Monday, July 27, 2009

Why our AMA Supports Healthcare Reform

I think that we need to respond to the misperception, even deliberate propaganda, that our AMA is not informing its members regarding its position towards healthcare reform.
There are multiple resources readily available from our AMA.

* AMA Web Site:
* AMA News:
* Health System Reform Bulletin:

Also a recent article highlights the important issue why our AMA supports health system reform initiatives ( )

"The AMA is supporting the legislation partly on the strength of its Medicare payment reform plan, which would spend an estimated $245 billion over 10 years to align physician rates more closely with the costs of providing care. But the Association also backed the bill because it would use health insurance market reforms to cover most Americans, offer a choice of plans to consumers through a health insurance exchange, dedicate new money to boost primary care services and address physician work force problems."

Lets not forget that we also face major Medicare payment cuts and our AMA is proactively involved preventing these cuts.
For more information see

Lets not use our AMA as the piƱata de jour! Lets stand together and focus on the task ahead. Divided we will fail!

AMA - Outreach Recruiter

Friday, July 24, 2009

Rogue Doctor Forced to Resign!


July 24, 2009, For Immediate Release. The Pinellas County Medical Association
(“PCMA”) is aware of the inflammatory email sent by Dr. David McKalip regarding
President Obama and “Obama Care.”
Dr. McKalip’s act has been denounced by the Florida Medical Association. In
response to the Florida Medical Association’s request for an apology, Dr.
McKalip issued a public apology.
Following our awareness of the communication, the PCMA immediately called an
emergency special meeting of its Board of Governors and authorized the release
of this statement.
The Pinellas County Medical Association regrets and is appalled by the
statements and act of Dr. David McKalip. Dr. McKalip acted in poor taste
and on his own accord when preparing and issuing his message, with neither
the knowledge nor approval of the Pinellas County Medical Association or
its Board of Governors. The Pinellas County Medical Association joins with
the Florida Medical Association in denouncing and condemning Dr. McKalip’s
act and his offensive “Obama Care” statements. Dr. McKalip’s act in no way
reflects the opinions of the Pinellas County Medical Association or its
Board of Governors. Dr. McKalip has submitted his resignation as
President- Elect and as a member of the Board of Governors of the Pinellas
County Medical Association, and his resignation has been accepted

Rogue FMA Board Member Goes Too Far

A truly sad day for organized medicine when passion turned into blind hatred.
The attempted "apology" is pathetic and I hope that our leadership is taking the appropriate corrective action.
Our FMA deserves better and now is the time to come together to reconsider our position.

Posted on Fri, Jul. 24, 2009
Doctor criticized over Obama e-mail

St. Petersburg Times

A prominent St. Petersburg doctor and conservative activist has drawn a flood of criticism for e-mailing an image depicting President Obama as a witch doctor with a loin cloth, exotic head dress and bones in his nose.
``ObamaCare, coming soon to a clinic near you,'' reads the caption on the e-mail forwarded earlier this week by St. Petersburg neurosurgeon David McKalip.

Several popular liberal blogs, including Talking Points Memo, Huffington Post and Daily Kos, highlighted McKalip's e-mail Thursday and castigated him for racism. McKalip said he was flooded with calls from people attacking him over the e-mail, which he said he had forwarded to ``a limited group'' of about 150 people.

``I am not a racist. I am simply a person speaking up to make sure patients don't get hurt by the government and by insurance companies,'' said McKalip, who earlier this month organized ``tea party'' rallies across Florida denouncing Obama's healthcare overhaul proposals.

``Because I've been so effective in pointing out how the government plans are going to hurt patients in very serious ways the only way they can neutralize my message is to discredit me personally.''

McKalip, who has written guest columns for the St. Petersburg Times on tax and healthcare issues, teaches at the University of South Florida and is president-elect of the Pinellas County Medical Association and a board member of the Florida Medical Association -- which denounced McKalip's e-mail and urged him to apologize to President Obama.

He has become an increasingly visible political activist, founding advocacy groups including Cut Taxes Now, the Florida Taxpayers Alliance and Doctors for Patient Freedom.

McKalip noted that he helped organize a career counseling day several years ago for African-American Boy Scouts and blamed liberal activists for promoting the witch doctor image more than he ever did. He called the e-mail ``satire,'' but later Thursday night released a statement apologizing directly to Obama.

``I recognize that this image is offensive and hope that the nation refocuses on assuring all Americans have access to high-quality, affordable healthcare with no party interfering in the patient-physician relationship,'' McKalip said.

