Category: Daily News

Anthony White worked as a custodian for Los Angeles World Airports, a department of the City of Los Angeles. In November 2005, while off duty, he sustained several gunshot wounds to his left leg. He was briefly hospitalized and took several medical leaves of absence to recover from his injury. He returned to work in May 2006 and was assigned to perform light duty tasks in a warehouse.

At the end of August 2006, White took another medical leave of absence which lasted for approximately two years. According to one of White’s physicians, White was suffering from “Post Traumatic Stress Disorder and Intractable Pain secondary to gunshot wound in 2005.”

In May 2008, during his leave, White was arrested in Arizona and was apparently charged with nine felony counts relating to identity theft and fraud. When White returned to work in 2008, his prior position (day shift custodial supervisor) was not available and the airport placed him in an available position at the same level on the graveyard shift.

White did not like working the night shift and requested a transfer to the day shift as a reasonable accommodation for disabilities related to his 2005 injury. However, because White failed to provide the airport with any viable explanation why working the day shift rather than the night shift would impact his disability, the airport denied his reasonable accommodation request.

White resigned from his position in 2010 on the same day he began serving a sentence on two felony charges in Arizona. He subsequently filed the present lawsuit against the airport, the City, and others, in which he alleges a variety of disability related employment claims under the Fair Employment and Housing Act (FEHA).

The case was tried to a jury. The court granted the airport’s nonsuit motion on several claims; the jury found in favor of the airport on White’s remaining claims. The outcome was affirmed in the unpublished case of White v City of Los Angeles.

White’s primary contention on appeal is that the trial court erred in denying his motion for new trial. He argues the evidence does not support either the jury’s verdict or the court’s nonsuit.

The court of appeal held that the “evidence – when properly viewed in the light most favorable to the judgment – does not support White’s assertion that the airport refused to consider any accommodation absent a showing of a “permanent restriction.” During the discussions with White about his request for an accommodation, the airport focused mainly on whether White had any limitations due to his disability and, if so, how working during the day rather than at night might impact those limitations. Given that White said he could perform his job without any accommodation and the City’s medical office cleared White to return to work without any restrictions, the airport’s request for some additional information regarding his request for accommodation was not unreasonable.”

In medicine, compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions.

Poor compliance with drug regimens is a common problem in many disease areas, especially when patients suffer from chronic conditions. In particular, low rates of adherence to therapies for asthma, diabetes, and hypertension are thought to contribute substantially to the human and economic burden of those conditions. Estimates from the World Health Organization indicate that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations.

But new technology may help improve compliance statistics. The FDA has approved the first digital pill with an embedded sensor to track if patients are taking their medication properly, marking a significant step forward in the convergence of healthcare and technology.

The medicine is a version of Otsuka Pharmaceutical Co Ltd’s established drug Abilify for schizophrenia, bipolar disorder and depression, containing a tracking device developed by California based Proteus Digital Health.

The system offers doctors an objective way to measure if patients are swallowing their pills on schedule, opening up a new avenue for monitoring medicine compliance that could be applied in other therapeutic areas.

The system works by sending a message from the pill’s sensor to a wearable patch, which then transmits the information to a mobile application so that patients can track the ingestion of the medication on their smartphone. The underlying technology is Proteus Discover which is comprised of ingestible sensors, a small wearable sensor patch, an application on a mobile device and a provider portal.

About the size of a grain of salt, the sensor has no battery or antenna and is activated when it gets wet from stomach juices. That completes a circuit between coatings of copper and magnesium on either side, generating a tiny electric charge.

In the longer term, such digital pills could also be used to manage patients with other complicated medicine routines, such as those suffering from diabetes or heart conditions.

Proteus has been working on the pill tracking system for many years and the sensor used in Abilify MyCite was first cleared for use by the FDA in 2012.

The California company has attracted investments from several large healthcare companies, including Novartis AG, Medtronic Inc and St. Jude Medical Inc, as well as Otsuka.

In workers’ compensation claims, it is not uncommon for claim administrators to encounter claimants who assert that they are profoundly disabled from the effects of what seems like a trivial injury. A minor hand injury can end up a multi-body part claim of disability basically from head to toe.

But not everyone succumbs to the effects of injury, even a catastrophic injury. The events of this Veteran’s day weekend offered a good example.

