Hurricane Irma Now Category 4 Storm: Florida And Puerto Rico Declare Emergencies

(THIS ARTICLE IS COURTESY OF CNN)

 

(CNN)Hurricane Irma strengthened to a Category 4 storm Monday afternoon, churning west in the Atlantic Ocean and prompting emergency declarations in Florida and Puerto Rico.

Although Irma’s path remains uncertain, the possibility it could threaten the United States led Florida Gov. Rick Scott to declare a state of emergency in all 67 counties in his state.
“In Florida, we always prepare for the worst and hope for the best, and while the exact path of Irma is not absolutely known at this time, we cannot afford to not be prepared,” Scott said in a statement released late Monday afternoon. “This state of emergency allows our emergency management officials to act swiftly in the best interest of Floridians without the burden of bureaucracy or red tape.”
The governor of Puerto Rico, Ricardo Rosselló, declared a state of emergency and activated the National Guard after the National Hurricane Center declared a hurricane watch for Puerto Rico due to Irma. Classes will not be held on Tuesday in the public education system nor in the University of Puerto Rico, according to a release from the governor’s office. Rosselló warned the public on Sunday that the island could feel Irma’s wrath around noon Wednesday.
As of 5 p.m. ET, Monday, Irma was about 490 miles (790 kilometers) east of the Leeward Islands, the National Hurricane Center said. It is packing maximum sustained winds of 130 mph (215 kph) as it heads west at 13 mph (20 kph). Landfall is expected early Wednesday on the island of Anguilla.
Computer models show the system moving through the Caribbean, and by the end of week, it will turn right toward the north, said CNN meteorologist and weather anchor Tom Sater.
“There is a small window. If it turns sooner rather than later, we could maybe see the system slide by the East Coast into the ocean, but that window is shutting quickly,” Sater said. “It definitely looks like we will be impacted by a major hurricane that is a Category 3, 4 or 5.”

Hurricane watches are in effect for the Nrn Leeward Islands. TS force winds are most likely to begin late Tuesday. http://hurricanes.gov/#Irma 

The hurricane center said swells generated by Irma would begin impacting the northern Leeward Islands on Monday.
“These swells are likely to cause life-threatening surf and rip current conditions,” the hurricane center said.
A string of Caribbean islands are now under hurricane warnings, including Antigua, Barbuda, Anguilla, Montserrat, St. Kitts, Nevis, Saba, St. Eustatius, St. Martin/Sint Maarten and St. Barts, the hurricane center said.
“A hurricane warning means that hurricane conditions are expected somewhere within the warning area,” the hurricane center said. “A warning is typically issued 36 hours before the anticipated first occurrence of tropical-storm-force winds, conditions that make outside preparations difficult or dangerous. Preparations to protect life and property should be rushed to completion.”
And Irma will only strengthen this week, CNN meteorologist Allison Chinchar said. “Over the coming days, it’s going to get into that warmer water. That’s going to help the storm intensify.”

Puerto Ricans warned

Hurricane Irma expected to gain strength, size

Hurricane Irma expected to gain strength, size 01:51
Irma is expected to remain a “dangerous major hurricane” through the week and could directly affect the British and US Virgin Islands, Puerto Rico, Hispaniola, Turks and Caicos, and the Bahamas, the agency said.
Puerto Rico’s disaster management agency, AEMEAD, is monitoring Irma and has opened an information hotline.

Florida governor says be prepared

It’s too soon to know the impact Irma could have on the continental United States, where no warnings or watches are in effect.
“Regardless, everyone in hurricane-prone areas should ensure that they have their hurricane plan in place, as we are now near the peak of the season,” the hurricane center said.
Chinchar said Irma could affect not just the eastern coast of Florida, but also farther up the East Coast.
“If there was a US landfall, we’re talking a week from today,” Chinchar said Monday.
Gov. Scott urged the state’s residents to ensure their disaster supply kits were ready. “Disaster preparedness should be a priority for every Florida family,” he tweeted Sunday

Why Irma could be especially intense

Irma is a classic “Cape Verde hurricane,” meaning it formed in the far eastern Atlantic, near the Cape Verde Islands (now known as the Cabo Verde Islands), before tracking all the way across the Atlantic, CNN meteorologist Brandon Miller said.
And Cape Verde storms frequently become some of the largest and most intense hurricanes. Examples include Hurricane Hugo, Hurricane Floyd, and Hurricane Ivan.

Pediatricians say Florida hurt sick kids to help big GOP donors

(THIS ARTICLE IS COURTESY OF CNN)

 

Pediatricians say Florida hurt sick kids to help big GOP donors

Updated 12:03 AM ET, Sat August 19, 2017

St. Augustine, Florida (CNN) When he was 11 years old, LJ Stroud of St. Augustine, Florida, had a tooth emerge in a place where no tooth belongs: the roof of his mouth.

LJ was born with severe cleft lip and palate, which explained the strange eruption, as well as the constant ear infections that no antibiotic could remedy.
With her son in terrible pain, Meredith Stroud arranged for surgeries to fix his problems.
But just days before the procedures were to take place, the surgeons’ office called to cancel them.
Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn’t take it.

Doctors: 'Trick question' hurt sick kids

Doctors: ‘Trick question’ hurt sick kids
LJ wasn’t alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children’s Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.
The state moved the children to other Medicaid insurance plans that don’t specialize in caring for very sick children.
Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn’t find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.
“He was in pain every day,” Stroud said. “I just felt so helpless. It’s such a horrible feeling where you can’t help your kid.”
LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children’s Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.
The doctors aren’t just worried; they’re angry.
First, the data analysis the state used to justify switching the children is “inaccurate” and “bizarre,” according to the researcher who wrote the software used in that analysis.
Second, the screening tool the state used to select which children would be kicked off the program has been called “completely invalid” and “a perversion of science” by top experts in children with special health care needs.
Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn’t automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.
Finally, parents and Florida pediatricians raise questions about the true reasons why Florida’s Republican administration switched the children’s health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.
“This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics.
Experts outside Florida are also disturbed that the children were switched out of CMS, a program that’s served as a model for other states for more than 40 years.
“CMS is well-known and well-respected,” said Dr. James Perrin, professor of pediatrics at Harvard Medical School. “It’s one of the earlier programs to build in assurances that these kids get the kind of care they need.”
“These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “This is really very troubling.”
Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children’s health care.
“The process in Florida was particularly abrupt and poorly executed,” he said.
Mara Gambineri, a spokeswoman for the Florida Department of Health, said that “at no time (during the insurance switch) did children go without medically necessary services.”
State officials, including a spokesman for Governor Rick Scott’s office, initially declined to comment directly on the pediatricians’ and parents’ concerns that the children might have been switched to benefit contributors to the Republican Party of Florida. On Friday, after this story was published, the Florida Department of Health released a statement asserting that such a claim “is 100 percent false.”
“The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs,” Gambineri wrote in an earlier email. “The department remains committed to providing quality health care services to Florida’s children with special health care needs.”

A mother’s anguish

In spring 2015, LJ’s mother received a phone call from a nurse at the Florida Department of Health.
Stroud had no idea that one word she would say to that nurse — just one single word — would cause her son months of pain and suffering.

Meredith Stroud's son, LJ, was born with cleft lip and palate. He lost his Children's Medical Service coverage when he was 11.

The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.
Despite his birth defect, LJ goes to school and plays with friends, so she answered no.
Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.
LJ was one of 13,074 Florida children kicked off CMS — that’s about one in five children in the program — as a result of the telephone survey, according to a presentationtestimony and a letter from Florida’s top health officials.
Stroud thinks back to her answer to the nurse’s question about limitations.
“That question’s not fair,” Stroud said of the one that got her child kicked off CMS. “What [the Florida Department of Health] did was totally wrong.”
“It was a trick question,” she added.

Pediatrician: ‘A truly duplicitous question’

Experts agree with her.
“I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids,” said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.
What Florida did was “completely invalid,” added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.
The pediatricians explained that many children with serious and chronic medical conditions — such as cleft lip and palate, HIV, diabetes and cystic fibrosis — are often able to do things other children can do. However, they still require extensive and highly specialized medical care.
The question the Florida Department of Health nurses asked — “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” — would lead to disqualifying children who truly have special medical needs from a program designed for them, said Stephen Blumberg, associate director for science at the National Center for Health Statistics and one of the world’s leading experts on the epidemiology of children with special health care needs.
Question No. 3

“Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

“You would get false negatives. Your conclusion would be that a child does not have special health care needs when, in fact, the child does,” he added.
Gambineri, the Department of Health spokeswoman, said it no longer uses the survey that resulted in 13,074 children being removed from CMS.
“It is unfortunate the negativity surrounding this issue is a continued topic of inquiry, as the department and our stakeholders have put in a significant amount of time and effort to move past this issue for the benefit of the children we serve,” she wrote.

Six pediatricians from across Florida gathered to tell CNN their concerns about children losing CMS coverage. They accuse the state of hurting sick kids to help big GOP donors.

