July 19th, 2009 at 07:07am
Under Personal Injury Law
Personal Injury Law Firms experienced in negligence, malpractice and other types of personal injury actions have taken note of recent product liability actions involving the drug, Duragesic.
Duragesic® is the trade name for a pain-medication patch containing fentanyl, a potent opioid analgesic. Duragesic is a transdermal system-the medicine, fentanyl, is absorbed through the patient’s skin and into the bloodstream, providing pain relief for up to three days (72 hours) from a single patch application.
Duragesic is prescribed in five dosage strengths: 12, 25, 50, 75 and 100 mcg of fentanyl per hour. The 50, 75, and 100 ug/h doses are only prescribed for patients who are already on and tolerant to opioid therapy, and require continuous opioid administration. Moreover, the Duragesic label warns that 12 mcg/hour as an initiating dose has not been systematically evaluated; therefore, Duragesic should be used only in patients who are opioid-tolerant.
Fentanyl was found to be a good choice for transdermal application because of its physicochemical properties and high analgesic potency. However, Fentanyl is not without its serious adverse effects. Pharmacologically, fentanyl acts on the central nervous system causing analgesia, sedation, severe respiratory depression, muscle rigidity, seizures, coma, and hypotension. Adverse reactions include mood changes, euphoria, dysphoria, drowsiness, constricted pupils, nausea, and vomiting. The most serious side effect of fentanyl overdose is hypoventilation (respiratory depression), which can be fatal.
Development of Duragesic
Currently, only eleven transdermally administered drugs are on the market; seven of which were developed by ALZA. In 1981, ALZA responded to a plea from a White House-created committee of scientists and physicians to develop more potent analgesics with alternative delivery systems for critically ill and dying patients who were suffering from intractable pain. ALZA began work on a project to develop a fentanyl transdermal patch in late 1982.
In early 1983, ALZA representatives met with agents from the DEA to discuss the handling of fentanyl. Among other issues, the DEA expressed concern that the dosage be kept to an absolute minimum, because of the potential for overdose and abuse.
In 1991, ten years after ALZA proposed the development of a transdermal fentanyl patch, Duragesic was made available for sale in the United States. Originally, Duragesic was approved to treat acute, postoperative and moderate-to-severe pain. However, due to the slow onset of drug levels from the transdermal delivery and three day maintenance of drug levels with Duragesic, the system was more suited for treatment of chronic pain conditions, in particular, cancer patients. By 1998, the World Health Organization (WHO) recommended transdermal fentanyl for treatment of cancer pain in stable patients.
Since receiving FDA approval in 1990, ALZA and Janssen aggressively sought the expansion of Duragesic use beyond cancer patients. For example, transdermal fentanyl has been used to treat rheumatologic pain and severe back pain.
The FDA has also approved an expansion of Duragesic to treat pediatric patients.
Janssen’s most recent advertising campaign to expand the use of Duragesic was thwarted by the FDA. In the late 1990s, the company sent a document called Top Ten List to doctors urging physicians to switch their patients to Duragesic patches rather than use more traditional type pain relievers. Among the reasons listed is the phrase “It’s not just for end stage cancer any more!” However, in 2000, the Department of Health and Human Services wrote a letter to Janssen informing the company that its promotional pieces concerning the “Broadening of indication” for Duragesic were misleading and contained misrepresentations. The government agency responded, “The suggestion that Duragesic can be used for any type of pain management promotes Duragesic for a much broader use that is recommended by the PI, and thus, is misleading.”
Currently, Duragesic is the most widely prescribed transdermal medication. From 2002 to 2003, the total number of fentanyl patch prescriptions within the United States rose from 4.5 million to 5.4 million-a twenty percent increase. And the resulting sales figures for Duragesic have been enormous: total annual sales in the United States have reached one and a half billion ($1,500,000,000.00) dollars annually.
And in 2005, Duragesic sales generated two point one billion ($2,100,000,000.00) dollars worldwide.
