Posts Tagged ‘Medicaid’

Grassley & Senate Watchdog Target Doctors Prescribing Mass Amounts of Dangerous Drugs

Tuesday, January 24th, 2012

ProPublica
By Charles Ornstein and Tracy Weber
January 24, 2012

An influential U.S. senator is grilling officials in nearly three-dozen states, demanding to know how they are cracking down on physicians who prescribe massive amounts of potentially dangerous prescription drugs.

Iowa Republican Charles Grassley sent letters to 34 states Monday asking what steps they had taken to investigate doctors whose prescribing of antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients far exceeds that of their peers.

The request is a follow-up to a 2010 letter Grassley sent all states that requested statistics on top prescribers of these drugs.

“These types of drugs have addictive properties, and the potential for fraud and abuse by prescribers and patients is extremely high,” Grassley wrote in Monday’s letters. “When these drugs are prescribed to Medicaid patients, it is the American people who pay the price for over-prescription, abuse, and fraud.”

ProPublica reported in November that Florida allowed at least three physicians to keep treating and prescribing drugs to the poor amid clear signs of possible misconduct. One doctor kept prescribing narcotic pain pills to Medicaid patients for more than a year after he was arrested and charged in 2010 with trafficking in them.

A number of the top-prescribing Medicaid doctors around the country are listed in our Dollars for Docs database of payments made by 12 pharmaceutical companies to physicians for speaking and consulting Medicaid, jointly funded by the states and federal government, provides health care coverage to about 60 million low-income enrollees.

Grassley, the senior Republican on the Senate Judiciary Committee, has long argued for greater transparency in health care. The painkillers and mental health drugs Grassley is inquiring about are among the top drivers of Medicaid drug spending.

His letter to Ohio notes that the top prescriber of the anti-psychotic Abilify wrote 13,825 prescriptions in 2009 — about 54 prescriptions per weekday. Ohio paid $6.7 million for that those prescriptions, state officials reported to Grassley.

The biggest prescriber of another anti-psychotic, Seroquel, wrote 18,890 scripts at a cost of $5.7 million. Grassley wrote the tally would amount to nine prescriptions per hour. When Ohio submitted the data to Grassley last year, it did not identify the doctors by name or license number.

“After an extensive review of prescribing habits of the serial prescribers of pain and mental-health drugs in Ohio, I have concerns about the oversight and enforcement of Medicaid abuse in your state,” he wrote. “While I am sensitive to the concerns of misinterpretation of the data you provided, the numbers themselves are quite shocking.”

Grassley’s letter to Maine cites a physician who wrote 1,867 prescriptions for the powerful painkiller OxyContin in 2009, nearly double the second-highest prescriber. The doctor also wrote 1,723 prescriptions for another painkiller, Roxicodone, nearly three times as many as the next highest prescriber.

Calls to officials in Ohio and Maine have not been returned.

In his letters to the 34 states, Grassley asked that officials tell him by Feb. 13 what action, if any, they have taken against top prescribers, whether those doctors are still eligible to bill Medicaid, whether any of the doctors were referred to their state medical boards for investigation, and what systems have been set up to track possibly excessive prescribing, among others.

Grassley is sending letters to 12 other states that never provided him data, as requested, on their top Medicaid prescribers. Four other states will not receive follow-up letters because the senator felt their initial responses to his 2010 letter were adequate.

ProPublica reported in November that since Grassley’s initial letter requesting the data in 2010, Louisiana, Arizona, Oklahoma and New York have kicked some high-prescribing physicians out of Medicaid. California has temporarily suspended or placed restrictions on 15 to 20 doctors in the past two years for prescribing disproportionately high volumes of painkillers and antipsychotics to Medicaid patients.

But Grassley said more needs to be done.

“When a doctor writes more prescriptions than seems humanly possible, it makes sense to ask questions,” he said in a statement to ProPublica. The statement noted that some states never responded to his original letter in 2010.

“If state and federal taxpayers are being cheated because of inappropriate prescriptions,” Grassley said, “the state and federal governments have to get to the bottom of it and stop it.”

Read article here:  http://www.propublica.org/article/senate-watchdog-targets-high-prescribing-medicaid-docs

« Return to news items


Share

U.S. to Force Drug Firms to Report Money Paid to Doctors

Monday, January 16th, 2012

The New York Times – January 16, 2012

by Robert Pear

The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul. “The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.

WASHINGTON — To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.

Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.

Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Federal officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.

Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.

The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.

Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.

Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.

The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.

Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.

Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.

The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.

Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.

Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”

In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”

The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”

The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.

“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.

Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.

“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.

Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.

Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.

As an example of inappropriate payments, the inspector general of the Department of Health and Human Services cited a case in which manufacturers of medical devices had provided financial incentives — in the form of consulting agreements, lavish trips and other perks — to induce doctors to use particular hip and knee replacement products. Under a civil settlement with the government, the companies agreed to new compliance procedures.

