Posted 3/5/2018 12:00 am
Updated 2 weeks ago
Hospitals in the Arkansas Delta are fighting the opioid epidemic with every weapon at their command, including a little-noticed lawsuit by a Monticello hospital against the larger opioid manufacturers.
It’s a battle not envisioned just four years ago, when, in 2013, drug abuse didn’t even make a list of top community concerns by Delta hospitals.
Three years later, prescription drug abuse was the No. 1 worry, said Mellie Boagni Bridewell, executive director of the Arkansas Rural Health Partnership of Lake Village. “It was a real big shocker because we had heard occasionally … about we’re having a drug problem here,” Bridewell said. “But it was never really brought out to the forefront until that.”
Arkansas had the second-highest rate of opioids prescribed in the country every year between 2014 and 2016, according to the Centers for Disease Control & Prevention of Atlanta. In 2015, 392 Arkansas deaths were caused by opioids, a 9.5 percent increase from the previous year, Bridewell said.
The ARHP, which is made up of 10 Delta hospitals, received a $750,000 grant in October from the Health Resources & Services Administration, an agency of the U.S. Department of Health & Human Services, to help it wage war.
Some health care providers in the Delta have reported success in curbing addiction to the prescription painkillers by reducing the amount of opioids prescribed. And in December, Drew Memorial Hospital Inc. in Monticello filed a lawsuit alleging that larger manufacturers of drugs with names like OxyContin and Percocet had misled the public about the addictive nature of opioids.
Drew Memorial is seeking class-action status for about 90 hospitals all over Arkansas to recoup losses for uncompensated care for the treatment of patients addicted to opioids, said one of its attorneys, C.C. “Cliff” Gibson III of the law firm Gibson & Keith of Monticello. Hospitals owned by the state or federal government won’t be included in the class.
Gibson said last week that he didn’t have an estimate of how much money hospitals have lost. For the fiscal year that ended March 31, 2016, the latest figures available to Arkansas Business, Drew Memorial reported $33.5 million in net patient revenue and $3.2 million in net income.
Drew Memorial also named in its suit former Little Rock physician Richard Johns, 52, who was sentenced in August to nine years in federal prison for selling fraudulent painkiller prescriptions. The 49-bed nonprofit hospital accused him of running a “pill mill” that sold thousands of prescriptions.
More doctors could be named in the suit, which is one of more than 200 naming opioid manufacturers, Gibson said.
Gibson said the opioid problem isn’t confined to the Delta. “It’s statewide.”
Kicking the Habit
It wasn’t until August 2016 that then-U.S. Surgeon General Vivek Murthy declared that opioids were an “urgent health crisis” and suggested that many doctors had been incorrectly taught that opioids were not addictive, according to the Drew Memorial lawsuit.
Since then, scrutiny has fallen on the opiod prescribers, and doctors aren’t writing as many prescriptions. But that’s causing other problems, according to Bridewell of the Arkansas Rural Health Partnership.
“They’re supposed to get patients off of these medications, but then there’s no way to help them,” she said.
Some of the patients addicted to opioids end up in hospital emergency rooms. “We’ve had issues where ER doctors have been threatened, and there’s been violence in our emergency rooms because of these doctors not giving out the medications that these people need.”
The grant the ARHP received will expand screening, education and counseling for those who are addicted to opioids.
Bridewell said the ARHP is training providers to assess patients. The problem is that small rural hospitals don’t have the room or the capability to hold the patients until a mental or behavioral health provider does an assessment, Bridewell said.
“The nurses don’t know how to handle those kinds of patients,” she said. “It’s just a mess.”
Dr. Brad Walsh, a family practice physician at the Family Clinic of Ashley County, said the city of Crossett has “a lot of opioid abuse.”
To curb the abuse, he said, the family clinic, which is owned by Ashley County Medical Center, doesn’t prescribe “a lot of opioids.” Clinic physicians also check with the Arkansas Prescription Monitoring Program, a database that lists what controlled substances the patient has filled. That program is overseen by the Arkansas Department of Health.
If doctors consult the database, that should reduce the number of patients who go from one doctor to another for opioid prescriptions, he said.
Still, some patients do find doctors who will write opioid prescriptions. “You hear the term ‘pill mill’; those are real things,” Walsh said. In a pill mill, a physician prescribes opioids to a large number of patients without trying to get to the cause of their pain, he said.
“Despite all the news, the prescriptions are still going out the door every day,” Walsh said. “We have high hopes that the [Drug Enforcement Administration] and the local authorities will take care of those over time.”
David Mantz, the CEO of Chicot Memorial Medical Center in Lake Village, said physicians at his hospital have turned to prescribing other pain treatments, including physical therapy, rather than opioids.
“At the same time, pain control is extremely important to us as a hospital,” he said. “Your community looks to the hospital for help in controlling their pain.”
Mantz said the doctors at the 25-bed hospital also check with the prescription database to see if patients have visited other doctors to get opioids.
“We’re starting to see some success with the decreased number of prescriptions written,” he said.
Hospital Sues Makers
Drew Memorial’s lawsuit joined several others filed across the country in alleging that drug manufacturers misled the public about the addictiveness of their medications.
“A reasonably prudent manufacturer, distributor, and prescribing physician would have, or should have, anticipated the scourge of opioid addiction and that it would wreak havoc on communities and leave health care providers holding the bill for providing life-saving and expensive care for those who became addicted to defendants’ drugs,” the lawsuit said.
The drug companies generated $11 billion in sales in 2014. “Arkansas is now awash in opioids and engulfed in a public health crisis,” the lawsuit said.
In 2016, the total number of opioid doses prescribed to Arkansas patients reached 236 million, enough to supply every person in the state with about 80 pills each, Drew Memorial said in the suit.
One of the named defendants is Purdue Pharma of New York, which vigorously denied such allegations in a statement to Arkansas Business in July regarding a similar lawsuit filed by a Sebastian County man who became addicted to opioids. “We share the concern about the opioid crisis and are committed to working collaboratively to find solutions,” the statement said. “We are an industry leader in the development of abuse-deterrent technology, advocating for the use of prescription drug monitoring programs and supporting access to Naloxone — all important components for combating the opioid crisis.”
Drew Memorial’s suit was filed in Drew County Circuit Court and then transferred to U.S. District Court in Pine Bluff before becoming one of the more than 200 lawsuits now part of the multidistrict litigation in U.S. District Court in the Northern District of Ohio. Gibson said the multidistrict litigation will streamline discovery that would be common for all the suits. After the common discovery, the cases are sent back to the court they came from for discovery specific to that jurisdiction.
Drew Memorial also alleged that manufacturers ignored “suspicious orders” that came from Arkansas, including those from Johns, the former doctor.
Drew Memorial alleged the defendants “unlawfully filled suspicious orders of unusual size, orders deviating substantially from the normal pattern and/or orders of unusual frequency, including those prescriptions issued by” Johns.
Johns is serving his sentence in the federal prison in Leavenworth, Kansas. He is scheduled to be released Dec. 30, 2024.