2017 in review … what killed us

Today is 04/21/2019.. who will not be here tomorromw

2016 in review … what killed us

6775 Americans will die EVERY DAY – from various reasons


140 will be SUCCESSFUL – including 20 veterans

270 will die from hospital acquired antibiotic resistant “bug” because staff won’t properly wash hands and/or proper infection control.

350 will die from their use/abuse of the drug ALCOHOL

1200 will die from their use/abuse of the drug NICOTINE

1400 will contract C-DIF from Hospital or Nursing home because staff doesn’t properly wash their hands are adhere to infection control  

80 WILL DIE mostly elderly.

850 will die from OBESITY

700 will die from medical errors

150 will die from Flu/Pneumonia

80 will die from Homicide

80 will die in car accidents




Here is the list from the end of 2016 if interested in comparing
United States of America
from Jan 1, 2017 – Dec 31, 2017 (11:36:39 AM)

Abortion*: 1090465
Heart Disease: 613479
Cancer: 590862
Tobacco: 349505
Obesity: 306566
Medical Errors: 251098
Stroke: 132915
Lower Respiratory Disease: 142741
Accident (unintentional): 135861
Hospital Associated Infection: 98860
Alcohol: 99859
Diabetes: 76380
Alzheimer’s Disease: 93409
Influenza/Pneumonia: 55149
Kidney Failure: 42702
Blood Infection: 33417
Suicide: 42713
Drunk Driving: 33760
Unintentional Poisoning: 31713
All Drug Abuse: 24970
Homicide: 16775
Prescription Drug Overdose: 14979
Murder by gun: 11477
Texting while Driving: 5981
Pedestrian: 4993
Drowning: 3909
Fire Related: 3495
Malnutrition: 2768
Domestic Violence: 1458
Smoking in Bed: 779
Falling out of Bed: 598
Killed by Falling Tree: 149
Lawnmower: 68
Spontaneous Combustion: 0

Totals of all categories are based upon past trends documented below.



I am being completely weaned off my meds, & suspect I will kill myself with the amount of pain I am in, & will be by the time this is over (the wean that is). Already can’t function.

My husband committed suicide after being abandoned by his pain dr.

Please pray for me as I am on the brink of suicide! I don’t want to die but can’t handle the pain anymore! The doctor that I am currently seeing will not give me enough pills to last all month every month… I have to wait until Oct to get in with a pain management doctor whom I already know by others that I know sees this doctor that he will help me, need prayer to hold on until oct… I keep thinking of my family who needs me hear.

“We just lost another intractable member of our support group two nights ago. She committed suicide because her medications were taken away for interstitial cystitis (a horribly painful bladder condition) and pudendal neuralgia, both of which she had battled for years

D D., journalist and prescribed fentanyl patient for a dozen years joined me on air last weekend with her husband and spoke of her suicide plan should the only relief from constant agony be heavily reduced or taken away.

I was told last Friday that my Dr. will be tapering my meds again . When I told him I didn’t think my body could take another lowering he stated ” it wasn’t my
License on the line”, I stated ” no , but it’s my life on the line”!!!!! I can not continue to live this way . I can not continue to suffer in agony when my medications and dose where working just fine before and I was a productive member of society . I can no longer take this. I have a plan in place to end my life myself When I am forced to reduce my Medications again . I just can’t do it anymore .

On Friday at around 9 p.m. U.S. Navy veteran Kevin Keller parked his red pickup truck in the parking lot at the Wytheville Rite-Aid, walked across the grass and stood in front of the U.S. Veterans Community Based Outpatient Clinic next door.

Sick and tired of being in pain, he pulled out a gun, shot a hole in the office door, aimed the gun barrel at his head and ended his hurt once and for all.

As a longterm pain patient with a current unsupportive pain dr, I just thought I’d share the reality of the position I’m in right now…

I’m in very bad pain all the time for very legit and well documented reasons. My pain dr however never gives me enough meds to help me. He just keeps reducing them, which is causing me to be in even more pain and suffer so much more. My quality of life also continues to go downhill at the same time. I was just given a letter by him recently too about some study indicating an increase in deaths if you take opioids and benzos. It stated he’s no longer going to give pain meds to anyone who is taking a benzo. I take one, because I have to, for a seizure disorder, not because I want to. He told me to pick one or the other though, plus went ahead and reduced my pain meds some more. He doesn’t seem to care the least bit. I’ve looked hard and so far I can’t find another one to get in to see near me at this time, but I’m desperately still trying. Unfortunately, they’re few and far between here, in addition to the wait for an appointment being long. I’ve even called hospice for help. So far, they haven’t been of much help either, because I don’t have a dr who will say I have six months or less to live. I told them either choice my pain dr is giving me is very inhumane, so I’d rather just quit eating and drinking, to the point where I pass away from that, while I get some kind of comfort care from them. I don’t really want to though, although I do have a long list of some very bad health problems, including a high probability that I have cancer and it’s spread. Am I suicidal? No. Will I be if my pain and seizure meds are taken away. Highly likely. I never ever saw this coming either. I don’t have a clue what to do and the clock is ticking, but I’m still fighting for an answer. So far, I can’t find not even one dr to help me though. Not one. I know my life depends on it, but at what point will these drs let my suffering become so inhumane that I just can’t take it anymore. I just don’t know right now. It’s a very scary place to be in for sure. That I do know.

The patient was being denied the medicine that had been alleviating his pain and committed suicide because, “he couldn’t live with the pain anymore. He could not see a future. He had no hope. He had no life.”

I am a chronic pain patient who has been on fairly high doses of opiates for about nine years now. My dose has been forcibly reduced since the cdc guidelines. I moved to Oregon from Alaska and can’t find a doctor to prescribe my medication. I pray I have the strength not to take my own life!

Zach Williams of Minnesota  committed suicide at age 35. He was a veteran of Iraq and had experienced back pain and a brain injury from his time in service. He had treated his pain with narcotics until the VA began reducing prescriptions.

Ryan Trunzo committed suicide at the age of 26. He was an army veteran of Iraq. He had experienced fractures in his back for which he tried to get effective painkillers, but failed due to VA policy. His mother stated “I feel like the VA took my son’s life.”

Kevin Keller, a Navy veteran, committed suicide at age 52. He shot v after breaking into the house of his friend, Marty Austin, to take his gun. Austin found a letter left by Keller saying “Marty sorry I broke into your house and took your gun to end the pain!” Keller had experienced a stroke 11 years earlier, and he had worsening pain in the last two years of his life because VA doctors would not give him pain medicine. On the subject of pain medication, Austin said that Keller “was not addicted. He needed it.”

