Senators face off over bill to help retired coal miners

Senators face off over bill to help retired coal miners

http://www.whas11.com/ext/news/nation-now/senators-face-off-over-bill-to-help-retired-coal-miners/417/nationnow/5NiKd4r2g0yCgKK8oQGKeC

 

 

While McConnell is not up for election until 2020… there are more Republican Senators up for re-election than Democrats… At the very least McConnell could be stripped of his Senate Majority Leader status.  Hillary Clinton has stated that – if elected – she is going to put coal miner out of  a job and close coal mines..  Apparently the Republicans just want to play games with their health insurance and let them suffer and die – or commit suicide – sooner than they would otherwise.

WASHINGTON — For nearly two decades, David H. Dilly worked as a strip miner for Simco-Peabody’s now abandoned mine in Coshocton, where he helped remove layers of soil and rock to unearth Ohio’s rich coal beds.

Since being laid off in 2008, amid the global economic meltdown and a contraction in the coal industry, Dilly has received about $300 a month in pension benefits.

Now, Dilly’s retirement money is in jeopardy. The health and pension funds that Dilly and more than 100,000 other coal miners across the United States rely on are threatened with financial insolvency.

Ohio’s two U.S. senators — Democrat Sherrod Brown and Republican Rob Portman — are among those pushing for a legislative fix that supporters say would protect the coal miners’ hard-earned benefits, without costing taxpayers anything. The bill has broad bipartisan support, with Democrats and Republicans from Pennsylvania, Indiana, and West Virginia leading an aggressive push to pass the measure before the end of the year.

But the bill has at least one powerful foe in Congress: Senate Majority Leader Mitch McConnell, R-Ky., who portrays himself as a staunch defender of his home-state’s coal industry.

“McConnell … has opposed this because he doesn’t like the United Mine Workers Union,” said Brown. “We could win this on a straight up or down vote,” the Ohio Democrat added, but McConnell has blocked such a move.

The United Mine Workers Union of America endorsed McConnell’s Democratic opponent, Alison Grimes, in the 2014 election, and the union’s political action committee spent more than $300,000 trying to defeat McConnell.

Robert Steurer, a spokesman for McConnell, did not directly answer questions about whether the senator was blocking the bill. Steurer also declined to spell out McConnell’s position on the proposal, saying only that he wants the bill to go through “regular order.”

“Senator McConnell has been and remains committed to helping ensure the retirement security of our nation’s retirees, including coal miners,” Steurer said in an emailed statement. “He appreciates the importance of this issue to many affected coal communities in Kentucky and around the country and continues to believe this issue deserves an open, transparent debate through regular order.”

At the center of the legislative standoff is a 12-page bill called the Miners Protection Act. The bill would transfer excess money from the Abandoned Mine Land fund — a coal mine clean-up program — to the 1974 United Mine Workers of America Pension Plan, which now pays benefits to about 120,000 retirees.

While it’s a private, multi-employer pension fund, the UMWA plan has a special guarantee from the federal government — secured in 1946 when then-President Harry Truman’s administration helped negotiate a contract with mine workers who were threatening to strike.

Under that agreement, “coal miners made a commitment to provide the nation with much-needed energy even at the risk of their lives and health in often dangerous conditions,” UMWA International President Cecil Roberts told a Senate Finance Committee hearing in March. In exchange, he said, the government promised to ensure miners have health care and pension benefits upon retirement.

Brown and others say the UMWA pension and health care plans were on sound financial footing until the 2008 economic meltdown. But then both the coal industry and the UMWA funds were devastated by the recession.

Now, with the coal industry in sharp decline, the workers’ health care and pension plans cannot recover.

“The plan has too few assets, too few employers, and too few union workers now paying in,” Brown said in a speech last month on the Senate floor. “If Congress fails to act, thousands of retired miners would lose their health care this year and the entire plan could fail as early as next year.”

Right now, about 6,500 Ohio retired coal miners receive these benefits, said Phil Smith, government affairs director of the mine workers union. In Kentucky, that number is approximately 10,000 retirees, he said.

“If we don’t get new money into this pension plan through this legislation within the next 12 to 18 months, that fund will be past the point of no return,” Smith said.

Congress was on the cusp of passing the Miners’ Protection Act last December, when supporters pushed to have it included in a massive, must-pass spending bill. But according to a February story in The Washington Post, McConnell blocked that effort at the last minute. Two Senate staffers confirmed McConnell’s actions to USA TODAY.

Others said McConnell has privately made it clear that he opposes the bill, although not because he doesn’t like the mine workers’ union.

“He is opposed to this in principle and sees it would be a bailout and would set a dangerous precedent” for the government to rescue a private pension fund, said Rachel Greszler, a senior policy analyst at the conservative Heritage Foundation.

In an analysis she wrote in March, Greszler blasted the miners’ bill as an irresponsible bailout that would force non-union coal companies — which also pay into the coal clean-up fund — to subsidize the union companies’ pension plan.

The Miners’ Protection Act would force all non-union coal companies to “prop up their competitors by further subsidizing their over-promised and underfunded health and pension benefits,” she wrote.

In an interview, Greszler said non-union coal companies are “very, very upset” about the bill. She declined to name any specific companies.

Greszler, who said she has talked to McConnell’s staff about the bill, said McConnell is torn between his policy objections to the measure and pressure from other Republicans who want him to let it advance.

Last week, Portman, Brown, and several other senators tried — unsuccessfully — to stall legislation to help Puerto Rico with its debt unless the Senate also advanced the mine workers’ bill. Although they didn’t stop the Puerto Rico bill, the senators did secure a promise that the miners’ legislation would get a vote in the Senate Finance Committee.

Portman and others said they expected the panel would approve the bill overwhelmingly, giving the legislation momentum for a full Senate vote before the end of the year. But others feared it would be jammed up, as lawmakers rush through a spate of must-pass bills and then hit the campaign trail before November.

In the meantime, Dilly said he and other coal miners are anxious and perplexed about the congressional inaction.

