Pt care at the VA appears to remain unchanged… whistle-blower not withstanding

Veterans Affairs whistle-blower faces punishment for revealing alleged harasser, email shows

http://www.foxnews.com/politics/2017/04/10/veterans-affairs-whistle-blower-faces-punishment-for-revealing-alleged-harasser-email-shows.html

An employee at the embattled Veterans Affairs hospital in Arizona is facing a punishment ranging from “reprimand to removal,” Fox News has learned, for publicly revealing the name of a colleague he claims harassed him after the whistle-blower exposed exceedingly long wait times for patients at the Phoenix facility.

In a letter dated March 30, the VA accused scheduling manager Kuauhtemoc Rodriguez of violating “privacy standards you are expected to enforce [and] breaching your responsibilities as a supervisor,” by sending the media a copy of an email he wrote to the hospital director that detailed alleged harassment and included the name of a colleague as one of the top offenders.

The VA claims divulging the name of a fellow employee violates its policy prohibiting release of “Sensitive Personal Information” (SPI) without permission. This includes “education, financial transactions, medical history, criminal or employment history, and information that can be used to distinguish or trace the individual’s identity.” 

‘VETS CONTINUE TO DIE’

Rodriguez acknowledged his email named an assistant as someone who had criticized him in front of veterans and others — but said he didn’t disclose any personal information.

“Just reporting someone’s name shouldn’t be secret — we are government employees,” Rodriguez told Fox News. “They are trying to twist anything they can to punish me.”

The Phoenix VA hospital was the epicenter of allegations ranging from lax care to misconduct in 2014 when a scheduling clerk became the first whistle-blower to disclose that a secret appointment wait list existed and dozens of would-be patients had died. 

In a report released in October 2016, the VA Inspector General’s Office (OIG) found that 215 deceased patients had open appointments at the Phoenix facility on the day they died. 

Rodriguez complained to the VA inspector general last November that 90 veterans still were waiting more than 400 days for care and five had died without seeing a doctor. In February, he filed another complaint alleging more than 4,000 veterans had their appointments inexplicably canceled by the Phoenix VA after they already had waited more than 180 days, documents show.

Whistle-blowers across the nation started reporting their own VA horrors, including Brandon Coleman, a Phoenix counselor who told the inspector general that many suicidal veterans were not getting timely care.

Being a whistle-blower comes with a price: many say they have endured a hostile work environment while waiting for their complaints to be remedied. Coleman and Rodriguez are two who went public with allegations and later claimed they received continued harassment at work.

Rodriguez detailed his alleged mistreatment in lengthy memos to the Office of Special Counsel, a department that reports directly to the president and is charged with protecting whistle-blowers. He said incidents included his desk being moved into a closet with no air conditioning; his promotion being halted; being told he was better suited for a rural outpost because “you have native blood”; and facing an increased workload.

The VA stood by the warning sent to Rodriguez.

“The Department of Veterans Affairs is obligated to ensure the confidentiality of its beneficiaries’ and employees’ personal identifying information,” the VA said in a statement regarding Rodriguez’s pending discipline. “Employees are expected to act in a manner that is consistent with VA’s core values of Integrity, Commitment, Advocacy, Respect and Excellence. Leadership should take action to ensure the safety of our patients and staff and preserve the integrity of our mission within applicable laws and regulations.”

The agency has given Rodriguez until April 13 to respond to its claims, and then an assistant chief said he would impose discipline ranging from “reprimand to removal.”

Rep. Phil Roe, R-Tenn., chairman of the House Committee on Veterans Affairs, has taken a dim view of the VA’s actions.

“It is unacceptable that any law-abiding whistle-blower would be punished for bringing the issues within VA to light,” Roe said in a statement, adding he has introduced legislation to enhance whistle-blower protections and allow for easier suspension, demotion or firing of bad employees.

That bill, the VA Accountability First Act of 2017, recently passed the House and forbids the VA from suspending or firing any employee without permission from the Special Counsel. It also shortens the amount of time the VA takes to investigate alleged misconduct, such as in Rodriguez’s case.

The First Amendment Coalition, a free speech advocacy group that aids the public in battles against government secrecy, also said the VA’s use of a privacy statute is overly broad if it claims names of employees should not be divulged.

“To threaten discipline up to and included firing seems at the very least heavy-handed; it’s not like the Social Security or bank account numbers were released,” said David Snyder, the coalition’s executive director.

