Saturday, February 26, 2011

The Airline Industry and Patient Safety

Air traffic controllers' errors and Patient Safety:

According to the Associated Press, reports of errors by federal air traffic controllers have doubled last year! Citing the Federal Aviation Administration's official tally, the report says there were 1,889 operation errors in the 12 months ending on Sept. 30, 2010 vs. 947 a year earlier. During the same period in 2009, there were 1008 errors. The FAA says the higher number of reported errors - which usually mean aircraft coming too close together - is due to better reporting and improved technology that can determine more precisely how close planes are in the air. Few of the errors fall into the most serious category, which could result in pilots taking action to prevent an accident, AP says. In the year ending Sept. 30, there were 44 such events vs. 37 in the prior year. At a hearing before the House aviation subcommittee earlier this week, FAA Administrator Randy Babbitt was asked about the rise in error reports. He states that the FAA is seeing more errors partly because a safety program, introduced in 2008, protects controllers from punishment for errors they voluntarily report. The program is receiving about 250 reports a week. Unfortunately, the medical industry does NOT pursue the same error prevention strategy. In the 10 years since publication of the Institute of Medicine’s report “To Err is Human,” extensive efforts have been undertaken to improve patient safety. The question remains: did they succeed? Yes, we are talking about the need for patient safety and physicians have to attend mandated medical error prevention courses. But did we change anything? According to a recent study of 10 North Carolina hospitals published in the New England Journal of Medicine[1], the authors found that harm remain common, with little evidence for widespread improvement. Prescribing errors occurred in 7.6% of outpatient prescriptions and many could have harmed patients.[2] Prescription-error related malpractice lawsuits are the second most frequent and the second most expensive types of suits filed against physicians. But practicing physicians in outpatient settings still do not have access to medical error databases representing the aggregation of voluntary incident reports. The Patient Safety and Quality Improvement Act of 2005 (Patient Safety Act) authorized the creation of PSOs to improve quality and safety by reducing the incidence of events that adversely affect patients but many of those PSO still are not open for incident reporting by primary care physicians in private practice. In 2006, outpatient visits accounted for $850 billion, making it more than 41% of our health care spending but most medical errors occurring in this setting are NOT being reported or registered. Subsequently, billions of dollars are being wasted and thousands of lives are lost every year. So what can we learn from the airline industry? That we should create the FAA equivalent of a Patient Safety Organization authorized to collect ALL medical error incidents which then can be used to educate and guide physician in error prevention strategies. I ask myself why the medical industry and physicians are opposing such a strategy? Our patients deserve an answer!



Thursday, February 24, 2011

Governor Scott and the PDMP: Accusations replace Facts

Unfortunately, Governor Scott pulls out all the stops to attack the supporters of the PDMP including the PDMP Foundation.
These are indeed groundless accusations without factual evidence to support the arguments made.

Excerpt from the article above:

Gov. Rick Scott is inventing another excuse for opposing a statewide prescription pill database.

Without offering any evidence, the governor this week accused the private foundation that is raising money for the database of wasting donations. "It's come to my attention that thousands of dollars have been spent on lawyers, travel, meals for board members," Gov. Scott told reporters on Tuesday. "I believe it's an invasion of privacy. And right now with that database, it appears that the money's been wasted."

In fact, board members of the Prescription Database Monitoring Program haven't charged a single expense to the foundation. A private company started by the former chairman of the foundation's board has picked up most of the legal expenses. "The first communication from the governor's office to our foundation was a baseless accusation. It's desperate," said foundation Vice Chairman Rene Bruer. He is a financial analyst who worked for the director of Florida's drug control office under Gov. Jeb Bush. "We're rising up above the politics. We just want to deal with the problem."

Excerpt from article above:

Scott's attack on the foundation took Bruer [Vice-Chairman of PDMP Foundation] by surprise, he said.

"We've never ever had anybody from Rick Scott's office ask us questions, join one of our phone calls. Nothing. Ever. There has been no dialogue between us. We welcome that," he said.

