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JESSICA SPAYD, ANP PF ALASKA UNJUSTLY 30 YEARS PRISON SENTENCED IN FAILED OPIOID WAR ON PATIENTS SUFFERING PAIN AND THEIR PROVIDERS
Ohio legislature to legalize accepting bribes for opioid settlement money
I have read where that collectively, the states involved in the multi-billion Tobacco Settlement, – suing the manufacturers for selling a legal product… a low single percent of that money was spent on what the settlement agreement ..between the Tobacco manufacturers and the states was stated what the states were supposed to spend it on, but many just put the $$ in the state coffers, to spend as they pleased.
Here, once again, all these states are- this time – suing not only the manufacturers but the wholesalers and retailers for selling a legal product and claiming it caused a opioid crisis and basically legally extorting hundreds of billions of dollars out of these legal businesses over what appears to be a fabricate opioid crisis because – at least – Ohio is attempting to hide from the citizens in Ohio where the 1.1 billion that Ohio is getting out of all these lawsuits so far. Does this mean that Ohio has no intention of spending that money on what they signed in the agreement?
Ohio legislature to legalize accepting bribes for opioid settlement money
The Ohio legislature is preparing to make $1.1 billion in opioid settlement spending secret. In addition to preventing the public from knowing how money is spent, the legislature plans to take the unprecedented step of revising the OneOhio opioid settlement agreement to legalize the bribery of elected officials to influence who gets the money.
The extraordinary changes were placed, both last minute and unannounced, into a giant 9,128-budget bill (HB 33) that legislators are rushing to pass before the budget year ends on June 30. The two-page measure to make spending secret and bribery legal was added to the 9,198-page budget bill on Wednesday, June 14, shortly before the Senate Finance Committee approved the sending the budget bill to the full Senate.
No senator has taken credit for the change. Senate Finance Committee Chair Matt Dolan, (R-Chagrin Falls), did not acknowledge the change during his 12-minute summary of what the bill included.
On Thursday, June 15, the Ohio Senate approved the budget bill without mentioning the two pages in the OneOhio budget amendment open meetings public records that legalize bribery for opioid settlement funds or the changing the law to keep spending secret.
The Ohio Senate and the Ohio House of Representatives have both passed different versions of the state budget. The House version, approved on April 26, does not include the secrecy and bribery provisions. The Senate version, approved June 15, does. Next, the leadership of both chambers will appoint a committee to work out differences between the House and Senate budgets.
If this “conference committee” leaves the opioid settlement measures in the final version, Ohio will have a state budget that makes history in an unexpected way: legalizing bribery to get $1.1 billion in government funds and requiring that all details on spending and decision-making be kept from the public.
Dark money: $1.1 billion in settlement funds
Ohio will receive $2 billion over 18 years from opioid settlements reached with about 10 defendants (wholesale distributors, pharmacies, manufacturers).
The 11-page OneOhio opioid settlement agreement — approved by nearly every county, municipality and township in Ohio — requires that decision-making and spending be done in accordance with open meeting and public records laws. The agreement divides money:
- 15% directly to the state of Ohio.
- 30% directly to local government.
- 55% to the newly created OneOhio Recovery Foundation
Ohio’s 110 local health districts and 50 mental health boards are separate governmental entities and were excluded from the settlement, despite their dominant governmental role dealing with opioid problems.
The proposed secrecy and bribery rules would apply only to money controlled by the OneOhio Recovery Foundation’s 55% share of the total payout. The $900 million that state and local governments spend directly will still be available to the public and bribing to get the money will remain illegal.
The $1.1 billion that goes to the OneOhio Recovery Foundation is what would become secret and eligible for bribery if the change slipped into the budget passes.
The OneOhio Recovery Foundation is run by a 29-member board appointed by the governor, attorney general, legislative leaders and local governments. Most board members are public officials themselves, with elected county commissioners being the most commonly appointed.
