“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
According to this report… CVS has decided to only allow 3 glucose test strips for Insulin dependent pts and it is being billed to Medicare Part B. Even though Medicare Part B will reimburse for 4 tests strips a day.
According to this article, the news reporter reached out to CVS and their response was that they suggested that this pt get her glucose test strips at another pharmacy.
I would hope that this woman takes ALL OF HER PRESCRIPTIONS TO ANOTHER PHARMACY and hopes that her doctor suggests to all of her pts that they find another pharmacy to take care of their medication needs.
In 2010 the Department of Defense told us there were 18 vets of foreign wars dying by suicide everyday in Washington state. That is approximately 6,570 per year.
Now, it’s 2019 and the suicide rate is increasing dramatically in Washington state each day, not only by the vets of foreign wars, but include cancer patients, fibromyalgia patients, RSD/CRPS patients, etc., who are all untreated for their pain.
Washington state was considered the first “Pilot Project” state in America, back in 2010. Now there are 6 pilot project states in the union.
Whatever passed in Washington state, passed nationwide. Blame ESHB 2876, sponsored and written by Jim Moeller (House Rep), in 2010.
I read it. There were no facts, or findings of law in Jim’s Bill. It was simply hearsay, and a story. No proof of what he wrote was backed up by any documentation.
ESHB 2876 was about a story of children getting into their parents medicine cabinets, finding pill bottles, overdosing, while their parents were not at home.
And, that my friends, became law. It was merely a story.
I interviewed each of the House of Representatives in the Washington state, Olympia, legislators’ offices. Each and everyone of them had a ‘boiler plate’ answer to me. They said: “I was told to not read it, and to not research it, but to sign it and send it up the governor’s office.” Governor Christine Gregoire then passed it into law.
I found out later, during my investigation, that the FDA pressured the legislators into signing ESHB 2876.
I confronted the FDA, and told them they have no jurisdiction over our Washington state legislators, and they need to get the hell out of our state, and don’t ever come back.
In the meantime, the doctors started leaving our state in droves. There were none to be found who would take chronic pain patients, and the suicide rate climbed even further.
I was sad. I was angry. I was in shock. I felt helpless.
But, God had a plan for me, and I kept advocating anyway, to the best of my ability.
Then I became empowered by FACEBOOK. A whole new world opened up for me, and now I am on fire, and grateful.
Please share this PRESS RELEASE.
Signed, Nealy Tynes President, International OPERATION PAIN RELIEF Email: opr.1@juno.com
Shorter version. HERC Meeting March 14th 2019. HERC members talking about chronic pain patients after they left the meeting. What was expected to be the final vote on the chronic pain task force proposal for medicaid, was paused they say, to investigate a possible conflict of interest by members and staff of HERC. This portion of the HERC meeting was a roundtable style discussion with the Chief Medical Officer of the OHA, and voting members of HERC, some of whom are also members of the chronic pain task force. * Introduction to the HERC meeting begins at the 38 min mark and goes to the 50 min mark. The audio begins with the HERC and OHA Chief discussions and how the HERC profiles and sees patients who testify and who they serve in a public health position. OHA Public News Release on pause: https://www.oregon.gov/oha/ERD/Pages/… World renouned pain experts have spoken out – against.. Oregon’s radical medicaid population experiment. Sean Mackey, MD, PHD Chief, Division of Pain Medicine Expert letter and Expert signatures https://static1.squarespace.com/stati…
Eli Lilly’s new “authorized generic” of its pricey Humalog insulin, called Lispro, is excluded from the 2019 national list of covered drugs from pharmacy benefit manager Express Scripts.
The big picture: So much for all the fanfare when Eli Lilly unveiled the insulin last month. Lispro’s price doesn’t change net spending on the insulin, even though it is cheaper for people paying cash out of pocket, and PBMs have little incentive to cover the drug if a rebate doesn’t exist or is tiny.
Does this just give everyone just one more proof that the PBM’s – which Express Scripts is one of the top three, along with CVS’s Caremark and United Health’s Optium Rx – are more part of the problem of high Rx prices than part of the solution. Apparently Lilly is paying little to nothing in the format of rebates, discounts or KICKBACKS. The PBM industry was created as an answer to the UAW’s (Ford, GM, Chrysler, International Harvester, John Deere) new contract in the fall of 1969. They were suppose to save everyone money… back then they were < 5% of the Rx business …but..today they are involved in the pricing and paying for 90%+ of all prescriptions and larger percent of the Rx market they got.. the more that they got into “forcing” the pharmas’ to give them discounts, rebates, KICKBACKS if the pharma wanted one or more of their medications on their formulary … meaning that they would be covered without prior authorization or quantity limits. I have read where some pharmas are have to pay some 40% -50% of the wholesale price to the PBM to get their meds on a particular formulary.
