MY BODY… MY CHOICE.. selectively applied ?

Why A VP Kamala Harris Could Be A Disaster For Marijuana Policy       “Kamala Is A Cop. No matter how excited Democratic voters may be about having the first woman of color on a presidential ticket, and no matter how liberal her Senate voting record may be, there is no escaping the fact that Senator Kamala Harris built her political career on her record as a prosecutor. In that position she oversaw the arrest and prosecution of thousands of people, mostly young people of color, for marijuana and other drug offenses. “

Here we have an ATTORNEY, who is not upset that the first time in history … someone within the SCOTUS staff “leaked to the media” information concerning a decision being considered  by the court.  If the SCOTUS decides to overturn Roe vs Wade… abortion decisions will be back in the hands of the states’ legislators.

So now, VP Harris, is now part of the chorus “my body, my decision”… but isn’t she part of the administration that has mandated COVID-19 shots and when/where we are forced to wear masks.

I have seen other articles where VP Harris fully supports treatment for addicts.

Apparently our VP, selectively supports “my body, my decision”.. I suspect that many other members of Congress are aligned with her mindset.. since abt 40% of Congress are ATTORNEYS.  They all are part of our judicial system…which encompasses the DEA.

 

 

The Real “Death Panels”: Oregon Medicaid planned to cut off opioids to chronic pain patients

The Real “Death Panels”: Oregon Medicaid planned to cut off opioids to chronic pain patients

https://tarbell.org/2019/03/gambling-with-lives-oregon-medicaid-cutting-off-opioids-to-chronic-pain-patients/

At the height of the Tea Party and Republican campaign against the Affordable Care Act, the GOP raised a false alarm about “death panels” that would purportedly kill the disabled based on a subjective judgment and “pull the plug on Grandma.”

But to real grandmothers like 60-year-old Wendy Morgan, who has suffered excruciating back and neck pain in the wake of two botched surgeries, degenerative disc disease and severe pain from MS for decades, there’s now a genuine death panel:  the Oregon Health Authority’s pain and evidence committees. They were slated on March 14 in Salem to finalize mandated opioid cut-offs to zero for Medicaid patients with chronic back and neck pain conditions, plus fibromyalgia. 

“This is going to come as quite a shock to a lot of people,” Wendy said before the vote. She had made preliminary plans with her husband to kill herself last spring after her opioid dosages were already cut 97 percent under pressure from government  agencies. “I never did anything wrong, always followed the doctor’s orders, but I was treated like a drug addict.” She managed to function as a homemaker even after she was forced to quit her sales job in 2009 and go on disability, but after her primary care doctor dropped her for using high doses of opioids and her pain specialist started a drastic taper in 2016, “I felt like killing myself,” she said. She went weeks without sleep, remained housebound, unable to even shower without agony and sunk into a deep depression. “It was an absolute nightmare,” she says.

Her husband, Larry Gordon, a retired postal worker, briefly but angrily testified on her behalf at a hearing in January before OHA’s Health Evidence Review Committee (HERC), as his wife of over 40 years sat quietly next to him.

If the plans are eventually voted in, the agency will target overwhelmingly disabled patients with 170 separate medical conditions that cause spine and neck pain for a total forced cut-off to zero opioids; these draconian limits  go far beyond even the CDC’s 2016 recommended voluntary 90 Morphine Milligram Equivalent (MME) upper limits for new — not long-term — pain patients. These voluntary guidelines have been “weaponized” in drastic cut-offs nationwide and spurred a wave of suicides by chronic pain patients.

Larry, dressed in a blue ball cap, windbreaker and blue jeans, proclaimed, “Doctors are abandoning patients left and right. Look at what’s happening in the real world: there’s people dying. If you take opioids away from intractable pain patients, they only thing they have left is to go straight to suicide. I had to tell my children that their mom’s going to kill herself because no one else will help her.”

Larry and his family have been petitioning local stakeholders, including the Oregon Medical Board and local newspapers, in order to bring attention to chronic pain patients’ access to painkillers. Click Here To Read The Gordon Family’s Full Story In Letters

Fortunately, Wendy recently found through a network of pain patients a Portland clinician willing to quietly resume her high dosages of methadone and occasional oxycodone pills, amounting to a quite rare medication level of 1100 MME. It’s not clear how long this arrangement will last, but for now, she says, “This nurse practitioner saved my life.” Her pain is worse than before because the years of forced tapering worsened her MS, but at least she can visit her grandchildren, go to their recitals and ball games, take a shower. “I can live a normal life.” 

