This appears to be from 2018,  I find it interesting that the TXBOP will hold a PHARMACY responsible for the failure to detect  patterns  of  inappropriate dispensing of prescription drugs is unprofessional practice and constitutes grounds for disciplinary action.  A person/entity that has a pharmacy permit to operate a pharmacy, can only do so.. if there is a state licensed Pharmacist on staff and there is a Pharmacist that is registered with the BOP to be “Pharmacist in charge” and responsible to the BOP for the legal operation of the Rx dept.  With the SCOTUS recently passing down a decision that “RED FLAGS” when involved in the confiscating a individual guns is UNCONSTITUTIONAL.  Could it be considered a “confiscation of a pt’s medication therapy” by a Pharmacist who fails to properly adjudicate perceived RED FLAGS and refuses to fill a pt’s  (controlled ) medication ? I am sure that other states have similar written “red flag rules” , implied or presumed to exist. Hopefully, that many of these – potentially unconstitutional laws/rules – will be challenged in the not too distant future.

Click to access You_might_be_a_pill_mill_if.pdf

Texas State Board of Pharmacy “Red Flags” Checklist for Pharmacies YOU MIGHT BE A PILL MILL IF… Check all that apply: (1) Your pharmacy fills a discernable pattern of prescriptions for prescribers who write essentially the same prescriptions for numerous persons, indicating a lack of individual drug therapy. (2) Your pharmacy operates with limited hours of operation or closes after a certain threshold of controlled substance prescriptions are dispensed, and has overall low prescription dispensing volume. (3) Prescriptions presented to the pharmacy are for controlled substances with popularity as street drugs, such as opiates, benzodiazepines, muscle relaxants, psychostimulants, and/or cough syrups, or any combination of these drugs. (4) The prescriptions for controlled substances contain nonspecific or no diagnoses. (5) The prescriptions are commonly for the highest strength of the drug and/or for large quantities. (6) Dangerous drugs or OTC products (such as multi-vitamins or laxatives) are added to the controlled substance prescriptions, maintaining relatively consistent 1:1 ratio of controlled substances to dangerous drugs and/or OTC products dispensed as prescriptions. (7) Prescriptions are authorized by the same prescriber with what appears to be different handwriting on the hardcopy prescription drug order forms. (8) Upon contact with the prescriber’s office, you are unable to engage in comprehensive discussion with the actual prescriber, or he/she is unconcerned about your apprehensions regarding his/her prescribing practices or unwilling to provide additional information, such as treatment goals and/or prognosis with prescribed drug therapy. (9) You rely solely on the prescriber’s representation, or on the representation of the individual answering the phone at the number on the prescription, that prescriptions are legitimate. (10) The prescriber’s clinic is not registered as a pain management clinic by the Texas Medical Board, despite routinely receiving prescriptions from the prescriber for opiates, benzodiazepines, and/or muscle relaxants. (11) Drugs prescribed are inconsistent with the prescriber’s area of practice. (12) The prescriber of the drugs is located a significant distance from your pharmacy. (13) The prescriber has been subject to disciplinary action by the licensing board, had his/her DEA registration removed, or been subject to criminal action. (14) The Texas PMP system indicates that persons are obtaining prescriptions for the same drugs from multiple prescribers or that persons are filling prescriptions for the same drugs at multiple pharmacies. (15) The person’s address is a significant distance from your pharmacy and/or from the prescriber’s office. (16) Multiple persons with the same address present prescriptions from the same prescriber. (17) Persons pay with cash or credit card more often than through insurance. (18) Persons presenting controlled substance prescriptions are doing so in such a manner that varies from seeking routine pharmacy services (e.g., willing to wait in long lines to receive drugs, persons arrive in the same vehicle with prescriptions from same prescriber, one person presents to pick up prescriptions for multiple others, persons refer to drugs by “street names” and/or comment on drug’s color, persons seek early refills, persons travel from outside reasonable trade area of pharmacy). (19) Your pharmacy charges and persons are willing to pay more for controlled substances than they would at nearby pharmacies. (20) Your pharmacy routinely orders controlled substances from more than one drug supplier, or your pharmacy has been discontinued by a drug supplier related to controlled substance orders. (21) Sporadic and non-consistent dispensing volume (including zero dispensing) varies from day to day and week to week, and your pharmacy does not maintain operational hours each week on Monday through Friday. (22) Your pharmacy employs or contracts security personnel during operational hours to prevent problems. (23) Your pharmacy has been previously warned or disciplined by the Texas State Board of Pharmacy for inappropriate dispensing of controlled substances (i.e., corresponding responsibility). If you checked any of the above items, you should review the laws and rules regarding corresponding responsibility and  non‐therapeutic dispensing, especially Board rule §291.29, in the law book or on our website:  www.pharmacy.texas.gov (click  on  Texas  Pharmacy  Rules  and  Laws).    Additional  educational  material  is  available  at:   http://www.pharmacy.texas.gov/Nontherapeutic.asp.    Failure  of  pharmacies  and  pharmacists  to  detect  patterns  of 

