From WSJ and Ken Ditkowsky–Feds arrest Corp Officers involved in Opioid drug kickbacks to docs

http://www.wsj.com/articles/former-insys-ceo-arrested-in-opioid-prescription-kickback-case-1481228056?emailToken=JRrzdvB/ZH%2BUhdE8aswy00ctY7NNCumSV0iSJ33Nf0HWrnHOve%2BtgqQzwtyvoGSuSQNi/d0f5HQ%2BXSHQh2wvX86amLR2mlThcHBGo9SdjV3SYB6LxBPU

Of course, everyone knows that the main revenue stream keeping Elder Cleansing alive is the over use of opiods and psych drugs on the elderly and disabled.

Only one problem, the use of psych drugs and opiods in elders and disableds comes with a black box warning against such use by the FDA and is highly illegal.

Probate courts condemn the elderly to slums and ghettos called “nursing homes” who then drug the patients to death.  If they resist, they are held down and shot up with halodol (Wyman and Teichert).  No one stops this.  If Protective Family members protest, they are smeared and called felons, drug addicts (when it’s the probate judges and attorneys forcing illegal drugs on seniors and disableds) and they are threatened.

Look at this indictment and see why it is nearly impossible to stop the machine, until people get fed up and light a fire under the FBI to do its job.

In Illinois, we have the IDPR to investigate, but when one mother complained (Gidan) that her disabled son was being held by a psychopathic father, the judge said “he didn’t have time to read the file (of abuse)” and kept the son with the abusive father. Soon the son will turn 18, but did he finish high school?  (nope)  Did he miss most days?  (yep), under the mother’s care did he get A’s in honor’s level classes? (yep). So why was this judge so stubborn he ignored all this and place an innocent disabled son with the father to skip school, drop out and get drugged into being a zombie with illegal psych drugs? (profit and kickbacks?)

And why does no on investigate.

Just today, a clouted attorney on the 18th floor made sure a woman was condemned to die in a nursing home, drugged and the protests of a Protective Son were ignored by the court. The demands of a clouted attorney were rubber stamped to drug, keep the elderly mother in a nursing home, and make sure she suffered the worst form of torture imagined.  She has bed sores and no one cares. They are per se mal practice, but you think this clouted attorney reported it?  Of course not.  He needs to be condemned to a nursing home, shot up and drugged with death the only way out and septicemia from bed sores.

Is anyone listening to Ken and I and Candice Schwager and Barb Stone–the only attorneys who will speak out.

The ARDC and Jerome Larkin hate it.  Talking about abuse of the elderly as an attorney in probate court means ARDC Attorney Melissa Smart will accuse the attorney in one of the ARDC’s kangaroo courts of “yelling fire in a crowded theater”.

No attorney in Illinois is supposed to protect the elderly here. They are condemned to die in the slums and ghettos of nursing homes with force psych drugging. Alice Gore lost $1.5 million (uninvestigated) and 29 gold teeth in a famous 18th floor slum-like nursing home when she could have been pampered at home by her kind and caring protective Daughter.  But the Daughter protested and was slapped with a $60k bogus judgment.  She was not deterred and to this day continues to appear on a highly popular cable show speaking out against what atrocities happened to her mother–Alice Gore, who was eventually drugged to death and all skin and bones in the end–an end that happened soon after she lost her 29 gold teeth to some miscreant dentist who has yet to still be investigated and punished for this horrific crime.

Has the ARDC investigated the lawyers involved?  Nope. Do they continue to abuse and drug disableds and seniors under the guise of an unlawful probate court?  Yep.

Read on for the full article.

JoAnne

Six former executives and managers at Insys Therapeutics Inc. were arrested on Thursday and charged with conspiring to defraud health insurers and bribe doctors in exchange for prescribing the company’s fentanyl painkiller, Subsys, the Justice Department said.

Among those arrested were former Chief Executive Michael Babich, who resigned from the company in November 2015. Mr. Babich, 40 years old, was charged with conspiracy to commit racketeering, conspiracy to commit wire and mail fraud, and conspiracy to violate the anti-kickback law.

The racketeering, wire fraud and mail fraud charges each carry penalties of up to 20 years in prison, in addition to fines and supervised release, the government said. Violation of the anti-kickback statute carries up to five years in prison.

–– ADVERTISEMENT ––

Before resigning last year, Mr. Babich had helped oversee the company’s early success, which included its stock becoming the best-performing initial public offering of 2013. He sold $30.6 million in Insys stock during his tenure as CEO, according to Thomson Reuters data. In addition, he was paid more than $10 million in accelerated stock options and cash as part of his severance from the company in 2015, according to Insys regulatory filings.

Mr. Babich didn’t immediately respond to a request for comment. His attorney said he intends to plead not guilty.

In a statement, Insys said the arrests on Thursday related to previously disclosed investigations and that the company “continues to cooperate with all relevant authorities in its ongoing investigations and is committed to complying with laws and regulations that govern our products and business practices.”

Thursday’s arrests were the latest to result from ongoing investigations into Insys, a once-highflying pharmaceuticals company based in Chandler, Ariz., that has struggled over the past year amid increasing scrutiny by prosecutors and regulators.

Including the arrests on Thursday, 11 former Insys employees this year have been charged with breaking federal law.

Shares of Insys fell 11.9% through the close of regular trading on Thursday; shares have fallen 67% so far this year. Global sales of Subsys soared 50% to $329 million in 2015, but have declined significantly this year amid heightened scrutiny of opioid abuse and the company’s business practices. Analysts expect Subsys sales to decline 28% to $237.7 million in 2016, according to FactSet.

Insys and its chief executive and majority shareholder, John N. Kapoor, were the subject of a Journal article in November that detailed the company’s relationships with doctors, including a pair of Alabama physicians scheduled to go on trial next month to face criminal charges of operating what prosecutors allege was a “pill mill.”

The charges on Thursday were brought byCarmen Ortiz, the U.S. attorney for the District of Massachusetts.

“I hope that today’s charges send a clear message that we will continue to attack the opioid epidemic from all angles, whether it is corporate greed or street level dealing,” Ms. Ortiz said in a statement.

Also charged on Thursday were Alec Burlakoff,the company’s former vice president of sales; former national sales director Richard Simon; former vice president of managed markets Michael Gurry; and former regional sales directors Sunrise Lee and Joseph Rowan.

Anthony Pacheco, an attorney for Mr. Rowan, said in an email that “the indictment in itself is nothing more than a list of the government’s unproven factual assertions and legal theories.”

Ms. Lee and Mr. Simon couldn’t immediately be reached for comment. The other former employees or their attorneys didn’t immediately respond.

Mr. Babich and the other defendants disguised the company’s bribes to doctors and other health-care practitioners as legitimate fees paid for promoting Subsys to colleagues at speaking events, the government alleges in a criminal indictment filed in U.S. District Court in Massachusetts.

Subsys, a rapid-acting and highly addictive opioid, is approved by the Food and Drug Administration to treat extreme cancer pain. Messrs. Babich, Burlakoff and Simon, however, targeted their sales efforts at doctors who prescribed fast-acting fentanyl for all types of pain, the indictment alleges.

The goal of the speaker’s program was to reward large prescribers of Subsys, the indictment alleges. Mr. Burlakoff allegedly told an Insys sales representative in a text message that prescribers “do not need to be good speakers, they need to write a lot of” Subsys, the indictment alleges. Speaking events were “were often just social gatherings at high-price restaurants that involved no education and no presentation,” the indictment alleges.

Mr. Babich and the others closely tracked how much money each speaker was paid, how many Subsys prescriptions they wrote and the resulting net revenue Insys received, the indictment alleges. For a time, the former employees also explicitly calculated the return on investment from each speaker, the indictment alleges.

Many insurers refused to pay for Subsys unless prescriptions met certain criteria, such as being prescribed for cancer pain or for patients who had already tried cheaper alternatives, the Journal reported in November. To help address the problem, Messrs. Babich and Gurry in January 2013 created and operated a reimbursement unit that worked on behalf of doctors to obtain payment authorization directly from insurers, the indictment alleges.

