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Attorneys Unveil Plan For National Settlement Of Lawsuits From Opioid Epidemic

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Attorneys who represent hundreds of local governments have a new proposal for how to deal with the opioid crisis. They unveiled the framework for nationwide settlement in federal court on Friday.



MARY LOUISE KELLY, HOST:

All right, attorneys representing hundreds of local governments around the country met this morning in Ohio. They unveiled a plan they hope will lead to a national settlement of lawsuits stemming from the opioid epidemic. Tens of billions of dollars are at stake. A lot of that money could go to helping people struggling with addiction, but big hurdles remain before the drug industry agrees to major payouts.

North Country Public Radio’s Brian Mann reports.

BRIAN MANN, BYLINE: The motion was filed in a federal court in Ohio by a team of attorneys who represent 1,200 counties, cities and towns that all say they need money to help respond to the opioid epidemic. One of those attorneys, Joe Rice, says they’ve been trying to reach a settlement with two dozen drugmakers and distributors that sold opioid medications. But during negotiations over the last year, companies haven’t signed on.

JOE RICE: The defendants don’t have a sense of how they get closure. How can they put this issue behind them? And with the whole country involved, it’s a difficult question.

MANN: The problem, says Richard Ausness, a professor at the University of Kentucky who follows opioid litigation, is that if companies like Purdue Pharma and McKesson settle for billions of dollars with one group of towns and cities, they could still face other litigation. What the drug industry wants, he says, is a deal that brings closure.

RICHARD AUSNESS: Because obviously they don’t want too many outliers suing them after they’ve settled with the majority. And this proposed settlement seems to anticipate that and try to provide for as much of a global settlement as is possible.

MANN: The plan unveiled today doesn’t include the dollar amounts for a settlement or a formula for who would pay. Negotiations haven’t gotten that far. What this plan does is lay out a deal where roughly 24,000 local governments would all be swept into a single group that could settle with drug companies together. Those communities would get to vote on any proposed payout. They could also opt out of the arrangements altogether. But attorney Joe Rice says he hopes for a lot of buy-in if this plan is approved by the court.

RICE: This is an attempt to bring a organizational load to the municipalities around the country in order they can speak with a voice.

MANN: This kind of closure and clarity could be an important bargaining chip because local governments hope for massive compensation, payouts that would rival the big tobacco settlements of the 1990s.

RICE: Tens of billions of dollars would be needed to make a significant – a real significant impact on this epidemic.

MANN: Attorneys for two of the drug companies involved in this lawsuit describe the proposal as interesting but preliminary. They said they haven’t had time to work through the details of how it would work. Some companies are also still reluctant to admit wrongdoing. Johnson & Johnson is facing a state civil trial right now in Oklahoma, accused of improperly marketing opioid products. Earlier this year, Jennifer Taubert, CEO of Johnson & Johnson’s Janssen division, testified before Congress, insisting the company isn’t responsible for the prescription opioid epidemic.

(SOUNDBITE OF ARCHIVED RECORDING)

JENNIFER TAUBERT: Everything that we have done with our products when we promoted opioid products, which we stopped marketing a long time ago, was very appropriate and responsible.

MANN: Joe Rice, attorney with the plaintiffs group that filed the motion today, says he doesn’t think this proposed settlement framework will resolve all opioid litigation against Big Pharma. But he does think it might allow companies or groups of companies to now come forward and cut a deal.

RICE: I think that the distributors could potentially all get on the same page. I think the manufacturers could potentially get on the same page.

MANN: The judge overseeing the consolidated federal opioid case in Ohio, Dan Polster, has been pushing for the parties to reach a settlement. So far, that’s been elusive, but sources tell NPR the creation of this new framework was one of the steps the court asked for to help make a final deal possible. Brian Mann, NPR News.

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Worlds Colliding: Rhiannon Giddens And Francesco Turrisi

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Rhiannon Giddens and Francesco Turrisi.

Karen Cox/Courtesy of the artist


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  • “Ten Thousand Voices”
  • “Pizzica Di San Vito”
  • “Little Margaret”

Rhiannon Giddens and Francesco Turrisi are both gifted multi-instrumentalists and devoted students of music history. Each has dug into the past to illuminate the present and worked to give credit where credit is due for the way instruments and ideas have moved over time between people and places.

While Rhiannon’s work has focused on the influence of African traditions on what we think of as American music, Francesco is an expert in the often unacknowledged influence of Arabic and Middle Eastern music on what we think of as European sound. They found common ground in their quest to dispel false cultural narratives and turned it into gorgeous music on a new collaborative album called there is no Other. Hear their live performance in the player.

