Trauma center, certificate of need bills die in Legislature again

This was the year that Gov. Rick Scott and Republicans in the Florida Legislature delivered on all their talk about opening up competition in health care. Like with medical marijuana legislation, it was a big failure.

One only needs to see every other billboard on Interstate 95 to realize the hospitals are in an all out war for patients in areas of heart surgery and maternity care. But Scott and House Republicans wanted to open up it even more in some very troublesome areas, critics said.

They wanted to add trauma centers across the state and to eliminate the requirement that hospitals prove community need before expanding into an area of practice.

Both bills (HB 7 and HB1077) died on Friday when the Senate refused to take them up. This is not the first time that Scott, a former health-care executive, has tried to get rid of these regulations.

This blog explored both issues during the session that also saw lawmakers fail to implement voter-mandated medical marijuana laws. 

When comes to specialized hospitals programs and trauma, hospitals need as many patients as they can get so they can perfect the practice. You know, brain injury and pediatric heart surgery are not exactly easy.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott wants to eliminate the need for hospitals to prove a community needs them to expand.

Trauma centers are no different.

Scott called for getting rid of a limit of 44 trauma centers statewide. Right now, Palm Beach County has two level-one trauma centers: St. Mary’s Medical Center and Delray Beach Medical Center.

Dr. Robert Borrego, medical director of the Trauma Center at St. Mary’s Medical Center, told The Post earlier this year that it is important to limit the number of trauma centers.

“Can you imagine coming to a center and you have traumatic brain injury and the neurosurgeons only do about 10 operations a year? Are you going to comfortable there or do you want somebody who does 1,000 operations a year?”

Update: County Health official: Zika-related birth defects to increase

Sick of hearing about Zika already? Get used to it as more birth defects related to the virus are expected in 2017 in Florida and throughout the U.S.

This summer, there will be a full-court press by health officials against Zika.

“It’s not something to be taken lightly,” said Dr. Alina Alonso, head of the Palm Beach County Health Department, in an interview with The Palm Beach Post.

“The main emphasis again is going to be on pregnant women. The CDC expects to see a 20-fold higher proportion of Zika-affected birth defects compared to those that were seen in the 2013-14, before Zika came to the Americas.”

Before 2014, there were three cases of Zika-caused microcephaly for every 1,000 births. That number is now up to 60 cases per 1,000. “That’s a large increase,” Alonso said.

Dr. Alina Alonso, head of the Palm Beach County Health Department says pregnant women with Zika are being tracked.

Microcephaly is a rare neurological condition in which an infant’s head is significantly smaller than normal.

On Friday, the Centers for Disease Control & Prevention released a report that 15 of infants were born with birth defects in pregnancies with a confirmed Zika virus infection in the first trimester. “These findings highlight why pregnant women should avoid Zika virus exposure,” the report stated.

The CDC suggest that because the full effects of the virus is unknown, all pregnant women infected with Zika should receive postnatal imaging and a comprehensive newborn physical exam and hearing screen.

So as the summer comes barreling down the calendar, the focus of health officials will be on the mosquito-borne virus that causes severe birth defects. More than 2,000 cases have been recorded in Florida.

Alonso said she dispatched teams last summer that went door-to-door in neighborhoods about Zika. “We were very pro-active,” she said. “I expect to see more cases because the mosquito is already established here in our environment.”

The Aedes aegypti is the main culprit that carries Zika. It also can transmit dengue fever, chikungunya, Zika fever and yellow fever viruses.

The Health Department will work with doctors to continue a registry of pregnant women who are positive with Zika. “We will see if they have healthy babies or affected babies,” she said.

Alonso said the best prevention, of course, would be a vaccine, but until then citizens have to practice prevention whether it is draining standing water or using repellant. About 80 percent of people who contract the virus don’t exhibit any symptoms of fever, rash, body aches. But for those that do, Zika can have serious, even neurological, consequences.

Zika can be transmitted through sexual activity, so Alonso suggests the use of condoms or abstaining from sex for people who have traveled to infected areas in the Caribbean and South America.

And Alonso doesn’t shy away from the fact that Zika can cost the state plenty.

“Because it is affecting pregnant women, it is affecting our tourism. It is very important,” she said.

Last week Gov. Rick Scott held a news conference with Alonso to talk about efforts to combat Zika. With serious tourist dollars at stake, Scott can claim some initial victories.

He has called on the CDC for advice and assistance. A Zika hotline was created. Lab testing capacity was expanded. He has demanded more money from Washington. He used emergency power to release $61 million from the general fund for research, prevention and response. Mailers were sent out to residents in multiple languages.

