FRONT LINE HEALTHCARE PROFESSIONAL – NO PPE’s – NO TESTS — RIP !

Posted on April 26, 2020 by Pharmaciststeve

I felt I needed to write a letter to Governor Cuomo regarding our family’s experience with Covid 19. I want this to be a call to action to make changes in how this terrible disease is being handled.

Governor Andrew Cuomo

Please share.

Dear Governor Cuomo,

I am writing to share the story of my husband, William Mantell, who died from Covid related pneumonia on April 17, 2020.

Bill was a healthcare worker on the front lines. He wasn’t a nurse or physician working in a hospital, but a pharmacist at a small community pharmacy that he owned for 31 years, in Rochdale Village, NY. As you know, retail pharmacies are deemed essential businesses by New York State and are expected to remain open. Bill did as he was instructed, where exposure to the public is not optional, and kept his pharmacy running to serve his patients and community.

Within the first week of this crisis, he sold out of hand sanitizer, disinfectant wipes, disinfectant sprays, masks, gloves, alcohol, thermometers, and even Tylenol. There were no cleaning supplies left on the shelves and it was becoming nearly impossible to replenish those items. Not only did Bill have limited product to sell to his patients and customers, but also there were very few supplies to clean the pharmacy with, and he had zero Personal Protective Equipment to keep himself and his employees safe. Bill was running a small business and he wasn’t in a position to quickly install plastic barriers at cash registers and other protective measures throughout the store that large corporate pharmacies had the resources to do.

In the beginning of this crisis, I was glued to the news at all times. I heard news stories about the nurses and physicians in hospitals who were begging for PPE to protect themselves. I listened to your news conferences where you asked the president for help obtaining equipment and PPE for those on the front lines in hospitals. I don’t recall the push for PPE for the workers on the front lines who aren’t in hospitals: the retail pharmacists, delivery people, grocery store employees, workers in essential factories, etc. If New York State is having difficulty procuring these items, how are small businesses supposed to? I feel like my husband was left to fend for himself. If Bill had the PPE earlier, would it have changed his outcome?

I want to bring to your attention the difficulty Bill went through to try to have a Covid 19 test scheduled. He called the testing hotline on March 28th and was told someone would get back to him within two days. Two days later he called again and was reassured that he was “still on the list”. Three and a half weeks later, on April 22nd, the NYS department of health called to schedule a test; this was five days after he died. Is it acceptable to have a person who is sick wait almost a month for a test? Why wasn’t his personal physician allowed to order a test? How did those waiting on lines at the drive through sites have their tests scheduled? If Bill had been tested and treated earlier, would it have changed his outcome?

It was extremely difficult for my family and me (and I am sure for every other family who has a sick loved one) to know that Bill was in the hospital suffering alone, with no family or friends by his side to support him. I understand the reasons why and I understand that the nurses have such a high patient load that they are often unable to extend the extra human elements they normally give those in their care. I know Bill was anxious, scared, and exhausted trying to take care of his needs on his own. If even one family member was allowed at their own risk, completely gowned from head to toe, to be there with him, to ensure that he laid on his stomach, did his breathing exercises, helped with the side effects caused by his medications and let him know that he wasn’t alone, would it have changed his outcome?

My story is one of nearly 17,000 in New York State. I am helpless in a time when there is so much uncertainty in the world. I have lost my best friend and my daughters have lost their father. I am calling on you, Governor Cuomo, to continue leading our state through this challenging time. Small businesses on the front lines need PPE to safely serve our citizens during this pandemic, and our loved ones need someone by their side to fight and survive.

In loving memory of my husband Bill,

Carole Mantell

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Could this be why we have so many “opiate related OD deaths ” on death certificates ?

Posted on April 26, 2020 by Pharmaciststeve

One in 3 death certificates were wrong before coronavirus. It’s about to get even worse

https://www.usatoday.com/story/news/investigations/2020/04/25/coronavirus-death-toll-hard-track-1-3-death-certificates-wrong/3020778001/

As the U.S. struggles to track coronavirus fatalities amid spotty testing, delayed lab results and inconsistent reporting standards, a more insidious problem could thwart its quest for an accurate death toll.

