Patient Abandonment

http://www.thehealthlawfirm.com/resources/health-law-articles-and-documents/Patient-Abandonment.html

Home Health Care
______________

Law Manual

Introduction

The relationship that exists between a physician and patient, or between other types of health care providers and the client, continues until it is terminated with the consent of both parties.  A patient having health needs, especially a patient who is disabled or feeble, may be dependant on the home health professional.  The patient has the right to expect that he or she will have access to the services he or she needs until receiving proper notice to the contrary and, preferably, until a substitute is provided.

Such a relationship can be terminated by the patient at any time.  The patient has the freedom to choose his or her health care providers.  However, the physician, nurse, or home health provider may also withdraw from the case as long as it is done properly and the patient is not harmed by this action.

The premature termination of medical treatment is often the subject of a legal cause of action known as “abandonment.”  Abandonment is defined as the unilateral termination of a physician-patient or health professional-patient relationship by the health care provider without proper notice to the patient when there is still the necessity of continuing medical attention. [1]

Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to have a proper civil cause of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of health care was contrary to the patient’s will or without the patient’s knowledge.

3. The health care provider failed to arrange for care by another appropriate skilled health care provider.

4. The health care provider should have reasonably foreseen that harm to the patient would arise from the termination of the care (proximate cause).

5. The patient actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, as well as a legal, duty to avoid abandonment of patients.  The health care professional has a duty to give his or her patient all necessary attention as long as the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for the attendance of another. [2]

Abandonment by the Physician

When a physician undertakes treatment of a patient, treatment must continue until the patient’s circumstances no longer warrant the treatment, the physician and the patient mutually consent to end the treatment by that physician, or the patient discharges the physician.  Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of his or her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship does not terminate merely because a patient’s care shifts in its location from the hospital to the home.  If the patient continues to need medical services, supervised health care, therapy, or other home health services, the attending physician should ensure that he or she was properly discharged his or her-duties to the patient.  Virtually every situation ‘in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient’s ‘needs for care have continued.  The physician-patient relationship that existed in the hospital will continue unless it has been formally terminated by notice to the patient and a reasonable attempt to refer the patient to another appropriate physician. Otherwise, the physician will retain his or her duty toward the patient when the patient is discharged from the hospital to the home.  Failure to follow through on the part of the physician will constitute the tort of abandonment if the patient is injured as a result.  This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician in the hospital should ensure that a proper referral is made to a physician who will be responsible for the home health patient’s care while it is being delivered by the home health provider, unless the physician intends to continue to supervise that home care personally.  Even more important, if the hospital-based physician arranges to have the patient’s care assumed by another physician, the patient must fully understand this change, and it should be carefully documented.

As supported by case law, the types of actions that will lead to liability for abandonment of a patient will include:

• premature discharge of the patient by the physician
• failure of the physician to provide proper instructions before discharging the patient
• the statement by the physician to the patient that the physician will no longer treat the patient
• refusal of the physician to respond to calls or to further attend the patient
• the physician’s leaving the patient after surgery or failing to follow up on postsurgical care. [3]

Generally, abandonment does not occur if the physician responsible for the patient arranges for a substitute physician to take his or her place.  This change may occur because of vacations, relocation of the physician, illness, distance from the patient’s home, or retirement of the physician.  As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient’s special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. [4]  Even where a patient refuses to pay for the care or is unable to pay for the care, the physician is not at liberty to terminate the relationship unilaterally.  The physician must still take steps to have the patient’s care assumed by another [5] or to give a sufficiently reasonable period of time to locate another prior to ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles apply to all health care providers.  Furthermore, because the care rendered by the home health agency is provided pursuant to a physician’s plan of care, even if the patient sued the physician for abandonment because of the actions (or inactions of the home health agency’s staff), the physician may seek indemnification from the home health provider. [6]

ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY

Similar principles to those that apply to physicians apply to the home health professional and the home health provider.  A home health agency, as the direct provider of care to the homebound patient, may be held to the same legal obligation and duty to deliver care that addresses the patient’s needs as is the physician.  Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives.  An ethical obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations. [7]