Ask Rob Jones. He braved the cold weather on Veterans Day to complete his mission: running 31 marathons in 31 days. This challenge was after losing both his legs to an improvised explosive device in Afghanistan in 2010, Jones has shown endurance that few can rival and certainly would not be seen by many as “disabled.”

“I’m pretty sore, but overall I am feeling pretty good,” Jones told Stars and Stripes as the sun rose over the Lincoln Memorial. Jones’ final run was on the National Mall in Washington, where he ran 26.2 miles to support his fellow veterans and raise money for charity.

Jones was laid out on a couch before setting out for his final run shortly after 7 a.m., bandages being taken of his back after falling during a race in Atlanta. He sat up, his artificial legs off, and clearly thought about this last race while he spoke.

Jones began his quest Oct. 12 in London, then flew to the States to race in Philadelphia, New York and Boston. He has raced in nearly every major city since then, running the equivalent of a marathon each day.

There was an air of exhaustion and pain about him, but he seemed determined. “I’m feeling good. I’m excited about this last one. It is going to be painful,” he said.

Or ask Brian Shul. He flew 212 combat missions in Vietnam and was shot down near the Cambodian border in an AT-28 Air Force jet near the end of the war. He was so badly burned that he was given next to no chance to live.

Barely surviving 2 months of intensive care, he was flown to the Institute of Surgical Research at Fort Sam Houston, Texas in 1974. During the following year, he underwent 15 major operations. During this time he was told by physicians that he’d never fly again and was lucky to be alive.

Months of physical therapy followed, enabling Shul to eventually pass a flight physical and return to active flight duty. Two days after being released from the hospital, Shul was back flying Air Force fighter jet aircraft. He flew the the A10, A7 and the F5. As a final assignment in his career, Shul volunteered for and was selected to fly the SR-71. This assignment required an astronaut type physical just to qualify, and Shul passed with no waivers.

Shul said after the rigorous physical “I did very well, passed the physical. The guy said, ‘wow, you’ve got one of the highest scores we’ve ever seen.’ I was very strong internally, even if I looked like hell on the outside.” He became a member of a small, select group of men who had the privilege of flying the SR-71.

He ended up flying the SR-71 Blackbird for four years. The SR-71 was the world’s fastest and highest-flying operational manned aircraft throughout its career. It broke an “absolute altitude record” of 85,069 feet. That same day it set an absolute speed record of 2,193.2 mph approximately Mach 3.3. It has flown from Los Angeles to Washington, D.C., at an average speed 2,144.8 miles per hour with an elapsed time of 64 minutes 20 seconds to cross the continent.

Shul’s comeback story from lying near dead in the jungle of Southeast Asia, to later flying the world’s fastest, highest flying jet, seems to suggest that the will to overcome “disability” is a major component to the healing process after what would otherwise be a catastrophic injury.

He spoke at the Lawrence Livermore National Laboratory last December, and this  YouTube video of his return to the flight line is humorous, inspiring, and perhaps a way to see a much different outcome to having had a so called “catastrophic Injury.”

Shul just refused to see himself as disabled, despite what dozens of doctors had to say about his prospects of recovery.

Chronic pain affects up to 20% of people in developed countries, and represents not only a profound impact on individuals and their families but also a sizeable burden on employers, health care systems, and society in general.

Management of chronic pain varies greatly between nations and even within nations. Literature supports a multidisciplinary approach as the standard of care, although various health care systems may not always support this concept consistently.

A new study published in the Journal of Pain Research evaluates another safe and effective drug-free treatment option for chronic pain sufferers — spinal cord stimulation (SCS).

Spinal cord stimulation, also known as dorsal column stimulation, uses low-voltage electrical stimulation to the spine to block the feeling of pain, via a small device implanted in the body. The field of neuromodulation for the treatment of pain has developed rapidly since the seminal paper on the electrical inhibition of pain by the stimulation of the dorsal column almost 50 years ago. (Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489-491)

Patients typically undergo a trial of neuromodulation with an externalized power source and if this trial proves to be positive and compelling, they subsequently have a subcutaneously implantable pulse generator for the long-term therapy.

Spinal cord stimulation technologies are fast advancing, and an update of the literature was much needed. The newest study, authored by an Australian team, looks at recent evidence for safety, efficacy and cost-effectiveness of spinal cord stimulation in back and limb pain.

