Dealing With People From The Dark Side

I was reading the recent sad DEA news release and the ABC News report, New York Doctor Charged as Head of $10 Million Oxycodone Ring. According to an excerpt from the ABC News report -

Investigators said 41 members of Pennsylvania "drug crews" were among those arrested in connection with the case. Officers seized a total of 28 firearms from them. "The firearms recovered in this case also highlight how the gun violence associated with cocaine and heroin trafficking is now the muscle in the illegal oxycodone trade,"..

Of course, I'm always intrigued with these type of criminal schemes and what could possibly possess educated, responsible, well-paid, white-collar healthcare professionals already living comfortable lives, to embrace the dark side of human nature? Is greed that powerful of a force?

Although I often share news reports about the [allegedly in this case] failings of those who've taken an oath to do no harm, I thought it was important to point out this one case to remind us that visiting the dark side requires dealing with people who've spent their entire lives in the dark side, and who are seriously darker than we could ever think of being.

It's not only having to worry about the risks of getting caught by the police, convicted in a court of law, and serving long prison sentences often associated with turning to the dark side. There's also the more serious risks and consequences that come from dealing with the shady people that we enlist to help us perpetrate our unethical and illegal schemes. They're not the soft, white-collar criminal types.

Some of these people are hardened violent criminal psychopaths.

Would you trust them with your life? For instance -

Do you remember Michael J. Kerkowski, a pharmacist who in the early 2000s ran afoul of the law by selling controlled substances to drug users and others without prescriptions? In order to perpetrate his crimes, Kerkowski enlisted convicted criminals Hugo Selenski and Paul Weakly to enable him, under the mistaken assumption that they were unconditionally trustworthy.

But Weakly and Kerkowski had other plans. They decided that even more money could be made by torturing, robbing, and murdering Kerkowski (and his unwitting girlfriend), taking the illegal profits for themselves, and then burying their bodies in his back yard. Pretty gruesome, huh? And now, over ten years later, the courts are still trying to convict Selenski for their murders.

And then there was the pharmacist whose schemes for buying stolen prescription drugs caused him to become a victim of one of America's most-prolific serial killers, Richard Kuklinski: The Iceman, a psychopath whose violent crimes paralleled those of America's first known serial killer.

Paul Hoffman, a pharmacist, was suckered into a scheme to buy stolen Tagamet® for pennies on the dollar from Kuklinski when he disappeared in the spring of 1982. Kuklinski never really had the stolen drugs and murdered Hoffman after he showed-up with the cash. A year later, his car was found in the rented warehouse that Kuklinski used for his car theft racket. Hoffman’s body was never found.

Kuklinski later confessed to this murder [begins at minute 27:50 of documentary], saying he first shot Hoffman but that he didn’t die immediately, so he finished him off by using a tire iron. He then shoved Hoffman’s body into a 55-gallon drum and left it near Harry's Corner Luncheonette, in New Jersey. He periodically checked on the drum to see if had been discovered, and eventually it disappeared.

So, now that we're reading more reports of firearms and underworld "muscle" being involved in what were formerly simple white-collar crimes of healthcare fraud, is taking a short visit to the dark side and entrusting the people you'll find there worth the risk? How much is enough? Be happy with what you've got and don't turn on the people who trust you with their lives, or it may just happen to you.

Why Do We Cheat?

Lance Armstrong’s confession has us thinking about cheating in all aspects of our lives. Cheating is a familiar story. First comes the cheating, then comes the lying about it, and then eventually comes the confession, most often because that person has been caught.

So why do we cheat? To answer that question for us is David DeSteno, a professor of psychology at Northeastern University and the author of Out of Character: Surprising Truths About the Liar, Cheat, Sinner and Saint Lurking in All of Us.

Source: Katie Couric Show

Accepting Responsibility

You know.. no one is perfect. Like the bad apples analogy I posted a while back, we all have varying degrees of imperfections. That's why the corporations are building robots to replace us. But, the key is to acknowledge our imperfections and not allow them to get the best of us.

If you've been a pharmacist for a while, then you'll know that there are many good pharmacists, who for whatever reasons, fall victim to their impulses and cross over that fine line between right and wrong, ethical and unethical. And that's okay. Any rational person realizes that we can't always be perfect in our behaviors. Sometimes we're gonna slip.

But, it's also important to understand that whenever we screw up, we need to own up to our mistakes. As long as they're not done to intentionally harm someone, most everyone can empathize with our faults and mistakes if we accept responsibility for them and do our best not to let them happen again.

