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Court Grants Preliminary Injunction Against Physician Gag Law Print E-mail
Written by Bernd Wollschlaeger, MD   
Tuesday, 27 September 2011 16:19

Since Taking Effect, Unconstitutional Gag Law Had Chilled Speech by Florida Doctors

 The Florida chapters of three national medical organizations, along with six physicians, applauded the decision of a federal district judge to immediately block enforcement of the new state law that bars healthcare professionals from asking patients if they own guns and have them stored properly.   These questions are a key element in the practice of preventive medicine.

The groups, along with individual doctors, had asked Judge Marcia Cooke of the U.S. District Court for the Southern District, Miami Division to issue a preliminary injunction because the new law has already curtailed the First Amendment rights of physicians across the state to speak with their patients about gun safety.  A preliminary injunction is an order that prevents a party from pursuing a particular course of conduct until a case has been decided.  To grant a preliminary injunction, the court must find that plaintiffs have a substantial likelihood of success on the merits of the case.

Lisa A. Cosgrove, M.D., FAAP, President of the Florida Chapter of the American Academy of Pediatrics (Florida Pediatric Society) said: "Pediatricians simply want to do what they do best: protect children.  We hope that now we will be able to get back to working with parents to maintain their guns, pools and poisons to keep kids safe."

Dennis Mayeaux, MD, Chair, Board of Directors, Florida Academy of Family Physicians said:  "The impact of this law has already caused serious rifts in physician-patient relationships.  Casual conversations with patients often bring other medical issues to light, and erosion of these opportunities also erodes the quality of care.  The preliminary injunction will now allow us to talk to our patients again about firearm safety."

Stuart Himmelstein, M.D., American College of Physicians Governor for Florida, stated: "Reversing this law is essential in order to preserve the sanctity of the doctor -patient relationship by keeping the government out of the exam room.  The preliminary injunction will preserve free speech between both doctors and patients as protected by the Constitution and which is necessary to obtain the highest of quality care that every citizen deserves."
 
Physicians and other healthcare professionals routinely provide their patients with information about a variety of health risks in the home and broader environment.  Such preventive counseling has become a cornerstone in the practice of medicine and is recommended by numerous professional medical societies.  In the course of practicing preventive medicine, healthcare professionals routinely ask and counsel patients about firearm safety.

The state chapters of the American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians collectively represent more than 11,000 healthcare professionals in Florida.  On June 24, 2011, these organizations, along with six individual physicians, filed papers asking the court to enjoin the law because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety. 

The lawsuit challenging the Physician Gag law was originally filed on June 6, 2011, shortly after Governor Scott signed it into law.  Prior to filing suit, the physician groups urged the Governor to veto the legislation since it infringes the First Amendment rights of healthcare professionals throughout Florida.  

The organizations and individual physicians in the lawsuit are represented by Ropes & Gray (lead counsel), Astigarraga Davis (local counsel), and lawyers from the Brady Center to Prevent Gun Violence's Legal Action Project.    
 
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Last Updated on Tuesday, 27 September 2011 16:25
 
Why can't we be friends? Examining Political Polarization Print E-mail
Written by Jeffrey Herschler   
Thursday, 22 September 2011 09:56
FOR CRYING OUT LOUD                                     

OK. Quick show of hands.  Who among us is in favor of mandatory safety belts in American automobiles?    How about federal guidelines dictating proper infection control standards in hospitals and ASC's?  And may I assume that the vast majority of us would not vote to eliminate federal oversight of pharmaceuticals?   And let's address TSA making us take off our shoes to pass through airport security:  Silly for sure, but I'm thinking we don't mind too much.  (see story:  Improved Technology promises to eliminate TSA's shoe removal requirement).  A few wackos on the periphery disagree but most reasonable men and women believe in a powerful government role for our society.  

Now. Yea or Nay.  Physicians should be allowed to own their practices and profit in that enterprise.  Citizens should be permitted to own private property including real estate and financial investments.    People ought to be monetarily rewarded for hard work and dedication;  those who are lazy and foolish will and should earn less.  Again, aside from a couple of kooks, I am receiving a lot of affirmative feedback.   Thus, it's safe to conclude that we overwhelming espouse free-market capitalism. 