inappropriate dispensing of prescription drugs is unprofessional practice and constitutes grounds for disciplinary action.

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Notice that this is a PBM (Express Scripts) is owned by the insurance company https://www.pharmacytimes.com/view/cigna-completes-purchase-of-express-scripts and has its own mail order pharmacy. Notice what was read from the letter from Express Scripts to the prescriber that they were MANDATING step therapy – step therapy is starting with the least expensive – or the PBM gets the largest kickback, rebate, discount from the pharma- for a particular med.  From what I heard from the prescriber reading the letter, the prescriber should chose the LEAST EXPENSIVE MEDICATION in this particular class/category.  The particular medication mentioned is typically used to treat ADD/ADHD, another subjective disease/mental health issue.  No test to determine how well – or poorly – the cheapest med would work for the pt and/or how much better that the med prescribed would have worked better than the cheapest med.  I have not had to deal with step therapy in years, but with subjective diseases, will/could the PBM decide any improvement in QOL issues – no matter how small… would/could decide that the particular least expensive med… is clinically significant enough to declare not necessary to try an more expensive meds.

It will be interesting how these PBM will deal with pts who have had pharmacogenomics testing done and this DNA test will clearly show which med  the pt’s metabolism would be the best metabolized …which would indicate optimal improvement of QOL, at lower doses and less side effects and should save all involved out of pocket costs.   https://www.nigms.nih.gov/education/fact-sheets/Pages/pharmacogenomics.aspx

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Could the data from these studies be much worse if they included the number of chronic pain pts who had their pain management abruptly curtailed,when a office practice is raided by the DEA/FBI/DOJ, the practice closed, all the pt’s medical records were confiscated and all those pts may have anything from close to 30 days supply of their pain medication to just maybe a couple of days or less.  So some pts may have the opportunity to wean themselves down, where others are basically thrown into cold turkey withdrawal.  I have heard horror stories from pts whose prescriber’s office had been raided and closed and the DEA stalled, denied, refused to provide the pts with copies of their medical records. This action by the DEA, almost assures that the chronic pain pts will not find to be accepted as a patient in another practice.  The data from these reports seem to be based on some sort of Insurance/PBM database, those pts being tossed to the curb by the DEA raiding a office practice and their pain meds abruptly discontinued without much documentation, may have not been  included in the data that was used to come to the conclusion of this study(s).

New Data on Opioid Dose Reduction—Implications for Patient Safety

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793299

In the US, prescribing of opioids for pain reached its peak in 2011 to 2012. By 2020, prescribing per capita had decreased to levels last seen in 1993.¹ Whether that reversal delivered some mitigation to an escalating North American tragedy of drug-related deaths remains a matter of anxious debate. Few, however, would contest the view that this ongoing reversal bears with unique intimacy on the 8 to 10 million US individuals who receive prescribed opioids on a long-term basis, or who may yet need them.¹ New research on prescription opioid dose reduction should cause us to look upon their situation with fresh eyes, and with concern.

