CVS is Destroying the Profession of Pharmacy – Part 4

https://pharmacistactivist.com/2020/June15_2020.shtml

CVS recently reported a 9% increase in same-store sales during the first quarter. During part of the first quarter many retail stores had to close/lockdown because of the COVID-19 pandemic. Many of the purchases in CVS stores were for a wide variety of products and other merchandise that have no relationship to healthcare needs and products. However, unlike many retailers that were required to close during the lockdown, CVS stores have remained open as an essential retailer during the pandemic for the sole reason that they include pharmacies. Not only did CVS experience a large jump in sales, but it announced that it planned to hire 50,000 people in part-time, full-time and temporary roles to keep pace with the demand. This situation is occurring at the same time that many smaller retail stores have had to remain closed and may not be able to reopen because of financial losses. In the interest of the safety of their patients and employees, many independent pharmacies have restricted prescription and other healthcare purchases to curbside pickup or deliveries and/or limit the number of individuals permitted in the pharmacy. CVS reaps great profits from having pharmacies, but harasses its pharmacists and technicians in requiring faster and greater assembly-line productivity in selling prescriptions without consultation. As noted in Part 3 of this series, CVS has betrayed and abandoned its own pharmacists and technicians, as well as the profession of pharmacy.
Ignoring safety
CVS wants others to think they have taken appropriate precautions to protect the safety of their customers and employees. It has failed to do so. It was slow in providing equipment and materials for the protection of its employees, and the implementation of cleaning procedures is woefully inadequate even now. A company can have very comprehensive policies/statements regarding cleaning/sanitizing, but when there is insufficient staffing to perform these tasks, they don’t get done. Where are all those 50,000 workers CVS said it was hiring? If CVS or another retail store is not able to provide a safe location, it should not be permitted to be open until it does. A California congresswoman recently wrote a letter to the CEO of CVS that includes the following statements:

“I am alarmed and disappointed by the conditions that exist in your facilities and for your delivery workers. I am sending along these pictures that show the unsafe conditions.”

In many areas of the country other retail establishments have been permitted to reopen with restrictions as long as appropriate precautions are observed (e.g., customers must wear masks). In my limited travels away from my home, I have been to stores with large signs on the doors saying, “No mask, no entrance.” At CVS, although employees are required to wear masks and customers are requested to, store employees have been instructed to not deny entrance or service to customers who do not wear masks. The message is that CVS management is willing to place CVS employees at added risk for the purpose of not losing a sale. Prior to the pandemic, it was the customers who were at primary risk because of the occurrence of errors resulting from the stressful workplace environment due to management negligence and metrics. Now it adds additional risks for its own store employees that go beyond the stress, burnout/moral injury, and other health issues they were already experiencing. Recently, a former CVS employee came back to the CVS store and committed suicide. The news has been suppressed but the situation is being investigated.

The front-line CVS pharmacists and other employees who place themselves at risk for the sake of more profits for their employer are heroes who should be recognized and rewarded! CVS management that works with no risk from their suites or home offices should be terminated and replaced with management that values its employees and customers.
Pharmacy hero Joe Zorek
Joe Zorek is one of my pharmacy heroes whom I first came to know when he was a student at the Philadelphia College of Pharmacy. Joe worked for CVS for 43 years and was the pharmacist-in-charge for 37 years at the store that was the highest-performing CVS store in his district. Joe’s accomplishments and service to his customers, community, and CVS are all the more remarkable because he experiences the challenges of multiple sclerosis (MS) that is exacerbated by standing for long periods of time. Therefore, it was necessary for him to be seated while he worked during certain periods of the day. The arrangement in which he was seated while he fulfilled and exceeded the responsibilities of his position description was unacceptable to his district leader, and the resulting harassment and the additional stress from management-imposed metrics resulted in a relapse of Joe’s MS. It was necessary for him to take disability leave, but with the expectation that he would return to his position. At the conclusion of the period of disability CVS terminated Joe Zorek.

