Monday, March 28, 2011

Pill Mill Issue

Attached a link to an article reporting that Gov. Rick Scott on Monday launched his own initiative to fight the problem. At a news conference where he was flanked by Attorney General Pam Bondi and a handful of law enforcement officers, Scott announced a statewide drug trafficking "strike force." Florida Department of Law Enforcement Commissioner Gerald Bailey will lead the effort, coordinating with local law enforcement agencies. Scott directed the FDLE to use $800,000 in unspent federal grant money to help pay for overtime and other costs associated with the effort. State Senator Fasano, a strong supporter of the Prescription Drug Monitoring Program, said he found it curious that the governor was able to come up with $800,000 for the law enforcement effort but not for the database. AG Bondi, who supports the database, acknowledged that she and the governor have a difference of opinion. But she praised the governor for taking action on the law enforcement front. "We need more tools for all these people standing behind us," she said. Later, Bondi said she considers the database one of those "essential" tools.
Further legislative update regarding the PDMP:
The state House of Representatives, at the urging of Speaker Dean Cannon, has proposed eliminating the database. But Senate President Mike Haridopolos has said that proposal won't make it through his chamber. In fact, fellow Republican Sen. Rene Garcia got nowhere in a Senate committee Monday with a bill amendment that would have killed the database. The amendment was dropped without even being put up for a vote.


Sunday, March 27, 2011

Florida gets the profits, Kentucky gets the problem

“We’ve got more people dying of prescription drug overdoses than car accidents,’’
U.S. Rep Hal Rogers.

Attached a link to a great article published in today's Miami Herald again focusing on the unresolved pill mill issue in Florida.
The sobering facts speak for themselves:

* As far back as 2002, early in the epidemic, one fourth of all OxyContin-related deaths in the country took place in eastern Kentucky.
* According to a study by the Substance Abuse and Mental Health Services Administration, there was a fourfold increase nationally in treatment admissions for prescription pain pill abuse during the past decade. The increase spans every age, gender, race, ethnicity, education, employment level and region. Nearly every family in eastern Kentucky has been touched by prescription-drug addiction and death.
* In Kentucky some harbor a deep resentment at Florida’s unwillingness to crack down on pill sales, for instance, at its refusal to set up a prescription database similar to those in other states to ensure that customers are not “doctor shopping’’ – scooping up some pills here, more pills there – by dealing with multiple physicians.

Meanwhile, dozens of people die every day in Florida and Kentucky but Governor Rick Scott and many of his political friends are stonewalling.



Thursday, March 24, 2011

Bad Medicine

Why opting out of health care reform is a bad choice?

In an excellent editorial published in the Miami Herald Steven Marcus, President and CEO of Health Foundation of South Florida, points out that:

“ Florida has a healthcare crisis — and we need to do something. The law is not perfect but it is a giant step in the right direction. The protections under the Affordable Care Act move us forward to a time when citizens won’t have to wait until they are so sick that they have to go to emergency rooms for the most expensive care. Rather, they will have coverage to go to a family or primary-care doctor. But before anyone looks forward to a healthier Florida and nation, here’s a dose of reality: The benefits from consumer protections increasingly are at risk of being taken away. The actions of many of Florida’s elected officials reflect a lack of concern for thousands of our low-wage workers and other citizens who will go without care and instead declare personal bankruptcy over a medical emergency. This leads to community bankruptcy for unpaid, expensive medical and hospital bills. Is this what Floridians deserve? I don’t think so. Let’s get behind this law and tell our officials to do the same, it will attract businesses and jobs to Florida by reducing costs that are dragging down our economy. Let Florida join the other states in planning by taking the federal money offered to create a brighter and healthier future for all Floridians.”

By blocking and stalling the implementation of the entire healthcare reform package the political leadership in Tallahassee jeopardizes the access to healthcare to four million uninsured residents in Florida. This rigid and ideologically misguided attitude will hurt the business of medicine in Florida, too. Recognizing this problem, Michael W. Garner, president and CEO of the Florida Association of Health Plans, said that Florida should pass bills to keep aspects of its health insurance market in state control, instead of letting the federal government regulate the market under the Patient Protection and Affordable Care Act (PPACA). He is correct stating that health insurance companies in Florida will have to struggle to meet the federal guidelines and standards set forth by the PPACA. It is obvious that Governor Rick Scott's ideologically driven policy is not only bad for our health but also bad medicine for big business in Florida.


