“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
Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief
More than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care, according to a major investigation.
Poor people cannot get pain relief in many countries of the world because their needs are overlooked or the authorities are so worried about the potential illicit use of addictive opioids that they will not allow their importation.
In Haiti, for instance, says the report, there are no nursing homes or hospices for the dying and most have to suffer without pain relief at home.
“Patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen,” says testimony from Antonia P Eyssallenne of the University of Miami School of Medicine. “Moreover, nurses are uncomfortable giving high doses of narcotics even if ordered to do so for fear of being “responsible” for the patient’s death, even if the patient is terminal.
“Death in Haiti is cruel, raw, and devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor.”
A doctor in Kerala, India, which has a palliative care service, told of the arrival of a man in agony from lung cancer. “We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible,” said Dr M R Rajagopal.
But when he returned, morphine stocks were out. “Mr S told us with outward calm, ‘I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree’. He pointed to the window. I believed he meant what he said.”
The commission’s three-year inquiry found that nearly half of all deaths globally – 25.5 million a year – involve serious suffering for want of pain relief and palliative care. A further 35.5 million people live with chronic pain and distress. Of the 61 million total, 5.3 million are children. More than 80% of the suffering takes place in low and middle-income countries.
Jim Yong Kim, president of the World Bank, said things had to change. “Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of these child deaths are from avoidable causes. We can and will change both these dire situations.”
Morphine is hard to obtain in some countries and virtually unobtainable in others. Mexico meets 36% of its need, China meets 16%, India 4% and Nigeria 0.2%. In some of the world’s poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually non-existent.
Oral and injectable morphine is out of patent, but costs vary widely and it is cheaper in affluent countries like the USA than in poor countries. A second issue is “opiophobia” – the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community.
“The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain,” says Professor Felicia Knaul, co-chair of the commission from the University of Miami, calling it “one of the world’s most striking injustices”.
Knaul says she only realised that many people suffered without pain relief when she was working to improve access to cancer treatment in low-income countries. “I was shocked. I had no idea. When people were showing me the data I thought it can’t be in this world,” she told the Guardian.
She had also experienced the need for morphine herself after a mastectomy for breast cancer. “When I woke up I couldn’t breathe because the pain was so bad. If they hadn’t arrived with the morphine I don’t know how I would have got through it.” And as a young girl in Mexico, she had to watch her father suffer as he died without pain relief.
“I don’t think that we have cared enough about poor people who have pain,” she said. “It doesn’t make them live any longer. It doesn’t make them more productive. It is simply the human right of not suffering any more pain and we don’t care about that for people who are poor.”
The commission recommends that all countries put in place a relatively inexpensive package of effective palliative care for end of life conditions that cause suffering, including HIV, cancers, heart disease, injuries and dementia.
One of their most emphatic recommendations, says Knaul, “is that immediate-release, off-patent, morphine that can cost just pennies should be made available in both oral and injectable formulations for any patient with medical need. The disparity and access abyss between the haves and have-nots is a medical, public health and moral injustice that can be effectively addressed by the commission’s recommendations.”
GAINESVILLE, Fla. (WGFL) — A Gainesville doctor seen yelling at a patient on a now-viral video responded with his own accusations Wednesday, saying the woman threatened his staff and refused to leave prior to the moment that was published on Facebook.
Jessica Stipe posted the one-minute video on her Facebook page after she said the doctor yelled at her when she complained she had been waiting at the Gainesville After Hours clinic for an hour and 15 minutes. Stipe told CBS 4 Gainesville she called Gainesville Police after the doctor grabbed her daughter’s phone and “shoved her” when she tried to get it back.
Dr. Peter Gallogly released a statement, the police report and statements from staff on Wednesday. The police report says the officer who responded to the clinic watched the video and had no reason to believe Gallogly struck or pushed Stipe’s daughter.
Gallogly says in his one-page statement: “Ms. Stipe had been increasingly belligerent and abusive to the office staff, cursing and threatening them with violence, because she was unwell and had been waiting to see me for more than an hour.” He wrote that she received her refund but refused to leave. “I went to the front desk only because after Ms. Stipe received her refund, she refused to leave the office, and continued her abusive behavior towards staff. Despite repeated requests from the office staff, she repeatedly demanded to see me instead of leaving.”
Gallogly said the video is heavily edited and taken out of context. “When I walked into the waiting room, Ms. Stipe (and her daughter) cursed and threatened me as they had done with the office staff previously.”
Stipe on Wednesday called Gallogly’s statements “absolutely not true.”
“What you saw is what it was,” Stipe said. “This is just ridiculous.”
She questioned why Gallogly took the phone and attempted to delete the video if he had done nothing wrong.
Gallogly acknowledged his actions shown on the video were inappropriate.
“At the very end of the events, I most regrettably lost my temper, and spoke to the two women in a most unprofessional manner. I make no excuses for my unacceptable behavior,” Gallogly wrote.
He wrote that he was “merely reacting to unreasonable provocations and threats of physical violence” and “Again, while not an excuse for my behavior, a basic reason for my reaction is that I simply regard my staff as family, and I over-reacted to defend them.”
