Dear Local Pain Clinic Known as “Tennessee Preferred Medical LLC,
This evening, when I arrived home after spending the day at my job, I found that my 8th grade son had already brought in the day’s mail, which included a flyer from our church regarding Easter Sunday services, a new children’s book for my preschooler from Dolly Parton’s wonderful Imagination Library program, and oh yes, this full color, two-sided, heavy card stock advertising mailer from YOU, Tennessee Preferred Medical, advertising your “Comprehensive Pain Management” services. Yes, your slick marketing mailer was delivered directly to the house where my husband Jon and I are raising our four surviving children, who range in age from one to 16 years old.
In case you aren’t sure which marketing material I’m talking about – I’m guessing it can get confusing when you send out so much – this is the advertisement you sent to my family today.
I mention my four surviving children because, well, you see, I would have five – two boys and three girls – except that my oldest boy, my teenage son Henry, became terribly addicted to prescription pain pills before he’d even reached his senior year of high school. God only knows what kind of adults would introduce a 16 year old boy to opiate-based prescription pain medication, knowing that he would likely become addicted, and it’s hard to imagine how a doctor could look himself in the mirror every morning if he had any clue that quite a few of the prescriptions he was writing for pain pills were actually being filled so that drug dealers right here in our hometown could then sell the pills to high school kids.
But anyway, back to my son, Henry. He suffered terribly from the things that being addicted to those pills did to his young body and mind, and I’m sure you know JUST what I’m talking about, since prescribing the exact same type of opiate pills is something you do at your clinics pretty regularly, making you bona fide pain pill experts in my book.
And then, two years ago next month, Henry died of a terrible brain injury caused by an overdose of those very same prescription painkillers. The two adults who were with him during the drug overdose (Maybe you’ve met them? They apparently had many, many painful conditions over the years that called for repeated visits to lots of local pain specialists like yourselves) decided not to call 911 for 17 hours, which as you would know – being experts and all – certainly didn’t help Henry’s chances for survival.
But Henry didn’t die right away. Even after all those hours without enough oxygen, my teenager managed to hang on for five long, horribly painful weeks in the hospital. Of course, I’m sure I don’t need to spell the details out for you of how hard those weeks before his death were for him, suffering as he did, because given your expertise in recognizing and treating just about any kind of pain a human being can suffer, I know you really get it.
Henry was only 18 years old when he died on May 31, 2010, and we all miss him an awful lot. As you can imagine, for my younger son (you know, the middle schooler who discovered your flyer in the mailbox on our front porch today?) losing his only brother, first to addiction to illegally prescribed and diverted prescription painkillers, and then to overdose from the same prescription pain pills has been especially hurtful. If any of you who own or work for Tennessee Preferred Medical are parents yourselves, I know you understand how hard it would be for a child to lose his only brother
And speaking of that, it appears that at least two of you folks running the show with Tennessee Preferred Medical are indeed parents yourselves. For example, David Hawk, a podiatrist who appears to be practicing….ummmm…podiatry, I guess, at “Tennessee Foot and Ankle Clinics,” located at 6221 Kingston Pike (the same address where your flyer says you diagnose and treat all kinds of serious pain conditions) shares in his personal bio posted on the TNFootandankle.com website that along with his wife, Tracy Hawk, he’s the proud parent of two children.
Here’s a helpful screenshot of David Hawk’s bio from the Tennessee Foot and Ankle Clinics website:
And Tracy Hawk, is listed as the Registered Agent for Tennessee Preferred Medical LLC, although the same records from Tennessee’s Secretary of State note that until some time in 2010 or 2011, David Hawk held that title.
But say there, Tennessee Preferred Medical, here’s what I don’t quite understand; the official address listed with the state for your “Comprehensive Pain Management” business (“Tennessee Preferred Medical LLC”) is the same 6221 Kingston Pike address in Knoxville where David Hawk practices podiatry at that Foot and Ankle Clinic. In fact, the podiatry practice’s website says that David Hawk actually owns the foot care practice, having purchased it in 2001.
But even though both health-related businesses that David Hawk owns – the podiatry practice and also Tennessee Preferred Medical’s “comprehensive pain management” practice for which I received that advertisement in the mail today – treat patients at the exact same address, Mr. Hawk apparently does not own the property itself. According to Knox County tax records, the property at 6221 Kingston Pike is owned by an entity identified as “Nu Life Clinics.”
I got a quick screenshot of that as well:
Do you guys have any idea who this “Nu Life Clinics” outfit is that owns the property on Kingston Pike where you’re managing all that chronic pain? All I could find out about them is that, according to Knox County tax records, they also own property at another location in the county where it sure looks to me like a chiropractor who ALSO specializes in getting rid of pain for patients has his office. That’s what it looks like to me anyway. If I’m right, what a coincidence THAT would be, huh?!
Clearly, a medical practice offering “comprehensive pain management” to treat the types of conditions you mention in that advertisement you sent to my house today – disorders like spinal pain, headaches, joint and nerve pain – would need to have an actual medical doctor and not just a podiatrist overseeing patient care. I mean, without an actual MD providing clinical oversight, dangerous narcotics could be prescribed in a potentially unsafe way, thus making their way out into the community at large, and I know that no one with Tennessee Preferred Medical would ever want to play any role in something like that happening.
How do I know that you are regularly prescribe narcotic pain pills out of your clinic locations, and aren’t focused on routinely recommending things like physical therapy, massage, TENS stimulation, surgery, or any non-pharma approaches to “pain management?”
Well, it says so right here on this screenshot I snapped of the front page of the Tennessee Preferred Medical website:
So given that you tell potential patients right up front that they can visit one of your clinics to “seek treatment through medication,” I’m sure you must have plenty of carefully trained Medical Doctors on staff – or at least a Medical Director with a medical license and DEA
prescribing privileges.
Perhaps this fella serves in that role for you? Dr. Riley Senter? He must, because you could definitely get in some hot water if a podiatrist happened to be acting in any way like an M.D. in treating “comprehensive pain.”
What’s kind of odd, though, is that while I found Dr. Senter listed as having some kind of affiliation with Tennessee Preferred Medical by Googling “M.D” + that 6221 Kingston Pike address of yours, and while he’s listed with both Cigna and BCBS of TN as a Medical Doctor (provider) affiliated with Tennessee Preferred Medical, LLC, according to the state Medical Board’s records, Dr. Senter has no affiliation with you, does not practice medicine at any address affiliated with you that I can find, and has no hospital privileges in Knoxville, or in any of the other cities where that advertisement you sent me says your clinics are located.
