Here’s Everything You Need To Know About The Patient’s Bill Of Rights

https://www.forbes.com/sites/amino/2016/03/21/heres-everything-you-need-to-know-about-the-patients-bill-of-rights/#33d8d99a6d01

This is the first in a series of articles that focuses on your rights as a patient—both inside the hospital and out. First up, we explore the “Patient’s Bill of Rights” (yes, that’s a thing!).

If you’ve ever been hospitalized and felt that you were at the mercy of the medical staff, you’re not alone. But you’re wrong.

As a patient, you have right to expect certain things during your hospital stay and from your healthcare team. In fact, those rights are spelled out in something called the Patient’s Bill of Rights.

(Photo by Adobe)

What is it?

For starters, it’s not one bill or single document, but a list of guarantees to every person who seeks treatment in a hospital or other healthcare facility. Typically, these guarantees are that you’ll be kept informed about your condition and treatment, treated fairly and have autonomy over medical decisions, among other things.

 

The Patient’s Bill of Rights sets the foundation for open, honest communication between you, your family members and your healthcare providers. And it explicitly encourages you to take an active role in making decisions about your treatment and care (more advice on how to do that here).

A brief history

“A Patient’s Bill of Rights” was the name of a document the American Hospital Association (AHA) introduced in the early 1970s. It was revised in 1992. It’s a list of 12 expectations you should have regarding information about your case, communication with your health care team, treatment, medical records and more.

 

The AHA encouraged each healthcare facility in the United States to adapt these 12 rights to fit the needs of their particular patient community. That’s why there’s not one single version of the Patient’s Bill of Rights, but many versions.

In 2003, in an effort to promote the idea that healthcare is a partnership between you and your provider, the AHA replaced its original Patient’s Bill of Rights with The Patient Care Partnership. This is simply a brochure (available in multiple languages) that tells you in plain, easy-to-understand terms what you can rightfully expect during your hospital stays.

Expectations include:

• High-quality care
• A clean, safe environment
• That you’ll be involved in your care
• That your privacy will be protected
• Help when leaving the hospital
• Help with billing claims

You can ask for a copy of The Patient Care Partnership when you’re admitted to the hospital.

Extra protections against insurance companies

Perhaps the most sweeping changes to patients’ rights legislation happened in June 2010, when President Barack Obama announced regulations that protect you as a patient when dealing with insurance companies. Many of those protections took effect in September 2010, after the enactment of the Affordable Care Act. Others were phased in slowly and took effect in 2014.

 

Two of the most significant of protections deal with dependents and insurance coverage for preexisting conditions. New regulations allow you to get health insurance even if you have a medical condition you’ve been wrestling with for a long time.

Prior to the passage of this new Patient’s Bill of Rights, insurance companies could deny you coverage if you had a preexisting condition.

What’s more, the Patient’s Bill of Rights under the Affordable Care Act allows you to get some preventative health screenings, like annual physicals, without extra fees or co-pays. Read the document in its entirety here.

 

Lorrie Klemons, a North Carolina-based patient advocate, says these initiatives play a key role in helping patients feel more empowered about their care. “These new protections create an important foundation of patients’ rights in the private health insurance market that puts Americans in charge of their own health.”

In the next article in this series, we explore the topic of informed consent—a critical component of patient empowerment.

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THIS IS TOTAL ADULT POPULATION OF UNITED STATES. WHEN YOU THROW AROUND WILDLY EXAGGERATED FIGURES, LIKE 100 MILLION PEOPLE WITH CHRONIC PAIN IN UNITED STATES, IT MAKES YOU AS SPOKESPEOPLE LESS TRUSTWORTHY:

ADULTS:249,485,228 Percent77%77%77%77%77%

Total 323,127,513

CAUTION: DON’T PICK UP A FIGURE/STAT  FROM SOME BLOG OR OTHER PAIN ADVOCATE WEBSITE  OR FACEBOOK PAGE THAT DOESN’T COME FROM SOME RIGOROUSLY RESEARCHED/RESPECTED GOVERNMENT WEBSITE OR ACADEMIC JOURNAL. IF THEY DON’T HAVE THE PROOF/CITE, DON’T USE THEIR FIGURES. EVER.

