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Rehab Hospitals May Harm A Third Of Patients, Report Finds

http://www.npr.org/sections/health-shots/2016/07/21/486756178/rehab-hospitals-may-harm-a-third-of-patients-report-finds

The physical therapy workouts a rehabilitation facility offers can be a crucial part of healing, doctors say. But a government study finds preventable harm — including bedsores and medication errors — occurring in some of those facilities, too.

Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.

In a government report published Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.

Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.

“This is the latest study over a long time period now that says we still have high rates of harm,” says Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.

“We’re fooling ourselves if we say we have made improvement,” Classen says. “If the first rule of health care is ‘Do no harm,’ then we’re failing.”

The oversight study, from the office of the inspector general of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.

Still, the findings echoed those of previous studies that found that more than a quarter of patients in hospitals and a third in skilled nursing facilities suffered harm related to their care.

“It’s important to acknowledge that harm can occur in any type of inpatient setting,” says Amy Ashcraft, a team leader for the rehabilitation hospital study. “This is one of the settings that’s most likely to be underestimated in terms of what type of harm can occur.”

For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.

Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.

The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.

That high number indicates there’s lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.

“We know a lot about preventing medication errors,” Thomas says.

An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient’s death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.

“It is a domino effect for any person who has had an adverse event,” says McGiffert, who was not involved in the study.

The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.

Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.

ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its Patient Harm Questionnaire and Patient Safety Facebook Group.

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Montana’s ‘Pain Refugees’ Leave State To Get Prescribed Opioids

http://www.npr.org/sections/health-shots/2016/07/20/481771231/montanas-pain-refugees-leave-state-to-get-prescribed-opioids?

MT was one of the early states to approve/legailize medical marijuana – which they are now trying to repeal/reverse. The Medical License Board seems to be on a “medical witch hunt”… they suspended the license of one rural physician because they “believed” that he was writing opiate Rxs to “maintain/support” ONE SINGLE ADDICT… keep in mind there is only 1 + million people  in the entire state and that a “nearby specialty medical facility” can be a couple of hours’ drive – EACH WAY…  In the very rural areas of the state.. the local physicians do what they have to do… to take care of pts. Two other physicians they have went after and after being exonerated once… they went back after them for nebulous reasons… like illegible medical records.  The legal expenses of fending off these witch hunts have bankrupt these prescribers and shut down their practices. 

Federal authorities say about 78 Americans die every day from opioid overdose. In Montana, health care officials report that abuse there is worse than the national average. But the casualties of the opioid epidemic are not all drug abusers.

On a recent night, three Montana residents, who call themselves pain refugees, are boarding an airplane from Missoula to Los Angeles. They say that finding doctors willing to treat chronic pain in Montana is almost impossible, and the only way they can get relief is to fly out of state.

Before Gary Snook drops into his seat, he pauses in the aisle, pressing his fingertips into his upper thigh. He bends his knees slightly and moves his hips side to side. He’s getting in one final stretch before takeoff.

“My pain, it’s all from my waist down,” he says. “It’s like being boiled in oil 24 hours a day.” Snook has been taking opioids since he had spine surgery for a ruptured disk 14 years ago. After the operation, he says he was in so much pain he couldn’t work. He’s tried all kinds of things to get better.

“I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he says. “I’ve tried anything that anyone has ever suggested me to try. Unfortunately what I do right now is the only thing that works.”

Snook says though he might seem desperate like someone who is addicted to pain killers, he’s not. He’s not craving a quick fix. He leaves his home for treatment because he has no confidence in the doctors in Montana and he wants to be healed.

“I believe pain control is a fundamental human right, or at least an attempt at pain control,” he says. “To deny someone with a horrible disease like me access to pain medications is the worst form of cruelty.”

It’s dark outside when Snook, his wife and the two other pain patients get off the plane in Los Angeles. They wheel their suitcases to a rented SUV. When they get to the hotel, they smile and greet the lobby clerk by name.

The trip has become routine. Every 90 days, they come here to see a doctor who gives them the care and prescriptions they say they can’t get at home.

Fear Among Montana Doctors

Montana is a tough state to find many options for any medical care. Because much of the state is rural, residents often travel long distances, including out of state, for specialty care.

In the past several years, the Montana Board of Medical Examiners has taken on several high-profile cases of doctors it suspects of overprescribing opioids. At least two Montana doctors have had their licenses suspended since 2014.

Executive Director Ian Marquand says his organization doesn’t play favorites. “The board does not encourage particular kinds of doctors, it does not discourage particular kinds of doctors. The door is open in Montana for any qualified, competent physician to come in and practice.”