Here’s a handy screenshot of Dr. Senter’s information from the state Medical Board so you can see what I mean:
Also, in my opinion – and you may feel otherwise – a doctor who has specialized in treating drug addiction, and treating addiction to opiates in particular seems an unusual choice to treat and diagnose patients at a clinic like yours that specializes in treating chronic pain. Do you see what I mean? Frankly, this could raise a few uncomfortable questions for you guys, if you get my drift.
Plus, according to the February 5, 2012 issue of the East Tennessee Business Journal, Dr. Senter just incorporated a new business for himself called “E. TN Med. Oversight, PC,” and it’s located out on Parkside Drive in far West Knoxville. Wow! That Dr. Senter is one busy guy!
And that brings me to my next point. If Dr. Senter is serving as your Kingston Pike Clinic’s staff M.D., you may want to double check that he’s really putting in the hours at the clinic that state law requires. See, new state regulations for pain clinics that went into effect on January 1, 2012 require an M.D. with certain credentials and well-defined, specialized prescribing training to serve as Medical Director at clinics like yours, and to be on site at least 33% of all operating hours. I only mention this so that in the wildly unlikely event that you don’t have a separate M.D. with all the required credentials on site 33% of the time at each one of the clinic locations listed on the flyer you sent to my house, I’d bust a move on that if I were you. You wouldn’t want to break the law or anything.
I mean, I know that podiatrists can legally prescribe narcotic pain meds like the kinds that killed my teenager, but from what I understand, podiatrists aren’t supposed to prescribe them for medical conditions that would clearly fall outside the scope of, y’know, podiatry. So problems like spinal pain or headaches probably wouldn’t be something for which a podiatrist could legally prescribe pain pills, or even treat.
But maybe, Tennessee Preferred Medical, just maybe you’re thinking that since you aren’t properly licensed as a pain clinic with the state – or at least you don’t appearto be listed among the properly licensed pain clinics in Tennessee – that you don’t need to worry about the whole M.D. issue so much. But given how the advertisement our family received from you today describes what it is you do, I don’t see much way around the fact that according to thelegal criteria defining “pain clinics” that went into effect in January, you do need to worry about that issue, and all the nitpicky state laws regarding how you can and cannot conduct business.
Plus, the rules from the state Board of Podiatry are pretty clear on the whole advertising thing, especially with regard to accidentally misleading anyone into thinking they will be treated by an actual M.D. rather than by a podiatrist, so you may want to keep an eye on that since I don’t see anything about podiatrists or podiatry on the marketing material you sent to my house.
But as I already said, I’m sure you’ve actually got doctors on site at all your different locations listed on the advertising mailer, so no worries, even though a quick Google search indicates that a podiatry practice also operates at the same address or in the same building complex at each of those other locations where your flyer says I can get my pain treated right away, by pain specialists.
Well Tennessee Preferred Medical, I guess I’ll wrap this up now. Basically, since you sent me something that I didn’t ask for, didn’t want to see, found very upsetting, and hope that others in our community don’t see, I figured I’d return the favor – mommyblogger style. I sincerely hope that you’ve enjoyed hearing from me just as much as I enjoyed hearing from you.
Sincerely,
Katie Allison Granju
Knoxville, TN
+++++
Please consider becoming a friend of Henry’s Fund on Facebook
While what Hawk says in the article is certainly not dispositive on the issue of the character of the clinic, it does answer some ‘questions’, as Lissa generously calls them, that Katie raised.
1) First and foremost is—as I pointed out– that cash is actually NOT an accepted from of payment UNLESS it is to pay copays and deductibles of valid insurance program. Katie and several of the commenters here were apparently somehow misreading the very clear language on the flyer, which addressed this. In bold. And in red. And underlined.
2) The director indicates that they accept no one from out of state, and have to ‘vet’ their potential patients, accepting only about 15%.
3) The article indicates they are fully aware of and accepting of and ‘excited’ about the new legislation that Katie snarkily expounded on in her post.
4) They voluntarily gave a newspaper interview to discuss their clinic and the new legislation.
Next up in my exhaustive research, I went over the clinic’s website, where I learned the clinic takes only patients WITH insurance, requires printouts of your three month history with any pharmacies before seeing you, and conducts random drug screens and pill counts if they prescribe you narcotics.
This took all of about four minutes.
Aron, what companies publicly advertise and what is practiced and reality is separate. I am pretty confident bernie madoff did not publicize he was going to still your money. Get real.
sorry about the grammar on the post inavdvertantly published
"4) They voluntarily gave a newspaper interview to discuss their clinic and the new legislation."
You mean the story about how places like this are under scrutiny, right?! It's not like it was a human interest story, LOL.
Anon writes:
.
>>>1) First and foremost is—as I >>>pointed out– that cash is actually NOT an accepted from of payment >>>UNLESS it is to pay copays and >>>deductibles of valid insurance program. >>>Katie and several of the commenters here were apparently >>>somehow misreading the very clear >>>language on the flyer, which addressed >>>this. In bold. And in red. And >>>>underlined.
Perhaps you're unaware, Anon, that as of January 1 this year ***no*** pain clinic in the state of Tennessee is ***allowed*** to accept cash for anything but co-pays and deductibles. The fact that TN Preferred Medical explicitly mentions this as they do in their direct marketing flyer doesn't say anything specific to the way they operate except that they apparently have served and expect to serve a clientele who prefer to pay cash, and who need to be proactively informed that the clinic can no longer accept cash for anything except for co-pays and deductibles.
The fact that they are mentioning "cash" at all in their advertising to consumers is a giant red flag to anyone who understands the pain clinic issue, and who cares about it. Given that you do not appear to fall into either of these categories, I doubt you see anything unusual or telling at all about a medical clinic proactively raising the issue of what cash can be used for in paying for their services. However, I still wanted to mention this.
>>>2) The director indicates that >>>they accept no one from out of >>>state, and have to ‘vet’ their >>>potential patients, accepting only >>>about 15%.
Perhaps that's true, and perhaps it isn't; I have no idea… And neither do you. I find it interesting that you simply accept this person at her word given the context in which she's making those claims. I mean, come on, have you ever once run across any media coverage of the pain clinic issue in which any clinic's "director" (as you inaccurately describe Ms Hawk) **admits** to her business engaging in any practices that would allow or encourage pill abuse or diversion?