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Architecture For Possible Nationwide Opioid Settlement Unveiled

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Updated at 4:20 p.m. ET

Attorneys for local governments across the country unveiled a plan Friday that they say would move the nation closer to a global settlement of lawsuits stemming from the deadly opioid crisis.

Final payouts could rival the massive tobacco settlements of the 1990s. Such a deal, if reached, could funnel tens of billions of dollars to communities struggling with the opioid addiction crisis, while restoring stability to one of the country’s biggest industries.

“There has got to be a comprehensive approach to addressing the national epidemic, and this is a step toward that,” said Joe Rice, co-lead council for attorneys who filed the motion, representing hundreds of the communities suing Big Pharma.

He said the framework, which attorneys filed in federal court in Ohio and still needs approval by the court, could help more than 24,000 communities across the U.S. fight the opioid crisis. None of the defendant companies, which are facing a tsunami of litigation stemming from the epidemic, have signed off on the framework yet.

“The defendants don’t have a sense of how they get closure, how can they put this issue behind them,” Rice said. “So they have asked us for a roadmap.”

In all, more than 1,800 lawsuits have been filed so far against drugmakers such as Johnson & Johnson, distributors like McKesson and street-corner pharmacies including CVS and Walmart. (Note: Walmart is one of NPR’s financial supporters.)

Plaintiffs claim the companies earned billions in profit by aggressively marketing and selling prescription opioids.

Richard Ausness, a professor at the University of Kentucky who follows opioid litigation, says unless some kind of structure like this is created, companies could settle for billions of dollars with one group of towns and cities but still face other lawsuits.

“Obviously they don’t want too many outliers suing them after they’ve settled with the majority,” Ausness told NPR. “This proposed settlement seems to anticipate that and provide for as much of a global settlement as possible.”

Attorneys for two of the drug companies involved in this lawsuit described the proposal as interesting but preliminary. The attorneys, who asked not to be named because they had not been authorized to speak publicly, said they haven’t had time to work through the details of how it would work.

Overdoses tied to prescription pain pills have killed more than 200,000 Americans, according to the Centers for Disease Control and Prevention, and cost taxpayers billions of dollars.

The wave of civil suits has already forced one drugmaker, Insys Therapeutics, into bankruptcy. Another major firm, Purdue Pharma, has indicated they may follow suit. Judge Dan Polster, who is overseeing a trial of hundreds of consolidated opioid cases, has repeatedly urged communities and companies to reach a deal.

That hasn’t happened yet. But intense negotiations are continuing, and sources tell NPR they expect many of the two dozen drug industry firms involved in the consolidated Ohio case to agree to some kind of substantial payout. In the end, there may be multiple settlements, involving separate companies or groups of companies, all contributing to a national fund designed to ease the opioid epidemic.

“Tens of billions of dollars would be needed to make a real significant impact on this epidemic,” Rice told NPR.

Under this plan, nearly every community in the U.S. — cities, towns, villages and counties — would be swept into a single “negotiating class.” Under that legal designation, local leaders would be able to approve or disapprove any settlements reached with drug companies. The vote would be weighted by population.

If three-quarters of communities sign off on deals that are struck, it would be finalized and money would be paid out, ending the company’s liability. A separate emergency fund, roughly 15% of any settlements would be set aside for towns or cities particularly hard-hit by the opioid crisis. And 10% of all drug industry payouts would go to pay the hundreds of private trial attorneys involved in the litigation.

Communities that don’t want to be part of any global settlement can also opt out entirely, but Rice says this plan was developed in consultation with many of the local officials and legal teams around the U.S. that are suing the drug industry.

Meanwhile, pressure has been growing on drug companies in recent months to reach some kind of accord with communities. In March, Purdue Pharma settled with the state of Oklahoma for roughly $270 million. Before its bankruptcy, Insys Therapeutics agreed to pay the federal government more than $225 million in penalties tied to opioid marketing. Five of that company’s executives were convicted of federal racketeering charges. Johnson & Johnson is currently on trial in Oklahoma state court.

With the much larger Ohio case set to begin in October, public scrutiny and pressure will only grow. Judge Polster has refused to dismiss claims against drug firms, and he’s made it clear he feels the drug industry is partly to blame for the opioid epidemic.

During a hearing in preliminary January 2018, Polster urged the parties to reach a deal that would “get some amount of money to the government agencies for treatment. Because sadly every day more and more people are being addicted, and they need treatment.”

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Why Air Ambulance Bills Are Still Sky-High

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In many rural areas, helicopters are the only speedy way to get patients to a trauma center or hospital burn unit. As more than 100 rural hospitals have closed around the U.S. since 2010, the need for air transport has only increased.