But Marc Mentel acknowledges that there’s fear around prescription painkillers in Montana’s medical community. He chairs the Montana Medical Association’s committee on prescription drug abuse, and he says he does hear of doctors being more wary.

Mentel, who started practicing medicine in the 1990s, says that when he was training, medical education didn’t include treating long-term pain.

“The perfect tool, the perfect medicine that would take away a person’s pain and allow them to function normally does not yet exist,” he says. “So we are trying to use any tool, any means we can to help lessen the severity of their pain.”

Mentel says opioids do help some patients, but he hopes his generation of doctors will learn more about pain and understand ways to treat it beyond opioids.

In March, the Centers for Disease Control and Prevention published long-awaited guidelines that said opioids should be the treatment of last resort for pain, and if used should be combined with other treatments such as exercise therapy.

“Patients are in pain,” Mentel says. “We don’t have great tools for them and we need to recognize that this is going to be a chronic-disease state. They may be in pain for the rest of their lives. So … how do we treat them without actually harming them?” he says.

The California Solution

For Snook, relief is found at a small strip-mall clinic in suburban Los Angeles.

i

Tennant says that doctors need to specialize in pain management to reduce the risk of improperly prescribing opioids.

Corin Cates-Carney/Montana Public Radio

Dr. Forest Tennant is a former Army physician who says he has consulted for the National Institute on Drug Abuse, the National Football League and NASCAR.

He has about 150 patients, half of them from out-of-state.

Tennant says there are legitimate reasons to be concerned about opioids, and that’s why doctors need to specialize in pain management.

To an untrained physician, Tennant says, addicts and pain patients can look similar. “Doctors can get conned,” he says. “I think that it is true that we’ve had a lot of opioids that get out on the street, and people get them … whether it is heroin or a prescription opioid.”

But opioids can also help people, Tennant says. Because of that, he says, the drugs shouldn’t be stigmatized, but used responsibly.

“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” he says.

Tennant is lobbying for a Montana bill to guarantee more access to opioids for pain patients, so people like Snook don’t need to travel so far for a prescription.

“Had I stayed in Montana, I would have killed myself,” says Snook. “I just want humanitarian care, and I get that in California.”

This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.

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Wisconsin ranks among worst in country for pharmacy robberies

http://www.wisn.com/news/wisconsin-ranks-second-in-country-in-pharmacy-robberies/40811910

nothing like telling the criminals all the NEW TRICKS AND TOYS that the “good guys” have to catch the criminals. Why don’t they just leave a key under the door mat and the alarm code scratched on the wall… so that they can get in and steal the controls.  After all the cops would have less job security if legal drugs didn’t get to the street.  Maybe Wisconsin is trying harder to be NUMBER ONE.. but.. they are going to have to go a way to catch up with INDIANA in pharmacy robberies

 WISN 12 NEWS COLLEEN HENRY INVESTIGATES THE LATEST WEAPON THIEVES. >> IT’S A SCENE THAT PLAYS OUT MORE OFTEN HERE IN WISCONSIN THAN MOST ANYWHERE ELSE IN THE COUNTRY, ROBBERY CREWS STEALING OXYCONTIN COUGH SYRUP AND CASH AT GUNPOINT. PHARMACY SURVEILLANCE CAMERAS NOW PHARMACY STAFF HAS A NEW TOOL TO HELP THEM ACTUALLY CATCH THEIR THIEVE IT IS ALL ABOUT THE TECHNOLOGY. IN THE SAME WAY A GPS CAN HELP YOU FIND YOUR SMARTPHONE, THEY ARE NOW USING GPS TECHNOLOGY TO THEM UP. AND, IT IS WORKING. ALERT STAFF AT THIS SOUTH-SIDE PAIR OF GUN-TOTING ROBBERS LAST COURT RECORDS SAY TWO MEN WALKED UP TO THE REGISTER HERE AT THE GUNS AT THE CLERK AND DEMANDED CASH, BUT PLANTED INSIDE T LOOT, A GPS CHIP. FIFTEEN MINUTES LATER, AT A NORTHSIDE CVS PHARMACY POLICE DIGITALLY TRACKED DOWN THEIR SUSPECTS CASIMIR MCMURTRY AND KEYON WILLIAMS ARE CHARGED WITH ARME ROBBERY. PINGING GPS DEVICE IN WILLIAMS’ POCKET. ANY QUESTIONS. >> STAFF HERE WOULDN’T TALK ON CAMERA, BUT A WALGREENS SPOKESMAN TELLS 12 NEWS IT’S COMMITTED TO PROTECTING THOSE IT SERVES. EDGE TECHNOLOGY AND ADVANCED SECURITY CAPABILITIES TO PREVENT CRIMINAL ACTIVITY AND TO SUPPORT LAST YEAR, WISCONSIN HAD 45 PHARMACY HEISTS. ACCORDING TO THE DEA, THAT WAS THE THIRD WORST RATE IN THE COUNTRY. BUT THE COORDINATED CRACKDOWNS APPEAR TO BE WORKING. THIS YEAR, WISCONSIN HAD ROBBERIES. >> IT’S A SAD SITUATION AND IT KIND OF MAKES YOU AFRAID OF COMMUNITY SETTING. >> DEAN ARNESON OVERSEES THE UNIVERSITY WHERE STUDENTS ARE THEIR PROFESSION AND THE TOOLS AVAILABLE TO PROTECT THEM. POLICE CAN FOLLOW. THEY HAVE PROVEN TO BE EFFECTIVE. THEY’RE ABLE TO TRACK THEM DOWN AMOUNT OF TIME AND HOPEFULLY IT — AS A DETERRENT. >> ONE LAW ENFORCEMENT SOURCE TELLS 12 NEWS IT DOESN’T DISCUSS