The foundation is caught in the middle of a political battle of wills, Bruer said.

"The PMDP Foundation is not here to play political ping-pong. We're strictly here to look at the overarching issue which is people dying from prescription drug abuse and doing what we can within the letter of the law to make sure that one of Florida's worst public health epidemics is dealt with," he said.

Wednesday, February 23, 2011

The Tip of the Iceberg

Attached an article from today's Miami Herald highlighting the arrest of several oxycontin dealers, wrongly called "doctors", Unfortunately, they represent just a tiny sample of the hundreds of drug dealers in white coat in South Florida who make millions in ill-gotten profits.
Meanwhile, the Oxy-Cartels are reinventing their business model and open "life style enhancement" and " wellness" clinics.
We have to stop them now!

The Miami Herald
Posted on Wed, Feb. 23, 2011
Pill-mill arrests hit right target: doctors

Fred Grimm
Law enforcement tested a promising antidote for Florida’s oxy epidemic Wednesday – doctors in handcuffs.

Arrests of so many drug-addled users and low-rent street dealers hardly matters. Not compared to that ignominious image of Dr. Zvi Harry Perper led out of a “pain management clinic” in Delray Beach Wednesday. That stuck at the very nub of the pill-mill industry. In tan scrubs and steel cuffs. Dr. Perper on a perp walk.

Fifteen pill mills were raided in Broward, Miami-Dade and Palm Beach counties. A few oxy street dealers and a handful of clinic employees were arrested, all replaceable entities in the pill-mill business model. But five doctors were busted. Seven others “voluntarily” surrendered their federal license to prescribe narcotic medicines. Doctors, cranking out oxycodone prescriptions for phantom pain and fake injuries, are the essential elements.

While a doctor may be a crucial to a pill mill, actual doctoring is just a bother. Undercover agents, posing as patients, were prescribed hundreds of oxycodone pills without so much as an examination by Dr. Jeffrey Lipman at Midtown Pain Management in Miami-Dade, according to Lipman’s arrest warrant.

It was easy to see why the DEA might have been suspicious of Lipman’s bedside manner. In the first six months of 2010, he ordered up 288,560 oxy pills for his patients. (There are more prolific oxy docs in the United States. All 39 of them work out of South Florida pill mills.)

The agents told the doc of prior drug abuse and taking oxy with alcohol. They described only minimal pain. In Dr. Lipman’s waiting room, another patient, who said he planned to sell his pills in North Carolina, asked an agent (who he thought was from Tennessee), “How easy was it to sell up there?” The doctor even discussed the “street value” of the oxy he was dispensing with the undercover agents. He figured $8 to $16 a pill.

Medical experts cited in the arrest warrant described Lipman’s clinic as “consistent with those of the usual pill mill, where cash is the only form of payment, patients often travel from long distances and sell prescribed controlled substances , physical examinations are not performed . . . and controlled substances are prescribed in excessive dosages and potentially fatal combinations.”

The raids came the day after Gov. Rick Scott reiterated his fervent, ideological opposition to a drug database, designed to prevent oxy shoppers from filling multiple prescriptions, moving from one pill mill to another – circumstances captured nicely by the pain clinics raided Wednesday.

The warrants noted how the pill mills flourish in Florida with minimal regulations, without the tracking system used in most states. “Consequently, individuals have been able to obtain unlimited and unmonitored quantities of controlled substances from multiple pain clinics for either personal consumption or resale in Florida and elsewhere.”

The raids only reinforced the notion, widely held by law enforcement and most of the state’s medical associations, that without a monitoring system, Florida invites criminal operations in the guise of medical clinics.

But after Wednesday, the pill mill industry will be forced to limp along with a dozen fewer doctors.

© 2011 Miami Herald Media Company. All Rights Reserved.

Read more:

Sunday, February 13, 2011

The Stubborn Rejection of Common Sense

Rick Scotts decision to derail the Prescription Drug Monitoring Program (PDMP) is either based on ideological rigidity, or plain simple ignorance.

