Integration- MEds

[Guest guest]

 

 

 

 

 

Teresa Hall

[Teresa.bodywork4u]

 

 

If he is the primary care physician and you do it anyway

<even if it is the patients choice> I

would make sure you have a good lawyer, as well as lots of insurance!

 

[Jason]

 

Could you or someone elaborate on this statement… I am looking for specific guidelines/

laws that govern our practice in the given situation… surely someone out

there has to solid information. Has anyone heard of anyone being sued

for giving Chinese herbs of any kind, in any situation?

Again the scenario #1 would be: MD does not participate, Patient wants

to taper, you the practitioner do not tell him/her to

taper… you give supporting herbs.

They get sick, they come after you.

 

Scenario #2: Patient is on multiple MEDS, they are not tapering, you

give supporting herbs, they get sick or die, the family (with) there MD comes

after you, saying you prescribed a ‘bad’ combo (herb/ drug)

interaction. Comments?

 

I am sure they are beneficial, but are waivers necessary?

 

I know many that give herbs without MD approval, or knowledge, when the

patient in on multiple MEDS…

What are the laws surrounding these type of situations?

 

-

 

 

 

 

 

 

 

[Guest guest]

Teresa Hall

[Teresa.bodywork4u]

 

 

 

If he is the primary care physician and you do it anyway

<even if it is the patients choice> I

would make sure you have a good lawyer, as well as lots of insurance!

 

[Jason]

 

Could you or someone elaborate on this statement… I am looking for specific guidelines/ laws

that govern our practice in the given situation… surely someone out there

has to solid information. Has anyone heard of anyone being sued for

giving Chinese herbs of any kind, in any situation?

Again the scenario #1 would be: MD does not participate, Patient wants

to taper, you the practitioner do not tell him/her to

taper… you give supporting herbs.

They get sick, they come after you.

 

Scenario #2: Patient is on multiple MEDS, they are not tapering, you

give supporting herbs, they get sick or die, the family (with) there MD comes

after you, saying you prescribed a ‘bad’ combo (herb/ drug)

interaction. Comments?

 

I am sure they are beneficial, but are waivers necessary?

 

I know many that give herbs without MD approval, or knowledge, when the

patient in on multiple MEDS… What

are the laws surrounding these type of situations?

 

-

 

 

 

 

 

[Guest guest]

, " " <@o...> wrote:

 

> I am looking for

> specific guidelines/ laws that govern our practice in the given

> situation. surely someone out there has to solid information. Has

> anyone heard of anyone being sued for giving Chinese herbs of any

kind,

> in any situation?

 

Jason:

 

I am not an attorney by any means, but I did work as a grad assistant

for 3 attorneys in a school of business admin in the early '90's. It

seems that you are asking about 2 seperate aspects of the legal

system. The first involves scope of practice and crossing the line to

practicing medicine without a license which is a criminal matter. The

second involves action taken against a practioner by a patient which

is a civil matter (remember the OJ Simpson trials).

 

The scope of practice will be dependent on the laws of the state. I

have only read the laws for the State of Wisconsin. If they are

representative, they address acupuncture to some extent, but are not

at all clear regarding herbal medicine. (I suspect that California

law involving TCM is further evolved).

 

In the case of civil action, anyone can file a claim for any reason.

They must show that they have been damaged and that it was the

practitioner's negligence that lead to the damage. In either case,

the court will look for precedents in the way the law is interpreted.

 

You seem to be asking for the precedents. Certainly this list is a

good place to search for anecdotes to start with. What attorneys do

when looking for these is use the available databases to search for

cases on point (or they assign that duty to a pee on like a grad

assitant). As I recall, one is called " Westlaw " or " West Law " and is

usually available at university libraries. (It's available on the

internet, but there is a substantial subscription, so it really isn't

worth it for a non-attorney to ). I do not recall the name

of the other, but can get it if you would like to know.

 

Don't know if you really want to go this direction, but I thought I'd

offer anyway.

