Insider Q&A: A front-row seat for the drug pricing battle

http://www.charlotteobserver.com/news/article105514881.html

I have blogged about MIDDLEMEN in the prescription distribution system. There has been recent information that these PBM’s – Like Express Scripts – are “demanding” rebates/kickbacks from the manufacturers of up to 70% to keep the manufacturer’s product(s) on the PBM’s formulary…   What is not clear is where the monies from that 70% goes… Over the last four years, Express Scripts’ net profits – based on Earnings Per Share (EPS) is UP > 50%.  It is also claimed that some of this money goes back to the insurance company and or the company that pays the insurance premiums or if the company is self insured… funds the employee’s health costs.

What few seems to know if the insurance company and or self funded employer calculate premiums or the employee’s share of premiums based on “rack rate” of all medical costs charges… does not include all discounts/rebates/kickbacks.  So an employee whose “share” of the employer’s health insurance cost is say – 30% –  but if the employer did the calculation on net costs.. the employee may be actually paying 60% or more of the net health insurance premium costs.

So if anyone wonders why prescription medication costs have “gone thru the roof”… it would appear that the for-profit motive of all these middlemen that has entered the market place since 1970… could share the blame for the”lion’s share” of the all the soaring price increases in prescription medications.

In the late 60’s, when there was few generics and no middlemen… the average prescription price was in the $4 -$5 range.  Since 1970… I can identify three different categories of  for profit middlemen in the prescription distribution system… there could be more …that are not so obvious ?

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https://www.prevagen.com/blog/faq/what-are-the-most-commonly-reported-benefits-of-prevagen/

Review the short advertising video on this SUPPLEMENT… they claim that it has been “CLINICALLY PROVEN” to improve you memory and yet on both the video and their website – briefly displays the statement:

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Which is required for SUPPLEMENTS that DO NOT have clinical trials that back up their statements…  but the FDA/FTC continue to allow these SUPPLEMENTS to be advertise that “SUGGESTS” MAY provide some medical benefit. 

Until Oct 1, 2016 Kratom… has been classified as a supplement until the head of the DME ( Rosenberg) decided that it was DANGEROUS… without any substantial/verifiable  facts that support the re-scheduling because it is a DANGEROUS DRUG.
What is the most commonly reported benefit of Prevagen?

Improves short term memory*

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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Medical students need exposure to chronic pain patients

www.kevinmd.com/blog/2016/09/medical-students-need-exposure-chronic-pain-patients.html

Pain. It permeates every aspect of medicine, crawls into the deepest corners of our practices, sinks its claws in and stays put. Opiates are at the center of a vicious national debate, and our patients are trapped in its clutches. But my thoughts are less on medications, protocols, and procedures and more on how we approach the patient who cries pain. Through everything I have observed, as a caretaker and student physician, I have come to a concerning conclusion: The burden is on the patient to prove his or her pain.

A patient recently repeated a remark made by her previous doctor, who had declared she was not in “that much” pain. My patient’s response was simple: “How do they know how much pain I am in? Only I know how much pain I am in!”

She was right. When a patient has any sort of pain, our question is always, “On a scale of one to ten, how bad is it?” They answer, and we immediately judge whether the number fits the presentation. Does the patient really look like an eight out of ten? Are they writhing in enough pain to satisfy us?

This is a ridiculous routine. Do not ask and then ignore what they say. Obviously, clinical judgment is an indispensable tool, so if a patient comes in with 10/10 pain but they are resting at ease on the emergency room stretcher, you can likely delay the exploratory laparotomy. But consider assessing their pain in context.

I recently saw a young lady who called her abdominal pain 10/10, but was interacting pleasantly, with no grimacing nor guarding, and only occasionally rubbing her right flank and flinching when the pain periodically recurred. On further exploration, she had never in her life experienced any significant pain – not even a sprained ankle for comparison. For her, this was the worst pain she could imagine.

Conversely, the judgment that follows mention of 12/10 pain is always the same: “There is no twelve,” we say out in the hallway, “they are just being dramatic.” But if we already ignore 8/10 pain, it follows that a patient may declare twelve out of ten pain to get our attention.

