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(Nola.com)   "Justice For Danny"   ( nola.com) divider line
    More: Hero, Oxycodone, Schneider, cleggett, St. Bernard, New Orleans, Drug addiction, Pain  
•       •       •

10063 clicks; posted to Main » on 13 Oct 2017 at 4:58 AM (6 days ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



58 Comments     (+0 »)
 
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6 days ago  
I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby
 
6 days ago  
But he privately blamed the victims, dismissing them as low-lifes who should have known better.
His son's killing changed his mind.


'Murica.
 
6 days ago  

vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby


Aren't you the Farker who works for a food bank? You're good peeps.
 
6 days ago  
Nice, subby - I thought you might a bit hyperbolic, but that was an actually riveting read.
 
6 days ago  

FormlessOne: Nice, subby - I thought you might a bit hyperbolic, but that was an actually riveting read.


Thanks. This hit me pretty hard. A family friend lost a child to overdose. I read through it twice in one sitting.
 
6 days ago  

ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're good peeps.


Appreciated. Four years in, it has really opened my eyes and shattered a lot of ingrained stereotypes (which I didn't think I held.)
 
6 days ago  

vicejay: ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're good peeps.

Appreciated. Four years in, it has really opened my eyes and shattered a lot of ingrained stereotypes (which I didn't think I held.)


I have you farkied as Meal Man which seems reductive but it's a compliment.
 
6 days ago  
TL;DR

Just kidding.  I read the entire article!

upvoted.
 
6 days ago  

vicejay: FormlessOne: Nice, subby - I thought you might a bit hyperbolic, but that was an actually riveting read.

Thanks. This hit me pretty hard. A family friend lost a child to overdose. I read through it twice in one sitting.


I kept thinking, "why won't anyone listen?" It has to be hard to watch a crisis unfold in front of you, at a glacial pace, while your best efforts to slow it or at least attract attention to it go unheeded for years, knowing that you're watching people die because of the seeming apathy of those with the power to prevent it.
 
6 days ago  

King Something: But he privately blamed the victims, dismissing them as low-lifes who should have known better.
His son's killing changed his mind.


What's tough for me is not coming down on friends when they become enlightened only after someone they know is involved be it drugs, suicide, teenage prenagncy --- all the usual things only low lifes do until it's one of your own.
 
6 days ago  
I remember the summer of '99, when I was a freshman in college. A fraternity brother was working at a gas station that summer, and he told me about a co-worker there who crushed up pain pills, cooked them and injected them. At the time I thought "wow,that's gross." Little did I know that that was the leading edge of the opioid epidemic.

After reading that... I'm glad someone did something for that community, but I'm mostly horrified at the turn this whole thing has taken. I look around now and realize it's everywhere. So scary, especially for those with kids. You have to be hypervigilant, and know their friends better than you did in my younger day. This stuff is orders of magnitude worse. My heart goes out to all who are affected by it.
 
433 [TotalFark] [BareFark]
6 days ago  
This article reminds me of the Florida pill mills, and what my junkie friends would refer to as "the Houston lick."  It takes a long time to build a case, and it is very sad what happens in the meantime.  Fortunately, people and authorities seem to be waking up to this kind of thing more and more.  It's all a mess, and a big one, I hope the right people can put a stronger stranglehold on it.
 
6 days ago  
An 'enabler' for this sort of thing is the current bullshiat to consider pain as 'the fifth vital sign' and reimbursement for Medicare/your local equivalent depending on "HCAHPS" (your internal voice calls this H-caps) popularity scores.

Hospitals get paid by ladling out the opioids. If they don't, the junkies downvote them on their Press-Ganey scores. And they lose funding. The management being all about funding, they require the docs to fork over Dilaudid and Oxy like there was no tomorrow.

You want this to become less prevalent, petition your congress-critter to remove consideration of patient reported pain levels and reimbursement as a popularity contest.
 
6 days ago  

FormlessOne: vicejay: FormlessOne: Nice, subby - I thought you might a bit hyperbolic, but that was an actually riveting read.