He is expecting protesters outside his office soon. The Daily Kos site is encouraging people to lodge complaints against him with his affiliated hospitals, USF, and the state Department of Health.

Adam C. Smith can be reached at

AMA Supports Reform

Kudos to Dr.Cecil Wilson, President Elect of the AMA, whose letter to the editor was published in todays Miami Herald.
He should be applauded for standing up for what we know is right: comprehensive healthcare reform benefiting all Americans.
Thank you Dr. Wilson for your commitment to our profession and the public health.

Bernd Wollschlaeger,MD,FAAFP,FASAM
AMA Member & Outreach Recruiter
AMA to Miami Herald: AMA Supports Reform

July 23, 2009 (published)

Miami Herald
Letter to the Editor

Floridians without health-insurance coverage are in dire straits (Report: 3,560 Floridians will lose health insurance every week, July 16). For their sake, we must achieve meaningful healthcare reform that provides all Americans with access to affordable, high-quality coverage.

The American Medical Association is committed to health reform this year that covers the uninsured, improves quality and ensures patients get the best value from healthcare spending. Important progress has been made with the House and Senate vigorously working on legislation. The AMA will stay actively engaged to make certain health reform that will improve the health of America's patients is accomplished.

The uninsured crisis playing out in Florida is one that can be seen all across America.

We must seize the opportunity this year to pass comprehensive health reform.

Cecil B. Wilson, MD
President-elect, American Medical Association

Thursday, July 16, 2009

AMA and Healthcare Reform

Attached todays press release from the AMA regarding its support for H.R. 3200. Obviously, our AMA is supporting the legislation which DOES contain a stripped down version of the public health insurance option. I wonder why their press release omits this important fact? Maybe, to avoid stirring up discussion and potential opposition from the hardliners within our AMA? Nevertheless, the press release is also a small baby step into the right direction and I hope that its not followed by two steps backwards. We will see.For more information about the bill see .



July 16, 2009

AMA SUPPORTS H.R. 3200, “America’s Affordable Health Choices Act of 2009”

House Bill Expands Access to High Quality, Affordable Health Care for Americans

WASHINGTON– Today, the American Medical Association sent a letter to House leaders supporting H.R. 3200, “America’s Affordable Health Choices Act of 2009.”

“This legislation includes a broad range of provisions that are key to effective, comprehensive health system reform,” said J. James Rohack, M.D., AMA president. “We urge the House committees of jurisdiction to pass the bill for consideration by the full House.” H.R. 3200 includes provisions key to effective, comprehensive health reform, including:

* Coverage to all Americans through health insurance market reforms
* A choice of plans through a health insurance exchange
* An end to coverage denials based on pre-existing conditions
* Fundamental Medicare reform, including repeal of the flawed sustainable growth rate (SGR) formula
* Additional funding for primary care services, without reductions on specialty care
* Individual responsibility for health insurance, including premium assistance to those who need it
* Prevention and wellness initiatives to help keep Americans healthy
* Initiatives to address physician workforce concerns

“The status quo is unacceptable,” Dr. Rohack said. “We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues. This is an important step, but one of many steps in the process. The AMA is actively engaged with Congress and the administration to achieve health reform that best meets the needs of patients and physicians. We are committed to passing health reform this year consistent with principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

# # #

Tuesday, July 07, 2009

Healthcare Reform Debate: Shall We Include Single-Payer In The Debate?

Dear Friends and Colleagues:

Attached an editorial from yesterdays Seattle Times written by Dr. John Geyman is professor emeritus of Family Medicine at the Universityof Washington, past president of Physicians for a National Health Program, and a member of the Institute of Medicine.
He argues that legislators are "only considering options that build on the present system."He adds that "after months of work, legislative committees in Congress have brought forth drafts of proposals that the Congressional Budget Office (CBO) is starting to score in terms of cost and effectiveness. As expected, the costs of these incremental proposals are high BECAUSE they are based on the CURRENT dataset of health care costs and on data provided by insurance company actuaries. "He is correct that legislators refuse to even consider a single-payer option and that the CBO has yet to score such an option and how it would compare to the models proposed during the current debate.
He ends the editorial with the following challenge: " President Obama has brought forward the concept of audacity of hope. Is it too audacious now to hope that the legislators we elect to Congress can see beyond their campaign contributions and the lobbying efforts by corporate stakeholders to require that single-payer be scored?"


The Seattle Times
July 6, 2009
A pay-go option for health-care reform
By John Geyman

As Congress recessed for the July Fourth holiday, the debate over
health-care reform was reaching a fever pitch. Now the top domestic issue
for the Obama administration, the biggest questions are how much a reform
bill will cost and how to pay for it, quite aside from how effective a
"reform package" will be.

