Professing the Values of MedicineThe Modernized AMA Code of Medical Ethics

http://jama.jamanetwork.com/article.aspx?articleid=2534495

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What? He failed a drug test … so how can he sue under the ADA?

www.hrmorning.com/failed-drug-test-sue-ada/

The moral of this story: Like the feds, the courts want to see you do everything in your power to work with disabled individuals. 

If you can’t show that you did everything in your power to help those with disabilities perform their jobs, you’re going to have a lot of difficulty getting a discrimination claim thrown out of court. That’s the legal landscape employers are now facing.

Driver was on amphetamine

Here’s an example of how tricky it is to comply with the ADA: John Lisotto was denied a position as a truck driver at New Prime Inc., a fuel hauler, because he failed the company’s medical exam during the hiring process.

Lisotto suffered from narcolepsy, and took a prescribed amphetamine — Dexedrine — to manage the sleep disorder.

In anticipation of the drug test, Lisotto submitted a letter from his physician to New Prime.

The letter said:

“the prescribed medication would not adversely affect [Lisotto’s] ability to safely operate a commercial motor vehicle as [Lisotto] had for many years been driving commercial trucks safely … while taking [Dexedrine] and had experienced no problems with narcolepsy.”

Prime’s medical examiner told Lisotto that he needed to be off Dexedrine for at least one month. He also told Lisotto that Provigil was the only medication for narcolepsy that Prime would accept.

After that, Lisotto’s drug test results came back and he was told by one of Prime’s nurses that he couldn’t work for Prime because of his positive test result for Dexedrine. He was then told to return home and take Provigil for six weeks to see how it would affect him.

Lisotto did exactly that.

But when he reached out to New Prime again to inquire about becoming a driver, he was shut down.

Eventually, he received a letter from New Prime’s medical review officer that said:

“Even though you had a prescription for amphetamines, in my opinion you have a disqualifying medical condition since narcolepsy is a safety concern.”

ADA claim

Lisotto then filed a disability discrimination lawsuit under the ADA.

New Prime fought to get his lawsuit dismissed, claiming that Lisotto was required to first seek administrative recourse with the Federal Motor Carrier Safety Administration, which is tasked with resolving “conflicts of medical evaluation” where the physician for a driver and the physician for the motor carrier disagree on a driver’s qualifications.

But the court said there was no such disagreement here. It said both parties’ physicians indicated that as long as Lisotto took proper medication, he appeared qualified.

Instead, it said the breakdown occurred when New Prime’s medical review officer failed to communicate with Lisotto’s physician to determine whether there was a legitimate medical reason to take his failed drug test at face value.

In other words, the biggest problem for New Prime was it cut off talks with Lisotto’s doctor and relied solely on the failed drug test to deny him a job without looking deeper into whether he could still do the job.

As a result, the court ruled Lisotto’s ADA lawsuit could proceed despite his failed drug test, which means New Prime is facing a costly lawsuit or settlement.

Cite: Lisotto v. New Prime Inc.

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New analysis recommends responsible prescription of opioids to pain patients

https://www.sciencedaily.com/releases/2016/07/160713102505.htm

A recent review and analysis suggests that some policies restricting opioid prescriptions to curb overdose deaths could be harming those who need them the most: pain patients.

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Every week I see a few new Face Book pages focused on chronic pain and at least one new petition to the White House, Congress are some bureaucratic entity.  While all these groups are fighting for the same final goal… no one seems to understand that thousands of voice – not in concert – just sounds like a ROAR of NOISE.

All those dozens of petitions… and most get a few thousand signatures at most.. the only one that I know about that got over 100,000 signatures was to recall the head of the DEA.. and that was months ago.. and to the best of my knowledge the DEA has the same leader.

Just look at the many groups that should be advocating/protecting those in the chronic pain community.

AARP… they are suppose to look out for those 50+… estimated guess is that at least HALF of the reported 100-116 million chronic pain pts… would fall into the 50+ age range.. and where is the AARP speaking up for their members and/or age group they are suppose to be supporting ?

ACLU… is suppose to defend civil liberties… other than taking the AG and Medical Licensing board of Indiana to court over emergency rule of mandatory urine testing for all pts taking opiates. Turned out that was a violation of the 4th Amendment

ADA… the Civil Rights Division of the DOJ, plus there are many states that have their own ADA laws. Nearly all of the activity I have seen enforcing this law has been dealing with those people who are HIV+, ethnic groups and those in the LGBT community.

