Reform Medicaid to maintain access:
Re the April 21st letter http://www.miamiherald.com/2011/04/20/2177745/reform-medicaid-to-maintain-access.html by Michael Garner, President and CEO,Florida Association of Health Plans. Mr. Garner claims that for-profit managed care companies will contain Florida's rising Medicaid costs by care coordination and quality improvement.
But a recently published study of the managed care pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties concluded that there is insufficient evidence to verify claims of cost savings. The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered. For example, Massachusetts is trying to contain rising health care costs by supporting the development of accountable care organizations (ACO's). These are networks of physicians, practices and hospitals that will share in any cost savings they generate by better coordinating and integrating patient care without adding unnecessary administrative overhead generated by managed-care companies. Geisinger Health Systems in Pennsylvania is using its networks to try out a model similar to patient-centered medical homes and high-risk care management programs. Sutter Health in California has focused on engaging its doctors on quality and efficiency programs. Before we turn over billions of dollars to private for-profit managed care companies we should seriously explore other methods and modalities to contain health care cost, improve the quality of care and to maintain access to medical services for all of those in need.
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com
Friday, April 22, 2011
Thursday, April 21, 2011
The Valentine's Day controversy
It's Time For An Attitude Adjustment
According to a recent New York Times article the president-elect of the American College of Surgeons resigned his position Sunday after weeks of controversy surrounding a Valentine’s Day editorial he wrote touting the mood-enhancing effects of semen on women during unprotected sex. Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; the entire issue of the newspaper was withdrawn. He is an emeritus professor of surgery at the University of Michigan School of Medicine. The editorial cited research that found that female college students who had had unprotected sex were less depressed than those whose partners used condoms. It speculated that compounds in semen have antidepressant effects.
Dr. Colleen Brophy, a professor of surgery at Vanderbilt University, submitted a letter of resignation from the surgery association during the controversy and said Sunday that she had no intention of reversing herself now that Dr. Greenfield has resigned. “The editorial was just a symptom of a much larger problem,” Dr. Brophy said. “The way the college is set up right now is for the sake of the leadership instead of patients.”
I hope that members of our profession distance themselves from those who still believe that their professional status renders them immune to public criticism. The change of attitudes within our profession must progress by large jumps instead of small increments.
Yours
Bernd
According to a recent New York Times article the president-elect of the American College of Surgeons resigned his position Sunday after weeks of controversy surrounding a Valentine’s Day editorial he wrote touting the mood-enhancing effects of semen on women during unprotected sex. Dr. Greenfield, 78, was the editor in chief of Surgery News when the editorial was published but resigned that position in the wake of the controversy; the entire issue of the newspaper was withdrawn. He is an emeritus professor of surgery at the University of Michigan School of Medicine. The editorial cited research that found that female college students who had had unprotected sex were less depressed than those whose partners used condoms. It speculated that compounds in semen have antidepressant effects.
Dr. Colleen Brophy, a professor of surgery at Vanderbilt University, submitted a letter of resignation from the surgery association during the controversy and said Sunday that she had no intention of reversing herself now that Dr. Greenfield has resigned. “The editorial was just a symptom of a much larger problem,” Dr. Brophy said. “The way the college is set up right now is for the sake of the leadership instead of patients.”
I hope that members of our profession distance themselves from those who still believe that their professional status renders them immune to public criticism. The change of attitudes within our profession must progress by large jumps instead of small increments.
Yours
Bernd
Wednesday, April 20, 2011
Controlled Substances
In an interesting article entitled “US Seeks To Rein in Painkillers” http://www.nytimes.com/2011/04/20/health/20painkiller.html the authors report that the Obama administration seeks legislation requiring doctors to undergo training before being permitted to prescribe powerful painkillers like OxyContin. This appears to be the most aggressive step taken by federal officials to control both the use and abuse of the drugs. Among the drugs that would most probably fall under a stricter licensing measure are OxyContin, fentanyl, hydromorphone and methadone. They are considered critical to pain treatment. But they also have been associated in recent years with a national epidemic of prescription drug abuse and addiction and thousands of overdose-related deaths. Proponents of the training argue that it would help doctors better identify patients who would benefit from treatment with long-acting narcotics, and help them unmask patients feigning pain to get drugs they then abuse. Opponents say a training requirement will reduce the number of doctors prescribing pain drugs and hamper patient care. The F.D.A. released new regulations on Tuesday that would require the makers of long-acting or extended release painkillers to provide training to doctors but would not require doctors to take such courses. This proposal is similar to the one rejected as too weak in last year’s debate. Dr. Janet Woodcock, who heads the F.D.A. Center for Drug Evaluation and Research, indicated that the new agency rules were effectively a placeholder until legislation was passed or were to be used if a relevant bill failed.
