Civil Rights Case Gives Hope to Pain Patients

https://www.painnewsnetwork.org/stories/2019/2/1/civil-rights-case-gives-hope-to-pain-patients

Selma Medical refused to schedule a new patient appointment for a man who was taking the addiction treatment drug Suboxone. He filed a civil rights complaint asserting that his rights were violated because has a disability.

According to the complaint, Selma Medical “regularly turns away prospective new patients who are treated with narcotic controlled substances such as Suboxone.”

The DOJ and Selma Medical settled the complaint out-of-court. The full agreement can be read here.

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Jan. 31, 2019 – 2:00 – Investigation by the California State Board of Pharmacy finds that a Walgreens employee in the Bay Area who worked as a pharmacist for nearly 11 years and wrote 745,00 prescriptions never had a license

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Pharmacies can make deadly mistakes while keeping the public in the dark

http://www.weny.com/story/39891507/pharmacies-can-make-deadly-mistakes-while-keeping-the-public-in-the-dark

Ohio (WEWS) — A secret crisis is unfolding inside pharmacies in the state and across the country. The struggle to fill an increasing number of prescriptions has fueled growing concerns over harmful and sometimes deadly prescription mistakes.

But Ohio pharmacies and others nationwide can make these mistakes and the public can be kept in the dark, a 5 On Your Side investigation has found, because they are not required to report these errors to state regulators.

Our findingsState regulators do not maintain comprehensive data on how many people have been harmed or killed as a result of prescription mistakes made by pharmacies.

In an effort to piece together how often these mistakes occur, our team reviewed four years of Ohio Pharmacy Board minutes, court dockets and autopsy reports.

We found there have been at least 491 complaints — filed largely be consumers involving prescription mistakes. In addition, we uncovered two people were killed and 31 people were harmed as a result of being given the wrong medication at local pharmacies across the state.

Alarmingly, industry experts are convinced those numbers are likely much higher. Our investigation found no one is certain just how many are harmed because pharmacies in Ohio are not required to report those complaints.

‘Try your best not to kill anyone’At the same time, demand and workload for Ohio’s 20,349 pharmacists and 20,649 pharmacy technicians is growing, according to Ohio Pharmacy Board records.

The Ohio Pharmacists Association , which represents pharmacists and pharmacy technicians, is concerned that 150 local pharmacies have closed their doors and small pharmacies are being bought out by large chains that the association believes fail to adequately staff pharmacies.

“It’s fill as fast as you can — try your best not to kill anyone,” said Antonio Ciaccia, the association’s Director of Government and Public Affairs.

Our investigation found heartbreaking and tragic mistakes:

Michael James Carmack was just 25 years old when he died in April of 2015 as a result of being given the wrong medication at his local pharmacy, according to the lawsuit that was settled and dismissed, as well as pharmacy board disciplinary reports . Court records reveal Carmack “ingested the wrong medication,” and an autopsy report confirmed “the pills in the prescription bottle did not match the prescription on the prescription label.” The pharmacist “neither admits nor denies the allegations,” according to the disciplinary records. However the pharmacy board said it has “evidence sufficient to sustain the allegations” and levied a $3,000 fine that the pharmacist agreed to pay.

In another case, a lawsuit alleged that 68-year-old Johnny Shepherd died as a “result of pharmacy negligence” after dispensing medication that was “mislabeled.” His wife Molly Shepherd is convinced “the medication killed him.”

“I loved him, and he loved me,” Shepherd said. “[His death] caused me to be miserable, living by myself.”

Tabatha Gonzalez said she was five months pregnant when she discovered she had been taking prescription medicine belonging to someone else. But fortunately, it turned out to be the identical medication and dosage. Even so, she remembers worrying, “Is my baby going to be OK?” she said.

The mother of a now 20-year-old remembers how a pharmacy mistake hospitalized her son when he was just 5 years old. Carrie Klein said her son, Freddie, suffered from a rare brain disorder since birth and required medication to control his seizures. “I got a magnifying glass and looked at the pill and sure enough, it was double the dosage,” she said. “They could have killed him.” The mistake was never reported until Klein filed a complaint on her own.

