Attached an important and troubling article from today's Miami Herald pointing out that "Florida Republican leaders have begun crafting anti-illegal-immigrant legislation modeled after an Arizona law that has incited widespread protests and fueled national and international debate over U.S. immigration policies.
Under the proposed bill, police would have broad power under state law to ask suspects for proof of legal residency."
I am strongly opposing such legislation and urge my specialty society to raise concerns regarding this bill as it pertains to the way family physicians practice medicine.
I often (even today) encounter patients, mostly uninsured, who are reluctant to go to the hospital because of their residency status fearing a backlash, or possible investigation by the immigration authorities.
Today I referred a Haitian patient to Publix to benefit from a FREE Metformin program. She asked me if she would have to provide a form of identification because she has no papers. I reassured her that she should not worry.
What will happen IF we have such a discriminatory law on the books? More undocumented immigrants will avoid doctors but will be taken by ambulance to emergency rooms for preventable illnesses instead. Who will pay? The taxpayer!
Just the debate of such a law in the legislature will trigger additional pressure on our State which already has to deal with a massive and continuous oil spill, high unemployment and a jittery tourism industry. Do we need anything else to shut down!!
Looking forward to your comments.
Yours
Bernd
Posted on Sat, Jun. 26, 2010
Florida GOP risks Hispanic anger with Arizona-like crackdown
Cristina Silva
Miami Herald/St. Pete Times
TALLAHASSEE — Florida Republican leaders have begun crafting anti-illegal-immigrant legislation modeled after an Arizona law that has incited widespread protests and fueled national and international debate over U.S. immigration policies.
Under the proposed bill, police would have broad power under state law to ask suspects for proof of legal residency, said Rep. William Snyder, a Republican from Stuart who plans to introduce the legislation in November.
"We have significant components from the Arizona bill that I plan to incorporate,'' he said. "We have the beginnings of it.''
The effort, which would be filed for consideration during the March legislative session, is already drawing broad support within the GOP.
Majority leaders in the Florida Senate and House said a new approach is needed to address the federal government's failure to temper illegal immigration.
It has the backing of both leading Republican gubernatorial candidates -- businessman Rick Scott and Attorney General Bill McCollum, whose office is helping to draft the bill.
Snyder, a former police officer, said the proposed legislation is needed to protect undocumented immigrants, who are vulnerable to abusive employers and violent criminals.
"This is a human right issue,'' he said. "They don't enjoy the same rights and privileges that you and I do. The solution is to enforce the laws that currently exist and to discourage people from coming here to `find a better life' when in fact they just come here and are victimized.''
Immigrant advocates and Hispanic lawmakers alike called the measure an unconstitutional assault on minority communities.
"The reaction is, 'What? This is ridiculous,' '' said Neelofer Syed, a Tampa immigration lawyer from Pakistan. "It is supposed to be that you are legal until you are proven guilty. This law is like, `We think you are guilty unless you establish that you are innocent.' ''
Rep. J.C. Planas, a Republican from Miami, called it an election-year stunt.
"I don't understand how anyone can think the Arizona law is good for Florida,'' said Planas, chairman of the Florida Hispanic Legislative Caucus. "It is a huge waste of police resources to start doing these things.''
Senate and House leaders said immigration reform is ripe for passage.
"What we want to do is encourage legal immigration and discourage illegal immigration,'' said incoming Senate President Mike Haridopolos, who cautioned that any changes will be shaped by how the Arizona law is put into practice after it takes effect next month.
Republican leaders in Pennsylvania, Rhode Island, Minnesota, South Carolina and Michigan have made similar vows to mirror Arizona's immigration law, amid growing criticism that the federal government has not adequately protected the nation's borders.
Civil rights groups such as the American Civil Liberties Union have filed legal challenges to the legislation, and President Barack Obama's administration is expected to follow suit.
Critics questioned why Florida lawmakers would consider replicating Arizona's untested immigration strategy while legal challenges are still pending.
"Rep. Snyder's proposal solves nothing, exploits public concern over immigration and just creates new problems,'' said Howard Simon, executive director of ACLU Florida.
The tension has become a rallying point for candidates on both sides of the political spectrum.
Democratic gubernatorial candidate Alex Sink has highlighted her Republican opponents' support of the law in stump speeches.
"She was opposed to the law in Arizona,'' said campaign spokeswoman Kyra Jennings. "She believes it unfairly discriminated against American citizens. She would veto that type of legislation.''
Championing tougher immigration laws is a risky election strategy, said George Gonzalez, a University of Miami political science professor.
"It is a way to channel people's anger and frustration about the labor market onto a group and to take advantage of it, too,'' he said.
But it could also anger Hispanic voters, an important constituency in Florida's increasingly diverse political landscape, Gonzalez said.
Florida's estimated illegal immigrant population ranks third in the nation. Arizona places seventh. But while Florida's undocumented population has dropped by 10 percent during the past decade, Arizona's climbed by 42 percent.
"None of this is foolproof,'' Gonzalez said. "It could blow up in the Republicans' faces either way.''
Snyder said he doesn't want his law to stir up the same accusations of racism that hounded Arizona's decision.
