“Whose Body Is It?”: Pharmacists Can’t Be Allowed To Deny Women Emergency Contraception
Women deserve the chance to prevent pregnancy after birth control failure, sexual assault, or unprotected sex. Emergency contraception, also known as the “morning-after pill,” is FDA-approved and prevents pregnancy after sexual intercourse. But it is time-sensitive; it only works if women are able to obtain it without delay or discrimination.
Unfortunately, healthcare providers are refusing to dispense emergency contraception based on their own religious or moral beliefs, thereby overriding women’s decisions about their bodies and lives. Pharmacists in at least 24 states have refused to sell birth control or emergency contraception to women. Some hospital emergency rooms refuse to provide emergency contraception to rape victims.
Some healthcare providers even lie to women—for example, by saying it will cause an abortion. In one case, a woman believed a Wisconsin pharmacist who called her a murderer. Although it will not work once a woman is pregnant, she did not fill her prescription and got pregnant. In a California incident, a couple with a newborn sought emergency contraception after birth control failure. The pharmacist called them irresponsible, refused to fill the prescription, and did not enter it into the system so that it could be transferred elsewhere.
Laws should require all hospitals and pharmacies to establish a system to ensure that women in need of birth control, including in emergency situations, receive it without discrimination and delay. Individual healthcare providers with religious objections may be accommodated—for example, by making sure two pharmacists are on duty—but not at the expense of patient access to critical healthcare. This approach is consistent with long-standing protections for individual religious beliefs in the workplace. Refusing providers must treat patients with respect and ensure that patients receive care from another provider. They cannot—as one Wisconsin pharmacist did—leave customers waiting indefinitely for assistance in the store and on the phone. A patient should not even know her healthcare professional objects.
Refusals often result in women feeling judged, shamed, angry, and vulnerable, and they reduce women’s trust in the healthcare system. Additionally, refusals violate informed consent, restricting women’s information and options. Delays or denials of emergency contraception can lead to pregnancy. For some women, pregnancy can entail severe health risks and even life endangerment. A refusal to provide emergency contraception can further traumatize an already traumatized woman—like a rape survivor. Refusals are most burdensome on people in rural areas, or those with low incomes and no job flexibility. For example, an Ohio woman refused emergency contraception at her local pharmacy had to drive 45 miles to find another pharmacy. And some women may be limited by their insurance plan to a particular pharmacy or provider.
Recognizing the harm of refusals, states, national professional associations, and pharmacy chains have acted to protect women’s access to emergency contraception. Twenty-three states and Washington, D.C., have laws and/or policies that improve women’s access to it, such as requiring hospitals to provide it to rape survivors. Major pharmacy chains have adopted policies ensuring that women leave the pharmacy with contraception in hand. Professional healthcare associations have issued guidance protective of patients’ right to receive care. The religious beliefs of pharmacists, doctors, nurses, or other healthcare providers should not trump a woman’s ability to make decisions about her reproductive health. Those decisions are personal, and they should stay that way.
By: Gretchen Borchett, U. S. News and World Report, October 15, 2012
“Uncle Will At Your Service”: Marriott Is Mainstay For The Romney campaign
On the campaign trail, Mitt Romney incessantly talks about his “five points” to get the country moving again, but the only points anyone traveling with the GOP nominee is interested in are Marriott points.
The candidate has made the hotel chain the semi-official innkeeper of his presidential campaign. From Iowa to Ohio to New York City, Romney has wheeled his carry-on bag into Marriott lobbies and passed the omnipresent portrait of J. Willard Marriott and his son, John Willard “Bill” Marriott Jr. — a Romney contemporary, fellow Mormon scion and, along with his brother, a donor of more than $1 million to the Republican’s effort.
The Romneys and Marriotts go way back. J. Willard was a dear friend of Mitt’s father, George, with whom he sold tamales in Washington during the Depression Era. Forty years later, J. Willard Marriott asked his namesake Willard Mitt Romney, a young consultant with Bain & Co., to help with his Roy Rogers fast-food chain. But Bain prevented those at the firm from working for any client who employed their chief competitor, McKinsey & Co., which Marriott did. Or from working in a peripheral part of the business, which Roy Rogers was.
