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The Daily Beast

How the VA Is Pushing Vets Into the Opioid Abyss

GettyDavid Parker, whose 12-year military career included deployments as a Marine to Iraq and Afghanistan, was getting out of his car last July at the Veterans Health Administration outpatient clinic in Fort Collins, Colorado, to seek treatment for his injured back when it suddenly gave out. Courtesy David Parker His body below his waist went numb. His face hit the pavement, and he lost control of his bowels.As a former military service member, he is one of more than nine million Americans who get medical care from the VA system, the federal government’s sprawling array of 170 hospitals and more than 1,000 clinics. Parker, who is 34, was transported to the hospital in an ambulance and was given a week’s worth of the opiate codeine as part of his treatment.He regretted what happened next.“You were supposed to take, like, two a day, max, and I was taking—I think, like, by the fifth day, I was taking four. Four or five a day,” he told The Daily Beast. “I was popping them like Skittles.”Military Veterans Exposed to Toxic Burn Pit Fumes Set to Get Bipartisan Boost Parker worried about becoming addicted. That’s why, the next month, after a cross-country move—when he went to an East Coast VA hospital for a pancreatic cancer screening and complained about his aching back—he was adamant that he not be given opiates. Staff gave him a pill that they said was ibuprofen, he claimed. In 20 minutes, his back felt great. Courtesy Todd Doyle “Whatever that ibuprofen was, I need to get that prescribed,” Parker said he told the doctor.“Well, it’s codeine,” the doctor replied, according to Parker.He was stunned. He did not want opiates, for fear of addiction, and he said he had informed the nurse of that very concern. Yet he said he was given them anyway.Although officials at the VA could not speak to Parker’s individual case due to privacy concerns, a spokesperson did tell The Daily Beast that the facility in question “follows standard guidelines for the safe prescribing of opioids and routinely monitors facility and provider level prescribing patterns.” They added that the facility was well below national targets for prescribing opioids.But among former military members, Parker’s experience is far from unique, interviews and a review of recent audits of VA care show. And even as the coronavirus pandemic continues to dominate the public-health conversation in America, veterans and their advocates say the agency needs to do more to rein in opioids before it’s too late.The Veterans Administration has come under withering criticism in recent years for contributing to the nation’s opioid epidemic. A decade ago, the VA prescribed opioids to one out of every four veterans in its care, according to government statistics. Due to injuries endured in combat, veterans are more likely than civilians to be dealing with serious pain. But the staggering number of prescriptions caused grave concerns.Critics included the American Legion, one of the nation’s largest veterans’ groups, which in 2015 reported, “Overuse of opiate prescriptions clearly creates problems for veterans within the VA health-care system.”Floyd Meshad, a Vietnam War veteran who runs the nonprofit National Veterans Foundation based in Los Angeles, California, opposes long-term opioid therapy for veterans in general. “If you get opioids and you stay on or get hooked, you don’t know if you’re better or not. You don’t feel anything,” he told The Daily Beast.Meshad asserted the VA has a history of not examining other treatment options: “The VA’s primary treatment is chemical treatment,” he said.It should be noted that the VA has succeeded in reducing opioid use among veterans as the opioid crisis gained national consciousness. In the past eight years, the agency has cut opioid prescriptions by 64 percent, from more than 679,000 in 2012 to 247,000 in 2020. It reduced the number of patients receiving opioids and benzodiazepines together, a combination that has often led to death, by 87 percent in the same timeframe. Officials credit the expanded use of alternative therapies and treatments, like acupuncture and cognitive behavioral therapy; the VA has also benefited from “aggressively emphasizing the safe and responsible use of prescription opioids,” according to a report issued by the VA’s Office of Public and Intergovernmental Affairs.In 2013, the VA launched its Opioid Safety Initiative, and in 2018, according to Dr. Friedhelm Sandbrink, the Acting National Program Director for Pain Management, it hired pharmacists trained to educate doctors who may be overprescribing opioids on best practices. It also instituted revised procedures that are supposed to reduce the chance for addiction. The procedures include doing a behavioral assessment of veterans to check for a family or personal history of addiction before prescribing opioids, conducting urinalysis tests for illicit use, obtaining documented informed consent from veterans in which they are warned that opioid use could kill them, and following up with patients prescribed opioids for long amounts of time.The changes reflected a shift in the VA’s thinking around opioids, according to Dr. Sandbrink. “I think we realized even more that the risks of opioid medications probably outweigh the benefits for many patients,” he told The Daily Beast.But Inspector General reports over the past year show VA facilities nationwide are still putting scores of veterans on opioids without first following their own safeguards.According to a Daily Beast review of dozens of audits, VA staffers are failing to assess veteran patients for risks like a family or personal history of addiction prior to prescribing opioids. They aren’t consistently obtaining documented informed consent from veterans in which they are warned that their opioid use could kill them. They often aren’t obtaining urinalysis tests to check for illicit use, or conducting follow-ups with patients on opioids for long terms. All of these procedures were outlined in the VA’s own updated clinical practical guidelines in 2017, and some also appeared in internal directives issued in 2009 and 2020.VA officials painted a different picture of the status quo.