More bureaucrats practicing medicine without a license ?

Gov. Maggie Hassan and Attorney General Joseph Foster went behind closed doors last week with state medical officials to present a draft of tough rules for doctors who prescribe opioids, the New Hampshire Union Leader has learned.
Hassan has asked the Board of Medicine to use emergency powers to adopt the rules, which would short-circuit the normal public input process used when state agencies adopt rules. Hassan’s office provided a copy of the rules, which have not been made public, to the Union Leader when requested.
The New Hampshire Medical Society said dozens of physicians have asked that the process be slowed down and proceed through the normal process.

“This is a very serious and complex problem, and it will affect patients,” said Janet Monahan, executive vice president of the 2,200-member Medical Society. “Not every patient that receives an opioid is an addict.”
Monahan said the opioid task force, which is part of the Governor’s Commission for Alcohol and Drug Abuse Prevention, Treatment and Recovery, opposes the emergency implementation.

“We’re not against the rules,” Monahan said, “but let’s have an open process and not rush it.”
Hassan’s spokesman said the emergency rules are only valid for six months, which gives time for the formal adoption to proceed.

“We’re in the middle of a crisis,” said Hassan spokesman William Hinkle. “This is about saving lives. This is a crisis situation.”
The draft rules take up 12 pages. A copy is available by clicking here.

• They require any doctor or nurse practitioner who prescribes opioids to have continuing medical education.

• Any opioid prescription would have to follow a documented evaluation that would include a patient’s pain intensity, previous pain treatments, history of addiction, family history and social assessments.
• Opioids could only be prescribed when other pain-management efforts have not worked and the benefits outweigh the risks. Supplies would be limited to five days for episodic patients and fentanyl could not be supplied to non-cancer patients.
• A prescriber must use the state-controlled drug database to review a patient’s drug history before writing a prescription. Prescriptions for chronic pain could only be written in multiples of a seven-day supply.
• A doctor must discuss the risks with his or her patient.

• Patients at high risk for addiction must sign a written agreement that includes permission for blood or urine tests, reasons for discontinuation and an agreement not to abuse alcohol or other drugs while on the medication.
Hinkle said the draft rules are a starting point, and his office is accepting input from physicians and other interested parties.

He said once the rules are presented to the board in public, the board can adopt them under emergency provisions.
“The timeline hasn’t been finalized,” he said.

Hinkle would not confirm that a meeting with the Board of Medicine is scheduled for Oct. 28. According to the Board’s website, its next regular meeting is Nov. 4.
Earlier Thursday, questions arose about how much contact Hassan’s drug czar, Jack Wozmak, has had with the N.H. Medical Society and other physicians.

New Hampshire Medical Society President Dr. Lukas Kolm said Wozmak has met with individual members, but not the society’s leadership group as a whole.
“To bring everybody together, that is what I have not seen,” said Kolm, an emergency room physician in Dover. He added that he doesn’t want the process driven by politics.

Hinkle responded by saying that the medical community has given some resistance to the rules.
Republican Party Chairman Jennifer Horn faulted Hassan for not working more closely with doctor groups and said it’s another sign of Hassan’s mismanagement and incompetence when it comes to dealing with the opioid epidemic.
“These doctors are on the front lines of combating New Hampshire’s heroin epidemic, and they deserve the full support of the governor’s office,” Horn said.

mhayward@unionleader.com

alcohol is still the largest category — it’s still the fastest growing category

Prescription overdose deaths fall in Oklahoma

what do you think the odds are that no one ever uses drugs to commit suicide ? According to all/nearly all stats… no one ever uses drugs to commit suicide… those that die of a drug overdose… does it accidentally…

http://www.tulsaworld.com/news/health/prescription-overdose-deaths-fall-in-oklahoma/article_837622d4-3bd4-5d74-894e-61f0662e4769.html?mode=story

Oklahoma saw the number of residents dying from unintentional overdoses drop last year, and that’s prompting cautious optimism that efforts to curb abuse could be taking hold in a state plagued by prescription drug abuse.

