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raidbossmadi · 3 years

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No Such Thing As Safe Chpt 2

Whumptober Day : 5 misunderstanding | broken nose Jurassic World Era

“She got you really good huh,” Jessica mused as she offered Tim a towel to stem the blood that was pouring from his nose.

“You know Delta,” he supplied, his voice muffled. “She doesn’t know how to play gently.”

“She might be a baby but you need to be more careful,” Jess sighed. “That skull of hers has some real power behind it.”

“It was my fault regardless. She’s just been so lonely lately since the cull took her sisters, and we’ve got to wait for the newest clutch to hatch and pass quarantine before she’ll have playmates again. She just sees me as another raptor anyway.”

“Sometimes I think you see yourself as one too,” Jess sighed as she put on a pair of nitrile gloves and gestured for Tim to sit on the veterinary exam table. “It would do you some good to remember that you're not. Lex isn’t going to be happy that you let one of the assets break your nose.”

Tim shrugged as he hopped onto the table. He honestly didn’t see what the big deal was, but he knew that Jess was worried and she was right that Lex would be too. “You girls worry too much, I know these animals like the back of my hand.”

“I know you do, but the fact of the matter is they’re dinosaurs Tim, they don’t have the same boundaries we do. Delta’s sister’s could handle a headbutt to the snout. Now hold still, this is going to hurt.”

“Can’t hurt anymore than our first date,” Tim teased. Jess was right though as she pulled the cloth away and placed her fingers on either side of his nose, there was a soft pop that was followed by a wave of white blinding pain. “Christ Jess, you don’t mess around.”

“Nope. Try not to faint in my office. I'll have to fill out an employee incident report and I don’t think either of us want that.”

Jess took the towel from him and threw it in the office hamper and her gloves in the trash. She wasn’t sure how she was going to explain on her daily report that while she hadn’t treated any dinosaurs today she had treated her boyfriend. She was just lucky Zia wasn’t in the office when Tim had come stumbling in, blood pouring from his face and nearly having given Jess a heart attack.

“I presume Robert knows? Otherwise I’m going to have to call him and let him know you won’t be returning to your post for the afternoon.”

“Oh come on Jess, it’s just a broken nose it’s no big deal.”

Jess shot him a look that could have made even a rampaging T. rex stop in its tracks. “Absolutely not, I’ll drive your happy ass back to your cabin myself if I have to but there’s no way you’re not spending the rest of the day resting.”

Tim sighed. “But Jess,”

“No, no but Jess. Since you didn’t go see the medic team that makes me your doctor but seeing as I’m also your girlfriend I’m telling you to go rest.”

“Yes Dr. Harding,” He said, giving in to her demands.

“I’ll cover for you with Lex, but only so long as you go rest. Take some Tylenol , oh and ice it too. It’ll help with the swelling.”

“Ok, ok, I’m going,” Tim said, getting up and heading for the door.

“I’m going to have Lowery track your biometrics so don’t think you can pull one over on me Tim,” Jess called after him. The clinic door clicked shut behind him before she could hear his answer.

Now alone in the clinic she shook her head and went back to her computer to check on the tasks that she was actually supposed to be doing. Men and their raptors, what a wild combination.

***

“I heard Delta got you good,” Muldoon said walking into Tim’s cabin unannounced. Which granted he was always welcome to do in the first place. Tim was laying on his sofa, head propped up by at least three pillows. He looked rather miserable, which was understandable given his current condition.

“She was just playing Robert. It’s not like she bit one of my fingers off,” Tim protested. He had a raging headache that it seemed even tylenol couldn’t touch. Even so he was determined to protect Delta’s honor.

Robert held up a hand defensively. “I’m not here to lecture you. I’ve had my fair share of field injuries from animals I’ve raised. Besides I figure your girls already gave you hell, and Lex would too if she knew.”

He placed a bottle of oxycontin down on the coffee table in front of Tim. “ I managed to get you some of the strong stuff from the medical team.”

“Robert, you didn’t have to do that, you know.” Tim protested.

“I know, consider it a favor. You’ll owe me a couple after this, considering Jess and I have both decided to cover for you by telling Lex you’re just a little clumsy. Which, to be fair, you are.”

“Gee thanks.”

“It’s either that or have Hoskin’s deal with Delta and you already know how he felt about her siblings. He was ready to cull them before we were even.”

“That’s because Hoskins doesn’t care about these animals, he just wants results. I don’t understand why he’s the I.B.R.I.S project head when he doesn’t seem to give a damn about these animals.”

“Take it up with your sister. Lex specifically asked for Hoskins to oversee it.”