As for her claim that they refuse to accept any customers who are not Tennessee residents, that certainly could be true. However, it seems like something they would mention in their promotional materials (website,etc) I will go back and look again, but I don't recall seeing anything on the advertisement I received or their website that indicated that they won't see out of state patients. But I am not 100% positive about that, so will double check.
However, assuming that Ms. Hawk's claim that they wont see any out of state customers is true, all that would necessarily mean with regard to any potential for pill abuse or diversion by the clinic's customers is that the clinics are kept plenty busy with in -state patients who are no less likely to feed their addiction or fuel their drug dealing operation via a pain clinic than are out of state customers.
Second, the idea that **any** medical practice of any type would screen out 85% of patients who come to them, only accepting 15% as patients sounds completely farfetched to me. The economics of that make no sense. If they have so much business already
that they are able to refuse to serve 85% of "customers" who solicit their services, then why are they spending huge amounts of marketing money sending tacky advertising mailers to what must be thousands of households on my side of Knoxville alone?
Last, while you describe Ms. Hawk as the "director" of Tennessee Preferred Medical, she is not their director. By law, she cannot be because she's not an M.D. with specialized training. She's actually the owner of the clinic (or co-owner) with her husband, a podiatrist.
>>3) The article indicates they are fully >>>aware of and accepting of and ‘excited’ about the new legislation that >>Katie snarkily expounded on in her >>>post.
Apparently, they aren't excited enough to have yet become properly registered with the state, even though it's now been almost half a year since the legislation passed.
As of today's date, Tennessee Preferred Medical does not appear on the list for Knox County clinics which have followed the law and have either applied to become certified, or received state certification.
I will address the rest of your comment in another response as I have time today. In the meantime, I hope you will respond to this question from me: do **any** of the issues that my own research revealed about this company give you reason for concern related to the risk of potential pain pill abuse and diversion?
-Katie
Tn PC 340 does not provide for podiatry in pain clinics
32 certified pain management clinics in Knox County according to the Tennessee Dept. of Health webpage. wth? that seems like an inordinately high number. oh, and this practice was not one of them.
Once again, Knoxville does NOT corner the market on this. In fact, I believe Florida has the most pill mills per capita. It's HUGE. But I stress this because there are often "gee whiz" comments regarding Knoxville like it is a one-off. It's not. And you all need to be vigilant regarding your own backyards. Have you counted how many are in your city? And more importantly, think about how many are out there and not under the heading of "Pain Clinic." How many docs in your area are handing out pain pills willy-nilly, making big-bucks and creating more problems.
well yeah, there are two are in our city of 250,000, at least those that are advertised, as you say as pain management clinics. why the harsh tone here, as katie and so many others have talked a lot about how many pill mills or pain clinics there were in tennessee. I don't think I implied at all that Knoxville has the market on this, I just mentioned that seemed like a lot. geez. I am sure knoxville is a wonderful place to live, no need to get so darned defensive.
thought this was interesting, and yes, tennesse certainly is not the only state with a big problem in regards to this epidemic.
http://www.cdc.gov/homeandrecreationalsafety/rxbr…
Courthouse records say this property is owned by the following purchased in 2006:
Location
Property Address 6221 Kingston Pike
Knoxville, TN 37919-4022
Subdivision Dr M H Lee Unit 2
County Knox County, TN
Current Owner
Name Hawk Family Properties Town Creek Llc
Mailing Address 798 Pine Ln
Friendsville, TN 37737-3613
Well that's interesting. Thank you SO much for tracking that info down, Sherry. I wonder what "Nu Life Clinic" is, and why the owner listed with the Knox Co Property Assessor's office (that's where I looked – that's the "Nu Life Clinic" listing) is different than other county ownership records. Anybody know how that works?
Dear anon, I suggest you get your own blog where you can outline and expound on all the information you keep supplying here in comments.
But that's not going to happen, is it? Because you want to come here to argue and provoke. You don't have a forum without Katie. You know as well as we do, that nobody would go to your blog because your position is not an ideological one but one based opositional defiance.
Sarah, my position is based on Constitutional law and the basic common sense principle that you don't publicly distribute 'facts' that you do not know to be true.
I don't seek a 'forum', which I would think would be pretty obvious considering I identify myself only as 'anon'. Although if I were a blogger, I think I'd do pretty well, as I've noticed on all her other posts, Katie receives usually about 4 to 20 comments on average, but on any post I happen to make the least little comment on, the response surges to 120 and counting. I assume that's the reason I've never had my comments blocked.
I do like a good political debate–that's true–but everybody keeps giving such fanciful counterarguments, such as that google makes a thorough investigation and "Cash for Copay and Deductibles Only" means 'cash-and-carry-drugs".
I wish there were some lawyers on this board, for better quality debate.
Anon – which specific facts have I published that you don't believe are accurate and supported by the referenced info I included with it. Reading my post, here are the published facts I am seeing:
- I arrived home from work to find that
a splashy mailer from a group of
4 pain clinics called "Tennessee Preferred Medical" had been sent to my family's home address.
- My teenager became addicted to opiate pain pills, ultimately dying of a brain injury noted in his autopsy to have been cause specifically by an overdose of opiates.
- Tennessee Preferred Medical regularly prescribes the same class of opiate pain medication to it patients.
-Per the flyer mailed to my home address, Tennessee Preferred Medical operates at a Knox County address listed as 6221 Kingston Pike
- David Hawk is a podiatrist (non MD)
who owns a podiatry practice operating at 6221 Kingston Pike.
-According to the promotional, public website owned and operated by Mr. Hawk's Knox County podiatry practice, he bought the practice in 2001, and he's married to Tracy Hawk.
-According to official records maintained by the Tennessee Secretary of State, Tracy Hawk is currently listsd as the Registered Agent for Tennessee Preferred Medical.
- The same official records indicate that sometime prior to this year – in 2010 or 2011 – Tracy Hawk replaced her husband, podiatrist David Hawk as the listed Registered Agent for Tennessee Preferred Medical.
- Although both the podiatry practice owned by David Hawk and the "pain management clinic" that appears to be jointly owned by David Hawk and his wife Tracy Hawk operate as businesses at the same 6221 Kingston Pike address, the official records maintained by the Office of the Knox County Property Assessor list the property owner for 6221 Kingston Pike as "Nu Life Clinic."
