Police get tips on prescription drug abuse

http://www.chicagotribune.com/suburbs/post-tribune/news/ct-ptb-inspect-training-st-0916-20160915-story.html

Apparently in INDIANA … the state could care less about HIPAA since they give law enforcement Carte blanche assess to the state’s PMP (INSPECT).  Some states make law enforcement to get a subpoena to get access to the state’s PMP database.  But then Indiana has for several years in a row the highest number of pharmacy robberies, one of the states with the highest number of meth lab busts and then there was the HIV +, HEP B&C epidemic in small Scott county (25,000 pop) – 180+ pts.

The reporter on this article… seems to have trouble with math… the number of prescriptions in Porter County averaged 67 doses/Rx…but apparently when the number of Rxs filled state wide the average increased to a EVEN 100 doses per Rx…  UNLIKELY accurate … I guess that the BIGGER you make the number.. the more important/troublesome it sounds ?

That 10,000 prescriptions as a “trigger” for a prescriber seems a bit strange… presuming that a chronic pain pt got the recommended long acting and short acting opiate… resulting in a single chronic pain pt getting 24 Rxs/yr.  Meaning that a prescriber would have around 300 chronic pain pts and writing Rxs for 14 pts per day.  Since most stable chronic pain pts would not require a monthly office visit…  Generating Rxs for that many pts would not take up much of the prescriber’s time.

Just more “cookie cutter” medicine ?  Indiana seems to keep trying… but.. can’t seem to get out of their own way 🙁

Mike Teeling came to a program on prescription drug monitoring to learn more and register himself and his department for the program.

Registering for INSPECT, the Indiana Board of Pharmacy Prescription Monitoring System, allows law enforcement and doctors to check for people who may be abusing prescription drugs, as well as giving the state the resources to keep an eye on doctors who may be making too many prescriptions. The database tracks prescriptions.

“Oftentimes we’ll run across people who have obvious prescription drugs we can identify and they don’t have a prescription vial or a prescription with them,” said Teeling, a detective with the Ogden Dunes Police Department. “It could be very beneficial to rule someone in or rule someone out as far as breaking the law.”

About a dozen officers from various police departments attended the training Thursday, held at the Porter County Sheriff’s Department and put on by the county’s Drunk Driving Task Force.

Through Aug. 1, pharmacists in Porter County filled 294,109 prescriptions for narcotics, which totaled 19.7 million individual doses.

“That’s more than 19 million pills on the streets,” said Ashley Crawford, a state inspector and compliance officer with the Indiana Public Licensing Agency, adding the top five prescription drugs across the state are Vicodin; Oxycontin; Xanax; Tramadol; and Adderall.

Across Indiana, pharmacists filled 4.5 million prescriptions for opioids alone last year, equivalent to 455 million doses of the drug.

“The numbers are staggering,” she said.

She talked about prescriptions for drug combinations that set off red flags, such as an “Rx Speedball,” which is an opiate and an amphetamine such as Adderall, and said “doctor shopping,” which is going from doctor to doctor seeking prescriptions, is not illegal, but lying to a doctor to get drugs or using forgery to get them are illegal.

Other red flags are paying for prescriptions with cash or a combination of Medicaid and cash, since some of the prescriptions can run upwards of $600, and doctors who write too many prescriptions.

“Our threshold is, if you’re writing up more than 10,000 (prescriptions), it’s a red flag for us,” Crawford said.

Crawford said 51 percent of the state’s licensed pharmacists participate in the database, as do 47 percent of the state’s healthcare practitioners. It’s not mandatory for doctors and other medical professionals to register, but the licensing agency is trying to change that “because that’s where the problem starts.”

Law enforcement officers who register to use the database can access it 24 hours a day, seven days a week, she said, adding police also have the ability to request an inspection on a doctor.

Her agency also has the ability to check if something seems out of whack.

“We ask pharmacists, ‘Who are your problem doctors? Who are your problem patients?'” she said, adding that information can be referred to the Drug Enforcement Agency for an investigation.

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Happy Jack’s Casino sued for drug test discrimination

http://www.argusleader.com/story/news/2016/09/15/happy-jacks-sued-drug-test-discrimination/90406402/

Refusing to hire a person with chronic pain because they can’t pass a drug test is illegal, according to a lawsuit filed against the owners of Happy Jack’s Casino in Sioux Falls.

