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Interim Meeting of The American Medical Association-Atlanta, Georgia

I’m sure some of you may have noticed my lack of postings over the last several days. I want to assure you that I am still alive and well. As a physician, one of the most important functions for me is advocating on behalf of “Patients” and our Profession of Medicine. We generally meet on a national level at least twice per year at various sites across the country. There are over 530 delegates representing every state and virtually every speciality and sub-speciality that you can imagine. Additionally, each delegate has an alternate. Today, we have multiple ongoing Reference Committees, during which anyone can make his/her case for a particular issue. We are the official body of The House of Delegates to the American Medical Association. I am presently in one reference committee discussing such topics as merging of Health Insurance Companies, Veterans Health, Pain Manangemet, Opioid Abuse, Access To Care,Women’s Health and their decision to determine their health care desires for themselves. This is in no way all encompassing, only a snapshot of this one committee. The General Meeting started with a “Big Bang”….A movement by a few obstructionists (we have them here too) for the AMA to  support the defunding of Planned Parenthood was resoundingly smacked down, not once but twice. It’s not over till it’s over,  so I am waiting to see what parliamentary methods will be conjured up to somehow come back to this issue.

So, this is my focus right now and through mid-week. I’ll be back to my regular routine as soon as possible, but for now, I’m in this fight to the end. I’ll rejoin you as soon as I can!

 

RAEMD95, November 15, 2015

 

November 15, 2015 Posted by | Access To Care, Health Care, Health Insurance Companies | , , , , | 2 Comments

“Punishing Those With Uteruses More Severely”: The States Sending Pregnant Addicts to Jail, Not Rehab

In response to a nationwide heroin epidemic, some Cincinnati hospitals are starting a new program to test all mothers or their infants for opiates, not just those deemed to be at risk based on their background.

The program is intended to help physicians identify newborns who could suffer from Neonatal Abstinence Syndrome (NAS), a group of symptoms related to drug withdrawal including excessive crying, irritability, diarrhea, and seizures. Mothers who test positive will be referred to treatment while their newborns receive extended care.

It’s a bold approach to a growing problem but it may only be effective in a state like Ohio, which, unlike many states, does not punish pregnant women who suffer from drug addictions. Women already bear the brunt of the heroin epidemic and they may face additional criminal and civil consequences if they become pregnant while using drugs.

According to the Centers for Disease Control and Prevention (CDC), heroin use has more than doubled among adults ages 18 to 25 in the last decade, and heroin-related overdose deaths have nearly quadrupled between 2002 and 2013. Among women, heroin use has increased by a staggering 100 percent from 0.8 to 1.6 users per 1,000 people, as compared to a 50 percent increase among men across the same time period.

Over roughly the same time period, the prevalence of NAS has increased from 1.2 to 3.39 per 1,000 hospital births, becoming a pressing public health problem in neonatal ICUs.

In light of the spike in heroin use, the CDC recommends that states increase access to treatment for drug addiction. But some states seem to believe that the best way to help NAS newborns is by threatening their mothers with jail time instead of providing treatment and social support.

In 2014, a Tennessee law went into effect allowing pregnant women who take narcotics while pregnant to be charged with aggravated assault, which could result in a 15-year prison sentence. In so doing, the state earned the dubious honor of becoming the first to pass a specific law that would punish drug-addicted pregnant women.

Weeks after it went into effect, a 26-year-old mother who admitted to using meth before childbirth became the first woman to be charged under it.

“Hopefully it will send a signal to other women who are pregnant and have a drug problem to seek help. That’s what we want them to do,” a county sheriff told the local ABC affiliate.

But critics including the American Civil Liberties Union (ACLU) and The American Congress of Obstetricians and Gynecologists (ACOG) say that such measures do not encourage women to seek help but rather discourage them from seeking prenatal care. Some medical experts even believe that legal prohibitions on pregnancy during drug use may increase abortions among women who would feel pressure to terminate their pregnancies in order to avoid prosecution.

