Shots fired and bomb planted at family medicine clinic - over opioids?

[Agast]

Suspect identified in shooting at Allina Clinic Crossroads in Buffalo, 5 people injured

Richard Ulrich added that his brother had back surgery a couple years ago and was put on opioids, which he believes led his brother to do what he did at the clinic.

The guy is 67. He looks like he could be one of my patients. WTF.

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[hyperalgesia]

I'm actually surprised this doesn't happen more often. Opioids in unstable, violent patients and throw in the occasional bad day for the doc or poor bedside manner.

 

[jsaul]

Suspect identified in shooting at Allina Clinic Crossroads in Buffalo, 5 people injured



The guy is 67. He looks like he could be one of my patients. WTF.

the brother said the suspect had back surgery which led to him being put on opioids.
So he had pain after surgery and then wanted more and more opioids. of the course the surgeon stopped prescribing after a month or less

I'm telling you if the surgeons had to take care of these patients forever after surgery and had to deal with the continued pain there would be guaranteed less fusions.

 

[bedrock]

the brother said the suspect had back surgery which led to him being put on opioids.
So he had pain after surgery and then wanted more and more opioids. of the course the surgeon stopped prescribing after a month or less

I'm telling you if the surgeons had to take care of these patients forever after surgery and had to deal with the continued pain there would be guaranteed less fusions.

agree. They should have to take care of their own messes. Plus if they faced the misery they caused every day, maybe, just maybe they would be more cautious about lumbar fusions.

 

[jsaul]

agree. They should have to take care of their own messes. Plus if they faced the misery they caused every day, maybe, just maybe they would be more cautious about lumbar fusions.

of course, if they have to see their complaining patients every month after surgery indefinately and had to hear their pain complaints they would think twie before their next fusion victim. currently the surgeon does not have to deal with the consequences and after the post fusion xrays" look good" 1month after surgery they tell the patient to see their primary or a pain doctor to deal with the pain because "their job is done"

 

[Ferrismonk]

The article says the clinic already had a restraining order against the man...

 

[SSdoc33]

Paging drusso.....

 

[Laryngospasm]

He go after the surgeon that caused the problems or the pain doc trying to help him? Let me guess.. And this is another illustration of the seriousness of maintaining or starting people on opioids. Even if you didn’t start them and they violate the contract they agreed to follow you risk a violent altercation. How many rvus was that worth?

 

[Agast]

Police: 67-year-old shooting suspect had ‘multiple contacts’ with police, likely intended to target Buffalo clinic

The shooting occurred at an Allina Health Clinic, police said.

m.startribune.com

“ Zandstra, who now lives in Maple Lake, said Ulrich has been upset that a doctor "wouldn't give him high doses of painkillers. There would be a month's worth of painkiller, and he'd have that gone in a week and a half. He'd get a buzz on them."

Urlich was so irate that he put the physician's name on a sign calling the doctor "a crook and just no good," and attached it to the mobile home's shed "facing the main road going to the hospital so everybody could see it."

 

[lobelsteve]

Person and not drug

 

[callmeanesthesia]

Person and not drug

I don’t recall anyone shooting up a pain clinic because they wouldn’t prescribe enough meloxicam...
It’s not the person. It’s an inevitable consequence of taking millions of people and giving them highly addictive drugs then limiting the supply. Many will wean down and be okay. Some will turn to street drugs. A few will blame the doctor, snap, and try to kill people.

 

[lobelsteve]

I don’t recall anyone shooting up a pain clinic because they wouldn’t prescribe enough meloxicam...
It’s not the person. It’s an inevitable consequence of taking millions of people and giving them highly addictive drugs then limiting the supply. Many will wean down and be okay. Some will turn to street drugs. A few will blame the doctor, snap, and try to kill people.

So the answer is clearly get rid of all opiates?

No, identify the addict and do not pour gas on that fire. Read the story, none of us would have fallen down that rabbit hole of giving him meds. This was a bad guy with an underlying addiction problem, mental health issues, and a criminal penchant.

 

[painfree23]

So the answer is clearly get rid of all opiates?

No, identify the addict and do not pour gas on that fire. Read the story, none of us would have fallen down that rabbit hole of giving him meds. This was a bad guy with an underlying addiction problem, mental health issues, and a criminal penchant.

no, the answer is to give everyone opiates (guns) and allow them to buy them anywhere!

 

[drusso]

Paging drusso.....

This is why I strongly advocate for Second Amendment rights for physicians and clinic defense protocols. As long as these events keep occurring, the rationale for my arguments will continue to be supported.