Tim rolled his eyes, Ingen security division was just another word for a bunch of military goons who had no idea what they were doing. He wasn’t sure why Lex hadn’t dissolved the branch entirely or at least restructured it. These people had no love for the dinosaurs at all.

“I’ve got to be on my way. We’re expecting a shipment from Sorna this afternoon, remember? You just focus on getting better, Tim.”

“Thanks,” Tim wanted to protest but he knew Robert would hear none of it. Instead he simply opened the bottle of painkillers, popped a couple, and tried to get comfortable once more.

#whumptober2021 #No.5 #Misunderstanding #Broken Nose #Jurassic Park #Jurassic World #Fic #Blood tw #Broken Bones tw #My writing #Edge of Chaos

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newstfionline · 6 years

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The Worst Drug Crisis in American History

By Jessica Bruder, NY Times, July 31, 2018

DOPESICK: Dealers, Doctors, and the Drug Company That Addicted America By Beth Macy Illustrated. 376 pp. Little, Brown & Company. $28.

In 2000, a doctor in the tiny town of St. Charles, Va., began writing alarmed letters to Purdue Pharma, the manufacturer of OxyContin. The drug had come to market four years earlier and Art Van Zee had watched it ravage the state’s poorest county, where he’d practiced medicine for nearly a quarter-century. Older patients were showing up at his office with abscesses from injecting crushed-up pills. Nearly a quarter of the juniors at a local high school had reported trying the drug. Late one night, Van Zee was summoned to the hospital where a teenage girl he knew--he could still remember immunizing her as an infant--had arrived in the throes of an overdose.

Van Zee begged Purdue to investigate what was happening in Lee County and elsewhere. People were starting to die. “My fear is that these are sentinel areas, just as San Francisco and New York were in the early years of H.I.V.,” he wrote.

Since then, the worst drug crisis in America’s history--sparked by OxyContin and later broadening into heroin and fentanyl--has claimed hundreds of thousands of lives, with no signs of abating. Just this spring, public health officials announced a record: The opioid epidemic had killed 45,000 people in the 12-month span that ended in September, making it almost as lethal as the AIDS crisis at its peak.

Van Zee’s prophecy and other early warnings haunt the pages of “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America,” a harrowing, deeply compassionate dispatch from the heart of a national emergency. The third book by Beth Macy--the author, previously, of “Factory Man” and “Truevine”--is a masterwork of narrative journalism, interlacing stories of communities in crisis with dark histories of corporate greed and regulatory indifference.

Macy began investigating the drug epidemic in 2012, as it seeped into the suburbs around her adopted hometown, Roanoke, Va., where she worked for 20 years as a reporter at The Roanoke Times. From there, she set out to map the local onto the national. “If I could retrace the epidemic as it shape-shifted across the spine of the Appalachians, roughly paralleling I-81 as it fanned out from the coalfields and crept north up the Shenandoah Valley, I could understand how prescription pill and heroin abuse was allowed to fester, moving quietly and stealthily across this country, cloaked in stigma and shame,” she writes.

The word “allowed” is a quiet curse. The further Macy wades into the wreckage of addiction, the more damning her indictment becomes. The opioid epidemic didn’t have to happen. It was a human-made disaster, predictable and tremendously lucrative. At every stage, powerful figures permitted its progress, waving off warnings from people like Van Zee, participating in what would become, in essence, a for-profit slaughter. Or as Macy puts it: “From a distance of almost two decades, it was easier now to see that we had invited into our country our own demise.”

Particularly grotesque is the enthusiasm with which Purdue peddled its pills. In the first five years OxyContin was on the market, total bonuses for the company’s sales staff grew from $1 million to $40 million. Zealous reps could earn quarterly bonuses as high as $100,000, one former salesperson told Macy, adding, “It behooved them to have the pill mills writing high doses.” Doctors were plied with all-expense-paid resort trips, free tanks of gas and deliveries of Christmas trees and Thanksgiving turkeys. There were even “starter coupons” offering new patients a free 30-day supply. As sales rocketed into the billions, noxious side effects began to emerge. Chief among them was the creation of a legion of addicts who, desperate to stave off withdrawal, made the leap to cheap heroin and, later, fentanyl. (“Four out of five heroin addicts come to the drugs … through prescribed opioids,” Macy notes pointedly.)

Many of the casualties have been young adults. In a poignant early scene, Macy joins a mother at the grave of her 19-year-old son. Kristi Fernandez wants to know “how Jesse went from being a high school football hunk and burly construction worker to a heroin-overdose statistic, slumped on someone else’s bathroom floor.” That question--and its larger implications--becomes an engine for the entire investigation, driving it forward with plain-spoken moral force.