Joe retained an attorney and sued CVS. In spite of strong CVS pushback, the strong persistence of Joe and his attorney over 5 years resulted in a settlement. The terms of the settlement are confidential (a condition imposed by CVS) and I don’t know the terms or the amount of the settlement. However, I am aware of the going hourly rate for skilled attorneys and the settlement has to be substantial. Joe is “silenced” because of the terms of his settlement, but his wife Paula has been a great source of encouragement and suggestions for many current and terminated CVS pharmacists and technicians. Both of them are heroes in their courage to challenge CVS management and in their advocacy for so many colleagues.
Selected comments from CVS pharmacists and technicians
The following are a small sampling of comments I have received:

“We are told we may use 2 masks a week even though the package says single use only. A sheet is provided to document that the counters and keypads have been sanitized hourly. That lasted about a week and now some days it is not done at all because overworked staff with reduced hours do not have time to do it.”

“I submitted an ethics line complaint about understaffing and risk of patient safety. They responded ‘where is this?’ And I said ‘everywhere.'”

“This CVS response (to Ellen Gabler’s article in the New York Times) is so vague, nonspecific, and full of ignorance that it makes me sick. At the same time, it further fuels the fire within me to expose CVS for the ethics-less sweatshop it is.”

“How many more deaths and articles written will it take for management to do the right things?”

“We are nothing but disposable bodies in this company and the sad thing is that there are unemployed pharmacists who will gladly take our spot with a big pay cut.”

“I ask my district leader for more help. He responds, ‘Nope. Maybe CVS isn’t the right place for you if you need more help.'”

“In spite of almost 20 years working for CVS, I still love being a pharmacist. I just hate my job. I am afraid. Afraid so much that I don’t have the fortitude to reveal my identity. I am afraid I will NOT find another employer if I am terminated by CVS. I know this because I have tried to find other positions.”

“I was written up for not meeting quota on calls and not getting people to refill prescriptions THEY DO NOT NEED.”

“I feel that I am committing fraud with the calls I am required to make and filling items that are not wanted.”

“I was brutally honest on those surveys. I was unemployed 3 months later. They are NOT anonymous.”

“I know 3 pharmacists who responded to the CVS surveys honestly and all of a sudden their scores went down and they were reassigned to other stores or floating duties.”

“The survey is described as anonymous but when you work in a rural pharmacy and there’s only you and your manager, you better bite your tongue.”

“I know of a pharmacist experiencing anxiety who went into very early labor after the pharmacy supervisor threatened her job if all prescriptions are not finished at night.”

“I am a tech and my #1 goal/job is to protect and support my pharmacist. My store has some of the best techs I have ever worked with, and we simply cannot keep up. We are always understaffed and always scrambling, and the pharmacists jump in to help the techs. Then we get patients yelling at us and corporate’s response to us is to reprimand us.”

“In my job as a tech the stress sent me into emotional overdrive. Eventually I landed in a psychiatric unit for 5 days due to the stress of not only my job but also not making enough money in spite of asking for raises.”

“In my estimation, EVERYTHING changed the day when the former CEO retired.”

(Editor’s note: I remember when CVS started and was an advocate for the professional role of its pharmacists and the profession of pharmacy. If the founder of CVS was aware of what CVS has become, he would be turning over in his grave. Oh! My mistake – he is still alive.)

Daniel A. Hussar
danandsue3@verizon.net

CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 1

CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 2

CVS is Destroying the Profession of Pharmacy – PART 3*

CVS is Destroying the Profession of Pharmacy – Part 4

CVS is Destroying the Profession of Pharmacy: Part 5!

CVS is Destroying the Profession of Pharmacy: Part 6

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CVS is Destroying the Profession of Pharmacy – PART 3*

https://pharmacistactivist.com/2020/June_2020.shtml

Along with Rite Aid, Walgreens, and Walmart!

*Editor’s notes: 1) The first 2 parts are in the February and March 1 issues of The Pharmacist Activist; 2) Reader responses to the editorials have been so supportive and valuable (Thank you) that I will continue the recent schedule of publishing two issues each month.

When you think CVS management can’t get any worse in damaging its own reputation and that of the profession of pharmacy, it finds a way to do it. Where to begin in the voluminous files of messages and news commentaries regarding CVS and other chain pharmacies just since March when I wrote my last editorial about CVS? Let’s start with some headlines regarding lawsuits and selected quotes:

“Blue Cross Blue Shield insurers sue CVS, alleging drug pricing fraud” (Axios Health; May 28, 2020; Bob Herman).

