Consumer self-reports of impaired access to health care services for pain management

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Indianapolis doctor wins defamation judgment against CVS

http://www.theindianalawyer.com/indianapolis-doctor-wins-defamation-judgment-against-cvs/PARAMS/article/42428

An Indianapolis physician whose patients were told at multiple CVS pharmacies that their prescriptions couldn’t be filled because the doctor had been arrested or was suspected of running a pill mill won a defamation judgment against the drugstore chain.

Dr. Anthony Mimms was granted summary judgment Tuesday on his defamation claim against CVS. A doctor since 2004, he had practiced with Rehabilitation Associates of Indiana until November 2013, when he left to form his own pain management practice.

Soon afterward, his patients were refused prescriptions in documented incidents at multiple Indianapolis CVS locations as well as at stores in Greenfield, McCordsville and Rushville. Pharmacists and technicians at these stores variously told Mimms’ patients that he had been arrested, that he was under DEA investigation, that his license had been revoked, or other reasons why they were not filling prescriptions he had written.

Judge Tanya Walton Pratt in the U.S. District Court for the Southern District of Indiana, Indianapolis Division, granted Mimms’ motion for summary judgment on his defamation claim and denied CVS’ cross-motion for judgment in its favor.

“The Court finds that, when viewed in context and given its plain meaning, the statements: ‘Dr. Mimms’ license has been suspended or revoked;’ ‘Dr. Mimms has been arrested, and if he hasn’t been he soon would be, therefore, [] find a new doctor;’ ‘CVS no longer fills prescriptions for Dr. Mimms because Dr. Mimms has been to jail, and is a bad doctor;’ and ‘Dr. Mimms is under DEA investigation’ amount to communications with defamatory imputation,” Pratt wrote. “ … (T)he Court determines the above statements are defamation per se.”

Pratt wrote CVS had failed to present sufficient evidence that the Drug Enforcement Agency and the Indiana Attorney General’s Office were investigating Mimms, rejecting its affirmative defense of truth. CVS also acted with actual malice when an employee stated Mimms’ license had been suspended or revoked, which was untrue and unverifiable. CVS’s argument of qualified privilege for its employees also failed.

Mimms also provided evidence that the statements made by CVS employees violated company protocol that expressly states, “Under no circumstances are you to make any disparaging comments about the customer’s prescriber.” Examples of what employees are instructed not to say expressly include: a doctor is under investigation, is operating a pill mill, is going to lose a license, is or should go to jail or be arrested.

Left to be decided at trial are whether other statements made by CVS employees are defamatory and the amount of Mimms’ damages.

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DHS Agents Bribed to Let Drugs, Illegal Aliens into U.S.

http://www.citizen-action.com/dhs-agents-bribed-let-drugs-illegal-aliens-u-s/article4636

While the nation was preoccupied celebrating the holidays and welcoming a new year, two disturbing news articles—reiterating what Judicial Watch has reported for years—shed additional light on the critical situation in the southern border region. The first, an investigative piece by one of the country’s largest newspapers, documents how hundreds of employees and contract workers at the Department of Homeland Security (DHS) have taken millions of dollars in bribes to let drugs and illegal immigrants into the United States. A few days later the Drug Enforcement Agency (DEA) is cited in a Texas news report confirming that El Paso, long known as America’s “safest city,” is a major corridor for Mexican cartels smuggling drugs into the U.S.

For more than a decade Judicial Watch has exposed the pervasive corruption among DHS agents charged with protecting the U.S-Mexico border. They include Border Patrol officers accepting bribes to help transport illegal immigrants and contraband into the U.S. and DHS employees from various agencies collaborating with Mexican smuggling operations to allow drugs, weapons and possibly terrorists into the country. A few years ago, two veteran Border Patrol agents got convicted for operating a multi-million-dollar human smuggling business in which illegal aliens were transported into the U.S. in government vehicles. In 2013 two officials assigned to crack down on corruption at DHS got indicted for ordering the falsification of records—including active criminal probes—to obstruct an investigation into crooked federal agents suspected of participating in the illegal smuggling of undocumented aliens and/or narcotics into the United States.

The problem has gotten much worse, according to the investigative news story published a few days ago. Reporters analyzed thousands of court records and internal agency documents that show that in the last decade nearly 200 DHS employees and contract workers have accepted nearly $15 million in bribes while getting paid to protect the nation’s borders and enforce immigration laws. From the article: “These employees have looked the other way as tons of drugs and thousands of undocumented immigrants were smuggled into the United States, the records show. They have illegally sold green cards and other immigration documents, have entered law enforcement databases and given sensitive information to drug cartels. In one case, the information was used to arrange the attempted murder of an informant.” Keep in mind that DHS is the monstrous agency created after 9/11 to protect the nation from another terrorist attack so this information is extremely troublesome.

