Shocking statistics for Jefferson & Clallam Counties in opioid database from Washington Post.

In the battle to determine who is to blame for the opioid epidemic that has killed more people than Viet Nam, it turns out that not only was West Virginia a capital of opioid prescriptions, but Clallam County was also. Between Jefferson and Clallam Counties, in a six year period both counties received and distributed over 43 million opioid pills!

According to the Washington Post that reformatted the data into searchable form, from 2006 to 2012 there were 5,817,030 prescription pain pills, enough for 28 pills per person per year, supplied to Jefferson County, Wash. Safeway was the largest distributor, selling 2,331,220 pills. Don’s pharmacy came in at 1,367,550 pills distributed, behind second place QFC in Hadlock.

But even those numbers were dwarfed by Clallam county, who distributed 37,838,060 prescription pain pills, enough for 76 pills per person per year.

•18,067,280 of the pills in Clallam County were distributed by McKesson Corporation and 19,907,900 were manufactured by SpecGx LLC.

JIM’S PHARMACY, PORT ANGELES pharmacy received the highest number of pills. They distributed 5,280,190 pills. But Chinook Pharmacy in Forks was not far behind with over 4.6 Million pills distributed.

It is clear to anyone following this story that a number of people are at the root cause of this human tragedy. Let’s count the ways:

  • There is clear evidence now that the pharmaceutical companies lied to the public and the government. Lawsuits underway have established that fact. Their salespeople spread misinformation about the products.
  • The Federal government, lawmakers, FDA and others, blindly took the word of the drug companies as to the safety and efficacy of these drugs.
  • The medical community bought the medical findings and the pharmaceutical sales peoples pitches. This included the medical providers at our local hospital, Jefferson Healthcare. This can be seen as a damning indictment of the the medical providers there, along with the administration of the hospital and it’s hospital commissioners. Who was watching the amount of pills being provided to patients? There were clear signs that there were problems with opioid prescriptions much earlier than 2012. What was Jefferson Healthcare doing to monitor their staff?
  • At the same time the medical professionals at JHC were writing all these prescriptions for opioids, they were well aware of problems with them,because Dr. James Kimber Rotchford was treating many of their patients for abuse of these same pain killers at his independent clinic, Olympic Pain and Addiction Services . It was widely known within the local medical community and a number of these providers were quite dismissive of Dr. Rotchford’s efforts. Dr. Rochford’s clinic was raided by the DEA in 2010 but was cleared of any wrongdoing. The basis for the raid was never uncovered.
  • The pharmacies ignored clear warning signs that vastly too many pills to make sense were being sold for their communities.

The outcome was a trail of broken lives, broken communities, massively enriched sales people and companies, many of whom then recycled these gains into political candidates campaign chests.

Read the whole story

https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?utm_term=.9591a96b0d8e

Sequim community members rally at city against addiction-treatment facility | Peninsula Daily News

It’s sad to see such opposition to a possible plan to bring a much needed treatment center for our addicted neighbors on the Olympic Peninsula. The MAT project was not well clarified in this article, which tended to simply focus on public reaction to the project at this meeting. The MAT project itself has been part of an overarching set of money that the Governor and legislature, along with the Congress at the end of the Obama administration, is distributing over a five year period to address opioid addiction. The project includes monies for a three county area, Kitsap, Jefferson and Clallam. This money, designed to put a central treatment facility on the Peninsula, is being looked at for Sequim because it is central to both sides of the Peninsula. It makes sense to put it in Sequim, and the Jamestown S’Klallam have offered up their expertise and land to make this possible.

It has nothing to do with the Trump Administration changing the hospital rules that will possibly force the Olympic Medical Center to close it’s facilities in Sequim. Representative Kilmer is working with other House and Senate members to see if they can reverse the ill advised rule from the Trump Administration, that has put our community clinics in Sequim in jeopardy. And while we all say we want to see treatment for the growing opioid and meth addicts that are in our communities, what are you willing to actually support rather than just say no to?

