In early December 2020, Michael Gamble was paid a surprise visit by law enforcement. At the conclusion of their search, they found at least 90 G of Fentanyl along with a loaded handgun with an attached extended magazine. None of this looks good, and easily crosses an Offense Level of 34 (with its approximate base number of 28 or greater). Michael Gamble, age 37, pleaded guilty to one count before United States District Judge Christy Criswell Wiegand and is scheduled sentencing for Feb. 9, 2023.
The DOJ has a case,and while everyone deserves legal representation, in the federal system 98% plea as opposed to going to trial, but I get ahead of myself.
How over the years did a medication initially develop in 1959 by Dr. Paul Janssen as an intravenous surgical anesthetic, wind up on our streets? Recalling my days as a surgical resident in the mid-1980s, this was on no one’s radar, except anesthesia. Interest came initially from large animal veterinarians, which morphed into skin patches for humans in the early 2000s to treat chronic pain. This was followed with user-friendly delivery options; a lollipop, tablet, and nasal spray.
Carfentanyl, a fentanyl analog is approximately 10,000 times more potent than morphine, 100 times more than fentanyl, and 50 times more than heroin. It is to be used as a general anesthetic for very large animals.
Former CEO of Health Clinic Convicted of Medicaid Fraud
St. Gabriel Health Clinic Inc. (St. Gabriel), a Louisiana nonprofit was contracted with the Iberville Parish School Board to provide primary care services to students as well as services related to the diagnosis and treatment of mental illnesses.
Evidence showed that St. Gabriel practitioners provided character development and other educational programs to entire classrooms of students and followed by fraudulent billing to Medicaid, as group psychotherapy.
Victor Clark Kirk, 73, of Baton Rouge, Louisiana, was the CEO of St. Gabriel Health Clinic Inc. and is scheduled to be sentenced on Jan. 12, 2023, faces a maximum penalty of 10 years in prison per count.
When facing the Federal Bureau of Prisons, retaining an experienced federal criminal defense attorney, and someone experienced in guiding you through the sentencing process, following the guilty verdict is critical to your future. Should you have any questions, contact us.
Preferred Family Healthcare Inc., was a charity that provided services across Missouri, Arkansas, Kansas, Oklahoma, and Illinois, including mental and behavioral health treatment and counseling, substance abuse treatment and counseling, employment assistance, aid to individuals with developmental disabilities, and medical services.
Conspiracy charges included embezzling funds, bribes, and kickbacks to elected public officials against Bontiea Bernedette Goss, 63, and her husband, Tommy “Tom” Ray Goss, 66.
Several former executives from the charity, former members of the Arkansas state legislature, and others have also pleaded guilty in federal court as part of the long-running, multi-jurisdiction, federal investigation including the following:
Former Chief Executive Officer, Marilyn Luann Nolan of Springfield, Missouri, pleaded guilty in November 2018 to her role in a conspiracy to embezzle and misapply the funds of a charitable organization that received federal funds.
Former Director of Operations and Executive Vice President Robin Raveendran, of Little Rock, Arkansas, pleaded guilty in June 2019 to conspiracy to commit bribery concerning programs receiving federal funds.
Former executive and head of clinical operations Keith Fraser Noble, of Rogersville, Missouri, pleaded guilty in September 2019 to concealment of a known felony.
Former employee and head of operations and lobbying in Arkansas, Milton Russell Cranford, aka Rusty, of Rogers, Arkansas, was sentenced to seven years in federal prison without parole after pleading guilty to one count of federal program bribery.
Political consultant Donald Andrew Jones, aka D.A. Jones, of Willingboro, New Jersey, pleaded guilty in December 2017 to his role in a conspiracy from April 2011 to January 2017 to steal from an organization that receives federal funds.
Former Arkansas State Senator Jeremy Hutchinson, of Little Rock, Arkansas, pleaded guilty in June 2019 to conspiracy to commit federal program bribery.
Former Arkansas State Representative Eddie Wayne Cooper, of Melbourne, Arkansas, pleaded guilty in February 2018 to conspiracy to embezzle more than $4 million from Preferred Family Healthcare.
Former Arkansas State Senator and State Representative Henry “Hank” Wilkins IV pleaded guilty to conspiracy to commit federal program bribery and devising a scheme and artifice to defraud and deprive the citizens of the state of Arkansas of their right to honest services.
When facing the Federal Bureau of Prisons, retaining an experienced federal criminal defense attorney, and someone experienced in guiding you through the sentencing process, following the guilty verdict is critical to your future. Should you have any questions, contact us.
Recently, some states have enacted Legislator Directed Patient Care, that conflict with the doctor-patient ethical relationship, and the oath, to do no harm.