The Equal Employment Opportunity Commission filed a complaint against M.G. Oil on Wednesday that says the company pulled back its employment offer for a woman named Kim Mullaney when she tested positive for hydrocodone.

Mullaney has a recognized disability and a valid prescription for the medication, the EEOC complaint said.

Because M.G. Oil didn’t offer Mullaney a chance to offer proof that the drugs were prescribed by a doctor for a medically-recognized condition, the company violated the Americans With Disabilities Act.

Blanket drug-testing rules that cover legally-prescribed medications do not comport with the law, the complaint says.

“Defendant M.G. Oil Company has a written policy requiring employees to disclose prescription and non-prescription drugs without consideration of whether the inquiry is job related and consistent with business necessity, in violation of the ADA,” the complaint says.

The EEOC’s regional attorney for Chicago’s District Office said in a news release that the company’s practice is a clear breach of the law, and that employers cannot deny jobs to people who take lawfully-prescribed medication.

“There is nothing happy about Happy Jack’s ignoring the information before its eyes. To the contrary, it is very, very sad,” Hendrickson said

The EEOC attempted to resolve the matter with M.G. Oil during its 2015 investigation of Mullaney’s initial complaint, but was “unable to secure” an agreement with the company.

An email to M.G. Oil was not immediately returned.

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Genetic Testing May Provide Faster Path to the Right Fibromyalgia Medication

nationalpainreport.com/genetic-testing-may-provide-faster-path-to-the-right-fibromyalgia-medication-8831433.html

By Ginevra Liptan, MD

Editor’s Note: Ginevra Liptan, MD is both a fibromyalgia patient and physician specialist. Her new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You…And Your Doctor is available now.

Someday in the not-so-distant future, before your health care provider decides which medication to prescribe for your fibromyalgia symptoms, they might first swab your cheek for a few cells and send them off for genetic tests. The genetic data hidden in those cells might reveal which medications you are likely to get benefit from, and which to avoid due to higher chance of side effects.

It sounds futuristic, but in fact this technology is available now, though it has not been widely adopted by medical providers. Testing for a person’s gene-drug interactions is called “pharmacogenetics,” and is a rapidly expanding field with multiple companies now offering panels of tests targeted to different illnesses.

Certainly genes don’t tell the whole story, and how we respond individually to a medication depends on multiple other factors in our environment. But we have long known that genetic makeup plays an important part in how we respond to different medications. Health care providers often see that our patients are likely experience a similar response to medications—good or bad—as their family members.

Using family members’ response to guide our prescribing is not very scientific. It would be far better to obtain specific, personalized genetic information for a patient prior to prescribing any medication. It would give us a head start to choosing the right medication, and shorten the painful trial-and-error process that we otherwise go through before finding effective treatments.

Having this head start could be especially valuable in fibromyalgia, as we tend to be extra sensitive to medications and more prone to side effects. So I was excited to learn that the first genetic testing panel devoted specifically to fibromyalgia was just released by Proove BioSciences in June 2016. In addition to testing for genes related to processing of typical fibromyalgia medications, they went one step further. According to Ashley Brenton, Ph.D., associate director of research and development at Proove, their test also assesses abnormalities in 11 genes that influence pain-processing and that affect your likelihood to develop fibromyalgia.

We already know that there is some genetic predisposition to developing fibromyalgia, from the simple fact that it tends to run in families, just like diabetes and many other chronic illnesses. But there is not one specific fibromyalgia gene. Rather there seem to be multiple genes that play a part in setting the stage for fibromyalgia, and the Proove fibromyalgia panel tests for the well studied of these genes. Primarily these are the genes that affect how well the brain makes and process certain chemicals like serotonin and norepinephrine, which are very important to regulating pain levels.

Dr. Brenton tells me they are also actively doing research on the genetic samples they collect. This type of research might help to discover new information about how to diagnose and treat fibromyalgia.

While seeing what your genes might reveal about pain-processing is fascinating, the component of the Proove fibromyalgia panel addressing specific gene-drug interactions is more practically useful. These gene-drug interactions come down to two factors: First is pharmacokinetics, or what your body does to the drug. The second is pharmacodynamics, or what the drug does to your body. These factors predict which drugs are most likely to be effective, which might cause side affects, and which might require close monitoring or dosage adjustments.