The attached articles and editorials clearly highlight the absolute necessity to declare a public health emergency and to implement the PDMP immediately!

1. More babies born addicted to pain drugs

a. In 2009, nearly 1,000 babies born in Florida hospitals were treated for drug withdrawal syndrome. The most recent data show no signs of a slowdown. During the first half of 2010, 635 cases were reported.

b. From 2006 to 2009, there was a 173 percent increase in newborns treated at Florida hospitals for drug withdrawal syndrome, according to Agency of Health Care Administration records obtained by the Orlando Sentinel.

2. Why does Gov. Scott oppose Florida prescription drug database?

a. “Scott's move to scrap a prescription narcotic database intended to temper the excesses of South Florida's rogue pain clinics makes no sense. Unless the governor somehow likes the drug tourism, overdoses and other human wreckage spawned by our pill-friendly culture. If it's not government's role to monitor controlled substances, then why bother monitoring anything? Let's just do away with driver's licenses, vehicle registrations and concealed weapons permits too, since cars and guns are legal. The database had support from just about everyone — legislators, law enforcement, responsible doctors and pharmacists and legitimate pain clinics.”

3. Pill mills: Scott, legislators undermining efforts, by Mike Fasano and Nan Rich,0,3980383.story

a. “Legislature is essentially allowing unneeded deaths to continue. It is, therefore, imperative that the legislature get out of the business of approving rules for bills that it has already passed. In the case of the Board of Medicine's rules, lives are at stake. Finally, the governor has eliminated the Office of Drug Control, which provides an important focus on the problem of drug abuse, and coordinates the numerous state agencies affected by this issue. State agencies across the board must deal directly or indirectly with the consequences of drug abuse, including our courts, law enforcement, prisons, foster care system, Veterans' Administration, health departments, mental health programs and even port security agencies. That's why the work of the ODC to coordinate the drug control efforts of each of these agencies is imperative, and why we're disappointed to see Gov. Scott unilaterally shut down this agency by laying off its entire staff. We therefore hope our legislative colleagues will consider taking immediate action to put our tough new pill mill regulations into action, and that the governor will put the Office of Drug Control back to work, and preserve the Prescription Drug Monitoring Program. This issue isn't about bureaucracy or the size of government — it's literally a matter of life and death.”

We should not ponder the question why our new Governor is not getting it. Instead, we should take action and develop a collaborative network of allies and supporters across the political spectrum to push back. Now its time to act! You can follow me on Twitter or at

Yours truly,

Bernd Wollschlaeger.MD

Tuesday, February 08, 2011

Governor Scott and the PDMP

Governor Scott and the PDMP:

The Governors proposal to eliminate the Prescription Drug Monitoring Program (PDMP) surprised many supporters of this project. Currently, the PDMP implementation has been stalled by a protest from a software company, which bid for the contract and lost.

The PDMP would require doctors and pharmacies to enter and report each and every prescription for controlled substances. With the help of the database healthcare professionals and, under very restricted and monitored circumstances, the police could then crosscheck the database for anyone who has received multiple prescriptions of narcotic drugs from multiple sources, a common practice among addicts and drug dealers who amass large quantities of drugs from so-called “pain clinics.”

The law establishing the PDMP clearly stipulated that it to be financed without tax dollars. It would be run with more than $500,000 raised from drug makers, foundations and federal grants, which would have to be returned.

Without a functioning PDMP unscrupulous pill-mill owners and their drug dealer cronies in white coat can obscure and conceal the dispensation of millions of prescription narcotics taking place behind the pain-mill walls.

Governor Scott argues, "That program has not been working," even though is has yet to be implemented! The fact that NO tax dollars have been or will be used for developing and deploying the PDMP one is left to ponder the question what is driving our Governor to make such a foolish decision?

The reason is clear: ideological blinders prevent him from realizing that seven (7) Floridians die every day from prescription narcotic overdose. He firmly believes that government can do only harm and that regulations will prevent business to thrive and prosper. That includes drug dealers, fraudsters and thieves too!!

