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I have always heard stories about females tend to get poorer quality of care out of doctors whose ethnicity is from foreign countries. We have seemed to have experienced this personally…

Barb was having some shortness of breath and I suspected either a pulmonary embolism (PE) or pneumonia.. so she called to get an appt with her cardiologist.  The cardiologist that she normally sees was not in the office on Monday but his partner – who I have seen before  –  after the office visit – he suggested that she get admitted to the local hospital for some test, which she reluctantly agreed to.   This doctor’s ethnicity – IMO – appears to be from the middle east – in general.

She arrived at the hospital… and it took them over ONE HOUR to get a room clean… when her admission was called in from the doc’s office before we left. Our local hospital was acquired by a larger hospital system “across the Ohio river” in Louisville,KY and the entire system just upgraded to a EPIC electronic medical records.  This system is so large that all of the practitioners that we see are now EMPLOYEES of this large healthcare corporation and each office practice is connect to this EPIC system.

Part of this change is that our PCP no longer sees his pts when they are in the hospital… all pts are cared for by a HOSPITALIST – another employee of the larger healthcare system.

Of course, there are APRN’s involved in direct pt care and this stay was no exception… one of these two is telling her she has pneumonia and the other is saying that she has a PE. The hospitalist was being “stingy” on authorizing her regular pain meds and other controlled meds… and they said something that they had to check the state PMP (INSPECT) to make sure that she was taking her meds…

Apparently, since they don’t know us… they apparently saw a large gap in her getting her oral pain meds… BECAUSE we had been in at our Florida condo in Aug, Sept and first two weeks of Oct and our PCP had sent them Rxs for them to the pharmacy that we use in Florida and the Florida PMP is not linked to Indiana’s ….  I don’t know if they did a toxicology on her… because she should have had her pain meds filled abt 6 weeks ago – she gets 90 days supply at a time – but her toxicology would show that she is taking her pain meds BUT no records that they could see of her having them filled.

Via Barb’s nurse, I requested that this hospitalist come talk to me… he told me that her shortness of breath was because of her opiates… respiratory suppression … but I tried to explain to him that respiration in chronic pain pts taking long term opiates … disappears and not a issue – of course he denied… he mentioned that people were ODing … which I replied that people were committing suicide because of meds being pulled… which he denied… he then told me that HE treated all pts with objective facts/tests – which my reply was you can’t treat subjective disease with objective measurements.   It was obvious that he was going to quote “DEA’s medical opinions” and recommendations from Beer’s report   which generally SUGGESTS that any pts over 50 should not take most medications because of the POTENTIAL – often low potential and/or potential without a lot of scientific support.

I came away from this interaction was that this doc was a certified , card carrying, self-centered, narcissistic IDIOT and like the cardio doc… his ethnicity was from the same world geography.

So Barb was discharged.

She was handed a packet of 13 pages of “educational crap” that is generated from EPIC that – IMO – is mostly “cut/paste” from Beers and DEA medial opinions.

This EPIC system has the ability for pts to login to a “portal” and review various things concerning there medical records… Including all the medication(s) that have been prescribed by all the practitioners within the system.

As I was going thru Barb’s records… this ASSHOLE doctor – who was in charge of her care for some 18 -20 hrs DISCONTINUED ALL CONTROLLED MEDS – with the exception of one – probably because he didn’t know that it was a control or what she was taking it for… in this centralized EPIC database.  He even DISCONTINUED some OTC meds that was listed in her medical records.

These are medication that mainly her PCP has prescribed and her pain clinic – that manages her implanted pain pump – has full knowledge of her entire list… in fact she just had her pump refilled a couple of weeks ago and they go over her entire med list every time.

Today I talked to the nurse assistant to our PCP to make a followup appt and she said that Barb’s CAT SCAN showed that she had some PNEUMONIA in one lung… AND she was only given a single dose of antibiotic while in the hospital and discharged with NO ANTIBIOTICS.  I have ask the nursing assistant to see if one of the other practitioners in the practice to call in some antibiotics for her because we could not get an appt with our PCP until Monday.

This ASSHOLE doctor… failed to understand … is that the now President of the hospital is also a practitioner in the practice that we go to and his parents/family patronized our independent pharmacy years ago… I have known him FOR DECADES.

