Doctors said it was just a migraine – then a friend had to save my

life. Here’s why suing is pointless

http://www.sacbee.com/opinion/op-ed/soapbox/article180955366.html

It was midnight and I paced around my bedroom holding ice packs on my head. I realized, this is not normal.

I went to Sutter Medical Center emergency room in Sacramento. With tears running down my face, I told the doctor I had the worst headache of my life. I was given pain medication and sent home, diagnosed with a migraine. But I was actually in the early stages of an impending stroke.

I was only 45. I’ve worked in politics for over 20 years and at the time was the senior strategist for the California Democratic Party.

Fourteen hours later, I didn’t know my son’s name. A friend saved my life by taking me to the emergency room again. I don’t remember much for seven days. Family and friends came to my bedside. Doctors talked about making nursing home arrangements for me.

When doctors wanted to release me 10 days after I was admitted, I told them something wasn’t right. I had severe back pain for six days, and was coughing up blood. They said I should still leave. I accepted their diagnosis. Again.

My story, later described in a suit, isn’t unique. A friend told her doctor that for two weeks, she had experienced the worst headache of her life, and asked if it could be a stroke. She was prescribed opioids. She had a major stroke that landed her, a 31-year-old dance teacher, in a walker, dependent on the pain meds. She eventually had to pay out of pocket for the treatment necessary to end her dependence.

A recent Johns Hopkins study showed medical errors are the third leading cause of death in the U.S., surpassed only by heart disease and cancer.

My friend and I face lifetime consequences from our strokes. But a 1975 California law supported by many of the lawmakers I have looked up to all but prevents us from suing for medical malpractice.

Under the Medical Injury Compensation Reform Act, damages for pain and suffering in a medical malpractice suit are capped at $250,000, and the maximum cap is typically only awarded in cases resulting in death.

So if a child is killed by a preventable medical error, his or her life is worth $250,000. Same goes for the elderly, or a stay-at-home mom or anyone else not making a salary that can be figured into the raw, unemotional math of “economic damages” in malpractice cases.

To put this in perspective, that $250,000 cap hasn’t changed one cent since 1975. In 1975, home prices averaged under $50,000, and the minimum wage was about $2 an hour.

If the malpractice law were adjusted for inflation, the law today would cap pain and suffering damages in personal injury cases at $1.3 million dollars. But the Medical Injury Compensation Reform Act doesn’t include a cost-of-living increase. So while court and expert witness costs rise each year, the award doesn’t.

Doctors say they fear that if the cap is raised their malpractice premiums will increase. I feel the same about my car insurance, but I pay it.

Because of my profession and my privilege, I was able to find a lawyer to take my case, though I dropped the suit when I realized that the aggravation of a drawn out court fight would hamper my healing. I also knew that any award would be much less than the $250,000 cap. And if I agreed to accept a settlement, I likely would have had to sign away my right to speak out. I believe it’s important to tell my story not only for myself, but for others.

I have advantages that come with an education and friendships with people in power. If I had been a farmworker, a minimum wage worker juggling two jobs, my access to justice would have been limited.

I am one of the lucky ones. I can read, write, walk and earn a living. But I carry with me anger that’s hard to let go. Medical errors are a difficult political and social issue to discuss. We all want to believe our doctor would never make a mistake that could alter our lives.

But doctors aren’t gods, even yours. They are human. And part of that humanity is making things right.

Medical errors devastate families, especially those that have few resources and don’t have a political voice in the halls of the Capitol. People working minimum wage, people of color, and women are the primary victims of this draconian law.

Our Legislature can choose to fix the Medical Injury Compensation Reform Act at any time by passing a bill and sending it to the governor to raise or remove the cap or just let juries decide.

This change would allow doctors to practice, knowing if an error happens, they have a path to make things right. And they can start to rebuild the trust of the patients who have been harmed.

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No new funding in Trump’s emergency opioid declaration

http://www.modernhealthcare.com/article/20171026/NEWS/171029906

Expectations the White House would make strides toward fighting the opioid epidemic fell short in the eyes of many when President Donald Trump on Thursday formally declared a public health emergency without calling for new funding to support treatment efforts.

