Osmin Morales, MD convicted

https://doctorsofcourage.org/osmin-morales-md/

Following only a 7 day trial, 72 y/o Osmin Morales, MD, an interventional pain management physician in South Miami, FL was convicted Jan 12, 2024 of conspiracy to unlawfully dispense and distribute controlled substances, and six counts of unlawfully dispensing controlled substances. Just shows how the government propaganda is still convicting innocent doctors and people need to help stop this.

So how is this being accomplished? In the DoJ report, they even say

“Under federal law, a physician is authorized to dispense (prescribe) controlled substances only when there is a legitimate medical basis for doing so, and the dispensing is consistent with accepted standards of professional medical practice.”

But then, to continue the government propaganda, the report says that Dr. Morales

“established a purported pain management clinic in which he issued prescriptions for controlled substances, principally oxycodone, morphine, and alprazolam… to most patients who sought them, without any appropriate medical basis.”

But when questioned, government agents always say they can’t determine legitimate medical practice because they aren’t doctors. They don’t have to, though, since they have everyone in America believing their propaganda that opioids cause addiction.

To stop these attacks on doctors, we must get the CSA repealed. Why? Because opioids need to be treated like any other non-controlled drugs that a doctors prescribes. For example, according to the government report (which we, BTW, can take with a grain of salt),

1. Morales “issued prescriptions…without examining the patients, often when he was not even present in the clinic. He also often pre-wrote many prescriptions for controlled substances and provided them to his office managers to hand out for cash payments of $250 to regular patients”, adding at the end of the statement their accusation “with the purpose of unlawfully maximizing the clinic’s profits.”

If this was standard medications and not controlled substances, none of these actions would be considered illegal by anyone, even the DOJ. They shouldn’t be considered illegal for controlled drugs either.  If a doctor can’t be at the office every day, but patients need their medications to continue, and the prescriptions, by law, can only be written for a month at a time, then it shows a compassionate, caring physician to make sure the regular patient can pick the scripts up. And if the doctor wants to consider that an office visit and doesn’t bill insurance for it, then the standard office visit price should be allowed.  $250 is low for a standard office visit today. The doctors not taking insurance in my area charge $350. And Florida is probably even more expensive.

2. A pain medicine expert witness, Dr. Rubenstein, testified that none of the patient medical records he had examined contained any proper medical basis for the use of opioids, such as oxycodone or morphine, nor any basis for the use of benzodiazepines, such as alprazolam. The pain medicine expert also testified that the combination of opioids and benzodiazepines that Morales regularly prescribed, both of which are central nervous system depressants, created an enhanced risk of overdose and death.’

These “pain medicine experts” that the government pays to say whatever they are told to say on the witness stand will someday answer for their crimes to humanity.  How can they say, in this day and time when a pain patient doesn’t even know if they will get their pain medicine, that there isn’t a need for an anti-anxiety medicine like alprazolam?  And the attacks on opioids and benzodiazepines is purely bogus government propaganda to attack physicians. They have been prescribed together for 50 years without any major problems.

3. The trial also exposed discrepancies in Morales’s medical records, which purportedly detailed patient examinations during periods when he was confirmed to be out of the country by U.S. Customs and Border Protection records.

But what about telehealth?  Couldn’t the doctor have conducted a virtual visit with these patients? Telehealth is accepted today. And if a pain management physician is alone in his practice, there must be a way for patients to receive their prescriptions in a timely manner so they don’t suffer or go into withdrawal. It would appear, though, that the DOJ report on the trial doesn’t mention this possibility. The visit could even have been conducted by phone call. Since pain patients have to be evaluated monthly, and usually the prescriptions are just continued, a face-to-face is not needed. It is even in the Controlled Substance Act that a face-to-face only has to be conducted every 24 months.

4. The Drug Enforcement Administration (DEA) agent testified that Morales prescribed opioids to over 1,000 patients, frequently at maximum doses, and a substantial number of these patients had criminal records related to drug dealing.

There is no such thing as a “maximum dose” with opioids.  If they are using the 90mme’s based on the CDC guidelines, even the CDC came out with a revision stating that is wrong.

5. In addition to job security of the DOJ offices and DEA agents, here is the main reason for these attacks: “Assistant U.S. Attorneys Emily Stone and Mitchell Hyman are handling asset forfeiture.”

