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Trial against opioid distributors wraps up in West Virginia

Trial against opioid distributors wraps up in West Virginia

CHARLESTON, W.Va. — Attorneys for major drug distributors made their final pleas to a federal judge Wednesday to absolve them while placing the blame elsewhere for a prescription pill health emergency in a part of West Virginia.Defense attorneys tried to find holes in assertions by the plaintiffs and their witnesses as two-day closing arguments wrapped up in the bench trial of a lawsuit against distributors AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp.In a state that has had the nation’s highest fatal opioid overdose rate, Cabell County and the city of Huntington are seeking more than $2.5 billion from the distributors that would go toward abatement efforts. A verdict isn’t expected for at least three weeks.Some 81 million pills were sent to the community of about 100,000 along the Ohio River from 2006 to 2014. The lawsuit accused the companies of creating a “public nuisance” with the onslaught and ignoring the signs that the area was being ravaged by addiction.The companies have placed the responsibility on doctors writing prescriptions and say poor communication and pill quotas set by federal agents also were to blame.Cardinal Health attorney Enu Mainigi tried to minimize the company’s involvement during her nearly two-hour closing argument, saying that over 32 days at trial, the court heard little about its conduct.“None of the evidence shows Cardinal Health’s conduct was unreasonable,” Mainigi said. “There’s no witness that has given the court a basis to find that we were a direct cause.”She also said distributors are not responsible for the diversion of pills from patients into others’ hands, whether that medication is sold, stolen or given away.“That’s a crime,” she said. “And Cardinal Health can’t stop any of that from happening.”According to testimony, there were nearly 6,500 overdoses in Huntington and Cabell County from 2015 to 2020, while there were 1,151 drug-related deaths from 2001 to 2018. About 2,500 babies have been born exposed to drugs and 8,252 people suffer from opioid use disorder — or about 10% of the current population.Like Mainigi, McKesson attorney Timothy Hester tried to downplay his company’s role, saying that 76% of McKesson’s pill shipments went to a veterans hospital in Huntington.“McKesson did not distribute 81 million pills,” Hester said.He said higher pill volumes in the county were driven by an increase in prescriptions, and he echoed Mainigi in saying the plaintiffs’ claim of harm was caused by pill diversion. However, no evidence was given by the plaintiffs that pills were diverted from VA shipments, Hester said.“The key players who contributed to this volume of prescription opioids are not parties here,” including doctors, drug dealers, pill manufacturers, pharmacies and three pill distributors in the area who are bigger than McKesson but are not part of the case, Hester said.Plaintiff attorney Paul Farrell, representing Cabell County, said he took “great offense” at some of the defense’s comments, including a notion that the distributors had no responsibility to control the supply of pills. If that were the case, the pills shouldn’t need a registration as required with the federal government.”They should just be in delivery trucks,” Farrell said.Farrell said the distributors had a duty to block larger orders that were deemed suspicious. “If the number of pills that came into Huntington and Cabell County, West Virginia, isn’t suspicious, I don’t know what is,” he said.“We had 81 million pills,” Farrell said. “And it wasn’t by accident.”Similar lawsuits have resulted in multimillion-dollar settlements, but this is the first time allegations have wound up at federal trial. The result could have huge effects on similar lawsuits that have been filed across the country.Last week, lawyers for state and local governments announced a potential $26 billion settlement over the toll of opioids with AmerisourceBergen, Cardinal Health and McKesson as well as drugmaker Johnson & Johnson. After full details are shared, each state will have 30 days to decide whether to join. And local governments will have five months after that to decide. If governments don’t opt in, the settlement total would go down.In separate, similar lawsuits, the state of West Virginia reached a $37 million settlement with McKesson in 2019, and $20 million with Cardinal Health and $16 million with AmerisourceBergen in 2017.