When a home health provider furnishes treatment to a patient, the duty to continue providing care to the patient is a duty owed by the agency itself and not by the individual professional who may be the employee or the contractor of the agency.  The home health provider does not have a duty to continue providing the same nurse, therapist, or aide to the patient throughout the course of treatment, so long as the provider continues to use appropriate, competent personnel to administer the course of treatment consistently with the plan of care.  From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to attempt to provide the same individual practitioner to the patient.  The development of a personal relationship with the provider’s personnel may improve communications and a greater degree of trust and compliance on the part of the patient.  It should help to alleviate many of the problems that arise in the health care’ setting.

If the patient requests replacement of a particular nurse, therapist, technician, or home health aide, the home health provider still has a duty to provide care to the patient, unless the patient also specifically states he or she no longer desires the provider’s service.  Home health agency supervisors should always follow up on such patient requests to determine the reasons regarding the dismissal, to detect “problem” employees, and to ensure no incident has taken place that might give rise to liability.  The home health agency should continue providing care to the patient until definitively told not to do so by the patient.

COPING WITH THE ABUSIVE PATIENT

Home health provider personnel may occasionally encounter an abusive patient.  This abuse mayor may not be a result of the medical condition for which the care is being provided.  Personal safety of the individual health care provider should be paramount.  Should the patient pose a physical danger to the individual, he or she should leave the premises immediately.  The provider should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as possible.  Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report.  If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies.  The home care provider should also immediately notify both the patient and the physician that the provider will terminate its relationship with the patient and that an alternative provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to determine that it should terminate its relationship with a particular patient.  Examples may include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, by providing illegal drugs or providing non-covered services and equipment and billing them as something else), or consistently noncompliant patients.  Once treatment is undertaken, however, the home health provider is usually obliged to continue providing services until the patient has had a reasonable opportunity to obtain a substitute provider.  The same principles apply to failure of a patient to pay for the services or equipment provided.

As health care professionals, HHA personnel should have training on how to handle the difficult patient responsibly.  Arguments or emotional comments should be avoided.  If it becomes clear that a certain provider and patient are not likely to be compatible, a substitute provider should be tried.  Should it appear that the problem lies with the patient and that it is necessary for the HHA to terminate its relationship with the patient, the following seven steps should be taken:

1. The circumstances should be documented in the patient’s record.
2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.
3. The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter.  A copy of the letter should be placed in the patient’s record.
4. If possible, the patient should be given a certain period of time to obtain replacement care.  Usually 30 days is sufficient.
5. If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter.  The necessity of the patient’s obtaining replacement home health care should be emphasized.
6. The patient should be informed of the location of the nearest hospital emergency department.  The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.
7. A copy of the letter should be sent to the patient’s attending physician via certified mail, return receipt requested.

These steps should not be undertaken lightly.  Before such steps are taken, the patient’s case should be thoroughly discussed with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.

The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment. [8]

Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence ….  [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians.  When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care. [9]

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Florida Supreme Court allows lawsuit against doctor for patient’s suicide

http://www.orlandoweekly.com/Blogs/archives/2016/08/26/florida-supreme-court-allows-lawsuit-against-doctor-for-patients-suicide

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My Story: What About Our Rights?

nationalpainreport.com/my-story-what-about-our-rights-8830709.html

By Douglas Marsh

I believe that one of the worst things that our wonderful government has done is target a group like the chronic pain community. For the most part, we are a group of people who at one time in our lives were active and very productive members of society, then one day our lives as we knew them all ended. Now we sit at home blogging and talking on social media about all the injustices we are experiencing. Their outright blatant attacks against all of us and the doctors who treat us with opiates have created an entire demographic of people who are been openly and publicly discriminated against by pharmacies, doctors, nurses, public interest groups, politicians, government agencies and the national news media. This has all been an unforgivable violation of our human and civil rights by our government and the news networks media icons like Anderson Cooper.