- The Property Assessor's records indicate that "Nu Life Clinic" owns one other piece of property at another address. The business operating at that address appears to be a chiropractor advertising pain management services.
- It's reasonable to assume that Tennessee Preferred Medical clinics have utilize narcotics as their primary pain management approach given thay the company's public, promotional website states that "if you have pain in any part of your body, you can come into our pain management clinics and seek treatment through medication." No other pain relief treatments or strategies are noted specifically or generally.
-Dr. Riley Senter, MD is listed with the public databases of both Cigna and BCBS as practicing medicine as a provider with Tennessee Preferred Medical, at the Knox County address.
- Dr. Senter's name comes up in an online yellow pages listing if you Google "M.D. + 6221 Kingston Pike"
-Dr. Senter's current, official information listed with the Tennessee Board of Medical Practice does not indicate any affiliation whatsoever with Tennessee Preferred Medical. It notes that his only current hospital privileges are with a hospital in Harriman, TN (Roane County)
- Thus, Dr. Senter apparently has no current hospital privileges in any county in which the advertising flyer mailed to my home indicates that Tennessee Preferred Medical has an operating "pain management clinic."
- Dr. Senter's records with the state Board of Medical Practice indicates that his only specialty is in treatment of addiction, and he earned that certification 30 years ago. He is currently listed in at least two online directories for opiate addict seeking treatment via drugs such as suboxone.
- Having a doctor with a specialty in treating opiate addiction via drugs that are themselves increasingly diverted for abuse acting as the treating physician at a "pain management clinic" raises significant and troubling questions of law & ethics.
-The February 2012 edition of the Tennessee Business Journal notes a new business having been incorporated by someone named Riley Senter,M.D.. The business address is in far west Knoxville, and the name is "East Tn Medical Oversight, PC."
-New state laws that went into effect on January 1 2012 specifically define exactly what training (past and ongoing) that the Medical Director of any pain clinic must have, and clearly require any M.D. serving in that critical role to be physically on site for a minimum of 33% of all hours that the clinic is open for business. Further, each clinic must have its own physician with the specified training on site for that percentage of time.
- The law allows podiatrists to prescribe narcotic and opiate pain meds, but only for treatment of conditions that are accepted to fall within the very limited scope of podiatric practice. Thus, the pain "anywhere in the body" that Tennessee Preferred Medical prominently notes on its website for which the company encourages people to come to their clinic to "seek treatment thru medication" would clearly require an M.D. to diagnose and treat, given that podiatrists are not trained or licensed to treat or diagnose conditions anywhere but in feet and ankles.
-Although state law unequivocally requires that all pain clinics operating in the state of Tennessee to have applied for state certification immediately following the law's effective date of 1/1/12, as of 4/8/12, Tennessee Preferred Medical's 6221 Kingston Pike clinic is not listed with the mandated state pain clinic registry – neither as currently certified or as pending certification
- Per their own marketing copy on the flyer they mailed to my home address this week,Tennessee Preferred Medical very clearly meets the new state law's definition of a "pain clinic," this subjecting the clinic's owners to follow all requirements of Tennessee's multi-element pain clinic legislation.
-Tennessee's Board of Podiatry has strict, clear regulations regarding proactive disclosure to consumers anytime a podiatrist advertises any healthcare services.
- The flyer sent to my home address this week never references podiatry, podiatric practice, feet, toes – you get the picture
- Online business listings indicate that a podiatric practice operates at the same address or one within the same building complex at every address listed for Tennessee Preferred Medical pain clinic on the flyer they sent to my home address this week.
-I did not invite or appreciate this pain clinic sending an advertising mailer to my home address this week, where my 14 year old son happened to be the one to see and read it first.
So Anon, I respectfully ask that you tell me which of these facts I have published is either not accurate or even has a reasonable likelihood of not being accurate. I look forward to your specific response to my clear question.
Katie
PS: thanks for bringing your online traffic mojo to my lowly blog!!! I think you're probably right that if it weren't for you, NOBODY would be reading my blog.
Was this not posted by you?
"They pushed their advertising messaging about where to get “pain management” with no referral and in cash – a direct to consumer ad play that is blatant code for “we prescribe pain pills; come get ‘em from us!” – right into the hands of my minor child, who was minding his own business on our private property. I don’t take kindly to drug peddlers coming into my home and soliciting my 14 year old son, and once Tennessee Preferred Medical decided to do that, they need to understand that I am going to raise hell. Game on."
Ummm, yes. But why are you asking that? It's clearly my comment.
Am I to assume that instead of responding my question regarding your specific disagreement with any of the many facts I laid out in the post itself, you are now sidestepping, and shifting to objecting to that comment? I guess so.
In any event, I stand by my opinions expressed in the comment as well. I'm sure you will now quibble with my opinion that this clinic is "peddling" pills, because my definition of "peddling" when it comes to prescribing pain meds is different than yours, or that cash for co pays and deductibles (which is, by law, the ONLY way that a pain clinic can now accept ANY cash) isn't "cash" as I characterized it in my comment. So go on and do that now, and then maybe you'll get on to answering the substantive question I have asked you.
-kag
"I wish there were some lawyers on this board, for better quality debate."
I share your wish that you find "better quality debate." Please do range far in your search and no need to let us know if you find a new home.
anon…
"Katie receives usually about 4 to 20 comments on average, but on any post I happen to make the least little comment on, the response surges to 120 and counting. I assume that’s the reason I’ve never had my comments blocked"
SERIOUSLY?!
The above comment is comical, to the point that I think you MUST be kidding. YOU increase Katie's amount of comments? has it occured to you that you happen to comment on posts that happen to generate more discussion? (sorry, everybody, for stating the obvious!)
You're right, you don't name call, but your condescending, self righteous manner in everything you write, makes it utterly and completely ridiculous that you throw up your hands and suggest that your only offense could be name calling..you most certainly are not the least bit respectful of, or open-minded to the opinions of others.
Yes, I do think I generate hearty comment pageviews, as the majority of these comments are directed at me. Count them.
If you quickly scroll back through the archives, the last time the comments sections saw comparable activity was a few weeks backs when I commented on that ghastly Trayon Martin post, at 95.
Since then, she's received nothing close, with the next highest tally being at 35, I believe.
Just numbers.
If you have a problem with it, simply ask Katie to block my comments. Who needs more pageviews?
Anon – you are flattering yourself. The idea that 22 comments on one post vs 122 comments on another one significantly changes the overall pageviews to my blog in any given month is bizarre and absurd.
