Friday, March 15, 2013

Physicians In The Dust

Here's the facts of a very recent Iowa appellate court case that exemplifies the opioid abuse problem.

Gallo v. Penford Products Co., No. 3-081/12-1472.

Gallo had been a warehouse worker for the Penford Products Co., a producer of specialty, naturally-based ingredient systems for papermaking, food and animal products.

He injured his lower back in February 2005 while dislodging a 50-pound bag of product from a palletizer machine and went to see Dr. Nate Brady at the St. Luke's Work Well Clinic in Cedar Rapids.

Brady took Gallo off work for a week and prescribed Percocet, a narcotic pain-reliever that Gallo had requested by name.

First mistake...

Gallo returned to see Brady twice more in March after suffering additional back strains at work and he remained on the Percocet for two more months.

Second mistake...

During that time, Gallo went to see Dr. Gordon Urbi, a family practitioner in Cedar Rapids, complaining of extreme back pain when he bent over to pick up clothing at home. Gallo obtained a prescription for another painkiller from Urbi in April 2005.

Four days later, Gallo went to see his personal physician, Dr. Casey Boyles, and he received a prescription for hydrocodone and muscle relaxants.

Do you think by this time that a state wide prescription drug database such as the Kansas KASPER or the California CURES system would catch these red flags?

The following month, Gallo returned to Boyles' office complaining of worsening pain symptoms. An MRI indicated that he had a new right side disk fragment and a herniated disk at L4-L5.

Gallo underwent surgery, but continued to complain of pain.

In July 2005, he received a transforaminal nerve block. That same month, Gallo reported hurting his back while moving a refrigerator at home and Boyles prescribed him Lortab, a Schedule II opioid pain medication.

One week later, Gallo came back to see Boyles and said he strained his back while sneezing. He obtained a second Lortab prescription with one refill.

On Aug. 5, 2005, Gallo went to see his wife's physician, Dr. Wayne Alberts. Gallo told Alberts that he needed a refill on his pain medication, but Boyles was out of town and unable to provide it. Alberts issued him a prescription for Lortab.

Within a week, Gallo had a second nerve block, and he returned to Boyles' office for more Lortab on Aug. 22.

The following month, Gallo was arrested for impersonating a doctor in order to obtain even more prescription pain medication.

Gallo had a history of drug abuse and underwent treatment in 1997 for addiction to narcotic pain relievers dating back to 1995. He also admitted abusing recreational and prescription drugs, including marijuana, morphine and hydrocodone.

In October 2005, Gallo checked into the Sedlacek Center for substance abuse treatment and he began seeing Alberts for symptoms of depression.

On multiple occasions between March and June 2006, Gallo went to the Mercy Medical Center emergency room complaining of back pain.

He received prescriptions Lortab, ibuprofen and hydrocodone.

Gallo did not report his history of prescription medication abuse to Mercy staff and claimed he did not have a family physician, even though Alberts was treating him at that time.

Again, would a prescription drug database system have been effective in catching this clearly addiction-based behavior?

Throughout this whole period, Gallo was still working at Penford up to 56 hours per week (though frankly I can't imagine that he was very efficient or effective in his "work").

Penford fired him in January 2007 after learning Gallo had been convicted for impersonating a doctor to obtain prescription medications.

Several physicians evaluated Gallo to determine his level of impairment, and they all returned findings that Gallo was able to work in some capacity.

Gallo also met with vocational consultant Steve Mootz in November 2007, but Mootz reported Gallo was unwilling to cooperate and lacked motivation to find a job, even though he had realistic prospects for obtaining work.

Deputy Workers' Compensation Commissioner Michelle McGovern noted that at the time Gallo met with Mootz, Gallo was collecting more than $5,000 per month in disability benefits from the Railroad Retirement Board, the Social Security Administration and the workers' compensation carrier for Penford.

McGovern posited that this substantial level of income might have been responsible for Gallo's reticence in finding new work.

That is a good theory in my opinion.

She determined that Gallo had a 60% industrial disability because of his back, and ruled his claimed depression was not compensable.

Gallo lost all the way up the appellate chain and though his attorney told WorkCompCentral he was considering further appeals it seems quite clear to me that Gallo should be happy with his 60% rating - that is one tough fact pattern to overcome and convince anyone, let alone a court of review that can not change any findings of fact, to reverse.

Now consider what could happen if this fact pattern occurred in Nevada, and Nevada had in place Senate Bill 75, by Richard Segerblom, D-Las Vegas.

SB 75 would allow any person who suffers an "injury" as a result of an addiction to a prescription drug to sue the manufacturer of the drug and possibly the prescribing doctor to recover actual damages, any costs associated with rehabilitation for the addiction, attorney fees and punitive damages.

The patient would have to prove the prescribing doctor knew or should have known about an existing addiction to the drug he prescribed to prevail in a lawsuit. The bill contains no such burden of proof for lawsuits against drug manufacturers.

Segerblom told the Associated Press after a hearing in the Senate Judiciary Committee on March 6 that he thinks providers are relying too much on prescription drugs.

Seems to me like Gallo had one up on the providers in his case - his creativity in drug acquisition, and collection of disability from multiple sources, would make a mockery of SB 75 and all that would be left is physicians in the dust.

Crazy man, just crazy...

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