So why not promote the best ideas for this country that embrace a strong, but limited, government that collaborates with a free market, subject to the rule of law?  In this Utopian world, each decision we make recognizes the need for balance between government and business.   Brand me an idealist.  Mock my naiveté.  Heck you can even call me wishy-washy for occasionally voting for a Democrat.  For crying out loud,  it's better than being a demagogue or an extremist.

Mr. Herschler is the Editor and Publisher of FHIweekly.

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Last Updated on Thursday, 22 September 2011 10:00
 
Heightened Risks in Healthcare M&A? Print E-mail
Written by Tara Pihn   
Thursday, 22 September 2011 09:31
 
With all this talk about Practice Mergers, Hospital/Physician Alignment and the ascent of ACO's, I have to bring up the possibility of inadvertently acquiring Whistle Blowers as a risk associated with Practice Acquisition.  None of the recent articles on the topic that I have read mention this very real risk.   Exhibit 1:   Whistle-Blower Suit at Mount Sinai  (11th Circuit Court via DBR).  The case involves an administrator employed in an Oncology practice that was acquired by Mt. Sinai in Miami Beach.  The complainant administrator had been employed by the practice for a dozen years and become an employee of the hospital in 2009.   I don't pretend to know the merits of the employee's case.  That said, some of the allegations seem improbable.  I do know that Mt. Sinai has enjoyed an above average reputation in the S. Florida healthcare community and recently was mentioned at the top of U.S. News & World Report's Hospital Rankings.  I am guessing they have a pretty good Compliance Department as well.  Without attempting to try this case in cyberspace, it's worth noting that opportunistic employees and former employees abound in this economy and have little loyalty to an acquirer. 

More recently I spotted this Whistle Blower headline in a local paper:  Doctors Receive $700k to resolve kickback allegations.  This involves Midtown Imaging and their employed doctors in WPB.  Again I don't pretend to know the merits of the case.  And for all I know, Midtown was culpable.   The point is that there are huge risks from within our organizations.  Payoffs from "blowing the whistle" can set one up for life so incentives are enormous. 

Meanwhile some law firms are trying to drum up business by soliciting Whistle Blower suits.  One example is www.TheWhistleBlowerLaws.com.  They are running this provocative advertisement headline in a S. Florida business paper:  Thinking About Blowing the Whistle on Corporate or Government Fraud?

There is no doubt that legitimate Whistle Blowers serve a beneficial purpose in exposing fraud and corruption and saving precious government resources.  However, just as in med mal, slip & fall, personal injury and product liability cases, frivolous litigation by opportunists (employees and their attorneys) does occur in the Whistle Blower world.   These unnecessary legal actions clog the courts and restrict an already sluggish economy.  They also harm lawful healthcare providers.    Compliance Departments must be extra vigilant in these trying economic times especially if engaged in a merger or acquisition.  An otherwise fine organization can be destroyed by one rogue employee.
           
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Last Updated on Sunday, 02 October 2011 13:16
 
Reader Response: Are Pain Management Clinics that Advertise in the Alternative Weeklies Legit? Print E-mail
Written by Jeffrey Herschler   
Sunday, 18 September 2011 15:13

I worked in the advertising department at New Times in the ‘90’s.  I don’t recall a single pain management clinic advertising at that time.  It’s a little like the twilight zone when look at these ads.  Some of the same clinics are advertising pain management and addiction treatment.  So the suppliers are meeting the demand and in that process creating demand for new services.  And all of this is being done in the open by licensed practitioners with prominent street signage, billboards and print campaigns.  
-Advertising Executive, Ft. Lauderdale

The readers of New Times who pay attention to (respond to) pain clinic ads are generally interested in pain meds and other controlled substances for non-medical (abuse, profit) purposes.  These are the same people I try to screen out during the new patient scheduling process.
– M.D., Broward

