When cause of death is opioid overdose is it murder or malpractice?

https://drjengunter.wordpress.com/2015/09/02/when-cause-of-death-is-opioid-overdose-is-it-murder-or-malpractice-the-case-of-dr-tseng/

Is a doctor guilty of malpractice or murder or is the patient responsible for his or her actions when there is a death by overdose? This is the question that a jury in Los Angeles will have to decide as they are presented the facts in the case of Dr. Lisa Tseng.

The prosecution’s version is that Dr. Tseng handed out opioids like candy without any regard for standard of care. Over the years at least 12 of her patients died from overdoses. She is now standing trial for three deaths…

So opioids are a big deal. I was once a far more liberal opioid scribe than I am now. Fifteen years ago we were all “under treating” pain and so we prescribed more and more opioids. That is what our professional societies told us. I saw almost no one get better or lead a more productive life. I also heard of more lost prescriptions than I can count. Pain scores rarely budged, but doses gradually escalated.

I don’t understand why doctors expect miracles from opioids and discount the stabilization of pain levels (scores).  All treatments tried by a patient up to this point have not been able to provide enough relief, so opioid therapy is chosen. And when pain levels are stabilized, that’s not considered a success? Keeping a person off disability is not considered a success? Allowing patients to keep caring for themselves and remain independent is not a success? Keeping a chronic pain patient from committing suicide is not a success?

I would never keep someone on a beta blocker if it wasn’t controlling their hypertension, so why would I keep someone in an opioid if it wasn’t lowering their pain score? If 240 Norco and 60 OxyContin a month isn’t helping your pain dramatically then you have opioid resistant pain…

Asking for opioids to “control” pain is, like I said, asking for miracles. Some patients will be helped “dramatically” with opioids, but some not. Some patients can’t tolerate opioids and some have a metabolism that decreases the effectiveness of opioids. Saying that a patient’s pain must be helped dramatically at a certain dosage sounds like this doctor treats patients like robots on a conveyor belt.

About ten years ago I decided that chronic opioids were not for my practice. The percentage of people in my 15+ year career in chronic pain who have truly benefited from them, meaning a significant reduction in pain scores with a corresponding improvement in functionality, is very small…

Expecting patients disabled by pain to increase their functionality just because they take opioids is a fairly narrow view of pain syndromes. I wonder, do you treat any cancer patients, Dr. Gunter? Anyone with trigeminal neuralgia? Tell me, doctor, do your chronic pain patients achieve “a significant reduction in pain scores with a corresponding improvement in functionality” with any other treatment you prescribe?

Oh wait, it looks like Dr. Gunter prescribes yoga:

The Feldenkrais Method® is a form of somatic education that uses gentle movement and directed attention to improve movement and enhance human functioning. Through this Method, you can increase your ease and range of motion, improve your flexibility and coordination, and rediscover your innate capacity for graceful, efficient movement. These improvements will often generalize to enhance functioning in other aspects of your life. The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables you to include more of yourself in your functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists you to live your life more fully, efficiently and comfortably.

Is this description from their website supposed to be easily understandable?  Dude, it’s yoga, no need to make it sound so fancy. And I don’t need to pay a doctor to tell me to try yoga. While yoga and stretching exercises can be part of a home treatment program, rarely do they help enough to be the only treatment being used. In fact, without something to decrease the pain, either before or after (and sometimes both), I can’t perform all of my daily stretching exercises. If Dr. Gunter was my doctor, I guess I’d be SOL.  (Free the weed.)

Speaking of freeing the weed, there’s no mention of cannabis in this doctor’s post. For anyone who alleges to treat pain, without offering access to cannabis (or opioids, in this case), you’re really worth nothing to me.

There is no scenario where I can see giving a 21 year man from out of state an opioid prescription of any kind unless he was in the emergency room with a traumatic injury. It doesn’t sound as if Dr. Tseng was anyone’s family doctor or internist trying to keep people afloat. Whether she started out with good intentions and was the most gullible person on the planet or this was truly a pill mill will be pretty easy to tell from a record review…

I love how doctors stand up for each other, don’t you?  Even if Dr. Tseng is guilty of being gullible — or if she’s simply guilty of trying to help treat the pain reported by her patients — she’s not a criminal. She’s not a murderer. And even if she was running a pill mill, do you think 100% of her patients were drug addicts and none of them were chronic pain patients? I wonder what happened to all her abandoned patients…

Are alcohol, car, or gun salespeople (dealers) responsible for those who abuse their products? If someone gets drunk, robs a bank with a gun, uses a getaway car, and then drives over a cliff like Thelma and Louise, who’s responsible? The person who sold him the alcohol, gun, or car? Or now that he’s dead, since he’s an alcoholic and a bank robber, who cares?

