Saturday, June 26, 2010

Arizona Law For Florida and Medical Practice

Attached an important and troubling article from today's Miami Herald pointing out that "Florida Republican leaders have begun crafting anti-illegal-immigrant legislation modeled after an Arizona law that has incited widespread protests and fueled national and international debate over U.S. immigration policies.
Under the proposed bill, police would have broad power under state law to ask suspects for proof of legal residency."
I am strongly opposing such legislation and urge my specialty society to raise concerns regarding this bill as it pertains to the way family physicians practice medicine.
I often (even today) encounter patients, mostly uninsured, who are reluctant to go to the hospital because of their residency status fearing a backlash, or possible investigation by the immigration authorities.
Today I referred a Haitian patient to Publix to benefit from a FREE Metformin program. She asked me if she would have to provide a form of identification because she has no papers. I reassured her that she should not worry.
What will happen IF we have such a discriminatory law on the books? More undocumented immigrants will avoid doctors but will be taken by ambulance to emergency rooms for preventable illnesses instead. Who will pay? The taxpayer!
Just the debate of such a law in the legislature will trigger additional pressure on our State which already has to deal with a massive and continuous oil spill, high unemployment and a jittery tourism industry. Do we need anything else to shut down!!
Looking forward to your comments.

Posted on Sat, Jun. 26, 2010
Florida GOP risks Hispanic anger with Arizona-like crackdown

Cristina Silva
Miami Herald/St. Pete Times

TALLAHASSEE — Florida Republican leaders have begun crafting anti-illegal-immigrant legislation modeled after an Arizona law that has incited widespread protests and fueled national and international debate over U.S. immigration policies.
Under the proposed bill, police would have broad power under state law to ask suspects for proof of legal residency, said Rep. William Snyder, a Republican from Stuart who plans to introduce the legislation in November.

"We have significant components from the Arizona bill that I plan to incorporate,'' he said. "We have the beginnings of it.''

The effort, which would be filed for consideration during the March legislative session, is already drawing broad support within the GOP.

Majority leaders in the Florida Senate and House said a new approach is needed to address the federal government's failure to temper illegal immigration.

It has the backing of both leading Republican gubernatorial candidates -- businessman Rick Scott and Attorney General Bill McCollum, whose office is helping to draft the bill.

Snyder, a former police officer, said the proposed legislation is needed to protect undocumented immigrants, who are vulnerable to abusive employers and violent criminals.

"This is a human right issue,'' he said. "They don't enjoy the same rights and privileges that you and I do. The solution is to enforce the laws that currently exist and to discourage people from coming here to `find a better life' when in fact they just come here and are victimized.''

Immigrant advocates and Hispanic lawmakers alike called the measure an unconstitutional assault on minority communities.

"The reaction is, 'What? This is ridiculous,' '' said Neelofer Syed, a Tampa immigration lawyer from Pakistan. "It is supposed to be that you are legal until you are proven guilty. This law is like, `We think you are guilty unless you establish that you are innocent.' ''

Rep. J.C. Planas, a Republican from Miami, called it an election-year stunt.

"I don't understand how anyone can think the Arizona law is good for Florida,'' said Planas, chairman of the Florida Hispanic Legislative Caucus. "It is a huge waste of police resources to start doing these things.''

Senate and House leaders said immigration reform is ripe for passage.

"What we want to do is encourage legal immigration and discourage illegal immigration,'' said incoming Senate President Mike Haridopolos, who cautioned that any changes will be shaped by how the Arizona law is put into practice after it takes effect next month.

Republican leaders in Pennsylvania, Rhode Island, Minnesota, South Carolina and Michigan have made similar vows to mirror Arizona's immigration law, amid growing criticism that the federal government has not adequately protected the nation's borders.

Civil rights groups such as the American Civil Liberties Union have filed legal challenges to the legislation, and President Barack Obama's administration is expected to follow suit.

Critics questioned why Florida lawmakers would consider replicating Arizona's untested immigration strategy while legal challenges are still pending.

"Rep. Snyder's proposal solves nothing, exploits public concern over immigration and just creates new problems,'' said Howard Simon, executive director of ACLU Florida.

The tension has become a rallying point for candidates on both sides of the political spectrum.

Democratic gubernatorial candidate Alex Sink has highlighted her Republican opponents' support of the law in stump speeches.