Skyrocketing costs that are out of control are the hallmark of our present
system. Yet legislators have already acceded to pressures and dollars from
stakeholders in the present system (within which costs are revenue) and are
only considering options that "build on the present system."

After months of work, legislative committees in Congress have brought forth
drafts of proposals that the Congressional Budget Office (CBO) is starting
to score in terms of cost and effectiveness. As expected, the costs of these
incremental proposals are high. The first number of $1.6 trillion over 10
years (while still leaving 36 million Americans uninsured) sent these
committees back to the drawing board. At the moment, leading Senate
Democrats are hailing $1 trillion over 10 years as potentially doable.

After presiding over huge deficits during their eight years in power,
Republicans are now demanding "pay as you go" (pay-go) policies. Together
with Blue Dog Democrats, they are threatening to act as spoilers of any
health-care-reform bill on its price tag alone.

Given the dimensions of these difficult economic times including a $1.8
trillion deficit for 2009, $5 trillion in new federal debt over this year
and next, and rising unemployment, pay-go makes good sense. And the
president is making the case that his health-care plan must pay for itself.

Conventional "wisdom" (as generated by the mainstream corporate media) says
that any health-care reform will cost a lot, and that there is no pay-go
option. But there is.

Single-payer financing (public financing coupled with a private delivery
system, a reformed "Medicare for All"), as embodied in Rep. John Conyers'
bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of
some $400 billion a year. That's enough to assure universal coverage for all
Americans while eliminating all co-pays and deductibles ? the ultimate
pay-go. Single-payer will give us far more efficient, affordable, effective
and reliable health care than our present multipayer system. Health insurers
have known for years that they can't compete on a level playing field with
single-payer, and have only been surviving by favorable tax policies and
other subsidies from the government.

This recent testimony before the U.S. Senate Committee on Commerce, Science
and Transportation by Wendell Potter, former head of corporate
communications at Cigna, says it all: "I know from personal experience that
members of Congress and the public have good reason to question the honesty
and trustworthiness of the insurance industry. Insurers make promises they
have no intention of keeping, they flout regulations designed to protect
consumers, and they make it nearly impossible to understand or even to
obtain information we need."

Many studies over the past two decades, including those by the CBO, the
Government Accountability Office (GAO) and the nonpartisan Economic Policy
Institute, have concluded that single-payer can assure universal coverage
and still save money. HR 676 needs to be brought out of the closet and put
on the table for CBO scoring against other options being considered in
Congress, all of which cost much more and fail to provide universal

President Obama has brought forward the concept of audacity of hope. Is it
too audacious now to hope that the legislators we elect to Congress can see
beyond their campaign contributions and the lobbying efforts by corporate
stakeholders to require that single-payer be scored?

(Dr. John Geyman is professor emeritus of Family Medicine at the University
of Washington, past president of Physicians for a National Health Program,
and a member of the Institute of Medicine.)

Sunday, July 05, 2009

Insurance Mandate Gains Support

Attached a letter to President Obama supporting an employer mandate SUPPORTED by the President and CEO of Walmart and the Service Employees International Union (SEIU), the largest healthcare employees union in the US.
This serves as evidence that those of us who do support an insurance mandate DO NOT belong to the extreme left-wing fringes as claimed by our colleagues in organized medicine!

"We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution."