Thanks. This hit me pretty hard. A family friend lost a child to overdose. I read through it twice in one sitting.

I kept thinking, "why won't anyone listen?" It has to be hard to watch a crisis unfold in front of you, at a glacial pace, while your best efforts to slow it or at least attract attention to it go unheeded for years, knowing that you're watching people die because of the seeming apathy of those with the power to prevent it.


here in Ohio a large number of people are dying weekly because of street drugs. in NJ i had a friend who was always seeking new doctors and clinics where he could get a script for pain killers. he became addicted to painkillers when he was on them due to severe knee area problems. he had his surgeries and was fine, according to one of my doctors - who explained Tommy manufactured pain in his mind. getting potent prescription painkillers was his life's driving force above all things. in one way or another Tom's fixation for painkillers made him unemployed, homeless and without a car at one time or another, and more than once.
 
6 days ago  
sinko swimo:
getting potent prescription painkillers was his life's driving force above all things. in one way or another

That. I've had several friends that came back from the service with injuries or developed issues as they got older and ended up getting lots of opioids. They're useful. Sometimes necessary. But after the bones heal/amputation site heals/gastric ulcers heal/etc then despite the assurance that you're not going to end up hooked if the problem is 'real', well, sometimes you do, The whole bullshiat story that you won't end up addicted if you have a 'real' injury/condition is not true. Not at all.

You can easily end up hooked right through the bag. Despite there having been a real underlying issue to start with. And there's jack-all of a plan for getting off the opioids once you're addicted. Some people don't have the body chemistry/mental makeup that ends up with them being addicted. Great. Some do, though.

Not handing them out to get paid might be a start. Having a clear plan to get un-hooked if you're on them for months 'legitimately' would be another.
 
6 days ago  

King Something: But he privately blamed the victims, dismissing them as low-lifes who should have known better.
His son's killing changed his mind.

'Murica.


He sounds Republican.
 
6 days ago  
Damned good story. Excellent job, Subby.

Here in the Shallow South, a 15-day supply of Oxycodone runs about $6 after insurance. Oxy is easy to get addicted to. A 30-day supply of Tapentadol- which is much harder to get addicted to- runs over $100 after insurance.

I just had surgery on my shoulder, and the doctor prescribed Oxycodone- 60 pills. Cost me $6. I stopped taking them after 4 days, because the analgesic effects last 4-6 hours, but the drooling imbecile effect lasts about 12-15 hours.

I've been in constant pain since December of 2002- when I had a career-ending accident on my Destroyer that left me walking with a cane. Over the intervening 15 years, I have had to fight constantly with my doctors to avoid getting prescriptions for Vicodin and Oxy. I started out with a relatively low dose of Tramadol, then my doc switched me to Tapentadol (after I rejected Oxy), and then a stronger scrip for Tapentadol a few years later. Tapentadol and Tramadol seem to lack the drooling imbecile effect of Oxy, the analagesic effect is substantially less, and it's twice as long between doses. But I can still function while taking Tapentadol, and a 30-days supply (90 pills) usually lasts me about 3 months because I only take them when the alternative is gnawing my leg off at the knee.

In order to prevent (or at least mitigate) an epidemic of overdose deaths from pill mills, the Shallow South legislature has recently made it much harder to get prescribed any pain relieving drugs. Only licensed "pain management" clinics can prescribe more than a 15-days supply, and there is a raft of intrusive regulations for the patients in order to get treatment for chronic pain. One of these is a mandatory "group counseling" session for all pain management patients to discuss non-medical relief for chronic pain (meditation, unicorn farts, and phlogiston therapy, essentially), and every pain management patient MUST have a prescription for Nalaxone in case of an overdose.

There has to be a way to deal with chronic pain without the use of physically addictive chemicals. I work for the US government, so taking anything even vaguely related to marijuana is not possible, leaving me with the options of trying to meditate away homicidal levels of pain or taking drugs with a high probability of addiction and overdose. There has to be a way to deal with people legitimately suffering (I'm actually a fairly modest case- some of the patients I've met are in suicidal levels of pain even with chemicals) without feeding the greed of insurance companies and other drug pushers AND without killing off a generation with cheap and easy narcotics.