And if Tennessee lawmakers are truly concerned about the welfare of drug-addicted pregnant women, perhaps they should consider funding a specific program to help them recover.

As it turns out, the states that punish drug-addicted pregnant women and the states that prioritize their welfare have a disappointingly narrow intersection. According to the Guttmacher Institute (PDF), 19 states have created or funded targeted drug treatment programs for pregnant women. Tennessee does not number among them. Nor do 10 of the 18 states where it is considered child abuse, although five of them do give pregnant women priority access in general programs.

Of the 15 states that require mandatory reporting to the state when substance abuse is suspected, only six have created or funded treatment programs for pregnant women.

Including Tennessee, a handful of states have gone beyond state reporting requirements and standard definitions of child abuse.

In 2013, the Alabama Supreme Court upheld the conviction of two mothers who had used drugs while pregnant and ruled that drug use during pregnancy constituted chemical endangerment of a child because “the plain meaning of the word ‘child’ in the chemical endangerment statute includes unborn children.”

With this ruling, Alabama joined the South Carolina Supreme Court, which ruled in 1997 that a viable fetus was a “person” and that “maternal acts endangering or likely to endanger the life, comfort, or health of a viable fetus” could be considered criminal child abuse.

Neither Alabama nor South Carolina has funded specific substance abuse treatment programs for pregnant women.

Reuters reports that five other states have tried to pass legislation similar to Tennessee’s new law. In March, for example, North Carolina legislators pushed for a law that would classify drug use while pregnant as assault, a class 2 misdemeanor in the state.

But women who use drugs while pregnant have also been charged under the “fetal harm” and “fetal homicide” laws that are already found in a majority of states. Last year, a chronically depressed and uninsured Wisconsin woman named Tamara Loertscher spent 17 days in jail because clinic discovered methamphetamines and marijuana in her system when she went in for a pregnancy test. Loertscher said that she stopped using drugs as soon as she suspected she was pregnant but it was too late.

Many “fetal homicide” laws were originally intended to punish those who injured or killed pregnant women—now they are being applied to punish and demonize pregnant women themselves.

As ACOG notes, several major medical and public health organizations in the United States have argued that states should try to curtail drug and alcohol use during pregnancy through treatment rather than criminal prosecution. The American Medical Association fought the 2013 Alabama Supreme court ruling and opposes legislation that criminalizes drug use during pregnancy. And the American Psychiatric Association said in a 2001 position statement that “societal resources [should] be directed not to punitive actions but to adequate preventive and treatment services for these woman and children.”

Even new universal testing initiative in Cincinnati is not without controversy. As Reuters reports, some advocates would prefer a screening program for pregnant women to mandatory testing. But if mandatory testing can be effective anywhere, it would be in a state like Ohio where there are no criminal consequences for drug-using pregnant women, no mandatory reporting requirement, and state-funded treatment available for pregnant women.

What a novel idea: Help people recover from drug addiction instead of punishing the ones who have uteruses more severely.

 

By: Samantha Allen, The Daily Beast, August 12, 2015

August 13, 2015 Posted by | Abortion, Drug Addiction | , , , , , , , | Leave a comment

“How To Stop Heroin Deaths”: Up To 85 Percent Of Users Overdose In The Presence Of Others

Philip Seymour Hoffman who died of an apparent heroin overdose on Sunday, was just one of hundreds of New Yorkers who fall victim to this drug each year. Heroin-related deaths increased 84 percent from 2010 to 2012 in New York City and occur at a higher rate — 52 percent — than overdose deaths involving any other substance.

I am an emergency physician at NYU Langone Medical Center and Bellevue Hospital, but I rarely see victims die of heroin overdose because most fatalities occur before patients get to the hospital. Overdoses often take place over one to three hours. People just slowly stop breathing; often they are assumed to be sleeping deeply, or they are alone.

The most frustrating part is that each of these deaths is preventable, because there is an antidote to heroin overdose that is nearly universally effective. Naloxone, an opioid antidote, is a simple compound that has been in clinical use for more than 30 years. It can be administered via needle or as a nasal spray, and it works by displacing heroin from its receptors in the brain and rapidly restoring the overdose victim to consciousness and normal breathing.