“It’s kind of a mystery as to why we can’t get it passed,” he said. “Coal miners like us, all we’ve ever done is worked our whole lives and they’re up there playing games.”

cryingeyevote

Happy 4th of July

4th_july_graphics_04

Death resulting from withdrawal and denial of care ?

Father of woman who died in Douglas County Jail suing for $1.35 million

http://www2.ljworld.com/news/2016/jul/03/father-woman-who-died-douglas-county-jail-suing-13/

Heading into the Douglas County Jail, Rachel Hammers understood that alcoholism put her health at risk.

In particular, Hammers, 32, was afraid that her jail sentence for drunken driving would send her into a fit of seizures induced by alcohol withdrawal, so she sought medical attention, according to a federal lawsuit filed in Kansas City, Kan.

A doctor prescribed medication for Hammers that would lessen the alcohol-withdrawal effects, and her medical records were faxed over to the jail prior to her incarceration, the lawsuit says.

The evening of May 11, 2012, after Hammers was booked into jail she called her family and told them she would be in touch the next day so she could speak with her daughter, the lawsuit says. Here are the Top 100 Criminal Defense Lawyers from SoCal Law Network that you should read about and understand the kind of legal help you need.

The next morning guards found Hammers unresponsive and bloodied in her cell. She was taken by ambulance to Lawrence Memorial Hospital, where she was pronounced dead just under an hour later.

Now, Hammers’ father, Joe Harvey, who is an oral surgeon in Lawrence, is suing Douglas County officials, employees and medical staff under contract at the jail, alleging that his daughter died needlessly and in pain.

Harvey’s lawsuit is seeking $1.35 million from the county to compensate for pain and suffering caused by his daughter’s death. Douglas County officials declined to comment for this article. But through court filings, the county has denied allegations of wrong-doing.

Harvey also declined to comment specifically on the lawsuit, saying only: “My family and I have great faith in our legal team.”

An early widow

By her early 30s, Rachel Hammers was a widow and a mother to three daughters and a son. Hammers married Sean Hammers in April 2010, but he died just 19 months later.

Hammers was one of eight children born to Harvey and his wife, Mary Hansen Harvey. She was a graduate of both Perry-Lecompton High School and Kansas University.

The lawsuit acknowledges that Hammers had a history of alcohol abuse and depression, but she had no criminal history prior to 2011, Douglas County District Court records show.

But in late 2011, that would change. Court records show that in 2011, Hammers had two drunken driving offenses, and parole violations related to those offenses which led to her incarceration in the Douglas County Jail on multiple occasions.

Harvey’s lawsuit alleges that jail officials should have known that Harvey’s serious alcohol abuse — she told doctors she often drank a liter of rum per day — put her at risk of serious injury if she didn’t receive the proper medication to reduce withdrawal symptoms.

Lawsuit filed

Harvey’s civil suit was filed in federal court in Kansas City, Kan. in April 2015, but it has gained new vigor in recent weeks as Harvey hired new lead counsel for the case, prominent Kansas City Attorney Arthur Benson.

The lawsuit lists as defendants the Douglas County Commission, Douglas County Sheriff Ken McGovern, then-Undersheriff Kenneth Massey, then-Undersheriff Steve Hornberger, Dr. Dennis Sale, the Douglas County Visiting Nurses Association, and three anonymous men who are alleged to have been involved in Hammer’s wrongful death.

Her father’s lawsuit argues that the oversights and failures leading to Hammers’ death were so egregious that they constitute a violation of her civil rights under the Fifth, Eighth, Ninth and 14th Amendments. These rights generally guarantee due process, protection from cruel and unusual punishment, basic human rights and equal protection under the law.

Although a direct cause of death could not be determined, Hammers’ autopsy report concluded that the best explanation was linked to “seizure activity.” She tested negative for both alcohol and drugs when the autopsy was performed.

The lawsuit states that policies and procedures established and enforced within the jail led staff to overlook Hammers’ medical records, put her welfare in the hands of unqualified employees and allowed for a delay in providing emergency medical care.

In total, the lawsuit claims six points where the defendants are at fault, including:

• Deliberate indifference to serious medical need and failure to provide access to medical personnel for evaluation and treatment.

• Failure to train/ Inadequate training.

• Failure to supervise/ Inadequate supervision.

• Wrongful death.

• Negligence.

• Breach of duty to third party beneficiary.

Backstory and timeline

The following is a brief timeline of Hammers’ last months, as outlined in the lawsuit and in Douglas County District Court records:

In October 2011, Hammers was arrested for her second drunken driving offense. Her first offense was five months earlier.

In February 2012, Hammers pleaded guilty to both drunken driving charges, and the next month she was sentenced to serve four days in jail. That sentence was to be followed by a year of parole in lieu of six months of incarceration.

Hammers’ four-day jail sentence was scheduled to begin on March 21, 2012, the lawsuit says. Weary of the impending symptoms of alcohol withdrawal as she served her sentence, she visited a doctor and received a drug prescription to alleviate any potential issues.

The doctor also forwarded Hammers’ medical history and prescribed drug regimen to jail staff, the lawsuit says.

As inmates are booked into the Douglas County Jail they go through a health screening process, Douglas County Sheriff’s Office Sgt. Kristen Dymacek wrote in an email.

“They are asked a series of medical and mental health questions as well as visually observed by corrections officers or deputies,” she said in response to questions from the Journal-World.

During the jail’s screening process, the booking officer indicated that Hammers did not have a health risk, the lawsuit says.

Over the next four days in jail, Hammers experienced moderate and eventually severe withdrawal. On the third day she was sweating heavily and was delusional and hallucinating.

While in jail, inmates experiencing medical issues can alert jail staff, Dymacek said. The staff will then decide what steps to take.

“Corrections officers and deputies are not trained to give medical examinations. They are trained in first aid and CPR,” she said. “Any inmate can alert (jail) staff of a medical need at any point and the appropriate measures are taken to take care of their medical needs.”

