Law Med Blog

Medical Discovery News: The case against Propofol

May 10, 2012 lawmed No comments

From Medical Discovery News By Norbert Herzog and David Niesel.

Most people had never heard of the drug propofol until Michael Jackson died from an overdose. His doctor was recently convicted and sentenced for being reckless when he administered the general anesthetic.

Since Jackson’s death, several scientific papers have begun urging the US Drug Enforcement Administration to regulate the drug. You may already be asking, though – why would anyone use propofol recreationally?

Within seconds, it acts on a person’s central nervous system, sedating them. A mistake can cause a drop in blood pressure, obstructed airway, respiratory failure, and even death. With such high risks, propofol does seem only useful in medical settings on surgical and intensive care patients who are highly monitored.

Before officials could classify it a controlled substance, they’d have to ask, “Is propofol being abused?” One condition for abuse is first documenting recreational use. Recent scientific … (Continued…)

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Propofol Shortage: The Economic Problem of a Generic Injectable

May 10, 2012 lawmed No comments

From MedCityNews By Frank Vinluan

Propofol drug shortages: The economic problem of a generic injectable

Propofol might best be known as the anesthetic Michael Jackson used inappropriately as a sleeping aid. Administered properly, the drug widely is used in hospitals to sedate patients. It also happens to be part of an industrywide drug shortage affecting hospitals throughout the country.

Injectable drugs maker Hospira (NYSE:HSP) is among the dwindling number of propofol manufacturers. The company recently restarted propofol production after a stoppage at its manufacturing plant in Clayton, North Carolina. The stoppage was voluntary and temporary, CEO Michael Ball said during during the company’s conference call to discuss first quarter financial results. Without going into detail, Ball said that Hospira has “completed corrective action” at the plant and propofol production has restarted. But restarting production isn’t a solution to the industrywide propofol shortage. And it’s not Hospira’s fault. Blame economics.

Three … (Continued…)

Drug Shortages Epidemic In Anesthesiology

May 03, 2012 lawmed 1 Comment

There is no end in sight to the now business as usual reality of drug shortages in medicine. Anesthesiology is hit particularly hard in the number of medications which are not being manufactured to meet demand. Here is a list of medications common to anesthesia practice which the FDA lists as being in short supply, and the reasons given. It contains the three most frequently administered medications in the practice of anesthesia: propofol, fentanyl and midazolam. Law Med points out that it is no coincidence that only drugs which are off patent and now generics seem to have shortages.

Alfentanil Injection Material shortage and increased demand.

Atracurium besylate Manufacturing delays.

Atropine Sulfate Injection Manufacturing delay and increased demand.

Bupivacaine Hydrochloride Injection Manufacturing delay.

Calcium Chloride Injection Manufacturing delay.

Chloroprocaine (Nesacaine) Injection Increased demand and manufacturing delay.

Etomidate Injection increased demand and manufacturing delay.

Fentanyl Citrate Injection Manufacturing delay causing increased … (Continued…)

KY 17th State To Opt Out Of Medicare CRNA Physician Supervision Requirement

April 27, 2012 lawmed No comments

The American Association of Nurse Anesthetists (AANA) is reporting that Kentucky has become the 17th state to Opt Out of the federal law which requires that a Certified registered Nurse Anesthetist (CRNA) be supervised by any licensed physician who is willing, regardless of specialty training, in order for services to be covered by Medicare or Medicaid. The question now has to be asked what purpose this absurd federal health insurance supervision law even serves at this point. Initially physician anesthesiologists (and now a decade later, like an angry horse trainer next to his dead mount still slinging the whip) shouted dire warnings to the nations elderly that their lives were now in grave danger should they require an anesthetic. This despite the delivery of anesthesia being one of the safest areas of medicine and nursing that exists.

With hundreds of thousands of anesthetics now delivered in multiple states under the … (Continued…)

Calif Anesthesiologists Taking CRNA Supervision Issue To Supreme Court

April 12, 2012 lawmed 3 Comments

The California Society of Anesthesiologists (CSA), along with the California Medical Association (CMA), wants the state Supreme Court to review a decision by two lower courts that state law does not require physician supervision of nurse anesthetists. ( CSA and CMA v. Schwarzenegger)

Last month their bid to appeal a San Francisco City and County Superior Court’s December 2010 decision failed when a state appeals court affirmed that decision.

In order for hospitals and surgery centers and critical access hospitals to receive reimbursement under Medicare when a certified registered nurse anesthetist (CRNA) alone administers anesthesia, federal regulations require that the CRNA must be supervised by a physician. However, federal regulations also allow that a state’s governor has the discretion on behalf of the State to opt out of the physician supervision requirement as long as it is consistent with state law. On June 10, 2009, former Gov. Arnold Schwarzenegger exercised … (Continued…)

ND Doctor In Propofol Rape Case Has Pleas Withdrawn Will Face Trial [VIDEO]

April 06, 2012 lawmed 10 Comments

We told you previously about the case of Dr. Jon Norberg, 41, of Fargo who was accused of raping a woman who was not his patient (turned out to be his wife) after administering the anesthetic propofol to her more than 30 times over an 18 month period. In January, in a deal with prosecutors, he plead guilty to felony reckless endangerment and a misdemeanor count of sexual assault. Compared to rape charges these were a walk in the park.