Trump announced plans to direct Acting HHS Secretary Eric Hargan to declare the opioid crisis a national emergency under section 319 of the Public Health Service Act. Trump said the scale of the epidemic requires the aid of every federal agency and the resolve of every American.

“I want the American people to know that the federal government is aggressively fighting the opioid epidemic on all fronts,”Trump said.

As a first step, the administration planned to rescind a current Medicaid rule that limits how long patients can receive mental health or substance use disorder treatment in residential facilities with more than 16 beds. Currently the program covers the costs for up to 15 days.

“A number of states have reached out to us asking for relief and you should expect to see approvals that will unlock treatment for people in need and those approvals will come very, very fast,” Trump said.

But eliminating the rule would take an act of Congress while the CMS has provided state waivers for some years.

Overall the declaration was seen helping raise public awareness.

“We strongly support President Trump’s decision to officially label the opioid epidemic a public health emergency,” said Rep. David McKinley (R-WV) in an emailed statement. “As ground zero for this public health emergency, it is time West Virginia received the resources it deserves, and today’s action is a big step towards accomplishing that.”

“Really, he’s going to be asking the entire government to get behind this effort,” said Tom Coderre, senior adviser at the Altarum Institute and a former chief of staff and senior adviser to the Assistant Secretary at SAMHSA during the Obama administration. “That’s the bigger message of today, but certainly the devil is always in the details.”

The president of the American College of Physicians Dr. Jack Ende released a statement saying he was encouraged by Trump’s annoucement but pointed out the need for adequate funding. He said the Public Health Emergency Fund currently had only $57,000 as a result of Congress failing to replenish it for several years.

“Efforts need to be made to make substance use disorder treatment more accessible to those in under-served areas,” Ende said. ” We hope that today’s declaration will be used in a way that achieves that goal.”

Others were more critical and saw the declaration another disappointment.

Grant Smith, deputy director of national affairs for the Drug Policy Alliance in a written statement called the announcement “a drop in a bucket.” “We need a well thought out plan from the Trump administration that resolves the many obstacles people face trying to access medication-assisted treatment and naloxone to save lives.”

Baltimore City Health Commissioner Dr. Leana Wen questioned why a broader national emergency, under the Stafford Act, was not declared. That would have made billions in emergency funding available through FEMA’s Disaster Relief Fund.

“I looked to the president to commit a specific dollar amount from new funding rather than re-purposed dollars that take away from other key health priorities,” Wen said.

Under a public health emergency, HHS will allow states and counties greater flexibility in how federal funds are used. The agency will also seek to waive current rules that prohibit patients from receiving medication-assisted treatment through telemedicine in order expand access.

“That does have a potential to help reach patients who live in more rural areas,” said Cynthia Reilly, director of the Pew Charitable Trusts’ Substance Abuse Prevention and Treatment Initiative. “It [the declaration] could certainly help with that aspect of the problem.”

The order also makes the Department of Labor’s Dislocated Worker Grants—usually given to help those out of work due to natural disaster—available to help people who are unemployed because of addiction. At a meeting of Trump’s opioid commission held last week, Labor Secretary Alex Acosta testified that this was the “number one issue” in joblessness.

Trump’s declaration allows HHS to hire temporary personnel. The agency can also direct states upon its governor’s request to temporarily reassign state and local public health department personnel who receive federal funding to work on addressing opioid abuse during the emergency period.

Despite such changes, some addiction treatment experts feel the administration’s decision not to call for new funding within the emergency declaration confirms that the White House lacks direction on dealing with the crisis.

“They don’t have a plan,” said Dr. Andrew Kolodny, co-director of policy research at Brandeis University. “They rattled off a few items, but there’s no real plan.”