Since forever, as part of that relationship, providers try to educate patients to make decisions for themselves, about what they feel is right for them, says “Dr. Stephanie Mischell.”
For some doctors, the debate comes down tomedical ethics.
But now, can providers (or anyone) even discuss, refer, or contact out-of-state providers to give them information about patients, regarding abortion services without the fear of litigation, or prosecution?
Prenatal Care.
Prenatal Care may also be affected, particularly if they allow prosecutions to go forward against women.
Healthcare providers might find themselves caught in the middle – being forced to make ethical choices when asking routinepast history questionsregarding past pregnancies, and their outcomes.
In doing so, they may place themselves and their patients in the position of being criminally prosecuted, for what otherwise would have been considered usual and customary medical care.
Heartbeat Detection.
Pediatric cardiologist and researcher, Colin Phoonof New York University Langone Health, shared that before the sixth week, “there is no heart; there’s nothing beating.”
What they are hearing is “a little flutter in the area that will later become, the future heart“- but
will become the future “pacemaker“ of the heart and gain the capacity to fire electrical signals, she said.
Erika Werner, a maternal-fetal medicine physician at Brown University, and a Society for Maternal-Fetal Medicine board memberexplained, “You can see a little flicker,” she said.” That’s it.
As a product manual (Huntleigh High Sensitivity Pocket Dopplers) for one such device explains, the sound is the amplified version of the difference between the transmitted and received signals.
“It is not the real sound made by blood rushing through an artery or vein, or movement of the fetal heart.”
It’s only been in the last few decades that doctors have been able to detect this “flutter” at six weeks, thanks to the use of more sophisticatedultrasoundtechnologies.
…at around 21-23 days after conception, two groups of cells form a horseshoe – known as a heart tube,
with cells creating a sound that seems like the first heartbeat,
although it may notpump the bloodfor another day or two.
In patients with Lupus (an autoimmune disease), should an inflammatory response flare during their pregnancy, this could then rise to the level of being considered “high risk“.
In this case, trained medical providers’ treatment plans may be interrupted by Legislator Directed Patient Care, without medical training, forcing themselves into the doctor-patient relationship, which may result in the loss of life. A scary result when considering Dobb’s.
Should the physician decide to ignore Dobbs, and provide what is the standard of care in the medical community, that would likely result inpregnancy lossormiscarriage, they and possibly their patients could expect to be criminally prosecuted – as you see, these are not easy decisions.
If the moral code of the provider is such that they go ahead and, provide what is considered usual and customary care, that is in line with their medical board code of ethics, and is the standard of care in the community, how will this impact their future should prosecution proceed?
Will some providers, depending on the severity of the state’s laws, begin to avoid practicing in those states altogether?
Could they face incarceration as an example to other providers?
Where does it end?
The Loss of an Experienced Medical Specialty – Who Suffers?
As state Legislator Directed Patient Care laws insert themselves into the physician-patient care model, this may create ethical issues for the provider, andmalpractice liabilities for the doctor, hospital, and their associated healthcare systems.
The result of having no contingency plans for the “dead space”that immediately followed Dobbs, created this cascading series of events that result in
reduced access to specialists – in states where certain procedures are not permitted.
ultimately to be mostly felt by minority populations,
with a decrease in new resident training,
leads to a generation of fewer and “less qualified physicians in this niche specialty,” which makes upObstetrics and Gynecology.
This new wave of disillusioned providers will not be used to being,
dictated to by non-medically trained legislators who
do not have their patient’s best healthcare interests at heart, or based on science, and then
tell them how to practice medicine.
Some may even face incarceration in some of the more extreme states, and if so – is practicing in those states even worth it?
Will their colleagues look the other way – or be concerned?
Likely, as we all have gone to school, before books started being banned, of course, we will be concerned.
Attorneys | You Can Help The Dam From Breaking |Bloomberg Law|“There is so much confusion”
‘Aiding and Abetting’.
Abortion bans before six weeks in some states depend on enforcement through lawsuits filed by private citizens.
Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – but which is a “flutter,” only.
Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking to the legal community for guidance, as confusion reigns from Coast to Coast.
Regulations
TheEmergency Medical Treatment and Labor Actobligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage.
By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.
This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.
Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.
Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.
“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”
Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.
The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie thisdisingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision
These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.
Dobbs Protecting Your Privacy and Healthcare Information
The Dobbs decision opened the conversation to the security of your private privacy healthcare information that we all assumed was secure. We have all been made aware of securing our company’s web infrastructure and firming up its variabilities. The weak link that remains involves our personal lives.
Our family’s cell phones, computers, laptops, note pads, i-pads, gaming things if they’re web-connected, and Alexa, right? Then we have electric cars, and homes, you get the picture. Last, let’s not forget our healthcare privacy.
not to make misleading claims that they “anonymize” or “aggregate” sensitive data to try to placate customers who might otherwise have concerns about their privacy.
