. Let’s talk about what medication you’re on,” Miles said. “You can’t stop anybody from being on it, but if you don’t know they’re on something, you can’t sit down.”
As Summit County’s drug overdose numbers continued to hover around 25 or 26 per week in January, a yearlong U.S. Senate probe revealed what Akron narcotics detectives already knew: fentanyl and carfentanil are coming here from China through the U.S. mail.
The potentially deadly drugs are often as easy to order online as a book.
But Akron drug dealers don’t have the synthetic opioid delivered to their own doors, narcotics investigators have said. They have the packages shipped to nearby vacant houses, hoping to make it more difficult for detectives to trace who may be receiving the shipments.
U.S. Senator Rob Portman — who pushed for legislation in 2016 that would force the postal service to track international packages — chaired the probe by a Senate Homeland Security and Government Affairs investigations subcommittee, which released its findings last week.
The federal investigation began simply by Googling “fentanyl for sale.”
Over coming months, investigators posed as first-time buyers and discovered international sellers of fentanyl and other drugs preferred to be paid through cryptocurrencies like bitcoin, but would accept PayPal, credit cards and other payments, too.
Investigators never followed through with purchases, but did subpoena payment information to find out who in the U.S. had purchased from the websites they had found.
They discovered people from 43 U.S. states bought the drugs, mostly in Ohio, Pennsylvania and Florida.
The synthetic opioids purchased had an estimated street value of $766 million.
Among them, Portman said last week, was a man near Cleveland who paid $2,500 over the course of 10 months to an online overseas seller for 18 packages.
The man who received the drugs died of a fentanyl overdose in early 2017, Portman said.
He was 49.
The average age of those who overdosed in Summit County between Jan. 19 and Jan. 25 was 40.2.
Most of those — about 54 percent — were men.
Portman and other senators introduced legislation in 2016 requiring the U.S. Postal Service to collect electronic data to track international packages.
But the U.S. Postal Service and State Department at the time said some countries would have trouble complying with the technology.
Portman, armed with new information from the investigation revealed last week, is pushing again.
Last year, he said the Postal Service received electronic data on about 36 percent of the more than 498 million international packages coming into the U.S.
“How many more people have to die before we keep this poison out of our communities?” Portman asked aloud last week at a hearing to discuss findings of the U.S. Senate investigation.
“Yes, the Postal Service is in desperate need of comprehensive reform,” Portman said. “But it is shocking that we are still so unprepared to police the mail arriving in our country.”
This chart is suppose to be based on DATA from the “all-knowing – always right” CDC..
opiate prescriptions in 2016 where at about the same level as 2006 ..maybe slightly DOWN..
and the number of OD’s almost DOUBLED in the same time frame.
They claim that there is 100 million chronic pain pts… reality is that we probably have between 20 – 30 million mod-severe chronic pain pts that are in need of opiate therapy 24/7 and are opiate dependent to maintain the best quality of life they can.
Best practices and standard of care suggests that pts with this level of pain should be provided both a long acting opiate and a short acting (immediate release) opiate for breakthru pain.
that would encompass these pts getting 24 Rxs/yr..
multiple 30 million by 24 and you get 720 million prescriptions… and currently the graph shows our country is currently filling/dispensing about 215 million opiate prescriptions.
So it would appear that we are coming up a “little short” on what could be considered the proper treatment of pts with mod-severe pain.. The other estimated 70 million may be able to get by with using a NSAID and/or “some” opiates and there is still “NONE” for those pts with acute pain and/or surgically induced pain.
So the DEA is cutting opiate production quotas in 2018 .. for the THIRD YEAR IN A ROW and it would appear that production quotas on the major opiates will be abt 50% lower in 2018 than they were in 2015.
Does this suggest that the CDC/DEA is from Venus and the rest of the healthcare system is from Mars ?
Does these numbers suggest that there is gross DENIAL OF CARE of those with chronic pain… and perhaps … the amount of denial is still INCREASING.
Louisiana’s elected officials seem determined to write the wrong prescription to combat opioid abuse.
Tracking the rest of the country, Louisiana has seen a sharp escalation in painkiller usage over the past few years and deaths associated with it. Worse, this has accelerated faster than in most states, in 2016 resulting in an age-adjusted opioid mortality rate of about 22 per 100,000 Louisianans, ranking Louisiana about in the middle of the 50 states.
