IF you can’t read… right mouse click on image and chose “view image” to enlarge
Filed under: General Problems | 14 Comments »
Did your health plan deny you care? You can fight back. Here’s how
Posted on July 6, 2019 by Pharmaciststeve
Did your health plan deny you care? You can fight back. Here’s how
https://www.latimes.com/business/la-fi-health-plan-coverage-appeal-20190705-story.html
Have you ever stepped up to the pharmacy cash register only to learn your new prescription will cost you hundreds of dollars — instead of your typical $25 co-pay — because your insurance doesn’t cover it? Or received a painfully high bill for a medical test because your health plan didn’t think it was necessary?
Most people have, but only a tiny fraction ever appeal such decisions. In 2017, for example, enrollees in federally run Affordable Care Act marketplace plans appealed fewer than one half of 1% of denied medical claims, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)
If you do appeal, your chance of getting the health plan’s decision overturned is a lot better than you might think. “About half of appeals go in favor of the consumer,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a healthcare consumer advocacy group.
There’s no sugarcoating it, though: Getting to “yes” with your health plan can be an ordeal, and you may need help from friends, family members, your doctor, insurance counselors, even legal aid societies.
In California, health plans are supposed to help facilitate the appeals process. When they deny coverage, they must inform members in writing how to appeal. And when they receive enrollee complaints, they are required to acknowledge them formally, which sets the clock ticking on a series of steps to resolve the dispute.
Unfortunately, insurers don’t always comply with these requirements.
Last month, the Department of Managed Health Care fined Anthem Blue Cross $2.8 million in a settlement covering more than 200 grievance and appeal violations. In some cases, Anthem classified grievances as “inquiries,” which means many enrollees did not get important information about their appeal rights, says Shelley Rouillard, the department’s director.
Mike Bowman, an Anthem Blue Cross spokesman, says the company “is making significant changes in our grievance and appeals process.”
Rouillard says Anthem has had more grievance and appeal violations than other insurers, but “this happens with all the plans.”
Regardless of the type of insurance you have, you can do several things to strengthen your position even before you file an appeal.
Get organized
You will need up-to-date medical records, as well as all communications with your doctor and health plan and any other paperwork that might bolster your case.
“Don’t do anything over the phone. Do everything in writing. You need a paper trail,” says Maria Binchet, offering her hard-earned wisdom from the trenches.
Binchet, a resident of Napa County, has a rare, disabling illness called myalgic encephalomyelitis/chronic fatigue syndrome. Because none of the doctors in her Medicare HMO network has expertise in the disease, she says, she has requested referrals to outside specialists on numerous occasions over the past 22 years, been turned down each time and appealed nine times. After one of those appeals, the health plan allowed her a single visit to a specialist — but he wasn’t taking new patients.
“You have to be persistent and resilient,” she says.
Binchet also advises that you request from customer services the unredacted notes of the health plan’s internal discussion about your case. The notes can help you determine how extensively your case was considered, who made the decision and whether that person was medically qualified to do so.
A letter or phone call from your doctor to the health plan can provide valuable support. “It’s important that you get someone involved who can talk about the medical evidence, because that’s what this is really about,” Fish-Parcham says.
Clock is ticking
When your paperwork is ready, you must appeal first to your health plan. For most private plans, your deadline for filing the appeal will be 180 days after care is denied. The insurer then faces a deadline — usually 30 days — to render its decision. If it upholds its initial decision or doesn’t meet the deadline, you can take the matter to the agency that regulates the plan within 180 days. If your health is in imminent danger, you can generally get an answer in a matter of days rather than weeks.
Unfortunately, different plans have different regulators, with varying appeal procedures. If you don’t know who regulates your health plan, call customer services and ask.
A large majority of Californians have policies regulated by the Department of Managed Health Care, but millions of others are in plans regulated by other state agencies, such as the California Department of Insurance or the federal government.
A good place to start is the Department of Managed Health Care (888-466-2219 or HealthHelp.ca.gov). Even if it is not your regulator, it can direct you to the right place, Rouillard says.
If you are one of the 26 million Californians in plans regulated by the department, you can request a free review of your case by outside medical experts if your appeal to the health plan failed or was not answered by the deadline.
These independent medical reviews are for cases in which a health plan doesn’t think a type of treatment is medically necessary or refuses to cover it because it is experimental — or won’t pay for emergency medical services after the fact.
An archive on the department’s website allows you to search past decisions for cases like yours. The summary language in those decisions might help you frame your arguments.
You can also request an independent medical review through the California Department of Insurance (800-927-4357).
If you are one of the 5.5 million Californians in a federally regulated employer plan, your regulator is the U.S. Department of Labor’s Employee Benefits Security Administration (866-444-3272 or www.askebsa.dol.gov).