Mr. Gurry and other unnamed conspirators taught reimbursement unit employees “how to mislead and deceive insurers regarding their employment, patient diagnoses, and tried and failed medications,” the indictment alleges. The reimbursement unit’s methods were effective: Roughly a year after the unit was launched, about 85% of prescriptions were approved for payment by insurers, up from roughly one-third of prescriptions in November 2012, the indictment alleges.

Write to Joseph Walker at joseph.walker@wsj.com

From Huffington Post: Judges for sale !

http://www.huffingtonpost.com/dick-simpson/judges-for-sale_b_1220061.html

Judges for Sale–Money buys Judicial favor and sympathy

01/20/2012 05:49 pm ET | Updated Mar 21, 2012

This column originally appeared in the Chicago Journal.

Hey bud, would you like to buy a judge? Judges in Illinois can be bought by cash or votes.

The Central Committee of the Democratic Party of Cook County buys judges with the promise of votes, naming them to the party’s official slate in exchange for implicit support. The key phrase at the slating session of prospective judges is “I am a lifelong Democrat,” which is code for saying, I’ll decide cases when I can the way the party wants.

Terry Lavin, a current slated candidate, put his credentials for judge at the slating session this way: “I have been a loyal Democrat. I voted in each of the Democratic primaries [of the] last twenty years. I helped the Speaker [Illinois House Speaker Michael Madigan] out on a number of elections in the south suburbs, same thing for [former state Senate President] Senator Emil Jones. When the Democratic Party wanted somebody to go down and testify in Springfield, I did that. When they needed help writing legislation, I did that.” Lavin is an able candidate, former president of the Illinois Trial Lawyers Association with many victories as a trial lawyer, but before the party slatemakers, that doesn’t count as much as party loyalty.

The political parties choose the judicial candidates for the bedsheet ballot, which has so many people running for so many offices that even informed political junkies don’t know much about the candidates for judges except their party affiliation. But campaign contributions also buy judges.

Lawyers give contributions to the very judicial candidates before whom they will appear. A thousand dollar contribution to this candidate and a thousand to that and pretty soon, you become a very effective lawyer, winning a lot of cases. You don’t need to know a whole lot of law if you buy the right judges.

On Dec. 15, 2011, the Illinois Campaign Finance Reform Task Force held public hearings on its working draft report, Public Campaign Financing and Illinois Elections. It was an excellent background report providing balanced information on the state of campaign financing, including judicial campaigns. The final report will be given to the governor this month.

The weakness in the draft, which more than a dozen witnesses including political and civic leaders from New Jersey and New Mexico pointed out, was that it ended without making any recommendations. This is despite the fact that the report provides evidence of major problems in interest group involvements in campaigns and the undue influence of large donors. I, and the other witnesses, testified that the Task Force needed to add a conclusion in support of the adoption of public funding — most especially, public funding of judicial campaigns.

Fittingly, the task force was meeting a week after former Governor Rod Blagojevich was sentenced to 14 years in jail for public corruption. Altogether more than 1,500 public officials have been convicted since the 1970s of corruption. Research at the University of Illinois at Chicago has estimated the “corruption tax” on the taxpayers is over $500 million a year.

Operation Greylord and other corruption investigations by the FBI and the U.S. Attorney General have led to the conviction of judges, lawyers and court personnel-fixing cases — even murder cases — for bribes. The nexus of party politics, crime and the courts has been known for decades.

But even when the mob isn’t involved, campaign contributions for judges undermine the credibility of the judicial system. In downstate judicial elections, supporters and opponents of “tort reform” and the outcome of “tort” lawsuits spent millions of dollars electing and defeating certain judicial candidates to win verdicts in the courtroom.

Illinois has a new campaign finance law which went into effect this year, but restrictions on truly large contributions (beyond $5,000 a person per candidate) and better reporting requirements are not enough. I personally support public financing at all levels like they have in Maine. But as I urged the task force, we must demand that the state legislature and governor pass legislation at least to support public funding of judicial elections. Merit selection of judges would be better still, but public funding would lessen corruption immediately.

2012, the year Blagojevich heads to prison, should be the year when we take money (and improper influence) out of judicial elections.

From Front line:

http://www.pbs.org/wgbh/pages/frontline/shows/justice/etc/synopsis.html

In “Justice For Sale,” FRONTLINE correspondent Bill Moyers examines the impact of campaign cash on the judicial election process and explores the growing concern among judges themselves that campaign donations may be corrupting America’s courts.

In the 39 states where voters elect some or all of their judges (see map of states), special interest money is pouring into judicial races helping to finance expensive tv ads, media advisers and pollsters, and threatening to compromise judicial independence and neutrality. This report includes a rare interview with U.S. Supreme Court Justices Stephen Breyer and Anthony Kennedy who speak out about the threat to judicial integrity.

“If there is the perception or the reality that courts are influenced in their decisions based upon campaign funding sources,” says Justice Kennedy, “we will have a crisis of legitimacy, a crisis of belief, a crisis of confidence.”

“Justice for Sale” looks at judges’ races in three states–Pennsylvania, Louisiana and Texas–talking to judges, media consultants and special interest groups who are donating big money to judicial campaigns.

In Pennsylvania, the pro-business group Pennsylvnians for Effective Government (PEG) surveys the voting habits of state Supreme Court justices and funds those who share their philosophy. PEG leader Bill Cooksees his group as being in competition with trial lawyers and labor unions who also contribute heavily to judicial campaigns. “Judicial elections are very partisan,” he says. “Do the judges know who the big donors are? Of course!” Helen Lavelle, a media consultant for a Pennsylvania judge who won re-election in 1999 acknowledges, “We sell a judge the same way we sell anything.” Although she believed in her candidate’s integrity, she’s concerned about money’s corrupting influence. “It’s unfair. People are ending up with a chance to be on a bench who have no business being there.”

Traveling to Louisiana, this FRONTLINE report investigates how in 1998 a business group financed a campaign against Pascal Calogero Jr., Chief Justice of the Louisiana Supreme Court, whom they viewed as unsympathetic to industry’s concerns. But after Calogero backed down on a crucial issue (and supported curbing a student law clinic which had several times successfully represented poor people against oil and gas interests in environmental cases), Calegero was able to secure enough donations from business to help him win another term.

In Texas–which Moyers calls “the heavyweight in partisan, expensive, knock-down, drag-out brawls for control of a state Supreme Court”– FRONTLINE looks at how special interests and their fundraising has dramatically changed the make-up of the Texas Supreme Court. Twenty years ago, Texas was known as the ‘lawsuit capital of America’ with judges and juries favoring trial attorneys and their clients. By 1998, the Texas Medical Association had successfully spearheaded a campaign by business to take back the courts. Today, all nine members of the Texas Supreme Court are Republicans and staunchly pro-business, according to critics. Texas Supreme Court Justice Tom Phillips is one of several Texas legislators, lobbyists and judges who talk about the politics and money scramble to run for judicial office. Although Phillips calls for reforms to lessen money’s influence, during his ten years on the court, he’s had to learn to play the money game.

Throughout this report, FRONTLINE tracks the mounting evidence–polls, surveys and reports–that trust in judges and the courts is eroding because of the perception that campaign contributions to judges are affecting their decisions on the bench. For example, a June 1999 survey conducted by the Texas Supreme Court and the Texas State Bar found that almost half the judges in Texas believe campaign contributions significantly influence judicial decisions. Lawyers who appeared before the courts were even more skeptical of the system–79% believe that campaign contributions affected the decisions.

“Try as they might, the nine justices of the Supreme Court of Texas today have their next election on their mind every day of their life,” says Bob Gammage, a former member of the Texas Supreme Court. Gammage believes that the justices strive to be impartial, but are dependent upon their campaign donors: “If you don’t dance with them that brung you, you may not be there for the next dance.”