At the age of 72, Dr. Morales has savings, a home, cars, maybe a boat, that the government will confiscate so they can divide the proceeds among all of the divisions that helped in the investigation, from federal agencies to local law enforcement.

The media plays into this–even the websites for doctors. The headline on Becker’s ASC Review, a website for medical professionals, was

Florida physician found guilty of selling prescriptions for cash

Those really guilty of using prescriptions for cash are the government agents, such as U.S. Attorney Markenzy Lapointe, DEA Special Agent Deanne L. Reuter, Assistant U.S. Attorneys Frank Tamen, Theodore Joseph O’Brien, Emily Stone and Mitchell Hyman, and the US Customs and Border Protection which helped in the case creation.

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I wonder how many times someone (individual or corporation) puts out an RFP (request for proposal) with a specific $$ figure attached. For someone to create a study to prove or disprove a specific conclusion. This is not an isolated situation with Dana-Farber, I have seen, over the years, numerous studies that have had questionable data used to facilitate the study producing a predetermined conclusion. We have all seen various federal/state agencies with agendas that do not match up with the “real facts”, but they continue to align with and support the agenda of the agency that employs them. According to this article, it seems that there can be little/no consequences for those doing such shenanigans.

Dana-Farber expands studies to be retracted to 6, plus 31 to be corrected over mishandled data

https://www.statnews.com/2024/01/22/dana-farber-research-retractions-corrections/

A review of alleged data manipulation in studies involving four top scientists at Dana-Farber Cancer Institute has led to plans to retract six papers and correct 31 manuscripts, the institute confirmed on Monday.

The news comes as the famed cancer research and treatment center is now reviewing scores of studies co-authored by some of its leading researchers, including CEO Laurie Glimcher, COO William Hahn, and prominent scientists Irene Ghobrial and Kenneth Anderson.

Dana-Farber confirmed the retractions and corrections in progress in an email to STAT, which reported on Friday that researchers were preparing to retract one paper and correct others. The higher numbers were first reported by the Wall Street Journal, which also reported that Dana-Farber concluded three papers needed no corrective action. But the institute did not say precisely which studies would be retracted or corrected.

“Correcting the scientific record is a common practice of institutions with strong research integrity processes at which basic research is conducted. Some of the potential errors that blogger Sholto David flagged had come up in our ongoing reviews,” Dana-Farber told STAT.

During a conversation with STAT last week, the institute’s research integrity officer, Barrett Rollins, said that all of the cases that have been assessed thus far appear “credible,” a term meaning the allegation carried enough scientific merit to warrant more investigation. STAT did not receive immediate clarification regarding whether Dana-Farber had recently decided to retract or correct additional papers.

The institute’s review of past research involving these four scientists grew after David, a molecular biologist who blogs about research integrity, wrote a Jan. 2 post flagging issues with dozens of studies and the Harvard Crimson covered it. The cancer institute, a teaching affiliate of Harvard Medical School, noted in a statement that Dana-Farber had taken “prompt and decisive action” in many of the cases flagged by David for which data now under scrutiny were generated in a Dana-Farber lab.

The corrections in progress include correction submissions that are currently being prepared for submission, awaiting acceptance from journals, and corrections that journals have already accepted. An additional manuscript with a potential error is still under examination, according to Dana-Farber.

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Court considers pharmacist liability in opioid-related case

https://www.pharmacist.com/Publications/Pharmacy-Today/Article/court-considers-pharmacist-liability-in-opioid-related-case

Judicial rulings in the large volume of opioid-related lawsuits continue to clarify pharmacists’ legal responsibilities that are broadly applicable beyond opioid litigation. A recent case from New Jersey addresses a novel approach to pharmacist liability. Rather than alleging that the defendant pharmacies were liable for causing a patient to become addicted to dispensed opioids, this recent case contended that the defendants’ pharmacists knew, or should have known, that the patient was already addicted to opioids and that their negligent dispensing of opioids exacerbated the patient’s pre-existing condition.

Background

The plaintiff was the estate of a deceased patient. The estate sued four pharmacies that had dispensed oxycodone to the patient, sometimes in combination with alprazolam. The patient allegedly died as the result of the defendants’ negligence. The prescriber of the controlled substances was also sued, but that lawsuit was separated from the pharmacy litigation.