However, I will absolutely concede to you that having someone repeatedly baiting other commenters in a specific thread with bold assertions of nonsense and illogical arguments, especially when the topic is a hot one anyway (like the Trayvon Martin case and pain clinics for example) will bump up the comment count in that specific thread.. No doubt about that.
Also, I have only banned 2-4 people that I can recall in the past 5 years at least. I don't "ban" commenters unless they threaten or harass me, or become such a boring pain in the ass that at a certain point, other readers/commenters are begging me to do it. So this idea you have that te reason I haven't "banned" you is because you are singlehandedly bringing me so much traffic that I just can't quit you, well…. Not so much…
-kag
Anon,
What a very unusual take you have on the page views. I won't be counting them. You obviously have, and drawn your own "conclusions". As i agreed with you earlier…you don't name call, and I suspect that helps you teeter just below the line of what's acceptable here.
The suggestion that you are "helping" katie by attracting page views…how odd.
You are my hero thank you Katie!!!!!!!
Lucy and Anon. Have either of you ever heard a little adage……if you can't say something nice, don't say anything at all? Katie allows great latitude in comments here but you both bring so much negative energy that even if your comments were meant for legitimate debate…..your point is lost. How would you treat a guest who showed up at your house or office, repeatedly, for the sole purpose of being confrontational? How about if that person went after your loved ones, or your personal hot spot? You do have someone or something IMPORTANT enough to you that you would expect to be treated with respect and sympathy. A special snowflake? Wow.
Anyone who "defends" the existence of "pain clinics" either has had their head in the sand during the past decade and is unaware of the additiction to opiate painkiller empedemic or has never had a loved one addicted to opiate painkillers. You would think that people who are in real serious legitimate pain would be able to get the necessary meds from their doctors who are familiar with their condition. Why do we need these clinics at all and why do they need to advertise? My personal physician does not send out bulk mail advertising his medical practice.
there are many pain clinics that are helping people with chronic pain that are doing good work and are not peddling pills to anyone that wants them, there are also pill mills. Making assumptions that all pm clinics are just handing out scripts is ridiculous as saying that all of them are above board and legitimately prescribing narcotics. I have an extremely rare disorder called Melorheostosis which has plagued me since i was diagnosed at age 9 i am now 31. i have had over 20 surgeries and am scheduled to have another @ the end of this month.I have become hyper-tolerant of opiate meds that keep me wanting to continue living. Bone growths, nerve pain, and unbelievably painful contracractures have disabled me + 3 years ago i was in a road rage induced( the other driver not me lol) which fractured 3 vertebrae in the cervical(2) and thorasic(1) region of my back and nearly crushed my leg. I was referred to a pain management facility by my wonderful Dr. who has seen me since I was diagnosed. He says that he is limited in the amount of schedule 2 narcotics that he can give and sent me to my pain clinic, he is probably uncomfortable writing my 2 narcotic scripts because it is a lot, and does not want to incur the scrutiny of the dea. There are people who need these clinics. That said is unscrupulous to send out these ads, as a good doctor will refer you if you need it or is unable to write what you need. I lost my older brother to oxys back in 2001, i am the one he stole them from after he figured out how to pick my lockbox. I miss him terribly but he chose to do it, he died because he made a poor decision, not because of a doctor and certainly not because of me. If you choose to drive 100 mph in a 35 and die no one is responsible but you, same thing with drugs and alcohol. I cant imagine carrying on without my meds, there are people who need this stuff, and the hysteria only` perpetuates the mystique for teens and makes it hard on folks like me who need this stuff. people who need the stuff are just as likely to sell some of their meds to make extra cash as those who are malingering so there is no ending this.
Katie, as I noted in the past comments, I have no idea as to the truth of any of the 'facts' you noted on your blog posts, and would never hazard to guess whether they're true (in public, anyway).
What I said was, your 'soliciting drug peddler' conclusion based on your 'facts' better certainly turn out to be correct, because if it's not, you're potentially opening yourself up for some doctors very angry at the way you've characterized them.
You jumped to conclusions in the past and got threatened with a countersuit before you turned tail. Why would you ever jump to conclusions that way again?
Also, your definition of 'pill peddler' is different from mine? Are you saying there's a different way to interpret that comment, in a ways that is NOT blatantly accusing the doctors of soliciting and dealing drugs?
Katie, I understand that, but what I'm saying is all you apparently know about THIS clinic is what you learned through google–mostly dealing with land and corporate records.
Unless you've done some other research beyond what you posted, you know nothing about how this clinic *actually* functions.
Don't you believe you should know basic information about how the clinic does business before you call it a drug peddler?
Weren't you supposed to have gone away by now?
Yep, sure can.
When the owners of clinics like the ones we're discussing proactively engage in certain practices and/or fail to take certain precautions, they are directly contributing to the creation of more opiate addicts, and are also playing a significant role in the huge problem of illegal diversion of Rx drugs for abuse and resale. And that's true no matter how much the people running that clinic swear up one side and down the other that they would never *intentionally* fuel addiction and overdose. Turning a blind eye to the obvious in exchange for more revenue can be just as unethical as "soliciting," as you put it.
This is really turning into a pointless conversation because despite your self congratulatory references to what you seem to believe are exceptional critical thinking and logical debate skills on your part, you are just making less sense with every comment you post. Using words like "dispositive" in your comments is, as the saying goes, simply putting lipstick on a pig.
But back to my question; can you help the rest of us in this comment thread understand what facts I've published that you believe were not accurate?
You keep giving me these post about the evil of pain clinics in general, but what I've you since the beginning is the same: do you know *anything* about the specific business and prescription practices of *this particular clinic*?
If not, you are not judge and jury and not qualified to make the determination that this is a bad clinic.
And if you're wrong, and this is in fact a legitimate clinic, what then?
What if I'm wrong about *what?* Wrong about the fact that they are sending out trashy flyers to solicit new customers? Wrong that they're owned by a podiatrist? Wrong that the Knoxville branch is not listed as certified with the state? Because I am *not* wrong about any of those things. What is it you think I may end up being "wrong" about?
Also, you keep talking about Google like there's something different and less reliable about using Google to find a company's current corporate filing with the state as opposed to say, calling the Secretary of State's office and having them fax or mail me a copy. Of course, if I'd done the latter, your argument would probably be that I'd used a FAX MACHINE to obtain info, making the document I'd received that way somehow suspect.
