Pa. unveils new ER guidelines for dispensing pain medications

Posted: Wednesday, August 13, 2014

Several times a day someone walks into the emergency room at St. Mary Medical Center complaining of pain and looking for medication to stop it, according to the department's director.

But not everyone seeking prescription painkillers leaves with the drugs or a prescription for them.

Three years ago, the Middletown hospital implemented new restrictions on how it dispenses controlled substances through its ER. The effort was part of an initiative to reduce the abuse and overdose deaths associated with opioid-based pain medications while also appropriately treating patients in pain.

The result has been fewer ER patients with pain complaints looking for prescriptions, Chairman of Emergency Medicine Dr. Gary Zimmer said.

The Pennsylvania Medical Society wants more hospitals to follow the efforts hospitals like St. Mary have put in place. At a press conference in Philadelphia on Wednesday, the organization announced the state’s new — voluntary — emergency department pain prescribing guidelines.

The recommendations are designed to make sure patients who are in pain get the relief they need, while also attempting to identify individuals who may be abusing controlled substances and refer them into treatment.

“As an emergency physician, I see the devastating impact of prescription drug abuse on a regular basis. I know this epidemic does not discriminate on the basis of race, age or gender,” said Dr. Ted Christopher, a medical society board member and emergency medicine doctor in Philadelphia.

National statistics confirm that prescription drug abuse in the U.S. has reached epidemic proportions. The National Institute on Drug Abuse estimated that 8.76 million Americans misused prescription drugs in 2010. The most abused prescription categories are painkillers, tranquilizers and stimulants.

Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills, according to Centers for Disease Control and Prevention in Atlanta.

The CDC estimates that drug misuse and abuse resulted in about 2.5 million emergency department visits in 2011, with more than half related to pharmaceuticals. Opioid pain relievers were involved in about 74 percent of the 22,810 deaths related to pharmaceutical overdoses in 2011, according to the CDC.

The new guidelines were created in collaboration with the Pennsylvania College of Emergency Physicians, which presented them to Gov. Tom Corbett’s Safe and Effective Prescribing Practices and Pain Management Task Force last month.

The task force has been charged with reviewing health care prescribing practices and identifying guidelines to promote safer and more effective pain management by health care providers. It is also working to ensure prescribers and dispensers are able to identify drug abuse and addiction problems in their patients in order to refer them for drug and alcohol assessment and for the appropriate level of treatment.

“These guidelines will help doctors break the deadly cycle of the unlawful obtaining of prescription drugs,” Pennsylvania’s Physician General Dr. Carrie DeLone said.

The list of seven prescribing guidelines include recommending providers choose the lowest potency necessary to relieve pain, when an opioid medication is indicated; dispensing only the amount of medication necessary to control a patient’s pain until they can access a pharmacy; and not writing discharge prescriptions that exceed seven days.

The guidelines also recommend emergency departments not prescribe long-acting opioids such as OxyContin, extended release morphine or methadone unless they coordinate with an outpatient provider.

“These guidelines are the next steps in fighting prescription drug abuse in Pennsylvania,” Christopher added. “Let’s not stop there. More work can be done and needs to be done in our battle against misuse and abuse of prescription drugs.”

The new state recommendations are similar to what St. Mary Medical Center has in place, Zimmer said.

St. Mary patients with chronic pain complaints can no longer automatically get refills through the ER; instead they are referred back to the prescribing doctor, Zimmer said. Also the hospital limits its discharge prescriptions to not exceed three days' worth of pain pills.

ER patients who are uninsured or don't have a pain management doctor are referred to two hospital-associated specialists who accept charity cases for follow-up care, Zimmer said.

Zimmer added that the hospital and its ER doctors are careful to make sure that pain patients are getting proper care in and out of the hospital setting.

“The reality is, unless a patient with chronic pain gets their care coordinated through a qualified pain management specialist, they are at very high risk for adverse events associated with controlled substances,” he said.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Did You Know?

