The number of overdose deaths from powerful painkillers more than tripled over a decade, the federal government reported recently — a trend that a US. health official called an epidemic, but one that can be stopped.

Prescription painkillers such as OxyContin, Vicodin and methadone led to the deaths of almost 15,000 people in 2008, including actor Heath Ledger. That’s more than three times the 4,000 deaths from narcotics in 1999.

The overdose deaths reflect the spike in the number of narcotic painkillers prescribed every year — enough to give every American a one-month supply, said Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention in Atlanta, which issued the new report.

Such painkillers “are meant to help people who have severe pain,” Frieden said. “They are, however, highly addictive.”

Prescriptions have risen as doctors aimed to better treat pain and as new painkillers hit the market.

The report shows nearly 5 percent of Americans ages 12 and older said they’ve abused painkillers in the past year — using them without a prescription or just for the high.

In 2008-09 surveys, Oklahomans reported the highest rate of abuse at 8.1 percent while the lowest was in Nebraska and Iowa at 3.6 percent. The national average was 4.8 percent.

Texas was below the national average for people who’ve abused painkillers in the past year at just 4.6 percent.

New Mexico had the highest overdose death rate with 27 deaths per 100,000 residents, while Nebraska had the lowest at 5.5 deaths per 100,000 residents. The national rate was 11.9 per 100,000 people.

Texas’ death rate was well below the national average at 8.6 per 100,000 residents, making it the state with the ninth-lowest rate of such overdose deaths.

Sales of prescription painkillers are highest in the Southeast and Northwest.

States oversee prescription practices and can rigorously monitor prescriptions and crack down on “pill mills” and “doctor shopping” by patients, Frieden said.

Doctors should limit prescriptions — giving only a three-day supply for acute pain, for example — and look for alternative treatments, he said.

“For chronic pain, narcotics should be the last resort,” he added.

Overall, there were 36,450 fatal overdoses in 2008, including accidental cases and suicides involving illegal drugs such as heroin and cocaine along with prescription medicines. About three-quarters of the deaths from prescriptions involved narcotic painkillers.

The report notes that fatal overdoses were more likely in men, middle-aged adults and whites and American Indians.

A federal drug plan announced this year calls for state programs to track prescriptions. All but two states — Missouri and New Hampshire — have approved them.

U.S. sees epidemic of prescription painkiller deaths is a post from: Accident & Injury Law in Texas

The Texas Supreme Court overturned a $32 million jury award to the family of a Texas man who died after briefly taking Vioxx, a painkiller the drugmaker later pulled from the market.

A jury in Rio Grande City in 2006 made the award to the family of 71-year-old Leonel Garza. He had heart disease for 23 years and died in 2001 after less than a month on Vioxx.

The award — originally $25 million in punitive damages, plus $7 million in compensatory damages — was reduced to about $7.75 million under the state’s damage caps.

A Texas appeals court later overturned the verdict because of jury misconduct and ordered a new trial.

Merck, the world’s second-largest drug-maker by revenue, stopped selling Vioxx in September 2004, amid evidence it doubled risk of heart attack and stroke.

Texas high court overturns award in Vioxx case is a post from: Accident & Injury Law in Texas

Medical procedures and surgeries on the wrong patient and wrong body part have declined stantially at Veterans Affairs hospitals nationwide, while reports of close calls have increased, according to a study that credits ongoing quality improvement efforts, which encourage better reporting and communication at hospitals. The study, published online in the Archives of Surgery, is based on reports from mid-2006 to 2009; they were compared with data from the previous five years.

Fewer surgical errors at VA hospitals is a post from: Accident & Injury Law in Texas

The Texas Medical Board last month disciplined seven Austin-area doctors, including two alternative practitioners.

The two are Dr. Russell Roby of Austin, who is known for his infomercials, and Dr. Philip Zbylot, a preventive medicine practitioner in Austin and Wimberley and chief medical official for Austin/Travis County in the mid-1980s.

The board said that Roby, 70, who gives allergy medication under the tongue rather than through injections as is usually done, failed to inform a patient that the treatment was not approved by the Food and Drug Administration and that anaphylactic shock could occur.

The board reprimanded Roby in 2004 for inadequate patient consent and disciplined him again in 2007 for inadequate disclosure, requiring him to tell patients that his treatments, therapies and formulas were not FDA-approved and had not been tested for their effectiveness. Roby failed to follow the 2007 requirements and did not disclose the ingredients in his formulation to patients, the board’s current order says.

The board also said it found that Roby had a sexual relationship with a patient who also was an employee.