The above statement… was made by someone who questions the the 100+ million number that is routinely stated as the number of chronic pain pts in the USA.

That 100+ million chronic pain pts that is normally claimed… HAS NEVER stated that all of those chronic pain pts are using/dependent on opiates 24/7.

If one looks at the number of surviving Baby Boomers (65 million) and the number of citizens > 70 (28 million)… these two groups – total of 93 million –  would most likely be a group suffering from age related chronic pain.

Has anyone ever noticed that TV commercials – especially during prime time – there is a BUNCH of ads for OTC pain meds (NASID’s, Tylenol/APAP, etc)… they are not continually running all of these commercials and not selling products.

Some chronic pain pts can manage their chronic pain on a day to day business with these OTC products, but may also use opiates for those times of activity induced pain.. like cutting grass, working in the landscape or garden.  Not everyone can afford to have all their maintenance around their house done by someone else, but taking opiates on those days when some of those task have to be done… the need for opiates comes into play for a chronic pain pts on a PRN basis.

Just like a lot of other things when dealing with chronic pain pts… jumping to conclusion based on a few facts… is not a true representation of what reality really is.

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CDC Ignored Warning About Opioid Guidelines

www.painnewsnetwork.org/stories/2017/9/5/cdc-ignored-warnings-about-opioid-guidelines

By Pat Anson, Editor

A consulting company hired by the Centers for Disease Control and Prevention warned the agency last year that many doctors had stopped prescribing opioid pain medication and that chronic pain patients felt “slighted and shamed” by the CDC’s opioid guidelines.

“Some doctors are following these guidelines as strict law rather than recommendation, and these physicians have completely stopped prescribing opioids,” PRR warned in a report to CDC in August 2016, five months after the CDC released its guidelines.

“Pain patients who have relied on these drugs for years are now left with little to no pain management options. Chronic pain is already stigmatized. Now chronic pain patients face the stigma of addiction, even when they are using opioids responsibly for pain management.”

PRR is a well-connected marketing and public relations firm based in Seattle that has worked for a number of companies and public agencies, including the Environmental Protection Agency, Starbucks, Nike, and the University of Washington.

PRR was hired by the CDC to improve the agency’s public image and to develop a communication strategy to help educate the public about the CDC’s controversial opioid guidelines.

Those guidelines, which discourage doctors from prescribing opioids for chronic pain, are voluntary and only intended for primary care physicians. But they’ve been widely adopted as mandatory throughout the U.S. healthcare system, causing additional pain and anxiety for millions of pain sufferers.

“Chronic pain patients feel or perceive that the CDC has failed them because doctors are making extreme generalizations in determining appropriate care for their pain patients,” PRR found.

The PRR report to CDC was obtained by Pain News Network under the Freedom of Information Act.  Excerpts from the report can be seen by clicking here.

PRR recommended that CDC take a number of steps to understand why the guidelines were being so poorly received by patients.

“CDC should consider conducting more research to understand the fears and concerns of patients with chronic pain conditions. Understanding this group’s perceptions and fears of the PDO (prescription drug overdose) guidelines will help the CDC more successfully communicate with patient advocacy groups and will help insure their targeted messages are being disseminated to patients,” PRR recommended.

“Overall, this will help CDC message and communicate to those living with chronic pain and help providers and patients understand best care options available to enhance and improve quality of life.”

No CDC Response to Recommendations

There is no evidence that CDC has followed through on the recommendations. When asked if the agency had conducted any research or surveys of pain patients in response to the PRR report, the CDC gave us only a brief and vaguely worded statement. Note the use of the word “will.”

“CDC will evaluate the uptake, utility, and public health impact of the guideline and will monitor and assess physician and patient response to the guideline; based on this information, we will update the guideline in the future, as needed.

