” they done Mess With the Wrong Aly”
from youarewithinthenorms
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA, AISHA GARDNER, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
PATI @plwin49
It’s ok to be dependent on a drug, such as an opioid, if it helps you to function & have a life. Doctors know the rule of benefits vs risk. But, now they risk their careers & everything they own if DEA sees “too many red flags.” They decide to err on being overly cautious, thereby abandoning patients who need their help to get safe pharmaceuticals.
This flawed prosecution targeted an exemplary physician
As the crescendo of a seven-year alleged healthcare fraud investigation, the Eastern District of Pennsylvania trial United States of America v. Dr. Mohamed Aly Rifai, a practicing internist and psychiatrist in the Greater Lehigh Valley, Pennsylvania, opened in late April 2024.
The trial is one of less than two percent of the federal criminal cases filed that ultimately end up in a jury trial. This flawed prosecution targeted an exemplary physician who, like most physicians in the United States, has spent most of their life serving the American people.(9)
Dr. Rifai is the CEO, chief psychiatrist, and internist of Blue Mountain Psychiatry. He holds the Lehigh Valley Endowed Chair of Addiction Medicine and is board-certified in internal medicine, psychiatry, addiction medicine, and psychosomatic medicine.
Carol Kennon
@carolkennon4Pediatrician, Neonatologist, Animal lover
This is a horrible time in the US. Nothing justifies the cruelty and mandated pain and suffering we’ve experienced for the past eight years. It has done no good for people with drug dependency or to manage drug problems. We’ve seen more OD deaths than ever before
He is a fellow of the American College of Physicians, the Academy of Psychosomatic Medicine, and the American Psychiatric Association. He is the former president of the Lehigh Valley Psychiatric Society.
THE RED FLAGS OF ENFORCEMENT FRAUD AND DECEPTION
The entire red flag concept is fabricated and exemplifies how the HFPP has given the DOJ-DEA the authority to make laws and criminalize matters. The board of pharmacies has never given pharmacists the authority to police doctors. (10,11)
Their only purpose is to fill prescriptions and warn doctors if there is a potential interaction or intolerance. Even then, it is up to the doctor whether or not they want to proceed. Criminalizing this aspect of medical care puts pharmacists in a tough spot. (12,12a)
THE PROBLEM WITH DOJ’s RED FLAG THEORY
According to the National Association of Chain Drug Store in the Amicus Curiae brief in Xiulu Ruan vs. the United States Case No: 20-1410 case before the Supreme Court United States:
“There are many problems with DOJ’s “red flags” theory. It has no basis in the CSA or its implementing regulations or even in the DEA’s Pharmacist’s Manual. It imprudently dismisses the individualized, case-by-case approach that pharmacists take when filling prescriptions in favor of a categorical approach to culpability. (10)
And it traps pharmacists in an untenable position—either face liability under the CSA for filling a facially valid prescription that raises a “red flag,” or face state-based professional liability,(11) and even civil suits,(12) for refusing to fill such a prescription.“
“But the critical point here is that § 1306.04 provides protection for pharmacists that the Court should not inadvertently eliminate: a pharmacist may only be held liable if the pharmacist “knowingly fill[s]” a “purported” prescription.
In other words, unless a pharmacist subjectively knows that a facially legitimate prescription has been prescribed for illegitimate reasons, the pharmacist should not face potential liability for dispensing medication based on that prescription.
Strict adherence to this knowledge element is critical to ensuring that pharmacists acting in good faith are not punished for filling facially valid prescriptions written by licensed and registered prescribers— a punishment that, if rendered, would chill other pharmacists from performing their duties.“
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9. https://frankspeech.com/v/3kmx Drs. L. Josepk Parker’s and Neil Anand on Kristi Leigh talking about data analytics used to target doctors
10 See Dispensing Controlled Substances for the Treatment of Pain, 71 Fed. Reg. 52716, 52720 (Sept. 6, 2006) (noting that “each case must be evaluated based on its own merits in view of the totality of circumstances”).
11 See, e.g., Wis. Pharmacy Examining Bd., Administrative Warning, Division of Legal Services and Compliance Case No. 17 PHM 095 (Dec. 6, 2018).
12 See, e.g., First Amended Compl. ¶ 2, Fuog v. CVS Pharmacy, Inc., No. 1:20-cv-00337-WES-LDA (D.R.I. Aug. 26, 2020), ECF No. 6 (challenging “corporate-wide discriminatory practices in refusing to fill, without a legitimate basis, valid and legal prescriptions for opioid medication”); Reasor v. Walmart Stores E., L.P., No. 3:19-CV-27-CRS, 2019 WL 5597302, at *3 (W.D. Ky. Oct. 30, 2019) (defamation suit by physician asserting that “the failure to fill his patient’s prescriptions necessarily imputed illegal conduct because pharmacists are required to fill prescriptions unless the Pharmacist has reason to know of some irregularity”).
12a.
THE PHARMACIST
Pharmacists are Masters in pharmacology, the science, but they’re taught little to no clinical medicine examination, diagnostics, or treatments, which is not their fault or part of their licensing.
If pharmacists were to be taught clinical skills, they would have to go to medical/dental school for at least 8 years and this is not going to happen anytime soon.
“Although § 1306.04(a) regulates both prescribers and pharmacists, the two roles are far from interchangeable, including for purposes of determining potential liability. With different licenses, education, skill sets, responsibilities, and workplaces from physicians, pharmacists play a vital but distinct role in a patient’s care. (See Amicus Curiae Brief National Association Chain Drug Stores, US Supreme Court Case No. 20-1410, Ruan vs. the United States of America)
@CarolKennon4
Pediatrician, Neonatologist, Animal lover
Specifically, when dispensing a controlled substance to a patient, as prescribed by a physician, a pharmacist relies on the physician’s assessment of the patient’s needs.