“…the pharmacy chain overcharged them based on ‘artificially inflated prices’ for generic drugs and concealed the true cash prices of those drugs.”
BCBS alleges “CVS offered lower cash prices on generic drugs to compete with Walmart and other low-cost pharmacies, but told insurers those cash prices were significantly higher than they actually were.”
“People enrolled in CVS’ cash discount program in 2015 got a 90-day supply of blood pressure medication nadolol for $11.99. But CVS told BCBS of Florida that the cash price was $180.99 and overcharged $169 as a result, according to court documents.”

“Big Pharmacy Chains Also Fed the Opioid Epidemic, Court Filing Says” (New York Times; May 27, 2020; Jan Hoffman).

“A new court filing…asserts that pharmacies including CVS, Rite Aid, Walgreens and Giant Eagle as well as those operated by Walmart were as complicit in perpetuating the crisis as the manufacturers and distributors of the addictive drugs.”
“The retailers sold millions of pills in tiny communities, offered bonuses for high-volume pharmacists and even worked directly with drug manufacturers to promote opioids as safe and effective, according to the complaint filed in federal court in Cleveland by two Ohio counties.”
“CVS worked with Purdue Pharma, the maker of OxyContin, to offer promotional seminars on pain management to its pharmacists so they could reassure patients and doctors about the safety of the drug.”
“From 2006 through 2014, the Rite Aid in Painesville, Ohio, a town with a population of 19,524, sold over 4.2 million doses of oxycodone and hydrocodone. The national retailer offered bonuses to stores with the highest productivity.”
“Walgreens contract with the drug distributor AmerisourceBergen specified that Walgreens be allowed to police its own orders, without oversight from the distributor. Similar conditions were struck by CVS with its distributor, Cardinal Health.”
“Despite being repeatedly fined by the DEA (for failing to report suspiciously high orders), the companies continued to sell outsize quantities of opioids.”
“Walmart devised a workaround to that reporting requirement. In mid-2012, it fixed a hard limit on opioid quantities it would distribute to its stores, foreclosing the need for its pharmacists to report excessive orders. Yet Walmart simply allowed its stores to make up the difference by buying the remainder of their large opioid orders from other distributors.
“The chains “rewarded pharmacists for churning volume rapidly and, in some instances, pointedly ordered them never to refuse a doctor’s prescription.”
“Supervisors ignored store pharmacists who warned about pill mill doctors, including those who were ultimately convicted.”

CVS Class Action Employment Lawsuit (California)

The lawsuit alleges 10 claims against CVS for California Labor Code violations, and also alleges that CVS engaged in unfair competition by violating the California Labor Code for profit while its competitors were following the laws as required.

Other litigation against CVS
For CVS’ own summary of litigation, I encourage you to access the CVS Health report (Form 10-Q) that it filed with the Securities and Exchange Commission for the quarterly period ended 3/31/20, and read the section on “Litigation and Regulatory Proceedings” on pages 28-33. Yes, 6 pages are needed and CVS must have an army of attorneys that it pays far more than its pharmacists, but not its executives.
CVS “Transform Health 2030” Report
On May 14, CVS issued its 13th annual corporate social responsibility (CSR) report and unveiled Transform Health 2030, the company’s new CSR roadmap for the next decade. The report identifies many excellent programs for which the beneficiaries are very needy and deserving organizations and individuals. These commitments of CVS have a value of millions of dollars.

I read the report in its entirety, and the content reflects several additional important, but unstated, messages. The word “pharmacist” does not appear even once in the lengthy report. The words “pharmacy” and “pharmacies” only appear in two of the many sections of the report that may be accessed by those with the persistence to click on two links. The two sections are “Developing our diverse workforce” and “NBA Point Guard and Former Villanova Wildcat Donte DiVincenzo Helps CVS Health Kick Off Free Health Screenings in Philadelphia.” The word “pharmacy” is included once in the press release, as an example of the CVS “commitment” to a Healthy Planet, in the following statement:

“Removed BPS from CVS Pharmacy customer receipts to increase their recyclability, while enrolling 1.1 million customers in digital receipts in 2019 for a savings of 48 million yards of receipt paper.”