But pediatricians in Florida point out that many children who were removed from Children’s Medical Services using the controversial questionnaire were never put back on.
“This was a truly duplicitous question,” said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. “It was a trick question.”
“It’s a perversion of science,” said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children’s Hospital.
Goldhagen added that he was speaking for himself and not the institutions where he works.
“It was a scam job,” added Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee who said that dozens of her patients with diabetes were removed from the program.

Dr. Nancy Wright, a pediatric endocrinologist, says dozens of her patients lost their coverage on Children's Medical Services. "For the children with diabetes that I work with, it was a disaster," she said.

“They really tried their darnedest to kick the kids out of CMS,” added Dr. Carrol Fenn, an orthodontist in West Palm Beach. “They’ve messed up kids’ lives.”
“They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing. How can someone in an office make a decision like that?” asked Dr. John Obi, an adjunct clinical professor in plastic surgery at the University of Florida, who operates on children with cleft lip and palate.
“I congratulate whoever came up with that question,” he added wryly. “If you want to exclude virtually anybody, that’s the way to do it.”

Johns Hopkins expert: ‘I’m speechless’

Christina Bethell’s team came up with that question — and she’s furious.
Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. She and her team spent many years and millions of dollars coming up with the right questions to accurately identify children across the United States who might have special health care needs.
The list of questions — known as the Children with Special Health Care Needs Screener — is publicly available on the Hopkins website. Many state and federal agencies use it to help decide which children might benefit from special health services.
The Florida Department of Health, however, used the questions to do something completely different: to kick children out of a program.
That’s scientifically invalid, Bethell said. Using the questions that way — especially the question about limitations — would lead to denying children with special health care needs the services they require.
“I’m speechless,” she said.
To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins — the Children and Adolescent Health Measurement Initiative — to support the children’s removal from CMS.
“I feel really manipulated,” she said.
She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.
“I’m angry,” she said. “And I’m crestfallen for these families.”

Grave consequences for Florida children

The Shabanehs in Tallahassee are one of those families.
Aref Shabaneh, 8, is blind, and his sister, Yasmeen, 11, is severely visually impaired. Their mother, Reema Shabaneh, says they were kicked off CMS in 2015.

Aref Shabaneh lost his Children's Medical Services coverage in 2015. He is blind and reads in Braille.

Shabaneh says she told the Florida Department of Health nurse that they didn’t have limitations.
“Aref wants to do everything by himself,” she said. “He can play ball with friends. The ball has a bell, so he can hear it coming.”
After they were kicked off CMS, Shabaneh said, she couldn’t find an ophthalmologist on the new insurance plan willing to care for her children.
“I was so scared,” she said.
When Jennifer Rodriguez received the phone call from the Department of Health nurse, she said, she told the nurse she didn’t know how to answer the question about limitations. Her son, Alejandro, suffers from a congenital heart defect, asthma and kidney problems. Sometimes, his heart races and he has trouble breathing, but other times, he feels up to playing soccer with his friends.
“When I tried to explain the answer, she cut me off and said she was just doing her job and needed a yes or a no,” she said.
Rodriguez says she answered that her son, who was 10 at the time, did not have limitations. He then lost his CMS coverage.
“It makes me angry, because you would think that since he’s seeing a cardiologist, a nephrologist, a urologist and an asthma doctor, they would see he’s not your average child,” she said.
LJ, Alejandro and the Shabaneh children filed lawsuits and were put back on CMS. They were represented by the Public Interest Law Center at Florida State University.

Alejandro Rodriguez wears a nebulizer mask to help him breathe. After he filed a lawsuit, the state put him back on Children's Medical Services.

Many Florida pediatricians say their patients also suffered when they were taken off CMS and put on other Medicaid plans. The doctors say those other plans typically have fewer pediatric specialists than CMS, which specializes in caring for very sick children.
Dr. Lisa Cosgrove, a pediatrician in Merritt Island, Florida, said she had a difficult time finding an orthopedist to treat a 6-year-old with a broken elbow who had been taken off CMS. The girl ended up having surgery later than she should have and now can’t extend her elbow all the way.
She said a baby born with a clubfoot also suffered because she couldn’t find an orthopedist willing to take the baby’s plan. The baby couldn’t have the necessary casts to twist the foot back into place and may need surgery, Cosgrove said.
Dr. Elizabeth Curry, a pediatrician in Port St. Joe, Florida, said that last year, she took care of a baby whose eye wiggled back and forth involuntarily, which can be a sign of a brain tumor.
Curry said it took her more than a month to find an ophthalmologist willing to take the baby’s Medicaid plan — and the doctor she finally found was three hours away, in Pensacola.
Fortunately, the baby turned out to be fine.
“This child could have had cancer. That’s a kid who should have seen a doctor right away,” Curry said. “I feel terrible for these children. It makes me so angry.”

Dr. Elizabeth Curry, a Florida pediatrician, says some of her patients didn't get the treatment they needed because the state had removed them from Children's Medical Services.

Because of problems like these, switching the children’s insurance “was a complete dereliction of Florida’s responsibility to children,” said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.
Gambineri, the spokeswoman for the Florida Department of Health, said the children didn’t suffer as a result of the switch, because the insurance plans they were moved to were “more than capable” of caring for them. She added that even before the 13,074 children were switched, those plans cared for tens of thousands of children with special health needs.
Other pediatricians agree that plans besides CMS have done a good job of caring for these very sick children.
The other plans “do a pretty good job with our families,” said Dr. Karalee Kulek-Luzey, medical director of the Pediatric Health Care Alliance, a group practice with multiple locations in the Tampa area. “They’re working really hard.”
“For the most part, they do a good job,” said Dr. Michael Freimark, a pediatrician in Plantation, Florida.
“We have a good relationship with the plans,” said Dr. Michael Gervasi, president and chief executive officer of the Florida Community Health Centers, a large medical practice with offices in several counties. Most of the time, he said, the plans take care of the children’s needs, but if there’s ever a problem, his practice contacts the plan, and they fix it.

Aref's older sister, Yasmeen Shabaneh, was also was removed from Children's Medical Services. She has a vision condition so serious that even a minor bump could cause her retinas to detach.

Florida’s ‘outreach’ to experts

In January 2016, about eight months after the Florida Department of Health started to move the 13,074 children out of CMS, Jennifer Tschetter, then the department’s chief operating officer, testified before the state legislature. She said that the decision to use the Hopkins screening tool was made “in consultation with … national experts.”
But it remains unclear who those experts were.
Tschetter, who has since left state government, did not respond to phone calls and emails seeking comment.
Gambineri, the Florida health department spokeswoman, said the department did “research” into what Louisiana, California, Texas and New York “were doing and experiences they had in regard to clinical eligibility for children with special health care needs.”
When asked for the names of individuals Florida consulted in those states, Gambineri didn’t respond.
Gambineri added that “outreach” was made to the federal Health Resources and Services Administration.
An official at that agency said she spoke with a Florida health official.
Dr. Marie Mann, senior medical adviser in the Division of Services for Children with Special Health Needs at the federal agency’s Maternal and Child Health Bureau, said she spoke with Stannard, who works for the Florida Department of Health.
Mann says she told Stannard she couldn’t give her any guidance.
“I told her I was not in a position to provide advice,” Mann said.
Mann said she suggested that Florida health officials reach out to Daniel Armstrong and Dr. Jeffrey Brosco, director and associate director respectively of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.
“We will make sure they’re both involved in this review process,” Stannard wrote back to Mann in an email obtained by CNN under the Freedom of Information Act.
CNN asked Gambineri, the department spokeswoman, whether the department ever reached out to Armstrong to review and make recommendations on using the telephone survey to screen children out of CMS.
“Not to our knowledge,” Gambineri answered.
“I played no role in the decision-making process related to the use of the tool for the Children’s Medical Services program,” Armstrong wrote in an email to CNN.
Brosco said he told the Department of Health that in his opinion, a child should not be kicked off CMS based on a parent’s answer to the question about the child’s limitations.
“I gave them my feedback, and they said, ‘thank you for your work,’ ” Brosco said.
In July, Brosco was named the Florida Department of Health’s deputy secretary for CMS.

Christmas shopping at the Florida Mall

Despite the lack of support from the very experts they’d consulted, Florida health officials forged ahead with using the phone survey to disqualify children from CMS.
They had a schedule to stick to.
In November 2014, state officials set out to “go live” with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.
Before implementing the surveys, the officials gave themselves 21 days to “solicit feedback from the field” about the questions they would ask the parents.
One of the first things they did was to ask one of the state’s most experienced pediatricians to leave a meeting.
It was St. Petery, who at the time was the executive vice president of the Florida chapter of the American Academy of Pediatrics and who has an encyclopedic knowledge of Medicaid rules and regulations. He’d served as interim director of CMS for six months during the mid-1970s.
He’d also been a thorn in the side of the state Department of Health for years. He’d been instrumental in a lawsuit that accused the state of failing to reimburse doctors properly in the Medicaid program and to ensure that children receive adequate care.
His side eventually won that lawsuit, and the American Academy of Pediatrics gave him a prestigious award for being “a tireless advocate for children’s health and well-being.”