Romney had to call up “Uncle Will” — as he called him — to decline the work, according to Mike Farmer, who accompanied Romney on the sales trip.
But Romney, who once sat on the Marriott board, has stayed loyal to the Marriott empire. And now so has the phalanx of campaign operatives, television producers, camera operators and reporters, checking in behind the candidate with corporate cards in hand. (On Sunday, the Obama campaign press corp was also camped out at a Courtyard Marriott in Williamsburg.)
“It’s our home away from home,” said Rick Gorka, a spokesman for the Romney campaign. “We’ve converted a lot of press.”
To build brand loyalty and try to beat the competition, Marriott rewards guests with lodging’s version of frequent flyer miles for each stay. A steady accumulation of Marriott points bestows first silver, then gold and finally platinum status, each precious metal coming with its own precious perks.
“I’m platinum,” Gorka said proudly as he swirled a large glass of bourbon on the back of the press plane. Having spent at least 150 nights in Marriott hotels since January and racked up a half-million points, he spoke reverentially about the “Taste of Platinum” program. He became almost misty discussing the time the West Palm Beach Marriott upgraded him to a two-bedroom condo with balcony, hot tub, washer and dryer. He said he daydreamed about a prolonged, free stay in a perhaps tropical destination with his girlfriend, who eagerly monitored his point total back home. “Points,” he said, “are gold for us.”
On his way back toward the front of the plane, Gorka hovered over the aqua-blue screen of a reporter’s laptop. She was gazing at the crystalline waters surrounding Marriott’s Scrub Island Resort, Spa & Marina in the Virgin Islands. “It’s a new Marriott, autograph collection” she explained to Gorka. “It’s on a private island, 52 rooms on the marina. It looks amazing.”
“Let me know if you go,” Gorka said.
The day had started, as so many of them do, with Romney staffers and Romney press corps members climbing out of their Marriott mattresses and picking at eggs in a private breakfast room off the lobby, this time of the Columbus Airport Marriott. One of the camera crew interrupted the breakfast of one of the embedded television reporters to ask, “Are you triple platinum now?”
“Oh, yeah,” she responded matter of factly. “I, like, lived in the Marriott New Hampshire. I have 200 free nights.”
It came time to board the bus, and a circle of cameramen discussed the finer points of Marriott points, saying things like “mega bonus.”
“Have you enrolled in the platinum challenge?” one asked this reporter, who had a lowly silver status. He described an alchemy by which every two-night stay results in a free night in another Marriott. As long as it isn’t too high end, interjected a colleague, “Only category three or four, not five.”
The press then loaded onto the bus, following Romney as he campaigned around the state. Then they boarded the plane, flew with him to Boston and boarded another bus to bring them to their hotels. As the coach rolled toward the entrance of the Courtyard Marriott in Waltham, one of the embedded network producers shouted to no one in particular: “Why don’t we stay at the Westin out here? Why does the Marriott own our souls?”
By: Jason Horowitz, The Washington Post, October 14, 2012
“Mitt Romney The Product”: A New Romney Appears On A Monthly, Weekly And Sometimes Daily Basis
As he tries to engineer a comeback in this week’s presidential debate, President Obama needs to recognize two things. First, when it comes to politics, Mitt Romney treats himself as a product, not a person. Second, Republicans cannot defend their proposals in terms that are acceptable to a majority of voters.
You can imagine Romney someday saying: “Politicians are products, my friend.” There’s no other way to explain why a candidate would seem to believe he can alter what he stands for at will. His campaign has been an exercise in identifying which piece of the electorate he needs at any given moment and adjusting his views, sometimes radically, to suit this requirement.
In that respect, Romney does Richard Nixon one better. When Nixon was looking to revive his career in the 1968 campaign, the terribly scarred veteran of so many political wars realized his old persona wouldn’t sell. And so he created what came to be known as the “New Nixon” — thoughtful, statesmanlike and tempered. The operation worked until Nixon’s old self got him into trouble.
