INDIANA… new OPIATE DOSING GUIDELINES — EFFECTIVE JULY 1, 2017

Posted on June 29, 2017 by Pharmaciststeve

 

INDIANA… new OPIATE DOSING GUIDELINES — EFFECTIVE JULY 1, 2017

http://iga.in.gov/legislative/2017/bills/senate/226#document-b9523207

 

 

 

Important Notice regarding Changes to Indiana Law concerning the Prescribing and Dispensing of Opioids:

 

Effective July 1, 2017, pursuant to Senate Enrolled Act 226, new laws concerning the prescribing and dispensing of opioids will go into effect. Please be advised, these changes affect any practitioner who maintains an Indiana controlled substance registration and a federal Drug Enforcement Administration registration as well as any pharmacy or pharmacist dispensing opioid prescriptions. The Indiana Medical Licensing Board is currently reviewing the statute should additional considerations for the prescribing of opioids be necessary.  For more information and a copy of the enrolled act, please visit the Indiana General Assembly website here.

 

Please note, that neither the Professional Licensing Agency nor its boards, can provide legal guidance regarding these laws.  If you require legal assistance, please contact a private attorney.

 

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States’ push to pass “right to die” – “physician assisted suicide” laws

Posted on June 29, 2017 by Pharmaciststeve

Until a few years ago, it was a CRIME for anyone to commit suicide regardless of the reason… there are also many groups that opposed capital punishment to eliminate the worse of the worse in our society.  Has anyone notice any of these same groups opposing right to die laws ?

When Obamacare was first passed there was “talk” about “death panels”

http://www.thirteen.org/bid/sb-howmuch.html    Slightly more than half of Medicare dollars are spent on patients who die within two months.   Total Medicare annual budget is 600 + billion and covers some 56 million people..

From the bureaucrats’ perspective… how many believe that we are spending TOO MUCH MONEY just “keeping a small percent alive”… just “financial leeches on the healthcare system” ?

OFFICIAL “DEATH PANELS” have seemingly not developed… at least not visibly.. but.. all of these various Federal and State agencies that have imposed adequate treatment for chronic painers is not – in the true sense – a death panel , but… denial of care and causing chronic painers – in desperation – commit suicide rather than spend another day enduring torturous level of pain.

And now we have various states endorsing suicide/physician assisted suicide to “end a pt’s suffering”

Bureaucrats seldom enact anything in a LARGE CHANGE… they make barely perceivable incremental changes until they end up accomplishing their ultimate goal… this may take several years or a decade or two… they will not rush things so that the “common day folks” won’t catch on to what is coming down around them.

Just like the frogs put in a pan of cold water and you turn on the heat.. and before they know it their ASSES ARE COOKED !

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call MORGAN & MORGAN ..UPDATE

Posted on June 29, 2017 by Pharmaciststeve

Below is the response to the pt that had originally contacted Morgan and Morgan abt two weeks ago..  Apparently that there are MORE PROFITABLE and DEEPER POCKETS …. lawsuits that they can devote their resources to…. Morgan & Morgan - ForThePeople.com

Thank you for allowing Morgan & Morgan to review your potential class action claim. After review, we have decided to decline representation on your behalf in this particular matter.

Our decision does not mean you do not have a viable claim. Rather, it simply means that we have made a decision not to represent you. We strongly suggest that you contact another attorney immediately for assistance, as law firms evaluate cases differently and another attorney may believe a claim can and should be pursued.

If you choose to contact another attorney, you should do so immediately as all legal claims are subject to a statute of limitations. In other words, if your claim is not filed against the responsible parties before the statute of limitations expires, then you will be forever barred from bringing a claim. Because we have not investigated your case, we are not making any determination as to the statute of limitations applicable to your claim. The statute of limitations in your case may have expired before you ever contacted our law firm, or the statute of limitations may expire in the very near future. As such, you should act quickly to avoid jeopardizing your potential claim.

Although we are declining to represent you at this time and will not be filing any lawsuit on your behalf, we wish you the best and again thank you for allowing us to review your potential case. Please consider calling us in the future if the firm may be of service to you.

Finally, please be advised that if you have a separate claim being investigated or handled by another Morgan & Morgan attorney or department (such as a medical malpractice or personal injury claim), this letter does not impact that other matter. This only relates to the potential class action you brought to our attention.

OKay folks, I just hung up with the law firm Morgan & Morgan and they are forwarding my case to the appropriate attorneys for a class action within their firm. They ask that the rest of you call as well to give your story and please refer to a chronic pain patient class action. The number is 1-888-670-2630 PLEASE call immediately as it will take 3 weeks to review our case and respond to us. Hope your all having as pain free day as possible!

need to ask for the medical malpractice dept when they call. It would be a medical malpractice class action based on the harm caused to us by the cdc guidelines and the doctors

A possible way to get results is to tell a representative, “hey, look up this case #7751565. 