Duragesic Defects:
Package Leak-Subsequent Recalls
The design/manufacturing defect most applicable to our case is an improper sealing of one edge of the Duragesic patch, resulting in millions of patches being recalled. During 2004, ALZA (through Janssen) initiated two large Class I recalls of Duragesic for this exact reason. The first was February 17, 2004 at which time Duragesic Control No. 0327192 (75 mcg/hr) was pulled from the market. The cited reason was a potential seal breach on one edge of the patch, which could result in fentanyl leaking from the patch. This recall included about 440,000 patches.
On April 5, 2004, Janssen expanded its recall of Duragesic to include 2.2 million patches (Control Numbers 0327192, 0327193, 0327294, 0327295, and 0330362). Again, the reason cited was the potential for a breach of the seal, which would result in fentanyl leakage. Janssen sent a “Dear Healthcare Professional” letter to inform of the expanded recall.
A leak of fentanyl from a Duragesic patch could cause patients to receive either too much or too little of the drug. If the fentanyl seeps out of the patch before its application to the skin, patients may receive too little medication to adequately treat their pain. In this situation, patients used to a specific does may experience withdrawal effects including sweating, sleeplessness, and abdominal discomfort.
Conversely, fentanyl leaks that occur while the patch is on the skin expose patients to a potentially life-threatening overdose of fentanyl. Duragesic is designed to deliver only a controlled amount of fentanyl into the patient’s skin. Patients wearing a defective patch that leaks fentanyl directly onto the skin will receive too much of the medication. If this occurs, patients could experience minor complications such as sedation, drowsiness, and nausea. Fentanyl overdose may result in more serious complications, including fatal hypoventilation (respiratory depression) or cardiac arrest.
When Jansen placed Duragesic on the market in 1991, reports of toxicity due to fentanyl overdosing were fairly common. In fact, one study in California of 112 deaths associated with fentanyl concluded that the general availability of the drug may be responsible for the high incidence of overdoses.
Furthermore, in a recent Duragesic lawsuit filed against Johnson & Johnson, Janssen, and ALZA, the plaintiffs alleged that “despite knowing of this defect, the defendants (Johnson & Johnson, Janssen, ALZA) took inadequate steps to advise physicians, hospitals, nursing homes and other health care professionals of the defect and the significant damages to users of the Duragesic patches.”
Heat-Induced Overdose
ALZA and Janssen’s knowledge of the overdosing potential caused by external heat dates back to 1986, when ALZA did lab testing on a nitroglycerin-delivering patch using the same co-polymer membrane used in Duragesic patches. ALZA subsequently did lab testing on Duragesic in 1988-that showed that a five degree Centigrade increase in temperature doubled Duragesic’s release rate. Dr. Curtis Wright, the FDA Medical Review Officer, was quite concerned in 1989 and again in 1990 that ALZA had not responded to his request for more information on the effects of external heat. After Duragesic hit the market in April of 1991, ALZA and Janssen learned of six reports from healthcare providers that external heat appeared to increase blood fentanyl levels in patients in the hospital setting and at home.
However, the first time Janssen or ALZA made an effort to warn of the effects of external heat came in a January 17, 1994 “Dear Doctor” letter with an attached proposed labeling revision. The labeling contained a new heat warning, which was buried at page 10 of the attachment, but no mention was made in the letter itself to alert physicians that external heat applied to the patch was potentially life-threatening.
GOVERNMENT REGULATION
In 2004, the FDA influenced Janssen and ALZA to issue two Class I Recalls of Duragesic, “due to improper sealing of one of their edges,” which could result in a life-threatening overdose of fentanyl. Yet, this was not the first time the FDA encountered problems with the companies’ handling of Duragesic. In fact, prior to the recalls in 2004, the FDA has required Duragesic labeling revisions 13 times.
And, as recently as July 2005, the FDA issued a Public Health Advisory concerning the use of Duragesic Patches in response to reports of deaths in patients using the patch.