The legal/attorney community, how many times a day do you see an attorney advertising on TV, wanting to sue someone for causing a accident and causing someone else pain and suffering. Yet, I have not seen the first incident of an attorney suing a healthcare professional INTENTIONALLY causing a pt pain and suffering because they reduced the pt’s dose and/or refused to fill their prescriptions.

40+ Governors to sign Massachusetts-inspired opioid prescription compact

Included in that number is Trump’s VP pick Gov Pence.. but don’t that let you decide that Hillary is the one… she has endorsed the one cent per mg opiate tax proposed by WV’s Senator. Everyone at the Federal/State level seems hell-bent on making the CDC opiate guidelines the “law of the land”.

If there are 100-116 million chronic pain pts out there, IMO.. they need to get their act together. The chronic pain community doesn’t need more leaders/advocates than they have those willing to follow.

Maybe it is time for a new “silent majority”… a new T.E.A. party (Tortured Enough Already) and the first order of business is to get organized and vote all the incumbents out of office with this fall’s election.

If the 99% that normally get reelected… get reelected.. the path to reduced opiates for all chronic pain pts has been put in place… another two years allowing that plan to be implemented may make it too long to reverse changes already in place.

They don’t feel your pain… throwing them out of office and letting them find a “real job” will be the first step in sharing your pain.  Their replacements will be so paranoid that they will start listing to their constituents… because if their constituents cleaned house once… it can be done again..

You can register to vote by mail and vote by mail… The only valid reason you can have for not voting is if you can’t make it to your mailbox or you don’t  have the money to buy two postage stamps.

Vote as if your life depended upon it

The only other alternative is to start suing to get your life back, I believe that voting will be the fastest and least expensive path to take.

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DEA, state crack down on pain doctor over opiate prescriptions, citing 18 deaths

http://www.seattletimes.com/seattle-news/health/dea-state-crack-down-on-pain-doctor-over-opiate-prescriptions-citing-18-deaths/

The state of Washington many years ago – as a cost saving measure – mandated that Methadone be used for Medicaid chronic pain pts.  Methadone has proven to be a very good medication for many chronic pain pts, however prescribers who are not very familiar with the idiosyncrasies in the dosing of Methadone over other opiates can be fatal to pts. It has been documented that 2-4 pts will die within TWO WEEKS of being first prescribed Methadone. So the deaths within Dr Li practice could be from the large prescribing of Methadone to pts.. as mandated by Medicaid by those politicians that like to practice medicine without any medical knowledge.  Likewise, the bureaucrats rescinded the practice’s ability to participate in Medicaid and thus these people who are Medicaid because they have little/no financial resources.. are given the alternative to PAY CASH FOR ALL THEIR MEDICATIONS.

Have you also noticed that the DEA has seemed to increase their actions on multi-location clinics and/or chain clinics and they are targeting ONE PRESCRIBER out of all working for the chain, and the clinics are allowed to remain open with the remaining prescribers.  Are they targeting the prescriber with the MOST FINANCIAL ASSETS and this is more about civil forfeitures of the prescriber’s assets to benefit the DEA.. than anything actually deal with anything else?

State health officials have suspended the license of Dr. Frank Li, medical director for a chain of eight pain clinics in Washington that serves as many as 25,000 patients. He also can’t bill Medicaid.

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State restrictions not associated with reduced opioid misuse among disabled adults

http://www.clinicaladvisor.com/pain-information-center/opioid-prescriptions-among-disabled-adults-unaffected-by-state-laws/article/509047/

Controlled substance laws are not associated with reductions in hazardous opioid use or overdose among disabled Medicare beneficiaries, according to research published in the New England Journal of Medicine.

Ellen Meara, PhD, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and colleagues, analyzed the associations between prescription-opioid receipt and state-level controlled-substance laws. Data were collected for disabled Medicare beneficiaries between the ages of 21 and 64 who were alive between 2006 and 2012 (8.7 million person-years). The researchers examined the annual prevalence of beneficiaries with 4 or more opioid prescribers, prescriptions yielding a daily morphine-equivalent dose (MED) greater than 120 mg, and treatment for nonfatal prescription opioid overdose, and estimated how opioid outcomes differed based on 8 types of state-level laws.