Tell them. “hey, I want to do that. A class action law suit based on the harm caused to me by the CDC Guideline  and the doctors.”   

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Obamacare is imploding and Repeal and Replace – no one will be happy..

Posted on June 28, 2017 by Pharmaciststeve

We have some 320 million people in the USA… when you look at all “the numbers” how our country is going to fund a health insurance program … the numbers don’t really add up..
As a country we have 55.5 million on Medicare
We have 72 million on Medicaid – up abt 50% since 2009
There is some people eligible for both Medicare/Medicaid .. so you can’t add the two together to get a realistic total number..
We have some 8.4 % unemployed (actual unemployed and non participation rate)
We have 47% of family households that PAY NO FEDERAL INCOME TAXES.
Our “national healthcare bill” is almost $1000.00/person/month…3.8 TRILLION DOLLARS..
3.8 trillion is the SAME amount as the Annual Federal Budget.
The question has to be asked … how much of that 3.8 trillion goes to the cost infrastructure and profits of various middlemen that may or may not be really necessary parts of our healthcare system ?
It is quite obvious that we are quickly moving toward a point of “no return” when we have more “takers” than “makers”
This issue may be a good example of how the impact of lobbyists and all the money that they spread around in Congress to help big companies to protect their profits.. and healthcare is just another FOR PROFIT BUSINESS..

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Judge rules that HIPAA doesn’t apply to DEA PMP searches ?

Posted on June 26, 2017 by Pharmaciststeve

US Does Not Need Warrant to Subpoena Oregon Drug Data

https://www.usnews.com/news/best-states/oregon/articles/2017-06-26/feds-dont-need-warrant-to-subpoena-oregon-drug-data

PORTLAND, Ore. (AP) — The 9th U.S. Circuit Court of Appeals ruled Monday that the U.S. Drug Enforcement Agency does not need a court order to subpoena a prescription drug database kept by the state of Oregon, but the ruling did not specify whether those subpoenas would violate constitutional protections.

The ruling reverses a 2014 judge’s ruling finding that the agency must obtain warrants to access the database, which Oregon uses to help healthcare providers identify abuse. The appeals panel, however, said nothing prevents Oregon from challenging individual warrantless subpoenas in court “in light of the particularly important privacy interest implicated here.”

The ruling did not resolve the question of whether the DEA’s administrative subpoenas violate constitutional protections against unreasonable search and seizure outlined in the Fourth Amendment of the U.S. Constitution protecting people against unreasonable searches and seizures.

The Oregon Prescription Drug Monitoring Program sued the DEA in 2012 over the administrative subpoenas for patient prescription records because under state law police must get court orders to check the same database. The DEA argued that the federal Controlled Substances Act allowed it to access the information without a warrant.

The American Civil Liberties Union joined in the case to litigate the broader issue of whether the requests violated Fourth Amendment protections.

The appeals court said that the ACLU does not have standing in the case and did not address that issue.

A similar Utah case may help to resolve that question, said Nathan Wessler, the ACLU attorney who argued the Oregon appeal.

The case began in 2012 when the DEA sought the records of one patient and two prescribing physicians as a part of an investigation. The state argued it could not be compelled to disclose health information about a patient without a federal court order.

 Oregon lawmakers approved the prescription database in 2009 and it became fully operational two years later. A pharmacy must electronically report information about the quantity and type of drugs dispensed, identifying information about patients and the names of doctors prescribed medication.

About 7 million prescription records are uploaded to Oregon’s system annually, according to the 2014 opinion on the case written by U.S. District Judge Ancer L. Haggerty.

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Often to get the justice you are entitled to… requires a law firm

Posted on June 26, 2017 by Pharmaciststeve

There are dozens of laws on the books that is suppose to protect segments of our population against discrimination regarding several different issues.

We have both the Civil Rights Act 1964 and The Americans with Disability Act 1990 and yet various Fed/State Agencies pass rules, laws, regulations, guidelines that discriminate against portion of our populations that are suppose to be protected.

Right now Congress is discussing repeal/replacement of Obamacare and they are talking about insurance guarantee of coverage for PRE-EXISTING ILLNESSES.. but they are not talking about GUARANTEED TREATMENT for pre-existing illnesses..

AG Jeff Session’s ONE PERSON’S OPINION wants Congress to OVER-RIDE the will of the people in some 30 states that has made Marijuana or Medical Marijuana legal in some form or another.

Who believes that the CDC did not know or should have known that any “guidelines” that they published would soon be adopted as standard of care and best practices in a wide area of the medical community.  Even choosing some of the poorest quality studies to use as justification for their guidelines…and refusing to acknowledge anecdotal evidence that opiates work long term for chronic pain pts.

