$78.5 Billion… that’s with a “B”

“The total economic burden is estimated to be $78.5 billion. Over one third of this amount is due to increased health care and substance abuse treatment costs ($28.9 billion). Approximately one quarter of the cost is borne by the public sector in health care, substance abuse treatment, and criminal justice costs.” (https://www.ncbi.nlm.nih.gov/pubmed/27623005).


“The United States is in the midst of an alarming opioid overdose epidemic and U.S. employers are challenged by the epidemic’s toll on their workers. Opioids were involved in the overdose deaths of more than 33,000 Americans in 2015, nearly quadruple the number from the year 2000 and more than any year on record. The estimated lost productivity for people in the United States with opioid use disorder totaled $20.4 billion in 2013. These statistics highlight the serious challenges businesses face: In 2013, prescription opioid dependence, abuse and overdose cost the United States $78.5 billion. More than one-third of this amount, $29 billion, is due to increased health care and substance abuse treatment costs. In 2011, approximately 25 percent of workers’ compensation prescription drug claim costs were for opioids. In this issue of Business Pulse, explore what the Centers for Disease Control and Prevention (CDC) is doing to inform physicians and individuals about the risks and benefits of prescription opioids to protect workers’ health and prevent opioid overdoses.” (https://www.cdcfoundation.org/businesspulse/opioid-overdose-epidemic).



In the late 1980s, when I was in medical school, I was taught, and correctly so, that opioids were addictive and dangerous pain relieving medications which should be used in very limited situations. I was taught that opiate pain relievers were only to be used for short-term treatment of severe acute pain like that experienced immediately following surgery or for long-term palliative (end-of-life) care in cancer patients. My respected medical school professors and fellow students did not question these ethical and wise standards. We all understood that prescription opiates carried the same risks of tolerance and adduction as heroin and other such street drugs. We wanted to effectively treat our patients’ pain but not turn them into addicts.

For a time, the manufacturers and distributors of prescription narcotic were satisfied with a constant income stream from their narcotics line of products. A few decades ago, these companies reconsidered the facts that opiates were inexpensive to manufacture, highly addictive, easy to market, and could be a source of huge profits. These companies then began a systematic and relentless campaign of advertising to healthcare providers, patients, and government officials.

To the healthcare providers, they provided new studies that proved that opiates were not as addictive as was once thought. They created new “long-acting” formulations and assured physicians that these new formulations actually deterred abuse and were completely safe for long term use in all adult patients. They sent representatives to physicians’ offices, held seminars, and funded biased and inaccurate studies to advance and support their bogus claims.

To the patients, they explained that if a physician does not provide complete pain relief, that physician is not practicing quality medicine. They created the notion that pain is the “fifth vital sign,” blanketed waiting rooms with posters showing pain being rated on scales from one to ten, and convinced patients to demand pain medications for every ailment.

To the governmental representatives, they sent lobbyists to promote the enactment of laws forcing physicians to prescribe pain medications, insurers to cover the costs of pain medications, and pharmacies to maintain large stocks of these medications on hand. They infiltrated the government oversight committees with their former executives and changed government policy and regulation so that new opiate formulations would be quickly approved.

The net result of the opiate campaign by manufacturers and distributors was to create an insatiable demand for their opiate products and record profits year after year. Once the prescribers were convinced that the government required pain to be treated aggressively, and the insurers were forced to pay for total pain relief, and the patients demanded the most potent narcotics, the epidemic became all but unavoidable.

The amount of social and financial damage caused by these opioid manufacturers and distributors is enormous. While the government, the medical community, and the patients seem unable to get any control over this epidemic, private law firms are getting involved and bringing civil suits against these pharmaceutical companies to hold them accountable for the harms they cause. The Law Firm of Fransen & Molinaro, LLP provides free consultations to potential clients for these types of lawsuits.


Aggressively, efficiently, and successfully litigating complex cases against companies worth hundreds of billions of dollars requires a legal team of experienced law firms with seasoned trial attorneys who also have the financial ability to advance the millions of dollars that will be needed. Fransen & Molinaro, LLP is working with a team of law firms that meet these criteria. One member of the team is the law firm of Levin Papantonio Thomas Mitchell Rafferty Proctor P.A. This firm has been handling mass tort, medical device, and pharmaceutical cases for decades. In 2004, Mike Papantonio helped launch a nationwide organization called Mass Torts Made Perfect. This organization holds annual conferences for the top personal injury attorneys and teaches them successful litigation strategies to use against multi-national corporations.