Let me give you some real-life examples from my practice (not their real names): “David” is in his 50s and has fibromyalgia and severe depression. Over the years he had tried, and failed miserably, all antidepressants that act by boosting serotonin levels in the brain, called SSRIs. His pharmacogenetic testing showed that he was a “poor responder” to that entire class of medication, but was likely to respond well to a different, less commonly used, type of medicine. And indeed he did.

The gene that showed up on David’s testing is one that affects how well our brains recycle serotonin, an important brain chemical associated with depression. Every human has this gene, but some of us have the long version, and some of us have the short version. Scientists have found that those that have the long version of this gene tend to respond well to SSRI medications with few side effects, but those that have the short version tend to find less benefit and more side effects. This is an example of a genetic difference affecting how a drug affects your body (pharmacodynamics).

Now let’s talk about another patient of mine, “Mary,” a very petite woman with a big personality who tells me that she requires “horse tranquilizers” to keep her asleep during surgery. She always warns the anesthesiologist that she will need high doses of medications to avoid waking up during surgery. This is because her body rapidly gets rid of that type of medication, and is a perfect example of how your body affects a drug (pharmacokinetics).

We all vary in how quickly our body gets rid of medications. This is determined by the genetic makeup of our liver enzymes that process medications. Because we know which drugs are processed by which enzymes, genetic testing can predict who might need dosage alteration of certain medications. There are several opiates that vary dramatically in how well they are processed by the body, including codeine, oxycodone, and tramadol. Having this information beforehand could vastly improve the process of finding the most effective, and safest, dosage of pain medications.

The science of gene-drug interactions is still young. This type of testing is expensive, but more insurance companies are starting to see the benefit and pay for certain types of pharmacogenetic testing. The Proove fibromyalgia profile is quite new, so many doctors and insurance companies are not familiar with it yet. If you want to learn more about this testing yourself, go to http://www.proove.com. Other companies that do non-fibromyalgia specific gene-drug testing include Genomind, PGXL Labarotories and Rxight.

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81-year-old hospitalized from reactions to wrong prescription

http://newjersey.news12.com/news/81-year-old-hospitalized-from-reactions-to-wrong-prescription-1.12317542

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5 New Prescription Drugs That Are Causing Mass Lawsuits

www.cheatsheet.com/health-fitness/prescription-drugs-causing-mass-lawsuits.html

Whether you have trouble sleeping, struggle with symptoms of intense anxiety, or need help managing a medical condition, prescription medications are a necessity for many people. So, it can be extremely troubling when you see that your prescribed medication is causing a major lawsuit.You may feel as though you’re putting your own life at risk. With so many prescription drugs out there, it’s tough to know which ones are causing the most commotion in the medical world, so researching your medication or asking your doctor about risks is always a good idea. Here are five prescription drugs causing mass lawsuits you’ll want to keep on your radar.

1. Nexium

A doctor showing different prescription medications | iStock.com

If you’ve suffered from gastroesophageal reflux disease or peptic ulcer disease, you’ve probably been prescribed a proton-pump inhibitor for relief of your symptoms. Prilosec, the first proton-pump inhibitor introduced in 1998, needed some major improvements. This led to the creation of Nexium. This medication works by blocking the release of acid to the stomach.

While Nexium seems innovative for its new approach in the treatment of acid reflux, Drug Dangers explains lawsuits claim this prescription drug may increase the risk of chronic kidney disease, perhaps by as much as 50%. Proton-pump inhibitors have also been shown to increase the risk of heart attack, bone fracture, and may lead to a magnesium deficiency. Birth defects and liver toxicity are also risk factors associated with taking Nexium.

2. Avelox or Levaquin

Fluoroquinolones are class of antiobiotics used treat infections like pneumonia, bronchitis, or even urinary tract infections. While this class of antibiotics is known for its effectiveness, certain types, such as Avelox and Levaquin, are linked to serious side effects causing an uproar in the medical community.

Unfortunately, the negative side effects can take years to surface. Drug Watch explains these medications have lead to lawsuits regarding aortic dissection, aortic aneurysm, and nerve damage. Aortic dissection happens when blood seeps into the layers of the tissue in the aorta. This can lead to stroke, heart attack, or paralysis once the walls of the aorta begin to break down. Anneurisms and nerve damage can also be serious. Until recently, the risk of nerve damage wasn’t even addressed at the time the prescription was written.