My sister demonstrates a useful paradigm. She is in chronic, bone-deep pain at all times. Her joints ache, her muscles spasm, her head pounds… daily. She suffers from Ehlers-Danlos syndrome and is in constant agony, but was blessed with a spirit that keeps her motivated and enables her to present a deceptively happy face. When she submits to going to the emergency room, we know she must be in unimaginable pain: pain bad enough that it is worth the mistreatment she will endure. Why? Because she internalizes her agony and thus she does not fit the stereotypical picture of a person in pain. So doctors write her off as exaggerating when she quietly uses her words. She does not appear worthy of their time.

I recently cared for a cranky elderly patient who had been reporting pain for days. At first, every question was met with a glare and a growl, but I was determined to be thorough and tried my hardest to coax out the quality of the pain. After several days of this, we had a breakthrough: the patient began to cry while describing shooting, burning pain, plus aches and cramps that made physical therapy too daunting. I returned to my chief and asked to change the patient’s orders: in addition to the typical opiates, I added gabapentin for neuropathic pain, muscle relaxants and heating pads for the cramps, and a B12 titer to address the paresthesias and fissures at the corners of my patient’s mouth. Impressed with my initiative, the chief agreed. When I arrived the next day, the labs showed a B12 level just below normal limits; I had been right. I went to see the patient and was met with a hesitant smile. The new regimen was beginning to work.

“That is what is missing in medicine these days,” my patient explained, “no one takes the time to listen, and no one took my pain seriously, until you did.”

So what is the “right” kind of pain? I once witnessed a resident describing an ER patient with pelvic pain as “actually not that crazy looking,” as if her presentation automatically implied mental instability. When my team told her the “good news,” that she could go home because we had not found any pathology, the patient, with a tortured expression, I will never forget, explained that it was not good news because we had not given her any help, any answers, or any hope. I trailed after my team as they left the room, embarrassed to be associated with them.

These attitudes are not universal, although it can feel that way to the patient. I strive to emulate physicians who approach patients with respect and an open mind. One such attending once explained how everyone has his or her own way of coping. “Some patients shout about it, some get very quiet, others look distracted, and still others joke about it, so you cannot take anything at face value.” It was some of the most important advice I ever received.

The best-case scenario is when pain has an obvious source and will resolve naturally, as with fractures and post-operative pain. But when patients start to complain disproportionately, or when no clear cause exists, we start to write the patient off in our minds. We run our battery of tests, while rolling our eyes.

What is it about pain that makes us want to judge patients, accuse them, and abandon them? Why do we go into medicine and then find ourselves surprised when our patients report pain? Pain is the body’s way of telling us that something is amiss, even if it is the pain receptors themselves! This does not mean such pain is a figment of the patient’s imagination, and it does not mean everyone must react identically. There is no available method to compare pain, and yet we still try to do so, because nuance is too hard to document, and too scary to treat. We do not understand pain well enough to treat it adequately, and we have no way of quantifying it other than asking “well, is it really bad? Or really bad? Or just … bad?”

I believe the solution starts at the foundation, as soon as we begin medical school. We need exposure to these patients, to understand what we are facing, so we are not surprised when we reach intern year. We must hear their stories, of mistreatment and misjudgment. Treatments are limited and outcomes are often poor; thus, our burden is enormous. We must stop the cycle, and we must remove the burden of “being believed” from the patient. We are the providers, and it is time to change how we understand and treat pain.

Sarah Cohen is a medical student.

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DEA defies senators’ appeal to reconsider ‘unprecedented’ kratom ban

https://www.washingtonpost.com/news/wonk/wp/2016/09/30/dea-defies-senators-appeal-to-reconsider-unprecedented-kratom-ban/#comments

Chuck Rosenberg – head of the DEA… with the following educational background…

He attended Tufts University, graduating in 1982 with a B.A., and Harvard, earning a Master’s in public policy.

https://news.vice.com/article/the-dea-chief-just-called-medical-marijuana-a-joke

Declared MJ “a joke” and the White House got a petition with 100,000 + signatures calling for replacing Rosenberg as head of the DEA… Does this demonstrate how useful/practical the White House petition system works ?

It is also the same person that had “determined” that Kratom represents an imminent hazard to public safety.