Dr. Louis St. Petery, a pediatric cardiologist and frequent critic of Florida's health policy, was asked to leave a state meeting where Children's Medical Services screening was discussed.

On December 13, 2014, St. Petery showed up at the Department of Health meeting. It was for the regional medical directors of CMS, the group of pediatricians who help run the program. St. Petery wasn’t one of the directors, but he’d been attending their meetings for many years in his role with the Florida chapter of the American Academy of Pediatrics.
St. Petery said that just before the meeting started, Tschetter, then the department’s chief operating officer, approached him.
“She said, didn’t I want to go Christmas shopping at the Florida Mall?” St. Petery remembered. The mall was adjacent to the conference center in Orlando where the meeting was taking place.
St. Petery said he told Tschetter that he hates shopping, especially around the holidays, and wanted to stay at the meeting.
“I protested. I asked her, is this meeting not in the sunshine?” he said, referring to Florida’s Sunshine Law, which gives the public the right to access most government meetings.
“After she told me for the third time to leave, I decided not to create a scene,” he said.
St. Petery got up and left.
Other doctors watched the action, stunned.
“We were all kind of shaking,” said Dr. Barbara Rumberger, one of the CMS regional medical directors who attended the meeting.
After St. Petery departed, health officials explained that they would start screening children off of CMS. Their justification: a new analysis showing that half the children on CMS might not belong there.
There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

A ‘totally inaccurate’ analysis

By Florida law, a child can be in CMS only if he or she has a “chronic and serious” condition requiring health care “of a type or amount beyond that which is generally required by children.”
The analysis Tschetter presented showed that about half of the children on CMS had lower than average risk scores, an assessment of how much a patient uses health care services.
Tschetter called these results “surprising.” By legislative mandate, children on CMS are supposed to have health needs greater those of other children.
“The analysis made clear, certainly to the department, that we were not meeting legislative direction: (that) the children in the plan have both chronic and serious health care conditions,” Tschetter told legislators. “It was clear to the department that something had to be done, because complying with legislative direction is certainly not optional.”
But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.
“It’s totally inaccurate,” said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.
Gilmer’s software, which is used by dozens of state Medicaid programs, tracks patients’ diagnoses and their prescription drug use to calculate risk scores for each individual.
After viewing Florida officials’ analysis of the data, he said they made two errors when they calculated that half the children on CMS had below-average risk scores.
First, he explained that his software relies on doctors’ diagnoses, and Florida failed to account for the fact that doctors frequently don’t document a child’s full diagnosis in the medical record. For example, if a quadriplegic child goes to the doctor because of bedsores, doctors often write down the reason the child came in — the bedsores — instead of the more serious diagnosis of quadriplegia.
Second, he said, Florida did the wrong calculation for disabled children, who represent 40% of the patients on CMS, according to Mallory McManus, a spokeswoman for Florida’s Agency for Health Care Administration.
He said his software compares disabled children with each other. Even the ones who fall in the lower half of the risk-score spectrum still have serious and chronic illnesses, he said, such as HIV or heart failure.
He said that what Florida did was akin to assembling a group of people who are over 7 feet tall and calling the bottom half of that group short.
Gilmer called Florida’s analysis “kind of bizarre” and said he was disappointed to see his software “misapplied” by the Florida Department of Health.
Spokeswomen for the Florida Department of Health and the Agency for Health Care Administration did not respond directly to Gilmer’s criticism.
Gambineri, the health department spokeswoman, said that the department no longer uses the screening method that it used in 2015 and that parents can ask to have their children re-screened at any time.
“Our mission is now and has always been to provide the best health care possible to the populations that we serve,” McManus wrote in an email.

Pediatrician: ‘We were just irrelevant’

Pediatricians say that by the time the Department of Health meeting was held at the Orlando conference center at the end of 2014, they felt like Florida was dead-set on screening a large number of children off CMS.
They said state officials didn’t listen to their concerns, even though they were stated repeatedly, both in person and in writing.
At the meeting, health officials asked the pediatricians to tell them what was on their minds, according to Rumberger, one of the doctors who was there.
She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.
The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.
“She said, ‘We’re going to park these. We’re putting these ideas in the parking lot for some time, and we’re not talking about these things today,’ ” Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.
“We were all amazed at what they did,” she added.
A few months later, the state held a series of telephone conference calls with the same CMS regional medical directors.
“They didn’t ask us ‘What do you think?’ or ‘Do you have any suggestions?’ ” Rumberger said. “It was just ‘This is how we’re going to do it.’ It was clear they didn’t want to have a free discussion.”
“It appears to be a very conscious decision to not get input and not receive any dissension,” said Goldhagen, the professor of pediatrics at the University of Florida. “We were just irrelevant.”
Dr. Rex Northup, another CMS regional medical director and associate professor of pediatrics at the University of Florida College of Medicine, agrees.
“It was like, ‘When we want your opinion on a given topic, we’ll let you know, and we’ll provide that opinion to you,’ ” Northup said, adding that he speaks for himself and not the university or any other institution.
Several doctors present on those conference calls said they voiced their concerns anyway.
There’s no record of these concerns. According to the Florida Department of Health, no minutes were taken of these phone conferences.
CNN asked the Florida Department of Health about the meeting where St. Petery was asked to leave and about doctors’ complaints that the state steamrolled through a screening tool that would harm sick children.
“When CMS began the process of implementing a new screening tool in 2014, the department may have underestimated the need for stakeholder input and the time required to obtain feedback and ensure our community was comfortable with the mechanisms for determining clinical eligibility,” responded Gambineri, the Department of Health spokeswoman.
She added that the department has “engaged our stakeholders using several methods” including public meetings to solicit input from patients, parents and providers and “remains open to feedback and input in order to best serve children with serious and chronic medical conditions.”
True to its schedule, the state started screening children off CMS in May 2015.
Florida pediatricians repeatedly told the state that it was hurting sick, vulnerable children.
In August 2015, Goldhagen, Rumberger, Northup and 11 other doctors with positions at CMS wrote a letter to a Department of Health official saying the screening process was “flawed” and was removing too many children.
The doctors did not receive a response, Goldhagen said.
Two months later, St. Petery wrote to Department of Health officials, sharply criticizing the use of the screening tool.
He said he never received a response, either.

Dr. Elizabeth Curry, examining Micah Creamer, says she wrote to the Florida Agency for Health Care Administration, expressing her concerns about patients being kicked off Children's Medical Services, but the agency didn't respond.

Curry, the Port Saint Joe pediatrician who practices in a rural area of the Florida Panhandle, said she also complained to the state’s Agency for Health Care Administration about children being kicked off CMS, along with other issues affecting children on Medicaid.
She said the agency worked with her on some of the other issues but didn’t respond to her complaints about the children being taken off CMS.
“Our Agency has been in contact with the provider and is working with the health plan to resolve what issues might be resolved,” wrote McManus, the agency spokeswoman.
Curry said she took her complaints even higher.
“I even called the governor’s office once and left a message,” she said. “I admit that I finally gave up. I’m just trying to take care of my patients.”
Pediatricians interviewed for this story said they felt pressure from the state not to speak to the media about the removal of the children from CMS.
On November 15, 2016, Dr. John Curran, then the Florida Department of Health’s deputy secretary for CMS, said on a conference call that a CNN reporter was working on this story, according to several doctors on the call.
That evening, a department official wrote an email to the doctors who’d been on the call. It advised these pediatricians that prior to responding to media inquiries, they should contact the department’s communications director.
“I’m going to be so fired for saying all these things,” Rumberger said.
But she and other pediatricians say they’re speaking up because they feel that the Department of Health hurt children because they didn’t listen to their concerns.
They say it could be because pediatricians don’t tend to have millions of dollars to donate to political campaigns.
But insurance companies do.

‘Like a plot in a Carl Hiaasen novel’

All of this — the telephone survey, the question about limitations, the analysis that’s been called flawed — leaves many Florida parents and pediatricians suspicious about why the state wanted to take 13,074 children off CMS and why it worked so hard and so quickly to do it.
Switching the children from CMS to the other Medicaid plans didn’t save taxpayers money, according to McManus, the agency spokeswoman.
The doctors wonder, then, whether the inspiration for the change was political: to send taxpayers’ dollars to generous donors to the Florida Republican Party.
CMS is a public program; it’s not owned by a private insurance company.
When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.
“I knew it had to be about money,” said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. “This sounds very believable for Florida, and I’m from Florida.”
“When this was all unfolding, I told my office manager, ‘I feel like we’re in a plot in a Carl Hiaasen novel,’ ” she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.

Dr. Nancy Wright, a pediatric endocrinologist, says she thinks the state's motivation for taking patients off Children's Medical Services "appears to be about money. ... It's clearly not medical."

