“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
CHICAGO (CN) – Considering whether to uphold a $1 million jury award, the Seventh Circuit heard Friday from an Indianapolis attorney who claims CVS pharmacists acted with actual malice when they told his patients he was under investigation for running a pill mill.
Dr. Anthony Mimms convinced a jury this year that CVS pharmacists defamed him by refusing to fill his patients’ prescriptions on repeated occasions at multiple pharmacies.
As a reason for their refusal, pharmacists and pharmacy techs told Mimms’ patients that he had been arrested, that he was under investigation by the Drug Enforcement Agency, or that his license had been revoked.
According to Mimms, CVS corporate employees knew that he was not under DEA investigation, and that he had only been named by a person questioned by the DEA who was later found to lack credibility.
Further, he said, CVS has a policy that explicitly told its pharmacists under no circumstances to make disparaging comments about a prescriber, such as that the prescriber is under DEA investigation, operating a pill mill, or about to lose their license – exactly the statements the pharmacists made about Mimms.
A jury found in Mimms’ favor and awarded him $1 million for damage to his reputation.
On appeal, CVS attorney Alice Morical with Hoover Hull Turner told the Seventh Circuit on Friday morning that “Mimms needed to show actual malice” on the part of the pharmacists who said the defamatory statements, but he failed to do so.
Instead, Morical said he “imputed knowledge of a corporate representative to four speakers in Indiana.”
She argued that the imputation of knowledge of Mimms’ innocence, known at CVS corporate offices, to lower level pharmacists was an error.
The verdict would expand Indiana law to criminalize an instance where “someone makes a statement and someone else in the company knows it is not true,” Morical argued.
But Mimms’ attorney, Bryan Babb with Bose McKinney & Evans, urged the Chicago-based appeals court to recognize that “there is no direct evidence, this is a difficult case.”
Babb said Mimms’ situation has important ramifications for whether a public figure – such as a federal judge – could pursue a defamation claim against a person who later denied making the statements at all, as happened with several pharmacists Mimms accused.
“Do we really want a public policy where the person can just deny making the statements and that’s the end of it?” Babb asked.
He said the pharmacists undoubtedly held ill will against Mimms, as many of his patients repeatedly came in too early to refill their prescriptions, and this ill will motivated the pharmacists to willfully and maliciously violate CVS’s non-disparagement policy.
“These folks were trained on the policy,” Babb said. “They knew when they said these things that they were false.”
He argued that the CVS policy expressly prohibiting its employees from accusing prescribers of being under investigation or running a pill mill is valid circumstantial evidence that the speaker must have spoken with malice if they intentionally violated that policy.
Without allowing this kind of circumstantial evidence, “if someone denies making a statement, how can you possibly get to their subjective state of mind?” Babb asked.
U.S. Circuit Judges Michael Kanne and Illana Rovner sat on the panel, joined by U.S. District Judge Thomas Durkin, sitting by designation from the Northern District of Illinois.
The court is expected to rule on the matter within three months.
The investigation by Missouri’s Sen. Claire McCaskill shed light Monday on the opioid industry’s ability to shape public opinion and raises questions about its role in an overdose epidemic that has claimed hundreds of thousands of American lives. Representatives of some of the drugmakers named in the report said they did not set conditions on how the money was to be spent or force the groups to advocate for their painkillers.
The report from McCaskill, ranking Democrat on the Senate’s homeland security committee, examines advocacy funding by the makers of the top five opioid painkillers by worldwide sales in 2015. Financial information the companies provided to Senate staff shows they spent more than $10 million between 2012 and 2017 to support 14 advocacy groups and affiliated doctors.
The report did not include some of the largest and most politically active manufacturers of the drugs.
The findings follow a similar investigation launched in 2012 by a bipartisan pair of senators. That effort eventually was shelved and no findings were ever released.
Bottles of Purdue Pharma L.P. OxyContin medication sit on a pharmacy shelf in Provo, Utah, on Aug. 31, 2016. George Frey / Bloomberg via Getty Images
While the new report provides only a snapshot of company activities, experts said it gives insight into how industry-funded groups fueled demand for drugs such as OxyContin and Vicodin, addictive medications that generated billions in sales despite research showing they are largely ineffective for chronic pain.
