Summary DEA raid Dr. Bockoff’s office: 3 DEAD – 1.15 million cash confiscated from Doc – will be hear about future deaths ?

Jessica Fujimaki suffered from a rare disorder called arachnoiditis. A common cause of this very painful and irreversible health issues is a error or “sloppy technique” of a practitioner doing a ESI procedure ( Epidural Spinal Injection). Anything that is injected into the spinal fluid must not only be sterile but must be preservative free and only a SOLUTION  – NOT A SUSPENSION.  ESI involve the injecting of a corticosteroid in the EPIDURAL SPACE – NOT IN THE SPINAL FLUID.  If the practitioner pushes the needle “a tad too far’ and accidentally injects the corticosteroid into the spinal fluid and the pt ends up with a VERY PAINFUL and IRREVERSIBLE MEDICAL ISSUE.   Outcomes – such as Jessica Fujimaki – is potentially what happens when these pts lose any/all pain management.  Likewise for Danny & Gretchen Elliott,  As long as our law/judicial system is entitled to qualified immunity  https://leb.fbi.gov/articles/legal-digest/legal-digest-qualified-immunity-how-it-protects-law-enforcement-officers  it would seem that they will do as they damn please and they have no consequences.

The DEA Shut Down a Pain Doctor. Now 3 People Are Dead

https://www.vice.com/en/article/dy7qqv/dea-beverly-hills-doctor-shut-down-opioids

After a California doctor was labeled an “imminent danger” to the public, the consequences were devastating for his patients and their families.

https://video-images.vice.com/articles/63b5f5d2c3a22546be38ae39/lede/1672885272343-dea-beverly-hills-doctor-shut-down-opioids-1.png?crop=1xw:1xh;center,center&resize=500:*
Jessica Fujimaki, 42, died in December, shortly after the DEA shut down her pain doctor. Image via GoFundMe campaign.

First, there was the double suicide—a husband and wife from Georgia who took their lives one week after the Drug Enforcement Administration (DEA) suspended the license of their doctor, David Bockoff, a pain specialist in Beverly Hills. After Bockoff lost his ability to prescribe fentanyl and other powerful painkillers on Nov. 1, dozens of his patients became “opioid refugees” with nowhere to turn. The third death came barely a month later.

Another ex-Bockoff patient, 42-year-old Jessica Fujimaki, died Dec. 10 at her home near Phoenix. Autopsy results are pending, but her husband told VICE News he believes the cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. She left behind two daughters, ages 13 and 11.

The DEA alleges Bockoff prescribed “alarmingly high dosages” of opioids to multiple patients, posing an “imminent danger” to the public. The doctor—who does not currently face any criminal charges—is attempting to fight back in civil court, denying any misconduct and alleging that DEA agents are the ones responsible for harming the public by effectively shutting down his practice with no consideration for people who relied on medications he prescribed.

“Much like a diabetic is dependent on insulin,” Bockoff’s attorney wrote in one court filing, “taking away the controlled substances allowed only by prescription from a DEA registered physician can be life threatening.”

On Tuesday afternoon, a federal judge in Los Angeles denied Bockoff’s request to override the DEA and restore his authority to prescribe, citing “serious concerns about the improper dispensing of highly addictive and frequently abused substances that can have devastating consequences.”

But exclusive interviews with Bockoff patients and court documents reviewed by VICE News make it appear as though the devastation came only after the DEA intervened against Bockoff, sending his patients into desperate spirals to stave off withdrawals and manage their pain. 

Jessica Fujimaki’s husband Tad said his wife was a gymnast and ballroom dancer when she was younger, but she suffered from a rare disorder called arachnoiditis, which in recent years combined with other health problems to leave her unable to function without pain medications.

Jessica began seeing Bockoff in late 2021. After years of the DEA cracking down on over-prescribing and billions of dollars worth of settlements against the pharmaceutical industry for helping to create an overdose crisis, finding a pain doctor was no easy feat. While illicit fentanyl smuggled across the border by Mexican cartels is fueling record overdoses, prescription medications have become more tightly controlled, with doctors, pharmacists, and insurers becoming highly restrictive with opioids under the threat of DEA raids and civil litigation.

The 80-year-old Bockoff had been a specialist in the field for over two decades and was one of the few physicians willing to treat Fujimaki and others with complex conditions and dependencies on high levels of opioids. In court filings, his lawyers called him “the last option for many patients with severe chronic pain.” Records show a medical expert consulted by the DEA raised concerns about five patients on unusually large doses of fentanyl and other drugs.

In a phone call with VICE News, Bockoff said of those five cases flagged by the DEA: “They typify my patients—I try to give absolutely the best quality of care possible.” Court records show those five patients disagree with the DEA expert’s assessment and are willing to testify on behalf of Bockoff in his efforts to get his DEA license renewed.

Bockoff said he fell into pain management as a speciality 30 years into his medical career, taking satisfaction in improving the quality of life for people with excruciating conditions. 

“There have been ups and downs through the decades with regard to the governmental view of opioids,” Bockoff said. “Hopefully we’re in a climate now where we’re a little more supportive of intractable pain patients, but I’m not sure.”