It's so funny to me how you always call my arguments illogical, when I'm you quoting you standard, well-established law.
Is this what happened last time? That the methadone clinic you 'thoroughly researched' was actually uninvolved seemed 'illogical' to you?
Anon-
You are making zero sense. Of course you can judge the accuracy of the facts I published. Are you saying you aren't sure whether to believe the data maintained by the state pain clinic registry? Or the Knox County property assessor's office? What piece of data or supporting material did I publish that you don't feel confident is accurate or reliable?
As for the wrongful death lawsuit I filed, and why the Knoxville clinic was first named as the defendant – I have a tape – and so does KPD – of Yolanda Harper explaining in some detail to an investigator that it was the Knoxville clinic where she was getting her drugs. Thus, we filed the lawsuit against that clinic with the reasonable belief that it was the source of her diverted methadone.
As it turned out, however, she was lying. She was actually getting it from a methadone clinic in North Georgia. In fact, that's where the methadone she sold in a school zone came from – one of several drug trafficking charges that resulted in her arrest and indictment on multiple methadone and other opiate pill- dealing charges on the day after the newspaper story about the Knoxville clinic lawsuit dismissal was published.
So if your point is that investigators were originally misled regarding where the methadone they and we knew she was diverting and selling to young people was coming from, and that led to me relying on inaccurate info in the first iteration of the lawsuit, you are 100% correct on that point. No doubt about it. Slam dunk for "Anon" on that one.
-kag
Katie,
I have so much faith in you…. Shame Shame on these idiots that have such mean, negative comments!! Someday soon they will pull up your blog and read that you and only you have finally got these evil people! I mean All of them!
One more thing, for them all to read, I wander if they have stopped and thought how they would react if that was their son or daughter that died the way Henry did.. I know I've changed after reading about Henry… In the last month I have witnessed 2 young people huffing inhalants in their cars, one a young girl at walmart parked 3 spaces from the front door, the other, a young boy at McDonalds parking lot, he was on break… After several calls to 911, the police finally came… The girl was unconscious when they got to her.. She was loaded up in ambulance and admitted to UT hospital. The boy was arrested.. I was able to talk to him before he was cuffed and put in the cruiser.. He may not have heard a word I said to him.. All I know is that I could not turn my head on these two kids and drive off… It's sad so very sad to me..
Couple days ago you asked about death dates and holidays.. They are very hard for me.. The hurt is awful. I want to stay in the bed. Those days and the days leading up to the day have not gotten any easier.. I honestly don't think they will ever be right.
Much Love and Great Big Hugs to you Katie!
You keep working hard!
Davonne
What a sweet, kind post Davonne, and how wonderful of you to do something about what you were witnessing. Henry's story has certainly touched so many of us, hasn't it?
I have been debating about writing something here since I read this yesterday, because I don't want to be attacked by anyone who thinks I am diminishing in any way what katie does or has done, and I can find the words to share some thoughts in a way that is useful, helpful or rings true. I am going to give it a try, and sincerely hope my words are read in the spirit they are intended.
I think maybe you have put Katie on a big old pedestal, which is kind of unfair to her, and could be disappointing to you. All of us have feet of clay. What makes me think that is your line that you have faith that she, and she alone, will finally get the evil people. The thing is, Katie doesn't do what she does alone, and that is a pretty big expectation to place on someone. Without the help of so very many people, she wouldn't be able to do what she does at all. Her sister, her husband, and other family members, her employer, friends, etc. etc. As I said, this is in no way diminishing what she does do, which is a lot, and it is certainly very admirable. But I think she would agree that without such a huge support system, she wouldn't have the energy or the time or resources to devote to her advocacy.
The thing about putting another human being on a pedestal is that inevitably they will do something to disappoint the person, and fall from the pedestal. Not because they are doing anything wrong, per se, because they are human. And what I've seen happen over and over again is the person who put the other person on the pedestal ends up very upset with them, because they are human! That's what I mean when I say that it isn't fair to Katie, or to any other person, to place them on one. Noone can live up to that kind of pressure and expectation.
Anyway, I guess this could be categorized as "things I have learned after living 55 years" or something like that. LOL. I myself have put people on pedestals in the past; in retrospect I think I may have done that with our son. And quite honestly, I regret it. I think it added to the pressures and feelings of not being good enough that I realized later he felt so much for most of his life. He said to me once that he was truly sorry that he wasn't perfect, that his illness was such a disappointment and cause of pain for us, and it just broke my heart. Did I make him feel he needed to be perfect? Maybe, maybe not. If I did, I certainly did do it intentionally. And it is too late to change that. But now that I am aware of what happens when people do that, I just wanted to pass these thoughts along.
Again, I cannot reiterate strongly enough that I admire Katie and am so impressed with all the good work she, her family and friends, and others do to help addicts and their families. It is very brave of her to share Henry and her family's story, in the hopes of helping others.
just reread this. meant to say didn't do it intentionally, not did do it intentionally. geez. should have proofread it before hitting send.
Hey folks – "Anon" just crossed the line with a comment he/she/it posted (I've deleted it). But even if that comment hadn't just triggered my "no maligning my dead child on his mother's personal blog," one strike you're out policy, his/her/its nonstop comments that seemed to have no point beyond the one he/she/it had already made in the 100 previous comments were growing tiresome, & were hampering the flow of thoughtful discourse on this important topic. Thus, Anon is being given some well-deserved time off from Mamapundit's comments.
-kag
people weren't agreeing with him so I guess he did what so many people do, attack on a personal level. what a shame. his comments were repetitive, but i notice when i go back and read most comments that we do have a tendency to do that, keep repeating our position. i remember learning in al-anon that if a person says the same thing over and over, they aren't stating their position or expressing their opinion anymore, that's already been done. what we don't like is that others aren't agreeing with what we've said and we think if we keep saying it again and again we can change their minds. i think that is true for all of us.
I hope you will keep us updated on what happens with this place. It surely looks like they aren't abiding by the law and may be very shady.
Thank God. There is a fine line between having a productive conversation – even one that strongly differs in opinion – and someone that is constantly trolling, possibly feeding into their mental health issues. In the end she was gleefully implying that she was generating comments, that her contributions were far more intelligent, that we somehow depended on her. It smacked of extreme narcissism. I really think she is the same person that was banned on the Knox Sentinel. Eventually they couldn't deal with her, either. I really hope she gets the help that she sorely needs.
I wish that there was something I could do to lessen your pain.