Bob Mason, aged 67, of Montana committed suicide after not having access to drugs to treat his chronic pain for just one week. One doctor who had treated Mason was Mark Ibsen, who shut down his office after the Montana Board of Medical Examiners investigated him for excessive prescription of opioids. According to Mason’s daughter, Mason “didn’t like the drugs, but there were no other options.”

Donald Alan Beyer, living in Idaho, had experienced back pain for years. He suffered from  degenerative disc disease, as well as a job-related injury resulting in a broken back. After his doctor retired, Beyer struggled without pain medicine for months. He shot himself on his 47th birthday. His son, Garrett, said “I guess he felt suicide was his only chance for relief.”

Denny Peck of Washington state was 58 when he ended his life. In 1990, he experienced a severe injury to his vertebrae during a fishing accident. His mother, Lorraine Peck, said “[h]e has been in severe pain ever since,” and his daughter, Amanda Peck, “said she didn’t remember a time when her dad didn’t hurt.” During the last few years of his life, Peck had received opiates for his pain from a Seattle Pain Center, until these clinics closed. After suffering and being unable to find doctors who would help with his pain, Peck called 911. Two days later, Peck was found dead in his home with bullet wounds in his head. A note found near Peck read: “Can’t sleep, can’t eat, can’t do anything. And all the whitecoats don’t care at all.”

Doug Hale of Vermont killed himself at the age of 53. He had experienced pain from interstitial cystitis, and decided to end his life six weeks after his doctor suddenly cut off his opiate painkillers. He left a note reading “Can’t take the chronic pain anymore” before he shot himself in the head. His doctor said he “was no longer willing to risk my license by writing you another script for opioids”  (see attachment A for details of the problem as relyed by his wife Tammi who is now 10 months without a husband as a direct result of the CDC guidelines to prevent deaths)Bruce Graham committed suicide after living with severe pain for two years. At age 62, Graham fell from a ladder, suffering several severe injuries. He had surgery and fell into a coma. After surgery, he suffered from painful adhesions which could not be removed. He relied on opioid painkillers to tolerate his pain, but doctors eventually stopped prescribing the medicine he needed. Two years after his fall, Graham shot himself in the heart to end the pain.

Travis Patterson, a young combat veteran, died two days after a suicide attempt at the age of 26. After the attempt to take his own life, Patterson was brought to the VA emergency room. Doctors offered therapy as a solution, but did not offer any relief for his pain. Patterson died two days after his attempted suicide.

54-year-old Bryan Spece of Montana  killed himself about two weeks after he experienced a major reduction in his pain medication. The CDC recommends a slow reduction in pain medicine, such as a 10% decrease per week. Based on information from Spece’s relative, Spece’s dose could have been reduced by around 70% in the weeks before he died.

In Oregon, Sonja Mae Jonsson ended her life when her doctor stopped giving her pain medicine as a result of the CDC guidelines.

United States veterans have been committing suicide after being unable to receive medicine for pain. These veterans include Peter Kaisen,Daniel Somers, Kevin Keller, Ryan Trunzo, Zach Williams, and Travis Patterson

A 40-year-old woman with fibromyalgia, lupus, and back issues appeared to have committed suicide after not being prescribed enough pain medicine. She had talked about her suicidal thoughts with her friends several times before, saying “there is no quality of life in pain.” She had no husband or children to care for, so she ended her life.

Sherri Little was 53 when she committed suicide. She suffered pain from occipital neuralgia, IBS, and fibromyalgia. A friend described Little as having a “shining soul of activism” as she spent time advocating for other chronic pain sufferers. However, Little had other struggles in her life, such as her feeling that her pain kept her from forming meaningful relationships. In her final days, Little was unable to keep down solid food, and she tried to get medical help from a hospital. When she was unable to receive relief, Little ended her life.

Former NASCAR driver Dick Trickle of North Carolina shot himself at age 71. He suffered from long-term pain under his left breast. Although he went through several medical tests to determine the cause of his pain, the results could not provide relief. After Trickle’s suicide, his brother stated that Dick “must have just decided the pain was too high, because he would have never done it for any other reason.”

39-year-old Julia Kelly committed suicide after suffering ongoing pain resulting from two car accidents. Kelly’s pain caused her to quit her job and move in with her parents, unable to start a family of her own. Her family is certain that the physical and emotional effects of her pain are what drove her to end her life. Kelly had founded a charity to help other chronic pain sufferers, an organization now run by her father in order to help others avoid Julia’s fate.

Sarah Kershaw ended her life at age 49. She was a New York Times Reporter who suffered from occipital neuralgia.

Lynn Gates Jackson, speaking for her friend E.C. who committed suicide after her long term opiates were suddenly reduced by 50% against her will, for no reason.  Lynn reports she felt like the doctors were not treating her like a human being (Ed:  a common complaint) and she made the conscious decision to end her life.

E.C. committed suicide quietly one day in Visalia California.  She was 40.  Her friend reported her death.  “She did not leave a note but I know what she did”.  The doctor would only write a prescription for 10 vicodin and she was in so much pain she could not get to the clinic every few days.   We had talked many times about quitting life. Then she left.  She just left.

Jessica, a patient with RSD/CRPS committed suicide when the pain from her disease became too much for her to bear. A friend asserted that Jessica’s death was not the result of an overdose, and that “living with RSD isn’t living.”



















Aliff, Charles

Beyer, Donald Alan

Brunner, Robert “Bruin”

Graham, Bruce

Hale, Doug

Hartsgrove, Daniel P

Ingram III, Charles Richard

Kaisen, Peter

Keller, Kevin

Kershaw, Sarah

Kimberly, Allison

Little, Sherri

Mason, Bob

Miles, Richard

Murphy, Thomas

Paddock, Karon

Patterson, Travis “Patt”

Peck, Denny

Peterson, Michael Jay

Reid, Marsha

Somers, Daniel

Son, Randall Lee

Spece, Brian

Tombs, John

Trickle, Richard “Dick”

Trunzo, Ryan

Williams, Zack

Karon Shettler Paddock  committed suicide on August 7, 2013  http://www.kpaddock.org/


Jessica Simpson took her life July 2017

Mercedes McGuire took her life on Friday, August 4th. She leaves behind her 4 yr old son. She could no longer endure the physical & emotional pain from Trigeminal Neuralgia.