Despite her symptoms and medical history, the lawsuit says, the nursing staff neither alerted a doctor nor monitored Hammers more closely; nor did staff adhere to her drug treatment prescribed for alcohol withdrawal.

Hammers was released from jail on March 27, 2012, after serving her four-day sentence. However, she violated the terms of her parole and two warrants were issued for her arrest the next month.

On April 19, 2012, Hammers checked herself into Lawrence Memorial Hospital for alcohol intoxication, depression and suicidal thoughts, once more reporting a history of seizures due to alcohol withdrawal.

Three days later, Hammers was booked back into jail. Once again the booking officer indicated she did not have a health risk. She was released from the facility eight days later.

Once again, Hammers failed to meet the terms of her parole and another arrest warrant was issued. She was booked into jail for the last time on May 11, 2012.

During her third and final medical screening Hammers reported daily alcohol use, hypertension and depression. Again she was determined to have no health risk.

That night Hammers spoke with her family from the jail and said she would be calling the next morning to speak with her daughter. However, the call was never made.

On Saturday, May 12, 2012, at 9:50 a.m., jail staff discovered Hammers in her cell, unresponsive and bloodied, the lawsuit says. “She had no pulse and she wasn’t breathing.”

Jail staff did not perform CPR on Hammers and insisted on waiting for nursing staff to arrive on the scene, the lawsuit says.

In addition, responding nurses did not immediately bring a defibrillator with them to try and resuscitate Hammers. More than five minutes passed before the device was brought to the cell “which diminished the likelihood that she could be successfully resuscitated,” the lawsuit says.

Hammers was taken by ambulance to Lawrence Memorial Hospital, where she was pronounced dead at 10:46 a.m.

More allegations

Many different factors led to Hammers’ death, the lawsuit says, and each factor was exacerbated by failures of all the defendants, individually and collectively, to fulfill their responsibilities.

Inadequate jail policies and procedures regarding both the routine and emergency medical care of inmates “comprise the moving force behind Hammers’ death,” the lawsuit says.

Those policies and procedures were created and enforced by Douglas County officials, employees and medical staff under contract, the lawsuit says.

Several other elements — all stemming from the jail’s policies and procedures — are listed in the lawsuit as factors contributing to Hammers’ death:

• Hammers’ medical history, which was readily available to jail and medical staff, was overlooked and her pre-existing and well-documented conditions were ignored.

• Improperly trained and unqualified jail staff members were entrusted to conduct medical screenings of inmates during the booking process and assess each inmate’s overall health risk.

• Improperly trained and unqualified jail and nursing staff were responsible for determining the severity of each inmate’s medical issues before contacting qualified medical staff.

• Medical staff under contract at the jail were improperly staffed during night and weekend hours.

Each of the factors constitutes a “deliberate indifference” to the medical needs of Hammers and the entire jail population, the lawsuit says. In addition, the collective “actions and omissions” of the defendants ultimately show a “conscious disregard” of civil rights.

Attorneys for Douglas County officials, employees and contracted medical staff all declined to comment on the pending litigation or the specific allegations.

Currently the Douglas County Jail houses 186 inmates and employs 94 staff members “which includes corrections officers, deputies, IT, kitchen staff, maintenance, lobby officers, reentry staff, etc,” Dymacek said.

As a part of an ongoing conversation, the county is considering moving ahead with a $30 million jail expansion, which would add 120 beds to the facility.

The jail, at 3601 North 1360 Road, opened in 1999 and Hammers is the only inmate to have died in the facility, Dymacek said.

Douglas County’s contract with the Visiting Nurses Association and Dr. Sale ended Thursday, said Assistant County Administrator Sarah Plinsky. A contract for the jail’s new medical services provider, Advanced Correctional Healthcare was approved by the Douglas County Commission on June 13, and officially began on Friday.

A jury trial for the lawsuit is scheduled to begin on Oct. 23, 2017, in Kansas Cit

So you think that you can influence members of Congress

http://www.opensecrets.org/lobby/

Lobbying Database

In addition to campaign contributions to elected officials and candidates, companies, labor unions, and other organizations spend billions of dollars each year to lobby Congress and federal agencies. Some special interests retain lobbying firms, many of them located along Washington’s legendary K Street; others have lobbyists working in-house. We’ve got totals spent on lobbying, beginning in 1998, for everyone from AAI Corp. to Zurich Financial.

To help you with the math… in 2015… lobbyist spent abt NINE MILLION DOLLARS A DAY  — 7 DAYS A WEEK.. to get what they want out of our Federal Goverment

Total Lobbying Spending
1998 $1,452,984,975 $1.45 Billion
1999 $1,437,744,966 $1.44 Billion
2000 $1,566,792,414 $1.57 Billion
2001 $1,633,780,756 $1.63 Billion
2002 $1,832,212,993 $1.83 Billion
2003 $2,061,307,915 $2.06 Billion
2004 $2,185,106,481 $2.19 Billion
2005 $2,440,863,167 $2.44 Billion
2006 $2,634,610,325 $2.63 Billion
2007 $2,870,073,188 $2.87 Billion
2008 $3,304,625,834 $3.30 Billion
2009 $3,498,204,573 $3.50 Billion
2010 $3,516,143,989 $3.52 Billion
2011 $3,326,126,537 $3.33 Billion
2012 $3,308,005,956 $3.31 Billion
2013 $3,238,734,632 $3.24 Billion
2014 $3,246,366,801 $3.25 Billion
2015 $3,217,347,061 $3.22 Billion
2016 $821,329,859 $0.82 Billion
Number of Lobbyists*
1998 $10,405 10,405
1999 $12,926 12,926
2000 $12,541 12,541
2001 $11,826 11,826
2002 $12,118 12,118
2003 $12,919 12,919
2004 $13,168 13,168
2005 $14,074 14,074
2006 $14,482 14,482
2007 $14,827 14,827
2008 $14,157 14,157
2009 $13,751 13,751
2010 $12,932 12,932
2011 $12,622 12,622
2012 $12,185 12,185
2013 $12,116 12,116
2014 $11,824 11,824
2015 $11,520 11,520
2016 $9,918 9,918

NOTE: Figures are on this page are calculations by the Center for Responsive Politics based on data from the Senate Office of Public Records. Data for the most recent year was downloaded on June 06, 2016.

