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Tag: 2019 News

FDA Approves Generic Naloxone Nasal Spray

Injured workers, and others have become addicted to opioid medications, which can easily lead to overdose death. Naloxone treatment is now a safety strategy to hopefully avoid this deadly consequence. It is become more available and less expensive as an option for those on this medication.

The Food and Drug Administration granted final approval of the first generic naloxone hydrochloride nasal spray, commonly known as Narcan, a life-saving medication that can stop or reverse the effects of an opioid overdose.

The agency is also planning new steps to prioritize the review of additional generic drug applications for products intended to treat opioid overdose, along with the previously announced action to help facilitate an over-the-counter naloxone product.

This approval is the first generic naloxone nasal spray for use in a community setting by individuals without medical training; however, generic injectable naloxone products have been available for years for use in a health care setting.

The FDA also has previously approved a brand-name naloxone nasal spray and an auto-injector for use by those without medical training.

products.

More generally, in an effort to promote competition to help reduce drug prices and improve access to safe and effective generic medicines for Americans, the agency is taking a number of new steps as part of its Drug Competition Action Plan. These steps include important work to improve the efficiency of the generic drug approval process and address barriers to generic drug development.

The FDA also remains focused on several additional priorities to address the opioid crisis, including: decreasing exposure to opioids and preventing new addiction; fostering the development of novel pain treatment therapies; supporting treatment of those with opioid use disorder; and improving enforcement and assessing benefit-risk.

Naloxone nasal spray does not require assembly and delivers a consistent, measured dose when used as directed. This product can be used for adults or children and is easily administered by anyone, even those without medical training. The drug is sprayed into one nostril while the patient is lying on his or her back and can be repeated if necessary.

The use of naloxone nasal spray in patients who are opioid-dependent may result in severe opioid withdrawal characterized by body aches, diarrhea, increased heart rate (tachycardia), fever, runny nose, sneezing, goose bumps (piloerection), sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness and increased blood pressure.

E-mods Used to Prequalify Contractors for Bidding

An employer’s experience modification rating, also called E-mods or EMR, is determined by dividing a company’s actual workers’ comp claim losses by the expected losses for the company’s specific occupations. The EMR plays a vital role in determining the premium a company pays.

The State of California and other public authorities, major utilities, private project owners and prime contractors for years have used the rating as a one-size-fits-all way to gauge a contractor’s safety record. Three consecutive years of EMR are usually considered, excluding the most recent year. Some treat a company with one EMR blip as a contracting untouchable.

EMRs are sometimes treated as vital to prequalification of a contractor to bid on a project. One sign of that trend occurred this year when the National Council on Compensation Insurance (NCCI) – the insurer-owned workers’ comp rate-making entity covering most states – added to its published material a boilerplate disclaimer against using EMRs to prequalify employers.

This new language is designed to raise awareness on this important topic and to reinforce the intended purpose of an experience rating worksheet for using the rate only to adjust the premium, according to Kathy Antonello, NCCI’s chief actuary. “This is consistent with the information we have provided to the public and the industry that it’s not appropriate to use E-mods to compare the relative safety of employers. The E-mod should be used for its intended purpose.”

A more comprehensive evaluation of safety performance usually includes other data and information – such as the reason for the higher EMR, style of the safety program, qualifications of the safety managers or U.S. Occupational Safety and Health Administration (OSHA) data used to calculate rate of injuries per hours worked – a different type of statistic.

Changing the deeply entrenched practice of using EMRs to prequalify contractors may not be as simple as writing a few articles and publishing a disclaimer, however. Companies that understand the value placed by owners and prime contractors on safety know that a low EMR impresses them as much as do held-down costs. “It will take a generation” to get out of the habit of using EMRs as a quick take on a company’s safety record, says one industrial construction contractor’s safety director. “There are union shop stewards who talk about EMRs on a regular basis.”

At a recent construction conference of the International Risk Management Institute, where Antonello, in a presentation, repeated cautions against using EMRs to prequalify, an insurance director at a large construction firm turned to someone sitting near him and said, “We use our EMR to compete all the time.”

Smaller contractors are the biggest losers in the “EMR equals safety” mindset, insurance brokers report. Fewer hours worked maximizes the effect of a single claim.

