Something is really wrong with the system when billionaires have their bail set at 1 million. If he wanted to flee and forfeit his bail money, his net worth would be impacted about the same as the average American getting a parking ticket.
Well he's probably got most of his money entrenched in the american economy (billionaires don't just sit on cash and let it depreciate from inflation).
If he actually flees, the US government could easily seize most of his assets.
Bail is to guarantee appearance to respond to the crime, not insure against the accused, and reflects the seriousness of the crime and how much the state would care if you don’t answer for it. That’s why if you go in on multiple sets of charges you have multiple bails. That’s also why your DUI bail was five figures or less. In most places there is a table for bail amounts that can be stiffened, softened, or denied entirely at the judge’s discretion, but it is all based on the crime and flight risk only.
$1 million is a fairly high bail, generally in the ADW/manslaughter/sexual assault neighborhood. A court is not set up to handle a $1 billion bail, as you’re suggesting. That sort of money isn’t just moved around like that ($1 million is difficult enough), and the court would almost certainly mishandle it.
Probably not, but for someone with a net worth of $1bn it seems extremely low. Just like said bail is extremely high for someone with a close to $0 or negative net worth.
How about setting it at $100m? That doesn't sound unreasonable given the situation.
Not mishandling is easy: you put it in a locked escrow account and don't touch it. It the depositor had to borrow against assets to secure the deposit, then let reasonable interest accrue against the principal and deduct.
Bail is set independently of net worth considerations and in a relatively impartial manner, which is the point. Judges do not have the flexibility to set a bail that high. Destitute murderers get $5 million+ bails all the time, which we would have to revisit if we started factoring in net worth (think about it).
Yes, I am aware. But to me it seems like a clear flaw in the current law.
Just like if you always fine people $100 for speeding, then average folk will generally adjust their behaviour and millionaires will be able to race around and not give a f*.
Bail is set independently of net worth, but is that how it should be?
There are tons of poor people stuck in jail awaiting trial for relatively minor crimes because they can't afford what would be a trivial bail amount to most HN readers. A rich person who commits a much more severe crime gets to sleep at home, or can flee if they think they don't have a good chance of winning without a big financial impact. Is that just?
Should we adjust criminal justice or adjust wealth? What you describe is a well-known inequality that comes with being wealthy; bail is built for the 99%, and being rich is a good, unfair way to remain in control of such a situation. But is altering the impartiality of several elements of the criminal justice system to pursue the occasional unjust rich guy the right answer? I don’t know. Is there any country in the world that does bail that way?
It seems like there could be a lot of unexpected drawbacks to such an approach, since on the other end it’s harder to justify a high bond for a destitute, transient murderer, for example. If you’re okay with $100 million for this guy, it follows that you’d also have to be okay with $10 for him. Otherwise justice is partial and biased, even more so than it is now. Ignoring net worth seems safer, but again, I don’t know.
It's not just about the 99% versus the 1%. There are tons of poor people stuck in jail awaiting trial because they can't pay a bail that middle-class people could afford. Many end up pleading guilty for a crime they didn't commit because it gets them out of jail faster than waiting for trial.
Assuming that $10 is high enough to ensure that the destitute, transient murderer will show up for trial, why shouldn't I be OK with it?
I’m aware and do not need explanation, because I was one of them. I could not afford $80,000, even with a 10% bail bond, and I plead guilty to a crime I did commit to get out of jail faster (I was in about five months). I realize that it might be startling to hear me argue for the status quo having been in that very position.
What you allege, that people happily plead out while innocent, does not happen. It just doesn’t, and it’s something I’ve heard repeated a lot by people who haven’t been inside. I was in a position to advise dozens of inmates on their cases during my time, and not once did that ever happen.
The truly innocent folks (and it’s hard to tell) were happy to sit to get their day to prove it or wait for the charges to get dropped. I’ve seen inmates rip up a plea bargain and throw it in the prosecutor’s face after sitting in county three years. Inmates are not dumb cattle looking for the first door. They understand what signing a plea bargain does. Even beyond that, innocent people are almost never arrested in the first place. There are very, very, very few innocent people in jail. I hate to break it to you, because I know it undermines liberal sensitivity and view on the world (which I know because I’m liberal, I’m not critiquing). You’re also coming at this from the perspective that assumes everyone should be able to bail out, which isn’t true. Would you revisit total bail denials, too?
Re: $10, how can you make that assumption? It’s disappointing that I’m being downvoted so heavily for pointing out that a seemingly minor change which is reactionary to one case could have implications far beyond intention. Being upset and changing things because of one billionaire is the very definition of mob-style reactionary grievance. There’s more to consider than just him, and I agree it sucks. This is a complicated issue and the easy engineering fix is very likely not the right one.