I don't know what the solution is, but the current systems (ignore the problem and it will go away or prohibit anyone from getting pain medication lest any of them get any relief whatsoever because pain is good for you) are demonstrably ineffective. Better drugs which cannot cause addiction would be a good step, but perhaps someone could devise a non-subjective means to determine a patient's level of pain.
 
6 days ago  
That was an amazing story, I hope there are more like the pharmacist out there. I still remember the early days of oxy when it was a miracle that you wouldn't get addicted to.
 
6 days ago  
img.fark.net

Joe Miller will pay.
 
6 days ago  
Wow, what an article.  I saw on the newsletter a "everybody should read" note on one of the links.  If that ever becomes a regular thing, this should be one of them.
 
6 days ago  
NOPD officers were evidently working private details for Cleggett's clinic. If the Louisiana State Board of Medical Examiners was not in cahoots with her, it was incompetent. How else could it have allowed this 24-hour pill mill to stay in business?

Now, mind you, they're not corrupt. Not at all. We prefer to use the term "colorful."

/sounds better in james carville's voice
 
6 days ago  

Wenchmaster: Damned good story. Excellent job, Subby.

Here in the Shallow South, a 15-day supply of Oxycodone runs about $6 after insurance. Oxy is easy to get addicted to. A 30-day supply of Tapentadol- which is much harder to get addicted to- runs over $100 after insurance.

I just had surgery on my shoulder, and the doctor prescribed Oxycodone- 60 pills. Cost me $6. I stopped taking them after 4 days, because the analgesic effects last 4-6 hours, but the drooling imbecile effect lasts about 12-15 hours.

I've been in constant pain since December of 2002- when I had a career-ending accident on my Destroyer that left me walking with a cane. Over the intervening 15 years, I have had to fight constantly with my doctors to avoid getting prescriptions for Vicodin and Oxy. I started out with a relatively low dose of Tramadol, then my doc switched me to Tapentadol (after I rejected Oxy), and then a stronger scrip for Tapentadol a few years later. Tapentadol and Tramadol seem to lack the drooling imbecile effect of Oxy, the analagesic effect is substantially less, and it's twice as long between doses. But I can still function while taking Tapentadol, and a 30-days supply (90 pills) usually lasts me about 3 months because I only take them when the alternative is gnawing my leg off at the knee.

In order to prevent (or at least mitigate) an epidemic of overdose deaths from pill mills, the Shallow South legislature has recently made it much harder to get prescribed any pain relieving drugs. Only licensed "pain management" clinics can prescribe more than a 15-days supply, and there is a raft of intrusive regulations for the patients in order to get treatment for chronic pain. One of these is a mandatory "group counseling" session for all pain management patients to discuss non-medical relief for chronic pain (meditation, unicorn farts, and phlogiston therapy, essentially), and every pain management patient MUST have a prescription for Nalaxone in case of an overdose.

There has to be a way to deal with chronic pain without the use of physically addictive chemicals. I work for the US government, so taking anything even vaguely related to marijuana is not possible, leaving me with the options of trying to meditate away homicidal levels of pain or taking drugs with a high probability of addiction and overdose. There has to be a way to deal with people legitimately suffering (I'm actually a fairly modest case- some of the patients I've met are in suicidal levels of pain even with chemicals) without feeding the greed of insurance companies and other drug pushers AND without killing off a generation with cheap and easy narcotics.

I don't know what the solution is, but the current systems (ignore the problem and it will go away or prohibit anyone from getting pain medication lest any of them get any relief whatsoever because pain is good for you) are demonstrably ineffective. Better drugs which cannot cause addiction would be a good step, but perhaps someone could devise a non-subjective means to determine a patient's level of pain.


Give kratom a shot if it's legal in your state. It's legal in most states. It's cheap, effective and won't kill you like opioids.
 
6 days ago  
I guess I must be lucky that I look enough like a scumbag junkie that doctors never prescribe those nasty painkillers for me. Never! The hardest I've had is oxycodone. LOL barely touches the pain
 
6 days ago  

vicejay: FormlessOne: Nice, subby - I thought you might a bit hyperbolic, but that was an actually riveting read.