In her initial post, Stipe wrote she was “severely sick” and had made a 6:30 appointment at the clinic. By 7:45, she said doctors had only taken a urine test and she was throwing up in a trash can. That’s when, she said, she asked for her co-pay back so she could go home and be seen somewhere else the next day.
Video%20provided%20by%20Jessica%20Stipe.%7B %7D
The video starts with Stipe telling Gallogly that it would be helpful for staff to tell patients if they’re not going to be seen in a timely manner.
“Are you kidding me?” Gallogly said on video. “Do you know how many people … I’ve got seven rooms back there. It’s 7:45 and we’ve already been working on you. We’ve done a urine test on you, I’ve seen you.”
She tells the doctor that they’ve only done the urine test. He asked if she thought that only took three seconds. She says she doesn’t know how long that takes. He asks if she wants to be seen or not. She says she wants to go home and get in bed.
“Then fine,” Gallogly tells her on video. “Get the hell out. Get your money and get the hell out.”
The doctor says she’d be waiting three hours if she went to another clinic, nine hours if she went to the ER.
The daughter recording the exchange can be heard saying “OK, you can get out of her face.”
The doctor tells Stipe, “Get the f*** out of my office. Now.”
Both Stipe and her daughter tell him she’s recording. The doctor holds the door open for them to leave. When the daughter asks his name, he says, “You’re recording this?” and appears to grab the phone and walk down the hallway with it.
Stipe told CBS 4 she believes he attempted to delete the video and then threw the phone back at her.
Stipe said she has contacted an attorney to demand accountability for his behavior.
“My ultimate goal here is that he needs to be looked at, he needs to be investigated and I don’t want anybody else in my community or any other community to receive that type of care or behavior towards them. It’s just not OK.
In the six years since the federal government asked pharmaceutical companies to reformulate prescription opioids so patients couldn’t use them illicitly, Thomas Andrew, the chief medical examiner of New Hampshire, has seen his caseload skyrocket.
“It’s almost as if the Visigoths are at the gates, and the gates are starting to crumble,” Andrew told The New York Times’ Katharine Seelye. “I’m not an alarmist by nature, but this is not overhyped. It has completely overwhelmed us.”
And he’s not alone:
Some medical examiners, especially in hard-hit Ohio, have had to store their corpses in cold-storage trailers in their parking lots. In Manatee County, Fla., Dr. Russell Vega, the chief medical examiner, said that when he reaches “overflow” conditions, he relies on a private body transport service to store the bodies elsewhere until his office can catch up.
In Milwaukee, Dr. Brian L. Peterson, the chief medical examiner, said that apart from the “tsunami” of bodies — his autopsy volume is up 12 percent from last year — the national drug crisis has led to staff burnout, drained budgets and threats to the accreditation of many offices because they have to perform more autopsies than industry standards allow.
Andrew is leaving his job to enter a seminary. Meanwhile, the medical examiner’s office in New Hampshire risks losing accreditation due to a National Association of Medical Examiners rule that says individual examiners may perform no more than 250 autopsies per year. We don’t have enough places to store the bodies of overdose victims, nor enough people to cut them open.
We can thank bad policy for this carnage. The Centers for Disease Control have released preliminary data that show fentanyl-related deaths roughly doubled in 2016:
Courtesy of the CDC
That brown line denotes the fentanyl class of drugs (conventional prescription opioids are the blue line, which has ticked up slightly but remains within historical range). Deaths involving fentanyl, which is more potent per milligram than more commonly prescribed opioids, doubled over the last year, from 10,000 in 2015 to 21,000 in 2016. Here are the actual numbers:
Courtesy of the CDC
The category of natural and semi-synthetic opioids includes morphine, codeine, oxycodone, hydrocodone, hydromorphone, and oxymorphone. Those deaths increased, too, but nearly as much as the category that includes fentanyl. The fact that cocaine deaths increased as much as they did flummoxes me, but it perhaps shouldn’t considering anecdotes from the northeastern U.S. about coke laced with fentanyl.
Why are so many more people using—and dying from—fentanyl? Because in 2010, the federal government began demanding that pharmaceutical companies create tamper-proof formulations. In more recent years, both the federal government and state governments have discouraged doctors from prescribing opioids for acute pain.
Combined, these actions greatly reduced the volume of prescription opioids available for non-medical use. But state actors did very little in conjunction with those policies to address the existing population of non-medical users, beyond locking up more people and modestly increasing the number of patients doctors can treat with buprenorphine and methadone.
That carelessness created a massive arbitrage opportunity for black market operators and introduced fentanyl into the American drugscape. The U.S. could not have planned a more effective epidemic.
My husband, Dr. Chris Christensen, is a Family Physician (MD) with 40+ years of broad spectrum primary care practice, most recently to the un(der)insured in rural Montana. He has been forced out of practice for several years, and now faces prosecution at a state level (the first case ever in Montana) for “overprescribing opioids” to chronic pain patients. This is ‘part and parcel’ of an overall effort to force physicians to give their first priority in health care decision making to the policies of the Federal bureaucracies and third party payors, rather than focusing their commitment on the care of the individual patient, who has entrusted their health and wellbeing to a physician of their choosing.
