The surgeon general just sent a worrisome letter to every doctor in America

In case you have been living under a rock , the batteries in your hearing aide are dead, both your computer and TV/cable are not working.. The Surgeon General of the US .. just attempted to turn the “opiate guidelines” of the CDC into the “law of the land”.  The impact on the chronic pain community could be substantial.

Let’s talk election… These two people are DEMOCRATS and if Hillary Clinton gets elected.. they will most likely stay in their appointed positions. This Surgeon General will keep “ringing the bell” of reducing opiate/benzo prescribing.  Ignore the facts/discussions about Clinton’s email servers, Benghazi and the Clinton Foundation. Hillary has come out in support of the proposed “soda tax” in Philli and Sen Manchin’s “opiate tax”… those taxes will fall under the same category of Alcohol and Tobacco as “sin taxes”.  Manchin’s tax is suppose to go to treat/help those who are suffering from a “opiate use disorder”… what was previously known as “ADDICTS OR JUNKIES”.

Of  course, this “opiate tax” won’t/can’t be collected from all the opiates/Heroin that is illegally sold on the street. Can’t catch the street suppliers, can’t stop the flow to the street.. so you tax the people who have a legal/legit medical necessity…

Opiate prescribing peaked in 2012 and has been dropping ever since, but the number of people OD’s… continues to increase.. but all the stats that the bureaucrats and the media is using is from 2012 or before for the number of opiate Rxs being written and compare them to current OD deaths… Is this a “apple to oranges” comparison ?

We all know that both AG’s under this administration has done NOTHING to enforce the ADA discrimination when it comes to chronic pain pts.  His first AG (Holder) left office being held in CONTEMPT OF CONGRESS… because according to our system the President is the final authority if/when laws are enforced.

Could this help explain the dramatic change in direction  of the DEA toward prescribers and pts in the war on drugs/pts during the 2010-2012 period.. which is still accelerating ? So if you are a chronic painer .. you need to look at your life 8 yrs ago and your pain management and  ask yourself “Am I doing better or worse than 8 yrs ago”.  This administration is part of the problem… but there is enough blame to be shared by Congress… which – IMO – consists of 535 self-centered, egotistical, narcissists in one very large “sand box” .. called “the establishment”.

Few like either Presidental candidate of the two major parties and everyone seems to ignore the Libertarian Party Candidate… Gary Johnson… soft spoken, two term Governor of New Mexico, in favor of  legalizing MJ/MMJ , wants a smaller government and successfully ran New Mexico while reducing the size of government and creating a surplus for the state. Other countries have multiple political parties running their governments… why have we allowed only two parties to control/dominate the way our Federal government functions ?

http://www.businessinsider.com/letter-surgeon-general-sent-every-doctor-on-opioids-2016-8

America’s doctor just knocked on the doors of every US physician across the country.

Virtually, at least.

On Thursday, US Surgeon General Vivek Murthy sent this letter to 2.3 million American doctors asking for their help to curb what’s being called an “unprecedented” epidemic of opioid painkiller overdose deaths.

It’s the first time in history that a surgeon general has sent a letter directly to American physicians.

This is a major signal to doctors and the public that it’s time for something to be done about the thousands of Americans who are dying each year from overdosing on prescription painkillers like oxycodone, fentanyl, and morphine.

Between 2013 and 2014, deaths from synthetic opioids skyrocketed by 79%, according to a new Centers for Disease Control and Prevention report released Thursday.

Since opioid painkillers slow breathing and act on the same brain systems as heroin, they carry serious risks of overdose and, in rarer cases, addiction. But cases that would normally be rare are happening with increasing regularity as the drugs are being given to so many people. Despite being home to 5% of the world’s population, America consumes 80% of its opioids.

These drugs are powerful. Fentanyl, the drug that killed Prince, is roughly 50 times stronger than pure heroin. And although the deadly drug is legal with a doctor’s prescription, it’s also being made illegally in underground labs and traded across the US.

Still, doctors’ prescriptions are a sizeable part of the problem.

