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Pill mills migrating to Indiana?

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Indiana Lawyer Focus

In national news reports about pain clinics and prescription drug abuse, Indiana is usually not mentioned.

Florida, Tennessee, Washington and Kentucky are often at the center of the conversation concerning a growing epidemic of doctors and so-called pill mills that prescribe narcotic pain medications in such high doses that patients are either addicts or soon will be. The stories emerging from these hotspots tell of patients standing in a line that curves around the pain management clinic, parking lots filled with cars sporting out-of-state license plates and a rate of prescription writing that indicates the physician spent five minutes or less evaluating the patient.

grooms Grooms

But the problem of over-prescribing of controlled substances and prescription drug abuse is escalating in Indiana. Awareness is growing, and calls for action are becoming louder.

The Indiana General Assembly has established the Health Finance Commission to study among other things, the regulation of pain management facilities and prescribers of controlled substances and may recommend legislation in 2013.

Members from the medical and legal professions are hesitant when asked if the Statehouse is the best place to find a solution to pill mills. Laws being enacted in other states are having unintended consequences and causing some physicians to quit prescribing pain medication altogether.

Sen. Ron Grooms, R-Jeffersonville, is a member of Health Finance Commission and, having spent his career as a pharmacist, has seen the problem up close. He emphasized he is not on a witch hunt and knows some people have debilitating pain that needs treated. However, he raised the question: Isn’t it somebody’s duty to make the medical community treat the patients rather than maintain their addiction?

Across state lines

The Clark County Wellness Clinic LLP, which recently started operating in Grooms’ hometown of Jeffersonville, highlights his concern of what could happen. Indiana has so few regulations related to pain-management facilities that as neighboring states clamp down, Grooms expects these operations will migrate across state lines to the Hoosier heartland.

In the case of Clark County Wellness, the clinic relocated from Georgetown, Ky., shortly after the Kentucky General Assembly enacted new legislation targeting pill mills. Activity at the clinic has neighbors worried that it could be a pill mill.

“Everything they’re doing is legal,” he said. “I think it’s a situation that provides medication to clientele whose medical issues need to be addressed rather than maintained.”

While the specter of migrating pill mills looms, the Indiana attorney general’s office and members of the medical community have noticed a growing problem of opioid prescribing among providers already in the state.

More and more physicians are being investigated by the Indiana attorney general and facing disciplinary action before the Indiana Medical Licensing Board for over-prescribing controlled substances.

From 1999 to 2009, unintentional poisoning, which would include prescription drug overdose, skyrocketed 502 percent in Indiana, according to a data presentation Dr. Joan Duwve of the Indiana State Health Department made to the commission. Over the decade, unintentional poisoning became the leading cause of injury death, outpacing unintentional motor vehicle accidents, suicide with a firearm, and homicide with a firearm.

Gabrielle Owens, director of the Licensing Enforcement Unit and Homeowner Protection Unit at the attorney general’s office, is unsure why complaints regarding pain medications are increasing. Either more doctors are over-prescribing or more people are aware of the issue and recognize drug abuse in their families and colleagues.

The reasons why physicians abuse their prescription pads vary, Owens said.

“We feel in some cases they were greedy. They were in it for the money,” Owens said. “Others, we

think, wow, they kind of got duped by drug addict patients who pulled the wool over their eyes.”

Still, she noted, the duped physicians had a responsibility to connect the dots.


 

No welcome mat

Whether the Legislature passes a “pill mill” law next session is uncertain. Yet, Grooms is confident if any bill emerging from the study commision gets a hearing before a committee, it will receive a passing vote.

The senator envisions any potential law as regulating both the facility and the physician. He said legislation could require pain clinics to have a special license and be owned by a licensed physician. Also, the treating doctors would possibly have to follow specific protocols such as taking a medical history, performing a physical exam, offering alternative care options, and offering to coordinate additional care with physicians from other specialties.

Pill-mill bills passed in Ohio and Kentucky are raising concerns among doctors in those states who say the laws are confusing and having unintended consequences. Indiana may be experiencing a similar situation with its law that regulates the treatment for weight loss and obesity.

This law – like the bill Grooms outlined – regulates the steps physicians must take before prescribing a controlled substance to overweight and obese patients. However, the law has not been well publicized and some doctors are getting tripped up, Brian Betner said.

An attorney at Hall Render Killian Heath & Lyman P.C., Betner has represented doctors before the Indiana Medical Licensing Board. Sometimes, he said, physicians may make a technical mistake or an innocent oversight that did not impact patient care but was still a violation that puts them at a licensing board hearing. Moreover, the board has little option but to impose disciplinary action which, in turn, can have long-term negative consequences for the doctors.

Michael Whitworth, physician and chairman of the Indiana Pain Society, cautions Indiana against following the lead of other states and hastily crafting a massive, convoluted bill that induces physicians to quit prescribing pain medication and leaves patients who are in chronic pain with no relief.