The DEA has also taken issue with Bockoff’s record keeping and patient intake process, but Tad Fujimaki said Bockoff was always professional with his wife’s treatment, requiring a thorough screening and regular check-ups to get prescriptions renewed. Her last visit was Oct. 31, a day before the DEA visited Bockoff’s office and suspended his license. Their pharmacy declined to fill the prescription, leaving her with a limited supply.

“It’s not like my wife could see a primary care provider and have him prescribe Percocet or something,” Fujimaki said. “No, it doesn’t work that way. We tried so many pain management doctors and nobody would take her because she’s so complicated.”

The Fujimakis ultimately resorted to taking a trip across the border from Arizona into Mexico, where they purchased opioid pills at a pharmacy to help Jessica manage withdrawals. “But the day before Thanksgiving shit hit the fan, basically,” he said. It seemed like she was having a heart attack and couldn’t move, he recalled. She went to the emergency room and received some opioids, but not her normal prescription. She died two weeks later. 

Tad believes her death was caused by stress on her organs and high blood pressure linked to the withdrawals. She was stable until the upheaval caused by the DEA action against Bockoff.

“Whoever signed off on the decision to suspend Dr. Bockoff’s license must’ve had a healthy family to go back to,” Fujimaki said. “They just don’t understand why we need these medications. They don’t even think about it. But there are patients who need this medicine to have a decent quality of life.” 

In court filings, lawyers for the DEA said Bockoff’s patients needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” adding that, “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs. The patients who arrived at Bockoff’s office after the DEA suspension received a list of emergency rooms in the LA area where they could be treated—not for their pain issues, but for their severe withdrawal symptoms from losing their prescriptions.

For the patients and their advocates, the notion that they were addicts or victims is absurd. One wrote a letter to the court in Los Angeles saying the doctor’s care had given them a new lease on life.

“This pain medication allows me to practice law and serve as a prominent traumatic brain injury litigator for the largest personal injury firm in California,” wrote the patient, identified by the initials E.C., in a letter reviewed by VICE News. “Dr. Bockoff counsels me on how to manage my pain and prescribes medication for me that allows me to manage my pain so I can be a contributing member of society.” 

Another patient, identified by the initials D.L., wrote to the court that they and other Bockoff patients were “in unbearable pain and many contemplating suicide” since the DEA action.

“No human being, already going through such a difficult life of pain, should have their only relief and hope pulled out from underneath them in a moment, with absolutely no advance notice to prepare, at a time and environment when the vast majority of pain doctors aren’t even taking new patients,” the patient wrote.

Another Bockoff patient, 61-year-old Danny Elliott died by suicide on Nov. 7, 2022, along with his wife Gretchen. Danny left a post on Twitter saying Bockoff was his third pain doctor to be shut down by the DEA since 2018. They tried to find another doctor with no avail, and although Gretchen was not a pain patient she chose to end her life at the same time as her husband.

IMG_4369.JPEG

An undated image of Danny and Gretchen Elliott. Provided photo.

Danny’s brother, Jim Elliott, shared an excerpt from a note Danny left behind after his suicide: “I just can’t live with this severe pain anymore, and I don’t have any options left,” he wrote. “There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares.”

Experts have warned for years that abruptly cutting off opioid users increases the risk of overdose and death, and authorities responded by forming the Opioid Rapid Response Program, “an interagency, coordinated federal effort to mitigate drug overdose risk among patients impacted by law enforcement.”

According to statements from the DEA and Centers for Disease Control and Prevention issued previously to VICE News, the Opioid Rapid Response Program was called into action when Bockoff’s license was suspended. But the CDC said that while it can notify local public health agencies and other stakeholders, it does not receive lists of affected patients or offer any direct outreach or resources to those affected, such as connecting them with another pain specialist. 

In effect, patients like the Elliotts and Fujimakis—who have done nothing beyond taking medications prescribed by their doctor—are abandoned and forced to navigate the system with no support from the authorities that upended their lives in the name of public health and safety.

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A former CDC staffer who helped develop the Opioid Rapid Response Program, Jennifer Carroll, described an effort with good intentions that has struggled to gain traction amid bureaucracy. Carroll, now a professor at North Carolina State University, blamed the DEA for much of the dysfunction.

“These clinic closures are outrageously disruptive—I’m surprised more people aren’t dead,” Carroll said. “The DEA operates this culture of control and fear, justified by control of drugs, that prevents us from keeping people from dying. It not only causes the problem, it prevents the solution to the problem.”

dea-beverly-hills-doctor-shut-down-opioids.png

Jessica Fujimaki, 42, with her husband Tad.

While the judge in Los Angeles declined to reinstate Bockoff’s license this week, he still has an opportunity to plead his case in the DEA’s administrative law courts, which adjudicate licensing disputes between doctors and the agency. Those proceedings are sealed from the public, but scheduled to start on January 19. Court filings reviewed by VICE News indicate both sides plan to call witnesses, with the DEA focused on Bockoff’s allegedly inadequate record keeping practices and the fact that he prescribed “several million dosage units for mainly opioids.” Federal authorities have also seized money from Bockoff, including over $140,000 cash (much of it Euros) from his home and nearly $1 million from his business bank accounts. 

The money was seized through civil asset forfeiture (a process that will require the government to show it was acquired illegally in order to confiscate it permanently), and when asked about it Bockoff said he was unfamiliar with the legal process. He noted that he’s been paying out of pocket to keep his office open to help with patient referrals. He called the deaths of his patients who lost access to medication “recurring tragedies.”