The case is scheduled in District Court of Ravalli County from Thursday, October 19 to November 17, 2017 with the exception of Wednesdays.
It is painful to witness him being tried in an extremely biased fashion in the media. Dr. Chris is a caring man and healer, and a loving husband and father. He treated patients, young and old, for a variety of ailments, not just chronic pain. He is an upstanding citizen, and in no way a criminal. I pray, with the assistance of an outstanding legal team, and God watching over us, that we can prove just that to a jury of his peers.
Overdoses from opioids have captured the national spotlight. And rightly so — they kill nearly 30,000 Americans a year and cause more than 1 million hospitalizations. Another overdose issue is playing outside their shadow: the misuse of over-the-counter pain medicines like acetaminophen, aspirin, ibuprofen, naproxen, and others.
These widely used “safe” medications can cause serious gastrointestinal bleeding; create stomach ulcers; damage the esophagus, intestine, and liver; and even kill. In the United States, misuse of these medications sends nearly 200,000 people to the hospital each year.
Roughly 8 in 10 Americans routinely reach for over-the-counter pain pills to relieve headaches, backaches, sore muscles, fevers, or colds. Most are unaware that these medications can be just as dangerous as prescription drugs if used incorrectly. As a gastroenterologist, I often see patients who have overdosed on over-the-counter pain medicines. I’m not alone: A national poll by the American Gastroenterological Association found that my colleagues and I see on average nearly two patients per week with complications from over-the-counter pain pills.
Many of those people were confident they could manage their pain or discomfort on their own with over-the-counter medication. Yet the same poll found that 39 percent of Americans knowingly took more than the recommended dosage. In most cases, they falsely believed that taking more medicine than what was indicated on the label would help them “feel better faster.”
Many Americans think about safety — we click our seat belts, strap on bike helmets, make sure the smoke detector has fresh batteries, and protect our computers from viruses. Yet many people are routinely endangering themselves by not carefully reading and following the instructions when taking acetaminophen, aspirin, ibuprofen, naproxen, and other over-the-counter pain medications.
This potentially harmful practice is relatively easy to fix. Consumers should take a minute to read the labels of their over-the-counter pain medicines. It will list the active ingredient and what to know about it, how much and how often to take the medication, what the side effects might be, and when to talk to a doctor. Few patients who overdose on over-the-counter pain medications connect their symptoms to these medications. Many wait too long to seek care; by then the damage is hard to undo.
Doctors, pharmacists, and other health care professionals can play their part, too, by asking their patients if they are taking any over-the-counter medicines and if these are the right medications for them.
To help improve the conversation on over-the-counter pain medications, the American Gastroenterological Association created Gut Check: Know Your Medicine, an educational campaign to encourage individuals to safely use over-the-counter pain medicines.
Patients and their doctors would benefit greatly by talking openly about the careful use of over-the-counter pain medications, to make sure these ubiquitous drugs bring needed relief instead of more pain.
Charles Melbern Wilcox, M.D., is professor of medicine in the division of gastroenterology and hepatology at the University of Alabama at Birmingham and a chair of Gut Check: Know Your Medicine. The campaign was developed by the American Gastroenterological Association with support provided by Johnson & Johnson Consumer Inc., McNeil Consumer Healthcare Division, which manufactures over-the-counter pain medicines. Johnson & Johnson Consumer Inc. had no input into the creation of this article.
Just a short question if I may.. I work at Walgreens as a tech we received a prescription for amoxicillin 500 bid but could not make out the directions.. the pharmacist refused to fill the script, but the store manager was pushing her to just fill it.. What would have been the consequences if she would if just filled it like he said. I get that it is amoxicillin bid. But the words and number in front of the bid were unreadable to all of us..
The script was given back to the patient in filled. There was no amount of caps on the script that we could make out only that it was bit but no amount of how many bid or an amount to dispense.. this was at 10.30 pm and the prescribed was not open we did try to contact
As Pharmacists want to be addressed as “Doctor” because they have a PharmD degree and yet some of them can’t even make a simple decision that is in the pt’s best interest… The recommended dose for Amoxicillin 500 is BID (twice daily) X 10 days.
The pharmacy profession wants Pharmacists to be granted “provider status” so that they can work at the “top of their license”and be able to charge for services.. just not depend on revenue from filling prescriptions to “pay the bills”.
If this is an example of a Pharmacists working at the “top of their license”… the pharmacy profession and the pharmacy educational system preparing these pharmacists – HAS A PROBLEM !
Behind the walls of the nation’s oldest veterans’ hospital, the reports were grim.
Medical experts from the Department of Veterans Affairs blamed one botched surgery after another on a lone podiatrist.
They said Thomas Franchini drilled the wrong screw into the bone of one veteran. He severed a critical tendon in another. He cut into patients who didn’t need surgeries at all. Twice, he failed to properly fuse the ankle of a woman, who chose to have her leg amputated rather than endure the pain.