Now that the Oregon panel has tabled the vote, she can breathe a sigh of relief if her other supply of medication fails — for now. 

That option was about to be closed off to a significant portion of patients –variously estimated between 60,000 and 80,000 chronic pain patients — who are part of the 25 percent of  all Oregonians who are on Medicaid. This latest delayed Oregon action flies in the face of mounting alarms by three former White House drug czars and over 300 leading health professionals and academics who warned in an open letter to CDC and Congress about the dangerous, unintended consequences of the  harsh crackdown on opioids for legitimate pain patients, as chronicled recently in The New York Times. These professional critiques have been joined by over 120 pages of anguished testimony from patients across the country about the agonizing impact of the resulting  hard-line approaches in their lives.

True, rigorous evidence that such policies are driving up suicides rates is relatively scarce, even though there are horrifying examples of patients like Jay Lawrence in Tennessee shooting himself on a park bench with his wife holding his hand. However, an important study published in 2017 in the peer-reviewed journal General Hospital Psychiatry found that veterans cut off from opioids after long-term use engaged in suicidal actions and thoughts at a rate nearly 300 percent higher than the overall veterans community, whose members are already killing themselves at a rate of 20 people a day. 

Oregon’s proposed but now tabled actions are even more extreme than the CDC guidelines spurring such tragedies, says the organizer of that open letter, Dr. Stefan Kertesz, a noted addiction researcher and primary care doctor specializing in vulnerable populations at the University of Alabama at Birmingham. “They’re gambling with the lives of a subset of patients,” he says. “There’s something cruel in going after patients with these conditions: it’s completely untested and there’s no evidence that you can swap in yoga and cognitive therapy across the state for opioids.” (Note: Like Kertesz, most, but not all, of the hundreds of clinicians across the country protesting the national and Oregon opioid cut-offs actually don’t have a history of sleazy ties to the drug industry.)

Look, for instance, at the dangers facing people like Sierra Brown, a former nurse who once had private insurance but is now a disabled Medicare-Medicaid patient who was denied pain medication for her damaged spine resulting from previously undiagnosed lupus and Sjorgen’s auto-immune disease . She fears she will continue to be treated like a drug-seeking addict if the influential Medicaid policies are eventually voted in. (She and others point out that Medicaid’s prescribing standards also influence private insurers.) Yet she has been given a reprieve of sorts: after showing up vomiting in agony at an ER last month, she was diagnosed with pancreatic cancer, but only after the admitting doctor first told her, “If you’re here for pain medications, we’re not giving you any.” Now, she is viewed as a near-angelic victim of cancer, and was generously provided with all pain medications she needed to be taken every few hours, from Dilaudid to Tramodol. “Pain-wise, I’m fine,” she says, relatively speaking. “Their attitude totally flipped. It’s totally disgusting.” But once she achieves her hoped-for remission  because they spotted her cancer early, “I’m scared I won’t be getting any pain medicines because of the law’s crackdown.”

In Oregon, making the case for keeping opioids away from patients like Sierra when they don’t have cancer, is the alternative medicine community. Some of them don’t seem to be much more immune from conflicts of interest than drug company shills, critics say. In fact, the ad-hoc Chronic Pain Task Force, an advisory subcommittee that’s helping drive Oregon’s move to shut off opioids for pain patients, is dominated by holistic practitioners with a financial stake in ending opioids by hyping a smorgasbord of alternative therapies that have weak or limited evidence that they work for any chronic pain patients at all  — let alone with that minority of long-term chronic patients who use opioids.

Indeed, OHA commissioned the nationally respected Oregon Health and Sciences University (OHSU) to do a review of the skimpy evidence on the efficacy of tapering and alternative therapies. In its rush to back alternative therapies as an “evidence-based” replacement for the removed opioids, the Medicaid agency brushed aside the OHSU findings that  \concluded the studies’ quality were variously “very low” for tapering, and “limited” or “insufficient” for the alternative therapies.  Even the agency’s own summary of the available  evidence branded all of the holistic therapies, some with potentially major  new funding streams, as having “no clinically significant impact” on long-term pain. Instead, the agency seems to be relying in part on a 12-year-old survey of the personal opinions of an earlier OHA advisory panel that found these alternative medicine  treatments as somehow having “fair” to “good” evidence for “moderate benefit.” In addition, Kertesz asks about the OHA’s dismissive approach to the new OHSU review it commissioned: “Why are they ignoring their own report that says there’s no evidence that a mandatory taper has been properly assessed, and certainly hasn’t been proven to be safe and effective?”