The Federation of State Medical Boards is meeting in Fort Worth, Texas this weekend—and the “opioid” crisis is on the agenda.
“The State Medical Boards must lead the effort on regulation of the opioid crisis. The DEA and other federal agencies must work with the Medical Boards to avoid confusion with physicians legitimately taking care of their patients.”
Sherif Zaafran, MD, tweeted out his comments made as the Federation meeting got underway.
Dr. Zaafran is the head of the Texas Medical Board and a member of the HHS Pain Management Best Practices Inter-Agency Task Force and a very important voice
Saturday, he will also moderate a discussion of nationally recognized leaders who will “discuss new steps in the effort to address the nation’s opioid crisis. Included on that panel is Vanila M. Singh, MD, MACM, who is the chair of the Pain Management Task Force that calls for patient-centered approach to improve treatment of pain.
That Task Force Draft Report received some 6,000 public comments and the HHS group will gather again in May to adopt it.
“The action is at the state level,” said Terri Lewis, Ph.D. “Pain patients and physicians need to ask their state medical boards, what are you doing now?”
Just this month, two federal agencies eased some previous guidance on opioid prescribing.
The Centers for Disease Control and Prevention said many physicians have misapplied the 2016 guideline that resulted in a serious reduction on opioid prescribing. The CDC tacitly acknowledged many physicians’ responses to the opioid crisis went too far.
Earlier this month, the FDA issued a safety announcement that it said “identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.”
These agencies have been receiving blowback—and plenty of it—from medical professionals who believe that the reaction to the “opioid crisis” tilted dangerously toward those who become addicted from opioids versus the million of chronic pain patients who were adversely affected by the physicians, insurers and state regulators reaction.
After posting these last night and pulling the title of the posts from the article itself… I started reviewing the “whole game” that is being played out between the DOJ/DEA, FDA, CDC and countless other agencies and healthcare corporations and provider that are struggling with the CDC guideline.
I have stated many times before, that the one agency that is completely silent and/or missing from the conversations is the DEA .
In all of this, what has not been revised is the Controlled Substance Act (1970) (CSA) and it appears that the DEA’s authority in using the CSA apparently remains UNCHANGED.
This is how the DEA could keep screwing with the chronic pain community:
The DEA controls the licenses of those who produce, prescribe or dispense controlled meds.
The Pharmas: the DEA still can raise/lower the annual production quotas that each pharma is allowed to produce each year. Opiate Rxs peaked in 2012 and end the ensuing years, the DEA has already decreased production quotas have been DECREASED abt 50% of what was allowed in 2012.
Wholesalers: the BIG THREE (Amerisource, McKesson, Cardinal controls about 80%+ of the medication market in the USA. Walgreens owns part of Amerisouce – not sure if it is a minority or majority interest. Cardinal is the primary wholesaler for CVS and Mc Kesson is the primary wholesaler for Rite Aid. The wholesaler Rochester Drug Cooperative, Inc – that was recently fined by the DEA for failing to report suspicious large pharmacy orders… it was reported that they are a “major wholesaler”, but they are really part of the “secondary wholesaler market” and are really “small potatoes” in the overall wholesaler market place. In Jan 2017, Mc Kesson paid 150 million fine ( https://www.justice.gov/opa/pr/mckesson-agrees-pay-record-150-million-settlement-failure-report-suspicious-orders ) for the same violation that Rochester Drug Cooperative, Inc was accused of and at least one of Rochester’s exec is facing 10 yrs in jail. DEA licenses wholesalers and can fabricate charges against wholesalers, fine the crap out of them and suspend the DEA licensed to one or more distribution centers.
Prescribers: We have seen the DEA fabricate charges and raid prescribers offices, close their practice down, use civil asset seizure laws to confiscate all their assets and put them in the DEA’S coffer. We have also seen the DEA use nothing but the number of Rxs and/or doses to justify a raid on a practice.
Pharmacy & Medical licensing boards: These boards usually “play along” with the DEA in fining or “busting” providers. The Medical board is mostly staffed with DEA licensed prescribers and Pharmacy boards are mostly staffed with non-practicing corporate Pharmacists – whose chains that they work for does have DEA licenses in their pharmacies.
Then there is that part of the controlled substance act “Corresponding Responsibility” ( https://www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_04.htm ) A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances. Because the DEA’s statutory authority only concerns the diversion of controlled substances for illegitimate uses.. they have no authority – and thus doesn’t have to care – if valid prescription does not get filled and the valid medical need of a pt is met.
So with this revision of the CDC guidelines and the FDA getting on board, the authority and the actions of the DEA against all DEA license holders and chronic pain pts could remain unchanged.