His law would be refined, he said, because it would only allow law enforcement officials to inquire about immigration status during a potential arrest or traffic violation. In Arizona, officers are required to request legal documentation during any lawful stop if ``reasonable suspicion'' exists.
Coming up with the precise language will be difficult, conceded Snyder, who recently defended his views on Fox News. ``Reasonable suspicion makes people nervous,'' he said.
But he vowed his final draft would apply equally to all illegal immigrants, regardless of skin color or ethnicity.
"I've never in my 32 years been accused of using the `N' word or being racially motivated,'' he said. "No one who knows me would say I have a racist bone in my body.''
Saturday, June 26, 2010
Shorter Work Days For Doctors
Attached a link to an important NEJM article http://content.nejm.org/cgi/content/full/NEJMsb1005800 entitled "The New Recommendations on Duty Hours from the ACGME Task Force."The goal of the ACGME's new approach to duty hours is to foster a humanistic environment for graduate medical education that supports learning and the provision of excellent and safe patient care.
At the heart of the ACGME's proposed changes is the recognition that the least-experienced residents need to be treated differently than more experienced ones. The plan recommends that first-year residents be limited to 16-hour shifts, and those in the second year and above work continuously for no more than 24 hours. They can stay an additional four hours to facilitate patient handoffs to another doctor. Currently residents are allowed to work up to 30-hour shifts.
The guidelines also include detailed expectations about direct supervision of younger residents by more experienced ones, in the hopes that a supervising doctor would catch any error before it affects a patient, according to Dr. Nasca.In addition, the ACGME will step up its monitoring and enforcement of the requirements, conducting on-site visits of each institution annually beginning in July 2011. The site visits are likely to cost each institution about $12,000 to $15,000, according to Dr. Nasca.
Those programs that don't comply with the rules could ultimately lose accreditation and be forced to disband.
I strongly support the proposed changes and call upon my colleagues to do the same.
Our patients deserve the same assurance about the quality of service as millions of airline passenger do already: strictly enforced duty hours for pilots, checklists before take-off and landing, elimination of human errors and the relentless pursuit of excellence.
We must change the way we do business! Our patients deserve it!!
Yours
Bernd
At the heart of the ACGME's proposed changes is the recognition that the least-experienced residents need to be treated differently than more experienced ones. The plan recommends that first-year residents be limited to 16-hour shifts, and those in the second year and above work continuously for no more than 24 hours. They can stay an additional four hours to facilitate patient handoffs to another doctor. Currently residents are allowed to work up to 30-hour shifts.
The guidelines also include detailed expectations about direct supervision of younger residents by more experienced ones, in the hopes that a supervising doctor would catch any error before it affects a patient, according to Dr. Nasca.In addition, the ACGME will step up its monitoring and enforcement of the requirements, conducting on-site visits of each institution annually beginning in July 2011. The site visits are likely to cost each institution about $12,000 to $15,000, according to Dr. Nasca.
Those programs that don't comply with the rules could ultimately lose accreditation and be forced to disband.
I strongly support the proposed changes and call upon my colleagues to do the same.
Our patients deserve the same assurance about the quality of service as millions of airline passenger do already: strictly enforced duty hours for pilots, checklists before take-off and landing, elimination of human errors and the relentless pursuit of excellence.
We must change the way we do business! Our patients deserve it!!
Yours
Bernd
Friday, June 18, 2010
Opioid Dependence
Attached a very interesting article supporting the fact that office based treatment of opioid dependence can decrease illegal activity and incarceration.
Yours
Bernd
Family Practice News
Volume 40, Issue 10, Page 31 (1 June 2010)
Opioid-Dependent Patients Respond to Therapy
DIANA MAHONEY
Article Outline
Major Finding: Office-based buprenorphine/naloxone treatment was associated with a statistically significant decrease in participants reporting illegal activity, from 19% to 2%, and in interacting with the legal system, from 16% to 1%.
Data Source: A secondary analysis of data from a randomized clinical trial of 166 opioid-addicted individuals treated with buprenorphine/naloxone in a primary care clinic.
Disclosures: Dr. Fiellin reported no relevant financial conflicts of interest.
MINNEAPOLIS — Opioid-dependent patients with a history of incarceration do well with office-based buprenorphine/naloxone therapy and have fewer interactions over time with the legal and criminal justice systems, according to a data analysis of a previous randomized, controlled trial.
“Our findings should offer some reassurance for community health care providers about initiating buprenorphine/naloxone treatment in the office setting,” Dr. David Fiellin reported. Office-based buprenorphine/naloxone treatment also can be an avenue for addressing other negative health consequences of chronic addiction, including referral for hepatitis C treatment, when indicated, as well as vocational and mental health programs.
Dr. Fiellin, along with lead investigator Dr. Emily Wang and colleagues at Yale University, New Haven, Conn., performed a secondary data analysis of a previous trial of three levels of psychosocial counseling and medication dispensing in conjunction with buprenorphine/naloxone maintenance treatment in a primary care clinic (N. Engl. J. Med. 2006;355:365-74).