The team approach is well-suited to handle the representation of cities, counties, and states in litigation against billion-dollar international companies like Purdue Pharma, McKesson, Teva Pharmaceuticals, Cardinal Health, AmerisourceBergen, Mallinckrodt, Janssen, Endo Health Solutions, Cephalon, Watson, Allergen, Johnson & Johnson, and others. The team will pool resources, work more efficiently, and replicate successful strategies. They know how to bring lawsuits designed to hold billion-dollar international companies responsible for the damages their opioids cause.

If you are a governmental official in California, Fransen & Molinaro, LLP wants to work with your city or county, or with the State of California to sue the corporations that have ruined countless lives and financially drained local governments. These corporations need to be held accountable.


There is no fee if there is no recovery.” “There is no reimbursement of litigation expenses if there is no recovery.” These two sentences are written, in boldface type, in every retainer agreement a governmental client will sign when it decides bring a lawsuit against the opioid manufacturers and distributors through Fransen & Molinaro, LLP and their associate attorneys. These contractually binding statements mean that there are zero upfront costs to the client.

This important fact should not be overlooked, because it means that the enormous litigation costs will be completely advanced by the attorneys and not come from your budget. This fact also means that there is no risk of financial loss to your department. Even if a suit is unsuccessful, no reimbursement will be sought by your attorneys. The retainer agreement will also state that, upon recovery, the lawyers will be paid thirty percent of the gross recovery plus reimbursement for litigation expenses. Considering that many personal injury attorneys charge forty percent of the gross recovery for simple automobile accident cases, the thirty percent contingent recovery rate is quite reasonable.

Another advantage to hiring Fransen & Molinaro, LLP and its associate attorneys is less obvious. By representing multiple governmental clients against the same manufacturers and distributors, many of the pleadings, discovery efforts, and litigation actions will be used in other cases. This means that the costs, for which each individual client is responsible will be less than if only one lawsuit was filed. Handling many similar lawsuits against the same defendants, allows private practice attorneys to not only decrease litigation expenses, but duplicate the tactics. Fransen & Molinaro, LLP and its associate attorneys are not new to litigation against billion-dollar corporations. Their experience and track make them the right choice.


The United States is suffering from a prescription opioid epidemic, the likes of which has never been seen before. In the late 1980s, when I was in medical school, I was correctly taught that opioids were addictive and dangerous pain relieving medications which should be used in very limited situations. I was taught that opiate pain relievers were only to be used for short-term treatment of severe acute pain like that experienced immediately following surgery or for long-term palliative (end-of-life) care in cancer patients. My respected medical school professors and fellow students did not question these ethical and wise standards.

Many people wrongly believe that those who suffer from opiate abuse and die from opiate overdoses are heroin addicts and abusers of other illegal street drugs. However, the truth is that the majority of opiate abusers are abusing prescription opiates. The prescription opiates causing the physical, economic, and social devastation are made by large scale pharmaceutical manufacturers, distributed by billion-dollar wholesalers, prescribed by licensed healthcare providers, and sold by pharmacies. The only true link to heroin and the current opiate epidemic is that most of today’s heroin users abused prescription opiates before turning to heroin.

Fransen & Molinaro, LLP will represent California counties and cities against opiate manufacturers and distributors and sue them to recover the money spent by these governmental entities fighting the opioid epidemic with its hundreds of millions of dollars in associated medical, criminal, and societal costs.

Big News (Fall 2017) for California Real Estate Licensees with Tarnished Records

Commencing January 1, 2018, the California Bureau of Real Estate (CalBRE) will allow disciplined licensees to petition the Commissioner to request the removal of license discipline information posted for public review on the CalBRE website. To be eligible for removal, the relevant license disciplinary action taken by CalBRE must have occurred at least 10 years prior to the petition for removal. There are guidelines, requirements, and limitations, of course. Fransen & Molinaro, LLP has been helping real estate professionals handle BRE issues for years, and stands ready to help with this new process. (Visit http://www.dre.ca.gov/files/pdf/reb/rebfall_17.pdf for more information). If you feel you meet the criteria for removal of discipline information, please don’t hesitate to contact us for more information.