Doing ‘more with less’Last year, more than 171 million prescriptions were filled at pharmacies across Ohio, according to the Henry J Kaiser Family Foundation . The Ohio Pharmacy Association said, “that number is skyrocketing” while pharmacies are “being forced to do more with less.”

“That is incredibly dangerous,” Ciaccia said. “We should not be sitting around waiting for the next error or the next death to occur.”

Even longtime pharmacists like Ray Carlson are taking the highly unusual step of voluntarily becoming “whistleblowers” to bring conditions inside pharmacies to the public attention. Carlson owns a successful compounding pharmacy in Poland, Ohio that provides specialized prescriptions for patients and hospitals in Northeast Ohio.

“This is very unusual for a pharmacist to not have his face blocked out or his voice garbled,” Carlson said in an interview.

For example, in a highly public move, Carlson took the Ohio Pharmacy Board to court in order to compel the board to survey Ohio’s pharmacies to ensure they were following both state and federal laws governing dispensing.

With Ohio’s growing opioid crisis, Carlson grew concerned over workplace conditions that may be leading pharmacists to be too busy to ask consumers a comprehensive list of questions regarding their medication and drug reactions, among others.

Carlson’s goal was to warn the public of the “impact and danger” if safe dispensing practices were not adhered to, including the potential for errors.

“Absolutely, it leads to errors,” Carlson said. “We know it’s being under reported if not reported at all.”

The case was ultimately dismissed, but Carlson continues to stress that pharmacies appear to be failing to spend adequate time with consumers simply because they are overworked and too busy.

In fact, he said the next time consumers pick up their prescriptions, they should notice the box they check that seems to indicate only that they have picked up their medication. By checking it, he said, consumers are also surrendering their rights to counseling and questions from the pharmacist.

“I can remember when it once took five pharmacies to fill just 100 prescriptions a day,” Carlson said. “Now, you got one pharmacy with two pharmacists doing 500 a day.”

“If I make you do more with less time and less resources—will you do better?” Ciaccia asked. “I don’t think anybody wouldI think everybody would actually say they would do worse.”

Pharmacies respondIn a statement to News 5, the National Association of Chain Drug Stores (NACDS), which represents 40,000 pharmacies nationwide, said “while some have attempted to link” prescription errors “with pharmacist’s current responsibilities,” the NACDS warns against a “rush to judgment” or “assume a causal relationship.”

The NACDS also supports “voluntary reporting of medical and prescription errors in a non-punitive forum” as opposed to mandatory reporting without fear of being subjected to lawsuits. You can read NACDS’ full statement here.

NACDS also points to a report by the Institute for Safe Medication Practices that “emphasize strongly the importance of voluntary reporting rather than mandatory as well as findings by the Agency for Healthcare Research and Quality within the U.S. Department of Health and Human Services.

The nation’s two largest pharmacies provided written statements to News 5 but declined on-camera interviews.

A spokesperson for Walgreens responded saying, “Prescription errors are rare and we take them very seriously. In the event there is an error with a prescription, our first concern is always for the patient’s well-being.” You can read Walgreens’ full statement here .

A CVS spokesperson also insisted “errors are rare,” saying the pharmacy “has comprehensive policies and procedures in place” to ensure safety. You can read CVS’ full statement here .

Walmart, the nation’s fourth largest retail pharmacy, said only, “We don’t have anything to add to your story.”

We shared our findings with the Ohio Pharmacy Board that is now promising to move forward with proposed rules that would require mandatory reporting of pharmacy errors.

Pharmacy Board Executive Director Steven Schierholt said the debate has long been that if pharmacist and technicians were fearful of possible criminal charges, it would have the opposite effect and encourage less reporting — not more.

He said the board has been working toward mandatory reporting that would encourage more accurate and full reporting without criminalizing pharmacists.