The pharmacist has neither examined nor diagnosed the patient and lacks the information the physician has collected on the patient’s medical situation, records, and history, including such things as x-rays, ultrasounds, lab results, and treatment plans.
The CSA recognizes pharmacists’ circumscribed role in dispensing controlled substances. It provides that pharmacists may not dispense Schedule II controlled substances “without the written prescription of a practitioner,” 21 U.S.C. § 829(a), and that they risk criminal and civil liability if they do, see id. §§ 841(a), (c), 842.
The CSA’s implementing regulations further explain that a prescription for a controlled substance “must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” 21 C.F.R. § 1306.04(a).
The regulations separately provide that such a prescription “may only be filled by a pharmacist, acting in the usual course of his professional practice and either registered individually or employed” by a registered entity. 21 C.F.R. § 1306.06.”
Consistent with the division of responsibility between prescribers and pharmacists, § 1306.04 limits when pharmacists may be held liable for filling controlled-substance prescriptions to situations where a pharmacist knows a prescription is illegitimate:
“The responsibility for properly prescribing and dispensing controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.
An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. [§] 829), and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.21 C.F.R. § 1306.04(a) (emphasis added).
A pharmacist violates this provision only if the pharmacist “knowingly fill[s]” a “purported” prescription—i.e., a prescription that was not written “in the usual course of professional treatment.”
So pharmacists should never be held liable for a physician’s actions. The law still holds that the doctor, not the pharmacist, makes the final decision.
So why should the pharmacist have any responsibility? If there is some idiot out there who doesn’t know what they’re doing, they need to be held fully responsible not the pharmacist.
ACCORDING TO DEA DIVERSION CONTROL
According to Thomas Prevoznik, DEA Deputy Assistant Administrator, 02/12/2021, letter to Richard A Lawhern Ph.D.: (14)
“The Controlled Substances Act (CSA) and its implementing regulations established a closed distribution system to ensure appropriate medical care and to maintain the system’s integrity through an accountability process. One of the most important principles underlying the CSA and its implementing regulations is that to be valid, every prescription for a controlled substance must be based on a determination by an individual practitioner that the dispensing of the controlled substance is for a legitimate medical purpose in the usual course of professional practice—United States v. Moore, 423 U.S.C. 122 (1975) and 21 CFR 1306.04(a).
Federal regulations do not define the term legitimate medical purpose nor do they set forth the standards of medical practice. It is up to each DEA-registered practitioner authorized by DEA to do so, to treat patients according to his or her professional medical judgment in accordance with a standard of medical practice that is generally recognized and accepted in the United States.
1. DEA has not promulgated any new regulations regarding pain treatment.
2. Federal law and DEA regulations do not impose a specific quantitative minimum or maximum limit on the amount of medication a practitioner may prescribe on a single prescription or the duration of treatment intended for a particular patient.
3. DEA has consistently emphasized and supported the prescriptive authority of an individual practitioner under the CSA to administer, dispense, and prescribe controlled substances for the legitimate treatment of pain within acceptable medical standards as outlined in DEA’s policy statement published in the Federal Register (FR) on September 6, 2006, titled, Dispensing Controlled Substances for the Treatment of Pain. 71 FR 52716.
While DEA is the agency responsible for enforcing the CSA, DEA does not act as the:
“Federal equivalent of a state medical board overseeing the general practice of medicine and lacks the authority to issue guidelines that constitute advice relating to the general practice of medicine.”
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14.
THE OPIATES
Opiates are the only pain medications that can be titrated to a patient’s response, which the FDA made very clear depends on the patient’s physiology. In fact, if you dig deep and play steps on things like indication, ops are the only drugs indicated for chronic pain management.
The package inserts for acetaminophen, ibuprofen, and naproxen limit the time that these prescriptions can be written, and they do have a ceiling effect.
The DEA and FBI have taken it upon themselves to define these drugs as an alternative to chronic pain management for which they are not approved. (13)
I will try the patience with a fungus ball, aspergillosis causing severe visceral pain on 800 mg of oxycodone a day, he was fully functioning at a high-end executive level. Of course, the majority who are uneducated will call this misuse, but in reality, it is a therapeutic intervention to suit the patient’s needs.
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13.
Carol D Pilkington 1957 – 2015
Patients are going to die. It is idiotic that doctors and pharmacists are liable for a patient’s death. I had a patient with lupus, Francis myelitis, CDIP who had it for years. She was so far gone that she did not respond to IVIG and ended up dying six months later.
Perhaps I should have gone to jail for not performing magic. Chronic pain patients are chronically ill patients. I’ve said multiple times, posted multiple times, that chronic pain falls into the category of chronic disease.
You cannot have chronic pain without having a chronic disease. Ultimately, these very ill individuals will die of their chronic disease.
And no one beholds; the FBI and the DA are quick to jump on the doctor and say they died because of you. I had a lady with chronic neuropathic diabetic pain for the 15% ejection fraction. I kept her alive for 5 years and was comfortable with oxycodone 20 mg three times a day.
Ultimately, she perished. She was on the transplant list but never made it. Of course, this a******DEA and FBI agents climbed all over me, claiming that I killed her with a prescription opiate. They never followed up on this, perhaps because they realized how foolish their theory was.
And, it is a fact, an unequivocal fact, that there are at the very least 50 million chronic pain patients in this country alone. At its peak, there were only 4300 pain doctors, and not all of these prescribed opiates.(15)
Do the math. Twenty thousand prescriptions are very, very low and not fulfilling the needs of those chronic disease patients. But, to the DA and FBI, it is a it is a crime if you address it properly.
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