 

 

Michael Buyze

[Guest guest]

Actually I am specifically interested in legal issues when a physician is not willing to work on reducing, and it’s the patients choice and you assist

>>>As long as you document in chart and feel comfortable with your knowledge you have nothing to fear

Alon

 

-

 

Friday, November 09, 2001 8:10 AM

RE: Integration- MEDS

 

 

 

..

For example, using modern research that shows that a given herb or formula, can greatly assist in getting someone off medication by increasing the half-life of the drug or a body substance etc. This herb might not be pattern based, and in actuality with some of these patients on 6-10 meds there is no clear pattern anyway. The question becomes, do any of you actively assist in getting patients off medication. This is assuming that the patient wants to and has asked your help. What are the legal issues surrounding this? This is also assuming that the doctor does not want to assist in the process. What is the group's experience on this one?

Many physicians are glad to have a way to help their patients get off meds without a cold turkey reaction, especially with antidepressants. Definitely a part of my practice. It depends on the situation at hand.

 

Actually I am specifically interested in legal issues when a physician is not willing to work on reducing, and it’s the patients choice and you assist. I am also not talking about a cold-turkey approach, but a tapering. And not just giving a supporting general Rx, but something specifidcally designed to reduce the side-effects of the withdraw, and replace the drug on some level.. Example and real case below:

 

On a side note, pertaining to my last post, if you or going to choose a herb/formula that modern research inChinashows that with administration via decoction was helpful in getting someone off a serious medication, would you feel comfortable in giving this in a extract form? Knowing that dosage is critical to prevent flare-ups or even serious harm?

Z’evAs long as you are aware of the potency of the product, and give the proper amount.

 

This is my question: How does one know the potency of products? I for example, when taking pills or extracts, am completely unsure of the actual amount of herb I am talking/ prescribing? At the latest symposium I even asked a Kan rep, how much actual herb is contained in a 1 oz. Bottle of extract, they could not figure it out. Even if they tell you there is X amount of herb in that product, what does that translate to, given the different non-traditional production methods? IS is stroger/ weaker, if so how much?

Z’ev since you have much experience with K’an herb extracts, maybe you can help this real life scenario:

So: one wants to guarantee 12 grams of chai hu and 6 grams of zhi gan cao in a liquid extract of xiao chai hu tang, how much would one need to take daily?

 

I have a real case that the patient is on the following meds:

 

Methotrexate

Prochlorperazine

Glucophage

Diovan

Deltasone

Amitriptyline

Ativan

And some other pn meds.

 

Personally I only believe her TCM pattern is of minor importance, And giving a 6 gents etc. rx (approach) will not do the trick when she starts coming off this stuff… But her tcm pattern is considered in supporting herbs and therapy. I am picking herbs based on other ideas at this point…

 

Comments?

-

Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

This is my question: How does one know the potency of products? I for example, when taking pills or extracts, am completely unsure of the actual amount of herb I am talking/ prescribing? At the latest symposium I even asked a Kan rep, how much actual herb is contained in a 1 oz. Bottle of extract, they could not figure it out. Even if they tell you there is X amount of herb in that product, what does that translate to, given the different non-traditional production methods? IS is stroger/ weaker, if so how much?

>>>That is why i choose to combine individual granules

Alon

 

-

 

Friday, November 09, 2001 8:10 AM

RE: Integration- MEDS

 

 

 

..

For example, using modern research that shows that a given herb or formula, can greatly assist in getting someone off medication by increasing the half-life of the drug or a body substance etc. This herb might not be pattern based, and in actuality with some of these patients on 6-10 meds there is no clear pattern anyway. The question becomes, do any of you actively assist in getting patients off medication. This is assuming that the patient wants to and has asked your help. What are the legal issues surrounding this? This is also assuming that the doctor does not want to assist in the process. What is the group's experience on this one?

Many physicians are glad to have a way to help their patients get off meds without a cold turkey reaction, especially with antidepressants. Definitely a part of my practice. It depends on the situation at hand.