“There are more prescription drug overdose deaths each year in Oklahoma than overdose deaths from alcohol and all illegal drugs combined,” Gov. Mary Fallin said in a statement, noting the trend. “Moving forward, we need to continue to push treatment and prevention programs wherever we can to help fight this dangerous public health problem.”

In 2014, 510 Oklahomans died from unintentional prescription drug overdoses, preliminary data from the state Health Department shows.

That’s a 5 percent decrease from 2013, when Oklahoma lost 538 residents to overdose. In 2014, because of the decrease, Oklahoma saw its lowest unintentional prescription drug overdose death rate, 13.2 deaths per 100,000 people, since 2007.

During the past few years, the state has seen some of the highest rates in the nation of painkiller abuse and deaths. In 2012, Oklahoma tied Kentucky for the third highest rate of painkillers prescribed, with a rate of 128 painkiller prescriptions per 100 people.

Darrell Weaver, director of the Oklahoma Bureau of Narcotics and Dangerous Drugs, said although 2014 saw only a 5 percent decrease in deaths, it’s still a decrease.

“I watched, over the last 10 years, those drug overdose deaths increase every year,” Weaver said. “Sometimes, I felt like ‘Oh my gosh — where’s the ceiling here?’ And anytime we can see the trend start the other way, I think that’s a very positive sign. Do we need more? We sure do.”

During the past several years, officials have lauded the state’s prescription drug monitoring program as a key resource in combating drug abuse.

The system tracks prescriptions filled for schedule II, III, IV and V controlled substances, which includes powerful painkillers such as oxycodone and hydrocodone.

In November, state law will require that physicians regularly check the system when prescribing these drugs.

Gov. Fallin, in making her remarks, highlighted that change, noting she worked hard to support that law’s aim to cut down on “doctor shopping” and the over-prescribing of potentially dangerous prescription narcotics.

“It is my hope it will help to reduce prescription overdose deaths and prescription drug abuse in general,” she said.

Research continues to show that Oklahoma’s efforts to beef up that monitoring program are in line with best practices for combating prescription drug abuse.

This past week, the Centers for Disease Control and Prevention released a report that showed information from state prescription drug monitoring programs can be used to detect and measure prescribing patterns that suggest abuse and misuse of controlled substances.

Researchers studied data from eight state monitoring programs and found prescribing rates varied widely by state.

Additionally, they found that a small minority of prescribers are responsible for most opioid prescriptions, and people who receive opioid prescriptions often also receive benzodiazepine prescriptions, such as Xanax, despite the risk for adverse drug interactions.

Drug overdose is the leading cause of injury and death in the United States, in large part because of abuse and misuse of prescribing opioid painkillers, sedatives, tranquilizers and stimulants, according to the CDC.

“Every day, 44 people die in American communities from an overdose of prescription opioids and many more become addicted,” Dr. Tom Frieden, CDC director, said in a news release. “States are on the front line of witnessing these overdose deaths. This research can help inform their prescription overdose prevention efforts and save lives.”

After states crack down on prescription drug abuse, they often see a spike in heroin use.

People who are addicted to opiate painkillers, such as oxycodone, are 40 times more likely to be addicted to heroin, CDC data shows.

In Oklahoma, the number of heroin deaths increased tenfold from three deaths in 2007 to 29 in 2012, health department data shows.

However, that increase could be because, in previous years, heroin deaths might have been underestimated and misclassified as morphine deaths.

Once in a person’s body, heroin metabolizes completely into morphine, so it is possible deaths could be misclassified, especially if there is no evidence of heroin use at the scene, and the heroin has already completely metabolized to morphine by the time the decedent’s lab samples are taken, according to the health department.

Weaver said his agency’s undercover drug agents haven’t yet seen an uptick in heroin activity.

“We’re watching that closely because I really felt the more we clamped down on some of these prescription opiates, the gloom would squeeze out on heroin, but we’re monitoring that closely,” Weaver said.

Meanwhile, Terri White, the state’s mental health commissioner, said the number of people seeking treatment for heroin and opiate abuse has increased along with overall numbers of people seeking treatment.