Corrupt DHS agents may have also contributed to the DEA’s distressing revelation that El Paso is a major corridor for Mexican drug traffickers. Judicial Watch has long reported this as part of an ongoing investigation into the dangerously porous southern border. The DEA’s recognition a few days ago, is among the first public confirmations by a government agency that the region is a key route for drugs that get disbursed throughout the country. El Paso is a major stop on the trade route for the Mexican drug cartels moving their product, the news report states, citing a DEA agent. “The drugs get smuggled into in this area and then transshipped to places like Chicago, Indianapolis, New York, Boston where there is a big user market,” according to the DEA special agent in charge of the El Paso sector. The special agent confirmed that “the biggest criminal drug threat is still the Mexican cartels.”

This has been well documented over the years in a variety of government audits and, more recently, as part of a broad Judicial Watch investigation into cartels, corruption and terrorism on the Mexican border. Drugs aren’t the only thing being smuggled in through El Paso. Islamic terrorists are also making into the U.S. with the help of Mexican drug cartels and ISIS has a training cell just a few miles from El Paso in an area known as “Anapra” situated just west of Ciudad Juárez in the Mexican state of Chihuahua. In 2014 Judicial Watch exposed a sophisticated narco-terror ring, operated by two of the FBI’s most wanted, with roots and financing in El Paso, illustrating that the area is a hotbed of crime despite being promoted as one of America’s safest cities.

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https://youtu.be/gVRXT_j9sCQ

Doctors are cutting opioids, even if it harms patients

www.bostonglobe.com/metro/2017/01/02/doctors-curtail-opioids-but-many-see-harm-pain-patients/z4Ci68TePafcD9AcORs04J/story.html?

This article is very disturbing in that it plainly points out what is going on in our country and it is being done at the directive of many in both the Fed/State judicial and legislative systems.  IMO.. the war on drugs has quickly evolved into a genocide over the last decade… and seems to be continuing to pick up momentum. World history suggests that this has happen in many other countries over the centuries…  A war  generally has two or more entities in battle, but when multiple entities are battling with a particular entity or group.. who is unable or unwilling to engage…then it becomes a GENOCIDE. Those in the chronic pain community have neither the physical, mental nor financial capacity to put up a fight. Unfortunately this genocide is nearly invisible as those in pain are forced to suffer in silence while being forced to become house/chair/bed confined because of denial of appropriate medical care.

More than half of doctors across America are curtailing opioid prescriptions, and nearly 1 in 10 have stopped prescribing the drugs, according to a new nationwide online survey. But even as physicians retreat from opioids, some seem to have misgivings: More than one-third of the respondents said the reduction in prescribing has hurt patients with chronic pain.

The survey, conducted for The Boston Globe by the SERMO physicians social network, offers fresh evidence of the changes in prescribing practices in response to the opioid crisis that has killed thousands in New England and elsewhere around the country. The deaths awakened fears of addiction and accidental overdose, and led to state and federal regulations aimed at reining in excessive prescribing.

Doctors face myriad pressures as they struggle to treat addiction and chronic pain, two complex conditions in which most physicians receive little training. Those responding to the survey gave two main reasons for cutting back: the risks and hassles involved in prescribing opioids, and a better understanding of the drugs’ hazards.

The results also suggest a substantial minority of physicians may believe the pendulum has swung too far, depriving pain patients of needed relief.

Now, Lillie said, keeping track of evolving science and state and federal guidelines add to the complexity. “For some people, they are simply having to say, ‘It’s too much. I can’t be all things to all people,’ ” she said.

As policy makers sought to tackle the abuse problem, “the physicians were an easy group to target,” said Dr. Joseph Audette, chief of pain management at Atrius Health, a large Massachusetts medical group. But the regulations won’t solve the addiction problem, he said. Instead, they make doctors reluctant to prescribe opioids.

“A lot of primary care doctors feel like they can’t comply. They’re overwhelmed,” Audette said.

The four-question survey was conducted Dec. 15 through 22, sent by e-mail to doctors across the United States by SERMO, an online community that enables physicians to anonymously share ideas and concerns. SERMO periodically taps into its worldwide membership of more than 600,000 to conduct opinion polls; for the Globe’s survey, the company randomly selected 25,000 American doctors. Nearly 3,000 replied.

Just over half of all respondents had cut back on opioid prescribing within the past two years or so, while more than two-thirds of family medicine and internal medicine doctors had done so.