But manufacturing the New Nixon took years of painstaking effort. New Romneys appear on a monthly, weekly and sometimes daily basis. Thus did Romney move far to the right on immigration last year because he needed to dispatch nomination rival Rick Perry, a moderate on that one issue. Since then, Romney has been trying to backtrack to appease Latino voters.
During the same nomination battle, Romney abruptly changed his tax policy to placate the supply-side-Wall-Street-Journal-Grover-Norquist axis in the GOP. Romney’s initial tax proposal was relatively modest. The right wasn’t happy. No problem, said Romney, and out came his new tax plan that included a 20 percent cut in income tax rates, “rate cuts” being a term of near-religious significance to supply-siders.
Romney pointedly asserted (again, in the primaries) that he wanted the tax cut to go to everyone, “including the top 1 percent.” But this doesn’t sell to swing voters now, especially after the leaked video in which Romney wrote off 47 percent of Americans as incorrigibly dependent. So in the first debate, Romney tried to pretend that he didn’t want to cut rich people’s taxes. He reassured us that “I’m not going to reduce the share of taxes paid by high-income people.” (By the way, he could cut taxes for the rich a lot and still keep their “share” of the government’s overall tax take the same.)
And then there’s abortion, an issue about which you have to wonder if Romney cares at all. Without much effort, you can find video online in which Romney declares with passion and conviction that he is absolutely committed to a woman’s right to choose — and video in which he declares with equal passion and conviction that he is absolutely opposed to abortion and committed to the right to life. Just recently, Romney moved again, offering this shameless gem of obfuscation to the Des Moines Register editorial board: “There’s no legislation with regards to abortion that I’m familiar with that would become part of my agenda.” There is no candidate I am familiar with who has tried to have as many positions on abortion in one lifetime as Mitt Romney.
But there’s an underlying reason for Romney’s shape-shifting. It’s the same reason Rep. Paul Ryan always resorts to impressive-sounding budget speak and mathematical gobbledygook to evade explaining the impact of his budgets on actual human beings.
Romney, Ryan and the entire right know that their most deeply held belief — the one on which they won’t compromise — is rejected by the vast majority of Americans. That’s their faith that every problem in the economy and in society can be solved by throwing more money at rich people through tax cuts.
Vice President Biden kept Ryan on the defensive during most of Thursday night’s debate precisely because he refused to let anything distract him from driving this central point home. Without pause and without mercy, Biden kept bringing viewers back to the obsession of the current Republican Party with “taking care of only the very wealthy.”
Obama doesn’t have to look angry or agitated in this week’s debate. He simply needs to invite voters to see that Romney, the product, will give them no clue as to what Romney, the person, might do as president. Romney keeps changing the packaging because he knows that the policies inside the box are not what voters are looking for.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, October 14, 2012
“Influence Peddling”: Scott Brown Backed Letter For Top Legislative Priority Of Compounding Pharmacy Industry
Senator Scott Brown joined 10 other senators in sending a July letter to the US Drug Enforcement Administration advocating a top legislative priority of the compounding pharmacy industry, which is under scrutiny following a deadly meningitis outbreak.
The July 24 letter did not directly relate to the injectable steroids that have been blamed for 14 deaths and at least 185 sicknesses nationwide. But it addressed an issue central to that controversy: how these lightly regulated pharmacies can deliver their drugs and who can receive them.
The firm at the center of the meningitis outbreak, the New England Compounding Center, was sending drugs in bulk to doctors, a move that Governor Deval Patrick said has misled regulators. Compounding pharmacies are supposed to mix medications for an individual patient, based on a prescription from a doctor. But some have acted like drug companies, shipping thousands of doses to clinics and doctors’ offices, a practice Massachusetts officials say may violate state regulations.
Gregory Conigliaro, a co-owner of the New England Compounding Center in Framingham, and his wife threw a fund-raising event for Brown six weeks after the letter was written, at their home in Southborough. Brown’s campaign said he has received about $10,000 from the firm’s executives and relatives, which he donated to charity this week after the outbreak, which was traced to New England Compounding Center on Oct. 4. The senator is in a tight reelection battle against Democrat Elizabeth Warren.