The lawsuit against the defendant pharmacies alleged that pharmacists honored prescriptions for the patient “that they knew or should have known were negligently, carelessly, and or recklessly prescribed, given their amount and frequency.” The lawsuit alleged that the pharmacists “engaged in professional malpractice by not noticing that the amount and frequency of the prescriptions were for addictive medications outside reasonable practice, and by not refusing to fill those prescriptions.”

The pharmacies moved to dismiss the lawsuit based on the learned intermediary doctrine, contending that it is the physician, and not the pharmacist, who has a duty to warn the patient. The pharmacies also contended that the lawsuit did not properly allege proximate cause, because it was the patient’s underlying condition that caused her death, and not any action or inaction by the pharmacists.

The trial court granted the pharmacies motion to dismiss the lawsuit, and the plaintiff appealed.

Rationale

On appeal, the court first considered the defendants’ defense based on the learned intermediary doctrine. The court recognized that the doctrine applies to pharmacists who accurately process prescriptions “issued in amounts and at frequencies within reasonable medical standards.” According to the doctrine, it is the prescriber, and not the pharmacist, who is the learned intermediary and who has the duty to warn the patient of medication-related risks. However, the plaintiff’s lawsuit did not allege the breach of a duty to warn the patient of risks. The lawsuit alleged the breach of a duty to refuse the improperly issued prescriptions. Therefore, the learned intermediary doctrine was ruled to be inapplicable.

The appellate court also disagreed with applicability of the defendants’ proximate causation defense. The court noted that a plaintiff need not allege that a defendant’s conduct was the only cause of the plaintiff’s injury. Rather, “a plaintiff may recover if he establishes that professional negligence increased the risk of harm posed by a preexisting condition and the increased risk was a substantial factor in producing the harm.”

The dismissal of the lawsuit was reversed on appeal and the case was remanded to the trial court for further proceedings.

Takeaways

This case illustrates a variation of the legal principle known as the “eggshell plaintiff” doctrine. Under that doctrine, an allegedly negligent defendant must accept the plaintiff’s condition when the plaintiff was presented to the defendant, even if that condition is as fragile or as delicate as an eggshell. The defendant cannot escape liability by arguing that the action taken by the defendant toward the plaintiff would have been harmless if the plaintiff had not been so susceptible to the harm.

The significance of this case is that pharmacists may have a legal duty to know a patient’s underlying condition, and to refuse pharmaceutical products or services that exacerbate the underlying condition. Pharmacists can know of an underlying condition based on a patient’s medication history or information contained in the medication record. Suspicions about a patient’s underlying condition that arise due to a pattern of medication use can be investigated by consulting with the patient or with the prescriber. ■

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Looks like the DEA has run out of valid reasons to go after some parts of the controlled meds distribution system.  According to this article, it suggests that the DEA is going after missing “i’s” being dotted and/or “t’s” being crossed. Clerical errors that does not have a single thing to do with the diversion of controlled meds. Pt may start getting a lot of being told that “the med they need is in backorder and/or out of stock”  What the Pharmacist is hoping that the pt doesn’t know about is that all pharmacies are required by state/federal law to keep a hard copy perpetual C-2 inventory.  Of course, the pt can’t see those inventory sheets, as a lot of protected pt HIPAA information there, but the pt – under such circumstances – asked the pharmacist, if the inspector from the state board of pharmacy came in and wanted to check on the particular day that the pt was told there was no inventory in the store for the particular med/strength the pt’s Rx was for on a particular date/time. What would the inspector find?  Some BOP’s consider lying to pts as unprofessional conduct. There is also some state pharmacy practice acts that require a pharmacy to keep in inventory Rx meds that is normally prescribed in their market area. It is anyone’s guess what a BOP will or will not enforce or take action on. Pharmacists within the state.

DEA’s Dangerous New Agenda

https://www.healthlawalliance.com/blog/dea-dangerous-new-agenda

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Some of the most dangerous people in our society are people with a law degree who get elected to a powerful position, become a judge or prosecutor, or are given a badge, gun, and laws to enforce and sometimes is allowed to make their own interpretations of those laws.