Snyder said there could be instances where Rodriguez’s reprimand may be technically correct, such as if he knowingly violated an agency guideline. But where the general public is concerned, most federal employee names do not fall under a category of “secret.”

“Is the mere existence of an employee’s name secret or to be withheld from the public? Certainly not,” Snyder said. “The mere existence of a name isn’t something they are entitled to redact” in document requests.

The media often uses the Freedom of Information Act (FOIA) to obtain documents, which often include emails naming the sender and recipient.

“What is redactable is medical, personnel or similar files,” Snyder said. “As a general matter, that is understood to mean sensitive private information. Just a name by itself does not fall into that category.”

Class Action Lawsuit Seeks Medicare Beneficiaries Serviced by SilverScript

Class Action Lawsuit Seeks Medicare Beneficiaries Serviced by SilverScript That Have Paid Excessive Copayments

http://www.digitaljournal.com/pr/3301572

Frier Levitt announced today a search for Medicare beneficiaries with Part D coverage through SilverScript Insurance Company (“SilverScript”) that may have paid excessive copayments for a possible class action lawsuit. Medicare beneficiaries with Part D benefits that pay more than $200 out of pocket for covered medications may have claims against SilverScript for overpaying for medications year after year and may be able to serve as a class action representative. Upon success, class action representatives are not only compensated for their loss, but also receive payment for their service as a class action representative.

Medicare beneficiaries that participate in SilverScript may have overpaid for the drug benefit copayment. SilverScript, the largest Medicare-approved Part D prescription drug plan provider, is a wholly owned subsidiary of CVS Health, Inc., which also owns and operates CVS Caremark, a Pharmacy Benefit Manager. SilverScript calculates Medicare beneficiary out of pocket copayments based in part on the amount of money that Caremark, who processes prescription drug claims, pays to the participating pharmacy at the point of sale. Through utilization of Direct and Indirect Remuneration Fees (“DIR Fees”), SilverScript and Caremark may have inflated the initial costs of medication paid to the pharmacy at the point of sale, only to reduce the amount paid to pharmacies months later, well after patients have received their medications.

The damage to Medicare beneficiaries occurs because SilverScript does not re-calculate the Medicare beneficiaries’ copayment and is believed to not refund the excess copayment made by patients. Patients paid a copayment at the point of sale based on a price set by SilverScript and Caremark that may not have been accurate.  Patients may have paid hundreds or thousands of dollars more than they should have over the course of a single year. Frier Levitt is looking to file a class action against SilverScript challenging the over payment by patients.

Medicare beneficiaries with Part D coverage through SilverScript who pay more than $200 out of pocket for covered medications are encouraged to contact attorney Steven L. Bennet, Esq. at sbennet@frierlevitt.com or (973) 618-1660. Beneficiaries have the right to express concerns with their Part D coverage and doing so does not put their coverage at risk.

About Frier Levitt, LLC

Frier Levitt is a national boutique healthcare law firm. Our 27 healthcare attorneys include pharmacist-lawyers, class action attorneys, trial attorneys and those whose practice concentrates in Medicare law. Our breadth of experience in the health care field provides a unique perspective to bring relief to Medicare beneficiaries unfairly charged excessive out of pocket costs to obtain drug benefits under Medicare. For additional information, visit www.FrierLevitt.com.

Media Contact:

Adam Toris
Marketing Director
Frier Levitt, LLC
Phone: 973.618.1660
Email: atoris@frierlevitt.com

 

Pharmacists fight effort to increase regulation of Xanax in Alabama

Pharmacists fight effort to increase regulation of Xanax in Alabama

http://www.al.com/news/index.ssf/2017/04/pharmacists_fight_effort_to_in.html

Members of the Alabama Pharmacy Association are fighting a decision to impose additional regulations on alprazolam -commonly known as Xanax – which will place the drug into the most tightly-controlled group of medications.

Alabama would become the first state in the nation to move alprazolam into the same category as the powerful opioids methadone, oxycodone and fentanyl.

“The State Committee of Public Health received a request from the Alabama Board of Medical Examiners to reschedule alprazolam from Schedule IV to Schedule II due to concerns about patient safety in the midst of the substance abuse epidemic that Alabama and the nation are facing,” according to a statement released by the Alabama Department of Public Health. “This epidemic is marked by overdose deaths including those from opioids and benzodiazepines. After consideration of the criteria outlined in SS 20-2-20 of the Alabama Code, it was determined that alprazolam has a high potential for abuse, which may lead to severe psychological or physical dependence, thereby warranting the rescheduling.”