Another Veteran Suicide In Front Of VA Emergency Department

 Depression and Pain makes me want to kill self. Too much physical and emotional pain to continue on. I seek the bliss fullness of Death. Peace. Live together die alone.

 Dr. Mansureh Irvani  suspected overdose victim  http://www.foxnews.com/health/2017/08/18/suspended-oral-surgeon-dies-suspected-overdose.html

Katherine Goddard’s Suicide note: Due to the pain we are both in and can’t get help, this is the only way we can see getting out of it. Goodbye to everybody,”   https://www.cbsnews.com/news/florida-man-arrested-after-girlfriend-dies-during-alleged-suicide-pact/  

Steven Lichtenberg: the 32-year-old Dublin man shot himself   http://www.dispatch.com/news/20160904/chronic-pains-emotional-toll-can-lead-to-suicide  

Fred Sinclair  he was hurting very much and was, in effect, saying goodbye to the family.  http://www.pharmaciststeve.com/?p=21743

Robert Markel, 56 – June 2016 – Denied Pain Meds/Heroin OD  http://www.pennlive.com/opioid-crisis/2017/08/heroin_overdose_deaths.html

 Lisa June 2016  https://youtu.be/rBlrSyi_-rQ

Jay Lawrence  March 2017  https://www.painnewsnetwork.org/stories/2017/9/4/how-chronic-pain-killed-my-husband

Celisa Henning: killed herself and her twin daughters...http://www.nbcchicago.com/news/local/Mom-in-Apparent-Joliet-Murder-Suicide-said-Body-Felt-Like-It-was-On-Fire-Grandma-Says-442353713.html?fb_action_ids=10213560297382698&fb_action_types=og.comments

Karen Boje-58  CPP-Deming, NM

Katherine Goddard, 52 –  June 30, 2017 – Palm Coast, FL -Suicide/Denied Opioids  http://www.news-journalonline.com/news/20170816/palm-coast-man-charged-with-assisting-self-murder

https://medium.com/@ThomasKlineMD/suicides-associated-with-non-consented-opioid-pain-medication-reductions-356b4ef7e02aPartial List of Suicides, as of 9–10-17

Suicides: Associated with non-consented Opioid Pain Medication Reductions

Lacy Stewart 59, http://healthylivings247.com/daughter-says-untreated-pain-led-to-mothers-suicide/#

Ryan Trunzo of Massachusetts committed suicide at the age of 26  http://www.startribune.com/obituaries/detail/18881/?fullname=trunzo,-ryan-j  

Mercedes McGuire of Indiana ended her life August 4th, 2017 after struggling with agony originally suppressed with opioid pain medicine but reappearing after her pain medicine was cut back in a fashion after the CDC regulations. She was in such discomfort she went to the ER because she could not stand the intractable pain by “learning to live with it” as suggested by CDC consultants. The ER gave her a small prescription. She went to the pharmacy where they refused to fill it “because she had a pain contract”. She went home and killed herself. She was a young mother with a 4 year old son, Bentley. Bentley, will never get over the loss of his mom.

Suicides: Associated with non-consented Opioid Pain Medication Reductions

“Goodbye” Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017


Pamela Clute had been suffering from agonizing back problems and medical treatment had failed to relieve pain that shot down her legs While California’s assisted suicide law went into effect a couple months before Clute’s death, the law only applies to terminally ill patients who are prescribed life-ending drugs by a physician. Clute wasn’t terminally ill

Kellie Bernsen 12/10/2017 Colorado suicide

Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017

  Michelle Bloem committed suicide due to uncontrolled pain

John Lester shot himself on Jan. 8, 2014.

 Anne Örtegren took her life on Jan. 5  

 Debra Bales, 52 – Civilian – January 10, 2018 – Petaluma, CA – Denied Pain Meds/Suicide

 Aliff, Charles – Could not locate info!
He may be able to help! Charles Aliff – https://www.facebook.com/profile.php?id=100009343944744…

Brunner, Robert – Could not locate info!

Cagle, Melvin – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…


Harold Hamilton – http://www.dispatch.com/…/chronic-pains-emotional-toll…

Hartgrove, Daniel – http://www.legacy.com/…/name/daniel-hartsgrove-obituary…

Ingram III, Charles – http://www.pressofatlanticcity.com/…/article_b7a4a712…

Jarvis, Michael http://www.chicagotribune.com/…/ct-indiana-doctor…


Kevin Keller, 52 – US Navy – July 30, 2014 – Wytheville, VA

Kershaw, Sarah – https://mobile.nytimes.com/…/sarah-kershaw-former-times…

Kimberly, Allison http://feldmanmortuary.com/…/Allison…/obituary.html…

Lane, Keith – Timothy Shields
August 8, 2017 · Colon, MI I would like you too include Kieth Lane . US Army , Vietnam in country , combat wounded . He died recovering from ulcers surgery of a stroke and heart attack in Battle Creek VA medical center in Michigan .

Lichtenberg, Steven – http://www.dispatch.com/…/chronic-pains-emotional-toll…

Markel, Robert – http://www.pennlive.com/…/08/heroin_overdose_deaths.html

Miles, Richard – Could not locate info!

Murphy, Thomas – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…

Paddock, Karon http://www.kpaddock.com/

Denny Peck, 58 – Civilian – September 17,2016 – Seattle, Wa https://l.facebook.com/l.php…


Peterson, Michael – https://l.facebook.com/l.php…

Reid, Marsha – https://www.painnewsnetwork.org/…/daughter-blames…

Simpson, Jessica – https://www.facebook.com/photo.php?fbid=1616190951785852&set=a.395920107146282.94047.100001848876646&type=3&hc_location=ufi

Daniel Somers, 30 – US Army – June 10, 2013 – Denied Pain Meds/Suicide http://gawker.com/i-am-sorry-that-it-has-come-to-this-a…

Son, Randall – http://www.wpsdlocal6.com/…/woman-says-marion-va…/…

Bryan Spece, 54 – USMC – May 3, 2017 – Great Falls, Montana – Denied Meds/Suicide https://www.painnewsnetwork.org/…/patient-suicide…

Tombs, John – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…

opiate OD dropping by single digits… pts in treatment – DOUBLING !

Opioid prescribing drops largest amount in 25 years


The number of opioid painkillers prescribed last year dropped by the largest rates in 25 years, new data show.

IQVIA Institute for Human Data Science, a health data firm, released a report that showed an 8.9 percent drop on average in the number of prescription opioids, such as OxyContin or Vicodin, that were filled by retail and mail-order pharmacies.