Reductions and stoppages in these patients’ prescription regimens are likely to reflect varied motivations and understandings among physicians and other professionals who care for them. Some may reduce doses out of a belief that the dose reductions confer safety and well-being, a perspective reinforced by studies in which voluntary tapers are achievable or even salutary for some patients. However, it is likely that many clinicians are reacting to a fraught public discourse and to external pressures as well, including measures that rate the quality of their work. According to a metric issued by the National Committee for Quality Assurance and taken up by most payers, patients taking a daily dose more than the equivalent of 90 mg of morphine count as receiving poor care, regardless of their prior dose history.² Such measures do incentivize either reduction or termination of the care relationship. Unsurprisingly, dose reductions and stoppage have become more common in recent years.³

Some retrospective studies found an association between dose reduction and poor outcomes, such as death by overdose, suicide, or mental health crisis, after comparing patients who underwent such reductions and others who did not. One limitation to such reports is that people who underwent reduction could have differed in important ways from those who did not. Differences in their risk could have spurred both the dose reduction and the outcome. For example, a patient with volatile behavior may be at risk for suicide, and that same volatile behavior could spur clinicians to alter prescriptions. Some may suggest that the dose reduction did not cause a subsequent suicide. If existing studies are confounded in this way, they render an unduly pessimistic portrait of the risk of harm resulting from prescription opioid reduction.

The new study by Fenton et al⁴ addresses these challenges with 2 methodological innovations. First, they apply an exposure-crossover design, in which each person serves as their own control in the assessment of event frequencies before and after the dose reduction. Second, they attempt to mitigate time-limited volatility in the period before and after dose reduction by focusing on outcomes occurring a full year after the taper was initiated (which they term postinduction).

The article by Fenton et al⁴ reports on 19 377 commercially insured and Medicare Advantage enrollees who underwent tapering (2008-2017) after a 12-month period of stable doses. Taper was operationalized as a 15% or more reduction in mean daily dose. The exposure-crossover method applies conditional regression models to compare periods after taper (12-24 months) with periods before in the same population, adjusting for clinical covariates such as drug- and alcohol-related diagnoses and demographic characteristics.

Fenton et al⁴ also report adverse outcomes. Compared with the period before dose reduction, the incidence of hospital or emergency department encounters for drug overdose or withdrawal was elevated by 57% (adjusted incident rate ratio, 1.57), in relative terms, and by 52% (adjusted incident rate ratio, 1.52) for mental health crisis in the 12 to 24 months following reduction.⁴ The elevations in observed risk were greater for patients whose baseline opioid dose was greater than the equivalent of 300 mg of morphine daily.⁴ Supplementary analyses comparing tapered patients with those not tapered were concordant: patients at stable dose remained at lowest risk, compared with patients whose doses were lower or higher.

By our count, this is the tenth retrospective comparative study to document an adverse association between opioid dose reduction and patient safety,^5–13 although a gain in safety was shown in one other study.¹⁴ We caution that the article by Fenton et al,⁴ despite its strengths, still cannot fully resolve potential bias from unmeasured factors, because many aspects of the clinical story remain outside of the researchers’ database. Evidence derived from retrospective analysis demands our caution. For that reason, it is deeply regrettable that such caution was absent when many health systems, government agencies, and payers incentivized dose reduction on the basis of retrospective data that were subject to all the same limitations, and many more.¹⁵