"It feels like it can't happen to you until it's in your home (town)," said Bickery. "Especially in a place where people are helped at and you know they're taking care of, especially during these struggling times. It's hard to think of someone being able to and willing to do that."

We need to train doctors and clinic staff need to have concealed-carry permits just like they have BLS, ACLS, etc. You pray to God you never have to manage an airway in an Emergency situation, but if you do there is no excuse for being unprepared. Ditto for self-defense and defense of your patients.

 

[SSdoc33]

This is why I strongly advocate for Second Amendment rights for physicians and clinic defense protocols. As long as these events keep occurring, the rationale for my arguments will continue to be supported.

Drusso's clinic:

 

[Laryngospasm]

no, the answer is to give everyone opiates (guns) and allow them to buy them anywhere!

Pretty sure if you could get opiates everywhere this wouldn’t have happened.

 

[NJPAIN]

We have created this "black box" called pain management. A specialty that revolves around a symptom not a disease or group of diseases. To many the implication is that if you have pain of any kind we can and MUST fix it to the satisfaction of the patient. Many patients are not sophisticated enough to understand that that simply cannot be true. Other physicians, particularly surgeons, know that it can't be true but conveniently use us as a trash container to deposit all of their failures into. As a result they operate on individuals that they should not operate on, they perform poorly planned and executed surgery and worst of all they do not adequately discuss the possibility of and implications of failure. Instead they forge ahead and direct the patient to pain management because we will make it all better. This needs to change or we all need KEVLAR.

 

[Laryngospasm]

The surgeon to patient “I’ve done all I can.. I’m sending you to pain management “

 

[drusso]

Drusso's clinic:

View attachment 329727

I hope that you and your staff never experience violence nor the threat of personal violence in your clinic.

 

[Pain Applicant1]

I pretty much only carry on my farm and am still not going to carry in my office. I don't think it would help me and the potential adverse consequences are too high for me.

I have at least one friend who has killed someone. I imagine I know more but he's the only one who volunteered this information to me as I would never ask. This was during the first gulf war and while he was in combat. A piece of his soul is missing and he still struggles with it. He told me early on he would go days without sleeping because he was scared of his dreams.

I see similar things with some of my vet pts and the same when I talked to inmates who have killed when I worked through the prison system.

My friend's killing can be completely justified but it seems like he's still living through hell for it. I would hate to be in that position.

 

[lobelsteve]

This is why I strongly advocate for Second Amendment rights for physicians and clinic defense protocols. As long as these events keep occurring, the rationale for my arguments will continue to be supported.

"It feels like it can't happen to you until it's in your home (town)," said Bickery. "Especially in a place where people are helped at and you know they're taking care of, especially during these struggling times. It's hard to think of someone being able to and willing to do that."

We need to train doctors and clinic staff need to have concealed-carry permits just like they have BLS, ACLS, etc. You pray to God you never have to manage an airway in an Emergency situation, but if you do there is no excuse for being unprepared. Ditto for self-defense and defense of your patients.

Unless you’re anesthesia trained. Then you hire 4 crna’s to carry guns for you.

 

[callmeanesthesia]

Unless you’re anesthesia trained. Then you hire 4 crna’s to carry guns for you.

Sux darts.

 

[Laryngospasm]

Ketamine darts.. they just drool until the police come 😂

 

[callmeanesthesia]

Ketamine darts.. they just drool until the police come 😂

No way - they’d be back for more as soon as they were released.

 

[xvaderx]

The surgeon to patient “I’ve done all I can.. I’m sending you to pain management “

"My doc said you HAVE to give me pain medications, they can't write it anymore"

 

[xvaderx]

We have created this "black box" called pain management. A specialty that revolves around a symptom not a disease or group of diseases. To many the implication is that if you have pain of any kind we can and MUST fix it to the satisfaction of the patient. Many patients are not sophisticated enough to understand that that simply cannot be true. Other physicians, particularly surgeons, know that it can't be true but convenient use use as a trash container to deposit all of their failures into. As a result they operate on individuals that they should not operate on, they perform poorly planned and executed surgery and worst of all they do not adequately discuss the possibility of and implications of failure. Instead they forge ahead and direct the patient to pain management because we will make it all better. This needs to change or we all need KEVLAR.

Let's also add the FEDERAL GOVT to the mix watching to see if we are giving too much or too little, using big data to analyze and penalize

 

[callmeanesthesia]

Let's also add the FEDERAL GOVT to the mix watching to see if we are giving too much or too little, using big data to analyze and penalize

Are you kidding? That’s been great for our overall safety. The only group these patients are more ready to blame for their ills than doctors is the government. “Sorry, but the DEA would take away my license if I prescribed the oxysomaxanax you want”
“Oh that damn government!”

