Health Care & Reproductive Rights

FOR IMMEDIATE RELEASE
Friday, March 20, 2009
Contact: Office of the Attorney General - Christine Gasparac (916) 324-5500
Cotchett, Pitre & McCarthy - Niall McCarthy (650) 697-6000

Brown Sues to Recover Hundreds of Millions of Dollars Illegally Diverted from Medi-Cal

LOS ANGELES – Responding to a whistleblower’s allegation of “massive Medi-Cal fraud and kickbacks,” Attorney General Edmund G. Brown Jr. joined legal action against seven private laboratories to recover hundreds of millions of dollars in illegal overcharges to the state’s medical program for the poor.

“In the face of declining state revenues, these medical laboratories have siphoned off hundreds of millions of dollars from programs intended for the most vulnerable California families.” Attorney General Brown said. “Such a pattern of massive Medi-Cal fraud and kickbacks cannot be tolerated, and I will take every action the law allows to recover what is owed,” Brown added.

According to whistleblower Chris Riedel, the CEO of Hunter Laboratories, “I confirmed with the California Department of Health Care Services that these practices were illegal. We then had a choice--either join the other labs in violating the law or be unable to compete for business. We choose to suffer the financial consequence, and follow the law.”

The lawsuit, which is pending in San Mateo Superior Court, contends that the 7 medical labs systematically overcharged the Medi-Cal program over the past 15 years.

The defendants include:
• Quest Diagnostics, Inc., based in Madison, NJ; its affiliate Specialty Laboratories, Inc., based in Valencia, CA; and 4 other Quest affiliates.
• Health Line Clinical Laboratories, Inc., now known as Taurus West, Inc., based in Burbank, CA.
• Westcliff Medical Laboratories, Inc., based in Santa Ana, CA.
• Physicians Immunodiagnostic Laboratory, Inc., based in Burbank, CA.
• Whitefield Medical Laboratory, Inc., based in Pomona, CA.
• Seacliff Diagnostics Medical Group, based in Monterey Park, CA.
• Laboratory Corporation of America, based in Burlington, NC.

California law states that 'no provider shall charge [Medi-Cal] for any service…more than would have been charged for the same service…to other purchasers of comparable services…under comparable circumstances.' Yet, these medical laboratories charged Medi-Cal up to six times as much as they charged some of their other customers for the very same tests. For instance,

• Quest Diagnostics, Inc. charged Medi-Cal $8.59 to perform a complete blood count test (CBC), while it charged some of its other customers $1.43 for the exact same test. This is one of the most frequently requested blood tests.

• Laboratory Corporation of America charged Medi-Cal $30.09 to perform a Hepatitis C Antibody screening, while it charged some of its other customers only $6.44 for the test.

• Health Line Clinical Laboratories charged Medi-Cal $12.65 to perform an HIV Antibody screening, while charging some of its other customers $1.75 for the test.

These are not isolated examples. They are part of a pattern of fraudulent overcharging and kickbacks that developed over the past decade. Here’s how it worked:

• The defendant labs provided deep discounts when they were being paid directly by doctors, patients, or hospitals. Prices were often below the lab’s cost and sometimes free.

• In exchange for these steep discounts, the defendants expected its customers to refer all of their other patients (where the lab was paid by an insurance company, Medicare, and Medi-Cal) to its lab. Under California law, this amounted to providing an illegal kickback.

• These sharply reduced prices, however, were not made available to Medi-Cal. Instead of charging the discounted prices, the defendants charged Medi-Cal up to 6 times more than the defendant charged others for the same tests. In effect, defendants shifted the costs of doing business from the private sector to Medi-Cal.

• Additionally, defendants offered their clients who paid them directly (not through Medi-Cal or other insurance) deeper and deeper discounts in order to get a larger share of the lab testing business. This created an unfair playing field, and laboratories that followed the law could not effectively compete. These law-abiding companies were sometimes forced to sell or go out of business completely.

The case was filed under seal in San Mateo Superior Court under California's False Claims Act by a whistleblower and qui tam plaintiff Hunter Laboratories, which processes blood tests. Hunter Laboratories had found that it could not compete in a significant segment of the marketplace where many of the major players were offering referring doctors, hospitals, and clinics far lower rates than they were charging Medi-Cal.