Going secret: 19 OneOhio regional boards
The regional boards were created by local Ohio governments and their members are appointed by county commissioners, city councils and township trustees. These 19 regional boards have considerable control over who receives the foundation’s $1.1 billion.
The secrecy-bribery provision also converts 19 regional opioid settlement boards, which now operate publicly in open meetings, into secret organizations exempt from the Ohio Open Meetings Act. If the secrecy-bribery rule survives the budget process, these government board meetings will go dark when Gov. Make DeWine signs the budget, probably July 1.
In all, the 19 regional boards have 289 board members. Harm Reduction Ohio identified 259 of these. These 19 government boards include the following board members:
131 elected officials (county commissioners, mayors, city council members, township trustees, sheriffs, judges, prosecutors, etc.)
81 government employees (mental health board directors, police chiefs, fire chiefs, law directors, county and municipal administrators, etc.)
41 private citizens (health care providers, lawyers, ministers, treatment providers, etc.)
3 whose profession could not be determined
Under the Senate plan, these board members could accept bribes. They would also conduct deliberations and make decision in secret.
Violating OneOhio agreement
The OneOhio settlement agreement approved by 800+ local Ohio government requires that all meetings and records be conducted according to Ohio’s open meetings and public records laws. (See Section 12 of the agreement above.)
However, from the very first state board meeting on May 16, 2022, OneOhio has claimed it did not have to follow the transparency requirements of the settlement.
Harm Reduction Ohio sued the board for violating Ohio Open Meetings Act and the Ohio Public Records Act. Harm Reduction Ohio won both cases.
On March 9, a Franklin County judge ruled the OneOhio foundation must follow the open meetings act. In April, after OneOhio continued to hold secret meetings, the judge issued a temporary restraining order that ordered OneOhio to immediately comply with his earlier ruling. The judge said both the settlement agreement and Ohio required OneOhio to conduct open meetings.
On May 11, the Ohio Supreme Court ruled 7-0 that the OneOhio foundation must follow the public records act. The court ruled that Ohio law — not just the settlement agreement — required compliance with public records law.
The language snuck into the budget bill would override the court decision and Section 12 of the settlement agreement requiring transparency.
Sen. Rob McColley, R-Napoleon, a member of OneOhio’s board, is the politician who snuck the secrecy and bribery language into the state budget. He explained his rationale to The Columbus Dispatch:
State Sen. Rob McColley, R-Napoleon, who serves on the OneOhio board, said the private foundation was never intended to be a public agency that is bogged down by state requirements. “That would really hamper the amount of public good it can do.”
Instead, the foundation should operate under its own rules and bylaws and hold open, public meetings, he said.
The OneOhio Recovery Foundation’s argument is that it is a private non-profit, even if 100% of its money is public money and its board is controlled by elected officials. In the foundation’s view, it should be able to spend money as if it is the Bill and Melinda Gates Foundation spending Bill Gates’ Microsoft fortune. The courts rejected these arguments. They ruled that, based on the foundation’s source of funds and who controls the foundation, the OneOhio Recovery Foundation was the “functional equivalent” of a governmental body.
One difference, of course, is that this is not Bill Gates’ money or that of private donors. It is public money being spent by public officials.
The budget bill would override the court decisions and convert $1.1 billion into private money once it arrives at the foundation. The public would have no right to know who receives money from the OneOhio foundation or how decisions were made.
From OneOhio’s perspective, bribery would be an internal problem, not a legal issue. The foundation has passed a conflict-of-interest policy that says the board “shall take appropriate disciplinary and corrective action” if a conflict occurs.
The legislature’s see-no-evil approach to OneOhio bribery has no precedent in Ohio law. Even JobsOhio, the state’s non-profit economic developed arm, explicitly banned bribery.
Redefining reality to OK bribery
The legislature legalizes OneOhio bribery by exempting elected officials directing OneOhio money from who is considered a “public servant” and “public official.”