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Where is the AARP ?

Our Mission

AARP is a nonprofit, nonpartisan, social welfare organization with a membership of nearly 38 million that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families — such as health care, employment and income security, and protection from financial abuse.

Since AARP represents those 50+… they claim that they have a membership of 38 million and that they fight for HEALTHCARE. How many of those 38 million members do you think suffer from CHRONIC PAIN, DEPRESSION, ANXIETY, MENTAL HEALTH ISSUE and are having a difficult time getting their medications or getting adequate/appropriate treatment for those health issues.

Someone would have to have their head stuck somewhere to not notice all the attention that is being paid to those who suffer from substance abuse , chronic pain and other subjective diseases.  You can search their website and there is a large array of articles on chronic pain and substance abuse.. including one by DR. OZ about treating chronic pain – WITHOUT MEDICATIONS..

It would seem that the only people that think that continuing the war on drugs is a good thing is those who work for the judicial system, those in Congress, those who operate addiction rehab centers and those that have lost a loved one from a opiate OD.. because their mental health issues could not be properly addressed.  That comes up to a percent in the low teens of the population.  So, as a country, we are spending 51 billion/yr because a small minority of our population thinks it is a good thing.

At $16 dues/member/yr those 38 million submit 600+ million dollars/yr… not counting all the royalties they collected from all those endorsement deals.  According to their 2013 Financial Statement published in their website their total revenue was 1.4 BILLION DOLLARS.  If they are doing any lobbying for those members who suffers from subjective diseases… it is either TOTALLY INEFFECTIVE or SO LITTLE that it is a waste of resources.

I have been a member of AARP for nearly 20 yrs and am starting to really question why/if.. I will renew our membership when it comes due.

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Pain-clinic patients worry as DEA moves toward revoking doctor’s registration

http://www.seattletimes.com/seattle-news/freaking-out-pain-clinic-patients-worry-as-dea-steps-up/

Since it is estimated that there is between 1.9 and 2.1 million serious opiate addicts in the USA… which .. if 25,000 pts of these eight clinics have been “thrown to the curb”… either means that these clinics were providing opiates to 12.5 % of all the addicts in the USA or there is a lot of legit chronic pain pts that are being thrown into cold turkey withdrawal… subject to having a hypertensive crisis, stroke and death.  I may have missed it… but I see no allegation or proof of deaths from opiates that had been provided to pts.  Another case of guilty without proof ?

Federal Drug Enforcement Administration officials are taking steps to revoke the DEA registration of Dr. Frank Li, medical director of Seattle Pain Clinics, whose license was suspended by state officials last week.

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The real reason that so many more Americans are using heroin

https://www.washingtonpost.com/news/wonk/wp/2016/07/20/the-real-reason-that-so-many-more-americans-are-using-heroin/#comments

President Obama has committed to sign the Comprehensive Addiction and Recovery Act, which includes among its provisions new policies to reduce inappropriate prescribing of prescription opioids such as Oxycontin and Vicodin. Given the ongoing epidemic of addiction and death caused by opioid painkillers, this seems like sensible public-health policy, but some critics charge that tighter prescribing rules simply cause prescription opioid users to switch to heroin, thereby feeding a second opioid epidemic. The prestigious New England Journal of Medicine recently published the first systematic analysis of this terrifying possibility.

