Psychiatric Drug Facts via breggin.com :

“Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems… Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision.” Dr. Peter Breggin
Showing posts with label Health Care Authority. Show all posts
Showing posts with label Health Care Authority. Show all posts

Apr 5, 2013

A MadMother responds to professionals who complain of my "lack of respect"



My response to the State’s Claims
Narrative of events leading up to the termination of my contract:


The department is being dishonest about the circumstances leading up the termination of my contract as an individual care provider.  I was verbally informed on October 30, 2012 by Dirk Bush at the HCS office.  I was at the office because I had received a call from a woman that I had applied to be an individual  in home care provider for, she told me that Dirk Bush, from the Home and Community Services Office, had informed her she could not use me as a care provider. Bush told her that I was disqualified due to a felony conviction for abandoning a client, and that my license was revoked. I knew that my license had never been revoked, and I do not I have a felony record.  


I am not surprised by these events; I am traumatized by them.  It has been my experience that this sort of abuse of power and authority is typical of the Department. I turned in a background authorization form to the ALTC office on the 24th of October, it is the first time the department had requested the authorization since I have been Isaac’s individual care provider in December of 2008. I submitted an identical BCCU authorization to the HCS office on the same day in order to complete the process of becoming a provider for the aforementioned client.  The BCCCU report was downloaded by ALTC the following day, the 25th; it has a handwritten notation on it that says, "11/17/2006 Wapato HCS" next to the highlighted sentence that reports  I answered "yes" to question 13 which is also  highlighted.  The BCCU report returned to HCS is dated October 26, 2012.  Significantly, the BCCU  reports, both the one containing an error and the amended BCCU report have no felony arrests or convictions or negative findings/actions from any source listed.  


After talking receiving the phone call from the client, I called Dirk Bush’s office but could not reach him. I then called the BCCU unit and spoke to Carrie, I told her that I had been denied a job based on the inaccurate report that had been issued. She told me to fax the information she required to issue an amended background report which she promised to generate immediately upon receipt of the requested information.  


I then went to the HCS office to speak to Dirk Bush.  When I arrived, I was told he was out of the office, so I said I would need to speak to his supervisor, and that I would wait.  I waited a short time and a man came out accompanied by two women who stayed behind the counter and behind the partial walls separating the reception area from the office area; only the man came through the door to speak to me.  I didn’t  know who he was, as I had never met Dirk Bush before and the man didn’t introduce himself, I assumed he was a Dirk Bush’s supervisor. The man was obviously not happy that I was there questioning the behavior of a department employee.  He was barely civil, and  proceeded to give me three different excuses for why I had been denied the contract for Margaret’s care.

When I refuted the first excuse he offered, he immediately came up with a second excuse; as soon as he  spoke, I knew for sure he was lying.  I informed him that I knew the second excuse he offered was also not a justification for denying a contract. Immediately after stating this, I had the impression that Dirk Bush seemed very angry. As a care provider, I am supposed to know what is and is not allowed; so naturally, I know what actually does prevent a person from working with vulnerable people. Bush was angry that I had the temerity to question his “authority” and refute his implausible excuses to defend myself. He seemed to be exerting a great deal of effort to remain calm.

I was not.  I was angry, for good damned reason. Bush had not introduced himself, so I pointedly asked him, “who are you? and why didn’t you introduce yourself to me?” As I explained earlier, I had been told Bush was out of the office, so I didn’t know if the man in front of me was Bush, or his supervisor.  When I asked why he hadn’t introduced himself to me, it appeared to make him angrier. He was rude and condescending, it was obvious to me that he had no respect for me whatsoever; and it was plain he felt no need to hide his contempt.  

Bush seemed to become be even more upset when I pointed out that before he had followed the procedures outlined in the WACs; he had misinformed a client that I have a criminal record that I in fact do not have; and he had denied me a job for the same reason.  I pointed out that what he had done is unethical, and  maybe even illegal. I asked if he believed there was anything wrong with how he had failed to inform me of a problem, or give me a copy of the BCCU report as required by law, before he had proceeded to misinform a client; and that because of his failure to follow procedures, he had slandered me. He had a copy of my background report so he knew I have no felony arrests or convictions; and he knew there was never a finding that I had ever abandoned anyone.  He responded by claiming he had done nothing wrong.  

I find it more than a little strange that in the 4 and 5 days between the time that HCS and ALTC respectively had each printed BCCU reports requested  and Dirk Bush falsely informing a client that I  had been disqualified as a care provider; neither ALTC or HCS made any effort to inform me that the department  had decided I was legally no longer qualified to be a state paid care provider, for any reason. They in fact have a duty to inform care providers of such determinations. Dirk Bush, is employed by the State of Washington as a Social Worker 3 for the Department of Social and Health Services, Home and Community Services office in Yakima; in his official capacity as an agent of the State of Washington Dirk Bush slandered me, denied me a 29 hour a month contract based on falsehoods. When I defended myself, he ultimately declared, “I just decided you’re not qualified based on character, competence and suitability, and I don’t need a reason.”  