In 88 cases, the VA concluded, Franchini made mistakes that harmed veterans at the Togus hospital in Maine. The findings reached the highest levels of the agency.
“We found that he was a dangerous surgeon,” former hospital surgery chief Robert Sampson said during a deposition in an ongoing federal lawsuit against the VA.
Agency officials didn’t fire Franchini or report him to a national database that tracks problem doctors.
They let him quietly resign and move on to private practice, then failed for years to disclose his past to his patients and state regulators who licensed him.
He now works as a podiatrist in New York City.
A USA TODAY investigation found the VA — the nation’s largest employer of health care workers — has for years concealed mistakes and misdeeds by staff members entrusted with the care of veterans.
In some cases, agency managers do not report troubled practitioners to the National Practitioner Data Bank, making it easier for them to keep working with patients elsewhere. The agency also failed to ensure VA hospitals reported disciplined providers to state licensing boards.
In other cases, veterans’ hospitals signed secret settlement deals with dozens of doctors, nurses and health care workers that included promises to conceal serious mistakes — from inappropriate relationships and breakdowns in supervision to dangerous medical errors – even after forcing them out of the VA.
USA TODAY reviewed hundreds of confidential VA records, including about 230 secret settlement deals never before seen by the public. The records from 2014 and 2015 offer a narrow window into a secretive, long-standing government practice that allows the VA to cut short employees’ challenges to discipline.
Some employees who received the settlements were whistle-blowers or appear to have been wronged by the agency. In other cases, it’s clear the employees were the problem.
In at least 126 cases, the VA initially found the workers’ mistakes or misdeeds were so serious that they should be fired. In nearly three-quarters of those settlements, the VA agreed to purge negative records from personnel files or give neutral or positive references to prospective employers.
In 70 of the settlements, the VA banned employees from working in its hospitals for years — or life — even as the agency promised in most cases to conceal the specific reasons why.
Michael Carome, a doctor and director of the health research group at Public Citizen in Washington, said removing records from personnel files and providing neutral references create potential danger beyond the VA.
“It’s unacceptable,” he said. “What they are saying is, ‘We don’t want you to work for us, but we’ll help you get a job elsewhere.’ That’s outrageous.”
The VA settled with a nurse who managers initially found had left a psychiatric patient bound in leather restraints for hours; a medical technician who made errors on critical bone imaging charts; and a hospital director accused of harassing female workers while his facility fell weeks behind in treating veterans.
The VA found radiologist Jorge Salcedo misread dozens of CT scans, images that detect tumors and blood clots, at a VA hospital in Spokane, Wash., according to Texas Medical Board records. Instead of firing him, the VA agreed to pay him up to $42,000 of unused sick and leave pay and let him resign with a clean reference in 2015. The Texas records show Salcedo told the medical board he resigned under investigation, but he didn’t admit or deny the VA’s findings.
The VA has been under fire in recent years for serious problems, including revelations of life-threatening delays in treating veterans in 2014 and efforts to cover up shortfalls by falsifying records. New VA leaders promised accountability, including increased transparency and a crackdown on bad employees.
In the years since, the VA has fired hundreds of employees involved in patient care. Details of each case — including the names of fired doctors — largely remain secret.
In denying requests for information, the agency cited federal privacy law and said protecting employees’ privacy outweighed the public’s right to know about problems involving veterans’ care.
Agency leaders who took over after President Trump’s inauguration declined to discuss how their predecessors handled cases uncovered by USA TODAY.
VA spokesman Curt Cashour said “we cannot explain or defend” settlements negotiated by past agency leaders.
In response to USA TODAY’s findings, VA Secretary David Shulkin ordered that all future settlement deals with employees involving payments of more than $5,000 be approved by top VA officials in Washington. In the past, decisions about most deals were left to local and regional officials. The settlements USA TODAY reviewed involved workers at more 100 facilities in 42 states.
In addition, the VA said it will review its policy of reporting only some medical professionals to the national data bank following USA TODAY’s questions about its investigation of Franchini, who did not get a settlement.
“We will review the specific elements of this situation, along with patient safety procedures and how and when we report to the National Practitioner Data Bank and state licensing boards,” Cashour said.
A forever reminder
April Wood lives with a permanent reminder of Franchini’s surgeries.
During Army boot camp in 2004, Wood sliced her hands on a rope during a training exercise and plunged 20 feet into a cargo net.
“I heard the bones break, and I felt it,” said Wood, 42. “And I know I let out a noise that’s ungodly.”
Her ankle did not heal properly, leaving her no choice but to accept a discharge months later. She moved to Maine and sought care for her foot at Togus VA hospital on the outskirts of the capital, Augusta. To Wood, Franchini seemed a savior.
“He said he could do all this wonderful stuff. So I was like, ‘Yay, finally somebody cares, somebody wants to help me.’ ”
She first went under Franchini’s knife in 2006. The result: years of excruciating pain.
Franchini said that she had “mushy bones” that were difficult to fuse, she said. She put up with the pain even while working long hours on her feet as a hairdresser and chasing three young children.
Franchini tried a second surgery in 2009, but Wood said her pain grew worse.