Think of how much more impressive that number would be if CVS had thought to express the length of receipt paper in inches (or centimeters if CVS could properly and fairly use ‘metric[s]’) rather than yards. There is a rumor that all the receipt paper that has been saved is to be used in making CVS brand toilet tissue, but I have not been able to confirm this.

One must question how the CVS wealth was accumulated in an amount so substantial that it is able to give millions away. CVS pharmacists, I, and many (but not enough) others recognize that its wealth has been accumulated at the expense of TMC (too many to count) customers who died or were harmed as a consequence of errors at CVS stores, pharmacists and pharmacy technicians who were terminated and can’t find other employment, and current pharmacists, pharmacy technicians, and managers for whom the abysmal working environment is excessively stressful and even suicidal for some.
Recommendations
It is clear that CVS has forgotten its roots and has abandoned the profession of pharmacy. It is now time for our profession to abandon CVS, and the following recommendations are provided to start this process:

CVS and other pharmacists with entrepreneurial interests should offer to buy or have a long-term lease to own the Pharmacy Department in CVS stores, so that the pharmacies can be operated properly, professionally, and profitably.
Boards of Pharmacy, the DEA, and other law enforcement agencies should conduct very thorough investigations of the CVS organization and stores to identify illegal, fraudulent, dangerous, unprofessional, and unethical practices that place customers and employees at risk.
The Federal Trade Commission and Department of Justice should conduct investigations of the monopolistic, anticompetitive, and illegal practices of CVS Health, and take action to require the divestment of Caremark, Aetna, and Omnicare (and other lesser-known subsidiaries that reduce competition) if CVS wishes to continue to own pharmacies.
Pharmacy organizations and colleges of pharmacy should reject any grants or financial support (including meeting exhibits and “unrestricted” educational grants) from CVS because of its continuing actions that are so destructive to the profession of pharmacy. It may be too late to save the independent and smaller chain pharmacies that have closed or were acquired (often by CVS) because of the anticompetitive and destructive actions of CVS, but every effort must be made to save independent pharmacies and the rest of our profession.
States and Boards of Pharmacy should enact legislation and regulations that require pharmacists to hold the majority ownership in pharmacies. North Dakota has set the standard that other states should follow.
Pharmacists and other employees who have been unfairly terminated by CVS should individually and/or collectively explore legal action. Some former CVS pharmacists have already been successful in taking these actions, but it requires determination and patience. Pharmacists who are aware of attorneys who have been helpful and successful in these efforts are requested to provide their names and contact information to me at the email address below, and I am also actively exploring the best options to pursue this.
More whistleblowers are needed. Current concerned pharmacists should document in detail medication/dispensing errors, as well as illegal, fraudulent, unethical, unfair, and excessively stressful management-imposed programs, activities, and workplace environments.

Daniel A. Hussar
danandsue3@verizon.net

Editor’s notes:
1) The next several issues of The Pharmacist Activist will include comments from anonymous (but with identities that I can confirm) CVS and other chain pharmacists, as well as from physicians and other healthcare professionals who are impacted by decisions and actions of CVS and other chain pharmacies.
2) My editorials regarding CVS and other chain stores are motivated by the purpose of supporting pharmacists in these stores, and the criticisms are directed at executives and other managers in policy-making positions.
3) Although the primary focus of this editorial is on CVS, pharmacists at Rite Aid, Walgreens, and Walmart should also be considering the above concerns that are pertinent to their employment. Future issues of The Pharmacist Activist will address concerns at these companies, including the continued sale of tobacco products.

CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 1

CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 2

CVS is Destroying the Profession of Pharmacy – PART 3*

CVS is Destroying the Profession of Pharmacy – Part 4

CVS is Destroying the Profession of Pharmacy: Part 5!

CVS is Destroying the Profession of Pharmacy: Part 6

Filed under: General Problems | 1 Comment »

I have been a student of our bureaucracy/bureaucrats for nearly 40 yrs and how they act can be highly predictable.