Monday, March 14, 2011

Florida is Open for (Drug) Business

Attached a link to a Miami Herald article from Friday, March 11th  reporting that with little debate Thursday morning, the House health and human services committee voted to eliminate the state’s plan for prescription drug monitoring database.Before the vote to eliminate the database, the committee passed a bill that would prohibit doctors from dispensing narcotics, making the drugs largely available only at pharmacies. It would  would require wholesale distributors of narcotics to report who they are selling the drugs to so law enforcement officials can identify unusually large purchases. The bill calls for appropriating $1.5 million to track down the large, non-pharmacy dispensaries and return the drugs to wholesalers.
Our legislators also decided to eliminate registration and inspection of pain clinics, and a ban on felons owning pain clinics.
Obviously, the committee chairman,Robert Schenck (R-Spring Hill) and his fellow legislators believe that our already burdened law enforcement officers will do a better job to crack down on drug dealers in white coat and the OxyCartel. But even Broward County Sheriff Al Lamberti pointed out that we cannot arrest ourselves out of the problem! Meanwhile, the drug dealers can rest assured that Florida is wide open for their business and that no one will bother them anymore to ask for clinic registration or  physician ownership verification. Maybe we should post a sign at the state border: Felons welcome!
Something is rotten in the state of Florida.

Tuesday, March 08, 2011

DOH wins PDMP Bid Protest

Attached you find a link to the Recommended Order by an Administrative Law Judge regarding the Prescription Drug Monitoring Program (PDMP) bid protest.
Let me explain briefly the circumstances for or those who may not know all the details:
The Department of Health (DOH) issued a Request for Proposals (RFP) for companies interested in bidding for the PDMP contract. The loosing bidder (Optimum Technology ) protested TWICE the DOH decision to award the contract to a competitor (Health Information Design).
An administrative law judge recommended today that the DOH enter a final order dismissing the Formal Written Protest.
That means the DOH WON the bid protest and may move ahead with the PDMP implementation.
I would expect that the DOH follows state law, awards the contract and moves to implement the PDMP. The only obstacles are the Legislature and the Governor who at this point in time defy state law!

Sunday, March 06, 2011

Pill Mill and PDMP Issue

In the last 2 days a series of articles were published in the Miami Herald and Sun Sentinel focusing on the "pill mill" and PDMP repeal issue.
I am hopeful that the heightened publicity will put pressure on our legislators to act.

Drug monitoring program worth saving, By Al Lamberti and Marcelo Llorente
Read more:,0,2826266.story

"On behalf of Floridians, we are pleading with Gov. Scott, Attorney General Bondi and legislative leaders not to sacrifice vital initiatives such as the PDMP in an effort to achieve a balanced budget. Too many lives are at risk, and the consequences are too great to eliminate the PDMP."

Sons and daughters, lost to a pill epidemic FRONT PAGE STORY
Read more:

Florida pill mills: Different drugs, same faces

"Felons can’t get a license in Florida as a pest-control operator. Colangelo can’t be a private detective or paramedic or title insurance agent or bail bondsman or labor union business agent. He can forget about employment with the Florida Lottery. Or qualifying as a notary.
“In Florida, this guy couldn’t own a liquor store,” said Broward Sheriff Al Lamberti. Yet according to the DEA, Vincent Colangelo, who couldn’t kill bugs, serve cocktails or tail a cheating husband, could operate seven pain clinics and a pharmacy in Broward and Miami-Dade counties. His pill mills peddled more than 660,000 doses of oxycodone in just two years. The feds calculated Vinny’s proceeds at $22,392,391."

Drug epidemic: Monitoring program a necessity, by Bruce Grant,0,6995046.story

"It's time to quit posturing and doing nothing while people die. If there is a better solution to the monitoring program, then let's hear it. Currently, 38 other states have an operational program, and another five have passed the law and are awaiting implementation. What do they know that we don't? Worse yet, Florida now has other states chastising us over our deadly inaction.
Florida must implement the monitoring program now. It is the single most-effective mechanism we have to stop the epidemic of prescription drug abuse. Inaction on the program or its repeal is an option that would only result in further deaths, greater human suffering, and tremendous human and economic costs we cannot afford. Let's put aside rhetoric and put this program into operation. Lives depend on it."