As of this writing, the OHA press office didn’t reply to repeated emailed and phoned requests for comment or rebuttal to the criticisms aimed at the now-tabled opioid proposal.

Oregon-style forced taperings continue unabated, with doctors across the country reacting to mounting pressure from agencies including state licensing boards and the DEA to slash their opioid prescribing — and then kicking out their chronic pain patients who have become known as pain or opioid “refugees.” Human Rights Watch recently issued a stinging report condemning such actions: “Many patients are involuntarily cut off medications that improve their lives or say they are unable to find a doctor willing to care for them.” Yet Oregon is the only state — so far — that tried to move so decisively to adopt these potentially deadly practices as official state policies. One possible factor, argues University of Southern Illinois rehab specialist, Terri Lewis: The financially-strapped Oregon Medicaid system is moving under a Medicaid waiver to reduce spending and limit care for disabled chronic pain patients who merit palliative care but aren’t actually getting it. 

This proposed punishing crackdown doesn’t stem primarily from what patients often see as sheer sadism on the part of officials. Instead, it’s driven apparently both by a desire to save money and  a well-meaning yet misguided, simplistic and wrong-headed response to the alarming rise of opioid-related drug overdoses, largely from illegally manufactured fentanyl — not legally prescribed pills. It’s an oft-told story:  how Big Pharma companies and their crooked distributors ramped up an oversupply of opioid pills starting in the late 1990s, but much of the flooding of the marketplace was clearly fraudulent and intended to hook a new generation of substance abusers who already had addiction histories. Why else flood one West Virginia town of 9,200 people with nearly 21 million pills?  Yet while prescriptions have fallen nationally nearly 20 percent since 2012, overdose deaths haven’t been stemmed at all, rising to as high as 70,000 deaths in 2017, more than AIDS, guns and car crashes killed people in any one year. Yet as few as 15 percent of opioid deaths today are due to prescription drugs, often stolen — even as 75 percent of  new heroin users started by using  “diverted” opioid pills they weren’t prescribed. Kertesz has pointed out that today’s prescription drug dosage limits are  a “funhouse mirror image” of the drug industry’s earlier propaganda to lower the “pain score” of patients and give out way more pills: it is still a focus on a number, not on the actual well-being of  patients.

Meanwhile, Oregon’s chronic pain patients remain political orphans whose plight is largely ignored by people across the political spectrum. They are scrambling on their own in blog posts, on Twitter and Facebook to try to get other people — or even their own factionalized pain community —  to fight back against the steamrolling impact of the Oregon Medicaid rules that will surely flatten them if the tabled rules come up for another vote.  Amara is a disabled Medicaid patient and co-founder of the Oregon Pain Action Group. She is suffering from a host of severe disc injuries following a botched epidural during childbirth and lives in intractable pain.  She told Tarbell, speaking anonymously for fear of retaliation, “It’s catastrophic and things are already so bad.”

She and others have been given a reprieve, but the specter of this cutoff still looms in the future if Oregon decides to go ahead with their plans in a future date. Pain patients know that their quality of life — if not their lives — are hostage to a delayed state vote. Tarbell will keep monitoring this proposed vote to see if it returns. 

Report: Medicare Advantage Plans Wrongly Deny Care, Physician Payments

Report: Medicare Advantage Plans Wrongly Deny Care, Physician Payments

Feds found 18% of physician payment requests that were turned down met Medicare rules

https://www.medpagetoday.com/special-reports/exclusives/98458

Medicare Advantage plans often denied medically necessary care to beneficiaries and payments to doctors that met Medicare coverage rules, according to a new report from the HHS Office of the Inspector General (OIG).

OIG found that 13% of prior authorization requests that were denied met Medicare coverage rules, as did 18% of physician payment requests that were turned down.

The type of care denied typically involved advanced imaging services, such as MRIs, and stays in post-acute care facilities, the report stated.

The report added that plans denied these services and requests by using clinical criteria that are not contained in Medicare coverage rules, by requesting unnecessary documentation, and via genuine error.

“Although [Medicare Advantage Organizations (MAOs)] approve the vast majority of requests for services and payment, they issue millions of denials each year and CMS’s annual audits of MAOs have highlighted widespread and persistent problems related to inappropriate denials of services and payments,” the report stated.