The time has come to stand up and speak up. We cannot allow him to dismantle the product of years of hard work. Lets not waste this opportunity to protect our public health and safety.

Yours truly,


Saturday, February 05, 2011

The Governors Wrong Move(s)

The Governors Wrong Moves (s) :

An editorial published in today’s Miami Herald points out that the Governor has turned down two federal grants that would start paving the way for consumer choices as part of the federal healthcare law. Mr. Scott is using a federal judge's recent ruling in Pensacola to make his case that the new law is unconstitutional, and therefore the federal money isn't needed. This includes a $1 million grant that would help consumers comparison shop for health plans and another $1 million grant for consumers to monitor insurance-rate changes to see how their premiums are spent. Our Governor seems to be so blinded by ideology that even reasonable approaches appear unacceptable for him! But he does not stop there! John Dorschner reports in an article published in today’s Miami Herald that healthcare advisors to Gov. Rick Scott have recommended that tax dollars, now focused almost entirely on government-own hospitals, include more money for private hospitals that provide care for the poor and uninsured. That may further aggravate the already dire financial conditions of cash-strapped public hospitals. In addition the end of the economic stimulus funds from the Obama administration has reduced payments to the Lower Income Pool, a fund for hospitals that serve large numbers of uninsured patients and those on Medicaid, the state-federal health insurance for the poor. LIP funds are a complicated mechanism in which public hospitals have to transfer tens of millions of dollars to Tallahassee before getting funds back. Now Florida may not be entitled to any LIP funds at all next year because it's in violation of a federal waiver in which it promised to spread Medicaid reform statewide -- something the state has yet to do and Governor Scott continues to resist! The waiver issue jeopardizes the receipt of $1.9 billion in healthcare funds that flow into the state through LIP and a sister program. Is our Governor going to deprive our State of these urgently needed funds too?
I am afraid he is digging in, ready to fight against our own best interests.


Friday, February 04, 2011

AG Bondi and Pill Mills

During a news conference in Panama City today Florida Attorney General Pam Bondi outlined her strategy to address the pain clinic issue and related prescription drug abuse. She announced four recommendations:

A mandatory six-month suspension and $10,000 fine for doctors who violate standards of care when prescribing controlled substances.

A third-degree felony charge for those who use fraud or misrepresentation to register as a pain clinic.

Escalating criminal penalties for doctors who fail to perform a physical examination before dispensing 72-hours worth of controlled substances.

Require anyone maintaining an inventory of controlled substances to report the discovery of theft to local law enforcement or the Florida Department of Law Enforcement within 48 hours or risk fines and administrative penalties.

She also called for strict enforcement of current laws and aggressive prosecution of violators.
I applaud AG Bondi for her efforts but prosecution and regulations alone won't solve the issue.
State Attorney Glenn Hess (Panama City) is correct stating that the penalties might not discourage the doctors because of the affluence of the doctors and the substantial($$$$$) profits they stand to make dispensing the pills. This explains why the number of registered pain clinics statewide increased to 932 , but police say many violators are unregistered. The Florida Department of Law Enforcement counts 1,167 "pill mills" in the state.
Vague language will also make some of the recommendations difficult to prosecute. Defining “standards of care” and a “physical exam” then showing how a doctor violated those requirements before writing a prescription will be a challenge.
AG Bondi omitted mentioning the most important linchpin of a successful strategy: a Prescription Drug Monitoring Program (PDMP) which can provide a valuable tool for physician to identify doctor shoppers and to safely prescribe narcotics to patients who often do not disclose other source of prescription drugs. The PDMP implementation is currently stalled due to a contested bid. Shortly after Statute 893.055 , which mandates the creation of the PDMP, was passed in early 2009, the Department of Health opened bidding on the contract to create the Prescription Drug Monitoring Program. When bidding closed this summer, the losing bidder contested the winner, and the DoH opened bidding again. The same loser, Optimum Technology, lodged another complaint -- this one about the terms of the bidding themselves. Which means construction of the database has yet to get underway. Meanwhile, seven Floridians die every day from a prescription drug overdose, 49 per week, 200 per month.
AG Bondi could resolve this issue by declaring a public health emergency, thereby enforcing the immediate implementation of the PDMP.
I hope she will listen and we should ask her to show the courage to make this decision.



