Why does our system allow Pharmacist to refuse to fill medically necessary Rxs without justification

 

These questions relate to Safeway:

1). Can a pharmacy refuse to refill a 30 day prescription (60 pills) if the refill date is on day 29? 

2). I was told by their Regional Office just now that it will depend on the pharmacist whether future refills are given?  They have spoken to my doctor twice…  I was told today it is each of their rights to accept or deny my prescription – they do not need a reason.  They asked my doctor to change my refill date… he said no.  I’m on disability. Thank you-

I get emails like this several times a week from all over the country…

FEMA and the American Red Cross recommend that people maintain a TWO WEEK SUPPLY of FOOD & WATER in the case of an emergency

https://www.fema.gov/pdf/library/f%26web.pdf

“Even though it is unlikely that an emergency would cut off your
food supply for two weeks, consider maintaining a supply that will
last that long.”
I have been told by pts that some Pharmacists refuse to fill/refill controlled medications until after the pt as taken their last dose. I guess that these Pharmacists live in a “perfect world”… Cars always start, pts always feel well enough to make a trip to the pharmacy in a very small (a few hours) window. Pharmacies are NEVER OUT OF STOCK of a particular medication. The area that they live in NEVER EXPERIENCE a tornado, hurricane, ice storms, wild fires, floods or “zombie apocalypse”, and that a opiate dependent pt being thrown into cold turkey withdrawal is just a “minor inconvenience”
I have been told by Pharmacists that work for the large chains that the chains have:
The allotted technician hours for a Rx dept is mostly determined by the number of prescriptions filled, but many of the large chains have removed the number of controlled Rxs filled from this calculation… so the if a Rx dept fills 20% controls… that volume doesn’t provide tech hours for the Rx dept.. So.. if the Rx dept fills ZERO CONTROLS… technically the Rx dept has better tech staffing.  Also historically Pharmacists in the chains get annual bonuses that are based on growth of Rx volume… I have been told that the chains have taken the controlled Rxs filled out of the bonus calculation.  So, it would appear that both directly and indirectly, some/many of the chains are actually discouraging the filling of controlled Rxs.
The DEA uses a phrase in the Controlled Substance Act 1970 – corresponding responsibility- that the Pharmacist is suppose to basically give a “second opinion” on the prescriber’s diagnosis … without doing a in person physical exam of the pt and not having access to the pt’s medical records.  IMO, the pharmacy practice act does not grant Pharmacists the legal right to be involved in giving a “second opinion”.. and I have yet to see/hear about a Board of Pharmacy (BOP) formally objecting to the DEA mandating that Pharmacist do this.
Basically, corresponding responsibility – from the DEA’s perspective – means that a Pharmacist can be held liable for getting a controlled medication into the “wrong hand”.. but the DEA has no authority to make sure that medication gets into the “right hand”.  “Corresponding Responsibility” should be a TWO WAY STREET… this is where the 51 Boards of Pharmacy should come into the picture, but I have yet to see a BOP to state anything other than “we don’t have the authority to require that a Pharmacist fill a prescription”
Could that be because the majority of BOP’s are “stacked” with non-practicing corporate/chain pharmacists… employed by the same corporate entities who are discouraging their pharmacists in filling controlled medications.
So if a Pharmacist gets a controlled substance in the “wrong hand”… if they get their employer fined by the DEA… they will be probably be fired…  we have a very serious & growing Pharmacist surplus..  so getting fired.. could mean long term unemployment.  Likewise, if the Walgreen/Rite Aid merger goes thru… two chains (CVS & Walgreens) will be controlling about 35% of all community pharmacy prescription depts.
The BOP could “come down” on the Pharmacist and fine, suspend, revoke their license.
So, it would appear that no one is going to “come down” on a pharmacist for refusing to fill a controlled medication prescription…  so there seems to be potentially more adverse consequences to a pharmacist for filling a controlled substance than just electing to “JUST SAY NO “.

Pain Patients Advocacy Week April 23-30, 2017

Could your healthcare just come down to “numbers” ?

Cherokee Nation Sues CVS, Walgreens, and Others Over Opioids

Did major chain pharmacies and distributors contribute to the opioid epidemic in Oklahoma?

http://drugtopics.modernmedicine.com/node/435207

The Cherokee Nation has filed a lawsuit against six major pharmacy chains and PBMs for failing to prevent the spread of illegally prescribed opioids in the Cherokee Nation.

The lawsuit was filed against McKesson Corporation, Cardinal Health, Inc., AmerisourceBergen, CVS Health, Walgreens Boots Alliance, Inc., and Walmart Stores, Inc. The lawsuit is reportedly the first of its kind, according to a Cherokee Nation press release, because it is “holding retailers responsible or perpetuating the opioid crisis in the 14 counties in northeast Oklahoma that comprise the Cherokee Nation.”