The companies that own the nine insurance plans contributed $8.6 million to Florida Republican Party committees from 2010 to 2014, according to an analysis done for CNN by the National Institute on Money in State Politics, a nonpartisan nonprofit group.
Here’s a breakdown of how much money each insurance company with a Medicaid contract contributed to Florida Republican Party committees from 2010 to 2014:
  • $5.9 million from Blue Cross and Blue Shield of Florida. Florida True Health is an affiliate of Blue Cross and Blue Shield of Florida. At the time the money was contributed, Florida True Health owned 40% of Prestige Health Choice, which has a Medicaid contract with the state of Florida. In 2015, Florida True Health purchased Prestige outright.
  • $90,000 from Simply Health, which owns a Medicaid plan called Better Health.
  • $849,433 from Miguel Fernandez, the former chairman of Simply Health. In addition, Fernandez donated about $1.3 million to Scott’s Let’s Get to Work political action committee from 2010 to 2014.

Insurance companies’ outsize contributions to Florida Republicans

Nearly all states pay insurance companies to insure some of their Medicaid patients; this is not unique to Florida.
And insurance companies often contribute money to state political parties. That’s not unique to Florida, either.
What is unusual is the size of the contributions, even for a large state.
Take UnitedHealthcare, an insurance giant with business in all 50 states. From 2010 to 2014, United contributed $442,500 to Florida Republican Party committees, according to the National Institute on Money in State Politics.
The company’s next largest contribution to any other state political party was $145,000 to California Democrats — less than half the Florida amount.
Humana, another insurance company with a national reach, gave substantially more money to Florida Republican Party committees than to any other state political party committees.
From 2010 to 2014, Humana donated $482,815 to Florida Republican Party committees. Its next largest contribution was $213,823 to Florida Democrats. The next largest contribution after that was $22,000 to the Illinois GOP, less than one-20th the size of the contribution to Florida Republicans.
Blue Cross and Blue Shield of Florida gave Florida Republican Party committees $5.9 million from 2010 to 2014 and gave Florida Democrats $1.8 million. The next largest contribution after that from any other Blue Cross and Blue Shield company in the United States was $730,696 from Blue Shield of California to Democrats in that state — about one-eighth the size of the contribution to Florida Republicans.

Florida’s payments to the insurance companies

Nearly all states pay private insurance companies monthly premiums to insure Medicaid patients. It’s become big business.
The Florida Department of Health declined to say how much it paid the private insurance companies to insure the 13,074 children when they were switched out of CMS.
“If they got 13,000 new kids, (it’s) that times however many dollars per member per month,” St. Petery said. “I think that’s a lot of money when you start talking about that many kids.”

LJ Stroud sued the state of Florida to be put back on Children's Medical Services. He has now had the procedures that he needs.

These children came from CMS, a Medicaid program for sick children, and the state pays insurance companies more money to care for such children.
This is how it works, according to McManus, the spokeswoman for the Florida Agency for Health Care Administration.
Florida takes a look at all the people who’ve signed up with an insurance company and calculates a risk score for that group based on factors such as the age of the enrollees in the plan and their health conditions.
A plan with the lowest risk score has a “typical population” and might be paid a rate of, for example, $320 per person per month, McManus said. A plan with sicker enrollees might have a risk score that’s twice as high and so would be paid $640 per person per month, she added.
The numbers can get even higher from there.
“The state will pay a pretty good rate for these children,” said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.
“They could get paid thousands more per month for a child with serious medical needs,” said Steve Schramm, founder and managing director of Optumas, a health care consulting group.
“The enhanced reimbursement may be 10 times what the insurance companies get for a well child,” said Goldhagen, former director of Florida’s Duval County Health Department.

Yasmeen Shabaneh sued Florida and was placed back on Children's Medical Services.

Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.
“Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.
Pediatricians questioned whether such outsize political donations were an attempt to gain influence and favor with Florida’s Republican administration, which orchestrated the transfer of the children out of CMS and to the private companies.
“It certainly raises a lot of suspicion and concern,” said Northup, the associate professor at the University of Florida College of Medicine.
“Why would they make contributions in the hundreds of thousands and the millions to Florida Republicans? Why would they be so uniquely committed to Republicans in Florida? It gives one pause,” he added. “If you follow the money, at the very least, it’s worrisome.”
“It’s the left-hand-washing-the-right-hand kind of business,” said Dr. Joseph Chiaro, who was Florida’s deputy secretary of health from 2005 to 2011. “It breaks my heart.”
Six Florida pediatricians gathered in Orlando to tell CNN their concerns. They practice in rural, suburban and urban areas. Some of them are Republicans, and others are Democrats.
They said they feared that big donors had influence on the state’s decision-making process and that in many cases, the children suffered as a result.
“I don’t see this in writing anywhere, but my impression is, this was a way for political payback at the expense of the sickest of the Medicaid children,” St. Petery said.
“It just comes back to money or power. It’s not about health care for the children,” said Wright, the pediatric endocrinologist in Tallahassee.
“Just follow the money,” said Colaizzo, who runs a rural health care clinic in Pahokee, Florida.
State leaders “don’t give a damn about the kids. They don’t give a damn about the families,” said Dr. Marcy Howard, a pediatrician in Crystal River, Florida.

State officials and insurance companies respond

State health officials did not respond directly to the pediatricians’ concerns that campaign contributors had influence over Republican leadership’s decision to take the children off CMS.
“The Statewide Medicaid Managed Care program was designed to provide comprehensive care to recipients through high quality health plans with a payment structure designed to ensure that plans paid an appropriate rate based on the health conditions of those enrolled in their plan,” McManus, a spokeswoman for the Florida Agency for Health Care Administration, wrote in an email.
“The program currently covers more than 2 million of Florida’s children, offers the strongest provider network and access standards in program history, and provides families with a choice of high quality, nationally accredited plans so that they can choose the plan that best suits their needs, including specialty plans for those who qualify.”

Alejandro Rodriguez also sued the state of Florida and was placed back on Children's Medical Services.

CNN reached out to officials at all nine insurance companies. Two responded.
“WellCare contributes to a variety of organizations that shape health care policy, including the Florida Republican Party committees, the Democratic Party committees and those without political affiliation,” wrote Alissa Lawver, a spokeswoman for WellCare. “The company also discloses and publicly reports all political contributions on its website above and beyond the requirements of state and federal law. As a provider of managed care, WellCare is committed to partnering with the state of Florida to provide access to quality, affordable health care solutions for the state’s most vulnerable populations. We maintain a robust provider network and offer comprehensive care management services to create personalized, coordinated care plans to help improve and maintain the health of families and children across the state.”
She added that WellCare has accountability to Florida’s Agency for Health Care Administration, “which provides careful oversight of the state’s Medicaid program to ensure all members, including children that transitioned from Children’s Medical Services, receive access to the right care, at the right time and in the most appropriate setting.”
Ethan Slavin, a spokesman for Aetna, said the company makes “donations to campaigns for both major political parties to support and address issues that impact our customers and members.”
He added that “we are required to meet state rules and regulations regarding our network of health care providers and are consistently compliant with those requirements” and that “we regularly work with our members, health care providers and the state of Florida to move children with special health care needs into the Children’s Medical Services program, when appropriate and in the best interest of our members. Our integrated care management program regularly identifies these children and assists in this process.”
Miguel “Mike” Fernandez, founder and former chairman of Better Health, said he had contributed several million dollars to both Republicans and Democrats. He added that states move Medicaid patients into the care of private companies so they can “move the risk off their financial books.”

A victory for Florida families

Many pediatricians use strong language to describe their anger and frustration with the Florida Department of Health and what it did in 2015 to the 13,074 children.
“This has just been a nightmare, and we’re still experiencing the fallout,” said Dr. Toni Richards-Rowley, treasurer of the Florida chapter of the American Academy of Pediatrics.
“It’s disgusting,” said Cosgrove, the pediatrician in Merritt Island. “It’s all about money and not looking out for the children.”
“Honestly, it makes me want to puke,” said Lida Sarnecky, nurse manager of the team at the University of Florida that takes care of children with cleft lip and palate.
“In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’ ” she said.
By June 2015, some Florida parents had had enough.
Five children, including Alejandro Rodriguez, and Yasmeen and Aref Shabaneh, sued the state Department of Health to get it to stop using the telephone questionnaire to take patients off CMS, claiming that the state Department of Health hadn’t gone through formal rulemaking procedures.
The children won.
The state didn’t fight the ruling. Instead, it came up with a new way to screen children for the program — one that doesn’t rely on a telephone survey and takes into consideration a child’s diagnosis.

Aref Shabaneh lost his Children's Medical Services coverage when his mother told the state he didn't have limitations. "Aref wants to do everything by himself," she said.