Earlier this month, the board issued a public reprimand of Roby, a relatively light form of discipline, and ordered him to take courses in professional boundaries, recordkeeping and ethics; pass a medical jurisprudence exam; submit all of his advertisements to board staff for review; pay a $3,000 fine; and continue his treatment for bipolar disorder.

“He skated,” said Dena Buckley of San Antonio, a former patient who said her complaint prompted the order. “It cost him $3,000, and he has to take classes. I have $25,000 in medical bills I am still paying.”
Buckley, 48, said the drops Roby gave her in 2009 caused her to go into anaphylactic shock and be hospitalized.

Roby disputed that the drops caused a severe reaction. He treated Buckley, who is not named in the board’s order.

Dr. Gary Albertson said he worked for Roby from 2004 until he quit in Apri1 2010. Albertson said that he didn’t recall any severe reactions but that he no longer uses drops as treatment because he does not consider them as effective as injections.

Roby said the main issue was using an outdated form that lacked the FDA disclosure. As for the inappropriate relationship, Roby said he stopped treating the woman once they became intimate. She became an employee and lived with him for seven years but fell out with him over a joint venture, the Roby Institute in Brazil, he said.

Zbylot, who the board said is 63, was medical director of Holistic Health Care Center in Boerne, which was inspected m March 2009 by the Department of State Health Services after a complaint that it did colon irrigation as a treatment for cancer without medical supervision, the order says. Zbylot said he became the medical director later that month, unaware of the states involvement.

Zbylot said he also was unaware that the medical board required patients to have physician orders for the treatment and added that because he was 60 miles away, he saw his job as developing protocols, not being on site to supervise.

“I didn’t understand that the board understood this to be part of the practice of medicine,” Zbylot said.

The board said Zbylot’s failure to consult with a lawyer or state authorities after he took the job “demonstrated indifference regarding the law by relying on nothing other than the statements of (the center’s) owners?’

Owner Michele O’Donnell said there were no requirements that doctors write orders for colon irrigation and “the medical board makes up the rules as they go.”

That matter is in litigation. The board ordered Zbylot not to supervise or delegate medical tasks to others. His practice also must be monitored by another doctor, and he must take a jurisprudence exam and a recordkeeping course and pay a $3,000 fine. Zbylot said he agreed to the punishment rather than undergo the expense of litigation.

The board also:

• Accepted the voluntary surrender of the license of Dr. Venkat Reddy Akkanti, a Bastrop pediatrician. The board accused him of prescribing large amounts of promethazine with codeine to numerous patients without showing it was necessary or documenting it. Akkanti denied the allegations but decided to retire at age 59, the order says.
• Ordered Dr. Rhonda Lee Anderson, an Austin psychiatrist, to pay a $1,000 fine and take courses in record keeping and drug-seeking behavior.  It said said she failed to use diligence in prescribing narcotics to a soldier who was an admitted drug abuser and was found dead in his barracks in 2008.
• Ordered Dr. Anthon Wolfe Shallin, a Georgetown internist, to pay a $3,000 fine and take courses in record keeping and urinary tract infections. The board said Shallin failed to meet the standard of care which led to a delay in diagnosing bladder cancer in a patient.
• Ordered Dr. David C. Riedel, a Liberty Hill psychiatrist, to take courses on record keeping and risk management after the board said he prescribed medicine to five relatives without examining or diagnosing them or keeping records.
• Ordered Dr. Robert Edward Cantu, an Austin psychiatrist, to pay a $1,000 fine and take a course in record keeping because of inadequate records.

State Medical Board disciplines 7 Austin-area doctors is a post from: Accident & Injury Law in Texas

A panel of cancer experts has ruled for a second time that Avastin, the best-selling cancer drug in the world, should no longer be used in breast cancer patients, clearing the way for the government to remove its endorsement from the drug.

The unprecedented vote Wednesday by the Food and Drug Administration advisory panel comes less than a year after the same panel reached the same conclusion.

In three unanimous votes, the six members of the FDA oncology drug panel voted that Avastin is ineffective, unsafe and should have its approval for breast cancer withdrawn.

“I think we all wanted Avastin to succeed, but the reality is that these studies did not bear out that hope,” said Natalie Compagni-Portis, the lone patient representative on the FDA panel.

The vote is not binding. FDA Commissioner Margaret Hamburg will make the final decision. The drug is approved for multiple cancers and will still be available for breast cancer, though most insurers are expected to drop coverage if it loses FDA approval.

