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Alan Rogers, Star-Tribune 

A drilling rig operates at a Wold Energy Partners well site last spring north of Rolling Hills in Converse County. A sharp uptick in Converse County oil activity led a 73 percent increase in taxable sales in the third quarter of 2018.


Health
breaking
Major opioid manufacturer asks judge to dismiss Wyoming lawsuit

The creator of OxyContin has asked a Wyoming judge to dismiss the Equality State’s lawsuit against the pharmaceutical company, claiming that the federal Food and Drug Administration’s previous findings invalidate the state’s legal challenge.

In October, Wyoming’s Attorney General’s Office announced it had filed suit against Purdue Pharma, the drug company most publicly associated with the opioid crisis, in Laramie County Circuit Court. In its lawsuit, the state claimed Purdue effectively used deceptive practices to market opioids in Wyoming, selling 16 million pills here between 2001 and 2017.

In its 115-page lawsuit, the state alleges that Purdue was deceptive in its marketing and that it worked to broaden the pool of patients who physicians deemed eligible for an opioid prescription. Further, the state claims that Purdue “overstated the benefits of chronic opioid treatment while downplaying its serious risks.”

In response, Purdue — through its Cheyenne attorneys, Richard Mincer and Erin Berry — alleges that the Food and Drug Administration had approved the use of opioids for treating chronic pain.

“First, as a matter of law Purdue’s statements are not false or misleading,” Purdue’s attorneys wrote in the company’s request that the case be dismissed. “The medications at issue are FDA-approved to treat chronic non-cancer pain, so any statements that are consistent with that approval cannot be deceptive or fraudulent as a matter of law.”

Purdue’s lawyers note that the FDA has “exclusive authority to determine whether a prescription is ‘safe and effective’” and they claim that Wyoming is attempting to undermine the FDA’s authority.

“The State bases all claims on the theory that it was a violation of Wyoming law for Purdue to promote opioids for a use specifically approved by the FDA — long term treatment of chronic non-cancer pain,” Purdue’s attorney’s wrote. “But statements that generally comport with FDA-approved labeling are not misleading as a matter of law.”

State Attorney General Peter Michael declined to comment Wednesday, citing his office’s “preparation of legal pleadings.” He told the Star-Tribune last spring, months before the state filed suit, that his office was working with other states to investigate opioid manufacturers.

His office’s lawsuit spends considerable time laying out the strategies Purdue deployed to ultimately sell more OxyContin in Wyoming, strategies that the suit claims were misleading and deceptive. The complaint ticks off sales calls, lunches and promotional tools used to make Wyoming physicians more comfortable with prescribing the drug and Wyoming residents more likely to be aware of and interested in OxyContin.

The strategy apparently worked: The suit claims OxyContin sales here jumped 800 percent between 1998 and 2004, and again increased 700 percent from 2006 to 2016.

Nationwide, OxyContin makes up about 30 percent of the painkiller market, according to The Week. It earned Purdue $1.8 billion in 2017 alone.

Wyoming’s suit claims that Purdue has made $35 billion in total sales of opioids. In Wyoming, Purdue dispatched a sales force that “logged more than 21 thousand sales calls to at least 453 different healthcare professionals” here.

The suit came months after Carbon County sued a number of opioid manufacturers, including Purdue. Before that, the Northern Arapaho Tribe sued several manufacturers. A number of other states, including Montana, have filed similar lawsuits, and counties in Idaho, Colorado and Nebraska have all taken legal action against pharmaceutical companies tied to opioids’ spread.

Between 1999 and 2016, more than 350,000 people died nationwide from overdoses that included opioids, according to the lawsuit. Wyoming has avoided the worst of the epidemic, which has laid waste to rural communities elsewhere in the U.S. Still, the suit alleges that “substance abuse treatment admissions for both heroin and non-heroin opiates increased by 345% between 2005 and 2017.” Overdose deaths related to the drugs have more than quintupled since 2003.

“More importantly, Defendants’ deceptive promotional practices have destroyed lives and devastated Wyoming families who have lost loved ones to the crisis,” the state wrote in its initial court filing.


National
AP
No deal to end shutdown; Trump says 'could be a long time'

WASHINGTON — No one budged at President Donald Trump's closed-door meeting with congressional leaders Wednesday, so the partial government shutdown persisted through Day 12 over his demand for billions of dollars to build a wall along the U.S. border with Mexico. They'll all try again Friday.

In public, Trump renewed his dire warnings of rapists and others at the border. But when pressed in private by Democrats asking why he wouldn't end the shutdown, he responded at one point, "I would look foolish if I did that." A White House official, one of two people who described that exchange only on condition of anonymity, said the president had been trying to explain that it would be foolish not to pay for border security.

In one big shift, the new Congress will convene today with Democrats taking majority control of the House, and Democratic leader Nancy Pelosi said they'd quickly pass legislation to re-open the government — without funds for the border wall.

"Nothing for the wall," Pelosi said in an interview with NBC's "Today" show set to air today. "We can go through the back and forth. No. How many more times can we say no?"