It’s our duty as the oppressed to stand up for ourselves and make our voices heard. Medgar Evers, Malcolm X and Dr. Martin Luther King opened the door for everyone’s civil rights and then others like Harvey Milk extended the fight for other groups. Every single one of these people fought against not only the odds, but also public opinion.

The Civil Rights movement of the late 50s through the mid to late 60s ended up becoming the Rainbow Coalition under the leadership of Reverend Jesse Jackson. This group became a very important player in the nation’s elections.

These are just a couple of examples how an oppressed and discriminated against group can become very important in the election process. This is why and how we should make our points to the elected officials and those campaigning for their offices.

The day will come when the Chronic Pain Community will be a deciding factor in the election process of State and Federal government officials. It has become our responsibility to create our own future by not just casting our votes, but by becoming a force to be reckoned with. I am putting a call out to all my pain riddled brothers and sisters to contact every candidate running for offices in your area, both new and incumbents. Ask them the questions that are important to us as a community like the legalization of Marijuana and the fair treatment and humane treatment of pain suffers with the use of opiates. Find out and share the answers to these questions on social media and the National Pain Report to let our fellow pain suffers know who should be our candidates.

Believe it or not, a day will come when our actions and influence will become huge in determining who will be elected. A day will come when our opinions will be asked on the National News on who the Chronic Pain Community is going to endorse in elections. Finally, the day will come when real funds are given for proper research and development of safe drugs and therapies for treating and eradicating Chronic and Disabling pain.

This movement could decide a new mindset and also change a lot of ways that business in the United States is conducted, just as the Rainbow Movement did with AIDS research and the Civil Rights Movement did with corprate hiring and voting rights among minorities. Just maybe we could change work place safety procedures to avoid accidents and injuries along with more in-depth medical training to further avoid errors and failed medical procedures.

I am truly sorry to make this a history lesson, and I do know that I can be very long winded at times. But I honestly believe that if all this is done in the same ways that these other movements were done, our cause just may open the nation’s eyes to the discrimination that every single one of us has experienced.

Douglas Marsh is a 50 years old pain patient who lives in southwest Louisiana. He and his wife Pam recently celebrated their 11th anniversary. He just joined the US Pain Foundation and is looking to become a much active advocate for pain patients.

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https://youtu.be/dm6xexu_wJY?t=3m32s

Ohio sheriff indicted on 43 counts, including 38 felonies

Sheriff running for reelection

http://www.wlwt.com/news/ohio-sheriff-indicted-on-43-counts-including-38-felonies/41346780

FREMONT, Ohio (AP) —An Ohio sheriff who is up for re-election this fall has been arrested on charges that he stole medications from prescription drug disposal drop boxes, deceived doctors into giving him painkillers and misused department funds.

A grand jury indicted Sandusky County Sheriff Kyle Overmyer on six felony charges in a 43-count indictment released Tuesday night.

Overmyer, 42, turned himself in and was being held in jail. His arraignment was set for Wednesday afternoon. Court records didn’t indicate if he has an attorney.

Overmyer easily won the county’s Republican primary for sheriff in March even though it was known then that he was under investigation. He said before the primary that the investigation was politically motivated.

The Ohio Bureau of Criminal Investigation began investigating the two-term sheriff nearly a year ago. The probe started after police chiefs in the county said it was odd that Overmyer had been collecting prescription pills from drop boxes, several media outlets reported.

Overmyer told The News-Messenger in Fremont in January that he collected the pills to promote better communication between area law enforcement agencies. He also said that he had done nothing wrong and that he passed a drug test conducted by state investigators.

According to the indictment, he deceived physicians and pharmacists to obtain prescription pain medication, including Percocet, Hydrocodone and Oxycodone. He’s also accused of misusing department money and tampering with records. The theft-in-office charges cover a period from 2009-2016, the indictment shows.

Overmyer was 34 when he was appointed sheriff in Sandusky County, which is about 40 miles southeast of Toledo, after the death of the former sheriff.

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Fighting Opioid Abuse with Technology

https://cvshealth.com/content/fighting-opioid-abuse-technology-0

According to this press release from CVS.. there Pharmacist only have to have A FEELING… that a Rx is not for a legit use… they don’t need REAL FACTS… so OPIOPHOBIC PHARMACISTS are able to use their personal feelings, biases, phobias to deny care to legit pts.