It’s an important conversation to have and I was disputing your characterization that people routinely plead out when innocent, which is a tenuous claim and strongly argues for reform which perhaps we should be slower to adopt. It’s a key point. I’m trying to remain civil and substantive, and I wish you’d extend me the same courtesy.
(Edit: I’m out of posting quota for today, but I at no point said what you’re claiming I’m trying to tell you in even the most uncharitable interpretation.)
Maybe we have a disagreement over what number constitutes "almost never"?
I'm trying to talk about the real problems bail causes in the justice system, and you're trying to tell me that it doesn't matter because basically everyone who gets arrested is guilty anyway. That's not substantive, and it's only superficially civil.
I think it's great that you're thinking about unintended consequences, which people often neglect to do, but I just don't see how it follows that because we increase bail for wealthy suspects we would therefore have to decrease it for impoverished ones. We can write the rules however we want.
ETA: Well, we can't necessarily write the rules however we want; there are Constitutional restrictions. In this case, the case could be made that increasing bail for wealthy suspects violates the guarantee of equal protection under the law. That's a different argument from the one you're raising, however.
I get your point an all, but he's 74 and charged with RICO conspiracy, as well as other felonies, including conspiracy to commit mail and wire fraud and conspiracy to violate the Anti-Kickback Law
That's a life sentence there so in theory he could try to make a run near the end of his trial...a year or two in hiding. What does he have to lose, his good name? But then he has so much money that even if he was left with $10mil he could in theory start Spanish lessons. The judges should make the super rich to pay for Marshals /FBI to watch them while in bail.
I doubt any judge will show mercy to him and common sense (not always right but..) says there's a LOT of paper trail incriminating him. It's a huge company and lots of salespeople, lots of payoffs. Not done with a wink and a nod.
One millionaire got a $54,000 speeding fine commensurate with his income and another got approximately $200,000 fine based on memory of exchange rates.
I mean, they took his passports and are making him wear a tracking device, that's the important part. For someone worth 10 figures, no bail amount reasonably imposed by a court would be sufficient to serve in practical terms as forced remand.
I trust this guy will get what he deserves, but surely there should be other people falling here?
Usually it's the taker of bribes that is the biggest criminal. Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
This is completely regardless of whether it was the "standard practice" at the time, or whether some pharmaceutical sales rep told them it was a good idea.
If just a couple of hundred doctors would lose their license and a few dozen end up in jail, that would make some headlines and perhaps make other doctors think twice before prescribing oxycodone to someone with normal back pain. Doing that is like amputating someone at the hip for toenail fungus.
> Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
No, they should have their license revoked. Those people are not doctors, they are opportunistic capitalists in the medical sector that should have no right to practise medicine.
In fact, this scheme could only work if doctors complied. I would say what they did was much worse than what the billionaire did. They're bad actors.
This permeates the whole system of education. Apparently, for a long time (And I sure hope this changed), doctors were taught opioids aren't addictive if the patient is in pain. See e.g
>Those people are not doctors, they are opportunistic capitalists in the medical sector that should have no right to practise medicine.
You can’t change these incentives without moving the US to a nationalized health care system, including public financing of education for doctors and much harsher regulation of the pharma industry. As long as you have doctors going into massive amounts of debt to finance their education and a drug industry with obscene wealth and power, you’re always going to arrive at this outcome. Capitalism is fundamentally opportunistic, which is why it has no business in healthcare.
Speaking as an American medical resident currently in training, please realize that opioids are the only pain medication aside from nerve modulators like gabapentin or pregabalin that have any serious effect after NSAIDs have been exhausted. We routinely use it appropriately for patients with gallbladder, kidney and very run-of-the-mill problems.
> Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
Opioids are a good choice for end of life care, but they're also useful in other situations, such as acute (short term) pain - post operative pain for example.
They're not a great choice for chronic (long term) pain, but even then they can be used carefully.
Right. Morphine drugs given for short durations after e.g surgery isn't at all uncommon in the countries where potent opioids are almost never prescribed for longer term use. That would probably not change.
All opioids are addictive. Doctors have to weigh the risks against the benefits, just like they do for any other treatment.
Do they err in the direction of over-prescribing? Probably. But to say that opioids should never be given to anyone who is not terminally ill would be to err in the opposite direction.
The normal practice in most other places (which doctors should be automatically investigated for, if systematically diverging from) is to only prescribe the most potent opioids in exceptional cases such as to terminally ill cancer patients.
This seems to work pretty well.