“It looks pretty damning when these groups were pushing the message about how wonderful opioids are and they were being heavily funded, in the millions of dollars, by the manufacturers of those drugs,” said Lewis Nelson, a Rutgers University doctor and opioid expert.
The findings could bolster hundreds of lawsuits that are aimed at holding opioid drugmakers responsible for helping fuel an epidemic blamed for the deaths of more than 340,000 Americans since 2000.
McCaskill’s staff asked drugmakers to turn over records of payments they made to groups and affiliated physicians, part of a broader investigation by the senator into the opioid crisis. The request was sent last year to five companies: Purdue Pharma; Insys Therapeutics; Janssen Pharmaceuticals, owned by Johnson & Johnson; Mylan; and Depomed.
Fourteen nonprofit groups, mostly representing pain patients and specialists, received nearly $9 million from the drugmakers, according to investigators. Doctors affiliated with those groups received another $1.6 million.
Most of the groups included in the probe took industry-friendly positions. That included issuing medical guidelines promoting opioids for chronic pain, lobbying to defeat or include exceptions to state limits on opioid prescribing, and criticizing landmark prescribing guidelines from the U.S. Centers for Disease Control and Prevention.
“Doctors and the public have no way of knowing the true source of this information and that’s why we have to take steps to provide transparency,” said McCaskill in an interview with The Associated Press. The senator plans to introduce legislation requiring increased disclosure about the financial relationships between drugmakers and certain advocacy groups.
Bottles of OxyContin medication sit on a pharmacy shelf. Bloomberg via Getty Images
A 2016 investigation by the AP and the Center for Public Integrity revealed how painkiller manufacturers used hundreds of lobbyists and millions in campaign contributions to fight state and federal measures aimed at stemming the tide of prescription opioids, often enlisting help from advocacy organizations.
Bob Twillman, executive director of the Academy of Integrative Pain Management, said most of the $1.3 million his group received from the five companies went to a state policy advocacy operation. But Twillman said the organization has called for non-opioid pain treatments while also asking state lawmakers for exceptions to restrictions on the length of opioid prescriptions for certain patients.
“We really don’t take direction from them about what we advocate for,” Twillman said of the industry.
The tactics highlighted in Monday’s report are at the heart of lawsuits filed by hundreds of state and local governments against the opioid industry.
The suits allege that drugmakers misled doctors and patients about the risks of opioids by enlisting “front groups” and “key opinion leaders” who oversold the drugs’ benefits and encouraged overprescribing. In the legal claims, the governments seek money and changes to how the industry operates, including an end to the use of outside groups to push their drugs.
U.S. deaths linked to opioids have quadrupled since 2000 to roughly 42,000 in 2016. Although initially driven by prescription drugs, most opioid deaths now involve illicit drugs, including heroin and fentanyl.
Purdue Pharma, the maker of OxyContin, contributed the most to the groups, funneling $4.7 million to organizations and physicians from 2012 through last year.
In a statement, the company did not address whether it was trying to influence the positions of the groups it supported, but said it does help organizations “that are interested in helping patients receive appropriate care.” On Friday, Purdue announced it would no longer market OxyContin to doctors.
Insys Therapeutics, a company recently targeted by federal prosecutors, provided more than $3.5 million to interest groups and physicians, according to McCaskill’s report. Last year, the company’s founder was indicted for allegedly offering bribes to doctors to write prescriptions for the company’s spray-based fentanyl medication.
A company spokesman declined to comment.
Insys contributed $2.5 million last year to a U.S. Pain Foundation program to pay for pain drugs for cancer patients.
“The question was: Do we make these people suffer, or do we work with this company that has a terrible name?” said U.S. Pain founder Paul Gileno, explaining why his organization sought the money.
Depomed, Janssen and Mylan contributed $1.4 million, $650,000 and $26,000 in payments, respectively. Janssen told the AP the company acted responsibly; Mylan objected to being included because of its “minuscule role” in opioid sales and marketing; while calls and emails to Depomed were not returned.