The current Texas AG, apparently decided to use his personal opinion and ability to impose his will on a pregnant female who had been told by her OB/GYN that the fetus she was carrying was unviable and would complicate her pregnancy and threaten her health and future fertility. I have read in other articles about this that the Texas abortion law has provisions to allow abortions under such circumstances. However, it was reported that the TX AG stated that this woman and her fetus either did not check all the “boxes” or “enough boxes” for her to be entitled to any abortion under TX law. Anyone who wishes to “get into the weeds/details” of this case. Here is a link https://www.theguardian.com/world/2023/dec/12/kate-cox-texas-abortion-case-explained

I just wonder what the cost was for this couple to go to court and the tax dollars that the TX AG spent to justify him exercising his ideology on this case.

Politicians Must Stop Playing Doctor

https://www.medpagetoday.com/opinion/second-opinions/108291

Personal ideology should not guide medical care, even for abortion

Lately, I’ve found myself using the words “irrational” and “U.S. Court of Appeals for the Fifth Circuit” in the same sentence with increasing frequency. To that mix, I add, “dangerous.”

The latest misadventures from the Fifth Circuit include a ruling in favor of Attorney General Ken Paxton and anti-abortion groups that Texas hospitals receiving Medicare cannot be required to perform life-saving abortions to stabilize patients, despite federal guidance.

This grim beginning to 2024 in Texas comes on the heels of the Kate Cox case, one that I believe Paxton pursued without empathy or reason.

The same day that a lower court granted Cox the right to abortion for an unviable and complicated pregnancy that threatened her health and future fertility, Paxton fought the decision and intimidated physicians and hospitals with a threat that the ruling would not shield them from criminal charges for violating Texas’ abortion laws, should they be involved in Cox’s care. He was successful

In his argument, Paxton belittled the original ruling: “Judge Guerra Gamble is not medically qualified to make this determination,” ignoring his own lack of medical qualifications.

I see a couple of concerning themes here. The first is that the state of Texas has determined itself to be more qualified than trained physicians to practice medicine. Had Paxton been genuinely concerned with medical expertise, he would have respected the professional opinions of Cox’s physicians and would not need to threaten them with litigation.

The second is that Texas politicians’ “practice” of medicine is decidedly antithetical to the practice of medicine that I was taught. Our Hippocratic Oath is succinctly distilled into the phrase: “First, do no harm.” I do not see Paxton abiding by that credo either in his challenge to the federal guidelines on EMTALA and emergency abortions or in his efforts against Cox. Neither bullying patients by weaponizing the legal system against them nor prioritizing personal ideology over scientific evidence is considered good medical care. Furthermore, denying an emergency abortion to a medically unstable patient who needs one is the exact opposite of preserving life, especially when the fetus carries a deadly condition.

Ideology has governed the state of Texas’s “practice” of public health, as well as its “practice” of medicine. In November, the Supreme Court reviewed U.S. v. Rahimi the decision issued by the Fifth Circuit upending decades of federal law that had previously disarmed people subject to restraining orders for domestic violence.

The original Rahimi Fifth Circuit ruling ignores the facts: access to firearms is a highly significant predictor for intimate partner homicide, increasing the risk by 1,000% Furthermore, the children of abusive relationships are not exempt from abuse, and firearms are the leading cause of death among children in this country. The Fifth Circuit ruling disregards public health expertise and consequently endangers women and children.

The Fifth Circuit’s practice of medicine continues with further frivolous barriers to care. SCOTUS has agreed to review a decision by the court limiting access to mifepristone (Mifeprex) and imposing wholly unnecessary burdens and confusion 

for patients who need this medication. These restrictions do nothing to improve patient outcomes or experience with mifepristone.

As physicians, we can follow neither our ethics nor the appropriate standard of care if politicians flagrantly disrespect our training. If they can undermine our careful decision-making so easily, what is the point of our expertise?

The medical students I train are already considering the politicization of healthcare in their future career plans. Despite ob/gyn becoming more competitive, many medical students are reluctant to consider residency in states with rigid restrictions. “I would like to train at an institution that teaches family planning. And I don’t think I’ll apply to [ob/gyn residency] programs in states where there are restrictions or bans on abortion,” said one of my third-years, who is already a valuable asset to our medical team.

If you drive away physicians with the threat of criminal charges when they don’t practice according to your personal beliefs, they will not come to your state.

Another casualty of ideological extremism? Women’s access to comprehensive reproductive healthcare.