The next day that I received the formal notification from the HCS office in the mail and  Joel Howell, the case manager at ALTC, called to inform me over the phone that my contract was terminated effective immediately.  Later that afternoon, I went to the ALTC office to pick up the paperwork.  Both notices were dated 10-31- and listed the reason for my termination as the inaccuracies listed on the BCCU report. Two days later,  on November 2nd, I received two more notices that my contract had been terminated, one from ALTC and the other from HCS.  I thought it was more than strange, how could a contract that had already been terminated be terminated a second time for a different reason?  More importantly, why did the second termination not have a state employee listed? The stated reason for the second termination was the one that Dirk Bush had used, “character competence, and suitability”; but the bases was not given in the space provided, and there was no department employee listed for who to contact with any questions.

I drove to the HCS office and I asked Joel Howell’s supervisor the basis of this second  notice terminating my contract when it was already terminated. I was told  by the supervisor, that she didn’t know what information had been used stating, “I wasn’t at the meeting.”  I can only assume she is referring to a meeting that must have taken place after the amended BCCU report was accessed by ALTC on November 1st at 7:12 pm and the termination notice dated November 2nd was mailed in time to be delivered by mail on November 2nd...

It is apparent from the time frame in which these events in fact occurred, that the second termination was issued before any formal determination about my character, competence and suitability was performed. This type of determination has a written protocol, and I can only assume it was not followed since it was not submitted as evidence that my "character, competence and suitability" demands immediate termination of my contract to be my son's care provider. I suspect the second termination was issued in a misguided attempt to cover up Dirk Bush’s unethical conduct since the department is liable for both civil and punitive damages resulting from Dirk Bush’s unethical actions . Dirk Bush exceeded his authority when he verbally terminated my contract on the October 30th; it was a punitive act of retaliation for defending myself when he slandered me.

None of  this explains why Dirk Bush did what he did.  There is nothing on the flawed  BCCU report that would have disqualified me as a care provider---Dirk Bush knew this since he had a copy of the BCCU report.  I believe the fact that I told him that what he had said about me was unethical, and probably illegal, and I suggested that denying a client their choice of a provider without cause is also highly unethical which enraged him.  

At this point, Dirk Bush’s actions and department’s failure to hold him accountable and mitigate the risks of further harm being caused by his unethical conduct, have placed Isaac and I at risk of having utilities shut off or being evicted. I have been deprived of my only income, March will be the fourth month for which I will not be paid, due to Dirk Bush’s actions.  

Once again, State employees have made decisions which have had an adverse effect on my son and myself.  It is not surprising to me that Dirk Bush and ALTC took actions that are not in compliance with the RCWs and WACs; in my experience with the department, it is not unusual for DSHS employees to violate the Law, violate individual rights and refuse to give any reasonable explanations to justify their actions.  

I was told by Joe Howell’s supervisor that only Jackie Klingele could release the information that had been used to determine my “character, competence and suitability” were grounds to immediately terminate my contract, and that only Isaac could sign the release for this information to be given to me.
via DSHS Manual Chapter 7A page 10:
a. Send a Provider Notification (16-198)letter to the provider when you are informing them of a denial and reason. You must terminate the provider with a ten-day notice, unless you believe the client is in imminent jeopardy, in which case termination is immediate, or the IP has a conviction for a disqualifying crime or negative action.  

Chapter 7A page 15:
Advance Notice Termination:
a.    Send the client a 10-day notice when taking action to terminate the IP contract. You must provide a 10-day notice unless you:
·         Have been notified by BCCU that the IP has been convicted of a disqualifying crime;
·         Have been notified by BCCU that the IP has a negative action/is on a registry; and/or
·         Believe the client is in imminent jeopardy.
In each of these situations, taking action to terminate must be immediate.

Immediate Termination/Summary Suspension:
a.    Provide a notice to the IP that the effective date is immediate when you have:
o   Been notified by BCCU that the IP has been convicted of a disqualifying crime;
o   Been notified by BCCU that the IP has a negative action/is on a registry;
o   Reasonable cause to believe that the client’s health, safety, and well being are in imminent jeopardy.

NONE of the above situations that require as immediate termination are applicable.
It is my only income, it is how I pay the bills and take care of my son... The supervisor at ALTC claimed that only my son, who is the client had a right to the information and that he must request it in writing himself.  ALTC staff and the department are aware (or should be since they have been informed more than once) that I have both general and medical Powers of Attorney for my son.  I can only conclude the supervisor was either mistaken, or purposely deceptive---neither of which is acceptable.

The department has a legal duty to inform individuals when a determination has been made that they are not qualified to work with children or vulnerable adults due to a finding of abuse neglect, or exploitation of a child or vulnerable adult. The notification is to be delivered along with a notice of the individual’s Due Process Rights, including the Right to a Fair Hearing.  The supervisor was  correct that I had no Fair Hearing Rights for even the wrongful termination of my contract; however, her assertion that I had no right to be informed of the information used in making the determination, is not accurate. The department had a legal duty to inform me of both the determination and the bases of such a stigmatizing determination. It is ludicrous to claim my son’s written permission is required! Even if it had required Isaac’s permission, the department is aware that I have Isaac's legal and medical Powers of Attorney, when I pointed this fact out, she then claimed only Jackie Klingele could inform me of the information used against me.