Help is available
As you wade through this process, there are organizations that can help.
One of them is the Health Consumer Alliance (888-804-3536 or www.healthconsumer.org), which can assist people in public and private health plans. It offers free advice, can help you get your documents in order and provides legal services.
Medicare enrollees can get free assistance from the Health Insurance Counseling and Advocacy Program (800-434-0222 or cahealthadvocates.org/hicap/).
Bernard J. Wolfson writes for Kaiser Health News, an editorially independent publication of the Kaiser Family Foundation.
As is pointed out in this article, even if the insurance company is mandated by law to tell you about how to appeal a denial…they may not tell you…
Remember that most all insurance companies are PUBLICLY TRADED FOR PROFIT COMPANIES and the most profitable thing for them to do is JUST SAY NO TO YOUR CLAIM.
As is pointed out in this article .. the vast majority of pts will just take the NO AS A ABSOLUTE FACT…
In those states where they are not required to notifying pts that there is an appeal process… all are obligated to provide you the appeal process – IN WRITING – IF YOU ASK ! Follow the appeal process – especially the timetable(s) – TO THE LETTER.
As is pointed out in this article – if you appeal – you have abt 50% chance of getting your claim APPROVED.
Personally, I have never lost an appeal with an insurance company… I consider tenacity a VIRTUE when taking on a denial of coverage by an insurance company. Now that Barb and I are both entitled to Medicare because of AGE… my tenacity has been emboldened … they can’t cancel our policy, they can’t raise our premiums nor retaliate because of my tenacity.
Here is something that Barb bought for me when we had the pharmacy and it was on my office desk then and to this day it is still in my home office. When we had the pharmacy the phrase that I routinely used when I got tired of discussing something – with an employee & even Barb, that I wanted done…. was “HUMOR ME… do it my way !”
Filed under: General Problems | Leave a Comment »
When POLITICIANS don’t know their “APPLES” from their “ORANGES”
Posted on July 6, 2019 by Pharmaciststeve
Trump Suggests Executive Order on Drug Prices, With a Scope That Is Unclear
https://www.nytimes.com/2019/07/05/upshot/trump-drug-prices-executive-order.html
www.nytimes.com/2019/07/05/upshot/trump-drug-prices-executive-order.html
He may be talking about a pilot program that would apply to only a small subset of drugs.
President Trump said Friday that the White House was writing an executive order to require pharmaceutical companies to offer the United States government among the lowest prices in the world, in comments that were not immediately clear to many experts on the country’s health care system.
“We’re working on a favored-nation clause, where we pay whatever the lowest nation’s price is,” Mr. Trump said to reporters Friday, specifying that an “executive order” was in the works. “Why should other nations like Canada — why should other nations pay much less than us? They’ve taken advantage of the system for a long time, pharma.”
The White House has made the high costs of prescription drugs a policy priority, and the Department of Health and Human Services has proposed a series of measures meant to help address that. But until today there had been no public mention of a broad executive order.
The administration is working on a plan that would use an index of international drug prices to set the price that Medicare pays for some drugs that are administered by doctors, such as cancer treatments. Last year, Mr. Trump used the phrase “favored-nation clauses” to describe that proposal, which would base the Medicare price on prices from more than a dozen countries, including Canada, Britain, Japan and Slovakia.
The price index idea, which the pharmaceutical industry and many medical providers have vigorously opposed, is still under review from the Office of Management and Budget and may begin as a five-year pilot program next year. But it would apply to only a small subset of the drug market, and would not affect the prices paid for more typical prescription drugs that are sold at retail pharmacies. An executive order on drug prices would most likely have no force of law on its own, but could direct the Department of Health and Human Services to pursue or expand this approach.
Outside of the doctor’s office or hospital, the federal government does not buy many medications itself. Under current law, Medicare’s main prescription drug program farms out its drug purchasing to private insurance companies, and is barred from negotiating with drugmakers directly. The federal government does buy drugs for some populations, including veterans and federal prisoners, but they represent only a small fraction of the nation’s drug market.
“The frustration that the U.S. pays much higher prices for drugs has been a persistent theme of this administration,” said Peter Bach, the director of the Memorial Sloan Kettering Center for Health Policy and Outcomes, in an email. “We will have to see what is ordered to understand what could actually be implemented by executive order. The scope will have to be pretty limited in that the government itself does very little purchasing of drugs. It is all done through intermediaries that we pay for the service.”
The Department of Health and Human Services published a white paper of possible drug pricing policies last year, and has begun rolling out regulations to help enact portions of it. Congress is also seriously considering a handful of measures related to drug pricing, some of which may become law this year.