Bernd Wollschlaeger,MD,FAAFP,FASAM

Wednesday, February 02, 2011

Florida Shuts Down the Implementation of the PPACA

Florida's political leadership has decided that they know best whats good for Florida's citizen and shut down the implementation of the Patient Protection and Affordable Care Act (PPACA). Normally, under the Federal Rules of Civil Procedure, a judge’s ruling cannot be enforced for 14 days after entry of judgment. Obviously, other rules apply in Florida. So what is going to happen now? Well, insurance companies can rescind policies, reintroduce life-time insurance limits, deny coverage for children. Sounds like a Brave New World to me. For more information see

Florida Health Grades

Attached links to two articles which made me feel ashamed being a Floridian. Why do our elected officials wage their ideological battles on the back of those in need. Its clear to me who will loose: our children and the most needy in our state.

* "Florida Official sends back $1M " reporting that state Insurance Commissioner Kevin McCarty said Tuesday he will forfeit a $1 million federal grant that was supposed to go toward beefing up oversight of health-insurance rates.McCarty's disclosed the decision to give up the $1 million grant during the conference call and also sent a letter Tuesday to a top federal health official. The Office of Insurance Regulation was awarded the grant last year to hire workers and upgrade technology. McCarty gave a brief explanation for his decision, saying he was concerned about intrusiveness of the federal government. He also pointed to a Pensacola judge's ruling. He did not give any indication whether Gov. Rick Scott influenced the move, though Scott said earlier in the day that the state will not spend much time or money carrying out the law until court challenges are resolved. Tuesday's decision was not the first time Florida has foregone federal funding that could help carry out the law. The state did not apply last year for money in what is known as the "Consumer Assistance Program" --- which is designed to help people with insurance decisions and information. Goodhue said that program could have provided $2 million to Florida, which was one of about 15 states that did not receive a grant. It also is unclear whether the state Agency for Health Care Administration will apply for a newly available grant to prepare for creating a health-insurance exchange, which would provide a sort of marketplace where consumers could shop for coverage. AHCA did not respond to repeated questions during the past two weeks from Health News Florida about whether it would apply for the exchange grant. Late Tuesday afternoon, AHCA referred all questions about the federal health law to the governor's office, which did not return a phone call.
* "Uninsured kids propel Florida's low health care rating" It's a good thing for Texas, Arizona, Mississippi and Nevada.
Without those states' abysmal child health systems, Florida's would rank last in the nation, according to a new analysis Read the complete study compiled by the Washington-based Commonwealth Fund. Still, at 47th overall, the Sunshine State's efforts to ensure that children receive timely, effective health care fall far short of the national standard. The group's report card included all 50 states as well as the District of Columbia. Individual state scores were based on 20 health indicators. They include a state's insurance coverage rates, typical premium costs to families, the percentage of children who see a regular doctor, infant mortality rates and childhood obesity statistics. Insurance rates depended not only on geography but also race: Florida's uninsured rate of more than 20 percent among black children was the highest in the country, according to the report. Florida's low ranking was driven by its high rate of uninsured children, said Cathy Schoen, one of the report's authors. The state's 17.8 percent was second only to Texas, with 18 percent. Both states could dramatically lower their uninsured rates if they raised the maximum a family could earn to be eligible for Medicaid and the Children's Health Insurance Program, Schoen said. Both cap incomes at up to 200 percent of the federal poverty level, or $44,100 for a family of four. How Florida's children rank vs. nation
50th - Percentage of insured children
51st - Percentage of children with a preventive dental visit in past year
15th - Percentage of young children receiving all doses of six key vaccines
35th - Percentage of children aged 10-17 overweight or obese
32nd - Infant mortality rate
0 - Rankings among 20 indicators in which Florida is in top 5