Senator McCaskill doesn’t have to run for reelection until 2022… her position on this … the voters will have forgotten about this by Nov 2022. One study suggested that 90% of the families with a chronic pain pt is struggling financially either because one spouse can’t work and/or the cost of therapy. Less than ONE MILLION DOLLARS to a dozen different pain advocacy groups… McCaskill is part of Congress with 535 members who the lobbyist industry spend 9+ million EACH DAY to INFLUENCE those 535 members. HYPOCRITE seems so inadequate for the mindset of Senator McCaskill and other like her
For many people, the face of the opioid crisis in this country is the scene of a drugged-out mother and father passed out on a couch with a little child forlornly looking at them. It is a heartbreaking image of a family being destroyed by addiction, and of young lives being shattered.
But the opioid crisis has another face, too, as we were reminded this week on the front page of this newspaper. That is the face of a woman who could be your friend, your neighbor or a family member, sitting calmly on a couch and talking about being cut off from the pain medications that make her life tolerable. Another heartbreaking image.
Opioids are a scourge. They have ensnared millions of people into addiction, and 64,000 Americans lost their lives to overdoses in 2016 alone. Greedy drugmakers and clueless doctors flooded our nation with poison.
Opioids are a salvation as well. For millions more, the drugs offer relief from chronic, incapacitating pain, and have given many people a chance at a better life.
This country has such a tangled, twisted relationship with drugs and drug abuse. We seem to lurch from one overreaction to another as we grapple with our drug problems.
Drugs go from miraculous to the epitome of evil, one after another. Marijuana, cocaine, morphine, heroin: all hailed, all condemned, most outlawed as dangerous. The opioids were just a continuation of this process.
In 1996, a drug manufacturer called Purdue Pharma introduced OxyContin. Mother Jones magazine said it debuted with the most aggressive marketing campaign in pharmaceutical history, downplaying its potential addictiveness.
At the same time, doctors were being pushed by pain management specialists to assess the pain of every patient they saw, and to treat pain more readily.
The American Journal of Public Health, in a 2016 article tracing the origins of the opioid epidemic, reported:
“The dimensions of the problem were and are immense. An estimated 25 million adult Americans, according to the most recent data, suffer daily from pain, and 23 million others suffer from severe recurrent pain, resulting in disability, loss of work productivity, loss of quality of life, and reduced overall health status.”
Researchers were telling doctors that pain management was an important aspect of patient care. Drug companies were promoting new opioids as a safe method of pain management. It is no wonder that the number of opioid prescriptions exploded.
But everything started to go wrong in short order. Again, from the Journal of Public Health:
“Purdue advertised Oxycontin as nonaddictive because the drug was released within the body over 12 hours; recreational users quickly learned to get high by crushing or dissolving the pills, or simply taking very high doses. Overstressed and well-intentioned general practitioners, and a number of unscrupulous ‘pill mill’ operators, wrote liberal prescriptions for the new analgesic. The ready supply of Oxycontin made diversion and sale, particularly by low-income patients on Medicaid or Medicare, attractive and easy; but when pill addicts found their drug too expensive, they sought an alternative.”
That alternative was heroin. As one addict said, Oxycontin cost $40 a pill, but he could get the same effect for $10 from heroin.
Drug overdose deaths increased 137 percent from 200 to 2014, and non-fatal overdose went up 200 percent. States in the West, Midwest and Appalachia were hit especially hard.
As the extent and depth of the problem began to sink in, the opioid backlash was underway.
In 2016, the federal Centers for Disease Control and Prevention issued new guidelines for prescribing opioids “as part of the urgent response to the epidemic of overdose deaths.” The guidelines urged primary care providers not to consider opioids as a “first-line or routine therapy” for chronic pain.
Terrified by the ways in which opioids had come to be abused and by the resulting wave of death, doctors, pharmacies and insurance companies quickly began changing their accepted practices.
A seven-day supply for new prescriptions, limits on daily dosage and other restrictions are now the industry standard for many pharmacies and health insurance companies. Patients are required to renew prescriptions within weeks instead of months.