The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.

The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.

http://www.nytimes.com/2012/01/17/health/policy/us-to-tell-drug-makers-to-disclose-payments-to-doctors.html?_r=2&pagewanted=all

« Return to news items


Share

The Psychiatric Drugging of America’s Foster Children by Psychiatrist Peter Breggin

Thursday, December 22nd, 2011

The Huffington Post – December 22, 2011

Remember that many of these children will be waking up on Christmas morning to count out their multiple mind-altering psychiatric drugs that they have been prescribed by psychiatrists and other prescribers hired by the states in which they reside and paid for by tax dollars. These kids don't need psychiatric drugs, they need human "angels" to rescue them from a system that is stacked against their well-being.

The most vulnerable among us are the littlest victims. Young children, torn from their birth families through various, often unspeakable tragedies. These children end up in state supervised foster care and too often are passed from hand to hand, house to house. There were approximately 662,000 children in foster care in the United States in 2010.

Now there is a Government Accounting Office (GAO) report confirming that foster children in five states — Florida, Massachusetts, Michigan, Oregon and Texas — are receiving shocking amounts of psychiatric drugs. In the words of ABC News, they are “being prescribed psychiatric medications at doses higher than the maximum levels approved by the Food and Drug Administration (FDA) in these five states alone. And hundreds of foster children received five or more psychiatric drugs at the same time despite absolutely no evidence supporting the simultaneous use or safety of this number of psychiatric drugs taken together.” The ABC News report shows one 7-year-old holding a bag filled with 13 psychiatric medications that she had taken.

During the FDA drug-approval process, the maximum dose of a drug is determined by giving that drug by itself without any other psychoactive substances. When two or more psychiatric drugs are given together, each at its maximum dose, toxic levels of exposure can occur. In addition, some of these children are being given higher than the FDA-approved dose of individual drugs.

One young child interviewed by ABC News described the effect of the antidepressant and antipsychotic drugs he was taking: “They made me feel like I had a thousand bricks on my head.” Another child said, “Some of the medications were for ADHD but I’m not ADHD, I’m just naughty.” A teen in foster care on multiple psychiatric drugs told ABC News she felt like a “guinea pig.”

Foster children are provided government insurance in the form of Medicaid that includes “mental health” services such as psychiatric evaluations and prescription drug coverage. Individual states administer Medicaid and the U.S. Department of Health and Human Services is responsible for overseeing the state programs.

In the states surveyed by the GAO, children in Massachusetts fared worst. Thirty-nine percent of the foster care children aged 0-17 on Medicaid were prescribed at least one psychiatric drug. By comparison, 10 percent of non-foster care children in Massachusetts were prescribed at least one psychotropic medication under Medicaid. It’s serious enough when 10 percent of non-foster care children from our poorer communities are receiving psychiatric drugs; it’s even more tragic when 39 percent of our most poor and abandoned children are being inundated with these drugs.

Other states in the GAO study had total numbers of foster care children on Medicaid being prescribed at least one psychiatric drug: Oregon — 19.7 percent; Texas — 32.2 percent; Florida — 22 percent; and Michigan — 21 percent. The statistics reported are eye-opening, and it is worthwhile to see the full GAO report. In Texas, for instance, 9.1 percent of foster care children aged 0-5 years old are on at least one psychiatric drug, and 58.2 percent of foster care children aged 13-17 years old are on at least one psychiatric drug. Massachussetts has 53.4 percent of foster care children aged 13-17 on at least one psychiatric drug, and almost 5 percent of foster children aged 0-5 are on at least one psychiatric drug.

Is this widespread psychiatric drugging medically appropriate or indicated? Absolutely not. First of all, these are young children, even infants, who have already been through extremely traumatic experiences. All of them have been taken from their homes and most of them will not have had a stable replacement home. Beyond that, one can only imagine their horrendous living conditions prior to being removed from their families of origin. These children do not need psychoactive substances — they need the best human, caring services that our society can provide. The drugs may make them temporarily more docile, but by disrupting and suppressing normal brain function and development, they add new stressors to their lives and prevent them from adapting and growing as best as possible.

ABC News reports, “Of all the psychiatric medications, antipsychotics are, by far, the most prescribed, especially for foster children. Foster children are given anti-psychotics at a rate nine times higher than children not in foster care, according to a 2010 16-state analysis by Rutgers University of nearly 300,000 foster children.”

These antipsychotic drugs — including Abilify, Risperdal, Seroquel and Zyprexa — can lead to obesity, elevated blood sugar and diabetes, pancreatitis, cardiovascular abnormalities and a disfiguring and sometimes disabling movement disorder called tardive dyskinesia. It’s been suggested they could shorten lifespan by up to 25 years in patients exposed to them for decades. Evidence is accumulating that they can also lead to shrinkage of the brain in those patients exposed to them for years.