“The VA has been recognized by many as a leader in the pain management field for the responsible use of opioids as well as in the treatment of Opioid Use Disorder, and the department is sharing its knowledge and experience with federal and local governments and across the nation’s health-care networks,” a spokesperson told The Daily Beast in response to the audit findings.Yet the audits indicate that the VA is still falling short. Most of the reports, published in the second half of 2020 and the beginning of 2021, documented dramatic shortcomings in checking veterans for whether they were at risk to become addicted to opioids. In the 28 audits released with the new procedures, only five medical centers—including Tomah, Wisconsin, Dayton, Ohio, and Saginaw, Michigan—were found to have assessed all of their patients for risks like a history of addiction prior to prescribing opioids. Only three consistently obtained documented informed consent from veterans to confirm they knew that opioid therapy can carry deadly risks. And only eight audits found VA facilities that conducted routine follow-ups with all of their patients on opioids.A spokesman for the VA Inspector General declined to comment on the patterns in the audits or on individual cases. The VA’s Office of Public Affairs also said it would not comment on specific cases, citing patient confidentiality concerns. Sandbrink argued that the VA’s national levels for obtaining documented informed consent and testing veterans’ urine are much higher than the levels found in the audits, though the study he referred to was conducted exclusively by employees of the VA.The VA facilities in Montgomery and Tuskegee, Alabama, performed as poorly as anywhere in the country, according to the audits. Practitioners at two clinics and a hospital failed to screen over two-thirds of veterans for a family or personal history of substance abuse. Only 45 percent were checked for addiction behaviors that suggest out-of-control drug use. And 79 percent were not given a form that confirms they understand that their opioid prescriptions pose deadly risks.“The [Office of the Inspector General] observed significant concerns with medication management of long-term opioid therapy,” the inspectors reported.Officials cited a shortage of providers and recruiting challenges due to their rural location as reasons they did not comply with behavioral assessments. They said they were not aware that requirements were in place to obtain veterans’ documented informed consent acknowledging that opioid therapy could kill them.At a Kansas City, Missouri, VA hospital, the Inspector General reported, staff failed to check 64 percent of patients for histories of drug abuse.”Deficiencies with aberrant behavior risk assessment, urine drug testing, informed consent, patient follow-up, and quality measure oversight… may have resulted in providers prescribing opioids for patients at high risk for misuse,” auditors wrote.Hospital officials told auditors, according to the report, that “because [opioid] risk assessments were often documented by other clinicians during varied episodes of care, providers believed requirements were met.” Nevertheless, the Inspector General recommended that the hospital revise its procedures and ensure patients are checked for increased chances of addiction.Many facilities were found to have failed to check the urine of a significant number of patients on long-term opioid therapy for illicit use. Auditors found that Madison, Wisconsin’s VA hospital failed to test 55 percent of patients. Officials told auditors that they were unaware of the requirement. This was not unusual: only seven of the 28 audits found hospitals consistently obtained urine drug tests, and many cited a lack of awareness or inattention to detail as the reasons for their failings.A few VA facilities, like in Chicago, Illinois, and Birmingham, Alabama, failed to document justifications for prescribing anti-anxiety benzodiazepines at the same time as opioids—a combination that exponentially increases the chances of fatal overdose. Officials in Chicago told auditors that they trusted that clinicians who prescribed opioids reviewed the notes of clinicians who had prescribed the same veterans benzodiazepines, but acknowledged there was no evidence they had discussed the risks and benefits with patients, or provided justification for it. Birmingham officials stated that clinicians did not pay attention to the requirements.Other VA medical centers around the country responded to the auditors with different reasons for their failures. Officials at the Madison and North Chicago facilities claimed they were unaware that monitoring requirements were in place to check for things like a history of substance abuse and adherence to long-term opioid therapy through urine drug testing. An official at the Danville, Illinois, center said that all of their long-term opioid therapy oversight stopped in general because medical staff had higher priorities. An official in Wichita, Kansas, stated that filling out separate progress notes was tedious, resulting in providers not consistently obtaining documented informed consent from veterans in which they are warned that their opioid use could kill them.The Inspector General does not review every hospital each year, and has only begun publishing checks on these opioid prescription protocols in the past 11 months. But they offer a rare