I did not find out the bases for the termination until Friday, March 15, 2013 when I received that information from Jackie Klingele by certified mail. When I read the packet of information, I realized that it appeared that the second termination was issued without any evidence that supports or substantiates the department’s actions. Not one allegation that I have ever abused, neglected or abandoned anyone, ever; which is no surprise to me.

The state's evidence consists of two pages of medical records one is the first page of a two page case note from an appointment on January 18, 2012 that has been in the possession of ALTC since June 5, 2012 and the other is the first page of a four page discharge summary written 2 days after Isaac was discharged, dated June 3, of 2011 that the ALTC has  had since August 23, 2011 The other “evidence” submitted that is supposedly grounds for my immediate termination the fact that I have failed to show the ALTC staff any time sheets. this is true, it is also true that both case managers have led me to believe that they are not required. 

I have been perceived as hostile, and perceived to not be respectful enough of department employees and mental health providers; which is understandable, although an unfair characterization, all things considered. The transcript of the phone call on January 12, 2012 is not accurate. I was not asking for ALTC staff to make an appointment, I was questioning why I had never received any response to my repeated requests for assistance with transportation to take my son to his mental health provider in Richland. My car was no longer capable of going on the highway; and because I was deprived of pay every month I could not afford to repair it.  The department and ALTC case manager, Joe Howell and the previous case manager, Peggy Latham, both know exactly why Isaac does not go to CWCMH. The state is implies that my comment, "I would not take a dog to CWCMH" is inappropriate for me since I am the care taker for a person with a psychiatric diagnosis. The fact is, the department is well aware that felony crimes committed by that mental health clinic's employees in Superior Court would perhaps explain WHY I would not take a dog there. The fact that my son gets mental health services in the nest County blamed on me, as if I made the decision that Isaac will no longer go to CWCMH, is absurd---In truth, if it had been up to me, Isaac would have not gone to CWCMH after the first appointment he had there with psychiatrist, Philip Rodenberger, the Medical Director of Central Washington Comprehensive Mental Health; but it was not my decision to make.

I have a long history with the department, more often than not, the RCWs and  the WACs are barely even paid lip-service; my Civil Rights and my son Isaac’s Civil Rights have been violated on a regular basis with impunity for over eighteen years. It is impossible to quantify the harm done to my son Isaac, and to my family by the illegal conduct of employees of the department. These crimes violate State, Federal and International Laws. Not once has any crime including physical assault, that I have reported to appropriate authorities in the department EVER been investigated by Law Enforcement.

It is true that I have cursed when upset. It is also true that I point out when a person who is a public servant, i.e. works for my son, Isaac; is in my opinion, incompetent.  A person who does not perform their job with ethical integrity; invariably, in my experience, will also lie to me, and will cover up harm done to my son---that is why such individuals have earned my contempt; particularly those who fail to file reports with Law Enforcement they are mandated by law to file--it is a job requirement. This failure is a Gross Misdemeanor Crime, and it is the reason there has never been a criminal investigation of crimes I have reported that were committed by state agents or designees who harmed my son. Not one of the people who have carelessly, or recklessly physically harmed my son, and worse, individuals who have violently assaulted or otherwise neglected and traumatized my precious son have ever been held accountable. It is no coincidence that every single instance when my son has been traumatized, assaulted, medically neglected and tortured, the crimes were perpetrated by employees of the department or it’s contracted providers.  I have not found a way to pretend that I have any respect for public employees and mental health professionals who are now complaining I don't show them enough respect. these people have never shown my son the respect, or the compassion he needs so very badly. The refusal to acknowledge the harm their ethical failures have caused, continues to exacerbate the harm already caused and validates my family's mistrust of the department.

Once again, the department has purposely allowed the unethical conduct of an employee to put my son at further risk---I can only assume it is because I challenged what is clearly unethical behavior,  including slander. It is insulting, it is horrifying, it is traumatizing. I am now be confronted with the need to not only defend my name, and fight being labeled as a person who is dangerous to children and vulnerable adults without any evidence I have ever abused or neglected anyone being offered to support this assertion. I am fighting to protect my son from further harm; my son has been harmed every single time the department has had a duty and the responsibility to care for and protect my son; indeed it is the department's consistent negligence in fulfilling it's duty to my son that is the direct cause of my son's iatrogenic injuries that have disabled him. The same negligent department that has NEVER protected my son from any harm, but has repeatedly and carelessly put my precious son in harm’s way. 

