AG prevails in landmark case in federal appeals court | Washington Attorney General

http://www.courierherald.com/news/318447781.html#

I am not an attorney, but… I try to apply common sense to what I read.. although the law and common sense doesn’t always seem to occupy the same space and at the same time… this court ruling is at the FEDERAL COURT LEVEL…  this phrase could be applied to all lawfully prescribed medications safe and timely access to lawful and lawfully prescribed medications.  This may end up being taken all the way to the Supreme Court or this ruling may only apply to the Ninth Circuit.. which I believe is the NW of the USA.  Almost every major court ruling has unintended consequences some good .. some bad… for the chronic pain community and those with subjective disease issues.. this could be a game changer and rewrite the rules of the game 🙂
In a closely watched case with significant repercussions, including for women’s reproductive rights, the federal Ninth Circuit Court of Appeals today agreed with the Attorney General’s Office’s that pharmacies must follow state rules to give patients timely access to medications.

“This unanimous decision is a major victory for the people of Washington. Decisions regarding medical care — including reproductive rights — are appropriately between a patient and his or her medical professionals,” Attorney General Bob Ferguson said.

In its unanimous decision, a three-judge panel reversed the lower court ruling in Stormans v. Wiesman, in which a pharmacy owner and two pharmacists challenged Washington rules requiring pharmacies to fill lawful prescriptions.

The plaintiffs refuse to provide certain prescriptions for emergency contraceptives based on their religious beliefs. For example, the pharmacy at Ralph’s Thriftway in Olympia, owned by plaintiff Kevin Stormans, turned away dozens of women seeking emergency contraceptives. The state argued that the rules comply with the First Amendment and ensure that Washington residents have timely access to necessary medications.

In its ruling today, the appellate court agreed with the Attorney General’s Office that the state rules are neutral and generally applicable, because they apply to everyone regardless of their motivation. The court also agreed that the state has a legitimate interest in ensuring that Washingtonians have safe and timely access to lawful and lawfully prescribed medications.

The court noted: “The rules also permit a religiously objecting individual pharmacist to deny delivery, so long as another pharmacist working for the pharmacy provides timely delivery.”

This case, formerly known as Stormans v. Selecky, has a long history. The rules at issue were adopted by the Washington Board of Pharmacy in 2007, after a lengthy process of discussion and public comment.

Stormans, of Ralph’s Thriftway, and two pharmacists who work elsewhere sued in federal court shortly after the rules were adopted. The plaintiffs objected to stocking and dispensing the emergency contraceptives Plan B and ella.

At the trial level, Judge Ronald B. Leighton of the federal District Court for the Western District of Washington had concluded that the rules violated the First Amendment by impinging on the plaintiffs’ exercise of their religion, and he issued a preliminary injunction blocking the rules from being enforced.

The state appealed, and in 2009 the Ninth Circuit reversed the preliminary injunction, concluding that the rules did not discriminate on the basis of religion and thus should be reviewed under the “rational basis” test, which asks whether the state has any rational basis for the rules. The Ninth Circuit sent the case back to Judge Leighton for review under this standard.

Judge Leighton concluded, however, that rational basis review did not apply, and in 2012 conducted a trial regarding the rules. Although nothing about the rules had changed since the Ninth Circuit’s 2009 ruling and the rules had not been enforced in the interim, Judge Leighton again concluded that the rules violated the First Amendment by impinging on the plaintiffs’ exercise of their religion.

The state appealed that decision in 2012. That appeal is the subject of today’s unanimous ruling written by Judge Susan P. Graber, appointed in 1998 by President Clinton, and joined by Judge Richard R. Clifton, appointed in 2002 by President George W. Bush, and Judge Mary H. Murguia, appointed in 2011 by President Obama.

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Woman sues Rite Aid after medication mixup

http://wvrecord.com/stories/510630080-woman-sues-rite-aid-after-medication-mixup

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http://emilyjerryfoundation.org/

This is about a very sad story about the loss of a beautiful 2 y/o due to a technician mistake, that the pharmacist didn’t catch.  This was apparently mostly because of a poor designed system.. that was having a “bad day”…

Pharmacists are relying more and more on technicians to help get prescriptions filled correctly. Unfortunately, not every state has good or even decent qualifications for technicians… on the above website link.. is a map of the US and the rating of how states deal with technician certification – if any.

