Could McKesson Settlement Set a Precedent That Would Require Clinical Laboratories to Track Physician Test Ordering?

www.darkdaily.com/could-mckesson-settlement-set-a-precedent-that-would-require-clinical-laboratories-to-track-physician-test-ordering-426

In today’s world of the Internet-of-Things, it is becoming easier to collect data on every purchase made by individuals and companies. That ability to track the actions of consumers and commercial business has not escaped the notice of law enforcement and regulatory authorities. For example, at some future point, it could be that regulators would want to access data held by clinical laboratories on the test ordering patterns of their client physicians.

A recent ruling by the US Department of Justice (DOJ) in a case involving McKesson Corp. (NYSE:MCK), may set a precedent that could eventually be cause for concern for medical laboratories that work with physicians who may be ordering more tests than are considered medically necessary under current regulations.

McKesson is a retail distributor of pharmaceuticals, and provider of health information and care management technologies and medical supplies. In a settlement with the DOJ, McKesson agreed to pay a record $150 million in civil penalties, as well as a staggered suspension of sales of controlled substances for a period of time from distribution centers in Colorado, Ohio, Florida, and Michigan, for alleged violations of the Controlled Substances Act (CSA).

In addition, the company has agreed to what the DOJ calls “enhanced” compliance for the next five years, and to hire an outside entity to monitor compliance. According to the DOJ and the US Drug Enforcement Administration (DEA), McKesson failed to detect and report suspicious orders of controlled substances in several states. The penalties and sanctions are the most severe agreed to by a distributor of pharmaceutical drugs to date.

A History of Failing to Report Suspicious Orders

This is not the only time McKesson, which is based in San-Francisco, has run afoul of compliance regulations. In 2005, officials from the DEA met with representatives of the company to warn them they were fulfilling orders from pharmacies that were ordering prescriptions online illegally. According to a DOJ news release, “The United States Attorneys allege that the orders that McKesson received from these pharmacies were unusually large, unusually frequent, and/or deviated substantially from the normal pattern. As a result, millions of dosage units of controlled substances were diverted from legitimate channels of distribution.”

Six US attorneys’ offices from Middle District of Florida, District of Maryland, District of Colorado, Southern District of Texas, District of Utah, and Eastern District of California, reached an agreement with McKesson in 2008. In that agreement, McKesson agreed to pay $13,250,000 and to set up a system to detect and report suspicious orders.

A Deadly Problem

The opioid epidemic in the US is an enormous problem that affects people from every socioeconomic group. According to data from the Centers for Disease Control and Prevention (CDC), “More than three out of five drug overdose deaths involve an opioid” and the number of deaths per year due to opioid overdose has quadrupled since 1999. In 2014, more than 28,000 people died from opioid overdose.

Those startling statistics have brought attention to the opioid epidemic, which includes questions about the sources of the prescription drugs that end up in the possession of abusers. Many, though not all, are legal with a prescription. In places like West Virginia, which has been especially hard hit, the effects of opioid abuse paint a stark picture.

A two-part series published in the Charleston Gazette-Mail describes the “trail of painkillers,” which the writers claim “leads to West Virginia’s southern coalfields, to places like Kermit, population 392.” Kermit is in Mingo County, where one pharmacy ordered close to nine million hydrocodone pills over the course of two years. And it’s not just Mingo County. The Gazette-Mail article states, “In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills.” That amounted, according to the report, “to 433 pain pills for every man, woman, and child in West Virginia.”

The Gazette-Mail quotes former Delegate and retired pharmacist Don Perdue as saying, “Distributors have fed their greed on human frailties and to criminal effect.”

Obviously, McKesson, and other drug distributors, disagree. The Gazette-Mail two-part report also quoted General Counsel to McKesson, John Saia, from a letter that had been previously released by the company: “The two roles that interface directly with the patient—the doctors who write the prescriptions and the pharmacists who fill them—are in a better position to identify and prevent abuse and diversion of potentially addictive controlled substance.”

However, Betsy C. Jividen, acting US Attorney in northern West Virginia agrees with the “criminal effect.” The San Francisco Mercury News reported her as saying, “In many instances, the suspicious orders placed by West Virginia pharmacies resulted in prescription narcotics being diverted for illegal use and abuse.”