Arbitrary and capricious decisions that are made “in my son’s best interests” by idiots who actually seem to believe such a thing is even possible without ever speaking to my son, or consulting those who know him. People who love Isaac and care enough about him to know it is impossible to act in his “best interests” without involving him in REAL LIFE---I am disgusted by the hubris and lack of insight into the harm that has been done to my son by the repeated instances of the department’s employees presuming that such a thing is even possible; it is a truly stunning that "professionals" can even believe making decisions about what is in Isaac's "best interests" without involving Isaac, is ethical or advisable.  The damage done to my precious son by those who have for the past twenty years done that very thing is incalculable. Jackie Klingele, a woman who has never met my son, has made decisions that will if carried out, have a profound and devastating impact on my son; I am more than outraged she has done this WITHOUT even asking Isaac for his input.  In all likelihood, Jackie Klingele does not even realize  how disrespectful it is for her to have proceeded in the manner she has. Her plan is basically to tell Isaac where he should live, to in effect, invalidate Isaac as a human being who is WORTHY OF CONSIDERATION.  

It is not possible to act in another person’s "best interests" without even considering the person’s history, day to day life, spiritual values and beliefs---Without asking the person what their interests are, any discussion and any decisions made, are not done out of consideration of a person’s “best interest;” it is done out of a desire to control the person, while ignoring the person's "interests" altogether.  

I am a MadMother, who has a son that in agony has asked me questions that are impossible for me to answer. Having to bear witness to some of the experiences that have caused my son so much agony is a heartache that is indescribable. It is an honor to know he trusts me enough to express his pain. I have a visceral need to protect my son from ever having to experience the type of disrespect and invalidation that continue to cause him so much pain and fear.  The question: “How could they take so much from me mom? The people that were supposed to be helping me had no compassion for me.”  
I now fiercely protect my son from t
he profoundly harmful effects of individuals who act with callous disregard, and lack compassion.



Mar 28, 2013

The lack of consideration for my son's sense of safety

Isaac in August 2011
His 25th birthday was yesterday...

This post is an update of the issues discussed in Worthy of Consideration, it offers some background of the last couple of years dealing with the state, and an update on where the current situation with the mental health and social service system that I am currently dealing with stands. 

When I started blogging, I knew that holding a mirror up to the way the publicly funded mental health and social service system operates in real world practice, and the devastating impact on the people the system theoretically serves, would make me a target.  I must admit that I did not consider the possibility that I am now confronted with. Although I am confident I have the evidence required to prevail, that is, I can effectively demonstrate that the state has essentially been dishonest about the events that led to the termination of my contract, and demonstrate that the state did not have grounds to terminate my contract, effectively immediately as it did. Additionally, the state has offered little if any, evidence that would cause a reasonable person to conclude that I am a danger to anyone. 

The adversarial conditions created by the department have once again, unnecessarily placed my son at risk for several months from the adverse effects of financial instability.  I was horrified to learn yesterday afternoon, that it can get worse. The department's actions are being orchestrated by Jackie Klingele, the Fair Hearing Coordinator, representing the Health Care Authority of the State of Washington; the same person that informed me it was acceptable for the department to continue to violate Medicaid Law and to be in contempt of a Washington State Supreme Court Order. The department's current misguided efforts that are theoretically on my son, Isaac's behalf, have put him at further risk, have caused financial instability unnecessarily; and have had a direct adverse effect on Isaac's day to day life in that he has not been able to participate in the social activities he benefits from since there has been no way to pay for them.    

I began writing this blog in the fall of 2010 when I realized that the felony crimes that had been perpetrated in Yakima County Superior Court involuntary commitment proceedings commenced when Nancy Sherman, Designated Mental Health Professional, (DMHP)  employed by Central Washington Comprehensive Mental Health, (CWCMH) used perjury and a fraudulent Court Affidavit as "evidence," to (illegally) detain my son. The woman who did this, attested in her petition, that she notified me verbally, then gave the wrong phone number on her attestation. Why she would not have notified me in person is not explained; I had accompanied my son, Isaac, and so had his elder brother, Nathan. Indeed, Nancy Sherman offered a fraudulent Affidavit in support of her petition, which was purportedly my Affidavit in support of her fraudulent petition for the court order Nancy Sherman illegally obtained to detain my son. Nancy Sherman perpetrated multiple felony crimes Under Color of Law acting as an agent for the State of Washington; she acted with impunity due to the department's utter failure to investigate the crimes that were reported subsequent to these events.  

I had no idea my son had been court ordered to involuntary treatment until the day after the second hearing had taken place. I did not find out that a fraudulent document had been used to support Nancy Sherman's petition until after the third hearing had taken place immediately prior to my son's precipitous release was ordered by Jeffrey Jennings the psychiatrist from CWCMH. This so-called doctor actually entered into Isaac's medical record that his medical decision, i.e. releasing a patient from inpatient hospital care; was due to being pressured by me to release my son as an inpatient. This is a flat out lie. How I had applied pressure to Jennings he doesn't say.  The fact of the matter is, I was never able to discuss Isaac's care with Jeffrey Jennings; he would not return the multiple messages I left for him at the hospital or his CWCMH office. 