Concern about those denials is growing as Medicare Advantage is increasingly responsible for more Medicare beneficiaries. In 2021, 42% of all Medicare beneficiaries were enrolled in a Medicare Advantage plan, and that is projected to rise to about 51% by 2030, according to the report.

“As enrollment in Medicare Advantage continues to grow, MAOs play an increasingly critical role in ensuring that Medicare beneficiaries have access to medically necessary covered services and that providers are reimbursed appropriately,” the report stated.

In a statement, American Medical Association President Gerald E. Harmon, MD, said the findings “mirror physician experiences.”

“Surveys of physicians have consistently found that excessive authorization controls required by health insurers are persistently responsible for serious harm when necessary medical care is delayed, denied, or disrupted,” he said.

Harmon added that “more needs to be done to reform prior authorization” and noted that the bipartisan Improving Seniors’ Timely Access to Care Act would help rein in excessive and unnecessary prior authorization requirements by requiring Medicare Advantage plans to “streamline and standardize prior authorization processes and improve the transparency of requirements.”

Because Medicare Advantage is a capitated payment model where companies are paid a fixed amount per beneficiary, there’s a potential incentive for insurers to deny access to services and payment in an attempt to increase profits, the report stated.

For their report, OIG investigators used a random sample of 430 denials from the 1-week period of June 1-7, 2019, to estimate the rate at which 15 of the largest MAOs denied prior authorization and payment requests that met Medicare coverage rules. The sample accounted for nearly 80% of beneficiaries enrolled in Medicare Advantage as of June 2019.

Commonly used methods for denying care included using clinical criteria that aren’t in Medicare coverage rules, such as requiring an x-ray before approving more advanced imaging, the report stated. Plans also asked for unnecessary documentation — for instance, they indicated that some prior authorization requests did not have enough documentation to support approval, yet reviewers found that beneficiary medical records in the case file were sufficient to support medical necessity.

The report found that most physician payment denials were caused by human error during the manual claims processing reviews (such as overlooking a document) or system processing errors.

Investigators discovered that plans reversed some of the denied care and payment requests that met Medicare coverage rules, typically when a beneficiary or provider appealed or disputed the denial, though in some cases plans identified their own errors. It’s not clear, however, how frequently such appeals are filed, or how often plans discover their errors.

The report concluded with three recommendations for CMS: 1) issue new guidance on appropriate use of MAO clinical criteria in medical necessity reviews; 2) update audit protocols to address issues such as MAO use of clinical criteria; and 3) direct MAOs to take steps to identify and address vulnerabilities that can lead to both manual review and system errors.

In a statement to MedPage Today, a CMS spokesperson said the agency agrees with all of the recommendations and is “actively reviewing the findings to determine appropriate next steps.”

The agency conducts audits of Medicare Advantage plans and can target those audits to “areas of concern, such as service types with a high rate of denial.” CMS will notify plans of non-compliance, and plans must submit corrective action plans, the spokesperson said. Plans that have “repeated violations are subject to increasing penalties … and even contract terminations.”

Plans are required to cover all Medicare Part A and Part B services, but they can “apply internal coverage policies, including additional coverage requirements to better define the need for the service, that are no more restrictive than Traditional Medicare’s national and local coverage policies to ensure that plan-covered items and services are medically necessary and appropriately targeted to the individual’s condition and diagnostic needs,” the spokesperson added.

The spokesperson continued that plans can also “apply third-party guidelines, such as guidelines used by contractors engaged by the Medicare Advantage plan to make coverage determinations” for services that aren’t subject to existing local and national coverage requirements.

Medicare Advantage Prgm are health insurance provided by FOR PROFIT INSURANCE COMPANIES – emphasis on PROFIT… the FEDS gives them Medicare Advantage programs a certain $$$/month/pt and they give the prgm a list of benefits that they can provide.  They can provide as many or as few as they believe that they can do and still show a profit.   This article suggests that all insurance companies are pretty much the same, indicate that they are going to cover and pay for a particular service/product and then try to decline to pay.