EIGHT STATES rated a “F”… FOUR MORE STATES were so bad.. they couldn’t even be rated a “F”.. another SIX STATES rated a “D”..  That is ONE-THIRD of our states that rated “D” or LOWER in the quality of  pharmacy technicians and/or their training/certification requirements.

Pharmacy chains are lobbying for increasing how many technicians that one Pharmacist may legally oversee…  and those numbers go all the way up to UNLIMITED.  Imagine having to be responsible for a unlimited number of ancillary technicians..  of varying capabilities… and everything that they say or do… without letting a mistake from one of these technicians slip past.

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Pitfalls of Point-of-Care Urinary Drug Screening for Pain Management

https://www.aacc.org/publications/cln/articles/2015/july/ask-the-expert#.Va_FdVvu1sU.linkedin

Why might some providers want to use point-of-care (POC) urinary drug screen testing in pain management clinics?

A:The most common reasons are convenience and fast turnaround time. Having immediate test results fosters patient engagement and satisfaction by reducing wait time and enabling practitioners to provide immediate consultations. The positive versus negative screen result is also easy for providers and patients to understand.

Another reason is cost. In the eyes of general practitioners, it is cheaper to purchase urinary drug test cups than to send a test to a central or reference laboratory. However, proper pain management testing often requires additional mass spectrometry–based drug testing. There is also a cost associated with managing POC urinary drug testing, which includes quality assessments of test kits, personnel training, proper result documentation, etc. As a result, POC urinary drug testing can be challenging to implement without lab support, and in clinics where there is high turnover among supporting staff such as nurses.

What are the clinical needs for drug testing in pain management clinics? Can these needs be met by POC urinary drug screen testing? Drug testing in pain management clinics is used to determine: (1) whether the patient is taking the pain medication as prescribed versus diverting it; and (2) whether the patient is abusing other substances.

To address the above needs, a POC urinary drug screen test must be able to detect the pain medication of interest and accurately identify any drugs of abuse.

Unfortunately, POC urinary drug screen testing has a limited ability to do these things. It is a screening tool only, and can produce false-positive or false-negative results due to the testing methodology. The cutoff concentration may also be too high in some cases for pain management use. Thus, any screening result that does not match the patient’s prescribed medication must be confirmed by mass spectrometry before the patient can be accused of non-compliance. However, many providers do not understand the presumptive nature of these test results and want to act on them immediately.

In addition, the drug of interest may not be screened by the POC test. For example, most opiate screens on the market primarily detect morphine and codeine. Depending on the assay used, hydrocodone and oxycodone may or may not be included. Some opioids, such as fentanyl, buprenorphine, tapentadol, and tramadol, are also not routinely detected by POC urine tests. However, this is not common knowledge to most providers. To many, if the opiate screen is negative, it means the patient is not taking the pain medication. Sadly, I have encountered cases in which patients were wrongfully dismissed from pain management programs because a test result was misinterpreted.

Another pitfall of POC urinary drug testing is that it cannot differentiate between the parent drug and its metabolite(s), which is critical for identifying diverting cases in which patients try to cheat the urine drug test by dissolving their medication in their urine sample. In those cases, high amounts of parent drug are present without any metabolite(s).

Lastly, POC urinary drug testing does not provide quantitative results. Therefore, one cannot determine if the patient’s dosages are supratherapeutic.

In conclusion, the utilization of a POC urinary drug screen test in a pain clinic is very limited and the information it provides is often not sufficient to enable proper patient consultation. Because most providers need assistance in interpreting toxicology tests, the use of POC urinary drug screening is likely to cause more confusion. Our institution addresses this problem with a pain management compliance test that offers decision support for pain management drug testing.

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Furor Grows Over Feds Issuing Warrant-Less Subpoenas

http://www.wilm.com/articles/national-news-104668/furor-grows-over-feds-issuing-warrantless-13789165

A legal conflict is intensifying between federal officials and civil liberties advocates defending Americans’ medical privacy rights in a case that points to the increasingly frequent use by bureaucrats of judge-less, warrant-less subpoenas.

As things stand now, the Drug Enforcement Administration is winning and privacy rights are losing.