Beginning in 1994, the FDA sent ALZA a “warning letter” identifying certain violations and deviations from Good Manufacturing Practices (GMP) regulations under the Food and Drug Act. This prompted the company to issue a letter to all health care professionals warning of Duragesic misuse.
In the late 1990s, the Department of Health and Human Services warned Janssen that its promotional materials to expand the use of Duragesic were in direct violation of the Federal Food, Drug, and Cosmetic Act and contained misrepresentations as to the safety and efficacy of the product. The agency determined that the promotional pieces were “false or misleading because they contain misrepresentations of safety information, broaden Duragesic’s indication, contain unsubstantiated claims, and lack fair balance.”
Following Janssen’s “voluntary” recall of Duragesic in 2004, the FDA issued a “Safety Alert” warning that the recall was “due to a potential leak in the product seal,” which could result in skin exposure to fentanyl. The warning adds that “skin exposure to any leaked medication from a DURAGESIC patch may cause nausea, sedation, drowsiness, or potentially life-threatening complications.” Govt Regulation 6. Janssen also wrote a letter to “Healthcare Professional[s]” informing them of the expanded recall in April 2004.
Furthermore, on September 2, 2004 the FDA issued Janssen another “warning letter.” This letter states that the latest Duragesic promotional pieces make “false or misleading claims about the abuse potential and other risks of the drug, including unsubstantiated effectiveness claims for Duragesic.” The letter states, “By suggesting that Duragesic has a lower potential for abuse compared to other opioid products, the file card could encourage the unsafe use of the drug, potentially resulting in serious or life-threatening hypoventilation.”
The Duragesic product label was again updated in June 2005 to add new safety information in several areas of labeling, and Janssen issued another “Dear Healthcare Professional” letter about these changes. Under a section entitled “Hypoventilation (Respiratory Depression),” the letter warns that “Serious or life-threatening hypoventilation may occur at any time during the use of DURAGESIC® especially during the initial 24-72 hours following initiation of therapy and following increases in dose.” Janssen also warns of a “potential for temperature-dependant increases in fentanyl released from the system resulting in possible overdose and death.” Therefore, the letter instructs all patients to avoid exposing Duragesic to “direct external heat sources, such as heating pads or electric blankets, heat lamps, saunas, hot tubs, and heated water beds, etc., while wearing the system.”
Finally, on July 15, 2005 the FDA issued a “Public Health Advisory” concerning the use of Duragesic Patches in response to reports of deaths in patients using the patch. The FDA stated it is conducting an investigation into the deaths related to fentanyl overdose in patients using Duragesic. According to the FDA, “Some patients and health care providers may not be fully aware of the dangers of this very strong narcotic painkiller. Therefore, FDA is issuing this public health advisory to alert patients and their caregivers and health care professionals by highlighting the following important safety information.”
MEDICAL LITERATURE
Fentanyl Overdose
Since Duragesic hit the marketplace in 1991, studies have shown continued high numbers of overdoses involving transdermal delivery of fentanyl. The most serious side effect is respiratory depression, which can be fatal. One study, published in 1991, examined 112 fentanyl-related deaths in the Eastern United States, mostly in California. Fentanyl deaths appeared to occur rapidly, “probably the result of acute respiratory depression.” While acknowledging the extreme potency of fentanyl, the author suggests that “the incidence of fentanyl-related deaths is probably determined by the general availability of the drug, rather than the relative potency of the analogs.”
In a study published in 2000, the Los Angeles County Department of the Coroner analyzed 25 cases involving fentanyl-related deaths. The author notes that the Los Angeles County Coroner’s Office evaluates nearly one case each month involving fentanyl patch-related death. Another study that same year identified 61 cases of transdermal drug overdoses in a Regional Poison Information System over a five-year period.
Head-Induced Overdose
Heat is expected to increase skin permeability, metabolism and elimination of fentanyl. If drug release from the system is much faster than permeation through the skin, the skin controls the transdermal absorption rate into the patient’s systemic circulation, rather than Duragesic’s special rate control membrane.