In my opinion additional education and training requirements for controlled substances prescribing are long overdue! Most physicians have no, or very limited knowledge, of the appropriate indication, pharmacology and adverse drug interactions of controlled substances. I often see patients who were prescribed Methadone, a long-acting opioid, at a four-times daily dosage schedule. These physicians seem to be clueless about the fact that Methadone metabolism rates vary greatly between individuals, up to a factor of 100! These metabolism rates can range from as few as 4 hours to as many as 130 hours, or even 190 hours. This variability is apparently due to genetic variability in the production of the associated enzymes. Ignoring these pharmacological facts can lead to accidental overdose and death.
Additional training requirements should be implemented to protect our patients and our families.
Yours
Bernd
In my opinion additional education and training requirements for controlled substances prescribing are long overdue! Most physicians have no, or very limited knowledge, of the appropriate indication, pharmacology and adverse drug interactions of controlled substances. I often see patients who were prescribed Methadone, a long-acting opioid, at a four-times daily dosage schedule. These physicians seem to be clueless about the fact that Methadone metabolism rates vary greatly between individuals, up to a factor of 100! These metabolism rates can range from as few as 4 hours to as many as 130 hours, or even 190 hours. This variability is apparently due to genetic variability in the production of the associated enzymes. Ignoring these pharmacological facts can lead to accidental overdose and death.
Additional training requirements should be implemented to protect our patients and our families.
Yours
Bernd
Thursday, April 14, 2011
Fla. House panel OKs compromise pill mill bill
Finally, the future for a prescription drug monitoring program is looking better every day. According to an April 12th Miami Herald article http://www.miamiherald.com/2011/04/12/2163473/fla-house-panel-oks-compromise.html compromise legislation designed to combat "pill mills" that supply prescription painkillers to drug dealers and addicts cleared a House committee Tuesday after the panel took out Gov. Rick Scott's proposal to repeal Florida's prescription monitoring system. The revised bill (HB 7095) instead would strengthen the database by giving pharmacies only seven days rather than 15 to submit prescription information to the state. Unchanged from the original legislation is a ban on dispensing controlled drugs by most doctors. That means patients would have to get prescriptions filled only at pharmacies. Doctors who violate the ban would face up to five years in prison. The House Appropriations Committee unanimously approved the revised bill. It next goes to the House floor. House Speaker Dean Cannon, R-Winter Park, also pushed for the database repeal, arguing that a ban on dispensing by doctors would be more effective, but Bondi said he's also supporting the compromise and helped bring it about. Bondi and Senate President Mike Haridpolos, R-Merritt Island, have been strong supporters of the tracking system, and the Senate's pill mill bill (SB 818) did not include the repeal.
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours
I urge you to continue pushing your legislators to support the House ( HB7095) and Senate bill (SB818).
The battle is not over yet !!
Yours
Friday, April 08, 2011
Florida Medicaid Reform
Friday, April 8th 2011
Letter To The Editor:
Managed Care is not the solution to rising Medicaid cost:
David Pollacks's letter to the editor suggests that moving Medicaid beneficiaries into managed care is the most effective solution to Florida’s Medicaid woes because managed-care organizations in Florida and across the country have a track record of improving outcomes while reducing costs. But is that true? A Georgetown University Health Policy Institute study of Florida's Medicaid Managed Care pilot program questions the use of for-profit managed care companies to reduce Medicaid costs.
The Georgetown study analyzed the impact of the pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties. The study concluded that there is insufficient evidence to verify claims of cost savings and also raises questions about patient access to medical care, particularly turnover among private plans that disrupts the patient-provider relationships. The study finds that some companies hoping to profit from providing Medicaid managed care services have not achieved the success they envisioned and sometimes choose to leave the program with little notice, causing a disruption for patients. In terms of managed care costs savings, the Georgetown study found "insufficient data available to draw conclusions," adding that reductions in expenditures may actually be due, in part, to patients being denied care. Furthermore, no encounter data, and no up to date data on cost savings are available to substantiate the claims made by proponents of the Medicaid HMO plans. Encounter data measures what services and medications patients are receiving and which ones are being denied - accountability that health advocates say is critical to ensure for-profit HMOs aren't lining their pockets at patients' expense.