Closing arguments held in West Virginia lawsuit over opioids

Closing arguments held in West Virginia lawsuit over opioids

CHARLESTON, W.Va. — Three major U.S. drug distributors should be held responsible for sending a “tsunami” of prescription pain pills that caused a health crisis in one corner of West Virginia, an attorney for local governments said in closing arguments Tuesday in a landmark federal lawsuit.Distributors AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp. distributed 81 million pills into Cabell County and the city of Huntington over eight years.The lawsuit by the city and the county accused the companies of creating a “public nuisance” with the onslaught and ignoring the signs that the community of about 100,000 people along the Ohio River was being ravaged by addiction.The plaintiffs are seeking more than $2.5 billion that would go toward abatement efforts.”I don’t know of anywhere else in the country that can show this tsunami of pills,” Cabell County attorney Paul Farrell said.The companies, in turn, say poor communication and pill quotas set by federal agents were to blame, along with a rise in prescriptions written by doctors.Farrell tried to show that the defendants’ conduct was unreasonable, reckless and disregarded the public’s health and safety.“The defendants saw everything, they overlooked a great deal and they corrected very little,” Farrell said. “The massive volume of prescription opioids distributed by the defendants demonstrates a failure to maintain effective control.”Farrell referred to testimony from Dr. Rahul Gupta, West Virginia’s former health officer and now President Joe Biden’s pick as the director of the Office of National Drug Control Policy. In 2016, Gupta conducted contact tracing of all 830 drug overdoses in the state and found that a significant percentage of those who died had opioids in their system but did not have a valid prescription for them, Farrell said.AmerisourceBergen attorney Bob Nicholas argued that the plaintiffs failed to show that the companies committed unreasonable conduct.”Licensed pharmacies dispensed the medicines that these doctors prescribed,” Nicholas said. “The only thing to be said about the distributors is that they did not second guess these medical judgments. They did not subvert the standard of care. They did not countermand medical decisions and withhold medicines. They weren’t qualified to do that. It wasn’t their place to do that. And medicine would not have gone where it needed to go.”Opioid overdoses have been linked to the deaths of nearly 500,000 Americans since 2000 and reached a record of nearly 50,000 in 2019. West Virginia has had the nation’s highest fatal opioid overdose rate.Farrell pointed to witness and expert testimony showing that from 2015 to 2020, there were nearly 6,500 overdoses in Huntington and Cabell County, 1,151 drug-related deaths, 2,500 babies born exposed to drugs and 8,252 people suffering from opioid use disorder — or about 10% of the current population.Anne Kearse, an attorney for the city of Huntington, displayed photos of expert witnesses and quote boxes with their testimony to show how opioids have caused widespread community harm. In one quote box, former Huntington Police Chief William Holbrook said the addiction crisis “has affected me profoundly.” And Jan Rader, the city’s fire chief, said the overdose carnage “cuts across every socioeconomic line. So there is no typical person that overdoses.”The federal bench trial began May 3. It had been scheduled to last through mid-August, but company attorneys rested their case earlier this month after just five days of witness testimony. Plaintiff attorneys conducted more than six weeks of testimony.Similar lawsuits have resulted in multimillion-dollar settlements, but this is the first time allegations have wound up at federal trial. The result could have huge effects on other similar lawsuits that have been filed across the country.Last week, lawyers for state and local governments announced a potential $26 billion settlement over the toll of opioids with AmerisourceBergen, Cardinal Health and McKesson, and the drugmaker Johnson & Johnson. After full details are shared, each state would have 30 days to decide whether to join. And local governments will have five months after that to decide. If governments don’t opt in, the settlement total would go down.In separate, similar lawsuits, the state of West Virginia reached a $37 million settlement with McKesson in 2019 and $20 million with Cardinal Health and $16 million with AmerisourceBergen in 2017.