But where does that leave the patients with chronic pain?
According to local patients interviewed by News-Post reporter Kate Masters, it is leaving them in limbo, and worried about what the future might hold.
They are finding it increasingly difficult to get the medicine they need and are encountering more hassles and roadblocks.
Terri Boettcher, of Middletown, said she and many others feel stigmatized. Restrictions by insurance companies and pharmacies are hurting patients’ ability to receive customized care.
After being injured in 2000, she tried several medications, surgery, steroid injections, physical therapy, acupuncture and more, all trying to manage the pain from a herniated disc.
Eventually, she and her doctor settled on a daily dose of oxycodone. However, under the new rules, her prescription has been reduced from a 60-day supply to a 20-day supply.
“I’ve had less pain relief because I’m trying to take less medication to make it last longer,” she told our reporter.
Her fear is that even more restrictions might result in her being denied continuous use of opioids completely.
Pain management specialists and their patients are groping for a way forward that does not endanger their health while helping to battle the huge societal problems caused by abuse of the drugs.
Dr. Paul Christo, a pain specialist and associate professor at the Johns Hopkins University School of Medicine, told our reporter that long-term pain management patients are not among those who are likely to abuse narcotic painkillers. Most have extremely high levels of discomfort and are too worried about being cut off from their medication to abuse or divert it, he said.
These specialists need the support of the insurance companies and national pharmacies to continue treating patients with chronic pain in the ways that are most effective. They need to be heard at the CDC as the rules on pain management evolve.
The broad-brush rules deployed to fight the opioid crisis in 2016 might have to be revised and narrowed so that doctors specializing in the treatment of pain have more freedom than primary care doctors do.
This is the only fair way to help those patients devastated by chronic pain.
The current attempts by a number of parties to castigate and humiliate pain patients and their medical practitioners is not just pathetic and mostly false, it is dangerous to the fate and life of many intractable pain (IP) patients. If it wasn’t so serious, some of the claims, biases and beliefs would make good comedy.
First and foremost there has been no discussion about the difference between intractable pain and chronic pain. There really is no bigger issue.
The proper identification and treatment of the IP patient is not only essential for the health and well-being of the IP patient, it is a major key to the prevention of overdoses and diversion of abusable drugs. IP patients must have special care and monitoring.
The basic definition of IP is a “moderate to severe, constant pain that has no known cure and requires daily medical treatment.”
Chronic pain, on the other hand is a “mild to moderate, intermittent, recurring pain that does not require daily medical treatment.” While there are millions of persons with chronic pain, only about 10% are intractable.
The cause of “intractability” is two-fold:
The initial injury or disease which initiated IP was severe enough to cause a pathologic transformation of the microglial cells in the spinal cord and/or brain. It is this transformation that produces neuroinflammation and the constancy of the pain. This process is known as “centralization” or “central sensitivity.”
To have enough injury to cause “centralization” one must have a most serious disease or condition of which the most common are: adhesive arachnoiditis, traumatic brain injury, reflex sympathetic dystrophy, post-viral encephalopathy, or a genetic disease such as Ehlers-Danlos Syndrome, porphyria, or sickle cell disease.
Medical practitioners must have minimally-restricted prescribing authority and autonomy to adequately treat IP. For example, the proper treatment of IP not only requires analgesics, opioids and non-opioid, but specific anti-inflammatory, hormonal, and corticosteroid agents that will cross the blood brain barrier and control inflamed and pathologic microglial cells. Treatment of IP has to be individually tailored and may require non-standard, off-label, or an unusual treatment regimen.
Make no mistake about it. The new treatment approach to IP is quite effective in reducing pain, controlling neuroinflammation, and allowing patients to biologically function well enough to have a good quality of life. Also be advised that the new IP approach is not just reducing pain but treating the underlying cause of pain. Consequently, a lot of expensive procedures, therapies, and opioids are no longer needed.
As long as I am practicing I will continue to push forward this new approach.