For years, compounding pharmacies have delivered controlled substances, in bulk, to clinics, veterinarians, and other health facilities for use there, according to two specialists in the field. But in recent years, the DEA has interpreted federal law as requiring those pharmacies to deliver the drugs to patients whose names are on the prescription, or to owners, in the case of animals. The DEA argues that it is not a change in interpretation, enforcement, or policy and that agents pursue leads about violations whenever they are known.
The industry position, echoed by Brown Friday, argues that the DEA’s interpretation creates a paramount safety concern. Industry officials say that medical professionals are in a better position to protect the drugs, which include strong opiates, from misuse or improper environmental conditions. Many must be injected by physicians and are sensitive to heat and light.
“As you know, they sometimes fall into the wrong hands,” Brown said Friday during an event in Dorchester, where he received endorsements from a coalition of police unions. “I was advocating getting it to the doctors, which I don’t think loosens regulations.”
But changing or clarifying DEA enforcement policy is also important to helping the industry avoid a legal gray area that could jeopardize its business, said Jesse C. Vivian, professor of pharmacy practice at Wayne State University in Detroit and the general counsel for the Michigan Pharmacists Association. Vivian and others say enforcement is now selective, meaning compounding pharmacies are at risk if DEA agents choose to crack down on them.
“What they’re really looking for is to legitimize what in fact they’re doing right now,” said Vivian, who is not involved in the industry’s lobbying effort, but believes the DEA is treating the industry unfairly.
The letter to the DEA’s top official, Michele M. Leonhart, was signed by a bipartisan group of senators. When a smaller group of senators signed a similar letter in 2011, Brown did not lend his support.
The July letter implores the DEA to open what is known as a rule-making process, which would allow the agency to take public input on whether it is interpreting current law correctly.
“DEA’s lack of action is a source of serious concern for us, our constituents, and the regulated community,’’ wrote the senators, including Brown.
“It is difficult to argue that controlled substances are more safely maintained by family members or animal owners than they are by trained, licensed, regulated doctors who would administer those substances only to legitimate patients,” it continued.
Brown emphasized Friday that the type of drugs covered by the letter are different from the steroids involved in the meningitis outbreak, and he once again urged a full investigation of the outbreak. He said that the Food and Drug Administration, not the DEA, oversees the safety of drugs at the center of the meningitis problem.
Brown referred inquiries about who asked him to sign the DEA letter to his campaign, which has declined to comment on that question. But Brown said there was absolutely no connection between his signing the letter and his fund-raising from industry officials.
“It’s a tragedy, and for anyone to try and politicize it is just wrong,” he said. “I’ve had hundreds and hundreds of fundraisers. There’s absolutely no connection. That’s the old spaghetti-on-the-wall-trick, see what sticks.”
His campaign has said he would donate the $10,000 that came from company executives to the Meningitis Foundation of America.
The compounding pharmacy industry’s lobby, the International Academy of Compounding Pharmacists, lists the delivery issue raised in the letter as the first of three legislative priorities on its website. In June, a month before the letter was written, members of the organization descended on Capitol Hill to make their case, according to the website, seeking face-to-face visits with lawmakers. A spokesman for the organization did not respond to two calls and an e-mail requesting comment.
The DEA says it has no latitude in changing its enforcement of the Controlled Substances Act, which governs how drugs can be delivered, unless Congress acts.
“We have to enforce the law the way it’s written,” spokeswoman Barbara Carreno said.
By:Noah Bierman and Frank Phillips, The Boston Globe, October 12, 2012
“Pilfering The Federal Treasury”: Mitt Romney’s Medicaid Shell Game
Mitt Romney is lambasting federal aid in his campaign for the presidency, including derisive comments against those who receive government assistance. But he pulled all the stops to pursue federal aid as governor of Massachusetts, even hiring “revenue maximization” contractors to scour federal programs for every possible penny — and using financial schemes to maximize and then divert the aid from his needy constituents.
