CLICK HERE: LISTEN TO DR. MARK IBSEN, MD,VIDEO ANALYSIS ON TRIAL OF DR. NEIL K. ANAND, MD
from youarewithinthenorms.com
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., 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., M.B.A., 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
To whom it may concern, please distribute this email to all members of the Montana Board of Medical Examiners.
Dear Montana Board of Medical Examiners (MBME),
I am a Montana native, born in the Flathead Valley at the base of the majestic Mission Range. I was transplanted to California at the age of six by my parents who were also native Montanans, as were their parents.
Over my lifetime I have visited Montana many times, sometimes for months in duration. My home state is incredibly beautiful. I am a center right conservative, more in tune with the typical Montanan than the stereotypical Californian. I have often contemplated moving back, but sadly, returning to Montana for anything other than a few weeks at a time is not an option for me.
The government ( DOJ, Local law enforcement, the DEA, the Pharmacy board, and the Medical boards ) has now inserted a criminal component into every facet of medicine.
Tort law and criminal law do not comport, so medicine cannot be practiced under a criminal legal standard… This leads to distrust between patients and physicians, creates fear in the public, and does not allow medicine to be practiced as it ought to be.”
This is due to my wife’s chronic pain, and Montana’s apparent bias against the use of opioid pain medications. Let me explain.
“Without a thought, the doctor gave them his aid, one after the other, and each mouse he healed was grateful. Soon, however, he began to tire and eventually became exhausted, yet still more mice came. “Surely, though, this deed will be worth it in the end,” he thought, and strengthened his resolve.”
My wife suffers from incurable intractable pain. After multiple surgeries and all other alternative therapies failed to provide relief, nearly two and a half decades ago, she was placed on opioid medications at sufficient dosages to provide her enough physical function to enable a reasonable quality of life.
The last 10 years of my career, and the active and rewarding first 6 to 7 years of my retirement were only possible because of her caring physician and the medications he prescribed my wife. I retired in 2010. My wife and I were enjoying life, including touring the country in our RV despite her being afflicted with a genetic condition causing incurable, worsening severe chronic pain.
Our ability to enjoy our “Golden Years” changed, with the DEA’s mistargeted, so called “War on the Opioid Epidemic” and the publishing of the CDC’s flawed and fraudulent 2016 opioid prescribing guidelines. My wife’s once well treated pain became progressively undertreated as her pain management physician was unjustly persecuted by the DEA and California’s, at the time, misguided Medical Board.
A Federal jury acquitted Dr. Lesly Pompy of unlawful prescribing, healthcare fraud, and maintaining a drug involved premises after a month long trial in Detroit Michigan. However State Board of Medicine despite an administratice Judges Opinion and Order refuses to grant him licensure in Micigan becaud of “Moral Turpitude.” Dr. Pompy was represented by Ronald Chapman II of the Chapman Law Group and founder of Chapman Consulting Group. He was also represented by George Donnini and Joe Richotte of Butzel Long.
Wanting both our lives back, six years ago I began “advocating” in earnest for my wife and subsequently other needlessly and inhumanely suffering chronic pain patients. The good news is progress has been made in some areas. The Medical Board of California’s (MBC) recently updated opioid prescribing guidelines is one such example. The pain patient relief laws passed in the last couple years in NH, RI, OK, AZ, MN, CO, and IL are other positive steps in ultimately reversing the harm done to millions of innocent pain sufferers like my wife.
As imperfect as it remains, the pain management environment in CA, has improved over the last couple of years. The MBC publicly acknowledged the damage they had done to the treatment of pain in CA with their infamous “Death Certificate Project”. The MBC then set out to ameliorate this damage, in part by updating their 2014 opioid prescribing guidelines.
I actively participated in their two-year long stakeholders’ process, which resulted in the publishing of their much-improved July 2023, Guidelines for Prescribing Controlled Substances for Pain. Here are three representative quotes extracted from these much-improved guidelines:
”It is recognized that between the Board’s death certificate project and the CDC 2016 Guidelines, a chilling effect was felt and physicians became less willing to treat patients with chronic pain.”
“As the Board discussed the need to update the 2014 prescribing guidelines, it was emphasized that a change in tone was necessary to provide support and guidance to physicians to prescribe in a way that is effective for their patients and to also have enough flexibility to deal with pain patients that don’t fall into the normal guidelines.”
“A physician who uses opioid therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve the patient’s pain …”
I respectfully recommend the MBME consider adopting the MBC guidelines, which while not ideal, are a much improved more humane pain patient, and pain patient physician approach to proper pain management.