 

[jsaul]

The surgeon to patient “I’ve done all I can.. I’m sending you to pain management “

More like.... surgeon to patient "the fusion looks great on xray"


Patient "but I'm still in pain"

Surgeon " then you need to see pain management "

 

[xvaderx]

Are you kidding? That’s been great for our overall safety. The only group these patients are more ready to blame for their ills than doctors is the government. “Sorry, but the DEA would take away my license if I prescribed the oxysomaxanax you want”
“Oh that damn government!”

Yes, from that aspect I love it and I'm very happy that Uncle Sam stepped in to give us an out (for now). But it is certainly a double edged sword to have the government directly involved, amassing data on how we treat patients on the front lines.. . .since who knows what conclusions they will draw from it.

By the way, a patient told me that the government clearly states that the guidelines do not apply to pain management (printed it out for me)

Misapplication of recommendations to populations outside of the Guideline’s scope. The Guideline is intended for primary care clinicians treating chronic pain for patients 18 and older. . . .

Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids. . . .

CDC Newsroom

Press releases, advisories, telebriefings, transcripts and archives.

www.cdc.gov

 

[Laryngospasm]

Yes the second cdc guideline... isn’t that nice. Hasn’t stopped the dea from continuing to harass and jail people who fail to misapply the guidelines.

 

[drusso]

Suspect identified in shooting at Allina Clinic Crossroads in Buffalo, 5 people injured



The guy is 67. He looks like he could be one of my patients. WTF.

Documents show several red flags for clinic shooting suspect

MINNEAPOLIS (AP) — The suspect in the fatal shooting at a Minnesota medical clinic was able to enter the building despite threatening violence there two years earlier, posting a sign near his home about a doctor he disliked and frightening a nurse at a nearby hospital so much that a colleague hit a

apnews.com

"He said Ulrich told him he dreamed about exacting revenge on the people who “tortured” him, referring to issues he had with back surgeries and the medication he was prescribed for them."

 

[NJPAIN]

More like.... surgeon to patient "the fusion looks great on xray"


Patient "but I'm still in pain"

Surgeon " then you need to see pain management "

I have a guy one year post dropping truck axle on his foot who's neuropathic/CRPS pain is well controlled on max dose gabapentin and DRG stimulator. Sent back to work followed by a dramatic increase in mechanical pain. Orthopods finally get CT scan and discover that his metatarsal fractures now one year out are unhealed. NOW they tell him to stop smoking, use ext bone stimulator and go back in a boot for 8 weeks. If that fails they will bone graft. I've already told him that although he should follow these recommendations and hope for the best, he needs to be prepared for failure and ongoing mechanical pain at which time they will throw up their hands and tell him "now you need go back to pain management". I've told him that pain management cannot make a broken bone that hasn't healed or a mangled foot not hurt when you walk on it.

 

[painfree23]

I have a guy one year post dropping truck axle on his foot who's neuropathic/CRPS pain is well controlled on max dose gabapentin and DRG stimulator. Sent back to work followed by a dramatic increase in mechanical pain. Orthopods finally get CT scan and discover that his metatarsal fractures now one year out are unhealed. NOW they tell him to stop smoking, use ext bone stimulator and go back in a boot for 8 weeks. If that fails they will bone graft. I've already told him that although he should follow these recommendations and hope for the best, he needs to be prepared for failure and ongoing mechanical pain at which time they will throw up their hands and tell him "now you need go back to pain management". I've told him that pain management cannot make a broken bone that hasn't healed or a mangled foot not hurt when you walk on it.

Was his response, “then why did they send me back to you”?

 

[drusso]

I have a guy one year post dropping truck axle on his foot who's neuropathic/CRPS pain is well controlled on max dose gabapentin and DRG stimulator. Sent back to work followed by a dramatic increase in mechanical pain. Orthopods finally get CT scan and discover that his metatarsal fractures now one year out are unhealed. NOW they tell him to stop smoking, use ext bone stimulator and go back in a boot for 8 weeks. If that fails they will bone graft. I've already told him that although he should follow these recommendations and hope for the best, he needs to be prepared for failure and ongoing mechanical pain at which time they will throw up their hands and tell him "now you need go back to pain management". I've told him that pain management cannot make a broken bone that hasn't healed or a mangled foot not hurt when you walk on it.

Did you try oxycodone? What's PHQ-9?

