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April 05, 2007
Over-prescribing Anna
Beka - The most “trusted name in news” rang out of my 10-year-old, 13-inch television set. I really need to get a new TV -- at times the set makes loud screeching noises and scrambles the picture, especially at night. The news was out about the cause of death regarding celebrity Anna-Nicole Smith. The media saga has been going on long enough. (Will it ever end?) But Larry King seemed to be struck by her death -- her body contained 9 prescription drugs including Chloral Hydrate, Ativan, Klonopin, Valium, and others. In the media, it was a big story. Her death resembled that of her own idol, Marilyn Monroe, who also had had excessive doses of Choral Hydrate.
Listening to the autopsy results described by the medical examiner made me wonder how and who had prescribed this potent mixture of medications. Are we, as a society, over-prescribing oral medications as a solution to health problems -- whether physical or mental in nature? Had Smith been a “doctor-shopper?”
In 1989, after a diagnosis of Graves’s disease and a hefty dose of radioactive iodine, I was thrown into full blown thyroid storm. To calm the excessive amounts of thyroid hormones sizzling in my body, I was given a popping mixture of Halcion, Xanax, and Chloral Hydrate. Since then, I have rarely seen Chloral Hydrate prescribed, until I heard of Smith’s autopsy results. I remember that I floated through air and heavy mist, cognitively impaired, for more than a week while my father kept me occupied with playing cards and teaching me Poker in my room as the steroid, Decadron, was degrading my high T3 and T4 levels. “Not functional” is the best way I can describe that period in my life, and I have never taken Chloral Hydrate again.
This leads me back to the basic questions about prescription writing. Is there a mechanism in place to control a patient’s ability to seek out multiple prescriptions from multiple prescribers to prevent potent mixtures and reactions? Recognizing the development of multidisciplinary care and massive communication among healthcare providers; should not multiple prescribers be talking to one another about what prescriptions they write for patients? How do you treat “doctor shoppers” in the first place? Is this situation a result of an unworkable healthcare system and unsuccessful treatments? Any thoughts?
April 5, 2007 in Beka | Permalink
Comments
The quality of education is, is not lower than 15 years ago
Posted by: what is in aleve | Jun 27, 2007 1:57:17 PM
To Momflorn:
Hi Mom,
where do pharmacists come in? They come in the same place nurses do. Simply, many if not all areas of medicine have become driven by business principles. The goal is to get as much profit with as little staff as possible. One chain in particular is requiring pharmacists to fill a quota of at least 350 prescriptions in a 12 hour period. That is about 29 rxs per hour or about 2 per minute. During that time they get lunch (maybe), take phone calls and counsel "customers" among other things.
Not all pharmacies have universal access. On top of that there is the reality that medicine is now a business-in spite of our illusions, titles and nice white little uniforms there exists the ugly pressure to produce a profit and not inconvenience our customers. Sorry the "professional nurses" in this blog can't relate to that ugly reality-since I'm sure you don't have to work overtime and be "team players", right?
As mentioned before, our problem is an unlimited demand chasing a limited supply. In addition, everyone from cigarette smokers, the sexually promiscuous and the obese are demanding minority rights to practice their self indulgent lifestyle.
Reality-healthcare is a business and eventually unhealthy self indulgent lifestyles will be viewed as a liability that the business of health care can't afford.
Sadly, the issue is no longer morality or health care-The profit gods don't care. Be advised-if you want to practice your lifestyle or you choose to work in health care it's gonna ya. In some cases money, in some cases time, in some cases your soul.
Posted by: Mike | Apr 11, 2007 6:49:23 AM
I think the alleged "Nurse" should also be held liable in this case. If she truly is a nurse, her license should be reviewed and possibly revoked. How could she in good conscience not render aid to an obviously very ill person. Continuning to over medicate(as ill as she was I doubt Anna could take all of these meds and injections without assistance)is or should be a criminal offense. If the nurse was the one providing that assistance, she should not be allowed to retain her license.
Posted by: Kathy | Apr 10, 2007 4:57:50 PM
Where do Pharmacists enter this equation?