In the sprawling cast of “Dopesick,” parents like Fernandez stand out. They have been galvanized by loss. Ed Bisch, an I.T. worker in Philadelphia, hadn’t even heard of OxyContin when it killed his 18-year-old son in 2001. He went on to build a message board, OxyKills.com, that became a parental support network and information clearinghouse. It attracted the attention of Lee Nuss, a grieving mother in Palm Coast, Fla., and together they started a grass-roots protest group: Relatives Against Purdue Pharma. One of the most memorable images of their work together formed during a civil trial against Purdue in Tampa, where Nuss came to a courtroom bearing the urn with her son’s ashes. Lawyers complained. The judge ordered it removed. “My son is not here in body, but he is definitely here in spirit,” Nuss told her friends. “He might have left the building, but he will be back!”

Macy introduces so many remarkable people that, midway through “Dopesick,” readers may find it challenging to keep track of them. Taken as a whole, however, this gripping book is a feat of reporting, research and synthesis. Among myriad sources, Macy cites the influence of two earlier works on the crisis: Sam Quinones’s “Dreamland,” which followed the heroin trail back to the Mexican county of Xalisco, and Barry Meier’s “Pain Killer,” published in 2003, which first brought Van Zee’s heroic work to light.

The final third of “Dopesick” is dedicated to recovery--the steep uphill climb facing former addicts and, more broadly, the nation. Here, Macy follows the struggle of Tess Henry, a former honor-roll student, athlete and poet, who tries to stay sober while raising a young son. Macy spends months driving Tess to Narcotics Anonymous meetings, charts her relationship with her mother and hopes for the best when Tess disappears, falling out of communication and into sex work.

This is the place where a traditional storytelling arc tells us to seek redemption. Macy advocates for medical-assisted therapies to help victims of the crisis and notes some pockets of progress. But the epidemic continues to grow, aided by a legal system that criminalizes victims and a health care framework that treats patients as consumers.

While Macy offers some glimmers of hope--chief among them the will of parents and advocates to keep fighting--what echoes long after one closes this book are the unsettling words of Tess Henry’s mother about her daughter: “There is no love you can throw on them, no hug big enough that will change the power of that drug.”

#Dopesick #OxyContin #Beth Macy #Purdue Pharma #opioid deaths

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pharmacyfollies · 6 years

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2 Hour Wait Parte Dos!! Pharmacy Follies

Well, spank my ass and call me Charles! The post I wrote about why it takes forever and a minute to fill a script went fucking VIRAL on Facebook!! In case you missed it, clicky here. I didn't want to edit it to add more things so this is part 2. These are situations that Pharmacy Folk deal with that can cause wait times to go up. Enjoy and be enlightened to the horror show known as the Pharmacy! :D

12. Sometimes, people bring the wrong insurance card and can't seem to understand that just because the scripts were written by a dentist, I can NOT bill your dental insurance. You are at the pharmacy now, so I need to see your pharmacy insurance card.

11. At the beginning of the new year, a LOT of insurances have deductibles. Even if you've never had a deductible in the past. This means they are going to charge you more for your prescriptions. Sometimes, it's a few bucks more and sometimes, they charge you the whole damn deductible at once. The pharmacy has no control over this. All we do is submit a claim by pressing "send" and the insurance sends back a price as to what to charge you. Any questions regarding that, you'll have to contact the insurance and speak to them. I won't speak for anyone elses pharmacy, but at the one I work at, we do NOT call insurances to question copay's or deductibles. That's a patients responsibility and quite frankly, I do not have time to do that.

10. Sometimes, insurances raise their prices. It happens. I know what you paid last year, last month or even last week. Insurances change their formularies all the time. Once again, the pharmacy has no control over that. Any questions regarding that, you'll have to call your insurance.

9. Sometimes, insurances change their formularies and what was covered last year, last week or yesterday is not covered today. The only thing the pharmacy can do is call the doctor to get a new medication or request your doctor do a prior authorization. Prior auths can take between 1-14 business days, from when the doctor contacts the insurance, for an approval or denial. Once again, the pharmacy has no control over that.

8. Speaking of doctor's offices, they're just as busy as we are. 99% of the time, they do NOT do refill requests over the phone. They prefer to be faxed, E-Scribed or a voice mail left on a refill request line. It's usually a 3 day turn around on a refill request. Calling the pharmacy and demanding that we call the doctor RIGHT AWAY, because you've been out of medication for a week and you're calling now for a refill request, will NOT guarantee that you'll get your refill right away as often times, the doctor's office will tell me to fax it/E-Scribe it/transfer me to the refill request line or will take a message and will call back later.