*The number of unique, registered lobbyists who have actively lobbied.

Feel free to distribute or cite this material, but please credit the Center for Responsive Politics. For permission to reprint for commercial uses, such as textbooks, contact the Center: info@crp.org

It is reported that 80% of the Meth on our streets come from south of our border.

emptyheadPharmacies in northern Maine halt sales of certain decongestants to thwart meth labs

https://bangordailynews.com/2016/07/02/news/aroostook/pharmacies-in-northern-maine-halt-sales-of-certain-decongestants-to-thwart-meth-labs/

LINCOLN, Maine — Nearly a dozen northern Maine Rite Aid pharmacies and several independent drug stores are halting nonprescription sales of certain nasal decongestants that contain pseudoephedrine in an effort to stop the illegal production of the street drug methamphetamine, according to pharmacy officials and the health advocacy group that requested the action.

“In the coming days, we are proactively removing non-tamper-resistant, single-ingredient pseudoephedrine products from select Rite Aid stores in northern Maine,” spokeswoman Kristin Kellum of the Camp Hill, Pennsylvania-based retailer, said Tuesday.

Tamper-resistant formulations of pseudoephedrine, such as Nexafed, are designed to block pseudoephedrine from being made into meth and will remain on the shelves.

“As a member of the community and a leading drugstore chain in the state, Rite Aid remains committed to taking appropriate action to help address the methamphetamine problem in northern Maine, while ensuring that we continue to serve patients with legitimate medical needs,” Kellum said.

The products are being pulled from 11 Rite Aid stores in northern Maine, Rite Aid spokeswoman Ashley Flowers said Thursday, declining to provide the locations or the product brand names. Rite Aid has around 4,700 locations nationwide and more than 60 stores in Maine.

“No Bangor stores are included,” she said in an email.

While there will be no behind-the-counter pseudoephedrine at the 11 northern Maine locations, if someone has a prescription, the Rite Aid pharmacists will be able to fill it, Flowers said.

“In Maine, a prescription is not needed to purchase a product containing pseudoephedrine; however, if a physician were to write such a prescription, we would fill it as we do today,” she said.

Aroostook County District Attorney Todd Collins said the change should make a difference because “methamphetamine simply cannot be manufactured without pseudoephedrine.”

Collins visited every pharmacy in Aroostook County last week to call attention to the issue of meth making in small clandestine “labs” and their connection to products like Sudafed that contain pseudoephedrine.

Some other allergy medications, including Allegra-D and Claritin-D, are being pulled as part of the change, a pharmacist from northern Maine who asked not to be identified said.

“We feel that this is a huge step forward in our effort to decrease substance abuse misuse [of the products],” River Coalition executive director and Partnership for a Healthy Northern Penobscot member Linda McGee said Tuesday.

The Save A Life Substance Abuse Task Force, facilitated by the Partnership for Healthy Northern Penobscot, was created in December 2014 and is a group of nearly 50 Lincoln community leaders, residents, physicians, pharmacists, people in recovery, educators and business owners who are meeting to address the region’s drug addiction problem, McGee said.

The group asked Rite Aid, Hannaford and Wal-Mart to stop carrying Sudafed, and Rite Aid was the first to respond. Hannaford has said they are unable to comply at this time, and the group is still waiting to hear from Wal-Mart, McGee said.

“There are a lot of people coming from southern Aroostook County to get Sudafed,” McGee said. “They arrive in carloads. They would get everything they could get and then head back.”

Several independent St. John Valley pharmacies also have reported high rates of southern Aroostook County residents visiting their stores and attempting to purchase Sudafed, and have decided to remove the nasal decongestant.

St. John Valley Pharmacy in Fort Kent, Madawaska Pharmacy, Mars Hill Pharmacy Inc. and Presque Isle Pharmacy are no longer carrying Sudafed.

Dwayne Carr, pharmacist at Presque Isle Pharmacy, said that store stopped selling Sudafed last week at the request of the Maine Drug Enforcement Agency and Aroostook County DA Collins. Carr said people were attempting to purchase the drug “on a daily basis” at Presque Isle Pharmacy.

Maine was one of the first states in the nation to make customers ask for pseudoephedrine, which was moved behind the counter in 2005, produce an identification to purchase it and to restrict how much people could buy to 9 grams per month. In 2013, state legislators strengthened the law by adding an electronic tracking system that prevented people from buying from several locations to get more than their monthly allowance.

The nasal decongestant is used to make “shake and bake” or “one pot” meth using plastic soda bottles that have been found all over the state, with about half discovered in Aroostook County.

“Many people don’t realize that the manufacturing process uses such caustic materials that the resulting concoctions are actually hazardous waste materials and need to be isolated by specialized teams and then destroyed by [Department of Environmental Protection] protocols,” Collins said. “It is an enormously expensive undertaking in addition to the risk of poisoning and explosion and fire that the meth manufacturing process presents.”

The “shake and bake” meth is made by mixing certain common household chemicals together with Sudafed or other drugs containing pseudoephedrine, which is “cooked” by adding lithium taken from batteries, according to Peter Arno, commander of Maine Drug Enforcement Agency division II, which covers the northern half of the state.

He said meth, an illegal stimulant that has plagued western parts of the U.S. since the 1980s, started to creep into Maine about seven years ago.

There was one meth lab bust in Maine during 2009, and the number has since increased every year, with two found in 2011, eight in 2012, 11 in 2013, 37 in 2014 and a record 56 manufacturing and disposal sites found last year.

With 40 meth labs found so far this year in Aroostook County, the area accounts for nearly half of the 85 meth labs found in the state by MDEA agents, according to the tally of clandestine labs kept by the Maine Department of Public Safety.