Under comments:

The DEA keeps a list of criminal prosecutions of doctors who lost their DEA registration as a result: http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

There are at least two prior instances of physicians getting convicted of murder for improper subscribing. Dr. Harrison Bass of Las Vegas was convicted of second degree murder in 2008 for a death related to running what sounds like a mobile pill mill. Dr. Noel Chua of Georgia was convicted of felony murder in 2007 for illegitimately prescribing “multiple controlled substances” to the victim.

Additionally, Dr. James Bischoff of Montana pled guilty to charges including negligent homicide in 2006 and Dr. Jesse Henry of New Mexico pled guilty in 2004 to charges including seven counts of involuntary manslaughter related to at least three deaths linked to over-prescribing of multiple opioids.

POSTED BY DAN | SEPTEMBER 3, 2015

http://www.latimes.com/local/lanow/la-me-ln-murder-trial-tseng-doctor-20150829-story.html

During opening statements in her case Monday, Tseng hunched forward in her chair, settling in for a landmark second-degree murder trial that’s expected to last for months. The general practitioner, who scribbled notes on a yellow notepad and tapped her foot over and over, is the first California doctor ever charged with murdering patients who overdosed merely for prescribing them medication, Niedermann said…

Your Daily Dose of Hypocrisy

http://nmpoliticalreport.com/12597/green-and-white-former-sheriff-wants-in-on-medical-marijuana/

Former sheriff wants in on medical marijuana

Darren White, whose law enforcement credentials include stints as cabinet secretary for the Department of Public Safety, Bernalillo County Sheriff and public safety director for the City of Albuquerque, is one of eight names serving as a board of director with Purlife, which filed an application with the state to open a medical marijuana nonprofit…

White’s previous public statements and actions against marijuana reform have been extensive—in 1999 he resigned as Department of Public Safety cabinet secretary after Republican Governor Gary Johnson announced that he was in favor of legalizing marijuana. As recently as 2007, when medical marijuana became legal in New Mexico, White was vehemently opposed to it…

White is an ally of Gov. Susana Martinez and frequently writes Twitter posts blasting anything critical of her administration. He appeared in a 2010 Martinez campaign ad as a sheriff.

Martinez ran that year opposed to the state’s medical marijuana program. Last year, she later voiced disapproval of decriminalizing marijuana possession. Earlier this year, Martinez vetoed a bill that would have allowed hemp cultivation for research purposes…

Closed Formularies

http://www.pharmaciststeve.com/?p=11653

The recent success of the closed pharmacy formulary in the Texas workers’ comp system has caught the attention of practitioners in other states. A new report from the Workers Compensation Research Institute concludes that, all things being equal, other states could see similar results. Texas was the first multi-payor state to adopt a formulary that requires pre-authorization for certain medications deemed as investigational, experimental, and those with “N” drug status under the Official Disability Guidelines, including many opioids…

Ex-Wife Lies to Unum, Results in Denied Disability

http://www.lawyersandsettlements.com/articles/first_unum/interview-unum-lawsuit-insurance-28-20746.html?securead=1&utm_expid=3607522-8.uTwqV-N-RqmmAyO2kCf6lA.1&utm_referrer=https%3A%2F%2Fwww.google.com%2F

Arlington, VA: Kevin was diagnosed with multiple sclerosis in 1998, one year after he took out an Unum, or Unum Provident policy. After a messy divorce, Kevin says his ex-wife told Unum that he had MS in the 1980s, which meant he had a preexisting condition and would be denied Unum long-term disability benefits…

“They saw that I suffered from migraines before I took out the policy and said they would never have underwritten my policy had they known…

Unum is demanding that Kevin pay back $300,000, which amounts to the long-term benefits he received until Unum stopped paying him in 2006…

Texas: Med Board lets DEA sneak peeks at patient records

http://www.pharmaciststeve.com/?p=11625

The Drug Enforcement Administration has been sifting through hundreds of supposedly private medical files, looking for Texas doctors and patients to prosecute without the use of warrants.
Instead, the agents are tricking doctors and nurses into thinking they’re with the Texas Medical Board. When that doesn’t work, they’re sending doctors subpoenas demanding medical records without court approval. The DEA can’t even count how many times it has resorted to the practice nationwide. A spokesman estimated it was in the thousands…

In Texas, the DEA’s criminal investigators do an end run around the Constitution’s warrant requirements by getting the Texas Medical Board to order doctors to open their records…

The problem is this: The medical board has authority to issue “administrative subpoenas,” as they’re called, because it’s in the business of administering the medical industry. The DEA isn’t. It’s in the business of criminal investigations, which can be hindered by the Fourth Amendment.