Many parents and pediatricians assumed the state would soon reach out directly to parents to let them know they could reapply to have their children put back on CMS.
They were very wrong.
Five months after the judge’s decision, St. Petery, the Tallahassee pediatric cardiologist, implored the secretary of the Department of Health to reach out to parents.
To St. Petery, the reasoning was obvious: A judge had said that the state had violated the law. Reaching out to the parents was a way of correcting wrongdoing.
The state had a notice on its website about the ability to be rescreened for CMS, and at a meeting with state legislators, a department official had given out a phone number parents could call. But St. Petery knew that busy parents of very sick children might not attend official state meetings or notice pages on government websites.
“I would hope that you would consider notifying each of the parents of those 13,074 children that the tool by which their child was screened out of CMS has been declared invalid, and that they have the right to appeal that decision,” St. Petery wrote to Dr. John Armstrong, then secretary of the Department of Health and the state surgeon general.
Armstrong wrote back that doing so would violate federal regulations, since the children had been switched to other Medicaid insurance plans.
“Federal regulations prohibit direct marketing to children currently being served by another managed care plan,” he wrote back to St. Petery.
CNN was unable to reach Armstrong for comment. Gambineri, the Florida Department of Health spokeswoman, said he “is no longer employed by DOH.”
Not satisfied with Armstrong’s response, St. Petery sought help from US Rep. Kathy Castor, a Democrat from Tampa. Castor took his concerns to the federal Centers for Medicare and Medicaid Services.
On March 23, 2016, an official at that agency sent an email to Justin Senior, then the Medicaid director at Florida’s Agency for Health Care Administration. CNN obtained the email under the Freedom of Information Act.
In that email, the federal official explained to Senior that federal regulations do not prohibit Florida from reaching out directly to families.
“To clarify, 42 CFR 438.104 does not prohibit marketing,” wrote Jackie Glaze, associate regional administrator for the Division of Medicaid and Children’s Health at the Centers for Medicare and Medicaid Services, citing a federal regulation.
More than a year later, on July 24, 2017, the Florida Department of Health sent a letter to parents letting them know that their children could be screened to get back on CMS. The letter was sent to 6,081 parents whose children were removed from CMS and put on another Medicaid plan and were still on that plan and financially eligible for Medicaid, according to Gambineri, the Florida health department spokeswoman.
That letter was sent nearly two years after the judge’s decision. Pediatricians say they’re angry it took that long to directly let parents know about the possibility of getting back on CMS.
Gambineri said there was concern that parents might get confused.
“It was originally thought to be, and still is considered a risk, in terms of confusion and disruption to families, to send a letter because they have had rescreening available since 2015,” Gambineri said a few months before the letter was sent out.

Nelson Mandela and Mr. Rogers

Now that LJ Stroud is back on CMS, he’s a happy, strapping 13-year-old who loves to play football and horse around with his brother and sisters in the family’s backyard in St. Augustine.
But his mother looks back on the dark days in 2015, after her son was switched off CMS, when she says he would lie on the couch in pain, unable to get the surgeries he needed.
It’s not just her son’s physical pain that makes Stroud angry; it’s his emotional pain.

Since LJ Stroud was placed back on Children's Medical Services, he's been able to play football again.

When LJ was on CMS, Stroud says, he received excellent care and was a contented, well-adjusted child, never thinking of himself as different despite his birth defect.
But she says that when he was in pain because he couldn’t have surgery, he started to feel sorry for himself.
” ‘Why did God make me this way?’ ” she says he asked. ” ‘Why can’t I be like my brothers and sisters?’ “
When she hears about how top Florida officials have spoken with pride of what they did to her son and to more than 13,000 other children, she becomes livid.
Last year, Armstrong, then Florida’s surgeon general and secretary of health, made a presentation to the Florida Children and Youth Cabinet, a panel created by the state Legislature to promote children’s welfare.
Declaring that the Department of Health “cares about every child in Florida,” Armstrong explained how the state removed the 13,074 children from CMS.
Armstrong’s presentation quoted two great advocates for children, Nelson Mandela and Fred Rogers.
First, he quoted Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”
And he quoted Fred Rogers, the star of the children’s television show “Mister Rogers’ Neighborhood”: “Anyone who does anything to help a child in life is a hero to me.”
Stroud struggles for words to describe what she thinks of Armstrong quoting these two champions for child welfare.
“It’s just — it’s just disgusting,” she said. “I feel my blood boiling just thinking about it.”

VA Treachery, Fraud, Malpractice And Lies (Part 2 Of 2)

 

Toward the end of part one I was speaking of the Ratings Board for the VA and how crooked they are and have been. In the guidelines for how the VA Ratings Board is supposed to conduct themselves it is stated that if their own Doctors agree with the Vet like their Neurosurgeon did in October of 2012 concerning the MRI I was finally able to get, that the Board would have to side on the side of the Veteran. Those guidelines also say that if the Veteran goes to civilian Doctors and those Doctors in writing agree with the Veteran that it is “reasonable to believe” that an active duty injury “could have caused” the veterans issues that they are trying to get a disability increase on then the Board has to side with the Veteran. As most any and all Veterans who have received negative answers at these Boards of Inquiry know, the VA personnel who are being paid by the VA, they pay no attention to those guidelines. As I said yesterday in part one, poop flows downhill, you know that these actions have to be being dictated to them from higher up in the VA chain of command. Otherwise why would these underlings be going against the very guidelines that they are told to uphold?

 

From about August of 1984 up until the heart attack I had while living in Ocala Fl in March of 1999 I suffered with not only my legs, hips and low pack being in constant pain, I suffered horribly with chest, neck, left shoulder and hand pain from the un-diagnosed heart pains. In 1999 I was working on a dedicated account for J B Hunt and I had another heart attack while at a company safety meeting. I was 42 at the time and my boss didn’t figure it was something serious so he pointed me in the direction of the hospital and I drove myself there. It was a Saturday morning and it was flu season and the ER was full of Mom’s and kids. When I was able to finally get up the ramp and into the building I went to the check in window, told them what was going wrong with me, they thought that I was lying just trying to get in front of the line. They did check my blood pressure though and as normal it was about 110/70.They had me sit in the waiting room for 5 1/2 hours before they finally called my name. When they finally did an EKG they freaked out because of them seeing the heart attacks. 3 days later they did a 4 way by-pass as all my arteries were 100% closed. At that time it seems that even the heart Doctors were unaware that the body in attempts to save itself will grow small veins around the blockages and into the heart. Trouble is that by blood would close these just about as fast as the new ones could grow. Literally your body is in a race against itself as it tries to keep some blood going to the heart. This was the first time that I ever got a hospital to do an EKG, ever. Over a span of 14 1/2 yrs I was never able to get a VA Doctor to do that simple 30 second test. How many yrs of my life did their ignorance, arrogance, and laziness shave off of my life span? This also doesn’t include the fact that during this time I had no quality of life at all. I couldn’t play any kind of games with my kids and my whole life revolved around working (being a long haul truck driver) and when I wasn’t working about the only thing I ever did was to sleep.

 

After my insurance ran out three months after the heart operation I had to rely on the VA system for my meds because I had no other way to afford them. The company I was working for would not let me come back to work so I did the only thing I could do, I had to lie my way into jobs with small companies or starve and go homeless. In January of 2002 I was able to get on with a company in Knoxville Tn that I stayed with until January of 2004 when my health made it impossible to do my job, so I had to quit. As was very normal with the VA system they change who they get their medications with quite often so even if you are getting the same medication from one supplier for a few months the VA would then change and you would get the same medication (supposedly) but the pill would look totally different. It also was and sometimes still is common to get a medication bottle that just says the name of it and to take it once or twice a day or to take at bed time or before breakfast, but that would be all that was on the bottle. About the first of January 2004 I got one such bottle that simply said take it twice a day but not what it was supposed to be for, this was not uncommon. I tended to follow what the bottles said so I started taking it two times a day, about twelve hours apart. Within a few weeks I was feeling so wore out I could hardly function at all. I had to quit my job because I thought I must be having trouble with my heart again. In mid February 04 I was able to get a heart-cath done through the VA in Johnson City (Mountain Home) Tn. When these are done a Cardiologist always has to be present, this day I had a young Doctor named Israel Garcia as the supervisor. I remember the name because of what he did. Before the test he was looking over the medications that I was on and he came across one that he said I did not need to be taking because it is only used if the patient had a history of strokes and I had not had one. Thirteen days after he took me off the med I had a stroke, the very next day they put me back on it, I’m still on it. I have never been mad at the man because all people make mistakes, I don’t believe he meant to hurt me on purpose, I forgive him. Yet because of this stroke I was not able to work until April of 2009, this VA doctors mistake cost me a little over five years of work income for my family.