Prescription painkiller work by binding receptors in the brain to decrease the perception of pain. The drugs can create a feeling of euphoria, cause physical dependence and, in some people, led to addiction. The drugs also cause sedation and slow a person’s breathing. It is one reason why an overdose on opioid drugs can take one to three hours after ingestion.

Suicide and celebrities: An opportunity for an open discussion

Posted: Tuesday, August 12, 2014

Happy people do kill themselves. Funny people kill themselves. Famous people kill themselves.

But when celebrities commit suicide, people pay more attention, which provides an opportunity to talk openly about an issue that many people are reluctant to discuss, mental health advocates said.

Robin Williams

“They’re just as human as everyone else, and mental illness, addiction, suicide don’t discriminate based on how famous you are or how wealthy,” said Sharon Curran, associated executive director of the Lenape Valley Foundation, a Doylestown crisis mental health organization. “No matter what kind of resources you have available to you, it’s still a serious disease.”

Authorities confirmed Tuesday that actor comedian Robin Williams, 63, committed suicide by hanging himself with a belt in his California home. He also had superficial cuts on his wrist and a pocket knife was found.

Also revealed was that Williams had been in treatment for depression and had bipolar disorder. The Oscar winner, who had long battled alcohol and drug addiction, also had reportedly checked back into rehab last month.

Behavior experts say there is no one clear answer as to why people commit suicide, but available research shows that people with poor coping skills, mental illness and drug and alcohol problems are far more susceptible to suicidal thoughts and behaviors.

More unusual are impulsive suicides committed in reaction to a single event, such as a job loss or romantic breakup, but that also doesn’t necessarily mean a lot of planning goes into most suicides, either, according to experts. While most people who commit suicide show warning signs, rarely will an individual take his or her own life in the fit of a psychotic episode.

Celebrity suicides like Williams' can be more baffling, especially when the person appears to be enjoying career and personal success.

“Most of us feel like we know them,” said John McIntosh, a psychology professor at Indiana University, South Bend, who has studied suicide trends. “They have money, power, influence, adoration, all the things that people want to have. I want to be just like that person. Why would they ever kill themselves?”

LIKE FAMILY

Celebrity suicides generate a lot of attention because people often feel an emotional connection to the person — like a family member — especially someone with a long and varied career like Robin Williams, McIntosh added.

Research suggests that when major celebrities kill themselves, calls to suicide prevention hotlines jump. Also, suicides among people who have the same demographic characteristics as the celebrity may also increase as happened in 1994 after the suicide of Nirvana front-man musician Kurt Cobain.

“(Williams’ death) alone is not going to cause a suicide, but you have people who are already vulnerable, and this could be one thing that makes them feel worse,” McIntosh said.

After more than a decade of declines, suicide rates in the United States started rising again in 2006, after the most recent economic recession hit. The numbers have continued rising every year since, according to national statistics. The increases are across all demographic groups, though white, middle-aged men still have a slightly higher rate, McIntosh said.

An average of one person committed suicide every 13.3 minutes in the United States in 2011, the most recent year that national statistics were available, and someone attempted suicide every 32 seconds.

Last year in Bucks County, 68 people killed themselves. So far this year the number stands at 47, according to the county coroner’s office. In neighboring Montgomery County, 87 suicides were reported last year, and so far this year the number is 68.

At any given time, 7 percent of the population is affected by major depressive disorder, which puts them at a high risk for suicidal thoughts and behavior, said Dr. Shivkumar Hatti, president of the Pennsylvania Psychiatric Society.

While thoughts of suicide are not unusual among people with depressive disorders, acting on those feelings is less common, Hatti added. That is why quick treatment is critical for individuals experiencing major depression. With medications and psychotherapy, more than 85 percent of people rebound.

“People need to understand this is a common disorder and there are multiple treatment options and it’s successful,” Hatti said.

