PDMPs and the privacy of patients and doctors


That’s when Lewis turned to the courts, arguing the board had gone fishing for a case against him. In a twist, he asserted that regulators violated not his rights, but those of his patients under the state constitution’s privacy provisions. Lewis’ lawyer, Ben Fenton of Los Angeles, said regulators should get a court order or a signed patient release to look through the databases, just as they must do for a patient’s medical records. After losing at lower court levels, Fenton took the case to the state Supreme Court, which has agreed to hear it this year but not scheduled a date.

Though access by law enforcement officials to prescription databases has been challenged in various states – successfully in Oregon — the California case is believed to be among the first in the country to challenge unrestricted access by medical boards to state prescription drug databases…

The California database, maintained by the state Department of Justice, contains details including physicians’ and patients’ names and is based on weekly reports from pharmacies about prescriptions they have filled for certain high-risk drugs including powerful painkillers. By law, the justice department must provide reports to certain civil and criminal investigators and no court order or warrant is required for access, including for medical board investigators.

Like California, nearly every state now has prescription drug monitoring programs, often known by their acronym PDMP. PDMPs were set up to detect “doctor shopping” by addicts and dealers who seek pain prescriptions from multiple physicians – the purpose that often gets the most attention. But those databases also give licensing boards and law enforcement a way to spot and rein in reckless prescribing by doctors…

As it stands, states tend to put up few barriers to medical licensing boards seeking information as part of their duties. Experts at the PDMP Center for Excellence at Brandeis University outside Boston knew of only one state — Iowa – that requires medical boards get a court order before looking at the databases…

Lewis’ lawyer, Fenton, noted that the original complaint against his client had nothing to do with drug prescriptions, yet the board still ran Lewis through the voluminous database, which contains patient names and medications. According to testimony cited in court papers, an investigator with the medical board said officials routinely check the names of physicians under investigation in the database…

The AMA weighed in in support of Lewis. While the organization supports keeping drug prescription databases…

Unlike medical records, prescriptions of controlled substances “are subject to regular scrutiny by law enforcement and regulatory agencies,” the court wrote when turning down Lewis’ appeal. As a result, the court said, patients have a “diminished expectation of privacy” about their information in the databases…

Under comments:

Anne, on April 28, 2015 at 4:22 pm said:
PDMP…..so open law enforcement don’t need warrants always…..many times they can just “say ”they are doing an investigation. Who can’t see this data? In Alabama, you the patient are expressly prohibited from reviewing YOUR OWN RECORDS even if you contest the accuracy. I have had eleven errors that I know of in my records since early 2011!

painkills2, on April 29, 2015 at 12:11 am said:
I was recently told by a nurse at the hospital that once information is entered into your electronic health record, it cannot be removed — doesn’t matter if it’s true or not.

So if a doctor believes a patient isn’t using her prescriptions (maybe because of an inaccurate drug test result) and is illegally selling them, that doctor will input that information into both your EHR and a PDMP. The doctor doesn’t need to be right — a drug test result is all that’s needed to label you for life.

I assume information cannot be removed from the PDMPs either. Once your records say you are a drug seeker, addict, or criminal, those labels will follow you forever. Every doctor you see will view that information, and my guess is that there will be many doctors who will refuse to treat any patient with those labels, especially pain patients.

Nothing can protect patients from the drug war, including HIPAA.

3/31/2015, Illinois Department of Human Services press release on PDMPs


More than 26,000 doctors and pharmacists and 1,100 dentists are using the system and sharing information with 17 other states…

The PMP began in 1986, and at that time monitored only Schedule II prescription drugs, including painkillers, such as morphine and hydrocodone. The PMP began collecting information electronically in 2000 and in 2007; the program was expanded to monitor Schedule III through V drugs, including Codeine, Vicodin and Valium.