Various state legislatures are passing opiate dosing guidelines in some form or another… and even though there are exemption to those daily limits for certain health issues… all too many prescribers are refusing to recognize or acknowledge that those exemptions exist.

You can put up dozens of petitions on various websites.. has anyone seen the first petition concerning chronic pain treatment effected any change?

Has the hundreds or thousands of FACE BOOK pages … made any difference ?

Has any of the calls, emails, faxes, letters sent to elected officials … made a difference ?

There is no guarantee that anything a politician/bureaucrat does.. is legal/constitutional ?

Cities, Counties, States are “piling on” and suing various entities that produce or sell the LEGAL PRODUCT of opiates…  because of the perceived “damages” that have happened because a number of people have ignored any personal responsibility and use/abuse some substances.

Those in the chronic pain community are technically protected from numerous discrimination by numerous laws … both at the Federal and State level… but those who are in charge of enforcing and protecting those in the chronic pain community seems to have little interest in doing their jobs.

That is what law firms are for… the chronic pain community has VOTES .. in unity, enough to decide just about any election in this country and they have the numbers that a few dollars from each would add up to a HUGE LEGAL WAR CHEST… 

The system can be REFORMED with UNITY.. .or each chronic painers can chose to suffer individually as they walk down a singular path.

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Suicide Among Veterans and Other Americans

Posted on June 26, 2017 by Pharmaciststeve

Suicide Among Veterans and Other Americans

2001 – 2014

https://www.mentalhealth.va.gov/docs/2016suicidedatareport.pdf

 

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Social Impact of Pain group announces that WHO will now classify chronic pain as a disease entity under the new edition of The ICD 11.

Posted on June 26, 2017 by Pharmaciststeve

Social Impact of Pain group announces that WHO will now classify chronic pain as a disease entity under the new edition of The ICD 11.

https://www.linkedin.com/pulse/social-impact-pain-group-announces-who-now-classify-chronic-mangino

SOCIETAL IMPACT OF PAIN:

The conviction of Doctor Mangino was obtained by convincing jurors that prescribing opioids for chronic pain was to be done only according to The World Health Organization [ and the “Opioid Prescribing Guidelines of The Pennsylvania State Board of Medicine ] “Ladder” of analgesia…which suggested a gradual increase in the dosing of opioids after patients had failed to improve from other medications.

These “Guidelines” of The Pennsylvania State Board of Medicine and WHO, are not “laws” under how Pennsylvania defines the crime of “unlawful prescription.” They are suggestions, with no force in the law. ( in most jurisdictions across the USA ).

There was no evidence presented at trial that Mangino violated any criminal standard for prescribing; which depended on his having specific knowledge that his patients were misusing or selling their opioid pain pills.

The Commonwealth prosecutors spent a lot of time and effort to get their expert witnesses to testify that Mangino could not prove his patients had “chronic” pain…because Mangino relied only on “his” expertise as a pain specialist without ordering all kinds of tests and outside consultations with other specialists.

Comonwealth kept referring to the guidelines and WHO “Ladder.,” to drive home the incorrect message to jurors that Mangino’s patients did not “need” the opioid medications…quoting Mangino’s interview statement claiming he said patients did not “need” medications…but after destroying Mangino’s complete sentence which was hand recorded in the destroyed interview notes–where Mangino stated that once he realized a patient did not need opioids…he “stopped prescribing.”

The point being that it was the WHO “Ladder” which was used to convince jurors that Mangino did not follow a gradual ascendency to his prescibed dosages of narcotics; but that he rather kept the patients on the same dosages they had been getting for over several years prior to coming under Mangino’s care.

In other words…Mangino refused to arbitrarily decrease the patient’s dose of opioids if it was working for them.

Pennsylvania told jurors that was a drug crime !

Even though the European pain societies had been considering classifying chronic pain as its own disease in 2001…long before Mangino was arrested: that information never reached the jury.

Mangino sent his lawyers plenty of medical articles which could have been incorporated into his medical expert’s ( Doctor Forrest Tennant ) report for trial testimony…Tom Leslie, Mangino’s lawyer, never sent the exculpatory-type articles…nor did he bother to insure that Doctor Tennant would forward an Expert Report to support Mangino.

While these articles themselves would have been inadmissible…Mangino’s expert could have made passing reference to them…and they could have been used to impeach the testimony of the Commonwealth experts. But I guess Mister Leslie’s law school failed to teach him that.

Maybe this new classification of pain as a separate disease will help to make trials more fair in the future. It’s a little too late for Doctor Mangino.

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‘Tortured to death’ by bureaucrats; Veteran protests for better care

Posted on June 25, 2017 by Pharmaciststeve

6.20-C- RTE VAP 02.jpg

https://www.facebook.com/GarysStand/

‘Tortured to death’ by bureaucrats; Veteran protests for better care

Gary Howard, a former Army Ranger who served in Vietnam, was out protesting the Department of Veterans Affairs on Monday to help push for better health care treatment for all veterans.