“The board is in the process of promulgating rules that would require a pharmacist to report instances of reckless behavior that resulted in a dispensing error, or unprofessional conduct that resulted in a dispensing error,” Schierholt said.

New rules regarding mandatory reporting of pharmacy errors will be proposed and released in the next few months.

There are some 4 + Billion prescriptions filled each year in the USA. I don’t know what the definition of “rare error ” is that is used by the chains.. But if 99.9 percent of prescriptions are filled without a ERROR… that means that FOUR MILLION PRESCRIPTION ERRORS are happening EVERY YEAR…  ABOUT ELEVEN THOUSAND A DAY – 7 days a week

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Last Sunday Barb and I decided to go out to Brunch at O’Charlie’s… by Monday neither one of us was feeling all that well…

but about 6PM Monday evening we both started taking turns over the next 18-24 hrs..  There could not have been more than 10 minutes between each of us starting…. Normally we don’t eat the same foods but this day – for some odd reason we both ordered a scrambled egg mess of potatoes, green peppers and a couple of meats.  Apparently, while not being able to taste/smell anything wrong with the meal… THERE APPARENTLY WAS  !!!

It is probably going to take me most of the weekend to go thru all the backlog of emails – some 600 already … FB messages and other things that have “piled up ” …

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So it would appear that Walmart has created a corporate edict for their pharmacists to not only cut the days supplies of opiate Rxs for acute pain but to also reduce the dose to 50 MME/day.

Here is just one of the MME conversion programs out there https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/  and a footnote off of this one particular program which all have – or should have a similar WARNING to not use these conversion numbers as ABSOLUTE

Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring. 

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material.  

wasn’t it Nero playing his fiddle while Rome burned ” ?

Will the Medical/Pharmacy boards doing anything while pts suffer ?

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Clampdown on opioids is hurting pain patients

https://starledger-nj.newsmemory.com/?publink=09353ea64

In the summer of 1994, I was working at my desk at the Department of Justice when my back started to burn. Moments later, my body seized up and I fell to the floor. Suddenly, at the age of 30, I was no longer able to sit or stand. I could barely walk short distances. These limitations, related to a surgical mishap, would continue for almost 20 years.

After dozens of failed treatments, I reluctantly tried prescription opioids. The pain medication enabled me to work despite my condition. I argued cases in federal court from a foldable reclining chair, negotiated settlements by video teleconference and, working remotely, managed litigation in U.S. attorney’s offices across the country.

When medical advancements led to an improvement of my health, I went off opioids without incident.

I was, as it turns out, incredibly lucky. A report released last month by Human Rights Watch paints a cautionary and at times harrowing picture of what pain patients are experiencing today.

Because of well-intended efforts to address the overdose crisis, many doctors are severely limiting opioid prescriptions. Patients who rely on opioid analgesics are being forcibly weaned off the medication or seeing their prescriptions significantly reduced. Other patients are unable to find doctors willing to treat them at all.

One such patient, Maria Higginbotham, has had more than a dozen surgeries to correct the collapse of her spine. She suffers from a painful condition in which the spinal cord fuses with adjacent membranes. Last year, her physician cut her pain medication by 75 percent, explaining that the reduction was to comply with federal guidelines.

In the past, Higginbotham could function. Now she needs assistance just to get out of bed and go to the bathroom.

The federal guidelines Higginbotham’s doctor cited were issued in 2016 by the U.S. Centers for Disease Control and Prevention. They were intended as nonmandatory recommendations for primary care physicians.

Increasingly, the guidelines are treated not as recommendations but as one-size-fits-all mandates. They are being misapplied by physicians, state legislatures, insurers and Medicaid programs.

Some physicians told Human Rights Watch researchers that they had taken patients off opioids, or reduced patients’ prescriptions, against their better clinical judgment.

“You set yourself up for a liability, even when you know they’re not addicted and they’re benefiting from opioids,” one physician said.

Other doctors said they had stopped treating pain patients altogether — even patients who don’t use prescription opioids.