EDIT: added "exceptional cases" - this can be other cases than just cancer, see e.g reply
It's not. But the practice of prescribing opioids is wildly different in other countries. So the base assumptions when weighing the benefits and drawbacks (addiction) need to change. Basically, doctors should try more alternatives and doctors need to tell patients that the pain may be the lesser evil compared to opioids. This also requires changed expectations from patients, about what doctors can do about pain.
I agree that the most powerful opioids should be used very sparingly. But that's quite different from restricting the use of addictive opioids -- which is to say, all of them.
Yes, this is only really a discussion about the most potent opioids like oxycodone, and only for long term prescription use.
Use of opioids in an IV in a hospital after a major surgery isn't what's discussed. That happens everywhere and doesn't seem to cause addiction problems.
My wife had to have a full spinal fusion. You probably don’t even have the mental tools necessary to start thinking about that kind of pain. The sort of pain that causes people to consider suicide as a preferable alternative.
Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose.
I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same.
For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.
I think this example would be one of the cases where the most potent opioids would be prescribed in any country. I'm not advocating never prescribing them - only to do it in exceptional cases.
For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient).
The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.
The industry term for this is "drug diversion," and it happens pretty frequently and is very under reported. The patient may not even be aware it's happening because a health care employee, real estate agent, teenager child, nanny, guest, etc may be stealing the medicine. It even happens in a hospital setting, with deadly results - https://www.medscape.com/viewarticle/825801
That's why if you have drugs someone may want to steal it's recommend you keep them locked up.
People here get their pain medication in quantities which have to suffice for a specific time, so if they need new medication before that time has run out this leads to questions and checks.
No painful hobbling, no peeing, simple math.
> You probably don’t even have the mental tools necessary to start thinking about that kind of pain.
As I don't know your story, you don't know mine. Get off your high horse before you lecture the peanut gallery.
With great sympathy to your wife, to those who've had lives taken and families destroyed by an addiction which started with a doctors over prescription, maybe hobbling to pee in a cup doesn't sound so bad.
I think one of the problems is that the medical and legal community seem to be incapable of doing anything but extremes. About 5 years ago I went to the doctors for headaches and was given a subscription for 90 pills every month of fioricet and expected to only take it when I needed it and not more than 3 a day. About a year and a half ago after I got a new doctor who was appalled, asked me if I would consider going down to 30, and was surprised when I told him I had no problem with that because it was unneeded and I was already only refilling it 1-2 times a year anyway. Now in the past year I hurt my shoulder pretty badly, to the point where I was having difficulty using it due to the pain and was dropping light weights. I was told physical therapy and aspirin and if it still hurt too much to use I could try more aspirin. We seem to swing wildly between giving out a ridiculous amount of drugs(90 a month no questions asked) to giving out none, even when people are in pain.
Why can doctors not prescribe something like 3 pills a month to someone? Its not nearly enough to get addicted on, but can help someone experiencing severe but temporary pain. Is it something in our legal framework that only allows doctors to prescribe a months worth at a time with the assumption that its taken every day? Is it some pressure from insurance companies who don't want to deal with paying out small claims like for 3 pills?
There's two issues here. The first is that "as needed" is really hard for pharmacies and insurance companies to handle; the only way they can avoid arguments (and potential lawsuits) is to dispense the maximum allowed. So even if your doctor expects that you're only going to need an 1 pill/day on average, if he writes "as needed up to 3 polls/day", you're going to be given 90/month.
The second issue is deliberate overprescription. Most insurance companies have rules on the amount of medication which can be dispensed -- 100 days is a common limit, but some limits are as low as 30 days. The justification for this is that they don't want you to end up with lots of unneeded medication if your needs change; but usually the real reason is that they don't want to end up covering costs which can be offloaded to your next insurance company if you change insurers. In response, some doctors will deliberately inflate prescriptions -- e.g., if your doctor thinks you need one pill/day and trusts you not to abuse the medication, he might write a prescription for 3 pills/day so that your insurance company will approve an amount which will last you for longer.
Where I live the two major hospitals now have surveys after every doctor visit where you "grade" the doctor and your experience. This has caused a lot of doctors to just give patients whatever the hell they want because otherwise their career may be in jeopardy.
Add to this the inherently difficult process of figuring out just how much pain a person is in and prescribing the correct medication.
It really is a lose/lose situation for doctors these days. The changes have to come from above them at the administrative level.
Yes. And the definitions taught in medical schools and passed from the SGs office should probably be approximately that if the back pain comes from your late stage cancer then it's fine to prescribe opioids. If it's not then don't.
Fast forward 10 years. Top story on HN is "I'm in excruciating pain and my doctor is refusing to prescribe me a painkiller because he's afraid of losing his license".
Top comment: "This is ridiculous! Why are all these regulations preventing people from getting proper health care instead of actually helping them?"