Worse, Jenning's care of my son can best be described with a single word, unethical. This "doctor" spoke to no one who knew Isaac. He had Isaac's current mental health providers contact information and not once in the eight days he was Isaac's attending physician, did he contact them. Jennings then released my son with absolutely no discharge planning whatsoever. I received a call waking me up on August 6th, 2010 stating Isaac had been released and wanted to know how soon I could pick him up. When I arrived at the hospital, it was obvious immediately that I had been misinformed.  When I entered the hospital at the psych unit entrance, I heard a woman telling a couple of people, "he wanted to go to the hospital and they committed him anyway." I discovered the woman was my son's attorney, she was sharing this private information about her client, my son, Isaac,  with strangers; even though she had refused to talk to me and Isaac's brother, Nathan.

All of the supposed safe guards which Washington State has in place to theoretically protect the Civil Rights of people who are mentally ill and therefore subject to involuntary commitment proceedings, failed utterly and completely to preserve or defend my son's Civil Rights. When I filed complaints on his behalf, every authority that is theoretically to act on civil rights complaints, denied having any duty or authority to do so. This includes HHS Office of Civil Rights, Disability Rights Washington, and the Department of Social and Health Services (DSHS) Division of Behavioral Health and Recovery (DBHR).  According to Washington State Law, the department has a legal duty to investigate; however, when I contacted the DBHR, I was informed there was nothing that DBHR could do, and in fact I was informed that DBHR had no duty and no authority, whatsoever by Ronald Moorehead, complaint manager, for DBHR. 

My first blog post titled, "It took one minute..." was posted on September 4th 2010, it was the text of an email I had sent to DBHR, and to my State legislative district's (14) State legislators, as well as every member of the Judiciary committee in the Washington State Legislature. It was updated for clarity and re-posted for the 2 year anniversary of this blog, and recently, it was updated again and resent to the original recipients on March 18, 2013. 


Central Washington Comprehensive Mental Health shredded the original Court Record in violation of the Washington State's Superior Court Rules governing the retention of court records. The CEO, of CWCMH, Rick Weaver, told me there was nothing wrong with CWCMH shredding the Superior Court Record by stating; "We do it all the time. " He has since been elected to serve on the board of directors, for NAMI Washington.


Here is the section of Washington State's Involuntary Treatment Law that clearly states what the department's duty is:

RCW 71.05.520

Protection of rights — Staff.

The department of social and health services shall have the responsibility to determine whether all rights of individuals recognized and guaranteed by the provisions of this chapter and the Constitutions of the state of Washington and the United States are in fact protected and effectively secured. To this end, the department shall assign appropriate staff who shall from time to time as may be necessary have authority to examine records, inspect facilities, attend proceedings, and do whatever is necessary to monitor, evaluate, and assure adherence to such rights. Such persons shall also recommend such additional safeguards or procedures as may be appropriate to secure individual rights set forth in this chapter and as guaranteed by the state and federal Constitutions.

[1973 1st ex.s. c 142 § 57.] 

Since I started this blog, I have written about a variety of obvious ethical and legal failures of the department specific to the mistreatment of my son; but I have also written about the broader issues of  mental health diagnosis and treatment and public policy, and how intentionally or not, Washington State policy continues to put children at risk of harm. 

To say that I am disgusted by the manner the department has handled the complaints I have filed on my son's behalf, would be the understatement of the century. Sadly however, I must admit I am not surprised at the department's intentional deceit, abdication of responsibility and abuse of power and authority, in a word, lawlessness. I am disappointed.  I find it more than a little ironic that my behavior/demeanor is reportedly perceived by some of these public servants as lacking the respect I should have for the people who work in the various divisions of DSHS and in the mental health public service system, who are now, and historically have, in every instance, consistently failed to protect or defend my son's rights, protect my son from harm, and to act on my son's behalf when they know my son has been negligently and criminally harmed. It is no coincidence, that these failures consistently coincide with instances of a state employee or contracted service provider being negligent and that negligence has been the direct and/or proximate cause of my boy being further harmed.  What is impossible for me to understand, is how people whose duty is to protect people who are served by the social service system operated by the department's authority, who are willing to become criminally complicit, by covering up crimes that victimize the children and vulnerable adults that others commit; when in  doing so, they commit further crimes. 

The contract that was terminated, is administered by ALTC. When I asked what the basis for the termination was, i.e. what information had been used to determine that my "character, competence and suitability" was such that it required my immediate termination; and effectively reduce my income to $0;  I was told I had no right to be told that information. I was told this by ALTC staff, Emily Watts, the supervisor for Joe Howell, Isaac's ALTC case manager. I was ultimately enlightened as to what the department's evidence against me was on March 15, 2013, when I received a copy of the state's evidence from Jackie Klingele, to be used at the Administrative hearing held on March 19, 2013. 

The question that needs to be answered is where is the evidence that would support the department's position (the dramatic surprise Jackie Klingele saved for the end of the Administrative hearing) which she elicited from Joe Howell by asking, "What do you think should happen for Isaac?" 