The percentage who believed patients had been hurt by reductions in prescribing differed little among specialties: 36 percent of all specialties, 38 percent of family doctors, and 34 percent of internists.

Still, nearly three-quarters of respondents believe chronic pain patients have adequate access to treatments other than opioids. Cindy Steinberg, a national advocate for pain patients, speculates that doctors probably don’t follow up after referring patients to other care, and may not know that many can’t afford it.

Although it’s unknown whether those who chose to reply to the survey are representative of physicians overall, the findings align with other data showing a reduction in opioid prescribing.

Dr. Stefan G. Kertesz, a professor at the University of Alabama Birmingham School of Medicine, has witnessed the downside of that trend: chronic pain patients who have essentially been abandoned by their doctors in the stampede away from opioids.

Kertesz recently published an article in the journal Substance Abuse showing that physician prescribing no longer plays a major role in sustaining the opioid epidemic, which is now driven by heroin and illicit fentanyl.

“But public discourse has been contaminated by aggressive and inflammatory language that frightens doctors,” he said in an interview. Even specialists in addiction, while agreeing doctors should be cautious about prescribing opioids, also “fear that doctors are pulling back in a chaotic way that could be harmful to patients,” he said.

Dr. Laura J. Simpson, a family medicine physician in Marblehead, sees benefits in the publicity about opioids’ harms: It paves the way for doctors to discuss why they won’t write a prescription for every pang.

“People now understand. They don’t see it as you just not helping them,” she said.

And Dr. Rebecca Andrews, a University of Connecticut medicine professor and internist practicing in Farmington, Conn., predicts that eventually the concern over opioids will lead to improved care, by deepening doctor-patient conversations about managing pain and pointing to the need for alternative treatments.

The decline in opioid prescribing is steady and nationwide, according to data from athenahealth, a Watertown company that provides electronic medical records.

In Massachusetts, doctors and nurse practitioners using athenahealth software, who already prescribed lower amounts than their peers nationally, made even steeper cutbacks.

In Massachusetts, the number of athenahealth patients receiving an opioid prescription dropped from a high of 6.9 percent in early 2015 to 5.3 percent as of Dec. 1. Nationally, prescriptions declined during that period from 8.7 percent to 7.8 percent.

But despite low prescribing rates in Massachusetts, the state has one of the highest rates of overdose deaths. Those deaths continue to increase — the vast majority resulting from illicit drugs.

Thus the effort to further restrict opioid prescribing amounts to “a case of generals fighting the last war,” said Dr. Stephen A. Martin, a family physician in Barre and University of Massachusetts Medical School professor publicly calling for a recalibration of attitudes toward the drugs.

Opioids are often a poor choice for treating chronic pain, and most specialists agree that past prescribing practices were too lax. But opioids work for some patients who can safely take a steady dose, and rely on the drugs for daily functioning.

Steinberg, who leads a chronic pain support group in Arlington, knows many such people whose doctors are taking them off opioids against their will. One member of her group has a severe spinal injury and now faces the loss of the one daily Percocet she relies on to sleep.

“In many cases, doctors are walking away completely. They don’t even want to see patients in chronic pain,” said Steinberg, the policy council chairwoman for the Massachusetts Pain Initiative , a nonprofit concerned with improving the lives of people in pain.

She implores doctors who curtail opioids to “partner with your patients and stay with them to help find other options.”

“It’s frightening,” Steinberg said, “to be living in that kind of pain and not have help.”

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25,000-Signature Goal Set For Petition Asking President-Elect Trump To Stop DEA’s War On Kratom

https://www.yahoo.com/news/25-000-signature-goal-set-petition-asking-president-162200630.html

WASHINGTON, Jan. 4, 2017 /PRNewswire-USNewswire/ — Less than three weeks remain for supporters of kratom to sign the petition at www.PetitionTrumpForKratom.com urging President-elect Donald Trump to either halt the DEA/FDA push to criminalize kratom or to reverse any 11^th hour ban that might be imposed in the waning days of the Obama Administration. A target of 25,000 signatures was announced today by the American Kratom Association (AKA), which launched the online petition on Monday, December 19th.

In the first two weeks since its launch of December 19^th, the PetitionTrumpforKratom.org Web site has attracted nearly 8,000 petition signers. In late November, AKA released a report by one of the world’s leading addiction experts who concluded that kratom has as low or even lower potential for abuse and dependence as nutmeg and St. John’s Wort.