The move is not entirely unprecedented, however. In March, Cabell County in West Virginia filed a lawsuit against drug wholesalers and several chain pharmacies. However, one of the attorneys working on the case, William Ohlemeyer, told Drug Topics that this lawsuit is unique because the Cherokee Nation is such a large political entity. He said that the lawsuit should be thought of in the same way as if a state were suing the companies, and added that it was the first state-wide claim against pharmacies and distributors.

Oklahoma, and Native Americans in particular, has been deeply impacted by the opioid epidemic. In the state of Oklahoma, 10.14% of the population aged 18 to 25 admitted to abusing prescription pain killers in the last year. The rate of opioid abuse among Native Americans is almost twice that of the general U.S. population. When former U.S. Surgeon General Vivek H. Murthy, M.D. visited tribal representatives in 2016, he said that the “prescription opioid epidemic that is sweeping across the U.S. has hit Indian country particularly hard.”

The petition filed by the Cherokee Nation claims that “the brunt of the epidemic could have been, and should have been, prevented by the defendant companies acting within the U.S. drug distribution industry, which are some of the largest corporations in America. These drug wholesalers and retailers have profited greatly by allowing the Cherokee Nation to become flooded with prescription opioids.”

Evidence

The lawsuit alleges multiple wrongdoings on the part of the defendants. These include allegations that the defendants “regularly filled prescriptions in circumstances where red flags were present,” “have not adequately trained or supervised their employees,” that “monetary compensation programs” for filling a certain number of prescriptions created incentive to ignore “red flags,” and “consciously oversuppl[ied] the market in and around Cherokee Nation with highly-addictive prescription opioids.”

Ohlemeyer argues that “it’s a very simple, straightforward claim,” and that he expects to prove that the defendants “recklessly or knowingly oversupplied opioids.” When asked about other states such as West Virginia, where the source of many illicitly obtained opioids came not from major chains but from community pharmacies, he argued that these drugs had to have come from the distributors. He said that looking at the data based on prescription drug monitoring programs can pinpoint where drugs are being over-distributed, and that “there is no question that pharmacies get their drugs from these distributors.”

The petition states that Walgreens, CVS, and Walmart each have “one or more pharmacies ranked in the top 10 of Oklahoma pharmacies that fill prescriptions for opioids, some of which are operating within or in close proximity to the Cherokee Nation.” Pharmacies, Ohlemeyer argued, “are supposed to figure it out. They are supposed to figure out that they [opioids] are being distributed [incorrectly] before they get out.”

Ohlemeyer summed it up this way: pharmacies and distributors failed in their “duty to make sure suspicious claims aren’t filled,” and there is “no other explanation for why there is so much of this drug on the street. It’s not because legitimate prescriptions are being written.”

Though this lawsuit is the first of its kind in terms of scope, Ohlemeyer believes that similar lawsuits will follow.

Walgreens declined to comment on the litigation. CVS Health Senior Director of Corporate Communications did not mention the lawsuit specifically in a statement to Drug Topics, but did say that CVS Health has “stringent policies, procedures and tools to ensure that our pharmacists properly exercise their corresponding responsibility to determine whether a controlled substance prescription was issued for a legitimate medical purpose before filling it.”

 

Typically chain stores will tell customers that they do have the authority to tell a Pharmacist to fill a prescription, because the Pharmacist is granted professional discretion by the Pharmacy practice act and the chain store only has a permit to operate a prescription dept… provided that there is a licensed Pharmacists that is designated as “Pharmacist in charge” (PIC) and is legally responsible to the board of pharmacy ( BOP) for the legal operation of the Rx dept.  Technically/legally the chain/permit holder has no authority in the Rx dept.. they only have the right to hire and fire the personnel working in the Rx dept.

Where is the BOP’s “friend of the court” statement regarding the limited legal rights of the permit holder in the operation of the Rx dept.

Strangely missing is lawsuits against the PIC and/or other Pharmacists working in the Rx dept… the lawsuits against the prescribers… someone had to write all of those opiate prescriptions that were filled in those chain drug stores.

Wholesalers are being sued for selling opiates to legally licensed pharmacies… which in turn had filled prescriptions written by legally licensed prescribers… the wholesalers have no access to the pt, to the pt’s records nor any direct information about the prescriber.

If some/any of these lawsuits against those who are part of the prescription distribution system prevail… against those that have no direct involvement in pt care… could we see more “cookie cutter medical care” based on some determination as to what is “average ” from some spread sheet(s).

Unfortunately, pts are generally spread out over your typical “bell curve” and their medical treatment should also be as individualized likewise.