So it was that the bison came upon a family of mice who were all sick, but they had nothing with which to pay for the doctor’s aid. “But without my care, your children will die. I must help, it is my duty,” he said.
One final important point; through our continuing advocacy, my wife and I have become friends with Helena MT physician, Dr. Mark Ibsen and his companion Susan Franzheim. They have visited us in our CA home. We have never met a more caring physician. The personal sacrifice Dr. Ibsen has made to care for and literally save the lives of patients abandoned by their physicians, and tragically their states’ medical licensing boards should be applauded, not persecuted.
Please read these July 2023 MBC guidelines (Pain Guidelines) with Dr. Ibsen in mind.
Sincerely,
Monty Goddard, PE MSCE
Montana Native &
Member of the Speakers Bureau of the National Campaign to Protect People in Pain
OR SEND
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ZELLE 3135103378
ALL WATCHED OVER BY MACHINES OF LOVING GRACE
BE SURE TO DONATE TO THE MARK IBSEN GOFUNDME DEFENSE FUND, WHERE THE SON ALWAYS RISES!!!
“..WE ARE HEALTHCARE PROVIDERS, PHYSICIANS, DENTISTS, PHARMACISTS, AND NOT GOD DAMN FUCKING DRUG DEALERS …DEA-DOJ !!!”
FOR NOW, YOU ARE WITHIN
THE NORMS
Frequently Asked Questions: The Intersection of AI, Statistics, and Justice
1. What was the central issue in the United States v. Anand case, and why was it significant? The central issue in United States v. Anand was the prosecution’s claim that Dr. Neil Anand, a physician, had engaged in fraudulent overbilling of federal insurers based on findings from an opaque, AI-powered audit. The case was significant because it represented a direct confrontation between the seemingly objective conclusions of artificial intelligence and the nuanced application of established statistical theory in a legal setting. It highlighted the potential for “artificial stupidity” when AI models make flawed assumptions and ignore the complexities of real-world data, particularly in fields like healthcare.
2. How did Dr. Wayne Winston, a mathematician, challenge the government’s AI-based accusations against Dr. Anand? Dr. Winston challenged the government’s AI by demonstrating that its analysis relied on flawed assumptions and failed to account for the inherent variability and complexities within medical billing data. He introduced the noncentral hypergeometric distribution, a statistical model developed by Sir Ronald A. Fisher, to analyze Dr. Anand’s billing patterns. This model, unlike the binomial distribution often implicitly used in simplistic AI analyses, is designed for finite populations without replacement and allows for weighted probabilities, making it more suitable for analyzing a fixed set of medical transactions and accounting for legitimate variations in practice. Dr. Winston’s analysis showed that Dr. Anand’s billing was statistically plausible and consistent with legitimate medical practice when the appropriate statistical methods were applied.
3. What is the hypergeometric distribution, and why was it more relevant to the Anand case than other statistical models? The hypergeometric distribution is a probability distribution that describes the probability of k successes in n draws, without replacement, from a finite population of size N containing exactly K successes. Unlike models like the binomial distribution, which assume independent trials with replacement, the hypergeometric distribution is tailored for situations where each draw affects the probability of subsequent draws, such as auditing a fixed number of transactions where each audited transaction is not put back into the pool. Sir Ronald Fisher’s noncentral hypergeometric distribution further refines this by introducing weighted probabilities, allowing for differences within the population. This was crucial in the Anand case because it allowed Dr. Winston to account for the specific context of Dr. Anand’s practice and patient population, demonstrating that his seemingly anomalous billing patterns could arise from legitimate factors rather than fraud.
4. Beyond the Anand case, how are AI and algorithms being used in ways that raise concerns about justice and fairness, particularly in healthcare? The sources highlight several concerning trends. Government agencies and private companies are increasingly using AI-powered algorithms to identify potential healthcare fraud and opioid overprescribing. These algorithms often rely on identifying statistical outliers and correlations rather than establishing causation, leading to the suspicion and investigation of healthcare professionals based on prescription volume, patient demographics, or practice patterns. This can disproportionately affect doctors serving marginalized communities with complex medical needs. Furthermore, the blurring lines between law enforcement and healthcare, facilitated by access to patient data through prescription monitoring programs (PMPs) and despite HIPAA regulations, means that medical practice is increasingly being scrutinized under a criminal, rather than a tort (medical malpractice), standard, which is inappropriate for the inherent complexities and judgment calls in medicine.