Is This a Precedent That Might Eventually Ensnare Clinical Laboratories?

The entire McKesson saga creates an interesting precedent for all healthcare providers, including clinical laboratories. If a healthcare provider is purchasing (or ordering) an unusually high volume of medical products or services in a way that could be ruled medically-unnecessary, illegal, or enabling patients to otherwise violate the law, does the federal government now have the power to hold the entities that supplied that provider accountable?

Staying with the example of prescriptions for hydrocodone and oxycodone that were at the center of the McKesson case, could federal investigators use the precedent in the McKesson case to take action against a medical laboratory that was performing pain management tests as requested by physicians in a pain management clinic, and where the laboratory noticed a pattern of unusually high utilization of these tests, but did nothing?

If McKesson can be held responsible for the orders placed by pharmacies, could clinical laboratories also be held responsible for potentially unnecessary tests ordered by doctors? Only attorneys experienced in this area of law and regulation can assess the current level of risk for providers. Currently, the likelihood of this precedent being applied to other types of healthcare providers is low. But the point of this news analysis is to call attention to a new legal precedent that does have the potential to be applied in other situations.

Obviously, there’s a tremendous difference between prescriptions for opioids and medical tests used by physicians to monitor the appropriate use of opioid prescriptions by their patients. However, the precedent set by this settlement could show the direction the regulatory winds are blowing.

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GOP looks to weaken pre-existing condition guarantee

http://www.channel3000.com/health/gop-looks-to-weaken-preexisting-condition-guarantee/463306882

(CNN) – House Republicans are hoping they can revive negotiations to weaken Obamacare once again.

GOP lawmakers in the House have taken the crucial step of putting their latest hope for a health care compromise on paper, circulating legislative text that could launch yet another round of health care talks just in time for the last of President Donald Trump’s first 100 days in office.

A draft amendment obtained by CNN, first reported by Politico, gives renewed insight into where the GOP may be moving next. The amendment would allow states to seek waivers to weaken several key Obamacare insurance reforms that protect those with pre-existing conditions, including the benefits insurers must cover in their policies and the ban on allowing carriers to charge more based on a person’s health background.

The amendment is an effort to once again try and bridge the gap between hardline conservatives in the House Freedom Caucus and more moderate Republican members — a divide so wide that when the compromise first emerged last week GOP aides remained skeptical that it would be enough to get leadership to the 216 votes it needs to pass the bill.

The amendment was negotiated between Tuesday Group leader Tom MacArthur, a New Jersey Republican, and House Freedom Caucus Chairman Mark Meadows, with consultation from the White House and House leadership. But there is still little proof that the amendment will finally be the breakthrough that gets the health care bill passed in the House.

The politics haven’t shifted

The math problem House leadership has always had remains the same. Any changes aimed at garnering support of conservative House Freedom Caucus members could deter moderates from the bill.

“We still don’t know how this amendment changes the net vote total,” a senior GOP aide told CNN. “The only ‘deal’ that matters is the one that gets us 216 votes.”

Leaving the Capitol Tuesday night, Meadows told reporters that he was still working with his group to garner support for the amendment.

“We’re evaluating this amendment and we’re looking to debate this as a caucus before we make a final decision,” Meadows said.

Members in the dark

Many members coming back into town Tuesday night knew little about the proposed amendment except for what they’d seen in news reports. Rep. Lou Barletta, a Pennsylvania Republican who’d been supportive of House leadership’s bill before, described the process as “very frustrating.”

“All I’ve seen is what I’ve read in the paper,” Barletta said. “Nobody should take any vote for granted.”

Rep. Mike Coffman, a Republican from a swing district in Colorado, said he’d been supportive of leadership’s first bill, but without seeing the amendment, which had not yet been leaked widely to the media, he said he didn’t know where he stood on it.

“It’s a change,” Coffman said. “I think certainly for the Freedom Caucus people, it moves them closer, but for somebody like me, it doesn’t.”

What’s in the amendment

The amendment would also allow insurers to charge enrollees in their 50s and early 60s more than younger ones.

States that requested these waivers would be required to put in place protections to minimize cost increases for those with pre-existing conditions, such as high risk pools.