10 years ago there was more of a mix of really damaged people; whether military veterans or people who were just plainly hurt. These were people whose pain was physically evident. Many of these people could not afford real pain intervention doctors or had become addicted to their pain medication. Pain meds are extremely habit forming.  They came to us to get a bi-annual MRI or CT if there was metal in their body and often times there was. So it was largely real pain patients who came for MRIs back them to justify the continued prescription for Pain Meds. But there was no control to how many doctors patients can see for meds and the opportunity to abuse the drugs is easy.  The ease of getting these drugs eventually brought in real druggies who gamed the system in order to get pills to consume or sell. Come here and see a few different pain clinics and a drug dealer can get lots of oxy codeine to sell.  This is when the business became swamped with more clinics and out of state "patients".   
-IDTF Owner, S. FL

These clinics would not be advertising in the weeklies if they weren't getting the patients, that's the bottom line. There is so much scrutiny on these clinics now I have to assume they are doing everything possible to make money and avoid the authorities, so whether they are legitimate or not it doesn't matter. It's like the ads for all the escort services and massage places in the sports section.
-Healthcare Technology Executive, Miami

Right. But are there enough legitimate cases of chronic pain in the Broward population that one newspaper in that community has over thirty advertising clients to serve this single category?  Where did this epidemic of chronic pain come from?                              
-Healthcare Executive, Dade County

Assume a $70 gross rev per visit with 40% margin. Do the math for the cognitive component excluding the technical component and other mark ups. I think you will find there are significant profits to be had with life long volume in repeat biz.  The specialty was created in answer to shrinking margins of anesthesiologists due to managed care
–Healthcare Consultant, Miami

In my view, a legit client would want to distinguish themselves from these other clinics that may or may not be 'pill mills'.  So I would recommend they find other avenues for marketing.
–Practice Manager, Broward

Most of those " doctors" advertising in these newspapers are looking for cash paying customers willing to pay any fee to obtain a prescription narcotic. These  "doctors" issue any prescription for any drug at any desired quantity. I have called and will call those doctors drug dealers in white coat. They should not be confused with a legitimate pain management specialist who applies multiple treatment modalities to treat pain. We must undertake all efforts to stop those pain mills. They serve no legitimate medical purpose.
-M.D. Miami-Dade

Interesting question. Years ago I owned several pain clinics. The answer is yes they would get value, but at what price?  The pain clinic would receive patient traffic from majority of patients "shopping" for prescriptions. Any real pain physician would not advertise in those papers. They would rely on referring docs (ortho, neuro).  Pain docs and pain clinics have such a bad reputation and for good reason, especially Broward County.  South Florida prescribes more pain meds than the entire country.
-Practice Management Consultant, Miami-Dade

Last year I was an IDTF Marketing Rep calling on the Pain Doc’s offices.   Here is what I remember:  parking lots full of revelers, (is this the doctor’s office or a tailgate for a UF football game?),  seeing the same “patients” in multiple doctors' waiting rooms on the same day,  the truly scary scene where a motley crew of tattooed low lifes and dazed & pierced hipsters were about to riot because the doc’s offices was locked up with a note saying the good doctor was on vacation (probably in the Caymans making a deposit in his offshore account).
– Healthcare Professional, South Fl

I know many of these pain clinics are nothing but drug suppliers no different from some guy on a street corner so I imagine the demographic for these publications is very much their target audience. But with that, a lot of people who have ‘legitimate’ issues will also go to them.  It stands to reason that younger people have more pain needs (that require pain management) than older folks.  They have car accidents, sporting accidents, back problems, etc.  The old-old have chronic pain, but not generally in need of pain mgmt, per se. Finally, we have a pain clinic in our building, and the jury’s out on how legit they are.  In terms of patient traffic, we see many more young people (25-45, probably more 25-35) than older folks.
-Practice Management Consultant, Broward

As is usually the case with most seedy industries, there is probably a small kernel of good that pain management businesses can do.  My guess is that it doesn’t generate enough net income to sustain a business so honest folks looked elsewhere.  After discovering the prescription/seedy side of the business, these people started making good money because it probably legitimately helped some folks.  When others saw this, they started jumping in and milking it for all that it is worth.  After 10 or more years operating like this, the industry ends up where it is currently.
-CEO, Radiologic Services Firm, Miami-Dade

Last Updated on Thursday, 22 September 2011 10:02
 
Florida Docs Blog Print E-mail
Written by Bernd Wollschlaeger, MD   
Thursday, 15 September 2011 09:46
A progressive viewpoint and healthcare vision....