After the whistleblowers filed the complaint, the Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse investigated the allegations and Attorney General Brown intervened under seal. The case became public this week.

Hunter Laboratories' attorney, Niall P. McCarthy of Cotchett, Pitre & McCarthy, commented that “At a time when California is laying off teachers and firefighters and is in a massive budget crisis, it is unconscionable that these defendants would bilk the system to the tune of hundreds of millions of dollars.”

Under California's False Claims Act, anyone who has previously undisclosed information about a fraud, overcharge, or other false claim against the state, can file a sealed lawsuit on behalf of California to recover the losses. They must notify the Attorney General as well.

Such a case is called a 'qui tam' case. If there is money recovery, the law provides that the qui tam plaintiff receives a share of the amount recovered if the requirements of the statute are met.

The lawsuit asks for relief in the amount of triple the amount of California’s damages, civil penalties of $10,000 for each false claim; and recovery of costs, attorneys’ fees and expenses. It is estimated that damages could amount to hundreds of millions of dollars.

The clinical testing field is a $50 billion industry nationwide. The defendants named in the lawsuit include some of the largest clinical laboratories in the country.

Quest Diagnostics is the leading provider of diagnostic testing, information and services in the United States, with more than 500 patient service centers in California.

Laboratory Corporation of America performs more than one million tests on approximately 400,000 samples each day and has more than a dozen patient centers in Los Angeles.

To report fraud or abuse, call the Bureau of Medi-Cal Fraud and Elder Abuse's hotline at (800) 722-0432.

FOR IMMEDIATE RELEASE
February 18, 2009
Contact: Christine Gasparac (916) 324-5500

Brown Announces Arrests of Nursing Home Employees Who Drugged Patients for Staff’s Convenience

BAKERSFIELD –Attorney General Edmund G. Brown Jr. today announced the arrests of a nurse, physician, and a pharmacist of a nursing home for “forcibly administering” psychotropic medications for their own convenience, rather than for their patients’ therapeutic interests, actions that are alleged to have resulted in the deaths of three residents.

“These people maliciously violated the trust of their patients, by holding them down and forcibly administering psychotropic medications if they dared to question their care,” Attorney General Brown said. “This is appalling behavior, which amounts to assault with a deadly weapon.”

Earlier today, California Department of Justice special agents arrested three individuals:

• Gwen Hughes, the former Director of Nursing at the skilled nursing facility of the Kern Valley Healthcare District in Lake Isabella, Kern County on charges of elder abuse and assault with a deadly weapon.

• Debbi Hayes, the former pharmacist at the Valley Healthcare District, on charges of elder abuse and assault with a deadly weapon.

• Dr. Hoshang Pormir, a staff physician at Kern Valley Healthcare District, who was serving as the medical director of the skilled nursing facility, on charges of elder abuse.

Upon taking over as Director of Nursing in September 2006, Gwen Hughes ordered that Alzheimer’s and other dementia patients be given high doses of psychotropic medications to make them more tranquil and easy to control. She ordered the administration of these medications to patients who argued with her, were noisy, or who were otherwise disruptive. Two patients who resisted were held down and forcibly given injections.

Ms. Hughes is also alleged to have directed Debbi Hayes, the hospital pharmacist, to fill prescriptions for these psychotropic medications. Hayes wrote and filled these prescriptions without first obtaining a doctor’s approval.

Dr. Hoshang Pormir approved these psychotropic medications only some time after they had been administered and without examining the patients first and determining whether these psychotropic medications were medically necessary.

Several of these patients are alleged to have had medical complications as a result of being given these psychotropic medications, including lethargy and the inability to eat or drink properly. It is believed that that three patients died and one patient suffered great bodily injury as a result.

The investigation

Kern Valley Healthcare District operates a small community hospital and skilled nursing facility in Lake Isabella. The case came to the attention of authorities in January 2007, when an ombudsman reported to the Bakersfield office of the California Department of Public Health that a patient in the skilled nursing facility had been held down and given an injection of psychotropic medication by force.

The Department of Public Health immediately sent an investigative team with a doctor, a nurse, and a doctor of pharmacology. They determined that 22 patients, including some who were suffering from Alzheimer’s at the skilled nursing facility, were being given high doses of psychotropic medication not for therapeutic reasons, but to simply control and quiet them for the convenience of the staff.