All states and the District of Columbia were evaluated for the study and had declines of more than 5 percent. Eighteen states had declines above 10 percent, including Pennsylvania and West Virginia, two states that are among the top five in the country with the highest rates of drug overdose deaths.

 The prescribing drop was 2 percentage points lower than the drop in 2016 and represented a 7.8 percent decline in new patients receiving prescriptions for opioids.

The data also show that the number of people who were prescribed medication to treat addiction, which helps stave off withdrawal symptoms, rose to 82,000 a month, nearly doubling.

“This suggests that healthcare professionals are prescribing opioids less often for pain treatment, but they are actively prescribing [medication-assisted treatment] to address opioid addiction,” said Murray Aitken, the data firm’s senior vice president.

Prescriptions for opioids rose in the 1990s as doctors provided them to patients who were suffering from pain. As addiction and death from overdoses began to climb, government regulators issued more restrictions and waged public awareness campaigns.

Despite those changes and the reduction in prescriptions, deaths from opioids have continued to rise, partly because people replace prescription painkillers with heroin, a cheaper, more available alternative. Government data show that 80 percent of people who take heroin first abused prescription painkillers. Deaths also have surged because heroin is being mixed with fentanyl, a more potent opioid that drug users often don’t know they are taking.

Overdoses from opioids killed more than 42,000 people in 2016, a fivefold increase from roughly two decades earlier. Government data show that roughly 2 million people in the U.S. are addicted to prescription opioids.

How to conduct a AUTHENTIC APOLOGY… even if you don’t mean it ?


They claim that with a GRAND JURY…. a prosecutor could get a “ham sandwich” indicted

Trial for doctor linked to Glen Cove overdose begins

Opening statements, undercover video in Day 1 of Belfiore opioid trial


The Merrick physician facing federal charges of illegally prescribing opioids, and causing the overdose deaths of two South Shore men, began on Wednesday, with prosecutors calling Dr. Michael Belfiore “a dealer, not a healer,” and Belfiore’s defense attorney insisting that the doctor is being unfairly prosecuted.

Belfiore was also implicated in the 2009 death of Mario Marra, of Glen Cove. Medical records in the case were subpoenaed, although charges were not filed.

 In a series of Herald reports last summer, Marra’s widow, Claudia, alleged that Belfore continued to prescribe her late husband fentanyl and other opioids, even after he knew Marra was addicted.

Medical records indicate that Belfiore prescribed Marra fentanyl on March 7, 2009. He died on March 15, according to the coroner’s report.

Belfiore, in an interview last summer, admitted Marra was a patient, but disputed much of Claudia’s account, adding that if Marra was “responsible with the medication, and took it as directed, he’d still be here.”

Belfiore’s trial, at the U.S. District courthouse in Central Islip, is expected to last five weeks, according to his attorney, Tom Liotti, of Garden City.

After a jury was selected, Assistant U.S. Attorney Bradley King made his opening argument, describing the circumstances in which John Ubaghs, of Baldwin, and Edward Martin, of East Rockaway, were found dead — both allegedly with bottles of oxycodone prescribed to them by Belfiore.

King also introduced the government’s first witness against Belfiore: Detective James Marinucci, of the Nassau County Police Department’s vice squad. Marinucci — undercover as James Burke, a factory worker with back pain — saw Belfiore as a patient six times in 2013, obtaining six prescriptions for oxycodone. He paid in cash each time.

In a lengthy video — taken by a hidden camera Marinucci wore on a necklace — shown to jurors, the undercover detective was seen and heard during an initial appointment with Belfiore in March 2013.

During the visit, Marinucci complained of back pain, and told Belfiore that his ex-girlfriend used to share her “Oxy 30s” with him — Marinucci testified that he used this “street” phrase for the medication deliberately with Belfiore.

Belfiore agreed to write Marinucci multiple prescriptions, including for oxycodone, anti-inflammatories and Trazodone, for sleep, but did warn the undercover detective — using colorful language — about the dangers of sharing controlled substances with others.

“I’m not gonna share a jail cell with you,” Belfiore joked at one point, later stressing, “You don’t understand the stigma that’s attached to these medications now.”

Liotti was expected to cross-examine Marinucci on Thursday.

Liotti, has maintained that opioid manufacturers are the culprits in Ubaghs’s and Martin’s deaths — and in the country’s larger opioid crisis.

The defense attorney reiterated the point during his opening arguments, also calling the grand jury process that led to Belfiore’s indictment, in which he was not allowed to be present, a “one-sided proceeding.”

“We offered our own expert testimony — the government wouldn’t allow it,” Liotti said, also warning jurors that he believed the government would try to connect Belfiore’s case to the hundreds of thousands of opioid deaths nationwide.

He also challenged prosecutors to define the number of pills Belfiore could have prescribed that would have met their definition of “with a legitimate medical purpose.”

“There can be no guess-work or speculation here,” he added.

Belfiore also, Liotti said, had been honest with law enforcement throughout the yearslong case, “perhaps to a fault,” and made reference to both Arthur Miller’s “The Crucible,” and the film “12 Angry Men,” as he tried to paint Belfiore as the government’s scapegoat.

“His career and his life are on the line,” Liotti said.

Look for more coverage of Belfiore’s trial in next week’s edition, and online.

WV: Charleston family says local pharmacy gave out the wrong dose of hepatitis A vaccine


With the increase of cases of Hepatitis-A, more people are getting vaccinated, but one Charleston family found out the vaccine they got Thursday was the wrong dose.

 A Charleston man said he was given the child dose of Hepatitis-A vaccine at the CVS pharmacy on Oakwood Road near Fort Hill. He is speaking out because he said the pharmacy never called him about this mistake. They only called one of his family members.

“As of right now, we have not received a call from CVS pharmacy,” Whitney Raines of Charleston said.

 Raines, along with his sister and brother-in law went to this CVS on Oakwood Road in Charleston to get vaccinated. He said late Thursday night his sister got a call from the pharmacist.

“She contacted my sister from her personal cell phone around 10 p.m. to tell her what had happened,” Raines said.

The CVS pharmacist told Raines’ sister that they were given the child dose of .5 ml and need to be given the other half. The adult vaccine is 1 ml. They had three days to get the rest of it. If they didn’t receive that other half the vaccine would not work. But Raine said he and his brother in law never got a call.

Raines went back to the CVS the Friday morning, but says the pharmacy manager didn’t seem concerned.