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New DEA teams in Cleveland and Cincinnati will combat flow of heroin and fentanyl

http://www.cleveland.com/metro/index.ssf/2017/10/new_dea_teams_in_cleveland_and.html

CLEVELAND, Ohio – The U.S. Drug Enforcement Administration said Friday that it is forming new enforcement teams in new enforcement teams in Cleveland and Cincinnati that will focus on eradicating the flow of heroin and fentanyl.that will focus on eradicating the flow of heroin and fentanyl.

The two enforcement teams are among six that the agency is forming across the U.S. to combat an opioid epidemic that claimed roughly 34,500 lives last year. The other four enforcement teams will be in New Bedford, Massachusetts; Long Island, New York; Charleston, West Virginia; and Raleigh, North Carolina, the agency said in a news release.

The DEA chose the six locations by studying data related to opioid overdose deaths and heroin and fentanyl seizures. The teams’ investigations will not be limited to the geographic areas near those cities, the agency said.

“The DEA’s top priority is addressing the opioid epidemic and pursuing the criminal organizations that distribute their poison to our neighborhoods,” the agency’s acting administrator, Robert W. Patterson, said in a news release. “These teams will enhance DEA’s ability to combat trafficking in heroin, fentanyl, and fentanyl analogues and the violence associated with drug trafficking.”

The agency’s fiscal year 2017 budget includes funding to establish the teams, which will be comprised of DEA special agents and state and local task force officers. The teams are part of a broader DEA strategy that also includes enforcement against international and domestic drug trafficking organizations, the agency said.

The teams are being established at a time when drug overdoses are the leading cause of injury-related death in the U.S. Nearly 54 percent of the country’s 64,000 drug overdose deaths in 2016 were caused by opioids, Centers for Disease Control and Prevention statistics show. 

In Ohio, more than 4,050 people died of unintentional drug overdoses in 2016, with many of those being caused by opioids. In Cuyahoga County, heroin and fentanyl killed more people last year than homicides, suicides and car crashes.

Officials in Cuyahoga County and statewide have taken steps to curb the opioid epidemic by addressing prescription drug abuse, which experts say is inextricably linked to heroin and fentanyl abuse.

On Friday, Cuyahoga County Prosecutor Michael O’Malley announced that his office is filing a lawsuit that accuses several major prescription drug companies of intentionally misleading the public about the dangers of painkillers as they raked in “blockbuster profits.”

Cuyahoga County files lawsuit accusing drug companies of racketeering, leading to opioid epidemic

The lawsuit is similar to one Ohio Attorney General Mike DeWine filed over the summer against some of the same manufacturers.

Cuyahoga County officials are also urging residents to return unused and unnecessary prescription drugs Saturday during the annual Take Back Your Meds Day. The annual event, which is part of the DEA’s National Prescription Drug Take Back Day, will feature more than 40 locations where people can return prescription drugs throughout the county.

The DEA being in charge of the war on drugs for some 43 years… are just now deciding to focus on new enforcement teams in Cleveland and Cincinnati that will focus on eradicating the flow of heroin and fentanyl in just SIX METRO AREAS  Cleveland, Cincinnati, New Bedford, Massachusetts; Long Island, New York; Charleston, West Virginia; and Raleigh, North Carolina

It is reported that we are up to 81 billion/yr in expenditures on the war on drugs and closing in on TWO TRILLION dollars expended since the Control Substance Act was signed into law in 1970… which started with at 43 million/yr budget and 1200-1500 agents.

Collectively, has the DEA had their head stuck up their ass for the last 47 years ? We how have the highest per-cent of our population in jail/prison than any other major country. Mostly for minor non-violent drug offenses.

I am sure that most know by now that we have FOR-PROFIT PRIVATE PRISONS Corrections http://www.cca.com/  is a major player… that lobby Congress for longer sentences for non-violent offenders… so that they make a profit for “baby-sitting” these inmates.

The only “social war” that we have been dealing with longer than the war on drugs is the “war on poverty” that started in 1965 and we have spent some 15 TRILLION on.

