Monday, September 11, 2017

More Unfinished Business: AB 1048 (Arambula):opioid prescribing

It's no secret that that the State of Opioids in California and elsewhere is a mess. In 1999 the Orgeon medical board sought to discipline a physician because it was claimed that he hadn't prescribed enough pain medicine. In 2001 the State of California made page one of The Washington Post when a patient's family sued because they said the doctor hadn't prescribed enough pain medicine. Now the shoe is on the other foot and doctors everywhere are beleagured for prescribing opioids to relieve pain. Comes now to the mini-partial rescue, Dr. Arambula, whose bill would allow pharmacists as of 07/01/18 to dispense Schedule II controlled substances as a partial refill if asked to do so by the patient or the prescriber. As of this writing the bill is on the Senate Floor where it is being sponsored by the CMA and guided by Alecia Sanchez from CMA's legislative office. This publication favors the bill -- a phone call or fax from you to your state senator advising an aye vote is our recommendation.

The matter will not be settled by this vote. It will continue to be an issue and will be the CME topic for the Union of American Physicians and Dentists at their meeting on October 28th (Marriott, Los Angeles airport). Contact UAPD for more information. 

Late Flash: AB 1048 cleared the state senate on 09/13/17, by 40 to zero. On 9/15/17 it was designated as "enrolled." 

Updating: AB 1048 is now on the Governor's desk according to the CMA Hot Lists dated 9/29/17 and 10/03/17 (that means the bill awaits the governor's signature). Phone calls, faxes, or e-mails intended to influence this legislation should go directly to the governor's office, 916-445-2841, 916-558-3160 (fax), or


"Opioid prescribing and panic," WORKCOMPCENTRAL, 08/15/17

See previous post this date (9-11-17) for current status of MOC and how ABMS boards profit from it (at members' expense, of course). 

UNFINISHED BUSINESS: first, the boards, MOC, and rapacious financial conduct

Under Unfinished business we wryly observe that MOC (Maintenance of Ceritification) remains viable and unwell. We now know without doubt that ABMS specialty board physicians and executives are profiting from MOC fees which, allegedly, are supposed to support the not-for-profit educational mission of our traditional (since 1922) specialty boards. In fact, reasonable argument can be made that the original not-for-profit motif of the boards has been converted into one of personal gain that belies the legal enablement of the boards under 501(c)3 rules and regulations. What is called for now is an investigation by the FTC (for possible restraint of trade) and by IRS (are the boards conducting themselves in conformity with the law governing 501(c)3 organizations)? 

Here's some grist from the mill, in this case, from the 990 Form filed by the American Board of Psychiatry and Neurology (ABPN) in 2015:

The MD president was allocated $613,314 as "reportable income from the organization (W-2/1099-MISC)." In addition his "estimated amount of other compensation from the organization and related organizations" was $322,686.

Four ABPN Directors are listed as having received "reportable compensation" ranging from $175,947 to $246,012. In addition, the same four got additional "compensation from the organization and related organizations" ranging from $73,914 to $83,546.

Two managerial remunerations were reported as $111,661 (with an additional $50,351 listed as "other compensation") and $106,552 (with an additional $37,608 listed as "other compensation").

The VP of Research came in for $286,384 plus $99,668 for "other compensation"). 

Other remunerations were equally fat.

Here's the point: if a 501(c)3 organization has high enough expenses including salaries it is obvious that it can't make a profit if all of the money it takes in gets distributed to private hands inside the organization in the form of expenses. In this way, a not-for-profit organization can make more money for its officers, directors, trusteee, and others than can a true for-profit business.

Is this the way we want our ABMS boards to function?


"Specialty Boards Profiting from Physician MOC Fees," MEDSCAPE, 08/01/2017

"Medical Staff Votes Against Mandatory MOC," WORKCOMPCENTRAL, 01/22/2016

Form 990 (2015), Part VII, Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees, page 8.