When methamphetamine hits the streets and rural roads of Maine, it’s called meth, crystal, crystal meth, chalk or ice, and looks like a clear, white or off-white crystal powder. The stimulant, which can be extremely addictive, can be snorted, smoked, dissolved into a beverage or injected.

“Methamphetamine use and production is a significant problem in our community and it needs a community solution,” Collins said. “The simplest, quickest and most effective community response would be to take pseudoephedrine off of the shelves from Houlton to Madawaska.”

BDN writer Anthony Brino and Jessica Potila of the St. John Valley Times/Fiddlehead Focus contributed to this story.

Is this what happens when a country dictates what the cost of a medication has to be ?

Epilepsy drug shortage leaves patients desperate-Image1

Epilepsy drug shortage leaves patients desperate

http://www.northbaynipissing.com/news-story/6746529-epilepsy-drug-shortage-leaves-patients-desperate/

TORONTO — Mistie Delorey isn’t sure where to turn next: the Fredericton mother has a dwindling supply of clobazam, a medication that prevents her eight-year-old son from experiencing life-threatening daily seizures — and there’s a critical shortage of the drug across the country.

“I’m terrified, I’m literally terrified,” said Delorey, whose severely autistic and non-verbal son, Cameron, suffers from multiple types of seizures, including the potentially lethal kind.

“The fatal seizures will happen with anybody taken off this drug — immediately. It’s that serious. You can’t be just taken off this drug for even one dose.”

Clobazam, one of two anti-seizure drugs her son takes, has kept Cameron well-regulated over the last four years, dramatically reducing the frequency of episodes to about four a year from roughly 17 a day before he began taking the medication, she said.

But when Delorey went to refill his prescription more than two weeks ago, the pharmacy told her it had none in stock due to a Canada-wide shortage. Other Fredericton drugstores she contacted also couldn’t accommodate her.

“Two of them outright said, ‘We have some, but you’re not getting it,’ because they have patients who require that medicine and they’re saving it for them, which I can understand.”

A third said it would try to help her. But because the pills must be sent to a compounding pharmacy to be made into a liquid — Cameron can only swallow pureed foods and liquids — the drugstore wasn’t able to fulfil her request.

She was finally able to secure four weeks’ supply of the drug from the local hospital, but only with the help of the Canadian Epilepsy Alliance, a network of organizations that advocates for people with seizure disorders and their families.

“It was a huge relief that I secured a month’s worth,” said Delorey, whose supply of clobazam for Cameron is now down to about 2 1/2 weeks.

“And then slowly, hour by hour since that happened, I’m just: What do I do next month?”

Suzanne Nurse, chair of the Canadian Epilepsy Alliance Drug Shortage Committee, said an estimated 20,000 to 40,000 Canadians rely on clobazam to control their seizures and there have been three major shortages in the last three years.

Generic drug manufacturer Apotex provides 70 to 80 per cent of the clobazam sold in Canada, with the rest of the market covered by generic drug maker Teva Canada and Lundbeck Canada, which sells the drug under the brand name Frisium. Pro Doc Ltd. sells a private-label brand in Quebec.

Nurse said there was a disruption in the supply of clobazam made by Apotex last June, which was resolved a month later. But then the company posted a notice in early December that the medicine was again on back-order and the shortage wasn’t expected to be resolved until this month.

“So there’s been many months now where the main supplier of this drug has not been supplying the market,” she said.

“We’re in a situation where there’s a very low supply or depletion of this drug in Canada, and it’s going to take a period of time to get back to regular supply levels where people won’t have any trouble getting the drug.”

Nurse said she’s been contacted by a number of patients or their families desperate for help to access clobazam, a benzodiazepine for which there is no suitable alternative for many patients.

A sudden discontinuation of clobazam is especially dangerous as it can cause life-threatening complications due to benzodiazepine withdrawal.

“They’re terrified that their loved one is going to die as a result of not being able to obtain this medication … I’ve spoken to people who have been seizure-free on this medication for decades. It’s the only drug that’s ever worked for some people,” she explained.

A spokesman for Apotex said the company this week released a quantity of the medication, sold under the generic name Apo-Clobazam, to distributors, who will then ship the pills to pharmacies.

“We have also received a new consignment of raw material and have commenced manufacturing more tablets,” Elie Betito said Wednesday. “Further product will be available to the market in early August.”

Health Canada has been working with manufacturers, distributors, provinces and territories, and patient groups to come up with strategies to resolve the shortage of clobazam, which is considered a “medically necessary” product, said Ken Moore, acting director of health product compliance and risk management.

Moore said there can be multiple and complex factors behind drug-supply disruptions, including problems with global supply chains and accessing raw pharmaceutical ingredients.

“The work we’re doing is trying to get a better ability to understand some of the factors at play and to be able to predict and preferably prevent shortages,” he said, adding that Health Canada has been told by the drug maker that there should be enough product available “to meet the current need.”

The Canadian Epilepsy Alliance said meeting that need is critical.

More than 300,000 Canadians are affected by epilepsy, a neurological disorder marked by sudden repeated episodes of sensory disturbance, loss of consciousness or convulsions related to abnormal electrical activity in the brain.

Not all seizures are classified as epileptic in nature. Seizures have a variety of causes, including Alzheimer’s disease, a previous brain infection or injury, or the use of certain recreational drugs or medications.

Anti-convulsive medications are the main treatment for epilepsy and other seizure disorders, but many of these drugs — not only clobazam — have been or are currently in short supply.

“About 75 per cent of the drugs used to treat epilepsy in Canada had one or more shortages in the last five years,” said Nurse, who works at Epilepsy Ontario.

“For people who live with epilepsy and their families, it’s like an active fault line has developed under their feet and the drug supply has become extremely unreliable,” she said.

“This is a crisis, and it needs to be treated as such.”