Norberg was accused of drugging his wife with the anesthetic propofol and sexually assaulting her on multiple occasions. Norberg has claimed his wife consented to receiving the propofol and that both of them agreed upon it as a treatment her chronic pain from an autoimmune disease. His estranged wife, a physician herself, claims otherwise and has painted her husband as a sadistic liar. Despite his plea to the misdemeanor sexual … (Continued…)

Supervision Of CRNAs Does Not Create Liability For Surgeons

April 05, 2012 lawmed 8 Comments

By Greg Stocks, The Law Med Blog

While any author certainly prefers that the reader take the time to read his or her work in its entirety, for those who want a quick answer without the evidence and law explained, here it is: Surgeons do not expose themselves to greater liability when they work with Certified Registered Nurse Anesthetists (CRNAs) alone vs physician anesthesiologists alone. Regardless of what anyone might tell you to the contrary, the courts and the case law are unambiguous and very complete on the matter. But don’t just believe me, read on for the irrefutable facts based in law.

It is worth noting from the outset that due to the incredible record of safety which the administration of anesthesia enjoys (so safe that it is the envy of every other medical and nursing specialty in this regard), concerns from surgeons over their liability exposure for anesthesia … (Continued…)

Suspended Ca Anesthesiologist Gave Daughter Propofol 500 Times: Hold Judgement

April 02, 2012 lawmed No comments

The California medical board has suspended the license of a doctor accused of giving his daughter hundreds of at-home doses of propofol, the powerful anesthetic that killed Michael Jackson, as a last-ditch, and effective, treatment for her debilitating chronic pain.

In an order filed Thursday, California Medical Board officials said Dr. Robert Markman of Northridge, a retired anesthesiologist who practiced from 1974-2001, is barred from practicing medicine pending a full administrative determination from the Board. He has never been disciplined by the Board in the past and has not been sued for malpractice during his years of practice. Based on the facts as presented in the Board’s order, the Law Med Blog is quite hesitant in passing negative judgment regarding Markman’s actions. While there are generally ethical issues when treating family members, assuming the facts are as stated he may be the best and only chance his daughter has for … (Continued…)

The Verdict Is In California: CRNAs Don’t Need Supervision

March 22, 2012 lawmed 1 Comment

Our friends at The Verdict Is In over on Medscape Connect have published this piece on the court battle occurring in California over the Medicare CRNA supervision Opt-Out signed by then governor Schwartzenegger. It was spawned by our earlier story on the subject and a recent dialogue between our two sites on the topic of HIPAA privacy rule violations and private civil actions for inappropriate release of private medical information. The Verdict Is In is written by an orthopedic surgeon who also went to law school and, likely in a fit of ‘I haven’t done anything with my life to this point so I better get off my ass’, then obtained a graduate degree in Quantum Mechanics and Computational Chemistry. (Law Med’s excuse is that he is a Gemini, and no Gemini worth his salt could be satisfied with just practicing anesthesia, so he went to law school ‘for fun’. … (Continued…)

Doc Guilty In Propofol Rape Case Wants To Withdraw Plea

March 20, 2012 lawmed No comments

Dr. Jon Noreberg, 41, of Fargo, the physician who plead guilty to felony reckless endangerment under an Alford plea in a deal reached with prosecutors back in January, now wants to withdraw his plea. An Alford plea means that the defendant does not admit his guilt but agrees that if the case goes to trial the prosecutor has enough evidence for a jury to find him guilty. Regardless, it results in a finding of guilty by the court and is considered a guilty plea.

Norberg was accused of drugging his wife with the anesthetic propofol and sexually assaulting her on multiple occaisions. Norberg has claimed his wife consented to receiving the propofol and that both of them agreed upon it as a treatment her chronic pain from an autoimmune disease. His estranged wife, a physician herself, claims otherwise and has painted her husband as a sadistic liar. Despite his additional … (Continued…)

CA Appeals Ct Says Nurse Anesthetists Can Practice Without Doc Supervision

March 19, 2012 lawmed 11 Comments

The California First District Court of Appeal in San Francisco handed down their ruling Thursday that highly trained Certified Registered Nurse Anesthetists (CRNAs) can continue to practice anesthesia in the state as they always have, and have safely done as a profession for 100+ years….without a requirement that they be supervised by a physician.

Nursing and hospital organizations argued that surgery, obstetrics and emergency care, all dependent on anesthesia, would become more expensive and less available if in-person physician supervision was implemented as a requirement. Doctors suddenly claim that their supervision is a new requirement essential for patient safety. “Physicians are the ones who are most trained and educated to react when anesthesia goes wrong,” attorney Long Do, litigation director for the physicians’ 35,000-member California Medical Association, said Friday. The association has not decided whether to appeal the appeal he said.

An attorney for the California Association of Nurse Anesthetists … (Continued…)

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