https://video.foxnews.com/v/5984887974001

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CVS Makes Plans To Ration Customers’ Health Care

http://thefederalist.com/2018/12/28/cvs-makes-plans-ration-customers-health-care/

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Kolodny Congress 5-2014 Opioiods from Media Policy Center on Vimeo.

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They Fell like Dominos: My License, My Certification, My Profession

https://opmed.doximity.com/articles/they-fell-like-dominos-my-license-my-certification-my-profession-21667cc4d596

They fell like dominos, one after another: first, my medical privileges, then my Ohio Medical License, then my state license, then my board certification, finally my DEA license. While, like most physicians, I had concerns about malpractice suit, a medical board investigation never crossed my mind.

I suppose that’s why the certified letter from an investigator with my state medical board took me by surprise. I was alleged to be “an unregistered terminal distributor of dangerous drugs.” I told the investigator everything. I hadn’t distributed anything. Seven months previously, my husband of 37 years announced that he was getting a divorce. I had no home, no marriage, no job, no doctor, not even a car. I couldn’t stop crying. I couldn’t eat. Worst of all, I couldn’t sleep. I tried alcohol; it didn’t help. In desperation, I had ordered a bottle of Xanax from a wholesaler.

That was it. I signed a release of medical records to confirm my statements and document the help I was getting and the progress I was making. I hadn’t seen any patients during that time, violated any laws, or driven under the influence. Since I wasn’t in any legal jeopardy, I didn’t need a lawyer.

Then the second certified letter arrived. The Board had reason to believe that I was “unable to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness…” I was ordered to submit to a forensic psychiatric exam. Failure to do so would constitute “an admission of the allegations…and a default and final order may thereupon be entered without the taking of testimony or presentation of evidence.” If I didn’t submit to their demands, I could lose my license.

The interview went smoothly. I had no personal or family history of alcoholism or addiction. I could spell W-O-R-L-D backwards. I did my serial 7s down to 57 and my presidents down to Kennedy, at which point the psychiatrist had said, “Enough!” I was still in therapy and taking an antidepressant, but I was back to work and feeling good. I thought that was it.

But again, I was wrong. Four months later, I got a third certified letter. This time the Board ordered me to submit to a 72-hour inpatient addiction evaluation. Knowing what was at stake, I submitted.

When I arrived at the rehab hospital, my phone, wallet and keys were confiscated, and my car, suitcase and body were searched. During my stay, I was assailed with questions I couldn’t answer, questions like “What’s your drug of choice?” and “Does your family know about your addiction?” I submitted to observed urine drug tests, sleep deprivation and hours of interrogation, group therapy and lectures on alcoholism. The cognitive dissonance was unbearable.

On the morning of the third day in rehab, I was told that, since I was still in denial about my addiction, I would have to stay in rehab at least 28 more days. I had packed for three.

I refused. I was reminded of the consequences to my career. I still refused. I had given the rehab hospital permission to contact my husband, my daughter, my brother and a longtime colleague. They would confirm that, except for that brief period, I was the epitome of sobriety. The nightmare would be over.

It wasn’t. Six weeks later, the fourth certified letter arrived. It stated: “We have reason to believe that you pose an imminent threat to your patients and we thereby are suspending your medical license.” I had to stop practicing immediately. I could have a hearing. It would be adversarial, but it was my last chance to salvage my career.

I prepared assiduously in the 15 days leading up to the hearing. I was an articulate, consistent and contrite defendant, but a terrible lawyer. After eight hours of testimony, the Board’s lawyer concluded that my children were enablers, my spouse was lying, my colleagues were clueless and I was a hopeless drunk full of excuses. Nonetheless, I was hopeful.

Shortly thereafter, the fifth certified letter arrived. I was offered a chance to face my accusers, the eight members of the state medical board, for five minutes at a public hearing. I took the offer. Three and a half minutes into my statement, the Board’s spokesman interrupted me and read a perfunctory statement echoing their lawyer’s sentiments. I was numb.

Two weeks later, the sixth certified letter arrived. It said, “There is clear and convincing evidence that you are impaired in your ability to practice medicine and your Ohio license had been permanently revoked.” The seventh certified letter said my state license was suspended, the eighth, that my Board certification was revoked, and the ninth, that my DEA license was invalidated.

It’s taken me months to be able to write about this. Months to get past the shame of a personal crisis made public, to recover from the pain of the ordeal, and to accept that never again could I practice the profession to which I had dedicated my entire adult life.