No, the solution is not putting doctors in jail. No, the solution is not piling regulations on top of more regulations. Only thing that's needed is educating people and providing less addictive alternatives. If the pack of pills has "Warning: this is highly addictive! Use only in emergency!" in big bold letters, then people will think twice about taking them.
Once you take kickbacks, your "professional judgment" is clouded. Are you giving that because it's better for me or because you'll get a bonus for prescribing that?
Kickbacks/bribes are absolutely despicable, there is no argument about that. I'm just against some elaborate set of rules that is going to regulate what doctors can prescribe or not. These decisions should be left to the doctors' discretion. And bribe cases should absolutely be prosecuted.
The cigarette warning labels are working just fine. The point is to warn people of the dangers and practically every smoker is already aware of those and yet they choose to smoke anyway. That's perfectly fine in my book - as long as one is making an informed decision, they should be able to pick the poison that kills them.
I don't know about the US, but in the UK at least I reckon it's the taxes that work better than the labels (the price of a pack of cigs has risen dramatically over the past 15 years or so)
At least they could no longer pretend surprise at the damage cigarettes did to them.
I say "pretend" because it was no great revelation in the 1960s that smoking was bad for you. My father said they were called "coffin nails" back in the 1930s, and the first thing doctors routinely advised their patients was to quit smoking.
And, of course, the black, scarred lung of a smoker was ridiculously obvious to any person who did an autopsy or operation on a smoker.
Putting doctors in jail isn't a solution to the problem, but it is legal justice for the crime of prescribing dangerously inappropriate medication for financial benefit.
> Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
This is a terrible idea. All opioids are theoretically addictive. They're also the most effective painkillers. Even cocodamol is an opiate. Escalating the War on Drugs like this is just going to leave a whole load more people in treatable pain.
No, I still agree. If a doctor is giving someone painkillers when they aren't necessary, then that's not much different from drug dealers on the street. Just because they are doctors doesn't mean they should get a free pass. Even more so, the opposite should be true, because we expect doctors to have integrity. If there is nuance to a specific case of this, then let that be determined in court.
The OP said no opioids should be prescribed unless the patient is terminally ill - since you say you agree, are you saying that opioids are only necessary for terminally ill patients?
> If a doctor is giving someone painkillers when they aren't necessary, then that's not much different from drug dealers on the street.
Well, you're not wrong. However, this isn't limited to opioids. If a doctor is not following the standard of care, according to their peers, and a patient has an adverse outcome then the Doctor is subject to board review and they may have their license revoked and/or be prosecuted. This is already in place and has been for some time. This is why most Doctors are generally extremely conservative in the treatments and interventions they recommend for their patients.
The main difference is that a doctor supposedly has a higher interest in your well being than your dealer does.
My understanding is that a doctor isn't going to be making more money because they're prescribing you opiods or not. But they do it anyways because it can help you through pain. Just like you can get stuff to help with your cold, even if it's not necessary
Airlines aren't the same as pillow manufacturers just because they lend you one on a flight.
That article makes a curious argument: that the UK won't have an oxycodone problem because they already have 2.5x more heroin users per capita than the US — so potential demand is already saturated. I mean, right, they probably won't have any more trouble from oxycodone than they already have from heroin and tramadol, but they already have a big opioid problem. (Maybe they're better at preventing overdose deaths than we are; I don't know.)
I don't know the article's sources, but it says "America has five times the general population of Britain, but only twice the number of heroin addicts." You can research this as easily as I can.
2 doctors who prescribed the 10,000x more potent than morphine that is only approved for late stage terminal cancer, note this is far far more potent than any other opioid. The doctors prescribed it for knee pain, minor injuries, headaches, minor Joint pain, any and everything and they owned their own pharmacy which essentiallY just sold that and one other opiodmillegally. 81 witnesses came forward showing how addicting themselves to this insanely worse than opiod substance ruined their lives.
Meanwhile one doctor had 23 Lamborghinis, many beach front condos and 2 doctors prescribed 1/3 of the total prescriptions in the world. Both serving 20+ years sentenced last year, NPs who pushed all this got 3 years, almost every executive has been charged and trial 2018
This is the back-story that makes the whole thing make sense. This isn't a War on Drugs over zealous prosecution, this was a brazen attack on the healthcare system to extract millions through illicit prescriptions which also destroyed lives due to the dangerous nature of the drug. Unreal!
Aren't you a little bit concerned that he might be guilty yet go unpunished? Or that he's innocent but goes down anyway?
There's a lot of money involved here, and a lot of political prestige as well. The opioid crisis is pretty big, and there's huge interest in both outcomes.