“It apparently doesn’t matter to the DEA that they’re abruptly stopping patients’ medications,” Bockoff said.

The doctor, according to court filings, plans to testify in defense of his medical practices as he petitions the DEA’s administrative law judge to reinstate his license. Independently, a group of Bockoff patients has filed a rare attempt to intervene in the DEA administrative court, according to records obtained by VICE News. 

John Flannery, a lawyer representing the patients, told VICE News in early December that they had so far received “no reaction from the administrative court” regarding their petition.

“The chronic pain patients continue to suffer without their medication,” Flannery said. “As far as we can tell, Dr. Bockoff was a healing physician and thus DEA’s false charges and the suspension of his authority to prescribe for his patients has created an ‘imminent danger’ to every one of 240 suffering pain patients.”

Another ex-Bockoff patient, Anne Fuqua, told VICE News that after the DEA action she was forced to start visiting a methadone clinic near her home in Alabama because she could not immediately find another chronic pain specialist who would treat her for a condition she described as similar to Parksinson’s disease, causing muscle spasms. While the methadone helped prevent withdrawals, Fuqua said, her pain has returned. 

An activist in the chronic pain community, Fuqua has been tracking suicides since 2014 in cases where patients abruptly lost access to their medical provider. So far, according to a database she shared with VICE News, she’s tallied more than 1,000 deaths using obituaries and other public records. That staggering total, she said, is likely only the tip of the iceberg as many deaths go unreported as suicides.

Fuqua said she’s heard from other ex-Bockoff patients who are considering suicide because they can’t find another doctor. An informal support network has popped up, she said, but facing a medical system that seems indifferent to their plight makes it difficult to endure.

“I don’t want to die,” Fuqua said. “There are so many others. I have all these people calling saying ‘How are you doing?’ We’re all doing that to each other. It’s basically code for, ‘Are you alive?’”

Could all chronic pain pts be diagnosed with Opiate Use Disorder ?

Could this mean that as the number of prescribers who have completed the new  obligatory requirement of taking the 8-hour training on managing patients with opioid and other substance use disorders that all pts that these practitioner who treat for chronic pain could be required to have at least a secondary diagnosis of “opiate use disorder” ?  Could the feds make the requirement to take this 8-hour training retroactive for all prescribers when they renew their DEA license –  which is every THREE YEARS.  In theory, every chronic pain pt could be diagnosed with opiate use disorder if the feds decided to go down this path.

The X Waiver Is Officially Dead

https://www.medpagetoday.com/special-reports/features/102520

But now, doctors will have to take substance use disorder training to get their DEA license

The Biden administration’s recent spending billopens in a new tab or window contained under-the-radar changes for addiction medicine, including eliminating the X waiver requirement for clinicians who treat opioid use disorder with medication-assisted treatment (MAT).

The X waiver, a special Drug Enforcement Administration (DEA) certification that allowed clinicians to prescribe buprenorphine (Suboxone), a partial opioid agonist that curbs opioid cravings, has long been considered a bureaucratic hurdle to improving treatment access for patients who struggle with opioid addiction.

While the administration has incrementally loosenedopens in a new tab or window the requirementsopens in a new tab or window for providers to obtain an X waiver in recent years, the provision included in December’s omnibus bill eliminates the certification entirely. The abolishment of the X waiver is included in the bipartisan Mainstreaming Addiction Treatment (MAT) Actopens in a new tab or window.

“Treatment for opioid use disorder is limited by there not being enough people that offer medications for opioid use disorder,” said Brian Hurley, MD, MBA, president-elect of the American Society of Addiction Medicine (ASAM). “Removal of the X waiver opens up the capability of prescribing to a much broader group of clinicians.”

Previously, obtaining an X waiver required 8 hours of training on prescribing MAT to patients with opioid use disorder. But in April 2021, the Biden administration nixed the training requirementopens in a new tab or window for doctors, nurse practitioners, and other providers who wanted to prescribe buprenorphine. Providers simply had to register for the waiver to prescribe.

But also included in the omnibus bill was another provision that bolsters training requirements for clinicians prescribing all controlled substances — not just MAT — called the Medication Access and Training Expansion (MATE) Actopens in a new tab or window.

This law requires all providers who apply for a DEA license to prescribe controlled substances to undergo a one-time, non-repetitive, 8-hour training on managing patients with opioid and other substance use disorders.

“That training is for you to get your DEA license, so that means, obviously, your controlled substance license,” said Rahul Gupta, MD, MPH, MBA, director of the Office of National Drug Control Policy, in an interview with MedPage Today. “That’s different from what used to be the X waiver training, which was primarily focused on prescribing of buprenorphine and opioid [abuse treatments].”

Hurley said ASAM is a “strong supporter of education for clinicians that have controlled substances prescribing authority, really to help preserve the safety of the patients that we treat.” As all controlled substances do carry a risk, it is critical for clinicians to understand how to prescribe them, and buprenorphine should not be singled out, he said.

Removing the X waiver does more than just make it easier to prescribe buprenorphine, Hurley said, adding that this action could pave the way for further de-stigmitization of MAT for opioid use disorder.

“When you put buprenorphine behind the X waiver, it creates the impression that the medication is complex or dangerous,” Hurley said. Clinicians routinely prescribe other medications that are more dangerous than buprenorphine — such as other opioids — which have not previously required additional training, Hurley said.