Note it is reported that it takes over ONE MILLIONS DOLLARS to get elected to the Penn. Supreme Court. What is the quid pro quo for that?  No wonder why their disciplinary board goes after attorneys that represent the little guy and scream corruption when the courts consistently rule in favor of big business, with no statute or common law to support such decisions–just pure nonsense.  Ask Andy Ostrowski about that and how he was wrongfully disciplined for speaking out against corruption.

on justice eroding in the US:

No wonder why I was taken out for running this blog and supporting the average citizen who did not receive justices, a law, a statute, anything, to support a bogus decisions.

No wonder why our Appellate Court and US Supreme Court keeps briefs inaccessible to the public so citizens that cannot afford an attorney have little hope of justice. The biggest firms and brightest attorneys (not necessarily the most expensive), are writing briefs that no one else will see or can use for their pro se cases.

What gives Illinois government the right to even withhold briefs from the public?  These should be online, for crying outloud.

The ARDC files are now all scanned in and they should be made public too.

The Illinois government does not own these documents personally. They belong to the people, and as such, they should be made publicly available.

What gives Illinois Clerk of Court Dorothy Brown the right to withhold pleadings from the public online and force people to go downtown to pay $1 for the first two pages and then 50 cents and a quarter after that when Federal Court documents are 8 cents per page on Pacer.  What is the legal justification for that?  Why has no one sued? When Pacer was sued for raising their prices to 10 cents per page, the price ended up once again at 8 cents per page.

Illinois citizens demand justice and fairness.

Too many cases now involve judges and lawyers that should not be in the courtroom. They make money illegally and through bribes. Dennis Wians is currently filing a brief at the Court of Appeals for a bogus large judgment rendered against him in probate.  He claims he only used his Power of Attorney to take care of his loved one. The miscreant lawyers ignored his complete and full accounting and the court rubber stamped a huge judgment against him.  He then went and filed Bankruptcy and the legal miscreants followed him there claiming the judgment was valid and that it was intentional and the debt should not be discharged. This is not the first time this has happened. It also happened in the Alice Gore Case (the famous one where her 29 gold teeth were pulled and a feeding tube inserted against her will. she still loved to eat and ate quite well with 29 gold teeth in her mouth).  Please pray for Dennis Wians, he will need your prayers and support.

The Mary Sykes case still has no discovery. It was quashed in trial court and the ARDC refused to allow myself or Ken Ditkowsky discovery.  We need a trust accoutning.
We need to find out where the valuable coins are and other bank accounts.  The Treasury of the State of Illinois claims it can barely pay the bills.  But thieves in the courtroom take millions with impunity and uninvestigated. The Federal Govt has a tax rate of 50% for criminal gains.  Why no Illinois?  Why just 4%. Forget that nonsense.  Illinois needs to ratchet up the tax rate to criminals and START COLLECTING on the taxes when tax fraud by court actors is reported.

Also, why no push to test doctors, lawyers, judges, police, fire, teachers, p0liticians, etc., for psychopathy?  It can now be detected with a PET brain scan. These are very dangerous entities with no love, guilt, remorse, conscience and they only enjoy bullying, injustice and criminal activity.  These people should be tested and delicensed. Brain scans are now down to $600 each, according to a local commercial.

From Roseanna Miller–Deaf woman wins $600k judgment for ill treatment by police under ADA

Now the real question is, why are the deaf being covered by the ADA but elders and disableds suffering abuse, bedsores and chemical restraints generally receive no protection from our state and federal court system under the ADA?

http://www.huffingtonpost.com/entry/deaf-woman-nypd-lawsuit-settlement_us_5630da6ce4b00aa54a4bfef1

Deaf Woman To Get $750,000 For Hellish Ordeal With NYPD

“Deaf individuals have rights, and they do not have to tolerate discrimination and injustices of any kind.”

10/28/2015 01:18 pm ET | Updated Oct 30, 2015

NEW YORK — A New York City woman, who is deaf and says NYPD officers wrongfully arrested her and then ignored her pleas for an American Sign Language interpreter, has settled her lawsuit against the city for $750,000, a sum her lawyers say is the largest ever deaf discrimination settlement for a single person.

“Our client is pleased that she can now move on with her life and put this horrific situation behind her,” Andrew Rozynski and Eric Baum, the lawyers representing 58-year-old Diana Williams, said in a statement Tuesday.

EISENBERG AND BAUM LAW CENTER FOR DEAF AND HARD OF HEARING
Diana Williams won a $750,000 settlement in a lawsuit against the NYPD.

“Due to the immense barriers they face when trying to communicate with the hearing world, Deaf individuals often find themselves without a voice to assert their rights,” Rozynski and Baum added. “Deaf individuals have rights, and they do not have to tolerate discrimination and injustices of any kind.”

Williams and her husband, Chris Williams, both of whom are deaf, are landlords of a building in Staten Island. On Sept. 11, 2011, when the couple were trying to evict tenants who hadn’t paid rent, the boyfriend of one of the tenants allegedly gestured that he had a gun.

Chris then called for police using a video relay service — which the couple later argued should’ve signified to police that they would need a sign language translator. But when officers arrived on the scene there was no translator, and it was only the tenant and the boyfriend, both of whom can hear, who could communicate their side of the story.

Some deaf tenants in the building later testified that the officers rejected their offers to translate for Williams, who cannot hear, speak English or read lips. Instead, Williams was arrested for allegedly getting into a fight with one of the tenants.

Panicked, Williams attempted to scrawl “HOSPITAL” in the dust on the window of the police cruiser, according to The New York Daily News. She made it to “HOSP.”

Williams was detained for 24 hours, during which a translator was never provided. She was released without charge.

“It is a sad reality that Deaf individuals continue to experience blatant discrimination on a routine basis.”

In 2012, Williams filed the federal lawsuit against the city of New York alleging that she had not only been wrongfully arrested, but that NYPD officers had ignored police guidelines for how to deal with the deaf, and in doing so violated the Americans With Disabilities Act.

Earlier this year, lawyers for the city argued that an arrest was neither a “service, program, or activity,” and therefore did not fall under the Americans with Disabilities Act, according to Courthouse News.

But U.S. District Judge Valerie Caproni found the city’s argument woefully unpersuasive.

“New York City takes the extraordinary position that, even though the Americans with Disabilities Act has been the law of the land for 25 years, it has no obligation to provide any accommodation to the hearing-impaired at the time of an arrest, even if doing so could easily be accomplished without endangering the officers or the public safety and without interfering in the lawful execution of the officers’ duties,” she wrote in an August decision, allowing the lawsuit to proceed to trial.

Reached for comment Wednesday, a spokesman for the New York City Law Department said only that “settling this case was in the city’s best interest.”

Advocacy group Helping Educate to Advance the Rights of the Deaf. (HEARD), has documented at least 40 stories of police brutality against deaf Americans in recent years.

“These stories highlight the woeful lack of training about — and awareness of — Deaf culture and communication within police departments across the nation,” HEARD founder Talila Lewis wrote in a 2014 blog post for the American Civil Liberties Union. “They illustrate the urgent need for systemic change.”

“Perhaps as alarming as the frequency and severity of these assaults, is the infrequency and leniency of formal charges against the officers responsible,” Lewis continued. “Deaf survivors of police brutality and family members of deaf homicide victims tend to prevail in lawsuits against police, costing taxpayers dearly, but officers are rarely formally charged or dismissed for their actions.”

Last year, actress Marlee Matlin, who is deaf and is married to a police officer, made a video to help inform deaf people of their rights when interacting with police.

Williams’ lawyers, in their statement Tuesday, said “it is a sad reality that Deaf individuals continue to experience blatant discrimination on a routine basis.”

“Ms. Williams hopes that the settlement will send a message to all law enforcement agencies across the country that they should adopt proper policies and procedures to ensure full communication access for Deaf individuals,” they said.

From the American Family Physician Website–information on the dangerous use of psych drugs as chemical restraints in nursing homes.

Appropriate Use of Psychotropic Drugs in Nursing Homes

Am Fam Physician. 2000 Mar 1;61(5):1437-1446.

The Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities. Updates of OBRA guidelines have liberalized some dosing restrictions, but documentation of necessity and periodic trials of medication withdrawal are still emphasized. Antidepressant drugs are typically underutilized in nursing homes. Tricyclic antidepressants have many side effects and thus are not preferred medications in elderly patients. Anxiety and insomnia are common problems in the institutionalized elderly. If behavioral measures are not successful, antidepressant medications with shorter half-lives may avoid drug accumulation, which can lead to excessive sedation, cognitive impairment and an increased risk for falls. In the elderly, antipsychotic medications can cause serious side effects, such as extrapyramidal symptoms and tardive dyskinesia. Newer antipsychotic drugs are less often associated with these side effects, but they should be used only for specific diagnoses and when behavioral and environmental measures are unsuccessful.

Improving the quality of care for nursing home residents has been a major concern for years. Recently, attention has focused on maximizing the appropriate use of psychotropic medications to manage agitation and other behavioral problems associated with dementia.

Mental disorders are present in a large percentage of the nursing home population. Antipsychotics, benzodiazepines and antidepressants are among the medications most commonly used to manage problem behaviors.1 Historically, antipsychotics and benzodiazepines have been used excessively (and without appropriate diagnosis or monitoring for side effects) in nursing home residents, often solely for the convenience of staff. Studies have found that most residents of long-term care facilities receive at least one psychotropic medication. Meanwhile, antidepressants have been underutilized because depression is often overlooked as a cause of behavioral disturbances in this population.2

The misuse of psychotropic drugs exposes patients to medication side effects and can lead to deterioration of medical and cognitive status. To combat this problem, the federal government passed nursing home reform legislation, the Omnibus Budget Reconciliation Act (OBRA) of 1987.3This legislation is directed at protecting residents of long-term care facilities from medically unnecessary “physical or chemical restraints imposed for purposes of discipline or convenience.”3

The Health Care Financing Administration (HCFA), an agency responsible for regulating nursing homes participating in the Medicare and Medicaid programs, developed interpretive guidelines for fulfilling OBRA requirements.4 These guidelines were implemented nationally in 1990 and remain in force5 (Figure 1).4 Updated guidelines were implemented in July 1999.6

View/Print Figure

HCFA Guidelines

FIGURE 1.

Summary of the Health Care Financing Administration (HCFA) guidelines.

Information from Health Care Financing Administration. Survey procedures and interpretive guidelines for skilled nursing facilities and intermediate care facilities. Baltimore: U.S. Dept. of Health and Human Services, 1990.

Summary of OBRA Interpretive Guidelines

All psychotropic drugs (antidepressants, anxiolytics, sedative-hypnotics and antipsychotics) are subject to the “unnecessary drug” regulation of OBRA. According to the HCFA guidelines,4“residents must be free of unnecessary drugs,” which are defined as those that are duplicative, excessive in dose or duration, or used in the presence of adverse effects or without adequate monitoring or indication. The remaining regulations apply to anxiolytic, sedative-hypnotic and antipsychotic drugs only.

Medical, environmental and psychosocial causes of behavioral problems must be ruled out, and nonpharmacologic management must be attempted before psychotropic drugs are prescribed to nursing home residents. Because treatment with psychotropic medications is indicated only to maintain or improve functional status, diagnoses and specific target symptoms or behaviors must be documented, and the effectiveness of drug therapy must be monitored. Specific dosage limits must be observed, and periodic dosage reductions or drug discontinuations must be undertaken. Side effects (of antipsychotics, in particular) must be monitored. Barbiturates and certain other older tranquilizers may not be prescribed unless they were being used successfully before a patient was admitted to a long-term care facility (Table 1).4 Phenobarbital can be used solely to control seizures.

View/Print Table

TABLE 1.

Drugs Not to Be Used in Nursing Homes*

Barbiturates

Amobarbital (Amytal)

Amobarbital-secobarbital (Tuinal)

Aspirin-butalbital-caffeine (Fiorinal)

Butabarbital (Butisol)

Pentobarbital (Nembutal)

Secobarbital (Seconal)

Other tranquilizers

Ethclorvynol (Placidyl)

Glutethimide (Doriden)

Meprobamate (Miltown)


*—In accordance with regulations relating to the Omnibus Budget Reconciliation Act of 1987, drugs listed in this table are not to be used unless started before admission to a nursing home, given as a single dose for a medical or dental procedure or used for the treatment of seizures (phenobarbital).

Information from Health Care Financing Administration. Survey procedures and interpretive guidelines for skilled nursing facilities and intermediate care facilities. Baltimore: U.S. Dept. of Health and Human Services, 1990.

OBRA restricts the use of antipsychotic drugs only in patients with dementia. None of the OBRA dosage restrictions or monitoring requirements apply in patients with psychotic disorders (e.g., schizophrenia).

Each nursing home is surveyed annually. Because facilities that do not meet HCFA’s legislated requirements may be denied Medicare reimbursement,7 physicians who prescribe medications for nursing home residents must document the medical necessity of noncompliance with regulations (e.g., drug prescriptions in excess of OBRA-mandated dosages). As a resource for physicians and facilities, a local consultant pharmacist reviews all charts monthly and assists with compliance.

According to the OBRA strategy, the long-term care facility, rather than the prescribing physician, is accountable for monitoring drug use.8 Some consider that this approach better reflects the realities of nursing home practice, in that the prescribing physician only visits the facility occasionally.8 Regardless of where final responsibility lies, physicians need to be aware of the HCFA interpretive guidelines for the fulfillment of OBRA requirements.

The updated HCFA regulations change some antipsychotic dosing restrictions.6  Medications considered potentially hazardous to the elderly are listed in Tables 2 and 3.9

View/Print Table

TABLE 2.

Drugs with a High Potential for Severe Outcomes in the Elderly

DRUGS COMMENTS

Psychotropics

Amitriptyline (Elavil)

Strongly anticholinergic and sedating

Barbiturates

More side effects than most sedative-hypnotic drugs; should not be used except to control seizures (phenobarbital)

Long-acting benzodiazepines

Long half-life and, hence, prolonged sedation; associated with an increased incidence of falls and fractures

Doxepin (Sinequan)

Strongly anticholinergic and sedating

Meprobamate (Miltown)

Highly addictive and sedating

Analgesics

Meperidine (Demerol)

Not effective when administered orally; metabolite has anticholinergic profile

Pentazocine (Talwin)

Confusion and hallucinations more common than with other narcotics

Miscellaneous

Antispasmodic agents (gastrointestinal)

Highly anticholinergic with associated toxic effects

Chlorpropamide (Diabinase)

Serious hypoglycemia possible because of the drug’s prolonged half-life

Digoxin (Lanoxin)

Decreased renal clearance; doses should rarely exceed 0.125 mg except when treating arrhythmias

Methyldopa (Aldomet)

Causes bradycardia and exacerbates depression

Ticlopidine (Ticlid)

More toxic than aspirin


Information from Beers M. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:1531–6.

View/Print Table

TABLE 3.

Drugs with a High Potential for Less Severe Outcomes in the Elderly

DRUGS COMMENTS

Analgesics

Indomethacin (Indocin)

More central nervous system side effects than any other nonsteroidal anti-inflammatory drug

Propoxyphene (Darvon)

Few advantages over acetaminophen and has narcotic side effects

Antihypertensives

Beta blockers

Can cause problems in patients with asthma or chronic obstructive pulmonary disease; may precipitate syncope because of negative inotropic and chronotropic effects

Reserpine*

Can cause depression, sedation and orthostatic hypotension

Miscellaneous

Antihistamines†

Highly anticholinergic

Cyclandelate (Cyclospasmol)

Generally ineffective for dementia or any other condition

Dipyridamole (Persantine)

Frequently causes orthostatic hypotension; of benefit only in patients with artificial heart valves

Ergoloid mesylates (Hydergine)

Generally ineffective for dementia or any other condition

Muscle relaxants

Increased cholinergic activity, sedation and weakness

Trimethobenzamide (Tigan)

Least effective antiemetic and can cause extrapyramidal symptoms


*—Reserpine is available alone (in generic form) and is also found in combination drugs such as reserpine-trichlormethiazide (Metatensin).