If legislators approve the reclassification at a committee meeting later this week, patients receiving the drug could no longer receive refills without a doctor’s visit. Under current regulations, doctors can provide up to six refills in six months for patients taking alprazolam.

 

Alprazolam is used to treat anxiety and panic disorders. It works more quickly than similar drugs and has a higher potential for abuse.

According to a 2014 federal report, emergency room visits for non-medical use of alprazolam more than doubled from 2005 to 2010. Drug abusers often combine alprazolam with other sedating drugs including opioids and muscle relaxants, increasing the potential for overdose and death, according to the U.S. Centers for Disease Control and Prevention..

Michael Hogue, pharmacy professor and assistant dean for the Center for Faith and Health at Samford University, said the reclassification of alprazolam won’t solve the serious problem of overdoses, but could cause many problems for patients taking the drug to treat anxiety.

Alabama has a shortage of psychiatric providers, Hogue said, which will make it difficult for patients who need to schedule a visit to refill a prescription.

“By changing alprazolam to schedule two, we are going to put incredible pressure on the psychiatric system in this state,” Hogue said.

The U.S. Drug Enforcement Agency classifies some prescription drugs with the potential for abuse, imposing more restrictions on the most dangerous and addictive substances. The DEA currently groups alprazolam with other anxiety drugs such as Valium and Klonopin. For the most part, Alabama follows federal classification, but state law allows public health officials to move drugs into more highly-regulated categories if there is evidence of widespread injury.

 

Hogue said he hasn’t seen any evidence to support the state’s effort to impose tighter restrictions on alprazolam.

Alabama ranks near the top in prescriptions per capita of anxiety medications and opioid painkillers, according to the CDC. Overdose deaths linked to those drugs rose after 2001, but have leveled off in recent years. The DEA put the painkiller hydrocodone in the most highly-restricted category in 2014, but Alabama physicians still prescribe it frequently, Hogue said.

“The only thing that changed was that the rate of heroin addiction skyrocketed after they changed the classification,” Hogue said.

And then there is this:

Alabama is the most stressed US state — where does yours rank?

8% of death certificates MIS-CLASSIFIED … Is this incompetence, stupidity, laziness ?

Diabetes is even deadlier than we thought, study suggests

https://www.washingtonpost.com/national/health-science/diabetes-is-even-deadlier-than-we-thought-study-suggests/2017/04/07/28689b94-faca-11e6-be05-1a3817ac21a5_story.html

Nearly four times as many Americans may die of diabetes as indicated on death certificates, a rate that would bump the disease up from the seventh-leading cause of death to No. 3, according to estimates in a recent study.

Researchers and advocates say that more-precise figures are important as they strengthen the argument that more should be done to prevent and treat diabetes, which affects the way sugar is metabolized in the body.

“We argue diabetes is responsible for 12 percent of deaths in the U.S., rather than 3.3 percent that death certificates indicate,” lead study author Andrew Stokes of the Boston University School of Public Health said in an interview.

About 29 million Americans have diabetes, according to the Centers for Disease Control and Prevention. There are two forms of the disease: Type 1, in which the pancreas makes insufficient insulin, and the more common Type 2, in which the body has difficulty producing and using insulin.

Using findings from two large national surveys, the study looked mainly at A1C levels (average blood sugar over two to three months) and patient-reported diabetes. In the latest study, researchers compared death rates of diabetics who had participated in these surveys to information on their death certificates.

What is diabetes?

A video from the Centers for Disease Control and Prevention offering information on the basics of diabetes. (Centers for Disease Control and Prevention)

The authors also found that diabetics had a 90 percent higher mortality rate over a five-year period than nondiabetics. This held true when controlling for age, smoking, race and other factors.

“These findings point to an urgent need for strategies to prevent diabetes in the general population. For those already affected, they highlight the importance of timely diagnosis and aggressive management to prevent complications, such as coronary heart disease, stroke and lower-extremity amputations,” Stokes said.

“We hope a fuller understanding of the burden of disease associated with diabetes will influence public authorities in their messaging, funding and policy decisions, such as taxation of sugar-sweetened beverages and use of subsidies to make healthy foods more accessible,” he said.