Dr. Tennant specializes in the research and treatment of intractable pain at the Veract Intractable Pain Clinic in West Covina, California, which remains in operation after recently being raided by DEA agents. Many of Dr. Tennant’s patients travel from out-of-state because they are unable to find effective treatment elsewhere.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.
As part of its FY19 budget request, the agency is looking into how to leverage PDMPs to track prescribing histories, as well as reporting suspected abuse to the DEA.
President Trump’s proposed FY19 budget for the U.S. Department of Health and Human Services stresses the need for the agency to make the opioid crisis a top priority.
While HHS’ budget would be slashed by 21 percent, Trump would give the agency $10 billion in new discretionary funding for both the opioid epidemic and mental illness. To accomplish this, HHS wants to track high prescribers and utilizers of prescription drugs within Medicaid.
HHS Secretary Alex Azar told the House Energy and Commerce Subcommittee on Health that the agency would “require states to monitor high-risk billing activity to
identify and remediate abnormal prescribing and utilization patterns that may indicate abuse in the Medicaid system.”
HHS could leverage data from the Centers for Medicare and Medicaid Services to help “identify a practitioner who is writing an inordinate number of prescriptions,” Rep. Michael Burgess, MD, R-Texas, told Azar.
And those trends could be easy to spot within those databases.
In addition to leveraging Medicaid data, HHS could potentially look to state PDMP data to identify bad actors, Azar testified. The agency could also use its “authority to make sure that whenever we exclude a provider, it will automatically lead to transmission of that information [to the Drug Enforcement Administration].”
The DEA would have the authority to yank a provider’s ability to prescribe controlled substances, Azar said.
Further, PDMPs are already helping states track opioid prescriptions, as they flag patients with suspicious prescribing history, said Azar. But as part of the HHS budget proposal, the agency asks Congress to “require states have effective programs for this type of risk identification.”
At the moment, all states except Missouri currently have PDMPs in place, with varying degrees of use. After Trump declared the opioid crisis a public health emergency, many states have sought changes to laws to increase PDMP efforts and data sharing among states.
While Azar supports the continued interoperability efforts between state PDMPs, “there is a resource and burden question about forcing that interoperability to be nationwide.” Azar told the committee data sharing between bordering states might be more realistic.
The committee also noted that past PDMP efforts by federal agencies to integrate data within EHRs had slowed five years ago. The effort, Burgess told Azar, is “one of the opportunities to reduce the burden on practicing physicians is a way to seamlessly integrate” EHR and PDMP databases.
However, there are states currently sharing data between PDMPs. Just last week, North Carolina became the 46th state to sign onto the PDMP data sharing collective, which is designed to give providers the full prescribing history of patients across state lines.
There is an estimated 20 -30 million pts dealing with moderate-severe intractable chronic pain. There is no known records how many of these same pts are or would test (CYP-450) as high/ultra opiate metabolizers and would require higher than “normal doses”. If HHS/DEA is utilizing databases to come to a “maybe probably cause” and take action on this “maybe”… based on some arbitrary MME dose that anything above is considered abnormal… have they just thrown DUE PROCESS – out the window ?
Wouldn’t we expect many/most of these 20-30 million will be caught in that dragnet along with their prescribers ?
Are we quickly sinking to the point where healthcare and how much a pt is entitled to is being dictated by and driven by DATA that has nothing to do with the evaluation of the needs of individual pts ?
LITTLE ROCK, Ark. (KTHV) — The opioid epidemic is putting a major strain on aspects of the criminal justice system you may not expect.
Last week we told you that a high number of cases is causing a backlog at the Arkansas State Crime Lab.
State coroners, also feeling the heat, are working to ensure each coroner is equipped with what they need to help combat the crisis.
Last year nearly 300 people in Arkansas died of an opioid overdose. While that number may be jarring, it is likely not even close to the reality.
Coroners often determine the cause of death, which is reported to state officials.
Many coroners in our state are so inundated by the epidemic, or uneducated about it, they likely aren’t properly recording the numbers.
“We are busier than I think we have ever been,” Kevin Cleghorn, President of the Arkansas Coroner’s Association said Thursday, Feb. 15. Explaining the opioid epidemic has put a major strain on Arkansas’ coroners. “It’s taxing. So, therefore, a lot of these cases go unnoticed.”