snapshot into whether VA medical staff have been examining patients for their risk of addiction.Despite the extensive failures found by inspectors, the agency may be shifting resources. As of last fall, it was moving on from questioning opioid therapy to another major concern: medication prescribed to treat COVID, according to a VA official. The public may never know how other VA facilities perform on checking for a history of addiction or obtaining documented informed consent from veterans about the fatal risks of opioid treatment.After Corey Troyer’s dad died of an opioid overdose in June 2011, Troyer went to his father’s house and found four different bottles of opioids. He checked the dates and discovered that they were all prescribed within three months of each other by the VA near his home in Tacoma, Washington, he said. Troyer’s dad John had a history of opioid addiction, for which he was in rehab from 2006 to 2008, he added.Troyer is unsure whether the VA asked about his father’s history of addiction prior to prescribing him opioids, but he believes that regardless, the institution is to blame for his death.“The VA just likes to throw medication at people to try to make them better instead of finding the root cause of what is actually wrong,” he said. The VA Puget Sound Healthcare System did not respond to requests for comment for this story.Merrie Brundage has a similar beef. Her late husband, Paul, who served in Vietnam, turned to the Augusta, Georgia, VA in 2009 to treat his neck pain, back pain, and PTSD. He was prescribed the opioids hydrocodone and tramadol, as well as muscle relaxants and antidepressants, she recalled. Brundage’s husband had a history of substance abuse, and progress notes issued by the VA—and reviewed by The Daily Beast—reflect that they knew he had one and that “his drug of choice [was] Opiates.” That didn’t prevent doctors from dispensing them to him anyway, according to Brundage.Brundage’s husband started abusing his medications, especially his opiates, and getting extra pills from coworkers, which Brundage said she told the VA many times. The doctors still didn’t change anything about his regimen, she claims.After gashing his head one morning in the fall of 2011 after taking an excessive amount of his antidepressant and his daughter’s muscle relaxants, Paul Brundage walked outside, fell into a retention pond, and drowned. The death certificate prepared by the Georgia Department of Human Resources said that the combination of pills was deadly.“Everything went south when he started going to the VA,” Brundage said. Even though her husband died in part from taking pills he was not prescribed, she still blames the agency for reawakening and enabling his addictive behavior. “As far as I’m concerned, they killed him.”The Augusta VA declined to comment on Brundage’s story, citing patient privacy concerns.Alex S. Bennett, a principal investigator at New York University’s School of Global Health who is conducting a four-year study on opioid use and misuse in the veteran community, said that making an array of resources and services accessible is key to reducing the risk of overdoses.Because many veterans have been injured in the line of duty and experience chronic, long-term pain, they are more susceptible to suffer from opioid dependence and overdose, he said, adding that he believes the VA has made improvements in curbing addiction.Veterans facing difficulties adjusting back to civilian life can encounter homelessness, unemployment, and post-traumatic stress disorder—all factors associated with a heightened risk of opioid overdose.“Oftentimes we look at the drug as the root of evil or good… and really it’s everything else. It’s the housing, it’s the mental health, it’s the physical health. So I think rather than focusing on the drugs as much, we need to focus on the whole person, the whole veteran,” Bennett said.Trump Came This Close to Making the Opioid Crisis More HellishGetting veterans off opioids after they’ve been prescribed them is difficult and risky. In a study of over a million veterans who received opioid prescriptions from the VA in fiscal years 2013 and 2014, veterans were found to die in greater numbers from overdose or suicide after stopping treatment, with heightened risk the longer patients were treated before stopping.Meanwhile, the VA Office of the Inspector General continues to publish audits that examine VA oversight of opioid treatment. The most recent report was published on May 27. And veterans are continuing to speak out, enraged at what they see as an institutional failure.Todd Doyle was in the Air Force from 1989 to 2013. He was prescribed sleeping pills, muscle relaxants, antidepressants, antihistamines, opioids, and opiates by the Reno, Nevada, VA, after his service to treat post-traumatic stress disorder, as well as disk degeneration in his back, he said.Doyle became concerned about the combination of medications he was on, noting he was on so many different ones that he stored them in a tote bag. He finally believed he needed to see a non-VA doctor when, while under the influence of the cocktail of medications prescribed to him, he passed out in the middle of the aisle of a Safeway drug store, he recalled. His wife and son had to carry him to the car.A spokesperson for the Reno VA declined to comment, as did Doyle’s doctor from the VA, both citing patient confidentiality.Doyle has since switched to a civilian doctor and weaned himself off opioids, but remains stunned at the hole he found himself in.“I mean, literally, I felt like they were just gonna prescribe stuff until I was dead,” he said.Read more at The Daily Beast.Got a tip? Send it to The Daily Beast hereGet our top stories in your inbox every day. Sign up now!Daily Beast Membership: Beast Inside goes deeper on the stories that matter to you. Learn more.

