ALN nurse consultants are on the leading edge of litigation support in issues related to the burgeoning opioid crisis. ALN provides expert consultation on any case where health and medicine intersect with the law. Every case we encounter undergoes a systematic approach with an individualized focus which gives our client the winning edge. Whether it is Medical Malpractice, Long-Term Care litigation, cases involving the DOJ and OIG, or Fraud & Abuse, ALN has experienced staff ready to dive in and serve as essential team members. And, we understand both sides of every issue, so our clients are always prepared.

ALN Nurse Consultants have experience in support of the litigation team engaged in cases related to allegations of reckless prescribing; wrongful death related to overdose from prescribed controlled substances; and pain management. In one such case, ALN was retained to evaluate the care and services provided by a physician under investigation by the Department of Health, Office of General Counsel for alleged:

  • prescribing controlled substances with little documentation of objective findings of chronic pain to justify ongoing and increasing prescribing;
  • insufficient documentation attempts to identify the etiology of the reported pain;
  • prescribing without documenting a thorough history into potential substance abuse;
  • lack of written treatment plan concerning the use of controlled substances;
  • prescribing controlled substances without consultation of the state Controlled Substance Monitoring Database and;
  • infrequent recommendation of non-medication related modalities of treatment.

The ALN team mobilized and created a work product to support extraction of the necessary information—on a tight deadline with a massive amount of patient records needing evaluation. Since the trend in allegations of reckless prescribing is emerging, ALN created a custom template for the client which helped the legal team more clearly understand the emerging facts of the case in relation to the allegations and provide easy access to the details. Our nurse consultants were able to review medical records for sixty patients, over 1,800 patient encounters amounting to over 8,200 pages of records, with just a two-week turnaround. With each patient, ALN zeroed in on whether the provider documented the etiology and objective findings of pain; followed the state’s standard of care in prescribing with regard to the applicable case law; checked the Controlled Substance Monitoring Database (CSMD); fulfilled other required testing to screen for potential addiction; and considered other therapeutic treatments for the patients’ pain. Our nurse reviewers also reviewed the state pharmaceutical database to evaluate for controlled substances prescribed by other providers during the time the patients were under the defendant physician’s care. Our reviewers analyzed more than 400 narcotic log entries for instances of “other prescribing” providers.

With the facts of the ALN audit in hand, the litigation team was able to move forward with full knowledge of the strengths and weaknesses of their case. The custom work product, sharp-eyed clinical review and quick turnaround was only possible because our client tapped into the knowledge and expertise of the ALN consulting experts.

Opiates are powerful painkillers that are highly addictive. The opiate crisis in America crosses social and economic boundaries. The CDC reports opioid dependence affects nearly five million people in the U.S. and leads to approximately 17,000 deaths annually. This statistic tripled from 1999 to 2016, and 20% of that rise was from 2015 – 2016. In 2017, researchers announced that the U.S. life expectancy decreased two years in a row, and was directly related to the opioid overdose epidemic.[1]  Trends in Medical Board License actions in every state have shown an increase in the number of cases involving opiate abuse by patients. Federal and State budgets definitively show a spike in resources dedicated to cases involving opiate abuse issues.

Physicians treating pain in light of the opioid crisis must be up to date on the most current state and federal standards of care and prescribing guidelines. The CDC published guidelines for prescribing opiates for chronic pain to provide recommendations for patients eighteen and older in a primary care setting. The guidelines focus on treatment of chronic pain (pain lasting longer than three months or past the time of normal tissue healing, not including active cancer treatment, palliative care, and end of life care). Research shows that chronic, non-cancer pain syndromes treated with long-term opiate therapy go hand-in-hand with the increase in opiate use disorders in the U.S. Examples of non-cancer chronic pain diagnoses are arthritis, migraines, and fibromyalgia.

As for treatment of surgical pain, until recently no evidenced-based guidelines existed for surgeons prescribing pain medications postoperatively. One patient after gall-bladder surgery may receive a prescription for ten oxycodone pills, and another after the same surgery might receive a prescription for 30 oxycodone with three refills. The University of Michigan developed a tool in 2017[2] (updated in 2018), which is now being widely incorporated into state HHS prescribing guidelines, detailing eleven common operations and pain control postoperatively based on extensive surgical quality research as well as patient data and surveys. Jay Lee, a general surgery resident who helped develop the guidelines, was quoted in a publication for the Institute for Healthcare Policy & Innovation from the University of Michigan, “It’s embarrassing to admit this, but we’ve never had any evidence to inform how many opioids we prescribe to surgical patients. These recommendations provide a crucial first step for improving the safety of prescribing opiates.”[3]

ALN Nurse Consultants make the difference in cases related to allegations of reckless prescribing; wrongful death related to overdose from prescribed controlled substances; and pain management. The crux of such cases is in the medical record details of how the prescriber examined and assessed the patient, prescribing details and follow up, as well as the prescriber and pharmacist’s adherence to state regulations and case law regarding prescription use of controlled substances.

 

[1] https://www.cdc.gov/drugoverdose/data/prescribing.html

[2] https://opioidprescribing.info/

[3] http://ihpi.umich.edu/news/how-many-opioid-pain-pills-do-surgery-patients-need-new-prescribing-guide-available