We know that the DEA abt 4 yrs ago “forced” all of the drug wholesalers to RATION controlled substances to pharmacies which is a violation of the Interstate commerce law ( https://www.britannica.com/topic/interstate-commerce-United-States-law ) but when the entity (DOJ) that is suppose to be enforcing this law is the same entity that is causing the law to be violated… who do you turn to ?
You can ask the same question about the Americans with Disability Act and the discrimination against chronic pain pts when they are denied acceptance into a practice, a Rx filled at a pharmacy or some other issue ?
Hypothetical: FDA/CDC and other oversight agencies implement policies and procedures that legit chronic pain pts are entitled to getting adequate pain therapy, but the DEA has continued to lower the pharma’s annual quota… wholesalers don’t have to forcibly ration controls to pharmacies …there will not be enough production to cover all the needs of acute and chronic pain pts.
Previously, I have been told that some pharmacies made sure that their “regular pts” got their pain meds and others fill controlled meds on a first come … first serve basis… when they ran out of a particular med towards the end of the month… everyone of their regular pts are just OUT OF LUCK ?
We all hear routinely, that the illicit use/abuse of controlled substances has DESTROYED families, but no one talks about how the CDC opiate dosing guidelines and their implementation has destroyed families as chronic pain pts have had their pain management therapy reduced or totally taken away.
Let’s hope that the changes that are coming out from the CDC and FDA do not end up doing more damage than the original launch of the CDC opiates dosing guidelines has caused over the past three years because of the DEA, DOJ and our politicians being entrenched in believing that opiate prescribing to treat chronic pain is the gateway to people using/abuse illicit drugs and ODing.
They are using laws and breaking laws to deny pain pts their necessary medications… and IMO… the chronic pain community is never going to get justice and their needed medications unless they get their dollars together into a legal defense fund to level the playing field by engaging law firms or lobbyists to help us do that.
The Centers for Disease Control (CDC) released an official statement to the mainstream media on Wednesday, April 24, 2019, with “clarification” regarding their 2016 Guidelines for Opioid Prescribing for Treatment of Chronic Non Cancer Pain.
To wit, they caution against forced tapers, discontinuing opioid therapy in patients who have been on opioid therapy long term, and against lowering doses to low levels that cause patient harms.
In perusing the linked page to the 2016 guidelines, which this author has visited several times a week for well over a year, it must be noted that the page has undergone an overhaul in the new year. It is much more “friendly” than previously, with kinder language, explanations contained on the landing page and site links that were not there before. One can use the Internet archive to look back and see the changes from previous.
CDC has announced they are in line with FDA regarding forced tapering of opioid medication in long time opioid therapy patients. This should not come as a surprise to anyone. What is a surprise is that any announcement is being made at all in this fashion by the CDC.
FDA is the authority in the Unites States regarding all prescribed medication and rules governing medication.
FDA issues the rules all other agencies must follow. No agency outranks FDA.
Astonishingly, the CDC guidelines have been adhered to across the board without a single document or rubber stamp from FDA.
This is a grave matter to consider. One that all Americans should really think about.
The regulatory agency that issues all rules regarding medications never once issued any official permissions from their agency for the wholesale application of the CDC guidelines for Prescribing Opioids for Chronic Pain.
Yet, the United States has across the board clinically applied these harmful guidelines. What does this say about authority?
To include over 30 states basing erroneous and extremely harmful legislation upon these guidelines. What does this mean? We need to really think about this.
It appears that some of the stakeholders ignored the hierarchy of government agency structure in their zeal to throttle opioids — even in the face of all that data we showed them time and again proving that what we were saying was true, that painful disease patients were not causing their “opioid crisis”.
They completely ignored the authority of the FDA.
It appears that those in the know counted on “Everyday Joe American” not understanding the rules around prescribed medication policy.
What is worse, the American public has passively allowed some to practice medicine via legislation in over half of our 50 states… all based on these guidelines issued by the CDC, which were never officially endorsed by the regulatory body FDA.
When advocates pointed out medicine was being practiced without a license, that FDA had never officially adopted the CDC guidelines as policy; they were demonized, ridiculed, and discredited.
What do we have left today?
A situation where an agency that has no business issuing policy statements on any drugs walking back a massively misapplied guideline that was blanket enforced across the United States without approval by the very government agency created to keep citizens from harm due to thoughtless policy such as this.
We must be serious and thoughtful about this going forward.
Why was this patently ignored by all involved?
Why were stakeholders encouraged to practice medicine without a license based on these guidelines, not based on thoughtful guidance from the actual rule making and regulatory agency on drugs — FDA?
It makes little sense, unless you view it through the lens of the population based study discovered by CIAAG and confirmed in DC on April 8, 2019.
F. Arcaeus, pages from ‘A most excellent and compendius….’. Credit: Wellcome Collection
The current narrative CDC is promulgating places the blame for the guideline fiasco, patient deaths, misery and force tapering on “physician misapplication”.