It's only when we deny our mistakes, cover them up, and try to fight "the man" when the shit hits the fan and the consequences become severe. So, if there's anything I'd like my readers to embrace, it would be to be honest, accept responsibility, and to recognize where the fault actually lies.

Fredo The Pharmacist

I see the profession of pharmacy as a brotherhood, one big family, but sometimes dysfunctional.

And like some dysfunctional families may do in order to fully understand the root cause of a problem before taking any action, we first try to address an individual family member's bad behaviors by calling them in to discuss it with one of their brothers from the state board of pharmacy.

But that doesn't always work to correct the problem.

As what can happen in many big families, there's often a competitive jealousy driving some members to try to prove their individual superiority, regardless of the potential consequences, that sometimes gets in the way of the entire family's best interests and may lead to their elimination from the family.

But don't just take my word for it, see for yourself.

The Best Gifts Come From Within

Give the gift of life this holiday season. Take the initiative and learn how to say "NO".


Source: Secret video is released of ‘drunk’ man asking strangers to help him into his car

60 Minutes | Hospitals: The Cost Of Admission

One of the driving forces for my early retirement from the profession was that I'd become disillusioned with the loss of our professional freedom and control of our own destiny. According to the CBS News television program, 60 Minutes, it seems like many other healthcare professionals feel the same way.

For more than a year, 60 Minutes has been looking into the admission and billing practices of Health Management Associates. It's the fourth largest for-profit hospital chain in the country with revenues of $5.8 billion last year, nearly half of that coming from Medicare and Medicaid programs.

60 Minutes talked to more than 100 current and former employees and heard a similar story over and over: that Health Management Associates relentlessly pressured its doctors to admit more and more patients -- regardless of medical need -- in order to increase revenues. Here's their report -


Source: 60 Minutes | Hospitals: The cost of admission

The Middle-Aged Pharmacist Conundrum

I read a comment in a forgotten pharmacy forum a while back in which a frightened young commenter said that she couldn't think of anything worse than to be a middle-aged pharmacist out there trying to find a job. She said that she would put up with anything in her present position in order to not lose her job and become one of "those" pharmacists.

That comment stuck with me. Not only because of the fear behind it, but because that middle-aged pharmacist, and that same scenario, could easily apply to me.

Now, I'd be lying if I said that there wasn't a little fear behind my decision to quit working in pharmacy, especially since I've been doing it so long and didn't have something else lined up beforehand. There's always that fear of the unknown.

But as time has passed, I've realized that my fear is really unfounded. There's no actual basis for it, it's only in my mind. There's nothing to be afraid of, I've planned and prepared for this time in my life. No matter what happens, I will survive. I've come to learn that fear is no justification for my actions.

So then, why would such a young commenter be so afraid of something 25-years into her future?

Working as a pharmacist, she would be generating a very comfortable income. If she lived below her means, avoided accumulating debt, saved a significant portion of her income and invested it wisely, upon reaching middle-aged she would be in such a safe financial position that fear shouldn't factor into her decision-making. Not being able to find a job at that age would be the least of her worries.

But on the other hand, I've worked with some older pharmacists who lived high on the hog their entire career, thinking that the gravy train would never come to an end. They hadn't prepared themselves for the worst case scenario, and now they're stuck working, not because they want to, but because they think that they have no other choice. Fear guides their actions.

If you haven't noticed, most of the pharmacist crimes that I've reported in my blog or on Twitter, were perpetrated by middle-aged pharmacists, people old enough to know better, but probably willing to do just about anything because they were desperate for money.

It seems to me that those pharmacists' fear of losing the lifestyle they grew accustomed to became greater than the fear of the consequences of crossing over that ethical line.

Perhaps it's one "those" middle-aged pharmacists that the young commenter is afraid of becoming?

But, on the other hand, perhaps "putting up with anything" out of fear could lead a young pharmacist into becoming one of those pharmacists upon reaching middle-age? Something to think about.

But, don't just take my word for it. Watch this hidden video of a middle-aged pharmacist interviewing for a position with a less-than-reputable independent pharmacy owner, and choosing to compromise his ethics during the fifth decade of his life in order to become employed.

Rise Of The Robots

Should humans brace themselves for a coming ‘robotics revolution’? I think so.