 

Actually I am specifically interested in legal issues when a physician is not willing to work on reducing, and it’s the patients choice and you assist. I am also not talking about a cold-turkey approach, but a tapering. And not just giving a supporting general Rx, but something specifidcally designed to reduce the side-effects of the withdraw, and replace the drug on some level.. Example and real case below:

 

On a side note, pertaining to my last post, if you or going to choose a herb/formula that modern research inChinashows that with administration via decoction was helpful in getting someone off a serious medication, would you feel comfortable in giving this in a extract form? Knowing that dosage is critical to prevent flare-ups or even serious harm?

Z’evAs long as you are aware of the potency of the product, and give the proper amount.

 

This is my question: How does one know the potency of products? I for example, when taking pills or extracts, am completely unsure of the actual amount of herb I am talking/ prescribing? At the latest symposium I even asked a Kan rep, how much actual herb is contained in a 1 oz. Bottle of extract, they could not figure it out. Even if they tell you there is X amount of herb in that product, what does that translate to, given the different non-traditional production methods? IS is stroger/ weaker, if so how much?

Z’ev since you have much experience with K’an herb extracts, maybe you can help this real life scenario:

So: one wants to guarantee 12 grams of chai hu and 6 grams of zhi gan cao in a liquid extract of xiao chai hu tang, how much would one need to take daily?

 

I have a real case that the patient is on the following meds:

 

Methotrexate

Prochlorperazine

Glucophage

Diovan

Deltasone

Amitriptyline

Ativan

And some other pn meds.

 

Personally I only believe her TCM pattern is of minor importance, And giving a 6 gents etc. rx (approach) will not do the trick when she starts coming off this stuff… But her tcm pattern is considered in supporting herbs and therapy. I am picking herbs based on other ideas at this point…

 

Comments?

-

Chinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

but the patient ontheir own wants to taper

>>>And they have the right to do so. You can always have them sign an AMA

Alon

 

-

 

Friday, November 09, 2001 8:15 PM

RE: Re: Integration- MEDS

> > > Friday, November 09, 2001 6:40 PM> > Re: Integration- MEDS> > , "" <@o...> wrote:> Integration to me is understanding the pharmaceuticals and herbs> > from a biomedical perspective, as well as a TCM perspective, and ifthe> > patient desires getting them off the meds having the knowledge touse> > the tools we have to do so.> > Among other things, this is illegal. we are not allowed to reduce or> recommend reduction in prescribed meds. We must work with a willing> MD.> > todd> > I am aware of the 1st part- illegal for us to recommend reduction.I guess the scenario is if the Dr. is unwilling, but the patient ontheir own wants to taper, and you give herbs to support the overallbody, and throw in a few that you know biochemically might aid theprocess, is there a legal issue here? Or are we saying if a patientcomes to us and says they are going to taper, without their physiciansapproval, we have to not treat, because we are aiding them? -JasonChinese Herbal Medicine, a voluntary organization of licensed healthcare practitioners, matriculated students and postgraduate academics specializing in Chinese Herbal Medicine, provides a variety of professional services, including board approved online continuing education.

[Guest guest]

"Eric Serejski"

"'Frances Gander'"

 

First of all, the questions raised below do not have easy answers and may have no answers yet.

The situation and concern around herbs is such that giving herbs on patients taking drugs (multiple

or not) should always be assessed carefully.

 

 

Q: Has anyone heard of anyone being sued for giving Chinese herbs of any kind, in any situation?

 

A: Not in this country, or maybe with ephedra in New York

 

Generaly law suits would be setteled privately in minor cases so we would not know of them.

 

Second, complains may have been issued with respective state boards. If the complains were

processed, they would be public knowledge and the board would be able to provide information.

 

Third, an internet query with the words “law suits Chinese herbs” may generate an answer.

 

 

Q: Scenario #1 would be: MD does not participate, Patient wants to taper, you the practitioner do

not tell him/her to taper… you give supporting herbs. They get sick, they come after you.

 

A: It will depend on how you document your folder. However, if the patient tells the practitioner that

she/he wants to taper, the practitioner needs to suggest the patient to consult their physician first

and then document the statement.