This is nothing more than artful deflection and political pandering at the highest levels.
Firstly, why would the CDC place a disclaimer on their work in the first place? Surely, if they were confident in their contracted work and guidance, there would be no need for a CYA.
Also, one needs to look no further than the DEA and their unhinged arresting of physicians, left and right, through PDMP (prescription drug program monitoring) targeting.
If physicians have “been allowed” all along (per what the CDC is now saying) to prescribe opioids at the amounts patients require to relieve their pain, then why is the DEA using the PDMP to target physicians who… prescribe any opioids?
In fact, isn’t the PDMP supposed to be an aid for doctors to keep drug addicts from working the system, not a tool for law enforcement (99.9% of whom are clueless about pharmacology and medicine, dosages) to use to target doctors in some kind of fantastical “pre-crime” Minority Report profiling system?
Social engineering has conditioned society at this point to view any person who needs or uses opioids in a negative, dim way. Therefore the CDC knows that they can wholesale push anything onto the public at this point and it will be believed by most, unquestioned.
Please start asking questions.
Don’t let these agencies attempt to talk their way, shame patients and doctors, and weasel around their extremely questionable actions and culpability.
It makes virtually no sense at all, the way this has all unfolded. Now it appears that it will be rugswept and hopefully no one with a credible reach will point it out to the public.
To illustrate how nonsensical the entire scenario has been and still is, think of it in this way:
Insurers are tired of paying out claims on texting and driving accidents. They want to reduce the numbers of teenagers even getting licenses in the first place. Stakeholders reach out to FCC.
In response, the FCC issues a broad guidance on driver’s licenses, across the country. All drivers license centers that test people for drivers licenses have a list of suggestions, 18 to be precise, of things that FCC thinks are pertinent to the fight against texting and driving.
These suggestions are not laws. They are not issued by Congress. However, the drivers license centers notice that if they don’t implement the suggestions, their funding is denied at the state level. Many of the centers have had to close in the wake of the suggestions. Some of the drivers license test implementers think the suggestions are unfair. These people have gotten visits from the government. They have been threatened with early retirement from government service or loss of their pension if they don’t go along with the suggestions from FCC. Whistleblowing does nothing. Whistleblowing only works if one can whistle blow to an agency that isn’t in on the scam… if they are all in, it does nothing but put a target on one’s back.
Others have pointed out that FCC has zero jurisdiction over drivers licenses. That is under the jurisdiction of the DMV.
Anyone who points this out finds themselves the target of attacks, personal and professional. The person finds their reputation is quickly destroyed in an insidious, relentless manner.
Soon the vast majority of the United States public believes that driver’s licenses are a very expensive and time consuming ordeal to obtain, versus what they used to be, a rite of passage for a teenager- something a parent would look forward to doing with their child as the age approached. People on social media view and attack others who speak out on this issue as non-conformist, elitist, or conspirators, as well as horrible parents for allowing their children to even drive, thanks to being socially engineered by government hired influencers.
The fact that a federal agency that had no invitation or business injecting themselves into rules and regulations of another agency is not even noted by anyone. It was worked out behind closed doors as usual.
The goal was obtained. Reducing the number of driver’s licenses being sought in the first place.
A simple analogy to illustrate.
It is this big, and the loss of critical thinking skills is how we have gotten to this point as a society.
No one thinks thoughtfully anymore before they make a judgment on an issue in today’s culture, largely because everything is designed to be “up to the minute, blink and you’ll miss it, move out of the way, so fast”.
Consider the idea pushed so heavily regarding opioid addiction — that “addiction will happen in three days exposure”.
Addiction will happen in three days exposure, to a person predisposed to addiction to any substance, guaranteed, for sure. Whether it be alcohol, nicotine, methamphetamines, cocaine, opioids… if one is an addict, it will happen.
However, most of the adult population of the United States has been exposed to an opioid medication at some point of their life by age 30. We do not have a society of 350 million opioid addicts.
This is a classic example of the social engineering promulgated upon society laid bare for all to see. Our parents and grandparents were not opioid addicts. They would not have entertained the notion that this was true. Why do we?
We hear stories of the infamous “morphine addicts” of long ago before morphine was made a prescription item — the women (of course) who were “addicted” to the cough syrups loaded with morphine and sold by country peddlers.
I have read these stories myself. I always think:
“How many of these women had untreated painful disease? Is it hard to imagine many did?”
“How presumptuous is it to assume all these women were ‘addicts’ and not merely dependent upon these medicines, went through withdrawal and were fine? I have never once read the word dependent in a single account.”
“Did these women destroy their lives, their families, after these medicines were put behind the counter? Or did they carry on with life? No one has much to say after the dramatic proclamation that there were ‘hoards of female morphine addicts.”