A bill introduced by Senator Rick Scott, a Republican from Florida, has not advanced to a committee hearing, but comes the closest to what the president described Friday. Mr. Scott’s bill would link a drug’s approval by the Food and Drug Administration to a requirement that the drug’s retail list price in the United States be no higher than the lowest price charged in Canada, France, Britain, Japan or Germany.
Prices for major pharmaceutical stocks fell slightly just after the president’s remarks, but largely recovered by the market close. A policy that would substantially reduce the prices paid for drugs in the United States would have large effects on those companies’ earnings.
The White House press office said it had no comment on the president’s remarks. Riley Althouse, a spokeswoman for the Department of Health and Human Services, said both the president and the H.H.S. secretary Alex M. Azar II were “both firmly committed to pursuing any and every solution — including importation and most favored-nation policies — that will deliver real results and keep American patients safe.”
Trump and many other politicians seem to not know the difference between the other countries “APPLES” and our “ORANGES”.. yes the other countries have lower medication prices. But they don’t have layers of publicly traded FOR PROFIT companies between the Pharmas’ and the pt or whoever is paying the final bill for the medication.
We have the Insurance company, the PBM and there is a 4th party that negotiates the discounts/rebates/kickbacks from the pharmas on behalf of the PBM’s – There is a post about this company .. somewhere on my blog.. but can’t find it out of the nearly 8000 posts on my blog..
The Veterans Administration is a good example of how these other countries function… the VA purchases medications on a bid basis with the Pharmas. There are no for profit middlemen in the distribution system between the Pharmas’ and the VA.. Some products are purchased via wholesalers but that industry works on a 5%-6% gross profit margin.
Some have stated that the insurance/PBM for profit industry and their infrastructure costs and net profits accounts for up to 50% of the cost the pt ends up paying. When you consider that we fill abt 4 BILLION prescriptions at abt a average consumer price of $60 ..that is 120 BILLION that the insurance industry “sucks off” our healthcare system out of just the medication part of healthcare which is just 12% of our total healthcare bill – abt $10,000.00 per person.
If one looks back to the day when there was no PBM and most all insurance companies were not for profit mutual companies and most everything was brand name medications… before 1970 and apply the COLA/CPI for all those years… the average price would expected to be in the $30 range.. but now we have 80%-90% generics which is suppose to SAVE MONEY.. One would expect that the average Rx price would be in the 20’s. But that is not our reality today.
Actually the FEDS are the ones that started all of this discount/rebates/kickbacks back in the 70’s. The politicians decided that since Medicaid was such a large purchasers of medication that they deserved a “discount/rebate/kickback” from the pharmas’. As I remember… it was a fairly modest amount 5%-10% from the brand name pharmas.
Of course, the brand name pharmas started raising their prices to compensate for the money that they had to “give back” to Medicaid. Then Congress decided to “change the rules” to help more generics to come to the marketplace and pharmacies were reimbursed by PBM’s/Medicaid on price based on AWP (Average Wholesale Cost) plus a dispensing fee … typically, back then, $2-$3 dollars per Rx.
There was a lot of “game playing” with the publish AWP… pharmacies were able to purchase generics much below the published AWP, but they billed the PBM’s based on the published AWP.
Once again, Congress had to address the perceived problems in how much Medicaid was being charge for medications… so they created MAC’s (Maximum Allowable Cost) on the most popular generics… this replaced the industry standard of AWP for generics for pharmacies to bill from. Of course, pharmacies … to protect their profit margins… only purchased a particular generic from the company that had the lowest price under the MAC price.
If Trump/politicians/bureaucrats believe that our system can function with the prices that other countries are functioning on without changing the inherent cost/profit structure of our system… someone is going to be hurt… it could be those employed by the insurance/PBM industry, it could be the community pharmacy system, it could be pts.
The insurance industry has one of the largest “pots of money” for lobbying, and they are not going to take cuts to their profits laying down. After all it was this industry that convinced Congress to turn the entire Part D & Medicare Advantage program over to private insurance industry and prohibited negotiating Rx medication prices.
Filed under: General Problems | 2 Comments »
It’s OKAY
Posted on July 6, 2019 by Pharmaciststeve
It’s OKAY !!!
Filed under: General Problems | 2 Comments »
Arsenic found in bottled water sold at Target, Walmart
Posted on July 5, 2019 by Pharmaciststeve
Arsenic found in bottled water sold at Target, Walmart
ATLANTA, Ga. (CBS46) — High levels of a potentially poisonous chemical have been found in certain brands of bottled water sold at Target, Walmart and Whole Foods stores.Well for avoiding hazardous or poisonous water there are many water purifier.There are water softener reviews as well which can give clear idea about them.
According to USA Today, tests conducted by the California Center for Environmental Health found high levels of arsenic in Penafiel, owned by Keurig Dr. Pepper and Starkey, owned by Whole Foods.