But the White House has rejected the Democratic package, and Republicans who control the Senate are hesitant to take it up without Trump on board. Senate Majority Leader Mitch McConnell called it a "total nonstarter." Trump said ahead of his White House session with the congressional leaders that the partial shutdown will last "as long as it takes" to get the funding he wants.

"Could be a long time or could be quickly," Trump said during lengthy public comments at a Cabinet meeting, his first public appearance of the new year. Meanwhile, the shutdown dragged through a second week, closing some parks and leaving hundreds of thousands of federal employees without pay.

Democrats said they asked Trump directly during Wednesday's private meeting why he wouldn't consider their package of bills. One measure would open most of the shuttered government departments at funding levels already agreed to by all sides. The other would provide temporary funding for Homeland Security, through Feb. 8, allowing talks to continue over border security.

"I said, Mr. President, Give me one good reason why you should continue your shutdown," Senate Minority Leader Chuck Schumer said afterward. "He could not give a good answer."

Trump's response about looking foolish was confirmed by a White House official and another person familiar with the exchange, neither of whom was authorized to describe the exchange by name. Trump campaigned saying Mexico would pay for the wall, but Mexico refused.

At another point Wednesday, Trump told Pelosi that, as a "good Catholic" she should support the wall because Vatican City has a wall, according to a congressional aide. Trump has mentioned the Vatican's centuries-old fortifications before, including at the earlier Cabinet meeting. But Democrats said they don't want medieval barriers, and Pelosi has called Trump's proposed wall along the U.S.-Mexico border immoral.

"I remain ready and willing to work with Democrats," Trump tweeted after the meeting. "Let's get it done!"

House Republican leader Kevin McCarthy said that there's no need to prolong the shutdown and that he was disappointed the talks did not produce a resolution. He complained that Democrats interrupted Homeland Security Kirstjen Nielsen as she was trying to describe a dreadful situation at the border.

Nielsen, participating in the meeting by teleconference, had data about unaccompanied minors crossing the border and a spike in illegal crossings, and she tried to make the case to the group that current funding levels won't suffice, according to the White House.

"We were hopeful that we could get more of a negotiation," said McCarthy.

He said the leaders plan to return to the White House Friday to continue negotiations. White House spokesman Hogan Gidley said on Fox that Pelosi will be "more able to negotiate" once she is elected speaker, as expected today.

The two sides traded offers, but their talks broke down ahead of the holidays. On Wednesday, Trump also rejected his own administration's offer to accept $2.5 billion for the wall. That proposal was made when Vice President Mike Pence and other top officials met at the start of the shutdown with Schumer, who left saying they remained far apart. On Wednesday Trump repeatedly pushed for the $5.6 billion he has demanded.

The partial government shutdown began on Dec. 22. Funding for the wall has been the sticking point in passing essential spending bills for several government departments.


Football
breaking
UW FOOTBALL
Suspended UW football player enters no-contest plea in misdemeanor case

FORT COLLINS, Colo. — Suspended Wyoming football player Youhanna Ghaifan entered a no-contest plea Wednesday in his misdemeanor case stemming from an incident at a Colorado hotel during the season.

Ghafain appeared for his disposition hearing at the Larimer County Justice Center in Fort Collins, where he pleaded to a Level 3 harassment charge involving a strike, shove or kick. If Ghafian stays out of trouble for the next six months, the case against him will be dismissed.

Judge Thomas Lynch ordered Ghaifan, who’s accused of trapping a female hotel employee against a wall and trying to kiss her, to complete 16 hours of community service as well as a boundaries class within the next five months. Ghaifan was also ordered to avoid any traffic citations exceeding five points while a no-contact order between Ghaifan and the victim was also issued as part of the deal.

A no-contest plea isn’t technically an admission of guilt, but the recommended sentence is accepted by the defendant in exchange for not contesting the charges.

Ghaifan is also facing a Level 2 false imprisonment charge, which is a misdemeanor. As part of the no-contest plea deal, that charge would be dropped and the case would be dismissed should Ghaifan comply fully with its terms before his next scheduled court appearance on July 5.

Ghaifan did not say anything other than to enter his plea and answer Lynch’s questions pertaining to the terms of the deal, declining to comment when offered the chance to do so by the judge.

He was represented in court by attorney Hannah Stephens, who declined to comment on the deal or the case as she led Ghaifan out of the courtroom.

The Mountain West All-Conference defensive tackle was cited on Oct. 26, just hours before Wyoming’s game against rival Colorado State. Authorities say the incident involved Ghaifan and an employee at the Fort Collins Marriott, where the team was staying.

According to the incident report, Ghaifan is accused of approaching a housekeeper after removing the doorstop she had used to prop open the door of a third-floor room she was cleaning. He then allegedly asked her “if she wanted to have some fun,” before pinning her arms against a wall and trying to kiss her before she pushed him away and told him she needed to leave.