So it is at the hearing I am suddenly confronted with the fact that I am defending Isaac's fair hearing rights; defending my slandered name; and in fact, defending my home and my family against the department's arbitrary and consistently unethical manner of "providing services" to people like Isaac, whom we entrust the department to serve as our agents. I can't help but wonder how is it even possible to assert that I should never be allowed to be left unattended with any child or vulnerable adult without offering any evidence that I have ever abused or neglected anyone, ever. The real world effects of the state's actions I am now confronted with are alarming, to say the least. 

Due to the manner in which the department has exploited a couple of pieces of Isaac's mental health medical record it has used as "evidence," has created confusion with Isaac's mental health care providers. In effect, his treatment providers have been instructed to refer us to the facility's Risk Management department, to not communicate with us directly for any reason. This is where Isaac currently receives his mental health care. In reality, in real life, in a blatant abuse of authority, the department has placed my son at further risk. AGAIN. 

That the department has created this situation placing my son unnecessarily at risk in a misguided attempt orchestrated by Jackie Klingele, to assert that I pose a risk to Isaac, and further implying that I am so dangerous that Isaac should live in a group home, is--- I don't think there is a word for the mess that Jackie Klingele's unethical behavior has brought to bear. Jackie Klingele's unethical conduct appears to be punitive, is criminally negligent; and it has created a situation that in reality, placed my son at further risk, unnecessarily. 

I reported how the department had continued to violate Federal Medicaid Law in October of 2011, and that it had been in contempt of a Washington State Supreme Court Order for the entire time I have been my son's care provider through SE Washington ALTC.  The fact is, the department remained in contempt of that Washington State Supreme Court Order until August 29, 2013; when the apparent the solution ALTC seized upon was to make sure that the number of hours assessed as necessary for Isaac's care were lowered to match the number of hours the state has been authorizing for payment. 

The department had, before the current assessment dated August 29, 2012, illegally deducted between 9 and 20 hours of pay from my check every month from December 2008 until August 2012, even though the department was well aware that doing so is illegal; and the state had been ordered to stop depriving care providers of pay, prior to the state ever  depriving me of pay illegally, and had been further ordered to pay care provider's the pay  owed to them with interest by Washington State's Supreme Court.  I reported how in response to my query, "What authority enables ALTC to continue violating Federal Medicaid Law and continue denying part of my pay in contempt of a Washington State Supreme Court Order every month?" I received a letter from ALTC staff, Jackie Klingele, whose written response avoided answering the question I had asked, entirely.

At this point in time, the cumulative wages the state has deprived me of, and the pay I have been deprived of as the result of the department's wrongful termination of my contract, is roughly $10,000.  

Aug 13, 2012

What's an emergency?


"emergency warning" issued after 2,173 deaths
In May of 2004 Washington State's preferred drug list took effect the only preferred drugs on it for long term chronic pain were methadone and morphine.  For years afterwards the rising death toll was a topic of discussion and debate at the monthly Pharmacy and Therapeutics Committee meetings without any definitive corrective action being taken.


Two years and nine months after the Feb. 18, 2009 meeting of the P&;T committee, during which it was stated that the deaths due to methadone overdose were continuing to occur; it was also stated that this 'issue' had been a regular topic for 3-4 years by then.  AFTER the death toll was publicized by the Seattle Times on December 10, 2011, the State of Washington's Medicaid program announced that it was issuing an EMERGENCY WARNING---Issuing a warning after two thousand people have died, is kind of like teaching your child about fire after they have burned your house down playing with matches... 

Strictly speaking, issuing a warning years after the State P&T committee members were aware, (and after over 2,000 deaths!) is not really much of a warning...it's obvious the situation wasn't considered an EMERGENCY---it seems as if it was issued because the deaths were publicized.


here are some excerpts from that 2009 meeting

WASHINGTON STATE PHARMACY AND THERAPEUTICS COMMITTEE MEETING
February 18, 2009

"So I mean…I can’t remember if it’s sixth or third, but the bottom line is Medicaid is almost 50% of all prescription related deaths in the State of Washington and growing. And so we’re just now doing the 2007 runs where we actually load DOH’s death certificate data into our claim system, and so we’ll be able to feedback and see, you know, are we now 50+% of the deaths. And I just think, you know, this is something I’m hopeful the state could start taking on a little bit stronger, because I think this is a distinction that we don’t want, and it just keeps growing. And quite frankly, I’m at a loss of what to do.

"The issue is not just opiates. The issue is who are getting these opiates? And then this is a slide that shows the ratio…or the percent of clients who have a psychiatric dose…or psychiatric diagnoses as it relates to the deaths. And basically, it says that at less than 120 mg of morphine equivalent, you know, a little less than 60% of the people have a mental health diagnosis. What is a sad fact is as we increase the amount of morphine that goes into our clients, the more likely we’re treating also a person that has a mental health issue.

"So we are giving our most vulnerable clients in the State of Washington huge doses of narcotics, and so that’s the first face. The next face applies to substance abuse, so that the more you get in a morphine equivalent, the more likely you are to have a substance abuse issue.