June 30, 2009
President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500
Dear President Obama,
As the Congress considers legislation reforming our health care system, many difficult choices lie ahead.
During the debate, we must keep our eyes trained on one clear imperative: reforming health care is
necessary not just to improve the health of all Americans, but also to remove the burden that is crushing
America’s businesses and hampering our competitiveness in the global economy.
As the nation’s largest private employer, the nation’s largest union of health care workers with over one
million members, and a think tank that has been a leader on health care policy, we have worked closely in
support of health care reform since 2006, when we came together to help break the stalemate that had
defined the health care debate for too long. Now, to move the debate forward once again, we are coming
together to advance what we believe are important proposals that should be included in the current efforts
to reform our nation’s health care system.
We believe now is the time for action on this vital issue. We commend the leadership of elected officials
who are committed to enactment of reform, and we appreciate the commitment to inclusion and
transparency which has been present thus far.
We are entering a critical time during which all of us who will be asked to pay for health care reform will
have to make a choice on whether to support the legislation. This choice will require employers to
consider the trade off of agreeing to a coverage mandate and additional taxes versus the promise of
reduced health care cost increases.
Today, health care costs more because we don’t cover everyone – the average family premium costs an
additional $1,100 because our system fails to provide continuous coverage for all Americans. And losing
coverage pushes people already dealing with financial hardship to the verge of financial collapse. One
accident or unexpected illness can financially ruin them. In 2008, half of all people filing for home
foreclosure cited medical problems as a cause.
A large and growing uninsured population also cripples our broader economic growth. The higher taxes
and premiums needed to meet rising health care costs threaten to consume the benefits of nearly all
economic growth over the next four decades, according to research published in the journal Health
Affairs. And the U.S. economy is losing up to $244 billion every year in lost productivity due to the
uninsured according to a new analysis by the Center for American Progress.
From a business perspective, health reform could not be more critical. A majority of Americans—158
million—receive their coverage through their job or their spouse’s job, according to the Kaiser Family
Foundation. But few businesses will be able to keep up with the pace at which premiums are rising.
Premiums are expected to rise by 20 percent in less than four years, according to research by professors at
Harvard University -- costing 3.5 million workers their jobs, and cutting insured workers’ average annual
incomes by $1,700.
Fiscally, the growing cost of health care is poised to drive our federal budget over a cliff. A recent report
by the Senate Finance Committee found that by 2017, “health care expenditures are expected to consume
nearly 20 percent of the GDP.” In his former role as Director of the Congressional Budget Office (CBO),
current Office of Management and Budget Director Peter Orszag testified to Congress that, “the single
most important factor influencing the federal government’s long-term fiscal balance is the rate of growth
in health care costs.”
We believe payment reform and efficiency initiatives need to be at the center of healthcare reform. The
President and the Congress have put forward good ideas to improve the productivity of our health care
sector. These policies need to be strengthened and adopted because health care reform without controlling
costs is no reform at all.
We are for shared responsibility. Not every business can make the same contribution, but everyone must
make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any
alternative to an employer mandate should not create barriers to hiring entry level employees. We look
forward to working with the Administration and Congress to develop a requirement that is both sensible
and equitable.
Support for a mandate also requires the strongest possible commitment to rein in health care costs.
Guaranteeing cost containment is essential. One way to ensure savings was recently advanced by former
Senate Majority Leaders Howard Baker, Tom Daschle and Bob Dole, “Implement pre-specified targets
for spending growth and enact a “trigger” mechanism that automatically enforces reductions,” (Crossing
Our Lines, Bipartisan Policy Center) President Obama suggested strengthening the role of Med Pac to
help enforce spending discipline.
With smart, targeted policies, we can create a financially-viable health care system that enables workers
to change jobs without losing their care, and allows businesses to become more nimble. Health care costs
will no longer stand in the way of their ability to retool for the 21st century. Focusing on health care cost
savings – and demonstrating a strong commitment to achieving these savings– would make this bill a win
/ win for employers, individuals and America’s competitiveness.

John Podesta President & CEO Center for American Progress (CAP)
Andrew L. Stern President & CEO Service Employees International Union (SEIU)
Mike Duke President Wal-Mart Stores, Inc.

Wednesday, July 01, 2009

Is Our AMA in Trouble?

s our American Medical Association in trouble? Well, an article by Nicholas Kristoff published in the New York Times on June 25th provided some food for thought.
Yes, we know now that our AMA's position regarding a public insurance option is a maybe but not an outright no. Nevertheless, the heated debate within our organization and the ideological rigidity displayed by some has created the impression that the AMA is AGAIN opposed to a meaningful reform of our healthcare system. Right or wrong, the impression counts and its out there.
Furthermore, our membership is indeed dwindling and as an outreach recruiter I can attest to the fact that its getting harder and harder to convince doctors to join or rejoin. For some we are too soft and for others not tough enough. For some we are too much on the right, for others too much on the left. The media reports regarding our recent Annual meeting does not help in that effort either.
In Florida alone our membership decreased by 14%! Having listened and spoken to hundreds of doctors in South Florida I can list a few reasons that our leadership must consider:
1)Doctors in private practice want to have their problems addressed and resolved today, rather than tomorrow. They are afraid that they are being forced to close shop and merge with larger groups , or to end up as hospital employees. I visit private offices every week and many are on the verge of financial insolvency!
2)Far too much time is being wasted on ideologically-motivated debate, and too little on the development and deployment of practical practice solutions. Talk the Talk, or Walk the Walk?
3)Our AMA delegation is comprised of individuals representing their own political interest and are detached from the constituents they supposedly should represent.
Therefore, I have resigned from the AMA delegation and return to where I came from: union style grass-root organizing, listening to our members and to find alternative modalities of membership representation. The Web 2.0 technology demonstrates what a few can do using these tools, and they can successfully bypass the encrusted and inflexible structures of organized medicine.
The time for change has come even for our AMA. The questions remains: will our AMA embrace or resist change? Thats an existential question for our organization and circling the wagons will only hasten our demise.
Looking forward to your comments.