“Setting these strict experience mod-factor thresholds can discriminate against smaller or midsized companies, disqualifying them from bidding on projects, despite their having an excellent safety and injury history,” wrote Sonja Guenther, a workers’ compensation specialist at Denver financial consultant IMA Financial Group, in a recent report on the issue. Larger contractors, with the help of consultants, can find ways to drive down their EMR that have little if anything to do with their actual safety record, critics add.

Travelers Beats Wall Street Estimates

Insurer Travelers Companies Inc’s quarterly profit beat analysts’ estimates on Thursday, as improved underwriting and lower catastrophe losses offset a decline in net investment income, sending its shares to a more than one-year high. Shares of the Dow-component rose as much as 4.2 percent to $141.52, levels last seen in March 2018. The stock was also the second-biggest boost to the Dow Jones Industrial Index.

Travelers is considered a bellwether for the insurance industry. The company said net written premiums rose 3 percent to $7.06 billion in the first quarter, with growth across all business lines.

Investors were particularly focused on its commercial auto insurance business, which has been posting losses for several years as more plaintiffs lawyers jockey to represent accident victims.

However, Travelers raised premium rates for auto insurance in the first quarter, helping to contribute a 6 percent rise in gross written premiums in its insurance business. This also did not lead to a drop in renewal rates and retentions, business insurance head Gregory Toczydlowski said on a call with analysts.

The company on Thursday reported that catastrophe losses, net of reinsurance, fell by $161 million to $193 million after wildfires and hurricanes dented its earnings over the past two years.

The company reported a combined ratio of 93.7 percent, compared with 95.5 percent a year earlier. A ratio below 100 percent means the insurer earns more in premiums than it pays out in claims.

A weak spot in the quarter, however, was net investment income , which fell 3.5 percent to $582 million due to lower private equity returns after a slowdown in market activity in the first quarter.

Insurers typically invest money they get from premiums in bonds and equities to earn profits, and a downturn in markets spells bad news for them.

The company’s net income rose 19 percent to $796 million, or $2.99 per share, in the quarter ended March 31. Core income was $2.83 per share, which beat analysts’ estimates of $2.74 per share, according to IBES data from Refinitiv. Total revenue rose 5 percent to $7.67 billion.

April 15, 2019 News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Employer Has Burden to Obtain Physicians RTW Form, Nurse Indicted for “Darknet” Sales of Opioids, Cannabis Shops – Illegally Uninsured and Tax Evasion, Sutter Medical Center Neurosurgeon Arrested for Comp Fraud, DWC Posts First Report on IBR Since SB 863, Mostly Good News From WCIRB Report, WCIRB Sees No Need for Mid-year Filing, More Gig Workers Seek Exemption from ABC Test, ICD 11th Edition to Include Chinese Medicine, Injured Tesla Workers Claim Foul Play.

$100K in Cal/OSHA Penalties for Fatal Injury

Cal/OSHA has cited an agricultural employer and a farm labor contractor more than $100,000 combined in proposed penalties after a worker was fatally crushed by a bin dumper at a walnut processing and packing facility in Tehama County.

On October 6, 2018, forklift operators at Crain Walnut Shelling in Los Molinos were filling bins with walnuts, which were then dumped into a hopper for processing. A temporary worker for Cal North Farm Labor, Inc. was instructed to clean the area around the equipment. The worker was under an 800-pound bin dumper when it emptied its load and automatically lowered to the ground, crushing him.

Cal/OSHA’s investigation determined the employer did not evaluate workplace hazards and the worker did not receive safety training from Crain Walnut Shelling or Fresno-based Cal North Farm Labor, Inc. before being assigned to clean concrete and machinery at the walnut processing facility.

“Working near large moving parts of equipment and machinery can be deadly,” said Cal/OSHA Chief Juliann Sum. “Employers must identify and evaluate workplace hazards and unsafe conditions and provide effective training to employees before they begin a new job assignment.”

Investigators found that Crain Walnut Shelling failed to ensure that the walnut bin dumper they designed included proper machine guards or lockout/tagout procedures to protect workers who maintain the machinery. Crain also failed to provide an extension tool for cleaning the area, which would have significantly minimized potential crushing hazards. Cal/OSHA identified four serious violations and issued four citations with proposed penalties totaling $67,500.