The entire apparatus of administrative law is something of a shadow government grafted onto a constitutional system back in the New Deal era, and this shadow government has few safeguards. Rather than checks and balances, the regulatory state is characterized by agencies that handle all the investigation, prosecution, adjudication and appeals in-house, with little interference from other bodies…

Salmonella Outbreak Prompts Widespread Cucumber Recall

http://patch.com/new-jersey/tomsriver/salmonella-outbreak-prompts-cucumber-recall-new-jersey

The recalled cucumbers, grown in Mexico and distributed by Andrew & Williamson Fresh Produce, have sickened 285 people in 27 states, including a woman in California who died from the illness, according to the California Department of Public Health.

Andrew & Williamson Fresh Produce, a San Diego-based company, initiated the recall of its “Limited Edition” brand of pole grown cucumbers. “The labeling on these cases indicates the product was grown and packed by Rancho Don Juanito in Mexico. These cucumbers were distributed between August 1 – September 3, 2015,” the California Department of Public Health said.

The New York Times reports the cucumbers were shipped to 22 states, including New Jersey. Eighteen of those states have reported infections. New Jersey health officials have not reported infections, the New York Times reported.

Other states that received the recalled cucumbers include: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Illinois, Kansas, Louisiana, Minnesota, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Carolina, Texas and Utah, Florida, Kentucky and Mississippi.

Health officials in California say it is unlikely that cucumbers in retail grocery stores will have any identifying brand information. “CDPH recommends that consumers check with their grocer to determine if the cucumbers they purchased are impacted by this warning,” California health officials said.

Domestically produced cucumbers are not involved in this outbreak, according to health officials.

The Bug Times

Brought to you by Flybynight Loans

There’s a roadblock on I-90 that won’t be cleared until it rains.

Earl and Merle are still fighting about gay marriage.

The latest quote from the Executive Suite: “I wish people would stop fighting and start spending.”

The Mayor has suffered from a headache for the past month.

He’s tried to ignore it.

He’s tried yoga.

Now he’s lifting the ban on painkillers so his doctor can treat him.

The Bug Times is a product of Corporations and Boredom. Nevertheless, we appreciate our readers. 🙂

Trump is Internet’s Most Popular Meme

I don’t know if that’s true, but it sounds true. 🙂

Doctors Are Prescribing Powerful Antipsychotics to Many People With No Mental Illness

http://www.truthdig.com

Large numbers of people with learning disabilities and no record of severe mental illness are being prescribed strong psychotropic drugs, possibly as a means of subduing and controlling uncooperative patients, research shows.

Researchers at the University College London (UCL) found that of 9,135 people who have intellectual disabilities and are treated with antipsychotic drugs, 71 percent—about 6,503 people—did not have a record of severe mental illness…

Under comments:

beaglebailey • 2 days ago
I’m in a pain clinic and my doctor thought I was depressed so he had me see the shrink. If you don’t comply, they can kick you out of the clinic.  I saw the shrink for less than 15 minutes and instead of prescribing an anti depressants, he prescribed an anti psychotic instead. A 15 minute interview and that’s the drug he came up with? And of course it had just hit the market so I’m sure he was getting a kickback.

How many people are aware that all the people who did mass shootings were on some type of antidepressants med?  The side effects of the drugs are often worse than the illnesses

rosemariejackowski • a day ago
This problem is increasing very fast because the government is keeping lists of doctors and patients who are prescribed pain meds. Pain meds and opiates are usually much safer than the other class of drugs. Anti psychotic meds should NOT be used for pain control. Opiates are safer.

Please read the article I link to and TAKE ACTION… call your representatives…write letters to the editor…get involved…someone you love may die because of this. The government has destroyed the doctor/patient relationship and created a conflict of interest for doctors. PLEASE GET INVOLVED.