“Who is to say they were all ‘morphine addicts’? (Only those with an agenda to push).”
“Misogyny is alive and well, even in historical storytelling. Women were “hysterical patients and exaggerating their symptoms” throughout history. Why would today’s women expect any different treatment?”
Please unite, stand up against these false narratives, these untruths, these engineered stories, and demand action for patients and society in the name of informed consent and truth in health care decision making.
Allowing our physicians to practice medicine without state sponsored restrictions, free and unfettered, should be first and foremost.
They are licensed and trained. They should be allowed to fully practice medicine under the law, as they are trained to do.
The legislation proposed and put into place in over half the states that is based upon guidelines that weren’t even approved by the regulatory body overseeing medications in the United States could be challenged at the very least. Legislation that was written by people not trained or licensed to practice medicine, I might add.
The forced compliance of society to participate in a study that was engineered into place without their informed consent is also a grave concern.
The PDMP system stand alone is wrought with privacy issues. It is extremely vulnerable to attack, easy to exploit, has very sensitive patient information contained within and no one in a position of authority seems to care that all of it is on the cloud without a single signature of informed consent.
The vast majority of patients do not even realize this system exists or what it even is or contains! I fail to see how any insurer or healthcare system could possibly think this falls under informed decision making or consensual care, or possibly justify this system as any kind of team building with the patient included.
These are but a couple of very real concerns that are glaringly obvious. Consider these, read the linked documents, and consider what I have said some more.
I don’t want any person to make quick decisions. I want every person to be thoughtful and deliberate in how they decide to proceed. I hope that all who read my work decide to unite behind the message — that we are taking our patient power back, as free American citizens, and demanding truth and transparency in our healthcare going forward.
CIAAG has the full dossier of Violation of a Nation at their website. Please download all documents and spread the truth of the government population study/clinical trial.
The only truly free society is an informed society.
Some of us has always wondered if the CDC really had any statutory authority to generate the opiate dosing guidelines since their primary statutory authority is to deal with contagious diseases.
Maybe they didn’t and that is why the then head of the CDC Thomas R. Frieden quickly made public statements that the guidelines did not bear the weight of law – they were just suggestions/guidelines.
A couple of nights ago, I going over a couple of pages from the CDC’s annual budget and there was a line item for dealing with HIV, HEP B & C.
One of the problems with substance abuse is the sharing of needles and likewise the sharing of any disease(s) that any of the previous people who had used the needle had.
A few years ago, the small southern Indiana Scott County had a “outbreak” of HIV, Hep B & C with about 200 people. After all the dust settled, all of those pts .. 85% of the HIV, Hep B & C were DNA verified from the same source… strongly suggested a lot of “needle sharing” of the substance abusers in Scott County.
So who within or outside of the CDC got convinced the CDC that if they tried to address opiate use/abuse… a reduction in substance abuse would decrease and also would the prevalence of the CONTAGIOUS DISEASES of HIV, Hep B & C. Which they get money to address.
The war on drugs is a 81 billion/yr and primary function of all bureaucracies is to grow their budget and the number of people on the payroll, because in the political world those two things equate to POWER & INFLUENCE in that world.
There is nothing in our legislative system that guarantees that a bill that Congress passes and a President signs into law or a agency creates a new interpretation of an existing law/regulation.. that it is constitution. Until someone challenges the constitutionality of the law/interpretation in our court system… Those laws/interpretation can be applied/enforced until they are declared unconstitutional by our court system. Of course, the only ones who win in challenging the constitutionality of a law/interpretation is the law firms.
A USA TODAY investigation finds the Department of Veterans Affairs has repeatedly hired healthcare workers with problem pasts, like neurosurgeon John Henry Schneider, whose license had been revoked after a patient death. USA TODAY
Neurosurgeon John Henry Schneider racked up more than a dozen malpractice claims and settlements in two states, including cases alleging he made surgical mistakes that left patients maimed, paralyzed or dead.
He was accused of costing one patient bladder and bowel control after placing spinal screws incorrectly, he allegedly left another paralyzed from the waist down after placing a device improperly in his spinal canal. The state of Wyoming revoked his medical license after another surgical patient died.
Schneider then applied for a job earlier this year at the Department of Veterans Affairs hospital in Iowa City, Iowa. He was forthright in his application about the license revocation and other malpractice troubles.
But the VA hired him anyway.
He started work in April at a hospital that serves 184,000 veterans in 50 counties in Iowa, Illinois and Missouri.
Some of his patients already have suffered complications. Schneider performed four brain surgeries in a span of four weeks on one 65-year-old veteran who died in August, according to interviews with Schneider and family members. He has performed three spine surgeries on a 77-year-old Army veteran since July — the last two to try and clean up a lumbar infection from the first, the patient said.
Schneider’s hiring is not an isolated case.