“We don’t have to rush in and craft a very detailed bill,” he said.

The IPS is proposing the state establish a Controlled Substances Commission, consisting of a variety of medical professionals from physicians to veterinarians. This group would develop regulations and disciplinary rules for opioid prescribing. If after two or three years the death rate from overdoses has not declined, then the state can try another approach.

Based on her work, Owens does not think the solution will come from one source. Instead, it will likely take a collaborative approach with the medical community, law enforcement, health department, Legislature and other groups coming together to formulate policies for Indiana.

INSPECT

The state’s database which tracks prescription narcotics, INSPECT, is universally praised and touted as something that, with wider use, could help combat over-prescribing. The system is the “gold standard” in drug monitoring in the United States, said Mike Rinebold, director of government relations for the Indiana State Medical Association.

Physicians, Whitworth said, should be required to check the database when prescribing narcotics to see if a patient has already been prescribed the drugs from another doctor. However, currently, only about 40 percent of Hoosier doctors with Controlled Substance Registry certification are enrolled in the database.

“That is a tragedy,” Whitworth said. “That means a huge group of physicians are not doing their due diligence when they take out their pens and write a prescription.”

Yet, INSPECT is headed for its own fiscal cliff. A federal grant that provides two-thirds of the funding for the program is set to expire this year.

Tens of thousands of Hoosier medical professionals in private practice, clinics and emergency rooms are impacted by INSPECT every day, Rinebold said. The ISMA has started talking to legislators who are involved in health care to raise awareness of the database and the importance of continuing funding.•

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  • hmmm
    Well that sounds bad and all, but worse were the bad old days in the 1980s when cancer patients and others with chronic pain couldnt get adequate narcotics for their suffering, driving many to extreme grief and suicide. "War on drugs" and all that stuff.

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  1. This guy sounds like the classic molester/manipulator.

  2. Louis D. Brandeis was born in 1856. At 9 years of age it would have been 1865. The Brandeis family did not own slaves. My source Louis D. Brandeis: A Life, by Melvin L. Urofsky.