Thanks. This hit me pretty hard. A family friend lost a child to overdose. I read through it twice in one sitting.


I just want to directly thank you for posting this article to Fark. I have a few friends that are directly involved in treating and counseling people for opioid addiction. I know that they will appreciate reading this.
 
6 days ago  

edmo: King Something: But he privately blamed the victims, dismissing them as low-lifes who should have known better.
His son's killing changed his mind.

What's tough for me is not coming down on friends when they become enlightened only after someone they know is involved be it drugs, suicide, teenage prenagncy --- all the usual things only low lifes do until it's one of your own.


It's never the users fault, is it?
 
6 days ago  

ginandbacon: vicejay: ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're good peeps.

Appreciated. Four years in, it has really opened my eyes and shattered a lot of ingrained stereotypes (which I didn't think I held.)

I have you farkied as Meal Man which seems reductive but it's a compliment.


Funny, I have you as "reduce the meal" man. (Ok, not exactly )
Hope all is on track in terms of health goals.

/vice, thanks for your deeds
//I was fishing for articles to submit...and they were overdose story after overdose story
///ay karamba
 
6 days ago  
freakingmoron:
I just want to directly thank you for posting this article to Fark. I have a few friends that are directly involved in treating and counseling people for opioid addiction. I know that they will appreciate reading this.

If you hadn't made that comment, I wouldn't be saying this:

If anyone here has an opioid problem and can't afford Narcan or clean rigs, you can get them for free from /u/FashionablyFake, moderator of reddit.com/r/opiates/ She and Tracey Helton have probably saved over 300 lives.

I personally can't stand 95% of addicts, but Fash and I lost a couple of friends to ODs this year, and that finally sold me on the Harm Reduction philosophy. At least that way, you might live long enough to get clean someday.
 
6 days ago  

ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're a good peeps person.


/Pet peape
 
6 days ago  

Resident Muslim: ginandbacon: vicejay: ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're good peeps.

Appreciated. Four years in, it has really opened my eyes and shattered a lot of ingrained stereotypes (which I didn't think I held.)

I have you farkied as Meal Man which seems reductive but it's a compliment.

Funny, I have you as "reduce the meal" man. (Ok, not exactly )
Hope all is on track in terms of health goals.

/vice, thanks for your deeds
//I was fishing for articles to submit...and they were overdose story after overdose story
///ay karamba


LOL it should actually be "Increase the Meals"...I'm supposed to be eating 6 meals a day but I can barely manage two. I have an ongoing goal to exercise more and I've been a little better about that, but fark, it's hard to change your habits, ya know? Especially with a bunch of rare neurological conditions that make eating and exercising almost unbearable...

As for TFA, I came up with cocaine and weed and hallucinogens. This opiate/opioid epidemic is really hard to wrap my brain around. Hell, I don't even drink coffee anymore. So watching people get hooked on the poppy is weird. And it's so easy to do it safely except we have these pharmaceutical companies aggressively pushing super addictive formulations of it and doctors who don't seem to care. I'm allergic so I wasn't exposed to it (except that one time I almost died and figured out never to do it again) but it's as common as candy it seems. There are so many cultures who smoke it and they don't seem to have the same addiction problems we have. And other countries have decriminalized heroin and started dispensing controlled doses to addicts which means they aren't dealing with varying strengths and all the poisons that get cut in. 

I don't know--it just feels like we could be a lot smarter about this. Probably not with this administration, but maybe in the future?
 
6 days ago  

NoahBuddy: ginandbacon: vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby

Aren't you the Farker who works for a food bank? You're a good peeps person.

/Pet peape


So did you ever read Samuel Pepys? My da read him to us when I was little and then he came up in one of my HS English classes. The teacher called him "peppeez" and I was so confused because I had always called him "Peeps" so I said "WTH? How did I come up with that weird mispronunciation of his name? WHO DOES THAT?" And then in the next class, our teacher was saying Peeps. He never acknowledged his mistake.