Opioid-ravaged West Virginia looks to $26B deal for help

Opioid-ravaged West Virginia looks to $26B deal for help

HUNTINGTON, W.Va. — Crumbling roofs and parking lots. Broadband glitches. Technology challenges. The priority list for Prestera Center goes beyond the mental health and addiction treatment services it provides to patients throughout West Virginia.One thing’s for sure: In one of the epicenters of the U.S. opioid explosion, the nonprofit group really could use some money. Whether from a potential national settlement deal with big U.S. drug distribution companies or from some other source, an infusion of cash would stem the tide of losses in staffing and other areas in recent years, along with the strain caused by the coronavirus pandemic.“Our needs are long,” Prestera addictions counselor Kim Miller said. “We need help.”More money could be on its way to places like Prestera across the country. This week, lawyers for state and local governments announced a potential $26 billion settlement over the toll of opioids with drugmaker Johnson & Johnson and drug distribution firms AmerisourceBergen, Cardinal Health and McKesson.But West Virginia isn’t included in the deal with the three distributors because it already settled with them and other drug wholesalers for a total of $84 million in a series of deals struck from 2017 through 2019. And state Attorney General Patrick Morrisey has so far resisted sharing in the $5 billion Johnson & Johnson would contribute under the potential deal. However, the earlier deals excluded municipalities and counties, allowing for the potential of much more money to flow into the state.Morrisey says he knows those fighting the opioid crisis need urgent support, but he’s concerned about how it would be distributed nationally. He argues that the proposed allocations are too focused on the size of each state’s population and don’t adequately take into account the depth of the crisis in West Virginia.If Morrisey rejects the settlement, the state would not receive a share of the distributed funds but it could continue litigation against J&J on its own in the hopes of reaching a better deal.Prestera CEO Lisa Zappia said she has mixed feelings about the proposed settlement and needs to see more details before she decides whether to support it.Prestera employs 550 workers at 55 locations in southern West Virginia and provides services to more than 20,000 people annually. There are addiction recovery centers, mental health treatment facilities, youth programs and suicide awareness initiatives, to name a few.Prestera didn’t qualify for paycheck protection loans that help businesses keep their workforce employed during the COVID-19 pandemic. It received a small amount of federal stimulus money for Medicare, but not enough to offset losses, Miller said. “We can’t afford to lose money year after year. You can’t keep the doors open. We had to scale back some services.”During the pandemic, the nonprofit tried to make use of telehealth services instead of in-person visits. But its broadband internet connection was rocky at best.“We’re just doing the best that we can with what we have,” Miller said.That’s where hope that settlement money, whether from the newly announced deal or some other one, trickles down to the ground level.Dreaming is free.“We would want to look at all of our infrastructure needs. Increasing our broadband. Rehabilitating some of the facilities that we have not been able to rehabilitate for a long time. Things like roofs,” Miller said. “We have a long list of maintenance issues that we’ve had to just repair and Band-Aid the best we can.”After his own struggles with prescription pain pills following a broken nose sustained in a college bar fight, Doug Leech underwent addiction treatment in Minnesota for a year because there were no residential facility beds available in his native West Virginia. The state has had the highest death rate from opioids in the country.Initially an accountant, Leech formed Morgantown-based Ascension Recovery Services out of his basement in 2016 to help others suffering from addiction. The behavioral health consulting management organization now has 50 employees and has developed programs in 35 states.“We know how to treat this disease,” Leech said. “But the payment model is flawed. The reimbursement rates are so low.”If West Virginia gets a piece of the national settlement money, Leech would want to continue shifting focus away from a fragmented system of addiction care to a long-term approach that loops in everyone, including hospitals, outpatient clinics and residential facility operators.“That’s my hope is that this money can go to help establish these systems and then we can begin working with the payers to implement a payment arrangement that will save them money and keep people sober long term,” Leech said.At Prestera, which receives more than half of its funding from Medicaid reimbursements, the parking lot at the Huntington headquarters looks like the aftermath of an earthquake. Simply navigating Prestera’s antiquated and glitchy phone system is tricky. Replacing it would cost $85,000.At another Prestera facility in the city along the Ohio River, Zappia said the roof is being replaced at a cost of $140,000. She also fears that the building’s 50-year-old boiler is on its last legs.“I’m holding my breath,” Zappia said. “I don’t have $300,000 to replace it.”Those buildings need to be in a condition where people can come in and feel like it’s a nice place to be, where it’s comfortable and inviting. That’s why infrastructure is important for us.”Prestera’s staffing levels are down nearly one-third in the past 10 years. There were pandemic-related furloughs and layoffs, although nearly all of those affected have been brought back. Many are still working from home.People are also not coming in for treatment like before the pandemic started. Some are worried about contracting COVID-19 by staying in a residential substance use treatment facility.“While we struggle financially, the importance of what we do has never been more apparent,” Miller said.Miller pointed to statistics showing that substance abuse has increased during the pandemic. So has the public’s levels of depression, anxiety and stress, including among children.“This pandemic is a mental health and substance use nightmare,” Miller said. “It’s going to increase people’s mental health problems. It will increase substance use. And we have to be prepared to meet that need.”