Back in April, an article in Consumer Reports said the Food and Drug Administration had known about the high arsenic levels in Penafiel since at least 2013.
Consumer Reports updated their story on May 3, reporting the FDA had still not issued a recall for the product.
On June 18, the Center for Environmental Health announced their independent testing found high levels of arsenic.
In some cases, arsenic can cause cancer and organ damage.
So far, the water has not been recalled.
Filed under: General Problems | 2 Comments »
Kansas patients can finally win big in doctor malpractice suits. But at what cost?
Posted on July 5, 2019 by Pharmaciststeve
Brenda Lundeen went in for routine surgery to relieve heavy periods.
What the Overland Park mom and grade school teacher got was a nightmare, as a medical mistake caused 194-degree water to pour through a hole in her uterus and scald her insides.
After three surgeries to remove parts of her burnt colon and intestines, months defecating into a colostomy bag and years of trauma, a jury awarded Lundeen $2 million in a medical malpractice lawsuit for noneconomic damages, commonly called “pain and suffering.”
That number was immediately knocked down to $250,000 — the maximum allowed under Kansas law at the time.
“I have felt since this began that I should try to speak up against the cap,” Lundeen said. “Not for me, but for all the people whose cases are way worse than mine.”
That cap on noneconomic damages is now gone — struck down in a Kansas Supreme Court ruling last month.
Doctors say that ruling will open the floodgates to high-dollar lawsuits that will drive up the cost of care for everyone. But patients like Lundeen and plaintiffs’ attorneys say Kansas doctors have for too long been shielded from responsibility for mistakes that cause a lifetime of suffering.
Both sides agree: It’s a new ballgame after the court’s decision in Hilburn v. Enerpipe.
“I think it definitely changes the landscape for any pending cases or any future cases,” said Michael Rader, a personal injury lawyer in Leawood.
In the past, Kansas lawyers often wouldn’t even take on medical malpractice claims, Rader said, because unless there were extensive economic damages (countable costs like lost wages and medical bills) the cost of going to trial might exceed the amount they could recoup if they won.
But now anybody who has gone to a lawyer and been turned down for that reason should go back and ask again, Rader said.
Lundeen said she spent two years looking for an attorney who would take her case, and that lawyer, Mike Hodges, warned her that it wouldn’t bring a financial windfall.
“We did not go into it obviously for the money, because we knew there wasn’t going to be any,” Lundeen said. “I really just wanted to not have another woman go through went I went through.”
Lundeen’s story
Lundeen had her surgery in 2010, on her 40th birthday. An endometrial ablation, in which a layer of the uterus is removed, can be done several ways, and Lundeen said she didn’t think her doctor fully explained the risks of the hydrothermal route.
When her uterus was perforated and the super-heated water flowed into her abdominal cavity, she said she woke up at the surgical center in indescribable pain and was taken by ambulance to the neighboring Menorah Medical Center.
Her doctor was supposed to follow her there immediately, but according to the lawsuit didn’t show up for three hours. The hydrothermal ablation machine used in her procedure was later determined to have disappeared.
The next day she had surgery to remove 6 to 8 inches of her burned colon and appendix. It wasn’t enough. She got a serious infection and five days later was back in surgery. This time she had 21 inches of intestine removed and the colostomy bag installed.
Lundeen lived with the bag for 11 months, going back to work in her classroom and trying to ignore the odor that would sometimes waft out of the bag. Other times the bag of feces was impossible to ignore.
“I had what they call ‘blowouts’ where it would completely detach from me and I would have to rush home (to change clothes),” she said.
Finally, she went to the Mayo Clinic for a last-ditch surgery to try to reconnect her bowels — a procedure she said even the staff at Mayo wasn’t sure would work.
It did, and she no longer needed the colostomy bag. But she will have to take several medications for the rest of her life, including one for ongoing nerve pain, and she has had to cut dairy products completely out of her diet and and can tolerate only small amounts of red meat or fried foods.
It was a grueling journey that she had to relive when her lawsuit went to trial. The verdict in 2015 was a huge relief.
“It was disbelief, really, that A: we got the verdict in our favor and, B: to hear what the jury awarded us,” Lundeen said. “Obviously I knew we weren’t getting that, but just the fact that that amount validated all the pain and suffering and everything we’d gone through. I have the physical ailments, but my husband, my girls my parents, they all were affected.”
The Supreme Court
Kansas legislators passed the $250,000 cap on noneconomic damages in 1986. It initially applied only to medical malpractice cases — the idea being that the state could better recruit and retain doctors if they knew their legal liability was limited.
The courts quickly ruled that the cap couldn’t apply only to that small subset of cases, though, and in 1988 the Kansas Legislature expanded it to all personal injury cases.