†—Over-the-counter and prescription first-generation antihistamines.

Information from Beers M. Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 1997;157:1531–6.

Impact of OBRA on the Prescribing of Psychotropic Drugs

Several multiyear, multifacility reviews have examined the impact of OBRA regulations on the prescribing of psychotropic drugs in nursing homes.2,7,8,10,11 Researchers confirm an encouraging trend toward increased awareness of the indications for neuroleptic drugs and the side effects of these medications.2

Since OBRA was enacted, overall use of antipsychotic drugs in nursing home residents has declined by nearly one third,10 and prescriptions for antidepressants have increased8 (by almost 85 percent in one study10). Furthermore, selective serotonin reuptake inhibitors (SSRIs), nortriptyline (Pamelor) and trazodone (Desyrel) are being prescribed significantly more often, and amitriptyline (Elavil) and doxepin (Sinequan) are being used less often.8

The prescribing patterns for anxiolytic and sedative-hypnotic drugs are less consistent. One large study documented a 12 percent increase in prescriptions for anxiolytics but found decreases in the prescribing of particular agents, such as diazepam (Valium) and diphenhydramine (Benadryl).8 Two studies2,7 unequivocally cited the implementation of OBRA regulations, rather than other educational and consultative interventions, as being responsible for decreased use of neuroleptic drugs and lower dosages of these agents when they are used.

A recent review11 found that specific guidelines (on appropriate diagnosis, target symptom documentation and reasonable dosage level) were widely followed, with compliance rates ranging from 70 to 90 percent. Less specific guidelines (on attempts to use nonpharmacologic interventions and the monitoring of drug efficacy and safety) were less well followed, with compliance rates below 55 percent.

Recommendations for the Clinical Use of Psychotropic Drugs

Prescribed judiciously, psychotropic drugs can enhance the physical and psychologic well-being of the elderly. However, altered drug disposition makes this age group particularly sensitive to undesirable side effects, which can lead to a decline in medical and functional status or the use of additional prescriptions and an increased risk of drug interactions. Psychotropic medications, including side effects and recommendations on use in the elderly, are briefly reviewed in the following sections.

ANTIDEPRESSANT DRUGS

OBRA requirements for the prescribing of antidepressant drugs are limited. The legislation mandates only documentation of an appropriate diagnosis, use of a reasonable dosage (Table 4), clinically acceptable duration of use and monitoring for common adverse reactions.

View/Print Table

TABLE 4.

Antidepressant Drugs and Dosages Preferred for Use in the Elderly

DRUGS GERIATRIC DOSAGE (MG PER DAY) SIDE EFFECTS
STARTING DOSAGE MAINTENANCE DOSAGE SEDATION AGITATION ANTICHOLINERGIC EFFECTS ORTHOSTATIC HYPOTENSION

Tricyclic antidepressants

Desipramine (Norpramin)

25

50 to 150

Low

Low

Low

Low

Nortriptyline (Pamelor)

10 to 25

40 to 75

Moderate

Low

Low

Selective serotonin reuptake inhibitors

Citalopram (Celexa)

20

20 to 40

Low

Low

Fluvoxamine (Luvox)

50

50 to 200

Low

Low

Paroxetine (Paxil)

10

20 to 30

Low

Low

Sertraline (Zoloft)

25 to 50

50 to 150

Low

Low

Miscellaneous

Bupropion (Wellbutrin)

100

100 to 400

Moderate

Low

Nefazodone (Serzone)

100

100 to 600

Moderate

Low

Low

Trazodone (Desyrel)

25 to 50

50 to 300

High

Low

Moderate

Venlafaxine (Effexor)

75

75 to 350

Low

Low

Low

Low


— = Very low or insignificant effects.

Nevertheless, choosing antidepressants with suitable side effect profiles is important in geriatric patients. The older tricyclic antidepressants, although highly effective, have side effects to which the elderly are especially sensitive. Of particular concern are excessive sedation, anticholinergic effects (dry mouth, constipation, urinary retention, blurred near vision, tachycardia and confusion), orthostatic hypotension and electrocardiographic changes. In elderly patients, it is better to use tricyclic antidepressants that cause less severe anticholinergic effects and orthostatic hypotension, such as nortriptyline and desipramine (Norpramin).

Subtle differences among SSRIs should also be considered. The half-lives reported for fluoxetine (Prozac) and its active metabolite are long (84 and 146 hours, respectively).12 Because of fluoxetine’s long half-life and the persistence of side effects (sometimes for weeks after discontinuation), this drug is generally not recommended for use in elderly patients. Sertraline (Zoloft) and its metabolite have considerably shorter half-lives (25 and 66 hours, respectively). Paroxetine (Paxil), which has no active metabolite, also has a considerably shorter half-life (24 hours) than fluoxetine.12,13

Most SSRIs are associated with significant drug interactions. Fluoxetine, paroxetine and, to a lesser extent, sertraline inhibit the metabolism of warfarin (Coumadin), cisapride (Propulsid), benzodiazepines, quinidine, tricyclic antidepressants, theophylline and some statins.12 In patients at risk for these interactions, citalopram (Celexa), a new SSRI now available in the United States, may offer an advantage. Studies have shown that compared with other SSRIs, citalopram has less of an inhibitory effect on the cytochrome P450 system.14 Citalopram is as effective as fluoxetine and sertraline in the treatment of depression.14

Trazodone and nefazodone (Serzone) are also recommended for use in the elderly. Both of these drugs are fairly sedating (trazodone more so than nefazodone) and therefore are useful in elderly patients with depression and agitation or insomnia. Because trazodone is associated with significant orthostatic hypotension, nighttime dosing may be preferable. If trazodone causes excessive sedation or postural hypotension, nefazodone is an alternative. However, nefazodone inhibits the cytochrome P450 3A4 pathway, and it may exhibit dangerous interactions with cisapride.12

Venlafaxine (Effexor) and bupropion (Wellbutrin) are effective, well-tolerated antidepressants that lack significant anticholinergic side effects. Because bupropion is structurally related to stimulants, bedtime administration should be avoided. Bupropion in dosages above 400 mg per day is associated with seizures.12 In dosages exceeding 200 mg per day, venlafaxine causes increased blood pressure in 3 to 13 percent of patients.12 Therefore, higher dosages of these drugs are not recommended.

The tetracyclic drug mirtazapine (Remeron) is another newer antidepressant. This drug is a weak blocker of alpha-adrenergic and muscarinic receptors. Because of these actions, mirtazapine can cause orthostatic hypotension and anticholinergic effects; however, these side effects are less severe than those occurring with tricyclic antidepressants. Somnolence has been reported by more than 50 percent of patients treated with mirtazapine.15 Research on the use of this drug in geriatric patients has been limited.12,15

Most antidepressants have a long enough half-life in the elderly that they may be given as a single dose in the morning or evening, depending on the sedative or activating properties of the particular drug. Dosages need to be titrated carefully: the more gradual the titration, the lower the likelihood of side effects.

Typical antidepressant dosage ranges are one half of those used in younger patients. Occasionally, however, a full dosage is needed to yield a therapeutic effect.

ANXIOLYTIC AND SEDATIVE-HYPNOTIC DRUGS

Benzodiazepines are indicated for the short-term management of anxiety and insomnia, but nonpharmacologic measures should be tried first. Emphasizing good sleep habits is a first step and should include decreasing afternoon caffeine intake, exercising regularly before dinner, avoiding naps, establishing regular sleep hours, treating nighttime pain, addressing nocturia and maintaining a comfortable bedroom environment (temperature, noise level, lighting, etc.).

When benzodiazepine therapy becomes necessary for older patients, it is preferable to use short-acting agents. Elderly patients can better tolerate temazepam (Restoril) and lorazepam (Ativan), which have relatively short half-lives (three to 18 hours and 10 to 16 hours, respectively) and relatively short durations of action.16,17 Long-acting benzodiazepines, which have half-lives that may exceed 100 hours, carry higher risks for elderly patients. Indeed, the continuous administration of a long-acting benzodiazepine can lead to profound confusion, cognitive impairment and falls. For this reason, OBRA guidelines permit the use of long-acting benzodiazepines in residents of long-term care facilities only if a trial of short-acting benzodiazepines fails.