CRISIS INTERVENTION

Amanda Hilzer worries Williams’ death will send the wrong message about recovery. She specializes in working with individuals with both substance abuse issues and mental illness at Livengrin, a Bensalem substance abuse treatment center.

Mental health issues and substance abuse frequently are co-occurring disorders, which makes effective treatment more complicated since the disorders are so intertwined, Hilzer said. Addicts often self-medicate with drugs or alcohol to reduce mental illness symptoms, she added. They also may avoid mental health treatment because of the lingering stigma associated with it.

National estimates are that 50 percent to 75 percent of individuals who abuse drugs or alcohol also have a mental illness, and as many as 90 percent of people who complete suicide had undertreated or untreated mental health and substance abuse issues, Hilzer said.

The linked nature of mental health and substance abuse requires integrated treatment that addresses both problems for long-term recovery success.

“If someone appears in the emergency room with a heart attack and a broken arm, we wouldn’t just treat one or the other,” Hilzer added.

Almost universally, suicide attempts or completions are the result of more than one factor, McIntosh and others said. A person could have good coping abilities most of the time, but gets to the breaking point when they are overwhelmed and unable to function normally.

While research shows most people exhibit signs of suicidal behaviors — which either aren’t taken seriously or go unnoticed — some are particularly good at concealing their feelings, especially if they live alone, McIntosh said.

Among the common misconceptions is that someone who is considering suicide doesn’t plan for the future.

That isn’t always the case, McIntosh said. Suicide is a crisis behavior, meaning a person considering killing themselves today, may not have thought about it three days earlier. It’s another reason why accessible and immediate mental health intervention is critical.

“If you can get a person through the crisis, they may never again think about suicide again.”

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Did You Know?

Other celebrities who committed suicide

Kurt Cobain, American musician and songwriter, founder of the band Nirvana, 1994, gunshot

Michael Hutchence, Australian singer and songwriter, and founder of INXS 1997, hanged.

Spalding Gray, American actor, playwright, 2004, jumped off the Staten Island Ferry

Freddie Prinze, American actor, comedian, 1977, gunshot

Alexander McQueen, British fashion designer, 2010, hanged

Tony Scott, British film director, 2012, jumped off the Vincent Thomas Bridge in Los Angeles

Herve Villechaize, French actor best known for playing “Tattoo” on the 1970s TV show “Fantasy Island,” 1993, gunshot

Brian Keith, American TV and film actor, 1997, gunshot

Andrew Koenig, American actor on the 1980s TV show “Growing Pains,” 2010, hanged.

Mindy McCready, American country musician, 2013, gunshot

Wendy O.Williams, American singer and founder of punk band “Plasmatics,” 1998, gunshot

More Information

Symptoms of major clinical depression

Feelings of depression or a loss in interest in things that an individual previously enjoyed every day for most of the day over at least two weeks. 

And at least one of these signs:

Change appetite

Change sleep pattern

Less energy

Difficulty with concentration

Feelings of guilt, hopelessness or suicidal thoughts

Source: Dr. Shivkumar Hatti, president of Pennsylvania Psychiatric Society

IF YOU ARE CONSIDERING SUICIDE OR FEELING DEPRESSED THERE IS HELP AVAILABLE THROUGH THE NATIONAL SUICIDE PREVENTION LIFELINE AT 1-800-273-8255

Judge in Bensalem suicide-pact homicide case: Where is the malice?

Posted: Friday, August 8, 2014 '

Where is the malice?

That is the question Bucks County Judge Albert Cepparulo wanted answered Friday during a hearing involving a 30-year-old Bensalem man charged with killing his mother in what was believed to have been a suicide pact.

Gus Yiambilis

“You have got to be kidding, if that is your evidence of malice for homicide,” Cepparulo said in response to prosecutor Alan J. Garabedian’s assertion that even if Karen Yiambilis wanted to die, it doesn’t mean her death isn’t a homicide.