A 2014 report from the American Academy of Neurology estimates that more than 100,000 Americans have died from prescribed opioids since the late 1990s. Those at highest risk include people between 35 and 54, the report found, and deaths from opioids in this age group have exceeded those from firearms and car crashes.

“As clinicians, we have the unique power to help end this epidemic,” Murthy wrote in his letter.

To make matters worse, the drugs are often prescribed alongside other drugs, like tranquilizers, which can raise the chances of accidental overdose and death. Yet they’re often prescribed together anyway.

In 2011, 31% of prescription-opioid-related overdose deaths involved these two kinds of drugs used together, according to the National Institute on Drug Abuse. “Unfortunately, too many patients are still co-prescribed opioid pain relievers and benzodiazepines (tranquilizers),” the institute said.

Here’s the surgeon general’s letter:

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Observers offer tips on how to survive your doctor or hospital

http://www.northjersey.com/news/health-news/observers-offer-tips-on-how-to-survive-your-doctor-or-hospital-1.1650967

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Government Forced To Return 55 lbs of Marijuana, Firearms, Bulletproof Vests and Truck After Verdict

countercurrentnews.com/2016/08/government-returns-55-lbs-verdict/

Michael Cindrich won a “Not Guilty” verdict from a Los Angeles, California jury in just a ten minute deliberation. That is what you can do if you know the law.

Jeff Caldwell of LibertyViral reports that Cindrich’s client has a medical cannabis card and rights to be a collective operator. A collective operator has the rights to buy and sell cannabis to a small group of medical cannabis users.

The police ILLEGALLY raided his house, taking all of his money and valuables.

Cindrich was able to recover 55 pounds of MMJ, 3 ounces of concentrate, a Toyota truck, 3 handguns, 2 hunting rifles, an AR-15, 2 bullet proof vests, ammo, and other items. He continues to fight for the release of $150,000 in cash and a motorcycle that, also stolen by police in the illegal raid.

This is Cindrich’s third cannabis-related not guilty verdict in four months.

Know the laws, know your rights. We cannot let cops break the laws and steal possessions. Illegal raids have to stop, that isn’t freedom.

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When John Kennedy took office Jan, 1961 our country was a total of 300 billion in debt. A debt that had been accumulated over the previous 185 yrs of the USA’s existence.. including the fighting of TWO WORLD WARS, a CIVIL WAR ,the WAR of 1812 and the Korean War

This fiscal year’s budget short fall – ONE YEAR – will be about TWICE the amount that took our country 185 years to reach in debt

Today our country is abt TWENTY TRILLION in debt. Four those of you who are weak on math .. over the last 55 yrs our national debt has grown SEVENTY TIMES..

Because “we the people” really owe that debt… in 1961 each person owed about $1,700

Today each person owes abt $62,500

Also considering that there are an additional 150 million people in our country now as opposed to 1961.

Both political parties are equally guilty for all of these giveaways.. for various reasons.. Don’t forget that Congress also stripped all the “excess money” in all the Medicare/SS/Railroad/Medicare disability trust funds and filled those “trust funds” with IOU’s from Uncle Sam.

when you chose who to vote for in the upcoming election… the more they use the word FREE.. promising you something… healthcare, college education,,, etc,,,,etc… they are going to put it on our nation’s “credit card”… which our children, grandchildren and great grandkids will have to deal with.

We are already dealing with a generation that it is questionable if their life will be better than that of their parents… the first time in the USA’s history.

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http://www.alternet.org/drugs/opioid-epidemic-greatly-exaggerated

Brian C. Bennett Drug Charts  This link takes you to dozens of charts that demonstrates that in the “larger picture” the abuse of various substances has been greatly exaggerated and inflated by the bureaucracy and the media. When did the media become part of our society’s “morality police” and stopped reporting the news/truth and started reporting their opinions ? The media has always had editors that have expressed their opinions, but they were labeled as such.

Last week, when Michael Walker of Beckley, West Virginia, read in his local paper that high-potency heroin—or opioids sold as or cut with heroin—caused an outbreak of 27 overdoses in just four hours in the nearby city of Huntington, he thought of his 19-year-old son, Matthew, who has been off of opiates for three months, the longest he’s been without the drug in years.