Anti-abortion advocates will inevitably challenge me on this, but the anti-abortion “murder” argument is an egregious misrepresentation and oversimplification of healthcare decisions in which abortion is determined to be the best option for the patient. This position suggests that hordes of callous and irresponsible women will casually line up to dispose of infant children, given the opportunity. That is not happening. Nor is Texas’s misrepresentation of federal guidance on emergency abortions and EMTALA happening: that the guidelines strive to turn emergency departments into abortion clinics.

What is happening is that a group of politicians are dictating medical care without medical training, and endangering women’s lives. These decisions are tantamount to enforcing decidedly inferior medical care that disproportionately harms women, prioritizing personal belief over evidence-based medicine, and in my view, effectively codifying misogyny into standard of care. This most recent decision by the Fifth Circuit, which allows the denial of an emergency abortion to a critically ill and unstable pregnant patient, highlights the chilling truth that the life of the mother is not, in fact, a priority in the eyes of the law.

For a group that professes to value life, the politicians and courts of Texas are certainly demonstrating otherwise, with unyielding dedication to preserving a black-and-white ideology and enforcing it without nuance or compassion, without firm grounding in scientific evidence, and even at the expense of women’s lives.

I would lose my job very quickly if I practiced medicine this way.

If politicians wish to play doctor, we should hold them to the same standard. The situation has become dire for too many innocent people.

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Over the 12+ yrs I have been working on my blog, I can’t count the total number of times that those in the chronic pain community have been told to contact their representatives in the Senate and House. Rep Goldman was way out of line demeaning this Angel Mom. It has also been reported that Mayorkas – who was the subject of this impeachment, was a no-show to the hearing.  Mayorkas is our Secretary of Homeland Security and who has repeatedly testified before Congress that our southern border is secure. Since the start of the Federal Fiscal Year 10/01/2021, we have documented abt EIGHT MILLION illegal immigrants coming into our country https://www.cbp.gov/newsroom/stats/nationwide-encounters

Dem Tells Mother Of Fentanyl Victim She Lacks Ability Speak On Mayorkas Impeachment

https://americanliberty.news/defense-news/dem-tells-mother-of-fentanyl-victim-she-lacks-ability-speak-on-mayorkas-impeachment/phouck/2024/01/

Rep. Dan Goldman (D-N.Y.) told a mother who lost her daughter to the fentanyl crisis that she lacked the background to speak at an impeachment hearing for Department of Homeland Security (DHS) Secretary Alejandro Mayorkas.

And that Republicans were using her.

From Fox News:

Goldman’s remarks to Josephine Dunn, whose 26-year-old daughter Ashley lost her life to fentanyl-laced pills, came during the committee’s hearing titled “Voices for the Victims: The Heartbreaking Reality of the Mayorkas Border Crisis.”

Dunn had been invited by Republicans to take part in the hearing and share the story of how she lost her daughter to fentanyl as Congress continues on with the impeachment proceedings against Department of Homeland Security Secretary Alejandro Mayorkas.

Expressing his “sincere condolences” to Dunn for the loss of her daughter, Goldman said that he wanted to “apologize in some ways” to Dunn because she was “being used as a fact witness for an impeachment investigation.”

“Obviously, given what your experience has been, you don’t have the background to understand what a high crime and misdemeanor is and how it relates to this,” he added in his remarks to Dunn.

Goldman’s attempt at diplomacy failed to impress Dunn. She told the Daily Caller that the Manhattan Democrat is “unaware about what my understanding, about what my education, what my experience is in any of those areas when it comes to misdemeanors or high crimes.”

“I have my opinions, and for him to assume that I want to just put more money into a system that has had plenty of money placed into it and is still broken is incorrect. Please don’t think for me. I have a brain, I can think and speak for myself,” she remarked.

As Goldman kept questioning Dunn, the pair became visibly frustrated.

“You would agree, would you not, that it would help to stop the fentanyl trade and fentanyl trafficking from coming into this country if we had more law enforcement officers at the border and more resources and technology to stop the fentanyl from coming in?” he pointedly asked Dunn. “Do you agree with that?”

Dunn snapped at the congressman, retorting “Border Patrol is now being used to make sandwiches and to screen people and let them into our country. So I disagree with you.”

“I would like the Border Patrol to be able to do the job that they were hired to do,” she continued. “Every Border Patrol officer that I have spoken to has told me that their hands are tied by this administration and Mr. Mayorkas. I’ve been to the border, sir, have you?”