Plus the justice everyone deserves is swift and not expensive. What's the chance this doesn't get stretched out to years and years, with huge legal fees racked up?
> Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
About ten years ago I had two teeth removed. The next day I received a phone call from the dentist office. They wanted to know how I felt. I felt fine and I was curious why they would call me about it. They told me that often after a tooth removal, patients were complaining about pain. Again I told her I was fine and that was it.
I can understand that sometimes people complain about pain, but that's the thing : they are supposed to complain about it, I mean they must be actively demanding treatment.
Never ever had I received a phone call from a doctor or her staff. I can't help thinking that they wanted me to complain about pain so that they could prescribe me pain relief medication.
Usually a dentist prescribes painkillers without finding out if you'll need them. Most people go "Oh, hey, vicodin", and take it because they have the prescription.
This dentist was, by the sounds of it, actually taking an opt-in route - you have to say "Yes, I am in pain" to receive painkillers. Seems more responsible to me.
it's a person giving a service under hippocratic oath. The fact that the person is an MD at all is because he took training that is carefully outlined by government. He prescribes only medication that is legal to prescribe under rules set by government. He's probably paid by some insurance scheme that is either directly government (where there is public healthcare) or at least mandated and controlled by government (e.g. ACA).
So I think it's fair to say that the doctors office is one of the offices where government is very present.
I know and I think we're much worse for it. No matter the intentions, when the government gets involved the services become poorer quality and more expensive. I definitely think we'd be better off if we stopped disadvantaging that services relative to other services.
This sidesteps the fact that informed and responsible citizens should have access to opiates even if they are not ill, much less terminally so.
I get that it's a compromise, but it is still a morally reprehensible position to believe only terminally ill patients should be allowed the choice to put opiates in their body.
The real problem is a mixture of Big Pharma propaganda, kickbacks, lack of proper education, deep socio-economic troubles, depression, and need for escapism. The solution is not to limit the freedoms of responsible citizens but to address each of those concerns in turn.
A lot of doctors didn't know that they were writing inappropriate prescriptions, because they were evaluating the tradeoffs based on information from the drug company that said these drugs were much less addictive than they really were.
It was in one of the linked articles that doctors are required to undergo special training from the FDA before they are allowed to prescribe fentanyl. So they absolutely should know.
I did see reporting that cost is $20,000 per month for this drug, which makes no sense as opioids are neither expensive to produce nor hard to develop?
For the same reason that you never see a SWAT team breaking down a rich criminal's door to arrest him, even if he has body-guards or registered firearms, or is accused of a violent crime.
(Yes, I know, someone will find such a video on youtube to prove me wrong).
None of the replies have hit the nail on the head: the money isn't in the jurisdiction of the sheriff. When a (street) drug dealer is caught, the cash is right there and can be seized. With this type of crime, it is elsewhere.
The only thing it's approved for is breakthrough cancer pain for patients already on opiates. Presumably it's safe for this purpose.
The problem is when it's used for different purposes- and the drug rep was caught lying to the insurance company to imply the prescription was for breakthrough cancer pain.
They certainly went after many medical cannabis providers with a vengeance and refuse to reschedule cannabis. I know someone who was able to quit a fentynal pump. Rather than jailing doctors we need to allow them to access cannabis for their patients as a far safer alternative, but Sessions is hell bent on forcing chronic pain patients into a choice between agony and suicide. What kind of kickbacks is Sessions getting from the drug cartels to start a war on medical cannabis?
I think you should specify when you write drug cartels if you mean traditional drug cartels in Central/South America/Asia or if you meant big pharma in USA.
> You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?
find and prosecute those responsible for importing fentanyl from China these are the biggest killers of American youth. I know a handful that died from heroin laced with fent or from straight fentanyl from the darkweb. Legalize opiates and treat addiction as a medical condition.
As a healthy 30 something person, I feel fortunate that I'm not in pain, nor do I have any addictions to these potent addictive pain killers.
But it is just more salt on the wounds for me because the monthly insurance premium I pay is huge, and people (after I asked around) consider my health insurance scheme to be very good. And yet every doctor visit, test etc means more bills to pay.
It forces me to conclude thus:
The healthcare system in the US is totally unfair to hardworking people of America, and the blame is not on the doctors/physicians. It lies squarely on this Pharmaceutical/Insurance Industry complex of creating more sick people, keeping costs artificially high to fleece more money as premiums from hardworking people, while making it easy to get prescriptions for such drugs.
EOD, it feels like my money is feeding this drug addiction epidemic. And politicians on the left, right and center in US are doing zilch to fix this.
w.r.t this article, I hope this owner gets a fair trial, and if convicted, I hope that he drags down every single person who was part of this scam, with him.