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In April 2018, 9-year-old Christian Bolling was hiking with his parents and sister in Virginia’s Blue Ridge Mountains, near their home in Roanoke. While climbing some boulders, he lost his footing and fell down a rocky 20-foot drop, fracturing both bones in his lower left leg, his wrist, both sides of his nose and his skull.

A rescue squad carried him out of the woods, and a helicopter flew him to a pediatric hospital trauma unit in Roanoke.

Most of Christian’s care was covered by his parents’ insurance. But one bill stood out. Med-Trans, the air ambulance company, was not part of the family’s health plan network and billed $36,000 for the 34-mile trip from the mountain to the hospital. It was greater than the cost of his two-day hospitalization, scans and cast combined.

“When you’re in that moment, you’re only thinking about the life of your child,” says Christian’s mother, Cynthia Bolling, an occupational therapist. “I know I’m being taken advantage of. It’s just wrong.”

The rising number of complaints about surprise medical bills is spurring efforts on Capitol Hill and at the White House to help consumers. Over and over again, the high cost associated with air ambulance service gives patients the biggest sticker shock — the subject has come up at nearly every Capitol Hill hearing and news conference on surprise medical bills.

Yet air ambulance costs are not addressed in any of the proposals introduced or circulating in Congress. Even a congressional decision last year to set up a panel that would study air ambulance billing hasn’t gone anywhere.

“We’re doing a disservice to patients if we protect them from hospital bills but bankrupt them on the way there,” said James Gelfand, senior vice president for health policy for the ERISA Industry Committee, a trade association for large employers.

The issue came up again Wednesday at a House Energy and Commerce subcommittee hearing where Rick Sherlock, president and CEO of the Association of Air Medical Services (the industry group for air ambulances), was among eight witnesses.

Rep. Ben Ray Luján, D-N.M., sharply questioned Sherlock as to why costs for air ambulance services have risen by 300% in his state since 2006.

“I’m trying to get my hands around why this is costing so much and why so many of my constituents are being hit by surprise bills,” Luján said.

Sherlock explained that reimbursements from Medicare and Medicaid do not cover the cost of providing services. So charges to private patients, he told the legislators, must make up that difference.

Air ambulances serve more than 550,000 patients a year, according to industry data, and in many rural areas, air ambulances are the only speedy way to get patients to trauma centers and burn units. As more than 100 rural hospitals have closed around the U.S. since 2010, the need has increased for air services.

More than 80 million people can get to a Level 1 or 2 trauma center within an hour only if they’re flown by helicopter, according to Sherlock.

The service, though, comes at a cost. According to a recent report from the Government Accountability Office, two-thirds of the more than 34,000 air ambulance transports examined were not in the patients’ insurance networks. That can leave patients on the hook for the charges that their insurers don’t cover, a practice known as balance billing.

In 2017, the GAO found that the median price charged nationally by air ambulance providers was around $36,400 for helicopter rides and even higher for other aircraft. The total generally includes the costs for both the transportation and the medical care aboard the aircraft.

Additionally, the Bill of the Month investigative series by NPR and Kaiser Health News has received more than a dozen such bills, ranging from $28,000 to $97,000.

Cynthia Bolling says her insurance company paid about a third of Christian’s air ambulance bill, and the family settled this week with Med-Trans, agreeing to pay $4,400 out of pocket.

Reid Vogel, director of marketing and communications for Med-Trans, says he can’t discuss a particular patient’s case because of privacy rules. But, he adds, Med-Trans works with patients to find “equitable solutions” when their bills are not covered by insurance.

Since nearly three-quarters of flights are for patients insured by low-paying Medicare, Tricare and Medicaid, he says, “providers must shift costs to insured patients.”

Yet private insurers usually will pay only an amount close to what Medicare reimburses, which is around $6,500. That gives air ambulance companies an incentive to remain out of network, according to a 2017 GAO report.

“A representative from a large independent provider noted that being out of network with insurance is advantageous to the provider because a patient receiving a balance bill will ask for a higher payment from the insurance company, which often results in higher payment to the air ambulance provider than having a pre-negotiated payment rate with the insurer,” the GAO found in its report.

Sherlock, of the air transport trade association, disputes the report’s findings, saying his members are actively trying to be in network in more places, although he can’t provide any specific numbers.

“I think that everywhere they can, they’re incentivized to be in network,” he says.

States are hampered in their efforts to ease the strain for residents.

The Airline Deregulation Act of 1978, which was intended to encourage more competition, prohibits states from regulating prices for any air carrier, including air ambulances. What’s more, many large employers’ health insurance is not governed by states but regulated by the federal labor law known as ERISA.