“So not only does the elimination of the X waiver create the regulatory pathway” for clinicians to prescribe buprenorphine without a separate certification, Hurley said. “It also removes the impression that the treatment of opioid use disorder with buprenorphine is a highly specialized, complex, or dangerous activity.”

While removing the X waiver is a positive change for addiction medicine, more action is needed to encourage providers to actually treat patients with addiction, said Allister Martin, MD, an emergency medicine doctor in Boston and CEO of the non-profit A Healthier Democracy.

“There are some parts of the population that could have been prescribing buprenorphine but simply because of the X waiver, they did not,” Martin said in an interview. “That’s the group that we now need to mobilize.”

DEA AND THE DEATH OF TRAVIS REYES

RE-HEARING CASE 22-6000: BEFORE THE UNITED STATES SUPREME COURT NORMAN CLEMENT vs. DEA AND THE DEATH OF TRAVIS REYES

https://youarewithinthenorms.com/2023/01/04/re-hearing-case-22-6000-before-the-united-states-supreme-court-norman-clement-vs-dea-and-the-death-of-travis-reyes/

The Case 22-6000 Norman Clement vs the DEA before the Supreme Court of the United States Petition for Rehearing involves life and death of millions of patients suffering pain and their healthcare providers treating the disease of pain. It ask questions:

  1. Weather “red flags” are guidelines created by DEA in which the agency “lacks the authority to issue guidelines that constitute advice relating to the general practice of medicine and further lacks authority to promulgated new regulations regarding the treatment of pain?
  2. We further ask this Court to determine whether a Pharmacists refusal to fill a  prescription for a “legitimate medical purpose” under the Pharmacists  “corresponding responsibility,” provision, constitute and violates the Eight Amendment prohibition against cruel and usual punishment?
  3. Whether it was the intent Congress for DEA to regulate the field and practice of medicine and pharmacy auger deference awarded to administrative agencies ?

RETIRED DETROIT POLICE SARGENT SUFFERED UNDER TREATMENT OF PAIN FROM ALS

MOVING THE GOAL POST BACKWARD AND FORWARD

Those pharmacists who merely question these DEA policies risk loss of employment and/or administrative sanctions. The DEA can impose these errant actions because they possess unchecked authority and weapons the ability to intimidate by seizings property and assets.  Under this interpretation, a golf ball can become a football and baseball bat can enforced as a hockey stick. The DEA Administrator need not determine the underlying legitimacy of the prescriptions a pharmacy filled, but rather, may use “red flags” as a proxy to presume a prescription was illegitimate. 

GERALD KILEY FLORIDA UMBILICAL HERNIA 2019, TAMPA FL, HOWVER LISTED BY DEA AS DRUG SEEKER (SEE LINK)

The question we seek out as pharmacist here in is  when does a golf ball become a football, at what point in the game does a baseball bat become a hockey stick and at what point does the umpire call a strike across the plate third down? 

When does the referee call a prescription written for a “legitimate medical purpose” illegal so that a pharmacy violates its corresponding responsibility whether or not there is evidence of a prescription’s illegitimacy?  At what point on the mile marker does a prescription written by a licensed authorized provider to treat a medical disease of a disease state become illegal or can the Umpire convert the rules of the game into scienter as an financial incentive to issue more fines and expand his/her authority?

DEA’S CAMPAIGN OF DIS-INFORMATION

The DEA has been waging a campaign of disinformation to sway the public to a point prescribed narcotic analgesic medications are indeed drugs, dangerous drugs who dosages are red flags indicating abuse and trafficking contributing to the so-called Opioid crisis around America.  Notably, DEA’s evidences always realize upon execration on numbers of “pills” and street language such as “pill mills,” “Holy Grails,” and “Cocktails,” not on medical disease states or clinical conditions.

August 29, 2019 DEA’s raid Pronto Pharmacy LLC, Tampa Florida

Prosecutors, have found these forms of distortion, redefinition of medical procedures effectively sells juries.  Further Judges often instruct the juries to ignore any clinical presentation or will not allow such testimony on the record. By 2006, federal regulatory agencies perceived what they called an “opioid crisis” and mistakenly attributed it to doctors “overprescribing” opioids and generating a growing population of opioid addicts. 

This formed the basis for an even more massive intrusion of federal and state power into the privacy of medical records, patient-doctor confidentiality, and the very way in which doctors are allowed to use scientific and professional knowledge to practice medicine. Medical decision making came increasingly under the purview of law enforcement, spark- ing a new wave of arrests and prosecutions.

Patients who had their pain controlled with long-term opioid treatment are being denied treatment or involuntarily tapered off their pain control, as doctors fear arrest and an end to their medical careers. A growing population of “pain refugees” has emerged, with some patients turning in desperation to the black market for opioids and some even turning to suicide.

As prescribing rates continue to plunge, overdoses from the non-medical use of opioids are skyrocket- ing, now largely caused by illicit fentanyl. These guidelines were disastrous for chronic pain patients. Many were driven to buy illegal drugs on the street, which were laced with poisonous fentanyl. In 2021 this led to 100,000 deaths in the United States. 