 

The stroke hit my left side which is my dominate side and I still feel some of the effects to this day, but not major, I’m used to it. Reality was that the medication I had been taking was a muscle relaxer so my taking it every twelve hours just about stopped my heart, as you know, the heart is a muscle. Now I was in a situation where I could not work at all and my family lost our home and we had to move into a ‘state apartment’. I was unemployed until I decided to lie my way into another driving job in April of 2009. I had to lie to get employment because the only job that I could do that I knew how to do was to drive a truck and no company would have hired me if they knew that I was ill. I felt as a husband and a dad I had to try to get our family out of the base living conditions we were living in, just barely surviving. My health for many years had mandated that the only work I could do was if I was sitting down and not lifting anything, that is very limiting in the employment spectrum. The left side of my face is still numb and I still have a little bit of trouble with objects coming quickly from my left to my right. Also I could only be on my feet for about ten minutes at the most before the pain in my low back and legs would force me to sit down, now day’s I am lucky if I can get 2-5 minutes before the pain puts me down and I am forced to use the power wheelchair the VA gave me back in 2007 all of the time.

 

I was able to work from April of 2009 until June of 2013 when I simply had used up every ounce of pain fighting ability that I could muster. In 2007 I had another heart-cath done in Johnson City at the VA and it showed that all of my grafts from the 1999 operation were 100% closed. Yet they refused to even try to do a balloon surgery to see if any of those grafts could be opened because in their words “that operation would probably kill me”. Folks, I know I am not the wisest person in the world but I have a question for you. When all of a persons arteries and grafts are totally closed and the only blood getting to the heart keeping you alive are those little veins I told you about earlier that grow around the blockages in a race for time, what does a person have to lose? You are going to die from this condition guaranteed! Yet the VA refused to do anything except give me more medications.

 

As I told you earlier I went back to work in April of 2009 for a small local company. I had resigned myself to the fact that I would simply work as long as I could expecting that one day I would simply go to sleep in a truck-stop somewhere and not wake up. I felt that the least I could do before I died was to give my family as much help financially as possible. Because I had been out of work for so long I didn’t even have the credits with social security to be able to leave them with even that check so I had to try to work as long as I could hoping I could work long enough to get those credits. Social Security and VA disability pensions are a poor mans life insurance for their families they leave behind. Because of the VA’s methods of operation I was going to not be able to leave anything for my family, this is why I had to try going back to work even though I knew I shouldn’t do it.

 

In September of 2011 I was in Atlanta having a trailer washed out for a customer and was leaning up against the outside wall of the business, it was a hot day and they had the big outside door propped open beside me. When they finished the trailer washout I stepped away from the wall and blacked out. I fell face first into the big metal hinges of that door busting my forehead open about three or four inches. The workers revived me and to make a long story shorter, I was taken unconscious in an ambulance to the nearest hospital which turned out to be less that a half mile away. The first three days I was there I was unconscious and remember nothing of it. Once I was awake the heart Doctors told me that when I got to the ER my numbers were 50/20 and dropping fast and that both of my kidneys had completely shut down, they told me that I would have been dead in another five to ten minutes if I hadn’t gotten there when I did. I was also told that the VA had me on four times too much blood pressure medicine and that it was what had made me black out. Once again I was minutes away from the VA killing me. While I was out on that third day they did a heart-cath on me, it was after that when I woke up. There were two heart Doctors talking with me about the condition of my blood flow. I told them what the VA Doctors had told me about why they couldn’t/wouldn’t try to balloon them open, I remember they just looked at each other and wagged their heads in disgust. Within the hour they had me in surgery where they were able to balloon open two of the grafts from the 1999 surgery and they put stints in them at that time. This is why I am still alive today was because of the quality of the Doctors at the Gwinnett Medical Center just outside of Atlanta.

 

These Georgia Doctors gave me a new med list to give to the VA Doctors and to no surprise they got upset about the new list. One of the meds is a very expensive one for the heart that is actually required by law for them to give to me because of my particular condition. The condition being when a person has no arteries open and all the person has for blood flow are stints in old grafts they must give you this medication. It took them twelve months before they agreed to do it and then it was only after a new VA Doctor I had been assigned went up the chain of command to insist they do it. I am not saying that all people or all Doctors at the VA’s around the country are worthless or evil, but many are and it seems that the chain of command above the Doctors are in many cases just plain evil. I know that the VA system goes through a huge amount of Doctors, it seems like every time you go to one of their clinics you have been assigned yet another new Doctor. Could it be that in many cases when a good Doctor gets a job with them that they see how crooked that system is and they decide to find somewhere else to work?

 

I am going to finish with one last kick in the privates that they are very guilty of, and that is they refuse to pay their own bills so you the patient ends up with all their medical bills laid against your credit. By their own rules they must pay those medical bills I have in Georgia, it has been almost five years now and they have paid nothing. By their own rules in a life or death emergency and you could not get to the nearest VA Hospital then the VA will pay that bill. I have been told several times that they believe that I could have made it to the VA in Atlanta so they have steadfastly refused to pay the $70,000 dollars in medical bills I have there. Folks, what part of arrived unconscious in an ambulance from a half mile away, five minutes from death do these people not understand? You have to believe that they can’t be that stupid so the other alternative seems to be is that they are that crooked, at least it seems that way to me. Last August my wife and I bought a house in Kentucky just outside of Lexington. We chose here because it is one of only two VA Hospitals I have ever heard good things about and in this twelve months we have been here I have been an inpatient twice already and they do actually seem to give a damn here unlike the other hospitals of theirs I have had experience with. But now about that $70,000 dollars on my credit that I can’t get off. When we bought the house I was forced to use the VA Loan program because I couldn’t get anyone else to finance us, not even the Credit Union that we have banked at for many years. Even through this loan, because my credit score was only 668 because of those medical bills our rate of interest is much higher than it should have to be, meaning that every month we have to pay more out-of-pocket of our set incomes for the house payment, leaving less for life’s other expenses. Okay, I’m done gripping about them, I know this was a long story folks, but I guarantee you this, everything I have said to you is true. As I said early on, I do not believe that anyone at the VA has a personal vendetta against me, I am just one of millions of service connected disabled Veterans who have been and are being treated like this. What is your opinion of the VA now?

 

 

 

 

A Highly Contagious Dog Flu Has Hit Florida

(THIS ARTICLE IS COURTESY OF TIME NEWS)

A Highly Contagious Dog Flu Has Hit Florida. Here’s What to Know

May 31, 2017

An outbreak of the dog flu, which has sickened hundreds of canines across the country over the last two years, has hit Florida for the first time. The highly contagious virus recently infected at least a dozen dogs in the Sunshine State, the University of Florida’s College of Veterinary Medicine said Wednesday. While the virus strain is not usually fatal and is not known to be transferrable to humans, it can spread rapidly and cause debilitating complications.

“There’s always that concern that another large outcome could happen again,” said Michael San Filippo, a spokesman for the American Veterinary Medical Association (AVMA), referring to an outbreak of the dog flu in Chicago in 2015, when hundreds of illnesses were reported. “We don’t want people to panic because typically, from what we know, it’s usually mild, although it can progress and can lead to other infections and be serious. We want to catch these things as early as possible.”

Here’s what to know about the dog flu:

What is the dog flu?

Canine influenza, more commonly known as the dog flu, is a respiratory disease that is easily spread among dogs, according to the Centers for Disease Control and Prevention (CDC). Symptoms are similar to what humans have when infected with the flu, including coughing, runny nose and fever. However, some dogs can suffer from life-threatening pneumonia. There are two different viruses, including the latest H3N2 virus, which was first detected in dogs in the U.S. in 2015. At the time, more than 1,000 illnesses were reported in Illinois, where it began, and several nearby states, according to the AVMA. At least six cases were fatal, the organization said. The affected states included Georgia, Massachusetts, New Jersey, Alabama, California, Texas, New York, Iowa, Michigan, Wisconsin and Indiana, according to Cornell’s Animal Health Diagnostic Center.

What happened in Florida?

At least 12 dogs were recently diagnosed with canine influenza after either attending two dog shows or being exposed to infected animals from the events, health officials said. The disease appears to have stemmed from a dog show in Perry, Ga. and another in Deland, Fla. — both of which took place late this month. All dogs being treated are in stable condition, according to the Florida Department of Agriculture and Consumer Services. This is the first time H3N2 canine influenza has been found in the state, health officials said.

It’s unclear how many cases of canine influenza there currently are in the country, as statistics are generally tracked locally, not nationally, a ccording to Edward Dubovi, a v irology professor at Cornell’s Animal Health Diagnostic Center. The 2015 outbreak appeared to have ebbed by that October, said C olin Parrish, another virology professor at Cornell. But health officials in Chicago say the dog flu is still a problem in the area. The Chicago Veterinary Medical Association, which did not provide recent statistics, urged pet owners in March to be “vigilant” and “take necessary action steps “ to prevent their dogs from contracting the virus.

How can dog flu be prevented?

Pet owners can discuss with a veterinarian whether their dogs should be vaccinated for the virus. Dogs are at the highest risk of contracting the virus at animal shelters, boarding kennels, grooming salons, canine daycare, dog parks and other locations where the animals are in close quarters.

West Virginia Becomes the 29th Medical Marijuana State

(THIS ARTICLE IS COURTESY OF THE MPP WEBSITE)

West Virginia Becomes the 29th Medical Marijuana State

Apr 19, 2017 , , , , , , , ,, ,


Today, West Virginia officially became the 29th state to pass medical marijuana legislation!