A VA hospital in Oklahoma knowingly hired a psychiatrist previously sanctioned for sexual misconduct who went on to sleep with a VA patient, according to internal documents. A Louisiana VA clinic hired a psychologist with felony convictions. The VA ended up firing him after they determined he was a “direct threat to others” and the VA’s mission.
As a result of USA TODAY’s investigation of Schneider, VA officials determined his hiring — and potentially that of an unknown number of other doctors — was illegal.
Federal law bars the agency from hiring physicians whose license has been revoked by a state board, even if they still hold an active license in another state. Schneider still has a license in Montana, even though his Wyoming license was revoked.
VA spokesman Curt Cashour said agency officials provided hospital officials in Iowa City with “incorrect guidance” green-lighting Schneider’s hire. The VA moved to fire Schneider last Wednesday. He resigned instead.
Cashour also said the VA would look into whether other doctors had been improperly hired.
“We will take the same prompt removal action with any other improper hires we discover,” he said.
The results of the investigation of Schneider and other VA practitioners with problem pasts reveal potentially dangerous shortfalls when they join the agency as well.
The VA Medical Center in Iowa City is pictured in 2014.(Photo: Press-Citizen file photo) (Photo: Press-Citizen)
In response to the findings, Cashour said the agency is also initiating an “independent, third-party clinical review” of the care Schneider provided with complications in Iowa City relayed to USA TODAY by patients or family members.
In an interview, Schneider maintained that he has not provided substandard care. He blamed poor outcomes for patients on other providers involved in their treatment or on unfortunate complications not caused by his care.
Schneider said his insurance company decided to settle some of his prior cases regardless of their merit, and he filed an appeal of the Wyoming revocation, a case that’s still pending.
“I’m a neurosurgeon; neurosurgeons across the country get litigation because of complications related to surgery,” he said.
Of 15 malpractice complaints identified by USA TODAY, four were settled, and two were dropped by plaintiffs. Six others were deemed valid by a trustee after Schneider filed bankruptcy in 2014, court records show. The trustee rejected the other claims.
One malpractice lawyer and neurosurgeon who is not familiar with Schneider’s case said that in general, having a dozen malpractice claims in as many years raises red flags.
“That’s certainly not usual. It’s definitely an outlier.” said Larry Schlachter, author of Malpractice: A Neurosurgeon Reveals How Our Health Care System Puts Patients at Risk.
For Schneider’s former patients and their family members, news of his hiring at the VA and return to the operating room after his Wyoming license was revoked came as a shock.
“What in the world?” said Scherry Lee, who is awaiting payment for a malpractice complaint against Schneider after a failed neck surgery in Wyoming in 2012. She says it left her in debilitating pain with difficulty speaking and swallowing. “How does this happen, especially with a neurosurgeon?”
A trail of malpractice claims
Less than two months after Montana issued Schneider a medical license in 1997, Jason Zimmerman was rushed to the emergency room at St. Vincent Healthcare in Billings.
He had excess fluid building up around his brain that was creating dangerous intracranial pressure, according to court records. A tube and valve system that had been implanted to drain excess cerebrospinal fluid had malfunctioned.
His family sued Schneider and a practice partner alleging they provided substandard care and Zimmerman suffered “profound neurological injury” that left him permanently impaired, the complaint says.
He and his family members ultimately dropped their malpractice suit because they worried Zimmerman’s prior substance abuse would impede the case, his sister Wendy Conaway told USA TODAY. Schneider blamed his partner for the injuries.
But it was only the first of four malpractice claims he would face over the next five years from surgical patients at St. Vincent hospital. The others settled for undisclosed amounts, court records show.
They included the case of Lloyd Hickey, who was paralyzed from the waist down after Schneider allegedly implanted a device improperly in his spinal canal, and Carmen Riddle, who lost bladder and bowel control after three spine surgeries by Schneider. The wife of Thomas Deiling settled her wrongful death claim against Schneider after her husband died from complications after four surgeries.
“I continued the lawsuit hoping I could force him out of practice, but I couldn’t because of the cap on medical negligence lawsuits,” Jeanine Deiling said in a recent interview. She said Schneider failed to properly diagnose and quickly treat a pervasive infection that ended up eating away at her husband’s spine.
Her best hope, Deiling said, was to add hers to the list of malpractice claims, and “if enough lawsuits added up, he’d never be able to get malpractice insurance and he’d have to quit practicing.”
Schneider did stop performing surgeries in Montana, but he started performing them in Wyoming instead. And he formed a company, Northern Rockies Insurance Company, that provided his own malpractice insurance, a move that eventually helped land him in bankruptcy and unable to pay off all his claims.
At hospitals in Cody and Powell, Wyo., and a surgical center in Sheridan, Wyo., Schneider performed operations between 2006 and 2012 that eventually prompted at least eight more malpractice complaints.
