Proposed Prescription Database Law Could Cut Painkiller Deaths

A proposed law could reduce accidental deaths and suicides from prescription painkillers.

Supporters of the controversial measure include two San Diegans who were featured in an NBC 7 Investigates story about prescription drug overdoses. Those residents are flying to the state Capitol to testify Monday on behalf of the legislation.

More than 1,000 Californians die every year from accidental or purposeful abuse of controlled substances. Those victims include Kristin Greene, a Lakeside resident who killed herself in November, 2013, with a toxic cocktail of painkillers and sedatives.

Documents obtained by NBC 7 Investigates reveal that Kristin had obtained more than 60 prescriptions from nine medical professionals and several pharmacies in the five years before her death.

Her story — and her family’s effort to prevent more prescription drug deaths — was the focus of an NBC 7 Investigates report in February.

Kristin’s sister, Lisa Bond, said Kristin might still be alive if doctors were required to check the state’s narcotics database, called CURES (the Controlled Substance Utilization Review and Evaluation System), before they prescribe controlled substances for new patients.

Senate Bill 482, authored by State Senator Ricardo Lara, of Bell Gardens, would require doctors to use the CURES database or be subject to discipline.

Bond and her husband are flying to Sacramento Sunday to prepare for Monday’s Senate committee hearing on the proposed law. They’ll be joined at the Capitol hearing by Clark Smith, M.D., a San Diego psychiatrist and addiction expert who also supports the mandatory use of the CURES database.

“I think if CURES were used on a regular basis, we would see tremendous progress in cutting back prescription drug dependence,” Smith told NBC 7 Investigates.

Supporters say it will prevent “doctor shopping” by drug addicted patients, like Kristin.

Her sister said if one of Kristin’s doctors had refused to write her a prescription, Kristin might have sought help for her addiction.

“Maybe at that point she would have said, ‘Hey, listen, I have a problem. I need to get in rehab again,’” said Bond. “Because she can’t get the drug. What’s she going to do? She needs to take care of that situation. Maybe then she would reach out and say, ‘I need to get rehab’, or anything. But she wouldn’t be able to get all those drugs.”

The California Narcotics Officers’ Association, the California College and University Police Chiefs Association and several consumer groups, including Consumer Watchdog, also support SB 482.

Opponents include CVS Health and Rite Aid stores and the California Medical Association (CMA).

The CMA says “the premature and overly-broad mandatory check” required by the proposed law would “negatively impact patient care” and “will discourage even appropriate prescribing of controlled substances.”

The CMA advocates a more “balanced” approach to the problem of prescription drug abuse: “This bill doesn’t achieve that balance and patients with legitimate medical (needs) will be the ones who are disproportionately impacted.”

Published at 7:05 PM PDT on Apr 24, 2015

Do you really need a CT Scan or X-ray?:

Patients are often exposed to cancer-causing radiation for little medical reason, a Consumer Reports investigation finds

When James Duncan, M.D., a radiologist at Washington University in St. Louis, experienced intense pain in his abdomen in 2010, he rushed to a local emergency room. His doctors suspected kidney stones, but they wanted to be sure, so they ordered a CT scan. Duncan remained motionless as the machine captured a detailed, 3D image of his abdomen. He knew that the test was done when the machine stopped whirring. So he was surprised when the scanner kicked back on after a few seconds.

“I later learned that the technician running the CT mistakenly believed that the first scan didn’t include the top of my kidneys, and decided to acquire more images ‘just to be sure,’ ” Duncan says. “The irony: I was getting ready to give a lecture on reducing radiation exposure from medical imaging. And there I was, reluctantly agreeing to a CT scan and then getting overexposed.”

Duncan will never know whether that specific scan caused any long-term harm, because it’s almost impossible to link radiation exposure from any one medical test to a future illness. But like other researchers, he knows that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.

X-rays have been used for almost 120 years, but the introduction of computed tomography, or CT scans, in the 1970s, was revolutionary. The new tests, which use multiple X-ray images, allowed doctors to see with unprecedented precision the inner workings of the human body, and earned the inventors of the device the 1979 Nobel Prize in medicine. Use of the tests grew quickly, rising from fewer than 3 million per year in 1980 to more than 80 million now.

But recent research shows that about one-third of those scans serve little if any medical purpose. And even when CT scans or other radiology tests are necessary, doctors and technicians don’t always take steps to limit radiation exposure.

All of that exposure poses serious health threats. Researchers estimate that at least 2 percent of all future cancers in the U.S.—approximately 29,000 cases and 15,000 deaths per year—will stem from CT scans alone. Even some standard X-rays, which expose you to much smaller amounts of radiation, can pose risks if you undergo multiple ones.

“No one says that you should avoid a CT scan or other imaging test if you really need it, and the risk posed by any single scan is very small,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “But the effect of radiation is cumulative, and the more you’re exposed, the greater your cancer risk. So it’s essential that you always ask your doctors why they are ordering an imaging test and whether your problem could be managed without it.”