Side effects of all benzodiazepines include excessive sedation, psychomotor slowing, cognitive impairment, confusion, forgetfulness, morning “hangover” effect, ataxia and falls. Occasionally, dysphoria, irritability and agitation develop in elderly patients treated with these drugs.16

Zolpidem (Ambien) is a newer medication with some advantages as a short-term sleep aid for the elderly. Compared with benzodiazepines, zolpidem appears to carry less risk for the development of tolerance, withdrawal phenomenon or rapid-eye-movement rebound. Side effects of zolpidem include drowsiness, dizziness, headache and gastrointestinal upset.17

OBRA regulations permit the use of antihistamines such as diphenhydramine and hydroxyzine (Atarax, Vistaril) for the management of anxiety and insomnia in elderly patients. However, even in low dosages, these drugs are associated with impairment of daytime functioning.17 Furthermore, the anticholinergic effects of antihistamines (delirium, confusion, disorientation, etc.) may exacerbate problem behaviors.17

Sedating antidepressants in low dosages are often used to treat insomnia. Nortriptyline (in a dosage of 10 to 25 mg per day) and particularly trazodone (in a dosage of 25 to 150 mg per day), which exhibits no anticholinergic effects, are well suited for use in geriatric patients.17

OBRA-specified dosages of commonly used anxiolytic and sedative-hypnotic drugs are listed in Table 5.

View/Print Table

TABLE 5.

Anxiolytic and Sedative-Hypnotic Drugs Commonly Used in the Elderly

DRUGS GERIATRIC DOSAGE (MG PER DAY)*
ANXIETY INSOMNIA ONSET OF ACTION

Short-acting agents

Benzodiazepines

Alprazolam (Xanax)

0.75

0.25

Intermediate

Estazolam (Prosom)

0.5

0.5

Fast

Lorazepam (Ativan)

2

1

Intermediate

Oxazepam (Serax)

30

15

Slow

Temazepam (Restoril)

15

Intermediate

Triazolam (Halcion)

0.125

Fast

Antihistamines

Diphenhydramine (Benadryl)

50

25

Fast

Hydroxyzine (Atarax)

50

50

Fast

Miscellaneous

Zolpidem (Ambien)

5

Fast

Long-acting agents

Benzodiazepines

Chlordiazepoxide (Librium)

20

20

Intermediate

Clonazepam (Klonopin)

1.5

1.5

Intermediate

Clorazepate (Tranxene)

15

15

Fast

Diazepam (Valium)

5

5

Very fast

Flurazepam (Dalmane)

15

15

Very fast

Halazepam (Paxipam)

40

20

Slow

Prazepam (Centrax)

15

15

Slow

Quazepam (Doral)

7.5

7.5

Intermediate


— = Not indicated.

*—The dosages given in this table are as established by the Health Care Financing Administration guidelines for fulfilling the requirements of the Omnibus Budget Reconciliation Act (OBRA) of 1987. They are not the maximum dosages. When the OBRA-specified dosage of a drug is exceeded, documentation of necessity is required.

ANTIPSYCHOTIC DRUGS

Because of their many deleterious side effects, antipsychotics should be used only as a last resort in the management of behavioral problems in the elderly (Table 6). The efficacy of these drugs for most problem behaviors is debatable. In several studies,5,8 antipsychotics have been no more effective than placebo. Some investigators believe that antipsychotic drugs should be used only for the management of psychotic features that cause patients “serious distress.”7

View/Print Table

TABLE 6.

Antipsychotic Drugs Commonly Used in the Elderly

DRUGS GERIATRIC DOSAGE (MG PER DAY)* SIDE EFFECTS
SEDATION EXTRAPYRAMIDAL EFFECTS ANTICHOLINERGIC EFFECTS ORTHOSTATIC HYPOTENSION TARDIVE DYSKINESIA

Phenothiazines

Chlorpromazine (Thorazine)

75

High

Moderate

Moderate

High

Yes

Fluphenazine (Prolixin)

4

Low

High

Low

Low

Yes

Mesoridazine (Serentil)

25

High

Low

High

Moderate

Yes

Prochlorperazine (Compazine)

10

Moderate

High

Low

Low

Yes

Promazine (Sparine)

150

Moderate

Moderate

High

Moderate

Yes

Trifluoperazine (Stelazine)

8

Low

High

Low

Low

Yes

Triflupromazine (Vesprin)

20

High

Moderate

High

Moderate

Yes

Thioridazine (Mellaril)

75

High

Low

High

High

Yes

Thioxanthene

Thiothixine (Navane)

7

Low

High

Low

Moderate

Yes

Butyrophenone

Haloperidol (Haldol)

4

Low

Very high

Low

Low

Yes

Dibenzoxazepine

Loxapine (Loxitane)

10

Low

Moderate

Low

Low

Yes

Dihydroindolone

Molindone (Moban)

10

Moderate

Moderate

Low

Low

Yes

Atypical antipsychotics

Clozapine (Clozaril)

50

High

Low

High

Moderate

Low

Olanzapine (Zyprexa)

10

Moderate to high

Low

Moderate to high

Moderate

Low

Quetiapine (Seroquel)

200

Moderate

Low

High

Moderate

Low

Risperidone (Risperdal)

2

Low

Low

Low

Low

Low


*—The dosages given in this table are as established by the Health Care Financing Administration guidelines for fulfilling the requirements of the Omnibus Budget Reconciliation Act (OBRA) of 1987. They are not the maximum dosages. When the OBRA-specified dosage of a drug is exceeded, documentation of necessity is required.

Common side effects of antipsychotics include sedation, anticholinergic effects, orthostatic hypotension, extrapyramidal symptoms and tardive dyskinesia. Extrapyramidal symptoms include dystonic reactions, pseudoparkinsonism and akathisia. All extrapyramidal symptoms are reversible on discontinuation of antipsychotic drugs.

Dystonic reactions are acute spasms of muscle groups and can result in a fixed upward gaze, neck twisting, facial muscle spasms causing grimacing, a clenched jaw and difficulty with speech. Often painful, dystonic reactions can be quite frightening to patients. These reactions typically occur soon after an antipsychotic drug is initiated.

Pseudoparkinsonism presents with classic parkinsonian symptoms such as rigidity, slowed movements, shuffling gait, slow, monotonous speech and pill-rolling tremor. The symptoms develop over a few weeks of antipsychotic drug therapy.

Akathisia is a form of agitation. Symptoms include inability to sit still, pacing, restlessness, foot tapping, and rocking and shifting of weight while standing. It can be difficult to distinguish akathisia from the agitation that is often present in patients with dementia. Akathisia generally appears days after the initiation of an antipsychotic medication.

Although often considered an extrapyramidal symptom, tardive dyskinesia is a separate, mechanistically distinct phenomenon. It is a long-term side effect that may persist after an antipsychotic drug is discontinued. Typical symptoms are rhythmic involuntary movements of the tongue, lips or jaw, such as protrusion of the tongue or puckering of the lips. Irregular involuntary movements of the extremities or spine are also possible. All traditional antipsychotics may cause tardive dyskinesia.

Older neuroleptic drugs are classified as high, moderate or low potency. Antipsychotic drugs with higher potency have a greater affinity for dopamine receptors and tend to cause more extrapyramidal symptoms. Antipsychotics with lower potency have a greater affinity for histaminic, alpha-adrenergic and muscarinic receptors. These drugs are more likely to cause increased sedation, orthostatic hypotension and anticholinergic effects. Elderly patients are sensitive to all these side effects.

Mounting evidence indicates that newer antipsychotics given in low dosages are much less likely to cause extrapyramidal symptoms.18 These drugs, which include clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal), have a greater affinity for dopamine-D2 receptors and are potent antagonists of the serotonin receptor.