Unfortunately prosecutors and the DEA has learned when facts don’t support the charges one just fabricates the facts. Thus the phrase garbage in is garbage out or  the legal term false en uno false en omnibus is applicable.

It would have been expected a higher level of scientific accuracy and integrity from an agency such as the DEA entrusted to protect citizens’ health and welfare.

“…Without the discipline of good science, nontransparent implementation produces poor public outcomes. These outcomes are pressed into service in the field, offer no benefit, and harm physicians, pharmacies, patients, and public policy at large…” 

URGENT!!! HELP AND SUPPORT NORMAN CLEMENT vs. DEA IN US SUPREME COURT CASE NO: 22-6000

DONATE LEGAL DEFENSE

OR SEND

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TO ZELLE: 3135103378 OR CASH APP: $docnorm

THE NEEDLESS DEATH OF TRAVIS REYES

From Bob Sheerin pain care advocate:

“Let me add another friend to my list of folks who had a long life ahead of him and died because of chronic pain! Travis Reyes an athlete, a friend!

Travis and I had a-lot in common, we both were stand out athletes who were hurt in the hights of our glory! We were good at anything with a ball (big or small) running, jumping, lifting weights, and both of us cared for the pain community because we both knew what torture was caused by chronic pain.

Travis had his dad’s undying love and support! His dad  and I went to his defense and talked to his doctor and his dad then would drove way out of his way to find a damn pharmacy that would filled his prescription medication once we got the doctor to call it in elsewhere.

Today an Arizona doctor called me and said, he would take Travis! I was so excited I left him a message that said, hey Travis that doctor will see you… How are you brother! Only to find out my friend is now gone 12-11-2022 at such a young age!

This is such a common theme in this frigging community that I have grown personally tired of. It makes me wonder how the hell am I still here when Travis was so damn young and strong!

That kid was the age of my own son and his only mistake in life was being a chronic pain patient living in a country who hates chronic pain patients!

Another common theme I’m way to tired of is saying, Travis you will be missed my friend and thank you for the fight you gave to this community! Love ya Brother! RIP and maybe tell the big guy we could use some help down here! And to his beloved father I’m so damn sorry.”

CONCLUSION

Wherefore, For the foregoing reasons,  we respectfully request this Petition for rehearing in Case number 22-6000 submitted in a timely manner be granted and the revocation and the Court should further grant this Petitioner’s writ of certiorari as the decision in this case by this Court will have far-reaching effects on the professions of Medicine, and Pharmacy. The Petitioner is a Pharmacist Not a Street Drug Dealer.

Respectfully submitted:

Norman J Clement, pro se 

P.O. Box 280139

Tampa Fl. 33682

ywtn@umich.edu or prontopharmacy@aol.com  

DECEMBER 12, 2022

 

Patient in Florida driving mile to Pronto Pharmacy Tampa, Florida because DEA’s Red Flag guidelines use to intimidate of physicians and pharmacist

Help 

URGENT!!! HELP AND SUPPORT NORMAN CLEMENT vs. DEA IN US SUPREME COURT CASE NO: 22-6000

DONATE LEGAL DEFENSE

OR SEND

$100 $250, $500 DOLLARS SEND

TO ZELLE: 3135103378 OR CASH APP: $docnorm

FOR NOW, YOU ARE WITHIN

YOUAREWITHINTHENORMS.COM,(WYNTON MARSALIS CONCERTO FOR TRUMPET AND 2 OBOES, 1984)

THE NORMS

Dr. POMPY FOUND NOT GUILTY !!” SO SAY WE ALL !!!

AUSA WAYNE F. PRATT, SMASHED TO THE GROUND BY RON CHAPMAN OF CHAPMAN LAW FIRM AND ATTY’S GEORGE DONNINI AND JOSEPH RICHOTTE: “POMPY FOUND NOT GUILTY !!” SO SAY WE ALL !!!

https://youarewithinthenorms.com/2023/01/04/ausa-wayne-f-pratt-smashed-to-the-ground-by-ron-chapman-of-chapman-law-firm-and-attys-george-donnini-and-joseph-richotte-pompy-found-not-guilty-so-say-we-all/

VICTORY FOR LESLY POMPY MD NOT GUILTY ON ALL COUNTS!!!

Since becoming fraud unit chief in 2010, the federal officials have successfully prosecuted more than 50 doctors and 30 pharmacists for felony violations involving fraud, controlled substances, and kickbacks.

In 33 years as an assistant United States Attorney, Wayne F. Pratt has prosecuted some of Michigan’s most “notorious narcotics traffickers and corrupt healthcare providers.” 

However Wayne F. Pratt messed with the “wrong Physician,” when he decided 8 years ago to taken on Lesly Pompy MD a Haitian born doctor, born out of the DNA of Jean-Jacques Dessalines, Toussaint Louverture , Marie Claire Heureuse Felcite Bonheur of the Haitian Revolution. Doctor Pompy, who chose to fight instead of running for the tall grass!!!

Wayne F. Pratt Chief of the Healthcare Fraud Unit Michigan

GOLLUM, LORD OF THE RINGS

It is said that Wayne F. Pratt, Chief of the Health Care Fraud Unit for the U.S. Attorney’s Office for the Eastern District of Michigan, has saved Medicare nearly $1 billion and has done more to fight health care fraud than almost anyone else in the U.S. Department of Justice. 