How should clinicians and health systems respond today, in light of these evolving, cautionary findings on opioid dose reduction? Our view is that opioid dose reduction is likely to offer benefit for some, while harming others. The harms may include worsening pain, distress, or death. Given this uncertain balance of harm and benefit, it would be wise for health systems to stop promoting this change to care. A policy of tapering all patients to doses lower than a specified threshold cannot be supported from available evidence. Quality metrics that incentivize these policies, such as the High Dose Opioid criterion promulgated by the National Committee for Quality Assurance,² are overdue for retirement. Indeed, experts who assisted the Centers for Disease Control and Prevention’s 2016 guideline urged that it not be adopted in the first place.¹⁶

What about individual care decisions? If an elective change to care involves both potential benefit and risk of serious harm, including loss of life, the longstanding norms of ethical medical care call for informed consent. We see no reason to set these norms aside when discussing dose reductions.

Clinicians will observe that, in some instances, consent will not be forthcoming, despite compelling evidence of harm resulting from prescription opioid therapy. To our view, a lack of consent does not compel a prescribing clinician to continue a treatment that they believe is actively harming that patient. However, that same clinician should proceed with reductions only after (1) documenting evidence of harm, (2) offering a plan to mitigate harm from the reduction, and (3) telling the patient what criteria will be used to decide whether the taper has failed or succeeded. When tapers fail, as many do, then clinicians must be open to reversing them. For this reason, the long-standing adage that opioid tapers must not be reversed, most recently cited in a draft revision to the Centers for Disease Control and Prevention’s opioid prescribing guideline,¹⁶ has been worn thin by studies such as this one and the many that precede it. To our view, that adage is not tethered to clear and compelling evidence. It should be set aside.

Finally, whenever consent is sought, it should be in the context of a serious conversation grounded in mutual respect, rather than an attempt to convince the patient to embrace something they do not really believe in. This is because patients—it has been overlooked far too often—are the moral equals of the people writing the prescriptions.

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‘We need this stuff’: Scott County initiatives help fight overdoses, addiction

https://www.whas11.com/article/news/local/indiana/scott-county-scott-memoria-lhealth-initiatives-fight-overdoses-addiction-narcan-vending-machine-indiana/417-5ba5579e-1eb2-4d4e-93e1-9713959af748

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In a recent lawsuit against Walgreens for their Pharmacists filling Rxs that the DEA claimed demonstrated RED FLAGS were being ignored https://www.pharmaciststeve.com/walgreens-priority-was-filling-drug-orders-fast-judge-told/

Catizone, who served as the executive director and CEO of the National Association of Boards of Pharmacy from 1988 to 2020, also submitted a 35-page declaration to the court. live testimony was given Thursday from Carmen Catizone, who said Walgreens did not meet the standard of care legally required of pharmacies. Among concerns, from 2003 to 2012, Walgreens had a policy passed on to pharmacists to merely call the doctor who issued a questionable prescription as opposed to doing any other due diligence. During cross-examination, Swanson took aim at the list of “red flags” or warning signs that suggest opioid abuse or diversion that Catizone said pharmacists are required to be on the lookout for.

“You don’t cite any federal or state statute that discloses each of these specific red flags you identify, do you?” Swanson asked, later noting that they also don’t appear in the Controlled Substances Act.

Does this suggest that the DEA is using RED FLAGS that does not exist in the Controlled Substance Act as part of their ALLEGATIONS that the practitioner, vendor (Pharmacy/Wholesaler) have violated the Controlled substance act. If RED FLAGS are unconstitutional involving the confiscating of guns, should they be EQUALLY UNCONSTITUTIONAL in using them in ALLEGATIONS that DEA license/permit holders have violated the Controlled Substance Act ?  What I have seen is that the DEA has observed what addicts, abusers, diverters have done over the years, certain combinations of meds that they had abused- disregarding the very large doses they were taking or other substances legal/illegal taken concurrently, paying cash for Rxs, traveling long distances to see prescriber or pharmacy to fill Rxs and coming to the conclusion – particularly with combo of meds legally prescribed and within recommended doses – that anyone being prescribed these meds – must be a diverter, abuser, addict… because that is what they casually observed being done by addicts, abusers, diverters.