Below is a link to a article from the National Institute on drug abuse that claims that Native Americans are 2-3 times more likely to be alcoholics than the rest of the USA population.  Since our Surgeon General recently stated that addiction is a mental health issue and not a moral failing… one would expect that the potential for abuse/addiction to other substances would be expected ?

https://www.drugabuse.gov/about-nida/noras-blog/2014/09/substance-use-in-american-indian-youth-worse-than-we-thought

We can’t torture those trying to kill us… but “torture” using denial of care – IS OK ?

Sen. John McCain (R-Ariz.) speaks to reporters after a Senate policy luncheon on Capitol Hill in Washington, June 16, 2015. The Senate on Tuesday voted to outlaw the practice of torture in an amendment to the 2016 National Defense Authorization Act. (Zach Gibson/The New York Times)Torture Is Already Illegal, So Why “Ban” It?

http://www.truth-out.org/news/item/31561-torture-is-already-illegal-so-why-ban-it

Sen. John McCain (R-Arizona) speaks to reporters after a Senate policy luncheon on Capitol Hill in Washington, June 16, 2015. The Senate on Tuesday voted to outlaw the practice of torture in an amendment to the 2016 National Defense Authorization Act. (Photo: Zach Gibson/The New York Times)

The US Senate voted by a high margin to ban the use of torture on June 16. The bill is an amendment to the 2016 National Defense Authorization Act, an annual defense policy measure. It passed 78-21 but the entire bill currently remains in the Senate. Leading the effort was Senate Armed Services Committee Chairman John McCain (R-Arizona) who coauthored the bill with Senate Intelligence Committee Vice Chair Dianne Feinstein (D-California). The bill is a departure from the CIA’s torture program during the Bush administration. However, it is also a redundant measure: Torture is already illegal under US and international law.

Under the CIA torture program, the US government snatched over 100 people it suspected were terrorists from various countries like Afghanistan, Pakistan and Mauritania, and detained them in numerous secret prisons around the world. They were subjected to numerous acts of torture, such as waterboarding, sexual abuse, anal rape, stress positions, sleep deprivation, beatings and wall slamming. While the program was ineffective in gathering useful intelligence, it was useful (indeed, its key purpose was) for exploitation: namely, to elicit false confessions that were used to justify the Iraq war and turn some detainees into informants.

US domestic law already prohibits torture, the punishment for which is either a maximum of 20 years in prison or a fine, or both. If someone dies as a result of torture, the perpetrator gets the death penalty or a life sentence. US courts’ jurisdiction in this matter applies to any US national or if “the alleged offender is present in the United States.”

Torture also violates international law. The UN Convention Against Torture explicitly prohibits torture. It even states, “No exceptional circumstances whatsoever, whether a state of war or a threat of war, internal political instability or any other public emergency, may be invoked as a justification of torture,” and adds, “An order from a superior officer or a public authority may not be invoked as a justification of torture.” The United States signed that treaty in 1988 and ratified it in 1994, so it is bound by it.

“They’re passing a bill that affirms exactly what has always been the case. Torture was illegal then and it’s illegal now.”

Moreover, torture violates customary international law, which, according to the International Court of Justice Statute, is “a general practice accepted as law.” The prohibition against torture is established under customary international law as jus cogens (Latin for “compelling law”), also called a “peremptory norm,” which is a principle under international law that forbids any deviation. As Human Rights Watch explains, jus cogens “has the highest standing in customary law and is so fundamental as to supersede all other treaties and customary laws (except laws that are also jus cogens). Criminal acts that are jus cogens are subject to universal jurisdiction, meaning that any state can exercise its jurisdiction, regardless of where the crime took place, the nationality of the perpetrator or the nationality of the victim.”

Walter Ruiz, defense lawyer for Mustafa al-Hawsawi, a defendant in the 9/11 case and Guantánamo detainee who was held and tortured in CIA black sites, clarified the reach of the Convention Against Torture in a conversation with Truthout. He explained that the convention is “a far-reaching international document that brings everyone and all nations together to affirm that torture is, in fact, illegal. So now they’re passing a bill that affirms exactly what has always been the case? As if to say, before, it wasn’t illegal? It’s nonsense. Of course it was illegal then and it’s illegal now.”

There’s nothing wrong with the passage of the Senate bill, according to Ruiz; he calls it a “nice, positive public affirmation of the principle.” However, he says, we must remember that it does not do anything new, and that the law prohibited torture during the thick of the “war on terror,” as well.

“[The bill] doesn’t change what has always been the case,” Ruiz said. “And it has always been the case in 2000 and 2001, 2002, 2003, when these things were happened by US-sponsored actors and by US government agents, as well.”

Ruiz’s team has argued in the Guantánamo military commission hearings that torture violates international law.

Other Forms of Torture

The Guardian recently reported that the “McCain-Feinstein amendment codifies an existing ban on torture introduced by Obama shortly after he was installed in the White House in 2009.” That order “restricts all government employees, including CIA agents, to only use the techniques specified in the Army Field Manual.” Yet former Air Force intelligence officer and SERE (Survival, Evasion, Resistance and Escape) instructor Michael Kearns told Truthout, “That manual allows torturous acts like sleep deprivation.”