Several case reports have described the development of life-threatening overdose caused by a heating pad or rise in body temperature. Frolich et al. reported a narcotic overdose in a patient that was using a warming blanket to relieve pain following surgery. Medical Literature 17, see M.A. Frolich et al., Opioid Overdose in a Patient Using a Fentanyl Patch During Treatment with a Warming Blanket, 93 ANESTH. ANALG. 647-48 (2001) (unable to obtain hard copy). The increase in absorption may account for other heat-related toxicity associated with transdermal fentanyl. G. Newshan, Heat-Related Toxicity with the Fentanyl Transdermal Patch, 16 J. PAIN SYMPTOM MGMT. 277-78 (1998) (unable to obtain hard copy).
One study, in 2003, examined the effect of heat on transdermal fentanyl absorption. The authors concluded that increases in skin temperature may result in increased systemic absorption of fentanyl. Therefore, warming blankets and heating pads should not be either used in conjunction with, or placed over Duragesic patches.
However, as of 2003, the Duragesic label warned that serum fentanyl concentrations may “theoretically” increase by one third in patients with a body temperature of 40 degrees Celsius because of accelerated drug release and increased skin permeability. The current label warns of a “potential for temperature-dependent increases in fentanyl release from the system.”
Matthew A. Passen is an
experienced Chicago Personal Injury Lawyer with Passen Law Group. Mr. Passen concentrates in all areas of
Illinois personal injury law, including truck accidents, auto accidents, wrongful death, brain injury, birth injury, construction accidents, and
medical malpractice in the Chicago area.
Prior to joining Passen Law Group, Mr. Passen was an associate in the litigation department of Jenner & Block LLP.
Mr. Passen received his B.A. magna cum laude, Phi Bete Kappa, in Economics from the University of Michigan in 2002. Mr. Passen obtained his law degree, summa cum laude, from DePaul University College of Law in 2006, where he graduated Order of the Coif. During law school, Mr. Passen was as a member of the DePaul Law Review.
During the 2003-04 academic year, Mr. Passen clerked for the Honorable Ronald A. Guzman, United States District Court for the Northern District of Illinois. He also spent the following semester clerking at the United States Attorney’s Office, Northern District of Illinois.
Mr. Passen is a member of the Illinois Bar. He is a member of the Chicago Bar Association, Illinois Trial Lawyers Association, Illinois State Bar Association, and the American Association for Justice. Mr. Passen also works with elementary teachers and students in Chicago-area public schools, as a volunteer in the Constitutional Rights Foundation of Chicago’s “Lawyers in the Classroom” program.
July 18th, 2009 at 07:08pm
Under Personal Injury Law
Grocery stores are often considered safe and making a run to the grocery store is a common, everyday occurrence for most families and individuals. But grocery stores are actually one of the riskiest places to be and many customers commonly find themselves in a sticky situation after being involved in an accident that leaves them with slip and fall injuries. A report, conducted by the National Floor Safety Institute (NFSI), even found that $450 million in legal settlements and expenses is paid out annually to victims of these accidents. Learning how to protect yourself whether you are a customer or employee is important, even in a place you’d think could never harm you.
Victims Over 60 At Higher Risk
Given the preponderance of spilled liquids, loose items and runaway carts at grocery stores and supermarkets, it is not surprising that slip and fall injuries are a danger to customers and employees. One of the most interesting finds of the NFSI report was that women, specifically 60 years or older, are more likely to endure a serious slip and fall injury. Grocery store falls take place most often in crowded entry areas, where water is often tracked into the store and not cleaned up as easily or quickly as promotes optimal safety. In addition, the high polish on most supermarket floors means that it is hard to detect stray liquids. Liquid-related risks can occur often in refrigerated areas where equipment may leak or in the produce area, where produce is kept fresh with water continually spraying the products available for purchase.
Victims’ Rights in Slip and Fall Injuries
It is a grocery store or supermarket’s obligation to provide a safe space for customers to walk and to prevent slip and fall injuries to the best of their ability. Grocery stores should always have unsafe areas marked and designated with caution signs as well as have employees nearby to continually scan the store for areas of potential danger. If the unavoidable does occur, you still have rights, whether you are a customer or an employee.