Shouldn't there be a way for one Pharmacist to know what another has dispensed to a patient? Perhaps it's time to look into the accountability of those who provide these substances to "vulnerable" people. I believe some Nationwide Pharmacies have on-line tracking of perscription meds. This allows a pharmacy tech in another state to know if there are reasons to deny a refill on a sedative or a possible drug-drug interaction. Someone's just not paying attention!
between
Posted by: momflorn | Apr 10, 2007 2:11:33 PM
This type of situation is, if not everyday, at least a common occurrence for me as the nurse in an AOD residential rehab facility. If addicts could redirect thier efforts at getting whatever thier drug of choice is into a beneficial direction, there would be nothing they couldn't accomplish. I concur with the the writer who stated that Anna broke ties with the people would might truly have had her best interests at heart because these people would have tried to help her in a healthy way. This way is too hard for most addicts which is one reason the recovery rate is so appallingly low. Addiction is far more complicated that most people realize. As for the doctors - the friend/psychiatrist was directly cuplpable in the death of Anna as far as I am concerned. However, other doctors may find themselves in the same situation due to lack of time and coordination of a client's health history. I have a friend who has been prescribed Xanax once and Klonipin twice by the same MD. All three of those bottles are sitting in the medicine chest. Fortunately this friend does not have an overtly addictive personality and so it isn't a problem at the moment. It is appalling how easy it is to obtain drugs with little or no patient education about what to do with "extra's". This stockpiling of benzos was accomplished by a patient with no other motive than to find some relief from anxiety (personally I think there are better alternatives but no one was asking me). Imagine what a creative, manipulative addict with enabling hanger oners can do.
Posted by: Donna RN | Apr 10, 2007 2:09:53 PM
There will always be over prescribing no matter how many systems we put in place, no matter how many oversights by the federal government. I for one do not want anymore rules to follow. Pharmacies are ususally good about notifying us about about abusers in small areas. The amount of time it would take to find abusers in a government regulated buracracy might not save anyone.
Also, people will get the drugs no matter what we do.
It is unrealistic to think some sort of government oversight will stop this practice.
It is sad and unfortunate to see the amount of drugs someone was able to abuse. I don't know the answer to this, I do know we have enough restrictions on the profession now.
Posted by: Pam | Apr 10, 2007 1:59:19 PM
I understand everyones anger at those around Anna and the circumstances surrounding her death. But one also has to look at a women who was severely depressed by the loss of her son, in some ways this was confounded by the post partum depression that she was also undergoing, and then there is the obsession with Marilyn Monroe-her life, her death, her fame, etc..
We have also got to look at the fact that people want to say that Anna had a lot of money, unfortunately that is not all that true either. She was recently named in a multi-million dollar lawsuit over the TrimSpa Diet Pills, and that was threatening her money affairs as well. All of these combined would lead me to believe that Anna knew exactly what she was doing! Don't get me wrong, I have nor will I ever be a fan of that Psychotic Howard K, but we also have to realize that Anna was mourning a loss, grieving for the one person in her life that never wanted anything from her but her love and devotion. Now it makes me wonder, if all of those medications found in her system were in fact self-administered for a reason. The one main reason, to DIE!! Anna knew exactly what she was doing, albeit the absolutely wrong thing to do, and she obviously needed some Serious Professional help;she alone took the pills, no one shoved them down her throat! We may want to blame others for Anna's death, but what about making Anna accept some of the blame as well. she knew exactly what she was doing. Even when all was seemingly well in her life, she still managed to take an enormous amount of medication to dull her senses, in addition to alcohol.
Lets not try and play the blame game. If it can be done, it will be done, and if someone wants to die, they will ultimately find a way to do so. Lets get on with our own lives, and let this one go away!!! Please enough already!!!!!
Posted by: sharon | Apr 10, 2007 1:31:45 PM
Beka,
ITA with what the other commenters said above my comment. Plus, my aunt is like this and has doctors like the ones that were describe in the other commenters comments.
Think thats it for now.
Thank you.
Jessica
Posted by: Jessica A Bruno | Apr 8, 2007 11:39:59 AM
Updating this discussion with journalistically obtained new facts -- Seems Anna Nicole was an Rx victim of her "friend"/psychiatrist who wrote all the prescriptions intended for her, whether under an assumed or birth-name or other person's name. Also, her "friend"/attorney Howard K. Stern's name was the "patient" for whom this malpracticing psychiatrist wrote most of these psychotropic Rxs, and the chloral hydrate Rx. But, what in the world was this shrink doing prescribing an antibiotic? Infections are not her area of expertise (if she has any expertise at all, which is questionable considering her shameful mishandling of this patient). A pt with a high fever, pain at a frequently-used intramuscular site, lassitude,inability to walk to her bathroom alone, and anorexia requires emergency treatment and hospitalization...NOT LEFT ALONE TO "SLEEP". Indeed, THE SLEEP OF DEATH. EVERY SYCOPHANT AROUND THIS TRAGIC PATIENT IS CULPABLE FOR THIS UNNECESSARY DEATH! I know that substance abuse addicts are very difficult to get off their substances of choice and that they fiercely or fearfully resist rehab measures; however, a patient with a 105 degree fahrenheit fever is in no condition to refuse anything or to fight off measures to get her to a hospital. Indeed, an ambulance or EMTs can be called for-- to assess her -- BEFORE SHE DIED. A local or hotel physician can be called to her room to assess her. With all the money surrounding her, every one of her hangers-on could have contacted a high-quality internist and/or an infectious disease specialist to see her. If necessary, her big, strong "bodyguard" and his wife (or ex-wife) the NURSE could have seen to it that she got into the ambulance that came for her.