What’s your goal

Chronic pain pts are often advised never to ask the practitioner for a particular medication or strength  for fear that they will be viewed as a “drug seeker”.  When a pt goes to a doc’s office – regardless if it is a PCP or some specialist…  If the pt’s labs are outside of normal ranges, the prescriber should automatically have a “goal” to prescribe some sort of therapy to enable the pt to get their labs back into what is considered a “normal range”

Maybe it should be suggested to chronic pain pts to their pain doc… what on the 1-10 pain scale is his/her goal for you.  After all you are seeing a PAIN SPECIALIST… does this specialist believe that he/she is comfortable with their pts having to LIVE or EXIST in a pain level > 5 most all of the time ?   Some believe that level of pain is – or should be considered – a torturous level of pain.

Opiates are one very few meds that doesn’t have a relative predictable LD50 – LD50 is a dose when given to a number of pts, 50% will die. One of the first thing that the body becomes tolerate to when a pt takes a opiate every day – and that is respiratory suppression.

This explains why opiate naive people that take some illegal fentanyl, they DIE FROM RESPIRATORY SUPPRESSION.

I would suspect that any pt asking a pain doc what level of pain was his/her goal for the pt and gets a very vague or gets something like…  we will have to see how things progress… would strongly suggest that the pt’s therapy and pain management outcomes will be more dependent on the pt’s opiate doses reach some MME/day limit that the physician believes is a hard daily limit.

If the prescriber has not done any testing for opiate metabolism rates using the CYP-450 opiate metabolism test or the PGx (pharmacogenomics) test… both of these tests are simple cheek swab or “spit in a tube” test.  If the pt is given the choice, I would chose the latter, it is a much more comprehensive test and will give the prescriber much more information about the pt’s metabolism.

If the prescriber has reached his/her daily MME limit and the pt’s pain intensity is still >5, then the pt has to either accept living in a torturous level of pain or if the practitioner has not ran one of the DNA metabolism tests – the pt might want to ask as to why not ?  ask the practitioner if they had the DNA test run, and the pt was shown to be a fast/ultra fast metabolizer… would the prescriber even increase the pt’s dose ?   If the answer is NO… then the pt has to decide if they wish to continue to live in a torturous level of pain or have the DNA test run themselves and if it demonstrates that they are a fast/ultra fast metabolizer.  Attempt to find a practitioner that will take those DNA test in consideration when determining how much opiates they would be willing to prescriber for you.

national pain council project

Biden Admin: creating Disinformation Governance Board under HDS

Disinformation Head Nina Jankowicz

 

The first video is of the person that Biden has appointed to head this new Disinformation Governance Board, One of her most infamous declaration of disinformation was that Hunter Biden laptop was “We should view it as a Trump campaign product ”  in this article https://www.msn.com/en-us/news/politics/disinformation-head-nina-jankowicz-addresses-hunter-biden-laptop-remarks/ar-AAWGM7G     This quote was Oct 15,2020 – just before the Nov election.  And the Delaware AG is currently convening a grand jury hearing on Hunter Biden various questionable activities – including his laptop. https://delawarebusinessnow.com/2022/03/delaware-u-s-attorneys-investigation-of-hunter-bidens-business-dealings-continues/  It has also been stated that because this Disinformation Governance Board is placed within/under a Presidential cabinet position,  BY LAW – Congress has NO OVERSIGHT ON WHAT IT DOES.

I posted yesterday this saterial video from the @TheBabylonBee https://www.pharmaciststeve.com/some-people-may-view-this-as-extremely-political-i-am-lmao/  concerning Eldon Musk and him buying TWITTER and Twitter’s become a FREE SPEECH platform.  Who believes that this disinformation governance board will “call out” the DEA and the CDC about the DISINFORMATION on our opiate crisis ? And we are on top of the primary voting season and we are just SIX MONTHS from the mid-term elections.

 

 

Some people may view this as extremely political – I am LMAO


How your health insurance can possibly be OVERCHARGING you on your Rx medications