When they embarked on the study, the investigators were curious about two findings from earlier research. The first was a higher obesity rate and shorter life expectancy among Americans than Europeans. (The researchers already knew that obesity and diabetes were related.) The second revelation was a rise in deaths by any cause among middle-aged white Americans.

“We tried to piece together causes of mortality in the U.S., looking closer at diabetes, which we knew was underreported,” Stokes said.

Mortality rates attributed to diabetes are imprecise largely because death results from both immediate and underlying causes, and not every one of them gets recorded. For example, cardiovascular disease might be recorded as the cause of a person’s death even though that disease may have been caused by diabetes.

 

Further challenging the task of identifying cause of death is that diabetics have a long history of problems before serious complications occur.

“When diabetes started 10 to 30 or more years before a patient died, the disease may not be in the forefront of the attending physician at time of death,” explains Catherine Cowie, an epidemiologist at the National Institute of Diabetes and Digestive and Kidney Diseases. And there are no clear guidelines about which conditions should be cited as cause of death.

Detailed electronic medical records may help pinpoint the primary cause. “But still, it’s hard [to get the full picture] in this day and age when health care for diabetics is divided between different practitioners,” she said.

She advises patients to report their diabetes to all their health providers, whether they are having complications at the time or not.

“We’ve been trying to promote healthy lifestyle to prevent diabetes and complications for a long time. This includes paying attention to ‘the ABCs,’ which are to bring down A1C, blood pressure and cholesterol. But I think this [study] is new evidence that it’s important to focus on these things. It’s more data to show what diabetes can lead to,” Cowie says.

In 2016, diabetes accounted for about $1.04 billion in National Institutes of Health funding, compared with about $5.65 billion spent on cancer research. Having a better gauge on the mortality figures could have an effect on research dollars, said Matt Petersen, managing director of medical information for the American Diabetes Association.

But the true death rate means only so much.

“What’s most important is why it is and what we can do about it. The goal of research is prevention and, if possible, cure. Short of uncovering a cure, key is figuring out how do we best treat it and reduce complications,” Petersen said.

For Type 2 diabetes, new drugs that work in combination and in different ways to address differing patient cases have rolled out in just the past two years. Healthy lifestyle choices can also affect outcomes.

“So I think the public should hear [that] yes, diabetes can be deadly, but that we have the ability to reduce the chance for this disease,” Petersen says. “And for those who have diabetes, we can treat it well and reduce the risk for debilitating and deadly complications.”

 

Awareness About Illegal Online Drug Sellers and Counterfeit Medications

ASOP Global Spreads Awareness About Illegal Online Drug Sellers and Counterfeit Medications

Alliance for Safe Online Pharmacies (ASOP Global) partnered with several nonprofit organizations, including NABP,
to launch a campaign to raise awareness of illegal online drug sellers and counterfeit medications. The campaign encourages dialogue among health care providers and patients regarding where patients purchase their medications, especially if patients are buying them online.
After offering the CE course “Internet Drug Sellers: What
Providers Need to Know” to over 1,000 health care providers,
ASOP Global found that less than 10% of providers reported
they were “very aware” counterfeit prescription drugs are being
sold on the internet and only 1.4% said they regularly discuss
the risks of illegal internet drug sellers with patients. ASOP
Global Executive Director Libby Baney said, “After completing the course, however, there was a ten-fold increase in the
expected frequency in which providers planned to discuss the
risks associated with buying prescription medicines online
with their patients and what they can do to avoid physical
and financial harm.”
For more information about the campaign, visit
www.BuySafeRx.pharmacy

When saying “Thank you” isn’t enough

When saying “Thank you” isn’t enough

https://www.linkedin.com/pulse/when-saying-thank-you-isnt-enough-jane-l-brown-esq-

How do you adequately thank someone who cares for you every day, all day?

My husband is my caregiver and words aren’t enough to express my gratitude. Even when he is at work he is on call, willing to run home to address my needs.

I seriously doubt that even his friends understand the stress he is under what with work, the financial strain, questions about the future, the sense of loss he feels, and the relentless work he does for me; I am the cause of it all.

As I write this I’m realizing that this is really about me and my feelings of guilt. I’ve said “I’m sorry” to him but that never feels right (after all, I didn’t cause it [MS] to happen).

