An Oregon jury has ordered medical manufacturer I-Flow Corp. to pay $4.75 million in damages to a Portland man who suffered severe cartilage damage after physicians used the company's pain pump to deliver anesthetics into his shoulder joint after surgery.

The lawsuit, which alleged that I-Flow encouraged the off-label use of its pumps for shoulder-joint surgery patients, is one of more than 100 similar suits filed against pain pump manufacturers nationwide. Studies shown that administering local anesthetics directly into the joint to treat post-op pain can result in chondrolysis.

Since evidence of this potential risk surfaced in 2006, I-Flow has packaged its pumps with instructions not to place catheters in joints and has posted a warning on its Web site, reports the New York Times. But patients and doctors are accusing manufacturers of failing to warn them of the chondrolysis risk, and manufacturers and medical experts say that existing research does not conclusively prove a link.

In a recent warning, the FDA notes that it "has not cleared any infusion devices with an indication for use in intra-articular infusion of local anesthetics," and it now requires the manufacturers of local anesthetics and pain pumps to include chondrolysis warnings on their product labels.

"Local pumps should absolutely not be used in the joint at all," says Arizona-based orthopedic surgeon David S. Bailie, MD, who published a case series on this subject last year. Instead of pain pumps, he says, physicians should use traditional pain medications and/or scalene blocks to treat joint pain after shoulder surgery.

Irene Tsikitas

An executive order easing Florida's nurse licensing regulations seeks to fill staffing shortages caused when Haitian nurses left the state to join disaster relief efforts in their homeland.

Nursing union leaders and hospital administrators in South Florida lobbied Gov. Charlie Crist to enact the temporary measure, which he signed last week. It permits the Florida Department of Health to expedite the licensing of nurses from other states to work in Florida facilities for up to 3 months.

Pascal J. Goldschmidt, MD, dean of the University of Miami's Miller School of Medicine, thanked the governor for enabling many more of the state's nurses to travel to Haiti. "It is amazing the amount of work that is going on there," he says.

The Miller School and Jackson Memorial Hospital in Miami have set up a 240-bed field hospital near the Port-au-Prince airport. The makeshift hospital, which can perform approximately 50 procedures a day, has 2 ORs outfitted with anesthesia machines, surgical lights and air conditioning, equipment considered luxuries where many surgeons operate under tents using the most basic of surgical instrumentation. The compound also contains 2 large tents for supply storage and staff housing, and will soon have a pathology lab and imaging center up and running.

"Now we're going to be able to use more modern medicine," says Eduardo de Marchena, MD, the Miller School's associate dean for international medicine. "This is the most inspiring effort I've ever participated in."

Daniel Cook

A postscript to last month's story on the ENT surgeon who allegedly gave unconscious male patients genital exams without their consent: United Health Care has dropped her as an in-network provider.

As a result, patients of Twana Sparks, MD, at the Gila Regional Medical Center in Silver City, N.M., must either pay more to continue to see her or drive hours to the next nearest ear, nose and throat specialist.

The state medical board had placed restrictions on Dr. Sparks's license after investigating allegations that she had unnecessarily examined the genitals of some of her male patients while they were under anesthesia in the OR.

In a letter to her patients dated Dec. 3, 2009, Sparks wrote, "Any visit to me will be more expensive to you. My restrictions have nothing to do with my skills as a physician or surgeon."

Dan O'Connor

Have you ever been a victim of sexual harassment on the job? Tell us in this week's InstaPoll. We'll report the results in this space next week.

The 2 procedures that 46 respondents to last week's poll question are most interested in adding are pain management (33%) and spine (30%). Receiving less interest: retina (15%), bariatrics (13%) and endoscopic sinus (9%).

Dan O'Connor