However, a decade of Blue Cross Blue Shield’s influence has twisted Chief Prosecutor AUSA Pratt’s body and mind; he has indicted healthcare providers based on Blue Cross Blue Shield’s precious bidding.

The love and hate relationship with his “precious” Master, Blue Cross Blue Shield, has gradually corrupted him like Gollum by the ring’s power. And like Gollum, he has come to love and hate himself.

PROSECUTORIAL CORRUPTION

There has been massive government overreach of power by agencies of the United States Government, changing the rules to make arrests on healthcare providers, piling up more healthcare providers’ scalps while attempting to make heroes of what can best be identified as prosecutorial domestic terrorists

According to Richard Lawhern, Ph.D. :

“It is now apparent that doctors, nurses, and pharmacists are being persecuted (not merely sanctioned) in a US national witch hunt by the Drug Enforcement Agency, Department of Justice, State Attorney Generals, and State Medical Boards for the imagined “crime” of “over-prescribing” opioid pain relievers to patients in moderate to severe pain.  

This unjustifiable witch hunt is unsupported by science or ethics.  But it has resulted in the departure of thousands of physicians from pain management practice.  Millions of patients in agony have been denied access to community clinics or force-tapered from opioid therapy that has been the only effective means of controlling their pain.  This campaign’s death toll in medical collapse and suicide is rising.”

FINAL SOLUTION

AUSA WAYNE F. PRATT

 

 

FOR NOW, YOU ARE WITHIN

 

 

YOUAREWITHINTHENORMS.COM,(WYNTON MARSALIS CONCERTO FOR TRUMPET AND 2 OBOES, 1984)

THENORMS

LOW HANGING FRUIT

SCOTT THOMAS, TAMPA, FL

could opioid lawsuits make it harder to get opioid Rxs filled ?

50 states sign up for Walmart’s opioid settlement framework -3.1 billion

the settling of these lawsuits Walgreen & CVS agreed to a 10 BILLION settlement paid out over 10-15 yrs and Walmart agreed to a 3.1 BILLION settlement.

part of Walmart’s agreement: https://corporate.walmart.com/newsroom/2022/11/15/walmart-announces-nationwide-opioid-settlement-framework

Walmart has adopted many approaches to fighting the opioid crisis, such as:

  • Educating and empowering pharmacists
  • Reducing the amount of opioids dispensed
  • Protecting against diversion and theft
  • Increasing access to overdose reversal medication
  • Educating our patients and our communities about opioid abuse
  • Advocating for state and national policies aimed at curbing opioid abuse and misuse

There are more lawsuits forming against other chain pharmacies. The money from the TOBACCO SETTLEMENT from 1999 will soon drop dramatically or dry up entirely Many of the states did not use the money from that settlement- as they promised for anti-tobacco education, but … just dumped the money in their general fund.  All those states have become financially addicted to that “free money” and unless they find a new source of “free money” they may have to cut public services and/or raise taxes.

Depending how many lawsuit keep coming and the chains are forced to settle because 90%+ of entities taken to federal court are found guilty. I presume that the chains don’t want to waste money on a law firm when the odds are they are going to be found guilty and paying out money.

The chains may come to the conclusion that stocking/filling controlled meds is not a good financial business plan and just stop stocking and filling controlled meds Rx.

Many states’ Pharmacy practice act – unless they have changed it – are required to stock meds normally prescribed in the pharmacy’s market.

There is a lot of shifting in the pharmacy market place

UP TO 5% of TRICARE beneficiaries will have to make a 30+ MINUTE round trip to get their prescription filled because of DOD contract

Kroger: announced that we are terminating our Express Scripts agreement for commercial customers as of December 31

The GoodRx-Kroger Blowup: Spread Pricing, Pharmacy Margins, and the Future of Discount Cards

 

Congress Made It Easier to Treat Addiction, but Harder to Treat Pain

Congress Made It Easier to Treat Addiction, but Harder to Treat Pain

https://www.acsh.org/news/2022/12/28/congress-made-it-easier-treat-addiction-harder-treat-pain-16767

The war on pain patients and the doctors who treat them continues, the latest volley being fired by Congress. Cato Institute’s Dr. Jeffrey Singer tells us about how the DEA, with the backing of lawmakers, is able to continue its ridiculous campaign that makes opioid prescribing even more difficult for physicians.

Late on the afternoon of December 23, the U.S. House of Representatives passed the approximately 1.7 trillion‐​dollar omnibus spending package, which now awaits President Biden’s signature. As is usually the case with such legislative monstrosities, the bill contains a few positive features and many negative ones. One positive part is that it repeals the so‐​called “X‑waiver” (an X is added to the DEA narcotics prescribing license), which the Drug Enforcement Administration has long required health care practitioners to apply for to prescribe the Schedule III opioid buprenorphine as medication‐​assisted treatment for substance use disorder. Inexplicably, health care practitioners have not needed an X‑waiver to prescribe the drug to treat pain. The X‑waiver requirement, which also limits the number of patients providers can treat, discouraged many practitioners from treating addiction.

Buprenorphine and methadone are both effective for treating opioid addiction, with some patients responding better to buprenorphine and others responding better to methadone. Unfortunately, the Drug Enforcement Administration regulates methadone outpatient treatment programs (OTPs) and requires most patients to take the methadone in the presence of clinic staff. Buprenorphine, on the other hand, is prescribed as a take‐​home medication by health care providers in their medical clinics.