So we have someone with NO MEDICAL BACKGROUND… using a law that was specifically to be used  interdiction of new and previously unknown illegal synthetic street drugs that result in injuries and death… which Kratom does not fit into.  Used “emergency regulation” to avoid a public comment period and has now admitted that there MAY HAVE BEEN A SINGLE DEATH SOLELY FROM THE USE/ABUSE OF KRATOM.  If these actions do not produce the “final straw” for Congress to at least muzzle the DEA or curtail their budget and/or dramatically narrow their scope of authority.  Is it just me, or does it seem that the DEA has ILLEGALLY expanded it statue of authority to exceed the intend of the laws that they are charged with enforcing ?

A bipartisan group of nine senators is calling on the Drug Enforcement Administration to delay its “unprecedented” decision to ban kratom, a plant that researchers say holds great potential for mitigating the effects of the opioid epidemic.

The DEA recently decided to place kratom into Schedule 1 of the Controlled Substances Act, the most restrictive regulatory category, on a temporary, emergency basis “to avoid an imminent hazard to the public safety.”

The Senate letter, spearheaded by Orrin G. Hatch (R-Utah) says: “Congress granted emergency scheduling authority to the DEA based on the need for law enforcement interdiction of new and previously unknown illegal synthetic street drugs that result in injuries and death. The use of this emergency authority for a natural substance is unprecedented, so it is important to determine whether the circumstances here necessitate a jump to Schedule I.”

“Given the long reported history of Kratom use,” the letter continues, “coupled with the public’s sentiment that it is a safe alternative to prescription opioids, we believe using the regular review process would provide for a much-needed discussion among all stakeholders.”

The DEA announced its plan to place kratom in Schedule 1 only one month ago, using an emergency authority that does not require it to solicit public feedback on the decision. Blowback from pain patients was swift and furious and appears to have caught the DEA off-guard.

People who take the plant have shared their stories on how kratom helped them overcome addiction to opiates or alcohol, or how it has helped them treat otherwise intractable pain. Researchers say that their work with the kratom plant could eventually lead to the development of nonaddictive alternatives to powerful opiate painkillers, and that by placing kratom in Schedule 1, the government is effectively crippling their ability to carry out that research.

Over 140,000 people have signed a White House petition asking the Obama administration to reconsider the move.

The DEA cites 600-plus poison-control center calls involving kratom between 2010 and 2015 in its justification for banning the plant, and notes that 15 deaths were linked to the use of the plant between 2014 and 2016. In an interview with The Washington Post, a DEA spokesman later clarified that all but one of those fatalities involved the use of other substances.

Earlier this week 51 U.S. representatives similarly called on the DEA and the White House to reconsider or at least delay the ban, which was slated to go into effect as early as Friday.

In an interview, DEA spokesman Russell Baer confirmed that the ban was not yet in place. “We have not yet determined a date when we will publish that final order” putting the ban into effect, he said.

Because of the uncertainty surrounding the final date of the ban, many online businesses selling the plant have already shuttered or got rid of their supplies for fear of running afoul of the DEA’s stringent Schedule 1 rules.

“Given the extremely short timeframe for the implementation of the proposed DEA scheduling order, we urge you to take appropriate steps to delay the order to allow both for a public comment period and sufficient time for the DEA to outline its evidentiary standards to Congress regarding the justification for this proposed action,” the letter from Hatch and colleagues concludes.

Baer said the DEA would respond to the senators’ and congressmen’s concerns, but could not say whether the ban would go into force before that correspondence happens.

“It’s not a matter of if. It’s simply a matter of when, in terms of DEA publishing the final order to temporarily schedule kratom,” Baer said. “Our administrator [Chuck Rosenberg] has determined that kratom represents an imminent hazard to public safety. So I have a sense that publishing our final order will be sooner as opposed to later.”

The text of the full letter is available here. The list of Senate signatories, sent by a spokesman for Hatch, is below:

Orrin G. Hatch (R-Utah)

Mike Lee (R-Utah)

Mark Kirk (R-Ill.)