But what is your beef with peeps?
 
6 days ago  
All the stuff that happened to the doctor after she got busted I looked at and said "Good but needs more" the chaos she caused will probably be felt for years to come.
 
6 days ago  
NOPD - "Not Our Problem, Dude"
 
6 days ago  
I've lost a friend and a cousin to heroin in the last year, also in the Big Sleazy. I used to enjoy a good nodding, but seeing someone die in person (pulling the plug) was enough to say "fark this shiat." The struggle is real.
 
6 days ago  
That was a good article and I am happy for him and all.  But I still can't get past this;

been shot to death after trying to buy drugs

From my experience, when you go to cop, you are in minimal danger if you know where you are.  Those guys don't want any ruckus around while they are open shop.  People who mug, rob or otherwise cause a scene are usually dealt with if they 'don't know any better'.

I think these instances are just robberies gone awry.
 
6 days ago  
Gulper Eel:
Now, mind you, they're not corrupt. Not at all. We prefer to use the term "colorful."

Having seen them in action after Katrina, and the entire Henry Glover thing, I think they've gone past "colorful" and into "felonious" and done the colorful dance of their people there.
 
6 days ago  
It was a great read, but incredibly depressing. And I'm not just talking about the overdoses.

The poor woman who had to go into the witness protection program with her entire family. Their entire lives were uprooted because she did the right thing. That's incredibly hard to expect of a person. Also, there's a suspicious lag in the story between "going into hiding" and "going into the witness protection program". I know as a country we are not good about protecting those who face danger on our behalf.

Just how much had to be done to shut the one clinic down. That's an ridiculously, resistant, one might say almost intentionally nigh-impossible level of detail and avoidance of mistakes to shut down one flagrantly criminal enterprise. How can anyone else hope to achieve change based on what they needed to go through to bring one doctor to justice? And even then, a car accident was what ensured that she wouldn't be allowed to prescribe again. Nothing else ensured that.
 
6 days ago  
Chiming in to thank subby for submitting this link.  Running across stories like this, that I probably wouldn't find otherwise, is one of the main reasons I browse Fark every day.
 
6 days ago  
This part astonished me:  ''...members of the Tactical Diversion Squad unit pounded on the front door of Dr. Cleggett's home, a turreted stone mansion in an upscale part of New Orleans East. They tried to convince her to surrender her DEA license -- the document that entitles doctors to prescribe controlled substances. They failed.  ...''    And had to come back a month later.
 
6 days ago  
I did and didn't enjoy reading that several times.

Thanks for the link
 
6 days ago  
Hitting 12 overdoses a day in my area. Insane.
 
5 days ago  

nanim: This part astonished me:  ''...members of the Tactical Diversion Squad unit pounded on the front door of Dr. Cleggett's home, a turreted stone mansion in an upscale part of New Orleans East. They tried to convince her to surrender her DEA license -- the document that entitles doctors to prescribe controlled substances. They failed.  ...''    And had to come back a month later.


How was she still in the country a month later?  Hello Mexico!  Or Canada.
 
5 days ago  

freakingmoron: I just want to directly thank you for posting this article to Fark. I have a few friends that are directly involved in treating and counseling people for opioid addiction. I know that they will appreciate reading this.


Quite welcome. It's been a while since an article/piece hit me like this one did.
 
5 days ago  
Thanks all, for the thanks. I'm really glad this piece has resonated with so many people, I was wondering if it was just me. Please share this piece around as much as you can within your circles.

I read it fast the first time. Even though it clearly states early it all started in 2001, my brain still was thinking, "Nice, someone shut down one of these farking pill mills recently." Halfway through, my sanity kicked in and I started over with the read.

New Orleans (and the whole Nola area, which includes St. Bernard) is a beautiful, flawed place. I guess most places are.
 
5 days ago  

pikov.yndropov: That was a good article and I am happy for him and all.  But I still can't get past this;

been shot to death after trying to buy drugs

From my experience, when you go to cop, you are in minimal danger if you know where you are.  Those guys don't want any ruckus around while they are open shop.  People who mug, rob or otherwise cause a scene are usually dealt with if they 'don't know any better'.