 

 

 

Q: Scenario #2: Patient is on multiple MEDS, they are not tapering, you give supporting herbs, they

get sick or die, the family (with) there MD comes after you, saying you prescribed a ‘bad’ combo

(herb/ drug) interaction. Comments?

 

A: First the family and/or MD would need to prove the combination was the cause of the problem.

This is actually a situation that is under serious consideration in ER where hospitals are starting to

be concerned about giving western drugs to patients that may be under combination of

non-allopathic components of no known history for interaction.

 

Second, it is possible to see this scenario happen. The reverse scenario is as possible: the

practitioner gives herbs and after that the patient receives western medication and suffers from the

combination. Who would be in fault?

 

 

 

Q: I am sure they are beneficial, but are waivers necessary?

 

A: Waivers should be integrated in the routine office waiver form and be relatively detailed to cover

the practitioner: it should include a request for a list of all medications a patient takes. I personally

always provide herbs very carefully for patients taking multiple drugs for a variety of reasons. On the

most simple rational: a herbal formula is a formula careful designed with, i.e., 5 or 6 herbs. Knowing

that the patient is already taking 1 or 2 or 3 additional components transforms the original formula

into a 8 to 10 components. Knowing the delicacy of how formula are designed, I would have a

difficult time to assess what the new formula is about.

 

 

Q: I know many that give herbs without MD approval, or knowledge, when the patient in on multiple

MEDS…What are the laws surrounding these type of situations?

 

A: The laws would depend on the state. Herbs are considered as tea and there is no regulation

around suggesting tea. However, as accidents will occur, the situation will change.

 

mbuyze wrote:

, ""

<@o...> wrote:

> I am looking for

> specific guidelines/ laws that govern our practice in the given

> situation. surely someone out there has to solid information.

Has

> anyone heard of anyone being sued for giving Chinese herbs of

any

kind,

> in any situation?

Jason:

I am not an attorney by any means, but I did work as a grad assistant

for 3 attorneys in a school of business admin in the early '90's.

It

seems that you are asking about 2 seperate aspects of the legal

system. The first involves scope of practice and crossing the line

to

practicing medicine without a license which is a criminal matter.

The

second involves action taken against a practioner by a patient

which

is a civil matter (remember the OJ Simpson trials).

The scope of practice will be dependent on the laws of the state.

I

have only read the laws for the State of Wisconsin. If they are

representative, they address acupuncture to some extent, but are

not

at all clear regarding herbal medicine. (I suspect that California

law involving TCM is further evolved).

In the case of civil action, anyone can file a claim for any reason.

They must show that they have been damaged and that it was the

practitioner's negligence that lead to the damage. In either case,

the court will look for precedents in the way the law is interpreted.

You seem to be asking for the precedents. Certainly this list is

a

good place to search for anecdotes to start with. What attorneys

do

when looking for these is use the available databases to search

for

cases on point (or they assign that duty to a pee on like a grad

assitant). As I recall, one is called "Westlaw" or "West Law" and

is

usually available at university libraries. (It's available on the

internet, but there is a substantial subscription, so it really

isn't

worth it for a non-attorney to ). I do not recall the

name

of the other, but can get it if you would like to know.

Don't know if you really want to go this direction, but I thought

I'd

offer anyway.

 

Michael Buyze

 

 

Chinese Herbal Medicine, a voluntary organization of licensed

healthcare practitioners, matriculated students and postgraduate academics

specializing in Chinese Herbal Medicine, provides a variety of professional

services, including board approved online continuing education.

 

 

[Guest guest]

Frances and Michael, thank you for your

input…

 

-JAson

 

 

 

Frances Gander

[fgander]

Wednesday, November 14, 2001

7:02 PM

;

 

Re:

Re: Integration- MEDS

 