The cap stayed at $250,000 for decades, even after inflation cut the actual buying power of that amount of money by more than half.
From the beginning, plaintiffs’ attorneys argued that it was unfair.
It was first challenged just four years after it became law, by a Fort Riley soldier paralyzed in a head-on crash caused by a semi-truck driver. The court upheld the cap but said it had concerns that it discriminated against those most severely injured.
In 2012 the state’s highest court handed down another verdict in a challenge brought by a woman whose doctor had removed the wrong ovary, rendering her infertile later when the ovary that was actually causing her pain also had to be removed. A lower-court jury had awarded her $575,000 in noneconomic damages, which the cap cut by more than half.
By a 5-2 decision, the justices upheld the cap again, but expressed concern that it hadn’t been raised since it was enacted.
That led the Legislature to embark on a multi-year effort to step it up slowly: to $300,000 by 2014, to $325,000 by 2018 and finally to $350,000 by 2022.
That didn’t sway the court when it took up the case of Diana Hilburn, another Kansan injured by a semi-truck driver. This time the justices ruled — by a 4-2 vote in June — that the cap was unconstitutional, that it violated Kansans’ rights to a jury trial.
The reaction
The ruling caught the entire business community by surprise, coming so quickly on the heels of the 2012 decision.
Health care providers were among the first to express concern.
Tom Bell, the president of the Kansas Hospital Association, wrote that the ruling “will undoubtedly create upward pressure on medical liability insurance rates, and it will certainly not help how Kansas is perceived during the recruitment of healthcare providers.”
The Kansas Medical Society, which represents doctors, said the state “has enjoyed a stable medical malpractice environment for many years” but that was about to change thanks to the “unfortunate and costly decision by the court.”
“The elimination of the caps on pain and suffering awards will soon translate into increased insurance premiums for physicians, hospitals and health care professionals which will ultimately be passed on to patients,” the group said in a statement released the same day the decision was published. “Health care is already a major part of every household and business budget and today’s decision will result in significantly higher liability costs for the health care system, which in turn will drive up health care costs already paid by Kansans.“
The two groups both said they were still analyzing the decision before deciding on next steps, which could include lobbying the Legislature to enact new caps that are structured differently, or pursuing an amendment to the state constitution (which would require two-thirds votes in the House and Senate, rather than simple majorities).
The full Legislature doesn’t return to Topeka until January, but legislative leaders have already taken note of the decision.
Senate Majority Leader Jim Denning, a Republican from Overland Park, said during a recent interim committee meeting that he heard that medical malpractice insurance rates went up 6% almost immediately after the decision was published.
Gov. Laura Kelly, a Democrat, has predicted it will be a major issue when lawmakers reconvene.
“I think it guarantees us a really exciting 2020 legislative session,” she told The Topeka Capital-Journal. A spokeswoman for her office declined to elaborate.
Kansas could explore other ways to structure a cap that have been upheld in other states. Missouri, for example, gives juries more leeway to take into account the severity of a case, with a cap of about $400,000 that can be increased to about $750,000 if the patient’s injuries are deemed “catastrophic.”
Other states peg their caps to inflation so they increase automatically. Or they lift the cap in cases where the medical practitioner was grossly negligent, committed fraud or intentionally harmed the patient.
The result
The impact the Hilburn decision will have on medical costs is hard to predict, but clues can be found in data from other states.
There are now 21 states (including Kansas) with no cap on noneconomic damages, according to the Center for Justice and Democracy at New York Law School.
In those states, the average annual cost of medical malpractice insurance is $10,445.57, according to Capson Physicians Insurance Company.
In the 29 states that have a cap, the average annual cost is $8,702.79.
But it’s an imperfect comparison because the caps vary widely from state to state (from $250,000 in California and Montana to more than $2 million in Nebraska) and because juries tend to be more generous in some states than others.
Rader, the personal injury lawyer, said Kansas juries tend to be more sympathetic to doctors.
“The juries are very conservative on medical malpractice cases,” Rader said.
That’s borne out in state data.
Only 14 medical malpractice cases went to jury trial in Kansas in the fiscal year that ended July 2017 (the most recent report available), and the jury found for the plaintiff in only two of them. In the previous year there were 13 medical malpractice jury trials in Kansas and the plaintiffs won only one.
Rader said other businesses, like trucking companies, are likely to be harder hit by the loss of the damages cap. But medical providers will still see their costs go up.
“Kansas doctors have been able to maintain the minimum amount of liability insurance because their exposure to damages in excess of coverage was slim,” thanks to the cap, Rader said. “Now that these doctors can be held accountable for their errors, they’re all under-insured now, no doubt about it. They’re going to have to purchase more insurance.”