“This was a new shot and they weren’t sure what they ordered and she in turn, blamed it on CVS for ordering the wrong shots,” Raines said reciting what the Pharmacy manager told him.

Raines said he’s concerned they were not the only three impacted and feels lucky his sister was able to tell him about the mistake but says calls should be made to all the individual patients.

“I don’t know how many people have gone through there to get the vaccination but I believe the lady just called out of pure kindness and I am sure there are people that didn’t hear of it and it is very concerning,” explained Raines.

We reached out to CVS Pharmacy and spokesperson Mike DeAngelis tells us that Raines, his sister and brother in law were the only ones impacted. He adds a full investigation on how the error occurred is being conducted and that the correct procedure was followed by reaching out to the patients impacted.

Here is a full statement from CVS:

CVS Pharmacy has stringent processes that our pharmacists follow for administering immunizations. On Thursday, April 19, three adult patients who visited the Charleston CVS Pharmacy at the same time to receive Hepatitis A vaccinations were inadvertently administered the infant dose of the vaccine. As soon as our pharmacist realized this error occurred, she followed correct procedure and contacted all three patients to apologize and make arrangements for them to be re-vaccinated. These three individuals are the only patients who were administered the incorrect dose. We are conducting a full investigation into how this error occurred. CVS sincerely apologizes to the three patients and a member of our management team will be following up with each one of them.

Also, it appears there was a misunderstanding that occurred during our pharmacist’s phone call. It was not her intent to suggest that the patients couldn’t ever be vaccinated if they weren’t re-vaccinated today.



TN Nursing Home medication errors (wrong drug, wrong dose, wrong time) to less than 5 percent IS ACCEPTABLE ?

Nursing home ranks at bottom


In a September 2016 court filing, federal prosecutors said Glen Oaks Health and Rehabilitation of Shelbyville was providing “grossly substandard, and/or worthless nursing home services to Medicare and TennCare” patients.

Nearly two years later Glen Oaks is still in need of improvements.

In recently released reports rating 28 nursing homes within a 50-mile radius of Shelbyville that are ranked by the Center for Medicare and Medicaid Services, Glen Oaks Health and Rehabilitation of Shelbyville got the lowest possible ranking.

One star

Based on the survey conducted late last year, Glen Oaks was ranked with one out of five stars, a “Much Below Average” rating.

Of the 517 nursing homes that accept Medicare payments within 200 miles of Shelbyville, 13.5 percent (70) were ranked with just one star.

The most recent health inspections of area nursing homes were conducted in late November and December 2017 and the results were posted recently on the Medicare website (Nursing Home Compare).

Of the 28 nursing homes that accept payment from the Medicare/Medicaid program within 50 miles of Shelbyville four were rated with just one star.

(One of those, Manchester Healthcare Center, is owned by the same company that owns Glen Oaks.)

Six in the area were rated with two stars, “below average,” (including The Waters of Shelbyville).

Five were rated with three stars (average).

Seven area nursing homes were rated with four stars (above average) including two in Lewisburg — NHC Healthcare and NHC Healthcare Oakwood. Lynchburg Nursing Center was also rated “above average.”

Six were rated with five stars (Much Above Average) including two in Tullahoma — NHC Healthcare Tullahoma and Life Care Center of Tullahoma.

About the ratings

The rating system, developed by the Center for Medicare and Medicaid Services (CMS), ranks nursing homes in three broad categories — health inspections, staffing and “quality measures.”

Glen Oaks was rated “below average” in health inspections and “much below average” in staffing (not enough personnel). The facility was rated as average in “quality measures.”

Quality measures

Glen Oaks was rated as “Average” — three stars — in this category.

CMS determines “Quality of resident care” using 16 measures. Each of the measures is expressed in a percentage of the number of patients and is compared with rates in Tennessee and nationwide. The measures include short-term residents and long stay residents.

One common problem associated with poor care or neglect of patients is pressure ulcers, commonly called bed sores. At Glen Oaks the percentage of short term patients with bed sores that were new or worsened was four times worse than the state average — 2.5 percent as compared with the Tennessee average of 0.6 percent and the national average of 0.9 percent.

The rate of bed sores in long stay residents at Glen Oaks was much closer to the state and national averages: 6.2 percent at Glen Oaks, 5.3 percent statewide and 5.6 percent nationally.

Glen Oaks also fell short in the high percentage of long-stay residents whose ability to move independently got worse. Glen Oaks: 34.3 percent got worse; Tennessee: 21.4 percent got worse; and nationally 18.2 percent got worse.

Glen Oaks did do better in some quality measure areas including the number of patients who got flu shots, a low percentage of patients who lost too much weight, low percentage of patients who suffered major injury from falls and low percentage of long term patients who had symptoms of depression.


It was in “Staffing” that Glen Oaks did most poorly with only one star — “much below average.”

CMS says of this category: “Higher staffing levels in a nursing home may mean higher quality of care for residents. This section provides information about the different types of nursing home staff and the average amount of time per resident that they spend providing care.”

At Glen Oaks the total amount of time a Registered Nurse is available per resident, per day is 26 minutes, half that of the national average. Tennessee’s average is 46 minutes a day and the national average is 50 minutes. The availability of physical therapy staff at Glen Oaks was also lacking: 3 minutes as compared with the state and national averages of 6 minutes.

Health Inspections

Glen Oaks was ranked “below average” (two stars) in this category.

Glen Oaks was cited for eight violations, as compared with the Tennessee average of four and the national average of 5.8.

In the most recent available “statement of deficiencies and plan of correction” from a July 2017 inspection.

According to the report:

* Glen Oaks failed to immediately report allegations that a resident had been abused. The incident was not reported until seven days later. CMS requires that such allegations be reported within 24 hours.

*Glen Oaks failed to adopt an abuse policy that met CMS requirements.

*Glen Oaks failed to provide care that protects its residents’ dignity.

*Glen Oaks failed to provide proper housekeeping services. This finding was the result of a wheel chair coated with a “heavy accumulation of dried debris”. Wheel chairs are supposed to be cleaned daily.

*Glen Oaks staff failed to properly secure medications, and failed to keep the rate of medication errors (wrong drug, wrong dose, wrong time) to less than 5 percent.

One example of this, was that a prescription medication that was supposed to have been stopped on June 9 was still being given to the patient on July 11.

*Glen Oaks staff failed to properly secure prescription medications. A prescription medication with no pharmacy label or any label indicating patient information was found unopened on a resident’s bedside table.

