“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
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.
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.
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.
‘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.”
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.
That’s what experts like Michael Botticelli, who was the Obama administration’s “drug czar,” want people to know. Botticelli is a firm believer that people suffering from drug and alcohol addiction can get well.
“One of the things that is really important to show is that people can and do recover,” said Botticelli, now executive director of Boston Medical Center’s Grayken Center for Addiction Medicine. “When they get access to quality care, they do get better.”
But not all drug treatments are created equal. An NBC News investigation found that federal loopholes have allowed unscrupulous drug treatment centers in South Florida to turn the nation’s opioid crisis into gold. They’ve billed insurance companies for millions of dollars’ worth of counseling and testing without helping addicts recover.
Because so many individuals and families seek treatment in moments of crisis, Botticelli said, they can be vulnerable to treatment centers more focused on profit than care.
How can families seeking treatment for a loved one learn to separate the “bad actors” from the good?
Experts and law enforcement officials have created lists of warning signs and questions that patients and their families should ask.
Watch Out For:
● Generic websites or advertisements that don’t clearly identify what treatment programs the site or advertiser represents. They may just be collecting phone numbers and email addresses for patient “brokers,” who will then try to connect you with whatever treatment center is paying them.
● Whether the person you’re speaking to receives referral fees from the treatment center. “Brokers” are paid by the head to get you or your loved one into a particular treatment center, whether or not it’s the right one for you.
● Offers to pay for travel. If someone is offering to cover travel to Florida or another location, call the treatment facility or your insurance company to confirm that the person is an employee. In certain states, paying for travel may also be considered an illegal inducement.
● Offers to pay for insurance coverage or to waive co-pays or deductibles. See above.
● Offers of free rent from “sober homes” — the offsite homes where addiction patients are often housed — in exchange for attending a particular drug treatment program.
● Daily or near-daily lab tests that cost thousands of dollars.
● A treatment center that doesn’t ask for in-depth information about the patient or doesn’t ask for access to any therapists or counselors previously used by the patient. Without this information, the center won’t be able to assess whether the patient is a good fit.
● Unsolicited referrals from marketers or hotlines to treatment centers out of state. Treatment centers that aren’t in your state may be considered out of network by your insurance company, meaning the centers will be able to bill the insurers more.
Questions You Should Ask:
● What’s the staff-to-patient ratio? The lower the ratio, the better. Are the counselors certified chemical dependency counselors?
● Does the facility have a medical director on staff? Are the doctors associated with the program certified by the American Society of Addiction Medicine?
● Can the treatment center handle other medical needs, like mental health issues or diseases like hepatitis C?
● Are licensed staffers available 24 hours a day?
● What kinds of support are offered after treatment? Does the program have an “alumni” program that offers followup, and does it help families put together an after-care plan?
● Is the program able to adapt to the medical history, trauma background, culture or gender identity of the patient?
● Is the center in-network with your insurance? If not, what out-of-pocket expenses should you expect?
● Is the program transparent, or does it simply tell you what you want to hear?
Not every program is a fit for every person. Schedule a tour and do research online. In addition to looking at the treatment center’s website and social media presences, read reviews, learn what others are saying about their treatment experiences and check whether the program is accredited.
The former operator of this drug treatment center in Florida was recently sentenced to 27 years in federal prison on charges that included sex trafficking and fraud. NBC News
There’s also a vibrant network of online groups have also cropped up, like those run by the nonprofit Magnolia New Beginnings. Founder Maureen Cavanagh said members in the closed groups are vetted, so once they’re inside, they can trust that the advice they get is good and can feel free to voice their pain and provide emotional support.
“They realize, sometimes for the first time, that there are other people going through this and they’re not alone,” Cavanagh said. “The worst thing in the whole world is to feel like you can’t talk to anybody about this.”
Former President Bill Clinton addressed the opioid and drug crisis on Saturday, telling mayors from across the country that the U.S. is far behind in dealing with the issue.
“It’s going to eat us all alive,” the former president warned at the U.S. Mayor’s Conference in Miami.
“We all have to acknowledge that we should have seen more of this before. But what we have to acknowledge now is that we have a chance to deal with this in a comprehensive way, and we’re not close,” the former president said.
The issue has remained a top concern for lawmakers, with Senate Republicans facing criticism that proposed cuts to Medicaid in their bill unveiled this week to repeal and replace ObamaCare could exacerbate the national epidemic.
While the legislation reserves $2 billion to help people deal with substance abuse and addiction, critics say the major cuts to Medicaid spending would not help the crisis, and the $2 billion fund would not make up for the cuts.
Republicans including Nevada Gov. Brian Sandoval and Ohio Gov. John Kasich have expressed concerns over the bill’s Medicaid cuts.
“I’m proud of the Republican governor of Nevada, Brian Sandoval, for being one of the very first governors to take to Medicaid expansion because he knew that he depended upon young workers, many of whom were here as the first of their generation,” Clinton said Saturday.
Sandoval and fellow Nevada Republican Sen. Dean Heller have expressed deep concerns about the Senate GOP legislation due to Medicaid cuts.
In the Medicare system – like most other insurance companies – have an appeal process for denial of payment of claims…
All those various insurance providers do not want pts to know but NOTHING – in regards to denial of claims is in CONCRETE… they all have appeal processes… they don’t have to tell you about the process – UNLESS YOU ASK.. then they are required to provide you their appeal process in writing.. .today.. that might be a web page.
A Administrative Law Judge (ALJ) hearing is the last/final appeal in the Medicare system. This is normally handled by a retired judge or attorney. The pt will present “their case” as to why their denied claim should have been paid for by Medicare/Medicaid.
Generally speaking, >50% of people who appeal their denied claims to this level will get their claim APPROVED. Often the ALJ hearing officer may not have an extensive medical background and will attempt to apply “logic” to what is medically necessary for the pt and how approving the requested service would help a pt’s quality of life from deteriorating further or improving their quality of life.
Typically, these hearings are pretty INFORMAL and the ALJ will have the written denial determination from the carrier and it is up to the pt to demonstrate how the product/service that is requested is basically medically necessary and within the guidelines of what Medicare/Medicaid should be providing.
The only cost to the pt in dealing with the hearing is traveling to where ever the in person hearing is held. If that is too far a distance for a pt to travel, they may be able to take advantage of a Video-Teleconferencing center which would be more convenient.
Sometimes, the fact that the pt requests a in-person ALJ hearing… the carrier will reconsider their denial and reverse their earlier denial and approve the claim, because they know that they will probably get their denial overturned and will end up paying for it anyway.
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Clinton issues warning on opioid crisis: ‘It’s going to eat us all alive