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[ 2.9 ms ] story [ 168 ms ] threadIf he actually flees, the US government could easily seize most of his assets.
$1 million is a fairly high bail, generally in the ADW/manslaughter/sexual assault neighborhood. A court is not set up to handle a $1 billion bail, as you’re suggesting. That sort of money isn’t just moved around like that ($1 million is difficult enough), and the court would almost certainly mishandle it.
How about setting it at $100m? That doesn't sound unreasonable given the situation.
Not mishandling is easy: you put it in a locked escrow account and don't touch it. It the depositor had to borrow against assets to secure the deposit, then let reasonable interest accrue against the principal and deduct.
Just like if you always fine people $100 for speeding, then average folk will generally adjust their behaviour and millionaires will be able to race around and not give a f*.
There are tons of poor people stuck in jail awaiting trial for relatively minor crimes because they can't afford what would be a trivial bail amount to most HN readers. A rich person who commits a much more severe crime gets to sleep at home, or can flee if they think they don't have a good chance of winning without a big financial impact. Is that just?
It seems like there could be a lot of unexpected drawbacks to such an approach, since on the other end it’s harder to justify a high bond for a destitute, transient murderer, for example. If you’re okay with $100 million for this guy, it follows that you’d also have to be okay with $10 for him. Otherwise justice is partial and biased, even more so than it is now. Ignoring net worth seems safer, but again, I don’t know.
Assuming that $10 is high enough to ensure that the destitute, transient murderer will show up for trial, why shouldn't I be OK with it?
What you allege, that people happily plead out while innocent, does not happen. It just doesn’t, and it’s something I’ve heard repeated a lot by people who haven’t been inside. I was in a position to advise dozens of inmates on their cases during my time, and not once did that ever happen.
The truly innocent folks (and it’s hard to tell) were happy to sit to get their day to prove it or wait for the charges to get dropped. I’ve seen inmates rip up a plea bargain and throw it in the prosecutor’s face after sitting in county three years. Inmates are not dumb cattle looking for the first door. They understand what signing a plea bargain does. Even beyond that, innocent people are almost never arrested in the first place. There are very, very, very few innocent people in jail. I hate to break it to you, because I know it undermines liberal sensitivity and view on the world (which I know because I’m liberal, I’m not critiquing). You’re also coming at this from the perspective that assumes everyone should be able to bail out, which isn’t true. Would you revisit total bail denials, too?
Re: $10, how can you make that assumption? It’s disappointing that I’m being downvoted so heavily for pointing out that a seemingly minor change which is reactionary to one case could have implications far beyond intention. Being upset and changing things because of one billionaire is the very definition of mob-style reactionary grievance. There’s more to consider than just him, and I agree it sucks. This is a complicated issue and the easy engineering fix is very likely not the right one.
Oh, I see. Guess this conversation is pointless, then.
(Edit: I’m out of posting quota for today, but I at no point said what you’re claiming I’m trying to tell you in even the most uncharitable interpretation.)
The felony conviction rate in the US is around 70%. That doesn't sound to me like "innocent people are almost never arrested in the first place."
The rate of false convictions for people on death row is about 4%. That's for by far the most scrutinized cases out there.
According to this article, it's believed that somewhere between 2% and 8% of convicted felons are innocent people who pled guilty: http://www.nybooks.com/articles/2014/11/20/why-innocent-peop...
Maybe we have a disagreement over what number constitutes "almost never"?
I'm trying to talk about the real problems bail causes in the justice system, and you're trying to tell me that it doesn't matter because basically everyone who gets arrested is guilty anyway. That's not substantive, and it's only superficially civil.
ETA: Well, we can't necessarily write the rules however we want; there are Constitutional restrictions. In this case, the case could be made that increasing bail for wealthy suspects violates the guarantee of equal protection under the law. That's a different argument from the one you're raising, however.
That's a life sentence there so in theory he could try to make a run near the end of his trial...a year or two in hiding. What does he have to lose, his good name? But then he has so much money that even if he was left with $10mil he could in theory start Spanish lessons. The judges should make the super rich to pay for Marshals /FBI to watch them while in bail.
I doubt any judge will show mercy to him and common sense (not always right but..) says there's a LOT of paper trail incriminating him. It's a huge company and lots of salespeople, lots of payoffs. Not done with a wink and a nod.
One millionaire got a $54,000 speeding fine commensurate with his income and another got approximately $200,000 fine based on memory of exchange rates.
Sure it will. Put a 50% net-wealth bail on him (500 mil). Accept shares if he doesn't have cash.
You will say it's not reasonable.