Since our PCP doesn’t come to the local hospital any more, we live in a metro area with about a population of about 1.6 million and the teaching hospital that Barb goes to for her pain clinic has the only LEVEL ONE TRAUMA CENTER for around 100 miles. and another major hospital complex two blocks away and both are about 10-12 miles from our house.

Of course,  I may just decide to go down the list of entities that oversees this ASSHOLE DOCTOR and the hospital complex and start filing complaints and I may have to explore the fact that he discontinued all her pain/anxiety controlled meds… may just be a discrimination under Americans with Disability and Civil Rights Act.

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DEA Is About to Demonstrate “How Little They Know About What They Imagine They Can Design”

https://www.cato.org/blog/dea-about-demonstrate-how-little-they-know-about-what-they-imagine-they-can-design

Last month the Drug Enforcement Administration, tasked with setting quotas for opioid production in the U.S, announced a proposal to reduce production levels another 10 percent, having already reduced production by 25 percent in 2017 and an additional 20 percent in 2018. This would bring down production levels to 53 percent of 2016 levels. Yesterday the DEA released a proposal to develop “use-specific” quotas. The DEA press release explains this as follows:

Today’s proposal amends the manner in which DEA grants quotas to manufacturers for maintaining inventories…The proposal also introduces several new types of quotas that DEA would grant to certain DEA-registered manufacturers. These use-specific quotas include quantities of controlled substances for use in commercial sales, product development, packaging/repackaging and labeling/relabeling, or replacement for quantities destroyed.

The rationale behind the production quotas is to reduce the amount of prescription opioids that can be diverted into the black market for non-medical use. But last month’s DEA quota proposal stated (Federal Register page 48172):

As a result of considering the extent of diversion, DEA notes that the quantity of FDA-approved drug products that correlate to controlled substances in 2018 represents less than one percent of the total quantity of controlled substances distributed to retail purchasers.

Therefore, it appears that diversion of prescription opioids into the black market is now a rare event. An obvious question then is why tighten quotas even further? Is the DEA on a mission to reduce or eliminate the use of opioids based upon this law enforcement agency’s belief that it knows best how health care practitioners should engage in pain management?

As I have pointed out many times, there is no correlation between per capita prescription opioid volume and misuse or opioid use disorder in persons age 12 and up. And opioid-related overdose rates soared while prescription volume plunged. In 2017, illicit fentanyl and heroin were involved in 75 percent of opioid-related overdose deaths, and 68 percent of all opioid-related overdoses were “polydrug,” i.e., involved multiple other drugs, including alcohol, cocaine, heroin, fentanyl, benzodiazepines, and barbiturates. In fact, less than 10 percent of opioid-related overdose deaths in 2017 were from prescription opioids that didn’t involve other drugs.

The DEA’s presumption to know just how many prescription opioids of all classifications and in all situations will be needed in the coming year for a nation of 325 million people is a great example of what FA Hayek called the “fatal conceit.” DEA prescription opioid quotas have already been tied to an acute shortage of injectable opioids that afflicted hospitals across the country in 2018.

Aside from that, these additional quotas will do nothing to stem the deaths from illicit fentanyl and heroin that comprise the overwhelming majority of opioid-related overdose fatalities.

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Addiction now defined as brain disorder…not behavior issue

http://www.nbcnews.com/id/44147493/ns/health-addictions/t/addiction-now-defined-brain-disorder-not-behavior-issue/

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.

“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

Even so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper recovery therapy,” Miller said.

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Walgreens’ Rx ‘asset purchase’ frustrating locals after company buys, closes pharmacies

https://www.wnewsj.com/news/122045/walgreens-rx-asset-purchase-frustrating-locals-after-company-buys-closes-pharmacies

A large national chain of pharmacies is upsetting some residents in and around Clinton County — even though that chain has no stores in Clinton County.

Walgreens recently purchased West End Pharmacy in Wilmington and Main Street Pharmacy in Blanchester, then closed them. Walgreens also recently purchased several other small pharmacies in Ohio and then shuttered those, including Lukas Pharmacy in nearby Lynchburg.

“We acquired the prescription files and the inventory from seven REM pharmacies in Ohio,” Walgreens corporate spokesperson Kelli Teno told the News Journal Tuesday. “All of the files and prescriptions have been transferred to the nearest Walgreens pharmacy and a letter was sent to all of those patients the same day that the last of those pharmacies closed on Oct. 31 to let them know about the change” to provide “minimal disruption to those customers impacted. We look forward to inviting them into our pharmacies.