“I know it’s early for Matthew, and what a struggle it still is,” said Walker, 42, a white working-class dad. “A lot of people call this a problem, but it’s an epidemic,” he said, while describing the situation in West Virginia.

West Virginia ranks No. 1 in the nation for overdose fatalities. Pill mills churning out OxyContin addicted many in Walker’s hometown, including his son. Once the dirty doctors were kicked out of town and the pill supply ran dry, Walker said his son turned to heroin. “You could walk down the street and knock on someone’s door, and there heroin was,” he said. 

Situations like the one in West Virginia sound off the opioid epidemic siren. Both local and national news carry its echo across the country, citing each outbreak as the relentless continuation of an ongoing drug crisis—one that’s described as having crept out of the so called inner-city and into affluent suburbs and rural towns, causing premature death en masse among the white population. Ask someone like Walker—middle-aged, working class, who is up on current events about opiates and heroin—and they’ll tell you how dire things are.  

But researchers at Rice University’s Baker Institute for Public Policy in Houston, Texas, say government data do not reflect what the media and politicians have said about the magnitude of the epidemic. 

The Baker Institute’s newly released Brian C. Bennett Drug Charts use data collected by the University of Michigan’s Monitoring The Future survey, along with the National Survey on Drug Use and Health, to chart drug-using trends over a span of 40 years. The charts deliver a bird’s-eye view of drug use in America and a counter-narrative to the opioid epidemic. 

Along with the charts—which we’ll get to—Rice University released a policy brief written by William Martin and Katherine Neill, both doctoral fellows in drug policy at Rice. “These charts,” they write, “caution against uncritically accepting alarming announcements of drug abuse epidemics by media, politicians, religious leaders, law enforcement agencies, drug treatment facilities, voluntary associations, or others with real or opportunistic reasons to sound the klaxon.”

Brian C. Bennett is a former military intelligence analyst who uses data to destruct drug war rhetoric. For years, he’s been a thorn in the side of many drug prohibitionists—mainly because his encyclopedic catalog of drug-using trends poke holes in what he calls prohibitionist fear-mongering. Like the time Los Angeles Police Chief Daryl Gates, who founded the DARE drug education program, said that “casual drug users should be taken out and shot.” 

That would be a lot of people dead in the streets. Many people identify as regular drug users each year, and the number of people who call themselves a “frequent-user” remains stable, despite screams that drug use is on the rise.  

In reference to cocaine users, which the LAPD targeted during the ’80s crack epidemic, the authors of the policy brief write, “It is clear that not all use is abuse and that most people who get into trouble with the drug recover from it, many on their own without treatment, participation in a 12-step recovery program, or relapse.” Rarely will you hear law enforcement speak of cocaine use in such plain terms. But that’s what the data show. 

The Fix reached out to Bennett to discuss his newly released charts, and how the numbers behind the opiate crisis paint a less frightening picture.  

Bennett’s charts appear counterintuitive if you’ve been watching the news. For instance, they show heroin use has remained stable between 1979 and 2014. Though there was a jump to 914,000 heroin users from 681,000 between 2013 and 2014, he asks his audience to keep in mind the size of the U.S. population ages 12 and older, which in 2014 was over 265 million. 

Because the charts are scaled to the U.S. population at large, such fluctuations look like flat lines—“insignificant in the big picture when charted,” he said.

The same can be applied to painkillers like OxyContin, says Bennett. In 2014, the number of people who reported using painkillers for “nonmedical use” in the past month was 5.1 million. Martin and Neill, the authors of the policy brief, write, “This is not a small number of potentially problematic users, but it is a small segment of the U.S. population—1.6 percent of those age 12 and older.” 

Bennett told The Fix that, “When looking at pills, the past year use numbers have been declining a bit.” But if you get your information from, say, the Partnership for Drug-Free Kids, who wield a budget of $88.4 million dedicated solely to keeping kids off drugs, they’ll tell you painkiller use is on the rise. 