3. Invokana

Doctor in blue gloves holding prescription drugs for patient | iStock.com

Diabetes can cause serious damage to the body, including blindness, nerve damage, kidney failure, heart disease, stroke, and high blood pressure. Invokana was developed to help sufferers better deal with this disease in conjunction with a healthful diet and daily exercise. This prescription drug helps to lower blood sugar by allowing the kidneys to remove sugar from the body via the urine.

Current lawsuits state Invokana manufacturers failed to tell patients and physicians this drug could increase the risk of kidney failure, heart attacks, and ketoacidosis, which is a condition that occurs when there is not enough insulin in the body and ketones enter the bloodstream, WebMD explains. Levin Papantonio Personal Injury Lawyers outlines the lawsuit, explaining doctors would have monitored their patients more closely had they known of these threats.

4. Byetta

Byetta is another prescription drug that works to help those who suffer from type 2 diabetes. This injectable medication should not be taken with insulin, Diabetes.co.uk explains. It’s meant to help lower blood sugar without promoting weight gain. Overall, users have reported Byetta has helped them lose weight, giving it an advantage over other drugs are used to treat diabetes.

So what’s the problem? According to The Schmidt Firm, this medication has been linked to kidney failure, pancreatic cancer, and thyroid cancer. Plaintiffs in the lawsuits say the drug-makers failed to warn them of these potential dangers.

5. Benicar

Doctor talking to a patient in an exam room | iStock.com

Benicar is one of the top 100 selling prescription drugs in the U.S., and it was introduced in the 2000’s to treat high blood pressure. This drug works by blocking a protein produced by the liver known as angiotensin II. This protein can narrow the blood vessels, which can limit or reduce the flow of blood. Benicar works to relax the blood vessels, which decreases the pressure in the veins and lets the heart work more efficiently. Many side effects of Benicar are mild to moderate, including nausea, rash, hair loss, and chest pain, though lawsuits against Benicar are for far worse side effects.

Drug Dangers explains Benicar was promoted as safer than other blood pressure medications of its kind, but it’s been linked to gastrointestinal complications and disease, including celiac-like symptoms and serious stomach pain. Some have even reported extreme weight loss and the inability to absorb nutrients.

We’re not saying you should avoid taking all prescription drugs, but you should always have a thorough discussion with your physician before beginning a new treatment to make sure you understand the potential benefits and risks.

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Ohio man’s morphine needs caught in pain-pill crackdown

http://www.dispatch.com/content/stories/local/2016/09/14/state-probes-of-mans-huge-morphine-doses-scare-off-prescribing-doctor.html

MIDDLETOWN — For more than 20 years, Kevin Morgan has been a prisoner of his pain.

Just to get out of bed and hobble with a cane, Morgan requires as much as 70 times the amount of painkiller a doctor would normally prescribe. The normal average is the equivalent of 80 to 120 milligrams of morphine each day. Morgan takes almost 5,700.

“It’s enough to kill an elephant,” said Konrad Kircher, Morgan’s attorney.

Those massive amounts of painkillers caught the attention of government agencies. When officials see such high doses prescribed, they become suspicious that the drugs might be going to an addict or a dealer. Investigations led Morgan’s pain-treatment doctor to drop him as a patient out of concern that he could lose his medical license.

Now, Morgan is tired of the pain, tired of fighting the bureaucracy and, at times, tired of fighting to live.

“They told me I’d only live to 37, 38 years of age,” Morgan, 51, said between heavy breaths as he sat slumped on a couch in his Middletown home, barely able to lift his chin from his chest because of pain. “I have no quality of life.”

Morgan requires those ultra-high opioid doses, three doctors determined, to cope with the pain after a 1994 horse-riding accident. The horse that Morgan was riding fell on him, rolling over him. Then it stomped his head several times, leaving Morgan , who was 29 at the time , an “incomplete paraplegic” with little feeling from his mid-chest down. He stayed in a hospital bed and wheelchair for seven years and was told he’d never walk again.

His case, supporters say, is such an exception that something needs to be done to help him, even changing the law.

Before the horse stomping, the Middletown man was a paramedic and a small-business owner. He was so concerned about his southwestern Ohio community that he became a special Butler County deputy sheriff — a state-certified volunteer who helps other officers with tasks such as traffic control.