Much has been written about prescription opioid abuse, and with good reason – it has reached epidemic proportions in the United States. One of the biggest challenges associated with opioid abuse is ensuring that patients with a legitimate need for the medications can access them, while preventing those who abuse or divert the drugs from obtaining them.

With a national spotlight on the problem, public awareness continues to grow. A recent survey by CVS Health shows the public agrees that pharmacists can help reduce prescription drug abuse by using their knowledge and professional judgment. In fact, pharmacists from across our enterprise are trained in identifying patients who are at risk for abuse or inappropriate use of controlled substances. Our pharmacists are empowered to refuse to fill prescriptions they feel are not being used for legitimate medical purposes.

Technology can also help. Prescription drug monitoring programs (PDMPs) are statewide electronic databases that gather information from pharmacies on prescriptions for controlled substances, including opioids, that have been dispensed. They allow both pharmacists and prescribers to review prescription histories for signs of abuse or diversion, and can help prevent unnecessary prescriptions from being written in the first place. The data can also provide a useful starting point for getting patients who are struggling with prescription drug abuse on the path to treatment for addiction.

While PDMP technology is currently available in 49 states, its scope is somewhat limited. For example, providers can only see information for the state in which they practice, not for all states where a patient may have been prescribed medication. And although PDMPs have been identified by the White House Office of National Drug Control Policy as an important tool in fighting prescription drug abuse, utilization rates are suboptimal. Health care professionals are not required to review PDMP information, and the process of accessing data is time-consuming, leading many to skip this step altogether¹.  

CVS Health is working at the federal and state level to implement policy changes to curb prescription drug abuse. Our recommendations include:

• Mandatory utilization of Prescription Drug Monitoring Program (PDMP) data at the point of prescribing would require prescribers to review the patient’s pharmacy prescription history, showing the prescriber whether the patient is doctor shopping (using more than one prescriber to obtain controlled substance prescriptions).
• PDMP data pushed directly to the prescriber’s e-prescribing device would give the provider instant access to the patient’s history before deciding whether the medication is for a legitimate medical purpose.
• PDMP interoperability across state lines would allow prescribers full visibility into patient prescription fill patterns and reduce or eliminate doctor and pharmacy shopping that occurs across state lines. PDMPs can currently share data across state lines in 22 of the 49 programs.
• E-prescribing for controlled substances has proven to be effective in reducing drug diversion and fraud.
• Daily PDMP data submission from pharmacies to the state database will ensure that each database is accurate and encourage use by reducing lag time between updates.

CVS Health is fully committed to the fight against prescription drug abuse, and has been actively engaging members of the health care community in robust discussions about the issue.

Learn more about what we’re doing to address this national crisis.

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Veteran Kills Himself in Parking Lot of V.A. Hospital on Long Island

www.nytimes.com/2016/08/25/nyregion/veteran-kills-himself-in-parking-lot-of-va-hospital-on-long-island.html?smid=fb-nytimes&smtyp=cur

A 76-year-old veteran committed suicide on Sunday in the parking lot of the Northport Veterans Affairs Medical Center on Long Island, where he had been a patient, according to the Suffolk County Police Department.

Peter A. Kaisen, of Islip, was pronounced dead after he shot himself outside Building 92, the nursing home at the medical center.

The hospital is part of the Veterans Affairs medical system, the nation’s largest integrated health care organization, which has been under scrutiny since 2014, when the department confirmed that numerous patients had died awaiting treatment at a V.A. hospital in Phoenix. Officials there had tried to cover up long waiting times for 1,700 veterans seeking medical care. A study released by the Government Accountability Office in April indicated that the system had yet to fix its scheduling problems.

Why Mr. Kaisen decided to end his life was not immediately known, but two people connected to the hospital who spoke on the condition of anonymity because they were not authorized to discuss his death said that he had been frustrated that he was unable to see an emergency-room physician for reasons related to his mental health. “He went to the E.R. and was denied service,” one of the people, who currently works at the hospital, said. “And then he went to his car and shot himself.”