The entire medical MJ market as we know it today could go away very quickly

apple cartHow the DEA could introduce big pharma to marijuana

http://www.marketwatch.com/story/how-the-dea-could-introduce-big-pharma-to-marijuana-2016-07-01

The U.S. could soon be one step closer to allowing marijuana sales at your local drugstore. But while that might mean good news for patients, it could also overturn 20 years of development in the medical marijuana industry.

A long-awaited decision by the Drug Enforcement Administration that could reclassify the drug’s status as a tightly regulated substance is expected this summer. That could signal a green light for the pharmaceutical industry to enter a market expected to be worth $6.7 billion in 2016, potentially leading to the development of new treatments to well-known illnesses.

But it could also shake up states where medicinal marijuana is already legal, which saw an estimated $2.4 billion in sales last year, as the standard prescription and pharmacy process replaces doctor’s recommendations and dispensaries. In short, experts say, the DEA’s decision could simultaneously legitimize medical cannabis across the U.S. and throw a still-developing market into chaos.

A change could lift a cloud over the burgeoning cannabis industry because “there’s no longer this question of…how to handle it,” said Rob Hunt, a general partner at cannabis-focused private-equity firm Tuatara Capital.

Tuatara Capital

 Rob Hunt.

But the risks to current business are substantial, experts say. “The entire medical market as we know it today could go away very quickly,” said Hunt.

The DEA treats marijuana as a Schedule I substance, marking it as unsuitable for legal medical use and having a high potential for abuse. Heroin and LSD have the same designation. But the Justice Department has essentially left states to manage marijuana enforcement, and 25 have legalized it for medical use. (Four, plus the District of Columbia, have approved it for recreational use.)

Read: The marijuana business might have a high-stakes pest problem

Market watchers have eagerly awaited the DEA’s decision. In April, the DEA said in a letter to Congress that it would decide whether to reclassify cannabis — to Schedule II, which concedes pharmaceutical uses, to even less restrictive categories — in the first half of 2016. (They could also remove it from the list of controlled substances entirely, or do nothing.) While that has passed, an agency spokesman told MarketWatch a decision could happen soon.

Most in the legal cannabis industry think a move to Schedule II is possible. A range of organizations and political figures have called for a change: The American Academy of Pediatrics, for example, advocates for a move to Schedule II to aid research into its use in treating children, according to Seth Ammerman, a member of the AAP Committee on Substance Abuse and a clinical professor of pediatrics at Stanford University.

The issue has also been raised during the presidential campaign. Democratic presidential candidate Hillary Clinton said in November that she supported moving it to Schedule II, and presumptive Republican nominee Donald Trump said in a February interview that while he was in favor of using cannabis for medical purposes he did not have a specific policy stance on legalization.

A move to Schedule II to would likely encourage pharmaceutical companies to invest in the cannabis industry, experts say, which could lead to products being available at neighborhood pharmacies rather than the dispensaries that generally distribute them today in states where they are legal.

“Schedule II substances are typically handled through pharma,” says Brett Roper, chief operating officer at Denver-based dispensary Medicine Man. “If they deploy a strict Schedule II element, typically Walgreens WBA, -0.25%  and CVS CVS, -0.77%  or another pharmacy…are going to be the places you have to buy your cannabis.”

Some worry that doing so could dismantle an industry that has been functioning since California legalized medical cannabis in 1996.

“You’d wipe out how many dollars worth of infrastructure, how many tens of thousands, hundreds of thousands of jobs, and you’d put it squarely in the hands of big pharma,” Roper says.

But others expect that if cannabis is rescheduled, businesses in states where it is already legal will be allowed to continue operations without rerouting them through pharmacies.

Either way, the pharmaceutical industry would likely have significant opportunities to develop new treatments — and to profit. Larger companies with locations in multiple states could begin clinical trials on drugs based on cannabinoids, the chemical components that make up the marijuana plant. THC produces psychoactive effects, which some contend is useful for appetite control and as a sleep aid, while cannabidiol is typically used to treat pain and other symptoms.

Pharmaceutical companies could start developing cannabinoid-based drugs for multiple sclerosis, Parkinson’s, and “ailments that actually cause real issues that are identifiable to people,” Hunt says. “That will only happen in the pharmaceutical industry.”

Read: These parents are fighting to give pot to their kids

The pharmaceutical industry group Pharmaceutical Research and Manufacturers of America did not respond to a request for comment in time for publication. Several large drug manufacturers also did not respond to requests for comment.

Some companies, meanwhile, have been legally developing cannabis-based drugs through careful coordination with federal authorities. Those companies are watching the DEA to see if a change in the designation for cannabis might mean larger firms would seek to partner with or even acquire them.

AFP/Getty Images

 
The seal of the Drug Enforcement Administration.

Doylestown, Penn.-based pharmaceutical company KannaLife Sciences is developing cannabis-based products by licensing a patent, held by the National Institutes of Health, that allows the development of drugs that use cannabinoids as antioxidants and in the treatment of neurodegenerative diseases.

It is working on a treatment for hepatic encephalopathy (HE), a neurological syndrome associated with liver disease, and chronic traumatic encephalopathy, which results from repetitive brain trauma and causes memory loss, confusion, aggression, depression and dementia.

See also: Marijuana industry finds unlikely spokespeople in athletes and parents

Other companies have developed cannabis-based treatments by working directly with the DEA, which requires intensive — and expensive — oversight of the testing and development process. Marinol, a drug developed by AbbVie Inc. ABBV, +1.29% using that process, is already available. A treatment for weight loss and nausea in AIDS and chemotherapy patients, it contains synthetic THC.

And London-based GW Pharmaceuticals GWPH, +2.41% has come close to completing the FDA approval process for a CBD-derived drug after reporting positive results for a Phase 3 trial on Monday. Its drug, Epidiolex, was developed to treat Lennox Gastaut syndrome, a rare form of childhood epilepsy.

“We’ve been able to navigate very well around challenging restrictions in terms of evaluating a Schedule I product,” says Stephen Schulz, vice president of investor relations at GW. “But it’s onerous and it’s cumbersome.”