Obamacare’s “essential health benefits” provision requires insurers to provide 10 services, including maternity coverage, substance abuse and prescription drugs, in all plans. And its community rating measure prevents insurers from charging more to people based on health history or gender.

The health reform law also limited insurers from charging older enrollees more than three times younger ones. The original GOP repeal bill would have widened that ratio to five-to-one. This provision prompted a lot of backlash from moderates and advocacy groups, such as the powerful AARP.

While MacArthur stressed that states would not be allowed to waive the Obamacare rule that requires insurers to cover those with pre-existing conditions, health policy experts say the amendment would greatly affect those who are sick or have had medical issues in the past. It would allow insurers to charge them more for coverage, and also it would let insurers once again offer skimpy policies. That would make it harder for the sick to find comprehensive policies that cover their treatments.

Obamacare’s protections for those with pre-existing conditions are among the law’s most popular provisions.

Congress “legalizing” Elder Abuse ?

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Indiana prosecutor urges against needle exchange

http://www.whio.com/news/local/indiana-prosecutor-urges-against-needle-exchange/ZSo8K8QbGAhm6okHPW2eTO/

There must be something in the water in Indiana or something that they are feeding bureaucrats.  The small county (Scott, pop 25,00) had a HIV +, Hep B&C “epidemic” of abt 200 people showing up a couple of years ago… Then Governor Pence (now VP Pence) was against a clean needle program in this county.. Then agreed to have one for THIRTY DAYS… eventually extended for one year and apparently has since been extended.  Each one of those people represented a lifetime cost to treat the diseases they contracted sharing needles was an estimated 130 MILLION…  Since these people have little/no financial resources… guess who is going to foot the bill…. Medicaid/taxpayers.

Keep in mind that Scott county is abt 30 miles north of Louisville, KY with a metro population – which includes 2-3 counties along the Ohio river of about 1.6 million people, and I-65 runs thru the dead center of the county… I-65 runs from Chicago area all the way to the Gulf of Mexico…. abt total of 800 miles.  Now this NE Indiana Attorney/county prosecutor … is coming out against a clean needle prgm in his county.  Just another part of our judicial system that wants to perpetuate the war on drugs ?

Muncie — A Delaware County prosecutor has urged county officials to oppose the organization of a needle exchange program, saying he believes the effort to decrease HIV infections was outweighed by risk of those needles being used to cook and use heroin.

The Star Press (http://tspne.ws/2oM4o71 ) reports council members unanimously authorized an attorney to draft a resolution opposing a needle exchange program following prosecutor Jeffrey Arnold’s presentation of Madison County’s needle exchange kit. The package included fresh needles, condoms, saline for injections, small heroin “cookers” with twist-tie handles and a bio-hazard container for used needles.

The Legislature passed a bill this month allowing counties to start needle-exchange programs without state approval. Gov. Eric Holcomb signed the bill Wednesday.

Nine of Indiana’s 92 counties have needle exchanges. They started after a 2015 HIV outbreak in Scott County.

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Opioid epidemic may be underestimated, CDC report says

http://www.cnn.com/2017/04/24/health/opioid-deaths-cdc-report/index.html

This report/presentation is the biggest bunch of BS I have seen in quite a while. Many coroners are ELECTED and may or may not have a medical background. And you pull out the unknowns:

no “national standardization for how to fill out a death certificate”

“there’s no clear-cut line on what an overdose is”

Total disregard that any of these OD deaths were in fact SUICIDES.  There are so many FACTOIDS floating around out there.. ANYONE, that produce a report that comes to a predetermined conclusion about opiate use/abuse in this country.

The more I see out of the CDC… the more I am coming to the conclusion that you can’t really trust any stats that they are generating as having any relationship with the REAL TRUTH.

(CNN)Experts say the United States is in the throes of an opioid abuse epidemic, causing 91 overdose deaths each day. Yet the total number of opioid-related deaths may still be underestimated, suggests new research from the US Centers for Disease Control and Prevention.