The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered such as such raising the generic prescription drug dispensing rates and pushing for adherence programs that produce better health outcomes.
So why do we want to turn over billions of dollars to private for-profit managed care companies?
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com
Letter To The Editor:
Managed Care is not the solution to rising Medicaid cost:
David Pollacks's letter to the editor suggests that moving Medicaid beneficiaries into managed care is the most effective solution to Florida’s Medicaid woes because managed-care organizations in Florida and across the country have a track record of improving outcomes while reducing costs. But is that true? A Georgetown University Health Policy Institute study of Florida's Medicaid Managed Care pilot program questions the use of for-profit managed care companies to reduce Medicaid costs.
The Georgetown study analyzed the impact of the pilot program taking place in Broward, Baker, Clay, Duval and Nassau counties. The study concluded that there is insufficient evidence to verify claims of cost savings and also raises questions about patient access to medical care, particularly turnover among private plans that disrupts the patient-provider relationships. The study finds that some companies hoping to profit from providing Medicaid managed care services have not achieved the success they envisioned and sometimes choose to leave the program with little notice, causing a disruption for patients. In terms of managed care costs savings, the Georgetown study found "insufficient data available to draw conclusions," adding that reductions in expenditures may actually be due, in part, to patients being denied care. Furthermore, no encounter data, and no up to date data on cost savings are available to substantiate the claims made by proponents of the Medicaid HMO plans. Encounter data measures what services and medications patients are receiving and which ones are being denied - accountability that health advocates say is critical to ensure for-profit HMOs aren't lining their pockets at patients' expense.
The study concludes that instead of rushing to implement this unproven and ill-advised pilot program statewide, more reliable cost-saving alternatives should be considered such as such raising the generic prescription drug dispensing rates and pushing for adherence programs that produce better health outcomes.
So why do we want to turn over billions of dollars to private for-profit managed care companies?
Bernd Wollschlaeger,MD,FAAFP,FASAM
Board Certified Family Physician & Addiction Specialist
16899 NE 15th Avenue, North Miami Beach, FL 33162
Phone: (305) 940-8717
E-mail: info@miamihealth.com
Sunday, April 03, 2011
Governor Scott and Mandatory Drug Testing
Governor Scott and Mandatory Drug Testing:
A recent article published in the Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2137314/gov-rick-scotts-drug-testing-order.html reports that Governor Scott signed an executive order last week that requires drug testing for many current state workers and job applicants. According to the article “Scott’s order applies to all employees and prospective hires in agencies that answer to the governor, and could affect as many as 100,000 people. Scott also supports a state Senate bill that requires all cash-assistance welfare recipients over the age of 18 to pay for and receive a drug test, a policy that could affect about 58,000 people.”
But is this executive order legal?
* In April 2000 U.S. District Court Judge Kenneth L. Ryskamp ruled that governments cannot require prospective employees to take drug tests unless there is a “special need,’’ such as safety. Ryskamp’s ruling led other South Florida cities, such as Pembroke Pines, to abandon their policy of drug testing all job applicants.
* Random drug-testing of current government workers also has been limited to those in jobs that affect public safety and to cases where a reasonable suspicion of abuse exists, according to a December 2004 federal court ruling in a case that involved Florida’s Department of Juvenile Justice. In that case, U.S. District Court Judge Robert Hinkle ruled that the DJJ violated the Fourth Amendment in ordering random drug-testing of all the agency’s 5,000-plus employees.
* State agencies already are allowed, but not required, to screen job applicants for drugs, under the Florida Drug-Free Workplaces Act. The law allows state agencies to test employees if there is a reasonable suspicion that workers are on drugs. But that suspicion must be well-documented and employees must be informed of the policy prior to testing.
* Howard Simon, executive director of the ACLU of Florida, said Scott is taking a “simplistic” approach to the law, pitting the public’s expectation of a “right to know” against each individual state worker’s right to privacy.
The article concludes that though no legal challenge to the governor’s order has been filed, one will be forthcoming.
I urge all of you to support the ACLU of Florida in their efforts to fight back against government intrusion into our lives camouflaged in the shroud of transparency.