The 59-year-old Yiambilis died of carbon monoxide poisoning April 7, and police charged her son, Koustantinos “Gus” Yiambilis, in her death.

The hearing was held at the request of his attorneys, who asked the court to dismiss the charges of homicide and causing a catastrophe against their client. The defense argued that the Bucks County District Attorney’s Office has failed to show evidence supporting either charge.

The defense contends that Karen and Gus Yiambilis both intended to commit suicide, but Gus survived.

Cepparulo, who is overseeing the case, is expected to issue a written decision on the dismissal requests within 60 days. Yiambilis family members at the hearing declined comment.

The open homicide charge means Gus Yiambilis is ineligible for bail and must remain incarcerated in Bucks County prison. He is also charged with a felony aiding in suicide, risking a catastrophe and misdemeanor reckless endangerment.

At the hearing Friday, Yiambilis’ attorney, William Goldman Jr., read from seven handwritten suicide notes left in the bedroom where authorities say Karen Yiambilis was found along with a borrowed gas generator.

Four of the notes were written by Karen Yiambilis to family members. Gus wrote the others.

In court, Yiambilis and his sister Eleni each cried as portions of the letters were read.

Suicide letters from Gus and Karen Yiambilis

Goldman has argued that the notes, along with testimony from a neighbor who claims it was Karen Yiambilis — not Gus, as police allege — who asked to borrow her gas generator the day of her death, show his client was not actively involved in the planning or execution of the suicide pact nor did he intend his mother to die and he survive.

“Karen Yiambilis expressed her intent by her own hand,” Goldman added. “There was no deception, no fraud, no duress.”

Goldman said the only reason Gus lived is because police were called to the one bedroom apartment, and pounded on the door for 10 minutes before Yiambilis answered it. Police said Yiambilis appeared lethargic and confused when he opened the door. Police noticed a haze in the apartment and smelled exhaust fumes.

Goldman also presented new evidence that he said shows his client played no role in his mother’s death. A recent fingerprint analysis shows that none of the 41 prints lifted from packing tape used to seal vents, doors and windows in the bedroom match Gus Yiambilis’, he said.

“Two people lived in that apartment, and that leaves one person: Karen Yiambilis,” Goldman added.

But there are no fingerprints of Karen Yiambilis to compare because her fingerprints weren’t taken when her body was released and then was later cremated, he said.

Goldman also tried to cast doubt on what prosecutors have cited as a key piece of evidence supporting the homicide charge — a statement Gus made while at the hospital for treatment of carbon monoxide poisoning. He allegedly said, “I can’t believe I killed my mother. She’s the only thing I got.”

Goldman suggested the statement was taken out of context.

“If someone were to say, ‘I’m Hulk Hogan’... it doesn’t make it true,” he said.

But prosecutor Garabedian countered that the homicide charge is appropriate because Karen Yiambilis died as a result of a gas generator that her son ran and even refilled once after it ran out of gas.

When Judge Cepparulo asked if charging him with both homicide and aiding in suicide is contradictory, the prosecutor responded that a judge or jury could see the death as a suicide, too, so it’s appropriate to charge it as well.

“That is just wrong,” Cepparulo said. “You cannot have homicide and assisted suicide. Those two don’t fly.”

Then Cepparulo asked Garabedian what evidence showed that Yiambilis’ actions were malicious, a requirement for a homicide charge.

“From every note I read, it was clear they wanted to commit suicide,” the judge said. “Is there any evidence ... that Mr. Yiambilis took certain steps to avoid dying by carbon monoxide? Did he try to make sure that he would live and his mother would die? Is there any evidence?”

Garabedian’s answer: Yiambilis survived.

“When officers knocked on the door, he answered (it), he left the (bed)room,” he added. “By answering the door he took himself out of the zone of danger.”

Goldman also argued that Yiambilis didn’t intend to cause widespread injury, damage or destruction and none happened. He added that steps were taken to reduce the gas exposure to others.