In the past year, 24 percent of residents who sought treatment from the publicly funded substance abuse treatment system sought care for opiate or heroin abuse.

Ten years ago, only 10 percent of people using the state’s system sought care for these drugs.

“Even though it’s not our largest category — alcohol is still the largest category — it’s still the fastest growing category, which is alarming, and why all of these efforts around prevention, treatment and changing prescribing practices are all critical,” White said.

It’s hard to draw conclusions from treatment data because of several factors that are involved in a person seeking treatment, White said.

“I can’t interpret from that if there are more people using heroin and switching from opioids or heroin,” White said.

Additionally, to combat prescription drug overdose, officials have pushed for more law enforcement agencies to carry naloxone, a prescription drug that can, if used early enough, reverse the effects of prescription opioid and heroin overdose.

Since 2014, Tulsa-area law enforcement officers have used naloxone on 23 people who survived after they were thought to be overdosing.

In July, Oklahoma City police announced they would train their officers to start carrying naloxone, and Midwest City police recently announced they would soon begin carrying the drug, as well.

White said these efforts, along with educating physicians on proper prescribing practices, are important actions the state has taken, and should continue to take, to combat abuse.

“This is a critical issue, and I think we should be hopeful about the decrease,” White said, “but we have to be committed to continuing all of the efforts to ensure it continues on a downward trend quickly because we’re talking about Oklahoman lives.”

Prescriber … LIE OF THE WEEK !

hypocracy

I got a email from a friend of mine that lives in one of the northern states and is a “Florida snow bird” 3-5 months a year..  and has done the same cycle for the last 10 + yrs.  This is a 70 something post-polio gentleman.  He has been seeing the same northern pain doc during the spring/summer months and a FL pain doc for the “snow bird months”…  The FL doc has been seeing him and writing him his pain meds for the past 5 yrs.

This FL pain doc told this snow bird that there was a new law in FL that requires all pain docs to only see/treat FL residents.

My suggestion to my friend was the same as to anyone that gets that infamous phrase “that’s a new law”… just get the person telling you that to show you a copy of the law and/or the statue number so that you can look it up on the web… If they can’t/won’t do either… the LAW doesn’t exist..

This particular gentleman, has owned his condo for some twenty years and rents it out during the “hot summer/spring season” and him and his wife use it during the winter months..  So they pay local property tax, have a local land line and a local electric bill.  I suggested to my friend that he take his US Passport, copies of those bills and go to the local driver’s license bureau and get a FL resident ID… which looks like a driver’s license but it clearly marked it is for ID use only.

He will appear to be a FL resident…

Here is what my friend found out from the doc’s office staff…. …..it seems the good doctor was doing a bit of bullshitting about the new law.  No new law, just his way of limiting his patients to residents.  His receptionist finally came clean about the dirty Doctor. 

 

Apparently this pain doc revoked his Hippocratic Oath and took the Hypocritical Oath ?

As a society… subjective/mental health diseases seems to be VERY LOW on fund raising

List of health-related charity fundraisers

https://en.wikipedia.org/wiki/List_of_health-related_charity_fundraisers

While this list is not complete, it is pretty lengthy and while there are some international listing.. in the good old USA.. the total fund raisers listed for subjective and/or mental health diseases … appears to be ZERO

Is this from the puritanical thread that remains in our societal fabric .. that those with subjective/mental health issues are WEAK ?

 

Doctor claims TOO MANY ESI’s being done !

 

Another example of horror stories don’t made good policy but they do make policy

Lawmakers push ban on herbal Viagra after Odom’s overdose

Lawmakers push ban on herbal Viagra after Odom’s overdose

There  has been 5-6 high school football players died this football season from head trauma… Where is all the politicians/bureaucrats concerned about the deaths and loss of their future of these young athletes… I guess that a major professional athlete voluntarily taking – or over taking – unproved, untested product is more important to set the bureaucratic wheels in motion. Apparently some lives are more important to bureaucrats than others..

http://nypost.com/2015/10/18/lawmakers-push-ban-on-herbal-viagra-after-odoms-overdose/

ALBANY — Lamar Odom’s near-deadly binge on drugs, hookers and herbal sex supplements has moved two state lawmakers to take a hard look at stopping so-called herbal Viagra.