7. Speaking of doctor's offices again, if you drop off a prescription and there's some sort of issue regarding it that necessitates a phone call to clarify it, we will call the doctor to ensure that we fill the prescription correctly. Often times, the doctor's office takes a message and will call us back. Sometimes, they call back right away and sometimes, they don't. Keep in mind, they're just as busy, and they usually call back once the doctor has a chance to do so.

6. Speaking of doctor's, if you are seeing a new doctor and need us to send a refill request, make sure you tell us that you are seeing a new doctor. You must do this with every refill that still has the old doctor's name on it. If you do NOT tell us this, we will send the refill request to the old doctor who will end up denying the request. Trust me when I say I do NOT like getting yelled at when you come to the pharmacy only to find out your script was denied because we sent it to the wrong doctor. We're not psychic. Help us so we can help you.

5. Occasionally, we run out of medication or we do not have certain medications in stock. Asking me to "check in the back" is all for naught because despite what some folks think, we do NOT have a "back" where we have to go down a flight of stairs, swing on a vine over crocodile infested waters and pass through a secret door guarded by eunuchs that leads to a room with an unending supply of every drug on this planet. We run out of medication when there's a high demand for it, like Tamiflu, and sometimes, medication goes on back order, like Atenolol, which means the manufacturer isn't making enough to supply the masses. Sometimes, we don't carry certain medications simply because there's no demand for it. Not only that, we cannot "hold" medication. It's first come first serve. If you are on a medication and you find that the pharmacy is often out of stock on it, it's best that you give them at least 5 days notice, before you run out, so that they can order it and have it in stock by the time you need it. Do NOT wait until Friday and the weekend because most pharmacies do not get deliveries on the weekend.

Please don't scream at pharmacy staff because they don't carry some rare medication that costs $10,000, Dorzolamide eye drops is on a long term back order or because they don't have enough Oxycontin 30mg. At best, we can try to see if anyone else in the area has your medication or call the doctor to see if it can be switched to something else. If not, we can usually order it in for the next day. Screaming at us will NOT negate any of that and it's not like I got any stashed in my cooter. Seriously.

4. Speaking of Oxycontin, if you are on C-II narcotics, for whatever reason, please try to fill these at one pharmacy. Pharmacies have access to a database that keeps track of controlled substance prescriptions. So when we see that you fill controls at various pharmacies, especially if we see you paying cash price, it raises suspicions. This means we WILL be contacting the doctor to verify that your prescriptions were written by him/her and aren't fakes. The DEA is cracking down on the overuse of controlled substances which means doctors AND pharmacy staff can lose their licenses if things aren't legit.

Also, when it comes to controlled substances, most pharmacies will let you fill your scripts between 1-3 days early. Any earlier than that, we will have to get the ok from your doctor, HOWEVER, if the pharmacist sees that you are CONSTANTLY getting way too early refills, he/she is legally within their rights, as a licensed professional, to NOT release it early. If you constantly try to get your controlled substances early, it arouses suspicion, gets you put on the pharmacy's "watch for early fill" list and it may get you banned from filling controlled substances at the pharmacy. And don't bother with the excuses. We've heard them all ranging from they got stolen out of your car AGAIN to dropping them down the sink/toilet to leaving them at a hotel in another city to the doctor said it was ok to take 15 Norco everyday.

3. Please keep in mind that this is a pharmacy and NOT a doctor's office/emergency room. Do NOT come straight to the pharmacy if you cut your finger so deep that you're gushing blood and can see tendons. Do NOT come straight to the pharmacy if your baby has a 104 degree fever. Do NOT come straight to the pharmacy if you're having really bad chest pain. Do NOT come straight to the pharmacy if you accidentally gargled with Draino instead of Listerine. Do NOT show me a picture of the weird bump that sprouted on your tallyhoohoo. If you are in dire need of emergency medical care, I cannot help you more than directing you to the nearest ER/urgent care center or dialing 911 on your behalf.

2. Once upon a time, pharmacies ONLY filled prescriptions. For some ungodly reason, Corporate thought it would be a GREAT idea for Pharmacists to give vaccinations AND check blood pressure, glucose levels and do cholesterol testing. So when my Pharmacist is in the Penalty Box, hockey speak for the little privacy room, spending between 15-30 minutes with patients giving them a Zostavax injection, checking someone's blood pressure or drawing blood to see if their cholesterol is down the shitter, that means prescriptions are NOT getting verified.