In response, Louisiana has sued opioid manufacturers, although Gov. John Bel Edwards and Atty. Gen. Jeff Landry are sparring legally over which of their offices will oversee that litigation. Additionally, a number of parishes, including Lafayette, and cities, including Baton Rouge, have also pursued legal action.
The suit filed by the Edwards administration last year alleges manufacturers intentionally misled consumers about risks and pushed pain products to spur greater profits, causing greater health and public safety costs for taxpayers. The Baton Rouge suit makes the same claim and goes after distributors as well, faulting them for insufficient monitoring.
In reality, government policy and its blindness to the true nature of the problem has led to misunderstanding of the crisis. And that has fed a jackpot-justice mentality that distracts from an effective response.
Only about 1 to 2 percent of individuals taking prescribed opioids experience addiction, and in clinical settings — a hospital, for example — deaths from overdose occur at minuscule rates of 0.02 to 0.2 percent. Numerous data sources confirm that opioid addictions and deaths occur overwhelmingly among people already abusing other substances or who suffer from psychological difficulties, or both. Further, these overdoses usually involve other addictive, controlled, or banned substances.
So, the problem is not a flood of opioids pushed by pharmaceutical companies and brokered by uncaring sellers hooking drug-naïve individuals. The issue is one of easier, typically illicit, access to drugs that feed the addiction of people who are already veterans of illegal drug use.
Worse, recent state policy decisions seem to have facilitated this abuse.
A growing body of evidence indicates Medicaid expansion has made opioids much more readily available on the black market. A report released last month from the U.S. Senate’s Homeland Security and Government Affairs Committee reveals how Medicaid drug fraud cases increased significantly after expansion began in the states; expansion states disproportionately registered these higher numbers, and overdose deaths rose about twice as fast in expansion states.
The data is consistent with increased usage mainly by experienced abusers of multiple drugs who skirt the law; that population in Louisiana faces elevated risk. Six months after the Edwards administration initiated Medicaid expansion in 2016, the state registered one of the highest ratios nationally of opioid prescriptions per resident, at almost 1:1.
Given this situation, clamping down on fraudulent prescribing and underground sales would best alleviate the epidemic. Yet, as Advocate columnist Dan Fagan recently recounted, even with a skyrocketing quantity of criminal complaints lodged with the state about Medicaid fraud, the Edwards administration has resisted pleas to budget more money dedicated to fighting the problem.
Instead, Edwards and local officials would rather fleece presumed bogeymen in lawsuits that have a better chance of padding government coffers and enriching trial lawyers than in significantly curtailing painkiller-induced abuse and deaths. Even Landry, who showed proper circumspection at this strategy of legal action when the administration first filed suit — perhaps because of Edwards’ aggressiveness — has ramped up efforts in this regard.
To tackle this problem, state government should reverse Medicaid expansion and use those savings to expand fighting Medicaid fraud and criminal activity involving opioids and focus on treating existing addicts. Local governments should target illegal drug trafficking. All should drop dubious lawsuits banking on big paydays that actually don’t provide a real solution.
WHITE SULPHUR SPRINGS — A congressional committee chairman investigating how drug companies dumped millions of painkillers into small-town pharmacies around the country said he’s facing resistance from within the executive branch.
Rep. Greg Walden, R-Ore., said Friday at a GOP congressional retreat at The Greenbrier resort
that authorities like the Drug Enforcement Agency are not cooperating with his committee’s investigation.
“I’m very frustrated with the DEA, very frustrated with the Department of Justice,” he said. “I’ve threatened to issue subpoenas to get to the bottom of it. They’re cooperating more right now than they were prior to that threat. But we will not stop until we know what the heck is going on.”
The comments came in reference to reports from The Washington Post and CBS regarding the pharmaceutical industry’s influence in advancing favorable legislation in Congress and stifling lawsuits from the DEA.
A DOJ spokesman did not respond to an email and phone call regarding Walden’s remarks.