The issue with cases going unnoticed, or unreported, is that death certificates, signed by the coroner, are collected by the Arkansas Department of Health and are then used to portray the epidemic our state is facing.
If coroners aren’t properly documenting the deaths, that affects funding the state needs to combat the epidemic.
The National Medical Examiner’s Association and the State Coroner’s Association both recommend that all bodies of people believed to have died of a drug overdose be brought to the State Crime Lab for an autopsy. But if you live in Little River County, or even as close as Hot Spring County, it can be very difficult to do so.
“A lot of our counties do not have ways to transport, they do not have means to store a body,” Cleghorn said.
“They do not have means to do full investigations simply because the funding is not there.”
Coroners in Arkansas are elected officials. They are not required to have a medical or investigative background.
And are not required to send bodies to the crime lab if the family or others ask them not to. Which could also explain why some deaths go unreported.
“I don’t necessarily like the good ole’ boy system, but I don’t know if it will ever go away,” Cleghorn said but assured us the Coroner’s Association is working hard to educate coroners on the opioid epidemic and their impact. One way of doing so is by offering classes across the State, to make things easier on participants. “I don’t know why someone if we are offering free classes, why they will not come and be a part of that. When it does nothing but make them better.”
Cleghorn says the public can help simply by checking in with County Coroners to see if they are attending training and submitting bodies to the crime lab.
Remember, these are elected officials.
Are coroners being ENCOURAGED in order to GET MORE FUNDING by declaring more deaths OPIATE RELATED DEATHS ?
hi, I take Oxycodone,( its workers comp), live in xxxx seeing a Dr. for pain, have 2really bad knees,. he’s more of a family Dr, an is willing to help me. the question is, the manager there, said I have to see the Dr,same day as I get my pills filled. t never had to do that before… that he can only see me no more than 5 days before script is filled..,she said its a law …I know other people on opioid, they get their scripts a week ahead of time, the one , gets predated scripts, for opioid… my question is this .. is it a workers comp rule now? I think the girl does not know too much about workers comp, I’m looking for somewhere else, its really hard here to find a pain Dr. they’ve shut alot down. the , one I went to b 4 was raided, they had own pharmacy, they were great, got quality pills, my husband takes pain pills,, he asked a pharmacist,,about how many days for filling scripts.he said,,, the script has to be filled in 14 days. I have been on workers comp for 18 years, , one more question, my husband is on 40 mg of Oxycontin , the 12 hr.. do you know did they change it? he notices a difference, my husband said something is wrong with them,not working for him, at first they were working . no problems, after that no relief.., and hasn’t been working since. he had drug test,, metabolites were 6100 ,, after he noticed no relief, he paid for a drug test. and the metabolites were, 1300..that’s a big difference, my metabolites are higher than his. he didn’t do anything different,,.. think the Dr,& insurance company and Purdue are doing something,to them. Dr. not saying anything.when he talked to him, I think he needs to get off those, and take short acting, he has spinal problems, appreciate you listening, an any help we would appreciate. thank you
It is often the case where front office staff make up their own set of rules and the prescriber has no idea of what is going on. He/she is focused on treating pts. Pts who run into such situations it is best that they discuss their concerns with the prescriber.
Sometimes front office staff self-appoint themselves as the “dictator” of their own “little fiefdom”.
I am sure that these “little dictator’s” world is not made up of perfect circles and perfectly smooth roads… they are never too sick to get out of bed, their cars never breakdown, Mother Nature never puts obstacles in their way.. like the rest of us in the real world.
Anytime someone tells you that they must or can’t do something because “it is the law”.. just ask for a copy of the law and/or statue number – so you can look it up on the web – if they can’t/won’t is because the law doesn’t exist and they have establish this “law” as their office policy… which they can do.
Metabolites from medication is never going to be a constant… more like a bell curve from the time you take it until the next dose is due… The body is in constant flux… a test is just a “moment in time”… just take your driver’s license out and look at your picture on it… that is a snap shot in time.. does it do a good job of representing you ?