Garabedian countered that Yiambilis put a large number of people in danger. He cited CO readings in two neighboring apartments reached potentially hazardous levels and the evacuation of four apartments for two hours while fumes dissipated.

“How many people need to die before we call this a catastrophe, judge?” Garabedian added.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Family: Cough syrup abuse led Bristol Twp. teen to stab grandmother

Posted: Monday, August 4, 2014 

In the days before he allegedly stabbed his grandmother, Dylan Campbell thought he was a god. He also believed that someone was trying to hurt his family.

He’d get down on all fours and rock. He started hyperventilating. He was hallucinating. His face wore a blank look, according to his aunt Noreen Carros, who lives with the 17-year-old, soon-to-be high school senior.

His bizarre behavior was so worrisome that his family took him to a hospital emergency room, where he was put under a 48-hour observation, Carros said.

Dylan Campbell

She said she had no idea what happened to her grand-nephew, until he confided in her. Now she wants to warn other people about what medical and drug abuse professionals call a cheap, legal, accessible and dangerous high.

And it’s probably in your bathroom right now.

The Bristol Township teen was abusing cough medications, and had been for months, Carros said. The family informed Bristol Township police that he was possibly abusing it the night he allegedly stabbed his grandmother, who suffered minor wounds.

While not as popular as a decade ago, cough syrup and cold tablets continue to be abused by teens looking for a cheap — and some may believe — safer high, according to medical experts.

A 2011 national survey found that one in 10 U.S. teens has used cough or cold medication to get high, making it more popular than cocaine, Ecstasy, LSD and methamphetamine among teens, according to the U.S. Drug Enforcement Agency.

Cough medications ranked fifth among 14 legal and illegal drugs that high school seniors admitted to abusing in the past year in a 2012 University of Michigan study. Overall, fewer than 6 percent of the seniors admitted abusing cough medications compared with marijuana/hashish (36 percent) and synthetic marijuana (11 percent), according to the study.

Many over-the-counter cough syrups contain the active ingredient dextromethorphan — also called DXM — a cough suppressant that has a dissociative anesthetic property, meaning in large doses it can alter an individual’s perceptions and create a feeling of detachment from their surroundings.

When taken in doses beyond what is recommended, DXM produces a euphoric high and hallucinations, according to medical literature. People taking high doses experience different worlds and contact with “superior” beings, some of the literature states.

In extremely high doses, the drug can cause aggression, violence and impulsivity and aggravate underlying mental health problems, drug abuse experts said.

While most chain drug stores frequently keep commercial cold and cough medicines containing DXM behind the counter, most major retailers don’t, said Katherine Aldridge, a drug abuse therapist at TODAY Inc. in Middletown, a substance abuse treatment center for teens.

Signs of cough syrup abuse can be tough to spot because the signs can be confused with other typical teenage behavior or common illnesses, Aldridge said. Aside from irritability, there are no physical signs of withdrawal when a person stops consuming the medication.

“They have to be under the influence for you to notice anything,” she added.

Individuals using DXM-based cough medication to get high often appear to be mildly to moderately intoxicated. But if high doses are taken, a person can hallucinate and experience sensations of physical distortion similar to what they might experience if ingesting PCP, better known as angel dust, Aldridge said.

With prescription-only codeine-based cough medications, the codeine attaches to the same cell receptors in the brain that heroin targets, medical experts say. Consuming more than the daily recommended therapeutic dose of promethazine-codeine cough syrup can produce euphoria similar to that produced by other opioid drugs, according to the National Institute on Drug Abuse.

How much cough medication can induce hallucinations varies, but similar to alcohol intoxication, smaller, thinner people with an empty stomach tend to feel the effects faster, often within 20 minutes to a half hour, Aldridge said. The euphoric effects can last three or four hours.

To kill the medicine taste, teens will mix a candy-flavored cough syrup cocktail called “Sizzurp.”

The attraction for teens is a combination of factors including it’s legal, affordable and doesn’t require teens to deal with unsavory characters, Aldridge said.