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Woman passenger from UK tests Covid positive at Hyderabad airport



Hyderabad: A 35-year-old international passenger who reached the Rajiv Gandhi International Airport here on Wednesday has tested positive for Covid-19 after undergoing an RT-PCR test at the airport itself. The woman passenger had traveled from the United Kingdom, which has been categorised as an ‘At Risk Country’. 

The passenger has been admitted to the Telangana Institute of Medical Sciences (TIMS) and samples were collected and sent for genetic sequencing. Officials said she did not have any symptoms and that her health condition was being monitored closely. 

According to officials, the woman hails from Rangareddy district and was on a visit to UK from Hyderabad. Though her close relatives tested negative, their health condition is also being monitored. 

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Revealed: how Sidney Powell could be disbarred for lying in court for Trump | US elections 2020



Sidney Powell, the former lawyer for Donald Trump who filed lawsuits across America for the former president, hoping to overturn the results of the 2020 presidential election, has on several occasions represented to federal courts that people were co-counsel or plaintiffs in her cases without seeking their permission to do so, the Guardian has learned.

Some of these individuals say that they only found out that Powell had named them once the cases were already filed.

During this same period of time, Powell also named several other lawyers – with their permission in those instances – as co-counsel in her election-related cases, despite the fact that they played virtually no role whatsoever in bringing or litigating those cases.

Both Powell’s naming of other people as plaintiffs or co-counsel without their consent and representing that other attorneys were central to her cases when, in fact, their roles were nominal or nonexistent, constitute serious potential violations of the American Bar Association model rules for professional conduct, top legal ethicists told the Guardian.

Powell’s misrepresentations to the courts in those particular instances often aided fundraising for her nonprofit, Defending the Republic. Powell had told prospective donors that the attorneys were integral members of an “elite strike force” who had played outsized roles in her cases – when in fact they were barely involved if at all.

A couple poses for a photo in front of a Trump campaign bus at a rally in Alpharetta, Georgia, on 2 December 2020.
A couple poses for a photo in front of a Trump campaign bus at a rally in Alpharetta, Georgia, on 2 December 2020. Photograph: Nathan Posner/REX/Shutterstock

Powell did not respond to multiple requests for comment via phone, email, and over social media.