Schulz declined to say whether he thought an ease in research restrictions would attract larger pharmaceutical companies to the business. But “It’s a very attractive space,” he said.

All WASH unlicensed medical marijuana dispensaries must now be closed.

bigbotherA few glitches as the new medical marijuana law takes effect today

http://www.bizjournals.com/seattle/blog/health-care-inc/2016/07/a-few-glitches-as-the-new-medical-marijuana-law.html

Friday marks the day when Washington’s long-time medical marijuana industry is integrated into the new, regulated, recreational industry the state has been fine-tuning since voters approved it in 2012.

All unlicensed medical marijuana dispensaries must now be closed. At the same time, 332 of the 388 licensed stores in Washington have been medically endorsed to offer medical-grade product. The Washington State Department of Health is still warning people that all the stores may not be fully prepared; patients should call before visiting.

The new law required the state to create a database of people authorized to buy medical marijuana, but announced possible delays due to software challenges on Tuesday.

The new medical marijuana law took effect Friday, and the department of health announced the database was actually operational a little after 8:30 a.m.

For medical marijuana patients to received the benifits outlined in the law, they must join this database and receive what is called a recognition card. Joining the authorization database is voluntary but is required to receive added benefits.

The benefits are:

  • Purchase products sales-tax free.
  • Purchase up to three times the current legal limit for recreational users.
  • Purchase high-THC infused products.
  • Grow more than four plants at a residence.

While registered medical marijuana users are exempt from sales tax, the 9.6 percent sales tax in Seattle for example, they are still required to pay that state’s 37 percent marijuana excise tax. The Seattle Times has reported that many believe this will lead medical users to the illicit market thought to be cheaper.

Yes, Assessing Pain Is Vital

imageYes, Assessing Pain Is Vital

http://www.painmedicinenews.com/Commentary/Article/07-16/Yes-Assessing-Pain-Is-Vital/36824/ses=ogst

I wrote in a blog last year that efforts to roll back pain as the fifth vital sign are likely to gain traction, despite inaccuracies and flawed thinking. That is precisely what has happened. A recent Medpage Today article titled “Opioid Crisis: Scrap Pain as 5th Vital Sign?” lays out similar flawed arguments touted by Physicians for Responsible Opioid Prescribing (PROP). At press time, the American Medical Association had been petitioned by its Illinois delegates to remove pain’s fifth-vital-sign status.

What are these flawed arguments? One is to falsely equate the Joint Commission standard to assess pain with a mandate to prescribe opioids. If anyone believes that administering opioids is the sole and automatic response to managing high pain levels, that in itself demonstrates a lack of education, knowledge and understanding. Such a perceived mandate would be a terrible misapplication.

The problem is not the Joint Commission standard but what happens afterward. This is where the system is failing with inadequate education about assessing and managing pain. Clinicians should assess and treat underlying disorders that cause pain, and they should work to eliminate the pain, but they should also understand that, for some patients with some types of pain, eradicating all underlying causes or the pain itself may not be possible. Yet pain must be prioritized and addressed. To do otherwise puts patients at risk for a host of complications, the most serious of which is the progression to pain as a chronic destructive pathology.

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So, is pain, after all, a vital sign? I have argued in the past that it is. But the main point is that assessing pain is indeed vital, whether or not pain is a vital sign. Furthermore, assessing pain as often as vital signs are assessed would seem appropriate. We assess cognitive function, reflexes and laboratory values, none of which are vital signs but are clinically important signs nevertheless. Pain is a symptom; however, it can become a disease when the nervous system changes as a result of it, as the 2011 report on pain in America from the Institute of Medicine, now the Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine, clearly indicates (“Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.” Washington, D.C.: National Academies Press; 2011). It is better to assess pain often and regularly and treat it adequately while it is still a symptom, and before it can progress to the point of disease, at which point it will demand chronic management, much like diabetes.

Another flawed argument is that we as health care professionals would not use dangerous methods to treat pain if only we could remain ignorant that the pain exists. Incredible as it seems, this is indeed the argument. In a letter dated March 28, 2016, the American College of Emergency Physicians (ACEP) wrote to the secretary of the Department of Health and Human Services to claim that asking patients about their pain care could lead to opioid overprescribing. The fear, also expressed by the members of PROP, is that patients who seek opioids will give poor marks to hospitals that do not provide the drugs, thus driving down financial reimbursement through the Centers for Medicare & Medicaid Services (CMS). Like PROP, the ACEP asked the department to remove questions pertaining to pain control from the 32-question survey known as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).

But increased reimbursement for improved health care results in a hospital is appropriate, and CMS should not deviate from the objective of creating incentives for better outcomes, particularly quality of pain control. The HCAHPS questions pertain to how often pain was well controlled and whether hospital staff did everything possible to help control the pain. These are quality improvement measures, and pain control is an important part of quality improvement.

Rational, compassionate in-hospital pain treatment would be better informed by considering the following points:
Quality pain control is a critical outcome that must be measured.
Quality pain control does not dictate prescribing opioids.
Patients should be involved in assessing the quality of their care. Asking patients about their quality of pain control does not dictate inappropriate care. What evidence there is indicates that satisfaction scores do not correlate with prescribing quantities.
Writing unnecessary opioid prescriptions in pursuit of greater financial reward is unethical.
If scores indicate poor outcomes for pain control, this may be an incentive to learn more about how to treat pain.

The HMD report addressed evidence of poorly managed pain by calling for more comprehensive assessment, and this is the direction in which medicine should move. Health care providers have a professional and ethical obligation to assess and reassess the pain of their patients, not to decide that assessing pain levels should no longer be part of routine care because CMS ties a small part of hospital payments to patient evaluations of how well their pain was treated. Patients often demand unnecessary antibiotics, but ethical physicians must learn when and how to refuse them, informed by the ethics of good care, not maximum reimbursement. Ethical, informed clinicians do not prescribe unnecessary medication for the sole purpose of gaining a high patient satisfaction rating.