Ohio’s anti-corruption statute (Ohio Revised Code 2921.01) defines “public official” as “any elected or appointed officer, or employee, or agent of the state or any political subdivision, whether in a temporary or permanent capacity, and includes, but is not limited to, legislators, judges. and law enforcement officers.”
The law defines “public servant” even more broadly, to include (a) “any person performing ad hoc a government function, including, but not limited to, a juror, a member of a temporary commission, master, arbitrator, advisor or consultant,” and (b) candidates for public office.
Anyone who meets this definition found in ORC 2901.01 cannot do what is defined as “Bribery” in ORC 2921.02. Bribery is offering, soliciting or accepting “anything of value” to influence a decision related to a public servant’s official’s duty.
Under the law tucked into the state budget, these public officials directing OneOhio money do not count as public officials. Specifically, the language says:
An employee, officer, or appointed member of the OneOhio Recovery Foundation is not any of the following…A public official as defined in section 2921.01 of the Revised Code.
Simple as that. With a skilled legislative knife, bribery is legalized without mentioning the word.
The change makes it legal to offer bribes to public officials, as well as for those public officials to accept them.
The change also ensures that public officials can legally accept grants and contracts directly from OneOhio because “Having an unlawful interest in a public contract” (ORC 2921.42) no longer applies to the foundation.
The budget measure overrides the court decisions requiring OneOhio to act in the open with a similar technique. It exempts OneOhio and its 19 regional boards from ORC 149.011 and ORC. 121.22, which are the Public Records Act and the Open Meetings Act, respectively.
On top of that, it exempts OneOhio and its board members and staff from Ohio ethics law, competitive bidding rules, being reviewed by the Ohio State Auditor or on making spending public information in databases.
Senator: Opioid settlement secrecy for “public good”
Sen. Rob McColley, R-Napoleon, a member of OneOhio’s board, is the politician who snuck the secrecy and bribery language into the state budget. He explained his rationale to The Columbus Dispatch:
State Sen. Rob McColley, R-Napoleon, who serves on the OneOhio board, said the private foundation was never intended to be a public agency that is bogged down by state requirements. “That would really hamper the amount of public good it can do.”
Instead, the foundation should operate under its own rules and bylaws and hold open, public meetings, he said.
The OneOhio Recovery Foundation’s argument is that it is a private non-profit, even if 100% of its money is public money and its board is controlled by elected officials. In the foundation’s view, it should be able to spend money as if it is the Bill and Melinda Gates Foundation spending Bill Gates’ Microsoft fortune. The courts rejected these arguments. They ruled that, based on the foundation’s source of funds and who controls the foundation, the OneOhio Recovery Foundation was the “functional equivalent” of a governmental body.
One difference, of course, is that this is not Bill Gates’ money or that of private donors. It is public money being spent by public officials.
The budget bill would override the court decisions and convert $1.1 billion into private money once it arrives at the foundation. The public would have no right to know who receives money from the OneOhio foundation or how decisions were made.
From OneOhio’s perspective, bribery would be an internal problem, not a legal issue. The foundation has passed a conflict-of-interest policy that says the board “shall take appropriate disciplinary and corrective action” if a conflict occurs.
The legislature’s see-no-evil approach to OneOhio bribery has no precedent in Ohio law. Even JobsOhio, the state’s non-profit economic developed arm, explicitly banned bribery.
Redefining reality to OK bribery
Would not apply to $1.1 billion in OneOhio foundation.
The legislature legalizes OneOhio bribery by exempting elected officials directing OneOhio money from who is considered a “public servant” and “public official.”
Ohio’s anti-corruption statute (Ohio Revised Code 2921.01) defines “public official” as “any elected or appointed officer, or employee, or agent of the state or any political subdivision, whether in a temporary or permanent capacity, and includes, but is not limited to, legislators, judges. and law enforcement officers.”