I think these instances are just robberies gone awry.


Yeah, but the kid was only in the lower 9th to score so the proximate cause of death was in fact buying drugs.
 
5 days ago  

Atomic Jonb: nanim: This part astonished me:  ''...members of the Tactical Diversion Squad unit pounded on the front door of Dr. Cleggett's home, a turreted stone mansion in an upscale part of New Orleans East. They tried to convince her to surrender her DEA license -- the document that entitles doctors to prescribe controlled substances. They failed.  ...''    And had to come back a month later.

How was she still in the country a month later?  Hello Mexico!  Or Canada.


She was addicted herself at that point, addicts don't generally have enough executive function to flee a city let alone a country.
 
5 days ago  

thehobbes: Hitting 12 overdoses a day in my area. Insane.


Overdoses or overdose deaths? Cuyahoga county is on pace for 2 deaths per day for the year =(
 
5 days ago  
My brother was a victim of a FL pill-mill. Once they went under for (obvious) legal reasons, he turned to heroin. He was a blubbering useless mess that at several points turned to overdoses to end his life. Thankfully, his body was so used to it he never bit it.

As of 3 years ago, he kicked the habit with treatment, and has been clean ever since. I wrote him off as dead years ago, but am very happy he is back. He still struggles with the effects of all the poison, but he is alive and as well.

/fark pain meds
 
5 days ago  

robodog: thehobbes: Hitting 12 overdoses a day in my area. Insane.

Overdoses or overdose deaths? Cuyahoga county is on pace for 2 deaths per day for the year =(


Overdose responses for heroin/fentanyl. Haven't read on the outcomes yet.
 
5 days ago  

vicejay: I've been in New Orleans since 1996, and had not heard of either of the stories in this long but incredibly engaging story. Though many years ago, this is some incredible story-telling.
/subby


Thanks for submitting this. Great read on an important subject.
 
5 days ago  

erewhon: An 'enabler' for this sort of thing is the current bullshiat to consider pain as 'the fifth vital sign' and reimbursement for Medicare/your local equivalent depending on "HCAHPS" (your internal voice calls this H-caps) popularity scores.

Hospitals get paid by ladling out the opioids. If they don't, the junkies downvote them on their Press-Ganey scores. And they lose funding. The management being all about funding, they require the docs to fork over Dilaudid and Oxy like there was no tomorrow.

You want this to become less prevalent, petition your congress-critter to remove consideration of patient reported pain levels and reimbursement as a popularity contest.


This sounds like tinfoil-hat conspiracy theory ranting!

But it's more or less true. Medicare holds back a percentage of its reimbursement to hospitals/health systems, and you "earn" it back by meeting the quality criteria.  IIRC, the current holdback is about 3%. So if your hospital bills Medicare $100 million, you get $97 million, and the last $3 million is paid as a "quality bonus".

The amount of the holdback you get depends upon documentation of compliance with various quality measures. Some of these are obviously relevant and useful: infection rates, surgical complication rates, mortality rates, etc. Some are not as obviously useful. Some are poorly supported by science. Some are bullshiat.

IIRC, the patient satisfaction domain accounts for about 10%. So if you totally flunked patient satisfaction and got a zero, that's 10% of 3% = 0.3% of your Medicare reimbursement gone. But again, if you bill $100 million, that's $300,000 less to distribute to C-level executives at bonus time.

To put this in perspective, the local 800-odd bed level 1 trauma hospital did about $400 million in Medicare/Medicaid billing (plus $24 million in franchise tax recovery) in 2015-2016.  So the Press-Ganey patient satisfaction score was worth about $1.2 million to the hospital.

Admin does not directly tell docs to prescribe more opiates. But they'll send out helpful notices that our beloved institution is lagging its peers in the pain management subcategory of the patient satisfaction domain, that clinicians should be more responsive to our patients' needs, and that administration will be closely monitoring each individual physician's patient data to follow trends and ensure compliance with quality standards.  You're expected to connect the dots.
 
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