Archive for March, 2008

Baxter Heparin Contaminant Identified by FDA

Thursday, March 20th, 2008

The AP has advised that the contaminant found in heparin has been identified. Specifically, Dr. Janet Woodcock, head of the FDA’s Center for Drug Evaluation and Research, advised that the contaminant is called oversulfated condroitin sulfate. Apperantly, this is an artificial chemical unlike the condroitin sulfate which is a natural compound. Oversulfated versions have not been widely studied and Dr. Woodcock said: “We cannot rule in or out whether this was accidentally or deliberately introduced into the product.” She said further, “We are investigating how it got in.”

Alarmingly, there could be corporate monetary gain at the end of this invesigation as oversulfated condroitin sulfate is a less expensive ingredient in the process of making heparin. We are investigating this angle.

These lots of contaminated and adulterated heparin were marketed by Baxter International and produced in China.

If you would like more information, please contact our law offices.

Boehringer Spiriva Respiratory Inhaler Found to Have Greater Risk of Stroke

Tuesday, March 18th, 2008

AWKO INVESTIGATION

Boehringer Inhaler May Raise Stroke Risk

Boehringer Ingelheim, a German based pharmaceutical manufacturer, has advised the FDA that patients using its respiratory inhaler may face a greater risk of stroke. The inhaler device is approved to treat chronic obstructive lung disease, including chronic bronchitis and emphysema.

The FDA confirmed today that data provided to it by Boehringer does support such a finding. Though a conclusion has not been reached as to the exact quantitative measure of the increased risk of stroke, data compiled within 29 studies reflect increased risk to patients using its Spiriva Handihaler.

According to the company’s analysis, two out of every 1,000 patients using Spiriva are at risk for stroke. However, the validity of this representation remains to be seen. Boehringer jointly markets the Spiriva inhaler with another pharmaceutical manufacturer Pfizer Inc.

If you have suffered a stroke during your use of the Spiriva Handihaler, please contact us for more information.

PREEMPTION UNDER SUPREME COURTS RIEGEL DECISION DOES NOT IMMUNIZE MANUFACTURER MISCONDUCT

Thursday, March 13th, 2008

The Supreme Court’s decision in Riegel v. Medtronic, Inc., __ S.Ct. __, No. –6-179, 2008 WL 440744 (Feb. 20, 2008) fails to effect the type of mass exoneration of medical device manufacture wrongdoing as suggested by the Defense Bar; Corporate Defense Counsel and the Industry.

I. Riegel v. Medtronic

Riegel is not new law: it has been the law of a number of federal circuits for some years now. See Horn v. Thoratec Corp., 376 F.3d 163 (3d Cir.2004); Martin v. Medtronic, Inc., 254 F.3d 573 (5th Cir. 2001); Brooks v. Howmedica, Inc., 273 F.3d 785 (8th Cir. 2001); Kemp v. Medtronic, Inc., 231 F.3d 216 (6th Cir. 2000); Mitchell v. Collagen Corp., 126 F.3d 902 (7th Cir. 1997). In fact, Riegel does not affect the posture of most civil actions filed or to be filed against manufacturers (certainly not as a facial bar to pursuing the claim through discovery) because:
1. No decision on pre-emption can be made until discovery is closed and proper motions for summary judgment are before the Court,
2. Riegel is completely inapplicable to claims for manufacturing defect (See Riegel, supra, at n. 2.); breach of express and implied warranty of fitness for particular purpose (See Cipollone v. Liggett Group, Inc., 505 U.S. 504, 526, 112 S.Ct. 2608, 2622, 120 L.Ed.2d 407 (1992); and In re St. Jude Medical Inc. Silzone Heart Valves Products Liability Litigation, MDL 1396, 2004 WL 45503 (D. Minn. January 5, 2004)); deceptive trade practices (See Medtronic v. Lohr, 518 U.S. 470, 501-501 (1996)); and negligent misrepresentation (See Cipollone, 505 U.S. at 526, 112 S.Ct. at 2624).
3. Failure to warn claims are based on a duty to disclose mandated by federal law. Thus, the failure to warn claims are based on “parallel” federal and state requirements, precluding pre-emption. (See Riegel, slip op. at 17).

It is critical to understand what the decision does—and does not—stand for. Riegel involved a device known as an Evergreen Balloon Catheter, manufactured by Medtronic, Inc. of Minnesota. The catheter ruptured in the heart of Plaintiff Charles Riegel and he brought a lawsuit in federal court within in the Northern District of New York. He brought claims for strict liability, breach of implied warranty, negligence in design, testing, inspection, distribution, labeling, marketing and sale of the device. The District Court found those claims pre-empted by federal FDA law, and the Second Circuit agreed. 451 F. 3d 104 (2006). The District Court did not find pre-empted claims for breach of express warranty and negligent manufacturing. Riegel, supra, at n. 2. No claims were brought for fraud, misrepresentation or deceptive trade practices, so the Supreme Court did not rule on whether fraud, misrepresentation or deceptive trade practices claims were pre-empted.