The CDC’s first published opiate dosing guidelines were at first attempted to be done with a great deal of it done in secret.  The meeting of the group was not published and they tried to keep the identity of all those participating in the meeting anonymous.

There was no period for the public to make comment on what was proposed… because there was NO PROPOSAL… the guidelines were created and published.

Immediately after they were published, the then head of the CDC Tom Frieden published a public statement to CLEARLY STATE that the guidelines DID NOT BEAR THE WEIGHT OF LAW… they were just GUIDELINES.

Many of us believe that the CDC did not have the statutory authority to generate these guidelines, thus besides not have the weigh of law they were basically UNCONSTITUTIONAL.

Our system is so designed that bills/laws/interpretation of laws  do not have to meet any constitutional verification before they are put on the books and they can be applied/enforced as long as they remain on the books or until they are challenged in our courts and declared unconstitutional.

Some believe that figuratively  the DEA and the VA were waiting outside of the meeting room door to get a copy of these new opiate dosing guidelines… they may have even been getting copies of the draft guidelines on a daily basis, because it would seem that those two agencies were ready to hit the ground running once the guidelines were officially published.

Again our medical system, once >50% of medical practitioners follow a particular process or policy and procedures it becomes a de-facto the standard of care and best practices. There seemed to be a coordinated push by the VA, DEA, insurance/PBM industry to influence these guidelines with practitioners go get them to adhere to these guidelines.  So once that >50% goal was reached either locally/regionally/nationally … the DEA could come in and accuse prescribers of not meeting the current standard of care and best practices and thus the DEA could draw the conclusion that the prescriber was prescribing controlled meds that were not medically necessary to many/most/all of their pts.

After a couple of years,  there was a growing number of statements that the CDC opiate dosing guidelines were being misapplied… and eventually the CDC agreed to reopen the guidelines for public comment to “revise” the guidelines.

This time the CDC followed the proper federal laws… they made a public announcement that they were revising the guidelines and had a public comment period..  Why shouldn’t they… they created the first set of opiate dosing guidelines without following any of the federal laws and they suffered no consequences and no one bothered to challenge the constitutionality of the original set of guidelines.

Historically, when laws/regulations are open for revision, they usually end up rougher/harder/stricter on those who they are to applied to.

It is no secret that PROP and FEDUP where making comments during the open comment period and those and other similar groups are in lock step with the DEA’s/VA’s agenda on treating pain with opiates and prescribing other controlled substances to people who have a medical need for treating their subjective diseases.

The community had better be prepared for new and tighter guidelines… maybe 50 MME/day limits – for all pts … acute, chronic , terminal.  Maybe limiting PCP’s to maybe 20 -30 MME/day for 7 days for acute pain – no additional pain meds. Expand the guidelines to make it illegal for a pt to be prescribed a opiate, benzo and muscle relaxant together – BY ANY PRESCRIBER(S).

If my suspicions are anywhere near close to where the revised guidelines will end up… the community had better stop all its in-fighting and start raising money to challenge these guidelines in our court system as to their constitutionality. If I am near correct, prescribers will start discharging chronic pain pts – IN MASS – with a 30 days of meds to wean down off their controls.  There is not enough pain clinics to accept or take appropriate care of all the chronic painers.

Suicides will increase dramatically, and street dealers will be more than happy to take care of all the chronic painers seeking relief from their relentless intractable chronic pain… and the street dealers won’t take insurance, won’t want you to pee in a bottle, no pain contracts nor care if you what more meds “early”.

Filed under: General Problems | 6 Comments »

https://www.facebook.com/ghostsurgeries/

This FB page is about The Mayo Clinic, in Rochester, MN and this page was just created in the last week.  There is quite a bit of context on this page so I am not going to try and cut/paste … because there is probably a lot more to come on this page going forward.

This does suggest why medical errors are the THIRD LARGEST CAUSE OF DEATH… behind cancer and cardio.

Filed under: General Problems | 2 Comments »

What to know about the Ga. anti-steering law

https://www.wtoc.com/2020/06/16/what-know-about-ga-anti-steering-law/

SAVANNAH, Ga. (WTOC) – It is likely that within the last year you have received a letter or a phone call from your insurance company stating that you can save money by using mail order prescriptions or that you must use a specific pharmacy suggested by your insurance company. What you may not know is that Georgia has just passed a law that may allow you to continue using whatever pharmacy you would like.