© Provided by USA TODAY Funeral homes are changing the way funerals are held during the coronavirus outbreak.

Up to 1 in 3 death certificates nationwide were already wrong before COVID-19, said Bob Anderson, chief of the mortality statistics branch at the National Center for Health Statistics in an interview with the USA TODAY Network.

“I’m always worried about getting good data. I think this sort of thing can be an issue even in a pandemic,” Anderson said.

Experts say the inaccuracies are part and parcel of a patchwork, state-by-state system of medical examiners, coroners and doctors who have disparate medical backgrounds, and in some cases none at all.

And the problem is about to get worse. The pandemic will undoubtedly inundate already overworked and sometimes untrained officials who fill out the forms.

Accurate death certificates are paramount for local health officials who are trying to determine where to focus resources to fight the spread of the coronavirus, said Dr. Umair Shah, executive director of the public health department in Harris County, Texas, which includes Houston.

“That death represents an ecosystem of people,” Shah said.

Inaccurate death reporting is a longstanding problem noted by numerous researchers in study after study.

A 2017 review of Missouri hospitals, for example, found nearly half of death certificates listed an incorrect cause of death. A Vermont study found 51% of death certificates had major errors. Nearly half of the physicians the Centers for Disease Control and Prevention surveyed in 2010 admitted that they knowingly reported an inaccurate cause of death.

Death certificates regularly lack enough details to accurately pinpoint the cause of death, Anderson said.

“For example, cardiac arrest is not an acceptable cause of death, because everybody dies of cardiac arrest,” Anderson said. “That just means your heart stopped.”

Lack of expertise
The widespread inaccuracy of death certificate information stems largely from the varying levels of expertise of those who complete the forms, experts said.

Physicians, coroners, medical examiners, and in some states, other medical personnel, such as nurse practitioners, can legally sign death certificates, said Dr. Sally Aiken, president of the National Association of Medical Examiners and a practicing medical examiner in Spokane County, Washington.

Coroners and medical examiners are responsible for certificates in homicides, accidents and suicides, Aiken said. Physicians fill out the form when natural deaths, such as those caused by COVID-19, occur in a hospital. But medical examiners and coroners do it if the person died at home or in another non-healthcare setting.

Medical examiners are generally physicians specializing in forensic pathology who can perform autopsies.

Coroners, however, are not always doctors. In some states, such as Alabama and Georgia, the only requirement for a coroner is that they are a non-felon of legal age to be elected to the position.

Even those with medical expertise, though, regularly get it wrong. In Vermont, there are no coroners. If a death is natural or happens in a hospital or out in the community, physicians, nurse practitioners or physician assistants fill out death certificates. And the state medical examiner’s office, which investigates violent deaths, reviews about 5,000 certificates each year to find and fix errors.

When the state medical examiner’s office compared 601 death certificates completed between July 1, 2015 and Jan. 31, 2016 with medical records, they found that 51% had major errors.

Lauri McGovirn, a medical examiner who worked on that review, said some physicians didn’t complete death certificates regularly, so they were unfamiliar with the process. Others viewed it as an administrative chore.

“It does make you wonder in other states where they don’t have the type of resources or the money to review every death certificate what their error rate may be,” McGovirn said.

Shortage of workers
In addition to expertise gaps, there’s a severe shortage of medical examiners nationwide.

In a recent report to Congress, the Justice Department said as many as 700 more forensic pathologists are needed. That same report noted that in addition to staffing, “budgets, resources and supplies are too inconsistent to ensure that death investigations are of the same quality across the United States.”

Dr. Ray Fernandez has been the chief medical examiner for Nueces County, Texas, for 19 years. He knows what the shortage means — a punishing workload.

Despite hiring another full-time pathologist and two part-time pathologists several years ago, he and his colleagues each perform 200 to 300 autopsies per year, regularly bumping up against the National Association of Medical Examiners’ recommendation of no more than 325 per year.

The organization has temporarily suspended that caseload limit amid due to COVID-19, but Fernandez said the more cases medical examiners take on, the greater the chance they’ll make mistakes.