1a. For the love of Sweet Merciful 6lb 14oz Baby Jesus, do NOT call the pharmacy and ask us to fill EVERYTHING in your profile. NO!! Not going to happen. Especially if I see that you fill prescriptions sporadically. You have to give me names of the medications. If you don't know the names of the medication, tell me what you're using it for. If you don't know that either, skip to 1b. The reason I refuse to fill everything is because it NEVER fails: At pick up time, this person will go through their sack of drugs, exclaim how they're no longer taking this and that, and in the end, out of 15 prescriptions, they only want 4 of them.

1b. For the love of all that's sanctified and holy, please keep an updated list, somewhere in your house or on your person, of ALL CURRENT medications you are on. Names, strengths and dosages. This is important for 2 reasons. It makes it easier for the pharmacy when it comes to refill time and most importantly, if you are ever in an accident or are in need of medical assistance, the attending medical professionals will need to know if you're on medication and what that medication is because if they need to treat you with medication, they need to make sure it will NOT interact with anything you're currently taking. I have LOST COUNT of how many ER's have called us to find out a patient's pharmaceutical profile because they were in a horrific accident and cannot operate because the patient has no idea as to what the names of the medication they're taking nor what they're taking it for. Seriously, ya'll. This is important shit to know in the case of an emergency.

#pharmacy #pharmacy tech #pharmacist #pharmacy technician #pharmacy hell #pharmacy follies

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gravitascivics · 5 years

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THE LAND OF DREAMS AND OATHS

One thing every citizen of the US should do, at least once, is attend a naturalization ceremony for new citizens. As part of that event, those seeking citizenship need to take an oath of allegiance. By taking the oath, the person makes a set of promises and those promises have been part of the ceremony since the 1700s. The promises are duties that include:

· Support and defend the constitution of the United States and its laws; particularly those laws formulated to protect the nation from its enemies;

· Forego any allegiance to other nations or sovereigns;

· Renounce any hereditary – such as those of nobility – titles;

· And submit to military and civilian service when the government calls for such service.

This oath is taken from a person’s volition – he/she chooses to take it; no coercion involved.

This step in becoming a citizen reflects a federal bias. To remind the reader, previous postings have outlined the central concept of that construct; a federal union is one in which a group of people come together and inviolably promise to do something. At times, this might have called for a promise to be witnessed by God and, if so, the promise is a covenant. Or it might not have, in which case the promise is a compact. The word federal is derived from the Latin word, foedus, which means covenant.[1]

Some might argue that this oath should not be limited to immigrants who are seeking citizenship but one in which natural born citizen be called upon to take. As it is, just being born within the borders of the nation ascribes to a person the status of citizen. Of course, such a person, if he/she does not want to be part of the union compact, can renounce his/her citizenry. That person can seek citizenship in another country. The assumption here – both culturally and legally – is that if a citizen resides here, he/she voluntarily agrees to that promise or oath.

But beyond the legality, one can, this writer believes, endow that oath with a spirit. The promise is a minimum. One can reasonably read into that promise a commitment for a citizen to express allegiance in a pro-active fashion, not because he/she is forced, but because he/she loves that union.

To describe this spirit, in an earlier posting, this blog shared an extended quote by the political writer, Alexi de Tocqueville. To remind the reader, here is a short excerpt of that more extensive quote describing America in the 1830s:

… [T]he political activity which pervades the United States must be seen in order to be understood … Everything is in motion around you; here, the people of one quarter of a town are met to decide upon the building of a church; there, the election of a representative is going on; a little further, the delegates of a district are traveling in a hurry to the town in order to consult upon some local improvements; or in another place the labourers of a village quit their ploughs to deliberate upon the project of a road or a public school … Societies are formed which regard drunkenness as the principal cause of the evils under which the State labours, and which solemnly bind themselves to give a constant example of temperance … [2]

This, according to Tocqueville, represented common scenes of those years.

America has changed. One would be hard pressed to describe this nation in this fashion today. This blog has offered ample evidence of the general reluctance Americans have in becoming politically engaged. Yet structurally, Americans are still a federalist union. This blog is dedicated toward informing and encouraging a more general understanding and commitment to a federal disposition among students and citizens, in general. Is there any evidence indicating a move toward a more involved citizenry?

This blog has also provided a general description – as a topic for students to investigate – of the opioid crisis. To use a more concrete issue to describe what is happening in terms of citizen involvement, this crisis is helpful. In that light, this posting will now describe a more current instance of how this issue of non-involvement has played a role in this crisis.