Yours
Bernd
A recent article published in the Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2137314/gov-rick-scotts-drug-testing-order.html reports that Governor Scott signed an executive order last week that requires drug testing for many current state workers and job applicants. According to the article “Scott’s order applies to all employees and prospective hires in agencies that answer to the governor, and could affect as many as 100,000 people. Scott also supports a state Senate bill that requires all cash-assistance welfare recipients over the age of 18 to pay for and receive a drug test, a policy that could affect about 58,000 people.”
But is this executive order legal?
* In April 2000 U.S. District Court Judge Kenneth L. Ryskamp ruled that governments cannot require prospective employees to take drug tests unless there is a “special need,’’ such as safety. Ryskamp’s ruling led other South Florida cities, such as Pembroke Pines, to abandon their policy of drug testing all job applicants.
* Random drug-testing of current government workers also has been limited to those in jobs that affect public safety and to cases where a reasonable suspicion of abuse exists, according to a December 2004 federal court ruling in a case that involved Florida’s Department of Juvenile Justice. In that case, U.S. District Court Judge Robert Hinkle ruled that the DJJ violated the Fourth Amendment in ordering random drug-testing of all the agency’s 5,000-plus employees.
* State agencies already are allowed, but not required, to screen job applicants for drugs, under the Florida Drug-Free Workplaces Act. The law allows state agencies to test employees if there is a reasonable suspicion that workers are on drugs. But that suspicion must be well-documented and employees must be informed of the policy prior to testing.
* Howard Simon, executive director of the ACLU of Florida, said Scott is taking a “simplistic” approach to the law, pitting the public’s expectation of a “right to know” against each individual state worker’s right to privacy.
The article concludes that though no legal challenge to the governor’s order has been filed, one will be forthcoming.
I urge all of you to support the ACLU of Florida in their efforts to fight back against government intrusion into our lives camouflaged in the shroud of transparency.
Yours
Bernd
Friday, April 01, 2011
Malpractice Reform
Attached you find a very interesting and thoughtful article regarding professional liability reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the professional liability of doctors who adhere to clinical practice guidelines.
The author points out that the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.
The author then suggests that "instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care."
Unfortunately, the malpractice reform debate is often reduced to a ONE SOLUTION ONLY issue: cap non-economic damages.
The proponents of those caps often forget that the non-economic damages among those patients who were harmed can often never be properly assessed. Non-economic damages, or quality-of-life damages,compensate injuries and losses that are not easily quantified by a dollar amount and are difficult to measure.
Therefore, we should pursue other solutions such as the application of evidence - and standards-based care to protect patients and our families who may fall victims to malpractice.
Yours
Bernd
March 28, 2011
A Market Solution for Malpractice
By RONEN AVRAHAM
Austin, Tex.
IT’S been a year since health care reform was signed into law, and since then both Republicans and Democrats have been trying to address one item it left out: medical malpractice reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the malpractice liability of doctors who follow clinical practice guidelines — in effect, granting them immunity.
Doctors love this proposal, and patients should too: When doctors follow good guidelines they are less likely to order too many or too few tests or to prescribe the wrong treatment.
Unfortunately, the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.
First, they often conflict with one another. Recommendations for when and how frequently to give women mammograms, for instance, notoriously vary depending on which group is giving them.
In addition, there are conflicts of interest. Guidelines produced by insurance companies sometimes put their interests first. Malpractice insurers, for example, may recommend yearly mammograms, even if they are not necessary, because they bear the costs of lawsuits for late diagnoses of breast cancer — and not the costs or health risks of the extra mammograms. Moreover, the nonprofit groups behind many other guidelines have traditionally depended on pharmaceutical and medical device companies to finance their work. Last year, the Council of Medical Specialty Societies issued a new code of conduct seeking to stop these industries from sponsoring the development of guidelines, but there are still too many loopholes, and thousands of guidelines produced before the reform are still in circulation.
Most troubling of all is that the groups behind the guidelines bear no liability for producing bad ones. No matter how poor the care they prescribe, it is the doctors who depend on them who are punished.
Mr. Obama’s proposal to limit the liability of doctors who follow these flawed guidelines (included in a $250-million plan for overhauling states’ malpractice systems) is clearly not the way to better care. Immunity is a good idea. It’s just that we need to create the incentives necessary for the production of optimal guidelines first.