In 2012, IDHS and the Illinois Department of Public Health (IDPH) announced the PMP Long Term Care (LTC) initiative – an unprecedented opportunity to change the drug prescribing culture in nursing homes. Based upon concerns of the legislature regarding substantial use of behavioral health medications within the nursing home population, IDHS and IDPH entered into an interagency agreement to reduce the use of chemical restraints and improve the quality of care…

According to what I’ve read about long term care and nursing homes, there’s actually an epidemic of untreated pain in these patient populations.  Instead of utilizing pain medications, those in nursing homes are prescribed cheap “behavioral health medications,” to keep them sedated and easy to manage.  And then patients don’t complain about their pain, but if they do, no one listens to them.

The National Association of Boards of Pharmacy’s PMP InterConnect program allows participating states to share information on prescriptions of controlled substances. Through this network, IDHS’ PMP is better able to identify when patients have been issued duplicate prescriptions for controlled substances across state lines. The program alerts prescribers and dispensers when patients exceed recommended limits on controlled substances…

PMP is also working to integrate controlled substance prescription data into Electronic Health Record (EHR) systems to allow access to prescription information across healthcare networks, including emergency departments and short and long-term inpatient care.

Last year, PMP collected 21 million prescription records and 26,000 doctors and pharmacists currently refer to that clinical data on a regular basis. Participating pharmacists and doctors complete about 150,000 PMP searches each month.

As I mentioned in a previous post, once information is stored in your electronic health record, it cannot be removed, even if it’s not true.

Indiana prescription tracking system (INSPECT) is in ‘crisis’


INDIANAPOLIS — A state system for tracking prescriptions has been “in crisis” and created a risk of exposing patients’ personal information, according to a state-commissioned report that Gov. Mike Pence’s administration tried to keep under wraps…

Still, lawmakers, who had to obtain a copy of the report through back channels after the Pence administration sought to force them to sign non-disclosure agreements to read it, remain so concerned about the program that they’ve sent the governor a bill that gives the pharmacy board more authority. The bill also creates a new oversight committee made up of the system’s users…

INSPECT collects data from pharmacies about prescriptions of narcotics, opioids and other addictive drugs and lets doctors, pharmacists and police get information from the database to track whether patients are obtaining more pills than they should.

The information in the system includes names, dates of birth, addresses, driver’s license numbers and details about prescriptions for controlled drugs — information that must be kept secure, Davisson said…

Unwarranted drug database search prompts new Utah law, lawsuits


Utah allows law enforcement unregulated access of any person’s private medical history in the database without reasonable suspicion of criminal activity, according to the complaint filed this week in U.S. District Court.

“In reality, there is zero oversight of how the database is being used by law enforcement. As a result, law enforcement is able to circumvent a person’s privacy rights on a whim by searching for that person on the database,” the lawsuit says…

Jones’ ordeal began after Unified Fire Authority reported to police that vials of morphine, fentanyl and midazolam were taken from ambulances in southeast Salt Lake Valley. Cottonwood Heights Police Chief Robbie Russo gave detective James Woods the names of 480 firefighters, including Jones’ name, to investigate regarding the missing medication. Russo got the list from Mayor Kelvyn Cullimore, a Unified Fire Authority board member, according to the lawsuit.

Woods determined through the database that Jones was dependent on opiates and seeing three different doctors. The detective then interviewed the doctors and pharmacists about Jones’ medical conditions and treatment. The detective reported his findings to the Salt Lake County District Attorney’s Office, which charged Jones with 14 counts of obtaining a prescription under false pretenses, a third-degree felony.

Jones, 50, was being treated for a back injury suffered in an accident and two knee replacements, Ayres said. His doctors were aware of each other and didn’t think he was abusing prescription drugs, according the lawsuit. Ayres said Jones never sought medication that was not prescribed to him nor has he abused it any way.

Prosecutors also filed felony prescription fraud charges against paramedic Ryan Pyle as a result of the database search. Those charges were later dropped. Pyle, too, has a federal lawsuit pending against Cottonwood Heights. No one was charged with stealing narcotics from the ambulances after the investigation…

A month before Jones’ trial was to start in 3rd District Court in November 2014, prosecutors dismissed the charges against him…