The Department of Public Health issued a Certificate of Immediate Jeopardy which resulted in the immediate dismissal of the Ms. Hughes. The matter was then turned over to the California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse.

Special Agents from the Bureau of Medi-Cal Fraud and Elder Abuse began a year-long investigation, with the co-operation and assistance of the Department of Public Health and the administration of the Kern Valley Healthcare District.

A search warrant was served on the facility in August 2008, resulting in the seizure of numerous medical files and records.

Criminal charges were filed in Kern County Superior Court. The defendants are being held in Kern County Jail in Bakersfield. They will be arraigned on Friday. If convicted, the defendants could face up to 11 years in prison.

The case is being prosecuted by the Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse, with the co-operation and assistance of the Kern County District Attorney’s Office.

To report elder abuse or Medi-Cal fraud, call the Bureau of Medi-Cal Fraud and Elder Abuse’s hotline at (800) 722-0432.

The complaints are attached.

Attorney General Brown Announces Two Arrests in $1.34 Million Medicare Fraud Case

SAN DIEGO —Attorney General Edmund G. Brown Jr. today announced the arrests of two individuals who “hatched a scheme” to file false claims under Medicare for medical services that were never performed.

“The defendants hatched a scheme to bilk Medicare out of more than a million dollars,” Attorney General Brown said. “They stole the identities of people on Medicare and made claims for procedures that were never performed.”

The two defendants -- a husband and wife -- owned and operated Balboa Therapy Center in San Diego. From July 2005 to June 2006, they, along with an accomplice, paid unsuspecting seniors at retirement homes $100 to obtain their insurance information and sign their names on blank medical forms.

The couple then paired the seniors’ signatures and Medicare insurance numbers with provider ID numbers from licensed physicians to submit fake claims. None of the claimed procedures were performed, and the physicians listed on the claims had no idea their names were being used to perpetrate the scheme.

Balboa Therapy Center functioned primarily as a front. Some of the staff at Balboa reported going days without seeing a single patient. The defendants hired licensed physicians as “directors” at the clinic to gain access to their Medicare provider ID number in order to submit the false claims to Medicare. The physicians were unaware that their provider ID numbers were being used to file the claims.

When some senior citizens began to receive receipts and other forms from Medicare indicating that they had been treated at Balboa Therapy Center, they contacted the California Department of Justice (DOJ). The DOJ’s Bureau of Medi-Cal Fraud and Elder Abuse began an investigation that led to criminal charges against the following defendants in San Diego Superior Court:

• Sanjay Patel, 41. Patel and his wife, Leena Patel, owned Balboa Therapy Center. They were arrested in Connecticut just before they attempted to flee the country for India.
• Leena Patel, 36.

The defendants, who are being held at Hartford County Jail in Connecticut, are being charged with thirteen criminal counts including grand theft, identity theft, health benefits fraud, receiving stolen property and money laundering. If convicted, they could face over twelve years in prison.

The Department of Justice’s Bureau of Medi-Cal Fraud and Elder Abuse investigates and prosecutes those who file fraudulent claims for medical services, medical equipment and drugs.

In the 2007/2008 fiscal year, Attorney General Brown was able to recover over $161 million in government funds that had been lost due to fraud and obtained 70 convictions.

To report fraud or abuse, call the Bureau of Medi-Cal Fraud and Elder Abuse’s hotline at (800) 722-0432.

The complaint and affidavit are available upon request.

# # #

SACRAMENTO- Attorney General Edmund G. Brown Jr. today announced an agreement requiring Bayer Corporation to stop a “deceptive ad campaign” regarding an oral contraceptive, “Yaz,” and obligating the company to spend $20 million publicly correcting misleading assertions about the product.

“Bayer’s deceptive ad campaign led young women to believe that its oral contraceptive would cure symptoms for which it was not approved for use,” Attorney General Brown said. “This judgment modification forces the company to stop making those claims and spend $20 million correcting misleading assertions about the product.”

Bayer claimed the drug could treat symptoms related to premenstrual syndrome (PMS), and acne, in addition to anxiety, tension, irritability, moodiness, fatigue, headaches, and muscle aches. None of these claims have been approved by the Food and Drug Administration (FDA).