“In early spring, the Minnesota Department of Health was notified of an unexplained death: a middle-aged man who died suddenly at home,” said Dr. Victoria Hall, a CDC field officer based in Minnesota. He’d been on long-term opioid therapy for back pain, and his family had worried he might be abusing his medication. The medical examiner assigned to the autopsy tested for and diagnosed both pneumonia and a toxic level of opioids.

 

Prince documents unsealed: No meds in home were prescribed to him

“However, on the death certificate, it only listed the pneumonia and made no mention of opioids,” Hall said.

The researchers say it may be difficult to track causes of death, such as this one, within surveillance systems that are based solely on autopsy report codes known as International Classification of Diseases, Tenth Edition, or ICD-10.

Over half of the deaths involving opioids in her study had not been captured in the state’s total, said Hall.

“While my research cannot speak to what percent we are underestimating, we know we are missing cases,” Hall said. “It does seem like it is almost an iceberg of an epidemic.”

 

Ohio coroner’s office running out of room because of overdose deaths

Hall presented her findings Monday at the annual Epidemic Intelligence Service Conference, which showcased recent CDC investigations. CDC’s “disease detectives’ support over 100 field investigations each year in the US and worldwide.

Rural and urban, men and women

Researchers led by Hall examined death records within the Minnesota Department of Health’s Unexplained Death surveillance system, called UNEX, for 2006 through 2015.

The CDC started the system in 1995 in many states, but Minnesota is the only one to maintain it.

The system was developed to “constantly be on the lookout for emerging diseases,” especially infectious diseases, explained Hall. It identifies cases in which there’s no clear explanation for death so more testing can be performed.

Because research has showed that opioid users are at increased risk of pneumonia, Hall and her colleagues searched for pneumonia as well as other infectious disease deaths among Minnesota residents over the age of 12 to see whether opioids might be involved and found in postmortem toxicology screenings.

Among the 1,676 deaths that fit the researchers’ criteria, 59 (or 3.5%) showed evidence of opioid use. Those 59 deaths had not been picked up by the state’s opioid surveillance system because they lacked the proper ICD-10 code. And, among these 59 deaths, 22 had involved toxic levels of opioids.

 

Christie will advise Trump panel on opioid addiction

The deceased ranged in age from 16 to 82, with a median age of 43, and 53% were female. Hall said the demographics of cases caught in the UNEX system were very similar to those captured in the state overdose system, with adults of all ages and ethnicities, both rural and urban.

“Opioids don’t discriminate,” Hall said.

Pneumonia was found in 32 of the 59 deaths. Deaths involving infectious disease like pneumonia can be complicated if you have opioids in your system, explained Hall.

“Opioids at therapeutic or higher than therapeutic levels can impact our immune system,” she said. “It actually impacts your macrophages — so that’s one of your main immune cells that’s going to help fight off infections — and it kind of dampens them down. It also dampens down your antibody response.”

 

Prescriptions may hold clues to who gets hooked on opioids, study says

The sedative action of opioids also affects mechanical aspects of breathing.

“When you take an opioid and it makes you breathe more shallow and breathe slower and less likely to cough, it’s a lot more likely things can settle in your lungs,” Hall said.

Among the 32 pneumonia cases, nine of the deceased had a history of drug abuse, six had chronic pain, and one was taking methadone.

“Over half the cases that we found that were toxic or lethal were not counted in the system,” Hall said.

‘Not just a Minnesota problem’

 

Prince documents unsealed: No meds in home were prescribed to him

Another complication of the opioid epidemic is that “there’s no clear-cut line on what an overdose is,” Hall said. Long-term users may be able to take a much higher dose than first-time users, so when national statistics are collected, the CDC must rely on a medical examiner’s judgment as to what is an overdose.

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More important, there’s no “national standardization for how to fill out a death certificate,” explained Hall, so when there’s a profound infectious disease, such as pneumonia, that’s the only thing noted.

“It’s quite concerning, because it means that the (opioid) epidemic, which is already quite severe, could potentially be even worse,” Hall said. A total of 33,000 opioid-related deaths were reported across the nation in 2015, a historic high, she said.

“While my data doesn’t support a percent that we’re underestimating, it puts out the question: Is there something we need to look into further?” Hall said. “This is not just a Minnesota problem.”