So how do I adequately express myself when saying thank you is insufficient and saying I’m sorry is wrong? My feelings are messing things up. I said above that I am the cause of it all, and in a literal sense that is correct, but when it comes to thanking my husband I need to get outside myself ~ saying thank you IS enough. I truly mean it so it’s both heartfelt and appropriate; coupled with an “I love you” should make both of us feel better.

I’m hopeful I will come to realize how wrong I am. Time will tell.

Of the opioid-related deaths, it is not clear how many are not counted as suicides

Chronic Pain and the Death of a New York Times Journalist

healthadvice.press/chronic-pain-and-the-death-of-a-new-york-times-journalist/

The death of the New York Times journalist, Sarah Kershaw, reminds me painfully of too many conversations I had with my patients during the course of my career as a pain doctor, about whether or not they wanted to live.

 During the 30 years of my practice, countless patients told me they had no hope for a life without severe disabling pain and would, therefore, prefer to die.  I believed them.

CDC Report

The CDC reports there are 44 deaths per day that involve opioids, but there are more than 105 deaths per day from suicide.  An undoubtedly significant (but uncertain) number of those suicides can be attributed to people with severe pain.

Suicides, by the way, come in at least two variations: active and passive. Active suicides intend to commit suicide and usually plan it. Passive suicides happen without premeditation by a person who finds it acceptable that her behavior might lead to death.

Of the opioid-related deaths, it is not clear how many either are active or passive suicides yet, are not counted as suicides.

The Misery of Chronic Pain

My patients often expressed to me that death seemed to be the only way out of the misery of pain. I often felt the most important role for me, even when I couldn’t relieve my patients’ pain, was to give them hope.

But, reality often trumped my best intentions. After living for years with little improvement of their pain, some my patients found it hard to sustain their hope, regardless of my efforts.

Here is where the intersection of relieving pain and preventing harm from opioids exists.

I always warned patients that, if they took more painkillers than I prescribed, they might not awaken.  More times than I care to remember, after I said this, my patient would look me square in the eye and say with complete sincerity, “That’s okay, doc. It would be better to die than to live with my pain.”

Through the years, I had patients who died from suicide.  Some used a gun.  Others used the pain medications I prescribed.

It was never easy to prescribe an opioid to someone who had such intense pain that she wished to die, but, often, there was no alternative unless I ignored the person’s need to mitigate the pain.

I worried whether the medicine I prescribed to help my patient get through days and nights of horrific pain would be used as I directed, or whether it would be used to enable my patient to escape a world of suffering.

Chronic Pain

I could never be sure, and it was a constant source of stress and unhappiness for me. To an extent, it was beyond my control. As a physician, I had to give my patients something to enable them to survive with pain. Yet, as a human being, I had to deal with the fact that the pain medication might be used when the patient could no longer survive with that pain and had lost hope.

Whether opioids are a reasonable treatment for people with disabling non-malignant chronic pain will continue to be a subject for debate, but there should be no debate about one thing:

People with chronic pain should not view suicide as their only option for relief.  We have to do more to prevent tragedies like the death of Sarah Kershaw from ever happening again.

Enforce the POSITIVE and ignore the NEGATIVE ?

Painkillers: Rule change is vital to fight opioid crisis

http://www.newsandsentinel.com/opinion/editorials/2017/04/painkillers-rule-change-is-vital-to-fight-opioid-crisis/

Hysteria from a small group of Ohioans who say they are chronic pain sufferers and will be negatively affected by the state’s new rules to restrict the prescription of painkillers should be dismissed by Gov. John Kasich and others in Columbus who understand why such rules are absolutely necessary.

Restrictions include limiting primary care physicians and dentists to prescribing opioids for seven days for adults or five days for minors; and requiring doctors to provide a specific diagnosis and procedure code for every painkiller prescription. However, the language is crystal clear that these rules do not apply to painkillers as part of cancer treatment or hospice care, and that the restrictions are meant to apply to those suffering from acute pain, not chronic pain.

In fact, in the governor’s own description of the new rules, “for acute pain prescribing,” it is spelled out rather plainly, “The new limits do not apply to opioids prescribed for cancer, palliative care, end-of-life/hospice care or medication-assisted treatment for addiction.”

So why are these few patients so upset?

Well, one woman told NBC News she did not believe the governor because “the online message boards for chronic pain sufferers lit up after Kasich unveiled the restrictions.”

Another woman, who says she has been suffering from complex regional pain syndrome since 2011 when a falling bookcase crushed her foot, said “I understand that there is a drug epidemic, but by doing this it is affecting people like me.”

