Medicaid Expansion in Florida

Attached a link to an editorial published in today's Miami Herald titled "Not so fast, Gov. Scott" focusing on Governor's Scott refusal to expand Medicaid. The editorial emphasizes that " for Floridians desperate to get basic healthcare the consequences could be dire. Train wreck, perfect storm, falling off the cliff — all of these phrases have been used to describe the impact of Mr. Scott’s decision unless the Legislature takes a more thoughtful approach. ....If Florida continues to ignore the “working poor” who can’t afford health insurance, these patients will have no recourse except to continue relying on public hospitals for unreimbursed care. But they will do so without the increased funding that the new law guarantees as compensation for the states, placing the burden on local taxpayers." The costs of uncompensated care will be passed down as a "hidden tax" to business that provide insurance for their employees, or to individual insurance policy holders. In 2008 this added an extra $1,017 to annual family health insurance premiums, and an additional $368 in individual premiums. The National Association of Public Hospitals estimates that about 4 million people who would have been eligible for Medicaid could go uninsured in states that have decided against expansion. In Florida, the move would expand coverage to an estimated one million more adults and children. Rejecting expansion will worsen the problem of uncompensated care in Florida, which already has the third highest percentage of uninsured patients in the country. But wait, it gets worse! Officials at the Jackson Health System are wary. They get $350 million in a special Medicaid appropriation from the Low Income Pool, far more than any other hospital in the state. They worry that if those funds are redistributed by Congress to cover Medicaid expansion nationwide, they could lose more than they gain in federal funds for new Medicaid patients. Without those funds Jackson Memorial Hospital and other hospitals in South Florida will be in dire financial straits. Lets remind ourselves why that is happening: Because the political leadership in this state is dominated by ideological "thinkers" who are refusing to acknowledge reality. Therefore, its of crucial importance that we act now using all available social networking tools at our disposal to educate and mobilize Floridians. Yours Bernd

Practical Pain Management

In case you missed reading this: Dr. Ilene Robeck wrote an excellent article titled " Chronic Pain in the Elderly: Special Challenges" published in the March 2012 edition of Practical Pain Management. Very thorough, easy to read and contains many practical tips for the daily practice. Kudos to Ilene!!! Yours Bernd

Pills, Guns and Missile Launchers

According to an article published in today's Sun Sentinel officers of the Broward Sheriff's Office raided the office and home of the Pompano Beach pain clinic owners Frank and Bernice Turturo and discovered, among other items, $250,000 in cash, gold coins and nuggets, two short-barreled assault rifles, a portable rocket launcher case and a tiny .22-caliber pistol that would fit in a brassiere. During a news conference at BSO's Fort Lauderdale headquarters today , Sheriff Al Lamberti called the firearms array "scary" and "sophisticated" and "not the day-to-day, target practice weapons you'd normally see." It does not surprise me that pain clinics in South Florida are operating in the criminal underworld of racketeering and drug trafficking . Guns are the necessary accessories required to intimidate anyone probing these shady businesses. Our law enforcement officers need more resources to crack down on drug traffickers and drug dealers in white coats. Yours Bernd

Getting High For Higher Scores

Attached a link to an article titled " Risky Rise of the Good-Grade Pill" reporting the abuse of ADHD drugs by high-school students to improve their grades. Its is troubling that the number of prescriptions for A.D.H.D. medications dispensed for young people ages 10 to 19 has risen 26 percent since 2007, to almost 21 million yearly, according to IMS Health, a health care information company — a number that experts estimate corresponds to more than two million individuals. But there is no reliable research on how many high school students take stimulants as a study aid. Doctors and teenagers from more than 15 schools across the nation with high academic standards estimated that the portion of students who do so ranges from 15 percent to 40 percent. I share the observation that physicians are being asked for prescriptions for Adderall solely for better grades. I recently " lost" a patient because I refused a mothers request to prescribe Adderall for her daughter to prepare for an " important exam." Despite the observation of increased ADHD prescription abuse a respected annual survey financed by the National Institute on Drug Abuse, “Monitoring the Future,” reports that abuse of prescription amphetamines by 10th and 12th graders nationally has actually dipped from the 1990s and is remaining relatively steady at about 10 percent. However, some experts note that the survey does not focus on the demographic where they believe such abuse is rising steadily — students at high-pressure high schools — and also that many teenagers barely know that what they often call “study drugs” are in fact illegal amphetamines. Most of these drugs are now being snorted to achieve the desired effect. A number of teenagers interviewed laughed at the ease with which they got some doctors to write prescriptions for A.D.H.D. Many youngsters with prescriptions said their doctors merely listened to their stories and took out their prescription pads. The prescription abuse is increasing because users were becoming more common, they said, and some students who would rather not take the drugs would be compelled to join them because of the competition over class rank and colleges’ interest. Whats the solution? Physicians should abide by the treatment guidelines. The disorder’s definition requires inattentiveness, hyperactivity or impulse control to present “clinically significant impairment” in at least two settings (school and home, for example), according to the Centers for Disease Control and Prevention. Crucially, some of this impairment must have been in evidence by age 7; a proper diagnosis for a teenager claiming to have A.D.H.D., several doctors said, requires interviewing parents, teachers and others to confirm that the problems existed long before. As physicians we have the ability to control this problem by carefully monitoring our own prescribing habits. I am interested in your response(s) Yours Bernd