“It’s not like there’s ten of them. There’s probably thousands — I know there are thousands,” Matt Barden, spokesman for the DEA, told the Daily Caller News Foundation about the DEA’s use of administrative subpoenas.

Maybe not for much longer. A federal district court in Oregon has ruled against DEA but more recently another federal judge, in Texas, ruled in January in U.S. vs. Zadeh that DEA agents can anonymously issue warrant-less subpoenas to search the medical records of 35 patients of Drs. Joseph and Abbas Zadeh in Dallas.

The Zadehs’ case will soon be decided by the Fifth Circuit Court of Appeals in Forth Worth in a “precedent-setting” case on the Fourth Amendment rights of individual citizens versus federal power, said Andy Schlafly, an attorney for the Association of American Physicians & Surgeons, who is representing the Dallas doctors.

“It has an enormous chilling effect on the practice of medicine,” Schlafly said. “For millennia, going back to Hippocrates, there’s been an understanding of the confidentiality of the patient and the physician, and the patient has been able to speak freely to the physician with true understanding of confidentiality. But these subpoenas disrupt that.”

It’s a case that concerns — but doesn’t surprise — former Virginia Attorney General Ken Cuccinelli, who joined U.S. Sen. Rand Paul, R-Ky., in suing the National Security Administration over its metadata cell phone collection.

“Literally, they let the DEA just go wandering through people’s medical records just to make sure laws aren’t being broken. Really? Are you serious?” Cuccinelli told the Daily Caller News Foundation.

Many Americans may be surprised to know federal agencies can and do routinely access personal information, generally from businesses, without first persuading a judge that they have “probable cause” of finding specified items, as required by the Fourth Amendment.

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http://www.insideedition.com/headlines/11146-hes-a-monster-victims-blast-neurosurgeon-arrested-for-allegedly-injuring-them

‘He’s a Monster’: Victims Blast Neurosurgeon Arrested For Allegedly Injuring Them

A neurosurgeon has been indicted on assault charges over surgeries he allegedly botched.

Dr. Christopher Duntsch is accused of maiming and killing at least two patients during operations in Dallas, Texas between July 2012 and June 2013.

On Wednesday, the 44-year-old was charged with five counts of aggravated assault causing serious bodily injury and one count of injury to a child, elderly or disabled person.

Last year, nine of his alleged victims showed up to an INSIDE EDITION interview struggling to walk, some limping, some using canes, and others unable to walk at all.

They came to talk about Dr. Duntsch, who specialized in relieving back and neck pain and called himself “The Best Neurosurgeon in All of Dallas” in commercials.

But the patients couldn’t disgaree more – and accused him of being a drug addict who maimed them during surgery.

They branded him “a snake in the grass,” “a monster,” “drug addict” and even “a psychopath.”

Read: Doctor Mocks Unconscious Patient: “I Wanted to Punch You in the Face and Man You Up” 

One of his alleged victims, Lee Passmore, said he never had crippling nerve spasms until Dr. Duntsch needlessly removed part of his spine during a procedure to relieve back pain.

He said: “It feels like somebody has an ice pick planted squarely in my back. I shouldn’t be this way.”

Another patient, Jeff Cheney, said Dr. Duntsch also removed a portion of his spinal cord by mistake. When he woke up, he found the right side of his body was paralyzed.

“I was horrified. I was speechless,” he said.

Ken Fennel and Mary Effurd both said they must now forced to use wheelchairs due to Dr. Duntsch’s incompetence.

Effurd said: “He took away my life as it was, my freedom.”

Jacqueline Troy said that she woke up from surgery finding herself unable to talk.

“I’m down to one vocal cord,” she said. “They didnt know if I would survive.”

Jeff Glidewell says his voice was almost lost forever after Dr. Duntsch mistook his esophagus for a tumor and sliced into it.

“He stuck a sponge in the hole of my esophagus and sowed me up,” he said.

And that sponge? Dr. Duntsch left it inside his throat.

Neurosurgeon Dr. Robert Henderson was brought into to repair, as best he could, the damage to some of these patients.

“This is almost literally a serial killer,” he said.