I have heard numerous attorneys state that those people who are taken to FEDERAL COURT – that 90%+ ARE FOUND GUILTY…  With DEA/DOJ/FBI, is it all that they have to do in Federal Court to find a healthcare practitioner/vendor “guilty” is to produce some ALLEGATIONS,  based on some “unconstitutional opinions” and NO REAL FACTS ?  By getting a conviction of a practitioner on such unconstitutional “RED FLAGS”… could that be considered the confiscation of all the medical records of the chronic pain pts of the practice pain therapy, especially when the DEA ..that many have claimed that the DEA refused, declined, stalled off the pts getting copies of their medical records … making them having little/no chance of getting into another practice and getting their pain management reinstated ? Intentionally throwing all those hundred or thousands of pts into cold turkey withdrawal and at risk of premature death and or forced into using the only option that they have to end their unrelenting torturous level of pain – SUICIDE ?

Breaking: Supreme Court Rules ‘Red Flag’ Gun Laws Unconstitutional

https://americanmilitarynews.com/2021/05/supreme-court-rules-warrantless-home-gun-confiscation-is-unconstitutional-in-9-0-vote/

The Supreme Court ruled Monday that warrantless gun confiscation from Americans’ homes is unconstitutional, voting unanimously on the side of a Rhode Island man whose firearms were taken by law enforcement without a warrant after his wife expressed concerns that he might hurt himself.

According to Caniglia v Strom, a lower court had previously determined that police confiscating the guns without a warrant fell under the Fourth Amendment’s “community care taking” exception, but a 9-0 vote from the nation’s top court struck down that ruling.

Justice Clarence Thomas wrote the unanimous opinion for the Supreme Court, stating that law enforcement can execute “many civic tasks in modern society,” but there is “not an open-ended license to perform them anywhere.”

“The very core of the Fourth Amendment,” Thomas wrote, is the “right of a man to retreat into his own home and there be free from unreasonable search and seizure.”

Some exceptions to the 4th Amendment do exist, including “exigent circumstances,” Forbes reported. For instance, if an officer sees an individual about to shoot another person through the window of a home, that officer has the right to enter the home to prevent the attack.

Another exception – the one on which this case was based – is called “community care taking.” The Supreme Court previously determined that police can bypass the warrant requirement to perform “community care taking functions, totally divorced from the detection, investigation, or acquisition of evidence relating to the violation of a criminal statute,” noting a situation when police took a gun from the trunk of an impounded vehicle without a warrant.

“In reaching this conclusion, the Court noted that the officers who patrol the ‘public highways’ are often called to discharge noncriminal ‘community care taking functions,’ such as responding to disabled vehicles or investigating accidents. But searches of vehicles and homes are constitutionally different, as the Cady opinion repeatedly stressed,” Thomas wrote in the court’s opinion.

In the case, Mr. Caniglia and his wife were arguing when he put an unloaded gun on their table and said, “shoot me now and get it over with.” Following the argument, Caniglia’s wife called the non-emergency police line, leading to a visit from law enforcement. The police convinced Mr. Caniglia to go to the hospital for psychological evaluation, despite disagreeing that his behavior was “abnormal” or “agitated.”

While Mr. Caniglia was on his way to the hospital, his wife told the police that he had two pistols in the home, at which point the officers searched the home without a warrant; however, Mrs. Caniglia couldn’t provide legal consent because the police lied, telling her that Mr. Caniglia had consented to the seizure of his firearms.

The officers subsequently located and confiscated the two handguns, prompting Mr. Caniglia to sue the police for allegedly violating his 4th Amendment rights.

Justice Samuel Alito wrote a concurring opinion for the ruling in which he addressed existing “red flag” laws that also call into question Fourth Amendment rights.