“COVID-19,” he said, “is impacting the system at a time when it’s already in a crisis with a shortage of people doing the work.”

To further complicate efforts to curb the spread of coronavirus, many medical examiners and coroners refuse to attribute a death to COVID-19 without a positive test before the person died. Some medical examiners are doing post mortem testing if they have the means. But with tests in short supply, that’s not always possible.

Dr. James Gill, vice president of the National Association of Medical Examiners and the chief medical examiner for the state of Connecticut, said he’s sending his staff to funeral homes to swab the noses of the deceased, which are then analyzed by an outside lab.

The family of the deceased and the first responders who attended to them need the lab results to know whether they should self isolate or get treatment, Gill said.

“You have to remember, though, that even if we are doing a swab on a dead person, those results may affect the living,” Gill said.

The National Center for Health Statistics, where Anderson works, updated its website on April 1 to clarify that those filling out death certificates should record COVID-19 as the probable cause if testing isn’t possible and if the medical records or circumstances support that.

Despite this, Anderson said, some physicians will simply list the cause of death as pneumonia when the pneumonia likely came after a COVID-19 infection. But he hopes fewer do.

“The fact is, a lot of these deaths are not going to be autopsied and post mortem testing is not going to be done, so we’re going to have to rely on second-hand accounts and what the symptoms were,” Anderson said. “We may miss some as a result.”

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Shasta Rayne calls out the bureaucrats on their calculated war on pts

Posted on April 26, 2020 by Pharmaciststeve

Shasta is good at going thru reams of printed material and condensing the information down. She works with facts, I have been a student of our bureaucracy for 30 + yrs… I read what they put to print… but.. often it is what is “between the lines”… I listen to what they say… but.. often it is more important in what they DON’T SAY.  There is some 2 million federal employees … most we will never hear their name, never see their face, but they are working in the “background” and ” off the radar”.  The primary function of a bureaucrat and the bureaucracy is to perpetuate and grow the bureaucracy.

The DEA started with 1200 employees in 1973… today they have over 12,000 employees and it is claimed that > 50% work at a desk. The question has to be asked… how do you arrest members of the various cartels … sitting at a desk ?

The CDC opiate dosing guidelines seem to be a just a mid-way point in a much longer battle/goal…. I have been talking about civil rights violations under American with Disability Act and Civil Rights Act for several years…

All of this may have started about TWENTY YEARS AGO… when Congress passed a law “Decade of pain” that started in early 2000.  Healthcare professionals were told it was mandatory to treat pain as a 5th vital sign.  The Joint Commission (JC) jumped on this with both feet, which meant that all the hospitals – nearly 100% – had to make sure that pt’s pain management was taken seriously and JC made it a MAJOR STANDARD… meaning if a hospital failed to meet this standard … they risked losing their accreditation… which is necessary for hospitals to have “deemed status” and able to bill for services provided to Medicare/Medicaid pts…  typically about 70%+ of a hospital revenue.

I am sure than a large number of con artists got controlled substances from well meaning prescribers and a lot from prescribers who were not so well meaning, but was more focused on the money they could generate.

This “decade of pain law” expired as a new President was just coming to office… Bush (43) was “tapped out”… in 2009 we were going to get a NEW PRESIDENT. Was it a coincident that we had a new Democratic President and a Democratic controlled Congress and in 12 months the decade of pain law was to expire.  The Congress did not renew that law and Obama signed “Obamacare” into law a few months later.

Was the decade of pain law a “set up” for the idea that prescribed opiates causes a lot of addictions ?  We know that we have 30-40 million people addicted to the two drugs alcohol and Nicotine.. could it be that we really have a untreated mental health epidemic and substance abuse and this decade of pain law and careless prescribing and prescribing driven by prescriber’s greed.

We have to remember that Congress is generally 40% attorneys and Congress created the controlled substance act and assigned this law to be handled by law enforcement and the only tool that law enforcement has to deal with the mental health issues of substance abuse is jail/prison.  The Obama administration was headed by a “trinity” of attorneys – Obama, Biden & Holder.  Biden graduated 5 yrs before the Controlled Substance Act and the other two afterwards… but the “brainwashing” of everyone dealing with controlled substances,  back in the early 70’s and going forward was pretty intense back then.