People who are put on pain meds – and gets good results – they tend to increase their activity… and end up being in pain from activity induced pain… there is also aging, deterioration of the condition causing the pain and MAYBE a little bit of tolerance.
Officials at the District’s only public hospital were unable to show that they promptly assessed a patient who repeatedly cried out that he couldn’t breathe, an investigation by the D.C. Department of Health has found.
The investigation also determined that the hospital’s initial report of the incident to regulators was not accurate.
The probe, made public this week, found multiple shortcomings in the care provided at United Medical Center’s nursing home to Warren Webb, who died of a heart attack at the facility in August.
Before his death, Webb called for help, fell out of his bed and was left on the floor for an extended period.
Inspectors concluded there was “no evidence that facility staff assessed [Webb] after he/she complained of not being able to breathe” and said hospital officials omitted key details about Webb’s death from an incident report they filed with the health department.
That report, among other things, left out the fact that Webb died and contained what one hospital employee told investigators was a false account of Webb being told at the incident’s conclusion to “wait for staff before attempting to get out of bed by himself.”
Regulators also found that the UMC nursing home did not have an instrument prepared to measure patients’ blood sugar in emergencies.
The Post obtained audio of a United Medical Center patient calling for help while laying on the floor in a dirty diaper. The patient died shortly after.(The Washington Post)
The health department began its probe in response to The Washington Post’s reporting on the circumstances surrounding Webb’s death.
Based on an audio recording of the incident and interviews with three eyewitnesses, The Post reported in October that Webb, despite crying out at least 25 times, was left on the floor for approximately 20 minutes by his charge nurse, Christiana Ekwue.
When Webb, 47, was finally lifted back into bed, his nurses were unable to find a pulse. He was transferred on a stretcher from the hospital’s 7th floor to its emergency room and was pronounced dead just after 6 a.m. on Aug. 25.
It is unclear what consequences, if any, hospital employees or managers could face as a result of the health department’s findings.
A UMC spokeswoman did not immediately respond to requests for comment.
Ekwue did not return calls for comment.
Tujuana Bigelow, right, in front of an image of her son, Warren Webb, who may have died as a result of medical errors at the United Medical Center Nursing home. (Michael Robinson Chavez/The Washington Post)
In a corrective plan submitted in response to the investigation,
UMC officials said two employees were “disciplined” as a result of the hospital’s internal investigation of the incident, but provided no further details.
The plan also said the nursing home’s staff were being retrained on “respiratory assessments, treatments and documentation” and that unit managers are now required to conduct hourly rounds to monitor the condition of nursing home residents.
The plan states that medical staff would be trained on “accurate completion of incident reports” and requirements for notifying the health department of events within the hospital. All incident reports being sent to regulators are also now being reviewed by the nursing home administrator, hospital officials said.
Webb’s death came at a critical moment for UMC, as the hospital was under scrutiny for dangerous medical errors that led regulators to shut down its obstetrics ward in early August. Concerns about patient safety and mismanagement ultimately led the D.C. Council to vote in November against renewing a lucrative contract for Veritas of Washington, the consulting firm hired by the city to run the hospital.
This week, the hospital’s former chief medical officer filed a whistleblower lawsuit asserting that he was fired for testifying before the council about problems at UMC.
The health department’s investigation sheds light on at least one key question about Webb’s death: whether his nurses immediately assessed him when he first called out for help. Medical experts place a heavy emphasis on prompt assessments — including measurements of heart rate, respiration rate, blood pressure and blood-oxygen saturation — for patients who complain of shortness of breath.
Investigators found no documentation or other evidence that such an assessment took place for Webb until he was lifted back into bed after 20 minutes on the floor.
The report also raises questions about the hospital’s initial, inaccurate statements to the health department concerning Webb.
In testimony before the D.C. Council’s health committee in October, top hospital officials said that they had performed “an exhaustive review” of Webb’s case and reported it to the appropriate regulatory authorities.
However, the health department’s inspection found that the report on Webb was incomplete and that the hospital did not file another report — required whenever a nursing home resident is taken to the emergency room — until 11 days after Webb’s death. D.C. law requires that such reports be filed within 48 hours.