The law defines “public servant” even more broadly, to include (a) “any person performing ad hoc a government function, including, but not limited to, a juror, a member of a temporary commission, master, arbitrator, advisor or consultant,” and (b) candidates for public office.
Anyone who meets this definition found in ORC 2901.01 cannot do what is defined as “Bribery” in ORC 2921.02. Bribery is offering, soliciting or accepting “anything of value” to influence a decision related to a public servant’s official’s duty.
Under the law tucked into the state budget, these public officials directing OneOhio money do not count as public officials. Specifically, the language says:
An employee, officer, or appointed member of the OneOhio Recovery Foundation is not any of the following…A public official as defined in section 2921.01 of the Revised Code.
Simple as that. With a skilled legislative knife, bribery is legalized without mentioning the word.
Read the change
The change makes it legal to offer bribes to public officials, as well as for those public officials to accept them.
The change also ensures that public officials can legally accept grants and contracts directly from OneOhio because “Having an unlawful interest in a public contract” (ORC 2921.42) no longer applies to the foundation.
The budget measure overrides the court decisions requiring OneOhio to act in the open with a similar technique. It exempts OneOhio and its 19 regional boards from ORC 149.011 and ORC. 121.22, which are the Public Records Act and the Open Meetings Act, respectively.
On top of that, it exempts OneOhio and its board members and staff from Ohio ethics law, competitive bidding rules, being reviewed by the Ohio State Auditor or on making spending public information in databases.
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Why drug shortages might worsen
Why drug shortages might worsen
https://www.beckershospitalreview.com/pharmacy/why-drug-shortages-might-worsen.html
FDA investigators discovered more quality issues at an Intas Pharmaceuticals factory in Ahmedabad, India, which halted some production after a November inspection found a truck full of shredded documents, Bloomberg reported June 15.
In May, the FDA inspected the facility and investigators said they could not ensure the “safety, efficacy, purity and overall quality of drug products manufactured” at the site, according to a 30-page report obtained by Bloomberg.
Some drug supply experts have pointed to the site’s shutdown in November as a cause of the shortages of cisplatin and carboplatin, two cancer drugs that have seen low supply for months. Intas produced about 20 percent of the nation’s supply of carboplatin, according to The Wall Street Journal.
The latest report could spur worsened drug shortages, Bloomberg reported, because the May visit found employees altering recorded data that did not meet U.S. standards for particles, such as black specks, fiber and glass, found in injectable drugs. The FDA also recorded evidence of Intas employees disregarding three years’ worth of more than 1,000 “spore-forming organisms.”
On June 1, the FDA instituted an import ban on all but 25 of Intas’ drugs made at its three India-based facilities, according to agency documents. The products excluded from the import ban include multiple cancer drugs in shortage, including cisplatin, carboplatin, fluorouracil and docetaxel.
The drugmaker also has not verified its quality test procedures for more than 100 of its drugs. Intas did not respond to Bloomberg’s requests for comment.
Recently, quality issues have prompted a cascade of drug supply issues, the American Society of Health-System Pharmacists said in May, and providers are growing worried about their ability to adequately care for cancer patients because of multiple shortages of oncology treatments.
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HEALTH Published June 22, 2023 7:39pm EDT Addiction complicates pain management, but new guidelines offer help for ‘complex patients’
Opioids are often prescribed for pain management after surgery — but for the 19 million people in the U.S. with a history of substance abuse, that option may not be safe or desired. That is why some doctors are recommending to better use cbd gummies for pain that could potentially help alleviate pain after surgery due to their anti-inflammatory and analgesic (pain-relieving) properties. Studies have shown that CBD can reduce both acute and chronic pain, making it a potential alternative to traditional pain medications.
Until now, there hasn’t been a cohesive set of guidelines for managing surgical pain in patients with a history of addiction and/or opioid tolerance.