Rosemarie Jackowski is an advocacy journalist living in Vermont…

http://dissidentvoice.org/2015/06/the-other-war-on-drugs/

friendnotfoe to beaglebailey • a day ago
My family doctor wanted me to see a dermatologist to check to see if there was any moles that needed to be checked. I only have one mole but I went to the dermatologist. He didn’t check anything but says if I have nights of trouble sleeping he is recommending a anti-depressant and anti-anxiety medication be given. All I said when asked is sometimes I may have a night of trouble sleeping. I swear they must get kick backs for recommending drugs. What dermatologist doesn’t check the skin isn’t that what he is suppose to do I told him my family doctor recommended I go there for that reason. Now when I see her she is going to see his recommendation and feel she must prescribe these drugs.

Bella_Fantasia • a day ago
It seems there is plenty of evidence that children and the elderly are being medicated beyond what is appropriate or necessary. This also is happening in the military. If you’ve never seen “The Wounded Platoon” it is worth the time. These young men are being given seriously strong, conflicting and apparently damaging drug concoctions just to keep them “functioning” in what is called combat, if one can call behaving like raging, raving maniacs functioning. I’d never seen such disturbing, deranged behavior in my life. While some had problems before joining the military, I’m quite sure they didn’t enter the military with that behavior. It is really is no wonder veterans today come home in such terrible shape.

“Before the Iraq war, American soldiers in combat zones did not take psychiatric medications, but by the time of the surge more than 20,000 U.S. troops in Afghanistan and Iraq were taking antidepressants and sleeping pills.”

“I was having a total mental breakdown. Every day we were getting in battles and never having a break. It seemed like, it was just crazy,” he says. “They put me on all kinds of meds, and I was still going out on  missions. They had me on Ambien, Remeron, Lexapro, Celexa, all kind of different stuff.”

Chronic pain created by the FDA

http://www.vocativ.com/news/228760/women-revolt-against-the-fda

Later this month, 35-year-old Angela Desa-Lynch plans to go camping—at the Food and Drug Administration. She will pitch a tent and roll out a sleeping bag in front of the FDA’s Washington D.C. headquarters, along with a couple dozen other pillow-toting friends. There, they will be conducting a hunger strike. The goal is to get the agency to remove from the market Essure, a medical device that they believe is hurting and even killing women…

Recently, a peer-reviewed study recruited more than 1,000 women from the Essure Problems Facebook group to try out an app for reporting “adverse events” to the FDA. Nearly 78 percent reported “serious events,” including hospitalization and disability. The most frequent reported experiences were fatigue, back pain, pelvic pain, mental impairment, “device dislocation,” meaning the coil moved from its intended place in the fallopian tube, and salpingectomy, the surgical removal of the fallopian tube. Also of note: lost libido, metal allergies (the coils contain nickel) and hair loss. The researchers also found suicidal ideation among 14 of the women and two suicide attempts…

“The only safe way to take out these Essures is hysterectomy,” he says, explaining that coils can easily break into pieces during removal, “and that’s a major problem.” …

The Essure activists will be joined during the meeting by activists fighting the FDA over two other women’s health issues: transvaginal mesh and power morcellators…

Desa-Lynch also argues that they have sexism in common. “In any one of those three different fights, a woman goes to the doctor and tells them what their problem is, we’re automatically written off as hormonal. We’re not listened to,” she says. “If this was happening to a man, if they had made this product for a man and 20,000 men came out and said, ‘We can no longer have sex anymore,’ I guarantee it would no longer be on the market.” …

“Just deep-fry a sack of sugar”

http://www.theonion.com/article/dennys-market-researcher-emerges-focus-group-shake-51241

Denny’s Market Researcher Emerges From Focus Group Shaken After Finding Out What Americans Really Want For Breakfast

UNM Project ECHO bites the dust

http://www.pharmaciststeve.com/?p=11648

Just six weeks after New Mexico announced that the overdose death rate had unexpectedly climbed, the state received a federal grant to target opioid overdoses with big data, better monitoring and more education. The New Mexico Department of Health said it received an $850,000-a-year grant for the next four years to enhance prescription drug overdose prevention. If renewed each year, the grant would provide $3.4 million for five more staffers working on overdose prevention initiatives.

“This funding allows the New Mexico Department of Health to develop new partnerships with the Board of Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities with a high overdose burden,” Health Secretary Retta Ward said in a statement.

After two years of decline, the number of people in New Mexico who died from a drug overdose in 2014 hit 536, a jump of 20 percent over 2013. Officials say 265 of those deaths were the result of prescription opioids. The statewide rate of 26.4 overdose deaths per 100,000 population stands at one of the worst in the United States, along with West Virginia and Kentucky.