https://www.facebook.com/pharmaciststeve/posts/10227166972189416

Today I saved a patient a combined $200 ( yes, TWO HUNDRED DOLLARS!) on their 3 prescription medications. Their insurance copays THAT ARE SET EXCLUSIVELY BY THE INSURANCE COMPANY ( we don’t have any input on copays) were $110,$90 & $80 while my price without insurance for the 3 medications were $20, $20 & $30. Many of you will be surprised to learn that on many generic medicines your price without insurance can be less than your insurance copay or an accumulation of copays ESPECIALLY IF YOU ARE SELF INSURED!
When you factor in your monthly insurance premiums those costs for medications are even more expensive than just the inflated copays. If you want a price quote just text me at 850-797-2711 and I’ll do my best to respond ASAP. #sowalrx PRICING AS TRANSPARENT AS THE EMERALD BLUE WATER!
this is an example how a independent pharmacy/Pharmacist watch out for their pt’s both HEALTH AND POCKETBOOK. At one time, the major PBM’s (prescription benefit managers) had in their contracts with pharmacies that it was a contract violation if a Pharmacist told the pt that the pharmacy’s cash price was LESS THAN what the PBM wanted as copays  — UNLESS the pt asked if the pharmacy’s cash prices was lower..
Thank goodness, our Congress finally did something right and passed a law that made having such clauses in those PBM pharmacy contracts ILLEGAL and pts like this one, the pharmacist/pharmacy was able to save the pt abt $200.
This graph shows an example of where most of the money goes that you pay at the Rx dept register. Nearly 50% goes into the pockets of MIDDLEMEN – who provide no product or service that provides any real contribution to pt’s health, well being and QOL.
Anyone not using a independent pharmacy, who would like to find one to patronize, there is a hyperlink to find one by zip code https://ncpa.org/pharmacy-locator  This database is maintained by a the National Community Pharmacist Association – whose membership is almost exclusively those who work or own independent pharmacies and has been around since 1898 and I have been a member of since 1983.

I heard it through the GRAPEVINE

It is a pretty accepted fact that the chronic pain community is – and has been – very divided… It seem that a small group of people who claim to be chronic pain pts and/or chronic pain advocates have been very busy at work trying to be more than just the “usual stuff” starting late summer – early fall last year. First it my blog getting labeled as a SPAMMER by FACE BOOK… some even made up stories about another chronic painer being the reason behind my blog being labeled as a SPAMMER.  Then there was the APDF protest in DC  last fall and one of the BOD members had done a TV interview with all three station in DC…  and some people called the station the day before the protest and told the newsroom that the protest was actually a PLANNED MASS SUICIDE and the interviews done…. were never aired…

During that same time frame, these same people, started calling and email one of the highly visible chronic pain pt’s pain doctor and apparently fabricating so many lies about the pt… that the pt was discharged from the pain practice that the pt had been going to for 27 yrs.

The question has to be asked, are these people who are putting themselves forward as pain pts and/or pain advocates or are they really just shills. What legit chronic pain pt goes out their way and fabricate lies/stories to try and get a chronic pain pts toss out of their pain clinic… knowing how difficult it is for a intractable chronic  pain pt to get into a new clinic. IMO… that has to done only by some people with a very depraved mind set.

IMO… it may get worse from here… have you noticed that there are a few “pain advocates” have been in hyper-mode…  talking about pts getting some severe side effects from using certain medications, or promoting some products for chronic painers to get/take when they have had their pain meds taking away…

Just be careful who you give your personal information to…  if someone is pushing a product, or you get a phone call from some law firm about physical damages you have experienced from taking one or more particular prescription medication(s) or you are “hooked-up ” with some entity selling some supplement that some claim helps with pts dealing with chronic pain or you are contacted by some entity – like a university – that is starting a new “pain study”…  because someone has gotten PAID to share your name/personal information or if you have purchased some product that they were pushing.

You may think that is perfectly OK for someone to monetize the selling of your personal information without your permission, but some of these individuals may be more interested in advocating for the money in their bank account.

Full disclosure: In the ten+ years I have had a active blog and advocating for chronic pain pts, my goal has always been to educate and motivate the chronic pain pt to advocate for themselves. I have NEVER requested money from pts that have sought out my advice, I have even turn down some of who have offered to pay me, I have never shared nor sold any personal pt information to any entity for my personal financial gain.  After this post is published, I expect that some of these “chronic pain advocates” to come after me…  I went to pharmacy school to help people and even though I am retired, I follow what I believe is my true advocacy.

 

 

 

21st century healthcare: Medical McCarthyism, when errors become crimes

Until COVID-19 became a issue, historically… medical errors was the third largest cause of death. After Cancer and cardiovascular. Has the DOJ and our judicial system got a “taste of blood” as more and more prescribers are being taken to court over mostly fabricated violations of the Controlled Substance Act.  As more and more District Attorneys are refusing to charge many criminals, is those in our judicial system just looking for any case that they can justify their paycheck ?

Selective Outrage in Healthcare, RaDonda Vaught vs. William Husel

https://www.daily-remedy.com/selective-outrage-in-healthcare-radonda-vaught-rn-vs-william-husel-do/

We lie all the time.