Citations were also issued to Cal North Farm Labor, Inc. for their failure to ensure that workers are trained on hazards related to cleaning and servicing around the bin dumper.

Cal/OSHA issued two citations classified as serious with proposed penalties of $33,750. Failure to develop and follow steps to de-energize or block the use of equipment, otherwise known as lockout/tagout procedures, before cleaning or working on machinery can result in serious or fatal workplace injuries. Cal/OSHA offers an eTool to help employers comply with lockout/tagout regulations and develop an effective safety program.

National Drug Take Back Day Set for April 27th.

The National Prescription Drug Take Back Day aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.

This year the National Prescription Drug Take-Back Day will be Saturday, April 27, 2019 from 10:00 a.m. – 2:00 p.m.  The DEA has an online site locator which quickly identifies a disposal site near your location.

The last Take-Back Day brought in more than 900,000 pounds of unused or expired prescription medication. This brings the total amount of prescription drugs collected by DEA since the fall of 2010 to 10,878,950 pounds.

Too often, unused prescription drugs find their way into the wrong hands. That’s dangerous and often tragic. That’s why it was great to see thousands of folks from across the country clean out their medicine cabinets and turn in – safely and anonymously – a record amount of prescription drugs.

The U.S. Drug Enforcement Administration (DEA) hosts a no-questions asked National Prescription Drug Take-Back event twice per year where temporary collection sites are set up in local cities throughout the nation for safe disposal of prescription drugs, including opioids.

DEA began hosting National Prescription Drug Take-Back events in 2010. At the last Take-Back Day in October 2018 over 5,800 sites across the nation collected unwanted or expired medications totaling 914,236 pounds (457.12 tons). The total amount of prescription drugs collected by DEA since the fall of 2010 is 10,878,950 pounds (5,439.5 tons).

Keep in mind that these items generally are not accepted at the drop box. Check with the collector ahead of time to determine what items are specifically not accepted.

–  Needles or other sharps
–  Asthma inhalers
–  Mercury thermometers
–  Iodine-containing medications
–  Illicit drugs or substances (including marijuana which is still a schedule 1 drug under federal law), and any prescription medications obtained illegally.

Opioid abuse is at epidemic levels in the U.S., and remains a top public health concern. Consumers should dispose of expired, unwanted, or unused medicines as quickly as possible to help reduce accidental or intentional overdoses or illegal abuse. The DEA’s “Take-Back” initiative is one of several strategies to reduce prescription drug abuse and diversion in the nation.

60 Arrested in National 32 Million Pain Pill Bust

Some 60 doctors, pharmacists and other licensed medical professionals in five states are being charged in connection with illegally prescribing more than 32 million pain pills, in some cases for sexual favors, federal prosecutors said Wednesday.

The people charged across 11 federal districts, include 31 doctors, seven pharmacists, eight nurse practitioners, and seven other licensed medical professionals, the Justice Department said. The cases involve more than 350,000 prescriptions for controlled substances across Ohio, Kentucky, Tennessee, Alabama, and West Virginia. The arrests were the latest effort to combat the nationwide opioid epidemic.

In one case filed in Tennessee, a nurse practitioner who branded himself the “Rock Doc,” allegedly prescribed powerful and dangerous combinations of opioids and benzodiazepines, sometimes in exchange for sexual favors; over approximately three years, the doctor allegedly prescribed approximately 500,000 hydrocodone pills, 300,000 oxycodone pills, 1,500 fentanyl patches, and more than 600,000 benzodiazepine pills.

In another case in Ohio, a doctor who is alleged to have been at one time the highest prescriber of controlled substances in the state, and several pharmacists are charged with operating an alleged “pill mill” in Dayton, Ohio. According to the indictment, between October 2015 and October 2017 alone, the pharmacy allegedly dispensed over 1.75 million pills.

A Kentucky dentist was charged for alleged conduct that included writing prescriptions for opioids that had no legitimate medical purpose and that were outside the usual course of professional practice, removing teeth unnecessarily, scheduling unnecessary follow-up appointments, and billing inappropriately for services.