CDC continues to develop resources for patients and providers about the risks and benefits of opioid therapy for chronic pain to improve the safety and effectiveness of pain treatment and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.”

CDC pledged in March 2016 to make changes to the guideline “if new evidence becomes available” and said it was “committed” to evaluating the guideline’s impact – “both intended and unintended.”

But in the 17 months since that pledge was made, there has apparently been no effort by CDC to assess the guideline’s impact on pain care, doctors, patients, suicides, addiction or overdoses — at least none that the agency will talk about.

“We’ve provided you our statement,” a CDC spokesperson said in an email.

PRR also declined to answer any questions about its report or if any follow-up research is being done.

“We are proud of our work, and we respect client communications protocols. Therefore, we refer you to the CDC to ask your questions directly,” said Jennifer Lynch, PRR’s business development manager.

For the record, this reporter was one of five individuals interviewed by PRR last summer, and asked a series of questions about the CDC guideline. Others who were surveyed include Barby Ingle of the International Pain Foundation, Paul Gileno of the U.S. Pain Foundation, chiropractor Sean Konrad, and Dr. Lynn Webster, a pain management expert and past president of the American Academy of Pain Medicine.   

“I was contacted by the PRR firm as well.  I was told that the CDC wanted to know what they did wrong with the opioid prescribing guidelines,” recalled Webster. “I think it is clear that the CDC should have had more input from the pain community in developing the opioid guidelines.

“Any intervention by the CDC or any government agency that affects millions of people should be accompanied with a plan to assess the effect of the intervention. In other words, the CDC should have planned to measure the effect on intended goals and any unintended consequences from the intervention.”

“CDC recommends close follow-up for patients who are using opioids to treat chronic pain, but they don’t seem to be eager to apply that same advice to their own intervention,” said Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management. “CDC seems to be eager to evaluate the impact of its guideline in terms of metrics such as number of opioid prescriptions written, but they seem to have little concern about assessing the extent to which decreased prescribing is adversely affecting people with pain.

“In all the discussion about the evidence base supporting the guideline, what seems to have gotten lost is a need to develop the evidence base to show how effective or ineffective that intervention has been. Unfortunately, this lack of evaluation is consistent with CDC’s lack of interest in evaluating the prevalence and demographics of chronic pain itself.”

Guidelines Made Pain Care Worse

There have been many unintended consequences caused by the guidelines. In a survey of over 3,000 patients and nearly 300 healthcare providers by PNN, eight out of ten patients said their pain and quality of life had grown worse. Many patients are having suicidal thoughts, and some are hoarding opioids or turning to illegal drugs for pain relief.   

Over half of the healthcare providers said they had stopped prescribing opioids or were prescribing lower doses. Many providers also believe the guidelines are ineffective or have made pain care worse:

• 40% believe CDC guidelines have been harmful to patients, while only 22% consider them helpful
• 67% believe guidelines have made it harder for pain patients to find a doctor
• 63% believe the guidelines have not improved the quality of pain care
• 66% believe guidelines have not been effective in reducing opioid abuse and overdoses
• 35% of providers are worried about being prosecuted or sanctioned for prescribing opioids

“I am not sure the CDC is aware of the increased legal trouble many physicians are experiencing as a result of the guidelines. Most of these physicians are just trying their best to help people in pain but are being accused of criminal conduct,” said Webster.

Webster was apparently the only pain management physician interviewed by PRR. The company also reviewed 11 online articles and blogs (about half written by doctors), which gave the guidelines mixed reviews.  PRR’s bare bones analysis could hardly be called comprehensive, yet two federal health officials portrayed it as a ringing endorsement of the guidelines by physicians.

“Practitioners are excited to see action taken to address the PDO epidemic,” wrote Tonia Gray and John O’Donnell of the Substance Abuse and Mental Health Services Administration in an appendix to the PRR report. “From our scan of responses, PRR found that many agree this is a step in the right direction to help providers make informed decisions and stem the PDO issue.”

That assessment certainly doesn’t reflect the thoughts of Dr. Webster.