Walden is the chairman of the House Energy and Commerce Committee, which is investigating pill dumping into West Virginia. The committee recently sent a letter to drug wholesaler Miami-Luken, asking why the company didn’t flag shipments of nearly 21 million painkillers sent to Williamson, a town of 2,900 people, over 10 years.
The committee sent a similar letter to H.D. Smith regarding a “possible oversupply” of drugs into stores like Family Discount Pharmacy, in Mount Gay-Shamrock. Citing DEA data, the letter asked if the company internally investigated its disbursement of 1.1 million hydrocodone pills into the pharmacy, an 1,880 percent increase from the year prior, for a town of roughly 1,800 people.
Both letters cite an investigation from the Charleston Gazette-Mail regarding massive shipments of opioids into West Virginia and joint investigations between The Washington Post and “60 Minutes” on the pharmaceutical industry’s political influence.
In looking for a legislative fix to the substance abuse problem, Walden said he and other Congressmen have asked the DEA and the DOJ for guidance and have not been hearing back. He said he hopes the investigation prompts action to curb the flood of opioids infiltrating small towns.
“We have solicited information from the distributors; we are evaluating that information,” he said. “Suffice to say, when 780 million hydrocodone and oxycodone pills come into West Virginia in six years, something is off the tracks, and people are dying as a result.”
Walden said, along with the investigation, the committee has been taking suggestions from its members for a piece of proposed legislation to handle the matter. The committee is scheduled to start drafting a bill in late February. He said there is also a possibility it would recommend criminal charges to the DOJ, if appropriate.
Though he hails a long way from Greenbrier County, Walden said the committee has taken a keen interest in West Virginia due the state’s legal history of prosecuting opioid wholesalers.
“Part of why West Virginia is a focus, by the way, is not only the damage we’ve seen, but also because the court cases and convictions that have occurred here open a window into what really happened here, which helps us go look at Ohio or Oregon or elsewhere,” he said.
In 2012, then-Attorney General Darrell McGraw filed lawsuits against more than a dozen drug wholesalers, including Miami-Luken and H.D. Smith. The lawsuit alleged that the companies’ shipments helped fuel the prescription drug problem in West Virginia. The distributors settled the lawsuits for a combined $44 million during the past two years, while admitting no wrongdoing.
Reps. Evan Jenkins, R-W.Va., and David McKinley, R-W.Va., joined Walden for the conference Friday.
Jenkins cited the letters, which named small towns across his home district. He said he will offer any help he can from his seat on the House Appropriations Committee to help rein in the problem.
“One of the root causes is just the flood of the opioids, the oxycodones and the hydrocodones that flooded into the pharmacies,” he said. “There needs to be accountability. The wholesalers, the distributors, the manufacturers, the dispensers need to be held accountable. The numbers are stunning, and the numbers have to stop.”
McKinley, who sits on the Energy and Commerce Committee, spoke as well. He said a lot of the opioid crisis comes from a divide between rural America at large and Washington, D.C.
However, he said it’s important for the committee to keep finding facts and building a three-dimensional understanding of the issue, including its causes and its byproducts.
“We’ve got a plan. We’re following our lead; we’re following our process, as slow as, unfortunately, it may be sometimes. We follow the process. We’ll come out with a good result,” he said.
Mentioning the committee’s past success investigating corporate wrongdoing with Enron and others, Walden said the committee will get the job done, but it will take time.
“This is what we do,” he said. “But we do our investigation first. We get the facts, and then we make decisions, whether it goes to the Department of Justice or results in legislative change. But let there be no mistake about this: We are on this, and we will not stop until we get the facts.”
For a Monday reporting deadline, Art Levine, a freelancer for Newsweek, Yahoo News and other publications, is looking for on the record or-or off the record interviews, with clinicians or patients about cardiac surgery patients — without a history of opioid use– denied opioids after surgery; he’s been told that’s happening, but doesn’t have any interviews confirming it. Also, he’s looking for a direct interview with a cancer patient without a history of long-term opioid use being denied opioids for pain. He can be reached via DM, Twitter at @ArtL7 or on facebook, at https://www.facebook.com/ArtLDC. His article’s primary focus is focused on chronic pain patients’ suicides and harm from the draconian cutbacks, and here’s a sample of his earlier writing on the topic: http://www.newsweek.com/va-opiod-policy-wreaks-havoc-former…
FYI I have been working with Art and some other advocates and doctors he interviewed me and others. I cannot wait to see what he writes. He has put a lot of time into this so if you know anyone who meets these criteria PLEASE contact him, Thanks, .