In yet another case, a doctor was charged for allegedly prescribing opioids to Facebook friends who would come to his home to pick up prescriptions, and for signing prescriptions for other persons based on messenger requests to his office manager, who then allegedly delivered the signed prescriptions in exchange for cash.

In addition Attorney General Barr and U.S. Attorney Thomas T. Cullen announced that the Appalachian Regional Prescription Opioid (ARPO) Strike Force will expand into the Western District of Virginia, making it the tenth ARPO Strike Force district.

ARPO is a joint law enforcement effort that brings together the resources and expertise of the Health Care Fraud Unit in the Criminal Division’s Fraud Section (HCF Unit), the U.S. Attorney’s Offices for ten federal districts in six states, as well as law enforcement partners at the FBI, HHS Office of the Inspector General (HHS-OIG) and U.S. Drug Enforcement Administration (DEA).

In addition, HHS announced that since June 2018, it has excluded over 2,000 individuals from participation in Medicare, Medicaid and all other Federal health care programs, which includes more than 650 providers excluded for conduct related to opioid diversion and abuse.

Since July 2017, DEA has issued 31 immediate suspension orders, 129 orders to show cause, and received 1,386 surrenders for cause nationwide for violations of the Controlled Substances Act.

Car Wash Issued $2.36 Million in Wage Theft Citations

The Labor Commissioner’s Office issued more than $2.36 million in wage theft citations to a Culver City car wash for failing to properly pay or provide required breaks to 64 workers. An investigation at Centinela Car Wash, Inc., DBA Playa Vista Car Wash uncovered a variety of wage theft practices that are common in the car wash industry. The citations, which name the corporation’s president and general manager as jointly and severally liable, are the largest issued against a car wash business by the Labor Commissioner’s Office.

Workers were required to report to an alley next to the car wash 30 minutes before the business opened to be selected to work that day. Those not selected were typically sent home several hours later without being paid for the waiting time. Workers were also frequently required to take extended lunch breaks with no split shift premium, or worked up to 10 hours a day with no overtime pay. Managers regularly altered workers’ time cards to reduce total hours worked.

Consequently, in addition to the car wash corporation itself, the corporation’s president, Hooman Nissani and general manager Keyvan Shamshoni, were both held jointly and severally liable for the wage theft violations.

The investigation was opened in February 2018 after the Labor Commissioner’s Office received a referral from the Community Labor Environmental Action Network (CLEAN), a nonprofit that assists car wash workers. CLEAN assisted in the investigation by contacting workers who might have been victims of the wage theft, and coordinating with workers so that investigators could interview them about working conditions at the car wash.

In March 2018, Centinela Car Wash, Inc. was cited $10,000 for failure to register with the Labor Commissioner’s Office as required by Labor Code sections 2054 and 2060. The registration application is available online at the Labor Commissioner’s website.

The $2,365,051 citation amount includes $1,849,151 payable to workers and $515,900 in civil penalties. Of the total due to workers, $487,045 is for minimum wage violations, $146,129 in overtime wages, $688,410 in liquidated damages, $258,394 for meal and rest break violations, $64,905 for split shift violations, $188,450 for itemized statement violations and $15,638 for waiting time penalties.

The civil penalties include $124,150 for minimum wage and overtime violations, $49,350 for meal and rest break violations, $49,400 for split shift violations and $293,000 for itemized statement violations. Investigators also issued a demand that Playa Vista Car Wash pay $19,000 to return illegal deductions from workers’ paychecks for towels used at the car wash.

Ringleaders of Sham Clinics Plead Guilty

12 defendants taken into custody in August 2017 on federal drug trafficking charges that allege they diverted at least 2 million prescription pills – including oxycodone and other addictive and dangerous narcotics – to the black market. Two grand jury indictments claimed the activity took place through a series of sham Southern California clinics that periodically opened and closed in a “nomadic” style

Authorities have now announced that the ringleaders, two San Fernando Valley brothers have pleaded guilty to federal criminal charges, admitting that they conspired to distribute powerful narcotics such as hydrocodone and oxycodone via sham medical clinics that hired corrupt doctors who wrote fraudulent prescriptions to black market customers.