Clozapine, olanzapine and, to a lesser extent, quetiapine may cause sedation, anticholinergic effects and orthostatic hypotension. Quetiapine has not been studied in the elderly.18 How this drug compares with other newer antipsychotics remains to be established.19 Risperidone is well tolerated,18 and several studies have demonstrated its efficacy in the management of psychotic and aggressive symptoms in patients with dementia.18,20 Risperidone, in dosages of 0.5 to 1.0 mg per day, has successfully alleviated behavioral disturbances in patients with Alzheimer’s disease.21,22 Clozapine is somewhat more difficult to use because of its association with agranulocytosis and the need for periodic monitoring of complete blood counts.

Final Comment

Psychotropic medications are sometimes required to maximize quality of life and functional status in nursing home residents. In tailoring pharmacologic regimens for these patients, physicians need to give careful attention to accurate diagnosis, appropriate dosing, side effects, drug interactions and pertinent drug pharmacokinetics. An ongoing evaluation of effectiveness requires reassessment at regular intervals to rethink medication regimens in light of changes in the health status of geriatric patients.

The Authors

show all author info

TATYANA GURVICH, PHARM.D., is a clinical pharmacologist in the family practice residency program at Glendale (Calif.) Adventist Medical Center. She received her doctor of pharmacy degree from the University of Southern California School of Pharmacy, Los Angeles, where she also completed a residency in geriatric pharmacology.

REFERENCES

show all references

1. Christensen DB, Benfield WR. Alprazolam as an alternative to low-dose haloperidol in older, cognitively impaired nursing facility patients. J Am Geriatr Soc. 1998;46:620–5.

Richard W. Sloan, M.D., R.PH., coordinator of this series, is chairman and residency program director of the Department of Family Medicine at York (Pa.) Hospital and clinical associate professor in family and community medicine at the Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, Pa.

From Katherine Hine–Warning, the US govt is trying to legalize forced psych drugging!

https://www.madinamerica.com/2016/11/warning-psychiatric-tsunami-upon-u-s/

Warning: A Psychiatric tsuNAMI is Upon U.S.

Well, our government is at it again.

(However, one correction — HR 34 has already passed, it’s the “21st Century Cures” amendment to HR 34 we need to oppose.)

text of bill can be found here:

http://docs.house.gov/billsthisweek/20161128/CPRT-114-HPRT-RU00-SAHR34.pdf

It is not clear if this is the last stop, or where in the process we even are, but as best I can tell: happening any moment, Congressman Tim Murphy (R, Pennsylvania) will be making another speech at another hearing about the Helping Families in Mental Health Crisis Act (H.R. 2646) which is now part of a new bill, H.R. 34.

H.R. 2646 was the controversial legislative package that did everything from increasing and sanctioning state-sponsored forced and court-ordered psychiatry to the re-organization of SAMHSA. There was not a group that went unscathed: babies, pregnant and lactating women, children, teens, adults, and veterans. The mixing of drug experimentation, programming, payments, delivery, tracking systems, prison systems, psychiatric systems, medical systems, educational systems—everything accounted for in 996 pages.

This new bill, introduced on the day after Thanksgiving, November 25, 2016 is part of a pattern of the government trying to slip controversial psychiatric policy through when no one is thought to be watching. We recently saw this with the FDA’s shock treatment regulation for comment being released days before the new year and due the day after a celebrated holiday.

This bill, H.R. 34, the Tsunami Warning, Education, and Research Act of 2015 [21st Century Cures Act] is the subject of a hearing at the Capitol, in H-313, tonight on Tuesday, November 29, 2016 at 5:00 PM. Among the most problematic issues this bill presents are multiple provisions for forced psychiatry not limited to IOC/AOT, ACT Teams, and Prison Psychiatry.

H.R. 34 also includes: SAMHSA reorganization, condoning of HIPPAA violations, electronic health records, a study of peer support specialists for future controls of the field, multiple attacks on young people and veterans, and a host of other potential human rights violations. Psychiatry is a fraud and this bill perpetuates it.

Tell your legislators to VOTE NO on H.R. 34!

Demand that your legislators stop sneaking controversial, damaging bills into other bills at the last minute. What is being called a “simple parliamentary procedure” seems rather shady to me. The legislature has not been able to pass some version of Murphy’s bill for years, and now they are going to try to sneak it in merged with the 21st Century Cures Act under the title Education, Research and Tsunami Warning Act of 2015. These actions further problematize our legislative processes.

It is urgent that people realize that no child will grow up without psychiatric evaluation. All people will become, in a generation or two, acclimated to being psychiatrized; psychiatry and its arms of drugs and institutions will become even more standard in our society.

At the very moment that people are becoming more vocal about the need for equality, eliminating racism and racist practices and systems, calling out sexism, homophobia, transphobia, xenophobia, and other forms of structural oppression, and addressing the outright fraud and other structural problems of psychiatry and its subdivisions, the government will solidify psychiatric practice in our society. This includes a great expansion of psychiatric reach into the prison industry and court systems.

Do not be fooled, this is a one way path that will allow the new administration the type of reach they want to keep us contained as they break down the existing structure, creating greater disparities, and further subjecting us, as a people who are already often oppressed, into further social control and subjugation to psychiatry.

Follow up with your legislators, and all legislators you can. Inform them about the dangers of psychiatry. Inform them about the dangers of this bill. Tell them that a bill that has been combined with multiple other bills totaling 996 pages (and involving who knows how many billions of dollars in taxpayer resources)—a bill that was introduced 3 business days prior to its hearing and 4 days prior to its assumed vote, under the name of a bill that has already passed, but has been deleted and replaced by this mess that has not been able to pass on its own for years—is not acceptable.

I am sure analyses of what the bill entails need to be made and many are working on making them. For now, take action. Call your elected officials today, tonight, tomorrow, and continue to do so to make your voice heard. The pro-psychiatry, pro-forced psychiatric treatment advocates are launching campaigns against us. We need to speak out, once again, for ourselves. No one else will. Make your calls now.

Find your Representatives in Congress

Find your Senators

H.R. 34 Bill Text

H.R. 34 Hearing Information

Those who want to take a closer look at this bill, please read on:

Even a cursory glance at the Table of Contents and the twenty-five titles it encompasses makes one have to take a deep breath to get the scope of how this bill can fundamentally transform our society—and not for the better.

Division A – 21st Century Cures starts off with Title I, NIH Innovation Projects and State Responses to Opioid Abuse. Title II includes Innovation Projects and includes privacy protections for human research subjects—a section called “High Risk, High Reward Research” is included here, as is the development of a “Taskforce specific to pregnant and lactating women.” These need to be read carefully.

Title III is Development and includes provisions such as patient-focused drug development, advancing new drug therapies, and a host of other sections designed for research on physical health.

Title V addresses Savings and this looks at issues of Medicare and Medicaid, and affects the Affordable Care Act.

Section VI looks at Leadership and Accountability and this is where the re-organization of SAMHSA is laid out and the provisions for the establishment of the “Interdepartmental Serious Mental Illness Coordinating Committee” can be found.

Title VII is designed for “Ensuring mental and substance use disorders prevention, treatment, and recovery programs keep pace with science and technology” and has both regional and national goals.

Title VIII is for “Supporting state prevention activities and responses to mental health and substance use disorder needs” that work on block grants.

Title IX is for “Promoting access to mental health and substance use disorder care” and these include grants for “treatment and recovery for homeless individuals”; “jail diversion programs”; “promoting integration of primary and behavioral health care”; “National Suicide Prevention Line” and other types of programs that track and turn in people to the system, acting as a pipeline to psychiatry. Section 9014 is “Assisted outpatient treatment” and Section 9015 is the Assertive Community Treatment grant program. It is important for people to specifically speak out against Sections 9014 and 9015 as inherently problematic for protecting human rights.

Subtitle B of Title IX is focused on “Strengthening the Health Care Workforce” and this includes education and training programs. Subtitle C targets college campuses.

Title X is for “Strengthening mental and substance use disorder care for children and adolescents” and increases pediatric access, programming, treatment, and interventions for young people, “screening and treatment for maternal depression” and Section 10006 is particularly worrisome, “Infant and early childhood mental health promotion, intervention, and treatment.”