Read: Woman Who Can’t Close Her Eyes Sues Her Surgeon

According to Passmore’s attorney, Dr. Duntsch had a serious drug problem.

Passmore’s attorney said: “There is one report that he spent an entire night doing cocaine at a party and then when the sun came up, he put on his scrubs and went off to the hospital to treat children.”

In 2014, INSIDE EDITION’s Lisa Guerrero confronted Dr. Duntsch and asked him if he had a drug or alcohol problem.

He said: “No mam, never have.”

She said: “I talked to a doctor who compared you to a serial killer. Do you have any response to that?”

He said: “Yes, I will deal with that in the context of libel later when I defend myself.”

But his patients agreed there’s a more fitting punishment: “He belongs in jail!”

Dr. Duntsch’s license to practice in Texas was suspended in 2013. He denies any wrongdoing and allegations of malpractice. If convicted of all charges, he could spend the rest of his life in prison. 

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Ruling: Washington can require pharmacies to dispense Plan B

http://www.seattlepi.com/news/article/Ruling-Washington-can-require-pharmacies-to-6401782.php

This is from the state of Washington… where the legislature decided that they knew enough about medical care that they could limit opiates a pt can have to 120 mg/morphine equivalents a day. Now the court system has decided that Pharmacist MUST FILL birth control Rxs… that they can’t decline to fill certain Rxs for any reason.  Can you say bifurcated opinions in the state about medications and who is entitled to what ?

SEATTLE (AP) — Washington state can force pharmacies to dispense Plan B or other emergency contraceptives, a federal appeals court said Thursday in a long-running lawsuit brought by pharmacists who said they have religious objections to providing the drugs.

The unanimous decision Thursday by the three-judge panel of the 9th U.S. Circuit Court of Appeals overturned a 2012 ruling by U.S. District Court Judge Ronald B. Leighton, who had found that the state’s rules violated the religious freedom of pharmacy owners. It was the second time the appeals court reversed Leighton in the case.

“This unanimous decision is a major victory for the people of Washington,” Attorney General Bob Ferguson said in a prepared statement. “Decisions regarding medical care — including reproductive rights — are appropriately between a patient and his or her medical professionals.”

Washington adopted rules in 2007 following reports that some women had been denied access to Plan B, which has a high dose of medicine found in birth-control pills and is effective if a woman takes it within a few days of unprotected sex. The rules said pharmacies must fulfill lawful prescriptions, but allowed individual pharmacists to refer patients to another pharmacist at the store if they have moral objections to fulfilling certain prescriptions.

A Ralph’s Thriftway pharmacy in Olympia and two pharmacists sued, saying the rules required them to violate their religious beliefs, because the drugs can prevent implantation of a fertilized egg, which they consider tantamount to abortion. They argued that they should be allowed to refer patients to a nearby drug store rather than fulfill the prescription themselves.

But the appeals judges — Susan P. Graber, Richard R. Clifton Mary H. Murguia — said that wasn’t good enough.

“Speed is particularly important considering the time-sensitive nature of emergency contraception and of many other medications,” Graber wrote for the panel Thursday. “The time taken to travel to another pharmacy, especially in rural areas where pharmacies are sparse, may reduce the efficacy of those drugs. Additionally, testimony at trial demonstrated how facilitated referrals could lead to feelings of shame in the patient that could dissuade her from obtaining emergency contraception altogether.”

Several groups intervened in the case, including women who said they were denied timely access to Plan B when they needed it — one cut short a vacation to return home to Bellingham, where she knew she could obtain Plan B from her regular pharmacy. They also included HIV patients, who argued that if druggists could refuse to dispense Plan B for religious reasons, some might also refuse to dispense time-sensitive HIV medications.

State officials agreed not to act on any complaints against the plaintiffs during the litigation, and to check with the judge before pursuing complaints against other pharmacies. Health Department spokesman Donn Moyer said Thursday it was not immediately known if the agency had received any recent complaints about women being denied access.

In his initial ruling, Leighton said the rules infringed on the pharmacists’ religious freedom and issued an order blocking them, but in 2009 the appeals court reversed that decision. After holding an 11-day trial, Leighton in 2012 basically reaffirmed his original reasoning.

But the appeals court found that the rules were neutral, rather than targeted at suppressing the religious objections of the pharmacists.