The Kansas Supreme Court decision doesn’t apply retroactively, so people like Lundeen can’t go back and seek the full judgments juries awarded them.
But Lundeen said she’s glad others will have a chance to be made whole financially.
“My lawyers told me about cases with way worse physical ailments than mine that still only got the cap, and that is not fair. It’s not right,” Lundeen said. “They gave me examples of people who have become paraplegic, quadriplegic, and it’s just like a joke that they’re supposed to sustain themselves for their lives on that amount.
“I’m hoping this means that they’re going to be more pro-patient than pro-doctor. We all know people make mistakes, but when it uproots your life as you know it I think there needs to be responsibility taken so we can continue living life the best that we can.”
Includes reporting by Jonathan Shorman of the Wichita Eagle.
Filed under: General Problems | 4 Comments »
76-Year-Old Veteran Denied Care, Commits Suicide In VA Parking Lot
Posted on July 5, 2019 by Pharmaciststeve
www.tinyfeed.fun/76-year-old-veteran-denied-care-commits-suicide-in-va-parking-lot/
Some of our veterans gave their lives in defense of this country. It takes a very brave person to be willing to sacrifice themselves for their country.
Sadly, many veterans are not being treated very well by their country. The man you see in this photo is 76-year-old Peter A. Kaisen.
Kaisen served in the United States Navy from 1958 to 1962. He was standing outside the Northport Veterans Affairs Medical Center when he took his own life.
He was a recurring patient at the hospital but had been denied service.
Thomas Farley, Kaisen’s friend for 40 years, said Kaisen went there for help with depression.
Kaisen retired from the Navy and became a Long Beach Police Officer.
In the 1960s, he was in a car accident and was permanently disabled. Kaisen had gone to the ER for help and didn’t get any.
So, he went outside to his car and took his life. What kind of a hospital turns away someone who is asking for help with a mental illness?
Who dropped the ball? The hospital stated that Kaisen didn’t go to the ER for help.
Are we to believe that he just drove to the hospital and shot himself in the parking lot?
Kaisen’s family is hoping that by sharing this story, it brings awareness to how the VA is treating our veterans.
Something needs to change – now. The past several years has revealed that many VA hospitals are falling short in their treatment of veterans.
Filed under: General Problems | 7 Comments »
The FDA Safety Information and Adverse Event Reporting Program
Posted on July 5, 2019 by Pharmaciststeve
MedWatch – The FDA Safety Information and Adverse Event Reporting Program
A MedWatch Safety Alert was added to the FDA Recalls webpage.
TOPIC: Multiple Ophthalmic Products by Altaire Pharmaceuticals Sold at Walgreens Stores: Recall – Due to Potential for Non-sterility
AUDIENCE: Consumer, Health Professional, Risk Manager, Pharmacy
ISSUE: Altaire Pharmaceuticals, Inc., announced on July 3, 2019 that it is voluntarily recalling the Over-the-Counter (OTC) drug products sold at Walgreens during the time period as indicated below:
• Lubricant Eye Drops Moisturizing Walgreens item #: 801483 NDC #: 0363-0185-13 Package Size: 15 mL. Lot Number 19095, Expiration Date: 04/21, Manufacturer Ship Date: 05/14/19.
• Lubricant Eye Drops Moisturizing Twin Pack Walgreens item #: 801477 NDC #: 0363-0185-49 Package Size: 2 x 15 mL. Lot Number 19095, Expiration Date: 04/21, Manufacturer Ship Date: 05/14/19.
• Sodium Chloride Ophthalmic Ointment, 5% Hypertonicity Eye Ointment Walgreens item #: 801482 NDC #: 0363-7500-50 Package Size: 3.5 gram. Lot Number TCI, Expiration Date: 03/21, Manufacturer Ship Date: 05/08/19.
• Sodium Chloride Ophthalmic Solution, 5% Hypertonicity Eye Drops Walgreens item #: 801402 NDC #: 0363-0193-13 Package Size: 15 mL. (Two Lot Numbers) (1) Lot Number 19105, Expiration Date: 04/22, Manufacturer Ship Date: 05/24/19 and (2) Lot Number 19050, Expiration Date: 02/22, Manufacturer Ship Date: 05/23/19.
• Lubricant Eye Ointment PF Soothing Walgreens item #: 801486 NDC #: 0363-0191-50 Package Size: 3.5 gram. Lot Number TBD, Expiration Date: 04/22, Manufacturer Ship Date: 05/24/19.
The products are manufactured and labeled exclusively for Walgreens. Altaire ships the products labeled for Walgreens only to Walgreens. The products are distributed at the retail level by Walgreens. Altaire has also requested that Walgreens notify its customers.
Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program:
• Complete and submit the report online.