Two Dirty Little Secrets About Electronic Health Records


Epic Systems, a privately-held company, is the largest provider of EHRs. Most of the big medical centers, including all of the top 10 academic medical centers in the US, use Epic. Like many other EHR companies, Epic requires hospitals and physicians to sign a non-dispargement agreement, or “gag” clause. In fact, Epic doesn’t even allow its hospitals and physicians to publish screen shots of its software in use.Think about that for a second: Epic users– including a large percentage of the leading physicians in the country– are legally forbidden to criticize their EHR or even share images of how it works…

Bob Wachter, a leading doctor at UCSF, recently wrote about a case in which a young patient nearly died after receiving a massive overdose of an antibiotic. The incident was caused in large part by the poor design and interface of the Epic system. Wachter needed to obtain permission from the CEO of Epic to reproduce screenshots to tell the story. Wachter, who was recently named Modern Healthcare’s most influential physician in 2015, would not have been able to fully tell this important story without the permission of Epic…

Instead, the primary goal of EHRs is to make sure that healthcare providers receive maximum reimbursement and to provide data to executives to help them “manage” their workers and their systems…

Final Appeal Letter by me

April 10, 2015

VIA FAX 800-447-2498

Mr. Donald Beaudette
Ms. Katherine Durrell
The Benefits Center
Post Office Box 100158
Columbia, SC 29202-3158

Unum Reference:  Claimant:  Johnna Stahl
Claim No. ***
Policy No. ***
Unum Life Insurance Company of America

Dear Unum:

I am in receipt of two letters dated March 5, 2015, one from Ms. Durrell and one from Mr. Beaudette. Mr. Beaudette’s letter mentions that a copy of my Social Security file was also sent to me, but I did not receive it.  However, I’m also having trouble receiving other mail, like monthly bills, so it’s not just mail from Unum that I haven’t received.

“We decline your request for a list of legally privileged communications and the remainder of your requests.”

So, Unum is making a claim of privileged communications. Tell me, are the photos that your field investigator took of the inside of my apartment considered privileged?  How about the reports on me mentioned in Unum’s notes in my file, but not included in the copy Unum sent me?  And if I could afford to retain an attorney, would that person be able to have access to Unum’s allegedly privileged communications?  In other words, do I have to sue Unum to get a complete copy of my file(s)?

“With respect to the remaining remarks in your letter, we believe we have fully explained our position in our prior communications and refer you to those letters.”

And I beg to differ.  As just one example, Unum still has not provided a definition of “Regular Care” specifically for a 30-year intractable pain patient.

“We refer you to www.unum.com/claimant, which will allow you to see certain communications pertaining to your claim online.”

It will also allow Unum the opportunity to put cookies on my computer and follow my every move on the internet.  Thanks, but no thanks.

“We understand from your November 29, 2014, letter that you have not yet requested an appeal.”

From that very same letter:

1. Response to Ms. Durrell’s letter dated 10/28/2014:

“You will need to submit a written letter of appeal outlining the basis of your disagreement.”

The reason my letter indicated an “intent” to appeal instead of the actual appeal letter is because it was my initial response after my benefits were terminated. Since there seems to be a question of my not having submitted a basis for the numerous disagreements I have with Unum: At this time, I am requesting that Unum consider all of my correspondence, including my Notice of Intent to Appeal, as part of my final appeal letter, and I incorporate same herein for all intents and purposes. (Forever and ever, amen.)

I’m not sure how I can be more plain, but maybe Unum is waiting for my “final” appeal letter, which I guess is this one.  So, without further ado:


“You will need to submit a written letter of appeal outlining the basis of your disagreement.  Please include any additional information you would like considered with your letter of appeal.”

As indicated above, all of my letters to Unum should be considered part of my appeal and a part of the basis for every single one of my disagreements.  Also, this will notify Unum of the additional information I would like considered with my letters regarding my claim, including its current status in your Appeals Unit:

1. Every post I made under “painkills2” at nmcannabisreview.com.

2. All posts on my blog, All Things Chronic, at wordpress.painkills2.com.  (I suggest you start with the post entitled “This Is What Desperation Looks Like.”)

3. All posts on Linda Nee’s website, lindanee.wordpress.com, including language like this:

“Failure to evaluate the totality of the claimant’s medical condition; and an inappropriate burden placed on claimants to justify eligibility for benefits.”