One aspect of this crisis is the role Mexican heroin dealers have played. This blog has been reluctant to report on this aspect due to a generally perceived prejudice some Americans have voiced against Mexican immigrants. But to be complete, this blog should report on the role a small percentage of Mexicans have filled.

As it turns out, this drug trade originates from a small town, Xalisco, Nayarit, in Mexico. The town’s name is pronounced as another Mexican city, Jalisco, but is spelled with an “X.” Near that town, the opium poppy plant grew extensively. The plant was harvested, and its milky fluid was extracted and cooked into a substance resembling a black tar. This, in turn, was molded into small round shapes – marble type balls – and were smuggled into the US. In the US, Xalisco dealers set up, across the nation, effective and extensive distribution systems using non-descript cars and an army of drivers with cell phones.

One aspect of the distribution was its actual delivery service. All a user or addict had to do was make a call and a driver showed up with the requested drug. These deliveries were cheap and convenient. They were particularly attractive to people – many of them young – who were hooked on pain pills, such as OxyContin, that were usually more expensive and harder to get. This blog, in a previous posting, described this “medical” aspect of the opioid crisis.[3] The point here is the victims were hooked on pills and shifted to heroin via these Xalisco distributors.

While the epidemic has affected most regions of the country, one state has been particularly hit; that was/is Ohio. One town in Ohio, Portsmouth, is highlighted by the journalist, Sam Quinones, in his book, Dreamland.[4] He begins the book by describing a recreational area in Portsmouth that apparently was the center of the town back in the sixties. It had a large pool and adjacent recreation area, called Dreamland, where the town “hung out” during the warmer days of the year.

In those years, the town was relatively doing well with a strong manufacturing base. But as with many manufacturing towns since those earlier days, Portsmouth lost those factories to mostly foreign competitors. The results of such a development was obviously devastating. But that is only the backdrop to the tragedy. Then, as this blog has described, the selling of opioid in the form of pain pills took hold. As the earlier cited posting describes, many otherwise average Americans became victims to the opioid epidemic:

They – the Mexicans – devised effective, on-demand distribution arrangements in numerous communities around the US. Their customers are not inner-city junkies, as the heroin trade of old was and found in major urban centers, but among, in many cases, middle class whites who have gotten themselves hooked on opioids.

Oftentimes, these middle-class customers became addicted after they were exposed to some chronic pain management protocol under the supervision of legitimate doctors. A lot of this, in turn, was based on an underestimation of the addictive quality of the drugs prescribed and aggressive drug company strategies in marketing opiates. Once hooked, these people became desperate to find cheaper and unlimited supplies of a substitute drug – heroin, a type of opioid – to satisfy their cravings.[5]

But times move on and many aspects of the story have changed since the early years of this century.

One, the cartels of Mexico, earlier not interested in cheap drug sells, eventually moved in and has disrupted the Xalisco system. Also, the general reaction to opioids in the US is taking a toll on the trade and there seems to be some improvement on meeting the crisis. In this, Portsmouth has gone through some positive changes. These changes remind this writer of the above cited Tocqueville quote describing an involved citizenry.

Here is another quote offered by Quinones:

Angie Thuma, the veteran Walmart shoplifter [to pay for her addiction] … told me the last time we spoke, “when I think about all the things I went through and I’m still alive, it gives you courage to keep bettering yourself.”

That seemed to be Portsmouth’s attitude. The town still looked as scarred and beaten as an addict’s arm. Wild-eyed hookers strolled the East End railroad tracks, and too many jobs paid minimum wage and led nowhere. Portsmouth still had hundreds of drug addicts and dealers. But it also now had a confident, muscular culture of recovery that competed with the culture of getting high – a community slowly pitching itself.

Proof to that was that addicts from all over Ohio were now migrating south to get clean in Portsmouth. No place in Ohio had the town’s recovery infrastructure.

On my last trip to Portsmouth, I met a young woman from Johnstown, a rural town northeast of Columbus that from her description sounded a lot like the 740 that RWR rapped about. She had been buying heroin from the Xalisco Boys in Columbus for a couple years. When she tried to quit, a driver who spoke English called her for a week straight.

“But, senorita, we have really good stuff. It just came in.”

Finally, she threw away her phone. There wasn’t much on it but dope contacts anyway. She was twenty-three, alone with a ten-month-old son, and – seeking to get clean with nowhere else to turn – she found refuge in Portsmouth.

“I love it here. I’m really afraid to go back,” she told me in the lilting drawl of rural Ohio, when we met at a party for a woman celebrating her first year clean.