"She was opposed to the law in Arizona,'' said campaign spokeswoman Kyra Jennings. "She believes it unfairly discriminated against American citizens. She would veto that type of legislation.''

Championing tougher immigration laws is a risky election strategy, said George Gonzalez, a University of Miami political science professor.

"It is a way to channel people's anger and frustration about the labor market onto a group and to take advantage of it, too,'' he said.

But it could also anger Hispanic voters, an important constituency in Florida's increasingly diverse political landscape, Gonzalez said.

Florida's estimated illegal immigrant population ranks third in the nation. Arizona places seventh. But while Florida's undocumented population has dropped by 10 percent during the past decade, Arizona's climbed by 42 percent.

"None of this is foolproof,'' Gonzalez said. "It could blow up in the Republicans' faces either way.''

Snyder said he doesn't want his law to stir up the same accusations of racism that hounded Arizona's decision.

His law would be refined, he said, because it would only allow law enforcement officials to inquire about immigration status during a potential arrest or traffic violation. In Arizona, officers are required to request legal documentation during any lawful stop if ``reasonable suspicion'' exists.

Coming up with the precise language will be difficult, conceded Snyder, who recently defended his views on Fox News. ``Reasonable suspicion makes people nervous,'' he said.

But he vowed his final draft would apply equally to all illegal immigrants, regardless of skin color or ethnicity.

"I've never in my 32 years been accused of using the `N' word or being racially motivated,'' he said. "No one who knows me would say I have a racist bone in my body.''

Shorter Work Days For Doctors

Attached a link to an important NEJM article entitled "The New Recommendations on Duty Hours from the ACGME Task Force."The goal of the ACGME's new approach to duty hours is to foster a humanistic environment for graduate medical education that supports learning and the provision of excellent and safe patient care.
At the heart of the ACGME's proposed changes is the recognition that the least-experienced residents need to be treated differently than more experienced ones. The plan recommends that first-year residents be limited to 16-hour shifts, and those in the second year and above work continuously for no more than 24 hours. They can stay an additional four hours to facilitate patient handoffs to another doctor. Currently residents are allowed to work up to 30-hour shifts.
The guidelines also include detailed expectations about direct supervision of younger residents by more experienced ones, in the hopes that a supervising doctor would catch any error before it affects a patient, according to Dr. Nasca.In addition, the ACGME will step up its monitoring and enforcement of the requirements, conducting on-site visits of each institution annually beginning in July 2011. The site visits are likely to cost each institution about $12,000 to $15,000, according to Dr. Nasca.
Those programs that don't comply with the rules could ultimately lose accreditation and be forced to disband.
I strongly support the proposed changes and call upon my colleagues to do the same.
Our patients deserve the same assurance about the quality of service as millions of airline passenger do already: strictly enforced duty hours for pilots, checklists before take-off and landing, elimination of human errors and the relentless pursuit of excellence.
We must change the way we do business! Our patients deserve it!!

Saturday, June 12, 2010

University of Miami and Professional Ethics

John Dorschner's very well written article reveals the disturbing facts surrounding the hiring of Charles Nemeroff,MD.
I am deeply troubled by UMs response emphasizing its " unflinching commitment to scientific integrity."
Whom are they kidding? It sets a bad example for medical students, researchers and residents at the University of Miami who are supposed to learn medical ethics and professional conduct from their teachers. Does the UM administration really believe that Nemeroff's transfer to Miami constitutes a clean slate to continue his work for the NIH? I hope not.
I am grateful that someone is calling it what it is: hypocrisy on steroids.


Senator tells University of Miami he's `troubled' over hiring


Sen. Charles Grassley has written a strongly worded letter to University of Miami President Donna Shalala saying he is ``disturbed'' and ``troubled'' by actions surrounding UM's hiring of a psychiatrist-researcher under investigation by a federal agency.
The letter from the Iowa Republican, dated Monday, was sparked by a Sunday story in The Chronicle of Higher Education about the relationship between psychiatrist Charles Nemeroff, now head of UM's department of psychiatry, and Thomas R. Insel, director of the National Institute of Mental Health, who led a yearlong project to toughen policies against conflict of interest.

On Wednesday, UM issued a brief statement: ``The University of Miami is responding to the inquiry from Senator Grassley and will continue demonstrating its unflinching commitment to scientific integrity. UM works tirelessly to advance the quality of its teaching, research, and clinical care programs while maintaining the highest ethical standards in all that we do.''