Angus King (I-Maine)

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Family bakery closes after left-wing bullies finally get their pound of cake

http://www.foxnews.com/opinion/2016/09/30/family-bakery-closes-after-left-wing-bullies-finally-get-their-pound-cake.html

Our system/society can allow healthcare discrimination against chronic pain pts and can declare that those who are suffering from the mental health disease of addictive personality disorder.. and only those addicted to opiates and meth… all those addicted to the drugs Nicotine and Alcohol are given a “get out of jail free” card.

But refused to bake a wedding cake because of difference in religious beliefs…  Although the First Amendment to the Constitution provides:

The First Amendment (Amendment I) to the United States Constitution prohibits the making of any law respecting an establishment of religion, impeding the free exercise of religion, abridging the freedom of speech, infringing on the freedom of the press, interfering with the right to peaceably assemble or prohibiting the petitioning for a governmental redress of grievances.

Apparently Congress failed to take into consideration the First Amendment when they wrote anti-discrimination laws.

So apparently this couple – for following their religious beliefs  – have been engaged in a THREE YEAR court battle,  fined $135,000 by the state of Oregon and have had to shutter their family bakery.  I guess that those chronic pain pts that have to endure the “pharmacy crawl” to get their medically necessary/ legal prescriptions is just a fact or life… and I guess that there is no comparable “bakery crawl”… without breaking some law ?

In 2013 a small family bakery in Northwestern Oregon refused to make a cake for a lesbian wedding.

The owners of Sweet Cakes by Melissa had no idea that their decision to follow the teachings of their Christian faith would lead to a multi-year legal battle. It’s a battle still being waged.

Click here to join Todd’s American Dispatch: a must-read for Conservatives! 

Aaron and Melissa Klein were eventually punished by the state of Oregon. — The couple was fined $135,000 for refusing to participate in the lesbian wedding event.

It was the price they had to pay for refusing to violate their conscience.

They also made the painful decision to close their beloved bakery – for good.

The left-wing bigots and bullies finally got their pound of cake. 

The Kleins made the announcement on the now-shuttered shop’s Facebook page.

https://www.facebook.com/Sweet-Cakes-by-Melissa-352725392798/

“The Kleins closed their business months ago and simply now updated their page to reflect that,” said Hiram Sasser, an attorney for First Liberty Institute.

First Liberty is one of the nation’s most prestigious law firms handling religious liberty cases.

“We are continuing our appeal and look forward to achieving justice for them and all people of faith who may find themselves in similar circumstances in the future,” Sasser told me.

To be clear, Aaron and Melissa Klein did not go looking to engage in a fight with the LGBT community. The fight came to them and to their business.

Since that day more than three years ago, the Kleins have faced unrelenting attacks from the LGBT community. Their business was boycotted. They were bullied. Their children received death threats.

The Kleins were literally run out of business by an anti-Christian mob.

It’s hard to believe that something like this could happen in the land of the free, the home of the brave.

But we live in a nation that pledges its allegiance to the Rainbow flag – a nation where gay rights now trump everyone else’s rights.

additional newsarticle:   http://www.nydailynews.com/news/national/oregon-bakery-pay-gay-couple-refused-cake-article-1.2103577

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Tricare Pharmacy Network Adds Walgreens, Removes CVS

http://www.military.com/daily-news/2016/09/30/tricare-pharmacy-network-adds-walgreens-removes-cvs.html

Isn’t this interesting… the PBM Express Scripts is one of the LARGEST PBM in the country as is CVS’ Health.. Caremark (PBM) division. So Express Scripts cancelled its contract with CVS to fill the prescriptions for TriCare –  which encompasses active/retired military…   So out of the some 68,000 community pharmacies in our country.. only the 9,600 CVS pharmacies – competitor of Express Scripts… gets pushed out of the network..  Since Express Scripts is legally an insurance company which makes them exempt from Sherman Antitrust Act by the McCarren Ferguson Act  1945 https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act 

which basically exempt insurance companies from the Sherman Antitrust Act… like anti-competitive practices and other things that are ILLEGAL for “normal businesses”.