In the early months of 2020, the state of Georgia passed House Bill 323, also known as the Pharmacy Anti-Steering and Transparency Act. The laws prohibit PBM (or insurer-owned pharmacies) from profiting off prescriptions “steered” from their PBM and insurance affiliates. They also restrict PBM and insurer patient steering, strengthen anti-mandatory mail order, add additional audit protections, and restrict mining of patient data. The Pharmacy Transparency and Anti Steering Act attempts to meet three goals; increase transparency, allow patients to choose their pharmacy, and make sure patients receive quality care regarding pharmacy services.

So, how do you handle the situation if your insurance carrier tells you must use mail order pharmacy? You may be able to simply opt out by calling them. Telling patients they must use mail order takes away the patients right to healthcare professionals help them manage their medications. Approach the subject with your insurer by calling the phone number on the back of your insurance card. The good news is if you are persistent with your insurance company, they might comply and allow you to continue to use your local pharmacy.

Filed under: General Problems | 1 Comment »

Association of American Physicians and Surgeons Sues FDA for “Irrational” Interference of Access to Life-Saving Hydroxychloroquine

https://www.thegatewaypundit.com/2020/06/association-american-physicians-surgeons-sues-fda-irrational-interference-access-life-saving-hydroxychloroquine/

The Association of American Physicians and Surgeons (https://aapsonline.org) filed a lawsuit against Department of Health and Human Services and the FDA for “irrational interference” by the FDA with timely access to hydroxychloroquine.

Never in history have we seen such a determined effort by the scientific community and pharmaceutical industry to downplay and lie about the use of a successful drug to treat a deadly disease.

Hydroxychloroquine is the first choice in a study of 6,000 doctors treating the coronavirus.
In the field and in independent testing hydroxychloroquine displayed amazing results in treating the COVID-19 virus.

But there was great pushback against hydroxychloroquine for two reasons. The first reason was because it was safe and very inexpensive. The second reason is because Donald Trump promoted its use.

It is not a stretch to say the Democrat establishment would rather see people die than see President Trump be proven right.

So the so-called experts went to great lengths to lie and smear the use of this drug as we have discussed previously.

I smell insurance industry interference in this issue… the medication hydroxychloroquine can still be prescribed by prescribers “off label”  What everyone may run into is that the insurance industry will not recognize it being prescribed off label but will most likely declare that it is an “experimental treatment” and refuse to pay for the therapy. There are some other things going on in the “background”, but this is the first time I have heard the FDA coming out with this sort of order

Filed under: General Problems | 5 Comments »

I really am hoping I can reach out to you. I’m feeling embarrassed about my visit to cvs pharmacy . The pharmacist tore me down emotionally in public today. I don’t know who to ask for help. I see an addiction doc who’s also my primary. I Needed to get back on my medicines to stay healthy. I stopped my meds for a while to have my baby. I went to the cvs I had always went to in my past. The pharmacist denied my scripts @first! Finally she said she would fill only one of them. In the end she said that my doc & I needed to answer some questions before filling my other script & that she was entitled to surpass my HIPAA law being that she’s my pharmacist. My docs office needed to answer some questions before her considering filling it. My doc office said it’s a violation of my HIPAA rights. The problem is she said she’s looking out for my best interest as though it was her decision. She degraded me about taking my anti anxiety med. it’s still hasn’t been filled. Any advice? Also she didn’t refer me to another pharmacist In that location but did put stickers&numbers on the script if I wanted to take it elsewhere she wouldn’t fill either. I felt it was a personal attack & degrading. Please help

According to what this pt wrote… the pt got a unwarranted “second medical opinion” on the therapy the pt has been taking for four years.

The medications involved are both controlled substances but neither was a C-II

One thing that the Pharmacist was correct about is that pharmacists can have access to a pt’s medical records without violating the HIPAA rules.

Most will agree that one of the primary functions of the practice of medicine is the starting, changing, stopping a pt’s therapy.

IMO, it is also inappropriate for a pharmacist to decide not to fill a prescription and not call the prescriber to discuss their concerns. To put the pt in the middle of the issue it is grossly unprofessional.