Read the whole story at the PDN:

Staff: Proposal not yet before council, planning commission
— Read on www.peninsuladailynews.com/news/sequim-community-members-rally-at-city-against-addiction-treatment-facility/

Trump Administration Slashes Medicare/Medicaid Payments. Local Hospital Is Targeted

The Peninsula Daily News (PDN) is reporting that the Trump Administration, against the wishes of hundreds of letters and testimony against it, is slashing Medicare and Medicaid reimbursal rates to clinics more than 250ft away from a central hospital. The new rule is called the “CY (for Calendar Year) 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System”

The rule announcement from July is found at

https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-and-ensures-site-neutral-payment-proposed-rule

and the October 30th update is found here:

https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-hospital-outpatient-and-ambulatory-surgical-center-policy-and-payment-changes

The goal of the proposed rule was to eliminate patient clinic visits to hospital clinics that charge more than non hospital clinics. The Center for Medicare and Medicaid Services (CMS) claims in it’s press release that, “Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.” They offer no proof to that claim.

The most affected facility for this on the Olympic Peninsula is Olympic Medical Center’s (OMC) offsite clinics in Sequim. Ironically the clinics serve a population that voted for President Trump in the last election and they will, if this rule is not overturned via legislation, be the most effected by it. The chart at the link below shows how various precincts voted in 2016.

https://www.nytimes.com/interactive/2018/upshot/election-2016-voting-precinct-maps.html#8.27/47.920/-122.715

The PDN is reporting that payments may be slashed up to 60%, which would apparently make these clinics financially nonviable. Medicare and Medicaid payments today are so lean that many physicians do not take new Medicaid/Medicare patients because they cannot survive on the reimbursal rates.

The outcome of this will be that seniors and the poor will have to travel further for medical care, and that some hospitals, like OMC may be forced to close their remote facilities and possibly even put their main hospitals in financial jeopardy. Hospital closings in the last decade in rural areas have reached new highs, leading to rural areas often being the most under-served areas for healthcare in the country. Forbes magazine, in 2017, had an article that researched the issue and found that “Approximately 2300 rural hospitals are in the United States. Of those, 81 have closed since 2010.” Forbes went on to show how President Trump’s proposed healthcare cuts were putting “673…at risk of closing”. The full story from Forbes is available at https://www.forbes.com/sites/bisnow/2017/07/26/obamacare-repeal-could-cripple-rural-hospitals-and-lead-to-more-closures/#6dbd6b4f42b8

It is not known how this will affect Jefferson Healthcare (JHC) as they have kept their clinics within the required 250 yard rule. They have worked around the issue by setting up their clinics in Quilcene and Port Ludlow in a different legal framework. They claim that they will be less affected.

There have been rumors from healthcare providers that other standalone clinics may be affected, those not attached to a hospital. We will track those as we hear from the community. Your comments and insights are welcome to be sent to albergstein@gmail.com

What is happening is an ongoing push to centralize healthcare in urban centers and reduce the costs. While healthcare costs are rising, much of these costs are centered in the last years of life. Our insistence on providing all out high cost medical support to terminally ill patients, for example, rather than focusing on expanded hospice care has led to a heavy weighing of costs to end of life medical intervention. From personal experience, I can say that in some locales there seems to not be honest dialogue between patient and provider about the likelihood of a successful outcome, leading to the patient not knowing that they are essentially terminally ill and wanting to continue, under the providers suggestions, with expensive treatment that will only likely extend life a few months.

Medical providers are also, due to litigation costs, often insisting on far more tests than necessary, driving up costs. There is no easy route out of that issue, as patient expectations are not often aligned with actual healthcare scenarios and outcomes. The inability to also properly judge physician history and ratings also make it hard for patients to know when some providers have a history of malpractice.

But the slashing of medicaid and medicare costs to OMC and other hospitals like it, is a cynical ploy by the Trump Administration and Congress to do a stealth attack on these services, one which was highlighted in an article last month.

Larry Kudlow, the director of the Trump White House’s National Economic Council, recently said he wants to take aim at “entitlements” as early as “next year.” A few months earlier, House Speaker Paul Ryan (R-Wis.) said he wants to see policymakers bring the budget closer to balance by cutting “entitlements.” Rep. Steve Stivers (R-Ohio), who currently chairs the National Republican Congressional Committee, made the same argument in August.