The investigators compared demographics, clinical characteristics, and treatment outcomes for 166 adults receiving primary care–based buprenorphine/naloxone treatment, stratifying by history of incarceration as determined by the legal domain of the Addiction Severity Index.
Of the 166 patients, 52 had previously been incarcerated, Dr. Fiellin reported. Former inmates were more likely than other patients to be older, male, an ethnic minority, and unemployed. Also, they were more likely to have long histories of opioid dependence, have received methadone treatment, and have hepatitis C infection. The mean dose of buprenorphine/naloxone (Suboxone) was 17.9 mg and 18.0 mg for the previously incarcerated and never incarcerated patients, respectively, he said.
Among the previously incarcerated patients, the mean consecutive weeks of opioid abstinence was 6.2 based on opioid-negative urine samples. For other patients, it was 5.9 weeks. Mean treatment duration was 17.9 weeks and 17.6 weeks. The percentage of previously incarcerated patients completing treatment was 38%; for other patients, it was 46%.
Among patients who remained in treatment, a subsequent longitudinal analysis of self-reported illegal activity and interactions with the legal and criminal justice systems, conducted at 4-week intervals, showed “office-based buprenorphine/naloxone treatment was associated with a statistically significant decrease in participants reporting illegal activity, from 19% to 2%, and in interactions with the legal system, from 16% to 1%,” Dr. Fiellin said.
About “25% of all of those dependent on heroin pass through the criminal justice system each year,” Dr. Fiellin said. Correctional facilities provide an obvious opportunity to engage opioid-dependent individuals with treatment. “Unfortunately, less than 0.5% of all opioid-dependent individuals receive treatment while incarcerated, and as such they are more likely to connect with services in office-based programs upon release,” he said.
From the Annual Meeting of the Society of General Internal Medicine
Yours
Bernd
Family Practice News
Volume 40, Issue 10, Page 31 (1 June 2010)
Opioid-Dependent Patients Respond to Therapy
DIANA MAHONEY
Article Outline
Major Finding: Office-based buprenorphine/naloxone treatment was associated with a statistically significant decrease in participants reporting illegal activity, from 19% to 2%, and in interacting with the legal system, from 16% to 1%.
Data Source: A secondary analysis of data from a randomized clinical trial of 166 opioid-addicted individuals treated with buprenorphine/naloxone in a primary care clinic.
Disclosures: Dr. Fiellin reported no relevant financial conflicts of interest.
MINNEAPOLIS — Opioid-dependent patients with a history of incarceration do well with office-based buprenorphine/naloxone therapy and have fewer interactions over time with the legal and criminal justice systems, according to a data analysis of a previous randomized, controlled trial.
“Our findings should offer some reassurance for community health care providers about initiating buprenorphine/naloxone treatment in the office setting,” Dr. David Fiellin reported. Office-based buprenorphine/naloxone treatment also can be an avenue for addressing other negative health consequences of chronic addiction, including referral for hepatitis C treatment, when indicated, as well as vocational and mental health programs.
Dr. Fiellin, along with lead investigator Dr. Emily Wang and colleagues at Yale University, New Haven, Conn., performed a secondary data analysis of a previous trial of three levels of psychosocial counseling and medication dispensing in conjunction with buprenorphine/naloxone maintenance treatment in a primary care clinic (N. Engl. J. Med. 2006;355:365-74).
The investigators compared demographics, clinical characteristics, and treatment outcomes for 166 adults receiving primary care–based buprenorphine/naloxone treatment, stratifying by history of incarceration as determined by the legal domain of the Addiction Severity Index.
Of the 166 patients, 52 had previously been incarcerated, Dr. Fiellin reported. Former inmates were more likely than other patients to be older, male, an ethnic minority, and unemployed. Also, they were more likely to have long histories of opioid dependence, have received methadone treatment, and have hepatitis C infection. The mean dose of buprenorphine/naloxone (Suboxone) was 17.9 mg and 18.0 mg for the previously incarcerated and never incarcerated patients, respectively, he said.
Among the previously incarcerated patients, the mean consecutive weeks of opioid abstinence was 6.2 based on opioid-negative urine samples. For other patients, it was 5.9 weeks. Mean treatment duration was 17.9 weeks and 17.6 weeks. The percentage of previously incarcerated patients completing treatment was 38%; for other patients, it was 46%.
Among patients who remained in treatment, a subsequent longitudinal analysis of self-reported illegal activity and interactions with the legal and criminal justice systems, conducted at 4-week intervals, showed “office-based buprenorphine/naloxone treatment was associated with a statistically significant decrease in participants reporting illegal activity, from 19% to 2%, and in interactions with the legal system, from 16% to 1%,” Dr. Fiellin said.
About “25% of all of those dependent on heroin pass through the criminal justice system each year,” Dr. Fiellin said. Correctional facilities provide an obvious opportunity to engage opioid-dependent individuals with treatment. “Unfortunately, less than 0.5% of all opioid-dependent individuals receive treatment while incarcerated, and as such they are more likely to connect with services in office-based programs upon release,” he said.
From the Annual Meeting of the Society of General Internal Medicine
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