An analysis in the Annals of Internal Medicine last year suggested that up to 85 percent of users overdose in the presence of others. This provides an opportunity for friends, family and other non-health care providers to intervene. In New York State, it has been legal to distribute naloxone to ordinary citizens since 2006. But the distribution has to be done with medical supervision. Naloxone is purchased by the city and state health departments, which then distribute the antidote through hospitals, harm-reduction programs and other outlets at no cost to patients.

Some New York City hospitals are now distributing kits containing naloxone to users and their friends and families. For the past three years, the New York City Department of Homeless Services has administered naloxone in shelters. And a new pilot program on Staten Island — which has the highest rate of heroin overdose deaths in New York City — is supplying the antidote through the Police Department’s 120th Precinct there.

The city’s health department is conducting a large study following people who get naloxone to assess how frequently the antidote is used to reverse overdose. In 2012, the health department filed a public letter to the Food and Drug Administration recommending that the F.D.A. approve naloxone for over-the-counter use. The letter stated that more than 20,000 kits had been distributed in New York City. It also noted that more than 500 overdose reversals had been reported by civilians who had administered the antidote.

Some people might argue that the widespread distribution of a safe, effective and inexpensive antidote might actually encourage drug use. But that’s like suggesting that air bags and seatbelts encourage unsafe driving. Naloxone is a public-health method of intervening when a life is in the balance. Its distribution is endorsed by the American Medical Association.

A new bill that would make it easier for users to obtain naloxone was introduced in the New York State Legislature just last week, and on Tuesday it passed the State Senate Health Committee. It would increase access to the antidote by allowing doctors and nurses to write standing orders — prescriptions that can be used for anyone — and issue them to community-based drug treatment programs. The programs would then train people on the signs of overdose and provide them with the naloxone kits. This means that the programs would not have to have a doctor present to distribute the antidote, overcoming one major hurdle that impedes widespread distribution.

This bill empowers a community to protect itself and others. If the bill becomes law, it would be one step closer to making naloxone available over the counter — as it already is in Italy.

According to the Centers for Disease Control and Prevention, drug overdose is now the leading cause of injury-related fatalities in the United States, ahead of motor-vehicle collisions and firearms accidents. We make cars safer by having speed limits, seatbelts, crumple zones and D.W.I. laws. We make it harder to buy a firearm with background checks and waiting periods, and we teach gun safety and sometimes mandate trigger locks. We can make heroin safer, too, by supplying methadone or buprenorphine as medications to treat physical dependence, providing clean needles to help prevent the spread of hepatitis and H.I.V., and facilitating the wide availability of naloxone to counteract overdoses.

While Mr. Hoffman’s death was without a doubt a tragedy, it is also emblematic of a societal need to take action to prevent the hundreds of deaths that otherwise go largely unnoticed. We can’t control heroin — that’s the job of law enforcement — but we can make it safer.

By: Robert S, Hoffman, Emergency Physician, NYU Langone Medical Center and Bellevue Hospital; Director of the Division of Medical Toxicology at New York University School of Medicine, Op-Ed Contributor, The New York Times, February 6, 2014

February 7, 2014 Posted by | Public Health, Public Safety | , , , , , , , | 1 Comment

Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax

In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.

Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.

Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.

“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”

Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.

But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.

Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”

As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”

He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.

Tort Reform Backfires in Texas

That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.

In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.

Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.

It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.

The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.

Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.

In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.

Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.

Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.

All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.

 

By: Wendell Potter, Center for Media and Democracy, September 1, 2011

September 1, 2011 Posted by | Conservatives, Consumers, Elections, Freedom, GOP, Government, Governors, Health Care, Health Care Costs, Ideologues, Ideology, Lawmakers, Middle Class, Politics, Public, Public Health, Republicans, Right Wing, State Legislatures, States, Teaparty, Uninsured, Voters | , , , , , , , , , , , , , , , , , | 1 Comment

   

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