The worker questioned why Mr. Kaisen had not been referred to the hospital’s Building 64, its mental health center. The staff member said that while there was normally no psychologist at the ready in the E.R., one was always on call, and that the mental health building was open “24/7.”

“Someone dropped the ball,” the worker said. “They should not have turned him away.”

Christopher Goodman, a spokesman for the hospital, said that there “was no indication that he presented to the E.R. prior to the incident.” It is unclear if any official record was made of a visit by Mr. Kaisen.

Mr. Goodman said “the employees here at Northport feel this loss deeply and extend their thoughts and prayers to all those impacted by this tragedy.”

Mr. Kaisen’s family declined to comment.

Lt. Kevin Beyrer, a Suffolk County detective, said that the F.B.I. was carrying out the investigation into Mr. Kaisen’s death because it had occurred on federal property. He said that the V.A. police had called the county police on Sunday at 12:32 p.m. and that it appeared that Mr. Kaisen had been alone at the time of his death.

The Northport hospital has been under scrutiny for mismanagement and poor care since The New York Times reported in May that it had closed all five of its operating rooms for months after sand-size black particles began falling from air ducts. The office of Representative Lee Zeldin, a Republican whose First Congressional District is on Long Island, had been looking into the allegations, Eric Amidon, Mr. Zeldin’s chief of staff, said in an email to The Times in June.

Jennifer DiSiena, Mr. Zeldin’s communications director, said on Wednesday that his office was trying to confirm the details of Mr. Kaisen’s death and “piece everything together.”

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CVS Specialty Pharmacy is the absolute worst Pharmacy I have been involved with since becoming Ill

http://www.newsmandan.net/my-journey-with-msa—blog/came-up-short-on-the-drug-for-controlling-my-ortho-static-hypotension

Ortho-static Hypotension is a sudden drop of blood pressure from a known or unknown reason causing the pt to become anywhere from dizzy to a temporary black out.. causing the pt to collapse and putting them at risk of numerous possible injuries… depending what their body hits on the way down to the FLOOR.  Less severe cases will happen when a person suddenly changes positions… like getting up from a seated to standing position

I have had a difficult week mainly due to the inept people at CVS Specialty Pharmacy.  Because I can only receive a 30-day shipment at a time, I am reliant on CVS to call and arrange a shipment when I am down to 5-6 days of supply.
This is the third month I have had to get on the phone with the pharmacy reps at CVS and then with Northera to work on having another 30-day supply shipped.
I contacted CVS but did not receive a response, all operators were busy, I left a message.
After I had spoken to the Northera representative, they were going to call CVS and then call me back. You can guess this one, I did not receive a call back from Northera. With three days left I spread the Northera over 7 days. I take six tablets 3 x’s a day. I cut it back to 4 tabs 3 x’s a day. Missing those six pills a day sent my OH into steep dives. One minute I was working in the garage, next minute I am on the floor wiped out, BP was 70/50.
I recovered and started watching television. Around midafternoon I had a second episode. Lucky I was in a sitting position. I should have remained seated.  I knew there was a problem so I decided to go to my room and lay down. I lasted for 5 steps and went down, crashing to the floor.  The second episode in less than two hours was a marked change compared to  previous episodes of OH (Orthostatic Hypotension) that I have experienced. This evolution of OH was new to me. It came on fast and lasted longer than the current episodes.
Last Monday I had to overcome similar OH episodes and again Tuesday thru Thursday. I was also experiencing serious balance issues and fell twice this week. Compare that to zero falls in the previous 4 months. The lower dosage was not helping me. Finally Thursday night Northera made arrangements to ship a 15 day supply over night to my home. I specifically asked the representative to not require a signature. Unfortunately they did not follow my request and required the UPS driver to get a signature.  So at 10:05 AM the UPS driver rang the door bell waited 10 seconds,  stuck a sorry we missed you post-it note on my door and drove away. It takes me 10 seconds just to convince my body to rise and walk. After all my brother is 70 years old. After several calls to the UPS Service line my medicine finally arrived at 8:30 PM Thursday night. Not in time to save me from two more bouts with OH. I did start regular dosing Friday morning.  I have had OH issues Friday, Saturday and again today. Today’s episode was minor compared to the other seven days.
I still do not understand what is going on with CVS Specialty Pharmacy’s handling of my prescription of Northera going forward. I am hoping that they switch it over to Walgreen’s Specialty Pharmacy as I hear they take care of their customers much better.