Why are these highly-toxic drugs being given to so many children in foster care? The antipsychotic drugs can suppress the highest centers of the brain — the frontal lobes — leading to indifference and apathy, which makes the children more docile and easier to manage. The use of multiple psychiatry drugs (polydrug therapy) produces similar effects. In the extreme, these children become zombie-like.

The newer antidepressant drugs such as Prozac, Paxil, Zoloft, Cymbalta, Lexapro, Wellbutrin, Effexor and Pristiq and have been shown to cause an increase in suicidal behavior in children. In addition, as the FDA-approved label and medication guides for these drugs confirm, they also can cause a general worsening of the individual’s condition, including depression, anxiety, hostility, aggression, impulsivity and mania. Many studies also suggest that a high percentage of children are driven into abnormal mental states by these drugs. When a child develops any one of these adverse reactions they are likely to have additional psychiatric drugs added to their drug cocktail rather than being carefully withdrawn from the offending substances.

As ABC News documented with one mother, parents or foster parents who object to the prescriptions of mind-altering psychiatric drugs for their young children are likely to be threatened with removal of the child from their care. In a separate case in Detroit, a child who was on Medicaid due to physical disability was taken off her mind-altering psychiatric drug by her mother when she displayed adverse effects.

The prescribing clinic called child welfare services and reported the mother. Welfare services removed the child from her mother’s care for a time. Fortunately, this child was later returned by court order to her mother and criminal charges against the mother were dismissed.

But word gets around. Complain about your child being placed on drugs and social services may intervene.

A mother in Millbrook, NY, was charged with medical neglect for not continuing her 4th grade son on a cocktail of psychiatric medications that was making him angry and listless. Off the drugs his energy returned and his mood improved, but public school officials kicked the boy out of school and reported the mother. The mother prevailed and was exonerated of “medical neglect” charges. Her son attended a private school and thrived. He is now a grown man and responsible citizen. His mother explained, “Kids don’t need drugs, they need individualized education and better family life. The priorities are all screwed up.”

In two of the ABC news foster care cases, the clinics that were authorized to deliver services to the children were also promoting themselves as being research facilities for “CNS Conditions” (central nervous system conditions, a misnomer for psychiatric conditions.) As research facilities those clinics have ties with pharmaceutical companies.

And what about the drug companies? Are they doing all they can to prevent the inappropriate use of their products? To the contrary, several of the largest drug companies have paid billions to settle claims they illegally marketed antipsychotics to children and other off-label populations, such as the elderly.

What is being done to these children should be viewed as chemical battery and child abuse. The misguided parents and foster parents are not the perpetrators. The psychopharmaceutical complex is the perpetrator, including the drug companies, the federal government and organized medicine and psychiatry.

The drugging of America’s children raise many issues including parental rights, children’s rights, child safety, off-label prescribing of the drugs and fraud and malpractice on the part of the researchers, psychiatrists and other prescribers. Most tragic is the silence! The stifled voices of victimized children and the self-serving silence of health professionals throughout the country who fail to take a public stand against the escalating drugging of our children.

Drugging traumatized foster children shoves them under society’s rug and is in no way therapeutic for the child. There are humane and effective approaches to helping our most vulnerable children. First, they need to be protected from predatory psychiatrists and other prescribers. Second, they need improved social services that could keep many of them in their homes or provide better assistance, training and supervision to improved foster care homes. When they inevitably become emotionally distressed and at times behaviorally disturbing, they do not need chemical readjustments of their brains — they need better attention from adults in the form of improved home-life or foster care, improved educational opportunities and psychosocial therapies aimed at helping them overcome and move beyond the trauma and stress they have endured and continue to endure as children and youth.

Sure, it’s easier to give them drugs. But has anybody noticed — it doesn’t help them in the long run. Exposure to psychiatric drugs in childhood is dangerous and over time can be damaging, disabling and even deadly.

No agencies and no associations — not NIMH, the American Medical Association, the American Psychiatric Association, the American Psychological Association, and the many other mental health associations — are willing to call a halt to the massive tidal wave of mind altering psychiatric drugs being thrown at America’s children. Several states, including Florida, Louisiana and New York have expelled “high prescribing” doctors from Medicaid but this is like nipping off the top of the iceberg. The primary problem remains: Placing children on psychiatric drugs instead of offering genuine help.

Dr. Robert Nelson, M.D., Ph.D. of the FDA Office of Pediatric Therapeutics, squirmed when challenged by Diane Sawyer in the ABC foster child series, but said the FDA had no plans to strengthen their warnings about psychiatric drugs and children.

The GAO, while courageously illuminating the great number of foster children on psychiatric drugs as well as the seriousness of children being exposed to multiple psychiatric drugs, falls far short of calling for the curtailment of the drugging of American children.