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178.
Read Alert
Filed under: General Problems | 1 Comment »
The ADA requires the government to make “reasonable accommodations” to ensure people with disabilities have equal opportunities to access public services and benefits
Posted on July 5, 2019 by Pharmaciststeve
Urgent Care: How Attorneys Are Battling The Opioid Crisis
When recovering opioid addict Jacob was called into court in Clinton County, New York, for violating a restraining order, the judge told him he had 90 days to quit using his addiction medication, Suboxone.
Jacob, whose last name Law360 is withholding for privacy reasons, said he was “heartbroken” and afraid of possibly relapsing. But his court-appointed lawyer didn’t object, so he figured he had no choice but to get off the medication he had used to treat his opioid addiction for 13 years.
“When [the judge] told me that, I was just devastated. I didn’t even know what to do, because I know how hard it is to come off of them,” Jacob said. “I had a court-appointed lawyer, and he didn’t even care. So I figured I was done. I had to do it.”
But five attorneys working pro bono helped convince the judge to let Jacob stay on his medication — just one way in which attorneys and legal advocates around the country are stepping up to help people affected by opioid addiction.
One of Jacob’s attorneys, Sally Friedman, is among over 30 lawyers and advocates from across the country who have come together to work on an opioid task force convened by the Legal Services Corp., the federally funded nonprofit that distributes funds to over 130 independent nonprofit civil legal aid programs around the country.
The task force released a 53-page report on June 10, with a suite of recommendations about how legal aid providers and the judiciary can fight the opioid crisis by helping people with opioid use disorders tackle legal problems that interfere with recovery and by standing up for them when they do head to court.
“The change is far too slow, but there is change happening. I’m on numerous task forces that are seeking to educate the legal community and courts about this issue,” Friedman said. “That’s huge. I mean, none of that was happening three years ago even.”
The Power of Legal Aid
In Jacob’s case, it was essential for the court to understand that forcing someone off Suboxone “dramatically increases the chance of relapse and possibly death,” said Friedman, who is vice president of legal advocacy at the Legal Action Center, a nonprofit that fights discrimination against people with addiction, HIV/AIDS or criminal records.
Jacob and others with opioid use disorders face the unique challenge that some of the medications that are prescribed to treat their addiction use opioid-based compounds, drawing the ire of judges and employers.
Fighting a Crisis
This month, a task force convened by the Legal Services Corp. released a 53-page report with numerous recommendations for how legal aid providers and the judiciary can fight the opioid crisis. Here are some of those proposals.
Legal aid providers should develop medical-legal partnerships with health care providers.
- Legal aid providers should build other partnerships with local organizations that serve those affected by the opioid epidemic.
- Legal aid providers should obtain training on the science of opioid use disorders and recovery.
- LSC should work with legal ethics bodies and health law experts to develop policies and materials that address privacy and ethical issues related to helping clients impacted by the opioid crisis.
- Courts should consider expanding alternate court options to assist people with opioid use disorders.
- Correctional facilities should collaborate with civil legal aid attorneys to decrease obstacles facing people who are returning to society from incarceration.
Suboxone, for example, contains buprenorphine, a partial opioid agonist that binds to opioid receptors in the brain, preventing cravings and withdrawal syndromes without providing a full opioid effect, according to the National Alliance on Mental Illness.
Jacob, then 34 years old and the sole provider for an infant daughter, said he’d been taking his two Suboxone each morning to “live a normal life” and overcome an addiction to the opioid painkiller Percocet. That addiction started when he was prescribed the drug for roughly two years following an all-terrain vehicle accident in the early 2000s.
It’s an all too common story when it comes to the opioid epidemic burning across the country.
There were over 47,000 deaths related to opioid overdoses in 2017— two-thirds of all overdose deaths in the country, according to the Centers for Disease Control and Prevention. Over 2.1 million Americans had an opioid use disorder in 2016, according to the Substance Abuse and Mental Health Services Administration.
Regional legal aid providers have been making efforts to combat this epidemic through existing programs and new initiatives. The LSC’s task force was aimed at bringing the lessons learned through successful local efforts onto the national stage so they can be applied around the country.
One of the most prominent of these regional efforts has been the medical-legal partnerships pursued by civil legal aid nonprofit Indiana Legal Services, whose managing attorney, Jay Chaudhary, has become recognized as a national leader on the issue. Through these partnerships, attorneys are embedded with health care providers to help people fix various legal problems affecting their health.
“Civil legal aid in my view works best as a value-add to everything else, whether it’s mental health, health care, substance abuse treatment and recovery,” he said. “Legal aid is a necessary component, because barriers arise to whatever the end goal is, sobriety or living with recovery.”