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Bright-Light Treatment Shows Promise for Fibromyalgia

https://www.medscape.com/viewarticle/881527

BOSTON — Morning bright-light treatment may be an effective adjunctive treatment for fibromyalgia, improving function and easing pain sensitivity, perhaps by shifting sleep patterns in a way that appears to help fibromyalgia, results of a pilot study suggest.

Helen J. Burgess, PhD, director, Biological Rhythms Research Laboratory and professor, Department of Behavioral Sciences, Rush University Medical Center in Chicago, Illinois, presented the study here at SLEEP 2017: 31st Annual Meeting of the Associated Professional Sleep Societies.

Morning light treatment has been shown to reduce depression. Moreover,  improved mood can lead to diminished pain and improvement in people’s ability to cope and function with pain.

Dr Burgess and colleagues tested the effect of bright-light treatment on function and pain sensitivity in 10 women meeting American College of Rheumatology 2010 criteria for fibromyalgia.

The women slept at home, keeping their usual sleep schedule for 1 week, followed by an overnight session in the sleep lab. During the overnight session, the researchers assessed baseline function (Fibromyalgia Impact Questionnaire [FIQ]), pain sensitivity (heat threshold and tolerance), and circadian timing (dim-light melatonin onset). 

The following morning, the women were randomly assigned to 6 days of a self-administered home morning (n = 6) or evening (n = 4) light treatment, using light boxes 1 hour per day. Afterward, function, pain sensitivity, and circadian timing were reassessed.

On average, the women completed 84% of the scheduled light treatments. No side effects were reported.

Both morning and evening light treatments led to improvements in function and pain sensitivity, but only morning light treatment led to a clinically meaningful improvement in function (>14% reduction in FIQ) and heat pain threshold (P < .05).

Dr Burgess noted that the improvement was about equal to that seen after cognitive-behavioral therapy and about half of that seen after weeks of intense exercise therapy. 

The study also found that phase advances in circadian timing were associated with an increase in pain tolerance (r = 0.67; P < .05).

Dr Burgess cautioned that more study is needed before light treatment can be used to manage chronic pain. “Our study sample was very small, and the results simply suggest that we keep investigating light treatment as a possible treatment to reduce pain and improve function,” she told Medscape Medical News.

“Noteworthy” Study

Approached for comment, Shelby Harris, PsyD, director, Behavioral Sleep Medicine, Sleep-Wake Disorders Center, Montefiore Health System, New York City, said this is a “very noteworthy and novel study since, in terms of helping sleep and fibromyalgia, the researched sleep treatments in this population — that we currently have on hand — are cognitive-behavior therapy for insomnia and medication interventions.”

“This study utilized a simple, quick method (light therapy) to help patients shift sleep patterns in a way that appears to help their fibromyalgia symptoms,” Dr Harris told Medscape Medical News.

“Patients with fibromyalgia typically suffer from difficulties falling asleep and staying asleep,” she said, “and this study noted that early-morning light exposure helped to advance their sleep timing, helping them to fall asleep earlier.”

“It is very possible that earlier sleep times, with less tossing and turning in bed throughout the night, can lead to more alertness in the morning, pain tolerance, helping to decrease pain and increase overall functioning. However, this was a small study and one that needs more research behind it,” added Dr Harris.

She also noted that some patients are “not ideal candidates for light boxes due to eye problems, and it would be interesting to see whether similar results would be found using natural outdoor light. This is worth studying further because a simple technique may make a big impact on the lives of those with chronic pain problems. More research is needed in this area,” said Dr Harris.

Kevin Fleming, MD, medical director of the Fibromyalgia and Chronic Fatigue Clinic at Mayo Clinic in Rochester, Minnesota, also thinks the study is noteworthy.

“Although a small study (just 10 patients) and only 1 week long, it is very suggestive of being useful because it fits with at least one physiology issue known to contribute to FM [fibromyalgia] — bad sleep. Light therapy may address that portion,” he told Medscape Medical News.

“Impaired sleep is known to be common in FM and likely contributes to pain (sleep deprivation makes people have widespread discomfort like FM),” Dr Fleming explained. “Why this is so is unclear; what sleep does for our muscles and brain is uncertain. But lacking good sleep contributes to pain, so it is reasonable to focus on sleep in treating FM.”