“I would urge the CDC to reassess their process and attempt to understand the unfortunate consequences their well-intended but misinformed decisions have had,” said Webster.

“One presumably unintended consequence is the recommendations/guidelines have been adopted as rules and laws, which has resulted in a significant change in care for millions of patients.  The guidelines were never intended to do that – they lack the backing of scientific evidence to be treated as a law.”

CDC has made few efforts to remind doctors, insurers, politicians and state regulators that the guideline is voluntary and only intended for primary care physicians. One of the few was a letter from a top CDC official to Richard Martin, a retired Nevada pharmacist disabled by chronic back pain.

“All of you at the CDC and like-minded groups, individuals, etc. are causing hundreds of thousands, if not millions of people, to suffer in pain needlessly,” wrote Martin, who sent 27 letters and emails to the agency before getting a response from Debra Houry, MD, Director of the CDC’s National Center for Injury Prevention.

“The Guideline is a set of voluntary recommendations intended to guide primary care providers as they work in consultation with their patients,” wrote Houry, who oversaw the development of the guideline. “The Guideline is not a rule, regulation, or law. It is not intended to deny access to opioid pain medication as an option for pain management. It is not intended to take away physician discretion and decision-making.”

Houry’s letter to Martin was dated June 1, 2016, a full two months before CDC received the PRR report, suggesting that CDC was already aware that problems were developing with the guideline and that many physicians considered it mandatory.

CDC ‘Propaganda’

To be clear, PRR’s review of patient and doctor attitudes about the guideline was only a small part of the work it performed for CDC. PRR also provided media training to CDC officials, analyzed news and social media coverage of CDC projects, developed logos and brands, shot promotional videos and pictures, and performed other work traditionally associated with public relations projects.

PRR also developed a series of fact sheets and graphics to help CDC promote the opioid guideline – many of which are still in use today.

The graphics advise doctors that “opioids are not first-line or routine therapy for chronic pain” and that physicians should “start low and go slow” when opioids are prescribed. They also encourage doctors to tell patients that “there is not enough evidence that opioids control chronic pain effectively long term.”

One PRR graphic claims that “as many as 1 in 4 people” who take opioids long-term become addicted. The graphic is based on a single study that even the author admits may have been biased and used unreliable data. A longtime critic of the CDC calls the graphic “propaganda.”

According to the National Institutes of Health, only about 5% of patients taking opioids as directed for a year end up with an addiction problem. Other estimates put the addiction rate higher and some lower.

prr designed graphic

It’s been difficult to assess how much PRR was paid for its work. Invoices sent to CDC indicate the original budget for the project was $240,596, but there were numerous delays and changes in the work performed. The invoices have been heavily redacted by the agency at the request of PRR, which considers the information proprietary.   

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Dr. Andrew Kolodny: Opioid crisis ‘not an abuse crisis, it’s an addiction epidemic’

https://www.washingtonpost.com/video/postlive/dr-andrew-kolodny-opioid-crisis-not-an-abuse-crisis-its-an-addiction-epidemic/2017/06/21/789fa53c-568a-11e7-840b-512026319da7_video.html

VIDEO ON ABOVE LINK

Dr. Andrew Kolodny, Co-Director of Opioid Policy Research at The Heller School for Social Policy and Management at Brandeis University says that the crisis of opioid addiction was originally “misframed” as a problem that only affected drug abusers. He calls it an “addiction epidemic” and notes that for the vast majority of people, opioids are not safe and effective treatments dealing with chronic pain.

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DEA does not think Trump border wall will stop drugs

www.oxygenemag.com/dea-does-not-think-trump-border-wall-will-stop-drugs/

President Donald Trump says his wall at the US-Mexico border will help stem the flow of illegal drugs into the United States. There’s one  problem with the plan: The drugs coming into the US Northeast often arrive by plane, boat, or hidden in vehicles, according to an  intelligence report by the Drug Enforcement Administration.