Bern Wollschlaeger,MD,FAAFP,FASAM
AMA Member

June 25, 2009
The Prescription From Obama’s Own Doctor
As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.
In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.
So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.
“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.
“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”
Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.
Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.
“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”
He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”
I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.
An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.
That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.
Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.
I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.
In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.
“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.
For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.
The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.
The student association declared that it "not only supports but insists upon a public health insurance option."
Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.
So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!

Prescription Drug Overdose

On June 23, 2009 Florida Gov. Charlie Crist has signed legislation aimed at curbing the growing black market of illegal prescription drugs flowing from South Florida pain clinics across the eastern United States. The new law, passed nearly unanimously in the Legislature, will require doctors and pharmacists to record patient prescriptions for most drugs in a state-controlled database.
Its about pain to reign in on the explosive growth of "pain clinics" in South Florida operated by unscrupulous owners, some associated with the criminal underworld and organized crime.
The number of overdose deaths are soaring, too!
Unfortunately, the prescription drug monitoring program cannot be implemented until the end of 2011 and so far funding is pending.
As physicians we must continue to push for the comprehensive implementation of such program because our patients and fellow citizens are being harmed by drug dealers in a white coat.
Lets not be complacent but proactive. We just won ONE battle but not the war against drugs.
Posted on Tue, Jun. 30, 2009

Prescription drug overdose deaths soar in Florida


Florida continues to see a rapid rise in fatal overdoses caused by prescription-drug abuse -- a trend fueled by a cottage industry of cash-only pain clinics -- while deaths from illegal drugs wane, according to a report from the state's medical examiners released Tuesday.
Nearly 1,000 deaths were caused in 2008 by the potent painkiller oxycodone -- a 33 percent increase from 2007, the report says. Four years ago, only 340 deaths statewide were attributed to oxycodone, the most popular drug in the black-market pill trade supplied by pain clinics.

Conversely, deaths from cocaine overdoses declined by 23 percent, to 648 in 2008.

Overall, prescription drugs accounted for 75 percent of the drugs found in overdose victims last year, the report says.

''The magnitude and severity of prescription drug abuse calls for strong, coordinated action,'' said Bill Janes, the director of the state's Office of Drug Control, in a written statement.

Florida took a step in that direction when the Legislature passed a law creating a statewide database to monitor prescription sales and increasing oversight of pain clinics, which operate with little scrutiny.

The prescription database is designed to detect addicts and drug dealers buying pills from multiple doctors -- often by faking ailments or medical records -- a practice known as ``doctor shopping.''

''It's almost impossible to monitor different people shopping doctors,'' said Dr. Joshua Perper, Broward County's medical examiner. ``A person can get hundreds or thousands of pills.''

This can also lead to dangerous drug combinations. Perper said the most common overdoses involve mixing several drugs, with oxycodone and anti-anxiety drugs such as Xanax and Valium among the most common combinations.

Though the new prescription monitoring law takes effect Wednesday, the database is not expected to begin operating until late next year.

Broward has become the nation's capital of illegal prescription drug trafficking, police say, with nearly 100 storefront pain clinics feeding a black market in pain pills stretching through Kentucky, Ohio, Tennessee, West Virginia and Massachusetts. Florida leads the nation in oxycodone sales -- largely because of these clinics -- according to U.S. Drug Enforcement Administration data.

In 2008, Perper's office detected oxycodone in 171 Broward County overdose deaths -- more than twice the number found in 2005.

The highest number of oxycodone overdoses were reported in Pinellas and Pasco counties, where the drug was detected in 308 deaths last year.

The medical examiner in that district, Dr. Jon Thogmartin, attributes the unusually high number to advanced detection techniques employed by his lab.

''Prescription drugs have really begun, to a significant degree, to replace illicit drugs,'' Thogmartin said.

Thogmartin said many victims overdose on pills prescribed to them by licensed doctors.

To health advocates, this shows that doctors practicing as pain-management specialists need more training and more oversight from the state medical board.

''It's unacceptable to open up a practice and call yourself a pain management physician and start writing prescriptions,'' said Dr. Laura Brown, a Bradenton physician on the board of the American Society of Interventional Pain Physicians. ``That's not pain management.''