We pretend to care about things we really do not and we pretend not to care about things that we really do. We have no consistent parameters guiding our behavior.

We watch identical acts of injustice or see similar tragedies unfolding and have vastly different perceptions. Behavioral economists call this the empathy gap.

We underestimate the influence of subjective beliefs on our own behavior and make decisions that only satisfy our current perceptions. It explains why the loss of European lives in Ukraine attracts greater media attention than the loss of lives of Central Asians in Afghanistan. This is not a new phenomenon.

But it appears in healthcare in uniquely unprecedented ways. The increasing government encroachment into healthcare has led to a slew of highly publicized criminal cases that were previously addressed more privately as regulatory concerns. Now medical errors are criminal acts.

This may be tragic enough, but our wavering response to these tragedies adds a veneer of shame to a dark time in healthcare, and will prove to be an indelible stain on our medical history.

Recently, a nurse in Tennessee named RaDonda Vaught was convicted for murder for what otherwise would be deemed a medical error. While a fatal error, it was an error nonetheless, that took place over the course of patient care. It should have been handled by the state’s medical licensing board and nurse oversight committees.

Instead, local prosecutors took it upon themselves to indict and inflict a vicious display of retaliatory justice in which Vaught found herself convicted by a jury for a medical error. The ramifications were quick and powerful.

Nurses all over the country shouted in protest. Nurses quit. The American Nurses Association issued a statement of concern:

“The nursing profession is already extremely short-staffed, strained and facing immense pressure – an unfortunate multi-year trend that was further exacerbated by the effects of the pandemic. This ruling will have a long-lasting negative impact on the profession.”

The outrage in support for Vaught was commendable. It shows a strong sense of solidarity in support of one healthcare worker. Such displays of support are sorely needed. And have strong reason to believe the government encroachment that led to Vaught’s conviction will be challenged. We likely have not heard the last of this case.

What we have not heard of is another ruling, that of an acquittal, for a physician who was indicted for prescribing fentanyl as a form of palliative care for hospice patients under his care. Dr. William Husel was indicted on fourteen counts of murder for treating patients with fentanyl to relieve their pain in the last days of their lives.

He violated no protocol. He adhered to clinical standards of care. He simply prescribed fentanyl at a dose that a non-medically trained prosecutor somehow believed to be excessive and therefore criminal. There was no clinical or legal basis for the charges. Yet he was made to endure a two month trial for what amounts to practicing clinical medicine.

Yet there is no outrage against the prosecutors in this case. No congratulatory support for the physician who risked life imprisonment to challenge bogus claims of criminality.

Why the glaring difference in response from the public?

At least in the cause of Vaught, an error took place. But Dr. Husel committed no error and ensured a pain-free quality of life for patients at the end of their lives. We clamor for justice in one case, and remain silent for the other.

This is what the empathy gap looks like in healthcare. And it is why little has been done to reign in government encroachment in healthcare. We have no consistent response to individual acts of injustice and therefore no consistent means of challenging government misconduct. Shakespeare recognized as much centuries ago when he wrote the following lines in The Merchant of Venice:

If you prick us, do we not bleed?

If you tickle us, do we not laugh?

If you poison us, do we not die?

The lines allude to the lack of compassion we hold for some but carry in abundance for others. It shows how empathy waxes and wanes and leads to different reactions to similar events. It is why Vaught’s conviction led to national outrage and why Husel’s acquittal hardly registered a blip on the national radar.

Healthcare is facing unprecedented pressure from a government encroaching more and more into healthcare. It has induced a state of fear and artificial conformity – a veritable state of Medical McCarthyism.

It manifests when we see errors become crimes. Yet, our inconsistent responses have allowed this to go on. We feign selective outrage when we see someone we can relate to being attacked. We ignore or show disdain when we see someone we cannot relate to being attacked.

Accordingly, our perceptions flutter. Of course, the physician deserved to be indicted. Of course, the physician got away with it. But the poor nurse, she must be a victim. Even if she made an error, she should not be criminalized for an error that could have happened to anyone.

We attribute systemic errors to the individual when convenient. And we remember the nuance in systemic problems when we can identify with the individual. There are no consistent parameters in our response.

It all depends on the perceptions we hold, fluttering amidst the winds of outrage, emerging out of the void of the unknown, where we find the empathy gap.