So the battered old town had hung on. It was, somehow, a beacon embracing shivering and hollow-eyed junkies, letting them know that all was not lost. That at the bottom of the rubble was a place just like them, kicked and buried but surviving. A place that had, like them, shredded and lost so much that was precious but was nurturing it again. Though they were adrift, they, too, could begin to find their way back.

Back to that place called Dreamland.[6]

Is there a silver-lining? Perhaps. Maybe the bottom of a nightmare offers enough motivation to rekindle the communal base of a spirited federal union. Sadly, if so, what a price to pay. Perhaps a more proactive civics program can help avoid such a price. Of course, neither the nightmare nor a proactive educational program can make the total difference, but they can be exploited toward helping.

[1] Daniel J. Elazar, “Federal Models of (Civil) Authority,” Journal of Church and State, 33, (Spring, 1991): 231-254.

[2] Alexi de Tocqueville, “Political Structure of Democracy,” in Alexis de Tocqueville: On Democracy, Revolution, and Society, eds. John Stone and Stephen Mennell (Chicago, IL: Chicago University Press, 1980/1835), 78-101, 78-79.

[3] See Robert Gutierrez, “And Then There Is Law-Abiding Behavior, Part II,” Gravitas: A Voice for Civics, May 21, 2019, accessed July 1, 2019, https://gravitascivics.blogspot.com/2019/05/and-then-there-is-law-abiding-behavior_21.html .

[4] Sam Quinones, Dreamland: The True Tale of America’s Opiate Epidemic (New York, NY: Bloomsbury Publishing, 2015).

[5] Ibid.

[6] Ibid., 344-345.

#federal union #covenants #compacts #immigration #civics education #social studies #Sam Quinones #Alexi de Tocqueville

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legalseat · 6 years

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Opioid Use Causes Increase in Medical Malpractice Litigation

It is no secret that opioid use (and abuse) has reached an all-time high in the United States over the past decade. Over 92 million individuals were prescribed opioid pain medication in 2015, representing 38% of the total U.S. population. Despite no overall change in the amount of pain reported by Americans, the sales of prescription opioids quadrupled from 1999 to 2014. With approximately two million reporting that they struggle with an addiction to pain medication, the opioid epidemic in this country has also resulted in an increasingly alarming number of deaths.

The Center for Disease Control reported 22,000 prescription opioid-related deaths in 2015, the equivalent to about 62 deaths each day, and an increase from 19,000 deaths reported in 2014. As the number of prescriptions has increased, so has the number of medical malpractice claims. If recent trends are any indication, lawsuits against medical providers, pharmaceutical companies, and drug wholesalers will likely increase as the opioid epidemic in the United States shows no sign of waning.

A History of Pain Medication Litigation

When it comes to opioid use, pharmaceutical companies are no stranger to lawsuits and have predated the eventual claims against the prescribing doctor themselves. Back in 2003, Purdue Pharma, the maker of OxyContin, was sued for its failure to warn patients against the risk of addiction in its medications. Four years later, the company eventually settled with its 5,000 pain patients for $75 million. At the same time, the company and three of its executives pled guilty to federal criminal charges for misleading patients and physicians and covering up clinical evidence about their medication’s addictive properties.

Since then, the same attorney in the Purdue suit filed claims against opioid manufacturers on behalf of cities and counties in five states that have suffered what has been described as a “public health and safety crisis,” costing hundreds of millions of dollars. Governmental officials from all over the country have filed suits against drug manufacturers and distributers, seeking to hold the companies responsible for “the strain on public services that drug addiction has caused.” Lawsuits allege that the companies engaged in deceptive marketing practices, including rewarding doctors for writing prescriptions. In addition, this past June a bipartisan coalition of 35 state attorney generals launched a multi-state investigation into opioid manufacturers. Many have compared the recent surge of lawsuits and investigations to the infamous movement against Big Tobacco, which resulted in cigarette companies paying out a $248 billion civil settlement.

A Doctor’s Responsibility: Medical Malpractice Claims

The pharmaceutical companies are but one entity in the supply chain of opioid medication, as the lawsuits have also trickled down to the prescribing doctors. Over the past four years, medication-related claims have been cited as the fourth most common medical malpractice cause of action, ahead of obstetrics-related complications. Forty-two percent of the alleged errors occurred in an office or clinic, with thirty-one percent related to inadequate patient monitoring, according to a study conducted by the medical liability insurer, Coverys. Thirty-eight percent of the claims involve the death of a patient.