Gov. Jim Justice signed the law today after the bipartisan bill passed both the Senate and House earlier this month.

While the law isn’t perfect, it’s a great start toward providing safe and legal access to medical marijuana for qualifying patients. A summary is available here.

This achievement didn’t happen overnight. In fact, MPP, along with many other advocates, has been working tirelessly to get a medical marijuana bill passed for years.

MPP released the following in a press release:

“This legislation is going to benefit countless West Virginia patients and families for years to come,” said Matt Simon of the Marijuana Policy Project, who is a West Virginia native and graduate of West Virginia University. “Medical marijuana can be effective in treating a variety of debilitating conditions and symptoms. It is a proven pain reliever, and it is far less toxic and less addictive than a lot of prescription drugs. Providing patients with a safer alternative to opioids could turn out to be a godsend for this state.”

Six states have adopted comprehensive medical marijuana laws in the past 12 months. Three of those laws, including West Virginia’s, passed through Republican-controlled legislatures. Lawmakers in Pennsylvania and Ohio approved them last April and June, respectively. The other three were approved by voters in November in states won by Donald Trump — Arkansas, Florida, and North Dakota.

“Intensifying public support and a growing body of evidence are driving the rapid growth in the number of states adopting medical marijuana laws,” Simon said. “Lawmakers are also learning about marijuana’s medical benefits from friends, family members, and constituents who have experienced them firsthand in other states. More than nine out of 10 American voters think marijuana should be legal for medical purposes. In light of this near universal support, it is shocking that some legislatures still have not adopted effective medical marijuana laws.”

Apr 19, 2017 , , , , , , , ,, ,


Today, West Virginia officially became the 29th state to pass medical marijuana legislation!

Gov. Jim Justice signed the law today after the bipartisan bill passed both the Senate and House earlier this month.

While the law isn’t perfect, it’s a great start toward providing safe and legal access to medical marijuana for qualifying patients. A summary is available here.

This achievement didn’t happen overnight. In fact, MPP, along with many other advocates, has been working tirelessly to get a medical marijuana bill passed for years.

MPP released the following in a press release:

“This legislation is going to benefit countless West Virginia patients and families for years to come,” said Matt Simon of the Marijuana Policy Project, who is a West Virginia native and graduate of West Virginia University. “Medical marijuana can be effective in treating a variety of debilitating conditions and symptoms. It is a proven pain reliever, and it is far less toxic and less addictive than a lot of prescription drugs. Providing patients with a safer alternative to opioids could turn out to be a godsend for this state.”

Six states have adopted comprehensive medical marijuana laws in the past 12 months. Three of those laws, including West Virginia’s, passed through Republican-controlled legislatures. Lawmakers in Pennsylvania and Ohio approved them last April and June, respectively. The other three were approved by voters in November in states won by Donald Trump — Arkansas, Florida, and North Dakota.

“Intensifying public support and a growing body of evidence are driving the rapid growth in the number of states adopting medical marijuana laws,” Simon said. “Lawmakers are also learning about marijuana’s medical benefits from friends, family members, and constituents who have experienced them firsthand in other states. More than nine out of 10 American voters think marijuana should be legal for medical purposes. In light of this near universal support, it is shocking that some legislatures still have not adopted effective medical marijuana laws.”

Xi Says Ready To Boost China-US Ties From New Starting Point With Trump

(THIS ARTICLE IS COURTESY OF THE SHANGHAI DAILY NEWS)

HOME » NATION

Xi says ready to boost China-US ties from new starting point with Trump

CHINESE President Xi Jinping said here Thursday that he is ready to work with his US counterpart, Donald Trump, to push forward China-US relations from a new starting point.

While meeting with Trump at the latter’s Florida resort of Mar-a-Lago, Xi said there are “a thousand reasons to make the China-US relationship work, and no reason to break it.”

Since the normalization of China-US relations 45 years ago, the bilateral relationship, even though experiencing ups and downs, has made historic progress and brought enormous and pragmatic benefits to the two peoples, Xi said.

The Chinese president said it takes political resolve and historical commitments from leaders of both countries to enhance the bilateral relations in the 45 years to come.

Xi also invited Trump to pay a state visit to China in 2017.

Xi said he has maintained frequent contacts with Trump through phones and letters for some time, and is glad to meet Trump here as his guest.

A sound bilateral relationship will benefit not only the two countries and peoples, but also the world at large, he stressed.

He added that cooperation is the only right choice for China and the United States, saying that the two countries are capable of becoming great cooperative partners.

The Chinese president also underlined the role of four newly-established high-level mechanisms for dialogue and cooperation between China and the United States in such areas as diplomacy and security, economy, law enforcement and cyber security, as well as social and people-to-people exchanges.

Xi urged the two countries to set up a cooperative priority list for early harvest, advance negotiations on the bilateral investment treaty, and explore the pragmatic cooperation in infrastructure construction and energy, among other areas.

He also said the two sides should properly handle sensitive issues, manage and control differences in a constructive manner, and strengthen communication and coordination in major international and regional affairs.

China and the United States should expand their cooperation in addressing global challenges, such as non-proliferation and the fight against cross-border crimes, Xi said.

Xi called on the two counties to strengthen communication and coordination in such multilateral mechanisms as the United Nations, the Group of 20 and APEC, so as to jointly safeguard world peace, stability and prosperity.

For his part, Trump accepted the invitation for a state visit to China with pleasure, and hoped to make the trip at an early date.

The United States and China bear heavy responsibilities as major countries in the world, he said, adding that he is full of expectations for the meeting and hopes to establish a sound working relationship with Xi for the greater development of bilateral relations.

The two heads of state also informed each other of their current priorities in domestic and diplomatic agenda, and exchanged views on regional hot-button issues.

Upon their arrival at Mar-a-Lago, Xi and his wife, Peng Liyuan, were greeted by Trump and US First Lady Melania.

Before the in-depth, friendly and long-time conversation between Xi and Trump, the two couples also enjoyed the singing of a traditional Chinese ballad and the recitation of Chinese ancient poems by Trump’s grandchildren.

Xi arrived in the southeastern US coastal town of Palm Beach earlier in the day for the first meeting with Trump, in a bid to chart the course of bilateral ties in a new era.

China and Finland look to the future: President Jinping Visits Finland In Route To U.S.

(THIS ARTICLE IS COURTESY OF THE SHANGHAI DAILY NEWS)

HOME » NATION

China and Finland look to the future

CHINA and Finland yesterday agreed to establish and promote a “future-oriented new-type cooperative partnership,” with both sides pledging to enhance political mutual trust and deepen pragmatic cooperation.

During talks between visiting President Xi Jinping and his Finnish counterpart Sauli Niinisto, the two heads of state stressed that to build a more forward-looking and strategic bilateral relationship that keeps pace with the times was in the fundamental interests of both countries.

“China and Finland are good friends and partners who respect each other, treat each other as equals and enjoy mutually beneficial cooperation,” Xi said. “The peoples of our two countries have always cherished a friendly sentiment toward each other.”

Noting that the development needs of China and Finland fit well with each other, Xi called on both sides to increase high-level exchanges, build up strategic mutual trust, explore potentials for cooperation and give support to each other in development.

Niinisto warmly welcomed the Chinese president for his visit on the occasion of the centenary of Finland’s independence.

Finland highly values China’s achievements in development and its important role in international affairs, he said.

The Finnish side hopes to carry out more high-level contacts and exchanges in all areas with China, and deepen cooperation in economy and trade, investment, innovation, environmental protection, tourism, winter sports and Arctic affairs, as well as within the framework of China’s Belt and Road initiative linking Asia with Europe and Africa, Niinisto said.

Finland also wants to strengthen communication and coordination with China on major international issues and push for an even closer cooperation between the European Union and China, he said.

In a written speech delivered on his arrival, Xi first extended congratulations to the Finnish government and people on the centenary of Finland’s independence.

“Since China and Finland established diplomatic ties 67 years ago, our relationship has maintained a steady and sound development no matter how the international landscape changes,” Xi said.

“Our relationship has become a model of friendly co-existence and mutually-beneficial cooperation between countries that are different in population and size, history and culture, social system and development level,” he said.

Xi said he looks forward to having in-depth exchanges of views with Finnish leaders on the China-Finland relationship and other issues of mutual concern, thus charting the course for the future development of the bilateral relations.

“I believe that with concerted efforts of both sides, my visit will achieve a complete success,” he added.

Finland was one of the first Western countries to establish diplomatic ties with the People’s Republic of China, and the first Western nation to sign an intergovernmental trade agreement with China.

Currently, Finland is China’s third largest trading partner in the Nordic region, while China has been Finland’s biggest trading partner in Asia for 14 years.

The two sides have cooperated in areas such as high technology, clean energy, innovation and Arctic research, and further cooperation on winter sports is expected as China will host the 2022 Winter Olympic Games.