“The state of Washington has a clear interest in making sure women can get emergency contraception in a timely and safe manner,” said Alex J. Luchenitser, associate legal director of Americans United for Separation of Church and State, in a prepared statement. “A pharmacy owner’s personal religious beliefs shouldn’t be permitted to undermine that access.”

The Washington, D.C.-based Beckett Fund for Religious Liberty, which joined in the representation of the plaintiffs, called the decision unfortunate.

“The government has no business punishing citizens solely because of their religious beliefs,” the group’s deputy general counsel, Luke Goodrich, said in a news release. “The pharmacists in this case willingly refer patients to over 30 pharmacies that stock the morning-after pill within a 5 mile radius, and no patient has ever been denied timely access to any drug.”

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Minnesota Family Says CVS Gave Them Wrong Prescription, Expired Medication

http://www.opposingviews.com/i/health/minnesota-cvs-issues-wrong-prescription-and-expired-medication-local-family

A CVS in Minnesota issued an apology after accidentally wronging a local family twice.

Vanessa Gilbertson said the same CVS pharmacy gave two of her young daughters wrongly labeled or expired prescriptions, KMSP-TV reported. 

“It’s like my trust is completely gone,” Gilbertson told KMSP-TV.

In June, the mother of three took a trip to the pharmacy in Delano, Minnesota, to fill a prescription for her 7-year-old daughter, Alyssa, who had an ear infection.

Fortunately, Gilbertson noticed the label, and the mistake was caught just in time.

“I would have been giving her double doses of that the whole time,” she said.

A CVS pharmacist apologized to the mother for the mishap and problem was fixed, KMSP-TV reported. In mid-July, the Delano pharmacy reportedly made a mistake with the family’s medications yet again. 

The second incident reportedly occurred when Gilbertson was in need of a prescription for her 5-month-old daughter with a severe bout of gastroesophageal reflux disease. 

Gilbertson realized there was an issue when she gave her daughter several doses of the medicine and saw no improvement in her baby’s health. After nine doses, Gilberston said she noticed her daughter’s symptoms beginning to return.

“She’s crying, not sleeping and vomiting,” she said.

That’s when the mother realized the medication had expired in June, KMSP-TV reported.

“My first thought was that this was just insane that this happened again,” she added.

The pharmacy has since issued an statement, apologizing to the family. 

Mike DeAngelis of CVS Public Relations said: 

“We sincerely apologize to Ms. Gilbertson. Her children’s prescriptions were corrected as soon as we learned of these incidents and our pharmacy supervisor has personally apologized to her. 

“The health and safety of our customers is our number one priority and we have comprehensive policies and procedures in place to ensure prescription safety. Prescription errors are a very rare occurrence, but if one does occur we determine what happened in order to prevent it from occurring again. 

“We have taken corrective action at the pharmacy and remain committed to ensuring that prescriptions are dispensed safely and accurately to our patients.”

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Cardinal Health introduces 5 must-have adherence tools at RBC

http://www.drugstorenews.com/article/cardinal-health-introduces-five-must-have-adherence-tools-rbc?utm_term=DSN204726&utm_source=Sailthru&utm_medium=email&utm_campaign=DSN-NLE-DSNam-07-22-15

Cardinal-Health-testimony  –

Above link is to the testimony of a VP of Cardinal Health at the June special committee meeting of the FL BOP , where it was admitted that Cardinal and the other two major drug wholesalers were indeed rationing controlled meds to community pharmacies.  Now they are coming out with a program to suppose to help pts be COMPLIANT with their medications…  It is highly unlikely that they are encouraging compliance of controlled meds for those pts  who have a medical necessity for such medications

• Cardinal Health Repackaging Solutions: cost-efficient methods of repackaging prescriptions and over-the-counter medications for patients;
• Consumer adherence products: help patients help themselves with medication reminders, tablets crushers and cutters, medicine spoons and droppers;
• Dispill: a low-cost, multi-dose packaging solution that makes it easier for patients to adhere to their medication regimen;
• Pharmacy Health Connect: a smartphone app that allows patients to easily refill prescriptions, set medication and refill reminders, as well as view current pharmacy news, events and messages; and
• Reimbursement Consulting Services: The improved dashboard summarizes a pharmacy’s key reimbursement and patient care opportunities, including visibility of available Medication Therapy Management cases, which gives the pharmacist insight into patients who most need their assistance. In addition to MTM integration, the dashboard offers patient-level adherence reporting, so a pharmacist may improve their patients’ overall care, as well as performance on CMS Star Rating metrics.