Given those risks, why are we—and our doctors—so scan-happy?

That’s the number of people estimated to die each year because of cancers caused by the radiation in CT scans alone.

For one thing, patients aren’t necessarily aware of the danger. A new Consumer Reports survey of 1,019 U.S. adults found that people are seldom told by their doctors about the risks of CT scans and other radiology tests. It’s no surprise, then, that only 7 percent of those who had a nondental X-ray and 2 percent of those who had a CT scan thought they might have received the tests unnecessarily. And only 4 percent ever told their doctor they did not want a CT scan. “That’s worrisome,” says Lipman’s colleague at Consumer Reports, Orly Avitzur, M.D. “Patients need to take the lead on this because their doctor may not.”

Other studies show that doctors themselves often underestimate the dangers CT scans pose. Moreover, some doctors may actually have a financial incentive to order the tests.

“Health care professionals shouldn’t have the right to image children or adults unless they first show that they can do it safely and appropriately, and most of the time in this country, that’s not happening,” says Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minn. “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”

Read more

MICRA appeal update

NOVEMBER 28, 2014

MICRA constitutionality might be early test of the “new” Supreme Court

The Supreme Court on Tuesday granted review in Hughes v. Pham.  A group who supported review is touting the court’s action as a decision to “review the constitutionality of [what the group characterizes as] the state’s arbitrary 39-year-old damages cap of $250,000 in medical malpractice cases.”  That’s wrong . . . at least for now.

The constitutionality of Civil Code section 3333.2 — the limit on noneconomic damages in healthcare professional negligence cases enacted as part of the 1975 Medical Injury Compensation Reform Act (MICRA) — is not currently before the court in Hughes, but it could be before spring.  If that happens, it will be a harbinger of change at the Supreme Court due to the court’s three newest justices, all appointed by Governor Brown.

The Hughes petition for review raises the constitutional issue, but, in granting review in Hughes, the court clearly did not agree to decide that issue.  In fact, the court did not agree to decide any issue in Hughes at all.  Hughes is a grant-and-hold case; action on the matter is deferred pending disposition of Rashidi v. Moser, S214430, and the eventual “action” on a grant-and-hold case is usually not a written opinion.  Moreover, the court will not decide the constitutional issue in Rashidi, either.  Indeed, the court is expressly avoiding that issue there:  the Court of Appeal upheld the constitutionality of the cap in a published opinion and the Rashidi plaintiff’s petition for review raised the constitutional issue, but the court specifically limited the case to an issue about how the damage cap is applied, thereby presuming the statute’s constitutionality.

But, just because Hughes‘s status as a grant-and-hold case means the court normally would not issue an opinion in the matter does not mean that the status won’t change.  The court can, and occasionally does, un-hold a case and order briefing, hold oral argument, and issue an opinion.  If that happens in Hughes, the court could decide the constitutionality of the MICRA damage cap in that case.  And it might happen.  Some history tells why.

Actually, the Supreme Court already decided the constitutionality of the MICRA cap.  It upheld the law almost 30 years ago in Fein v. Permanente Medical Group (1985) 38 Cal.3d 137.  Within the last ten years, however, plaintiffs lawyers have renewed their attack on the cap in court with somewhat different constitutional arguments.  So far, they’ve been unsuccessful.  For example (and a disclosure), Horvitz & Levy filed an amici curiae brief supporting the cap five years ago in a case raising the same constitutional issues as in Hughes.  In that case, the Court of Appeal upheld the MICRA cap’s constitutionality in an unpublished opinion and the Supreme Court denied review.  (The plaintiffs’ bar has also failed to raise the amount of the cap legislatively, most recently winning only 33 percent of the vote for a ballot initiative.)

Three years ago, however, when the Court of Appeal again rejected constitutional attacks on the MICRA cap, in Stinnett v. Tam (2011) 198 Cal.App.4th 1412, the Supreme Court again denied review, but Justices Kathryn Werdegar and Goodwin Liu voted to hear the case.

In Stinnett, the court was two votes short of review.  Within the next two months, there will be two new justices on the court — Mariano-Florentino Cuéllar and Leondra Kruger — who could join with Justices Werdegar and Liu in voting to decide the constitutional issue.  And the first opportunity to do so would be un-holding Hughes.  That could happen after a decision in Rashidi,  which was argued in October, or even before then.

A change in court personnel can profoundly affect the outcome of cases.  The court’s MICRA jurisprudence itself is a prime example.  When the Supreme Court first reviewed the constitutionality of MICRA, examining a part of that statutory scheme other than the damages cap, the court initially struck down the law in a 4-3 decision.  (American Bank and Trust Co. v. Community Hospital (1983) 190 Cal.Rptr. 371.)  There were three pro tem justices on the case; two voted with the majority and one with the dissenters.  Soon after the decision, Governor Brown (in his first stint as governor) appointed Joseph Grodin to the court, replacing one of the pro tems who had been in the majority.  Justice Grodin voted with the three dissenters to rehear the case and he and those three formed a new majority to uphold MICRA.  (American Bank & Trust Co. v. Community Hospital (1984) 36 Cal.3d 359.)