In response to the COVID emergency, the DEA, in conjunction with the Substance Abuse and Mental Health Services Administration, permitted OTPs to disburse up to 28 days of take‐​home methadone to “stable patients” and 14 days of take‐​home methadone “less stable” patients. The success of the take‐​home program led the SAMHSA to extend it to one year past the date when the President declares an end to the COVID Public Health Emergency.

I and many others have called on Congress to end the DEA’s requirement that healthcare providers apply for an X‑waiver on their narcotics license to treat substance use disorder. By including the Mainstream Addiction Treatment Act (MAT Act) within the giant omnibus bill that Congress just passed, Congress finally removed the X‑waiver requirement and, along with it, any limits on the number of patients practitioners are allowed to treat. The act also makes it easier to prescribe buprenorphine using telemedicine.

Unfortunately, a fly in the ointment is that the omnibus bill also contained the Medication Access and Training Expansion (MATE) Act which, among other things, will require all healthcare practitioners who apply for or seek to renew their DEA narcotics prescribing license to take an 8‑hour government‐​approved course in understanding and treating addiction. This unnecessary burden might provide money-making opportunities to organizations that offer courses. Still, it may make many healthcare practitioners not renew or seek a narcotics prescribing license, making it even more difficult for patients in pain to get relief.

In a July letter to the Chair and Ranking Members of the Senate Health, Education, Labor, and Pensions Committee, the President of the American Medical Association rightly opposed the 8‑hour course requirement, stating:

There could be serious unintended consequences for patient care were many physicians to forgo registration with the DEA to prescribe controlled substances instead of taking the eight‐​hour training. This could have the opposite of the MATE Act’s intended effect by leading to fewer instead of more physicians and other health professionals having the ability to treat opioid and other SUDs with evidence‐​based medications. It could lead to less access for patients with psychiatric and other mental health conditions that are effectively managed with controlled substances having access to medically necessary care. There could be severe consequences for patients with painful conditions or postoperative pain obtaining effective pain control as far fewer physicians may be able to prescribe any scheduled medications for them. In addition, physicians who continue to be registered with the DEA could be inundated by patients who could no longer be treated by their usual source of care.

Many states, including my state of Arizona, impose their own course requirements on licensed healthcare practitioners who wish to prescribe controlled substances. In Arizona, practitioners must take a 3‑hour course every two years. The letter from the AMA mentioned this:

There is no evidence showing that a one‐​time mandated education requirement, as the MATE Act requires, will have the result that we all want, which is improving patient outcomes and stopping patients from dying from a drug‐​related overdose. In response to increasing numbers of people dying from a drug related overdose, beginning in 2016–2017, states began enacting mandates to restrict opioid prescribing, require use of state prescription drug monitoring programs and require prescribers to take specific continuing medical education (CME) classes. These policy interventions have not had a positive effect on reducing drug‐​related overdose or increasing access to evidence‐​based treatment for SUDs. This includes the 40 states with mandated CME requirements. A one‐​time training mandate for SUDs, no matter how well‐​intentioned, will not have meaningful impact on reducing drug‐​related overdose for the same reasons state‐​level CME mandates have not had the desired effect.

Sadly, but not uncharacteristically, lawmakers give with one hand and take away with the other.

Kansas police cite end stage cancer patient for marijuana use at hospital

Three police officers showed up at Hays Medical Center to seize the 69-year-old vape and THC paste

HAYS, Kan. — Police cited a terminally ill Kansas man at the hospital because he allegedly used a weed vape and THC paste to ease the symptoms of the cancer that will kill him within weeks.

On Dec. 16, Hays, Kansas police raided the hospital room of 69-year-old Greg Bretz, who is suffering from terminal cancer, after a hospital worker at Hays Medical Center caught him vaping marijuana, KSNF reports.

Bretz said he has been vaping, as well as eating THC paste with bread, to relieve symptoms of his condition since being hospitalized roughly three weeks ago. 

Bretz is in the final stages of terminal, inoperable cancer and told The Wichita Eagle that he most often lies “flat on his back” in his hospital bed and can’t stand up without being assisted. Bretz told the Kansas City Star that his doctor told him to use whatever was necessary to relieve his pain, including products containing THC — the active ingredient in cannabis.

Police told Bretz that his vaping device could potentially be a fire hazard, due to the presence of oxygen in the room. In many vaping devices, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge or reservoir for inhalation. 

Medicinal cannabis is illegal Kansas, despite 68% of state residents support state-sanctioned medical marijuana access, according to the National Organization for the Reform of Marijuana Laws (NORML). Idaho and Nebraska also ban the practice.

50 states sign up for Walmart’s opioid settlement framework -3.1 billion

50 states sign up for Walmart’s opioid settlement framework

https://www.cnn.com/2022/12/21/business/walmart-opioid-settlement/index.html

  Walmart said it has reached settlement agreements with all 50 US states as part of a $3.1 billion nationwide opioid settlement announced last month.

In November, the retailer announced a settlement from multiple states’ attorneys general that accused the company of failing to regulate opioid prescriptions contributing to the nationwide opioid crisis.