In the same study, prescription computation was found to be the leading cause of medication errors, followed by the management of the medication. The majority of medication-related errors occurred within general medicine practices, opposed to other specialties. Opioid prescriptions make up almost twenty-five percent of such claims, making pain medication the most frequent root cause of medical malpractice actions involving prescriptions.

The claims often involve overdoses, with alleged medical errors occurring during the patient’s follow-up visit. According to Robert Hanscom, M.D., the Vice President of Coverys and co-author of the study: “Physicians continued to renew prescriptions without monitoring patients to see if they were getting better or not, if there were any changes in their clinical status…If patients are still in pain, that’s a red flag. It’s not helpful to keep prescribing the same opioid if they’re not improving.” When treating a patient with any kind of medication, there are risks involved at every stage, particularly during the initial clinical assessment and prescription.

Likewise, responsibly dispensing, administering, and monitoring are critical in determining whether a patient is on the right medication, at the right dosage, and for the right amount of time. Researchers point to patient mismanagement as a possible cause of such medical malpractice actions, while noting that doctors sometimes renew a patient’s prescription without reevaluating their current health status. Another cause of medical malpractice is physicians failing to properly advise patients of other treatment options.

However, proper care is not given when patients obtain such prescriptions through “pill mills,” where doctors perfunctorily write opioid prescriptions without first examining the patient. In July 2016, a Missouri jury awarded a plaintiff $17.6 million in a medical malpractice case against his primary care doctor after the patient was routinely prescribed pain medication that exceeded the recommended amount. The plaintiff, who was suffering from back pain at the time, ended up battling a drug addiction. The verdict was thought to send a strong message to doctors about the need for opioid reform.

One particularly egregious example of abuse is former doctor, Robert Rand. In 2015, the Nevada Board of Medical Examiners charged Rand with 74 counts of medical malpractice, alleging that he “violated the standards of practice in regard to opioid prescribing, practiced medicine beyond the scope of training and competence, engaged in unsafe and unprofessional conduct and maintained substandard medical records.” The complaint alleged that Rand prescribed massive amounts of opioids to his patients which were several times more than the high dose threshold. One such patient subsequently died from alcohol oxycodone intoxication.

Rand was also found guilty in federal criminal court for involuntary manslaughter and distribution of controlled substances, to which he was sentenced eight and ten years concurrently.

Like the lawsuits filed against the pharmaceutical companies, cities and states are taking action against doctors as well. Dozens of medical malpractice lawsuits have been filed by West Virginia (the state with the highest overdose death rate) and McDowell County (the county with a death rate three times higher), alleging that doctors overprescribed pain medication and flooded the market with substances that led to the plaintiffs’ uncontrollable addiction and subsequent deaths.

The future of opioid-related medical malpractice claims will likely depend on the accepted standard of care established by researchers and experts in the field. All agree that no doctor should be prescribing opioid medication to patients without first examining them, and to do so would be an obvious deviation from the acceptable standard of care. As established by the Drug Enforcement Administration, medical providers must first apply for and be granted a DEA number, which is connected to each of the provider’s prescriptions. In conjunction, the doctor must maintain a record of the patient’s examination that substantiates the prescription.

Likewise, a full medical history (including any history of addiction) should be taken by the doctor. While pain medication is ideally a short-term solution, sometimes a patient’s pain cannot be relieved. In which case, the patient can be referred to a pain management doctor who specializes in the management of chronic pain. Such a referral avoids a general practitioner from treating a pain that is beyond his scope of practice.

While most medical experts would attest to the above practices, as the opioid epidemic continues to pervade, recommendations and standards of care are continually being reevaluated and revised. Some medical professionals have proposed urine screening to ensure patients are taking the correct dosage of medication. The advent of computer tracking of prescriptions can make it easier to hold doctors and pharmacists accountable. Also, some states, such as Pennsylvania, are passing legislation that limits the amount of opioids that can be described at any given time but for certain exceptions.

As long as humans experience pain, there will always be a need for pain medication. In which case, the regulation of opioid prescriptions needs to be closely monitored and constantly reevaluated in light of the current drug use trends.

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legalroll · 6 years

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Opioid Use Causes Increase in Medical Malpractice Litigation

A History of Pain Medication Litigation

A Doctor’s Responsibility: Medical Malpractice Claims

Rand was also found guilty in federal criminal court for involuntary manslaughter and distribution of controlled substances, to which he was sentenced eight and ten years concurrently.

The post Opioid Use Causes Increase in Medical Malpractice Litigation appeared first on The Expert Institute.

Opioid Use Causes Increase in Medical Malpractice Litigation published first on http://ift.tt/2fPSFkQ

0 notes