She started spending much of her life in a wheelchair, unable to work. By 2012, she said her path seemed clear.
“I had to believe that something else was better than that amount of pain,” Wood said.
On Aug. 28, doctors at the Togus VA amputated Wood’s leg below the knee.
Nearly five months later, the phone rang. The VA had concerns about Franchini’s surgeries, including hers. Franchini had resigned while under investigation two years earlier, and VA officials had been examining hundreds of his former patients’ cases.
Using previous X-rays and medical records, they concluded that Franchini had improperly fused her bones, leaving her heel permanently arched higher than the ball of her foot.
Franchini’s surgeries “more likely than not contributed significantly” to the chronic pain that led to her amputation, the VA report concluded.
Wood, living in rural Missouri, sued the VA.
In an interview with USA TODAY, Franchini denied making mistakes and said he never got to respond to all of the VA’s findings. When the VA placed Franchini on leave after finding problems with a small sample of his cases in 2010, his attorney submitted two outside reviews saying the VA’s findings were not backed up by the medical records.
The VA eventually reviewed nearly 600 of his surgeries from his six years at Togus. The 56-year-old podiatrist said several doctors were in the operating room with him, and no concerns were raised at the time.
Since leaving the VA, Franchini said, he has performed numerous surgeries without complications.
“If I was so bad, I would be bad all the time,” he said.
Dangerous policy
The VA’s investigation of Franchini did not end his career.
In 2010, after the agency stopped letting him see patients, Franchini resigned and took a job with a surgical center in the Bronx.
Despite leaving the agency under investigation — a serious event for practitioners — VA officials did not disclose his resignation to the National Practitioner Data Bank.
Under a nationwide VA policy in place for nearly three decades, the agency doesn’t report such events for podiatrists and other kinds of medical providers, including thousands of nurses and physician’s assistants working for the agency.
VA officials say the agency is only required under federal law to report medical doctors and dentists, and that all other providers are optional.
However, a review of the database shows other institutions go beyond the law and report podiatrists and other providers who may have harmed patients.
Podiatrists, foot doctors who attend colleges of podiatry rather than traditional medical schools, are trained to treat conditions of the feet and ankles. They perform surgeries and prescribe drugs, prompting experts to say they should be reported to the data bank.
Congress created the national clearinghouse in 1986 to prevent problem medical workers from crossing state lines to escape their pasts and keep practicing.
“It makes no sense to report only half the people who can cause harm,” said Michael Gonzalez, an Ohio health care lawyer who represents hospitals. “There are podiatrists who do a lot of foot and ankle surgeries.” The lack of reporting to the national database is not the only gap found by USA TODAY.
VA policy recommends officials notify another government authority — state medical licensing boards — within 100 days of launching an investigation into medical workers who may have harmed patients.
The VA provided USA TODAY with such reports for fewer than 50 employees in the past 10 years.
The VA said it has reported more employees to state boards than appear in those records, but the agency can’t provide a number because its hospitals fail to follow the agency’s policy to share all such reports with headquarters.
Even when the VA does report medical providers to states, records reviewed by USA TODAY show delays in making such reports can stretch for years.
It took VA officials two years to report their findings about Franchini’s surgeries to state medical boards. In that time, he was able to get jobs with no indication of his past problems on his licenses. What’s more, he was able to get licensed in two more states after leaving the VA — Massachusetts and Connecticut. State medical boards won’t discuss investigations, but Franchini remains licensed in New York, Rhode Island, Massachusetts and Connecticut and has practiced in three of the states in the past two years. Notices to state boards are confidential unless they result in disciplinary action, so there is no way to know if there have been complaints about him since he left the VA. Three of his recent employers declined to comment.
Experts said the VA’s reporting practices leave gaping holes that could endanger patients.
“The VA should do the right thing and report them,” Carome said. “It’s about protecting the public.”
Hundreds more secrets kept
The secret settlements obtained by USA TODAY represent a fraction of the problem doctors and other employees the VA has discovered over the past 10 years.
Each year, the agency fires hundreds of medical workers and pays out hundreds of malpractice claims.
The providers’ names remain secret.
USA TODAY asked to inspect the records for thousands of those cases, but the VA blacked out or would not release the identities of the providers or the details of what took place.
That’s what makes the small set of secret settlements obtained by USA TODAY so unique.
Though the records do not describe the wrongdoing, they provide the names, job descriptions, the amount of the settlement payments and other terms.
In the 230 deals, the agency spent $6.7 million to settle with employees, including doctors, nurses and other health-care workers.
One of the biggest payments went to Mario DeSanctis, the former director of the VA’s Tomah medical center in Wisconsin. The hospital became known as “Candy Land” because of the dangerous doses of powerful narcotics routinely dispensed to veterans. VA investigators warned DeSanctis in 2012 that the center was known to police as a supplier for drugs in the area and advised him to take action, according to testimony in a U.S. Senate investigation of the case.