When a jury decided three years ago that a Utah care facility should pay nearly $1 million to the family of a patient who died after a nurse mistakenly gave him the wrong medicine and then concealed her error until it was too late to save him, both parties in a wrongful-death suit were unhappy with the verdict.
Jurors determined that the nurse was not acting in the course and scope of her employment when she hid her mistake and therefore, Provo Rehabilitation and Nursing was not vicariously liable for the concealment. The jury allocated 65 percent of the fault for patient Jack Adams’ death to the initial error and, as the nurse’s employer, the nursing home was ordered to pay $910,000 of the approximately $1.4 million damage award, plus court costs.
But lawyers for the man’s relatives contended that knowledge of the concealment should be ascribed to Provo Rehab and that it should pay the full award.
On the other side, Provo Rehab’s attorneys argued the plaintiff had failed to produce sufficient evidence that the mistake itself — rather than the nurse’s concealment of the mistake — caused Adams’ death and that the trial judge should have entered a verdict in favor of the care facility.
Both parties appealed and now, the Utah Court of Appeals has sided with the family, ruling that Provo Rehab must pay the entire $1.4 million award.
In a 3-0 opinion handed down last month, the court noted that as with all corporations, Provo Rehab can act only through agents, be they officers or employees. Under the law, the general rule is that the knowledge of agents concerning the business they do for the employer is imputed to the employer, according to the decision.
So, the opinion says, all of the nurse’s knowledge that was material to her work for the nursing home, even facts she did not share with others, “is automatically imputed to Provo Rehab.” And the conclusion that the facility had constructive knowledge of the mistake means there could not have been concealment, the opinion says.
Writing for the court, Judge Ryan Harris said that in the absence of concealment, “we have no trouble concluding that the expert medical testimony presented at trial was more than sufficient to establish that the Medication Error was a proximate cause of Adams’s death.”
The family’s attorney, Brad Parker, applauded the decision and compared the case to a situation where a grocery store employee sees a puddle of water on the floor. If the employee doesn’t tell the manager, that does not relieve the employer of liability if an innocent customer slips and falls, he said Friday.
Stephen Hester, an attorney who represents the nursing home, said Provo Rehab will appeal to the Utah Supreme Court. He said the concealment occurred outside the course and scope of the nurse’s employment, and that the concealment, not the error, caused the death.
“It eliminates an employer’s ability to defend itself in these circumstances” Hester said of the ruling, adding that an employer is entitled to defend itself when it has a rogue employee.
On Feb. 8, 2010, Jensen worked a six-hour swing shift as a licensed practical nurse at Provo Rehab. On a previous occasion, a narcotic pill ended up unaccounted for at the end of her shift and she had been told she would be fired if a similar incident ever occurred again, the opinion says.
At about 8 p.m., Jensen began a “medication pass,” walking down a hallway with a movable cart that held medicine she needed to administer. When she got to Adams’ room, the nurse made a crucial mistake: She mixed up his identity with that of another resident, the opinion says.
Jensen gave Adams three narcotics that had been prescribed to the other resident, according to the opinion.
A few minutes later, Jensen realized what she had done, and decided to conceal the mistake, the opinion says. She gave the other resident Adams’ less-potent medications and falsified medical records so they indicated both had been given the proper medicine.
Jensen later testified that at the time she did not think administering the incorrect medications would harm either man.
The nurse’s decision to hide what happened deprived Adams of an opportunity to be saved by the administration of another medication — known generically as naloxone — which will almost always reverse the effects of a narcotics overdose, the opinion says. The 71-year-old Spanish Fork resident was discovered not breathing the next morning and taken to a hospital, where he died two days later on Feb. 11, 2010.
The opinion says that at the time of his death, Adams had been at Provo Rehabilitation for 11 months for treatment for a number of medical conditions, including congestive heart failure and diabetes.
A retiree who had worked for Amoco, Adams enjoyed being with his family and tending to his roses, according to his obituary. He had celebrated his 50th wedding anniversary a few months prior to his death.