In a television ad, for instance, Bayer claimed that Yaz “can help keep your skin clear,” despite the fact that clinical studies have not concluded that taking Yaz results in acne-free skin.

The Attorney General’s Office contends that the advertisements for Yaz violated a 2007 agreement with Bayer after the company failed to adequately disclose safety risks associated with the use of Baycol, a drug used to lower cholesterol, which was pulled from the market in August 2001. The agreement required future marketing, sale, and promotion of pharmaceutical and biological products to comply with all legal requirements, and prohibited Bayer from making false or misleading claims relating to any products sold in the United States.

In addition to adhering to the 2007 judgment, the company agreed to:
• Conduct a $20 million corrective advertising campaign consisting of a television advertisement and a print advertisement that have been approved by the FDA’s Division of Drug Marketing, Advertising, and Communications (DDMAC) and reviewed by the Attorneys General involved in the suit.
• The television ad must be broadcast on national cable and network television.
• The print ad must be published in magazines with national distribution.
• Submit all new Direct to Consumer television ad campaigns for Yaz to FDA for pre-review.
• Cease any and all claims about the drug that are not FDA-approved.
• Submit an annual report to each participating attorney general’s office.

The States joining California’s agreement are; Arizona, Arkansas, Connecticut, Delaware, Florida, Idaho, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Washington, and Wisconsin.

The Modification of Judgment and the October 2008 Warning Letter are attached.

FOR IMMEDIATE RELEASE
Wednesday, February 2, 2009
Contact: Christine Gasparac (916) 324-5500

Brown Sues Drug Makers that Conspired to
Keep Generic Testosterone Supplements off Shelves

LOS ANGELES – California Attorney General Edmund G. Brown Jr. and the Federal Trade Commission today filed an antitrust lawsuit against four pharmaceutical companies that conspired to monopolize the sale of a testosterone supplement in a “predatory move” to reap huge profits at the expense of consumers.

“The companies plotted to keep cheap generic drugs off the market, costing consumers millions,” Attorney General Brown said. “This was a predatory move pure and simple, increasing drug company profits at the expense of critically ill patients.”

Testosterone supplements like AndroGel can prevent muscle loss, fatigue or erectile dysfunction in critically ill patients suffering from HIV/AIDS, diabetes, and advanced age.

The lawsuit contends that Solvay Pharmaceuticals illegally colluded with three other pharmaceutical companies -- Watson, Par and Paddock Laboratories -- to keep the three companies from producing generic alternatives to its testosterone supplement.

In return, Solvay agreed to pay Watson and the other drug manufacturers millions of dollars over several years. With this agreement, the drug companies sought to protect the monopoly position of AndroGel, forcing consumers to pay artificially high prices for the drug while the companies shared the extraordinary profits. Solvay Pharmaceuticals manufactures and distributes a testosterone supplement called AndroGel with annual sales exceeding $400 million in 2007.

Background
In 2003, Watson Pharmaceuticals and Par Pharmaceutical Companies, Solvay’s competitors, sought approval from the Food and Drug Administration to make and sell generic versions of AndroGel. These companies received final approval from the FDA. If they had begun to sell generic alternatives, Solvay would have seen a significant reduction in its profits from AndroGel sales. Typically, when generic alternatives are introduced in the market, the prices of brand name drugs are reduced by 50% to 80%. The price for AndroGel is $225.01 for a box of 150 individual units.

Without generics on the market, consumers and health insurance programs must pay more for branded medications. Pharmaceutical monopolies cost the state, its citizens and private insurers millions of dollars each year.

Attorney General Brown and the Federal Trade Commission filed a lawsuit in the U.S. District Court for the Central District of California in Los Angeles against the following pharmaceutical companies:

• Solvay Pharmaceuticals, Inc.
• Paddock Laboratories, Inc.
• Par Pharmaceutical Companies, Inc.
• Watson Pharmaceuticals, Inc.

Today’s lawsuit alleges that Solvay and the three pharmaceutical companies violated U.S. and California antitrust laws and laws banning unfair competition. The lawsuit seeks to:

• Declare the agreements between Solvay, Paddock, Par and Watson illegal and void.
• Permanently enjoin the defendants from similar and related conduct in the future.
• Fine the defendants $2500 for each prescription and user of AndroGel in California under the California Unfair Competition Act.