This is no secret — last week the Institute of Medicine put out a report listing new standards for promulgating guidelines. I was a consultant on the report, which goes a long way toward improving the system, but I worry about the extent to which these standards will be followed. I have a different proposal for improving the guidelines:
Instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care.
The profit-seeking forces of the market on the one hand and legal accountability on the other would help private regulators strike the right balance between patient safety and cost of care. Private regulators would discourage the overuse of expensive medical procedures because doctors, under pressure from insurance companies to keep costs low, would be unlikely to invest in guidelines recommending unnecessary procedures. But if the guideline-makers failed to recommend an appropriate procedure, they’d be held responsible for the patient’s health.
Just as they can now, doctors could deviate from the guidelines when required. Their discretion and autonomy would be preserved. But in most cases, when guidelines apply, doctors could follow them without having to worry about being held liable, and more important, about getting bad advice.
Such a system may not be too far off: medicine is already moving toward for-profit guidelines. UpToDate, First Consult and eMedicine are just a few new databases compiled by for-profit companies in the business of making technical, evidence-based medicine more accessible to doctors. This is certainly exciting, but to provide doctors with the peace of mind they deserve, these companies need to be held accountable for the advice they give.
Almost every other product Americans encounter is subject to laws that guarantee that the producer suffers when its product is subpar. There’s no reason medical guidelines should be any different. With the proper incentives, these private regulators could help President Obama carry out the health care reform he signed into law a year ago.
Ronen Avraham is a professor at the University of Texas School of Law.
The author points out that the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.
The author then suggests that "instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care."
Unfortunately, the malpractice reform debate is often reduced to a ONE SOLUTION ONLY issue: cap non-economic damages.
The proponents of those caps often forget that the non-economic damages among those patients who were harmed can often never be properly assessed. Non-economic damages, or quality-of-life damages,compensate injuries and losses that are not easily quantified by a dollar amount and are difficult to measure.
Therefore, we should pursue other solutions such as the application of evidence - and standards-based care to protect patients and our families who may fall victims to malpractice.
Yours
Bernd
March 28, 2011
A Market Solution for Malpractice
By RONEN AVRAHAM
Austin, Tex.
IT’S been a year since health care reform was signed into law, and since then both Republicans and Democrats have been trying to address one item it left out: medical malpractice reform. In last month’s budget proposal, the Obama administration offered a solution: a plan to encourage evidence-based medicine by limiting the malpractice liability of doctors who follow clinical practice guidelines — in effect, granting them immunity.
Doctors love this proposal, and patients should too: When doctors follow good guidelines they are less likely to order too many or too few tests or to prescribe the wrong treatment.
Unfortunately, the proposal will not achieve the noble goal of providing quality care at a reasonable cost because the current guidelines, written by nonprofit medical groups and for-profit insurance companies, are not good enough.
First, they often conflict with one another. Recommendations for when and how frequently to give women mammograms, for instance, notoriously vary depending on which group is giving them.
In addition, there are conflicts of interest. Guidelines produced by insurance companies sometimes put their interests first. Malpractice insurers, for example, may recommend yearly mammograms, even if they are not necessary, because they bear the costs of lawsuits for late diagnoses of breast cancer — and not the costs or health risks of the extra mammograms. Moreover, the nonprofit groups behind many other guidelines have traditionally depended on pharmaceutical and medical device companies to finance their work. Last year, the Council of Medical Specialty Societies issued a new code of conduct seeking to stop these industries from sponsoring the development of guidelines, but there are still too many loopholes, and thousands of guidelines produced before the reform are still in circulation.
Most troubling of all is that the groups behind the guidelines bear no liability for producing bad ones. No matter how poor the care they prescribe, it is the doctors who depend on them who are punished.
Mr. Obama’s proposal to limit the liability of doctors who follow these flawed guidelines (included in a $250-million plan for overhauling states’ malpractice systems) is clearly not the way to better care. Immunity is a good idea. It’s just that we need to create the incentives necessary for the production of optimal guidelines first.
This is no secret — last week the Institute of Medicine put out a report listing new standards for promulgating guidelines. I was a consultant on the report, which goes a long way toward improving the system, but I worry about the extent to which these standards will be followed. I have a different proposal for improving the guidelines:
Instead of nonprofit groups producing free guidelines, or insurance companies producing ones that serve their own interests, the government should require health care providers to buy or license guidelines from what I call private regulators, for-profit companies with expertise in evidence-based medicine. Doctors would have immunity from malpractice cases if they followed the guidelines. However, the private regulators themselves would be liable if their guidelines were found to deviate from optimal care.