A major focus of the grant will be to better coordinate a Board of Pharmacy registry that is to be used by medical professionals who prescribe pain medication — an online tool called the Prescription Monitoring Program. The information is meant to help monitor patients who misuse pain prescriptions by shopping for several different providers around the state to write scripts.

But because there are seven medical occupations that can prescribe — from medical doctors to dentists — there are inconsistencies in how the database is used, as each reports to a different regulatory board where enforcement varies.

“Sometimes people get introduced to opioids in different ways. They’ll get injured and go see a medical provider and they’ll prescribe opioids. In cases, that person can then get addicted and overdose can result,” said Dr. Michael Landen, an epidemiologist with the state Health Department. “This whole pathway starts with that initial prescription and ensuring that prescription is appropriate is important.”

The grant will not only allow the state to capture more data from prescription writers, but also to deploy caseworkers into areas where they see “prescription hot spots” for drugs such as oxycodone, fentanyl, methadone, hydrocodone and buprenorphine.

“We’ll be able to use the data to work with individual doctor’s offices to improve prescribing in those offices,” Landen said.

Between 2001 and 2011, for instance, oxycodone sales in the state tripled, according to the Health Department.

Another emphasis for how the money is used will be to coordinate education efforts with the state Workers Compensation Administration, which has data on prescriptions for workers who were injured on the job — such as those with back ailments from heavy machine work or long-distance driving.

Landen said Washington state had success reducing overdoses in this population, which might come from a background where they haven’t seen addiction and don’t recognize it.

“We’d be able to analyze the data and make decisions on how to improve prescribing through their program,” he said.

Which means they will be seeking out any doctors prescribing over the maximum morphine-equivalent level and “educating” them about reducing dosages (and abandoning patients).

Some states, for instance, have looked at a “lock in” requirement, in which workers filling pain prescriptions have to use one medical provider and one pharmacy to better monitor usage.

Now only used in Medicaid, but soon coming to Medicare.

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

How did the state successfully complete the grant if the programs didn’t work?

The Health Department also will collaborate with the Human Services Department to increase public awareness of potential harm from prescription opioid medications.

Landen said the grant also will pay for an evaluator who can assess the state’s effort on overdose prevention and determine what approach is working.

For a state with a medical cannabis program that’s about 8 years old, it’s surprising that overdoses keep rising. Other states’ programs have reduced overdose deaths by about 25%, yet not here in New Mexico. Perhaps it’s not surprising after all, considering the sad condition of New Mexico’s medical cannabis program.  Without a program that provides adequate access for all, there are few public benefits to be had.

And New Mexico is one of the poorest states in the country, so poverty plays a big role in overdose deaths and suicides.

Targeting opioids doesn’t seem like a very thorough plan. It leaves out so many drugs that contribute to overdoses, like alcohol, anti-anxiety drugs, muscle relaxers, and anti-depressants. And it leaves out one of the most important issues of all:  suicide.  (Way to honor National Suicide Day, Department of Health.) And what’s the deal with the Department of Health working with the Worker’s Compensation Administration? Easy to pick on the disabled, right?

Ironically, in January of this year, the University of New Mexico was announcing it might have found the “holy grail” of stopping opiate abuse (mostly centered around education):

https://painkills2.wordpress.com/2015/01/26/has-university-of-nm-found-the-holy-grail-of-stopping-opiate-abuse/

New Mexico’s Project ECHO is all about reducing opioid usage in chronic pain patients, and last I heard, is working with the Veteran’s Administration. UNM calls it a program for pain patients — I call it a program to treat addiction. The fact that the program doesn’t work just confirms my opinion that addiction in the chronic pain population is not the huge problem it’s made out to be. If you can’t find and don’t treat enough chronic pain patients that suffer from drug addiction, the program won’t work.

Ironic that the federal government is spending so much more money on programs that aren’t working, but I would say that most of the funding is really for the PDMPs, the blacklist for pain patients. And PDMPs are popular with the DEA, insurance industry, government agencies, and now the medical industry.

It’s also ironic that in October, 2013, Dr. Katzman authored a study about the epidemic of chronic pain. From someone who’s recognized the problem, all the way to today with Project ECHO, this doctor has taken a mighty long fall in a really short time. Here are my posts about the director of the program, Dr. Katzman:

https://painkills2.wordpress.com/?s=katzman