Twenty-five years ago, a tiny fraction of children were prescribed psychiatric medications, and that was largely confined to stimulants. In the early 1990s we were blowing the whistle on the increasing attention psychiatry was paying to children. I wrote an op-ed piece in the Wall Street Journal in 1989 and spoke frequently through the media about how children being blamed and diagnosed for problems in families, schools and in society. From 1990 to 1995 the increased prescribing of psychotropic drugs for preschoolers had begun.

What is to be done?

It is time for state attorney generals to launch full-scale investigations into the practices of these Medicaid psychiatrists. When appropriate, they should be charged with battery and with fraud, and sued for malpractice. But the psychiatrists are largely responding to the campaigns conducted by the psychopharmaceutical complex.The entire system, from the drug companies and insurance companies to the medical and psychiatric associations, and also the researchers and universities, need to be investigated for participating in this widespread medical abuse of children.

This Christmas, as many of us gather around a Christmas tree watching the children in our families wake up with shining eyes and happy laughter… remember. Remember that there were approximately 662,000 children in foster care in the United States in 2010.

Remember that many of these children will be waking up on Christmas morning to count out their multiple mind-altering psychiatric drugs that they have been prescribed by psychiatrists and other prescribers hired by the states in which they reside and paid for by tax dollars. These kids don’t need psychiatric drugs, they need human “angels” to rescue them from a system that is stacked against their well-being.

Only an outraged citizenry will change this. Write your Congressional representatives and senators. Write your state representatives and senators. Write your state attorney general’s office requesting a full investigation in your state of the crisis with foster children and psychiatric drugs. If you are a parent or a foster parent being pressured to keep your child on psychiatric drugs, call your local paper, referencing the ABC News investigation. If you are a reporter, plan a local series on this issue. If you are a teacher, a social worker or professional in the Medicaid system, consider becoming a whistleblower against the chemical assault of these children. If you are a medical professional learn how to help children safely taper off their psychiatric drugs while assisting their families in obtaining more useful services. Always remember that withdrawal from psychiatric drugs can be hazardous and needs to be done carefully with experienced clinical supervision.

It’s the Christmas season. Let’s not forget the kids who are so drugged their eyes cannot sparkle anymore. Become one of their real-life angels.

Peter R. Breggin, M.D. is a Harvard-trained psychiatrist and former full-time consultant with NIMH who is in private practice in Ithaca, New York. Dr. Breggin is the author of more than twenty books including the bestseller Talking Back to Prozac and the medical book Brain-Disabling Treatments in Psychiatry, Second Edition. His most recent book is Medication Madness, the Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime. He is also the author of dozens of peer-reviewed scientific articles, many in the field of psychopharmacology. On April 13-15, 2012 in Syracuse, New York, the annual conference of Dr. Breggin’s 501c3 nonprofit international organization, The Center for the Study of Empathic Therapy, will present a panel of lawyers, experts, survivors and families concerning antidepressant-induced violence and crime. Conference information is available on www.EmpathicTherapy.org.

« Return to news items


Share

Two High Ranking Senators – Grassley & Kohl – Question Use of Psych Drugs in Nursing Homes

Monday, August 15th, 2011

MedPage – August 15, 2011

Emily P. Walker

Click image to watch video: Psychiatric Abuse of the Elderly

WASHINGTON — Two high-ranking senators have urged the Centers for Medicare and Medicaid Services (CMS) to take a closer look at potential over-prescribing of atypical antipsychotics to nursing home residents.

There are eight atypical antipsychotics approved by the FDA to treat schizophrenia and/or bipolar disorder, including clozapine (Clozaril), aripiprazole (Abilify), and quetiapine (Seroquel).

Atypical antipsychotics are not approved to treat dementia, and must carry black box warnings that elderly people who take atypical antipsychotics have an increased risk of death, compared with those who take placebo pills for dementia.

Still, it’s clear that these drugs are being used in nursing homes to control behavioral problems related to dementia. A 2011 report from the Department of Health and Human Services Office of the Inspector General (OIG) found that 14% of all nursing home residents with Medicare had claims for antipsychotics and 88% of the atypical antipsychotics prescribed off-label were for dementia.

And in 2009 Elli Lilly, the makers of olanzapine (Zyprexa), pled guilty and paid $1.4 billion to the federal government for allegedly targeting doctors who worked in nursing homes and assisted living facilities to prescribe olanzapine off-label to elderly patients with dementia.

In their letter, Sens. Charles Grassley (R-Iowa) and Herb Kohl (D-Wisc.), urged CMS administrator Donald Berwick, MD, to examine the issue of overuse of antipsychotics in nursing homes more closely. The letter is a follow-up to one the senators sent in May after the release of the OIG report, which the senators themselves requested.

The newest letter, sent Aug. 1, requests that CMS investigate what role pharmacy benefit managers — who manage prescription drug coverage for Medicare beneficiaries living in nursing homes — play in fueling the possible overuse of atypical antipsychotics in elderly people in long-term-care facilities.