A 24-page report prepared by the DEA in May found that drugs coming from Mexico do often enter through the southwestern border, but they do so concealed in vehicles, like tractor-trailers. Moreover, drugs coming from Colombia are more often transported by plane and boat,
the reports notes.

Transnational criminal organizations “generally route larger drug shipments destined for the Northeast through the Bahamas and/or South Florida by using a variety of maritime conveyance methods, to include speedboats, fishing vessels, sailboats, yachts, and containerized sea cargo,” the reports reads. “In some cases, Dominican Republic-based traffickers will also transport cocaine into Haiti for subsequent shipment to the United States via the Bahamas and/or South Florida corridor using maritime and air transport.”

Speaking Monday at a joint news conference with Finland’s president, Trump turned his attention back to the wall he has promised to build along the US border with Mexico. “The drugs are pouring in at levels like nobody has ever seen,” Trump said. “We’ll be able to stop them once the wall is up.”

The DEA report does not address the wall but details how drugs enter the country, and many of the examples illustrate that it is not through land routes. “According to DEA reporting, the majority of the heroin available in New Jersey originates in Colombia and is primarily smuggled into the United States by Colombian and Dominican groups via human couriers on commercial flights to the Newark International Airport,” the document states.

DEA agents load bales of cocaine into a van after a news conference at the U.S. Coast Guard base in San Juan, Puerto Rico, Wednesday, Oct. 23, 2013. Associated Press/Ricardo Arduengo

The report, which focuses heavily on the growth of Domg cocaine-filled suitcases on commercial flights — sometimes with the help of airline employees — or via mail.inican trafficking groups, outlines a variety of ways drugs enter the United States, including via couriers carrying The drugs are often transported by boat from the Bahamas or Venezuela up through Miami. The main hubs for transport include the Dominican Republic and Puerto Rico.

“Due to Puerto Rico’s proximity and status as a US territory, Dominican Republic-based traffickers commonly direct drug shipments to Puerto Rico, where they are partitioned into small units and sent directly to the Northeast, mainly through the US postal system, parcel mail service, and couriers on commercial flights,” the report states.

At the end of the intelligence report, the DEA makes a recommendation, but it doesn’t involve building a wall.

“As key distributors of heroin, controlled prescription pills, and fentanyl—in their various forms—Dominican traffickers play a critical role in fomenting the national opioid epidemic, specifically in the Northeast,” it states.

The report adds that “successful targeting of their networks by US law enforcement would be an essential component to any broad strategy for resolving the current opioid crisis.”

The DEA did not respond to a request for comment about the report.

A U.S. Border Patrol vehicle patrols near the U.S-Mexico border on May 11, 2017 in San Diego, California.
Getty Images/John Moore

Trump this week appeared to be emphasizing drug trafficking as a rationale for the border wall, as he is claiming illegal crossings already have declined under his administration. “We’re up to almost 80 percent” reduction in illegal immigration, Trump said at Monday’s press conference. (There are questions, however, about the numbers Trump cited. )

“But you need the wall to do the rest, and you need the wall for the drugs,” Trump added. “The drugs are a tremendous problem. The wall will greatly help with the drug problem.”

Though Trump continues to insist that Mexico will pay for the wall — or at least reimburse the costs of it — the DEA report notes the role of Dominican networks in the Northeast. “Although Mexican traffickers may threaten their dominance in future decades, Dominican traffickers continue to position themselves to remain a significant element of the regional drug trade regardless of their extent of influence or role,” the report reads.

It’s also unclear how a wall would help curb the influx of illegal drugs if the shipments are entering the country by air and sea. Moreover, the Trump administration at one point was to the US Coast Guard, which is responsible for drug interdiction at sea, in order to fund the border wall.

The president’s proposed budget request ended up maintaining funding for the service at the same level , but the head of the Coast
Guard told reporters in April that even current spending wasn’t enough to interdict all of the drug shipments spotted.

“We have an awareness of over 80 percent of the maritime flow of drugs in the Eastern Pacific where most of it takes place, but also in the Caribbean,” Coast Guard Commandant Paul Zukunft said. “But last year, with all of that awareness, there were 580 events that we had at least one level of information on that we just did not have enough ships or enough planes to track those down.”