What the Court did hold was that “premarket approval…imposes ‘requirements’ under the MDA as we interpreted it in Lohr.” Riegel, slip op at 9. The Court noted:
…the FDA requires a device that has received premarket approval to be made with almost no deviations from the specifications in its approval application, for the reason that the FDA has determined that the approved form provides a reasonable assurance of safety and effectiveness. Slip op at 10.

The Court noted that federal manufacturing and labeling requirements applicable across the board to almost all medical devices did not pre-empt the common-law claims of negligence and strict liability at issue in Lohr. The federal requirements, we said, were not requirements specific to the device in question—they reflected “entirely generic concerns about device regulation generally.” Slip op at 8-9. However, “premarket approval is specific to individual devices.” Slip op at 9. Because a PMA “is safety approval,” id., it can only follow that pre-emption relates only to the specific pre-market approval sought by the manufacturer and given by the FDA.

Having decided that a PMA imposes requirements specific to the device being approved, the Court then had to determine whether state common law claims imposed a requirement “different from or in addition to” the federal requirement. Riegel, slip op. at 10. The Court made clear that the federal statute “does not prevent a State from providing a damages remedy for claims premised on a violation of FDA regulations; the state duties in such a case ‘parallel,’ rather than add to, federal requirements.” Riegel, slip op. at 17 (emphasis added).

Finally, the Supreme Court addressed the FDA regulation on pre-emption, 21 CFR 808.1(d)(1), in a very murky passage. That regulation provides:
Section 521(a) does not preempt State or local requirements of general applicability where the purpose of the requirement relates either to other products in addition to devices (e.g., requirements such as general electrical codes, and the Uniform Commercial Code (warranty of fitness)), or to unfair trade practices in which the requirements are not limited to devices.

II. Pre-Emption Is Factually Intensive Requiring Discovery Prior to Adjudication.

Dismissal based on alleged pre-emption is inappropriate without an examination of a complete factual record. Riegel, supra, was decided after summary judgment, not on a motion to dismiss. Most, if not all, other significant medical device pre-emption decisions were decided after summary judgment. See, e.g. In re Vioxx Products Liability Litigation, 501 F.Supp.2d 776 (ED La., 2007); In re Guidant Corp. Implantable Defibrillators Products Liability Litigation, 2007 WL 844683 (D. Minn. 2007); In re Medtronic, Inc. Implantable Defibrillators Litig., 465 F.Supp. 2d 886 (D. Minn. 2006); Goodlin v. Medtronic, Inc., 167 F.3d 1367 (11th Cir.1999). Pre-emption decisions are based on what requirements are imposed on a medical device by the FDA, whether the claims at issue deal with those requirements or not, and whether the FDA requirements themselves have been violated.

Accordingly, though the industry hopes Riegel will allow it to do anything shy of criminal misconduct, it does not stand for such a proposition nor does it allow such relief. Rather, though it does change the law in several circuits and will frustrate the efforts of victims of defective medical devices which were approved through a full premarket approval process, if the companies violate the Medical Device Act and federal regulations, such actions give rise to viable and compensable claims.

Stryker Howmedica Trident Ceramic Acetabular THR Hip Prosthesis Recalled in Australia

Thursday, March 13th, 2008

As reported today, the manufacturer of the Stryker Trident ceramic on ceramic system, Howmedical Osteonics issued a voluntary global recall for two hip implant components after the Food and Drug Association determined that it “failed to act on patient claims the products caused bone fractures and required corrective surgery.”

As reported, Stryker Australia recalled the components – Trident Hemispherical and Trident PSL shells - of its Trident system in late January of 2008, but the Australian public was not notified of the recall as it was voluntary.

Alarmingly, as reported, Therapeutic Goods Administration documents show problems regarding the artificial hip component were first raised in Australia in 2001.

But The Age can reveal that the FDA also cautioned the company’s Irish subsidiary after a 2006 investigation found several problems regarding the making of the implants in Cork, Ireland.