Since this pt has been on this medication for abt 4 yrs.  The only reason that a pharmacist has the valid reason to refuse to fill a pt’s Rx is because the dose is perceived as too high, the pt’s health records indicates that the pt is allergic to a new Rx and/or there is a significant level one drug to drug interaction.

Who believes that this pharmacist  – if the pt and prescriber jumps thru all the hoops and over all the hurdles this time.. that the pharmacist would not create/fabricate some more hoops and hurdles the next month, when the pt needs for medications  and keep this up month after month until the pt and prescriber gets fed up and the pt takes the Rxs to another store.

Everyone needs to ask themselves the question … should I have to BEG ANYONE to allow me to spend my money in their business ?  Does anyone deserve your business if all they want to do is put unnecessary obstacles between you and your medically necessary medications ?

Filed under: General Problems | 3 Comments »

Watchdog report slams DEA’s money-laundering operations

https://www.politico.com/amp/news/2020/06/17/watchdog-report-dea-money-laundering-325723

Findings that DEA-handled funds may have fueled crime echo the furor over Operation Fast & Furious.

The Drug Enforcement Administration laundered tens of millions of dollars in the course of drug trafficking investigations over the past decade without complying with laws governing such operations, according to a newly released review from the Justice Department’s in-house watchdog.

Justice’s Inspector General Michael Horowitz found that the DEA failed to move millions of dollars in profits from completed operations to the U.S. Treasury and did not report all such undercover operations to Congress as the law requires.

In some cases, the financial transactions handled by the DEA facilitated the purchase of aircraft by drug trafficking organizations, but the DEA apparently showed little interest in determining just how the aircraft were used until auditors asked about the issue.

Horowitz’s review echoed many of the findings that fueled a controversy almost a decade ago over a federal gunrunning investigation known as “Operation Fast and Furious,” that allowed suspected gun traffickers to purchase weapons in order to trace their flow.

As many as 2,000 of the weapons crossed the border into Mexico, investigators found, prompting a loud outcry against the Obama administration from Republicans in Congress.

Drug trafficking organizations “are not only involved in drug trafficking, but also participate in violent crimes and have been linked to terrorism,” the new IG report finds. “This elevates the risks that the DEA’s involvement in money laundering activity may inadvertently support particularly egregious criminal activity. Despite these risks, officials in the DEA and in the Department conveyed the idea that allowing money to ‘walk’ is not as inherently risky as letting drugs or guns ‘walk.’”

The report also indicates that DEA sometimes changed the focus or nature of the undercover operations without seeking the appropriate approvals from higher-ups at DOJ. In one instance, a narco-terrorist was added as a new, “atypical” target of a DEA money laundering effort, without high-level approval.

“Because of the sensitivity and additional risks involved in investigating narco-terrorists, we believe that the addition of this target should have immediately alerted [senior officials] that this target did not fall within the initial scope of approved activity,” the review said.

The new report spans three fiscal years, from 2015 to 2017, but some of the money-laundering operations date back to the 1990s and the report suggests neglect of the legal requirements for well over a decade.

DEA is supposed to report details of its undercover operations to Congress on an annual basis but has not done so since 2006 or earlier, the watchdog found.

DEA and Justice Department officials agreed with 19 recommendations Horowitz made to address shortcomings found during the audit.

DEA tightened some of its policies on the undercover operation issues in 2018, but didn’t take more significant action until April of this year, well after the inspector general’s team gave Justice and DEA officials the initial findings.

“While DEA acknowledges a need for improvement in the areas noted in the OIG’s report….significant progress has been made in recent years and that effort continues today,” DEA Chief Compliance Officer Mary Schaefer wrote in a response attached to the report.

Filed under: General Problems | 6 Comments »

Coronavirus can still pass between face mask wearers — even when they’re 4 feet apart: study

COVID-19 can be transmitted between people who are standing more than four feet apart, even if they are wearing a mask, a new study has found.

The research, published in Physics of Fluids, notes that face coverings alone do not prevent droplets of fluid that are projected by a cough, a discovery the researchers called “alarming.” It adds to the importance to also maintain proper social distancing measures, they said.