AKA is focused intently on getting as many people as possible who have benefited from kratom to share their opposition to any classification by the DEA of the coffee-like herb as a Schedule I drug. The official deadline for signers to add their names to the petition is 11:59 p.m. EST on January 22, 2017.  The list of those signing www.PetitionTrumpForKratom.org will be presented to President-elect Trump in his first full business day in office: Monday, January 23, 2017.

American Kratom Association Director Susan Ash said: “We need a strong message sent from the kratom community to the new White House that the attack on kratom producers and consumers must end.  There is no room in an Administration committed to limited government and allowing responsible adults to live free lives for the DEA’s regulatory overkill response to kratom. We urge everyone who wants to keep kratom legal to go to www.PetitionTrumpForKratom.org and sign their name.”

The petition at www.PetitionTrumpForKratom.org reads in part:

“President-elect Trump:

Your promise to end excessive government regulations and restore the limited role of government in the lives of Americans is the reason that we are appealing to you today.

The three-five million Americans who choose to use the natural herb kratom to maintain their well-being desperately need your help.   We are concerned that the Drug Enforcement Administration may soon choose to curb access to this herb.  If such an ‘eleventh hour’ step is taken during the waning days of the Obama Administration, we ask that you reverse it upon taking office.  If the DEA has not acted by January 21^st, we ask that you put an end to regulatory proceedings targeting kratom.

The DEA and the U.S. Food and Drug Administration have openly declared war on kratom consumers, and these agencies are blatantly abusing their powers to criminalize both those who produce and sell kratom products, and those who purchase and consume them.  These federal regulators are doing all they can to deny American consumers their freedom to make individual choices on the safe products they want to use to maintain their health and well-being.

Despite credible evidence proving kratom is no more addictive than a cup of coffee, and its use presents no threat to the public health, the DEA and the FDA are continuing their efforts to classify kratom as a dangerous drug – with the same classification as heroin or cocaine.

Who are we?

We are veterans … and lawyers … and factory workers … and school teachers … and health care professionals.  We are mothers and fathers … and grandparents and senior citizens. 

We are the real face of America.  Our choice to consume kratom does not make us “drug abusers” any more than drinking a cup of coffee would …”  

The American Kratom Association is proud to be playing an instrumental role in helping to coordinate the broad-based national opposition to the DEA’s attempt to effectively ban kratom.  In addition to creating www.PetitionTrumpForKratom.org, AKA also:

• Led the charge when the DEA opened a public comment period running through December 1, 2016.  Of the more than 23,000 comments submitted before the deadline closed, the KratomComments.org Web site created by AKA was responsible for 16,379 comments – roughly 71 percent of total comments received at Regulations.gov. (The campaign Web site is now inactive.)
• Issued on November 30, 2016 a long-awaited analysis by Dr. Jack Henningfield, Ph.D., vice president of Research, Health Policy, and Abuse Liability at PinneyAssociates, concluding that there is “insufficient evidence” for the U.S. Drug Enforcement Administration (DEA) to ban or otherwise restrict kratom under the Controlled Substances Act.  According to the comprehensive Henningfield analysis, kratom’s potential for abuse and dependence is as low or lower than such widely used and unscheduled substances as “nutmeg, hops, St. John’s Wort, chamomile, guarana, and kola nut.”  
• Conducted in November 2016 an online survey of 105 emergency room (ER)/trauma health care professionals that found zero reported cases of deaths related to kratom. The new poll of America’s front-line medical professionals also uncovered precisely zero percent support among those surveyed for a DEA ban on the coffee-like herb kratom.
• Encouraged a set of two letters sent on October 1, 2016 by a politically diverse group of 11 Senators, including Sen. Orrin G. Hatch (R-UT), Sen. Ron Wyden (D-OR) and Sen. Cory Booker (D-NJ), calling on the DEA to halt the proposed scheduling and allow for a regular rulemaking process permitting the public, scientific experts, and Congress to provide input. 
• Facilitated letters to the DEA and the Office of Management and Budget sent on September 2, 2016 by a bipartisan group of 51 U.S. House Members urging a halt to the DEA’s push to ban kratom.
• Worked with the Pain News Network on a September 2016 survey of 6150 kratom users about their experience with the herb.
• Promoted a successful and widely publicized September 13, 2016 “March for Kratom” in September at the White House.
• Circulated  a “We The People” petition targeting the White House that accumulated more than 142,000 signatures.

ABOUT AKA
 
The America Kratom Association, a consumer-based non-profit organization, is here to set the record straight, giving a voice to those suffering and protecting our rights to possess and consume kratom. AKA represents tens of thousands of Americans, each of whom have a unique story to tell about the virtues of kratom and its positive effects on their lives. www.americankratom.org

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