But then it is reasonable to put a $50k bail on a poor person, which doesn't even have that money? In this case the bail is >100% net worth.
And if the shares lose value while he's out on bail? Our defendant just lost their incentive to reclaim them.
Usually it's the taker of bribes that is the biggest criminal. Any doctor who can be shown to have given addictive opioids to people that aren't terminally ill should be investigated.
This is completely regardless of whether it was the "standard practice" at the time, or whether some pharmaceutical sales rep told them it was a good idea.
If just a couple of hundred doctors would lose their license and a few dozen end up in jail, that would make some headlines and perhaps make other doctors think twice before prescribing oxycodone to someone with normal back pain. Doing that is like amputating someone at the hip for toenail fungus.
No, they should have their license revoked. Those people are not doctors, they are opportunistic capitalists in the medical sector that should have no right to practise medicine.
In fact, this scheme could only work if doctors complied. I would say what they did was much worse than what the billionaire did. They're bad actors.
http://edition.cnn.com/2016/08/25/health/us-surgeon-general-...
This makes you wonder how many professors at medical schools also go on nice holidays paid for by pharma companies or lobbyists.
You can’t change these incentives without moving the US to a nationalized health care system, including public financing of education for doctors and much harsher regulation of the pharma industry. As long as you have doctors going into massive amounts of debt to finance their education and a drug industry with obscene wealth and power, you’re always going to arrive at this outcome. Capitalism is fundamentally opportunistic, which is why it has no business in healthcare.
Opioids are a good choice for end of life care, but they're also useful in other situations, such as acute (short term) pain - post operative pain for example.
They're not a great choice for chronic (long term) pain, but even then they can be used carefully.
Do they err in the direction of over-prescribing? Probably. But to say that opioids should never be given to anyone who is not terminally ill would be to err in the opposite direction.
This seems to work pretty well.
EDIT: added "exceptional cases" - this can be other cases than just cancer, see e.g reply
Use of opioids in an IV in a hospital after a major surgery isn't what's discussed. That happens everywhere and doesn't seem to cause addiction problems.
Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose.
I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same.
For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.
I edited that my post above (sorry if your reply looks odd after the edit)
The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.
The industry term for this is "drug diversion," and it happens pretty frequently and is very under reported. The patient may not even be aware it's happening because a health care employee, real estate agent, teenager child, nanny, guest, etc may be stealing the medicine. It even happens in a hospital setting, with deadly results - https://www.medscape.com/viewarticle/825801
That's why if you have drugs someone may want to steal it's recommend you keep them locked up.
Not even dying in hospice care stops family: https://www.washingtonpost.com/national/health-science/dying...
As I don't know your story, you don't know mine. Get off your high horse before you lecture the peanut gallery.
With great sympathy to your wife, to those who've had lives taken and families destroyed by an addiction which started with a doctors over prescription, maybe hobbling to pee in a cup doesn't sound so bad.
Why can doctors not prescribe something like 3 pills a month to someone? Its not nearly enough to get addicted on, but can help someone experiencing severe but temporary pain. Is it something in our legal framework that only allows doctors to prescribe a months worth at a time with the assumption that its taken every day? Is it some pressure from insurance companies who don't want to deal with paying out small claims like for 3 pills?
The second issue is deliberate overprescription. Most insurance companies have rules on the amount of medication which can be dispensed -- 100 days is a common limit, but some limits are as low as 30 days. The justification for this is that they don't want you to end up with lots of unneeded medication if your needs change; but usually the real reason is that they don't want to end up covering costs which can be offloaded to your next insurance company if you change insurers. In response, some doctors will deliberately inflate prescriptions -- e.g., if your doctor thinks you need one pill/day and trusts you not to abuse the medication, he might write a prescription for 3 pills/day so that your insurance company will approve an amount which will last you for longer.
Add to this the inherently difficult process of figuring out just how much pain a person is in and prescribing the correct medication.
It really is a lose/lose situation for doctors these days. The changes have to come from above them at the administrative level.
I assume, definition of this phrase would be the point of contention .
No, the solution is not putting doctors in jail. No, the solution is not piling regulations on top of more regulations. Only thing that's needed is educating people and providing less addictive alternatives. If the pack of pills has "Warning: this is highly addictive! Use only in emergency!" in big bold letters, then people will think twice about taking them.
That is until you buy a larger pack and have some.left over the next day that is.
I say "pretend" because it was no great revelation in the 1960s that smoking was bad for you. My father said they were called "coffin nails" back in the 1930s, and the first thing doctors routinely advised their patients was to quit smoking.
And, of course, the black, scarred lung of a smoker was ridiculously obvious to any person who did an autopsy or operation on a smoker.