• Glen Oaks failed to follow infection control practices in dispensing medications to eight patients. The facility’s workers failed to “wash/sanitize hands between residents for two residents, failed “to prepare medications in a safe manner for two residents,” failed “to dispose of unused medications appropriately for one resident,” and failed to “protect respiratory equipment from contamination for seven residents.”

In summary

In a summary of all health inspection deficiencies in recent years, Glen Oaks was cited eight times in the period from March 2017 to March 2018; three times from March 2016 to March 2018 and six times from March 2015 to March 2016.

Fire safety inspection

In July 2017, fire inspectors identified six “smoke deficiencies,” reporting that Glen Oaks did not:

• have walls in “special areas” constructed so that they can resist fire for one hour or more or have an approved fire extinguishing system,

• have a fire alarm that can be heard throughout the facility,

• Inspect, test, and maintain automatic sprinkler systems,

• Properly select, install, inspect or maintain portable fire extinguishers, and

• Ensure smoke barriers are constructed to provide one hour fire resistance.

Glen Oaks corrected all the fire safety issues 44 days after the inspection.

Not first problem for owners

Glen Oaks has been owned by Vanguard Healthcare LLC since July 2007. The company has been in litigation with the federal government since 2016 accused of filing false claims. (See related story.)

• Vanguard healthcare CEO William “Bill” Orand did not return phone calls seeking comment. Glen Oaks administrator Cassandra Callahan also did not return phone calls seeking comment.

WV AG: suing the DEA because the national drug quota system had utterly failed our citizens

West Virginians weigh opioid response as they look at GOP Senate candidates


Republican candidates running in the Mountain State’s Senate primary have spent time in court, in Congress and in a correctional facility.

Each has different ideas about how to fix the opioid epidemic, and voters are carefully weighing those ideas, less than three weeks until the election that will decide who gets to challenge Sen. Joe Manchin, a Democrat.

West Virginia Attorney General Patrick Morrisey is taking credit for a court victory that inspired a freshly proposed Drug Enforcement Administration (DEA)  rule that could cut down on opioid production.

“We’ve been tackling the problem about as aggressively as any office can,” Morrisey said. “Part of the reason why we sued the DEA is that we found out the national drug quota system had utterly failed our citizens, they were rubber-stamping ever increasing amounts of pills flooding into our state and across the country.”

West Virginia has the highest rate of drug overdose deaths in the country, and those fatalities are driven by opioids, according statistics kept by the Centers for Disease Control and Prevention.

Congressman Evan Jenkins (R-W.Va.) is the only candidate in the GOP primary field now serving in D.C., and since Congress cuts checks meant for opioid education and treatment, he believes he’s best positioned to continue the fight as senator.

“We’re walking the walk,” Jenkins said. “I have served on the appropriations committee, the $6 billion working with the white house that we’ve just approved is a significant, positive step in the right direction.”

Jenkins also helped establish Lily’s Place in Huntington, a neonatal abstinence syndrome center that was visited by First Lady Melania Trump last year.

President Trump won West Virginia by 42 points in 2016, and an outsider candidate with a business background is now pitching himself as the best to address the state’s opioid crisis – with a broad pitch that sounds a lot like the one candidate Trump brought to coal country.

“The wall is very important,” Don Blankenship said. “Ending the sanctuary cities is important, drug testing public officials – particularly teachers and judges and prosecutors, is important, and basically getting after the doctors and keeping better measurement of who is prescribing the drugs and who is distributing them.”

Blankenship recently served a one-year prison term following a conviction to skirt mine safety regulations, tied to his role as the former chief executive of Massey Energy, when the Upper Big Branch mine disaster occurred and killed 29 people.

The former coal baron is now trying to get his conviction, which he insists is not a liability, overturned.

And with regard to the opioid epidemic, Blankenship believes he’s the only one running whose hands are clean from the crisis.

“I think both of them are greatly responsible for the epidemic,” Blankenship said about his opponents Jenkins and Morrisey, “because they haven’t done enough.”

Will PBMs Be the Next Target of Opioid Lawsuits?


Although suing physicians and pharmacists over the opioid crisis is nothing new, up until now pharmacy benefit managers (PBMs) have been off the radar screen. But in February, a south Texas county included the three largest PBMs—CVS, Express Scripts, and OptumRx as well as some smaller ones operating in Texas—in a nationwide lawsuit focusing on the opioid epidemic because of their role in allowing access to prescription opioids.

PBMs set the rules that determine drug availability and how much patients have to pay out of pocket to get them. So why haven’t they been targeted until now?


Harry Nelson, managing partner, Nelson Hardiman, LLP, a healthcare law firm, says physicians have been targeted based on their role as prescribers and as frontline decision makers with the capability to avoid opioid overprescribing, dependency, and resulting harm. Similarly, pharmacists have been sued because of their roles as dispensers and their capacity to serve as the last safeguard before patients end up at risk from overprescribing.

“While PBMs play a critical role in drug’s pricing and availability, they are not expected to question physician’s therapeutic choices,” Nelson says. “They don’t have the same professional obligations that pharmacists do to avoid suboptimal dispensing choices. As unlicensed entities, they don’t hold individual licenses, as physicians and pharmacists do, so they are not held to the same standard. Their roles and responsibilities are less well-defined, so there is less basis to hold them responsible.”








Nonetheless, PBMs actually have a lot of power, says Christopher J. Metzler, PhD, JD, CEO, Gordium Healthcare, a multidisciplinary behavioral healthcare organization. They are the middlemen who operate between the doctor, patient, and pharmacy. They provide insurance contracts with pharmacies and can deny a claim’s payment. They have the most to gain from a prescription’s cost.

Given the number of governmental entities now bringing lawsuits, and the limited number of manufacturer and distributor targets, Lawrence Ingram, a partner in the law firm Freeborn & Peters’ Litigation Practice Group, and a member of its Insurance and Reinsurance Industry Team, foresees every entity in the distribution chain eventually getting caught up in this type of litigation. 


Similar lawsuits likely

In the Texas case, The Webb County lawsuit alleged that PBMs drove the opioid epidemic as a result of increasing profits from the drugs.

Nelson says since it doesn’t cost much to name a PBM as an additional party in litigation, he expects PBMs to increasingly be named in opioid-related lawsuits. “While it takes some creativity to do something new (like looking at PBMs) as a responsible party, my hunch is that other lawyers are likely to learn from this and will be interested in a potential additional source of settlement funds,” he says.

Metzler also expects more PBMs to be sued. “Lawyers who present a well-written and brutal set of discovery questions, review the prescription paper trail, and talk to pharmacies and patients will find a treasure trove of evidence to present to a jury,” he says.