When McCarren Ferguson was passed.. most all insurance companies were mutual companies … not for profit and “owned” by their policy holders… during the 90’s many/most of these mutual insurance companies “de-mutalized” and became publicly traded – FOR PROFIT companies.  AND where was Congress to allow these  FOR-PROFIT companies to continue to be allowed to violate the Sherman Antitrust Act with impunity ?  Maybe the collective “lobbying money” flowing to member of Congress was enough to convince them to ignore this little over sight.  Another good example of once a law is passed… it is never repealed… regardless of how inappropriate it may have become and/or how it gives certain competitors advantages over their competitors ?

This is the same set of laws that allows these same group of PBM’s to all – about the same time – exclude the same medications or class of medications from their formularies… without being accused of acting in collusion.

Walgreens will soon rejoin Tricare’s pharmacy network for users nationwide, officials announced Friday, while CVS pharmacies will leave.

That means Tricare users will now be able to fill their prescriptions off-base at Walgreens pharmacies without paying out-of-network rates, and CVS users will need to find a new pharmacy or pay unsubsidized rates for their medications.

The change takes effect Dec. 1, officials said. It will impact all beneficiaries, including Tricare for Life users and military retirees. The network will add about the 8,000 Walgreens stores and lose more than 9,600 CVS pharmacies.

“Starting Dec. 1, 2016, Walgreens pharmacies will join the Express Scripts, Inc. network serving Tricare beneficiaries across the United States,” Tricare officials said in a news release. “Additionally on Dec. 1, CVS pharmacies, including those in Target stores, will leave the network.”

Poll: How will the Tricare pharmacy change impact you?

More than 59,000 pharmacies are in the Tricare network, Express Scripts officials said. As of Dec. 1, that number will drop to 58,000, they said. Tricare currently serves about 9.4 million beneficiaries.

Despite the switch and drop of about 1,000 Tricare network pharmacies nationwide, about 98 percent of users will continue to have access to at least one in-network pharmacy within a one to five mile radius of their home, officials said.

The change came after a series of recent contract negotiations with retail pharmacies, officials said.

“As part of our contract with Tricare, Express Scripts helps the Department of Defense maintain an affordable pharmacy benefit by continuing to secure competitive rates with retail pharmacies,” Jennifer Luddy, an Express Scripts spokesperson said in a statement. “This change is intended to provide better value to Tricare and maintain convenient access for beneficiaries.”

The switch will also impact users who rely on Coram for speciality medications provided by mail-order since that service is a part of CVS.

“When CVS leaves the network, beneficiaries currently using Coram/CVS to fill their prescription will need to switch their prescription to another speciality network pharmacy,” Tricare officials told Military.com. Officials said Kroger, which is a current retail pharmacy provider, as well as Walgreens will both become speciality network pharmacies starting Dec. 1, and may carry the medications previously supplied by Coram.

“Beneficiaries filling specialty drugs will receive additional outreach to ensure they are able to move their prescription to a new network pharmacy with no disruption in their prescription therapy,” Tricare officials said.

Walgreens had previously been a Tricare in-network pharmacy. But a 2011 contract dispute over reimbursement rates from Tricare’s drug contractor Express Scripts resulted in the store leaving the network. At the time, Walgreens brought in an estimated $5.3 billion in annual revenue from the system. And although they later resolved the overall dispute with Express Scripts, the decision to exclude Tricare’s business from the retailer did not change.

“Walgreens is very proud to partner with Express Scripts to serve the Department of Defense and Tricare beneficiaries,” company officials said in a statement Friday. “We will work closely with Express Scripts in the next two months to ensure a smooth transition to Walgreens.”

Officials with CVS did not respond immediately to requests for comment.

— Editor’s note: This story was updated to include additional information on CVS-based services and statements Express Scripts and Walgreens.

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FDA warns against the use of homeopathic teething tablets and gels

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm523468

The U.S. Food and Drug Administration is warning consumers that homeopathic teething tablets and gels may pose a risk to infants and children. The FDA recommends that consumers stop using these products and dispose of any in their possession.

Homeopathic teething tablets and gels are distributed by CVS, Hyland’s, and possibly others, and are sold in retail stores and online.

Consumers should seek medical care immediately if their child experiences seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, or agitation after using homeopathic teething tablets or gels.

“Teething can be managed without prescription or over-the-counter remedies,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “We recommend parents and caregivers not give homeopathic teething tablets and gels to children and seek advice from their health care professional for safe alternatives.”