Medical Malpractice:EMRs Can Be Your Friend or Foe in a Lawsuit

The electronic medical record (EMR) is touted as one of the best new additions to medical record keeping due to its time-saving abilities, its ease of transferring records and its tailor-made templates, which should make it all but impossible to fail to document an important step in patient care. And, yes, recording the detailed care of the patient can be your best friend in the event of a malpractice case. However, some of the very features that make the EMR so quick and easy to use make it potentially dangerous with a couple of pitfalls.

Read the Full Article

– Paul


Q: How do I contact you, Paul J. Molinaro, M.D., J.D.?

Start by calling the law firm of Fransen & Molinaro, LLP at (951)338-9226 or (888)MDJDLAW. When our receptionist answers (nine times out of ten, it will be Lorri) tell her you would like to speak with Paul about a potential medical malpractice matter. If I am available, I will speak with you right then and there. If I am not available, leave your full name and telephone number with her, and I will call you back.


Q: How much do you charge to speak with me about a potential medical malpractice case?

Nothing. The initial consultation with me is free, though, I guess we can accept tips if offered without any duress.

Q: Is everything said to you confidential?

Even though you are not actually a client when we first speak, you are a “potential client” or a “PC” as we lawyers will call you behind your back. The communications between a PC and attorney are confidential. Thus, feel free to (and please do) tell me everything when we speak – even things that you feel will hurt your potential case. I need to be given accurate and truthful information.


Q: When I do speak with you on the telephone, what will you ask me?

I will ask you many things, but first I will ask for your full name and telephone number. I will be taking notes, so you will probably hear me clacking away on my computer keyboard as we speak. I will then ask you whether you are calling about yourself or someone else. If you are calling about yourself, I will ask your age. If you are calling about someone else, I will ask for that other person’s full name and age.


Q: What else will you ask me?

I will then ask you what happened and let you start giving your story. Of course, there is a pretty good chance that within 30 seconds of you speaking I will start asking questions. I will not be cutting you off to be discourteous. I just have a habit of directing such initial conversations so that we get to the pertinent parts as soon as possible. Directing the conversation is how physicians get quick and accurate histories from patients and how lawyers get quick and accurate fact patterns from PCs. As I ask questions and you answer, we will have a conversation which should provide me with enough information to determine whether you have a viable medical malpractice matter.


Q: What information should I know and have ready before I call you so that I can answer your questions?

One of the things I will always try to ascertain is the date that the potential medical malpractice occurred. For example, if we are discussing a surgery, I will want to know the exact date of the surgery. If we are discussing a missed diagnosis, I will want to know the exact date you discovered that the diagnosis was missed. I will also want to know the full names of the physicians or other health care providers that you believe harmed you and the full names of the hospitals or medical facilities where the incident in question occurred. If you had tests or diagnostic imaging studies done, I will ask the date they were done and what the results were. If you were given medications, I will ask for the names and dosages of the medications and the name of the prescriber. If you had a surgery, I will ask you exactly what type of surgery you had done. Thus, if you have your medical records, it would be a good idea to have them in front of you when you call me. If you do not have them, you can still call and do your best to answer my questions. If the records are needed, you can always get them later.


Q: Will you tell me if I have a good case in our initial phone call?

Due to California’s Medical Injury Compensation Reform Act of 1975 (“MICRA”), and many other factors, my firm ends up telling about 99% of the medical malpractice PCs that call me to try other law firms (and to do so before the statute of limitations runs, if it has not run already). Very rarely (meaning almost never), in an initial phone consultation, will I tell a person that he or she has a bad case or tell them to forget it and move with his or her life. Every lawyer has an opinion about what makes a case “good.” Of course, I think quite highly of my opinion, but not so highly as to think I am always correct. In fact, in 2011, I traded medical malpractice cases with another lawyer. We each thought our cases had little chance of success but that the other lawyer’s case was “solid.” After trading cases, we each settled and both of our clients were pleased with the results. I was wrong on one case but right on another! So, if I tell you that my firm will not represent you, and I recommend that you contact other lawyers, you should absolutely do so. The State Bar of California and your local county bar association are great referral sources.