In recent years, the next phase in the evolution of neuromodulation has become available with the development of dorsal root ganglion (DRG) SCS and the emerging use of two novel advances in stimulation frequencies, being high-frequency SCS (at 10,000 Hz) and burst SCS.14-19 These recent advances have improved the efficacy and expanded the applicability of SCS.

The authors reviewed the scientific evidence from three studies looking at the different routes of spinal cord stimulation: dorsal root ganglion SCS, burst wave form SCS and high frequency 10 (HF10) SCS. They found that the literature supports the use of traditional SCS for chronic pain, and provides high-quality evidence that dorsal root ganglion SCS and HF10 SCS are safe and effective for back and leg chronic pain.

Lead author Paul Verrills from the Metro Pain Group in Melbourne, Australia, thinks the study findings represent “unheralded evidence that we can safely treat back and leg pain using spinal cord stimulation techniques.” Most importantly, spinal cord stimulation has relatively few side effects compared to other chronic pain therapies, and reduces the risks of complications.

Verrills goes on to say, “Spinal cord stimulation should now be considered earlier in the treatment continuum and not simply as an end-stage salvage therapy.”

In May 2011, Sim Carlisle Hoffman M.D. was indicted on 884 felony counts alleging healthcare insurance fraud in violation of section 550. Hoffman was the owner of Advanced Professional Imaging (API), Advanced Management Services (AMS), and Better Sleeping Medical Center (BSMC) in Buena Park, and prosecutors accused him of running a “medical mill” for the sole purpose of insurance over-billing without providing any legitimate treatment to patients.

Orange County District Attorney Tony Rackauckas and California Insurance Commissioner Dave Jones originally announced the hundreds and hundreds of charges against Hoffman, BSMC neurologist Dr. Michael Heric of Malibu, Hoffman’s administrator Beverly Mitchell of Westlake Village and API billing collector Louis Santillan of Chino Hills.

The 2011 indictment was ultimately dismissed in 2013 on the ground that the prosecution had failed to provide exculpatory evidence to the grand jury.

Rather than proceed by indictment, in January 2014, the prosecutors filed a felony complaint against Hoffman. The complaint alleged 159 counts of insurance fraud. One year and one-half later – after four amendments and two demurrers – the people filed a fifth amended complaint, alleging violations of section 550, subdivision (a)(5) (33 counts), subdivision (a)(6) (135 counts), and subdivision (a)(7) (one count).

The preliminary hearing began on September 1, 2015, and ended on November 23 of that year. The resulting transcript spanned over 2,300 pages. Over 53,000 pages of documentary evidence was submitted. During the preliminary hearing, the complaint was amended again. This final amendment contained 102 counts alleging a violation of section 550, subdivision (a)(6), and one count alleging a violation of subdivision (a)(5). Defendant was held to answer on all 103 counts.

Following the preliminary hearing, prosecutors filed an amended information containing 121 counts: 120 counts of violating section 550, subdivision (a)(6), and one count of violating subdivision (a)(5). the amended information, for each count, included both patient names and references to the preliminary hearing exhibit numbers containing the evidence relevant to the particular offense.

The court overruled a demurrer to several counts, finding notice to be adequate, and concluded the People were permitted to allege multiple acts that form the basis of each count. It cautioned, however, that there was still work to be done before setting a trial date to ensure the defendant had clarity on what he would need to defend against at trial.

In response, Hoffman filed the present petition for a writ of mandate directing the court to sustain the demurrer. The Court of Appeal initially summarily denied the petition. But the California Supreme Court granted review and instructed the Court of Appeal to issue an order to show cause.

The issue is whether an information may allege a single offense in a single count, but describe within that count multiple discrete acts, each of which constitute the charged offense.

The Court of Appeal just concluded this month that the information was proper and denied the writ petition in the published case of Sim Carlisle Hoffman v The Superior Court of Orange County.

Each count alleges a single offense. Any complications, or undue prejudice to defendant, arising from the fact that multiple discrete acts may constitute the charged offense in each count are adequately dealt with by a unanimity instruction at trial, or by other tools at the court’s disposal, such as a severance of counts, or trial continuances where appropriate. A demurrer on these grounds is not the proper vehicle to address defendant’s concerns.

The court correctly overruled the demurrer.