I have learned over these months that countless other unwary practitioners have been victims of the same disciplinary fervor. I know now that, to keep their licenses, most of these physicians will submit to what’s demanded of them and they will stay silent to protect their reputations. I, however, was physically, emotionally and financially unable to submit to my Board’s final demand. As a result, I lost everything professionally. I have nothing to lose by speaking out.

My colleagues need to know that if a Board investigator contacts you, you must immediately contact your lawyer. Unlike in a civil case, Boards can presume you’re guilty and ignore exculpatory evidence. Unlike in a criminal case, Boards don’t have to advise of your civil rights because you don’t have any. They can coerce you into medically unnecessary treatment, rob you of your personal freedom, publicly defame you and deprive you of your livelihood, all with complete impunity.

State legislatures cannot abridge the civil rights of its citizens. However, they allow state medical boards to do so based on the rationale that medical professionals must adhere to higher standards than average citizens. I accept that. However, boards should not be allowed to violate our civil rights when evaluating whether or not we are adhering to those standards. Perhaps in the long run, we can repeal the laws that allow this travesty. For now, any of you who can speak up, please do. Talk to your colleagues, your medical society, your state representative. For those who can’t speak up, please know this: you aren’t a pariah, you aren’t worthless, and you definitely aren’t alone.

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CNN Exclusive: California launches investigation following stunning admission by Aetna medical director

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

California insurance commissioner Dave Jones launched the investigation after being contacted by CNN.

During the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.

Jones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”

“It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.

“That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”

The insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.

Members of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.

“Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.

“This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.

The Gillen Washington case

Gillen Washington, 23, says he hopes to force change at Aetna.

The deposition by Aetna’s former medical director came as part of a lawsuit filed against Aetna by a college student who suffers from a rare immune disorder. The case is expected to go to trial later this week in California Superior Court.

Gillen Washington, 23, is suing Aetna for breach of contract and bad faith, saying he was denied coverage for an infusion of intravenous immunoglobulin (IVIG) when he was 19. His suit alleges Aetna’s “reckless withholding of benefits almost killed him.”

Aetna has rejected the allegations, saying Washington failed to comply with their requests for blood work. Washington, who was diagnosed with common variable immunodeficiency, or CVID, in high school, became a new Aetna patient in January 2014 after being insured by Kaiser.

Aetna initially paid for his treatments after each infusion, which can cost up to $20,000. But when Washington’s clinic asked Aetna to pre-authorize a November 2014 infusion, Aetna says it was obligated to review his medical record. That’s when it saw his last blood work had been done three years earlier for Kaiser.

Despite being told by his own doctor’s office that he needed to come in for new blood work, Washington failed to do so for several months until he got so sick he ended up in the hospital with a collapsed lung.

Once his blood was tested, Aetna resumed covering his infusions and pre-certified him for a year. Despite that, according to Aetna, Washington continued to miss infusions.

Washington’s suit counters that Aetna ignored his treating physician, who appealed on his behalf months before his hospitalization that the treatment was medically necessary “to prevent acute and long-term problems.”

“Aetna is blaming me for what happened,” Washington told CNN. “I’ll just be honest, it’s infuriating to me. I want Aetna to be made to change.”

During his videotaped deposition in October 2016, Iinuma — who signed the pre-authorization denial — said he never read Washington’s medical records and knew next to nothing about his disorder.

Intravenous immunoglobulin can cost as much as $20,000 per treatment. It helps patients like Gillen Washington stave off infection.

Questioned about Washington’s condition, Iinuma said he wasn’t sure what the drug of choice would be for people who suffer from his condition.

Iinuma further says he’s not sure what the symptoms are for the disorder or what might happen if treatment is suddenly stopped for a patient.

“Do I know what happens?” the doctor said. “Again, I’m not sure. … I don’t treat it.”

Iinuma said he never looked at a patient’s medical records while at Aetna. He says that was Aetna protocol and that he based his decision off “pertinent information” provided to him by a nurse.

“Did you ever look at medical records?” Scott Glovsky, Washington’s attorney, asked Iinuma in the deposition.

“No, I did not,” the doctor says, shaking his head.

“So as part of your custom and practice in making decisions, you would rely on what the nurse had prepared for you?” Glovsky asks.

“Correct.”

Iinuma said nearly all of his work was conducted online. Once in a while, he said, he might place a phone call to the nurse for more details.

How many times might he call a nurse over the course of a month?

“Zero to one,” he said.

Glovsky told CNN he had “never heard such explosive testimony in two decades of deposing insurance company review doctors.”

Aetna’s response

Aetna defended Iinuma, who is no longer with the company, saying in its legal brief that he relied on his “years of experience” as a trained physician in making his decision about Washington’s treatment and that he was following Aetna’s Clinical Policy Bulletin appropriately.