Now, if, during our conversation, I do feel that you have a good case, I will invite you to come to my office for a face to face meeting with me. We will then meet and discuss the next step to take. The next step is having me review your medical records. If you are not able to come to my office due to illness, disability, or distance (I take cases throughout the State of California), I will ask you to send me copies (never originals or your only copies) of your medical records for my review. I do not charge PCs for my review of their medical records.


Q: After you have reviewed my medical records, then what?

After I have reviewed your medical records, I will tell you whether I think there was medical negligence (malpractice) committed. If I do not believe that any medical negligence was committed, I will tell you that my firm will not represent you, and I will recommend that you contact other lawyers before your statute of limitations expires. The State Bar of California and your local county bar association are great referral sources.

If I do believe that medical negligence was committed, I will talk to you about retaining a medical expert to review your medical records and provide an expert opinion as to whether medical negligence was committed. While I am a medical expert, of course I will never act as such in a case in which I am the plaintiff’s lawyer. Because medical experts charge for their initial reviews, we will talk about the amount charged and how much of that fee you will be expected to pay. Expert review fees vary depending on the specialty of the physician performing the review, the amount of medical records requiring review, and the complexity of the potential case.


Q: After the medical expert provides an initial opinion what happens?

Well, that depends on the opinion. If our medical expert says there was no medical negligence committed, I will tell you so. I will then recommend that you contact other lawyers before your statute of limitations expires. The State Bar of California and your local county bar association are great referral sources. However, I will caution you that you should inform those other lawyers that a medical expert has already reviewed your case and said that no negligence was committed. I will also caution you not to file a case yourself as doing so could put you in the position of having filed a frivolous case. If you file a frivolous case, you could end up paying a lot of money to the defendants you sued frivolously.

If the medical expert says there was medical negligence committed and tells me that he or she can’t wait to start working on the case, I will tell you so. My office will then, with our agreement, become your attorney and begin the process of filing suit. My office will then front the costs of the lawsuit from that point forward – the exact details of the terms will be set forth in a written retainer agreement.

If the medical expert says there was probably medical negligence but that he could just as easily be a defense witness, I will then recommend that you contact other lawyers before your statute of limitations expires. The State Bar of California and your local county bar association are great referral sources. My office only takes cases where the medical expert not only provides an opinion that medical malpractice was committed but is eager to work on the case.


Q: Anything else to add?

Yes. Don’t hesitate to call me if you think you have a case. However, don’t start the call by telling me what a great case you have. Don’t tell me how I should be glad you called me instead of the other attorneys who would jump at the chance to take this case. Just tell me what happened. I’m pretty sure I will figure out whether it’s a case my firm will handle. If you do not trust me to determine whether you have a good case, call someone you do trust. I do not base my opinion of potential cases on whether you feel the doctor was a jerk. I do not base my opinion of potential cases on whether you feel the hospital staff didn’t really care about you. I do not base my opinion of potential cases on whether your neighbor who was a medic back in the day said you have a case. I do not base my cases on a situation where you almost got hurt by a doctor. I base my opinion on what actually happened and is shown to have happened in the medical records and whether you suffered actual and substantial harm as a result of what happened.


Q: Your last answer kind of put me off. You sound a bit arrogant.

That’s not a question. It’s a comment.


Q: Okay, wise guy. Are you arrogant? Will you be rude to me when I call?

It depends on who you ask, and I will try not to be. I really enjoy speaking with PCs. I really enjoy taking cases. I really enjoy handling medical malpractice cases. However, when my firm passes on a case, and the PC wants to know why, I provide my opinion. Sometimes that opinion is not what the PC expected or wanted to hear. Sometimes I help a PC see things with an objective eye – focusing on the difference between bad bedside manners and medical negligence or the difference between what is substantial harm (enough to bring a lawsuits) and minor harm. Sometimes, after formally reviewing the medical records, I can help provide closure by explaining what happened.


Q: Got it. Thanks.

You’re welcome. I look forward to speaking with you.


Along with the recession, depression, slump, downturn, economic reset, crash, or whatever euphemism used to describe the massive consumer debts now facing many Californians, came squads of scammers looking to make quick bucks by promising to solve personal financial problems. These scam artists push their “services” through radio, television, mail, internet, and cold calls. When faced with overwhelming debts, thought processes get paralyzed, and desperation overrides good judgment and common sense. Conmen take full advantage of this phenomenon by pretending to be compassionate professionals who can solve enormous financial problems for just a few easy and affordable payments. Continue reading