The settlement, according to the office of New York Attorney General Letitia James, who co-led a coalition of attorneys general in the negotiation, will also “include broad, court-ordered requirements Walmart must comply with, such as robust oversight to prevent fraudulent prescriptions and flag suspicious prescriptions.”

In this week’s announcement, Walmart said that the agreements with the 50 states “are intended to resolve substantially all opioids-related lawsuits brought by state and local governments against Walmart.”

“Walmart believes these settlements are in the best interest of all parties and will provide significant aid to communities across the country in the fight against the opioid crisis, with aid reaching state and local governments faster than any other nationwide opioid settlement to date, subject to satisfying all settlement requirements,” the company said in the statement.

Walmart added that it “strongly disputes the allegations in these matters, and these settlements do not include any admission of liability.”

“Promising negotiations,” are still underway with other pharmacies including Walgreen (WBA)s and CVS (CVS), James’ office said last month. Those two chains have tentatively agreed to pay a combined $10 billion to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.

US states, cities and counties have filed more than 3,000 lawsuits against opioid manufacturers, distributors and pharmacies, accusing them of downplaying the addiction risk and failing to stop pills from being diverted for illegal use.

More than 500,000 overdose deaths over the past two decades – including more than 80,000 in 2021 alone – are blamed on the US opioid crisis, government data show, with an estimated 9.5 million Americans age 12 and older reported in 2020 to have misused opioids, including 9.3 million prescription pain reliever abusers and 902,000 heroin users.

California wants to revoke a CVS mail-order license for illegally filling opioid and ADHD prescriptions

California wants to revoke a CVS mail-order license for illegally filling opioid and ADHD prescriptions

https://www.statnews.com/pharmalot/2022/12/21/cvs-adhd-opioids-california-prescriptions/

The California Board of Pharmacy has filed a complaint accusing CVS Caremark of neglecting red flags that should have given the PBM and mail-order pharmacy “reason to know or suspect that numerous controlled substances … were not issued for a legitimate medical purpose” from July 2018 through July 2021. The drugs included the anxiety drug alprazolam (Xanax—Pfizer), the ADHD drug amphetamine/dextroamphetamine (Adderall—Shire), and opioid analgesics such as hydromorphone (Dilaudid—Rhodes Pharmaceuticals) and acetaminophen/oxycodone (Percocet—Endo Pharmaceuticals).

The board wants the license for the CVS unit to be revoked or at least suspended. The board also wants to prohibit certain CVS Health leaders from serving as an officer or manager in connection with that particular CVS license for 5 years, if the unit is placed on probation or until the license is reinstated.

In addition, records show the mail-order unit shipped more than 2,100 prescriptions prematurely to patients, according to the board. CVS also allegedly violated a law that requires controlled substances to be prescribed to state residents only by prescribers licensed in California. The board found that just three of the top 100 providers whose prescriptions were handled by the CVS unit held licenses to practice medicine in California, at least during part of the time that the investigation took place. The remainder were not allowed to practice medicine without restrictions in California, according to the complaint.

How long before many of us will end up living in a “MEDICAL DESERT”

Look alive as hospitals close and cut services, lawmakers urge HHS

https://www.beckershospitalreview.com/hospital-management-administration/look-alive-as-hospitals-close-and-cut-services-lawmakers-urge-hhs.html

Hospital closures, service reductions, mergers and acquisitions are creating a bed shortage and impeding patients’ access to timely care, a group of Massachusetts lawmakers contend in a letter to HHS that requests information from the agency on its part in monitoring or interfering with service reductions.

Citing more than a dozen studies, analyses and news articles, the 10 lawmakers argue that demand for hospitals and healthcare organizations exceeded capacity even before the COVID-19 pandemic, resulting in lower quality of care, longer waiting times and higher prices. Hospital closures, service reductions, mergers and acquisitions are now adding to the “worrying signs of distress,” the lawmakers wrote to HHS.

“Despite health care systems operating over capacity and receiving substantial financial support from federal, state and local government in recent years, hospitals across the country are closing their doors, reducing their services, or consolidating,” the letter states. “We are concerned that this pattern will result in communities facing increasingly significant barriers to healthcare, and seek your assistance in ensuring those communities have sufficient hospital resources to guarantee access to a full continuum of high-quality care.”

They requested answers from the agency to seven questions by Jan. 15 to “better understand whether, and if so how, federal government action or inaction has impacted hospital closures and service reductions”: 

1. What data does HHS gather on hospital closures, service reductions, or mergers or acquisitions due to financial distress?
2. What data does HHS gather on spillover effects on surrounding healthcare facilities after hospital closures?
3. What actions is HHS taking to identify the effects of hospital closures or service reductions on public health and health care access?
4. What actions is HHS taking to ensure accessibility for communities that rely on safety-net hospitals?
5. What engagement has HHS had with stakeholders at the local, state and federal levels to address concerns with hospital closures and service reductions?
6. What support does HHS provide to hospitals to adopt models of care to mitigate or avoid financial distress?
7. What support does HHS provide to health care systems to ensure long-term financial sustainability and surge capacity?

Massachusetts’ Sen. Edward J. Markey initiated the communication to HHS. Sen. Elizabeth Warren and Reps. James P. McGovern, Lori Trahan, Jake Auchincloss, Katherine Clark, Seth Moulton, Ayanna Pressley, Stephen F. Lynch and Bill Keating signed the letter.