The same researchers found previously that droplets of saliva can travel 18 feet in five seconds when an unmasked person coughs, so masks are important. However, repeated coughs are likely to reduce their effectiveness, the experts found in the new study, using computer models.

“The use of a mask will not provide complete protection,” study co-author and University of Nicosia professor Dimitris Drikakis said in a statement. “Therefore, social distancing remains essential.”

If a person has a coughing fit, “many droplets penetrate the mask shield and some saliva droplet disease-carrier particles can travel more than 1.2 meters (4 feet),” Drikakis added.

The calculations from the simulation also noted that droplet size could be affected due to hitting the mask, escaping and eventually, entering the environment.

“The droplet sizes change and fluctuate continuously during cough cycles as a result of several interactions with the mask and face,” Drikakis explained.

“Masks decrease the droplet accumulation during repeated cough cycles,” Dr. Talib Dbouk, the study’s co-author, added. “However, it remains unclear whether large droplets or small ones are more infectious.”

The study’s findings have implications for health care workers, who are often unable to maintain proper social distancing.

The researchers suggested wearing “much more complete personal protective equipment,” including helmets with built-in air filters, face shields, disposable gowns and two sets of gloves.

Earlier this month, the World Health Organization updated its guidance to recommend that governments around the world encourage the widespread use of fabric face masks while in public settings.

Initially, the WHO advised only those who are experiencing symptoms of COVID-19 or are caring for someone infected with the novel virus to wear a face mask. The WHO’s new recommendations also lag behind those from other top health agencies, such as the Centers for Disease Control and Prevention (CDC).

In April, the CDC updated its guidelines to recommend all Americans wear cloth face coverings while in public, “especially in areas of significant community-based transmission.”

As of Tuesday morning, more than 8 million coronavirus cases have been diagnosed worldwide, more than 2.1 million of which are in the U.S., the most impacted country on the planet.

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Finally: Common Drug Improves COVID-19 Survival in Trial

https://www.medpagetoday.com/infectiousdisease/covid19/87086

Dexamethasone, the familiar glucocorticoid, reduced deaths in hospitalized COVID-19 patients with severe disease by one-third compared to those receiving usual care, according to topline interim results from the RECOVERY trial released early Tuesday.

Deaths in the dexamethasone arm were reduced by one-third (RR 0.65, 95% CI 0.48-0.88, P=0.0003) among patients receiving mechanical ventilation, and by one-fifth (RR 0.80, 95% CI 0.67-0.96, P=0.0021) among patients requiring oxygen versus patients receiving usual care, according to a statement from the study’s authors.

But dexamethasone showed no benefit among patients who did not require respiratory support (RR 1.22, 95% CI 0.86-1.75).

RECOVERY is a U.K.-based pragmatic trial in which hospitalized patients are randomized to various open-label treatments: besides dexamethasone, these include tocilizumab (Actemra), convalescent plasma, azithromycin, and lopinavir/ritonavir (Kaletra); hydroxychloroquine was also being tested until enrollment in that arm was stopped earlier this month, after it failed to show any benefit.

“Dexamethasone is the first drug to be shown to improve survival in COVID-19,” said RECOVERY trial chief investigator Peter Horby, MD, PhD, of University of Oxford, in the group’s statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.”

Horby described dexamethasone as “inexpensive, on the shelf and can be used immediately to save lives worldwide.”

Sir Patrick Vallance, the U.K.’s chief scientific adviser, characterized the news as a “ground-breaking development” in the fight against COVID-19.

In the trial thus far, 2,104 patients were randomized to receive 6 mg of dexamethasone via intravenous injection for 10 days compared to 4,321 patients receiving usual care. Among the usual care group, 28-day mortality was highest (41%) among patients requiring mechanical ventilation; mortality was 25% in those who required oxygen only and 13% among those not requiring any respiratory support.

The investigators estimated that treating 8 ventilated patients or 25 requiring supplemental oxygen would prevent one death.

Recruitment to the dexamethasone arm of the trial was stopped on June 8, as a sufficient number of patients were enrolled to determine if the drug had meaningful benefit.

They added that given the “public health importance of these results,” they are working to publish the full details soon.

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