Please take care of yourself.
-Laura
Wow. Just wow. I have no idea what to say. That's just..rather…insensitive of that clinic. And this anon person surely is spending good time cleaning up that clinic's name. Or at least just bashing you Katie. Geez.
Regardless of how this clinic is operating from a legal standpoint, does it not strike anyone as unethical how they advertise their services? I mean, what can they do for someone that their own doctor cannot or will not do? Prescribe opiate painkillers? Cater to doctor shoppers? Do they realize that some medicare recipients get their opiate prescriptions filled at Walmart for $4.00 for a 30 day supply and then sell their pills to addicts for $40 – $100 a pill depending on the medication, to supplement their income? Do they really want to contribute to these practices by advertising? Doesn't the oath doctors take go something like this: first, do no harm? If you run an ethical medical practice you have to keep in mind that your practices may have far reaching consequences way beyond your control. First, do no harm.
helga, excellent reminder. First do no harm. Not only for doctors, for all of us. thank you.
Katie – you are a badass! LOVE it!
Katie, thank you for this very interesting post. The entrenched nature of the pill industry sounds terrifying. Who is supposed to be monitoring these places? It is hard to understand how there can be such apathy from those in charge. Please keep blowing the whistle.
I also just wanted to comment about anon. I know you pride yourself on allowing most comments through. But I would have cut anon off early and fast. And especially, don't get sucked into that negative energy with lengthy replies. Although I can see how it's tempting, But, some people you'll just never reach. And that's ok. Save your precious energy to fight the battles that matter.
I wholeheartedly cosign this!
Thank you, Ms. Granju, for pointing out the details of this most bizarre arrangement, whereby a variety of healthcare providers have gotten involved in the business of "oversight" at clinics where prescriptions for narcotics are routinely prescribed for patients who clearly are not responsible with their handling of the medications.
You may also be interested in knowing this is nothing more than a business model, and a very successful one. Several local chiropractic clinics hire nurse practitioners and physician assistants to perform a wide variety of spinal injections without any on-site supervision, even though NP/PAs receive no training for such procedures in school and EVEN THOUGH THE CHIROPRACTORS CANNOT PERFORM SUCH PROCEDURES THEMSELVES. They employ MD/DO providers (who are off-site the majority of the time) to sign off on the NP/PA procedure notes. One of the doctors mentioned in your article is one of the doctors who signs off on the NP/PA procedure records in some local chiropractic businesses.
One of the chiropractors who operates a business like this (I talked to him a few years ago) told me he hired a friend, an MD who is licensed in Tennessee but lives in Nevada, to fly down once a month to sign off on these procedure records while he was recruiting other MDs to provide "oversight." Soundy shady? Sure does, and with good reason.
I grieve for the loss of your son to substance abuse, and I wish you the best in striking a chord that resonates within our community to make people take a closer look at matters like this.
Rep. Bill Hensley is currently sponsoring a bill in the TN House ,
HB1896 in an effort to provide closer supervision of mid-level practitioners in "pain management". The Tennessee Association of Nurse Anesthetists has spent countless man hours and resources in an effort to block this bill. CRNA's are frequently employed in this capacity because of a specific skill set and education in epidural, sub arachnoid, and various other VOO-DOO like local anesthetic injections. The TANA lobby cites prohibiting autonomy is a restraint of trade and implies the Federal Trade Commission is in agreement.It is my opinion that the lack of over sight or accountability only fosters the free reign of pain management pill mills.
I am a CRNA but I am also the mother of an opiate addict. I have done CPR on my overdosed child in my kitchen floor.She obtained her opiates not from organized crime or a foreign drug cartel; but right here in the Volunteer State from a pain clinic licensed by the state of Tennessee Board of Health. … So, I have seen this horror unfold right before my eyes from the perspective of an anesthetist and a desperate mother trying to save my child from an out of control health care business. I urge you to write your legislators , Tn Board of Medicine as well as the Tn Dept of Health.
Glad to hear the voice of reason Mr. McCoy !!!
I was watching "doomsday preppers", and came across this pain mgmt clinic's commercial (4/10/12). I looked it up on the internet, and came across this site.
I see these pain clinics as potentially hazardous, but as anon and some other opposing posters here have pointed out, there should be a process of fairness in all aspects to deal with the problem of drug diversion.
I have read about the nurse's struggle with her daughter's addiction, and I have seen for myself many people who have family members who struggle with drug addiction.
Unfortunately, the problem can not be attributed to one cause. "Pain Clinics" are only part of the problem. The way I see it, the problem can be only dealt with if there are rational and sensible laws and targeted enforcement with limited resources. Making a law making it mandatory to have health insurance to get pain medication is with good intentions, but there are people who can't afford shoulder surgery, continue to work, and function better with opioid medication than they would if every physician denied them treatment over this law.
My suggestion? Use law enforcement to catch providers who are writing excessive amounts of pills. Comb the records to see if they are writing huge amounts without doing random pill counts and drug screens to substantiate their trust in the patients they treat with these medications. Do sting operations to see if these physicians deal with families/friends/anonymous tips calling in to let physicians know their loved ones are abusing/diverting/supplementing their treatment plan. Have authorities notify physicians who are exceeding what is considered normal, and follow up on it to make sure it either stops or is thoroughly evaluated. No nurse practitioner or P.A. should be immune from legal and professional sanctions because they are participating in such behavior.
A new plan should make it evident to the population that any concerns about physician "overprescribing" will be taken seriously by a.) the state medical board, b.) local, state, and federal law enforcement, and c.) one way or another, the providers themselves.
But no matter what way we go as a society, these are dangerous substances in the wrong hands, and the black market for these drugs will always be there. Nothing short of a ban will ever truly protect everyone, and this will never happen as long as physicians can be sued for putting old folks on NSAIDS out of DEA and medical board fears and causing kidney failure or life threatening or fatal ulcer bleeding.
Now I know this blog is heavily stoked in a negative, painful experience. What I am getting ready to say is perhaps controversial, at best, but I'm going to say it, because it is my opinion…..