PDMP Goes Online! 
Fla. prescription database goes into operation.

United Health On the Move
United Healthcare will acquire the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties.  This serves as an example of how lines are blurring between insurance companies and health-care providers.

Pill Mills Under Pressure

Accomplishments made despite the initial resistance by the current administration in Tallahassee.


READ MORE.
                       Reader Response, click HERE.  
Last Updated on Thursday, 15 September 2011 09:50
 
Why Rep Ryan's plan doesn't go far enough Print E-mail
Written by Tara Pihn   
Wednesday, 07 September 2011 16:24

OK.  Let's recap.   There has been a lot of talk about unfunded liabilities and monstrous debt accumulation by the US government.    We've known this was coming (for at least the last thirty years) but there has been little political appetite by either party to face the music.   The Great Recession (and the easy money policy response) exacerbated the problem and our leaders decided to finally address it.   The Bi-Partisan Debt Commission recommends over $4 trillion in budget cuts (over ten years) with heavy hits to entitlements.  But these recommendations are not adopted.  Nothing happens.  The 'Pubs engage in a bit of brinkmanship and refuse to raise the debt ceiling.  Meanwhile the Ryan Plan recommends an austerity plan ($6.2 trillion in budget cuts over ten years) that includes re-shaping Medicare.  He is careful to exclude citizens over 55 (he states in the WSJ on April 5 "But because government should not force people to reorganize their lives, its reforms will not affect those in or near retirement in any way.").  The Dems deride Ryan's Plan and staunchly stand up for all citizens and the Medicare benefits to which they are entitled.  Rep Ryan's Path to Prosperity is promptly tabled since Progressive and even moderate Republicans won't support it.   At the 11th hour, the debt ceiling deal goes through with massive budget compromise.  Only $2.4 trillion is cut, some of it fake.  Nobody is impressed.  Including S & P.  Downgrade in US credit rating results.  Then we have a global financial market meltdown.
 
It is allegedly extreme but in reality Rep Ryan's plan doesn't go far enough.  We have to cap Medicare benefits now, for everybody.  For those over 55.  For those over 60.  Hell, for those over 70.   To quote the Prez, "we all need some skin in the game".  Now, before relegating me to the lunatic fringe, click on this link: US BIRTHS 1947-1964.  As you can see the Demographic Bulge is happening right now.  It's peaking right now.  The people enjoying benefits and about to benefit are hitting their maximum numbers over the next decade.  That's why it is Mission Critical to reform Medicare immediately with no Sacred Cows.

See related article from the New York Times:  Federal Budget (2011 and 2012) - Obama and Ryan Budget Plans

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Give Me Liposuction or Give Me Death Print E-mail
Written by John Leighton Esq.   
Wednesday, 31 August 2011 17:35

IN MY OPINION

Another incident of death on the liposuction surgery table has occurred.  It is outrageous and must be stopped. How can so-called rejuvenation centers continue to get away with multiple incidents of catastrophic injures?

With South Florida a Mecca of cosmetic surgery facilities, more needs to be done to ensure the safety of patients undergoing procedures. Lack of licensed medical personnel, botched surgeries and improper procedures resulting in seizures, vegetative states and death are occurring all too frequently.  And Florida does not even require these health care providers to carry any liability insurance.

Before undergoing cosmetic surgery, a patient should research their physicians and any medical facility online to check for prior claims and what insurance is maintained.  They should also speak with friends and colleagues to check out the credentials of the provider and learn of their reputations.  Much can be found online through the Florida Department of Health.

If you have a story of catastrophic cosmetic surgery, send your comments to DearJohn@LeightonLaw.com.

Mr. Leighton is the Managing Partner of Leighton Law.  Contact him at 888.395.0001 or visit www.LeightonLaw.com.

                            
                                  Reader Response, click
HERE. 
Last Updated on Wednesday, 07 September 2011 16:29
 
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