To address this, the American Society of Anesthesiologists (ASA) gathered 15 medical organizations representing over 500,000 physicians to develop seven guiding principles to improve pain management before, during and after surgery for these patients.
The guidelines have been published in the Regional Anesthesia & Pain Medicine journal.
FOR ACUTE LOWER BACK PAIN, THESE ARE THE BEST MEDICATIONS, NEW STUDY FINDS
Dr. David Dickerson, an anesthesiologist and pain specialist at North Shore University Hospital in Chicago, Illinois, is chair of the American Society of Anesthesiologists’ Committee on Pain Medicine. (ASRA is the American Society of Regional Anesthesia and Pain Medicine.)
“Patients with these complex issues may require additional care after surgery,” Dickerson told Fox News Digital.
Woman upset in hospital
Opioids are often prescribed for pain management after surgery — but for the 19 million people in the U.S. with a history of substance abuse, that may not be a safe or desired option. Now, a new set of guidelines may help. (iStock)
“When someone undergoes a surgical procedure and they have a substance use disorder, chronic pain or pre-operative opioid tolerance, their nervous system is different,” he told Fox News Digital in an interview.
“Their ability to self-soothe in the face of injury or pain is also going to be a very different experience.”
TAKE THESE 5 SMART STEPS TO RELIEVE MUSCULOSKELETAL PAIN
As the director of four hospitals, Dickerson sees patients with many different types of pain in many different care environments. It’s why he’s calling for adopting a unified approach for patients who may not have a straightforward experience with pain management when it comes to surgery, injury, trauma or disease.
“Their ability to self-soothe in the face of injury or pain is also going to be a very different experience.”
“We want to make sure the patient has a consistent experience in terms of getting pain alleviated and also minimizing the risks of pain treatments,” he said.
Over a span of several years, Dickerson and other pain management specialists and physicians crafted the following seven principles to use as a “north star” for screening, treating and educating these vulnerable patients, while building awareness and education for safe and effective surgical care.
1. Identify patients at risk
Physicians should “screen for substance abuse preoperatively, risk stratify and refer for treatment as needed,” the first principle states.
The doctor should speak with the patient prior to surgery to determine whether there is any history of substance abuse, identify any risk factors and provide recommendations for referrals as needed.
“Clinicians should identify patients with a substance use disorder and facilitate evaluation and treatment before surgery.”
“As the majority of patients receive a post-surgery opioid prescription and 100,000 Americans die annually from accidental opioid overdose, clinicians should identify patients with a substance use disorder and facilitate evaluation and treatment before surgery,” Dickerson told Fox News Digital.
“Identifying and treating substance use disorders saves lives — especially when we recognize that 19 million Americans have at least one substance use disorder.”
2. Coordinate care for complex patients
“Coordinate care pre-operatively for complex patients and consult with pain medicine, behavioral health or addiction medicine specialists to optimize the treatment plan,” the second principle states.
It’s also important to note that CBD gummies should not be used as a substitute for medical treatment and recovery after surgery. but this is a good option for patients to alleviate pain.
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COVID VACCINE MANUFACTURER’S LIABILITY, ILLEGAL MANDATES AND HUMAN RIGHTS VIOLATIONS
COVID VACCINE MANUFACTURER’S LIABILITY, ILLEGAL MANDATES AND HUMAN RIGHTS VIOLATIONS
On June 22, 2023, in the United States District Court for the Southern District of Florida, the Court in which President Trump stands indicted, Drs. David Basch and Richard Arjun Kaul filed a lawsuit (Kaul/Basch v Federation: 23-CV-22325) (K11-14) against, amongst others, Defendant Federation of State Medical Boards and 2024 US Presidential candidate, Christopher J. Christie, on racketeering charges pertaining to injuries caused by the so called COVID ‘vaccine’:
“The most recent catastrophe is that related to the mass forced/coerced inoculations of the American public with an mRNA toxin, that the public was deceived into believing was a ‘vaccine’ against COVID-19. This gene manipulating toxin has resulted and will continue to result in, amongst other things, premature death, increased rates of cancer, cardiac disease, and early-onset dementia/neuro-cognitive deterioration.”