Tom Frieden the then head of the CDC and Kolondy were coworkers in their younger years and it has been reported that Kolondy first took this “opiate dosing guidelines” to the FDA and reportedly told him to “get lost”…  Frieden, probably expected that he would be replaced with a new administration coming into power in 2017.  Was he trying to help a old friend, or just trying to “make his mark” before he left ?

Chronic painers and substance abusers have a few things in common, both are dealing with a disease/illness – one if physical and other other is mental health.  As Shasta pointed out, “they” are just trying to make the chronic painers  functional… and… that is the same things that they are trying to do with substance abusers…  If they are successful, a couple of things could happen… all of these people could get back into the work force and start paying taxes – getting off Medicare/Medicaid rolls and the cost of their health issues will be pushed onto their employers’ health insurance costs and the private insurance industry and SS & Medicare starts getting an increased inflow of money.

A lot of dollars are going to be moved from the bureaucracy’s balance sheet and on to the profit and loss statement of public businesses.

Just have to follow the money trail ?

Filed under: General Problems | 8 Comments »

Medical care in NEW YORK seems to be “the pits”

Posted on April 26, 2020 by Pharmaciststeve

https://youtu.be/hmJ21gQ4l_A

Filed under: General Problems | 1 Comment »

Are they dying in New York from LACK OF CARE ?

Posted on April 26, 2020 by Pharmaciststeve

Filed under: General Problems | 2 Comments »

Aurora Walmart ordered to close after three COVID-19 deaths linked to store

Posted on April 25, 2020 by Pharmaciststeve

Aurora Walmart ordered to close after three COVID-19 deaths linked to store

The Tri-County Health Department closed the Walmart off East Exposition in Aurora on Thursday, due to an outbreak of the virus

https://www.9news.com/article/news/health/coronavirus/aurora-walmart-closed/73-0df81b80-84ed-4720-bb7a-52fa866470f0

AURORA, Colo. — A husband and wife are two of the deaths linked to an outbreak of COVID-19 at an Aurora Walmart.

Family members confirmed Sandy and Gus Kunz died just two days apart, after contracting the virus.

Family members said Sandy Kunz, 72, was an employee at the Walmart off East Exposition in Aurora, which was closed Thursday by the Tri-County Health Department (TCHD). TCHD said it received complaints from employees and customers about the lack of social distancing and employees wearing masks.

Gus Kuntz, 69, did not work at the store.

Paula Spellman, Sandy’s sister, said the couple spent more than 25 years together.

“Sandy and Gus loved nature and were a happy couple; they both left the earth together,” reads an online obituary.

TCHD said a third person connected to the Walmart also died, a 69-year old man who worked for an independent security company. On Friday, the health department said an additional 11 people connected to the store have tested positive for COVID-19.

RELATED: Colorado coronavirus latest, April 24

RELATED: Here are counties extending stay-at-home orders (or considering it)

TCHD said a third-party contractor deep cleaned the store overnight after it closed Thursday.

A spokeswoman for Walmart provided an emailed statement on Friday:

“The Tri-County Health Department has advised us to temporarily close our store at 14000 E Exposition Ave in Aurora. Colorado has been hit especially hard by COVID-19, and several associates at this store have tested positive. Sadly, one of our associates has passed away. The temporary closure will allow third-party cleaning experts to further clean and sanitize the store. We recognize how hard this is for our associates in Aurora and everyone impacted by this difficult situation. We want to do everything we can to support them at this time. We will continue to work closely with Tri-County Health Department and take additional steps as needed to re-open the store.”