The OFFICIAL WAR ON DRUGS started in 1970 with the passage of The Controlled Substance Act which created the BNDD ( Bureau of Narcotics and Dangerous Drugs) which evolved into the DEA on July 1st,1973.

The Controlled Substance Act (CSA) replaced the Federal Narcotics bureau which had a 2 million/yr budget with the BNDD with a 43 million/yr budget and 1500 new employees charged with fighting the war on drugs.

Now 47 yrs later with a estimated 81 billion/yr spent on fighting the war on drugs… the DEA seems to admit that they are unable – or the war on drugs itself – is a MISSION IMPOSSIBLE…but Coast Guard’s Paul Zukunft stated that they need MORE MONEY.

It is claimed that the drug cartels generate 100 billion/yr in revenue from the sales of illegal drugs… so we are quickly approaching a point where we will be spending more money than we are trying to stop.

We are dealing with people with mental health issues and after nearly FIVE DECADES… those who wish to self medicate the demons in their heads and/or monkeys on their back.. seem to continue to find drugs… Would we have fewer OD’s, and fewer crimes committed to fund their drug seeking if we provided pharmaceutical grade opiates and clean needles to those who’s interest in abusing opiates cannot be changed.

Likewise, it can be expected that there will be a dramatic drop in the spread of HIV, HEP B &  C  from the sharing of “dirty needles”.

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Hurricane Harvey Emergency Dispensing of Prescription Medications

Governor Greg Abbott has declared a state of disaster in the following counties: Aransas, Austin, Bee, Calhoun, Chambers, Colorado, Brazoria, DeWitt, Fayette, Fort Bend, Galveston, Goliad, Gonzales, Harris, Jackson, Jefferson, Jim Wells, Karnes, Kleberg, Lavaca, Liberty, Live Oak, Matagorda, Nueces, Refugio, San Patricio, Victoria, Waller, Wharton and Wilson.

The laws and rules governing the practice of pharmacy in Texas, allow pharmacists to provide emergency refills when the prescriber cannot be reached. Specifically, in an emergency, a pharmacist may use his/her professional judgment in refilling a prescription drug order for a drug (other than a Schedule II controlled substance) provided failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

In most cases, pharmacists may not dispense more than a 72-hour supply of medication. However, in the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

 failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering;  the natural or manmade disaster prohibits the pharmacist from being able to contact the practitioner; the governor has declared a state of disaster under Chapter 418, Government Code; and the board, through the executive director, has notified pharmacies in this state that pharmacists may dispense up to a 30-day supply of a prescription drug.

Accordingly, Gay Dodson, R.Ph., Executive Director/Secretary, has authorized ALL pharmacists in Texas to dispense up to a 30-day supply of medication (other than a II controlled substance) for patients affected by Hurricane Harvey. Board rule 291.34(b)(8)(E) outlines the procedures for dispensing medication in emergency situations as follows:

§291.34 Records

(b) Prescriptions. (8) Refills. (E) Natural or manmade disasters. If a natural or manmade disaster has occurred that prohibits the pharmacist from being able to contact the practitioner, a pharmacist may exercise his professional judgment in refilling a prescription drug order for a drug, other than a controlled substance listed in Schedule II, without the authorization of the prescribing practitioner, provided: (i) failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering; (ii) the quantity of prescription drug dispensed does not exceed a 30-day supply; (iii) the governor has declared a state of disaster; (iv) the board, through the executive director, has notified pharmacies that pharmacists may dispense up to a 30-day supply of prescription drugs; (v) the pharmacist informs the patient or the patient’s agent at the time of dispensing that the refill is being provided without such authorization and that authorization of the practitioner is required for future refills; (vi) the pharmacist informs the practitioner of the emergency refill at the earliest reasonable time; (vii) the pharmacist maintains a record of the emergency refill containing the information required to be maintained on a prescription as specified in this subsection; (viii) the pharmacist affixes a label to the dispensing container as specified in §291.33(c)(7) of this title; and (ix) if the prescription was initially filled at another pharmacy, the pharmacist may exercise his professional judgment in refilling the prescription provided: (I) the patient has the prescription container, label, receipt or other documentation from the other pharmacy that contains the essential information; (II) after a reasonable effort, the pharmacist is unable to contact the other pharmacy to transfer the remaining prescription refills or there are no refills remaining on the prescription; (III) the pharmacist, in his professional judgment, determines that such a request for an emergency refill is appropriate and meets the requirements of clause (i) of this subparagraph; and (IV) the pharmacist complies with the requirements of clauses (ii) – (viii) of this subparagraph.