She does not understand.

Ohio and the rest of our region are being ravaged. The number of fatal overdoses from opioids such as oxycodone have more than quadrupled nationwide, since 1999. By 2013, overprescribing had reached such absurd levels — approximately 250 million prescriptions that year — that there were enough prescription painkillers floating around for every person in the country to have a bottle, according to the Centers for Disease Control and Prevention.

Kasich, the state Department of Health and the state Board of Pharmacy are right to implement rules that might stem the tide. And, again, they are doing so in a way they stress is NOT meant to punish chronic pain sufferers. The cries of those who fail to see the magnitude of this epidemic, and imagine they might be “affected,” should be disregarded.

This moronic, opiophobic editor has pointed out what could be the “ulterior motive” for all of these bureaucratic agencies with their opiate dosing guidelines.  They create rules/laws/guidelines that are not suppose to affect chronic pain pts… but when prescribers start cutting back and stopping chronic pain pts pain management meds they do NOTHING. Where are the various bureaucratic agencies (Medical, pharmacy, etc ) whose primary charge is to protect the public’s health and safety… in seeing that prescribers and pharmacists observe the new laws that are suppose to make sure that chronic pain pts are being taken care of  by the healthcare providers that they are suppose to oversee ?

It is a well known fact that those families with a chronic pain pt… 90% are struggling financially and that law firms will not sue on a contingency basis for a person who is handicapped/disabled, elderly, unemployable.. .because in our legal system the “value of life” of one of these pts has LITTLE VALUE… So it appears that we are slowly moving toward a prohibition of the prescribing of opiates without officially declaring such a prohibition.

I guess that they learned their lesson from about 100 yrs ago when they tried to have a prohibition of alcohol.

New Pharmacists: full of books smarts… pt skills … NOT SO MUCH ?

10 Things They Don’t Teach You in Pharmacy School

http://www.pharmacytimes.com/contributor/alex-barker-pharmd/2016/09/10-things-they-dont-teach-you-in-pharmacy-school

In pharmacy school, you’ll learn about many, many different drugs, drug interactions, dosages, and loads of science. However, there are some (practical) things most pharmacy schools simply don’t cover.
 
Here are 10 things I didn’t learn in pharmacy school that would’ve better prepared me for my job as a pharmacist:
 
1. Customer Service Skills
When I went to pharmacy school, there was nary a mention of customer service skills. Most pharmacists I know either picked up these skills from a part-time job (like a school library worker, pharmacy intern, or barista at Starbucks) or did their best to muddle through after they got their first “real” job.
 
2. Multitasking
Being a pharmacist requires you to keep a lot of balls in the air at once, so to speak. Unfortunately, there’s not much discussion about multitasking in school, and the students who can’t figure out how to juggle often end up dropping out—or struggling mightily throughout their time at school and in their first job.
 
3. Empathy
Many educational programs fail to prepare students for the reality that many of their future patients will be sick, scared, worried, confused, in a hurry, or all of the above—and they may act less-than-courteous under the circumstances. Learning how to respond with empathy most often takes place in actual work settings and requires lots of practice.
 
4. Communication Skills
Many come out of school lacking basic written and verbal communications skills—and I’m talking about skills like not sending e-mails riddled with misspellings, speaking loudly and clearly so others can hear you, and being concise when talking to patients.
 
5. Leadership Skills
Managing a team is an art, and pharmacists are often required to manage several direct reports in their first job. To manage well right off the bat, students need to have leadership tools and training. Furthermore, students should learn not only how to supervise others, but also how to manage laterally (their coworkers) and their boss, too.

6. Listening
Eighty percent of communication involves listening. Many patient problems could be avoided if pharmacists had basic training in how to actively listen. Pharmacy students should be taught to repeat what patients are saying in their own words to ensure understanding, demonstrate a “listening posture” (eye contact, nonverbal cues like nodding) and give their undivided attention.
 
7. Hiring Good Staff
The individuals you hire can make or break you. Learning how to interview effectively and hire quality individuals is a skill that will benefit pharmacists throughout their careers. A simple explanation and a few anecdotes from a seasoned pharmacist about positive qualities and red flags would add value to any pharmacy school curriculum.
 