I recently watched The Terminator again on TV last week. More and more, the technology in that film is coming into existence. Think about it. Just a few years ago, most of us never imagined the use of military drones as they're being used today. As rules of engagement continue to change, militaries adapt their tactics to include the increasing use of unmanned weaponry.

However, behind the hot button issue of drones lies a military robotics industry that is developing machinery which is not only finding its way onto the battlefield, but into civilian life, as well.

Robots today have the capability to drive automobiles, perform surgeries, and do household chores, among other tasks. As integration escalates, what legal and ethical issues arise?


Source: Aljazeera, The Stream: Rise of the robots

Dispense Or Not Dispense | What Would You Do?

There were many times in my career while I was working in retail pharmacy when a physician or a dentist presented me with controlled-substance prescription written for himself/herself or a family member, wanting me to fill it for them, and I refused.

In some of those cases, something bad later happened, and subsequent investigations revealed that those physicians or dentists (or their family members) had substance abuse problems and were getting their prescriptions filled at multiple pharmacies in order to hide their problem.

Of course, I learned early that if you're going to refuse to fill a self-prescribed prescription then you're going to get grief from not only the prescriber, but sometimes from your co-workers or supervisors who don't understand (or care about) the potential problems or conflict of interest.

In a couple of instances, I was even reported to the BOP for refusing to fill their prescriptions. States vary in their rules about pharmacists' rights to refuse to fill prescriptions, so I once had to endure a cross-examination to justify my refusal. It was a hassle, but the BOP sided with my actions.

In essence, I refuse to enable another healthcare provider's potential substance abuse problem, or to become indirectly responsible when something bad happens after I filled their prescription. I'm not going to be sucked into any schemes, become part of the problem, and possibly hurt someone.

And the reason that I refuse to fill controlled-substance prescriptions for providers who self-diagnose and self-treat is specifically highlighted in the following video.


Source: 'Doctor of the Year' Arrested on DUI Charges After Crash

What would you do? Would you want to be the pharmacist who filled the prescriber's self-prescribed controlled-substance Rx when something like this happens, and especially if someone is killed?

One Family's Tragic Fungal Meningitis Story

It's one thing to look at the numbers of patients affected by fungal meningitis from the contaminated corticosteroids compounded by NECC. The numbers are staggering.

But, it's truly heartbreaking when you listen to the families of those who died after being injected with those contaminated medications. Then one can come to fully understand why this tragedy needs to be prevented from ever happening again, regardless of any regulatory hardships some compounding pharmacies may have to endure.

Here's a PBS Newshour presentation of one of those patients, Diana Reed, a beautiful 56-year-old Tennessee woman who was caretaker for her ALS-affected husband Wayne, and who died suddenly of fungal meningitis after receiving tainted steroids for neck pain.

The Suicide Plan | PBS Frontline

PBS FRONTLINE explores the underground world of assisted suicide.

In this groundbreaking 90-minute film FRONTLINE explores the underground world of assisted suicide and takes viewers inside one of the most polarizing social issues of our time – told not only by the people choosing to die, but also by their “assisters,” individuals and right-to-die organizations that put themselves in legal jeopardy by helping others to die.

Watch it on-air or online beginning Tuesday, November 13th.

The Lost Wizard

The tragic story of one of the greatest inventors known to mankind, Nikola Tesla.

It's A Jungle Out There

Ran into the ex-wife again at the grocery store. Seems as though she had some "work" done and somehow thinks I should foot some of the bill. Like she doesn't already have enough money.

Of course, we got into an argument again and her dark side quickly became visible to all the other shoppers. It's a jungle out there young men. Be very careful. A leopard is capable of changing it's spots these days. With her new looks, I'm sure she'll find another victim soon enough.

The Corporation

First released in 2003, yet still provoking, witty, and sweepingly informative, The Corporation explores the nature and spectacular rise of the dominant institution of our time.

Part film and part movement, The Corporation has transformed audiences and dazzled critics with its insightful and compelling analysis. Taking its status as a legal "person" to the logical conclusion, the film puts the corporation on the psychiatrist's couch to ask "What kind of person is it?"

Here's the trailer -


Source: TheCorporation.com 2.0

Beyond Cynicism

A great conversation between Robert Reich and John Stewart on The Daily Show.

Analyzing Bernie Madoff

Forbes contributor Todd Essig, Ph.D., psychoanalyzes the biggest crook in U.S. history (so far).

Which Path Will You Take?