The spokeswoman said this Walmart had several safety measures in place, prior to the closure, including:

  • Plexiglass barriers at checkout lanes
  • Floor decals at entrances and check out lanes to help customers judge social distancing
  • Limiting the number of customers in the store at the same time
  • Temperature checks, basic health screenings and mask/face covering requirements for employees
  • Encouraging customers to wear masks while shopping

In order to reopen, Tri-County Health Department says Walmart will have to meet several requirements:

  • A deep cleaning and disinfection of the entire store
  • “Robust and reliable” structure for employee screening for illness, tracking employee illness and reporting to TCHD
  • Reporting new positives to TCHD
  • Employee education and training for COVID infection prevention measures
  • “Confidence” from TCHD in “the supervision of the systems in place to ensure a safe environment”

Jessie Metcalf says she has worked at the store for five years, as a cashier. She said things started to change as the virus spread through Colorado.

“[Walmart] told us we had to start wearing gloves and our masks, then they started taking our temperature every day,” the 66-year-old said. “But I was still under the impression, I didn’t think that the virus was there.”

Metcalf said employees knew some of their co-workers had become sick or were taking time off, but she said Walmart did not disclose the details. She would later learn about the positive cases and deaths.

Metcalf said she is concerned about being exposed herself, and the exposure to customers.

RELATED: What do you do if you feel unsafe going back to work?

“We should have been told about [positive cases] the first time it happened,” she said. “So we could decide on our own if we want to stay there and risk our lives or stay home.”

“I don’t think Walmart was doing everything they could to take care of the customers’ benefit and our benefit,” she added.

Even though she said she feels healthy today, with no symptoms, she is worried about tomorrow.

“I’m probably going to go and try and get a test done, just to make sure I don’t have it. I don’t want to infect my family.

Filed under: General Problems | 1 Comment »

CVS CAREMARK USES DIRTY MONEY TO BUY ITS WAY OUT OF CRIMINAL ACTIVITY AGAIN!!!!

Posted on April 25, 2020 by Pharmaciststeve

CVS CAREMARK USES DIRTY MONEY TO BUY ITS WAY OUT OF CRIMINAL ACTIVITY AGAIN!!!!

https://www.facebook.com/permalink.php?story_fbid=10157995843780499&id=172075625498

Add this to the $1.1 BILLION DOLLAR LONG LIST of Fines since the year 2000!! (This list is pictured below). When are we going to stand up as a country and stop DIRTY MONEY like CVS CAREMARK and other PBM’s from simply buying off judges and politicians, paying a fine, and continuing with ILLEGAL, IMMORAL activity that costs EVERY taxpayer, employer and independent pharmacy tens if not hundreds of BILLIONS annually????
Within a Medicare part D plan, it is illegal for the processor (Caremark) to charge the Federal government more than they pay the pharmacies. In the most recent “Payoff” an actuary for AETNA (a company CVS CAREMARK has purchased ) realized CAREMARK (who processes the prescription claims for Aetna) was defrauding the Federal government by charging Aetna a much higher rate than they paid the pharmacies. Then Aetna would of course charge the federal government that inflated rate. (Theoretically, by CVS-CAREMARK’s corrupt thought process, they were not defrauding and overcharging the Federal government, they were overcharging Aetna).
The actuary for Aetna has been fired for leaking this information (which it is illegal to fire a whistleblower ). The law also states that if you are guilty of FRAUD, WASTE AND ABUSE within a state or federal program, you will be banned from those programs forever, but it appears CVS CAREMARK will pay a fine and go on business as usual!

I have had the opinion for some time that corporate America is working under the premise that nothing is illegal UNTIL YOU GET CAUGHT… then you pay the fine and find a new way to get back to business as usual.  Is this an example ?

Filed under: General Problems | 1 Comment »

Doctors: Execution Drugs Could Help COVID-19 Patients

Posted on April 24, 2020 by Pharmaciststeve

Doctors: Execution Drugs Could Help COVID-19 Patients

https://www.usnews.com/news/business/articles/2020-04-21/doctors-execution-drugs-could-help-covid-19-patients

A group of medical professionals is asking death penalty states for medications used both for lethal injections and to help coronavirus patients who are on ventilators.

The Associated Press

This July 25, 2014 file photo shows bottles of the sedative midazolam at a hospital pharmacy in Oklahoma City. Many of the medications being used to sedate and paralyze COVID-19 patients placed on ventilators and to also treat their pain are the same drugs that put inmates to death by lethal injection. Last month, nationwide demand for these drugs surged 73% during the pandemic.