Wilson Compton of the National Institute on Drug Abuse, who led the analysis, discovered that the timing of the prescription opioid and heroin epidemics is not consistent with the simple narrative that increased controls on the former instigated use of the latter. Heroin use and heroin-related emergency-room visits and hospitalizations were rising for years before the 2009-2011 period in which controls of prescription opioids expanded — for example, by strengthening of state prescription-monitoring programs, crackdowns on pill mills and the introduction of an abuse-deterrent formulation of Oxycontin.

Compton and colleagues also noted that fatal heroin overdoses began rising in 2007 — prior to the initiation of tighter opioid prescribing practices — and have not showed any consistent relationship with prescription opioid overdoses since. Heroin deaths rose from 2011 to 2012, when prescription opioid deaths had their only year-on-year drop, but they kept rising the next year, when prescription deaths were flat and have kept increasing since the time that prescription opioid deaths began rising again.

If controls on prescription opioids are not driving the heroin epidemic, what caused this drug to reemerge? Compton and colleagues point to the establishment of heroin markets that expanded access to a cheaper, more potent opioid that appealed to people addicted to prescription painkillers. This is highly plausible, given evidence that Mexican heroin traffickers made special efforts to expand into communities with established prescription opioid problems.

Compton also points out that “addiction to pharmaceutical opioids drives many people to seek new sources whether there are any controls in place or not.” As users become tolerant to the effects of opioids, they often consume an increasing amount of the drug until they simply cannot afford to purchase the dozens of pills they want each day from legal or illegal sources. Heroin, which once may have seemed unthinkable, thus becomes attractive because of its affordability.

Compton does not deny that some people, particularly those who are already using some heroin in addition to pharmaceutical opioids, might increase their heroin use if their doctors cut them off their prescription, and indeed studies of people being treated for heroin addiction document that such patients exist. But consider this analogy: If you live in Hawaii, most of the tourists you meet will have arrived by airplane, but it does not follow that most of the world’s tourists who board airplanes are going to Hawaii.

By the same token, studies of the select sample of people being treated for established heroin addiction by definition will never capture data on the far larger number of people who responded to reduced access to pharmaceutical opioids by ceasing use of those drugs. Nor will such studies make apparent an even more important group of beneficiaries of more careful opioid prescribing rules: the individuals in the future who will not be inappropriately prescribed opioids in the first place.

Keith Humphreys is a professor of psychiatry and mental-health-policy director at Stanford University.

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Don’t let a lawyer be your doctor

http://setexasrecord.com/stories/510964210-don-t-let-a-lawyer-be-your-doctor

The following is a public service announcement from the Southeast Texas Record:

There are many personal injury attorneys advertising in Texas media and making misleading and inflammatory claims about prescription drugs, the companies that manufacture them, and the doctors who prescribe them, according to a recent medical survey.

Heart attacks, strokes, hemorrhaging, aneurysms, and internal bleeding are some of the things that can happen when patients discontinue taking prescribed medication or alter their dosages in response to misinformation from personal injury attorneys looking for clients for lawsuits against drug companies and doctors, the doctor survey says.

Eight out of 10 Texas doctors agree that “personal injury lawsuit ads can lead patients to stop taking their medicines as prescribed,” according to a recent survey by Texans Against Lawsuit Abuse.

“Consumers need to understand that the intent of these ads is to generate lawsuits, not to provide sound health information,” says Steven L. Gates, president of the Texas Osteopathic Medical Association. “They should remember two very important things: Don’t believe everything you see in any ad – especially medical lawsuit ads. And, patients should always ask their doctor, not a lawyer, about health concerns.”

If you have misconstrued the scare tactics of personal injury attorneys as legitimate medical advice and suffered adverse consequences, you should be entitled to hold those attorneys accountable for their unprofessional behavior.

Don’t be a victim. Don’t change your medical regimen because of something you heard a personal injury attorney say. If you have questions about your treatment, ask your doctor.

Don’t let a lawyer be your doctor. Don’t let biased advertisements mislead your loved ones with fast talk and hysterical claims.

Don’t let personal injury attorneys drum up business at your expense with one-sided ads about prescription drugs. To find out what you can do about those ads, visit the Texans Against Lawsuit Abuse website at tala.com or call 1-800-476-1442.

Ref.: Personal injury attorney Louisville Kentucky Hughes & Coleman.

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The results of DENIAL OF CARE and COLD TURKEY WITHDRAWAL

This appeared in a closed FB page dedicated to chronic pain pts and their advocates. To those who know what they are doing.. it is well known that cold turkey withdrawal from opiates or benzos can cause a hypertensive crisis… causing a stroke and sometimes DEATH..  We routinely see prescribers being charged with various crimes for pts dying from ODing on controlled meds… Does anyone believe that we will see charges against health care DENIERS when pts DIE from cold turkey withdrawal ?