"And when you consider that on top of this we’re treating some of our bi-polar clients and schizophrenic clients and other, now, children who are getting some of these other medications, including the atypical antipsychotics as well as the antidepressants…I mean, the…we just compound the issue.

"And then I think the sad fact is now we’re creeping down into the teenagers. So these are teenage deaths with narcotics that are prescribed to the teenagers who have a coroner or a death certificate data that state on a more likely than not basis that the death was related to a narcotic. (emphasis mine)

"And so what is the distribution by prescribers? Well, you can see that in over 1,000 milliequivalents per day, we have about 35 providers that prescribe in these doses.

"in the 35, it includes the University of Washington, Harborview as well as some very reputable pain specialists as well as some solo practice, ARNPs, and family practice, etc., etc.

"there’s no agreement on how high you can go, and it is a number of small providers that believe that you can go up several thousands of milligrams a day. I think our highest is up to 7,000 or 8,000 milligrams of morphine a day.

"And then again, I think methadone is an issue. I mean, we would hope that these 35 prescribers actually know about the issues with methadone and its depo effect and that small genomic class of clients who might actually have the unfortunate gene history to actually have increased amounts of this. But methadone is not our only high use, it includes hydromorphine as well as fentanyl, and so some of that fentanyl is actually even being used at nursing homes. I mean, that’s a very frequent event where fentanyl is used in lieu of multiple dosing through the day to save some nursing time. But I would stipulate that it’s all the drugs; and just eliminating methadone alone from the preferred drug list is not, I think, the solution. Next slide.

"You know, and again, when we work together…and I think Siri’s come up with a really nice in the original 320 group that were 10 or more prescriptions per month, which we found out was not 100% sensitive and specific for abuse or misuse, that when we notified the prescribers, we saw an instant 25% reduction because of the poly-prescribing issue." Jeff Thompson

"The prescriber got the client into this issue. I’m going to be really…I’m going to be firm. On the 1,000 mg, it is a prescriber issue. It’s not a client issue, because the majority of these clients are getting them from just one prescriber. Out of the 800, there’s about 200 that are getting it from more than one prescriber. So this is a prescriber issue, not a client issue. I’m sorry, these are, but I really…I think that we’ve gotten ourselves into this problem as medical professionals. It’s not the client’s problem. unnamed man

"Jeff, this is Carol Cordy. It sounds like you’ve spoken with some of these 35 prescribers personally
Jeff: Yeah.
Carol Cordy: You have?
Jeff: Yeah.
Carol Cordy: And do they…I mean do you get the sense that they don’t want to be in that position  not to be prescribing all that narcotic?
Jeff: They typically don’t see the problem.
Carol Cordy: They don’t? So there is the problem."
here the discussion about pain killers begins on pg 86

In 2010 Senator Charles Grassley asked for information on the top prescribers of pain medications and neuroleptic drugs because of the rampant illegal marketing, and Medicaid fraud. What is interesting is an email from the Governor's Office:

Why wouldn't  Washington State respond?
 Then there is this:
A top prescriber who accounted for 1-2% of the entire Rx budget but the problem is considered resolved when SHE closes her office---
via The Seattle Times

State plans emergency warning on risks of methadone

Washington state will issue a public health advisory that singles out the unique risks of methadone, a commonly prescribed pain medicine that's linked to the most accidental overdose deaths.

12-21-2011
A few excerpts:
"To save money, the state steers Medicaid patients, workers' compensation recipients and state employees toward methadone, a long-acting painkiller that costs less than a dollar a dose. Since 2003, at least 2,173 people in Washington have died from unintended overdoses linked to the drug, The Times found.

"Committee Chairwoman Karen Keiser, D-Kent, became frustrated with Dr. Gary Franklin, medical director for the Department of Labor & Industries, which handles workers' compensation.

"Keiser asked Franklin — a principal defender of the state's decision to designate methadone as a preferred drug — if the painkiller is more difficult to manage than other long-acting narcotics. When Franklin responded by discussing the toll of long-acting opioids in general, Keiser said: "Dr. Franklin, answer the question about methadone."

"She later told him: "That's something I'd like to get a straight answer on. And I'm not getting a straight answer."

"Franklin told lawmakers that methadone is not at the heart of the state's struggle with painkiller overdoses. "It's dose, not a specific opioid," he said.

"Almost no one dies from a single opioid. When you look at death certificates, and I've reviewed many of these at L&I, you never see just methadone or just OxyContin or just fentanyl listed," he told the committee.

"Coroners, in fact, will not ever say on a death certificate that this death is from methadone. It is always a combination of multiple opioids plus other drugs."

"But a Seattle Times analysis of death certificates turned up 443 cases since 2003 in which methadone was the only drug listed when someone fatally overdosed. And this was using a conservative sift, excluding cases where the deceased had so much as a history of alcoholism.
emphasis mine)

"Sen. Cheryl Pflug, R-Maple Valley, told Franklin that she was troubled even by those cases in which methadone had combined with other drugs to cause a fatal overdose.