The case that captured the attention of Wyoming Board of Medicine officials was Russell Monaco, a father of two who went under Schneider’s knife in 2011 for a procedure to decrease pressure on nerves in his lower back, according to a wrongful death suit filed by his wife, Kathy.
After the operation, he was prescribed a litany of narcotics that can depress breathing, including fentanyl, oxycodone, valium, and Demerol. Monaco’s oxygen levels dropped dangerously low, but Schneider discharged him anyway, medical board records show.
He went home and took the medications as prescribed, the lawsuit says, but his family found him dead the next morning. The coroner determined the cause of death was “mixed drug overdose.”
“I tried to wake him up and yelled and the girls came down screaming,” his wife, Kathy Monaco, told USA TODAY. “It was horrible, I mean, I live that day over every day.”
The Wyoming Board swiftly placed restrictions on Schneider’s license and ultimately revoked it in 2014.
Schneider filed bankruptcy in December that year, leaving malpractice claimants hanging without payment even now, including the Monaco family.
In an interview, Schneider laid blame for Monaco’s death on a physician assistant who prescribed the medications. He said an aide in the operating room caused Hickey’s paralysis, and he blamed Riddle’s injury on a hematoma caused by medications prescribed by another provider. In Deiling’s case, Schneider asserted standard tests didn’t initially pick up the infection or indicate he needed more timely treatment.
Vetting revelations
The VA hiring process is seemingly rigorous.
Applications are vetted, education and licenses verified, references checked, and interviews conducted. For clinical hires, a review and approval by a professional standards board also is required.
But when applicants disclose prior problems with medical licensing short of revocation, malpractice or criminal histories, VA hospital officials have discretion to weigh the providers’ explanations and approve their hiring anyway.
The VA hospital in Muskogee, Okla., hired a psychiatrist in 2013 with multiple disciplinary actions against his Oklahoma license, including for sexual misconduct, according to internal documents obtained by USA TODAY.
Hospital officials knew about his past, but approved his hiring anyway with the condition he be closely monitored during his probation period, the documents show.
And yet the psychiatrist, Stephen Lester Greer, went on to have a sexual relationship with a VA patient and ended up pleading guilty in August to witness tampering for trying to persuade the patient to lie about it to federal investigators.
The VA hired a psychologist to work at a clinic in Lafayette, La., in 2004, despite his revealing previous felony convictions on his application, according to the internal documents, which don’t identify the provider by name. The VA didn’t run a criminal background check until a year after he started work. It showed eight arrests, including for burglary, drug dealing and reckless driving resulting in death.
Still the VA allowed him to continue practicing until two years ago. By that time, the VA had received multiple complaints about patient mistreatment by the psychologist. An internal investigation found he was a “direct threat to others, (and) to the Department’s mission.” The VA fired him earlier this year.
The VA hospital in Jackson, Miss., hired ophthalmologist Daniel K. Kim, despite his being sanctioned by licensing authorities in Georgia. During his subsequent surgeries at the VA, a World War II veteran was blinded in 2006 and he allegedly implanted the wrong lens in another patient’s eye in 2012. Kim has denied any wrongdoing, and a VA investigation suggested a nurse assisting Kim caused the blinding.
Psychiatrist David Houlihan landed a job at a VA hospital in Wisconsin in 2002 and was promoted to chief of staff two years later, even though the Iowa Board of Medicine had charged him with engaging in an inappropriate relationship with a patient and taking patient medications home.
He went on to earn the nickname “candy man” at the Tomah, Wis., VA because of the prolific amounts of narcotics he prescribed. The VA fired Houlihan in 2015 after revelations a 35-year-old veteran patient had died from mixed drug toxicity at the facility. He has denied any wrongdoing, but agreed to surrender his medical license in Wisconsin earlier this year.
Some of the VA’s policies can attract medical workers with past malpractice or licensing problems. Agency clinicians aren’t required to have malpractice insurance — the federal government pays out claims using taxpayer dollars — making the VA a good fit for providers who may have difficulties securing malpractice insurance in the private sector if past issues have rendered them too risky.
The Iowa City VA had been looking for a full-time neurosurgeon for nearly a year when Schneider came along.
In his job application, Schneider disclosed “all the issues” and the VA hired him after a “group of his medical peers thoroughly reviewed” his file and “approved his competency,” the VA said in a prepared statement provided to USA TODAY.
Schneider began work in April at an annual salary of $385,000.
Complicated surgeries
Complications soon began cropping up.
Schneider, who describes himself as a spinal specialist, performed surgery in July to remove a benign tumor from a 65-year-old patient’s brain.
Richard Joseph Hopkins survived three more brain surgeries for ensuing complications before dying Aug. 23 from infection.