The profit-seeking forces of the market on the one hand and legal accountability on the other would help private regulators strike the right balance between patient safety and cost of care. Private regulators would discourage the overuse of expensive medical procedures because doctors, under pressure from insurance companies to keep costs low, would be unlikely to invest in guidelines recommending unnecessary procedures. But if the guideline-makers failed to recommend an appropriate procedure, they’d be held responsible for the patient’s health.
Just as they can now, doctors could deviate from the guidelines when required. Their discretion and autonomy would be preserved. But in most cases, when guidelines apply, doctors could follow them without having to worry about being held liable, and more important, about getting bad advice.
Such a system may not be too far off: medicine is already moving toward for-profit guidelines. UpToDate, First Consult and eMedicine are just a few new databases compiled by for-profit companies in the business of making technical, evidence-based medicine more accessible to doctors. This is certainly exciting, but to provide doctors with the peace of mind they deserve, these companies need to be held accountable for the advice they give.
Almost every other product Americans encounter is subject to laws that guarantee that the producer suffers when its product is subpar. There’s no reason medical guidelines should be any different. With the proper incentives, these private regulators could help President Obama carry out the health care reform he signed into law a year ago.
Ronen Avraham is a professor at the University of Texas School of Law.
Monday, March 28, 2011
Pill Mill Issue
Attached a link to an article http://www.tampabay.com/news/health/gov-rick-scott-announces-plan-to-combat-pill-mills/1160274 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.
Yours
Bernd
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.
Yours
Bernd
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 http://www.miamiherald.com/2011/03/27/v-fullstory/2135476/kentucky-the-other-end-of-the.html 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.
Yours,
Bernd
U.S. Rep Hal Rogers.
Attached a link to a great article published in today's Miami Herald http://www.miamiherald.com/2011/03/27/v-fullstory/2135476/kentucky-the-other-end-of-the.html 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.
Yours,
Bernd
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 http://www.miamiherald.com/2011/03/22/2128720/one-year-after-healthcare-reform.html 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.
Yours
Bernd
In an excellent editorial published in the Miami Herald http://www.miamiherald.com/2011/03/22/2128720/one-year-after-healthcare-reform.html 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.
Yours
Bernd
Monday, March 14, 2011
Florida is Open for (Drug) Business
Attached a link to a Miami Herald article from Friday, March 11th http://www.miamiherald.com/2011/03/10/2107891/house-kills-plan-for-drug-monitoring.html 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.
Yours
Bernd
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.
Yours
Bernd
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!
Yours
Bernd
http://www.doah.state.fl.us/internet/search/docket.cfm?RequestTimeout=500&CaseNo=11-000257&Petitioner=OPTIMUM%20TECHNOLOGY%2C%20INC%2E&Respondent=DEPARTMENT%20OF%20HEALTH&URLString=Count%3D1%26BPCount%3D1%26DWH%3D1%26Pet%3DOptimum
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!
Yours
Bernd
http://www.doah.state.fl.us/internet/search/docket.cfm?RequestTimeout=500&CaseNo=11-000257&Petitioner=OPTIMUM%20TECHNOLOGY%2C%20INC%2E&Respondent=DEPARTMENT%20OF%20HEALTH&URLString=Count%3D1%26BPCount%3D1%26DWH%3D1%26Pet%3DOptimum
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.
Yours
Bernd
Drug monitoring program worth saving, By Al Lamberti and Marcelo Llorente
Read more: http://www.sun-sentinel.com/news/opinion/fl-prescription-drug-forum-20110305,0,2826266.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: http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html#ixzz1FqNyNtUh
http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html
Florida pill mills: Different drugs, same faces
http://www.miamiherald.com/2011/03/05/2099419/florida-pill-mills-different-drugs.html
"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
http://www.sun-sentinel.com/news/opinion/fl-drugs-oped0306-20110306,0,6995046.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."
I am hopeful that the heightened publicity will put pressure on our legislators to act.