The FDA began steps to remove Avastin’s breast cancer approval in December, but drugmaker Roche took the rare step of appealing that decision and lobbied the agency and Congress for a second hearing.

The dramatic, contentious tone of the two-day hearing underscored the difficulty of removing an option for cancer patients, even when backed by scientific evidence.

After the vote, patients erupted in shouts against the FDA and its panelists. “What do you want us to take? We have nothing else!” shouted Christi Turnage of Madison, Miss. She said her cancer has been undetectable for more than two years since starting therapy with Avastin.

A spokesman for the Abigail Alliance, which pushes for patient access to experimental medicine, said the vote should be overruled. “This was a kangaroo court,” said Steven Walker, the group’s co-founder. “There wasn’t one dissenting thought up there, let alone one dissenting vote.”

Assuming the FDA follows through on the withdrawal, Roche could lose up to $1 billion in revenue for its bestselling product, which generates more than $6 billion per year. Avastin is FDA-approved for various types of colon, lung, kidney and brain cancer, which are not part of the debate. Without insurance, a year’s treatment of Avastin, including administration fees, can cost $100,000.

Panel urges end of using drug to treat breast cancer is a post from: Accident & Injury Law in Texas

Three Austin doctors were among 75 disciplined this month by the Texas Medical Board, including Dr. James Edward Hansen, a neurologist, who surrendered his medical license after closing his practice.

The board’s order said Hansen suffered a spinal injury while biking and was unable to practice. It said the discipline is authorized when a doctor cannot practice skillfully and safely because of “mental or physical condition” and when the board is seeking to resolve a complaint or contested case against the doctor.

The board also ordered Dr. Dennis Barson Jr., a general practitioner, to take a course in patient boundary issues after allegedly providing false information about a court-ordered drug test for a close friend. The order said Barson did not admit guilt but signed the order to avoid litigation.

The board also ordered Dr. Lloyd Elvin Arnold Jr. to pay a $500 fine for allegedly closing his practice without giving proper notice to patients so they could get or transfer their records.

UPDATE:  I received a nasty letter from one of the doctor’s lawyers threatening a defamation lawsuit because of comments made by other people based on this article were allegedly untrue.  It’s definitely a shame some doctors and lawyers feel they can bully people who exercise their free speech rights.  While I definitely feel I can’t be held liable for someone else’s comments on this site – I’m too busy working on client files to deal with the hassle .  So I’ve removed all the comments.

Board disciplines three doctors is a post from: Accident & Injury Law in Texas

The Texas Medical Board was among 33 similar boards nationally that did not discipline many doctors who either lost their hospital privileges or were restricted in their hospital practices, a national report released Tuesday said.

“This is a serious failing on the part of state medical boards,” Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group and overseer of the study, said in an interview. Public Citizen is a nonprofit consumer advocacy group founded by Ralph Nader.

Hospitals report sanctions against doctors to the National Practitioner Data Bank, which the health research
group viewed over a 20-year period, from 1990 to 2009.

It found that state boards did not discipline 55 percent of the 10,672 physicians who had been listed in the national data bank, including 3,218 doctors who permanently lost their hospital practice privileges. The report said that in Texas, 60.4 percent of 725 doctors during the two decades escaped medical board action.

One unnamed doctor who did not receive discipline by the state board in Texas had 22 medical malpractice payments totaling $2.6 million between 1996 and 2008 that included claims that he operated on the wrong part of the body and injured three patients permanently, the report said.

“Either state medical boards are receiving this disturbing information from hospitals but not acting upon it, or much less likely, they are not receiving the information at all,” Wolfe said in a written statement. “Something is broken and needs to be fixed.”

Texas Medical Board spokeswoman Leigh Hopper said that under board rules, hospitals are required to tell the board when they discipline a doctor whose continued practice is a threat to the public welfare but that not all of them do.
Further, the national data bank does not notify the board of hospital disciplinary reports, and the board would have to look up individual doctors by name to see whether any were taken. That would not be practical with 49,397 instate doctors, Hopper said.

Not all doctors disciplined by a hospital merit board action, she added. A substance abuser, for example, might be referred to a confidential treatment program, with no public action taken.

Wolfe said that for a nominal fee, medical boards can pay the data bank to be notified of hospital actions against physicians in their state. Hopper said she was not aware of that service or the cost.

For $3.25 per doctor per year, the national data bank would provide notice of any actions against the doctor within 24 hours, data bank spokesman David Bowman said.

For Texas, that cost would be about $160,540 a year — an amount that Hopper said equals the salaries of four investigators at the agency.