  3. My name is Matthew Lucas Major, I recently went through a jury trial in Bloomington , In. It was the week of Feb 19-21. Although I have been incarcerated since August 5, 2014. The reason I 'am writing to you sir is on the 21 of February the jury came in with a very excessive and wrongful verdict of guilty on 6 child molesting charges against my daughter who was 9 at the time I was accused. I also had 2 other Felonies one of Intimidation and 1 of Sexual Vicarious Gratification. Judge Marc Kellam on the second day of trial gave me a not guilty on those 2 felonies. The jury was sent out during that time and when brought back Judge Kellam told them to not concern themselves with the 2 Felonies that he ruled on them. They were told to not let evidence they had already heard influence there verdicts. I never in my life touched any child sexually and definitely not with my own daughter. When I was arrested Detective Shawn Karr told me I would be convicted guilty just on my daughters word even without evidence. That's just what happened. my public defender did me so wrong he never once proved to the court and jury all the lies the child told, and Jeremy Noel my public defender could of proven the lies easily. The stories in Serenity's depositions and Forensic interview changed and were not consistent as Prosecutor Darcie Fawcett claimed they were. Yet my attorney never mentioned that. The facts that the child accused me of full penetration in her vagina and rectum was proven lies. Doctor Roberta Hibbard of Riley hospital in Indianapolis confirmed Serenity's hymen intact, no scars, no tearing, no signs of rape to her. Yet my attorney didn't use that knowledge . the DNA was all in my favor. I tell you I will spend my entire life in prison going through rape and beatings etc. even Judge Kellam abused his authority by telling the jurors to listen and believe what the prosecutors side in evidence like my daughters testimony. In one interview with the detectives my daughter got flustered with her mom and said on camera " I'm saying what you told me to mom"!! Yet Mr. Noel said nor did anything to even resemble a defense attorney. Judge Kellam allowed edited version of a taped conversation between the child and her mother. Also Judge Kellam allowed the Prosecutor too bring in to my case a knife found under my seat, the knife wasn't part of my case. She was allowed by my attorney and the judge to put a huge picture of it on the screen and huge picture of my naked privates in a full courtroom and open court. Ms. Fawcett says to jury see how easy Mr. Major could reach the knife and cut his Childs throat. Even though I had no weapons charge against these cases. This gave the jurors prejudice thought against me thinking I threatened her with that knife and how scared she would of been knowing i could get it and kill her. On my sentencing court March 19, 2014 my public defender told Judge Kellam he wish to resign from being my attorney and wished for the court to give me outside council to file a error to trial or appeal. We were denied. Now after openly knowing my public defender don't want to represent me he has to. Well when as parents we make our kids clean a room when they really don't wish to, well the child will but don't mean she will do a good job, that's where I'm at with Mr. Noel. please dont ignore mine and my families pleas for your help . we have all the legal proof you could need to prove Im innocent. Please dont make my spend years in prison innocent when you can fix this wrong. Im not saying Im a perfect man or that I was a perfect dad to my 2 children none of us are. Ive made some bad choices in life and I paid for them. But I didnt ever touch or rape my daughter . I love my children with all my heart. And now through needing attention and a ex-wife who told my granny several times she wish she could put me in prison to get me out of their lives. Well my ex finally accomplished her goal. Sad part is she is destroying our daughter with all this horrific lies and things she taught my daughter to say. My daughter will need therapist to ever hope for a chance of a normal life after what she had done to her by her mom and their side of the family. My daughter told everyone even on stand she had a dream months before i supposedly molested her in this dream I was molesting her and when I finally did it matched her dream perfectly. She admitted to watching movies about little girls being molested and watching U-Tube videos about child molesting all before it happened supposedly to her. Doesn't that sound very unusual that a non molested 9 yr old would need to know so much about being molested? The only reason I could think a 9 year old would need so much information is to be prepared to know what to say and be able to say how it felt what took place etc.. So when questioned by authorities she would be prepared. And there again sir if a parent is pre grooming a 9 year old child she would need intimate details . Like telling her daughter about a couple moles on my private area. The child admitted to sneaking my cell and looking many many times at nudes of me and my girlfriend even one where my penis was entering my girlfriends vagina. In that picture my moles are obvious. Yet when prosecutor showed everyone in court my privates and pictures of the moles she said the only way the child would know about them is if she saw them for herself. My attorney once again said nothing about the pictures my child saw. Or could a ex-wife be able to describe my moles to help her case against getting rid of me? I beg you help me. This is my very existence. Ive lost everything , a good job, a wonderful girlfriend, my freedom, but worse thing Ive lost is my children. They were my reason to get up every morning and strive to be better. The wonderful bond I had with my Serenity is gone. After this I would be afraid to even hug her for fear of what next can they do to me. I'm not afraid to tell you I sit here in this cell and try to hold back my tears. Everyone knows you cant show weakness in prison. My life has already been threatened here at Wabash Valley Prison. After only 3 days of arrival. I was tricked into signing a waiver now Im in G Block General Population with 6 child molesting felony charges. Mrs. Hart as a 18 year old I almost died hooked to machines in hospital almost 1 month and now I know that fear was childish compared to this . I cant help but put emotions in this, after all Mrs. Hart Im human and God help Me I never been more afraid in my life. I didnt hurt my little girl I didnt touch her sexually. As much as it shreds me and fills my mind what Im facing I worry more about my mom and granny because of their great love for me mam they are suffering so deeply. I aint done this things but my loved ones suffering right along beside me and If you take my case you will be in essence freeing them also. I sent momma this letter and asked her to email it to you. I'm scared I have been done so unjustly by our legal system and I need you to fix this and give me freedom. I ask you please don't just ignore my pleas. Here in America its nice to be able to trust our legal justice system, well they destroyed my and my loved ones trust in our justice system . And I'm trusting in You !!! My entire family is suffering this nightmare with me. My 77 year old granny had a stroke and isn't doing so well. My single mother that raised 3 kids alone is dying from Lupus and since my arrest has stayed so sick and weary. Our lives torn to peices by a government I was taught I could trust in. my momma has tried so many innocent project and wrongfully accused and cant get anywhere. please please help me. A quote from the late Nelson Mandela: To be free is not merely to cast off ones chains, But to live in a way that respects and enhances The Freedom Of Others. I have Faith in you and your clinic to cast my chains off and give me freedom I do deserve as a wrongfully accused Man, son, brother, father, friend. Matthew Major DOC# 246179 Cause # : 53c02-1308-FA-000779 God Bless you. Please contact me with your decision so I know you made a life changing decision for me , just please at least write me so I know you care enough about your citizens to respond to cries for your help. You can speak openly with my mother Charlotte Spain (828) 476-0406: 71 Lakeview Dr. Canton, NC 28716 Thank You Matthew Major I know yall get thousands of request and inmates claiming innocence, and each person who are innocent deserve to have organizations like yours willing to fight for them and I give yall so much Thanks and I thank God everyday yall are out there caring enough to help free the innocents. Since discovering firsthand how easily lives and families can be destroyed by Poor Defense attorneys not doing their job . And Prosecutors allowed to do as they please in court

  4. Frankly, it is tragic that you are even considering going to an expensive, unaccredited "law school." It is extremely difficult to get a job with a degree from a real school. If you are going to make the investment of time, money, and tears into law school, it should not be to a place that won't actually enable you to practice law when you graduate.

  5. As a lawyer who grew up in Fort Wayne (but went to a real law school), it is not that hard to find a mentor in the legal community without your school's assistance. One does not need to pay tens of thousands of dollars to go to an unaccredited legal diploma mill to get a mentor. Having a mentor means precisely nothing if you cannot get a job upon graduation, and considering that the legal job market is utterly terrible, these students from Indiana Tech are going to be adrift after graduation.

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