Finally, the Commission points to several recent cases it has brought against companies that misuse customers’ data, without parental consent,
CafePress for improperly collecting and indefinitely retaining sensitive consumer data.
What can you do to protect yourself, but will we?
data encryption,
username ID and
password, and
two-factor authentication,
together can be used to help ensure the confidentiality of information.
But nothing is perfect, so you must keep your passwords updated.
Personal Data Examples: Credit card or personnel number of a person, account data, number plate, appearance, customer number, or address.
Sensitive Information Examples: Social security number, Birthdate/place, Home/Mobile phone number, Home address, Medical Records, Bank Account Numbers, IP address, Passwords, Gender, and Ethnicity.
HIPAA: applies to Healthcare providers and Healthcare Plans.
Safeguard:“protects health Information” or “PHI.”
Steps you can taketo decrease how your cell phone or tablet collects and shares your health and other personal information, such as where you go and what you do, without your knowledge.
Avoid, downloading unnecessary or random apps, especially those that are “free.”
” giving any app permission to access your device’s location data, other than (e.g., navigation and traffic apps).
turn off the location services on your personal cell phone or tablet.
consider using communication apps, mobile web browsers, and search engines that are recognized as supporting increased privacy and security.
Inside the Court’s ruling, Justice Thomas wrote that
“in future cases, we should reconsider all of this Court’s substantive due process precedents.”
“Because any substantive due process decision is ‘demonstrably erroneous,’wehave a duty to ‘correct the error’established in those precedents.” Just food for thought…
The More Restrictive States
Louisiana.
Louisiana is an example of extreme regulations, which defines “a viable in vitro fertilized human ovum” as a “juridical personwhich shall not be intentionally destroyed,” along with at leastfive states, that have introduced bills establishing fetal personhood. Now,
the ’embryo’ may be considered an individual, and if a couple is undergoing IVF, your criminal liability implications have suddenly exploded.
Why, because all of the embryos will have to be used.
IVF – Fertility Treatments
IVF and in some cases, even genetic screening, is seeing extreme statements from extreme states;
Will patients have to use all the embryos they develop,
a) which forces an individual or couple to expand their family before they can afford to do so, or
b) forgo the opportunity to have children, or
c) suggests that the couple limit the number of embryos to one or two, and hope that they are chromosomally balanced and will result in a live birth, but if not…
d) putting them through IVF stimulation over and over again, associated with the financial, emotional, psychological, and physical implications.
For states that take abortion bans to the extreme, and specify that,
Life begins at fertilization,
a) each excess embryo would have the same rights as an embryo,
b) all the embryos would then have to be implanted (by law), and
c) which could lead to financial hardships for an unprepared family to have multiple children all at once, high-risk pregnancy, multiple babies, risking the life of the mother and/or the children,
d) or regarding the fear of prosecution, the couple would decide not to have any children or
e) they would elect to move to another state.
Added to all this; are threats of violence that extremists have targeted at our behavior and beliefs, while representatives have kept quiet, and made this acceptable behavior.
Some miscarriages require immediate medical interventions to prevent life-threatening infections or tubal rupture. Every year between 10% and 20% of known pregnancies end in miscarriages, mostly because the fetus is not developing normally, according to theMayo Clinic.
Post Dobb’s, providers may now fear that the ‘state’ may view their treatment – as if they are providing abortion services, even if they have the necessary training and clinical skills, albeit the services may be similar.
If there is a malpractice (or negligence) claim where the provider was handicapped by the laws of their state, how then will this be reflected in their malpractice and liability carriers’ representation(s) going forward?
But it is in those most restrictive states, that women of color (and not those of means) could see even higher maternal mortality rates, increased child poverty, and face a greater risk of prosecution for seeking illegal abortions.
Religion
Religious freedom in America should mean that we all have a right to our religious beliefs. But it should not give us the right to use religion and beliefs to discriminate against others who do not share them—especially when doing so risks lives.
Abortion bans before six weeks in some states can depend on enforcement through lawsuits filed by private citizens. Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – which is a “flutter (or the beginning of our pacemaker),” and not a heartbeat.
Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking for answers (and to date, getting few). I am sure that most of you are getting calls (if not, you will), as confusion reigns, from Coast to Coast.
By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.
This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.
Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.
Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.
“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”
Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.
The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. In view of these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision
These laws and policies that restrict or otherwise interfere with the patient-physician relationship put patients at risk by limiting access to quality, evidence-based care.