Title XI is the loss of privacy rights under HIPAA (you may recall issues around Matsui’s billthat was basically incorporated into the structure).

Title XII further strengthens “Mental Health Parity” which works on the premise that psychiatry is as legitimate a science as physical health medicine, and perpetuates the fraud of the pharmaceutical and psychiatric industries, ensuring also that training, education, information and awareness of eating disorders are covered under these processes.

Title XIII is for “Mental Health and Safe Communities” Subtitle A includes the expansion and over reach of Law Enforcement and Psychiatry working hand in hand through Involuntary Outpatient Commitment (torture) “Assisted Outpatient Commitment” (as a second section in this same bill, here Section 14002. Title XIII also includes “Federal drug and mental health courts”; “mental health in the judicial system”; “Forensic Assertive Community Treatment Initiatives”; “mental health training for Federal uniformed services”; “school mental health intervention teams”; “Active-shooter training for law enforcement”; “Improving Department of Justice data collection on mental illness involved in crime”; and “Reports on the number of mentally ill offenders in prison”, further attempting to discriminate against people with psychiatric histories. In this section, the limited patients’ rights for the Department of Veterans Affairs are noted, and this of course is and continues to be a concern; for example, we know veterans and their fetuses are being subjected to shock treatment.

Subtitle B focuses on “Comprehensive Justice and Mental Health” in prisons and jails, local and federal law enforcement training, and GAO reporting and needs to be looked at very carefully in the future.

Title XV addresses Medicare Part A and reimbursements. Title XVI, Medicare Part B and treatment/payments/ and Continuing Access to Hospitals Act of 2016; all of which need thorough review.

Title XVII includes other Medicare provisions and XVIII still other provisions around employer health reimbursement.

Division D is “Child and Family Services and Support” and includes Title XIX, “Investing in Prevention and Family Services”, restructuring prevention services, programs, and payments as they relate to foster care, and perhaps one of the few sensible things, Section 19032, “Development of a statewide plan to prevent child abuse and neglect fatalities.”

Title XXI looks also and securing support for foster families and children and Title XXII addresses “reauthorizing adoption and legal guardianship incentive programs.”

Title XXIII is for “Technical Corrections” for data and programming and “Technical corrections to State requirement to address the developmental needs of young children.”

Title XXIV is for “Ensuring states reinvest savings resulting from increase in adoption assistance” and like “Title XXV, Social Impact Partnerships to Pay for Results” and the extension of the TANF program and other types of social supports, this needs to be read and understood.

From Ken Ditkowsky–Time to End the Silence! The public outcry for judicial accountability is deafening.

To:
Subject: Re: News Alert: Annoyed Dems dismiss recount as ‘waste of time’ – What should the real headline be?????
Date: Nov 29, 2016 2:13 PM
Take a look outside today – the Sun is out, the weather is mild, the air is fresh, and it is great to be alive.  It is even a quiet news day!    However, the media is up and at them pouring vitriol and irrelevancy into the atmosphere.
The real news of the day is obscured by nonsense such as the recount, who President elect Trump is going to appoint for his personal dog=catcher and who Senator **** objects to him because of his stand on *****.   However, lets look at two fact situations:
Fact situation 1.   An attorney, is involved in a company that supplies Hospice services to the dying.   He has a company, and is the Trustee of employee funds – such as their retirement funds.   It is discovered that this attorney in engaged in a fraud wherein he steals millions of dollars of Government health care funds.  Upon his discovery he steals the employee trust funds.   He is indicted and his trial is set.   At his trial he pleads guilty.
Fact situation 2.   An attorney is involved in the active practice of law.  During the course of his practice (or her practice) the attorney discovered that certain Judges are “wired”  (“fixed”) or otherwise corruption.   Pursuant to 18 USCA 4 and Attorney Rule 8.3 the attorney reports the criminal activity that he/she observes.
My question is very simple.   Which attorney is more ethically challenged?
Here in Illinois I am referring to actual cases that have been presented to the Illinois Attorney Registration and Disciplinary Commission.   The commission – affirmed by the Supreme Court of Illinois determined that the attorney in Fact Situation 2 was the not only unethical but deserved to have his/her law license suspended.   In two of the three cases in which this fact situation 2 occurred the offense was so obscene to the Supreme Court of Illinois that interim suspensions were imposed!
It is submitted that the two fact situations represent ipso facto represent serious problems for a democratic society.   The suppression of the duty of the legal profession to expose criminal conduct within the judicial system is not only reprehensible but a breach of the public trust.   It is one of the most serious breaches of the public trust as it is a ‘gold standard of corruption!’ and totally contrary to the core values of America.   Why is the media not interested?   Why is there no hue and cry?    How do the miscreants get away with their perfidy?
The fact is they do because the media is obsessed with worrying about non-issues and frightened to disclose Establishment political and judicial figures raping Ms. Liberty!   Like it or not, this scenario has been the proximate cause of the Sanders and the Trump movement.   It may sound like an old record, but no matter how the present political climate is couched the average American no longer is going to voluntarily tolerate from any political or judicial figure calling US stupid, or insisting that up is down, right is left, dark is light *****.
That said, the rumblings of dissent are starting to grow.   The cover- up is also gaining momentum!    No amount of recounts are going to change Wrong into Right or confuse fidelity and honesty with deceit and fraud.   That does not mean that the miscreants are not going to try.    The Attorney Registration and Disciplinary Commission is still going to try and we can expect that the Supreme Court of Illinois will rubber=stamp their perfidy.    The fact situation 1 scenario is the Seth Gillman proceeding.    The actual criminal acts of Seth Gillman were not sufficient for anything but cursory action on the part of the Attorney Registration and Disciplinary Commission of Illinois; however, when it became public that Mr. Gillman was co-operating with the FBI in its investigation of similar criminal scenarios the IARDC acted promptly – it requested from the Illinois Supreme Court an interim suspension of Mr. Gillman’s license.
Obviously, the alleged (now admitted) theft of trust funds, health care funds and fraud were to plebeian for such an ‘august’ group such as the IARDC to concern itself with; however, the co=operation of Gillman (like the facts in fact situation 2) merited immediate response.
NB.  it has been reported that the IARDC acted in a similar manner when Operation Greylord was being undertaken by the United States of America.
Why does the press (media) not cover such serious assaults on America by the public officials at the IARDC and the Illinois Supreme Court?     We all know the reason!     We also know that today is the day that we  – i.e. you and me – have to take some action to removed the corrupt public officials from office and shame the media into doing its job and honestly and appropriately exposing the criminals who prey on us (us being you, me and the great unwashed).
If we remain silent and allow the mainstream media to distract us from the duty that we have of protecting ourselves – we will have no democracy, no freedom, and no republic.
 
Ken Ditkowsky
From Joanne;
And I still note that the City Lawyers have not turned over numerous tapes of blacks and minorities being gunned down on Chicago’s South Side.  What attorneys are covering that mess up at the ARDC and costing taxpayers millions by enraging federal court judges to issue sanctions and the little guy gets no relief.
It has been reported on this blog highly suspicious property records by judges and clouted attorneys and the ARDC wherein it appears one person takes out a loan, and another (ingratiated and looking for quid pro quo) is paying it off; i.e. money and bribe laundering.
It would take the FBI or the states attorneys minutes to get a warrant and pull the bank records to see the type of individuals expecting quid pro quo for hundreds of thousands of dollars per miscreant.
This blog has been publishing this information for quite a long time now, yet no indictments have appeared on the horizon.
Illinois citizens should be asking why?  Is not the FBI still getting millions for investigations.  Is not the IRS and Illinois Dept of Revenue listening?
How much clout does it take to cover up hundreds of thousand in bribes?
Why was it determined that one states atty from a small county was found with $500k in her election campaign fund. Who put it there and what are they expecting for quid pro quo on that amount.
Just where are the state’s attorneys, OIG (Office of Inspector General) and the FBI on all of this.
Again, more questions than answers.
The Public deserves better from its elected and appointed officials who are paid hamsomely to do their job.
JoAnne