“Dr. Iinuma’s decision was correct,” Aetna said in court papers. “Plaintiff has asserted throughout this litigation that Dr. Iinuma had no medical basis for his decision that 2011 lab tests were outdated and that Dr. Iinuma’s decision was incorrect. Plaintiff is wrong on both counts.”

Gillen Washington receives an infusion of the medicine needed to boost his immune system. He calls it “the magic juice.”

In its trial brief, Aetna said: “Given that Aetna does not directly provide medical care to its members, Aetna needs to obtain medical records from members and their doctors to evaluate whether services are ‘medically necessary.’ Aetna employs nurses to gather the medical records and coordinate with the offices of treating physicians, and Aetna employs doctors to make the actual coverage-related determinations.

“In addition to applying their clinical judgment, the Aetna doctors and nurses use Aetna’s Clinical Policy Bulletins (‘CPBs’) to determine what medical records to request, and whether those records satisfy medical necessity criteria to support coverage. These CPBs reflect the current standard of care in the medical community. They are frequently updated, and are publicly available for any treating physician to review.”

Jones, the California insurance commissioner, said he couldn’t comment specifically on Washington’s case, but what drew his interest was the medical director’s admission of not looking at patients’ medical records.

“What I’m responding to is the portion of his deposition transcript in which he said as the medical director, he wasn’t actually reviewing medical records,” Jones told CNN.

He said his investigation will review every individual denial of coverage or pre-authorization during the medical director’s tenure to determine “whether it was appropriate or not for that decision to be made by someone other than a physician.”

If the probe determines that violations occurred, he said, California insurance code sets monetary penalties for each individual violation.

Girl has blunt message for Aetna after her brain surgery request was denied

CNN has made numerous phone calls to Iinuma’s office for comment but has not heard back. Heather Richardson, an attorney representing Aetna, declined to answer any questions.

Asked about the California investigation, Aetna gave this written statement to CNN:

“We have yet to hear from Commissioner Jones but look forward to explaining our clinical review process.

“Aetna medical directors are trained to review all available medical information — including medical records — to make an informed decision. As part of our review process, medical directors are provided all submitted medical records, and also receive a case synopsis and review performed by a nurse.

“Medical directors — and all of our clinicians — take their duties and responsibilities as medical professionals incredibly seriously. Similar to most other clinical environments, our medical directors work collaboratively with our nurses who are involved in these cases and factor in their input as part of the decision-making process.”

Gillen Washington became emaciated and gravely ill after four months without treatment.

‘A huge admission’

Dr. Arthur Caplan, founding director of the division of medical ethics at New York University Langone Medical Center, described Iinuma’s testimony as “a huge admission of fundamental immorality.”

“People desperate for care expect at least a fair review by the payer. This reeks of indifference to patients,” Caplan said, adding the testimony shows there “needs to be more transparency and accountability” from private, for-profit insurers in making these decisions.

Murphy, the former American Academy of Allergy Asthma and Immunology board member, said he was “shocked” and “flabbergasted” by the medical director’s admission.

“This is something that all of us have long suspected, but to actually have an Aetna medical director admit he hasn’t even looked at medical records, that’s not good,” said Murphy, who runs an allergy and immunology practice west of Philadelphia.

“If he has not looked at medical records or engaged the prescribing physician in a conversation — and decisions were made without that input — then yeah, you’d have to question every single case he reviewed.”

Murphy said when he and other doctors seek a much-needed treatment for a patient, they expect the medical director of an insurance company to have considered every possible factor when deciding on the best option for care.

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“We run into the prior authorization issues when we are renewing therapy, when the patient’s insurance changes or when an insurance company changes requirements,” he said.

“Dealing with these denials is very time consuming. A great deal of nursing time is spent filling and refilling out paperwork trying to get the patient treatment.

“If that does not work, then physicians need to get involved and demand medical director involvement, which may or may not occur in a timely fashion — or sometimes not at all,” he said. “It’s very frustrating.”

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who will not be here tomorrow

2016 in review … what killed us

2017 in review … what killed us

6775 Americans will die EVERY DAY – from various reasons

2700 people  WILL ATTEMPT SUICIDE

140 will be SUCCESSFUL – including 20 veterans

270 will die from hospital acquired antibiotic resistant “bug” because staff won’t properly wash hands and/or proper infection control.