It’s true that opioids were prescribed liberally in recent decades. Doctors began doing this in the 1990s. There were some bad actors, such as “pill mills” and wayward pharmacies. Opioid medication too often fell into the wrong hands.

Moreover, opioids are not the magic bullet we once believed them to be. The evidence about their efficacy across a broad population is limited. Even when their use is appropriate, opioids carry risks, and the risks increase at higher doses. The CDC was right to encourage judicious, responsible prescribing. But chronic pain is a large umbrella category, encompassing a wide range of injuries and diseases, some of which are incurable. A one-size-fits-all approach to treatment does not work.

The recent clampdown has had harmful consequences. Some patients told researchers that they were forced to quit working or go on disability when their medication was denied. Others are now homebound. Many mentioned the possibility of suicide.

Patients also said that they were turning to alcohol or illegal substances to treat their pain.

What began as an effort to protect patients may be morphing into one that is harming them. The CDC’s National Center for Health Statistics estimates that 50 million Americans have pain every day and nearly 20 million have pain that limits major life activities. If the experiences that patients described to Human Rights Watch are common, the harm to patients could be widespread.

The CDC’s own data show that fatal overdoses are driven largely by illegally produced fentanyl, its analogs and heroin, not by medically prescribed opioids.

For all these reasons, the CDC should address the misapplication of its guidelines, as the American Medical Association recently did. The agency needs to revise its guidelines to recommend that physicians not abandon pain patients or engage in “forced tapering.”

The CDC should also study and address any unintended consequences of its 2016 guidelines, as it promised to do.

Tackling the overdose crisis is a vital public policy goal. But chronic pain patients should not become casualties in that fight. Kate M. Nicholson is a civil rights and health policy attorney. She served for 20 years in the Justice Department’s civil rights division, where she drafted current regulations under the Americans with Disabilities Act. She gave a TEDx talk about chronic pain, “What We Lose When We Undertreat Pain.”

What began as an effort to protect patients may be morphing into one that is harming them.

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www.kevinmd.com/blog/2019/01/the-conflict-between-pharmacists-and-their-corporate-superiors.html

Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of medications like warfarin and vancomycin — and more. I rely upon them in the hospital daily to catch mistakes and advise on drug dosages and choices. Many in the community give flu vaccinations. Some are even trying to gain ”provider” status under Medicare, allowing them bill directly for treating patients. This has been accompanied by a drastic change in the preparation of the average pharmacist. Where once it was a five-year bachelor’s degree, now it is a graduate degree — a change recent enough that as of 2014, over 60 percent of pharmacists practicing had trained under the old system.

Some of these changes are controversial — a recent article put out by the Texas Medical Association details how some pharmacists inappropriately deny pain medication to cancer patients because of concerns over the opiate crisis, though CDC guidelines explicitly exempt such patients from the guidelines. The American Medical Association has come out as well, noting the story of a patient who attempted to commit suicide due to bone pain from metastatic prostate cancer after his perfectly appropriate opiate prescription was denied by a pharmacist.

But these stories of prescriptions denied and conflicts miss a more fundamental issue. As pharmacists’ roles have changed, their professional norms, practices, and regulations have not kept up to date. This means that corporate policies may have inappropriate influence over their decisions and provide an unbalanced incentive towards one action.

Let me give an analogy. Suppose a homeless patient with no money or insurance is assaulted or hit by a car. They are taken to the nearest ED and wind up in that hospital’s ICU with a brain injury. No one is paying for that patient’s care. And the hospital is losing millions every week for what promises to be an extended stay. Can the hospital CEO march down and order the doctors to make the patient DNR/DNI and turn off the ventilator — or be fired? No. In California, this is explicitly prohibited by law as a “corporate bar” on the practice of medicine. But in every state, the prevailing norms of medical practice means that an attempt to do this would be met by howls of outrage by doctors who would recognize this as a grievous breach of medical ethics, which obligate us to treat all patients equally and never withdraw life-sustaining treatment on cost grounds alone. Few, if any, doctors or nurses would comply, and threats of reporting the case to the local district attorney for murder charges would promptly start flying.