“This case also implicates another body of law that petitioner glossed over: the so-called “red flag” laws that some States are now enacting. These laws enable the police to seize guns pursuant to a court order to prevent their use for suicide or the infliction of harm on innocent persons,” Alito wrote.

“They typically specify the standard that must be met and the procedures that must be followed before firearms may be seized,” he continued. “Provisions of red flag laws may be challenged under the Fourth Amendment, and those cases may come before us. Our decision today does not address those issues.”

In March, the Biden administration urged the Supreme Court to uphold the lower court’s ruling, arguing the actions taken by law enforcement to confiscate the petitioner’s firearms without a warrant were “reasonable.”

“The touchstone of the Fourth Amendment is reasonableness,” the DOJ’s brief stated. “For criminal investigations, this Court has generally incorporated the Warrant Clause into the Fourth Amendment’s overarching reasonableness requirement, but it has not generally done so for searches or seizures objectively premised on justifications other than the investigation of wrongdoing.”

“The ultimate question in this case is therefore not whether the respondent officers’ actions fit within some narrow warrant exception, but instead whether those actions were reasonable. And under all the circumstances here, they were,” the brief added.

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AMERICAN PAIN AND DISABILITY FOUNDATION:
We are all set up to go and advocate for a child with a government representative from the State of Tennessee. I knew these kids were something from the beginning and they were willing to fight for themselves and for us! I put the time, money, sweat, and most of all the effort in because I saw no future on our current path.These kids have been an absolute blessing to APDF and the pain community and it turns out IMHO the only ones who can save themselves and maybe us too if they don’t mind😉! These awesome kids have fought and died like a soldier to save pain patients and if that government official doesn’t take this to heart 💔 they have no intention of doing so for us. I am so proud of these kids words can’t describe what part of my heart cares more for them. An accident brought us together but fate kept it going! Although, the ridiculous attacks in the pain community are very real and vicious. I knew only the pure of heart would rule the day! This couldn’t of came at a better time as their funding was cut by nastiness in our own community, but it shows there is a plan and a future for pain patients of any size and age. On their first fight for themselves hopefully they will show us how its done and come together immediately. I have total faith in these kids from the start and knew something brought us together. I’m excited and I believe this will be a battle of all CPP battles and even if its just for the kids, I’m okay with that too! I’m an adult and we can handle what we are dished out as wrong as it seems. But its even way more wrong when it’s your baby suffering. These kids don’t fight and argue and the only fighting they do is to stay alive! My only hope is they go into this battle and fight as hard as they can for the right reason’s and that reason is no more suffering for everyone! No republicans and no democrats and no pain groups just kids who are the most deserving people on earth and maybe we will get lucky in passing! 😘 GO FIGHT WIN GUYS! ❤❤❤❤
#americanpaindisabilityfoundation #CANCERSUCKS #rarediseaseawareness #treatoursolgers ##cppkids #fightstartsnow

Tulsa mass shooter allegedly gunned down his doctor after asking for help with pain

The above incident happened about 10 days ago and one person who claims to be a chronic pain advocate made a few videos about this incident, some believed that this person stated that the doctor DESERVED TO BE SHOT,  others believed that it was implied, others stated that is was suggested.

After those videos were posted,  many in the chronic pain community basically went ballistic .. some who were chronic pain pts, some who were both chronic pain pts and healthcare providers and some who were just healthcare providers who deal with chronic pain pts.  Ir really doesn’t matter what was actually said, there is a old saying “what you perceive, is what you believe ..”