Xi’s visit to Finland is his first trip to a European Union member state this year, and also his first to the Nordic region as president.

After Finland, Xi will travel to Florida today for a meeting with US President Donald Trump.

It will be the first meeting between Xi and Trump, heads of state of the two biggest economies in the world.

Trump Promises 1 Trillion Boost In Infrastructure Spending Then Cuts 13% From Transportation Dept

(THIS ARTICLE IS COURTESY OF ‘THE HILL’ NEWS IN D.C.)

Trump budget proposes 13 percent cut to Transportation Dept

The department’s funding would be cut by 13 percent, to $16.2 billion, according to the proposal released early Thursday.

“The Budget request reflects a streamlined DOT that is focused on performing vital Federal safety oversight functions and investing in nationally and regionally significant transportation infrastructure projects,” the budget document says.

“The Budget reduces or eliminates programs that are either inefficient, duplicative of other Federal efforts, or that involve activities that are better delivered by States, localities, or the private sector.”
The budget limits funding for the Federal Transit Administration’s Capital Investment program, eliminates funding for the Essential Air Service program and ends federal support for long-distance Amtrak trains.

The blueprint also eliminates funding for the Transportation Investment Generating Economic Recovery (TIGER) grant program, which was set up by the Obama administration’s 2009 economic stimulus package to provide an extra injection of cash for surface transportation projects.

The grants are appropriated by Congress every year but were never authorized. The proposal estimates that scrapping the program would save $499 million annually.

TIGER grants are a popular funding tool among cities and states. Transportation Secretary Elaine Chao expressed support for TIGER grants and the Transportation Infrastructure Finance and Innovation Act loan program during her confirmation hearing.

But the program has drawn the ire of Republicans, who have sought to eliminate or reduce the grants in previous spending bills.
“If [TIGER grants] were to be cut, then it’s big time trouble,” Sen. Bill Nelson (D-Fla.), ranking member on the Commerce, Science and Transportation Committee, told The Hill last week.

“Department of Transportation TIGER grants are something that are considered essential to rehabbing our infrastructure.”

Sen. Susan Collins (R-Maine), who chairs the Senate Appropriations transportation subcommittee, has promised to protect the grants in any spending bill.

Trump vowed as a candidate and after winning the White House to improve the nation’s infrastructure, calling for repairing U.S. roads, bridges and airports.

“Crumbling infrastructure will be replaced with new roads, bridges, tunnels, airports and railways gleaming across our beautiful land,” Trump said during a joint address to Congress last month.

“To launch our national rebuilding, I will be asking the Congress to approve legislation that produces a $1 trillion investment in the infrastructure of the United States — financed through both public and private capital — creating millions of new jobs.”
This report was updated at 10:16 a.m.

Nikki Haley Will Serve as Donald Trump’s Ambassador to the United Nations

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Nikki Haley Will Serve as Donald Trump’s Ambassador to the United Nations

File photo of South Carolina Governor Nikki Haley speaking at the National Press Club in Washington
Kevin Lamarque—Reuters South Carolina Governor Nikki Haley speaks at the National Press Club in Washington, D.C., on Sept. 2, 2015.

Haley was a frequent critic of Trump’s rhetoric during the campaign

South Carolina Gov. Nikki Haley will accept the nomination to the post of U.S. Ambassador to the United Nations from President-elect Donald Trump, according to two sources familiar with Trump’s presidential transition.

Haley, the popular governor whose national stock rose after leading the response to the Charleston church shooting last year, is the first woman and the first Indian-American tapped by Trump for an administration post, and his first departure outside his inner circle of advisors. An official announcement is expected later Wednesday.

Haley, 44, is midway through her second term as governor, where her state has seen widespread economic growth under her tenure. But her lack of traditional foreign policy experience is likely to draw scrutiny during Senate confirmation hearings. Haley is close with former Massachusetts Gov. Mitt Romney, one of the leading contenders to be Trump’s Secretary of State.

Haley endorsed Florida Sen. Marco Rubio and then Texas Sen. Ted Cruz during the contentious Republican primaries, and was a frequent critic of Trump’s rhetoric. She reluctantly announced her intent to vote for Trump just two weeks before Election Day, telling reporters, “This is no longer a choice for me on personalities because I’m not a fan of either one, what it is about is policy.”

According to a transition source, Haley’s post will be of Cabinet-rank, a departure from the past two Republican administrations in which it was a sub-Cabinet-level post. Haley’s nomination must be confirmed by the Senate.

Study: States with medical marijuana have lower prescription drug use—Plus Fewer Drug Overdoses And Deaths

 

Study: States with medical marijuana have lower prescription drug use—This Causes Fewer Drug Overdoses And Fewer Drug Related Deaths As It Is Impossible To Overdose (Die) From Marijuana Usage!

Prescription drug prices are up, making policy experts increasingly anxious. But relief could come from a surprising source. Just ask Cheech and Chong.

New research found that states that legalized medical marijuana — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for drugs used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on prescription medications.

The study, which appears in Health Affairs, examined data from Medicare Part D from 2010 to 2013. It is the first study to examine whether legalization changes doctors’ clinical practice and whether it could curb public health costs.

The findings add context to the debate as more lawmakers express interest in medical marijuana. Ohio and Pennsylvania have this year passed laws allowing the drug for therapeutic purposes, making the practice legal in 25 states, plus Washington D.C. The question could also come to a vote in Florida and Missouri this November. A federal agency is considering reclassifying it under national drug policy to make medical marijuana more readily available.

Medical marijuana saved Medicare about $165 million in 2013, the researchers concluded. They estimated that, if the policy were nationalized, Medicare Part D spending would have declined in the same year by about $470 million. That’s about half a percent of the program’s total expenditures.

That is an admittedly small proportion of the multi-billion dollar program. But the figure is nothing to sneeze at, said W. David Bradford, a professor of public policy at the University of Georgia and one of the study’s authors.

“We wouldn’t say that saving money is the reason to adopt this. But it should be part of the discussion,” he added. “We think it’s pretty good indirect evidence that people are using this as medication.”

The researchers found that in states with medical marijuana laws on the books, the number of drug prescriptions dropped for treating anxiety, depression, nausea, pain, psychosis, seizures, sleep disorders and spasticity. Those are all conditions for which marijuana is sometimes recommended. Prescriptions for other drugs treating other conditions, meanwhile, did not decline.

The study’s authors are separately investigating the impact medical marijuana could have on prescriptions covered by Medicaid, the federal-state health insurance program for low-income people. Though this research is still being finalized, they found a greater drop in prescription drug payments there, Bradford said.

If the trend bears out, it could have meaningful public health ramifications. As doctors and public health experts grapple with the consequences of excessive prescription painkiller use, medical marijuana could provide an alternate path. Experts say abuse of prescription painkillers — known as opioids — is in part driven by high prescribing. In states that legalized medical uses of marijuana, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.

Questions exist, though, about the possible health harms or issues that could result from regular use.

It’s unlike other drugs, such as opioids, in which overdoses are fatal, said Deepak D’Souza, a professor of psychiatry at Yale School of Medicine, who has researched the drug.

“That doesn’t happen with marijuana,” he added. “But there are whole other side effects and safety issues we need to be aware of.”

“A lot of people also worry that marijuana is a drug that can be abused,” agreed Bradford. “Just because it’s not as dangerous as some other dangerous things, it doesn’t mean you want to necessarily promote it. There’s a lot of unanswered questions.”

Meanwhile, it is difficult to predict how many people will opt for this choice instead of meds like antidepressants or opioids.

Because the federal government labels marijuana as a Schedule I drug, doctors can’t technically prescribe it. In states that have legalized medical marijuana, they can only write patients a note sending them to a dispensary. Insurance plans don’t cover it, so patients using marijuana pay out-of-pocket. Prices vary based on geography, but a patient’s recommended regimen can be as much as $400 per month. The federal Drug Enforcement Agency is considering changing that classification — a decision is expected sometime this summer. If the DEA made marijuana a Schedule II drug, that would put it in the company of drugs such as morphine and oxycodone, making it easier for doctors to prescribe and more likely that insurance would cover it.

To some, the idea that medical marijuana triggers costs savings is hollow. Instead, they say it is cost shifting. “Even if Medicare may be saving money, medical marijuana doesn’t come for free,” D’Souza said. “I have some trouble with the idea that this is a source of savings.”

Still, Bradford maintains that if the industry expanded and medical marijuana became a regular part of patient care nationally, the cost curve would bend because marijuana is cheaper than other drugs.

Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School, who has written two books on the subject, echoed that possibility. Unlike with many drugs, he argued, “There’s a limit to how high a price cannabis can be sold at as a medicine.” He is not associated with the study.

And, in the midst of the debate about its economics, medical marijuana still sometimes triggers questions within the practice of medicine.

“As physicians, we are used to prescribing a dose. We don’t have good information about what is a good dose for the treatment for, say pain,” D’Souza said. “Do you say, ‘Take two hits and call me in the morning?’ I have no idea.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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