“This incident raises serious concerns about FDA enforcement of prescription drugs,” said state Sen. Jeff Klein (D-Bronx).

Klein was furious to discover the FDA knew Reload and other similar herbal supplements contained the same prescription-only ingredient that’s in Viagra but did nothing to remove it from store shelves. The products — with names like Weekend Warrior and Hard Wang — can be found in Bronx bodegas, as well as Nevada brothels.

The FDA issued warnings about the supplements two years ago, but regulators have had trouble removing them from the market.

They’re largely sold by fly-by-night companies that simply shut down their Web sites and disappear when confronted, only to later repackage the products with new names and Web sites.

“A lot of these products are made with little or no oversight in foreign countries,” said Sen. Jose Peralta (D-Queens). “We don’t know what manufacturing standards are in many of these places.”

 

 

A Prescriber talking to one of the clinic’s pt .. More PharmDeity’s denial of care ?

https://youtu.be/4bkIMGctVn8

Another threat to mental health care ?

Court case threatens physician-patient confidentiality

http://www.ama-assn.org/ama/ama-wire/post/court-case-threatens-physician-patient-confidentiality?utm_source=BulletinHealthCare&utm_medium=email&utm_term=101715&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend

What if patients no longer felt safe sharing personal—yet crucial—information with their physicians? A case to be heard by the Washington Supreme Court threatens the integrity of the patient-physician relationship, potentially raising new obstacles to communication and trust.

In Volk v. DeMeerleer, a treating psychiatrist was charged with liability for his patient’s homicidal actions in 2010. A lower court decided that the psychiatrist could not have identified the actual victims as targets because the patient had communicated no threats against them during his treatment.

An appeals court then examined the duty of a mental health professional to protect a third party when an outpatient occasionally expresses homicidal ideas without identifying the ultimate target. The majority reversed the trial court and ruled that mental health professionals who treat voluntary outpatients may owe a duty to protect “all foreseeable victims, not only those reasonably identifiable victims who were actually threatened by the patient.”

However, a state law designed to protect doctor-patient confidentiality provides that mental health professionals owe a duty to third parties only when a patient has “communicated an actual threat of physical violence against a reasonably identifiable victim or victims.”

The Litigation Center of the AMA and State Medical Societies joined six other health care associations in Washington in an amicus brief opposing the court of appeals decision. “Therapy is not effective if patients stay away or do not open up when they do seek treatment,” the brief said.

An important part of mental health treatment is that patients feel that they can trust their physicians. This is especially important when a patient needs to communicate something that would embarrass himself or herself if shared publicly. When patients do not feel they can be honest with their physicians, such distrust interferes with the therapeutic relationship.

“This case illustrates the difficulties in treating patients who have combinations of serious problems, are not under the ‘control’ of the psychiatrist and do not meet the criteria for involuntary commitment,” the brief said. “Any diminution in patient confidentiality, as the [court of appeals] decision … would do, will jeopardize the chances for continued and successful mental health treatment and will cause some practitioners to cease serving such patients.”

Without reasonable boundaries on legal liability for physicians in connection with psychiatric care, patients may refuse to seek mental health treatment, and physicians may decline to treat patients with severe mental illnesses. If patients and physicians do not feel that they are working together in treatment, proper care cannot be administered because it requires honesty and confidentiality—the building blocks of trust.

Read about other cases in which the AMA Litigation Center is involved that are related to confidentiality, patient privacy and the patient-physician relationship.

By AMA staff writer Troy Parks

Another Doctor suing CVS for Defamation

Judge refuses to dismiss defamation lawsuit against CVS

http://drugtopics.modernmedicine.com/drug-topics/news/judge-refuses-dismiss-defamation-lawsuit-against-cvs

http://www.virginiadefamationlawyer.com/Goulmamine.pdf

A judge has ruled that a doctor’s defamation lawsuit against CVS Pharmacy can proceed, denying the chain’s argument that alleged comments from pharmacy employees were protected by a recognized privilege.