Secrecy surrounding executions could hinder efforts by a group of medical professionals who are asking the nation’s death penalty states for medications used in lethal injections so that they can go to coronavirus patients who are on ventilators, according to a death penalty expert and a doctor who’s behind the request.

In a letter sent this month to corrections departments, a group of seven pharmacists, public health experts, and intensive care unit doctors asked states with the death penalty to release any stockpiles they might have of execution drugs to health care facilities.

“Your stockpile could save the lives of hundreds of people; though this may be a small fraction of the total anticipated deaths, it is a central ethical directive that medicine values every life,” according to the letter.

But it’s unclear what drugs the states may have, as they have tended to release information about execution protocols and drug supplies only through open records requests or lawsuits. Only one state, Wyoming, responded directly to the letter, and it indicated it doesn’t have the drugs in question.

“I’m not trying to comment on the rightness or wrongness of capital punishment,” said Dr. Joel Zivot, one of the medical professionals who signed the letter. “I’m asking now as a bedside clinician caring for patients, please help me.”

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for some, it can cause severe illness, requiring them to be placed to ventilators to help them breathe.

Many medications used to sedate and immobilize people put on ventilators and to treat their pain are the same drugs that states use to put inmates to death. Demand for such drugs surged 73% in March.

Twenty-five states have the death penalty, while three have moratoriums on capital punishment.

While some states contacted by The Associated Press, including Alabama and Florida, didn’t respond to inquiries about the letter, others, including Arkansas, Texas and Utah, limited their comment to mainly saying they don’t have the medications in question. Tennessee wouldn’t confirm whether it has the drugs and indicated it has no plans to give any medications to a hospital. Oklahoma said it hadn’t received any requests for such medications from state hospitals.

States may be hesitant to turn over their drugs because they have had problems securing them as many pharmaceutical companies oppose their use in executions, said Robert Dunham, executive director of the Death Penalty Information Center.

Since 2011, 13 states have enacted new statutes that conceal information about the execution process, according to the Death Penalty Information Center, which takes no position on capital punishment but has criticized the way states carry out executions.

Drugs being requested include the sedative midazolam, the paralytic vecuronium bromide and the opioid fentanyl. They’re needed because putting a patient on a ventilator “with no drugs … would be torture,” said Zivot, an associate professor of anesthesiology and surgery at Emory University in Atlanta who has studied medicine’s role in capital punishment.

The tense debate over the supply of execution drugs was highlighted in a 2018 lawsuit that several pharmaceutical companies filed against Nevada over accusations that it illegally obtained its inventory.

In a court brief, 15 states, including Florida, Oklahoma and Texas, called the lawsuit part of the “guerrilla warfare being waged by antideath-penalty activists and criminal defense attorneys to stop lawful executions.”

The lawsuit was dismissed this month after Nevada agreed to return its supplies to the companies, leaving the state without any drugs to carry out executions.

Pharmaceutical companies have long warned that states’ use of these medications for executions could result in shortages, Dunham said.

“Some of the responses over the past several years had been, ‘That’s chicken little saying the sky is falling,’” Dunham said. “But with COVID-19, the sky has fallen.”

Here is video of what happens when someone who has lost a child to a medical malpractice and hears part of a story and reacts to the headlines

https://www.facebook.com/dicksongilbert2019/videos/2768258276556061/

Prison execution is normally done with three different meds… first they are given a large dose of a barbiturate or benzo class of meds, which will make them “go to sleep”, then they are giving a large dose of a med that will paralysis their diaphragm and they stop breathing and last they are given a high dose of POTASSIUM CHLORIDE that will cause their heart to STOP. All of these meds are given via IV and in fairly rapid succession… and “the end” comes fairly quickly.

The docs are wanting the sedation meds because of the pandemic we are running short of meds used to keep vent pts sedated, because of all the DEA reduction in pharma production of these controlled meds. If a pt that is on a vent and not is not sedated they will most likely routinely have a GAG REFLEX… trying to get rid of the vent tube that is down their throat and without it… the vent won’t do what it is suppose to do.

Another unintended consequence to the bureaucrats’ moral compass pointing in the wrong direction ?