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Man ‘hogtied’ by Mississippi police dies as wife alleges threats over hospital visit

http://www.theguardian.com/us-news/2015/jul/21/man-hogtied-mississippi-police-dies-wife-alleges-threats-hospital-visit?CMP=ema_565

The family of a man who died after being “hogtied” by police in Southaven, Mississippi, say they were threatened with arrest after they requested to visit him in hospital before his death.

Troy Goode, a chemical engineer from Memphis, Tennessee, died on Saturday evening after Southaven police were called to a reported disturbance. Goode was arrested after “acting strange” and resisting officers, according to police. Goode and his wife, Kelli, had attended a rock concert in the city and the 30-year-old father had taken LSD, according to police.

Eyewitness video shows Goode was placed face-down on a stretcher with his arms and legs bound during the arrest, before he was placed in the back of an ambulance. He told officers he was having trouble breathing in this position, according to lawyers for the Goode family. He died in hospital about two hours later.

“The use of force was unnecessary. Troy was not a threat to anyone,” attorney Kevin McCormack, who represents the Goode family, told the Guardian. McCormack added that as a cause of death had yet to be established, the family were not yet calling for criminal charges against the officers.

According to the lawyer’s account, Kelli Goode had asked Southaven police officers if she could accompany her husband to the hospital but was told she would be arrested for obstruction of justice if she arrived at Baptist Memorial Hospital-DeSoto, where her husband was taken.

McCormack says family members later called the hospital and were told again they would be arrested if they visited. It is unclear if police or hospital staff members made these comments, and neither responded to a request for comment by deadline.

“No mother and no wife should be prevented from doing that,” McCormack said. “They were obviously distraught. They didn’t know … what Troy’s condition was, they didn’t know if he was going to be OK.”

Within an hour of the second visitation request, the hospital called the family to confirm Goode had died.

The eyewitness video was posted to YouTube by David McLaughlin, an attorney based in Memphis, and appears to show the aftermath of Goode’s arrest. He is surrounded by a large group of officers as he is wheeled to the ambulance on a stretcher.

“Video it Brady, just in case he dies,” says a voice off camera.

“He is really white,” says another voice, in reference to Goode.

“They’ve got him hogtied,” says another.

The video stops as officers point at the cameraperson. Bystanders were threatened with arrest for filming the incident, according to a statement issued by Goode’s lawyers.

The Supreme Court ruled that police can be videoed by the general public while performing their duty.. as long as it does not interfere with them doing their duty..

McLaughlin, who was eating dinner with his family at a nearby restaurant, later told local newspaper the Clarion-Ledger that he had initially looked out the window to see Goode talking to police before backing away from them in an erratic manner.

The lawyer then walked outside and saw Goode on the ground with an officer on his back. According to the newspaper’s account, McLaughlin then walked back inside the restaurant before returning outside to see Goode was at this point hogtied on the stretcher.

“Paramedics arrived on scene, and I see them put him in a four-point restraint or hogtie, I don’t know how else to describe it,” McLaughlin told the Clarion-Ledger. “His legs were crossed, pulled back, by my vantage point, his hands were pulled back, and I think affixed to at least one of his legs.

“He looked to me like he was struggling or convulsing or both. He appeared to be in distress to me.”

Goode’s is the second death in police custody to occur in Mississippi this month, according to The Counted, an ongoing investigation into officer-involved deaths in the United States.

Jonathan Sanders, a 39-year-old unarmed black man, died after reportedly being placed in a 20-minute chokehold by a Stonewall police officer. The medical examiner has provisionally ruled Sanders died of asphyxiation, according to attorneys.

Goode was the father to a 15-month-old son and worked as a plant engineer for nexAir, a local industrial supply company. He was also a local charity volunteer, according a statement from the family’s lawyers.

Asked by the Guardian if the family planned to launch any civil litigation over the case, McCormack responded: “All options remain on the table.”

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