“Commencing in early 2020, just after the announcement of the purported pandemic, Plaintiff Kaul began writing articles and filing legal documents that highlighted the multiple profit purposed COVID related frauds that mandated knowingly toxic and ineffective mRNA ‘vaccines’, the wearing of masks and ubiquitous, but non-specific PCR testing.”
“In a time period commencing in or around May 2020, Defendant FSMB-FBM/agents in collusion and conspiracy with co-conspirators Pfizer/Moderna/agents and others did order American state medical boards and coerce foreign medical councils to compel, under penalty of license suspension/revocation and or medical registration suspension/erasure, its physicians to deceive patients into being inoculated with an mRNA compound that patients were falsely led to believe was a vaccine against COVID, but that Defendant FSMB-FBM and its corporate/state medical board co-conspirators knew was not only not a vaccine, but a substance with immense/lethal toxicity.”
“Crimes Against Humanity: Defendant FSMB-FBM and its ‘vaccine’ manufacturer co-conspirators CEO Joaquin Duato/Agents (Johnson + Johnson) CEO Albert Bourla/Agents (Pfizer), Pascal Soriot/Agents (Astra Zeneca) and CEO Stephane Bancel/Agents (Moderna), knew that the ‘vaccine’ was toxic and ineffective, and that it would cause death, permanent injury, and generational injury in that ‘vaccine’ caused genetic mutations/injuries would be transmitted in reproduction.”
On June 14, 2023, there was a second attempt on Kaul’s life and liberty, the first being on May 27, 2021.
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On this episode of Real Pain, Real Talk: APDF patients and advocates, Bob Sheerin & Andrew Hohenthaner, to talk about how pain impacts
Episode 2. On this episode of Real Pain, Real Talk, our Host,
Kat Hatz, is joined by two fellow APDF patients and advocates, Bob Sheerin
& Andrew Hohenthaner, to talk about how pain impacts everything, from
functionality to basic quality of life. We discuss our journeys as patients and
advocates, both before and after the Centers for Disease Control &
Prevention (CDC) issued draconian Guidelines for Prescribing Opioids in 2016,
which were revised in 2022 but with no substantive improvements. We also talk
about the heartbreak involved when we advocate for a community we belong to,
that consists of extremely vulnerable, disabled, and marginalized individuals.
We try to raise awareness about how hard it is to know we will continue to lose
members of our community until substantive changes are made to the harmful and
widely adopted current policies pertaining to pain medicine. In addition, we
discuss how those policies have hurt us and countless other patients. We hope
this episode is heard by both the pain community and healthy people, as we try
to give a voice to people who face intractable chronic pain. Please tune in and
help us debunk a flawed media narrative that has been pushed by government
agencies, legislators, insurers, and others, and which has resulted in millions
of preventable harms and deaths that pain patients have sustained. Follow our
podcast, and you will immediately be notified when a new episode is out!
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Another group of bureaucrats being formed to created prescribing limits on controlled meds
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Effective July 1, Florida Will Prohibit Offshore Storage of Health Records and Require Additional Ownership Disclosures
Effective July 1, Florida Will Prohibit Offshore Storage of Health Records and Require Additional Ownership Disclosures
https://www.lexology.com/library/detail.aspx
A new Florida law will require certain Florida-licensed providers to ensure that patient information is physically maintained only in the continental United States and its territories or in Canada. Florida SB 264, which goes into effect July 1, 2023, amends the Florida Electronic Health Records Exchange Act, adding a ban on offshoring health information that goes beyond the requirements under HIPAA and most other generally applicable health privacy and security laws. Florida licensees to which the new requirements apply will need to attest upon initial licensure and any renewals that they are in compliance with the new requirements. Applicable licensees will also be required to ensure that no individual or entity with a controlling interest in the licensee has an interest in an entity that has a business relationship with certain foreign countries, as discussed below.