" Eric Serejski " " 'Frances Gander' " First of all, the questions raised below do not have easy answers and may have no answers yet. The situation and concern around herbs is such that giving herbs on patients taking drugs (multipleor not) should always be assessed carefully. Q: Has anyone heard of anyone being sued for giving Chinese herbs of any kind, in any situation? A: Not in this country, or maybe with ephedra in New York Generaly law suits would be setteled privately in minor cases so we would not know of them. Second, complains may have been issued with respective state boards. If the complains wereprocessed, they would be public knowledge and the board would be able to provide information. Third, an internet query with the words “law suits Chinese herbs” may generate an answer. Q: Scenario #1 would be: MD does not participate, Patient wants to taper, you the practitioner donot tell him/her to taper… you give supporting herbs. They get sick, they come after you. A: It will depend on how you document your folder. However, if the patient tells the practitioner thatshe/he wants to taper, the practitioner needs to suggest the patient to consult their physician firstand then document the statement. Q: Scenario #2: Patient is on multiple MEDS, they are not tapering, you give supporting herbs, theyget sick or die, the family (with) there MD comes after you, saying you prescribed a ‘bad’ combo(herb/ drug) interaction. Comments? A: First the family and/or MD would need to prove the combination was the cause of the problem. This is actually a situation that is under serious consideration in ER where hospitals are starting tobe concerned about giving western drugs to patients that may be under combination ofnon-allopathic components of no known history for interaction. Second, it is possible to see this scenario happen. The reverse scenario is as possible: thepractitioner gives herbs and after that the patient receives western medication and suffers from thecombination. Who would be in fault? Q: I am sure they are beneficial, but are waivers necessary? A: Waivers should be integrated in the routine office waiver form and be relatively detailed to coverthe practitioner: it should include a request for a list of all medications a patient takes. I personallyalways provide herbs very carefully for patients taking multiple drugs for a variety of reasons. On themost simple rational: a herbal formula is a formula careful designed with, i.e., 5 or 6 herbs. Knowingthat the patient is already taking 1 or 2 or 3 additional components transforms the original formulainto a 8 to 10 components. Knowing the delicacy of how formula are designed, I would have adifficult time to assess what the new formula is about. Q: I know many that give herbs without MD approval, or knowledge, when the patient in on multipleMEDS…What are the laws surrounding these type of situations? A: The laws would depend on the state. Herbs are considered as tea and there is no regulationaround suggesting tea. However, as accidents will occur, the situation will change.

mbuyze

wrote:

 

, " "

<@o...> wrote:

> I am

looking for

>

specific guidelines/ laws that govern our practice in the given

 

> situation.

surely someone out there has to solid information. Has

 

> anyone

heard of anyone being sued for giving Chinese herbs of any

kind,

 

> in any

situation?

Jason:

 

I am not

an attorney by any means, but I did work as a grad assistant

 

for 3

attorneys in a school of business admin in the early '90's. It

 

seems that

you are asking about 2 seperate aspects of the legal

system. The

first involves scope of practice and crossing the line to

practicing

medicine without a license which is a criminal matter. The

second

involves action taken against a practioner by a patient which

 

is a civil

matter (remember the OJ Simpson trials).

The scope

of practice will be dependent on the laws of the state. I

have only

read the laws for the State of Wisconsin. If they are

representative,

they address acupuncture to some extent, but are not

at all clear

regarding herbal medicine. (I suspect that California

law

involving TCM is further evolved).

In the

case of civil action, anyone can file a claim for any reason.

 

They must

show that they have been damaged and that it was the

practitioner's

negligence that lead to the damage. In either case,

the court

will look for precedents in the way the law is interpreted.

You seem

to be asking for the precedents. Certainly this list is a

good place

to search for anecdotes to start with. What attorneys do

when looking

for these is use the available databases to search for

cases on

point (or they assign that duty to a pee on like a grad

assitant).

As I recall, one is called " Westlaw " or " West Law " and is

 

usually

available at university libraries. (It's available on the

internet,

but there is a substantial subscription, so it really isn't

worth it for

a non-attorney to ). I do not recall the name

of the

other, but can get it if you would like to know.

Don't

know if you really want to go this direction, but I thought I'd

 

offer

anyway.

Michael

Buyze

 

The

Chinese Herbal Medicine, a voluntary organization of licensed healthcare

practitioners, matriculated students and postgraduate academics specializing in

Chinese Herbal Medicine, provides a variety of professional services, including

board approved online continuing education.

 

 

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