5. What are the ethical concerns surrounding the use of AI in law enforcement and healthcare, as highlighted by Pope Francis and the discussion of Qlarant? Ethical concerns revolve around a lack of transparency, accountability, and the potential for bias and injustice. Pope Francis emphasized the need for human control over AI, particularly in life-altering decisions, and warned against machines making choices that impact human dignity. The example of Qlarant illustrates these concerns, where AI algorithms marketed for fraud detection are accused of perpetuating a system of “tyranny” by disproportionately targeting Black and Brown healthcare professionals based on correlations that do not necessarily indicate wrongdoing. These algorithms often lack consideration for the nuanced realities of medical practice and can lead to modern-day “witch hunts” reminiscent of historical persecutions of those who challenged prevailing views, like Giordano Bruno and Galileo.
6. How do prescription monitoring programs (PMPs) and data analytics by companies like Qlarant contribute to the blurring lines between healthcare and law enforcement, and what are the potential consequences? PMPs, initially intended as medical decision tools, are now being used by law enforcement as a basis for investigations and indictments of physicians for their prescribing habits. Private companies like Qlarant use data from these programs and other sources, run through proprietary algorithms, to identify “high-risk” prescribers and potential fraud.
This process often occurs at the behest of government agencies and insurers, blurring the lines between financial oversight, medical practice regulation, and criminal investigation.
The consequences include increased distrust between patients and physicians, fear among doctors about facing legal repercussions for legitimate medical decisions, and a potential chilling effect on the practice of medicine, particularly in pain management and for underserved populations. This shift towards a criminal law standard in medicine, which operates under a tort law framework, is fundamentally incompatible with the complexities of patient care.
How have federal prosecutors historically pursued cases against physicians for prescribing controlled substances?
- Historically, the regulation of medical practice, including the dispensing of controlled substances, has been primarily a state function, overseen by State Medical Boards. These boards were considered the authoritative bodies for determining the standard of care and when a physician’s conduct fell outside the scope of acceptable practice. Federal involvement, through agencies like the DEA and the Controlled Substances Act (CSA), was understood to regulate the drugs themselves and prevent illicit trafficking, not to dictate the practice of medicine or turn good-faith medical disputes into federal crimes. The “good-faith” defense for doctors, meaning they prescribed in the course of their professional practice with a legitimate medical purpose, has been a part of federal law for over 100 years, dating back to the Harrison Narcotics Act of 1914.
What is the three-pronged approach federal prosecutors have allegedly used to secure convictions against physicians in “scope of practice” cases?
- According to the source, federal prosecutors have been employing a three-pronged approach that has resulted in a high rate of guilty verdicts (9 out of 10) in “scope of practice” cases against physicians. This approach relies on: (1) the broad and often subjective phrase “not for a legitimate medical purpose,” (2) the testimony of a hired government expert to challenge the physician’s medical judgment, and (3) the ability to demonstrate substantial wealth of the accused physician, which can potentially influence a jury’s perception. This method is criticized for bypassing the traditional state-level regulation of medical practice and turning differences in medical opinion into criminal matters.
How does the use of the “not for a legitimate medical purpose” standard in federal prosecutions impact physicians?
- The use of the phrase “not for a legitimate medical purpose” by federal prosecutors is a central point of contention. This standard, while present in regulations, is described as “ambiguous” and “open to varying constructions.” Applying this vague standard in criminal prosecutions, especially without a strong scienter requirement (proof that the physician knew they were acting outside the scope of practice), can make it difficult for physicians to know when their conduct crosses a legal line. It risks criminalizing good-faith medical judgments and deterring physicians from prescribing necessary controlled substances, particularly in complex pain management cases, due to the fear of severe penalties.
What is the significance of the Supreme Court case Ruan v. United States regarding the prosecution of physicians?
- Ruan v. United States is a crucial case that addresses the required mental state (mens rea) for convicting physicians under 21 U.S.C. §841 for unlawfully dispensing controlled substances. The Supreme Court held that the statute’s “knowingly or intentionally” mens rea applies to the “except as authorized” clause. This means that once a physician presents evidence that their conduct was authorized (e.g., by possessing a DEA registration and issuing a prescription), the government must prove beyond a reasonable doubt that the physician knew they were acting in an unauthorized manner or intended to do so. This ruling rejects the idea that physicians can be convicted merely by showing they prescribed outside an objective “usual course of practice” standard, emphasizing the need for proof of subjective intent or knowledge of illegitimacy.
