Becker's ASC Review

50 QUALITY & ACCREDITATION Pain Center Chain Linked to 700 Patient Deaths, Largely due to Opioids: 7 Indicted By Shayna Korol T wo Italians and five Americans have been charged in a fraud and drug trafficking conspiracy to distribute opioids in Tennessee and Florida "pill mills." The alleged conspirators ran the Knoxville, Tenn.-based Urgent Care & Surgery Center Enterprise, which operated opioid-based pain management clinics that led to the death of approximately 700 patients. Here are six things you need to know: 1. e defendants include: • Luca Sartini • Luigi Palma (alias Jimmy Palma) • Benjamin Rodriguez • Sylvia Hofstetter • Courtney Newman, NP • Cynthia Clemons, NP • Holli Womack (Holli Carmichael), NP Mr. Sartini and Mr. Palma were arrested in the Rome, Italy by Italian authorities. e U.S. seeks extradition. Prosecutors described Ms. Hofstetter as the largest drug dealer ever to appear in an East Tennessee federal courtroom. Mr. Rodriguez is set to self-surrender and all other defendants were charged in previous indictments. 2. e defendants ran UCSC Enterprise from April 2009 to March 2015. e defendants allegedly hired medical providers with DEA registration numbers that allowed the providers to prescribe controlled substances. According to the DOJ's report, the prescrip- tions were typically written for large doses of controlled substances to individuals who had traveled long distances, telling the physicians they suffered from severe chronic pain. 3. e superseding indictment alleges the de- fendants distributed oxycodone, oxymorphone and morphine in sufficient quantities to gener- ate clinic revenue of at least $21 million. 4. e indictment alleges approximately 700 UCSC Enterprise patients are now dead and a significant percentage of those deaths resulted from overdosing on narcotics pre- scribed by the UCSC Enterprise. 5. e indictment also alleges that many patients arrived in groups sponsored by drug dealers who paid for the pain clinic visits and prescriptions to obtain all or part of the opioids and other narcotics prescribed to the patients. In return, opioid-addicted patients would receive a portion of the prescribed narcotics for free from the sponsor. 6. As a result of the Attorney General's Opi- oid Fraud and Abuse Task Force Initiative investigation, approximately 30 narcotics traffickers have been charged and convicted federally. Approximately 80 to 90 smaller narcotics distributors have been charged and convicted. e Jan. 19 superseding indict- ment is among 35 related indictments charg- ing about 140 individuals including medical providers employed at the pill mills. n HCA Warns Patients They 'Will Feel Pain' in Effort to Curb Opioid use: 4 Things to Know By Brian Zimmerman N ashville, Tenn.-based Hospital Corporation of America and Brentwood, Tenn.-based LifePoint Health are working to change patients' pain expectations to help curb the nation's opioid overdose crisis, according to a report from Nashville Public Radio. Here are four things to know: 1. HCA is introducing a new pre-surgery protocol to help manage patient expectations of pain. Under the new protocol, physicians will tell patients they "will treat the pain, but you should expect that you're going to have some pain. And you should also understand that taking a narcotic so that you have no pain really puts you at risk of becoming addicted to that narcotic," Michael Schlosser, MD, CMO for HCA, told Nashville Public Radio. 2. Dr. Schlosser spent a decade as a spinal surgeon at Nashville-based Centennial Medical Center, HCA's flag- ship hospital, where he prioritized soothing patient pain. "I just wanted my patient not to be in pain, thinking I was doing the right thing for them and certainly not an outlier among my colleagues, but now looking back on it, I was putting them at significant risk for developing an addic- tion to those medications," Dr. Schlosser told Nashville Public Radio. 3. LifePoint Health is also working to change patient expectations of pain management and making a special effort to identify patients presenting at the emergency de- partment specifically for the purpose of obtaining opioids. "We really do have a lot of responsibility and culpabil- ity and this burden, and so we have to make sure we do whatever we can to stem this tide and turn the ship in the other direction," John Young, MD, national medical direc- tor of cardiovascular services for LifePoint Hospitals, told Nashville Public Radio. 4. The new approach to managing patient expectations represents a shift in care priorities. In 2001, The Joint Commission referred to pain as the fifth vital sign in its "Examples of Implementation" manual. HCAHPS patient satisfaction surveys included questions on pain manage- ment for years, potentially spurring further reliance on opioid painkillers. n

• Cover