“It’s cough medicine for God’s sake. It’s nothing I would get arrested for,” Aldridge said. “Schools don’t call police for a bottle of cough medicine in the backpack.”

Individuals can quickly develop a tolerance to both DXM and codeine cough syrups so the more they use it, the more they require higher doses to generate the same high they once got. Like other dissociative drugs, cough medications are not considered to be physically addictive like heroin or cocaine, but when abused, it can cause increased dopamine in the brain leading to psychological addiction, according to the National Institute on Drug Abuse.

“It does have a strong psychological aspect to it often with a strong urge to use,” added David Fialko, a drug prevention specialist with the Council of Southeastern Pennsylvania.

Other health dangers associated with cough medication abuse include impaired motor function, numbness, nausea or vomiting, increased heart rate and blood pressure and, at high doses, extreme agitation, increased body temperature, and a buildup of excess acid in body fluids.

High doses of acetaminophen, a pain reliever commonly found in DXM-based medications, can cause liver damage, according to the National Institute on Drug Abuse. With codeine-based medications, there is a high risk of a fatal overdose, the NIDA said.

If someone consumes a lot of cough medication containing DXM, there is a good chance they’ll pass out, said Dr. William Lorman, vice president for clinical services at Livengrin, a Bensalem substance abuse treatment center. Some teens and young adults will experience with cough medications the “buzz,” but don’t develop a high tolerance level, he added.

Dylan Campbell told his aunt that he had been abusing cough medications for three months before the alleged stabbing, Carros said. He confessed to drinking as much as a bottle a day of over-the-counter cough medication, as well as taking it in tablet form, she said.

Dylan said that he believed the cough syrup expanded his mind and helped him concentrate better, Carros said. The family had no clue anything was wrong until he was rushed to the hospital, she added.

The night of the alleged attack on his grandmother, she said, family camped out in the living room to watch Dylan, who was still behaving like he was in a trance, Carros said.

“He was not there whatsoever,” she added.

Dylan is scheduled to appear in court for a preliminary hearing on charges of aggravated and simple assault and related offenses in October, according to online court records. While he was initially incarcerated in lieu of 10 percent of $15,000 bail, he was released July 11 after his bail was changed to unsecured, according to court records.

Carros said Dylan is now in a residential drug treatment center.

“I’ve never encountered anything like this. People need to be aware of it. It’s something most people have in their medicine cabinets,” she added. “It’s horrible. He has always been a really good kid.”

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Just The Facts

Signs that a person might be abusing cough products include mood swings, a change in behavior, trouble speaking, trouble walking straight, the appearance of being drunk, a decrease in school or work performance, finding over-the-counter drugs in the person's room or backpack, over-the-counter drugs disappearing from the cabinet, and taking cold medications when not ill.

Short-term effects include blurred vision, numbness, muscle spasms, heart attack, confusion, dizziness, drowsiness, nausea, vomiting, increased heart rate, slurred speech, psychosis, hallucinations, anxiety, sexual dysfunction, anxiety, poor co-ordination, over heating, itchy skin and rash.

Withdrawal symptoms include restlessness, insomnia, vomiting, diarrhea, muscle aches, cold flashes, bone aches, depression, problems with memory and thinking, and drug craving. 

Source: Council on Drug Abuse

Did You Know?

Two commonly abused cough and cold medicines are:

Dextromethorphan (DXM) a cough suppressant and expectorant found in many OTC cold medicines. It may produce euphoria and dissociative effects or even hallucinations when taken in quantities greater than the recommended therapeutic dose.

Promethazine-codeine cough syrup a medication that contains codeine, an opioid that acts as a cough suppressant and can also produce relaxation and euphoria when consumed at a higher-than-prescribed dose. It also contains promethazine HCl, an antihistamine that additionally acts as a sedative. Although only available by prescription, promethazine-codeine cough syrup is sometimes diverted for abuse.