“There was a brief spike in the use of [painkillers] in the 2009 and 2010 estimates,” said Bennett. But he adds that ad hoc reports exaggerate these upticks. “This helps illustrate an important point concerning reporting of these numbers: the tendency is to cherry pick the numbers to paint the worst possible picture. That is why it is so important to consider the complete data sets when discussing these issues.“

Since the number of heroin users has not spiked dramatically over the years, then what about mortality rates? After all, the CDC reported a record number of drug overdoses—47,055—in 2014. 

“If you compare the number of deaths to the number of [heroin] users, you find that not many of them are actually dying,” said Bennett. Again, the data backs him up: around 900,000 people reported using heroin in 2014 but only 10,574 of them died. That amounts to only 1.16 percent of heroin users dying from the drug. 

“The claim of ‘record numbers’ of deaths may be accurate—but rather insignificant in the big picture,” Bennett said. 

“Let us consider the total number of deaths,” he continued. “In 2014, there were 2,626,418 deaths. Thus the ‘epidemic’ of opioid deaths is greatly exaggerated, and constitutes a mere 0.6 percent of all deaths.” For some context, Bennett said to look to the infant mortality rate, which is currently 582 per 100,000 live births. 

But such statements fly in the face of people like Walker in West Virginia, and many others who have lost loved ones to overdose. “The people that are on the front lines see the hurt and the utter devastation that this is causing,” he said, adding that the people in power could care less about the state of affairs in West Virginia. 

Martin and Neill acknowledge the data do indeed reflect Walker’s experience. “Midwest regions near the Appalachian Mountains have higher levels of problematic opioid use than other parts of the country,” they write, noting West Virginia has the highest rate in the country, at 35.5 per 100,000. To this, they attribute economic insecurity as one of the major culprits driving up overdose rates. 

But Bennett says local data and anecdotal experiences must not trump the “big picture,” especially when it comes to making sensible policy reforms. What do those reforms look like for Bennett? “Let people get drugs of known dose and purity—via pharmacies for chemical compounds, and via the tobacco/alcohol model for naturally occurring forms of intoxicants,” like mushrooms, peyote, or opium, he said. 

As for why there has been exaggeration about the opioid problem, the researchers at Rice say it has to do with who is now affected by opioids. “To put it bluntly, White Lives Matter,” they write.

The CDC has been tracking the recent demographic shift in opiate use. In 2000, black Americans aged 45-64 were the dominant opiate users. Within the last decade, the largest group of opiate users became whites aged 18-25. Because 90 percent of new heroin users—like Walker’s son—are white, the researchers say it is seen as a public health problem deserving of our attention.

And still, heroin use remains a big problem in minority communities, especially where economic and social resources are scarce. 

“Ultimately, the blame for the hysteria lies squarely at the feet of the government agencies for describing their findings the way they do, and the media parrots who do nothing but pass it along unchallenged—or worse, further exaggerate and magnify the hysteria,” said Bennett.

The team at Rice insists an accurate picture of drug use in America will lead to better policy. “Policies that can deal effectively with these complex problems must build on a foundation of accurate data, not fear and stereotypes.”

“The way forward is not via the roads of the past,” said Bennett.

Meanwhile, all Walker says he can do for his son is pray. Walker wants to become an activist and voice for change, but he says people in his community have not been willing to give him a platform. “They don’t want to hear it,” he said.

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CDC: Fentanyl Urgent Public Health Prob

www.painnewsnetwork.org/stories/2016/8/26/cdc-fentanyl-an-urgent-public-health-problem

Who believes that the alphabet soup of federal agencies will change their direction of believing that legal opiate prescribing  is the major/direct cause of opiate addiction/abuse ? Maybe this information will force the DEA and others in law enforcement to change their enforcement focus. Maybe it will be a moment of ENLIGHTENMENT to politicians/bureaucrats that trying to “cure” those suffering from the mental health disease of addictive personality disorder is just making all of the increased numbers of substance abuse centers a revolving door and creating a “golden goose” for those for profit entities.  Maybe we will follow the lead of other countries and treat substance abuse like other mental health issue and you treat/maintain… you cannot cure… Doing this will cause the drug cartels to have few customers… it will shred their business plan.. they will have to find another illicit business plan to make money.