So a remedy likely has to come from Congress. And it has proved to be a heavy lift.

For example, the committees that deal with regulation of the air industry — the Commerce Committee in the Senate and the Transportation Committee in the House — don’t make health policy or regulate health insurance.

Last year, some lawmakers sought to let states regulate air ambulances with a provision in the bill reauthorizing the Federal Aviation Administration.

But that measure was ultimately eliminated. Instead, the bill called for the creation of an advisory committee to study air ambulance prices and surprise bills.

“The air ambulance lobby did a very good job playing defense during FAA authorization,” says Gelfand.

The panel, which was supposed to be formed within 60 days of the law’s enactment date — Oct. 5, 2018 — still has not been created.

Representatives from the air ambulance industry don’t think congressional action is necessary, although they are calling for higher reimbursements from Medicare.

Chris Eastlee, vice president for government relations at the Association of Air Medical Services, says his group does not favor more congressional regulation of prices but would support mandatory disclosure of costs to the secretary of the Department of Health and Human Services. Greater transparency, Eastlee’s group argues, will help companies negotiate more in-network contracts.

A fix for surprise bills that is supported by some researchers and advocates would require every health care provider within a medical facility to accept any insurance plan that contracts with that hospital. It might also help bring down air ambulance bills, says Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy.

It would avoid the situation where someone picks an in-network hospital only to find out that a surgeon or anesthesiologist at that hospital doesn’t take the patient’s insurance. Air transport should also be included in the rule, Adler says.

“It’s the exact same situation as with the out-of-network emergency facility rates,” Adler says. “The same solutions should apply.”

Gelfand suggests also that the House Ways and Means Committee require air ambulance companies seeking to participate in Medicare to always charge in-network rates.

That would require only a small tweak of the legislative language, as Gelfand sees it. “Every proposal that includes something to address surprise bills for emergency care, all you [would] have to do is add in the words ‘air ambulances,’ ” he says.

Right now, the closest any surprise-billing proposal has come to addressing air ambulances is a draft legislative plan on medical costs from Sen. Lamar Alexander, R-Tenn., and Sen. Patty Murray, D-Wash.

Their plan would require that bills for air ambulance trips be itemized to show both medical charges and the transportation charges — so patients and health plans can understand them better.

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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Toronto Raptors Clinch Their First NBA Title, Denying Warriors A 3-Peat

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The Raptors’ Kawhi Leonard and Kyle Lowry celebrate after Toronto wins the NBA championship, defeating the Golden State Warriors 114-110 in Oakland, Calif.

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The Toronto Raptors have snatched their first NBA title, edging out the Golden State Warriors, 114-110, in Game 6 of the finals at the Warriors’ Oracle Arena in Oakland. Toronto completed the series 4-2.

With the score 111-110 and just seconds left in the 4th quarter, the Warriors’ Steph Curry missed a 3-pointer. Golden State then called a timeout it didn’t have and was given a technical foul. After that there was some confusion. In the end, Toronto prevailed.

It was a close-fought game from beginning to end, with the two teams trading out the lead.

A fast-paced and entertaining first half featured 14 lead changes and four ties in the last professional basketball game played in Oakland.

Raptors fans party in Toronto as their team wins the NBA championship in Oakland, Calif.

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Toronto led 33-32 after one quarter in which the Raptors scored seven 3-point shots. But the Warriors’ Klay Thompson kept the Warriors in the game scoring 10 points.

The Raptors led by three points at the half, 60-57, largely on the strength of a 21-point effort by guard Kyle Lowry. Pascal Siakam had 13 points and Serge Ibaka scored 10 for Toronto. Raptor star Kawhi Leonard had nine points, but also picked up three fouls.

The Warriors’ Thompson had 18 points, followed by Andre Iguodala with 11 points. Curry had nine points.

The Warriors led 88-86 after three quarters. Golden State saw its top scorer Thompson injure his knee late in the quarter.

The Golden State Warriors, led by Splash Brothers Curry and Thompson, have won three of the last four NBA championships. They were early odds-on favorites to three-peat their way to another title and seal their claim to being one of professional basketball’s historic dynasties.

But Toronto got in the way of all that.

Going into Game 6, the Raptors had already accomplished what few other teams could dream of: they’d beaten Golden State on the Warriors home court, the Oracle Arena, three times this year—once in the regular season and twice in this series.

The Warriors had hoped to stretch the series to Game 7 and give the court they’ve called home for 47 seasons a proper send off. Next year, Golden State will play in the new Chase Center in San Francisco. It’s only a handful of miles away, but there are many die-hard Oaklanders who think their Warriors might as well be moving to Mars.

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