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DEA agent on trial, accused of working with lying informant to concoct bogus drug cases

http://www.cleveland.com/court-justice/index.ssf/2017/04/dea_agent_on_trial_accused_of.html

CLEVELAND, Ohio — Testimony in a civil trial began Tuesday for a U.S. Drug Enforcement Administration agent accused of misconduct in a series of botched cases in Mansfield that landed a man in prison for 18 months for a drug deal in which he did not participate.

Mansfield resident Joshawa Webb filed suit against agent Lee Lucas and others for a decade-old drug case in which he was charged.

The U.S. Attorney’s Office dropped the case against Webb in 2007, along with those of several other people ensnared in a federal crack-cocaine investigation known as Operation Turnaround. A paid informant named Jerrell Bray admitted to staging phone calls and identifying the wrong people when setting up drug deals on behalf of federal agents.

Lucas was indicted in 2009 and a jury acquitted him in 2010 on accusations that he lied on written reports and in court to corroborate Bray’s testimony. Webb’s lawsuit has been pending since 2007 and finally made it to trial this week after appeals and court battles. A jury was picked Monday.

Bray admitted in that he used his friend, Jeremiah Conrad, as a stand-in for Webb during a drug deal. Lucas posed as a drug user and took part in a controlled buy and later said Webb was the one who sold him the drugs, even though Conrad is noticeably shorter and leaner than Webb.

Jon Loevy, Webb’s attorney, said in his opening statements Tuesday that he is asking the jury to decide whether Bray was fooling the DEA or whether they knew and, at the very least, turned a blind eye. He said his client has never sold crack cocaine, though he has convictions for dealing marijuana and severely beating his stepfather.

“You can’t just lie to make drug cases. And that’s what happened in Operation Turnaround,” Loevy said.

He listed several reasons why the jury should not be swayed by any arguments Lucas might make that Bray fooled him, including accusations that Lucas concealed his informant’s own drug crimes.

Lucas maintains his innocence. His attorney Thomas Roth said Bray concocted his story to sidestep an attempted murder case in Cleveland at that time. 

Roth read from a transcript of Lucas’ criminal trial where Bray testified that he went to federal authorities because “I was trying to get myself out of trouble, so I was lying, sir.”

The attorney said Webb and Bray were friends. He also said Webb, at one point, admitted he was guilty of the drug conspiracy charge in his indictment.

Roth said that Loevy’s description of the DEA agent “is not the Lee Lucas I know.”

Webb is also suing retired Richland County Sheriff’s Office detective Charles Metcalf. Metcalf pleaded guilty in 2009 violating the civil rights of Dwayne Nabors, the owner of a car detail shop. He testified against Lucas at the agent’s criminal trial.

Michael Heimlich, an attorney representing Metcalf, said his client’s role was limited and that Metcalf was not involved in the drug deal that resulted in Webb’s arrest. He said the detective was on scene for backup in case anything happened.

Heimlich told the jury that Loevy has been careless with the facts of the case.

The trial could last for several weeks.

Lucas’ trial has been the talk of the federal courthouse this week, as many who worked with him still remember the burly career drug agent. He was heralded by his fellow law enforcement officers for having a tireless work ethic. During his time. He worked closely with the Cleveland police department’s narcotics unit.

Lucas was suspended for 45 days for failing to include all required information in reports in cases against two suspects.

Bray died in September 2012 at the age of 40, while he was in the middle of serving more than 13 years in prison for lying during the operation.

Herman Price, another man whose case was to be tried along with Webb’s, settled Monday with defendants in Richland County. Loevy, who also represented Price, refused to discuss the settlement terms, as did an attorney representing the Sheriff’s Office.

Richard County Sheriff’s Major Joe Masi referred a cleveland.com reporter to the attorney. When asked for a copy of the settlement agreement, he said the Sheriff’s Office doesn’t have one.

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Judge rules in favor of Tennessee clinic in meningitis outbreak case

http://www.commercialappeal.com/story/life/health/2017/04/24/judge-rules-favor-tennessee-clinic-meningitis-outbreak-case/100867202/

A federal judge has ruled that the U.S. Food and Drug Administration and a state pharmacy board can be found at fault for the 2012 fungal meningitis outbreak that took the lives of some 77 patients who had been injected with fungus contaminated drugs.