The permissions that Kearns refers to are included in the Army Field Manual‘s Appendix M. While there are protections against certain acts of torture, Appendix M explicitly allows others, such as separation and sleep deprivation for so-called “unlawful enemy combatants.” The manual states that physical separation “involves removing the detainee from other detainees and their environment,” while a “field expedient method” of separation using “goggles or blindfolds and earmuffs” can be used to “generate a perception of separation” if physical separation is not feasible. According to the manual, “separation” is intended to prevent detainees from communicating with each other, suppress resistance to interrogation, “prolong the shock of capture” and “foster a feeling of futility.” This is all done while ostensibly still complying with prohibitions against torture and ill treatment.

The manual makes several linguistic contortions to say that their form of separation is humane and not a form of isolation. However, both the Committee Against Torture and Just Security, a US national security law forum based at New York University School of Law, argued that the manual’s separation technique is no different than isolation or solitary confinement, which is widely regarded as a form of torture and ill treatment by human rights groups and the international community. Isolation can lead to several harmful psychological effects, such as anxiety, depression, anger, paranoia, memory loss, disorientation, hallucinations, self-mutilation and suicide.

Appendix M also states that isolation “must not preclude the detainee from getting four hours of continuous sleep every 24 hours.” However, the Committee Against Torture notes that four hours of sleep is not enough, especially over the course of long periods of time. It says, “Such provision applicable over an initial period of 30 days, which is renewable, amounts to authorizing sleep deprivation – a form of ill-treatment.”

Indefinite detention – detaining people for a prolonged period of time without charge or trial – is a form of torture.

Solitary confinement also occurs in US domestic prisons. Of the over 2.4 million people in prison throughout the United States, around 80,000 are held in solitary confinement. They are confined in solitary cells for 22 to 24 hours a day. Many people held in solitary confinement are mentally ill and the isolation makes their illness worse. In March 2014, Michael Anthony Kerr, a 54-year-old Black man and mentally ill prisoner who was held in solitary confinement at a North Carolina prison for 35 days, died in a prison van. Kerr had schizoaffective disorder, a mental illness that has symptoms of schizophrenia and bipolar disorder, and was not treated in prison. A September 2014 autopsy revealed that Kerr died of thirst, but did not determine how he became dehydrated. Other forms of abuse and torture by guards occur regularly in US prisons, including sexual abuse and rape, coercion, beatings, choking, wall slamming and stunning with electronic devices.

Ruiz also pointed out that indefinite detention – detaining people for a prolonged period of time without charge or trial – is a form of torture. In an interview with HuffPost Live, Kristine Huskey, a Guantánamo defense lawyer who worked on the Omar Khadr case, noted that a report by Physicians for Human Rights “looked at the consequences of indefinite detention on individuals. And there’s an actual physical harm, and in many cases its severe: hypertension, chronic and acute stress … problems to the nervous system … PTSD.” She added that there are instances where “indefinite detention can rise to the level of torture.” Moreover, indefinite detention also violates human rights and international law. Article 9(1) of the International Covenant on Civil and Political Rights – which the US is also a party to – states: “Everyone has the right to liberty and security of person. No one shall be subjected to arbitrary arrest or detention. No one shall be deprived of his liberty except on such grounds and in accordance with such procedure as are established by law.”

However, in May 2009, just months after entering office, President Obama acknowledged that some Guantánamo prisoners would continue to be detained indefinitely without charge or trial. That policy has not changed. Currently, there are 116 prisoners remaining in Guantánamo. Of those, 51 are cleared for release and over three dozen are recommended for indefinite detention by the Obama administration.

Despite the Senate’s passage of the torture ban, it is important to remember that torture is already illegal under US and international law. It is also crucial to scrutinize what is defined as torture, considering that certain forms of torture remain in active practice, including solitary confinement, sleep deprivation and indefinite detention.

As Ruiz pointed out, the Senate’s torture ban “doesn’t change anything … It’s stating the obvious.”

 

regulators would want to access data on the test ordering patterns of their client physicians.

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 map above from the Gazette Mail two-part report shows the concentrations of opioid use per person through West Virginia from 2007 through 2012. (Image copyright: Charleston Gazette Mail.)

The map above from the Gazette Mail two-part report shows the concentrations of opioid use per person through West Virginia from 2007 through 2012. (Image copyright: Charleston Gazette Mail.)

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.

Congress targeting sick/elderly’s ability to get appropriate healthcare ?

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 ?

Indiana: many bureaucrats not the sharpest knife in the drawer ?

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 ?

— 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.

CDC: can we believe any data/stats they produce ?

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.
“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.”
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.
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.”
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’

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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