Notice that the TX BOP is concerned about ...interruption of a therapeutic regimen or create patient suffering... but this does not apply to pt that have a medical necessity of C-II’s.. So those pts with ADD/ADHD and/or chronic pain… will just have to deal with the flooding, loss of home, finding food/water… while the chronic pain pts may also have to deal with cold turkey withdrawal and all the physical symptoms of withdrawal..

“..In most cases, pharmacists may not dispense more than a 72-hour supply of medication. However, in the event of a natural or manmade disaster, the Texas Pharmacy Act (Sec. 562.054) and board rule 291.34 allow a pharmacist to dispense up to a 30-day supply of a prescription drug, other than a Schedule II controlled substance, without the authorization of the prescribing practitioner if:

 failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering..”

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More DENIAL OF CARE by a Pharmacist “floater” on a existing chronic pain pt

IMG_8234     CLICK ON Link to play video 

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I-Team: The Opioid Conundrum

http://www.lasvegasnow.com/news/i-team-the-opioid-conundrum/803064908

VIDEO ON ABOVE LINK

LAS VEGAS – Nightly newscasts across the country are filled with stories about the opioid epidemic — the opioid crisis. Tens of thousands of Americans who die each year are found with opioids in their systems, and so government at every level has stepped in to put limits on otherwise legal medications, including here in Nevada.

For millions of chronic pain patients, the crackdown has been a nightmare. They are the forgotten victims in the opioid debate.

Approximately 50,000 people a year die with opioids of one kind or another in their systems. The number you don’t hear is this one — there are as many as 25 million Americans who suffer with chronic pain. For many of them, opioid medication means the difference between leading somewhat normal lives, or surviving in constant agony.

These are not the people who O.D. on heroin or mix drugs with booze. For the most part, they suffer and die in silence.

“It was like, for the first time in my life, I wasn’t in pain anymore. I felt great for a couple of years and then they started this total crackdown,” said Gary, a chronic pain patient, who asked that his real name not be used.

Gary’s life changed when his spine was shattered in a rollover accident. After several operations, his doctors prescribed opioids and he was able to lead a somewhat normal life, even as the discs in his back crumbled further. But then the opioid crisis blew up. His prescriptions were cut in half and it became tougher to find a pharmacy that would fill them.

“I’d have to drive to 10 to 12 pharmacies just to get four prescriptions filled. Just to fill them,” he said.

Reporter George Knapp: “And they look at you like…”
Gary: “Yeah, like you’re a criminal.”

“The only ones who understand chronic pain are the ones who have chronic pain. When you have chronic pain, it’s on your mind all the time,” said Jeremy, a chronic pain patient, who asked that his real name not be used.

Jeremy is a self-employed business professional whose work requires him to both drive and walk daily. A skiing accident and later a hip replacement led to sharp, constant pain over half his body. He tried various surgeries, therapies, and medications but nothing worked until a time-released pain med called oxycontin was developed.

“You can go to work and function and chronic pain patients don’t get high off of oxycontin. It just alleviates their pain and allows them to function,” he said.

The opioid crisis has meant significant reductions in the amounts that can legally be prescribed for Jeremy, Gary, and pretty much every other chronic pain patient. Contrary to what their doctors recommend, their medications have been reduced by half, sometimes more. And they’ve been told, more reductions are likely.