"I don't really care that the coroner isn't willing to say this was caused by methadone," she said. "If the person has a toxic level, and they were taking methadone and other drugs known to have a synergistic, respiratory depressive effect, and they quit breathing, it doesn't take a rocket scientist to know we might have a problem."  State Plans Emergency Warning 12-21-2011

PHARMACY AND THERAPEUTICS COMMITTEE MEETING
February 15, 2012
a few excerpts:
"And we’re left with the background problem, which is what we had when we looked at the Oregon Medicaid study from 2007, which is that the number of people who are prescribed methadone have a much higher rate of substance abuse history and also a much higher risk of opioid death than people prescribed other types of long-acting opioids. And so to pin the cause of those deaths on methadone relative to other long-acting opioids is tricky. And in the 2007 study when they controlled for history of substance abuse there was no longer and increased risk with methadone. I would say that there is no question that this is a very high risk class" Barak Gaster

I'd like to know Mr. Gaster, if this is an accurate statement, how many were dying before??!!
"it’s interesting that when the PDL was instituted in 2004 it coincided roughly with a…the brakes being put on and the rise of methadone deaths. And so it’s hard to say that methadone being on the PDL is contributing in a significant way to the number of deaths." Really Mr. Gaster... 

"So if you remember back in August… this is Jeff Thompson. We brought to you the top 20 prescribers represent 70% of the high dose in Medicaid and we sent letters and gave them feedback reports and I personally called all 20. And they are all actively engaged in the new law. They are getting education. Some are pain specialists. Some are primary care doctors. Some are ARMPs that do refill mills or refills. And all very concerned with what’s going on and are actively engaged with us."  

Susan Rowe: "This may crossover into DUR but we’ve talked about other classes of medications that also increase respiratory depression. And so my thought is that on our agenda for this next year would be to look at some of our pain patients and how many are getting concomitant benzodiazepines, muscle relaxants and other things that put them in danger as drug combinations are used." here

What a good idea! I can't help but wonder why education about the use of prescription drugs and over the counter drugs which pose a risk when used concomitantly with opiate pain medications were not part of prescriber education already... 

via Investigate West
New Prescription Drug Law Holds Promise, but Concerns Linger
JANUARY 22, 2012
By Carol Smith
InvestigateWest


a few excerpts:
"The passage of a new law, regarded as one of the toughest in the nation, makes Washington the first state to require dosing limits for doctors and others who prescribe these medicines. The law, RCW 2876, went into effect January 2, but those who have watched the epidemic spiral out of control still see significant challenges ahead."

Lax Oversight
"A key limitation of the new law: While it gives state regulators a reason to discipline doctors, the statute does not require the state to check whether doctors or other medical professionals are breaking it.

"That’s in contrast to the U.S. Drug Enforcement Administration, which monitors whether medical professionals with narcotic permits are following its rules. The new state program also falls short of Washington’s Medicaid program, which routinely tracks how much narcotic medication doctors hand out. Instead, the system set up by the new law relies on complaints from patients or medical professionals to trigger investigations.

"As a result, the Medical Quality Assurance Commission, which investigates doctors and other healthcare professionals, can’t say how much of a problem excessive prescribing is for Washington doctors, dentists, advanced nurse practitioners, physicians assistants and other providers licensed to prescribe these powerful medications.

"The state’s actions came after the doctor’s offices had been raided the previous year by DEA agents, an action that resulted in charges related to financial transactions the DEA indicated could be used to hide drug trafficking activity.

"Doctors and others disciplined for drug-related issues are usually given chances to go into rehab, get additional training, or pay fines. In 2009, however, Spokane-area doctor Keith L. Hindman, went to prison for health care fraud and prescribing controlled substances for non-medical purposes.

"The DEA, in contrast to the state, does carry out surprise inspections. The agency has shut down the top five prescribers in the state over the last several years, including a clinic in Vancouver, Washington.

"For his part, Thompson of Medicaid sent a letter last summer to the top 20 doctors prescribing opiates to Medicaid patients, alerting them that they’d been flagged for the volume of their prescribing.

“That doesn’t mean they are good or bad doctors,” he said. “There is no definition. However, it does say, it’s worth looking at why they are so high.” here
Jeff Thompson: 
In 2009 there were 35 prescribers that Thompson was concerned about. Between Feb. 2009 and April 2010 the five top pain drug prescribers were prosecuted. A sixth, the top neuroleptic prescriber, whom Thompson stated in his April 22, 2010 email accounted for 1-2% of the entire Medicaid Rx budget closed her office. It seems that it would be advisable to investigate and prosecute her criminal behavior, and perhaps retrieve the money defrauded from the public coffers...NO Effort was made to recoup the money defrauded from the people of Washington through the Medicaid program...   

It appears the warning letters sent were a response to Grassley's investigation. 

A strange thing about the data that Washington State sent to Senator Grassley's office: Why weren't the national provider numbers issued in 2007 used to identify the top prescribers listed?




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