Source: National Institute of Drug Abuse

Newtown man held on ear-biting, other assault charges

Posted: Wednesday, July 30, 2014

The first time he met James W. Worthington was the night in March that Worthington bit off most of his right ear, a 28-year-old man testified in district court in Newtown on Wednesday.

Anthony McGeehan said that he was celebrating St. Patrick’s Day at the Green Parrot Irish Pub on North Sycamore Street in Newtown Township with some friends when he encountered Worthington in the parking lot as he was leaving the bar with two friends.

James Worthington (Right) 

The two men ended up in an argument that turned physical and ended with Worthington biting him twice, resulting in the disfiguring ear injury, McGeehan testified during the first of two preliminary hearings involving assault charges against the 24-year-old Newtown man.

Worthington is charged in the March 18 ear-biting incident, as well as a Feb. 28 assault on his then-girlfriend. He is also awaiting trial in Bucks County Court stemming from an April 2013 arrest on charges of possession of a controlled substance — anabolic steroids, possession of marijuana and possession of drug paraphernalia, according to court records.

“The charges are serious, I’m not trying to depreciate that,” his attorney, Louis Busico, said following the hearing. “This is only a preliminary hearing — it’s Round 1 — and Mr. Worthington looks forward to clearing his name at trial.”

On the witness stand, McGeehan testified that he never spoke to him before their parking lot confrontation. Newtown Township police allege that Worthington became enraged after McGeehan told a friend, who had been talking with Worthington, that it was time to leave.

McGeehan testified that he and Worthington got into a “heated argument” after McGeehan said something to one of his friends who was talking to Worthington. But he could not recall anything else about the argument.

At some point the men became “wrapped up” in each other and ended up on the ground. Worthington straddled him and a second unidentified person held him on the ground by the shoulder, he testified. Unable to get up, McGeehan said he covered his face because he thought Worthington was going to punch him.

“I went to protect my face,” he said.

While his hands were covering his face, he alleges that Worthington bit his neck, which court documents say resulted in an abrasion with an imprint of Worthington’s front teeth; the second bite led to what was described as “an auricular amputation” of the outer ear. Paramedics found the missing chunk of ear in the parking lot.

Worthington was pulled off the man and then ran away after someone said they called 911, according to police.

“Before this defendant ripped your ear off with his teeth, did you strike him?” Bucks County prosecutor Robert James asked.

“No,’’ McGeehan replied.

McGeehan also testified that doctors had to remove part of his stomach tissue to save the remaining cartilage in the damaged ear.

The day after Newtown Township police filed charges in the Green Parrot incident, Worthington entered Passages Ventura, a California substance abuse center where he underwent treatment for more than a month for “mental health and substance abuse issues,” according to documents filed with the district court.

Weeks before the alleged ear-biting incident, Worthington’s one-time girlfriend testified that he shoved her, slammed her head onto the ground, kicked and choked her.'

James W. Worthington

The woman testified that she and Worthington planned to spend the evening alone at his mother’s Newtown home. During early morning hours, things turned violent when Worthington allegedly saw text messages where she implied she was going to end their relationship.

She testified that an argument turned physical after Worthington shoved her to the ground, tried to throw her cellphone out the bedroom window and threw her belongings around the room. She managed to get the phone back, and started to pack her belongings to leave, she said.

Before leaving, she testified, she went outside to the backyard deck where she found Worthington smoking a cigarette. Under cross examination, the woman testified that she approached Worthington threatening to leave, but that she didn’t want to go.

“I still wanted to make it OK,” she testified. “I basically wanted to keep him as calm as possible.”

But Worthington grabbed her overnight bag and started throwing her personal items. A curling iron landed on the neighbor’s roof, she said. A friend found her makeup bag in a nearby bush two months later.

At one point, Worthington threw her across the deck and slammed her head twice on the ground, kicked her in the ribs and wrapped his arm around her neck and choked her until she passed out, she testified.