So on what grounds could PBMs be sued? Nelson says PBMs may not hold licenses that impose obligations, but their contractual commitments as intermediaries between health plans and pharmacies provide a potential argument that they also owe responsibility to patients, who are arguably third-party beneficiaries of those contracts. In other words, health plans are contracting with PBMs for the benefit of patients, so PBMs have the responsibility to protect patients from harm. There may also be an argument that PBMs are in a better position than individual pharmacies because of their data access to red flag problematic prescribing practices.

Ingram says allegations would likely be that the PBMs somehow allowed a greater amount of these drug products to be permitted in communities than could be supported by legitimate medical needs.

Likely outcomes

As a novel legal theory, lawyers will have to explain in detail to the courts what PBMs are and how they operate. “Unless lawyers are able to do so and prove causation, this will be a very difficult road to travel,” Metzler says. “As in most novel legal theories, this is a test, the outcome of which is uncertain. It is up to lawyers to educate, persuade, and prove causation.”

In the future, Nelson says PBMs may put additional safeguards in place to scrutinize troubling practices that surface through data, such as potential indicia of excessive prescribing. For patients, getting access to opioids is likely to get even tougher, with another hurdle in the form of PBMs. This may also make opioids more expensive, as PBMs begin to factor in the additional costs and risks associated with opioid prescribing.

Politicians Get the Opioid Crisis Wrong as Patients Suffer and Street Drugs Kill


Determining the true cause of the opioid crisis is crucial – is it prescription painkillers or street drugs? Congress should not be passing legislation to solve the wrong problem. There will be serious public health consequences for cracking down on the wrong type of drugs.

The crisis will not abate if the real problem is not addressed effectively. There are good reasons to fear that special interests are pushing us in the wrong direction by targeting deep-pocketed pharmaceutical companies instead of elusive street dealers and foreign drug cartels.

A critical data point was provided by research confirming what police and doctors working on the front lines have said for years: the center of gravity in the opioid epidemic shifted from the overprescription and abuse of prescription painkillers to heroin and deadly fentanyl about a decade ago. If policymakers insist on treating pain medications as the more serious aspect of the epidemic, they will be making a grave mistake.

The skeptical position on our current drug war, stated bluntly, is that trial lawyers are eager to bring enormous lawsuits against pharmaceutical companies, and they have more than enough political influence to shape legislation. Many legislators prefer the narrative of rapacious Big Business getting the American people hooked on pills to reap windfall profits.

On the other hand, there is no money to be made by going after drug dealers and street gangs. There is no political profit from tightening border security to choke off the flow of drugs from Mexico and South America. Border security looks like all pain and no gain to politicians – they get hassled by activists, ridiculed as xenophobes by the media, and shunned by special interests. Fighting the War on Drugs is even more thankless, as clear-cut victory has proven elusive for decades.

One element of the opioid crisis is a problem the Washington elite loves to attack, while the other is something it doesn’t want to touch with a ten-foot pole. It seems reasonable to worry that the establishment will reverse-engineer a diagnosis that justifies the course of treatment it would much rather pursue.

Daniel Horowitz wrote in the fifth installment of his opioid series at Conservative Review that the danger of political misdiagnosis was the primary reason he set pen to paper (or keyboard to pixel, if you prefer):

The politicians are still blind to nature of the illicit drug/chemical warfare crisis in this country that they misleadingly refer to as a prescription opioid crisis. The good news is that Congress has made this issue the top legislative priority for the coming month. The bad news is that, as we have noted in our continuous series of articles, legislators are completely misdiagnosing the problem, ignoring the data showing both what the crisis actually is and what caused it. As such, their solutions are making the problem worse, as they focus exclusively on government practicing medicine, monitoring patients, restricting prescriptions and even morphine use in hospitals (not just outpatient prescriptions), and shoveling billions of dollars to special interest health care cartels to “treat” a problem they refuse to properly identify.

This week, four House and Senate committees will hold hearings and analyze over 30 pieces of legislation to address the “opioid crisis.” Almost all of the hearings, witness testimony, and legislation fail to address the core problems causing the alarming flood of illicit drugs: Mexican cartels, transnational gangs, open borders, and sanctuary cities.

Horowitz added that even the prescription drug side of the opioid crisis has been deliberately misunderstood for political reasons:

To the extent that this is a health care issue, they refuse to address the 800-pound gorilla in the room – the role of the Medicaid expansion fueling over-use of painkillers among Medicaid patients, a population inherently vulnerable to addiction, while they severely restrict use of much-needed painkillers for other patients.

At least one major government report, released by the Senate Homeland Security Committee in February, has examined the relationship between Medicaid expansion and increased levels of painkiller prescription and abuse, but it was resolutely ignored by the media and trashed as a cheap shot at Obamacare by Democrats.

Horowitz charges that the current round of congressional hearings on the drug crisis “feature heads of organizations and programs that stand to benefit from endless taxpayer funds,” while very little attention is paid to the politically awkward and unprofitable problem of drug cartels flooding America’s streets with heroin, fentanyl, and cocaine.

Meanwhile, a legal offensive comparable to the gigantic lawsuits against Big Tobacco is taking shape in the courts, led by some of the same lawyers and firms that went after the tobacco companies.

“The prospect of the biggest payday since the $200 bill­­ion tobacco settlement in 1998 has drawn many of the same plaintiff lawyers who appear again and again in big tort cases over everything from VW diesels to Vioxx to the BP Deepwater Horizon disaster,” Daniel Fisher observed at Forbes in January, as multi-district legislation against opioid manufacturers and distributors gained momentum.

Fisher quoted University of Georgia law professor Elizabeth Burch comparing the legal muscle behind these mega-lawsuits to an “oligopoly” and noting that “the same five lawyers are involved in practically every proceeding.”

Lawsuits against drug companies and distributors allege they have deceived the public on a massive scale with advertising for their products, flooded markets with opioids, pushed doctors to prescribe them, and failed to investigate illicit drug orders properly. The industry responded by accusing litigants of misunderstanding how the distribution system for prescription drugs works and turning pharmaceutical corporations into lucrative scapegoats.

On the legislative side, Senator Bernie Sanders (I-VT) introduced a bill this week targeting opioid manufacturers with $7.8 billion in fines for deceptive advertising and establishing criminal liability for corporate executives found to have “contributed to the epidemic.”