Report: Texas not punishing enough doctors is a post from: Accident & Injury Law in Texas

Federal law protects pharmaceutical companies from lawsuits by parents who claim that vaccines harmed their children, the Supreme Court ruled Tuesday.

The court ruled 6-2 that a special tribunal set up by Congress is the only way parents can be compensated for the negative side effects that sometimes accompany vaccinations.

The majority said that Congress found such a system necessary to ensure that vaccines remain readily available and that federal regulators are in the best position to decide whether vaccines are safe and properly designed.

The National Childhood Vaccine Injury Act of 1986 “reflects a sensible choice to leave complex epidemiological judgments about vaccine design to the FDA and the National Vaccine Program rather than juries,” Justice Antonin Scalia wrote.

Justices Sonia Sotomayor and Ruth Bader Ginsburg dissented, saying the threat of lawsuits provides an incentive for vaccine manufacturers to constantly monitor and improve their products.

The decision is a victory for vaccine-makers such as Wyeth and GlaxoSmithKline. Kathleen Sullivan, who represented Wyeth in the case before the court, told justices that ruling against the company could lead to thousands of lawsuits in which parents claim, for instance, that the mumps, measles and rubella vaccine played a role in their children’s autism.

The Obama administration backed the vaccine-makers. Justice Elena Kagan was recused because of her work on the case as solicitor general.

The case was brought by Russell and Robalee Bruesewitz on behalf of their daughter Hannah, 18. Hannah began to have seizures as an infant after receiving the third of five scheduled doses of Wyeth’s Tri-Immunol diphtheria-pertussis-tetanus vaccine. The company, now owned by Pfizer, has taken the drug off the market.

The 1986 federal law said that all such claims must, first go to a special tribunal commonly called the Vaccine Court. The program has awarded nearly $2 billion for vaccine-injury claims in nearly 2,500 cases since 1989. It is funded by a tax on immunizations.

But the tribunal ruled against the Bruesewitzes, saying they had not proved that the vaccine harmed Hannah, who will need lifelong care.

Ruling protects vaccine-makers from lawsuits is a post from: Accident & Injury Law in Texas

Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm, from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents didn’t decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections.

“It is unlikely that other regions of the country have fared better,” said Dr. Christopher Landrigan, lead author of the study published today in The New England Journal of Medicine.

It is one of the most, rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than 1 million injuries a year in the U.S. That Institute of Medicine report led to a national movement to reduce errors.

But instead of improvements, Landrigan’s team found a high rate of problems. About 18 percent of patients were harmed by their medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

Mistakes still common in hospital care, study finds is a post from: Accident & Injury Law in Texas

Six Austin doctors were among 77 disciplined by the Texas Medical Board, including one who surrendered his license to practice internal medicine.

Dr. Michael Bowen Pickrell was ordered by the board in May 2009 to be monitored by another doctor, take part in the board’s drug testing program and be treated by a psychiatrist after the board said he improperly prescribed narcotics to some patients and self-medicated for depression and “steroid psychosis,” among other allegations.

Pickrell said Monday that he complied with the board’s order but could no longer afford to keep paying another doctor to monitor his practice. His contract with a major health insurer was canceled, and he was seeing too few patients, he said.

“I really tried to comply, and it was really a financial hardship,” Pickrell said.

He said that much of what was in the 2009 order was inaccurate, but he signed it anyway so he could continue practicing. “I’m still angry,” he said.

The board also:
■    Ordered Dr. Jeffrey L. Butts, who practices addiction medicine, to take a record-keeping course after the board said he did not adequately document a patient’s medication. The order was the result of a mediation agreement. ■    Fined Dr. Stephen Longmoor Brown, a radiation oncologist, $1,000 and ordered him to take a medical record-keeping course. The board said Brown failed to keep an adequate record on a longtime patient he prescribed narcotic pain medicine to and regularly spoke with by phone.
■    Fined Dr. Carlos Rubin deCelis, an oncologist, $500 and ordered him to take a course in medical jurisprudence. The board said he inappropriately gave pre-signed prescription forms for controlled substances to nurse practitioners — only to be used for established patients needing immediate help with pain.
■    Fined Dr. Maureen Lenore Adair, a psychiatrist, $500 for writing prescriptions for controlled substances between January and May while her state certificate was expired.
■    Ordered Dr. Douglas Hall Rankin, in family practice, to take a course in anxiety disorders. He was disciplined for inappropriately prescribing a medication to a patient and failing to properly manage the patient’s anxiety, according to the board’s order.

State board disciplines 6 Austin doctors is a post from: Accident & Injury Law in Texas