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Anesthesiologist Guilty on 2 Counts of Manslaughter

Anesthesiologist Guilty on 2 Counts of Manslaughter

A Manhattan jury found Stan Xuhui Li, MD, guilty of manslaughter for overprescribing painkillers to two patients, Joseph Haeg, 37, and Nicholas Rappold, 21, who later suffered fatal overdoses. The 60-year-old anesthesiologist from New Jersey, was found guilty of two counts of second-degree manslaughter, six counts of recklessly endangering the lives of six other patients, and 180 counts of selling prescriptions for controlled substances (view all charges here). Dr. Li ran a pain-management clinic out of a basement office in Queens 1 day each weekend, seeing up to 100 patients a day. Posting a price list on his wall for drugs, Dr. Li accepted payment primarily in cash and pocketed nearly $500,000 over 2.5 years. He prescribed opioids such as oxycodone and anti-anxiety drugs such as alprazolam to high-risk patients—ignoring evidence of drug abuse and addiction, drug diversion, prior overdoses, and degenerating health. Manslaughter In both manslaughter counts, Dr. Li was charged with failing to perform adequate examinations to verify Haeg and Rappold’s reports of chronic pain and ignored repeated warning signs of addiction. According to prosecutors, Haeg received 15 prescriptions for controlled substances from Dr. Li, including oxycodone, within 3 months leading up to his death. In the final month, Haeg received more than 500 pills in two visits, the last visit only 3 days before he died of acute oxycodone intoxication. Rappold also died 3 days after his last appointment with Dr. Li. He was found with a bottle of Xanax with only 35 pills remaining of 90 from a prescription prescribed only 3 days before. Cause of death was acute intoxication by the combined effects of Xanax...

Quantifying Drug-Seeking Behaviors in the Emergency Department

Pain is one of the most common reasons for patients seeking care in EDs, accounting for up to 42% of all emergency room visits. Emergency physicians vary widely in prescribing patterns and often have difficulty assessing patients’ level of pain. There may also be reluctance to provide pain medications due to concerns that patients are trying to obtain prescription drugs for non-therapeutic purposes. “These individuals— who are often labeled as drug-seeking—are a difficult group of patients to manage in the ED,” says Casey A. Grover, MD. “They often present to the ED with conditions that are difficult to evaluate, and may also engage in deceptive behaviors in an effort to fool clinicians into giving them additional medications.” It is estimated that up to 20% of all ED visits may be due to drug-seeking behavior. “Drug-seeking patients have been known to use large amounts of medical resources,” says Dr. Grover. “They may occupy beds in EDs that would be more appropriately used for people truly in need of emergency care.” Prescription drug abuse and misuse is a growing epidemic throughout the United States, and more and more emergency physicians are encountering drug-seeking patients in daily practice. “Despite the magnitude of the problem,” Dr. Grover says, “there is still much to learn about these patients, their patterns, and how best to manage them.” Intriguing New Data on Drug-Seeking Behavior Studies have been conducted on screening tools to identify drug-seeking behaviors in chronic pain patients, but few have provided quantitative data on such behaviors in the ED. With this in mind, Dr. Grover and colleagues performed a case-control study examining the relative...

Drug Poisoning Death Trends

The CDC’s National Center for Health Statistics has released a data brief indicating that poisoning became the leading cause of death by injury in the United States in 2008. Available at http://www.cdc.gov/nchs, the report states that drug poisoning deaths increased six-fold between 1980 and 2008. To Access Full Program: visit...

Chronic Pain: Analyzing the Public Health Burden

There has been greater recognition over the past several decades of the pervasiveness of poorly assessed, poorly treated chronic pain, culminating recently in an Institute of Medicine report quantifying this healthcare issue. Evidence also suggests that the quality of and access to assessment and treatment of pain are poorer for racial and ethnic minorities. “This is a very large public health problem,” says Perry G. Fine, MD. “The issue has become even more important because of its concurrent overlap with the liberalization of prescribing patterns for opioid analgesics to treat chronic, non-cancer pain.” Chronic Pain is a Costly Problem Well over 100 million people in the United States are living with chronic pain that has some debilitating effect on their daily lives, costing society over $600 billion a year in direct medical costs and lost productivity. According to the American Pain Foundation, pain affects more Americans than diabetes, heart disease, and cancer combined (Table). The duration of pain in adults aged 20 and older who report having pain is longer than 1 year for 42% of patients (Figure). As these health and economic tolls have made their mark, they have exposed training gaps for healthcare professionals in recognizing and treating chronic pain adequately. “With some additional training and by adopting well-established practice guidelines, the risks of abuse can be managed and limited for both patients and physicians.” “We have not established a systemic approach to comprehensively prevent and treat chronic pain,” says Dr. Fine, “and comorbid psychiatric disorders can further complicate issues of treatment selection and adherence. Physicians are doing their best to return their pain patients to optimal...
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