The State Bar of Texas is already investigating Powell for making other allegedly false and misleading statements to federal courts by propagating increasingly implausible conspiracy theories to federal courts that Joe Biden’s election as president of the United States was illegitimate.

The Texas bar held its first closed-door hearing regarding the allegations about Powell on 4 November. Investigations by state bar associations are ordinarily conducted behind closed doors and thus largely opaque to the public.

A federal grand jury has also been separately investigating Powell, Defending the Republic, as well as a political action committee that goes by the same name, for fundraising fraud, according to records reviewed by the Guardian.

Among those who have alleged that Powell falsely named them as co-counsel is attorney Linn Wood, who brought and litigated with Powell many of her lawsuits attempting to overturn the results of the election with her, including in the hotly contested state of Michigan.

The Michigan case was a futile attempt by Powell to erase Joe Biden’s victory in that state and name Trump as the winner. On 25 August, federal district court Judge Linda Parker, of Michigan, sanctioned Powell and nine other attorneys who worked with her for having engaged in “a historic and profound abuse of the judicial process” in bringing the case in the first place. Powell’s claims of election fraud, Parker asserted, had no basis in law and were solely based on “speculation, conjecture, and unwarranted suspicion”.

Parker further concluded that the conduct of Powell, Wood, and the eight other attorneys who they worked with, warranted a “referral for investigation and possible suspension or disbarment to the appropriate disciplinary authority for each state … in which each attorney is admitted”.

Wood told the court in the Michigan case that Powell had wrongly named him as one of her co-counsel in the Michigan case. During a hearing in the case to determine whether to sanction Wood, his defense largely rested on his claim that he had not been involved in the case at all. Powell, Wood told the court, had put his name on the lawsuit without her even telling him.

A man holds a sign reading "The dead cannot vote" at a rally in Alpharetta, Georgia.
Trump supporters attend a rally in Alpharetta, Georgia, where Sidney Powell spoke on efforts to overturn the 2020 election. Photograph: Nathan Posner/REX/Shutterstock

Wood said: “I do not specifically recall being asked about the Michigan complaint … In this case obviously my name was included. My experience or my skills apparently were never needed, so I didn’t have any involvement with it.”

Wood’s attorney, Paul Stablein, was also categorical in asserting that his client had nothing to do with the case, telling the Guardian in an interview: “He didn’t draft the complaint. He didn’t sign it. He did not authorize anyone to put his name on it.”

Powell has denied she would have ever named Wood as a co-counsel without Wood’s permission.

But other people have since come forward to say that Powell has said that they were named as plaintiffs or lawyers in her election-related cases without their permission.

In a Wisconsin voting case, a former Republican candidate for Congress, Derrick Van Orden, said he only learned after the fact that he had been named as a plaintiff in one of Powell’s cases.

“I learned through social media today that my name was included in a lawsuit without my permission,” Van Orden said in a statement he posted on Twitter, “To be clear, I am not involved in the lawsuit seeking to overturn the election in Wisconsin.”

Jason Shepherd, the Republican chairman of Georgia’s Cobb county, was similarly listed as a plaintiff in a Georgia election case without his approval.

In a 26 November 2020 statement, Shepherd said he had been talking to an associate of Powell’s prior to the case’s filing about the “Cobb GOP being a plaintiff” but said he first “needed more information to at least make sure the executive officers were in agreeing to us being a party in the suit”. The Cobb County Republican party later agreed to remain plaintiffs in the case instead of withdrawing.

Leslie Levin, a professor at the University of Connecticut Law School, said in an interview: “Misrepresentations to the court are very serious because lawyers are officers of the court. Bringing a lawsuit in someone’s name when they haven’t consented to being a party is a very serious misrepresentation and one for which a lawyer should expect to face serious discipline.”

Nora Freeman Engstrom, a law professor at Stanford University, says that Powell’s actions appear to violate Rule 3.3 of the ABA’s model rules of professional misconduct which hold that “a lawyer shall not knowingly … make a false statement of fact of law to a tribunal”.

Since election day last year, federal and state courts have dismissed more than 60 lawsuits alleging electoral fraud and irregularities by Powell, and other Trump allies.