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This news report was from – according to YouTube, TWO YEARS AGO. I wonder how many prescribers have been “taken out” by our DEA & judicial system in that time frame this video and that judge’s ruling has been out there. I vaguely remember the trial, I believe that it was in CALF and the “expert witness” for the prosecutor, stated that 25% of pts who took an opioid would become addicted. The judge corrected the witness – on the stand – that the percentage was only 5%. Depending on which study you wish to believe, the real rate is between 0.6% – 2%. In the end, our DEA/DOJ has been using the war on drugs to deny 98+% of pts that have a medical necessity for a controlled med, to ATTEMPT <2% of our population from becoming addicted.

The DEA started escalating the war on drugs after the Decade of Pain Law expired in 2010, when the CDC was reporting about 12,000 OD deaths from ALL DRUG OVERDOSES. I expect the OD/poisoning numbers to be > 100,000 for 2023. The vast majority are from illegal drugs from China and Mex cartels. Could that be considered an ABSOLUTE FAILURE by the DEA/DOJ?

That trial against J&J, was because J&J was the WHOLESALER to the entire pharma industry of RAW OPIOID PRODUCTS. They produced no patient-ready finished opioid product, nor marketed a finished opioid product to prescribers.

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42 USC 1395: Prohibition against any Federal interference

https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)

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I find it interesting the statements made by attorneys that CVS hires to defend lawsuits or actions against the chain. This case is just another example:  Kristina Dahmann, an attorney for CVS, she pointed out that the state requires no minimum level of staffing at pharmacies, and that weeks-long backups filling prescriptions don’t necessarily mean that patients are waiting that long for their medicine. “Numbers alone don’t tell the story,” she said.

She obviously did not make any claims about pts going without their medications, because of the number of days of unfilled Rxs in the queue where up to an average number of Rxs a store would fill.  I was at an FL BOP meeting in mid-June 2015, where they were discussing a new regulation that would mandate that pharmacists NOT start looking for a reason not to fill a controlled med, when handed a new Rx. Part of the new regulation was to mandate each FL-licensed pharmacist would have to have 2 continued education hrs every 2 hrs. At the end of the meeting, the BOP’s attorney was caught on a “hot mike” moment saying, “We are going to teach Pharmacists COMMON SENSE.”  Personally, I never figured that common sense was something that could be taught. Maybe pts who are patronizing CVS to have Rxs filled might want to consider their options. Here is a hyperlink https://ncpa.org/pharmacy-locator  to find an independent pharmacy, where pts will be dealing with the Pharmacist/Owner, who generally focuses on the pt’s health, rather than how many $$ they can get out of the pt,

Ohio Attorney General asks that CVS store be put on probation “for a period of years”

Understaffing found at Canton pharmacy appears to be widespread

https://ohiocapitaljournal.com/2024/01/16/ohio-attorney-general-asks-that-cvs-store-be-put-on-probation-for-a-period-of-years/

A deputy attorney general working for the Ohio Board of Pharmacy on Thursday recommended that the board fine CVS and place a store it operates in Canton on probation for “a period of years” after inspectors in 2021 found risks to patient safety due to understaffing.

Attorneys for CVS blamed the problems on the coronavirus pandemic. But the board of pharmacy inspectors found similar problems at a dozen other CVS stores in Ohio — some occurring as recently as last year. 

Problems have also been reported at CVS stores in other states. They raise questions about whether they’re due, as CVS contends, to a shrinking labor pool and increasing demands, or whether they’re the product of relentless cost cutting and consolidation by the company.

When Board of Pharmacy inspectors visited Canton store No. 2063 on Sept. 13, 2021, they found a pharmacy so understaffed that the inside counter was closed, the phone wasn’t working and the line of cars to the dive-through snaked around the side of the building. Stock — including controlled substances — hadn’t been shelved. The staff was so harried that it took inspectors 20 minutes to get somebody’s attention, according to the report, which CVS hasn’t disputed.

Inspectors found that it took almost two weeks for the overwhelmed pharmacy to fill many prescriptions. And on a follow-up call a month later, they were told the backlog for some was a full month.

During that period, the pharmacy also filled a prescription with the wrong medication. The patient was supposed to receive a statin to control cholesterol, but instead got the hypnotic sleep drug commonly known as ambien. Fortunately, the mistake was detected before that person took the medication and went for a drive.