Making sure teachers in medical schools don't tell their students that opioids aren't addictive is another.
Information to the public about what pain and pain treatment is, and what treatments are effective compared to their side effects is yet another.
This is a terrible idea. All opioids are theoretically addictive. They're also the most effective painkillers. Even cocodamol is an opiate. Escalating the War on Drugs like this is just going to leave a whole load more people in treatable pain.
It's a complex problem, but I think this Vice article is a good summary of how the UK has avoided a comparable crisis: https://www.vice.com/en_uk/article/ppm5eg/the-truth-about-ox...
Well, you're not wrong. However, this isn't limited to opioids. If a doctor is not following the standard of care, according to their peers, and a patient has an adverse outcome then the Doctor is subject to board review and they may have their license revoked and/or be prosecuted. This is already in place and has been for some time. This is why most Doctors are generally extremely conservative in the treatments and interventions they recommend for their patients.
My understanding is that a doctor isn't going to be making more money because they're prescribing you opiods or not. But they do it anyways because it can help you through pain. Just like you can get stuff to help with your cold, even if it's not necessary
Airlines aren't the same as pillow manufacturers just because they lend you one on a flight.
Meanwhile one doctor had 23 Lamborghinis, many beach front condos and 2 doctors prescribed 1/3 of the total prescriptions in the world. Both serving 20+ years sentenced last year, NPs who pushed all this got 3 years, almost every executive has been charged and trial 2018
Aren't you a little bit concerned that he might be guilty yet go unpunished? Or that he's innocent but goes down anyway?
There's a lot of money involved here, and a lot of political prestige as well. The opioid crisis is pretty big, and there's huge interest in both outcomes.
Plus the justice everyone deserves is swift and not expensive. What's the chance this doesn't get stretched out to years and years, with huge legal fees racked up?
About ten years ago I had two teeth removed. The next day I received a phone call from the dentist office. They wanted to know how I felt. I felt fine and I was curious why they would call me about it. They told me that often after a tooth removal, patients were complaining about pain. Again I told her I was fine and that was it.
I can understand that sometimes people complain about pain, but that's the thing : they are supposed to complain about it, I mean they must be actively demanding treatment.
Never ever had I received a phone call from a doctor or her staff. I can't help thinking that they wanted me to complain about pain so that they could prescribe me pain relief medication.
Am I being paranoid?
Usually a dentist prescribes painkillers without finding out if you'll need them. Most people go "Oh, hey, vicodin", and take it because they have the prescription.
This dentist was, by the sounds of it, actually taking an opt-in route - you have to say "Yes, I am in pain" to receive painkillers. Seems more responsible to me.
That would be absolutely unacceptable, imho.
And I thought being in pain was not enough to be prescribed opiods anyway? Isn't the pain supposed to be chronic or the patient incurable?
Episodic pain should not be treated at all, imho.
So I think it's fair to say that the doctors office is one of the offices where government is very present.
I get that it's a compromise, but it is still a morally reprehensible position to believe only terminally ill patients should be allowed the choice to put opiates in their body.
The real problem is a mixture of Big Pharma propaganda, kickbacks, lack of proper education, deep socio-economic troubles, depression, and need for escapism. The solution is not to limit the freedoms of responsible citizens but to address each of those concerns in turn.
Yep. Investigate all of us. High quality understanding of medicine right here..
Also, if a doctor is writing an inappropriate script based on a kickback are their licenses getting suspended?
So almost certainly not.
Not condoning it, just suggesting that's the real reason why.
(Yes, I know, someone will find such a video on youtube to prove me wrong).
With cannabis up in 1, though, I guess those scheduling guidelines don't actually mean a damned thing.
The problem is when it's used for different purposes- and the drug rep was caught lying to the insurance company to imply the prescription was for breakthrough cancer pain.
> You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency. You’ve heard of OxyContin, the pain medication to which countless patients have become addicted. But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?
There's big money in opioid addiction.
But it is just more salt on the wounds for me because the monthly insurance premium I pay is huge, and people (after I asked around) consider my health insurance scheme to be very good. And yet every doctor visit, test etc means more bills to pay.
It forces me to conclude thus: The healthcare system in the US is totally unfair to hardworking people of America, and the blame is not on the doctors/physicians. It lies squarely on this Pharmaceutical/Insurance Industry complex of creating more sick people, keeping costs artificially high to fleece more money as premiums from hardworking people, while making it easy to get prescriptions for such drugs.
EOD, it feels like my money is feeding this drug addiction epidemic. And politicians on the left, right and center in US are doing zilch to fix this.
w.r.t this article, I hope this owner gets a fair trial, and if convicted, I hope that he drags down every single person who was part of this scam, with him.