Shortly after the election, Trump named Powell as a senior member of an “elite strike force” who would prove that Joe Biden only won the 2020 presidential race because the election was stolen from him. But Trump refused to pay her for her services. To remedy this, Powell set up a new nonprofit called Defending the Republic; its stated purpose is to “protect the integrity of elections in the United States”.

As a nonprofit, the group is allowed to raise unlimited amounts of “dark money” and donors are legally protected from the ordinary requirements to disclose their identities to the public. Powell warned supporters that for her to succeed, “millions of dollars must be raised”.

Echoing Trump’s rhetoric, Powell told prospective donors that Defending the Republic had a vast team of experienced litigators.

Sidney Powell speaks at a press conference on election results in Alpharetta, Georgia.
Sidney Powell speaks at a press conference on election results in Alpharetta, Georgia. Photograph: Elijah Nouvelage/Reuters

Among the attorneys who Powell said made up this “taskforce” were Emily Newman, who had served Trump as the White House liaison to the Department of Health and Human Services and as a senior official with the Department of Homeland Security. Newman had been a founding board member of Defending the Republic.

But facing sanctions in the Michigan case, some of the attorneys attempted to distance themselves from having played much of a meaningful role in her litigation.

Newman’s attorney told Parker, the judge, that Newman had “not played a role in the drafting of the complaint … My client was a contract lawyer working from home who spent maybe five hours on this matter. She really wasn’t involved … Her role was de minimis.”

To have standing to file her Michigan case, Powell was initially unable to find a local attorney to be co-counsel on her case but eventually attorney Gregory Rohl agreed to help out.

But when Rohl was sanctioned by Parker and referred to the Michigan attorney disciplinary board for further investigation, his defense was that he, too, was barely involved in the case. He claimed that he only received a copy of “the already prepared” 830-page initial complaint at the last minute, reviewed it for “well over an hour”, while then “making no additions, decisions or corrections” to the original.

As with Newman, Parker, found that Rohl violated ethics rules by making little, if any, effort to verify the facts of the claims in Powell’s filings.

In sanctioning Rohl, the judge wrote that “the court finds it exceedingly difficult to believe that Rohl read an 830-page complaint in just ‘well over an hour’ on the day he filed it. So, Rohl’s argument in and of itself reveals sanctionable conduct.”

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Govt to introduce important Bill, Covid situation likely to be discussed



The government on Thursday will table ‘The National Institute of Pharmaceutical Education and Research (Amendment) Bill 2021’ in the Lok Sabha. A discussion on Coronavirus (Covid-19) pandemic and its various related aspects is also likely to take place in the lower House.

Health Minister Mansukh Mandaviya will move the ‘The National Institute of Pharmaceutical Education and Research (Amendment) Bill’ in the Lok Sabha to amend the National Institute of Pharmaceutical Education and Research Act, 1998.

Under rule 193, a discussion on Covid-19 pandemic and various aspects related to it will likely take place. According to sources, the members may also raise their concern and ask for the government’s preparedness for the new Omicron variant. Under Rule 193, members can seek details about the new Covid variant. “Short duration discussion is likely to be held in the Lok Sabha on the Covid and its various aspects, including new Omicron variant,” sources said.

Union Minister Gajendra Singh Shekhawat, Prahlad Singh Patel, General V.K. Singh, Krishan Pal, Bhanu Pratap Verma, Rameshwar Teli and Kaushal Kishore will lay papers on the table. Reports and action reports of different standing committees will also be laid in the day.

The Lok Sabha on Wednesday passed the Assisted Reproductive Technology (Amendment) Bill 2021 (ART) by voice vote as the amendments moved by the DMK MP N.K. Prem Chandran, Trinamool Congress MP Saugata Roy and Shiv Sena MP Vinayak Raut were negated. The ART Bill seeks to regulate fertility clinics. All such clinics will have to be registered under the National Registry of Banks and Clinics of India.

The opposition is likely to continue to raise its voices on price rise, unemployment and extended jurisdiction of the Border Security Force (BSF) in some states. The opposition parties are also demanding a law guaranteeing the minimum support price (MSP).

(Only the headline and picture of this report may have been reworked by the Business Standard staff; the rest of the content is auto-generated from a syndicated feed.)

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