Pharmacy benefits managers may receive rebates from drug companies for prescribing certain drugs, and CMS should look at their role in “unnecessarily increasing the use of antipsychotic drugs and to subsequently take action to address such practices and curb excess use.”

The letter also urges CMS to consider requiring that physicians, who off-label prescribe drugs with black box warnings to seniors, certify that a Part D provider will cover the drug.

If CMS followed the senators’ advice, Medicare payments for antipsychotics that “lack a medically-accepted indication” should be drastically reduced, the senators said.

“Taking such proactive steps will create disincentives for entities that administer pharmacy benefits to allow these practices to flourish while also providing CMS with clearer means to recoup erroneous payments,” Grassley and Kohl wrote.

A recent study found that the prescription cost for a typical antipsychotic increased from $38 to $41 between 2004 and 2008, while the price tag for an atypical antipsychotic rose from $226 to $323, the researcher found. Overall, the cost of typical antipsychotics in the U.S. was $600 million in 2008, while the cost of atypical drugs reached $9.9 billion.

That same study concluded that atypical antipsychotic use is growing, especially among seniors, and the drugs are increasingly prescribed off-label, sometimes without convincing evidence to support that use.

In 2008, 91% of the prescriptions written for atypical antipsychotics were for circumstances where the evidence for the efficacy was uncertain, the researchers found.

However, a separate study found that after the FDA issued a black box warning about the risks of using the drugs to soothe behavioral problems in dementia patients, there was a decline in prescribing the drugs to patients in the VA medical system.

http://www.medpagetoday.com/Geriatrics/Dementia/28052

 

« Return to news items


Share

Dosed in juvie jail: Troubled doctors hired to treat kids in state custody

Monday, June 20th, 2011

By Michael LaForgia

Palm Beach Post Staff Writer

By the time Florida started paying Dr. Gold Smith Dorval to counsel and medicate jailed children, the Pembroke Pines psychiatrist already had experience with kids in state custody.

He had used them, authorities said, to bilk the government out of money for the poor.

When Dorval pleaded no contest to a felony grand theft charge, it should have barred him, by law, from working for Florida’s Department of Juvenile Justice.

It didn’t.

And, like Dorval, other doctors have emerged from past troubles and gotten jobs at DJJ – with authority to prescribe drugs to kids in state jails, a Palm Beach Post investigation has found.

Some psychiatrists took DJJ jobs after they were cited for breaking the law, making grave medical missteps or violating state rules. Others were hired after they were accused of overmedicating patients, sometimes fatally.

All were empowered to prescribe drugs to jailed kids as powerful antipsychotic pills flowed freely into Florida’s homes for wayward children.

“It’s appalling. A psychiatrist is a psychiatrist. They’re licensed, they’ve been to medical school, and there is a certain trust placed in that person’s judgment when they tell you that this child needs to be medicated,” said John Walsh, an attorney with the Palm Beach County Legal Aid Society who has represented children in juvenile court. “This just illustrates that we always have to be on guard with children.”

In two years, Florida bought hundreds of thousands of tablets of Seroquel, Abilify, Risperdal and other antipsychotic drugs for children housed in state-run jails and programs. The meds were administered in a juvenile justice system that doesn’t track prescriptions and has no way of telling whether doctors are prescribing to make kids easier to control.

In some jails and homes, pills were prescribed by psychiatrists who took huge speaker fees from companies that make antipsychotic drugs, The Post found. In others, the task fell to doctors with troubled pasts.

In response to the newspaper’s first reports, published last month, DJJ Secretary Wansley Walters launched an investigation into the department’s use of antipsychotic drugs. DJJ officials declined to discuss The Post’s latest findings, citing the probe.

Spokesman C.J. Drake acknowledged, though, that the department has struggled to find psychiatrists willing to work in jails and programs. He also said DJJ sometimes has relied on companies that employ a stable of doctors, rather than signing a contract with a single physician.

As a result, Dorval went to work in a Broward County jail for children – even though he would have failed a state-mandated background check required by the contract.

Doctor’s bogus billings

In the late 1990s, Dorval claimed he was providing juvenile delinquents and other vulnerable children with needed therapy. Instead, state investigators said, he used bogus counselors to bill Medicaid for more than $350,000 in fraudulent claims.

He charged the government for offering more than 24 hours’ worth of children’s therapy in a single day, investigators said, and structured the scheme around kids who were homeless or in DJJ custody or foster care.

He tended to bill “for those children that the system ‘lost,’ ” according to an affidavit for his arrest.

Originally charged with four felonies in Broward, Dorval pleaded no contest to one count of grand theft in 2004.

Later, to keep his medical license, he agreed to pay $10,000 and was suspended, reprimanded and put on four years’ probation.