The FDA is analyzing adverse events reported to the agency regarding homeopathic teething tablets and gels, including seizures in infants and children who were given these products, since a 2010 safety alert about homeopathic teething tablets. The FDA is currently investigating this issue, including testing product samples. The agency will continue to communicate with the public as more information is available.

Homeopathic teething tablets and gels have not been evaluated or approved by the FDA for safety or efficacy. The agency is also not aware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children.

The FDA encourages health care professionals and consumers to report adverse events or quality problems experienced with the use of homeopathic teething tablets or gels to the FDA’s MedWatch Adverse Event Reporting program:

• Complete and submit the report online at www.fda.gov/medwatch/report.htm; or 
• Download and complete the form, then submit it via fax at 1-800-FDA-0178.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency is also responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

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While this might seem like a very good idea.. but it ignores the law of supply and demand…  It is estimated that this “free college for all” will have a price tag of 1.25 TRILLION/yr…  and that is going to add to the national annual deficient and national debt.. since we are taking in 3.2 trillion in taxes and Congress spends 500 billion more than we take in.

I believe that we are at a point in our society and with employers that a person applying for a job with a high school education only is mostly viewed with a YAWN …  National high school graduation rate is around 75%.

About 70% of high school graduates go on to enter a college… Currently just 40% of high school graduates that enter college graduate in FOUR YEARS with a degree  https://www.satprepct.com/sixty-percent-of-all-college-freshmen-do-not-graduate-in-four-years/

So for every 100 high school graduates … four years later there will be abt 25%-30% new college graduates.

Another 20% will graduate at a total of SIX YEARS in college…  which strongly suggests that college is NOT FOR EVERYONE.

What is going to be the cost for our public colleges to expand facilities/student capacity and how long is it going to take for a equilibrium to be reached… what is going to be the drop out rate after the first 1-2 semesters…  How many billions are going to be expended for students that “go no where” ?

Let’s presume that we have 10%-20% increase in the number of high school graduates getting a college diploma in four years… Many people will BS college degrees are working as a waitress , barista or some other job that really doesn’t require a college degree.
Our daughter is the perfect example of a college degree with no where to go… After getting her BS Psychology degree.. the degree provided no real career path.. it wasn’t until a few years later she obtained her Master in Psychology and became a Family Therapist … opened her private practice and now able to charge clients $120/hr for consulting with her.

There are many vocational jobs that go wanting for people to fulfill them… that may take months or 1-2 yr of training.

Could we be setting up the position that employers will not seriously look at a applicant because they don’t have a college degree in some major… just like today they look at those who don’t have a high school diploma ?

As we all know… when there are many more applicants than available jobs.. salaries/hourly rate tends to fall or remain static for years.

Another “good idea” without full considerations if it will produce good or bad outcomes ?

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‘New low’: Dead vets left to ‘decompose’ in VA morgue for weeks without burial

http://www.foxnews.com/politics/2016/09/29/new-low-dead-veterans-left-in-va-hospital-morgue-for-weeks-without-burial.html

An Illinois Veterans Affairs hospital already under fire for excessive wait times, festering black mold and kitchen cockroaches faces a new shame – the bodies of dead patients left unclaimed in the morgue for up to two months without proper burial, whistleblower documents allege.

The whistleblower, whose identity is not being revealed for fear of retaliation, complained last month to the VA’s inspector general about the Edward Hines Jr. VA Hospital’s handling of veterans’ remains in cases where families have not come forward to claim the body. The complaint singled out Christopher Wirtjes, chief of Patient Administrative Services, saying “The Chief of PAS has the funds available, yet has no sense of urgency to lay the veteran to rest.”

Sen. Mark Kirk, R-Ill., whose office also received the complaint along with emails, is now calling for Wirtjes’ firing and in a statement, slammed the hospital – located in the Western suburbs of Chicago — over its recent history of controversies.

“Hines VA — the hospital that has been overrun with cockroaches and mold and left vets waiting for care for months on secret wait lists, has reached a new low in the treatment of our veterans,” Kirk told FoxNews.com. “We now have reports of bodies being left to decompose in the morgue for months on end.”