Dan

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Cincinnati responds to 30 heroin overdoses in one day

http://local12.com/news/hooked-on-heroin/district-3-police-respond-to-20-heroin-overdoses-in-one-day

Obama’s first chief of staff Rahm Emanuel.. that this philosophy of how you could get done within the legislative process.

“Things that we had postponed for too long, that were long-term, are now immediate and must be dealt with. This crisis provides the opportunity for us to do things that you could not do before.”

Maybe I have not seen it… but.. I have not seen much of the DEA/law enforcement having press releases on much of this Heroin/Fentanyl mixture that has been confiscated and the people involved with its distribution arrested.  Likewise there has been little public announcements of oral doses/tablets of Fentanyl being sold on the street.  Keep in mind.. there is no legal commercially available oral Fentanyl doses made in the USA.

There is another old saying within legislative circles….“Horror stories don’t make good laws… but… they do cause laws to be passed”

Is someone… some entity..  putting these two philosophies together to create some larger agenda.  On one hand we have various states that are making Naloxone – up until now can only be purchased by prescription – to be mostly purchased as a over the counter medication.  We have guidelines to restrict/limit the amount of opiates that someone suffering from documented chronic pain… but.. the number of time that a individual is revived with Naloxone is unlimited and – as a society – we provide little/no mental health therapy after a person is revived… and the failure rate of those that do get therapy is a high percentage.  It would seem to be like a revolving door and like a virtual ATM for those who operate rehab facilities.

Those with addictive personalities are suffering from a chronic disease… but.. like chronic pain.. our society does not seem to provide long term therapy… just short term fixes. Our “boat” is LEAKING and we are trying to plug the holes with  CHEWING GUM ?

CINCINNATI (WKRC) – Cincinnati emergency crews responded to 30 heroin overdoses in the course of one day Tuesday, August 23.

Officials said most of the overdoses were located in the west side of Cincinnati. The Cincinnati Police Department said in a statement Tuesday evening they were not sure of the exact cause of the increase yet. They warned anyone who may be using dangerous drugs to be aware of the increased danger.

Three people overdosed in one house and one man overdosed while driving through an intersection. Another overdosed with his child in the car at a gas station. Fire crews worked quickly to save as many lives as they could.

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THE HOUSE OF REPRESENTATIVE

this is what the Representatives could be literally looking at if the chronic pain community comes together and VOTES THE BUMS OUT.

So far calls from constituents, letters from constituents , on line petitions has caused not much more than a “virtual pat on the back” that they understand…. BUT… they are concerned about the opiate epidemic. BUT.. they will remember your concerns when a law comes up for action.

Congress passed the Control Substance Act 1970 which created the DEA and they have the legal ability to amend or repeal that law.  After 46 yrs all Congress has done has allowed  – turned a blind eye/deft ear – the DEA to REINTERPRET that law to establish regulations that suits the DEA’s agenda for the immediate – or longer period.

No one may ever know what/who has influenced this agenda or process… is there lobbyists for certain companies “bending the ear” of  the members of the most appropriate Congressional committees. Undoubtedly, the “higher ups” of the DEA have fairly ready access to those same members of Congress.

It would seem that the only individuals that are not able to influence the members of Congress is the constituents that they are suppose to represent.

The question has to be asked.. if they are not listening to you… why are you voting them back into office ?

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Lawsuit: Indifference by medical staff at Forsyth jail led to woman’s death

https://triad-city-beat.com/2016/08/lawsuit-indifference-medical-staff-forsyth-jail-led-womans-death/

A lawsuit filed in Forsyth County court alleges that a private healthcare company and medical staff at the local jail displayed deliberate indifference, causing the death of a woman awaiting trial in 2014.