The new privacy requirements apply to all “qualified electronic health records that are stored using technology that can allow information to be electronically retrieved, accessed or transmitted” used by the categories of health care providers listed below. “Qualified electronic health records” are electronic health records that can provide clinical decision support, support physician order entry, capture and query relevant quality information, and exchange electronic health information with and from other sources. The new anti-offshoring requirements are separate from the recently passed Florida Digital Bill of Rights, which our Mintz privacy colleagues covered here.
Impacted provider types encompass facilities including, but not limited to, hospitals, clinics, ambulatory surgical centers, home health agencies, hospices, nursing homes, labs, pharmacies, and individual practitioners including physicians, physician assistants, advanced practice registered nurses, registered nurses, pharmacists, dentists, chiropractors, podiatrists, certain behavioral health providers, physical therapists, occupational therapists, speech-language pathologists, audiologists, and respiratory therapists. The law only applies to providers who use “certified electronic health record technology”, or CEHRT, which meets the federal interoperability standards. Because of ambiguity in the statute, it is unclear if the law is meant to apply only to providers who participate in the CMS payment programs that require CEHRT or if the requirements are more broadly applicable to any provider who utilizes CEHRT, regardless of whether they are required to do so.
The new licensure requirements included in the statute require providers applying for and renewing their Florida Agency for Health Care Administration (AHCA) licensure to submit an affidavit attesting under penalty of perjury that the applicant is in compliance with the prohibition on offshoring health care information. Failure to maintain compliance with the requirements could result in disciplinary action by AHCA.
The requirement to store qualified electronic health records within the U.S. and Canada also extends to third-party vendors and subcontractors who store such records on behalf of the affected Florida providers. This could also affect vendors overseas who access electronic health records if the access involves downloading a copy of the records. Because of the potential reach of this law, providers operating in Florida should take steps to confirm that neither they nor their vendors are storing electronic health records outside of the U.S. and Canada.
While HIPAA does not prohibit offshoring health information, covered entities outside of Florida should always take steps to ensure that vendors who store PHI offshore are able to comply with all of the privacy and security requirements under HIPAA and other applicable privacy laws. Third-party payers, including Medicare Advantage plans and state Medicaid programs, also often include provisions restricting or prohibiting the use of offshore vendors, so providers should stay on top of how and where their health records are being stored.
The new law also requires entities licensed by AHCA to confirm that no individual or entity with a controlling interest in the licensed entity holds, directly or indirectly, an interest in an entity that does business with a “foreign country of concern.” “Foreign countries of concern” include “the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country of concern.” Under Florida law, a controlling interest is defined to mean a person or entity that serves as an officer or director of or has a 5% or greater ownership interest in the licensee or a management company that manages the licensee. The law as drafted does not include a carve-out for ownership interests held by publicly traded entities, unlike the current ownership limitations related to holding an interest in a facility that has previously had its license revoked. Notably, as drafted the restrictions do not include any carve out for activities that the Office of Foreign Assets Control has permitted to be conducted with sanctions nations. Additionally, the inclusion of the People’s Republic of China in the list of foreign countries of concern will require entities licensed in Florida to review potential business relationships that they or their parent companies have in China that are otherwise permissible under U.S. law.