In a nine-page ruling issued Monday, U.S. District Judge Rya Zobel concluded that lawyers for a Tennessee pain clinic had presented sufficient evidence in her Boston, Mass. courtroom for the claims that the two agencies acted recklessly to go forward.

Zobel denied a motion filed by attorneys for some 20 Tennessee victims of the outbreak to dismiss claims by the Specialty Surgery Center in Crossville, Tenn. that the government agencies could be found at fault for failure to take action against the New England Compounding Center, the maker of the deadly spinal steroids.

Citing a “special duty” provision of Tennessee’s comparative fault law, Zobel concluded that the clinic’s lawyers presented “sufficient assertions to state an affirmative defense of comparative fault” against the FDA and the Massachusetts Board of Pharmacy.

Under Tennessee law, Zobel’s ruling could clear the way for any damages awarded against the surgery center to be reduced by the percentage of fault found by a jury against the FDA and the Massachusetts board. However, the two agencies, who are not parties to the suit, could not be forced to pay anything to victims.

Noting that the ruling is only a preliminary one, a victims’ attorney expressed confidence in the ultimate outcome, adding “We are confident that “once we present this to the court on a full factual record that the court will find that the governmental agencies were not reckless.”

Zobel did dismiss parallel comparative fault claims against the Tennessee Health Department and the Tennessee Board of Pharmacy.

Zobel cited the claims by the surgery center lawyers that the FDA received numerous complaints that NECC was violating the FDA’s guidance on drug compounding but “nevertheless failed to take any subsequent action to address the serious nature of the complaints which proximately caused the alleged injuries.”

She noted that as early as 2002 the FDA was made aware of problems at NECC and four years later issued a warning letter but then failed to act.

“Defendants allege the FDA acted recklessly because it knew NECC had sterility and potency issues but failed to take any substantive action,” the ruling states.

As for the Massachusetts board, Zobel cited evidence presented by the clinic’s lawyers showing the the board “was aware of NECC’s failure to comply with applicable state and federal law and manufacturing guidelines, failed to inform other state pharmacy boards of  of the threat to public health caused by NECC’s non-public track record of regulatory noncompliance with state and federal law.”

In a footnote Zobel noted the November 2012 congressional testimony of then Massachusetts Health Commissioner Lauren Smith that the state pharmacy board’s failure to take decisive action against NECC in response to the 2006 complaints “has contributed to these tragic events.”

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Man’s family sues doctors after fatal overdose

http://www.wpxi.com/news/top-stories/mans-family-sues-doctors-after-fatal-overdose/515967345

According to a wrongful death lawsuit filed Tuesday in Allegheny County Court of Common Pleas, doctors at a McKeesport clinic prescribed Classic painkillers in March 2013 after an MRI showed a mild bulged disk in his back. 

 

Classic continued to receive pain medication for two years before the doctor wrote a note saying, in part: 

 

“Patient in the past few weeks has demonstrated overuse, urgency in wanting to obtain further quantity when overtaken and has called this office several times insistent on knowing when his medications would be prescribed.” 

 

Family members said Classic had a near fatal overdose less than a month later, but found other doctors to prescribe painkillers to him. The lawsuit alleges this patter continued until his fatal overdose in October 2015. 

The lawsuit was filed by Classic’s mother. Seven doctors and counselors are named as defendants.

 

“She had been waging an almost one-woman crusade to get these doctors to stop prescribing to her son,” said Alan Perer, the Classic family’s attorney. “She failed in her attempts to prevent this from happening to her son. She would like to see the system improve.” 

 

Channel 11 reached out to the seven doctors and counselors named in the lawsuit. All either declined to comment or did not return phone calls. 

 

The prescription drug monitoring program was not implemented until several months after Classic’s death. The program requires doctors to put patients getting prescription drugs into a shared system to prevent “doctor shopping.” 