At the least, she needed IV fluids due to febrile dehydration and inability to take anything p.o. She needed antipyretic medication. And, probably needed the abscesses in her gluteus to be lanced. Giving her an antibiotic without lancing the source of the fever...which quite possibly could have been the painful abscessed area...is highly dangerous as the pus then, when lysed by the antibiotic, can get into the circulation causing septicemia. I think the pathologist made too light of this latter condition.
This whole tragedy points to the gross negligence and malpractice of the so-called "friend"/psychiatrist (who is now being investigated by California authorities). With "friends" like this, who needs enemies? As to Anna Nicole's "friend"/attorney, I think he is more than an enabler...I would call him a murderer! Nothing he has done has been to help her off Rx drugs (not to mention the methadone he probably gave to Daniel Smith which contributed to this young man's death); everything he has done has worsened her addictions for his own monetary benefit. This is a disgusting display of how human leeches can suck the lifeblood out of anyone they target for MONEY and with the MD "friend", for notoriety. Sadly, Anna Nicole had no real friends...at least not in the end. As any drug addict does, she cut her ties with family, with mother and with a clear-thinking boyfriend (most likely the father of Dannielynn), and with anyone who had her real interests at heart and warned her to stop drugging herself. (In drama, it's all about motivation. With the motivations of her true family and true friends and true boyfriend, she would have been taken to the hospital IN TIME or a qualified MD would have been called to her room IN TIME. With the motivations of the sycophantic creeps who took advantage of her celebrity and her money and continue to do so, her desperate declining health was the last thing that would be noticed or attended to. These latter wanted to maintain their cow-towing positions, not do what was in the patient's best interest!) Sorry, all, for the rant,
but THIS WAS A VERY PREVENTABLE DEATH...AND I FEAR FOR THE INFANT GIRL NOW IN THE CLUTCHES OF THE MONEY-VULTURE
"friend"/lawyer. In his presence, and with his name on the good doctor's Rxs, Daniel DIED, Anna DIED....Are the authorities aiming to raise that number to 3 DEATHS?
Posted by: creativdoc | Apr 7, 2007 7:06:45 PM
hi - this is a thorny question. I don't have "an answer", but I do have some thoughts.
The first thing that came to mind- and quickly left it- was some kind of governmental record-keeping, but due to the lack of any morality in the use of private information by at least our government, that's definately out.
"Doctoer shopping" is, in some ways, an ambiguous practice. I'm thinking specifically of my mother-in-law,stricken with a metastatic lymphoma, and stomach and bowel cancer. What she went through when her long-time doctor became suddenly- and long term- unavailable- was obscene. Her pain had increased, but instead of treating it, the physician she was assigned to raised the phantom of "addiction" in a pain-ridden 88 year old woman. Time to doctor shop.
Of course, it's also an all too common practice for drug abusers. (The failure of the US to make available an adequate number of treatment programs is a whole other topic.)
At one time, at least, the government here kept track of the number of scheduled drugs a physician prescribed overall, and that seems to be the pick of the litter to me, provided it was judicially applied - as in, leave the oncologists alone.
Posted by: ann RN | Apr 6, 2007 3:41:46 PM
Hi Bekka,
Just an opinion on my part, but it seems the problem may be prostitution-no, not the sexual kind. Rather, there are the pimps that prescribe what the patients want, while the hookers-the pharmacy chains pressure pharmacists to give the patients what is prescribed.
In addition, there is political correctness(social cowardice)which states that a persons lifestyle is sacred and fast becoming equivalent to minority status. All this together turns the medical professions into a business and our patients into customers. Simply, it is getting harder to say no to our Johns-oops our customers, no our patients. Can't seem to keep the roles straight anymore.
Posted by: Mike | Apr 5, 2007 8:40:38 PM
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