A lawsuit filed in Forsyth County court last week alleges that medical staff at Forsyth County jail acted with deliberate indifference, causing the death of a pregnant woman who was undergoing withdrawal from opiates while awaiting a hearing on charges of prescription drug fraud in 2014.

The lawsuit, filed on Aug. 17 by the estate of Jen McCormack, names Correct Care Solutions — a Tennessee-based healthcare company with extensive contracts in detention facilities across the country — as defendant.

McCormack’s unexpected death at Baptist Hospital after being found unresponsive in the jail in downtown Winston-Salem first came to light in a series of articles [1, 2, 3] published by Triad City Beat in 2015 that included details of her deteriorating health during the 16 days of her detention while calling into question an official narrative suggesting she died as a result of a hunger strike.

McCormack’s death certificate, which is cited in the lawsuit, notes an “uncertain contributory role of reported intent to starve self v. deficient pre-emptive custodial intervention.”

Meanwhile, on Aug. 18, the US Justice Department announced that it will gradually phase out contracts with private prison providers, noting among other factors that “they do not provide the same level of safety and security” as those directly administered by the government. A review of inmate medical records by the Nation that focused on 11 immigrant-only contract prisons, including one in west Texas where Correct Care Solutions was the medical provider, found “prison medical units repeatedly failing to diagnose patients correctly despite obvious and painful symptoms, as well as the use of under-qualified workers pressed to operate at the borders of their legal scope of practice.” The investigative report, published in February, also said the files showed “men dying of treatable diseases — men who very likely would have survived had they been given access to adequate care.”

The lawsuit filed in Forsyth County court last week by McCormack’s estate fills in critical gaps about her access to medication in the jail and about concerns raised by an obstetrics nurse at an off-site clinic as to whether her deteriorating condition warranted her hospitalization.

McCormack had received Subutex — a brand name for the opioid-withdrawal medication buprenorphine — during a stay at Forsyth Medical Center prior to her arrest, according to the lawsuit. She also received Zofran to treat nausea. McCormack had wanted to receive treatment for her addiction to prescription drugs at an inpatient facility, but because no beds were available she planned to go home and begin outpatient rehabilitation, according to the lawsuit. Instead, she was arrested for multiple charges of felony prescription-drug fraud and booked in jail.

McCormack experienced nausea and vomiting for much of her time in jail, complaining of dizziness and chest pain, and exhibited lethargy and disorientation that worsened over time. The lawsuit alleges that although Zofran was ordered to treat her nausea, it was only administered to her once. The complaint alleges, “As a result of her uncontrolled nausea, decedent was unable to take many of the medications that were prescribed for her symptoms of opioid withdrawal, anxiety disorder, depression, and prenatal vitamins for her unborn baby.”

The lawsuit alleges that Registered Nurse Miriam Cornatzer Hauser and Nurse Practitioner Emma Aycoth, who worked in the medical unit at the jail at the time of McCormack’s detention and who are named as individual defendants in the lawsuit, and other members of the nursing staff “failed to properly and adequately assess decedent’s signs, symptoms and her severely deteriorated condition.”

The complaint alleges that Cornatzer and Aycoth violated McCormack’s constitutional rights “by intentionally, willfully, maliciously and with conscious and deliberate indifference, failing to secure adequate and reasonable medical care for decedent when they subjectively knew or should have known that decedent had an objectively serious medical need and faced a substantial risk of harm, by disregarding such risk of harm and by failing to take reasonable measures that were readily available to avoid that risk.”

The complaint goes on to say that the two nurses “had actual knowledge that decedent had failed for several days to take in and retain amounts of food and/or liquid sufficient to sustain life, as a result was exhibiting a seriously declining physical condition, and required immediate medical attention and intervention.