Although a judge withheld a formal finding of guilt, the plea disqualified Dorval from seeing patients in a juvenile jail. Even so, his employer, Miami-based Compass Health Systems, sent him to work at the Broward Juvenile Detention Center between August and December 2007.

No one screened his background beforehand.

In written responses to questions, Dorval said he was doing as he was told when Compass sent him to work in the Broward juvenile jail.

“At that period you cited, the psychiatrist that was seeing patients at the DJJ was out. Therefore I was designated by the management office to go and cover for that psychiatrist, until they switched me again to another place. I was not aware of any wrongdoing,” wrote Dorval, who stressed that he never signed a contract with DJJ. “I am only an employee. Wherever they send me to work I have to go.”

As for the criminal charges, he offered this explanation: “This case was a simple matter that became complicated, because my first lawyer messed me up.” After wrangling over the facts, “they decided to offer me a plea that would allow me to get a chance to fight for my license to practice medicine,” he wrote. “It was a real nightmare that generated in me a post-traumatic syndrome that I will never forget.”

DJJ officials declined to comment on Dorval’s hiring, again citing the investigation.

Compass officials didn’t respond to questions about Dorval.

DJJ had no contract with Compass as of May, records show.

Patient’s death missed in screening

In state-operated jails and programs, the rules say DJJ must screen doctors’ backgrounds and verify that physicians’ hold valid medical licenses. In privately run programs, which house the majority of children in the department’s custody, that responsibility falls to contracted companies.

Such screenings don’t catch everything: Doctors who kept their licenses after the state accused them of serious lapses have gone on to work in juvenile jails and homes.

Dr. Charles J. Dack is an example. For six years, Dack, a Lakeland-based physician who is board-certified in addiction and child psychiatry, prescribed a cocktail of antidepressants and powerful painkillers, including methadone and morphine, to a patient named Mary Tuxbury.

Eventually, Dack ramped up the doses of pills Tuxbury was taking, keeping her “at a toxic level of morphine for approximately two and a half years,” regulators from the state health department said. In March 2002, Tuxbury was found dead. She was 42.

An autopsy showed she died of “multiple drug intoxication, namely opiates and tricyclic antidepressants.”

Regulators charged Dack with failing to meet care standards and inappropriate prescribing. Dack settled the allegations in August 2007. He admitted no wrongdoing but agreed to pay a $7,000 fine and complete a course on “misprescribing” drugs.

A year later, he was hired to care for children at three privately run programs in Central Florida: Wilson Youth Academy, Peace River Youth Academy and New Beginnings Youth Academy. He worked in the homes until April.

Dack didn’t respond to messages seeking comment.

Doctor hired after child’s death

Other DJJ doctors weren’t cited by regulators, but they were accused in court of fatal neglect. Roughly one in eight of the psychiatrists who have worked for DJJ in the past five years has settled a malpractice lawsuit in Florida, records show.

Among these was Dr. Samuel McClure. As a psychiatrist in Orlando, McClure diagnosed an 11-year-old boy named David Morganthal with attention deficit disorder. He prescribed powerful, mind-altering drugs for David – even though the child was much smaller than other kids his age, according to court documents.

One morning in November 2001, David’s mother woke to find her son dead on the floor of her double-wide mobile home. When they laid David out at the morgue, he measured less than 4-foot-2 and weighed 49 pounds.

Lab tests showed his blood contained an unusually high concentration of an antidepressant: about 60 percent more of the medication than doctors had expected.

The drug, mirtazapine, still hasn’t been approved as safe for children. David was taking the drug along with another antidepressant that hasn’t been approved for kids, citalopram.

The autopsy concluded the boy probably died from a seizure and heart problems caused by “reaction to prescription medication.”

Read the rest of the article here: http://www.palmbeachpost.com/news/state/dosed-in-juvie-jail-troubled-doctors-hired-to-1549240.html?viewAsSinglePage=true

« Return to news items


Share

Feds to start directly targeting drug company execs in health care fraud schemes

Saturday, June 11th, 2011

Natural News – June 10, 2011

by Ethan A. Huff

The days of drug companies simply settling out of court every time they break the law may soon be coming to an end. In a move that represents a significant shift toward punishing individuals for crimes rather than faceless corporations, federal officials say they will begin personally going after CEOs and other company executives whose companies fraudulently bilk Medicare, Medicaid, and other federal programs out of millions of dollars, or that falsely market dangerous drugs.

When a 1996 law was passed that banned drug companies convicted of felony charges from further participating in any federal health programs, Big Pharma quickly devised creative ways to get around it. As a result, drug companies for years have been able to continually break the law without much consequence by simply settling for a few million dollars, and continuing on with shady dealings that raked in a whole lot more (http://www.naturalnews.com/001867.html).

