Friday, May 30, 2014

VA SECRETARY SHINSEKI TAKES THE HIT OVER VETERANS ADMINISTRATION FIASCO


Dateline, Washington, DC, 5/30/14 -- Our posting of 21 May 2014 in www.politicsofhealthcare.com stated that General Shinseki was "being prepared and prepped to take a fall." It can now be stated with reasonable legal certainty that the foreplay is over. The General has resigned. He has been sliced and diced, his head served on a platter to an irate public, while other problems with veterans outside the VA  system continue to be buried in the avalanche of scandal.


Among these items is  how a forensic panel reportedly altered the diagnosis of post-traumatic stress disorder (PTSD) for 14 formerly active duty soldiers in order to rescind their expensive PTSD  retirement benefits. In our previous release on this subject (see reference below) we told how this diagnosis and its attendant retirement benefits were predicted to cost the government from $400,000 to possibly over one million dollars. So, in a process akin to Utilization Review for injured workers in California, akin also to the Independent Medical Review process in California, officials who did not interview or examine the patients were reported to have altered the medical diagnoses from PTSD to "anxiety disorder" or something else less expensive in terms of retirement benefits to satisfy fiscal demands (see Army's denial in NBC story cited below under references).  Our opinion is that the PTSD benefits for these soldiers were sacrificed just as the veterans who were denied care were disenfranchised.  Now that  Shinseki has taken the hit, we can expect  more self-serving outrage and maybe even prompt house cleaning at the VA. There is still time to see whether or not there are  PTSD retirement benefits to other injured veterans at Madigan and elsewhere that should be restored lest they lose out in a smokescreen of retaliation against a bureaucrat who turned out to be out of his m├ętier as the VA Secretary.


References


"Army releases findings of Madigan PTSD investigation," Rebecca Ruiz, NBC News, 3/15/13


"What we don't want is people making decisions based on money instead of care of troops," comment by Rep. Norman Dicks, The Weinmann Report, www.politicsofhealthcare.com, 2/26/12

Wednesday, May 28, 2014

DRUG TESTING FOR LAWYERS AND PHARMACEUTICAL EXECUTIVES



District Attorney Tony Rackauckas representing Orange County and County Counsel Orry Korb from Santa Clara County have filed a consumer protection lawsuit against five opioid manufacturers. The accusation is that the five companies conducted a more than decade-long marketing campaign to mislead doctors about the risk of long-term opioid management. The named defendants are Purdue Pharma, Teva Pharmaceutical Industries Cephalon, Janssen Pharmaceutical, Endo Health Solutions, and Actavis. The lawsuit also names the American Pain Foundation, the American Academy of Pain Medicine, and the American Geriatric Society.

The lawsuit asserts that "opiod makers were not the first to mask their deceptive marketing efforts in purported science. The tobacco industry also used key opinion leaders in its effort to persuade the public and regulators that tobacco use was not addictive or dangerous."

We owe this information to Tom Lynch whose editorial, "Another Day, Another Battle in the War on Over-Prescribing," was published as a column by WorkCompCentral on 5/28/14.

Our interest is how this matter now dovetails with the Malpractice Initiative that the trial lawyers are expected to qualify for the November ballot in California in an effort to repeal the MICRA reform instituted by Gov. Brown during his first administration. The Initiative is aimed at drug-testing for physicians and doesn't mention that annual insurance premiums for a family of four may be increased by as much as $1,000.

Although the trial lawyers espouse drug testing for physicians, pilots, and others, they do not include themselves.

We now recommend that they find a way to include drug testing not only for themselves but also for pharmaceutical companies, their executives, and all of their employees including sales department personnel.

Just call it The Full Employment Drug Testing Act (FEDTA).

Late Flash: the trial lawyers' initiative to increase malpractice awards for themselves has been designated Proposition 46 while the campaign against it, which we support, will be called the No on 46 Campaign.

Additional References

"When Should Lawyers be Drug Tested?" by Dr. Robert Weinmann, www.workcompcentral.com, 4/28/14

"Random Drug Testing for Lawyers," The Weinmann Report (www.politicsofhealthcare.com, 4/24/14)

"California's Ballot initiative will mandate random drug testing ONLY for doctors (why not attorneys?)," by Rehan Sheikh, facebook.com/PhysiciansForFairness, {https://www.facebook.com/PhysiciansForFairness}, twitter.com?Voice_MD {https://twitter.com/Voice_MD} 5/20/14


 

Wednesday, May 21, 2014

WE ARE ALL VETERANS: COMMENTS ON THE CURRENT VETERANS' ADMINISTRATION FIASCO


WE ARE ALL VETERANS: will the same dismal outlook overtake our military veterans in the VA system as it did the Post-Traumatic Stress Disorder victims at Madigan General Hospital (see our blog from Sunday, February 26, 2012)?

The latest ringing quote from President Obama, "I  will not stand for it!" is vaguely reminiscent of other outstanding verbalizations from the president, e.g, when he said that "I will not let any bureaucrat stand in the way of the care that you need," then stalwartly pushed ahead with the IPAB (Independent Payment Advisory Board) woven deftly into the ACA (Affordable Care Act) in Section 10320 (see our previous posts on this issue wherein we tell how the IPAB is designed to limit access to care without pesky Congressional oversight).

The latest medical scandal concerns the Veterans Administration (VA). On the rack at the moment is former General Ric Shinseki. The issue is to what extent the VA may have cooked the appointment books such that 40 veteran patient-deaths are attributable to delayed medical care at the Phoenix VA.

Speaking out in evident ire, President Obama said "it is dishonorable ... it is disgraceful." As a result 26 VA facilities are now under investigation. While Shinseki  promises to get to the bottom of the matter, the press noticed he wasn't standing next to President Obama during the president's  press conference (speculation is the General was in a roadside foxhole  as would be any sensible soldier while a hostile straffing mission worked the skies above).