The Chinese Heparin Distribution Labyrinth Behind the Wall

Thursday, March 13th, 2008

Why was Baxter International, Inc.’s Heparin recalled and APP Pharmaceuticals Heparin unaffected by the recent outbreak of allergic reactions and deaths? The answer is simple yet complex. Clearly, Baxter secured its product through a chain of distribution which, along the way from the slaughtered pig to the extraction and packaging of the raw agent, became adulterated. What may be ultimately discovered, however, is that the distribution chains utilized by Baxter and APP were both complex and susceptible to error but that Baxter failed to perform any testing and quality control on its product as it was entering the United States. The FDA has reported that Baxter’s representations as to its distribution chain in the aftermath of the outbreak and recall were not accurate. So, not only was there a failure at the point of entry into the U.S., but Baxter’s own understanding and grasp of its vendor supply chain was murky to say the least.

The FDA did apparently visit some of APP’s distributors in China but failed to inspect countless Baxter sites. However, it is not the FDA’s role or obligation to protect consumers. Rather, once it approves a product (based on the manufacturer applicant’s own representations), the drug maker is wholly responsible for pre-sale inspection and testing and post-marketing surveillance.

Baxter’s failings here are too many to count and, fortunately for consumers who have been harmed, it will not be able to hide behind the recently expanded and bastardized legal tenant of “preemption”.

Number of Allergic Reactions and Death from Baxter’s Heparin Increases

Thursday, March 13th, 2008

The number of reports of serious adverse reactions and events to Baxter International, Inc.’s Heparin has now reached approximately 700 with perhaps as many as 21 deaths. The symptoms to look for include tongue and eyelid swelling, rapid increase in heartbeat and blood pressure drop.

Now, the main focus has turned to a contaminant that mimicked the drug’s key ingredient and questions of whether the China based distributors were using a counterfeit alternative. Given that the symptoms in patients and victims were reportedly similar to toxic reactions to chemicals, it stands to reason that the CDC and FDA are analyzing the product which was on hospital shelves but which was not yet utilized. A toxicology screen should lead to the culprit agent and then, hopefully, we will know more about Baxter’s apparently negligence and, potentially, criminal behavior.

For more information, feel free to contact us anytime by clicking here.

Aftershock of Scientific Protein Labs Heparin Recall Expands

Wednesday, March 12th, 2008

Heparin Sodium Sold by Baxter International Led to Recall due to Allergic Reaction to Adulterated Ingredients
Scientific Protein Laboratories of Waunakee, Wisconsin has just received word that three of its larger purchasers of the active ingredient in Heparin have cancelled orders and will stop doing business with the company. The companies, based out of Japan, manufacturer Heparin and compete with Deerfield, Illinois based Baxter International Inc. in the production of Heparin Sodium for use during surgery.

Scientific Protein issued a statement Monday saying: “The three Japanese companies made clear that the recall was simply a precaution, as there has not been a pattern of adverse reactions to heparin reported in Japan similar to what has been observed in the U.S. and Germany.”

Allergic reactions have been linked to China-sourced heparin ingredients in Germany where dozens of adverse reactions have also been reported. In the U.S., however, FDA officials said a foreign “heparin-like” substance was founded in recalled batches of heparin sold by Baxter.

The very complex supply chain, which begins with pigs at farms in rural China winds through unregulated and uninspected family workshops to small village depots to factories like those run by Scientific Protein in its Changzhou factory.

The FDA is currently investigating the exact nature of the defect and cause of adulteration of the Heparin supplied by Baxter.

If you or a loved one has suffered from the use of Heparin, please contact us for more information.

Heart Doctors report Risks of Defibrillator and Pacemaker Hacking- Possible Compromise of Patient Safety?

Wednesday, March 12th, 2008

In another blow to patient confidence in pacemakers and defibrillators, Keith Weinstein of the WSJ report in Heart-Device Hacking Risks Seen, that physicians studying the vulnerability of pacemakers and defibrillators have demostrated that such devices may be prone to cyber-attacks, or hacks, that could potentially compromise patient privacy, or even worse patient safety. A massive Medtronic defibrillator recall and Boston Scientific / Guidant Pacemaker recall in 2005 has played an impoortant role in raising concerns regarding heart device safety.

According to the report, Physicians use a device called a “Programmer” to communcate with the device wirelessly. The Programmer allows the Dr. to tell the device at what rate to pace a heart, and when to send what should be life saving charges to start a heart that has fallen into a fatal arrythmia.

According to the researchers, computer hackers could transmit the same radio signals used by the programmers to a patient’s device and potentially cause a defibrillator to shock or shut down, or reveal confidential patient data.

The study, urges Medtronic, Boston Scientific, and St. Jude to develop secure methods to “stop unauthorized people from hacking into the implanted medical devices that receive instructions via radio waves, a growing category that also includes spinal-cord stimulators and drug-delivery pumps.”