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CMS updates COVID-19 guidance to Medicare Advantage and Part D plans

Posted on April 24, 2020 by Pharmaciststeve

CMS updates COVID-19 guidance to Medicare Advantage and Part D plans

https://ncpa.org/newsroom/qam/2020/04/23/cms-updates-covid-19-guidance-medicare-advantage-and-part-d-plans

On April 21, CMS released a guidance document to Medicare Advantage organizations, Part D sponsors, and Medicare-Medicaid plans updating previously released information from March 10. People should take 2021 Humana Medicare advantage plans for health precaution. The guidance includes several relevant provisions for community and long-term care pharmacies, including:

  • Coverage of testing and testing-related services for COVID-19
  • Relaxed enforcement of signature log and prior authorization requirements
  • Suspension of plan-coordinated pharmacy audits
  • Requirement for Part D sponsors to permit 90-day fills, refills, or transition fills
  • Relaxation of short-cycle fill requirements for LTC patients.

NCPA successfully advocated that CMS temporarily waive Part D medication delivery documentation and signature log requirements during the public health emergency and adopt a temporary policy suspending plan-coordinated pharmacy audits. NCPA also successfully advocated for community and LTC pharmacies regarding relaxing prior authorization, point-of-sale edits, and short-cycle dispensing requirements. For more information, see NCPA’s member summary.

Filed under: General Problems | 1 Comment »

Correspondence: Are ESIs Still Worth It?

Posted on April 23, 2020 by Pharmaciststeve

Correspondence: Are ESIs Still Worth It?

https://www.practicalpainmanagement.com/correspondence-are-esis-still-worth-it-benzocaine-orofacial-pain

Dear PPM,

Regarding “Epidural Steroid Injections: Are the Risks Worth the Benefits?” (July 2019), most pain management providers, let alone referring providers and patients, may not be aware of the background surrounding the FDA stance and the initial request to ban the use of epidural steroid injections (ESIs). In July 2018, the New York Times’ Sheila Kaplan reported that, in 2013, Pfizer Pharmaceuticals requested that the FDA ban the use of Depo-Medrol in the epidural space. Neither organization made this public at the time. The article cited a review of FDA records between 2004 and March 2018 showing 2,442 serious injuries (including 154 deaths) reported with the injection of steroids into the epidural space. As injury attorneys serving Sugar Land state, more injuries go unreported. It may be reasonable to assume more injuries occurred but were not reported or attributed to ESIs.

While the FDA has not banned the use of steroids in the epidural space, many other countries have done so. Pain management societies, practitioners, and patients should be better informed about safety communications regarding ESIs, as well as warnings contained in steroid package inserts. Depo-Medrol has labeling stating: “Serious neurologic events, some resulting in death, have been reported with epidural injection of corticosteroids. Specific events reported include, but are not limited to, spinal cord infarction, paraplegia, quadriplegia, cortical blindness, and stroke…. The safety and effectiveness of epidural administration of corticosteroids have not been established, and corticosteroids are not approved for this use.”

Multiple articles in the literature demonstrate a lack of long-term benefit from such injections beyond a few weeks, compared to less expensive, more conservative, and safer options. Match this with the costs of these procedures, and I don’t understand why these injections continue to be done since it doesn’t help the victims who got injured in a car accident. There have been catastrophic outcomes from ESIs. In my own practice, I had a patient with no prior history of low back injury nor surgery who had 7 ESIs done by another provider. Her most recent MRI showed adhesive arachnoiditis with no other injury as the likely cause. She is in constant pain. Rather than being eligible for compensation after the fall,  she deserves a compensation from her previous provider for the pain she endures. 

I believe the primary motivators for doing these procedures lie in habit and financial gain. In fact, I have heard from some hospital administrators that, “even though we know they don’t work, as long as we have a fee for service mode and can make money, we will allow providers to do them.” One VP from a major insurance company told me that they keep paying for ESIs “because no one wants to be the first to say no and deal with the backlash.” There are many reasonable and less risky pain management procedures that help to manage pain, but an ESI is not one of them.

– Terence K. Gray, DO

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