Friday, March 04, 2011

Florida Judge Stays Ruling

In a surprising move judge Roger Vinson stayed his own ruling against the ENTIRE new health care law. This is essentially a suspension of the judge's order to hold the implementation of the Patient Protection and Affordable Care pending appeals. As a result, Governor Sean Parnell of Alaska, a Republican who announced last month that his state would not put in effect the health law in light of Judge Vinson’s ruling, said Thursday that “our administration will treat the federal health care law as being in place.” Consequently, Governor Rick Scott should follow suit and immediately rescind his decision to withhold implementation of the federal health care law. Otherwise, Floridians will NOT be able to benefit from the services the law does offer. This includes the:

* Ban on withholding insurance due to pre-existing conditions
* $50 million dollar fund to help states experiment with alternatives of medical liability
* One percent Medicare bonus for physicians who are reporting health quality-outcomes using
a health information technology platform

Now is the time to act! I hope he does.

For more information see

Thursday, March 03, 2011

Health Department Faces Deep Cuts

Attached an article from today's Miami Herald highlighting that a Health Department report calls for cutting 1,608 department jobs and for the state to stop paying for primary-care services at county health departments. The proposal would save about $22.3 million and comes as some state officials want to rely more on federally qualified health centers to provide primary care. That's odd: one the one hand the current administration in Tallahassee refuses to implement the Patient Protection and Affordable Care Act citing government intrusion as their biggest concern, BUT on the other hand they have no problems to shift the financial responsibility for necessary primary care to the federally qualified and funded health centers! Lawmakers required the department to submit the report by Tuesday, a week before the start of the 2011 legislative session. That would provide time for the Legislature to consider changes this year. Allegedly, the report also calls for the elimination of $4.8 million for AHEC thereby practically gutting the programs. Another proposal calls for lifting the requirement that the health department secretary be a physician.
I guess we are moving full speed backwards.

The Miami Herald
Posted on Wed, Mar. 02, 2011
Fla. Health Department may cut 1,600 jobs

By Jim Saunders
Health News Florida
TALLAHASSEE — Under fire from lawmakers, the Florida Department of Health has proposed a sweeping plan to reorganize --- and shrink -- its operations. Among other things, it would move the state out of the primary-care business.

The recommendations, released in a 154-page report late Tuesday, call for cutting 1,608 department jobs and consolidating dozens of divisions and bureaus. One of the proposals would buck the powerful doctors' lobby by lifting a requirement that the department secretary be a physician.

The reorganization would lead to many department duties being shifted to other state agencies, privatized or eliminated altogether.

In one major change, the report calls for the state to stop paying for primary-care services at county health departments. The proposal would save about $22.3 million and comes as some state officials want to rely more on federally qualified health centers to provide primary care.

In another big change, the report calls for contracting with a private company to run at least part of the Children's Medical Services program. CMS serves children who have a variety of serious medical conditions.

State lawmakers last year required the department to conduct a review of its operations and come up with recommendations for possible changes. House leaders, in particular, have been highly critical of the department, contending that it is unfocused and has taken on too many roles over the years.

While the department worked on the recommendations, new Gov. Rick Scott's transition team also issued a blistering appraisal of the agency. Some transition team recommendations --- such as moving away from primary care and allowing a non-physician to serve as department secretary --- are evident in the report.

But many public-health advocates have worried that changes in the department would go too far. As an example, they expressed repeated concerns last year that changes would gut prevention and education programs.

The report calls for making major changes in the department's organizational chart, going from 11 divisions to six and 50 bureaus to 18. Programs would be moved around to fit under the new framework.

Also, many programs would be moved to other state agencies, including the Department of Children and Families, the Department of Environmental Protection and the Agency for Health Care Administration.

Other programs would be farmed out to private contractors or see their funding disappear. Many of the programs targeted for elimination serve only specific geographic areas of the state.

But some cuts would have broader reach, such as the proposed elimination of $4.8 million for the Area Health Education Centers Network, which is involved in anti-smoking programs. The report says the so-called AHECs could pursue other sources of money.

In all, the report calls for eliminating 1,608 department jobs, though at least 180 would shift to other state agencies. It was not immediately clear how many of the targeted jobs might be vacant.

Lawmakers required the department to submit the report by Tuesday, a week before the start of the 2011 legislative session. That would provide time for the Legislature to consider changes this year.

Scott's transition team went further than the report's recommendations and called for a merger of the department with the Agency for Health Care Administration. Scott administration officials have said the idea is still being considered, though lawmakers have not publicly taken it up.