“This report demonstrates that you can obtain private information without authorization. You can reprogram the device without authorization,” according to William Maisel,from Harvard. Dr. Maisel further stated “our report is a theoretical risk, not an actual risk” and said there was no reason for anybody to consider deferring an implantation or removing a defibrillator.

“I find it absolutely terrifying, the idea of having computer-controlled devices implanted in us,” said Aviel Rubin, a professor of computer science at Johns Hopkins University who wasn’t involved in the research. “If you can imagine what you might do in a very busy area, sending out a signal that would cause all of the people in the local area’s implanted devices to start operating incorrectly, it’s a really scary future we’re headed towards.”

According to the WSJ report, Dr. Maisel and his collaborators — Kevin Fu of the University of Massachusetts, and Tadayoshi Kohno of the University of Washington, both computer-science professors — emphasized that the findings are as yet limited to one model of defibrillator made by Medtronic, the Medtronic Maximo, which was subject to a previous Medtronic recall related to a defective medtronic battery.

Defective Edwards Science Catheter Burns Heart during surgery- $40 Million Dollar Verdict

Wednesday, March 12th, 2008

In another amazing story detailing the extent that medical device manufacturers are willing to go to put profits over safety, a Washington man, and his attorneys have successfully exposed a company that put millions of patients lives at risk, and defraided thousands of hospitals, by failing to disclose known risks with it heart surgery devices.

A Washington state jury awarded 40.1 million in damages to a man who needed a heart transplant after his heart was scarred, singed and burned by a malfunction involving a defective Edwards monitor and catheter.

According to the AP report, Mr. Singh had gone to Providence Everett Medical Center in October 2004 for heart bypass surgery , and the doctors used the monitor, and had placed several attached cathetrs in the man’s heart. When the physician could not remove the catheter, he pulled back some of the tissue which revealed that the catheter had overheated and burned his heart.
The doctor could not restart Singh’s heart, so he was transferred him to another hospital while his circulation was maintained with a mechanical heart pump. The patient was in a chemically induced coma until he received a a transplant several weeks later.

According to the report, the hospital blamed Edwards for failing to disclose a problem with the monitor. The company was even pordered to pay the hospital $310,000 for fraud.

According to a press release from the man’s attorneys:

According to court documents, Edwards first became aware of a software bug in its monitors back in 1998, but ignored internal recommendations to correct the problem. In 2002, the software bug caused a similar incident in Japan — caught on video tape — but the smoldering catheter had been removed from the patient before overheating.

Despite the Japan incident, Edwards did not warn or advise healthcare professionals to stop using its monitors, court records show. Instead, the company simply began distributing re-designed products in March 2003 that no longer contained the software error.

The jury awarded Singh $24 million, his wife $6 million and their children $750,000, $500,000 and $500,000 respectively.

Even after this incident occurred, Edward continued to put profits over safety, and continued to deny any problem with the monitor and did not warn other hospitals. It took another two years for the company to finally issue a recall.

Chattem Corporation recalls IcyHot pain patches for serious burn injuries

Tuesday, March 11th, 2008

On February 12, 2008, the FDA issued a Class II Recall on Chattem, Inc. Icy Hot Heat Therapy Products. Typically, these products are used externally for temporary relief of pain in the muscles and joints and for arthritis pain. The list of products can be found on the FDA’s website at www.fda.gov. The recalled IcyHot heat patches are:

Icy Hot Heat Therapy Air Activated Heat-Back
Icy Hot Heat Therapy Air Activated Heat- Arm, Neck, and Leg
Icy Hot Heat Therapy Air Activated Heat-Arm, Neck, and Leg single consumer use “samples” included on a limited promotional basis in cartons of 3oz. Aspercreme Pain Relieving Crème

The defective IcyHot heat patches were manufactured from October 1, 2006 through July 31, 2007 and distributed them from December 4, 2006 through February 4, 2008.
Chattem is a Tennessee corporation which manufactures the recalled IcyHot Heat Therapy patches. According to the FDA website, the company recalled these defective pain patches because of consumer reports of first, second, and third degree burns, skin irritation, and skin removal.

According to the company’s website, persons with concerns about IcyHot burns may visit the FDA website at http://www.fda.gov/cdrh/safety/icyhot-qa.html. Consumers should stop using the product immediately. If you have suffered first second third degree burns or need skin grafts or grafting from IcyHot heat therapy patches, you should retain the product for any future comsumer claims.

According to the FDA website, Healthcare professionals and consumers may report any problems with the use of this product to the FDA’s MedWatch Adverse Event Reporting program either online at www.fda.gov/MedWatch/report.htm

If you are interested in more information about the IcyHot Pain Patch recall or you would like to speak to an IcyHot Burn lawyer, please visit our website at www.awkolaw.com.