“The sleep clock (circadian rhythm) is set at least in part by your exposure to bright light, such as sunlight. Exposure to bright light or light therapy can remedy that part of the sleep disorder,” he noted.

Dr Fleming said light therapy for fibromyalgia is worth continued study. 

“There’d be no way to do a randomized trial I can think of, but size could be increased and compared to usual FM care for 12 months,” he said.

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CALL TO ACTION!! CODE RED!!

I have received confirmation for a face to face sit down with a Congreeman in DC!
WE NEED YOUR LETTERS!
I will hand deliver them to the Congressman myself! I am still waiting confirmation from the Senators office!
Trump just made step 1 to taking our medication away! It’s our job to educate others on how vital this medication is to our ability to function. And a sit down in Washington is as good as it gets!
Write those letters! Email in your photos for our collage and those videos for our YouTube channel. LETTERS ARE THE MOST IMPORTANT!
We are on our way everyone!! Just hang tight ❤️
Remember Together We Are Strong!

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County pays $520,000 to settle excessive force, false imprisonment lawsuit

http://www.mlive.com/news/flint/index.ssf/2017/10/lawsuit_claiming_excessive_for.html

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Trump Administration Declares Opioid Crisis A Public Health Emergency

Title 42 – THE PUBLIC HEALTH AND WELFARE CHAPTER 7 – SOCIAL SECURITY SUBCHAPTER XVIII – HEALTH INSURANCE FOR AGED AND DISABLED §1395. Prohibition against any Federal interference

SEC. 1801. [42 U.S.C. 1395]  Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.

The above statute is applicable (only) to care of patients 65 and over (under Medicare and/or Medicaid); and/or persons formally recognized as having “disabled” status under SSI or SSDI:

https://www.ssa.gov/OP_Home/ssact/title16b/1614.htm#act-b1614-a

As I watch President Trump’s speech on addressing the OVER-HYPED “opiate crisis”… the HYPERBOLE in the speech… surpassed all existing SUPERLATIVES in the  English language.

Trump claimed that our Federal government  is going to do some very aggressive arm bending to get the Pharmas to find/create a NON-ADDICTING OPIATE…

We have been down that path and the two drugs that was to suppose to meet that goal… Talwin & Stadol… these two drugs – been on the market for decades – either were abused and/or didn’t do much for pain management… or BOTH..

Trump claimed that we are going ELIMINATE ADDICTION…. he talked about his Brother that had abuse issue with the two drugs – ALCOHOL & NICOTINE – which we currently have an estimated 45 million addicts to the former and 35 million to the latter…  but.. I guess that ADDICTION is not going to go down that path…  and address those addictions… whose use/abuse of those two drugs cause 550,000 deaths each year. He also pointed out that part of the elimination of addiction was the use of DOJ suing anyone that is believed to be part of the problem.

Does all of these promises by Trump … violates sections of Title 42 as posted at the head of this post ?

Trump only mentioned the treatment of chronic pain… but.. stated that the FEDS were going to produce “best practices” in treating chronic pain… we have seen what the CDC considers “best practices” as to opiate dosing to treat chronic pain.

That section of Title 42 seems to suggest that a lot of things that numerous Federal agencies are doing or have done..  the chronic pain community may want to take the suggestion of our President that the legal route may be the only thing left to protect those with chronic pain being able to get adequate treatment will be down the legal path…

While it is claimed that 90% of the chronic pain community are struggling financially,  there are 100 + million in that community and a few dollars from each into a legal defense fund could go a very long way to “level the playing field”.

No law firm is going to take on this type of case on a contingency basis, because within out judicial system the “value of life” of those who are disabled/handicapped, elderly/retired, unemployed is pretty much on par with the value of the family pet… LITTLE OF NOTHING…

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Police: Man hijacks ambulance to ‘score some oxy

https://www.ems1.com/ambulance-crash/articles/347764048-Police-Man-hijacks-ambulance-to-score-some-oxy/

DANVILLE, Pa. — A man stole an ambulance with a crew inside, drove it to a pharmacy to steal pills and crashed into a pole, according to police.