For millions of people, the consequences have been immediate and drastic. They can’t sleep, can’t work, lose their jobs. Some decide to put an end to the constant pain by taking their own lives.

“People are dying. People are committing suicide right now because their doctor tapered them down involuntarily off opioid medications,” said Rick Martin.

He has seen it from both sides. He spent decades working as a pharmacist, and even though he has chronic pain from a deteriorating spine and hip, with medication, he continued to work and could also pursue his passion — landscape photography.

“I used to be able to do stuff by myself, but I can’t do that anymore.”

Chronic pain patients like Rick follow their doctor’s instructions, undergo monthly drug screenings and urinalysis and have become collateral damage in the opioid crisis. Most of the publicity has focused on overdose deaths among people who obtain opioids illegally, mix them with booze or other drugs including heroin. 

The CDC, DEA, and various opioid task forces have responded to deaths caused by illicit drugs by cutting back on legally prescribed medications, the same drugs that make life bearable for millions with chronic pain.

Insurance companies have slashed coverage, and pharmacies now operate under strict quotas, to the point they won’t fill prescriptions for new patients, even those fresh out of surgery. Opioid prescriptions have actually declined significantly in each of the last three years, yet opioid deaths keep rising.

“The unintended victims are the senior citizens. If they can’t get their medications, they aren’t going to go buy heroin and shoot it and die of a heroin overdose. they’re going to suffer,” Jeremy said.

So, how do we explain that while legal prescriptions keep dropping, opioid deaths keep rising? It isn’t a simple issue, though politicians have seized on it as a winner. Cracking down on drugs is a tried and true political strategy, even though enforcement has never worked as a solution to drug abuse.

In the coming months, 8 News NOW will be looking beyond the obvious rhetoric about various opioid issues. As part of this project, we’d like your input. We’ve created a page where opioid patients, pain doctors, pharmacists, families of O.D. victims can share stories, either publicly or privately.

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Nurse Arrested After Protecting Patient From Blood Draw

http://www.medscape.com/viewarticle/885157

Video images released Thursday show a Utah nurse screaming while being arrested for refusing to allow an officer to draw blood from an unconscious patient.

According to the Salt Lake Tribune in Salt Lake City, the images came from officers’ body cameras and University Hospital burn unit footage and were released in a news conference.

The video shows that after the nurse, Alex Wubbels, explained to Salt Lake Police Detective Jeff Payne that, according to the hospital’s policy, the police needed a warrant or consent from the patient or had to put the patient under arrest before she could allow a blood draw, she was handcuffed and shoved into a patrol car while she screamed, “Help! Help! Somebody help me! Stop! Stop! I did nothing wrong!” She was not charged, but several news reports indicated she was in the patrol car about 20 minutes.

In the video, Payne acknowledges that none of those three conditions had been met but says he still has the authority to take the blood.

According to the Tribune, Payne wrote in a report that he was carrying out a request from Logan police to draw the sample to check whether it showed the patient had illicit substances in his blood at the time of the crash.

In a videotaped statement after the incident, Wubbels said, “The only job I have as a nurse is to keep my patients safe. A blood draw just gets thrown around like it’s some simple thing. But blood is your blood, that’s your property.”

The Washington Post reports, “Wubbels was right. The U.S. Supreme Court has explicitly ruled that blood can only be drawn from drivers for probable cause, with a warrant.”

Today the American Nurses Association (ANA) released a statement expressing outrage and is “calling for the Salt Lake City Police Department to conduct a full investigation, make amends to the nurse, and take action to prevent future abuses.”

“It is outrageous and unacceptable that a nurse should be treated in this way for following her professional duty to advocate on behalf of the patient as well as following the policies of her employer and the law,” said ANA President Pam Cipriano, PhD, RN.  

The encounter is now the subject of an internal investigation by the police department, the Tribune reported.

According to the Washington Post, Salt Lake police spokesman Sgt. Brandon Shearer told local media that Payne was suspended from the department’s blood draw unit but is still on active duty.

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