 

[Ducttape]

Did you try oxycodone? What's PHQ-9?

and why are you asking that?

is it because the unreasonable patients are weeded out of your practice before they see you?



inappropriate patient + inappropriate drug + inappropriate "self defense" weapon ==> disaster.


in reality, the only parameter that we can reasonably alter is the drug part. and the primary mechanism is probably with educating "providers" (esp surgeons) that the concept of long term use for chronic noncancer/nonpalliative pain treatment really has to stop.

 

[drusso]

and why are you asking that?

is it because the unreasonable patients are weeded out of your practice before they see you?



inappropriate patient + inappropriate drug + inappropriate "self defense" weapon ==> disaster.


in reality, the only parameter that we can reasonably alter is the drug part. and the primary mechanism is probably with educating "providers" (esp surgeons) that the concept of long term use for chronic noncancer/nonpalliative pain treatment really has to stop.

Relax, I was being funny...

 

[Ferrismonk]

Unless you’re anesthesia trained. Then you hire 4 crna’s to carry guns for you.

You mean the hospital hires 4 CRNAs then maneuvers to put you out of business too.

 

[Pain Applicant1]

You mean the hospital hires 4 CRNAs then maneuvers to put you out of business too.

Speaking of CRNAs, I heard this commercial on the radio yesterday. We're under attack from more than just patients. It's a multifront war boyz, lol! You can watch the video here.

Media Campaigns

National NP Awareness Campaigns More Lifesaving NP-Delivered Care New in 2022, AANP launched a multimedia awareness campaign that highlighted yet another example of lifesaving NP-delivered care. Lifesaving NP-Delivered Care In 2021, NPs remained on the front lines of health care delivery, providing…

www.aanp.org

Charlene's Story: Choosing an NP was the right choice for my family.

 

[Pain Applicant1]

Whoops, I meant this website here

We Choose NPs

When Patients Choose, Patients Win. Patients win when they have a choice of health care providers. Increasingly, patients are embracing prevention and

www.wechoosenps.org

 

[Agast]

Woman fires at man during an argument at University Medical Center, striking 2 bystanders: NOPD

Only in America. Unsurprisingly people thought there was an active shooter in the hospital.

 

[Ferrismonk]

Woman fires at man during an argument at University Medical Center, striking 2 bystanders: NOPD

Only in America. Unsurprisingly people thought there was an active shooter in the hospital.

How is this possible when it's illegal to carry a gun in a hospital?

 

[Laryngospasm]

Woman fires at man during an argument at University Medical Center, striking 2 bystanders: NOPD

Only in America. Unsurprisingly people thought there was an active shooter in the hospital.

Correction only in NOLA lol... that’s how arguments are done.

 

[Agast]

How is this possible when it's illegal to carry a gun in a hospital?

Funny enough, they were standing outside the hospital. But she was such a bad shot she blew out the glass door and hit someone standing inside the ER.

 

[Ferrismonk]

Oops

 

[myrandom2003]

Has anyone actually just put the blame back on the surgeon? Like, “I don’t believe you should have been fused”.
Or is it a don’t bite the hand that feeds you mentality?

I have been known to say that on occasion Back when I was employed.

We have a surgeon in our area that used to do his own injections but with saline and when they failed, said they needed surgery then punted the patients to the pain management group he worked with. (Hearsay)

He got in trouble for some kickback dealings and hired a bunch of lawyers. Now he practices 2 miles from
His old group. Same tactics, different zip code.

 

[lobelsteve]

I have counseled patients to not have surgery. I have cc’d surgeons on if ongoing pain will not be my problem. Pit inappropriate post op rx in my notes to the surgeon. Have also told patients to walk after unsuccessful surgery I recommended against.

 

[SSdoc33]

It doesnt help anyone to tell a patient they shouldn't have had a surgery. Just pisses off the patient and surgeon even more. But, definitely advocate for them to avoid future surgeries if not indicated. Flat out tell them 'i dont think you should have surgery'

 

[jsaul]

its hard to go against the surgeon when the surgeon says that the patient will be paralyzed if they don't get the surgery to "fix " their problem.

 

[Laryngospasm]

Yes and built in belief that the surgeon must be right. It really is a thing.. not sure where it comes from but it’s hard to argue against. I typically suggest they get a second opinion from a skilled and conservative third party surgeon when I am of the belief that surgery is not in their best interest. This way they have a surgeon telling them and not lowly old me.

 

[hyperalgesia]

I had a guy complain to my hospital admin - "He strongly recommended against me getting surgery". That was borderline malpractice to him.