If this pt had died of a medical error, I would bet that attorneys would be circling like vultures circling over “road kill”… but.. will they bother to take a second look at this unnecessary PREVENTABLE DEATH ?

Loss of Life due to CDC Guidelines – It is with a very heavy heart that I report that one of our  members lost a cousin due to the government’s gross negligence of the chronic pain patients. I won’t divulge names at this time, as I want to respect the family’s time to grieve. It was reported by one of our members that she lost her cousin, age 56, due to a massive stroke caused by the sudden discontinuance of his meds. His meds were not discontinued because it was in the best interests of his health. It was because of the government’s War on Heroin. He was taken off life support rather than being left in a vegetative state. Please keep this family in your prayers as his two daughters try to cope with this tragic loss. A doctor is responsible for this death. Our government is responsible for this death. The CDC, DEA, and the State of Florida is responsible for this man’s untimely and needless death. Please keep this family in our prayers.

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Walgreens gives away pharmacy guide on treating LGBTI customers with respect –

The guide carries information on HIV, PrEP, hormone therapy for trans people and how to create an inclusive and welcoming pharmacy

  http://scl.io/W-dnuSxx#gs.fkacar8

Wouldn’t it be nice if Walgreens wanted all pts to consider Walgreens an inclusive and welcoming pharmacy?  Unfortunately, they have created their “Good Faith Policy”  (http://paindr.com/is-walgreens-opiate-policy-deceptive/) instructing their Pharmacists which customers are allowed to fill their controlled medications and which are not.  HARDLY INCLUSIVE AND WELCOMING ?  Of course, last quarter Walgreen reported a 4.6% increase in prescription volume… so turning away from their prescription dept a certain subset of the population has not seemed to harm their overall prescription business.  Could it be considered a DISCRIMINATORY POLICY by “welcoming ” one group of people covered under the Americans with Disability Act and “discourage” providing prescriptions to another group of people covered under the ADA ?

Walgreens, the largest drugstore chain in the US, is distributing 70,000 copies of a new resources guide on treating LGBTI customers with respect to health care professionals across the country.

The guide has been produced in partnership with Human Rights Campaign (HRC). It carries information on appropriate LGBTQ terminology and identities, and on the health disparities experienced by LGBTQ people.

There are also section related to transition services and hormone therapy for trans people, HIV medication and PrEP. There is also advice on creating an inclusive and welcoming pharmacy environment.

‘LGBTQ people often experience barriers to care, and, for many, their most frequent interaction with a health care professional occurs right in their own neighborhood pharmacy,’ said Tari Hanneman, Director of the Human Rights Campaign Foundation’s Health Equality Project, in a statement.

‘This guide will help ensure that they are treated with dignity, respected in their identities, and able to gain the necessary and inclusive health care we all need to live and thrive.’
LGBT people are 68% more likely to smoke cigarettes; and are 2.5 times more likely to suffer from depression and anxiety

‘With almost 8,200 drugstores nationwide, touching the lives of eight million customers daily in stores and online, we have a tremendous opportunity to serve as a model of quality and individualized care for people of all sexual orientations and gender identities,’ said Richard Ashworth, President of Pharmacy and Retail Operations for Walgreens.

‘By making training materials available to all our pharmacists and health care service providers, we can do even more to create a welcoming environment and build LGBTQ patients’ confidence and trust that the health care advice we provide is sensitive to their unique needs and concerns.’

Among the disparities noted by the guide are that LGBT people are slightly less likely than non-LGBT counterparts to have health insurance; LGBT people are 68% more likely to smoke cigarettes; and are 2.5 times more likely to suffer from depression and anxiety.

The guide comes two months after the US Department of Health and Human Services (HHS) Office for Civil Rights introduced a regulation that provides explicit protections from discrimination on the basis of gender identity and sex stereotyping, in healthcare and insurance.

This extends to health care programs – including pharmacies – that receive any federal funding.

In 2014, the Williams Institute in Los Angeles published a report on the discrepancies experienced by many LGBT people in accessing healthcare, including the fact that 29% of LGBT people reported not having a personal doctor, compared to 21% of the non-LGBT population.

Walgreens – headquartered in Deerfield, Illinois – has consistently scored the top mark of 100 in HRC’s annual Corporate Equality Index, which scores companies according to their LGBT-friendly policies and procedures.

The Walgreens/HRC guide can be read here. – Read more at: http://scl.io/W-dnuSxx#gs.fkacar8

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