Minas Matosyan, a.k.a. “Maserati Mike,” 38, of Encino, and Hayk Matosyan, 32, of Granada Hills, each pleaded guilty on Monday to one count of conspiracy to distribute a controlled substance. United States District Judge Philip S. Gutierrez has scheduled a July 15 sentencing hearing for the brothers, each of whom faces a statutory maximum sentence of 20 years in federal prison.

The Matosyan brothers were arrested in August 2017 pursuant to a grand jury indictment that charged 12 defendants in a scheme to divert at least 2 million prescription pills for sale on the black market. A September 10 trial date has been scheduled for most of the remaining defendants.

According to his plea agreement, Minas Matosyan admitted to controlling the sham clinics and hiring corrupt doctors who allowed their names to be used on fraudulent prescriptions in exchange for kickbacks. Minas Matosyan also admitted to stealing the identities of other doctors and then issuing prescriptions in those doctors’ names, either by personally acquiring prescription pads in the doctors’ names or by arranging for other co-conspirators to do so. The elder Matosyan also admitted to staffing receptionists at the clinics who would falsely verify the phony prescriptions when pharmacists called to verify them.

Minas Matosyan sold narcotic prescriptions to black market customers – either directly or through couriers – and also sold bulk quantities of hydrocodone and oxycodone he had acquired from phony prescriptions filled at pharmacies by other customers.

In May 2016, Minas Matosyan spoke with a doctor and offered him a “very lucrative position” where the doctor would “sit home making $20,000 a month doing nothing,” according to the plea agreement. After the doctor declined the offer, Matosyan stole the doctor’s identity, sending a co-conspirator a text message containing the doctor’s full name, medical license number and national provider identifier number that the co-conspirator used to order prescription pads in the doctor’s name. Over the next two months, Matosyan and his co-conspirators sold fraudulent prescriptions purportedly issued by the victim doctor for at least 9,450 pills of oxycodone and 990 pills of hydrocodone, the plea agreement states.

Hayk Matosyan admitted in his plea agreement that he aided the conspiracy by serving as a courier of oxycodone or related proceeds from the sale of oxycodone.

The investigation in this case is being conducted by the Drug Enforcement Administration; Internal Revenue Service Criminal Investigation; the U.S. Department of Health and Human Services – Office of Inspector General; the Ventura County Sheriff’s Office, Pharmaceutical Crimes Unit; and U.S. Immigration and Customs Enforcement’s Homeland Security Investigations.

The primary investigative agencies received substantial assistance from the Los Angeles County Sheriff’s Department, the Los Angeles Police Department, the California Department of Justice, and the Orange Police Department.

This matter is being prosecuted by Assistant United States Attorney Benjamin Barron of the Organized Crime Drug Enforcement Task Force.

Two Employers Fined $300K For Finger Amputation

Cal/OSHA has issued more than $300,000 in serious citations to two employers after a temporary worker lost two fingers cleaning machinery at a food manufacturing facility in Los Angeles.

On October 2, 2018, the employee for Priority Workforce, Inc. was assigned to JSL Foods, Inc., a maker and distributer of noodles, pasta and baked goods. The worker was cleaning a dough rolling machine when his left hand was partially pulled into the moving rollers and two of his fingers were amputated.

Cal/OSHA’s investigation found the machine had not been adequately guarded to prevent fingers from entering pinch points, or de-energized and locked out to prevent movement while the worker was cleaning it. Neither employer had trained the worker to follow lockout/tagout procedures before cleaning the equipment. Lockout involves isolating a machine from its power source and using a device to prevent machinery from being restarted, while a tagout device on a machine shows it is prohibited to operate.

“Lockout/tagout procedures are required to protect employees who maintain powered equipment with moveable parts,” said Cal/OSHA Chief Juliann Sum. “Employers must ensure the procedures are in place and are followed.”

Cal/OSHA cited JSL Foods Inc. $276,435 in proposed penalties for seven violations, including one willful repeat serious violation and one willful repeat serious accident-related violation for failing to follow lockout/tagout procedures. JSL Foods, Inc. was cited twice in 2015 for the same violations.

Cal/OSHA also cited Tustin-based Priority Workforce Inc. $29,250 in proposed penalties for three serious violations for failure to establish, implement, and maintain an effective Injury and Illness Prevention Program, failure to ensure employees were effectively trained, and failure to ensure the machinery was adequately guarded.