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.”

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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.

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

$100 $250, $500 DOLLARS SEND

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

 

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

THE NORMS

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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

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.”

AUSA WAYNE F. PRATT

 

 

FOR NOW, YOU ARE WITHIN

 

 

THENORMS

LOW HANGING FRUIT

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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

 

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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.

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50 states sign up for Walmart’s opioid settlement framework

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

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.

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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.

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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. 

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How to Help Prevent Flu and RSV? You Might Not like the Answer

https://www.doximity.com/articles/4dae41d9-5fb8-445f-81b7-1867349286b7

As respiratory viruses surge across the country, a number of public-health officials and doctors are encouraging masking to protect against flu and RSV, in addition to Covid-19.

Whether masks are enough—and whether people are willing to wear them after the country has largely moved on from pandemic precautions—is another matter.

“I’m not optimistic” that people are willing to mask again, says Eric Topol, director of the Scripps Research Translational Institute in La Jolla, Calif. “There’s such a reluctance to go what is considered backward, even though it’s actually forwards in terms of helping one another.”

Masks help provide protection against flu and RSV, medical experts say, as do other precautions. RSV, a common respiratory virus, also often spreads through expelled virus particles on surfaces, so frequent hand-washing and cleaning of contaminated surfaces can help fight its spread, says Scott Roberts, an infectious disease specialist at the Yale School of Medicine.

Most Americans never considered wearing a face mask to prevent the spread of illnesses until Covid emerged. Since 2020, the face protections and guidance around them often grew contentious, with disputes erupting over schools, at workplaces and within families. On Monday, Rochelle Walensky, the director of the Centers for Disease Control and Prevention, encouraged Americans to wear high-quality, well-fitting masks to help prevent the spread of many respiratory viruses.

The CDC is considering incorporating other respiratory illnesses into its calculations that assess when and where people should wear masks, Dr. Walensky said Monday, adding: “One need not wait on CDC action in order to put a mask on.”

About a third of Americans say they aren’t likely to wear a mask outside of their homes if Covid-19 cases increase in their area, according to a poll conducted in early December by Axios and Ipsos.

Public health officials in Los Angeles County, where Covid-19 cases have been rising since late October, appear to be poised to reinstate a mask mandate for indoor public settings when the county’s CDC community level moves from medium to high and two thresholds for hospitalization are met. Los Angeles County public health director Barbara Ferrer said on Dec. 1 that masking could be reinstated by later this month. In response to news stories about the potential reinstatement, many social-media users expressed a reluctance to comply.

For the week that ended Nov. 26, the CDC classified most of the U.S. as having high or very high levels of influenza-like illness, which can include cases of Covid-19 and RSV, also known as respiratory syncytial virus.

Well-fitting masks are especially good at reducing transmission by respiratory droplets emitted when people cough, sneeze or talk, which is one way that flu, RSV and Covid spread. Public transportation, including flights, and indoor gatherings with people whose exposure status you don’t know—especially in spaces that are crowded or poorly ventilated—are good places to be vigilant, public health experts say.

RSV is often spread by touching an infected surface, which is less common with flu and Covid. Frequent hand-washing is important to guard against RSV, although it’s a sensible precaution against other illnesses too, doctors say.

Getting vaccinated against Covid-19 and flu will provide a layer of protection against those viruses. This year’s flu vaccine formulation appears to be a “very good match” to circulating strains, according to the CDC.

There is no RSV vaccine. Carrying hand sanitizer or sanitizing wipes with you to the office and social gatherings is a good idea, says Dr. Roberts.

As holiday gatherings approach, those planning to spend time with elderly or immunocompromised people should consider wearing a mask regularly for a week before getting together, says Katelyn Jetelina, an epidemiologist who writes the public health newsletter “Your Local Epidemiologist.” RSV and flu can also be dangerous in very young children.

Getting tested is an important precaution, too. Dr. Topol said he plans to take a rapid Covid-19 test before a meeting next week, and has asked other participants to do the same.

Watch for symptoms of infection and stay home if you’re sick or potentially contagious, health professionals urge.

“No one wants to hear this because so many fun holiday events are coming,” says Dr. Jetelina, “But if you’re sick, you need to stay home.”

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