The horse’s hooves damaged his brain’s pain receptors. That, combined with genetic defects, causes Morgan to need massive doses of painkillers.

That is “much higher than any I’ve personally heard,” said Rep. Stephen Huffman, R-Tipp City, who is a physician but who had never heard of or examined Morgan.

Dr. Forest Tennant has. He is the California pain-medication expert who has examined Morgan several times and concludes that he is a “tragic and rare patient.”

“Frankly, we get a case like this once every 10,000 patients,” Tennant said.

Tennant was so intrigued by Morgan that he tested him twice. Each time, he gave Morgan a blood test to determine what drugs were in his system. Hours later, he watched as Morgan took his medication. Then he gave Morgan another blood test. It showed that Morgan’s body properly absorbed the medication, but it did not make him high. Instead, he remained lucid and able to cope with pain.

“I don’t know if you would call it a life,” Morgan said. “When I think of life, I think of being able to function, being happy, not feeling like a prisoner.”

The State Medical Board of Ohio, the State Board of Pharmacy and the federal Drug Enforcement Administration all investigated. They concluded that Morgan was taking all the medication and not abusing it.

“There’s a difference between a drug addict and being drug-tolerant,” Morgan said. Without the medication, he said, the pain can become so severe that he has seizures.

Extremely high prescribed doses are unusual, but in extremely rare circumstances, they “may be legitimate,” State Medical Board spokeswoman Tessie Pollock said.

Morgan’s original pain doctor, Tim Smith, agreed to surrender his medical license in 2013 after the State Medical Board said he inappropriately prescribed high doses of controlled substances and failed to properly document treatment for some patients. Because the patients weren’t named publicly, it’s unclear whether Morgan was among the 12 whose cases the state cited.

Morgan’s second pain doctor, Thomas Knox, then treated Morgan, but again state regulators noticed the high doses of opiates. Under Knox’s treatment, Morgan again submitted to tests conducted by Tennant, who again found that despite the high doses, Morgan wasn’t selling the drugs or using them to get high.

“He has to take a gallon in order to make a pint work,” Tennant said. “He’s very open about everything. He’ll take a urine test or blood test whenever and wherever you want.”

Knox tearfully told Morgan, who has never been arrested, that he could no longer treat him for fear of losing his license.

Ohio law and privacy rights prevent the government agencies involved from discussing Morgan’s case even though Morgan signed a consent form allowing release of his medical information.

Knox cooperated with state investigations and produced documentation of his treatment of Morgan, but “repeated inquiries” by both the State Medical Board and the State Pharmacy Board made the doctor think that if he didn’t drop Morgan as a patient, the investigations could end badly.

“If it becomes a threat to your practice, tough decisions have to be made,” said Daniel Zinsmaster, Knox’s attorney. “It was a decision made reluctantly and, I think, with sadness. I think his desire would have been to try to assist Mr. Morgan.”

Knox, ironically, at the time was a contract worker for the State Medical Board on pain management, including examining allegations of over-prescription of painkillers. After the state investigated Knox, it canceled his contract.

Morgan’s attorney and Tennant believe that the patient is caught in a bureaucratic morass because officials saw doctors over-prescribe medications through “pill mills,” and doctors now are wary of being accused of over-prescribing.

The result is a life that Morgan isn’t sure is worth living even when he gets the medication.

“It feels like a buzzing and a constant stinging that never stops, to the point where I go three, four days and I don’t eat, even with the pain medication,” Morgan said.

Kircher, who is representing Morgan for free, isn’t sure the case merits a lawsuit. He prefers a change in Ohio law to address rare cases such as Morgan’s.

“The goal is to create exceptions,” Kircher said. “Kevin can be the example for people who have slipped through the cracks. The only goal is to get Kevin the treatment he needs.”

Tennant suggested a law to appoint a few physicians to handle cases such as Morgan’s — to ensure that drug addicts or dealers aren’t tricking the system but that those who genuinely need high doses to survive get them.

“I don’t know another way out for him,” Tennant said.

Huffman, the state legislator and doctor, isn’t sure such legislation is necessary because the State Medical Board has stringent requirements for reporting.

“I think it’s a very unfortunate situation,” Huffman said. “It has to be frustrating for the patient.”

Morgan won’t say how he is getting his pain medication, but he said he has spent $80,000 on it since his doctor stopped treating him nine months ago. Now, he’s broke and doesn’t know what to do.