I think that these proactive laws on clinics are only dealing with part of the problem, and essentially will do little to curb the apparently insatiable appetite for these drugs by the population. Unless it is a federal law, Tennessee is a long, skinny state with borders and airports in the 21st century. Transport of controlled prescriptions across state lines WILL continue. Where there is an itch, shady people will be there to scratch. The controversial statement is this: Like it or not, you can blog about it all day, try to shame them into submission, spread the news, rub elbows with lawmakers, etc etc etc… BUT, until you give them enough room to actually hang themselves with solid evidence that can survive a trial, it will not close it down, no matter how much public outcry occurs. If they don't prove themselves to be a.) violating DEA or state law, or b.) operating outside the scope of the standard of care, or c.) surviving any complaint against them in a system of due process, then they will still operate, and their share of the burden of drug distribution illegally will never be legally enforced. If, however, enough people complain, and the clinic is operating irresponsibly, then rest assured that the providers WILL be sanctioned here in Tennessee and disciplined professionally, and in current times, they will not be able to skip from state to state to practice, probably ever, without hardcore accountability.
2 things:
1) Years ago I was in business-to-business telecom sales, which entails a ton of cold-calling to generate new business. I remember cold calling a so-called "pain clinic" – the first I had ever seen or heard of. My main recollection is walking in to an empty waiting room in a shady-looking building (i.e. didn't look at all like a typical physician's office) and seeing nothing but a window with a little ledge like you see at any dr's office front desk – except that it was unattended. There was a sign on a piece of 8 1/2" x 11" paper that, although I don't remember its wording, made it clear why this place existed. Even someone as naive as I, who has never smoked a cigarette, much less smoked pot or taken an illegal drug, knew right off the bat that something was not right there and that I didn't want to make a sales call on these people, who most likely didn't have an "administrator," who I would normally aim for on cold calls. After that day I began to notice pain clinics springing up all over town. These are not "doc-in-the-box," legit urgent care centers where you can see a dr. for strep throat or other relatively minor ailment at an affordable price vs. waiting for a primary care dr. in a large practice. These places are primarily there for dispensing painkillers, and I got the impression that they're not really choose about their clientele.
2) Several years after the aforementioned incident I was selected as one of just 12 or 13 people to sit on a Knox County grand jury panel. The first or second time we met we received a couple hours of training on and visual exposure to the worst of the illegal drugs (crack, RX pills, etc..) from one of the county's drug enforcement experts, an ex-FBI agent who had been involved in many, many busts and who explained the mindset of a drug addict, who is *only* interested in how they are going to get their next hit and nothing else. The one thing he said that will stick with me forever is that Knoxville was the hydrocodone ("hydro" on the street) capital of the nation – BAR NONE, including NYC. I can only imagine how much worse it is today, what with judges even getting in on the action.
People, I was naive about drug use and drug addiction. Fortunately I've never had any personal exposure or interest in it, nor do I have any family or friends who have gotten caught up in it. I'm one of the few lucky ones. But for anyone in Knoxville or Knox County to believe that we don't have an institutionalized, HUGE problem with drugs here is just inconceivable to me after my grand jury duty. Why else will people steal a Corvette and sell it for just enough to cover their next hit?? It happens every day. There are drug deals going on all around you — yes, even in West Knoxville, where you may think you're immune. Once you know what kind of crimes are fueled by drug addiction, you'll see it all around you and realize that you could become a victim of someone's insatiable drug habit at any time.
If more people were privy to the talk we had from one of Knoxville's drug-related law enforcement people, more would understand the magnitude of the problem here and in other towns our size and smaller. We have no choice but to open our eyes and deal with it for the good of this society.
Katie, maybe a live, televised panel discussion featuring this guy could be arranged (if the city/county would allow it) so that more people could understand the drug problem. He was working to keep drugs out of schools at the time he spoke with us. I can tell you privately who he was.
P.S. The gentleman I referred to in my prior post is acknowledged in this report: http://www.metrodrug.org/web/wp-content/uploads/2… – published by the Metropolitan Drug Commission in 2007, a bit before my very eye-opening tour of duty on the Knox County grand jury.
If you give even a cursory glance to the charts starting with #1.18, you'll see that local students were outpacing the national average for use of various drugs in many instances.
I can assure anyone reading this that the problem is exponentially worse today. It is only logical given the amount of deaths, arrests and crimes directly attributable to drug use that we see in the media each day — and I'd venture to say that the majority of it never even hits the media, as Katie has pointed out many times since Henry lost his life. Katie's receipt of a direct mail from a pain clinic is only further evidence of the problem we have just beneath the surface in Knoxville and Knox County.
I challenge any of you who doubt the *informed opinions* expressed in this blog re: pain clinics to go visit one, look around, ask a staffer for a prescription for the painkillers of your choice, and report back to us all.
The city of Knoxville is often very good about running pain clinics out of town by surrounding the clinic and harassing the heck out of it clients until they have to shut down. I'm not saying it happens all the time but it is at least helps, somewhat.
I say this because there was a well-written suggestion about what should be done around here and due-process…
I'm not being Pollyanna about this but I was a crime reporter in Mass. for 10 years. I covered many small, semi-suburban-rural towns and I promise you that drugs are a problem up there as well. Even worse was the drug scene in Florida when I lived there for another 10 years. I've seen elderly crackheads; one was actually a dealer. And the drug culture was enormous. Sorry, but Knoxville doesn't even come close.
I only mention this because on rare occasions I see comments on this blog where there seems to be a virtual "tsk, tsk," shake of the head, and sanctimonious, "What's wrong with those people in Tennessee?" That's dangerous thinking. Drugs are insidious and everywhere. And it seems that if I dare point that out backs get up and I'm told it wasn't meant THAT way. Yes, it was. It's a way to self-comfort. Don't do that. Be ever vigilant. It's next door to you, too.
Hey all you naysayers-who think Katie is just a grieving mother-and says nothing based on fact-check out this article(written by the press) http://www.salon.com/2012/04/11/americas_pill_pop…
Katie,
I would be extremely interested to know if the "clinic" chose a certain zip code or area in which to market to….there have been several cases where these types of places target what they think their demographic is. Not trying to start a North Knox vs. West Knox (or East or South) battle my mamaw in Karns didnt get one (I asked). My mother and I didnt get one and we live in Fountain City. Now, my co-worker who lives in Holston Hills did. I know in my company, we do target our advertising and marketing toward our demographic…we know where the majority of our customers reside. It may sound a bit discriminatory, but we are aware that Farragut,for example, probably does not and will not use our services/products. Just a thought.
Please,PLEASE keep up the investigative efforts….shine the light where it needs shining. And these pill mills are NOT WELCOME Knoxville! Aand Im sure more Knoxvillians agree with us than with "Anon". With views like his/hers I would want to remain anonymous too!!!