The lawsuit is attached.

Sacramento – Attorney General Edmund G. Brown Jr. today urged a federal appeals court to block the court-appointed Receiver from “commandeering $8 billion” from the shrinking California Treasury for extravagant prison construction.

“Federal law does not allow the Receiver to commandeer the finances of the state to spend $8 billion for unaccountable and extravagant prison construction,” Attorney General Brown said. “The court should rein in the Receiver, who is now spending more than $2 billion per year on inmate health care. This is almost $14,000 per inmate and nearly double what it was just three years ago.”

In a reply brief filed today with the United States Court of Appeals for the Ninth Circuit, Attorney General Brown describes the fundamental legal errors that the court-appointed Receiver has made in attempting to force the state to fund his prison construction program against its will.

Brown argues that the Prison Litigation Reform Act, signed into law in 1996, bars federal judges from ordering the construction of new prisons and that any relief must involve the least intrusive means necessary.

A just-released draft of the Receiver’s plan, however, demonstrates the unbridled scope of the Receiver’s plan.

The plan calls for the construction of 7 new prisons with 10,000 new beds -- the size of 70 Walmarts. It envisions yoga rooms, regulation basketball courts with electronic bingo boards, music and art therapy, horticultural therapy, and landscaping which shields fences from inmates’ view. While some details have been deleted in a subsequent draft, the fundamental structure and many of the extravagant amenities remain.

Brown argues that to force such an $8 billion plan on California against its will—particularly at a time when the state must make huge budget cuts to programs including health care, infrastructure, and schools—violates federal law and the state’s sovereign immunity under the 11th Amendment to the Constitution.

The appellate court, therefore, should reverse the District Court’s order of a $250 million down-payment toward the $8 billion plan.

The State of California has acknowledged the need to provide health care that meets Constitutional standards, and has taken a series of steps to improve prison health care. This includes increasing the numbers of qualified medical staff at prisons and improving the process by which inmates are assessed and how they are treated.

Under the Receivership, healthcare spending has increased from $7,601 per inmate in 2005-2006 to $13,778 per inmate in 2007-2008. That’s far more than the average citizen in California pays for healthcare coverage.

Background
In August of this year, the court-appointed Receiver filed a motion seeking to compel Governor Arnold Schwarzenegger and Controller John Chiang to allocate $8 billion from the California Treasury over the next 5 years, including $3 billion in this fiscal year, for prison healthcare facility construction. Attorney General Brown has argued that the federal court does not have the authority to mandate state prison construction, nor has the Receiver justified the massive sums called for in his plan.

SACRAMENTO- Attorney General Edmund G. Brown Jr. today announced that California will recover $112 million for its Medi-Cal program as part of a national settlement with Eli Lilly and Company for the unlawful off-label marketing of its anti-psychotic drug Zyprexa, which the company aggressively marketed for such unapproved uses such as treatment for depression, anxiety, irritability, disrupted sleep, nausea and gambling.

“This settlement means that Eli Lilly can no longer reap massive profits by aggressively marketing this drug for unapproved uses at the expense of state health care programs for seniors and the infirm,” Attorney General Brown said. “California’s Medi-Cal program will receive almost $112 million, which is more than welcome at a time when the state faces massive budget deficits.”

Eighteen percent of the $112 million recovered for the Medi-Cal program will go to relators (whistleblowers) – the remainder will be split between the State, which will receive $54 million and the federal government, which will receive $41 million.

Beginning in 2001, Eli Lilly launched a marketing campaign called “Viva Zyprexa!” which encouraged physicians to prescribe Zyprexa for children, adolescents, and dementia patients.

In October 2008, the California Attorney General entered a settlement with Eli Lilly over the Zyprexa marketing campaign. In his original complaint, Attorney General Brown alleged that Eli Lilly engaged in unfair and deceptive practices when it marketed Zyprexa for off-label uses and failed to adequately disclose the drug’s potential side effects (including diabetes and hyperglycemia) to healthcare providers.