Sanders expressed a desire to extract even more money from the industry to deal with the drug crisis he accuses them of creating: “At a time when local, state and federal government are spending many billions of dollars a year, those people will be held accountable and asked to contribute to help us address the crisis. It shouldn’t just be the taxpayer that has to pay for the damage that they did.”

If Congress and the courts get the opioid crisis wrong, patients who truly need medication for chronic pain will suffer even more than they already do. They already complain that the drugs they need have been excessively stigmatized and doctors have been intimidated out of writing prescriptions.

The patients themselves resent being treated like drug addicts. They have good reason to fear their access to vitally needed medication will grow even more restricted, between heavy-handed legislation and lawsuits that could clobber drug companies with billions of dollars in damages and settlements. Insurance companies are in the mix as well, performing calculations of benefit and risk, including legal risk, that can contradict the judgment of physicians.

“I’m looked at as an addict. I feel this stigma every single day: you’re a chronic pain patient, you must be an addict,” fibromyalgia patient Edwina Caito told the IndyStar in November.

“Nobody is hearing us, because everyone on the no-opiate bandwagon is screaming the loudest and we don’t have a voice.” Caito added.

Some doctors are worried that severe new limits on prescription opioids proposed by the Center for Medicare and Medicaid will leave chronic pain patients unable to obtain the medications they need. Doctors who questioned the new limits said they could force patients to seek out more dangerous illegal substances to manage their pain or even drive them to suicide.

“People who are gonna use heroin and fentanyl are gonna go ahead and use it. People who are really dependent on opioids, because there is no access to treatment, they are gonna move on to heroin. Only set of people this is going to affect is a lot of people who are stable on this medications,” Yale University addiction medicine fellow Dr. Ajay Manhapra predicted in March.

In early April, officials with the Centers for Disease Control conceded that its 2016 guidelines on opioid prescription might have been based on flawed data. Specifically, the research supporting the guidelines was criticized for failing to distinguish between overdoses of legally obtained pain medication and deaths resulting from illicit heroin and fentanyl. The number of deaths attributed to prescription drugs in 2016 was almost doubled by this faulty analysis, according to doctors who believe the CDC should scrap its current guidelines completely and explain why the data was handled so badly.

None of this is meant to absolve drug companies of all possible misbehavior, argue that prescription drug abuse is no longer a problem at all, or dismiss all funding for addiction treatment as taxpayer money siphoned off by special interests. The point is that government at every level should examine the opioid crisis clearly and honestly, with the vision of lawmakers as unclouded as possible by big money or political narratives, before regulations are imposed and funds are allocated.

There are already too many examples of people suffering unnecessarily because the problem has been diagnosed incorrectly. There should be no room in this process for political narratives, hidden agendas, grandstanding, or blind panic.

Iowa lawmaker/pharmacist literally calls ‘BS’ on CVS rationale for high drug prices


Pharmacy giant CVS has for months ignored questions in Ohio about a controversial pricing practice, but an Iowa legislative committee on Wednesday got the executive in charge to describe it.

He came after a lawmaker threatened a subpoena.

Rich Ponesse, senior director of trade finance for CVS Caremark, appeared before the Iowa House Government Oversight Committee to explain the difference between what his company pays retail pharmacies and what it charges health plans, a practice known as “spread pricing.”

Most people know CVS as a retail pharmacy, but its CVS Caremark subsidiary manages pharmacy benefits for health plans, including those that contract with Medicare, Medicaid and private employers. CVS Caremark and two other “pharmacy benefit managers” dominate a business in the United States that is worth more than $300 billion a year.

In Ohio, a group of lawmakers and the Department of Medicaid have asked for — and received — confidential data to determine whether the state is getting gouged through spread pricing. Medicaid officials said Thursday they are beginning a promised review.

“We are just starting to go through a very manual process to analyze that information,” Medicaid Director Barbara Sears said. The analysis should be completed by June, she said.

CVS Caremark has not answered questions from The Dispatch about the spread pricing. But Ponesse told the Iowa legislative committee that his company uses it and that it’s fair to customers.

“As far as spread pricing is concerned, we are very transparent with our clients,” Ponesse said, according to a video of the hearing that state Rep. John Forbes, D-Urbandale, posted on Facebook. “They have multiple options. One is a pass-through option and the other is spread pricing.”

Ponesse said some managed-care companies opt for spread pricing because the risk of pharmacy costs suddenly jumping is mitigated by using that option, Ponesse said.

However, the spread pricing option appeared pretty risky for one Iowa county. Ottumwa pharmacist Mark Frahm told the committee that he determined that CVS Caremark in January reimbursed him $1,000 for drugs he supplied to inmates at the Wapellow County Jail, and then billed the county $5,000 for the same drugs. Worse, Frahm said, the drugs cost him $1,500, so he lost $500 on the deal.

He, Forbes and county officials checked 160 claims from the jail and determined that on average, CVS Caremark was paid $26 more for a filling a prescription than it paid a pharmacy.

The spread on some drug prices was extreme. One cost the county $123.91, but CVS Caremark only paid the pharmacy $2.69. Another cost the county $162, but the pharmacy only got $16.

Ponesse, the CVS executive, said his company’s pricing is “not an exact science,” but overall it treats retail pharmacies fairly.

 “My group at CVS Caremark does price every single generic drug; we set the reimbursement levels,” he said. “I do not have a magic formula that says, ‘Here is what every pharmacist is buying every drug at.’”

Ponesse said his company regularly adjusts reimbursements for pharmacists who use a CVS portal to complain that reimbursements were forcing them to lose money. Forbes, who also is a pharmacist, was incensed.

“You never adjust. Bullshit,” he said. “I’ve been in this business for 38 years. You can’t fool me.”

Forbes said CVS Caremark’s reimbursement-appeals system is rigged. When Iowa pharmacists intentionally put made-up drugs in the portal, they got the same canned brushoff as when they complained about reimbursements for real drugs, he said.

“They’re just not even reviewing them,” Forbes said. “That’s what I think.”

Ponesse denied the accusation, promising the panel data on adjustments CVS Caremark has made.

In a phone interview Thursday, Forbes said, “Normally I don’t get upset too much,” but Ponesse’s praise of CVS’s mail-order business and his assertions of fair reimbursements were too much for him.

So how did he get the guy who sets pharmacy reimbursements to the hearing?

“I said I want somebody who’s not going to get in here and say, ‘I need to check that,’ or, ‘I’ll have to get back to you.’ I want somebody who knows,” Forbes said. “I also said that if we have to use subpoena power, we will.”

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