An unusual fatality in a child due to oxycodone

An unusual fatality secondary to oxycodone in a child is reported. A 2-year-old female child was conveyed to a local hospital after exhibiting signs of rubbing of the mouth and staggering. A hospital toxicological immunoassay screen for drugs of abuse and tricyclic antidepressants was performed on a urine sample and reported as negative. She was discharged and found unresponsive the next morning. She was conveyed to a second hospital in full cardiopulmonary arrest and despite resuscitative efforts, was pronounced dead upon arrival. An autopsy was performed and postmortem specimens were submitted and screened for drugs using mainly chromatographic techniques. Quantitation was achieved by gas chromatography with nitrogen phosphorus detection. Confirmation was performed by gas chromatography/mass spectrometry. Oxycodone was the only drug detected in the following concentrations: heart blood, 1.36 mg/L; gastric contents, 7.33 mg in 33 mL (222.34 mg/L); liver, 0.2 mg/kg; and urine, 47.23 mg/L (47,230 ng/mL). In addition, immunoassay testing of the urine was positive for the opiate class of drugs. This case report demonstrates an unusual cause of death in a young child with emphasis on potential limitation in hospital urine screening tests and the importance of complete forensic toxicological testing in all child deaths.     

Open wide--I meant your pocketbook: repercussions of the dental exclusion to the Medicare act

For many Americans, dental coverage is merely a matter of cosmetics, a pretty smile. But for the elderly, a dental condition can affect nutrition, health, and financial well-being. In her note, Amanda Schwob explores the dental exclusion to Medicare, a provision of great concern to the elderly. Ms. Schwob seeks to define the scope of the dental exclusion by means of the plain language of the Medicare statute, case law, and legislative history. This analysis reveals startling uncertainty in this area of law. Next, Ms. Schwob considers several proposals before Congress as well as state reimbursement policies. The note concludes with concrete suggestions to remedy the ambiguity surrounding Medicare's dental exclusion.