Under this settlement, Eli Lilly agreed to change its marketing practices and to cease promotion of its off-label uses. Off-label uses are those not approved by the FDA when it approves the sale and use of a particular drug. Physicians are allowed to prescribe drugs for off-label uses, but federal law prohibits pharmaceutical manufacturers from marketing products for off-label uses.

The total settlement is $1.415 billion—the largest recovery in a health care fraud investigation in U.S. history. The settlement includes $800 million in civil damages to be paid to the States and $615 million as a result of criminal charges brought against the company for illegal marketing.

Although both California and the U.S. contribute 50% to the funding of the Medi-Cal program, California’s share is larger than the federal share due to the federal Deficit Reduction Act, which provides monetary incentives to states to use False Claims Acts to pursue Medicaid fraud.

SACRAMENTO—California Attorney General Edmund G. Brown Jr. today joined a lawsuit against the United States Department of Health and Human Services (DHHS) to halt the implementation of a Bush Administration “midnight regulation” that could potentially “endanger a woman’s right to contraception,” including emergency contraception given to rape victims.

“California has carefully and thoughtfully struck a balance between the right to use contraceptives and the right of healthcare providers to abstain from administering them,” Attorney General Brown said. “This illegal and stealth regulation threatens to erode women’s hard fought privacy rights.”

Poised to take effect on the day of President-Elect Barack Obama’s inauguration, the regulation undercuts state contraception laws and jeopardizes billions of dollars in federal public health money.

On December 19, 2008, DHHS issued the regulation, one of several highly controversial “midnight regulations” issued in the waning days of the Bush Administration. The regulation purports to implement three federal funding restrictions designed to force states to permit healthcare providers to refuse to provide certain health care to which the providers have a religious, moral or ethical objection. If California does not comply with the new federal regulation, it stands to lose millions, if not billions, in federal funding.

One of the most objectionable aspects of the new federal regulation is its failure to define the word “abortion.” An earlier draft contained a very broad definition that would have clearly included some forms of contraception, including emergency contraception. In comments filed with the DHHS in September, Attorney General Brown pointed out that the failure to include a definition of so critical a term would allow the term to be “improperly extended beyond the scope of the authorizing statutes and does not afford meaningful protection for a woman’s access to other healthcare services, including those involving contraception and fertility treatments.” Instead of addressing widespread concern about the term, the DHHS eliminated the definition entirely.

California law allows healthcare workers and providers to object to dispensing contraception or performing abortions for moral or ethical reasons if they notify their employer of their objection in writing. The new federal regulation would reduce the healthcare protections afforded to women in California by allowing a healthcare provider to refuse procedures or referrals to which the provider objects without notifying the employer, the facility or the patient.

In today’s lawsuit, California joins six other states in challenging the regulation on the grounds that it :
• Fails to define “abortion.” By failing to define the term, DHHS created unnecessary ambiguity, allowing the term to be interpreted as encompassing all forms of contraception.
• Deprives patients of the right to receive factual and objective medical information and access to medical information.
• Overrides states’ rights to promote the general health and welfare of their citizens.

“We applaud Attorney General Jerry Brown’s proactive stance in protecting patients’ access to vital health care services and information,” said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “This HHS regulation poses a serious barrier to the states’ enforcement of their laws protecting patients.”

The complaint and accompanying exhibits are attached.

LOS ANGELES – Attorney General Edmund G. Brown Jr. today announced a multi-state agreement with Shell Oil Company to stop young people from purchasing tobacco products at its convenience stores.

“I commend Shell for joining the growing list of companies that are demonstrating their commitment to prevent illegal access to tobacco,” Attorney General Brown said. “Smoking remains a serious public-health problem in our country, and we need to do everything possible to keep young people from picking up the habit.”

Attorneys General throughout the country won this agreement after a nationwide investigation of tobacco selling practices at convenience stores affiliated with Shell.

The agreement includes the following provisions:

• Retail personnel will receive training about the health risks associated with childhood tobacco use.
• Shell will administer independent compliance checks to monitor sales practices at certain Shell convenience stores, to ensure they are not selling tobacco to minors.
• States will impose sanctions against contract operators that sell tobacco to minors.
• Vending machines and self-service displays that sell tobacco products will be forbidden at Shell-associated convenience stores.
• In-store tobacco advertisements will be limited to reduce youth demand for tobacco products.
• Shell will require all convenience store operators to notify the company if tobacco products are sold to minors in violation of the law.