But now, company execs could face criminal charges for crimes committed by their companies, even if they claim to have had no awareness that any crimes were being committed. And drug companies will no longer be able to skirt by after breaking the law — if they cheat the government health system, they will lose any eligibility to participate in it. After all, ignorance of the law or of the illicit dealings of one’s company have never been a legitimate excuse for anyone else to evade justice — why should it be any different for drug companies?

“When you look at the history of health care enforcement, we’ve seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy,” said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department (HHS), to The  Washington Post.

“To our way of thinking, the men and women in the corporate suite aren’t getting it. If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.”

« Return to news items


Share

In shift, feds target top execs for health fraud

Wednesday, June 1st, 2011

Business Week – May 31, 2011

By RICARDO ALONSO-ZALDIVAR

Federal investigators say they are starting to target individual executives in health care fraud cases previously aimed at impersonal corporations.

It’s raising the stakes for corporate honchos at drug companies, medical device manufacturers, nursing home chains and others who deal with Medicare and Medicaid.

Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a big check and promise not to break the rules again.

Now, on top of fines paid by a company, senior executives can face criminal misdemeanor charges even if they weren’t involved in the scheme but could have stopped it. And they can also be banned from doing business with federal programs, a career-ending consequence.

http://www.businessweek.com/ap/financialnews/D9NI94V01.htm

« Return to news items


Share

Grassley Investigates Drugging of Elderly with Antipsychotics

Wednesday, June 1st, 2011

DesMoines Register
May 31, 2011

Sen. Charles Grassley recently sent a letter to the administrator of the U.S. Centers for Medicare and Medicaid Services. He wants some answers after a federal report Grassley requested found many nursing home residents with dementia are given antipsychotic drugs. These drugs are not approved to treat dementia. They can be lethal for those afflicted with it, and Medicare has been paying for them.

Grassley is right to ask questions of the agency. But keeping seniors safe is a responsibility that extends far beyond CMS — from the halls of Congress to state legislatures to nursing home workers in rural Iowa.

Washington

Politicians talk out of both sides of their mouths. They say they want to cut federal spending. They say there should be less government regulation. Then when something goes wrong, they demand federal agencies solve the problems or they take them to task for not doing what they were supposed to do.

Drug safety, nursing home oversight, and ferreting out problems in government programs like Medicare requires staff and resources. That takes money – some of the same money lawmakers propose cutting from the federal budget.

State legislatures

The “cut government but still expect it to keep everyone safe” attitude is prevalent at the state level, too. Shortly after Gov. Terry Branstad took office, one of his appointees cut positions for nursing home inspectors. It underscored a lack of understanding about the important and complicated work of making sure homes meet more than 150 regulatory standards.

In addition to observing care, talking to staff, interviewing residents and other tasks, an inspection team reviews medical records. It is frequently a registered nurse employed by the state who finds problems with medications. Having too few state inspectors puts seniors at risk.

Nursing homes and staff

Improving the quality of life for patients with dementia is difficult — and there are too few drugs approved specifically to do so. Even if doctors are aware of the risks, they may prescribe specific drugs to make patients more comfortable or less agitated. Also, drug companies benefit when more people take their drugs, and they want doctors to prescribe their drugs to, well, as many people as possible. In fact, several drug companies have faced criminal charges for promoting antipsychotic drugs for unapproved uses.

It’s up to nursing home staff and physicians to ensure that drugs prescribed are safe for specific patients.

* * *

Every day about 10,000 Americans become eligible for Medicare. An aging population means more people will be diagnosed with dementia. More will need care in facilities. Everyone — from doctors prescribing drugs to the government paying for them — must do more to keep older people safe.

Read article here:  http://www.desmoinesregister.com/article/20110601/OPINION03/106010328/-1/GETPUBLISHED03wp-rss2.php/More-need-help-protect-our-elderly

« Return to news items


Share

In shift, feds target top execs for health fraud

Tuesday, May 31st, 2011

Associated Press
May 31, 2011

Lewis Morris, general counsel for the Department of Health and Human Services inspector general, poses for a portrait in his office in Washington, Thursday, May 26, 2011. (AP Photo/Jacquelyn Martin)

WASHINGTON (AP) — It’s getting personal now. In a shift still evolving, federal enforcers are targeting individual executives in health care fraud cases that used to be aimed at impersonal corporations.

The new tactic is raising the anxiety level — and risks — for corporate honchos at drug companies, medical device manufacturers, nursing home chains and other major health care enterprises that deal with Medicare and Medicaid.

Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren’t involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.

Many in industry see the more aggressive strategy as government overkill, meting out radical punishment to individuals whose guilt prosecutors would be hard pressed to prove to a jury.

The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.

“When you look at the history of health care enforcement, we’ve seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy,” said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department.

“To our way of thinking, the men and women in the corporate suite aren’t getting it,” Morris continued. “If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.”

Lawyers who represent drug companies say the change has definitely caused a stir, but the end result is far from certain.