Investigators blamed the hospital when a 35-year-old Marine veteran died two years later after he was prescribed a fatal cocktail of more than 13 drugs. His father had visited him hours earlier and said he was lying in the mental health ward, babbling and holding his head. The VA fired DeSanctis, but he fought it, and the agency struck a deal with him. It let him resign and paid him and his lawyer $163,000. It pledged neither side would divulge the details of the agreement. DeSanctis did not respond to interview requests. “It makes me sick,” the veteran’s widow, Heather Simcakoski, said of the secret payout. “He shouldn’t have anything. He should have been fired.”
Patients in the dark
The VA’s policy about medical mistakes is clear: Patients should be notified as soon as possible.
In 2012 — two years after the agency revoked Franchini’s clinical privileges — the VA’s top leaders had still not told the patients.
The findings reached VA headquarters in Washington, sparking a scramble to head off a crisis.
Chief Medical Officer Andrea Buck recommended that because there was an “absence of ongoing harm,” the agency should create a plan to notify Congress and a communication strategy before talking to his patients, according to records in a federal lawsuit against the VA.
It would be the next year — after Wood’s leg was amputated — when the VA told patients.
The notification surprised Kenneth “Jake” Myrick, 43, an Army combat veteran from Maine. It meant the VA would allow him to be re-examined for grueling pain he had endured for years. The result of his VA review: “substandard” care. Surgeons reviewing the case determined Franchini improperly used a technique that involves rerouting tendons to shore up failing ankles. Myrick said the operation failed, forcing him to walk with a cane. Not until doctors performed corrective surgery years later could Myrick properly walk again, he said.
By the time the agency informed Myrick about the surgical errors it had discovered, it was too late to sue. Maine’s three-year deadline to file suit for medical negligence had expired.
He’s one of at least six veterans suing the VA in a case that accuses the agency of fraudulently concealing Franchini’s mistakes. The VA has denied the claim, arguing in court that nothing prevented the veterans from suing earlier.
Brewster Rawls, a longtime Virginia malpractice lawyer and Army veteran who filed an unsuccessful claim for one veteran, called the delays “inexcusable.”
“How is the claimant supposed to know when (the VA) was sitting on this?” Rawls asked. “What they did was just wrong.”
Myrick said that if the VA followed its own guidelines, it could have helped the veterans the agency is supposed to serve and made sure other patients were not harmed.
“They were just trying to protect themselves,” Myrick said. “We are told to have honor, duty and sacrifice. The VA had no honor. They failed in their duties, and they were willing to sacrifice the people they were supposed to serve.”
Senator says soaring opioid epidemic calls for get-tough approach
(INDIANAPOLIS) – Legislators fighting the opioid epidemic may shift their focus next year to punishing drug dealers.
Indianapolis Senator Jim Merritt (R) says he’ll introduce several bills which would impose longer sentences for drug crimes. One would set an automatic 10-year minimum sentence for dealing the painkiller fentanyl. That would make it the only drug with a mandatory minimum in Indiana. Merritt says fentanyl or fentanyl mixed with other drugs is to blame for most of the soaring number of Indiana overdose deaths.
Merritt’s also calling for nonsuspendible prison terms for pharmacy robberies.
The emphasis on longer prison terms represents an about-face from a revision of Indiana’s sentencing laws three years ago, whose goals included seeking alternatives to prison for drug offenses. Merritt says that was “a different time.” With opioids becoming the main drug threat, Merritt says the stakes have grown, and says the state needs to send dealers a clear message.
Merritt says he’ll also introduce a bill to tear up Indiana’s laws attempting to outlaw synthetic drugs like Spice — laws Merritt authored. Merritt says the makers of those drugs continue altering their formulas faster than the state can outlaw them. He’s instead proposing an approach taken by Marion County Prosecutor Terry Curry to prosecute those drugs under a beefed-up version of Indiana’s “lookalike drug” law, imposing the same penalties for drugs which mimic marijuana or L-S-D as you’d get for the real thing.
September 18, 2017 Marilyn Tavenner President and CEO America’s Health Insurance Plans 601 Pennsylvania Avenue, NW Washington, DC 20004
Re: Prescription Opioid Epidemic
Dear Ms. Tavenner,
The undersigned State Attorneys General are sending you this letter to urge America’s Health Insurance Plans (AHIP) to take proactive steps to encourage your members to review their payment and coverage policies and revise them, as necessary and appropriate, to encourage healthcare providers to prioritize non-opioid pain management options over drug offences for opioid prescriptions for the treatment of chronic, non-cancer pain. We have witnessed firsthand the devastation that the opioid epidemic has wrought on our States in terms of lives lost and the costs it has imposed on our healthcare system and the broader economy. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction, who are among the most vulnerable consumers in our society.
