Palliative Care, Medical Marijuana, Abortion, Practice Management, Rx Price Controls
In 1999, the Oregon Board of Medical Examiners was the first to discipline a physician for undertreating patients in pain. But the verdict of a California jury is expected to have even more impact.
The case stems from care provided to an 85-year-old man, whose hospice nurse found his pain to be "out of control." After several phone calls to his physician, she was told to contact another doctor. The patient died the next day. His children sued the first physician under California's Elder Abuse and Dependent Adult Civil Protection Act, which allows survivors to sue for a patient's pain and suffering. In awarding the plaintiffs $1.5 million in damages, the jury found the doctor's conduct reckless and abusive.
A recent CNN online news poll suggests that public opinion is on the side of the jury. Two out of three people believe a physician should be held liable for not providing a terminally ill patient with enough pain medication.
In keeping with a court ruling last year, Canada has decriminalized the possession of marijuana for medicinal purposes. The new regulations went into effect last month, despite arguments from the Canadian Medical Association that the new rules put physicians in an "untenable position."
Doctors now must counsel patients about the risks and benefits of marijuana. But so little is known about the drug's benefits and effects, the Canadian group warns, that "informed consent is impossible." What's more, the association fears that the regulations could damage the therapeutic relationship, if patients believe that the drug would benefit any medical condition or see doctors as a conduit for obtaining illegal recreational drugs.
States' attempts to outlaw partial-birth abortion have failed to survive court challenges, but opponents of the procedure have proposed a back-door approach that may succeed. Legislation recently introduced in both houses of Congress would recognize as "persons" babies born alive, regardless of their stage of development.
Under the "Born Alive Infants Protection Act" sponsored by Sen. Rick Santorum (R-PA), any baby born alivewhether the birth occurs as a result of natural or induced labor, cesarean section, or induced abortionwould be entitled to the same protection under law as all other Americans.
The HHS Office of Inspector General has issued a special advisory bulletin to alert physicians that questionable advice peddled by some management consultants could lead to violations of criminal and civil statutes. In particular, HHS cites practices such as using inappropriate billing codes to support higher levels of service than actually warranted. A recent report from the General Accounting Office also zeroed in on advice to attract better-paying patients by offering them more follow-up care and more-convenient appointments than given to Medicaid patients.
Acting on such advice could violate the nondiscrimination clause of the Civil Rights Act of 1964.
In mid-May, a federal appeals court upheld Maine's mandatory Medicaid drug-rebate demonstration program, praising the state's courage in attempting such a "novel" experiment.* But Maine's victory may be short-lived. Pharmaceutical Research and Manufacturers of America (PhRMA)the drug industry trade group that had challenged the constitutionality of the programis back in court, suing the Centers for Medicare & Medicaid Services (formerly HCFA) and HHS Secretary Tommy Thompson.
PhRMA contends that the Maine Rx Program violates federal Medicaid laws because it would, in effect, be funded entirely by rebates from manufacturers of prescription drugs. Under the new program, state officials can negotiate pharmaceutical rebates and discounts; beneficiaries pay the same discount rate the state does for the drugs, and the rebates are used to cover the subsidies paid to participating pharmacists. In June, PhRMA prevailed in a suit brought on similar grounds against Vermont's discount drug program.
*See "Rx price controls: Maine gets a go-ahead," July 9, 2001.
Joan Rose. Practice Beat. Medical Economics 2001;16:18.