The National Institute of Health said Insel was unavailable for comment.

Grassley and his staff have been investigating Nemeroff, once head of psychiatry at Emory University in Atlanta, because he received millions of dollars from drug companies while doing what was supposed to be impartial research for the National Institutes of Health on drugs made by the companies paying him.

Grassley reported Nemeroff received $2.8 million from GlaxoSmithKline and other drug makers over seven years for promoting drugs like GSK's Paxil. Emory eventually asked him to step down as head of psychiatry and suspended his work on major NIH grants.


The Chronicle story said Insel ``quietly helped'' Nemeroff get hired at UM.

In summer 2009, when UM was thinking of hiring Nemeroff, Medical School Dean Pascal Goldschmidt e-mailed Insel saying that Nemeroff had said Insel would be able to provide a ``confidential opinion'' on him, according to documents released by the Senate Finance Committee.

Insel responded that he could not provide a formal, written recommendation because of NIH rules, but ``I can discuss informally by phone. Happy to do this,'' he wrote in an e-mail.

Goldschmidt told The Herald last fall that he thought Nemeroff was a talented researcher but didn't want to hire him if he couldn't get NIH funding.

The Chronicle article quotes Goldschmidt as saying Insel assured him that the Emory ban on Nemeroff's NIH grant activity for two years didn't carry over to Miami, and that Nemeroff would be able to apply for NIH funding as soon as he took his new job.

Goldschmidt was quoted in the Chronicle as saying that the Emory ban on Nemeroff's grant activities was due to ``political pressure that the university was under.''


In Monday's letter, Grassley wrote that he was ``troubled'' by that comment.

``President Shalala, I hope that you would agree -- contrary to Dr. Goldschmidt's views that disciplining researchers for failing to disclose conflicts of interest is merely a political issue -- that enforcing federal conflict of interest policy involves ethical and legal issues that ensure taxpayer trust.''

Grassley demanded Shalala produce five types of documents concerning Nemeroff, UM and NIH grants.

In last fall's Herald story, Goldschmidt called Nemeroff ``an exceptional psychiatrist and an exceptional scientist who has one issue in which he recognizes he made a mistake,'' by not informing Emory how much he received from pharmaceutical companies.

In March, UM started a transparent process, in which outside companies' pay to UM doctors is now listed on a website. Nemeroff is not listed there because the information concerns the period before he started last fall, the university has said.

Nemeroff told The Herald last fall that he decided in retrospect he should have declared drug makers' payments to him, but he thought Emory's regulations didn't require it.

The Chronicle article includes e-mails, also obtained by The Herald, indicating that Nemeroff and Insel were trying to get together at conventions and had each other's cell phone numbers.

When Nemeroff e-mailed Insel that he was taking the UM job, Insel wrote back: ``Congrats on a new position! Should be a new beginning.''

Insel told The Washington Post on Tuesday that he didn't have ``any great relationship'' with Nemeroff, and believed the psychiatrist's actions were ``so outrageous, he became the poster boy for conflict of interest.''

On Wednesday, Bernard Carroll, former head of psychiatry at Duke University and once Nemeroff's boss, told The Herald that he found Insel's comments to the Post ``disingenuous'' because the two have known each other since the early 1990s and Nemeroff helped Insel find a job at Emory.

Read more:

Conservative Cheerleaders


Letter To The Editor

RE: Conservatism's cool, Miami Herald 06/12/2010

Nicholas Rohrhoff, Chairman of the Medical Student Section of the FloridaMedical Association claims that young people should evaluate conservative principles, including limited government.

Well,he may be unaware that many of his peers, including medial students like him at the University of Miami, significantly benefit from government intervention into medical education.

For example, many students rely on government subsidized loans to finance their education. He also seems to forget that most physician training is subsidized by the federal government.Today less than 5 percent of medical school revenues comes from tuition and fees. Instead, medical schools rely heavily on federal and state support. Once medical students receive their degree they continue with their Graduate Medical Education, i.e. residency or specialty training. The largest source of funding for graduate medical education is the federal Medicare program, which reimburses teaching hospitals for both the direct cost of operating these programs. Florida’s Medicaid program also provides funding to graduate medical education.

I hope that he appreciates that having received government funding and subsidies for his medical education and training he is also guaranteed a much higher earning potential than many other Americans. But may be not, because now he wants lower taxes too!