“This was an asset purchase, so we purchased their files and then they closed the stores,” said Teno. “I really can’t provide a lot more on the background, what happened there, for public disclosure.”

She pointed out that, for former Main Street Pharmacy customers, “the distance to the nearest Walgreens is twelve-and-a-half miles”, and for former West End Pharmacy customers, it’s 17 miles (to the nearest Walgreens).

“We look forward to welcoming them at our pharmacies and hope that they find value in our services and products that we can provide,” Teno added. “We hope it’s minimal disruption to those. We have a number of locations in Ohio so our goal is to provide as minimal disruption to access to their medicines as possible.”

Readers share frustrations

On Monday the News Journal asked its readers who were formerly customers of the two closed Clinton County pharmacies to share their stories with us on Facebook, and how/when they found out their prescriptions had been transferred to out-of-county Walgreens pharmacies.

The emotions of those who shared their thoughts ranged from frustration to disbelief to anger.

Responses included:

• “The prescriptions were transferred to Walgreens in Xenia. When I called they had no idea where records were. Hope to transfer anywhere but Walgreens. I knew they bought West End but no communication from Walgreens at all.”

• “This was a nightmare!! My records were NEVER found! After a week I had to call my doctor to get a refill through him! I received a letter from Walgreens 15 days AFTER my pharmacy closed!”

• “Found out through Facebook, sent to Walgreens in Milford.”

• “Closed without notifying me at all. Still trying to get my medicine.”

• “I did get a letter from the Blan pharmacy, but it was already a done deal and unfortunately they were the only pharmacy in Blan or Wilmington to carry one of my particular meds. Now not sure what to do!”

• “I work on a daily basis with pharmacies for my clients and it has been such a nightmare to help them track records down. What I’ve seen from here in town is a lot of folks had their stuff sent to Xenia Walgreens.”

• “I can’t imagine the hardship this has caused those who can’t drive to these locations to get their meds, let alone try to figure out how to get them transferred. Thanks Kratzer’s for taking care of these folks.”

• “No notifications just went to pick up a script and the next day I’m driving to Mt. Repose in Milford to get my scripts. Was told today that Walgreens will no longer take my insurance as of Jan 1st. So aggravating.”

• “I happened to pick up a prescription at Main Street Pharmacy on the day they were closing. They informed me that all our family prescriptions were being transferred to the Milford. I called Kratzer’s and they took care of transferring all our family prescriptions and helped get a coupon to save us money. They were awesome and extremely helpful. Filled all the monthly prescriptions at no additional costs.”

• “My prescriptions were transferred to Walgreens and I was notified, however, they are not contracted with my insurance so I am using Blanchester CVS.”

• “I received a letter a week after West End closed. My Rx were sent to Xenia and they were unable to find my info. I transferred to Longs and they have been great.”

• “My prescription account was transferred to Walgreens in Xenia was notified after they transferred everything.”

• “Notified after they closed the door.”

• “We received a letter in the mail that our records were transferred to Walgreens in Xenia. They wouldn’t let us move them beforehand and now no records are found.”

Assisting locals

Mark Kratzer owns Kratzer’s Hometown Pharmacy of Wilmington as well as Town Drug of Sabina, Downtown Drug of Hillsboro and Barr’s Hometown Pharmacy of Xenia. He said he’s actively doing what he can to help locals put in a pinch while also working with legislators across Ohio pushing back at mega-companies that are reducing pharmacy options for Ohio residents.

Kratzer said that in the weeks since the Wilmington, Blanchester and Lynchburg pharmacies were closed, “A number of people are calling and asking for their complete profiles to be transferred to our store. When they closed, no patient knew anything about what was going on.”

Kratzer, who is in the process of opening another pharmacy in Middletown as well as in Lebanon, said he was told by Lukas pharmacist Tom Black that many of their now-former customers, especially the elderly, would not be able to drive to Hillsboro for their medications.

“He asked if we were willing to deliver to Lynchburg,” Kratzer said.

So he has begun free delivery to Lynchburg and to New Vienna “until I can get a pharmacy in there (Lynchburg)”, and he is also doing free next-day delivery to Blanchester “until we see what we can do” additionally there.