It has not been well disclosed that Experian owns Narxcare and that Experian HQ is in Ireland and that they are storing all of the health information databases off-shore, because that makes those databases outside of our HIPAA laws. Some have compared the collecting and selling of data to the “California gold rush” in the mid 19th century
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HERSH PATEL, MD: THE BOTHRA TRIAL, HOW DEFENSE ATTY LAWRENCE MARGOLIS EXPOSED DEA EXPERT PATEL AS A COMPLETE FRAUD
THE MYTH OF MORPHINE MILLIGRAM EQUIVALENT DAILY DOSE: NABARUN DASGUPTA et al. DOES THE MATH
reported by norman j clement rph., dds
THE MYTH OF MORPHINE MILLIGRAM EQUIVALENT DAILY DOSE
In 2016, the CDC issued its Guidelines for Prescribing Opioids for Chronic Pain Patients. In publishing the guidelines, the CDC explicitly stated that they were meant to be voluntary and “not prescriptive,” stating that healthcare practitioners knew their patients’ unique clinical situation and should weigh the potential risks and benefits when prescribing opioids. Many of its recommendations were based on what the CDC characterized as “Type 3” or “Type 4” evidence, which are categories of evidence that are less probative and carry a significant risk of inaccuracy. The guidelines thus came under significant criticism from many pain and addiction specialists for lacking a strong basis in the evidence.
Others criticized the use of morphine milligram equivalents (MMEs) in determining the appropriate dosing of different opioids. As Fudin and others have argued, MME dosing was designed in an attempt to examine opioids with similar analgesic effects and should not be used to determine an exact mathematical dosing conversion.
“MME IS NOT A STANDARDIZE CLINICAL METRIC”
The pharmacology and unique properties of each opioid and patient individuality must be considered when a therapeutic opioid conversion is contemplated. Conversion should not simply rely on a mathematical formula embedded within the CDC calculator software.
Furthermore, the current calculation for methadone employed by the calculator could allow for potentially dangerous conversions. This is especially problematic, considering this calculator is intended to target nonspecialist general practitioners. We expect a higher level of scientific accuracy and integrity from an agency entrusted to protect citizens’ health and welfare.
Recognizing the controversy surrounding MMEs, in August 2021, the FDA held a “public workshop” entitled “Morphine Milligram Equivalents: Current Applications and Knowledge Gaps, Research Opportunities, and Future Directions.” The workshop’s stated purpose was to “provide an understanding of the science and data underlying existing MME calculations for opioid analgesics, discussing the gaps in these data, and discussing future directions to refine and improve the scientific basis of MME applications.”
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$10, $15, $20, $25,$50, $75, 175, $500. OR MORE TO CASH APP:$docnorm
ZELLE 3135103378 or Donate to the “Pharmacist For Healthcare Legal Defense Fund,”
NABARUN DASGUPTA et al.DOES THE MATH
During the workshop, Nabarun Dasgupta of the University of North Carolina Injury Prevention Research Center presented research stating: “Contrary to conventional wisdom, conversion values are not based on pharmacologic properties. Instead, they arose 60 years ago from small single-dose clinical studies in post-operative or cancer populations with pain score outcomes; toxicologic effects (e.g., respiratory depression) were not evaluated.”
The research concluded: “The overlooked inconsistency among daily MME definitions revealed by our study calls into question the clinical validity of a single numerical risk threshold. . . . Our findings call into question state laws and third-party payer MME threshold mandates. Without harmonization, the scientific basis for these mandates may need to be revisited.”86 Some critics consider the use of MMEs to be “junk science.”
Nevertheless, many states implemented statutory or regulatory limits on the dose (in MMEs) and number of opioids that may be prescribed to patients in acute, chronic, and postoperative situations, respectively, and they encouraged policies promoting the rapid or abrupt tapering of chronic pain patients off the opioid therapies on which they had been maintained long-term.
In 2018, Oregon proposed a mandatory reduction to zero opioids calculation for methadone employed by the calculator could allow for potentially dangerous conversions. This is especially problematic, considering this calculator is intended to target nonspecialist general practitioners. We expect a higher level of scientific accuracy and integrity from an agency entrusted to protect citizens’ health and welfare in Medicaid patients over 12 months. The state reversed itself after receiving fierce criticism from pain management and addiction specialists.
for now, youarewithinthenorms.com
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