8. Flexibility
Things tend to be pretty black and white in pharmacy school; there’s usually a clear right answer and a clear wrong one. In the real-world pharmacy, there’s lots of gray and sometimes no clear correct answer. Pharmacy students should be encouraged to be creative, adjust to changing circumstances, and look for new approaches to patient problems.
 
9. Managing Debt and Personal Finances
Almost every pharmacy student has school loans and will go on to have a mortgage, car loan, or credit card. Although managing personal finances doesn’t exactly fall into the realm of a traditional pharmacy education, the number of students carrying significant debt upon graduation would be sufficient justification.
 
10. Interview Skills
Although there may be some opportunity for pharmacy students to practice interviewing during the residency process—and many schools offer optional career counseling—formal, required training on job interview skills would be helpful. With the job market becoming more and more challenging for pharmacists, industry-specific training would be a welcome addition to any curriculum.
 
If you’re a pharmacy student, it’s not too late to educate yourself on these topics in advance of graduation. If you’re already out in the “real world,” chances are you’ve learned many of these things on your own—and perhaps the hard way. In any case, pharmacy schools would do well to incorporate training in these areas to ensure that they’re turning out marketable, employable graduates.

Washington chronic pain pts: Don’t worry… we don’t feel your pain

Chronic-pain patients feel sting of Washington state’s opioid crackdown

http://www.seattletimes.com/seattle-news/health/chronic-pain-patients-feel-sting-of-washington-states-opioid-crackdown/

As physicians tighten their prescribing practices for opiates, patients feel punished for the actions of doctors they’ve never seen, such as at the now-closed Seattle Pain Centers. Patients deserve more understanding, experts say.

Chris Hegge has been taking opioids almost 20 years for relief from seven back surgeries, including a spinal fusion.

The drugs have helped him walk his dog, practice tai chi and lead a relatively pain-free life, said Hegge, 57.

 But now the doctor he has relied on for relief is in trouble. His medical license was suspended in December for what state officials called “unprofessional” prescribing practices.
 Hegge scrambled to find a new doctor before his pills ran out and pain and withdrawal kicked in. His current doctor wants to cut his dose by 10 percent a month.

Hegge says he’s being punished for others’ misdeeds. “Why do innocent patients have to suffer because of doctors being investigated? Instead of fighting chronic pain,” Hegge said, “I’m fighting the system.”

After years of surging opioid prescriptions, leading to addiction and deaths, the pendulum swung back hard against abuse, culminating in the July shutdown of the Seattle Pain Centers (SPC), a chain of eight Washington clinics. That state action, amid allegations of improper oversight that may have contributed to patient deaths, sent 8,000 patients looking for new providers.

Pain-treatment experts express sympathy for “legacy” patients like Hegge, who were prescribed high doses of opioids before a new approach took hold with new state rules in 2012.

 “They have reason to be upset because frankly they were caught up in a medical experiment that high-dose opiates were the way to go,” said Dr. David Tauben, chief of pain medicine at the University of Washington.

“It could take years to get these folks’ (doses) down because their bodies have been so transformed by exposures that create changes in the brain, spinal cord and elsewhere.”

Their problems are compounded by doctors who now fear sanctions for prescribing high doses — fears that may come from misunderstanding the state’s rules. Doctors don’t have to slash dosing for legacy patients, according to Tauben and others. It says so in state and federal guidelines.

 

That’s not much relief for Hegge.

“It’s like a primitive voice in my head keeps repeating, ‘have pain, stop the pain,’ ” he said, about a visit last month to an emergency room to seek help for pain, anxiety and symptoms of withdrawal.

“Never goes away”

Some doctors have long been reluctant to treat chronic non-cancer pain patients. With concerns about abuse and overdoses, and the complexity of diagnosing and treating pain, such patients tend to require more monitoring than a doctor’s schedule often allows.

“The amount of work to manage those patients safely and effectively is really high,” said Dr. Tom Schaaf, a member of an opioid-practices task force convened by the state medical and hospital associations.

No one knows what happened to all of the SPC patients and if any resorted to dangerous street drugs. Tauben, Schaaf and others believe the vast majority found new providers. Some were treated for withdrawal in emergency rooms.

“But from an ER perspective we’re not seeing large numbers of folks having difficulty accessing pain management at this point,” said Dr. Nathan Schlicher, an emergency physician in Tacoma, and member of the state opioid task force.

There was one suicide thought to be linked to the closure of SPC. Denny Peck, 58, of Thurston County, left a note in September saying he had run out of pills and couldn’t stand the pain caused by a commercial fishing accident 26 years earlier.