“Rick was strong, he was a bull,” his sister Annette Rainsford said. “Why would you go into someone’s head four times?”
James Wehmeyer, a 77-year-old Army veteran, said Schneider performed his first spinal procedure in July. The neurosurgeon subsequently did two more operations to try and clean up infection from the first, prompting concerns something might be amiss with his treatment.
“I thought that, but I didn’t know,” he said. “I’m not a doctor.”
Wehmeyer said it’s been a month since his last surgery, and a nurse still visits him at home every three days to clean out the wound, which he said hasn’t healed.
“There’s a big hole in there they’re trying to close up,” he said.
At least three other patients suffered infections after procedures Schneider conducted at the Iowa City VA — two deep-wound and one superficial — but they were cured with antibiotics, Schneider said.
In September, Schneider was arrested on federal criminal charges of lying and trying to conceal assets in his bankruptcy case in Montana.
His patients in Iowa City showed up for surgery but had to be rescheduled when he didn’t show up for work. Schneider told his VA bosses what happened when he got back to Iowa.
He continued practicing.
Schneider, who pleaded not guilty to the charges, said in an interview that infections suffered by his VA patients were not his fault, but rather complications that can occur in neurosurgery.
He said Hopkins’ case was a “tragic” example, where he developed two brain bleeds and then fluid buildup, each requiring another surgery.
“I’ve had a great run at the VA with zero issues,” he said. “Have I had to take patients back (for surgery) for post-op infection? Yes. I mean, I can’t prevent every infection.”
One of Schneider’s patients from Wyoming said that whatever the case, the VA never should have hired him.
“Here the veterans, they went and served their country, and they’re messed up and everything,” said Michael Green, who is awaiting payment for a malpractice claim that alleged Schneider placed a screw incorrectly in his lower spine. “And then turn that guy loose on them, that’s what doesn’t make sense.
Online obituary for Richard J Hopkins. (Photo: Handout)
CBS’s SEAL Team has been mostly quiet this season regarding social issues. In its place, recent episodes have taken a deeper perspective into the lives of soldiers during and after deadly missions. This week’s episode offers the latest example with a critical look at Veterans Affairs.
The April 24 episode “Medicate and Isolate” takes a more somber look at some of the soldiers suffering from past trauma. Clay (Max Theriot) who was injured in a recent bombing attack, has been staying with former SEAL Team member Brett Swan (Tony Curran). Sadly, Brett suffers from his own war injuries and must attend an appointment with Veterans Affairs for prescriptions. While Clay has never visited a VA hospital, he’s still disheartened to see it up close.
Brett: Little different from your Rain Man suite at the military hospital.
Clay: Yeah, they definitely leave this out of those flashy recruiting videos.
Brett: This is a soldier’s reward for serving. A health care system that runs like the post office.
Actually, if it were run like the post office it might be better. The setting features overworked and understaffed members who tend to the soldiers. “My workload doesn’t offer me as much time as I’d like to review your paperwork,” the one nurse who attends to Brett says. After Brett and Clay wait all day to meet with the doctor seeking treatment for Traumatic Brain Injury, they are told he has to cancel and the next available appointment is in two months. There are places that treat mail with more dignity and efficiency than our soldiers.
While the episode makes a statement at the end insistent that “the characters and incidents in this episode are fictional and do not represent the majority of Veterans or their experience with the VA,” it’s not too lenient on it, admitting that “challenges faced by these men and women are all too real.”
Bureaucracy and indifference plague government-run health care, something we learned all too well about from the Obama VA scandal in 2014. Just like Brett, there are real soldiers who are put through an unproductive system of waiting lists, red tape and understaffed workers. Unfortunately for them, their plight isn’t always highlighted on primetime.
As Brett puts it so eloquently, “These old-timers bled on the sands of Iwo Jima to defend our right to be an inefficient nation.” Such is the description for any government-run health care: inefficient and poorly run. Keep this in mind the next time you hear someone call for “Medicare for All.”
In the end, sadly, Brett’s dismay at the results (or lack thereof) from the VA center drive him to commit suicide. Even worse, his case is not an isolated one. We deserve better, and the men and women who defend our nation deserve more.
This message is for the Mothers & Fathers of our nation’s youth. It contains graphic images of what could happen to your child returning home from our Armed Forces. It demonstrates the sad truth for your son or daughter, for you and for your loved ones that to die on the battlefield is better than returning home to this #Betrayal. My prayers go out to each member of our military forces and the horrors facing them on returning home. Robert D. Rose Jr. BSW, MEd, USMC Semper Fidelis
According to this report… CVS has decided to only allow 3 glucose test strips for Insulin dependent pts and it is being billed to Medicare Part B. Even though Medicare Part B will reimburse for 4 tests strips a day.
Express Scripts won’t cover Eli Lilly’s new generic insulin