The opioid epidemic is the preeminent public health crisis of our time. Statistics from the Surgeon General of the United States indicate that as many as 2 million Americans are currently addicted to or otherwise dependent upon prescription opioids.1 Millions more are at risk of developing a dependency— in 2014, as many as 10 million people reported using opioids for nonmedical reasons.2 The economic toll of the epidemic is tremendous, costing the U.S. economy an estimated $78.5 billion annually.3 State and local governments alone spend nearly 8 billion dollars a year on criminal justice costs related to
1 Surgeon General of the United States, Opioids, https://www.surgeongeneral.gov/priorities/opioids/index.html (last updated June 1, 2017); Nora D. Volkow, M.D., America’s Addiction to Opioids: Heroin and Prescription Drug Abuse, National Institute on Drug Abuse (May 14, 2014), https://www.drugabuse.gov/about-nida/legislativeactivities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse. 2 See Surgeon General, supra fn. 1 (citing National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration, 2014). 3 Healthday News, Opioid Epidemic Costs U.S. $78.5 Billion Annually: CDC (Sept. 21, 2016), http://www.health.com/healthday/opioid-epidemic-costs-us-785-billion-annually-cdc.
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opioid abuse.4 The human cost is even more staggering: Opioid overdoses kill 91 Americans every single day.5 More than half of those deaths involve prescription opioids.6
The unnecessary over-prescription of opioid painkillers is a significant factor contributing to the problem. Although the amount of pain reported by Americans has remained steady since 1999, prescriptions for opioid painkillers have nearly quadrupled over the same timeframe.7 This four-fold increase in prescriptions has contributed to a commensurate increase in the number of opioid overdose deaths.8 The dramatic increase in supply has also made it relatively easy to obtain prescription opioids without having to resort to the black market: Over 50% of people who misuse opioids report that they obtained them for free from a friend or relative, while another 22% misused drugs that they obtained directly from a doctor.9 While illegal opioids like heroin remain a serious problem that also must be addressed, the role played by prescription opioids cannot be ignored. While there is no panacea, any comprehensive effort to address and end the opioid epidemic must tackle the ever-increasing number of prescriptions for opioid painkillers. You could see page and see what needs to be done when it comes to the legalities.
Reducing the frequency with which opioids are prescribed will not leave patients without effective pain management options. While there are certainly situations where opioids represent the appropriate pain remedy, there are many other circumstances in which opioids are prescribed despite evidence suggesting they are ineffective and even dangerous. For example, the American Academy of Neurology has explained that while the use of opioid painkillers can provide “significant short-term pain relief,” there is “no substantial evidence for maintenance of pain relief or improved function over long periods of time.”10 Another recent study concluded that the use of opioids to treat chronic, non-cancer related pain lasting longer than three months is “ineffective and can be life-threatening.”11 When patients seek treatment for any of the myriad conditions that cause chronic pain, doctors should be encouraged to explore and prescribe effective non-opioid alternatives, ranging from non-opioid medications (such as NSAIDs) to physical therapy, acupuncture, massage, and chiropractic care.
4 Id. See also Costs of US Prescription Opioid Epidemic Estimated at $78.5 Billion, Wolters Kluwer (Sept. 14, 2016),http://wolterskluwer.com/company/newsroom/news/2016/09/costs-of-us-prescription-opioid-epidemicestimated-at-usd78.5-billion.html 5 Understanding the Epidemic: Drug overdose deaths in the United States continue to increase in 2015, Centers for Disease Control and Prevention, https://www.cdc.gov/drugoverdose/epidemic/ (last updated Dec. 16, 2016). 6Prescription Opioid Overdose Data, Centers for Disease Control and Prevention, https://www.cdc.gov/drugoverdose/data/overdose.html (last updated Dec. 16, 2016). 7 See Surgeon General, supra fn. 1; Opioid Addiction 2016 Facts and Figures, American Society of Addiction Medicine (2016), https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. 8 Vivek Murthy, The Opioid Crisis: Our Solution, TIME (Oct. 13, 2016), http://time.com/4521562/2016-electionopioid-epidemic/ 9 Opioids, Substance Abuse and Mental Services Administration, https://www.samhsa.gov/atod/opioids (last updated Feb. 23, 2016). 10 Gary M. Franklin, MD, MPH, Opioids for chronic noncancer pain: A position paper of American Academy of Neurology, 83 Neurology 1277 (2014). 11 Eric Scicchitano, Geisinger doctors: Opioids ineffective for chronic pain put patients at risk, The Daily Item (Dec. 7, 2016), http://www.dailyitem.com/news/local_news/geisinger-doctors-opioids-ineffective-for-chronic-pain-putpatients-at/article_2d66014f-511e-554f-bed5-768886b48616.html (citing, generally, Mellar P. Davis & Zankhana Mehta, Opioids and Chronic Pain: Where is the Balance? 18 Current Oncology Reports 71 (2016), available at https://link.springer.com/epdf/10.1007/s11912-016-0558-1)
Insurance companies can play an important role in reducing opioid prescriptions and making it easier for patients to access other forms of pain management treatment. Indeed, simply asking providers to consider providing alternative treatments is impractical in the absence of a supporting incentive structure. All else being equal, providers will often favor those treatment options that are most likely to be compensated, either by the government, an insurance provider, or a patient paying out-of-pocket. Insurance companies thus are in a position to make a very positive impact in the way that providers treat patients with chronic pain.