"If there is misconduct it will be punished," the president declared, ringingly adding, "I will not stand for it!" Meanwhile, Ron Nabors will supervise review of the VA and the expected IG Report which will tell us what's to be done and whether or not Shinseki still has a job. Obama, meanwhile, declares "we all know it takes too long for veterans to get care" while simultaneously inserting commens that the problem was also true for previous administrations regardless of party lineage. Trouble is these remarks come from the same source that first promised that no bureaucrat would interfere with the care we need, then said that we could keep our doctors, and finally for strike three that we could keep our current insurance if that's what we wanted to do.

"What we don't want is people making ... decisions based on money instead of care of the troops!" So said Representative Norman Dicks, D-Belfair.  The issue then was lifetime benefits for soldiers diagnosed with PTSD (post-traumatic stress disorder). 14 soldiers with this diagnosis were reportedly costing the government from $400,000 to $1.5 million in lifetime benefits. To save this money, a forensic psychiatry team changed the diagnosis.  President Obama needs to apply the same language he used re the Veterans Administration, in short, it's time to ask if bureaucrats in the Madigan decision "cooked the books."

This writer was never satisfied with the explanations put forward at the time. Neither are we satisfied with the way in which the VA situation is being investigated -- it looks like Gen. Shinseki is being prepared and prepped to take a fall. The immediate reasonable solution is to assign more physicians to each of the 26 VA facilities now under review. This adjustment should start in Phoenix. The Madigan  situation should also be reviewed with possible restoration of benefits that remain denied.


The overriding issue is whether or not the entire country is being prepared for reduced access to  care, what Philip Klein referred to as "access shock." The issue is to what extent "choice" will be sacrificed by the ordinary citizen so that insurance companies can enhance profits by reducing costs by such methods as simply offering less in terms of physician access and access to diagnostic and treatment facilities. It's called scrimping and skimming.

Now we find out that scrimping and skimming in the Veterans Administration may have led to the death of former troops just as it is expected that the IPAB portion of the ACA will lead to derelict care, diminished levels of treatment, and even to the death of patients mired in a bureucracy of healthcare mandates that has been a disappointment from rollout despite constant revisions.

"I will not stand for it," he said? No, WE will not stand for it, or better not, lest we hoist ourselves on the same rope we used to strangle PTSD care at Madigan and VA care everywhere. We are all veterans of unwise decisions that have converted medicine into a succession of programs beneficial mostly to insurance companies and like-minded corporate interests.

The time has come for all of us to shout "I will not stand for it!"

Disclaimer

The writer is an Army veteran, Captain, USAMC (U.S. Army Medical Corps), and admits to bias on the part of the veterans.

References

The Weinmann Report (www.politicsofhealthcare.com, 2/26/12

"Head of Madigan removed from command amidst PTSD probe," Seattle Times, 2/20/12,  by Hal Bernton

"Army insists doctors at Madigan aren't discouraged from diagnosing PTSD," The News Tribune, 2/10/12,  by Adam Ashtone

"Rationing comes home to roost in the form of denial of care," www.politicsofhealthcare.com, 2/17/12, and www.workcompcentral.com, 2/24/12

"President Obama's oblique references to healthcare," www.politicsofhealthcare.com, 2/27/12

"President Obama apologizes and promises to interfere with care you don't need," www.politicsofhealthcare.com, 11/08/13

"Obamacare insurer says Americans have to break the 'choice' habit," www.washingtonexaminer.com/article/2548386, 5/13/14
 

Monday, May 12, 2014

DO DOCTORS EXPIRE IN 10 YEARS?


"Do doctors expire in 10 years" is the title of the lead article in AAPS news from the Association of American Physicians and Surgeons, Vol. 70, No. 5, May 2014. Our readers may enjoy comparing this piece with items from The Weinmann Report, www.politicsofhealthcare.com, "How Physicians Eat their Young," 12 Feb 2014 and "Money and Medicine," 21 July 2012.

The subject is recertification and reveals how boards, associations, and other organizations may use Maintenance of Certification (MOC) to enrich themselves and their organizational coffers at the expense of their own members. The AAPS poses this theoretical question: if "one day a highly trained, experienced physician may be board certified -- and the next day, after examination results are revealed or a deadline for MOC compliance passes, he may be decertified and unemployable. In that one day, could he have become demented, or fallen behind in keeping up with this field?"

The article points out that "resolutions against MOC have been enacted recently by the American Medical Association and the state medical societies of New Jersey, Michigan, Ohio, Oklahoma, New York, and North Carolina."

In the same issue, Larry Huntoon, MD, PhD, points out that the American Academy  of Neurology (AAN) was to feature an MOC International Session but did not feel required to file a conflict-of-interest disclosure from Lois Margaret Nora, MD, CEO of ABMS. In 2012 Nora earned about $330,000 in compensation from ABMS and associated organizations according to the ABMS form 990."

AAN reportedly told AAPS that no such disclosure was necessary because AAN did not give CME credits for attendance at this session.

Once again we see an assault on physician autonomy, this time from within, from persons who benefit financially by imposing MOC requirements on hapless physicians whose evolving practices may not meet the confinements of MOC predators.

Additional References

Journal of American Physicians and Dentists, V. 18, # 3, Fall, 2013, "Maintenance of Certification (MOC) : the elite Agenda for Medicine," Christman, Kenneth, "the elite medical establishment correctly foresaw that there as a huge treasure in the medical certification  business").

Journal of American Physicians and Dentists, V. 16, #2, Summer, 2011, "Board Certification -- a Malignant Growth," Dubravic, Martin, MD.