But if you read the articles from the Texas Medical Association and the American Medical Association, it is clear that corporate policies are significantly affecting how pharmacists practice at a time when their role has significantly changed. Once, pharmacists were primarily concerned with one thing: the safe production and dispensation of medications. Their calls to doctors once consisted of, “Did you really mean to write for 50 mg Tramadol for this patient?” If the answer was yes, they dispensed the medication. Now, as their training and role have changed, their calls are, “Are you sure 30 pills of 50 mg Tramadol is the correct choice for this patient?” And if the doctor can’t explain convincingly enough, they may well deny the prescription. And I don’t believe there is necessarily anything wrong with that. Pharmacists have a right to refuse to dispense medication and a duty to use their medical knowledge to help their patients. Like nurses, there are actions they may disagree with and vocalize their disagreement but carry them out anyway. And there are actions which they feel are so wrong that they refuse to dispense a medication.

But the fact is: Unlike doctors, pharmacists do not have a professional culture or legal protections that fights strongly against interference from their corporate superiors. Corporations almost overwhelmingly employ them. And under threat of losing their jobs, they are forced to bend to the orders of their corporate superiors to dispense thousands of opiate prescriptions without question thanks to the massive profits involved. And now after lawsuits against those same companies over those practices to deny opiates under blanket policies without consideration to individual patient characteristics. When a patient walks in with severe pain for any reason and needs opiate pain medication — whether for cancer, severe trauma, or another cause that requires them, rare as they may be — the pharmacist has every incentive to deny that script, and no repercussions if they say no. Contrast that to the physician, who is obligated and held liable in a balanced way for both acting and failing to act. Of course, a common response is that a patient can always go to another pharmacy. But this justification becomes increasingly thin as patients are directed to order from certain pharmacies by their insurance companies or else face sky-high copays (not that they may not face sky-high copays anyway).

When they decide to push back on, approve or deny medications based on medical merit, pharmacists are effectively practicing medicine. I don’t even believe this is necessarily a bad thing, provided the training is appropriate and roles delineated. But as pharmacists’ abilities to deny and change medications on both cost and medical grounds expands, it is time to expand the profession’s protections against corporate interests, and provide for a balanced oversight that appropriately recognizes both a duty to stop dangerous prescriptions and to allow through legitimate ones.

Vamsi Aribindi is a surgery resident who blogs at the Medical Intellectual.

This article does a very good job of explaining why the average pts dealing with subjective diseases that requires the pt takes one or more controlled substances is probably better served by patronizing a independent pharmacy.  Where the pt is typically dealing with the Pharmacist/owner and what is absent is the “corporate overlord” that the chain pharmacist employee has to deal with and most likely has to fear for his job for trying to do what their education/experience and common sense tells them what to do that is in the best interest of the pt.

We have a serious and growing Pharmacist SURPLUS… it is claimed that we are graduating 15,000 new Pharmacists each year but there is only a job opening for 10,000 of them.  So we have 5,000 new pharmacist with many having > $100,000 student loans that they have to start making payments on in 6-9 months after graduating.  Salaries are falling to levels that have not been seen since about the turn of the century.

The typical independent will provide much more prompt and timely service in getting prescription(s) filled for several reasons. Without all that corporate overhead cost and the stock holders and stock market to “make happy” they can afford to have more staff on hand.  Most independents offer home delivery service and can put a priority on “walk in “prescriptions because the deliveries are typically bunched into few/several larger runs during the day, so putting some walk in prescriptions to the head of the line… doesn’t cause any home delivery to be delayed and gets the walk in prescription finished and the pt promptly on their way.

How to find a local independent pharmacy/Pharmacist

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https://www.ktuu.com/content/news/Board-reprimands-pharmacists-over-refusals-to-fill-opioid-prescriptions-504881401.html

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