In the U.S., more than 14,000 gas stations sell Shell gasoline with more than 13,000 of them in states joining this agreement. There are more than 1,200 Shell stations in California, and most stations include convenience stores that sell tobacco products. Although Shell does not directly own or operate the convenience stores at its stations, Shell has agreed to adopt these procedures designed to reduce sales of cigarettes to minors.

Nationwide, 47% of underage youths who reported buying cigarettes said they got them at gas station convenience stores. Studies have linked retail tobacco marketing with underage smoking. In addition, many convenience stores are located near schools and playgrounds.

Recently, there have been other multi-state agreements to curb the sale of tobacco to minors at gas station convenience stores, including Conoco, Phillips 66, 76, Exxon, Mobil, BP, ARCO, and Chevron, as well as retail and pharmacy outlets operated by Kroger, 7-Eleven, Walgreens, Rite Aid, CVS, and Wal-Mart. Grocery stores are also participating, including Ralphs, Safeway, and Vons.

Studies show that most adult smokers began smoking before the age of 18. Young people are particularly susceptible to the hazards of tobacco, often showing signs of addiction after smoking only a few cigarettes.

In addition to California, the following states have signed on to the agreement: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming. The District of Columbia is also participating.

LOS ANGELES--California Attorney General Edmund G. Brown Jr. today announced a crackdown on rampant prescription drug fraud in California, including the top fifty abusers who average more than 100 doctor and pharmacy visits to collect massive quantities of addictive drugs like Valium, Vicodin, and Oxycontin.

“These prescription drug addicts are abusing the system, draining time and money from hundreds of doctors and pharmacies who are there to help real sick people, not con artists,” said Attorney General Brown. “On my order, California Department of Justice special agents launched a statewide search for the most aggressive prescription drug addicts. We want to end these dangerous cycles of fraud and abuse.”

Launched in June this year, the new crackdown has already led to the arrest of dozens of suspects, including Frankie Greer, 53, who visited 183 doctors and 47 pharmacies to feed a prescription drug habit that included some of the most dangerous painkillers in lethal combinations. In a one-year period, Greer sought out multiple doctors at hospital emergency rooms to prescribe her over 4,830 hydrocodone tablets, 2,210 oxycodone tablets, 156 Oxycotin, along with a variety of additional addictive painkillers.

Greer is not alone. The National Survey on Drug Use and Health estimates that 20 to 30% of the state’s drug abusers primarily use prescription drugs. In addition, the National Institute on Drug Abuse has estimated that 48 million Americans have used prescription drugs for non-medical reasons. A 2005 survey by the Drug Abuse Warning Network estimates the non-medical use of pharmaceuticals accounted for more than 500,000 emergency room visits in California, an enormous drain on the state’s healthcare system.

In addition to costing the state millions each year, prescription drug abuse can have serious public safety consequences, as many of the top abusers hold down regular jobs including truck drivers, transit operators and medical practitioners. The Attorney General has been working in cooperation with the Troy and Alana Pack Foundation, founded by Bob Pack, whose 7 and 10-year old children were killed by a driver who was under the influence of prescription drugs obtained from multiple doctors.

This initiative is part of the Attorney General’s comprehensive plan to address prescription drug abuse in the state and make it easier for doctors to keep track of prescription drug records. Earlier this year, Attorney General Brown unveiled a plan to provide doctors and pharmacies with real-time Internet access to patient prescription drug histories. Under Brown’s proposal, health professionals would have computer access to the drug histories of patients, replacing the current outdated system that required mailing or faxing written requests for information. Each year, more than 60,000 such requests are made to the California Department of Justice.

The state’s database, known as the Controlled Substance Utilization Review and Evaluation System, contains 86 million entries for prescription drugs dispensed in California, giving healthcare professionals the technology they need to fight the prescription drug abuse currently burdening California’s healthcare system.

“Doctors and insurance companies should be on the alert,” added Attorney General Brown. “We are aggressively pursuing the top prescription drug abusers, and we’re also making it easier for doctors to verify health history information provided by new patients. We encourage insurance companies to develop a similar system for protecting themselves against prescription drug fraud.”