Yours
Bernd
Drug monitoring program worth saving, By Al Lamberti and Marcelo Llorente
Read more: http://www.sun-sentinel.com/news/opinion/fl-prescription-drug-forum-20110305,0,2826266.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: http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html#ixzz1FqNyNtUh
http://www.miamiherald.com/2011/03/05/2100118/sons-and-daughters-lost-to-a-pill.html
Florida pill mills: Different drugs, same faces
http://www.miamiherald.com/2011/03/05/2099419/florida-pill-mills-different-drugs.html
"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
http://www.sun-sentinel.com/news/opinion/fl-drugs-oped0306-20110306,0,6995046.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
reform
* 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.
Yours
Bernd
For more information see http://www.nytimes.com/2011/03/04/health/policy/04judge.html
* Ban on withholding insurance due to pre-existing conditions
* $50 million dollar fund to help states experiment with alternatives of medical liability
reform
* 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.
Yours
Bernd
For more information see http://www.nytimes.com/2011/03/04/health/policy/04judge.html
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.
Yours
Bernd
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.
I guess we are moving full speed backwards.
Yours
Bernd
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.
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!
[1] http://www.nejm.org/doi/full/10.1056/NEJMsa1004404
[2] http://science.icmcc.org/2010/08/26/outpatient-prescribing-errors-and-the-impact-of-computerized-prescribing/
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!
[1] http://www.nejm.org/doi/full/10.1056/NEJMsa1004404
[2] http://science.icmcc.org/2010/08/26/outpatient-prescribing-errors-and-the-impact-of-computerized-prescribing/
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.
http://www.palmbeachpost.com/opinion/editorials/scott-makes-it-up-again-accusations-against-group-1276631.html?sms_ss=email&at_xt=4d6663c1bb07e380%2C0
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."
http://www.palmbeachpost.com/news/state/fla-drug-database-fund-raiser-disputes-gov-scotts-1273905.html?page=2&viewAsSinglePage
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.
These are indeed groundless accusations without factual evidence to support the arguments made.
http://www.palmbeachpost.com/opinion/editorials/scott-makes-it-up-again-accusations-against-group-1276631.html?sms_ss=email&at_xt=4d6663c1bb07e380%2C0
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."
http://www.palmbeachpost.com/news/state/fla-drug-database-fund-raiser-disputes-gov-scotts-1273905.html?page=2&viewAsSinglePage
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!
Yours
Bernd
The Miami Herald
Posted on Wed, Feb. 23, 2011
Pill-mill arrests hit right target: doctors
Fred Grimm
fgrimm@MiamiHerald.com
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.
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2011/02/23/v-print/2082013/pill-mill-arrests-hit-right-target.html#ixzz1EqMoYvC7
Meanwhile, the Oxy-Cartels are reinventing their business model and open "life style enhancement" and " wellness" clinics.
We have to stop them now!
Yours
Bernd
The Miami Herald
Posted on Wed, Feb. 23, 2011
Pill-mill arrests hit right target: doctors
Fred Grimm
fgrimm@MiamiHerald.com
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.
http://www.miamiherald.com
Read more: http://www.miamiherald.com/2011/02/23/v-print/2082013/pill-mill-arrests-hit-right-target.html#ixzz1EqMoYvC7
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 http://articles.sun-sentinel.com/2011-02-12/health/fl-prescription-drugs-born-addicted-20110211_1_newborns-prescription-drug-winnie-palmer-hospital
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? http://articles.sun-sentinel.com/2011-02-12/news/fl-rick-scott-pills-mayocol-b021311-20110211_1_pain-clinics-prescription-drug-pill-mill-epidemic
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 http://www.sun-sentinel.com/news/opinion/fl-pills-oped0213-20110213,0,3980383.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 www.twitter.com/dadedoc or at http://floridadocs.blogspot.com
Yours truly,
Bernd Wollschlaeger.MD
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 http://articles.sun-sentinel.com/2011-02-12/health/fl-prescription-drugs-born-addicted-20110211_1_newborns-prescription-drug-winnie-palmer-hospital
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? http://articles.sun-sentinel.com/2011-02-12/news/fl-rick-scott-pills-mayocol-b021311-20110211_1_pain-clinics-prescription-drug-pill-mill-epidemic
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 http://www.sun-sentinel.com/news/opinion/fl-pills-oped0213-20110213,0,3980383.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 www.twitter.com/dadedoc or at http://floridadocs.blogspot.com
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,
Bernd
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,
Bernd
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