“I didn’t fight back at all. I just wanted it to end,” she said.

When she tried to leave the home a second time, she testified that Worthington took a golf club and threatened to smash her car window. She also testified that Worthington threatened to send intimate pictures and videos of her to students at the high school where she is a teacher.

After the second confrontation the woman testified she “gave up” trying to leave and went back upstairs to sleep. On cross examination, she acknowledged she didn’t call or text anyone after the allegedly physical confrontation; she also waited seven hours before calling police to report the incident.

Following testimony in both cases, District Judge Donald Nasshorn held Worthington for trial on all charges including aggravated assault and recklessly endangering another person in the Green Parrot case and unlawful restraint, simple assault and harassment in the Feb. 28 case, but he dismissed a terroristic threats charge.

Worthington remains free after posting 10 percent of $50,000 bail in each of his criminal cases; initially he was free on unsecured bail in both cases, but the orders were changed in late June, according to online court records.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia

Another AWOL Bucks County inmate captured in Tullytown

Posted: Monday, July 28, 2014 

Another AWOL Bucks County Community Corrections inmate has been apprehended a little more than a month after he allegedly left the minimum security center without permission.

Bristol Township police patrolman Erik Barros, who was off duty, spotted Milton Ainsworth III, 35, of Bristol Township, walking along the Levittown Parkway in Tullytown on Monday morning. Barros, who was familiar with Ainsworth, called in his location, Bristol Township Lt. Guy Sava said.

Tullytown and Bristol Township officers found Ainsworth, who has been missing from the corrections unit in Doylestown since June 18. He was taken into custody without incident, Sava said. Bucks County Sheriffs officers were nearby and responded to the scene to take Ainsworth to Bucks County prison on an arrest warrant charging him with felony escape.

Ainsworth pleaded guilty in Bucks County Court to simple assault and theft charges on May 21. He was sentenced to 3 to 23 months in jail and two years probation. He also received time served since his arrest in February, according to online court documents.

Available court documents do not say when Ainsworth was moved into the Community Corrections unit, a step-down unit designed to help inmates transition back into the community and earn money toward their fines and other costs.

Ainsworth’s arrest leaves three other Community Corrections inmates at large, including one missing since February. The men have been convicted on charges such as probation violations, drugs and theft, according to county records and the prison.

The county program has come under scrutiny since a 23-year-old Bensalem inmate on county work release went AWOL on June 6 and four days later allegedly stabbed a Bensalem police officer who was attempting to arrest him on escape charges.

The suspect, Matthew Miller, is charged with criminal attempted homicide and related charges, as well as escape. The officer, who was protected by his bullet-proof vest, was not seriously injured.

After Miller’s arrest, it was revealed that Bucks County averages one to two inmates a month disappearing without permission from Community Corrections. So far this year, nine Community Corrections participants have gone missing — four in June. A 10th inmate turned himself in two hours after going missing and was disciplined internally, a county official said.

Authorities also learned that Miller had previously been convicted of escape while a Community Corrections inmate in 2011, but that the prior escape did not automatically disqualify him from participating in the program again.

The Community Corrections unit provides a far more relaxed environment than the county jail, officials said. Doors are not locked. The property isn’t fenced in. Inmates live in dorm-style housing. They work on the premises, hold jobs in the community or perform court-ordered community service. There are mandatory daily drug tests, and random inmate counts are conducted at least seven times a day.

Participating inmates must be approved by the court as well as screened by the prison for behavior, mental health and criminal history to make sure they are considered low-risk offenders, prison Director William Plantier said. The risk assessment looks at the sentence imposed, violence of the crime, prior incarceration and classifies an inmate as maximum, medium or minimum security, he said.

Often drugs are behind an inmate going missing, Plantier said. Others are lured away by family or a romantic interest, he added.

Jo Ciavaglia: 215-949-4181; email: jciavaglia@calkins.com; Twitter: @jociavaglia