The SPC fallout appears to have fueled some doctors’ fears.

Robert Moran Jr., of Tumwater, said his doctor told him in July he was going to cut his dosage. “He just started saying, ‘We have to cut you back; I’m not going to lose my license,’ ” according to Moran, 60, who said his right arm, nerve-damaged in a motorcycle accident, aches more and is almost useless to him with a lower dose of painkillers.

He sleeps in a recliner because of the pain, he said, rarely showers and eats off disposable plates because he hasn’t been able to install the dishwasher he bought. “Imagine having a pain at the level of a bad toothache and it never goes away,” he said.

Moran’s doctor did not respond to requests for comment.

Under current state rules, Hegge and other patients sign a pain contract with their providers, agreeing to submit to random drug tests, pill-counting and other checks.

Hegge, now on disability, was a chemical-dependency counselor for 10 years. He weighs the costs and benefits of his morphine use, he said, including unpleasant side effects. He believes he’s a smart consumer.

But state officials suspended the license of his longtime doctor, Philip Roger Matthews, in December, saying he prescribed high doses with not enough care, endangering patients.

In his response, Matthews disputed that and called the suspension of his license “excessive and unwarranted.” He said he has not injured any patients and does not pose a risk to them.

His license remains suspended pending further action by the state. He did not respond to requests for an interview.

No upper limit

While legacy patients may deserve some flexibility, experts say the medical evidence is clear: there are more risks than benefits associated with daily doses above 120 milligrams of morphine, or the equivalent in other opioids.

Generally, doctors want to taper doses for patients like Hegge, who takes about 360 milligrams of morphine a day. But they should do it with care.

“Even a tiny reduction will be experienced by the patient’s central nervous system as increasing pain,” Tauben said. “It is a slow journey that involves an empathic response to these individuals caught in this shifting pendulum.”

Doctors will not lose their licenses just for prescribing above the state-recommended daily threshold of 120 milligrams of morphine, according to Tauben and others.

Doctors may prescribe above that limit, the rules state. If they do, they should consult with a pain specialist.

They don’t even need to do that if the patient meets criteria such as being on a tapering schedule, or the patient’s function is improved without apparent risk, or the prescribing physician has a certain amount of training in pain management.

But the rules “got distorted” by some, Tauben said.

The state Department of Health put out a reminder late last year — a month after Peck’s suicide.

“In fact, there is no upper limit for opioids in the Washington state pain rules,” wrote Melanie de Leon, executive director of the Medical Quality Assurance Commission, which disciplines doctors.

“While the opioid epidemic is a public health crisis, we must not forget the crisis that is the patient without relief from debilitating pain or functional improvement,” de Leon said.

Guidelines issued last year by the Centers for Disease Control and Prevention called for “very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages.”

Schlicher, the ER doctor, said he thinks providers understand the rules. But they also have to safeguard against patients who don’t want to do what the doctor deems necessary and “bounce between providers,” he said, rather than building a relationship with a doctor that might evolve to allow higher dosing.

“I have sympathy for both sides, patients and doctors,” Schaaf said.

Educating doctors

Micah Matthews, deputy director for the medical quality commission, said state officials tried to educate doctors about the new rules. They even went on a yearlong road show. “We gave presentations to some 5,000 practitioners around the state,” Matthews said.

If a patient thinks the state is interfering in his treatment, Matthews said “that’s an educational opportunity we’re willing to take on with the physician.”

He said patients should give his email to their doctors so they can ask Matthews or state medical consultants about appropriate practices under the rules.

Tauben advises patients to give de Leon’s “technical assistance” memo to their doctors or clinic administrators. Patients should also encourage their doctors to visit a weekly teleconference the UW hosts to discuss complex chronic pain cases, he said.

Above all, Schaaf said, patients shouldn’t give up their “search for finding a doctor who will listen and be honest with you about your condition but is willing to compromise with you toward a goal of least medication with best functional status.”

If the state/federal laws are not being observed by prescribers… causing chronic pain pts to have needless pain and suffering. Why is the Medical Licensing Board not taking action against those prescribers… since the primary function of all medical licensing boards is to protect the public’s health and safety… Apparently in the state of Washington… they seem to only interested in what they perceive as over-prescribing of opiates and little/nothing about pt’s unnecessary and needless suffering from untreated pain.