Between 2006 and 2012, states added 81 controlled substance laws. In 2012, 47% of Medicare beneficiaries filled opioid prescriptions, 8% had 4 or more opioid prescribers, 5% had a daily MED greater than 120 mg, and 0.3% were treated for nonfatal prescription opioid overdose.

“We observed no significant associations between opioid outcomes and specific types of laws or the number of types enacted,” concluded Dr Meara. “For example, the percentage of beneficiaries with a prescription yielding a daily MED of more than 120 mg did not decline after adoption of a prescription drug monitoring program.”

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Democrats Unite, But What Happened To ‘Medicare For All’?

http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

Just think about it… back in when we were trying to put together Obamacare. There existed two perfectly good national systems – Medicare & Medicaid… but.. Congress had to create a whole different costly infrastructure… creating another set of rules and hiring abt 12,000 IRS agents to make ACA function from the financial side.

They claim that there would be winners and loser in a single payor system.. and some of those BIG LOSERS would be the insurance industry.. because if the government is paying all the bills… why would there be a need for an insurance company ?  Of course, the insurance industry has one of the largest war chests to funding lobbying efforts.

IMO… the more that we have had middlemen trying to help our society save money while providing better healthcare to everyone.. the more expensive it all gets. Are all these middlemen creating a on-going mirage of saving money while in fact diverting more and more of our healthcare dollars to fund their infrastructure and generate a profit to keep their stockholders and the stock market happy.

Just how much of the THREE TRILLION spent on our healthcare.. is being wasted on needless middleman infrastructure and/or how many – if not all – people in our society could be provided with their needed healthcare needs ?

After a raucous debate lasting nearly a year, the Democrats are united on health care. But that unity does not include a call for a single-payer “Medicare for all” health system.

“This campaign is about moving the United States toward universal health care and reducing the number of people who are uninsured or under-insured,” Sen. Bernie Sanders (I-Vt.) said Tuesday in endorsing his rival Hillary Clinton, the presumptive Democratic presidential nominee.

Sanders did win a few health care concessions in the negotiations leading to the endorsement. Clinton vowed to support more funding for community health centers and access to a “public option” government insurance plan, which she has supported in the past.

But on Sanders’ top health priority — his “Medicare for All” plan — there was not a word. At the Democratic Platform Committee meeting over the weekend, an amendment to add a single-payer plan to the document was defeated.

It wasn’t much of a surprise.

Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress.

“To try to do it in one fell swoop would be massively disruptive,” said Paul Starr, a professor at Princeton who was a health policy adviser to President Bill Clinton.

The U.S. health care system, said Jeff Goldsmith, a health care consultant and health futurist, is “the size of a country — it’s bigger than France — and it employs 16 million people.”

In moving to a single-payer system, he said, “you’re talking about reallocating $3 trillion, reducing people’s incomes and creating” in effect a single entity that would set prices for all medical services. Single-payer supporters dispute the idea that getting from here to there could not be done.

“We’re so used to such a complicated system in the U.S. that we envisage any change would be incredibly complicated as well,” said Steffie Woolhandler, a physician and one of the founders of the single-payer advocacy organization Physicians for a National Health Program. “But what you’re doing with single-payer is actually simplifying the system.”

For example, said Woolhandler, “the latest data is U.S. hospitals are spending 25 percent of their total budget on billing and administration, and hospitals in single-payer nations like Canada and Scotland are spending 12 percent.”

But while a single-payer system would undoubtedly produce efficiencies, it would also bring huge disruptions. Said Starr, single-payer supporters “haven’t worked through the consequences.”

One of the biggest is exactly how to redistribute literally trillions of dollars. The problem, said Harold Pollack, a professor at the University of Chicago, is that the change will create losers as well as winners.

“Precisely the thing that is a feature for single-payer proponents is a bug for everyone who provides goods and services for the medical economy,” he said, since their profits — and possibly their incomes — could be cut.

And it’s not just the private insurance industry (which would effectively be put out of business) that could feel the impact to the bottom line. Parts of the health care industry that lawmakers want to help, like rural hospitals, could inadvertently get hurt, too. Many rural hospitals get paid so little by Medicare that they only survive on higher private insurance payments. Yet under single-payer, those payments would go away and some could not make it financially. “You would not want to wipe out a third of the hospitals in Minnesota by accident,” Pollack said. “And you could,” if payments to hospitals end up too low.