“This state has done everything but put me in a coffin and nail the nails in there. I have nothing to hide,” Morgan said.

“I did nothing wrong.”

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Poor Correspondence Between Pain Data and Actual Symptoms Hurts Patients

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DEA wants to criminalize deadly ‘Pinky’ drug suspected of killing Park City teens

http://kutv.com/news/local/dea-wants-to-criminalize-deadly-pinky-drug-suspected-of-killing-park-city-teens

They show an image of LEGAL FENTANYL PATCHES BOXES… and the article is about a “opiate substance” ..not scheduled… not commercially available as a prescription item in the USA… and how does the death of these two teenagers have anything to do with the legal treatment of  pain by prescriptions generated by legally licensed prescribers for people with legit medical necessity ?

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When Information Breaches Lead to Lawsuits

http://www.renalandurologynews.com/hipaa-compliance/when-information-breaches-lead-to-lawsuits/article/522626/

When it enacted HIPAA, the Department of Health and Human Services (HHS) chose to use a “carrot” rather than “stick” approach to enforcing the law. Penalties have been given for major breaches, but aside from that, there is little financial skin in the game for providers. At least until now.

When a provider wrongfully discloses protected health information, HIPAA does not provide patients with a legal remedy other than reporting the incident to HHS. But courts have begun to look at the issue differently, ruling, in some cases, that providers can be sued under state rules pertaining to privacy and negligence for breaches.

“Courts are beginning to say that just because the federal government didn’t give a remedy, it shouldn’t preclude patients from bringing a suit in states,” said Chad Eckhardt, a member in the regulated business group at Frost Brown Todd, which has its headquarters in Cincinnati, Ohio. 

Recourse at the state level

It was a 2014 Supreme Court decision in Connecticut that set a precedent allowing providers to be sued for HIPAA violations.  A patient filed a lawsuit against her obstetrician when the provider mailed her medical records to a court in response to a subpoena related to paternity suit filed by her ex. She was not informed of the subpoena by her provider and she filed for negligence, negligent emotional distress, breach of contract, and negligent misrepresentation as to the safety of her records. Although originally dismissed, her case ended up at the state supreme court, which ruled that her case stated a claim for which relief may be granted and remanded it for trial.

There are numerous torts for which individuals can seek redress for personal injury, but some are not suitable for filing lawsuits related to HIPAA violations. Two such torts are invasion of privacy and public disclosure of private facts, Eckhardt said.  Plaintiffs have to prove damages. Those torts rarely result in physical damage, so plaintiffs have to prove mental or emotional distress. Courts, he said, are reluctant to provide a remedy for non-physical damage under torts.

Negligence is another category that requires plaintiffs to prove damages. Under this tort, physicians can be considered negligent because they did not comply with a standard of conduct (HIPAA). “If the federal government says this is the minimum standard of confidentiality and you don’t meet those minimum standards, you are negligent as a matter of fact,” Eckhardt said.

Breach of contract is another option for plaintiffs, though the damages are much less than with a tort, Eckhardt said. Some states, like Ohio and West Virginia, have also created torts specifically for the unauthorized disclosure of medical records.

“More states are creating this tort for unauthorized released of records and if they don’t have one, courts are going to try to find a remedy for harm done if there is actual damage to an individual,” Eckhardt said.

Setting precedent

A case out of Indiana was the first to show that employers can be held accountable for their staffs’ HIPAA violations. A patient sued Walgreens and one of its pharmacists when she found out the pharmacist had looked up and released medical records to the plaintiff’s ex-boyfriend. The pharmacist was currently married to the woman’s ex, to whom she provided prescription information. The woman won $1.4 million in damages, holding Walgreens accountable for the employees’ breach of confidentiality under HIPAA for reasons including negligent supervision.

Physicians need to ensure they are training all employees upon hiring them and annually thereafter, he said. Consistent training can help a provider prove they have not been negligent in supervision of their employees and reduce their liability.

As part of training, the importance of caring for hyper-sensitive information like HIV status and mental health conditions should be emphasized. In addition, practices need to review office processes to determine where people can get tripped up. For example, if a subpoena is received, what should employees at each level do with the request?

“Courts are going to try to find a remedy for harm done if there is actual damage to an individual,” Eckhardt said. “Courts are allowing awards for individuals, especially for hypersensitive information because it is so stigmatizing.”

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