Customers
If you are a customer, inform the store manager as soon as possible, and get that person’s contact information. Contact the appropriate medical personnel and have your injuries checked out. Speak with a personal injury law firm for consultation if a supermarket or grocery store does not cooperate in compensating you for your injuries. Your personal injury attorney can help you recover the damages and compensation you deserve after a slip and fall injury. This can include, but is not limited to, attorney’s fees, medical bills, lost wages, and other benefits.
Employees
If you have been injured in a slip and fall accident on the job, inform a supervisor as soon as possible. Fill out the proper paperwork and consult with your employer’s doctor. A workers’ compensation claim may become relevant to employees who are not thoroughly examined by the company’s medical personnel, or if an employee’s wages decrease or lost because of missed work and low mobility because of a slip and fall injury. An employer will typically try to resolve a workers’ compensation claim through its insurer, but you may wish to have legal representation to make sure your rights are upheld and you are given the care and compensation you deserve.
July 17th, 2009 at 01:08pm
Under Personal Injury Law
Idaho’s laws in regard to personal injury will be very similar to those in all other states of the nation. However, there will be some differences in both law and the attitudes of the courts from state to state, even region to region.
Even from one city to another, there is the possibility of encountering minor differences in law, and you are almost certain to run into differing dispositions and attitudes from one jurisdictional region to the next. As such, an Idaho personal injury lawyer that has experience practicing in the area where you were injured would be the best act to take upon being injured in Idaho.
Types of Personal Injuries
The term “personal injury” is pretty broad and includes several types of injuries. Specifically (and legally), it includes all injuries that occur to you personally and includes both physical and psychological (including emotional damage) injury and applies whether the injury was sustained through another intentionally, negligently, or by accident.
In other words, personal injury includes both physical injury to your body, as well as emotional injury resulting from distress, humiliation, depression, and other similar situations that are caused through the actions of others or through the negligence of others.
Negligence cases will most often involve a form of physical injury, though psychological damages will often be claimed in association with the physical.
As an example, if you were attending a public event (concert, sports event, or simply shopping at the local grocery store) then slipped and fell due to a failure to maintain the grounds (ice or snow that hasn’t been cleared, banana peels or other garbage that hasn’t been cleared, etc.) and break your arm, then personal injury could include both the broken arm as well as the humiliation suffered from falling in public.
If you were to break your watch or tear up your new boots however, this would not be included as part of any claim of personal injury.
Emotional harm can further include slander, false arrest, libel, character defamation and more.
Variations of this law that pertain to Idaho can be reviewed by an Idaho personal injury lawyer to ensure that you are able to take full advantage of any and all claims of personal injury and have the full force of the law on your side.
Preparing to Meet Your Idaho Personal Injury Lawyer
In many personal injury cases where the fault is very clear or an attorney feels highly confident about winning, they may work out an agreement that give them a percentage of the money won in a personal-injury lawsuit (usually around 33 percent) rather than charging you for time.
However, if that is not the case, you will be charged by time. Whether you are contacting your lawyer for the first time, asking for simple advice, or asking what to bring for a meeting, you will likely be charged an attorney’s fee. Minimizing your costs will be beneficial to you as you will receive a larger amount of the claim the less you use up your attorney’s time.
One of the most important things you can do to save both yourself and your attorney time (which will save you money) is write up a detailed story that describes exactly how you sustained your physical injuries as well as any distress or other psychological effects that you have suffered as a result.
Be sure to include details leading up to the event, and pertinent details that happen afterward (especially anything that caused emotional distress such harassing phone calls after the injury took place, undue pressure to settle from the party at fault, humiliation you felt due to the injury being witnessed, etc.) and all details that you can think of, even if you think it might hurt your case.
Your lawyer will do everything he or she can, and withholding anything at all can hurt your case or come back to bite you later. Your lawyer is interested only in helping you with the legal aspect and isn’t there to judge you or your motives.