A civil legal aid attorney can help someone keep their housing, reduce excessive child support obligations, negotiate a debt repayment plan, or get their driver’s license back so they can get back to work, Chaudhary said.
Even knowing how to craft a letter can make a difference in confronting the fallout from opioid addiction. Chaudhary recalled putting his writing skills to work to help convince a homeless shelter to take in people using opioid-based addiction medications like Suboxone.
For people who are trying to stay in recovery, homelessness can push them into relapse, but those who are evicted from their homes are unlikely to do the research to know if their eviction is legal, and don’t know how to fight it, Chaudhary said.
Most people with a substance abuse disorder, even when facing these issues, wouldn’t think to look to an attorney to help them in their recovery, said Brandon George, the director of the Indiana Addiction Issues Coalition.
As an addict in long-term recovery himself, George is painfully aware of that reality for many the coalition tries to assist.
When George stopped using heroin and crystal meth, he had an enormous amount of credit card debt, was behind on child support payments and had a suspended driver’s license, he said.
“I thought I was just bad with money and had baby mama issues,” he said. “I had no idea that these were legal issues. My brain just did not connect the dots.”
When George was first asked in his role as coalition director to work with Chaudhary in an addiction treatment training project at Indiana University, he was skeptical. He said he thought the attorney “stuck out like a sore thumb.”
Once the group began handling case studies, however, George said he instantly realized how useful legal aid could be, from helping support people in their housing and financial situations to helping sort out child custody issues.
George also touted the key role attorneys can play by helping people obtain felony conviction expungements. “People pay lifetime sentences socioeconomically because of felony convictions,” he said, which in turn can hinder recovery.
Now, George is working on connecting recovery organizations to civil legal aid attorneys nationwide, establishing a model where people coming in to the recovery organization can have their legal problems identified and receive a referral to an attorney, or learn when an attorney will be available on-site.
On the Front Lines
In providing these services, legal aid attorneys have a first-hand look at how the courts’ response to the opioid crisis can impact those struggling with addiction.
Friedman said she saw another client go through “tremendous” pain when, like Jacob, she was ordered to stop using medication-assisted treatment and began tapering down the dose.
“They just slog through their days not knowing if they’re going to end up in jail in two weeks, or relapse and overdose,” she said. “The human toll is devastating.”
As they did in Jacob’s case, lawyers are turning to the Americans with Disabilities Act to keep people with opioid dependency from being ordered off buprenorphine, according to Melissa Trent, an attorney with Brooklyn Defender Services and another onetime member of Jacob’s legal team. The ADA requires the government to make “reasonable accommodations” to ensure people with disabilities have equal opportunities to access public services and benefits.
“You can’t be denied participation in a probation program because you have a wheelchair,” she said. “People who have opioid addiction are people who have a disability under the Americans with Disabilities Act. … The argument is that the reasonable accommodation would be their medication-assisted treatment.”
Groups like the Legal Action Center are also working to spread awareness and best practices in other ways.
This means suing employers that fire employees for using medication to treat their opioid dependence, lobbying for laws like 2008’s Mental Health Parity and Addiction Equity Act, which requires insurers to designate funding for treatment services, and creating informational materials so that other attorneys know how to defend their clients’ right to stay on opioid-based medication, according to Friedman.
That theme of education runs through several of the recommendations in the recent LSC report. Among other proposals, the task force calls for the development of new medical-legal partnerships, getting specialized training to aid attorneys, increasing education about opioid use disorders in the courts and improving collaboration between state agencies and treatment providers.
Of course, funding remains a pressing need, according to Chaudhary, who said more diverse funding could help spread legal aid programs to drug courts and community recovery organizations.
Legislation known as the Support for Patients and Communities Act, which targets the opioid crisis and was signed into law in October, made many federal funding streams newly available to support civil legal aid, according to Stefanie Davis, assistant general counsel in the office of legal affairs at the LSC.
However, Davis added, “the funding that we are able to get even as it increases is not nearly enough to meet the need that exists for legal aid.”
That funding matters for people like Jacob, who says that without the pro bono legal help he received, he might have ended up relapsing or in jail, instead of raising a family.
“It saved my butt, I know that. It saved my life pretty much. Who knows what would have happened?” he said. “It’s a happy ending for sure.”
–Editing by Aaron Pelc.
Have a story idea for Access to Justice? Reach us at accesstojustice@law360.com.
Filed under: General Problems | 7 Comments »
national medical malpractice advocacy association
Posted on July 4, 2019 by Pharmaciststeve
national medical malpractice advocacy association
As an advocate for social justice, NMMAA empowers the community through education and activism. With active NMMAA patient advocates throughout the country, informed citizens organize and protest injustices, raise awareness, educate, inform, and build coalitions.
Filed under: General Problems | Leave a Comment »