There are also questions about how feasible it would be to have the federal government run the entire health care system. “It’s hard to be nimble” when a system gets that big, said Ezekiel Emanuel, a former health adviser in the Obama administration now at the University of Pennsylvania. “No organization in the world does anything for 300 million people and does it efficiently.”

To try to do it in one fell swoop would be massively disruptive.

The politics of Medicare — which serves roughly 50 million Americans — already make some things difficult or impossible, he said, pointing to a current fight in which doctors and patient advocacy groups blasted a proposal to move to a more cost-effective way to pay for cancer drugs. “You already can’t do certain things in Medicare because of the politicization,” he said. ”When you cover the whole country, it would be a lot of gridlock.”

Pollack agreed, and pointed out it’s not just the health care industry that could revolt. When the Affordable Care Act was rolled out in 2013, he said, “the people who couldn’t keep their old plans — a very tiny number as a percent of Americans” were furious. “We saw how difficult that was and how angry the public was when that promise wasn’t kept. Now imagine the major shift we’d have to do to move to a single payer system.”

There’s also the question of whether it’s simply too late to go back to the health care drawing board.

Single-payer supporter Woolhandler insists it is not. “Other nations have gone to single-payer systems,” she said. “It usually can be done in about a year.”

The last industrialized country that did the switch was Taiwan, in the mid-1990s. Taiwan, however, with its 23 million residents, has a population larger than New York and smaller than Texas, and had no existing private health insurance system at the time.

“What I’ve often said is we could have done this in the 1940s when Harry Truman proposed it,” said Starr, who has written at length on the history of American health politics. “Health care at that point was probably about 4 percent of [gross domestic product] and there existed at that time a relatively small private insurance industry.” Today health care spending in the U.S. is approaching 18 percent of the nation’s GDP and the private health insurance industry accounts for half a trillion dollars per year.

Both Starr and Pollack, however, said it would be possible to make a switch, although it would have to be carried out over a very long period of time.

“You could imagine some kind of long transition, where you gradually expanded Medicare,” said Starr, “for example moving it down to age 55” and then in later years continue to lower the age threshold.

But even if the U.S. did manage to execute a single-payer system, said Pollack, it would likely prove problematic, particularly in how it would be financed.

“The major value of a single-payer system would be to help the bottom third of the income distribution, and that means the top 20 percent of the population will have to pay more,” he said. “I’m actually in favor of that, but let’s not kid ourselves. That’s a knife fight that’s going to be had.”

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Billings medical marijuana patient faced with leaving Montana to treat “excruciating pain”

http://www.ktvq.com/story/32430890/billings-medical-marijuana-patient-faced-with-leaving-montana-to-treat-excruciating-pain

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Governors to sign Massachusetts-inspired opioid prescription compact

http://www.politico.com/states/massachusetts/story/2016/07/nga-members-signing-ma-modeled-opioid-prescription-compact-103787

BOSTON – More than 40 governors are agreeing to double down on efforts to fight the opioid epidemic through tweaks to the opioid prescription process that are modeled on findings from Massachusetts’ opioid working group.

Those tweaks are enumerated in the Compact to Fight Opioid Addiction, which represents the first time in more than ten years that National Governors Association members have developed a contract to spur coordinated action on a national health issue.

The same day Baker arrives in Iowa, he will brief the press on the NGA’s work on the opioid epidemic, followed by a panel hosted by Baker and New Hampshire Gov. Maggie Hassan, the health and human services committee co-chair, about fighting the opioid epidemic. The panel will also include US Secretary of Health and Human Services Sylvia Burwell.

“Bringing governors together around core strategies to end the opioid epidemic adds momentum behind state efforts and sends a clear signal to opioid prescribers and others whose leadership is critical to saving lives,” Baker said in a statement released today. “Massachusetts is proud to bring our plans to the table for other states as we work collaboratively to find meaningful solutions to this public health crisis.”

The Massachusetts-connected recommendations in the compact include social media efforts like Massachusetts’ “state without stigma” and Good Samaritan advertisements, integrating prescription data for primary medical providers, ironing out opioid prescription guidelines, and creating opioid prescription education around athletic programs.

This compact was the result of a vote during the NGA’s winter meeting to create a set of guidelines for opioid prescriptions.

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