Kratzer said, “We’re calling different Walgreens continuously; they call back and say, ‘I’ve got 300 profiles to send before yours’.

“It doesn’t make any sense for Walgreens to purchase those three stores; they’re not going to retain any of these customers. Who is going to go that far to get their prescriptions?”

Working with legislators

Kratzer said he has been working with Ohio legislators — initially now-former House Speaker Cliff Rosenberger and currently State Sen. Steve Wilson (R-7th District) and Ohio Rep. Steve Lipps (R-62nd District) and others — and the Ohio Pharmacists Association against the alarming reduction of pharmacies in Ohio — down 208 in just the past three years.

“I think things will turn around with help of legislators at the state level. I think we’ll see a lot of changes next year,” Kratzer said. “We just have to knuckle down and keep fighting against corporate takeovers, low reimbursements, less staff, and lower pay” for pharmacists and techs.

And for the most important reason of all — customer safety.

”When you’re understaffed, you increase the risk of a miss-fill,” he added.

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DEA sues Colorado pharmacy board for refusing to release patient data

https://www.beckershospitalreview.com/pharmacy/dea-sues-colorado-pharmacy-board-for-refusing-to-release-patient-data.html

The federal Drug Enforcement Administration has sued the board that regulates Colorado’s pharmacies, demanding it share information from a database that tracks opioid prescriptions and setting up a clash over patient privacy amid the nation’s overdose epidemic.

The requested information is part of an investigation into whether two unnamed pharmacies broke the law in dispensing opioids and other drugs, according to a DEA agent’s declaration filed in the lawsuit.

“Such violations of law could potentially contribute to significant public harm in Colorado, including the overdose or death of patients,” diversion program manager Kerry Hamilton wrote.

The DEA previously issued administrative subpoenas to the State Board of Pharmacy for the information, which is kept under the state’s Prescription Drug Monitoring Program, or PDMP. The program tracks opioid and other drug prescriptions, including the names of doctors, patients and pharmacies.

State officials refused to provide the information, though, citing patient privacy concerns. That prompted the lawsuit, which seeks a judge’s order enforcing the subpoenas and was filed last week in federal court in Denver. In addition to the Pharmacy Board, the lawsuit also names Patty Salazar, the head of the state Department of Regulatory Agencies, and Appriss, Inc., a Kentucky company the state pays to collect and maintain the PDMP data.

“The Department of Regulatory Agencies is committed to combating the opioid epidemic that remains a devastating issue for many Colorado communities,” DORA spokeswoman Jillian Sarmo wrote in an emailed statement following the lawsuit’s filing. “We continue to work with our partners in other agencies in this fight, but we have an obligation to do so in a targeted and thoughtful manner that ensures the privacy of the hundreds of thousands of individual patients in the state whose personal prescription records have no connection to any criminal activity and whose disclosure has no relevance to any criminal investigation.”

Federal authorities say they need the patient information to link prescribing and dispensing practices to real-world harm. For instance, they argue in the lawsuit that having the name of a patient could tell them whether that patient overdosed after filling a prescription at a shady pharmacy. Or it could show whether a pharmacy should have noticed that a particular patient was filling suspiciously large and potent orders of drugs.

The DEA also says there are legal limits that prevent it from releasing the information, meaning that patient privacy won’t be compromised.

“We recognize that this information is sensitive, but, just as the state does, we respect that sensitivity and will protect the confidentiality of that information from public disclosure,” Colorado U.S. Attorney Jason Dunn, whose office is working with the DEA on the case, said in a statement. “We are disappointed with the refusal to comply with these lawful subpoenas, a refusal that has forced us to seek aid from the court in getting the information we need to carry out important law enforcement investigations aimed at combating the prescription drug abuse epidemic.”

A spokesman for Dunn said no one at the office could comment further.

MORE: Colorado’s new U.S. attorney wants law enforcement to treat overdose deaths as homicides as he focuses on opioids

The lawsuit and Hamilton’s attached declaration provide little insight into the DEA’s investigation. Hamilton writes that one of the pharmacies ranked among the top pharmacy purchasers over the last two years for three different types of opioids. Both pharmacies — which Hamilton refers to only as Registrant #1 and Registrant #2 — have “been selected by a number of patients of medical practitioners whose own prescribing practices have raised concern with the DEA,” Hamilton wrote.