And now Senate Majority Leader Mitch McConnell is making the identical pitch.

http://www.msnbc.com/rachel-maddow-show/mcconnell-eyes-cuts-medicare-social-security-address-deficit

This all comes after slashing taxes to the wealthiest Americans and corporations earlier in the year.

It is worth remembering that this administration and previous ones have spent approx. $170M a day for 16 years funding the war in Afghanistan. We have the money to fund Medicare and Medicaid at appropriate levels. It’s all about priorities.

Just last month, our legislators from both Clallam and Jefferson counties, including some of our county and hospital commissioners and executives, traveled to Washington D.C. and met with numerous staffers, both at the White House and Congress. Some of them, such as Republican Congresswoman Jamie Herrera Butler, was not in Washington and sent out a staffer who knew nothing of the issues.

It remains to be seen if our legislators can fix this problem in Congress next year. If you want to help ensure it gets done, vote Democratic on Tuesday November 6th. Putting Democrats at least in charge of the House will allow a real debate and bipartisan approach on how this all proceeds. Representative Kilmer, who is up for re-election, along with other Democratic Representatives have been fighting hard to protect rural hospitals. These politicians are not perfect. None of them will agree with all of us all the time. That’s just not how this representative democracy works. But these Democratic politicians in our district have a track record and to elect more Republicans and expect a different outcome seems unrealistic.

Otherwise these kind of cuts are going to continue to come at us, with the outcome being far worse healthcare options for all of us, no matter who you voted for in this election. This is not “making America great again.”

The final rule will appear in the November 13, 2015 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.

 

One-of-a kind collaboration expected to train health care workers on Peninsula – PDN

This is a great idea to try and work to train and bring on qualified local people quickly.  Thanks to the Littlejohns and the Jamestown S’Klallam Tribe for also helping to fund the initiative. Jefferson Healthcare has tried with little success to find medical professionals willing to relocate here for the long term. I personally have seen them pass over qualified local candidates in favor of people from elsewhere, only to see them leave after a few years of work here. Now this program presents the opportunity to grow candidates on the peninsula, which is far more likely to having them stay for the long haul. A good use of our tax dollars, I’d say.

PORT ANGELES — Peninsula College is teaming up with health care providers from Clallam and Jefferson counties in a wide-ranging $1 million effort funded by state lawmakers, the college foundation, local hospitals and others. The goal: Add registered nurses, medical assistants and certified nursing assistants to a rural medical industry workforce on the North Olympic Peninsula that is typically starving for job applicants.

http://www.peninsuladailynews.com/news/one-of-a-kind-collaboration-expected-to-train-health-care-workers-on-peninsula/

Medicare proposal bad news for OMC, says CEO – PDN

So here comes the first of many negative changes to the health care from the Republican dominated Congress. There is still a chance this won’t be implemented, but don’t bet on it. Americans have put these people into office, they have taken away the government’s ability to negotiate drug prices and now are going to take away the funds needed to protect the most helpless of us from losing their medications.

PORT ANGELES — In the first six months of 2017, Olympic Medical Center reported a $1.1 million loss in revenue, and it could face more financial setbacks next year if Medicare weakens a discount drug program, Chief Executive Officer Eric Lewis said.

You may need to sign up for a subscription to read this, but please do. Support your local newspaper or you may find it gone!

http://www.peninsuladailynews.com/news/medicare-proposal-bad-news-for-omc-says-ceo/

POINT OF VIEW: The Peninsula’s dental health emergency – PDN

By Dr. Michael Maxwell
ACROSS THE STATE and in the North Olympic Peninsula, low-income people are facing an oral health crisis.
Simply put, there are not enough clinics and providers to serve them.
In Clallam County, only 22 percent of adults on Medicaid and just 41 percent of children on Medicaid received dental care in 2015.
In the same year in Jefferson County, only 12.7 percent of adults on Medicaid and just 37 percent of children on Medicaid received dental care.
This is not a cosmetic luxury but a serious health concern that is taking a huge toll on our communities.
Many health care advocates are urging our state Legislature to address this crisis.
 
Read the rest of the story at:
Dr. Michael Maxwell is a family physician and CEO of the North Olympic Healthcare Network, a ­federally qualified community health center in Port Angeles.
He lives in Port Angeles.