Adopting an incentive structure that rewards the use of non-opioid pain management techniques for chronic, non-cancer pain will have many benefits. Given the correlation between increased supply and opioid abuse, the societal benefits speak for themselves. Beyond that, incentivizing opioid alternatives promotes evidence-based techniques that are more effective at mitigating this type of pain, and, over the long-run, more cost-efficient.12 Thus, adopting such policies benefit patients, society, and insurers alike. When it comes to accidents and injuries the truck accident attorneys from Thon Beck Vanni Callahan & Powell Company can provide the required legal assistance.
The undersigned Attorneys General serve an important role in combating the opioid epidemic. As the chief legal officers of our States, we are charged with protecting consumers, including patients suffering from chronic pain and opioid addiction. Among other things, we are committed to protecting patients from unfair or deceptive business practices and ensuring that insurers provide consumers with transparent information about their products and services.
We are thus committed to utilizing all the powers available to our individual offices to ameliorate the problems caused by the over-prescription of opioids and to promote policies and practices that result in reasonable, sustainable, and patient-focused pain management therapies. In the near future, working in conjunction with other institutional stakeholders (such as State Insurance Commissioners), we hope to initiate a dialogue concerning your members’ incentive structures in an effort to identify those practices that are conducive to these efforts and those that are not. We hope that this process will highlight problematic policies and spur increased use of non-opioid pain management techniques. In case of workplace related injuries workers comp law firm has lawyers that can help you get the compensation you deserve. The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable. We ask that you quickly initiate additional efforts so that you can play an important role in stopping further deaths.
We look forward to having this discussion with you.
Sincerely,
Leslie Rutledge Pamela Jo Bondi Arkansas Attorney General Florida Attorney General
12 Harrison Jacobs, Pain doctors: Insurance companies won’t cover the alternatives to opioids, Business Insider (Aug. 10, 2016), http://www.businessinsider.com/doctors-insurance-companies-policies-opioid-use-2016-6 (“If you look at the long-term cost of [opioids], plus monitoring, office visits and drug screenings . . . it’s cheaper long-term to do the more advanced therapy,”) (quoting Dr. Timothy Deer, co-chair, West Virginia Expert Pain Management Panel).
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Wasn’t it 46 state attorney generals in the late 90’s that sued all the Tobacco Industry and got a settlement of a minimum of 206 BILLION dollars paid out over 25 yrs..
Isn’t some of the same members that signed this letter are lining up to sue the pharmaceutical industry over causing the opiate crisis ? How much do you think that settlement is going to total ?
Do you think that these same AG’s would hesitate to sue the health insurance industry for failing to conform to the AG’s wishes to reduce opiate prescriptions and/or limit opiates to only those who have cancer ?
They have already successfully sued a industry for the “damages” of producing and selling a LEGAL PRODUCT… and after that settlement that same industry went back to selling that same LEGAL PRODUCT.
After all it was our judicial system that in 1917 declared opiate addiction was a CRIME and NOT A DISEASE.. and they have operated under that judicial decision and in 1970 our Congress passed the Controlled Substance Act…that created the Federal Narcotic Bureau and its two million/yr budget with the BNDD (Bureau of Narcotics and Dangerous Drugs) with a 1200-1500 new agents and a 43 million/yr budget. Which has now entails abt 12,000 employees of the DEA and the war on drugs now costing 81 billion/yr AND GROWING.
It would appear that now our judicial system is trying to prove that they can stop opiate use/abuse/addiction by eliminating the prescribing of legal opiates for all pts except those suffering from cancer.
For over ONE HUNDRED YEARS our judicial system has attempted to “cure addiction” by using the only “treatment/cure” that they have available to them and that is jail/prison….. and we have seen how well that has worked over the past ONE HUNDRED YEARS
So now our judicial system has decided that abstinence will solve the opiate crisis.
House Bil No. 4405 was passed by the House in June of 2017 is up for discussion, but has yet to be voted on by the Senate Committee.
A pharmacists may refuse to dispense a prescription for a controlled substance if the pharmacist has reason to believe that the prescription was written for fraudulent reasons or being filled for a purpose that is not a medical purpose.
The amendment to the House Bill would protect the pharmacist from being liable for any damages that end in injury, death, or loss to a person or property because the pharmacist wouldn’t fill it.
“A pharmacists may refuse to dispense a prescription for a controlled substance if the pharmacist has reason to believe that the prescription was written for fraudulent reasons or being filled for a purpose that is not a medical purpose.”
Both of the above conditions means that the prescription is illegal/fraudulent prescription and the Pharmacist has a legal/professional responsibility to call the authorities. If the Pharmacist returns the prescription to the pt… then – IMO – the pharmacist is NOT CONFIDENT – does not have FACTS – that the prescription meets the above criteria. So they decline to fill the prescriptions because “they are not comfortable” So will “not comfortable” meet the above criteria for valid denial of filling a controlled substance ?
Also, the fact that this law is isolating a particular “type of pt”… does this make this proposed law in conflict with the Americans with Disability Act and/or Civil Rights Act and thus UNCONSTITUTIONAL… but… if signed into law… and no one challenges the CONSTITUTIONALITY of this proposed law.. it will be enforced as written
More than 25 million people dying in agony without morphine every year