Needle exchange law in West Virginia halted amid lawsuit

Needle exchange law in West Virginia halted amid lawsuit

A judge in West Virginia has granted a group’s request to prevent a law tightening requirements on needle exchange programs from being implemented next monthBy JOHN RABY Associated PressJune 28, 2021, 9:46 PM• 3 min readShare to FacebookShare to TwitterEmail this articleCHARLESTON, W.Va. — A judge in West Virginia has granted a group’s request to stop a law tightening requirements on needle exchange programs from being implemented next month.The American Civil Liberties Union’s West Virginia chapter filed a federal lawsuit last week. A judge issued a temporary restraining order Monday and scheduled a July 8 hearing on the issue. The law was set to take effect July 9.“We’re encouraged by this decision from the court,” chapter legal director Loree Stark said. “This harmful, constitutionally flawed bill should never be allowed to take effect. Harm reduction saves lives.”Republican Gov. Jim Justice signed the bill in April over the objections of critics who said it will restrict access to clean needles amid a spike in HIV cases.The governor’s office did not return an email seeking comment Monday.The bill would requires licenses for syringe collection and distribution programs. Operators would have to offer an array of health outreach services, including overdose prevention education and substance abuse treatment program referrals. Participants also must show an identification card to obtain a syringe. Advocates view the regulations as onerous.Supporters said the legislation would help those addicted to opioids get connected to health care services fighting substance abuse. Some Republicans lawmakers had said the changes were necessary because some needle exchange programs were “operating so irresponsibly” that they were causing syringe litter.The ACLU chapter called it “one of the most restrictive state laws governing syringe exchange services in the nation.” The group said it would likely lead to more HIV cases and the spread of other bloodborne illnesses.The law, if implemented, would take effect amid one of the nation’s highest spikes in HIV cases related to intravenous drug use. The surge, clustered mainly around the capital of Charleston and the city of Huntington, was attributed at least in part to the cancellation in 2018 of Charleston’s needle exchange program.It has led to an investigation by the federal Centers for Disease Control and Prevention that last week found emergency departments and inpatient medical personnel rarely conducted HIV testing on intravenous drug users in Kanawha County.Previously, city leaders and first responders complained that the program in Kanawha County led to an increase in needles being left in public places and abandoned buildings, and it was shut down.The CDC describes syringe programs as “safe, effective, and cost-saving.”On Saturday, dozens of volunteers formed the letters “HIV SOS” at a health event as activists seek a public health emergency declaration in Charleston for the HIV crisis as well as overdoses from prescription pain pills.———Associated Press writer Cuneyt Dil contributed to this report.