Thursday’s hearing was a continuation of one that began in November, and the pharmacy board isn’t expected to make its decision until next month, when it will also take up allegations against another Ohio CVS store. But the penalties it can impose range from a small fine to revocation of the store’s license — and that decision could indicate how hard a line it will take in subsequent proceedings.

The hearings come after the pharmacy board in July released citations against eight CVS pharmacies in response to a records request from the Capital Journal. The board subsequently released citations against five others. They detailed problems similar to some of those alleged at the Canton store — and some revealed losses of controlled substances such as opioids.

On Thursday, lawyers for CVS put on testimony from Dennis McAllister, an expert witness who has worked as a pharmacist in many roles and who served for decades on the Arizona State Board of Pharmacy. 

He said that after viewing some of the earlier hearings and reviewing the inspection reports, he believed the problems suffered at the CVS store in Canton were severe, but they were emblematic of what was happening in the industry nationwide. 

The number of pharmacists and pharmacy technicians had been going down for a decade. Then COVID hit, making workers reluctant to work on the frontlines just as the workload spiked with pharmacies giving covid tests and administering vaccines, McAllister said.

“The industry in general wasn’t able to do stuff in time,” he said.

McAllister praised the hard work of the employees at the Canton store and credited it with quickly fixing problems inspectors found there. But CVS might have something to do with the diminishing pay and more-harried working conditions that have beset the industry, likely leading to the diminishing number of students entering pharmacy school. 

The chain increased the number of pharmacies it owns from 5,474 in 2005 to 9,939 in 2021, according to the German data-gathering firm Statista. Much of that has been from aggressive acquisition of competing pharmacies, closing them and moving their prescriptions to an existing CVS store.

In Thursday’s hearing, board member Tod J. Grimm pointed out that the Canton CVS absorbed the prescriptions of two other pharmacies, but only increased pharmacists’ hours there by two per week.

And at least after the worst of the pandemic, CVS employees said that understaffing CVS stores wasn’t due to a labor shortage, it was a choice.

“Understaffing is pretty deliberate from our upper and middle management,” Iggy Aleksick, a pharmacy technician at a CVS in Bowling Green told the Capital Journal in August, explaining that management wouldn’t OK additional hours even though workers were available.

And while McAllister made much of the burden created at the Canton store by giving covid and flu vaccines, CVS employees said the company relentlessly pushes the services because they’re a source of revenue. Simon Souhrada, a technician at the CVS in Mount Vernon until last June, said it was frustrating to be ordered to make phone calls as the prescription backlog there grew.

“It was all calling people, trying to sell them on vaccines and we would get daily emails demanding that we go faster and faster on these things while the queue (of unfilled prescriptions) was piling up and there was no one to fill it,” he said. “She just focused on all the wrong things and didn’t do anything to help.”

Kristina Dahmann, an attorney for CVS, has relentlessly tried to keep the focus in the hearing on the fact that the problems at the Canton store arose at the height of the pandemic.

In her closing statement, she pointed out that the state requires no minimum level of staffing at pharmacies, and that weeks-long backups filling prescriptions don’t necessarily mean that patients are waiting that long for their medicine.

“Numbers alone don’t tell the story,” she said.

But in their questioning of McAllister, the expert witness, members of the pharmacy board seemed skeptical of claims that the problems inspectors found at the Canton CVS were typical of pharmacies everywhere. All but one are pharmacists themselves, and independent pharmacists have said that while the pandemic was challenging, it didn’t lead to anything like the delays or chaos that the Board of Pharmacy found at numerous CVS stores.

It’s also unclear whether, as they assess the evidence of what happened at the Canton CVS in late 2021, the board will view it in isolation. While Dahmann insisted that problems there were due to the exigencies of the pandemic, board inspectors continue to allege dangerous conditions due to understaffing at Ohio CVS stores. 

In November, inspectors cited three stores for violations in 2023, including six-day backlogs filling prescriptions, dirty conditions and losses of hundreds of doses of the painkiller tramadol.

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CHIEF JUSTICE JOHN ROBERTS

AUSA WAYNE PRATT

DRUG ENFORCEMENT AGENCY (DEA) ARMED WITH BADGES, GUNS, AND PROFOUND STUPIDITY NEEDS CONGRESSIONAL REFORM OR BE DISBANDED (updated Repub, Part-1) :ETIOLOGY OF PAIN CARE TULSAFICATION

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