“People are alarmed,” said Brien O’Connor, a partner in the Boston office of Ropes & Gray. “They want to know what facts and circumstances would cause the Justice Department to indict someone who hadn’t even known about the misconduct. They are doing all they can to achieve compliance.”

Others say high-powered corporate targets won’t go meekly.

“If the government does continue to press its campaign against individuals, we will see the limits of the government’s theories tested,” said Paul Kalb, who heads the health care group at the law firm of Sidley Austin in Washington. “In my mind, there is a very important open question as to whether individuals can be held criminally culpable or lose their jobs simply by virtue of their status.”

Although the Obama administration has increased scrutiny of corporate America generally, this shift in health care enforcement seems to have come up from the ranks, government and corporate attorneys say.

Investigators and lawyers at the HHS inspector general’s office, the Justice Department and the Food and Drug Administration started moving more or less independently toward holding executives accountable. Morris outlined the inspector general’s position in congressional testimony this spring, saying his office will use its power judiciously.

A test case is playing out with an 83-year-old drug company chief executive, Howard Solomon of New York City-based Forest Laboratories. Forest makes antidepressants, blood pressure drugs and other medications. Last month, the inspector general’s office notified Forest that Solomon could potentially be banned from doing business with federal programs.

The power to ban or “exclude” an individual rests with the inspector general. It’s routinely applied to low-level violators, but rarely to people of Solomon’s rank. In the industry, they call it the “death penalty.”

Last year, a Forest subsidiary pleaded guilty to criminal charges as part of a settlement with the Justice Department in which the company also agreed to pay $313 million to resolve long-running investigations. Prosecutors charged that Forest deliberately ignored an FDA warning to stop distributing an unapproved thyroid drug, promoted the use of an antidepressant in treating children although it was only approved for adults and misled FDA inspectors making a quality check at a manufacturing plant.

The company said it had considered the case closed. But then came the inspector general’s letter.

“No one has ever alleged that Mr. Solomon has done anything wrong and excluding him would be completely unjustified,” Herschel Weinstein, Forest’s general counsel, said in a statement. “In prior cases where a senior executive has been excluded, that individual has been accused of wrongdoing and ultimately has either been convicted of or (pleaded) guilty to a crime.”

Forest is fighting the move to ban Solomon. The inspector general’s office refused to comment on the case, and no final decision has been made. In congressional testimony, Morris said that when there is evidence an executive knew or should have known about misconduct, the inspector general “will operate with a presumption in favor of exclusion of that executive.”

Separate from the inspector general’s power to ban, the FDA has resurrected something called the “Park Doctrine,” which makes it easier for prosecutors to bring criminal charges against an executive.

The doctrine, stemming from a 1970s Supreme Court case, allows the government to charge corporate officers in the chain of command with a criminal misdemeanor. They could face up to a year in prison and fines if they had the authority and responsibility to prevent, detect or resolve misconduct affecting the public welfare but failed to do so.

It’s making an entire industry nervous.

Read article here:  http://www.google.com/hostednews/ap/article/ALeqM5jIGsUXYEAKspVXkeAdCDNumbbNFA?docId=d620a807289f47a6b01dfe728972a0b3

« Return to news items


Share

Gem of the Week: Big Pharma in Juvie

Friday, May 27th, 2011

Mother Jones
By Jen Phillips
May 27, 2011

GreenColander/Flickr

Instead of the usual Eco-News Roundup of stories from our other blogs, we’re experimenting with a new format. This week, I’m shining a light on a news article from the past 5 days that covered an underreported environmental topic or illuminated a new side of an existing issue. Hopefully this format will be more relevant, and more interesting, than the old Eco-News Roundup.

This week’s gem for reporting on science, health, and the environment goes to… the Palm Beach Post in Florida, for revealing ties between psychiatrists in juvenile halls and manufacturers of antipsychotic drugs. The Post‘s investigation found that a handful of psychiatrists working for Florida’s Department of Juvenile Justice (DJJ) were paid high speaking fees or given gifts by pharmaceutical companies like AstraZeneca. “In at least one case, the number of Medicaid prescriptions a psychiatrist wrote for children rose sharply around the time he was paid, The Post found.” Even worse, the antipsychotics were prescribed by the DJJ doctors were not approved for safe use in children.

Since the Post‘s investigation, the DJJ has launched an internal investigation about the use of antipsychotics in its system. However, as the Post found while reporting, the DJJ’s record-keeping system is in bad shape, making it hard for even DJJ employees to find the information they’re looking for. In addition, not all juvie programs are run directly by the DJJ. “No information was available,” the Post noted, “on the amounts of antipsychotic drugs dispensed in the more than 100 remaining programs for juveniles… run by private contractors.”

Read the Post‘s entire, in-depth investigation at their site, here.

http://motherjones.com/blue-marble/2011/05/big-pharma-juvie-kids-drugs

« Return to news items


Share