Hamilton argues in her declaration that Colorado has previously provided federal agents with the types of PDMP data, including patient information, they currently are seeking. She says the state has already handed over some data on one of the two pharmacies now under investigation.

“That information that the DEA obtained from the PDMP has been used to advance its investigation,” Hamilton wrote.

But Sarmo said the state evaluates each subpoena it receives individually.

“The PDMP program’s practices regarding such subpoenas have not changed,” she wrote in an email. “What has changed are the DEA’s subpoenas. The current subpoenas involved in this lawsuit are substantially broader and less targeted than the DEA’s prior subpoenas.”

Sarmo said the state intends to fight the lawsuit. It is uncertain when the case will be resolved.

 

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This pharmacy is ten days behind on filling prescription. Hire some people. Never mind. I’m transferring all my prescriptions out ASAP.

— at CVS Pharmacy.    2100 East Dublin Granville Road, Columbus, Ohio 43229

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Epidural Steroids Home Page

https://www.burtonreport.com/infspine/epiduralsteroidhomepage.htm

all patients who’s Interventional Pain Management Clinics and the doctors (doctors of a mixed bag called “proceduralists”) who are performing Epidural Steroid Injections to read this report in full, clicking on ALL HIGHLIGHTS IN RED, for a thorough understanding. It is imparaitive that every patient know just how dangerous these spinal epidurals are and it’s never okay for any doctor NOT to give patients full disclosure of the nuerotoxins that are being used in corticosteroids, including all serious neurological adverse events before signing any consent forms. It’s NEVER OK to not give FULL INFORMED consent and legally IGNORANCE is No Excuse.
I also advise any patient being forced by using extortion tactics to give this report directly to the Clinic Manager and seek out a lawyer as soon as possible. No lawyer or doctor can argue the facts in this report done on behalf of the many millions who have died suffering in severe intractable pain and the urgent need to eliminate this practice using nuerotoxic chemicals anywhere near the Human Spinal Cord.
NO JUDGE could argue on the side of any defendant who uses nuerotoxic chemicals in Spinal Epidural Procedures and walks away from the catastrophic harms in silence.
These procedures must be eliminated from all human medical care.

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Kaiser Permanente CEO Bernard Tyson dead at 60

https://www.foxbusiness.com/money/kaiser-permanente-ceo-bernard-tyson-dead

Health care provider Kaiser Permanente CEO Bernard Tyson died Sunday at the age of 60, FOX Business confirmed.

Tyson had been active on social media as of Saturday, after speaking at a gathering called AfroTech.

“It is with profound sadness that we announce that Bernard J. Tyson, Chairman and CEO of Kaiser Permanente, unexpectedly passed away early today in his sleep. On behalf of our Board of Directors, employees and physicians, we extend our deepest sympathies to Bernard’s family during this very difficult time,” Kaiser Permanente told FOX Business in a statement.

The California-based health care organization described Tyson as “an outstanding leader, visionary and champion for high-quality, affordable health care for all Americans.”

Kaiser Permanente’s board of directors named Gregory A. Adams, Executive Vice President and Group President, as interim Chairman and CEO effective immediately.

In 2013, Tyson became CEO of Kaiser Permanente, one of the nation’s largest not-for-profit health plans serving 12.3 million members. Kaiser Permanente had roughly 9 million members when Tyson assumed the post.

During that same time, Tyson also grew revenue from $53 billion to more than $80 billion. He earned about $10 million in compensation in 2016, according to Modern Healthcare.

Tyson garnered praise during his time at the top of the health care provider, including his inclusion in TIME’s Health Care 50 for his work boosting community health in areas in need, like West Baltimore’s 21223 zip code.

His career at Kaiser Permanente began more than 30 years ago. He was born in the San Francisco Bay Area, where the company is headquartered, and attended Golden Gate University in San Francisco.

Most all of us have all heard of the horror stories of pt care that Kaiser provides.. especially chronic pain pts and those having to deal with subjective diseases.. In fact a letter was recently sent to pts that Kaiser will not longer prescribe certain classes of controlled substances and put a low limit on the mgs/day of opiates that a pt can have… regardless of the pt’s needs or conditions causing the pain.  Is it inconceivable that Mr Tyson would not be using Kaiser to provide for his healthcare ?

Here is the letter that Kaiser sent out just last month:

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