DOJ: 2 states' transgender restrictions unconstitutional

DOJ: 2 states' transgender restrictions unconstitutional

CHARLESTON, W.Va. — The U.S. Department of Justice on Thursday challenged bans involving transgender people that target athletes in West Virginia and children in Arkansas, slamming them as violations of federal law.The department filed statements of interest in lawsuits that seek to overturn new laws in those states. In West Virginia, a law prohibits transgender athletes from competing in female sports. Arkansas became the first state to ban gender confirming treatments or surgery for transgender youth.The DOJ said the laws in both states violate the equal protection clause of the 14th Amendment. It also said the West Virginia law violates Title IX, which prohibits discrimination on the basis of sex in any education program or activity receiving federal funds.And in a third case, West Virginia’s Supreme Court on Thursday reinstated a lawsuit filed on behalf of a transgender male student who said an assistant principal harassed him when he tried to use the boys bathroom.The American Civil Liberties Union, its West Virginia chapter and LGBTQ interest group Lambda Legal challenged the athlete ban on behalf of an 11-year-old transgender girl who had hoped to compete in cross-country in middle school.“A state law that limits or denies a particular class of people’s ability to participate in public, federally funded educational programs and activities solely because their gender identity does not match their sex assigned at birth violates both Title IX and the Equal Protection Clause,” the Justice Department filing said. The state law “does exactly this.”In Arkansas, the ACLU filed a lawsuit last month challenging the transgender youth prohibition, which is set to take effect on July 28. It prohibits doctors from providing gender confirming hormone treatment, puberty blockers or surgery to anyone under 18 years old, or from referring them to other providers for the treatment.The ACLU filed the lawsuit on behalf of four transgender youth and their families, as well as two doctors who provide gender confirming treatments. The lawsuit argues the prohibition will severely harm transgender youth in the state and violate their constitutional rights.“A state law that specifically denies a limited class of people the ability to receive medically necessary care from their healthcare providers solely on the basis of their sex assigned at birth violates the Equal Protection Clause,” the Justice Department filing said. “These restrictions explicitly target transgender people.”Republican lawmakers enacted the ban in April, overriding a veto by GOP Gov. Asa Hutchinson. The governor vetoed the ban following pleas from pediatricians, social workers and the parents of transgender youth who said the measure would harm a community already at risk for depression and suicide.Hutchinson said the law went too far, especially since it wouldn’t exempt youth already receiving the care. Gender confirming surgery is currently not performed on minors in Arkansas.Arkansas Attorney General Leslie Rutledge, also a Republican, asked a federal judge this week to dismiss the lawsuit over the state’s ban. And West Virginia Republican Attorney General Patrick Morrisey on Thursday asked a judge to allow him to intervene on the state’s behalf to defend the athlete ban.Several other states also have enacted bills this year over school sports participation bans. South Dakota Gov. Kristi Noem implemented the move by executive order. Other states, including Kansas and North Dakota, passed bans only to have them vetoed by the governor.In February, the Biden administration withdrew government support for a federal lawsuit in Connecticut that seeks to ban transgender athletes from participating in girls high school sports. A federal judge dismissed that lawsuit in April.The West Virginia Secondary School Activities Commission, which oversees scholastic sports, said earlier this year that it had not received any complaints about transgender athletes on girls teams.Several Democrats said the bill was discriminatory, but supporters have argued that transgender athletes would have physical advantages in female sports. Some Republicans said the bill was about protecting athletic opportunities for athletes who are identified as girls at birth.Republican Gov. Jim Justice signed the bill despite warnings from some lawmakers that the NCAA could retaliate and decide not to hold college tournaments in the state. Justice had said that while it concerned him that the state could miss out on a sporting event, he believed the benefits of the law “way outweigh the bad part of it.”In the transgender bathroom case, the West Virginia Supreme Court reinstated some negligence claims and sent the lawsuit back to a lower court for further proceedings. A circuit judge had dismissed the lawsuit, saying the Harrison County school board was immune from liability for the actions of an assistant principal.The lawsuit filed on behalf of student Michael Critchfield accused the board of failing to create a safe school environment. The ACLU had said Liberty High School Assistant Principal Lee Livengood followed Critchfield into the boys bathroom in November 2018 at the school and said, “You freak me out.” Critchfield said he also was ordered to prove his gender by using a urinal. He was 15 at the time.An attorney for Livengood had previously argued that his client was unaware of Critchfield’s gender identity and was not told of an arrangement Critchfield had with the principal to use the boys restrooms.