As a society, we try to use the same/similar puritanical thread in our societal fabric to “cure” those who are in LGBTQ community.. Another failure of that 17th century mindset that persist within some in our society.  No longer on our society’s radar is the ONE MILLION attempted suicide and 50,000 that succeed every year.. we are likewise oblivious to the > 500,000 deaths every year from the use/abuse of the two drugs Nicotine/Alcohol.

Maybe one day the “morality police” will come to the conclusion that there are some within our society that are or will get into a  “death spiral”  and try as we may… they can’t be saved from crashing.

By Pat Anson, Editor

The Centers for Disease Control and Prevention is finally acknowledging that the U.S. has a fentanyl problem that is growing worse by the day. And that more people are dying in some states from overdoses of illicit fentanyl than from prescription opioids.

“An urgent, collaborative public health and law enforcement response is needed to address the increasing problem of IMF (illicitly manufactured fentanyl) and fentanyl deaths,” CDC researcher Matthew Gladden, PhD, said in the agency’s Morbidity and Mortality Weekly Report.  

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine. It is prescribed legally in patches and lozenges to treat chronic pain, but in recent years there has been a surge in overdoses linked to illicit fentanyl obtained on the black market, where it is often mixed with heroin.

In a new analysis of opioid overdoses in 27 states, the CDC identified eight “high burden” states where fentanyl overdoses sharply increased, even though fentanyl prescriptions were relatively stable.

Those states are Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.

In six of the eight states, the CDC said fentanyl was the “primary driver” of synthetic opioid deaths – meaning they outnumbered overdoses from legal synthetic opioids. That is a major concession by the agency, which has long maintained that prescription opioids were primarily responsible for the nation’s so-called opioid epidemic.

The data analyzed was from 2013 and 2014. More recent reports from several states indicate the fentanyl problem has significantly worsened. The DEA recently reported the U.S. is being “inundated” with counterfeit prescription drugs made with fentanyl.  

“This finding coupled with the strong correlation between fentanyl submissions (laboratory tests) and fentanyl-involved overdose deaths observed in Ohio and Florida and supported by this report likely indicate the problem of IMF is rapidly expanding,” Gladden wrote. “Recent (2016) seizures of large numbers of counterfeit pills containing IMF indicate that states where persons commonly use diverted prescription pills, including opioid pain relievers, might begin to experience increases in fentanyl deaths because many counterfeit pills are deceptively sold as and hard to distinguish from diverted opioid pain relievers.”

The CDC hasn’t been completely silent about the fentanyl problem. In October 2015 the agency issued a health advisory to public health departments, healthcare providers and medical examiners to be on the alert for fentanyl overdoses.  Warnings to the public, however, have been scarce as the agency focused instead on controversial guidelines that discourage doctors from prescribing opioids for chronic pain.

Even the U.S. Surgeon General appears to be neglecting the fentanyl problem. This week Surgeon General Vivek Murthy, MD, said he would be sending letters to over two million physicians urging them to follow the CDC guidelines and pledge to safely prescribe opioids. Nowhere in the letter or on a website promoting the “Turn the Tide” campaign is fentanyl even mentioned.  

Critics of opioid prescribing have long maintained that opioid pain medication is often a gateway drug to heroin and other illicit substances, but recent research indicates that is not true.

“Although the majority of current heroin users report having used prescription opioids non-medically before they initiated heroin use, heroin use among people who use prescription opioids for non-medical reasons is rare, and the transition to heroin use appears to occur at a low rate,” researchers reported in the New England Journal of Medicine.

Another recent study of military veterans found there was no significant link between heroin use and legally prescribed opioids or chronic pain.

Further compounding the problem is that some heroin and fentanyl deaths are falsely reported as overdoses from opioid pain medication due to inadequate or nonexistent toxicology tests.

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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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