Pennsylvania was one of the last states to implement a state wide drug database system… Only Missouri still does not have a state wide PMP.  Of course, back in 2005 Pres Bush (43) signed into law a NATIONAL prescription database http://nasper.org/  but Congress had never funded it operation.  So healthcare providers in PA were “flying blind”… but the bureaucracy will not take any responsible in this death, and who “forced” this man to take all those opiates ?  SEVEN DOCTORS… isn’t it illegal to obtain controlled substances for non-legit reasons.. Of course, you can charge someone who is DEAD for the illegal activity done while they were alive.. Couldn’t the parents had him arrested for this illegal activity… at least … he might still be around..

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NH treats overdoses as crime scenes, targets drug dealers

http://www.foxnews.com/us/2017/04/24/nh-treats-overdoses-as-crime-scenes-targets-drug-dealers.html

VIDEO ON LINK

Dakota Kilburn was just 23-years-old when a dose of heroin claimed his life. The young father was found unresponsive in his parent’s Manchester, Vermont home on November 18th, 2015.

His heartbroken parents remember a young man filled with potential until addiction took hold.

“He said ’till you do it you’ll never understand. It gets you, it holds onto you and all you ever do is want it,’” said Daniel Kilburn, Dakota’s father.

“He loved being outside, he loved singing loud, he loved playing with little kids,” said Maisie, Dakota’s mother. “He just enjoyed life. He really did.”

DRUG DEALERS WOULD FACE MANSLAUGHTER CHARGES FOR OPIOID OVERDOSES UNDER PROPOSED FLORIDA LAW

Intent on finding Dakota’s supplier, police followed the clues to neighboring New Hampshire where two men were charged under a statute that aims to hold those who sell drugs with a ‘death resulting’ responsible for the loss of life.

Francis Mayhle, 25, a childhood friend, was sentenced to a year in prison. Daniel Fogg, 27, who sold Mayhle the fatal drug, which he provided to Dakota, got 6 1/2 to 14 years.

“They are literally selling poison, killing people with that poison and for them, they need to face a punishment,” said Ben Agati, a senior assistant attorney general in New Hampshire. “They need to face some measure of justice.”

The previously little used-charge carries up to life in prison.

“We were dealing with just an influx of overdoses, overdose deaths, misery,” laments Jon DeLena, the Assistant Special Agent in Charge for the Drug Enforcement Administration, Manchester District.

DRUG DEALER CONVICTED OF MURDER IN FATAL FENTANYL SALE

Facing a rising death toll, hit hard by the opioid crisis wracking the nation, the DEA and the Attorney General’s office in New Hampshire and law-enforcement across the state have launched a collaborative program that trains officers and prosecutors to treat overdoses as crime scenes.

“The syringe has become the murder weapon,” DeLena said.

The approach is emerging as model for other efforts nationwide. It aims to ensure the right evidence is gathered, streamlines investigations and targets dealers whose actions claim so many lives.

“The first step is to try to figure out where this drug came from that killed this person and how do we quickly identify the source and take them off the street,” DeLena said.

A strike force was created to respond 24 hours a day, packed with experts, including a prosecutor and homicide detective.

“The homicide detective looks at this a little differently and slows things down, maybe would observe things differently than we would,” DeLena said.

Police officers on the scene of an overdose can call for advice or request additional manpower.

“We’re able to help advise them about what’s going to be usable at trial and what’s not,” Agati said.

A database helps to connect the dots.

“From a tragic overdose death scene to maybe two or three different cities in New Hampshire down into Massachusetts to a supplier down there,” said DeLena of the trail they often follow. “We’re able to arrest everybody that was involved along the chain that led to that person’s death.”

The approach has led to roughly a dozen “death resulting” prosecutions but some critics say aggressive arrests won’t curb the crisis.

“It’s going to end up saving absolutely no lives and result in millions or tens of millions of dollars being spent locking up drug dealers who will simply be replaced by other dealers,” argues Ethan Nadelmann of the Drug Policy Alliance, a New York based non-profit focused on reform efforts.

But the Granite State program is gaining nationwide attention from fellow prosecutors and investigators say they’ve heard, through cases they’re working, that traffickers are keenly aware of the efforts and are trying to avoid the Granite State.

“The abilities that we now have to investigate and hold people accountable are tremendous,” Agati said.

Daniel Kilburn, Dakota’s father, wants dealers to know they will face consequences.

“Too many of them,” Kilburn said, “are let go way too easily or with a slap on the wrist.”

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