And what did this “advocate” do… stirred up the “tribe of minions” aligned with this “advocate” and they started attacking a advocate from APDF, who has been successfully advocating for pediatric chronic pain pts in Vanderbilt Hosp in Nashsville, Many of these kids are END STAGE CANCER PTS.   He even took Vanderbilt to court when Vanderbilt stated that he could not advocate for the kids…even with the parent’s agreement/consent.  Vanderbilt LOST !!!…  Vanderbilt had a “NO OPIATE POLICY” and didn’t want to change it  – even for pediatric chronic pain pts.  Here is picture (dressed up to go trick-treating last Oct ) of one of the “little angels” that got to enjoy her final months of life, because of better pain management during her last months.  Without this advocate intervention on this kid’s behalf, she would have spent Halloween in a torturous level of pain, unfortunately she has now passed .   This advocate does the majority of advocating ” off the radar” and doesn’t not seek the spotlight for doing good !
These minions came out besmirching this advocate’s good deeds and throwing out untruths and your basic “mud slinging”… that often happens within political elections. I suspect that this same group will come after me, once this post goes up on my blog…  I have INTENTIONALLY not mentioned any names – they know who they are – and if you see anyone “slinging mud” toward me after this post… you will know who they are as well.

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Healthcare System Sues Cigna Over Emergency Care Reimbursements

https://www.lexology.com/library/detail.aspx?g=a1c5223f-0d66-40a1-8d43-078765fafa0a

Tenet Healthcare and nineteen of its hospitals filed a complaint against Cigna Health and Life Insurance Company in Connecticut Superior Court, alleging that Cigna had reimbursed its claims at unfair and unreasonable rates. The plaintiffs also allege that Cigna wrongfully denied claims for emergency medical services, although they are legally obligated to provide Cigna plan members with emergency medical care.

Cigna immediately removed the suit to Connecticut District Court, where it remains pending. The District Court has issued the standard scheduling orders for civil cases. Cigna has not yet filed its formal response to Tenet’s complaint.

In its complaint, Tenet claims Cigna reimburses its claims according to a unilateral payment methodology, resulting in steeply discounted payments. Tenet alleges that it did not agree to discounted payments, which bear no relation to the reasonable and fair value of the medical services provided to Cigna plan members. Tenet further alleges that Cigna has arbitrarily denied many claims of its members for emergency services rendered by Tenet and its hospitals.

As a result of its action, Tenet accuses Cigna of violating its common law right to payment for the fair and reasonable value of its services. It also claims that Cigna violated the legal obligation of health insurers to cover emergency medical services for its members and pay reimbursements in the amount of the fair market value of those services. Finally, Tenet alleges that Cigna violated the Connecticut Unfair Trade Practices Act.

Tenet claims that Cigna also refuses to add its hospitals to its roster of in-network providers, leaving plan members with no place to seek in-network non-emergent medical care in their geographical areas. According to Tenet, this refusal allows Cigna to continue unilaterally defining the level of reimbursement for services that Tenet provides to Cigna plan members.

Tenet’s complaint details allegations specific to various hospitals in different states, including Arizona, Florida, Tennessee, Alabama, Massachusetts, and South Carolina. Each hospital alleges state law claims and violations of the Emergency Medical Treatment and Labor Act (EMTALA).

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Nuts. Fruit. Cookies and pound cake. Even potato chips. You don’t have to look hard to find things that are coated in chocolate. But people? Never. But that’s what happened last week in Lancaster County, Pa., at the Mars Wrigley plant. Two plant employees were rescued after getting trapped in a large tank of chocolate and were taken to a local hospital. Here’s a song about falling into a vat of chocolate.

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I don’t normally step on the “third rail”… how many times have we seen practitioners “taken out” with the FACTS from the DEA that they violated some “red flags”… none of which are defined in the controlled substance act and more often than not… the DEA uncovered these “red flag violations” by data mining the various states’ PDMP ?

Just imagine, if the ATF starts down the path of the DEA.. after all they are also part of the DOJ..  and starts data mining Electronic Medical Records and/or all prescription records – after all the PBM industry pays for some 90% of all prescriptions and with pharmacies filling some FOUR BILLION Rx per year… the PBM’s have huge databases… and the PBM’s are all about generating revenues and profits…  just let the ATF to go on a “fishing expedition” thru their databases. Find a person who has meds prescribed by a Psychiatrist, has a anti-depressant or some other “mental health med” prescribed/filled,  someone who is a chronic pain pt and taking opiates…  RED FLAGS of potential “mental instability” … under the “influence of opiates”…  Compare those names with the national gun register and could a person find someone from the local law enforcement or ATF… at their front door wanting to confiscate their guns ?