The drive to end pain control assessment appears to come from the belief that people with substance abuse problems will complain if a practitioner fails to give them the drugs they seek. Thus, ignorance is deemed a better alternative to appropriate clinical judgment. But supporting evidence for this belief is lacking, as a top CMS official recently wrote in JAMA (2016 Mar 10. [Epub ahead of print]): “It has been alleged that, in pursuit of better patient responses and higher reimbursement, HCAHPS compels clinicians to prescribe prescription opioids. However, there is no empirical evidence that failing to prescribe opioids lowers a hospital’s HCAHPS scores. … On the other hand, good nurse and physician communication are strongly associated with better HCAHPS scores.”

Advocates in favor of eliminating pain assessments are attempting to benefit patients and society at large. The principles that not all pain can be relieved and that opioids are not always the answer are good and deserve wider dissemination. But there is nothing in assessing the quality of pain relief or in patient satisfaction surveys that says opioids must be administered, and if such is automatically happening, then education on pain assessment needs improvement. Pain treatment has never been, nor should it ever be, synonymous with opioid therapy. In its zeal to eliminate problems with opioids, society must not dismiss pain, whether that pain is a symptom or a disease.

Sadly, because of today’s opioid crisis, many patients are being denied humane treatment of their pain. There is no rational argument that appropriate in-hospital pain control contributes to the opioid crisis in our communities. This attack on our most vulnerable patients must stop. The problem isn’t that we ask our patients too many bothersome (to the clinician) questions. Neither does the solution to the opioid crisis lie in denying the majority of patients compassionate pain control.


Lynn R. Webster, MD, is a past president of the American Academy of Pain Medicine and author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” Visit www.thepainfultruthbook.com. He also is a member of the Pain Medicine News editorial advisory board. He lives in Salt Lake City.

 

Guilty by association ?

Former suspects sue over DEA raid

http://www.indystar.com/story/news/local/hamilton-county/2016/06/30/former-suspects-sue-over-dea-raid/86529042/

INDIANAPOLIS — Former employees of medical clinics in Central Indiana that were raided two years ago by the Drug Enforcement Administration filed a lawsuit Wednesday alleging unlawful arrest.

In July 2014, local police and federal agents with the DEA arrested doctors and staff affiliated with the Drug Opiate Recovery Network (DORN) on charges of selling prescription painkillers to their patients, calling the operation a pill mill.

The defendants have maintained their innocence and questioned the validity of the accusations. Charges have since been dismissed against nine of the 12 suspects — everyone but three doctors.

In the lawsuit filed in U.S. District Court in Indianapolis, the former DORN staff members are seeking unspecified monetary damages from drug agents, police agencies and cities involved in the arrest. The former employees are Cassy Bratcher, Carmel; Jessica Callahan, Muncie; Andrew Dollard, Noblesville; Eric Ley, Noblesville; Joeseph Mackey, Howard County; Yvonne Morgan, Eaton, Ohio; Felicia Reid, Carmel; and Derek Tislow, Avon.

Many of the staff members, the lawsuit says, lost jobs, spent significant savings on legal defenses and bail, and are no longer employable due to the criminal charges and subsequent publicity.

The lawsuit alleges that DEA agents Gary Whisenand and Dennis Wichern, Hamilton County Drug Task Force Maj. Aaron Deitz, the Carmel Police Department, the Hendricks County Sheriff’s Office, the Johnson County Sheriff’s Office, the Howard County Sheriff’s Department, the city of Kokomo and the town of Cumberland performed false arrests and took part in malicious prosecution, negligence and defamation.

Carmel, Johnson County and the DEA had no comment on ongoing litigation. None of the other defendants could be reached Wednesday.

The lawsuit, filed by attorney Jeffrey S. McQuary of the firm Brown, Tompkins, Lory & Mastrian, based in Indianapolis, alleges the employees were not responsible for prescribing medication and were merely performing their jobs.

The lawsuit claims that prior to being arrested and charged, the staff members were performing often mundane clinical duties such as answering the phone, scheduling appointments, ordering drug screens, processing patients and physically handing prescriptions to patients.

“The employees had no reason to believe the doctors had done anything wrong,” McQuary said. “I don’t think the doctors did anything wrong, but even assuming for a second that a doctor was prescribing medication outside of the legitimate scope for doing so, how on earth would the employees have known that?”

The lawsuit alleges that one suspect was told by a DEA agent she was arrested in hopes she would testify against the doctors. McQuary said using the staff members for leverage in the prosecution of the doctors might be only plausible explanation for the arrest of staff members.

The drug case has stalled since authorities in a multijurisdiction drug task force announced on July 25, 2014, that they had uncovered an extensive drug ring after a nine-month investigation.

In charging documents, authorities accused the doctors of illegally providing patients prescriptions for Suboxone, a synthetic heroin substitute, in exchange for cash.

At the time, authorities said thousands of patients streamed into the clinics, and consultations would take minutes or less. Patients paid up to $160 to obtain prescriptions, authorities said, and doctors pocketed hundreds of thousands of dollars in legal fees.

Dr. Larry Ley, the former head of the clinic, faces charges in Hamilton County. Prosecutors there also are pursing charges against Dr. Ronald Vierk. Howard County is pursuing charges against Dr. Luella Bangura and Ley. Wayne County is pursuing charges against Vierk and Ley. All have maintained their innocence as the cases have progressed.

Hamilton County and Wayne County courts, however, dismissed charges against the staff members, essentially ruling staff members could not be held legally responsible for the prescriptions written by doctors.

One of the cleared suspects, Dollard, had asked the Indiana Disciplinary Commission to investigate and ultimately disbar five prosecutors for their roles in what he called one of the most corrupt, dishonest and unethical prosecutions in the history of the state.

Dollard was DORN’s attorney. He also is a former candidate for Hamilton County Council.

The commission declined to discipline any of the prosecutors.

Dollard also has filed a civil lawsuit accusing Current Publishing in Carmel of defamation for its news reporting in relation to the drug raid. A trial has been scheduled for 2017.