Legal observers have been discussing how Governor Brown (in his second two terms as governor) could reshape the Supreme Court.  An early indication of that impact will come when his three appointees this time around — Liu, Cuéllar, and Kruger — vote whether to treat Hughes as a typical grant-and-hold or to use that case as the vehicle to reevaluate the constitutionality of MICRA’s damage cap.


DECEMBER 12, 2014

MICRA opinion filing Monday

On Monday morning, the Supreme Court will file its opinion in Rashidi v. Moser, which was argued on the October calendar.  In Rashidi, the court will answer this question:  If a jury awards the plaintiff in a medical malpractice action non-economic damages against a healthcare provider defendant, does Civil Code section 3333.2 entitle that defendant to a setoff based on the amount of a pretrial settlement entered into by another healthcare provider that is attributable to non-economic losses or does the statutory rule that liability for non-economic damages is several only (not joint and several) bar such a setoff?

Rashidi is perhaps more notable for what is not being decided than what is.  The statute the court will interpret is the part of the 1975 Medical Injury Compensation Reform Act (MICRA) that limits to $250,000 the recoverable amount of noneconomic damages in healthcare professional negligence cases.  The plaintiffs’ bar doesn’t want the statute interpreted; it wants the statute struck down as unconstitutional, and the plaintiff asked the court to do that in Rashidi.  But the court specifically limited the issue (See below) it would decide to the narrower statutory construction question.

The opinion can be viewed Monday starting at 10:00 a.m.


Study: Victims of mistakes in hospitals not reporting errors:

The Haverhill Gazette

By Lauren DiTullioStaff Writer | Posted: Thursday, December 11, 2014 1:10 am

Twenty years ago, one mistake at a renowned Boston hospital cost a Boston Globe reporter her life and permanently damaged the heart of a North Andover teacher. Today, nearly one in four Massachusetts residents still believe they or someone close to them has been affected by a medical error, a recent study by the Harvard School of Public Health found.

Of those people, more than a third chose not to report the mistake.

Justin Sayde,  administrative and research manager at Harvard School of Public Health, said the aim of the study was to gather preliminary data and get a sense of the scope of the medical error problem in the state. It was co-commissioned by the Health Policy Commission and the Betsy Lehman Center for Patient Safety and Medical Error Reduction.

The center is named for the Globe healthcare columnist who died after she was prescribed four times as much chemotherapy medication as necessary during a study at the Dana-Farber Cancer Institute in 1994. Maureen Bateman of North Andover died a little more than two years after she participated in the same trial.

“We’re just really trying to wrap our heads around the extent of this issue,” Sayde said. “It is very much still an issue. That’s the takeaway point. There have been some improvements, but something needs to be done.”

The study, released a week ago, asked 1,224 Massachusetts residents whether they or someone close to them believed they had experienced a medical error situation. Twenty-three percent responded that they had. Of those people, 54 percent chose to report the error, while 37 percent chose not to.

“The challenge here is that the reporting is spotty. The requirements depend on where you live. It’s different state by state,” Sayde said.

Of those who reported the incident, most told only their doctor, and just 8 percent reported it to a state agency. Those who chose not to report the error gave a variety of reasons, but 36 percent said it was because they didn’t know how.

“I think part of the issue is that most of the public isn’t aware of how to report these errors,” Sayde said. “I wish I could say there’s a hard and fast rule about what should be done if you think you’ve been involved in a medical error situation. The whole purpose of the Lehman Center is to look at what’s happening and try to … formulate a protocol.”

The Department of Public Health requires that hospitals report errors like the one that killed Lehman and injured Bateman, in addition to many other types of mistakes. The state defines a “serious reportable event” as an error that is “clearly identifiable and measurable … and of a nature such that the risk of occurrence is significantly influenced by the policies and procedures of the healthcare facility.” Examples include falls that result in injury, operations done on the wrong body part, procedures that leave foreign objects inside the patient, complications due to contaminated medications and more.

In 2012, Methuen’s Holy Family Hospital reported three major errors. In 2013, the number more than doubled, with eight incidents reported. The case was similar at Lawrence General Hospital and Merrimack Valley Hospital, which has since merged with Holy Family Hospital and is now called Holy Family Hospital at Merrimack Valley. Both reported four incidents in 2012. In 2013, the number at Lawrence General rose to seven. Merrimack Valley Hospital reported eight.

Lawrence General Hospital’s Chief Medical Officer, Dr. Neil Meehan, like Roach, attributed the increase to new reporting standards for hospitals. Still, he acknowledged that those in the field have been pushing to address a wide variety of patient safety issues in recent years. Lawrence General’s Chief Executive Officer Dianne Anderson sat on an expert panel during a presentation about the problem at the recent relaunch of the Lehman Center. Established in 2004, it closed in 2010 due to lack of funding, but was re-established this year as part of a larger piece of healthcare legislation passed in 2012.


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