350 will die from their use/abuse of the drug ALCOHOL

1200 will die from their use/abuse of the drug NICOTINE

1400 will contract C-DIF from Hospital or Nursing home because staff doesn’t properly wash their hands are adhere to infection control  

80 WILL DIE  – mostly elderly.

850 will die from OBESITY

700 will die from medical errors

150 will die from Flu/Pneumonia

80 will die from Homicide

80 will die in car accidents

70 From ALL DRUG ABUSE

http://www.romans322.com/daily-death-rate-statistics.php

United States of America

CURRENT DEATH TOLL
from Jan 1, 2018 – Dec 31, 2018 (6:27:30 PM)

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Someone just died by:

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Just the Data … Raw and Undigested

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Abortion *:	1091318
Heart Disease:	613959
Cancer:	591325
Tobacco:	349779
Obesity:	306806
Medical Errors:	251295
Stroke:	133019
Lower Respiratory Disease:	142853
Accident (unintentional):	135967
Hospital Associated Infection:	98937
Alcohol *:	99937
Diabetes:	76440
Alzheimer’s Disease:	93482
Influenza/Pneumonia:	55192
Kidney Failure:	42735
Blood Infection:	33443
Suicide:	42746
Drunk Driving:	33787
Unintentional Poisoning:	31738
All Drug Abuse:	24989
Homicide:	16788
Prescription Drug Overdose:	14991
Murder by gun:	11486
Texting while Driving:	5985
Pedestrian:	4997
Drowning:	3913
Fire Related:	3498
Malnutrition:	2770
Domestic Violence:	1459
Smoking in Bed:	780
Falling out of Bed:	598
Killed by Falling Tree:	149
Lawnmower:	68
Spontaneous Combustion:	0

Your chance of death is 100%. Are you ready?

Totals of all categories are based upon past trends documented below.

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Sources: http://www.cdc.gov/nchs/fastats/deaths.htm http://www.cdc.gov/nchs/data/hus/hus15.pdf#019 http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf http://www.druglibrary.org/schaffer/library/graphs/graphs.htm http://www.alcoholalert.com/drunk-driving-statistics.html http://www.cdc.gov/nchs/fastats/suicide.htm http://wonder.cdc.gov/wonder/prevguid/m0052833/m0052833.asp http://www.cdc.gov/motorvehiclesafety/Pedestrian_Safety/factsheet.html http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-factsheet.html http://www.nfpa.org/categoryList.asp?categoryID=953 http://www.dvrc-or.org/domestic/violence/resources/C61/ http://www.time.com/time/magazine/article/0,9171,1562978,00.html https://s3.amazonaws.com/s3.documentcloud.org/documents/781687/john-james-a-new-evidence-based-estimate-of.pdf

 

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SAN FRANCISCO–(BUSINESS WIRE)–In response to a recent 60 Minutes story about McKesson’s January 2017 settlement agreement with the federal government, McKesson issued the following statement:

We were disheartened to see today’s 60 Minutes story on McKesson and the opioid crisis contain sweeping and unsubstantiated accusations against our company. We provided extensive information to the news outlet by way of interviews with and statements from McKesson and its representatives – including a categorical denial of any criminal behavior or intent. Shockingly, it all ended up on the editing room floor, but nonetheless they made it seem like we refused to cooperate. Sensational journalism focused on finger-pointing and the blame-game does an enormous disservice to those who have suffered losses in this crisis and to those who are focused on finding solutions to this horrible epidemic. The public deserves the facts.

The story has too many inaccuracies and mischaracterizations to address here — one can find the real facts at www.McKesson.com/FightingOpioidAbuse.

McKesson has worked diligently to enhance our monitoring of controlled substances and to develop a more constructive dialogue with the Drug Enforcement Administration. We have invested millions of dollars in our controlled substance monitoring program, and are constantly evolving it to stay one step ahead of those who would divert prescription medications for illegitimate use. We’re developing innovative practical solutions – like a new “red flag” system for pharmacists as they’re filling prescriptions for patients who are at risk for abuse or diversion. And we are working closely with federal and state policymakers and regulators to advance common-sense proposals that can help stem diversion, while simultaneously protecting the availability of appropriate pain therapies for patients with serious illnesses and injuries.

McKesson has been a leader in the healthcare industry for over 180 years: each day helping deliver thousands of safe and effective medicines to the millions of patients who need them. We look forward to setting the record straight and taking care of what matters most: the families and patients who need our support.

Contacts

McKesson
Kristin Hunter Chasen, 415-983-8974
Kristin.Chasen@McKesson.com

https://www.businesswire.com/news/home/20171217005108/en/McKesson-Responds-60-Minutes-Story

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https://www.usnews.com/news/healthiest-communities/articles/2018-06-07/trump-administration-launches-scare-tv-ads-to-fight-opioid-abuse

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