In June, Redouane Goulmamine, MD, filed a $20 million defamation lawsuit against CVS. Goulmamine alleges that some employees of CVS pharmacies in Virginia told his patients that he overprescribed painkillers and was being investigated by the Drug Enforcement Administration. The chain also refused to fill his prescriptions.

CVS attempted to quash the lawsuit, but U.S. District Judge Robert Payne of the Eastern District of Virginia recently denied most of the arguments in CVS’ motion to dismiss.

Goulmamine operates The Spine Center in Petersburg, Va. He specializes in physical medicine and rehabilitation musculoskeletal-spinal medicine, and provides pain management services for his patients. In October 2014, CVS sent Goulmamine a letter questioning his prescribing patterns.

A March 2015 follow-up letter to Goulmamine stated: “Despite our attempts to resolve the concerns with your controlled substance prescribing patterns these concerns persist. Thus, we are writing to inform you that effective March 24, 2015, CVS/pharmacy stores will no longer be able to fill prescriptions that you write for controlled substances.”

According to Goulmamine’s lawsuit, several CVS pharmacy employees made defamatory remarks about him before and after the chain stopped filling his prescriptions for controlled substances.

One patient was allegedly told by a pharmacist “He [Dr. Goulmamine] is being investigated for writing too many pill prescriptions.”

Another CVS pharmacy employee allegedly told one of the doctor’s patients “we will not fill his prescriptions anymore” and “you shouldn’t be taking these pills.” And on March 30, 2015, a CVS employee allegedly told one of Goulmamine’s patients “I would advise you to find another doctor; your doctor isn’t going to be in business much longer.”

Goulmamine said all of the statements allegedly made by CVS employees are false. “If CVS had ever done any rudimentary investigation into Dr. Goulmamine and The Spine Center or had ever called him directly, it would have known that all of its statements about him were not true,” the lawsuit states. “No other local pharmacy has had any similar concerns about filling Dr. Goulmamine’s pain prescriptions and certainly has not made any similarly defamatory statements about him.”

CVS has denied that it made defamatory statements regarding Goulmamine to his patients.

#Walgreen Pharmacists FED UP with working with little/no ancillary help ?

Customers frustrated by Walgreens pharmacy closures, long lines

http://www.wwmt.com/news/features/top-stories/stories/Customers-frustrated-by-Walgreens-pharmacy-closures-long-lines-220270.shtml#.ViKu3SsSWQw

KALAMAZOO, Mich. (NEWSCHANNEL 3) – Walgreens pharmacy locations around Kalamazoo and Battle Creek have been struggling to stay open, and customers say they are frustrated by closures and long lines.

We’ve been hearing from a lot of viewers in emails and on Facebook wondering why their Walgreens pharmacies were closed at seemingly random times in the day.

So on Friday, we went to the company to find out.

Walgreens customers in Kalamazoo and Battle Creek tell us they have been seeing signs of late telling them that their pharmacy was closed at time when it should be open.

“You never would see it coming, all of a sudden there’s pieces of paper on the walls where they were saying we will not be open after six o’clock tonight, and that was because they couldn’t get a pharmacy on duty,” said customer Dennis Martin.

Martin says over the last few weeks, his pharmacy location in Battle Creek has had frequent closures and when it was open, there were long lines.

We found the pharmacy was open, but there was a hefty line on Friday night.

At other Walgreens locations we visited Friday, the pharmacies were open.

Walgreens told Newschannel 3 that they are trying to deal with a problem, which is affecting specific locations in Battle Creek and Kalamazoo.

A spokesperson for the company told us:

“We currently have an unusual situation with a number of our pharmacists on leave at the same time. As a result, our pharmacy hours in a few locations have intermittently been reduced.”

He says Walgreens is trying to fix the problem by bringing in pharmacists from Grand Rapids and Detroit, and says hours should be back to normal in the next few days.

The company added that due to privacy concerns, they could not say why so many pharmacists were taking leave at the same time.