Ghaifan was taken back to Laramie by Wyoming staff before the game and suspended indefinitely. A University of Wyoming spokesman said Wednesday afternoon Ghaifan’s status with the team hasn’t changed.

A junior defensive tackle, the 6-foot-4, 282-pound Ghaifan had 20 tackles in the eight games he played this season after being a first-team all-Mountain West selection as a sophomore. Ghaifan graduated in December and said as he was leaving the courtroom he’s yet to decide if he’ll return to Wyoming for his senior season.


State-and-regional
Lawmakers take step to combat costs of air ambulances

A bill to protect injured Wyoming workers from high air ambulance costs could be the first step in a broader effort by lawmakers to partially shield the entire state from the hefty bills levied by the companies.

Under this first piece of legislation, which is limited to state workers’ compensation claims, air ambulance companies would be given a choice of payment: They could accept roughly double the Medicare rate from the state, or they could accept a smaller amount and then bill the injured worker for the remaining sum, which is known as balanced billing.

Rep. Eric Barlow, the co-chairman of the Joint Labor, Health and Social Services Committee, said the first option would be quicker and provide more certainty for the air ambulance companies and would keep injured Wyomingites from facing significant bills.

“We don’t want greater burden to be shifted (to injured workers) ... at the same time they’re dealing with their actual medical health,” Barlow said Wednesday.

The solution is likely unique to Wyoming. Barlow said states were trying a variety of methods to protect residents from being balance billed, but he hadn’t heard of any state trying this solution.

How to pay air ambulances for workers’ compensation claims has been a thorn in the state’s side for years. In 2015, four large companies sued the state’s Department of Workforce Services because it limited how much it would pay the companies for flights. The companies argued successfully that a 1978 federal law protected air ambulances from being regulated by states.

The effects of the companies’ successful lawsuit are clear in the bill. Previously, the state capped payments for air ambulance companies at just over $3,900 and denied bills from the companies that routinely topped $30,000. This bill would increase how much the state would pay these companies for workers’ comp-related claims while still allowing the companies to directly bill the injured worker should the air ambulances choose not to accept the state’s payment.

Barlow said that if the companies accepted the proposal of a doubled Medicare rate, they would be paid promptly and with certainty. If they instead decided to balance bill the worker, they would face lengthier fights that may not result in the companies getting the amount they desire, he said.

It’s unclear if this choice is acceptable to the companies. Barlow said no representative from an air ambulance firm has attended a recent Labor, Health and Social Services Committee meeting. Messages sent Wednesday afternoon to three of the four companies that sued the state in 2015 were not returned. (The fourth company, Rocky Mountain Holdings, is a subsidiary of one of the other companies.)

Barlow said another bill was being drafted to expand the protections offered under this legislation to all Wyoming residents. He declined to offer details, as it was still in its early stages, but he said it would roughly mirror the workers’ comp bill.

Costs levied by the transport services are routinely significant. A 2017 U.S. Government Accountability Office report found that Air Methods — one of the companies that sued Wyoming — was charging $49,800 for an average flight in America.

The report summed up the fundamental issue with air ambulances and the eye-popping bill that comes from riding in one: patients have little choice — if they’re even conscious — about whether to be life flighted.

“Although most patients have little to no choice over the service during air ambulance transports,” the report states, “they might be billed for charges that can have potentially devastating financial impacts.”

How to deal with this problem is especially difficult because that federal law — the Airline Deregulation Act of 1978 — essentially ties the hands of state officials. The law was designed to better promote “efficiency, innovation, and low prices,” according to the accountability office’s report.

The average cost of a flight charged by Air Methods, the largest air ambulance company in the U.S., jumped 283 percent between 2007 and 2016. What was once an extreme price — $30,000 — is now below average.

In contrast to the costs borne by patients, eight air ambulance companies told the authors of the federal report that costs per flight were between $6,000 and $13,000, as of 2017. One helicopter requires a staff of 13: four pilots, four nurses, four paramedics and a mechanic.

The report makes explicit that owning an air ambulance service is good business. The largest companies are owned by private-equity firms. One provider was purchased in 2015 for $2 billion.

“The presence of private equity in the air ambulance industry indicates that investors see profit opportunities in the industry,” the report states.

The report further notes that — because patients have little choice in the matter — air ambulance companies can increase prices with little fear of losing business.

“Consequently, air ambulance providers are not subject to the price competition that typically occurs in competitive markets, where if prices are too high, consumers will find alternatives such as a lower-priced service or provider.”

That finding runs completely counter to the U.S. Department of Transportation’s guidance, which claims that once an air ambulance company is approved, its prices will be checked by “the competitive marketplace.” Instead, prices have jumped dramatically, as have the number of ambulances in the air, even as the number of transports needed has dropped.

Barlow said lawmakers have heard concerns from private insurers, from employers and from Wyoming residents. This first bill is limited to workers’ comp, but legislators are actively looking at expanding beyond that.

“It’s a narrow-scoped option,” he said, “but it’s potentially a broader approach and hopefully could envelop all of Wyoming.”