In his first budget proposal, Romney promised balancing the budget without tapping reserves, and “without the use of fiscal gimmicks.” However, buried in the details, he suggested tapping reserves such as taking $4 million from the Catastrophic Illness in Children Relief Fund, and he included fiscal gimmicks to maximize and divert federal aid into his general state coffers.
His strategies are akin to tax schemes using offshore bank accounts — but instead of avoiding federal taxes, seeking to pilfer the federal treasury. The Wall Street Journal labeled such financing mechanisms “Medicaid Money Laundering” and a “swindle.”
Medicaid is a matching grant program. If a state with a 50 percent match rate like Massachusetts spends $50 on qualifying services, the federal government will provide an additional $50 so there is $100 total for Medicaid services. The federal match payment is much higher in some states, such as Mississippi where its almost 75 percent.
Unfortunately, some states concocted budget shell games, often with private consultants, providing an illusion of state spending to claim federal matching funds, when no state spending has occurred. As governor of New Hampshire, Judd Gregg developed such a practice labeled “Mediscam.” Gregg taxed hospitals serving the poor, routed the money into an “uncompensated care fund” which he sent right back to the hospitals, and used the round-trip of money to claim federal matching funds. Then, the swindle gets worse, because he routed the federal Medicaid funds into his general coffers rather than for Medicaid services.
Romney’s schemes were similar to Gregg’s. Buried in his 2004 budget, Romney proposed maximizing federal aid by taxing hospitals, shifting the resulting tax payments in and out of an uncompensated care fund, back to hospitals as adjustment payments, and diverting resulting federal Medicaid funds to state general revenue. He also proposed using taxes on nursing homes and pharmacies in his efforts to maximize and divert federal aid.
In such strategies, health care facilities serving the poor are used to claim federal funds to help the poor. But the health care facilities and the poor may get nothing, as the state diverts the federal aid to general coffers — and revenue maximization contractors reap millions in contingency fees. Romney used such private companies to help carryout his strategies.
After a US General Accounting Office report responding to concerns of Republican Senator Charles Grassley, the Romney administration vigorously defended using contingency-fee revenue maximization consultants and revenue practices – that the GAO labeled illusory. The GAO responded that “hospitals should benefit from increased federal reimbursements and Massachusetts’s arrangement appeared to result in lower payments to hospitals, despite increased claims for federal reimbursement.” The Romney administration even defended double (if not quadruple) billing practices “of allowing multiple agencies to bill Medicaid” for “services for the same beneficiary.” The GAO concluded that the Romney administration “did not provide convincing evidence that the [Medicaid] services provided by the four state agencies were unique,” and the Bush administration agreed with the GAO’s conclusions.
The Bush administration implemented regulations trying to reduce such practices, and the Obama administration continues efforts to improve fiscal integrity in the Medicaid program. However, Romney would virtually end federal oversight by block-granting federal Medicaid funds to states.
It’s not hard to imagine how a governor — one that employs complex shell games to find loopholes in federal rules in order to maximize and divert federal aid — would use the federal funds if handed to the state without any federal oversight. The answer to state misuse of federal aid is not to give those states even more discretion to do whatever they wish – but to simplify the claiming process, reduce loopholes allowing the revenue schemes, and improve oversight to ensure Medicaid funds are used as intended.
Romney has undergone dramatic and hard to follow shifts in his apparent views of government aid. Romney2004 proposed cutting healthcare while simultaneously proposing illusory schemes to maximize and divert federal Medicaid funds. Romney2006 changed course with the first nearly universal healthcare plan. Now Romney2012 is turning back to cuts, denouncing federal aid he once schemed to maximize and divert, condemning those who need government aid, and seeking repeal of national health care reform that is nearly identical to the plan he signed into law. And now he proposes giving all the federal money from the Medicaid program to states without federal control.
Romney2004 would have a field day with Romney2012’s plan.
By: Daniel L. Hatcher, Law Professor, University of Baltimore, Published in The Boston Globe, October 12, 2012
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