Of course, those people in possession of guns, that they have obtained thru break-ins, robbery, bought off the street and the like – don’t have to worry… there is no record of them buying/owning a firearm.

Just look at this recent case Dr. Bauer reports to prison Thursday 85 y/o doctor sent to jail for 5 yrs on the ALLEGATIONS by the DEA of “not adhering to good medical practices”  which I have never seen the DEA DEFINE, and THOUSANDS of his chronic pain pts were tossed to the curb. All those pts having to suffer thru cold turkey withdrawal, committing suicide, having to live/exist in a torturous level of pain and a untold number of premature deaths from their untreated pain.   I guess that all those “bodies” left in the wake of the DEA actions, will be just unfortunate collateral damage.

Fortunately or unfortunately, my two INDIANA SENATORS are not part of the 10 Republican Senators that have abandoned the party’s platform, I have no one to write to hoping they will change their vote.  Probably most/all are not up for re-election this Nov and figure that “all will be forgotten” the next time they run for re-election.

Senate Republicans Betray Base, Join Democrats on Gun Crackdown

DEVELOPING STORY: While you were attending church this morning, a bipartisan group of U.S. senators were conspiring to take away your constitutional rights.

The lawmakers, including enough Republicans to overcome the chamber’s “filibuster” rule, on Sunday announced an agreement on a plan that would curtail the right to bear arms.

“This is the ultimate betrayal of conservative voters,” said nationally syndicated radio host Todd Starnes. “Senate Republicans are more interested in being accepted at Georgetown cocktail parties than they are keeping their word to constituents.”

The bill included support for state “red flag” laws, tougher background checks for firearms buyers under 21 and a crackdown on a practice called “straw purchases.”

“Our plan saves lives while also protecting the constitutional rights of law-abiding Americans,” the group, led by Democrat Chris Murphy and Republican John Cornyn, said in a statement. “We look forward to earning broad, bipartisan support and passing our commonsense proposal into law.”

Ten Republicans signaled their support for the preliminary deal, indicating the measure potentially could advance to a vote on passage and overcome roadblocks by other Republicans who oppose most gun control measures.

The senators include: Chris Murphy, John Cornyn, Thom Tillis , Kyrsten Sinema, Richard Blumenthal, Roy Blunt, Cory Booker, Richard Burr, Bill Cassidy, Susan Collins, Chris Coons, Lindsey Graham, Martin Heinrich, Mark Kelly, Angus King, Joe Manchin, Rob Portman, Mitt Romney, Debbie Stabenow, and Pat Toomey.

President Biden specifically thanks Sen. John Cornyn (R-TX) and Sen. Thom Tillis (R-NC) for their help in weakening the Second Amendment.

I want to thank Senator Chris Murphy and the members of his bipartisan group—especially Senators Cornyn, Sinema, and Tillis—for their tireless work to produce this proposal. Obviously, it does not do everything that I think is needed, but it reflects important steps in the right direction, and would be the most significant gun safety legislation to pass Congress in decades. With bipartisan support, there are no excuses for delay, and no reason why it should not quickly move through the Senate and the House. Each day that passes, more children are killed in this country: the sooner it comes to my desk, the sooner I can sign it, and the sooner we can use these measures to save lives. 

White House

Biden had called for banning the sale of assault weapons and high-capacity magazines, or, if that were not possible, raising the minimum age to buy those weapons to 21 from 18. Biden also pressed for repealing the liability shield that protects gun manufacturers from being sued for violence perpetrated by people carrying their guns.

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