A 2014 study from the VA claims that on average about 20 Veterans died from suicide each day. Howard feels like he and others are being “tortured to death” by the stress of waiting for treatments and results.

Howard explained his struggles to get treatments, he talked about driving over five hours to see a doctor only to have an eight-minute conversation in the doctor’s office.

Howard stated, “It takes three or four doctors trips before they even do anything to help you.”

He continued with other stories about having important appointments made a year in advance be canceled just days before, and being forced to wait about six months to learn that he has cancer.

Howard stressed that his problem is not with the individual health care workers, but the bureaucrats over the system that keep veterans from getting good health care.

“We’ve got to fight,” Howard said, “so these younger guys coming back don’t have to go through this,” Howard stated.

Howard is looking to reach out to his fellow veterans that can help, because he wants to start something that brings better health care to his “brothers.”

In his efforts, he tried to reach a fellow Army Ranger: Sen. Tom Cotton. Howard stated, “I tried to reach him because as a fellow ranger, I know he wouldn’t leave me behind.”

After reaching the senator’s office, Howard was informed by the senator’s assistant that Cotton was unavailable address his problem.

Gary Howard sees his protest is part of his duty.

“I’m a Ranger I can do more, and more is expected of me.” said Howard.

In fact, Howard says there might even be a higher calling.

“I feel inspired by God to do this,” he added.

Howard said he lives south of Yellville, so it takes him an hour to just drive to Harrison for a local VA doctor’s appointment.

“I haven’t left my house in a long, long time,” he said. “I had to push myself. I hope God takes me here on the side of the road.”

Sitting in his wheelchair beside Main Street, drivers would stop by to speak to him and offer support.

“Thank you for your service,” one woman called out from her car when she stopped on the street.

A Harrison Police officer stopped by to help Howard move to a safer place. An employee of the clinic in front of which he sat brought out water and a snack, further reinforcing his gratitude to local health care workers.

Another woman stopped by to speak with him while he was on the street. He told her he does have prostate, lung and skin cancer and has been told by hospice workers he has only weeks to live.

Howard said he was told that one man can’t change the VA. But he said there was one man 2000 years ago who did change the world, so he wants to try.

But he vowed to continue with his protest until he can no longer keep it up — or until he loses his last fight.

“I’m not afraid to die,” he said. “I lost my fear of dying in Vietnam. But I’m going to man up, Ranger up.”

 

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Pts who insist on fighting the system… will end up coming up short

Posted on June 25, 2017 by Pharmaciststeve

I’ve read your 2014 article about pharmacists refusing to fill legitimate/on-time prescriptions. Well my mother is having issues here in florida with filling a narcotic prescription that she has a legal and legitimate script for. She is on social security disability. She had issues with a discount pharmacy that wanted her to transfer all of her scripts there and so my mother transfered some of them to the discount pharmacy. I guess the owner/pharmacist found out she still had more scripts, non narcotic, at her favorite pharmacy and refused to fill her narcotic prescription from then on. Now shes going to another pharmacy and the owner is starting to give my mother the same type of song and dance. My mother does everything totally legal and i hate to see these pharmacies get away with not filling her narcotic script just because they want all of her money not just a part of it. At least that’s the way we see it. What would you suggest my mother can do about this situation? I really would like to help her fight this because its stressing her out and shes also an epileptic so she doesn’t need all this added stress to cause an episode. Where can we start, to try and stop what these money hungry pharmacists/owners are doing? Thank you in advance for any reply I receive. We appreciate anything you can tell us. 

This is a good example of a pt “fighting the system”… the DEA is forcing the drug wholesalers to ration the purchases of controls as a per-cent of their total prescription medication purchases.

The DEA considers a pharmacy/pt only filling controls at a pharmacy a RED FLAG… and if a pharmacy is in business to take care of a pt’s needs … in this day in age.. that means filling all their prescriptions.. especially if controlled medications are involved.

In this particular incident…the question has to be asked why this pt’s “favorite pharmacy” will not fill her controls meds.. maybe she is not their “favorite pt” ?

IMO.. this pt has two options… continue to try and fight the system… until she cannot find anyone to fill her controls or she goes along with “the system” and find one pharmacy that will fulfill all her prescription needs.

Especially when controlled medications are involved… having prescriptions filled is not the same thing as dropping by the closest grocery store to buy a few groceries or stop at the closest filling station when your car needs fuel.

The prescription distribution system has a lot of  “moving parts” that the typical pt is – or never will be – aware of that influences how things are going to happen and no matter how much the pt wants the transaction to be like general merchandise transaction… it MAY NEVER HAPPEN…  The pt can either adapt or stress out trying to get things to happen the way that they want/expect.

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