I really have a hard time to understand this conservative hypocrisy. For me its nothing else but an expression of egocentric individualism. So, please try your best and be a good doctor but stay away from political cheerleading.

Bernd Wollschlaeger,MD,FAAFP,FASAM

16899 NE 15thAvenue ,North Miami Beach, FL 33162

Phone: 305-940-8717

Conservatism's cool

In mid-term elections, voter turnout defines success. To win, it is imperative to target likely voters and mobilize sympathetic yet diffident constituencies to the polls. Barack Obama's successful courtship of young voters in 2008 cast John McCain's GOP as the party of yesterday -- a group of old, white men out of touch with an increasingly diverse and engaged youth -- never to regain electoral clout.

This was not a triumph in the battle of ideas.

Because the adolescent prerequisite of peer affirmation to consider anything persists in this age group, conservative policies were not even entertained by many young voters as potential solutions to America's problems.

The Obama campaign manipulated this phenomenon brilliantly by wooing young voters not with policy prescriptions but retail politics. Before the Iowa caucuses, he skipped an AARP event to attend a hip-hop concert. And he was far ahead of other candidates in high-tech outreach through e-mail, YouTube and social networking media. The results were a 135-percent increase in the Democratic youth vote from 2004 and an electoral prize that set him on a trajectory to the White House.

In the general election Obama was the candidate with whom young voters would rather have a beer. Reporters who covered both campaigns marveled at how many more young volunteers the Obama campaign had at the ready. Supporting him became the cool thing to do.

His personal appeal to the demographic drew them to his party. Gallup Poll data indicate that in 2000, 36 percent of young voters identified themselves as Democrats and 35 percent as Republicans. In 2008, 45 percent in that age group indicated affiliation with the Democratic Party -- only 26 percent with Republicans.

This support extended from politics to policy. The same poll reported 69 percent of young voters said the government should do more to solve problems whereas only 27 percent said government does too much. In both style and substance, conservatives had lost touch with the next generation of Americans.

How then to make conservatism cool again? Enter former Florida House Speaker and current Republican candidate for U.S. Senate Marco Rubio. It is reasonable to suggest that Rubio would not want to collect votes based on the perception that he is the coolest candidate. He is, by all accounts, a serious policy person. His book, 100 Innovative Ideas for Florida's Future, was accompanied by ``idea-raisers'' held across the state where citizens could contribute their views.

Appearing a decade younger than his 38 years as he effortlessly transitions from English to Spanish and back, he plays flag football and is married to a former Miami Dolphins cheerleader.

When asked recently about the notion that he was the Republican Obama, referring to the president's recent slide in the polls, he quipped, ``I'm not sure people even want to be the Democrat Obama these days.''

Still, he would win any poll -- in a landslide -- on which candidate young voters would most like to join for a beer.

Yet his distaste for identity politics is clear: He defines himself simply as a conduit to advance a set of ideas that has made this country the greatest in the history of the world. In a less Herculean task but one of no less consequence, he could serve as the catalyst to broaden the appeal of conservatism to incipient voters.

Rubio seeks election to the U.S. Senate to stand up to the Obama agenda and offer a clear alternative. A Harvard Institute of Politics poll released in March suggests there is an opportunity to persuade young voters with that platform. Only 38 percent of young people approve of President Obama's handling of the deficit and a majority disapprove of his management of the economy (51 percent) and healthcare (53 percent).

Most telling, just 14 percent of those polled attending a four-year college believe that it will be easy to find a job after graduation.

In 2008, voters under 30 made up 14 percent of Florida's electorate. Gov. Charlie Crist's decision to run as an independent amplifies the importance of each of those votes. Though young people are unlikely to vote in mid-term elections, in this three-way race they could be decisive. Rubio trails Crist in a recent St. Petersburg Times/Miami Herald/Bay News 9 poll by just 3 points.

Rubio has been presented as a plausible counterweight to the president for many reasons -- the most significant comparison may manifest in the electoral etiology of his meteoric rise. An aggressive approach will lead young people to evaluate conservative principles -- limited government, low taxes, and boundless opportunity -- on the merits.

If his overtures succeed, a statewide electoral victory propelled by young voters could begin a movement that energizes, modernizes and unifies the Republican Party before returning them to power in Washington.

Nicholas J. Rohrhoff is chairman of the Medical Student Section of the Florida Medical Association and a student at the University of Miami School of Medicine.