“Jack had a contagious laugh and was loved by all who knew him,” the obituary says. “He was a wonderful person with a honest integrity. He is known as a true gentleman and had a way of making everyone around him feel special.”
Jensen told her employer about the medication mistake after Adams’ funeral, according to a news release from the family’s attorney. Adams’ wife, Verlo Jean Adams, and daughter, Shaunna Lane, filed the wrongful-death suit in 4th District Court in December 2010. The widow died in 2011.
I am not sure what legal decisions set precedents and what won’t, but this is a interesting conclusion to a death that may have been caused by both a medical error – giving a pt the wrong medication – and the nurse covering up the error. Does this have applications to health care corporations (insurance companies, hospitals ..etc..etc ) where the employee is following the corporation’s policies and procedures in regards to how many opiate a prescriber may give to a pt or prohibit the prescriber from providing opiates to any/all pts.
How this decision may impact the ability of pts and/or get the interest of law firms that wish to go after the “deep pockets” of these corporations for violating various discrimination laws and deterioration of the pt’s quality of life and/or inability to do many daily self-care functions that they were able to perform before their pain management meds were reduced or taken away.
eeeeHi Steve I saw an older post to send you info on pain management doctors cutting patients meds. I was a pain patient with this office for 11 years Dr. Roger B. Stephens in Sacramento, Ca. Dr. Stevens retired many years ago & the other doctors Dr.Kim & Dr.Leano took it over but the name remains on the door. Dr. Kim & Dr Leano both prescribed for me for the last 11 years I was considered a model patient never any problems ever in 11 years until recently. I was abandoned at my last monthly apt. looking back at how the visit played out & how it all went it was pointed out to me it was most likely planned to happen. Anyway I requested my sudden forced rapid taper they were ignoring the negative effects already happening to me I still was going to be forced to continue regardless of what happened to me. Per usual the excuse we always disagreed on was used & blamed on the CDC guidelines one size fits all dose excuse everyone was being taken down to & was being used to justify my medically unnecessary taper & torture no matter how much what they were doing was wrong & killing me even though they agreed with me repeatedly at many many many visits this shouldn’t be done & they used to fight to keep my meds no longer. My forced taper was was also blamed on the third party provider, drug addicts, societies opinion & the CDC guidelines all were used as the reason for my pain meds being forced to reduce against my will & my families wishes all was ignored & finally at my last apt. I was released after asking for a temp stall in tapering or at least a slow down on the dose amount of the tapering asking why I suddenly went from tapering by only one 30 mg. tablet a month to now I was to be reduced by 80 % to almost 90% of medications I took for 2 decades successfully. I never was given an answer except for the third party provider doctor said so & had dictated I had to be reduced rapidly in just 3 to 4 months down to the CDC max. dose no changes it was in stone . I had been slowly tapering for almost a year after a forced med change & severe dose reduction I had been reducing by 1 30 mg tablet a month & then suddenly it was to be all done in just weeks without any explanation why it must be sped up I was truly afraid for my life that this would kill me. I was terrified to be returned to pain I hadn’t felt without pain relief in 20 years & didn’t think I or my body would survive it. To be returned to basically no effective meds & all that pain was going to be even worse then ever before because now I know the benefits of pain being relieved & was so afraid I wouldn’t survive my body would fail or I wouldn’t be able to cope with it. So anyway she gave me my 30 day script a one sentence letter saying we didn’t agree on my treatment so she wouldn’t treat me any longer & she also gave me list of other pain doctors in the area. The same doctors she had spent the last year threatening me with them that they would treaty me worse then her when she would justify her actions and cancelled my apts. & would not see me again.
When a pt has their meds reduced or stopped generally they move from just being “handicapped pt” to a “non-functioning handicapped person” and the whole family suffers from the action of the prescriber. This posts deals with the potential consequences for the prescriber for the harm done to “the family” the last thing that the prescriber would be expecting is to be sued by the family for loss of companionship…
I wonder why no ones does a survey on people who are diagnosed with other chronic conditions (high blood pressure, A-Fib, Diabetes, High Cholesterol and started on medication and they are still taking that same, similar or more medication a year later ?