“As indicated in our October 28, 2014 letter, enclosed, the appeal timeframe is mandated by ERISA. However, due to the delay in fully responding to the inquiries in your November 29, 2014 letter, we are granting you an additional 30 days beyond the current appeal timeframe to submit your appeal.”

Interesting.  So, the appeal timeframe is mandated by ERISA, but only when Unum wants it to be. Only when Unum hasn’t made any mistakes, like not responding to my November 29, 2014 letter until March 5, 2015.  I wonder how many other mistakes will be found that can negatively affect Unum’s position on the denial of my benefits?  Until I receive a full copy of my file from both Unum and Social Security, along with the agency’s answers to my questions and requests outlined in my March 2, 2015 letter, that question cannot be answered and I cannot fully represent myself in this matter.

This will formally notify Unum that within the copy of my claim file, it also sent copies of some of Eileen Lisker’s hospital bills from Frick Hospital.  I tried to reach out to Ms. Lisker through a relative and was told the message would be passed along, but I have not received any further communications from the Lisker family.  I believe it is Unum’s duty to notify its claimants of any HIPAA violations and ask that you do so.

“If we do not receive your formal written appeal and supporting documentation by April 10, 2015, we will be unable to complete an appeal review and the determination on your claim will be final.”

C’mon, who’s kidding who?  Unum has already decided that its termination of my claim is final.  It hopes that I won’t find an attorney to take my case, and since I can’t fight back, that will be that. It’s a very uneven fight:  Unum, a massive corporation, against one disabled and poor individual. Doesn’t seem quite fair, does it?

This letter is not meant to regurgitate every one of my questions to Unum that remain unanswered — it is not a full and complete account of all of my disagreements.  (For some reason, I feel like I have to add this language, as Unum appears to have difficulty understanding English, picking and choosing which words of mine it wants to use against me.)

Linda Nee says that I shouldn’t take Unum’s attack on me personally, but considering the additional pain and agony Unum has caused me, that’s very hard to do.  I have never wished a life of chronic pain on anyone, even DEA agents, as it’s something that no one should have to suffer from, even the employees of evil corporations.  And until I sat down to type this letter, I wouldn’t have considered myself a vengeful person…

But here I am, in the middle of a pain storm, trying to concentrate on what this letter should include, and I can’t help wishing that every Unum employee included in this attack against me suffer as I have suffered — and will continue to suffer at Unum’s hands.  If there is such a thing as an evil curse — kharma, if you will — then I hereby ask the powers that be to deliver some justice for me.   In the alternative, my blog and Linda Nee’s website will have to do.  Because no matter what happens, Unum will always be on my shit list.  I will not be satisfied — justice will not be served — until Unum is taken to task for every illegal thing that it does.  For every disabled person it has harmed.   A person cannot suffer as Unum has made me suffer and just leave those consequences to kharma.

Even though I haven’t slept in over 24 hours, the left side of my face is swollen, my current pain level is creeping up to a 9, and the light hurts my eyes, I’m now going to get into my car, drive to the UPS Store, and pay to have this fax sent.

Ya’ll have a nice day.

Johnna Stahl

Voices of MMJ patients in NM


Kevin Nelson
March 25 at 4:05pm
I am Very upset with the way I was treated at R. Greenleaf in Albuquerque! I was sold a domeless ceramic nail that I was assured would work with my setup. When I got home I was to small so I returned to the dispensary & you can imagine my disappointment when I was told by the staff & R. Greenleaf when I was told they wouldn’t exchange it for something that would work for me & that sense it has not been used I should try to sell it on the street to someone! Now I’m out the money & cannot use my medicine. I am completely baffled by the way this was handled by them & the ridiculous solution they had for me. Never again will I return to R. Greenleaf.