An unnamed hospital worker identified as “the person who reviews all incident reports for completeness and correctness” acknowledged errors in the incident report to health department investigators, saying it “should have contained the facts that the resident became unresponsive, CPR was started and that the resident was sent to the ER.”
The employee also said the statement about Webb being encouraged to ask for help when trying to get out of bed “is not right” and “should have been amended.”
When asked by investigators why the false statement about Webb was included, the hospital employee who originally typed up the report said, “I don’t know why I did that.”
(CN) – A group of HIV-positive plaintiffs filed a class action lawsuit against pharmacy giant CVS and its subsidiaries in federal court Friday, claiming that the company’s pharmacy insurance plan violated their privacy by forcing them to purchase HIV/AIDS medication at CVS retail stores or have them mailed to their homes.
The lawsuit, filed by four John Doe plaintiffs in the Northern District of California, claims that CVS Caremark stopped covering their prescription costs at out-of network pharmacies, along with other restrictions. As a result, the plaintiffs have had to compromise their privacy, according to the lawsuit. A similar lawsuit was filed in the Central District of California the same day.
According to one of the plaintiffs, he was forced to accept the program because he was running low on his month’s supply of medications, which would have cost him more than $2,000 out-of-pocket if he purchased it at his local pharmacy.
“I received no written notice to prepare for this impending policy change,” John Doe One said in the lawsuit. “I had to scramble into action since I only had a seven-day supply remaining.”
He purchased a three-month supply to be delivered to his home, only to discover that the delivery came during the day while he was at work, “baking in the afternoon sun.” Storage at high temperatures can degrade the medications, the lawsuit states. Additionally, the medications were left out for his neighbors to see, risking both his privacy and possible theft.
After that, John Doe One decided to pick up his medications at a CVS store instead. Whereas his local pharmacy had accurate records of the medications he takes, the lawsuit said the CVS pharmacist had no such information. Additionally, the medications are filled at a remote location and not at the pharmacy. Plaintiffs are asked to go to the CVS pharmacy to pick up the shipment.
“CVS Caremark does not have a full and accurate record of all of the medications JOHN DOE ONE is taking and cannot anticipate or warn against potential adverse drug interactions, which are common with HIV/AIDS Medications,” the lawsuit states.
According to the lawsuit, the company incentivizes employers to enroll their employees in the program, and names Amtrak as a defendant. Additionally, the lawsuit states that the plaintiffs have concern over their privacy when picking up medications at the stores.
“At my retail specialty pharmacy, they have a little alcove for privacy,” John Doe Two said in the lawsuit. “I can take my medications out and match it with a list I have of all my drugs. I can meet with my pharmacist and explain any changes I have felt and ask any questions I have. At CVS, I am within hearing distance of everyone waiting in line, including many people who do not have HIV/AIDS. I can hear other patients’ questions and the pharmacists’ answer. I am concerned with other people finding out about my HIV positive status.”
The plaintiffs say they’ve been forced to stick with the program because they can’t afford the out-of-pocket expenses for the medications. When asked if they could opt-out of the CVS Caremark program, they were either denied or ignored, according to the lawsuit.
One of the plaintiffs called CVS Caremark “more than 20 times” to try to opt-out, but was denied.
The lawsuit said that by forcing HIV/AIDS patients to purchase their medications through CVS pharmacies, the company “effectively reduces the quality of prescription drug care provided to Class Members, and thus a reduction or elimination of benefits, by forcing enrollees to only obtain such medications through their sister co-conspirator and wholly-owned subsidiary.”
According to the lawsuit, CVS Caremark’s business practices specifically target HIV/AIDS patients.
“The Program denies HIV/AIDS patients full and equal access to utilize the in-network pharmacies and method of delivery of their choice specifically because of the medications attributable to their illness, while at the same time permitting other enrollees to enjoy full access to the pharmacies of their choice,” the lawsuit states.
The plaintiffs are represented by Alan Mansfield of Whatley Kallas LLP. Calls made to Mansfield and CVS Caremark were not immediately returned.