Adverse Economic Impact of Opioid Abuse

Attached a link to an article titled "Pain Pills Add Cost and Delays to Job Injuries" highlighting the adverse economic impact of narcotic pain prescriptions. According to the article workmans compensation insurance carriers spend an estimated $1.4 billion annually on narcotic painkillers, or opioids. But they are also finding that the medications, if used too early in treatment, too frequently or for too long, can drive up associated disability payouts and medical expenses by delaying an employee’s return to work. Workers who received high doses of opioid painkillers to treat injuries like back strain stayed out of work three times longer than those with similar injuries who took lower doses, a 2008 study of claims by the California Workers Compensation Institute found. When medical care and disability payments are combined, the cost of a workplace injury is nine times higher when a strong narcotic like OxyContin is used than when a narcotic is not used, according to a 2010 analysis by Accident Fund Holdings, an insurer that operates in 18 states.Between 2001 and 2008, narcotics prescriptions as a share of all drugs used to treat workplace injuries jumped 63 percent, according to insurance industry data. Costs have also soared. In California, for example, workplace insurers spent $252 million on opioids in 2010, a figure that represented about 30 percent of all prescription costs; in 2002, opioids accounted for 15 percent of drug expenditures. Nationwide, data suggests that a vast majority of narcotic drugs used to treat occupational injuries are prescribed by a tiny percentage of doctors who treat injured workers; in California, for example, that figure is just 3 percent. Also, the bulk of such prescriptions go to a relatively small percentage of injured workers, including those who might be addicted to the drugs or those who sell them, experts said. Whats the solution? We must adopt new pain treatment guidelines for doctors which include the emphasis on NON-narcotic pain treatment modalities. In New York, one proposal would require a doctor to refer a patient who is not improving to a pain specialist when an opioid dose exceeds a certain level,Washington State has already adopted such a policy. Furthermore, we need to financially incentivize doctors to apply alternative approaches like specialized psychotherapy or referring addicted workers to treatment facilities. I am interested in your responses. Yours Bernd

Face-Off and Bath Salts

Attached a link to an article published in today's Sun Sentinel titled " Face-eating attack spurs crackdown on synthetic drugs" highlighting the widespread and growing use of synthetic drugs camouflaged as "bath salts" and "incense." These dangerous drugs that are being sold across store counters and several of those I personally found displayed in our neighborhood foodstore. Regulators have struggled to control these drugs as manufacturers stay one step ahead of them by changing ingredients to escape legal action. Frustration reached a fever pitch this week with speculation that the Miami "Cannibal" may have been high on bath salts when he chewed off most of a man's face in Miami on Saturday before he was gunned down by police. Many so-called "bath salts" are sold in small packets under names including Ivory Wave, Bliss and Vanilla Sky. Most come with labels that say they are not for human consumption and are intended as real bath salts to sooth customers. Others claim to serve as deodorizers and pool and spa cleaners. In reality, they have contained chemicals such as mephedrone and MDPV that produce a high similar to illegal narcotics such as cocaine and methamphetamines. They come in tiny jars, resemble crystals, and are packaged in quantities small enough to be snorted or swallowed. Florida banned those chemicals last year, then had to add 92 chemicals to its list of banned ingredients this year to keep up with the manufacturers. (For more information about "bath salts" see the NIDA web site) In my opinion we should launch a public awareness campaign to educate parents, schools, colleges and employer groups about this growing threat to public health and safety. We must recognize our individual responsibility to reach out to those we love and care for. Its not too late. Yours Bernd

US Military and Mental Health

Attached a link "Branding a Soldier With ‘Personality Disorder" to an article in which the author reports that military commanders pressure clinicians to issue unwarranted psychiatric diagnoses to get rid of troops. In the case described a 50-year old female behavioral health professional was diagnosed suffering from a a personality disorder, a diagnosis that the military has used to discharge thousands of troops. Subsequently, she was sent home.She disputed the diagnosis, but it was not until months later that she found what seemed powerful ammunition buried in her medical file, portions of which she provided to The New York Times. “Her command specifically asks for a diagnosis of a personality disorder,” a document signed by the psychiatrist said. By comparison, a diagnosis of post-traumatic stress disorder is usually linked to military service and leads to a medical discharge accompanied by certain benefits. In recent weeks, questions about whether the Army manipulates psychiatric diagnoses to save money have been raised at Joint Base Lewis-McChord near Tacoma, Wash., where soldiers undergoing medical evaluations before discharge complained that psychiatrists rescinded PTSD diagnoses, leaving the soldiers with diagnoses like personality disorder that did not qualify them for medical discharges. If these ALLEGATIONS are correct then several questions and issues must be addressed: Did military psychiatrist, or those contracted by the military, violate the code of medical ethics? Should the U.S. military order their credentialed medical staff to follow evidence-based diagnostic guidelines before reaching a mental health diagnosis? Shouldn't soldiers have the right for a second-opinion BEFORE facing a potentially dishonorable discharge? Those brave man and women in uniform deserve better treatment. Yours Bernd