Shawn Gentry
March 25 at 5:11pm
::ALERT:: So I go to assist a patient in possible conflict resolution with R. Greenleaf and I find another HUGE issue over the already stupidity they found themselves in…. Not only did they flat refuse to refund a patient for an unused product that was “guaranteed to work.” It didn’t and the patient made another huge trek to get something to work and was refused return or exchange (according to the patient). 100% satisfaction guarantee huh? Anyway on to the more insane issue that effects everyone that uses their website…. So they are selling ads on their website now. A website for patients ONLY. So to make money from those ads, you have to usually submit to an “inventory” of IP addresses and “soft data” to verify that a person visited so they can get paid for the traffic. This is a very good case for a HIPAA Violations… Someone with some more tech savvy sense in this matter should look in to this matter with a quickness. If they are disclosing our IP or any data is “unauthorized disclosure of personal identifiable information.

Death From Drug Addiction: Families Speak Out In Obituaries In Hopes Of Saving Others



While I do not know all the details of this particular story, I did hear a few things in the news story that caused me great distress. First, the young man had been recently arrested but let out of jail because of overcrowding. His parents begged the system to keep him locked up. They believe this would have saved his life. I would argue that the arrest and experience in jail only exacerbated his drug use…

We know that when you flood a community with Naloxone you reduce overdose deaths by 49%…

I don’t know where this information came from — there’s no cite or reference — but I don’t believe it’s true.  Naloxone by itself doesn’t reduce overdose deaths by 49%, but I’m sure this drug has a pretty good success rate in the specific patient population that is addicted to heroin. It’s just that most people who overdose on heroin are doing drugs by themselves, hidden away from anyone who might be able to administer Narcan.

And the stigma of pain patients or their family members having to pay for an additional drug just in case of an overdose… I just don’t see how Narcan will help prevent overdoses in the pain patient population. Of course, knowing the federal government, along with peeing in a cup and pill counts, pain patients will soon be required to also buy Narcan — just in case.

What the federal government has in mind for pain patients is having us all register as drug addicts, across every state, with the information being available to just about anyone (especially future employers, insurance companies, and doctors).

You think it’s hard now to get certain medications to treat pain, just wait until the PDMPs are used nationwide.  It’ll be like being on the FBI’s Most Wanted List. If you want to switch doctors, say your pain doctor just wants to do more injections — all the potential doctors you could see will be looking you up on the PDMP (hey, that rhymes), maybe even talking to your prior doctors.


The push for naloxone, which includes an expanded grants program for states to purchase the drug, is part of a new initiative to be announced Thursday by Health and Human Services Secretary Sylvia Burwell to reduce deaths from prescription painkillers, such as OxyContin and Vicodin, and heroin. Heroin-related overdose deaths increased 39% from 2012 to 2013, and prescription opioids accounted for more than a third of all overdose deaths in 2013.

Since Naloxone may help those who overdose from heroin, and since “heroin-related” deaths are on the rise, this is a great idea.  However, saying Naloxone will help deaths from prescription painkillers is a little, shall we say, too hopeful?  No, what will help pain patients is to have their pain adequately treated, not to have Narcan at the ready just in case of an overdose.

The HHS effort will focus on curbing overprescribing and inappropriate prescribing of pain pills, expansion of overdose reversal programs, and increasing access to treatment programs that use medication as well as counseling to help addicts…

These efforts don’t include increasing access to pain management treatments or programs — no, this is just about addiction.  This whole program, all this money, it’s all about addiction.

To increase access to treatment, the Substance Abuse and Mental Health Services Administration will provide $12 million in grants to purchase medicine used to treat opioid addiction, such as buprenorphine, and train healthcare providers to use the medicines as part of a treatment program. The president’s budget asks for another $13 million to expand the program in 2016.

The government will also invest $20 million this year and has asked for $45 million next year for prescription drug monitoring programs which track prescriptions for narcotics to prevent addicts from going from doctor to doctor to collect multiple prescriptions. Doctors, pharmacists and other medical professionals can access the databases before prescribing. The systems can also identify doctors who may be overprescribing.

“Some states have very sophisticated systems to identifying troubling patterns. Other states are less developed,” Frank said. “We’re moving toward having best practices in all 50 states.”

While the title of this article is “HHS to fund more naloxone programs to halt opioid deaths,” the link says “heroin” rather than “opioid.”  Really, they are one and the same to the media, even though one is illegal and one is not.

And the drug war continues… as always, funded by the federal government… I mean, us.