“Decedent’s condition would have been diagnosed by a physician as mandating treatment and/or was so obvious that even a lay person would easily recognize the necessity of medical attention,” the lawsuit continues. “Defendants RN Cornatzer and NP Aycoth failed to notify physician staff or otherwise secure reasonable and necessary medical attention for decedent. Their failure to do so and deliberate indifference ultimately led to her death.”

Aycoth declined to comment and Cornatzer could not be reached for this story.

The lawsuit accuses Correct Care Solutions of maintaining “policies, practices and/or customs” that constituted deliberate indifference to McCormack’s serious medical needs and that “were a direct and proximate cause” of the nursing staff’s conduct.

The lawsuit charges that the company’s cost-cutting policies were “a moving force” in McCormack’s death, while alleging that “CCS has stated that it is committed to measures that minimize the need to transport inmates offsite.”

Jim Cheney, a spokesman, said Correct Care Solutions would not be able to comment because the case is under litigation.

The lawsuit alleges that “misconduct of nursing staff” at Forsyth County jail and other detention facilities served by Correct Care Solutions was “widespread,” adding that at least seven inmates, including McCormack, have died at the local jail “due to inadequate or improper medical care.”

Correct Care Solutions, along with the Forsyth County Sheriff’s Office, is currently defending itself against a lawsuit filed by the family of Dino Vann Nixon, a man who died in the jail in 2013. The lawsuit alleges that medical staff refused to provide Nixon with Xanax, an anti-anxiety medication also known as benzodiazepine. A report by a local medical examiner found that his death “was related to withdrawal from benzodiazepine.”

Despite the finding by the medical examiner, the defendants deny that Nixon’s death was related to withdrawal from the medication, while maintaining that he received appropriate care.

Correct Care Solutions also provides medical services in the Guilford County detention center. A woman named Ellin Schott who had been arrested for panhandling died at Cone Hospital after her health rapidly deteriorated during a brief stay in one of the jails in downtown Greensboro. A local medical examiners report chronicled medical staff’s apparent unwillingness to provide Schott with her prescribed anti-seizure medication and concluded that the immediate cause of death was “complications of prolonged seizure activity.”

According to the lawsuit filed in Forsyth County court last week, McCormack reported to the nursing staff on the fifth day of her detention that she was weak and dizzy, that she had been vomiting, and that the anti-nausea medication she had been receiving “is not sufficient.”

The lawsuit alleges that Dr. Alan Rhoades assessed that McCormack was apparently fainting, further concluding that she was exhibiting “drug seeking behaviors.” The complaint continues, “Decedent had been placed on Vicodin because CCS did not have access to Subutex. Dr. Rhoades ordered that Vicodin dose be decreased and ordered, ‘no change in management otherwise,” with the doctor emphasizing the first two words in all capitals.

Rhoades’ LinkedIn page identifies him as the medical director for the Forsyth County jail, along with the three Guilford County detention centers. Rhoades could not be reached for comment for this story.

The next day, according to the lawsuit, McCormack visited an OB/GYN at a clinic off site from the jail. “The obstetrical nurse contacted NP Aycoth expressing concern about decedent seeming drugged and drowsy and because decedent had vomited ginger ale she had been given,” the lawsuit alleges. “The obstetrical nurse questioned whether decedent should be hospitalized, and NP Aycoth instructed the obstetrical nurse to have decedent returned to the jail.”

Later that day, the lawsuit alleges that despite discovering that McCormack had vomited in her wash basin back in her cell and was struggling to eat, Aycoth failed to report those developments to physician staff.

“After September 9, 2014, nursing staff made no assessment of blood pressure or vital signs until September 13, 2014,” the lawsuit alleges. “Meanwhile, decedent was becoming more and more dehydrated due to continued nausea and vomiting. Nursing staff made no measurement of decedent’s food and water intake or output except for one notation of water intake that was made on September 13, 2014. Decedent was becoming at high risk for a serious and significant dehydration setting the stage for injury to her brain, kidneys and heart that did, in fact, cause a severe downward spiral in decedent’s condition, including changes in cognition, damage to her kidneys placing her at high risk for kidney failure, and culminating in a cardiac arrest that led to hypoxic brain injury and death.”

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