BOP/ COVID-19 / Hydroxychloroquine / The Science Was Not There
BOP buys $60,000 worth of hydroxychloroquine
White House economic adviser Peter Navarro reportedly clashed with the National Institute of Infectious Diseases director Dr. Anthony Fauci over the efficacy of hydroxychloroquine as a coronavirus treatment.
Unproven COVID-19 treatment drug;
Many Trump-friendly pundits, however, are convinced of the drug’s effectiveness, most notably those on Fox News shows from which the president is known to take policy cues.
INDICATIONS:
Malaria (not recommended for the treatment of complicated malaria.)
There are insufficient data thus far to know whether hydroxychloroquine or chloroquine has a role in the treatment of COVID-19. For this reason, we strongly recommend that patients should be referred to a clinical trial whenever possible.
We do not routinely use azithromycin in combination with hydroxychloroquine for treating COVID-19. Although one study suggested the use of azithromycin in combination with hydroxychloroquine was associated with more rapid resolution of virus detection than hydroxychloroquine alone [62], this result should be interpreted with caution…
II) Remdesivir (Testing canceled, not because the drug wasn’t working, but because it proved too difficult to enroll the required number of patients. (Endpoints News))
…is a novel nucleotide analog that has activity against SARS-CoV-2 in vitro [43] and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [44]. Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [45].
IIa) The WHO is launching a trial to further evaluate:
…remdesivir, hydroxychloroquine/chloroquine, and lopinavir-ritonavir with and without interferon beta [76]. Various other antiviral and immunomodulating agents are in various stages of evaluation for COVID-19. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.
III) Convalescent plasma —
In the United States, the Food and Drug Administration (FDA) is accepting investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [50]; pathways for use through these applications include clinical trials, expanded access programs, and emergency individual use.
IV) Tocilizumab
…is an interleukin (IL)-6 receptor inhibitor used for rheumatic diseases and cytokine release syndrome. Elevated IL-6 levels have been described in patients with severe COVID-19, and case reports have described good outcomes with tocilizumab [66-69].
TERRE HAUTE – An inmate at the federal prison complex in Terre Haute who had COVID-19 has died, and three others there also have tested positive for the disease, the Bureau of Prison said Tuesday.
A Federal Bureau of Federal Prisons truck drives past barbed wire fences at the Federal Medical Center prison in Fort Worth, Texas, Saturday, May 16, 2020. Hundreds of inmates inside the facility have tested positive for COVID-19 and several inmates have died with numbers expected to rise. (AP Photo/LM Otero) (Copyright 2020 The Associated Press. All rights reserved.)
Tarrant County Public Health (TCPH) reported 485 new cases of the coronavirus Sunday, of which 423 were caused by the Texas Fort Worth Federal Medical Center prison outbreak. So far, the county has seen 3,695 positive cases and 780 recoveries.
As of Friday 5/8/2020, 823 inmates tested positive in FCI Lompoc (2 have died), and another 644 at FCI Terminal Island (6 have died at the San Pedro facility).
70 inmates test positive at the Lexington Federal Medical Center (FMC) in Lexington, Kentucky, however “communication with [FMC Lexington] has been sporadic, and sometimes it’s non-existent,” Lexington Health Department Spokesman Kevin Hall
COVID-19 continues to spread through Ohio prisons, with the FCI Marion and Pickaway correctional institutions combining for nearly 2,500 confirmed cases of the coronavirus. That is an estimated 80 percent of the inmates in those two prisons.
Union Files National Grievance Over Alleged Safety Violations at Federal Prisons During Coronavirus Pandemic. Forced leave, lack of protective gear, and privacy breaches are among the allegations.
The continued inaction of the BOP to swiftly reduce the population of inmates, particularly the elderly and those with underlying health conditions, is an unfolding story with tragic consequences.
April 14, 2020 (Marshall Project):
Nearly 600 prisoners and staff members are infected with COVID-19 in the federal system. Thirteen prisoners have died. Bureau of Prisons
Brooklyn, NY – Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.
Bureau of Prisons Implements Partial Lockdown to Halt Spread; The challenge is that prisons and jails are not built to provide 6′ of separation to inmates and correction staff. I have to assume that PPE, cleaning materials and testing for all parties are not diligently implemented.
The Metropolitan Detention Center in Brooklyn, N.Y., had the first known case of coronavirus in the federal prison system. The facility is shown here in February 2019. KATHY WILLENS / AP
New procedures due to coronavirus concerns will last 14 days, after which the agency will re-evaluate. By COURTNEY BUBLÉ
wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.
An easy and cheap option for all inmates and correction staff, in either Jail, Halfway House, State, Federal or Private facility. We can argue the efficacy benefit later.
Routine Ongoing Outpatient visits
Not In-patient
Tx plan reviewed every 90 days
FAQ Home Confinement On COVID-19. BOP Website Displays…..