Facebook “clarifies” its policies without “changing” them, again


Facebook’s claim to “always” allow such photos might come as a surprise to the countless women who were banned for posting photos of themselves breastfeeding children…

Facebook says that “we continue to see an increase in government requests for data and content restrictions.” The United States topped the list, with “United States Law Enforcement” making 14,274 requests for information on 21,731 accounts; Facebook agreed to turn over the information in 79.14% percent of these cases…

The Boring Life of a Private Investigator



In 2005, private investigators, hired by Hewlett-Packard to uncover the source of media leaks about the company, used Social Security numbers of H.P. directors to assume their identities and obtain their phone records…

In my work, I am routinely asked to break the law. An attorney once suggested that I bribe a bank officer for account numbers and balances. This could lead to charges of commercial bribery, unlawful possession of personal identification information and larceny. Felonies. A spurned husband once asked me to hack into his wife’s Facebook account and bug her phone and car — which would include computer tampering, trespassing and eavesdropping. Felonies. I’ve been asked to obtain flight manifests, steal trade secrets and impersonate mailmen. Felony. Felony. Felony.

It appears that Express Scripts really sucks



Tonight I heard from Rachel bat Avraham,* a courageous Express Scripts employee who’s been following my Express Scripts saga here:

I would advise any of you out there who are fed up with Express Scripts to continue to hound the media and turn it into a public affair, because I promise you, the higher-ups won’t like the bad press. And if you do it, you don’t risk being tossed out on your can without any unemployment.


(2012) I started this page minutes ago and Medco already contacted me…



11/24/2014, Express Scripts is Sued by Compound Pharmacies for Denying Claims

Now, three compounding pharmacies are fighting back. Last week, three compounders filed a lawsuit charging Express Scripts is illegally blocking legitimate prescriptions and unfairly forcing patients to seek more expensive treatments or forgo medical care…


On April 8, 2014, attorneys from Sommers Schwartz filed a collective action complaint against Express Scripts on behalf of employees claiming to have not received wage and overtime compensation in violation of the Fair Labor Standards Act (“FLSA”). The plaintiffs assert that the company intentionally failed to pay all of its call center employees for time spent each day loading up their complex computer and phone systems, time they spent working on their unpaid lunch breaks, and time spent shutting their computers down – tasks for which the U.S. Department of Labor has declared call center employees are to be compensated. Express Scripts has more than a dozen call centers throughout the United States. The lawsuit is currently pending in the U.S. District Court for the District of Minnesota.


1/30/2015, “Who is going to start the class action lawsuit? ”


Whistleblower Accuses Express Scripts Of Hiding Overcharges

Law360, New York (May 01, 2014, 2:05 PM ET) — A former senior manager for finance adjustments with Express Scripts Holding Co. has filed a whistleblower suit against the company in New Jersey court, claiming she was canned after protesting the company’s inaction over a coding error that led to overcharges for compound prescriptions. Darcy Dinielli says in the April 21 Morris County complaint that Express Scripts reimbursed at least two clients who complained about the overcharges in 2012 but says that, despite many other clients being impacted by the coding error, the company chose not to reimburse those who had not discovered the mistake…


Federal and State Litigation Regarding Pharmacy Benefit Managers


A federal court in Missouri has thrown out a consumer class-action lawsuit that was brought against pharmacy benefits company Express Scripts over a 2008 data breach in which millions of customer records were believed to have been illegally accessed…



I have previously written about my issues getting my son’s vigabatrin from Accredo Pharmacy here, here and here. (Update: this message was left on my blog Hi – This is Jennifer Luddy from Express Scripts. We do care very much about our patients, and if you have a service concern, we want to make it right. Please send me an email at ExpressRxHelp@express-scripts.com, and I will assist you.)

BCBS Nurse Accused Of Illegally Accessing Patient Records


The state database with the names, addresses and prescription records for 1 million Minnesotans was set up in 2010 to monitor the abuse of prescription drugs.  It is administered by the Minnesota Board of Pharmacy…

Access to the database is mostly limited to physicians and pharmacists, but two Blue Cross Blue Shield employees also have access. The reason for that is because the state pays Blue Cross to monitor drugs in state-run medical programs…