The whistleblower, who has spoken with Kirk’s office, described a “horrible issue” at the hospital in the letter to the IG: “Some veteran’s remains have been left in our hospital morgue for 45 days or more until they are stacked to capacity at times.”

On at least one occasion, a body had liquefied and the bag burst when staff had attempted to move it, said Alissa McCurley, Kirk’s deputy chief of staff.

Kirk talked to VA Secretary Bob McDonald last week in Washington and demanded the firing of Wirtjes, whom the Office of Special Counsel determined had orchestrated a secret wait list that was exposed by another whistleblower in 2014. McDonald was noncommittal, Kirk said.

Internal VA emails chronicle how a frustrated Hines clerk attempted to obtain permission from Wirtjes for burial of unclaimed veterans on three occasions.

The first email chain began on Dec. 7, 2015.

“[There is] an invoice for an unclaimed veteran that has been here for over 30 days. Please approve for burial at Abraham Lincoln,” the clerk wrote to Wirtjes and several others.

Three days later, the clerk wrote again: “Approval of unclaimed Vet D?? Status?”

On Dec. 23, the clerk wrote to human resources: “Any further on my poor unclaimed? I WILL file a police report, but I hate doing that…”

Emails from  June 14, 2016 and Aug. 29, 2016 state that two different veterans languished in the morgue for a month or more. 

A manager, who is the chief of inpatient and processing, discussed the dilemma of how a local mortuary would be paid for accepting a veteran’s body because the family did not have the money for a burial. He said he would “try to figure it out with the funeral home. … At least he would be laid to rest.”

“I have not heard anything as to the approval for funeral home pick up. It will be a month tomorrow,” the clerk responded.

Cook County policy suggests embalming three days after death “at the discretion of the medical examiner.” Often, the body will be embalmed and returned to a freezer for up to a month while the Coroner’s Office attempts to locate family members. Unclaimed bodies are then buried in a county cemetery. Veterans are interred in a national military cemetery within 60 days.

However, Hines does not employ medical examiners or embalmers to properly care for decedents locked in their freezer for 30 days or more, McCurley said.

Wirtjes could not be reached for comment despite inquiries to him, his office and a VA center spokesman. But the spokesman for the hospital, Rick Fox, disputed the allegations and said Hines was following all laws:

“We take whistleblower allegations very seriously and absolutely agree that all of our veterans deserve dignity and respect, in life and in death. While our investigation into this matter is still ongoing, we have found allegations related to consistent problems with dignified and timely burials to be unsubstantiated. However, we have taken this opportunity to review our policies and procedures and are currently working to improve them.”

Staff from the VA’s Office of Medical Inspector were at the hospital conducting an investigation Monday afternoon, but it’s unclear what they found, McCurley said. 

Asked about the allegations, the IG office said: “The OIG doesn’t confirm or deny the existence of any ongoing investigations.”

Kirk, chairman of the Appropriations Committee on Military Construction and Veterans Affairs, last week introduced a bill titled Respectful Interment for Passing Veterans Act which requires “expeditious and respectful provision of burial and funeral services for indigent, deceased veterans and remains of deceased veterans that are unclaimed.”

Earlier this year, Kirk authored a bill requiring VA kitchens to undergo regular health inspections after Hines whistleblowers repeatedly documented cockroaches served in food. The VA system currently has no required kitchen health inspections from an outside entity.

In September 2015, veterans from Hines’ long-term care facility complained of a black mold infestation that had gone unchecked.

Hines is planning on demolishing the kitchen in an effort to destroy the roaches and will renovate the long-term care facility within 45 days, the spokesperson said.

Kirk sent a two-page letter to the secretary Wednesday to press for Wirtjes’ firing. A 2014 law created after the VA wait list scandal gave McDonald the power to fire civil service employees engaged in misconduct.

“If manipulating scheduling wait times putting veterans’ health at risk and failing to allow the burial of unclaimed veterans’ remains is not misconduct, then I ask you what is,” Kirk wrote. 

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DEA BAN ON KRATOM  DELAYED

http://www.inquisitr.com/3552500/dea-kratom-ban-delayed-herbal-supplement-will-still-be-legal-on-september-30/

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