WTVR reported that the Americus Hose Company Ambulance Service crews had just dropped a patient off at an emergency room when Adam Zaharick, a hospital patient, hijacked the ambulance and drove away.

They realized what was going on and jumped out of the ambulance for their own safety,” Americus Hose Company employee Bob Hare said.

Zaharick said that after he was released from the hospital, he wanted to “score some oxy,” according to police. He added that he wanted to put on a show by stealing the ambulance.

Police said Zaharick first crashed into a truck on the hospital campus, and then drove to a CVS pharmacy where he crashed into a pole.

“I don’t know what all kind of damage he’s done, but the ambulance is pretty banged up,” Hare said.

After the crash, Zaharick ran into the pharmacy and jumped over the counter to try and steal pills.

An off-duty federal corrections officer was in the store and tackled Zaharick to the ground until police arrived. He was arrested and faces charges of robbery of a motor vehicle, robbery and burglary.

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Gottlieb: Next Steps in Opioid Crisis May be ‘Uncomfortable’

http://www.raps.org/Regulatory-Focus/News/2017/10/25/28752/Gottlieb-Next-Steps-in-Opioid-Crisis-May-be-Uncomfortable/

In testimony before the House Energy & Commerce Committee on Wednesday, FDA Commissioner Scott Gottlieb said that the next steps in efforts to combat the ongoing opioid crisis will be difficult, but necessary given the spread of the epidemic.

“We’ll need to touch clinical practice in ways that may make some parties uncomfortable,” Gottlieb said, pointing to restrictions on prescribing and mandatory education for physicians as possible steps.

“Long ago we ran out of straightforward options,” he added.

Gottlieb’s remarks come as the US continues to struggle with overdoses that claimed the lives of at least 64,000 people in 2016, according to provisional data from the US Centers for Disease Control and Prevention (CDC).

Gottlieb also said the agency will be taking another look at the benefit-risk framework for opioids in light of the ongoing epidemic to inform its regulatory decisions, “including recommending that products be withdrawn from the market.”

In July, Endo Pharmaceuticals voluntarily withdrew its reformulated Opana ER (oxymorphone hydrochloride) from the market less than a month after FDA requested that the company pull the drug due to public health concerns over abuse.

Medication-Assisted Treatments

Gottlieb announced several steps FDA will take to promote the development and use of medication-assisted treatment (MAT) for opioid addiction.

The agency is also working to draft guidance to promote the development and use of non-abstinence-based endpoints for addiction treatments and support the development of drugs that address symptoms of addiction, such as cravings.

And Gottlieb said that FDA will do more to promote the use of existing addiction treatments such as naltrexone, buprenorphine and methadone.

“One concept that FDA is actively pursuing is the research necessary to support a label indication for medication-assisted treatment for everyone who presents with an overdose, based on data showing a reduction in death at the broader population-level,” he said, adding that the agency is also considering updating the labeling for such drugs to reflect that they may need to be taken for long periods of time.

Lastly, Gottlieb said that FDA will take steps to address the stigma associated with MATs.

“The stigma reflects a view some have that a patient is still suffering from addiction even when they’re in full recovery, just because they require medication to treat their illness,” Gottlieb said.

Access and Affordability

During his testimony, Gottlieb said that inadequate insurance coverage is part of the reason some people with opioid addictions do not receive necessary treatment.

Gottlieb also raised the point that currently the vast majority of opioids dispensed in the US are inexpensive, immediate release formulations. Going forward, Gottlieb said that insurance coverage and reimbursement could be an issue for new abuse-deterrent or non-addictive pain treatments.

“It will be the case that some of those newer drugs will be more expensive than the older formulations, and I think we need to think about how we provide incentives for those to be used—perhaps preferentially—if we think the public health outcome is going to be better,” he said.

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