On February 6, 2005, the New York Times reported that Paul Kornak pled guilty to fraud and criminally negligent homicide a month earlier.[1] Kornak was a nonphysician employee at the Stratton Veterans Affairs Medical Center (SVAMC) in Albany, New York. On November 21, 2005, a federal judge sentenced Kornak to the maximum prison term of six years. According to a local report, "At least one veteran died and 64 others suffered unduly or were harmed by the forgeries, which involved manipulating their medical backgrounds so they would qualify to participate in lucrative drug studies ...."[2] A decade earlier, two pharmacists had warned that patients were placed at risk or had died because of similar unethical experimentation.[2]

This is the first paragraph excerpted from Jeffrey Fudin's story, Blowing the Whistle: A Pharmacist's Vexing Experience Unraveled (pdf) published in Am J Health-Syst Pharm. 2006;63(22):2262-2265. ©2006 American Society of Health-System Pharmacists. Posted on Medscape.com 01/03/2007

I thought I would mention pharmacist Fudin's story because of three reasons.

Firstly, because it isn't often that you'll hear or read stories of heroic pharmacists, fighting against the multitude of apathetic supervisors, unethical leaders, or criminal operatives found throughout the healthcare system, and risking it all to do the right thing. Jeffrey Fudin is one of those heroes, and someone whose actions I truly admire. He's the kind of pharmacist we should all try to emulate.

Secondly, because most of the abusive, unethical, corrupt, or criminal stories pharmacists discuss with each other usually involve retail or community pharmacy practice. If you've read any pharmacist blogs or Twitter posts, you'll see that the they tend to focus on the abuses suffered at the hands of the chains, the PBMs, or even their patients. Many pharmacists mistakenly tend to think that such abusive situations don't happen as often in hospital pharmacy practice. They do.

I also wanted share pharmacist Fudin's story because, also having worked at VAMCs twice in my itinerant career, I've found the work environments to be THE MOST toxic of any I've experienced, and the hospitals staffed with some of THE MOST sociopathic people (including a few pharmacists) that I've come across in my life. So, I can understand how pharmacist Fudin would, almost unbelievably, have to fight so hard, and against so many, when just trying to the right thing for his patients.

And thirdly, here's the worst part -

One veteran reportedly died because of these intentional crimes. Yet, only one of the perpetrators or enablers was held criminally-liable, and served (minimal) time in prison.

I can't help but wonder - were any of the supervisors whom dismissed pharmacist Fudin's efforts ever even reprimanded for their apathetic or unethical behaviors, are they still working at that one VAMC, or have they retired or moved on to other positions?

If you happen to run into such a supervisor, how will you react? Have you decided beforehand which path will you take when something similar happens to you?

Sterilization For Human Betterment

Efficiency doesn't go unnoticed. In the mid-20th century (1930s-1950s), the country's intellectual elite such as doctors, geneticists and Supreme Court justices supported forced sterilizations. Their goal was to rid society of people labeled "feeble-minded" or "defectives". Needless to say, it did nothing to stem the growth of political corruption.

California's movement was so effective that in the 1930s, members of the Nazi party asked California eugenicists for advice on how to run their own sterilization program.


Source:California's dark legacy of forced sterilizations

The Daily Show: Drug Testing

The funny thing is, I'd bet there's a higher percentage of drug use amongst politicians as a group.


Source: The Daily Show with John Stewart Noli nothis permittere te terere

Frozen Souls | A Short Film

According to the film's director -

We wrote this short to get in touch with the audience beyond the wall of personal beliefs about war. The challenge was to find a core ethical value shared by the widest audience possible.

We found these universal value in the principle that a modern soldier goes to war to protect civilians (of all nationalities!) at his own risk, for a personal ethical choice. The fact that in modern war this principle is disregarded (civilian death as "collateral damage", no count for civilian casualties vs paranoid count for military casualties, etc.) is a dangerous attack to "common sense".

Soldier Greene's story explores the meaning of the existential mission of a soldier, slowly unveiling the ethics of warfare, often expressed on media but in fact disregarded in the field.

Dedication, courage and altruism shown by an Afghan mother struggling to save her son's life, will reveal to Greene his own deepest motivation when he chose to be a soldier, until the extreme sacrifice of death.

We wrote about an American soldier in Afghanistan because he well represent the paradox of a war projected daily in our homes, but shown in a cool and distant fashion. A war where all good values are "here" and all horrible facts are "there", breaking the ethical chain which always should connect moral values and action.

Frozen Souls from Guido Freddi on Vimeo.