Researchers are working furiously to find a vaccine.

The National Institute of Allergy and Infectious Diseases has announced that vaccination trials have begun using an experimental DNA serum.

The trial aims to enroll at least 2,490 healthy participants in areas of confirmed or potential active mosquito-transmitted Zika infection, including the continental United States and Puerto Rico, Brazil, Peru, Costa Rica, Panama, and Mexico.

“A safe and effective Zika vaccine is urgently needed to prevent the often-devastating birth defects that can result from Zika virus infection during pregnancy,” NIAID Director Anthony S. Fauci said on March 31.

“Evidence also is accumulating that Zika can cause a variety of health problems in adults as well. This trial marks a significant milestone in our efforts to develop countermeasures for a pandemic in progress.”

 

Gov. Rick Scott may be the mosquito’s worst enemy.

 

Florida bill eliminates considering community need for hospital expansion

 

When it comes to highly specialized hospital programs, practice makes perfect.

The intricate ballet of say operating on an infant’s heart means hospitals with such programs need the patient pool limited so they can be proficient.  As a result, few have such a program.

This is why when competitors say they want to establish a specialized unit they must obtain a certificate of need. It may sound bureaucratic but the certificate of need tests whether a community actually needs a hospital to expand.

St. Mary's Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)
St. Mary’s Medical Center in West Palm Beach, Florida on June 5, 2015. (Allen Eyestone / The Palm Beach Post)

Gov. Rick Scott and some legislators once again want to blow up the law that would make it necessary for hospitals to prove there is a need in the community for a service or another hospital. The result could be a free-for-all in a hospital competition that is already cut-throat in Florida.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott wants to eliminate the need for hospitals to prove a community needs them to expand.

The News Service of Florida reports that lining up with the governor are House leaders, Sen. Rob Bradley, R-Fleming Island. They filed a proposal last week that would eliminate the state’s “certificate of need” regulatory process.

The News Service story reported that the certificate of need process determines whether hospitals, nursing homes and hospice facilities are built.

But SB 676 also says that the regulation the restriction be removed for hospitals looking to improve or expand a public facility.

Under the process, the state Agency for Health Administration reviews projects and determining whether they should be allowed to move forward.

Scott and House Republican leaders have failed to get this measure passed the Senate previously.

“By eliminating the state’s restrictive CON process we’ll increase competition and drive down the cost of health care for Floridians,” Bradley said in a prepared statement.

“For years, this cumbersome process has been used to block the expansion of facilities and restrict competition. So, in addition to driving costs, we should also see a significant economic impact in terms of the creation of new jobs by removing this barrier.”

 

Gov. Scott calls on federal government to handle Zika like a hurricane

Gov. Rick Scott said today that the federal government must address the Zika virus threat like an incoming hurricane.

He made the statement prior to travel to Washington D.C. next week to meet with congressional leaders on the issue. Treating Zika like a catastrophe triggers triggers specific preparation and response efforts by the federal government.

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Aedes aegypti is the mosquito that carries the Zika virus.

“Florida has now had more than 100 documented cases of the Zika virus,” he said. “We are now headed into summer, when heat and rainfall cause our mosquito population to grow.”

South Florida remains a likely place in the U.S. for a Zika virus outbreak by the mosquito Aedes aegypti.

The Zika virus has been linked to a range of birth defects, including a condition which causes children to be born with abnormally small heads and underdeveloped brains and Guillain-Barré syndrome, which can lead to paralysis.

Currently, there are no native-borne cases in Florida. All infections involve travelers to South America.

Gov. Scott expressed concern that the Olympic summer games in Brazil will heavily increase travel to a country where the Zika virus is spreading rapidly.

Governor Rick Scott holds a brief press conference at Palm Beach International Airport announcing his order for Florida National Guard recruiters to work from nearby armories after attacks in Tennessee on July 18, 2015. (Richard Graulich / The Palm Beach Post)
Governor Rick Scott says the federal government needs to address the Zika virus like a natural disaster.

“Like the movements of a hurricane, many things about the Zika virus are still unknown,” he said.

“We don’t yet know for certain what will happen with this virus, but we owe our citizens a vigorous and thorough preparation effort at the federal level to best protect their health.”

 

New law allows nurse practitioners to prescribe narcotics

The Florida Nurse Practitioner Network hailed the governor signing into law new legislation that allows their members to prescribe painkillers to patients.

This is landmark legislation,” said Janet DuBois, president of the network. “This legislation ensures that nurse practitioners can prescribe a variety of controlled substances and pain-relieving drugs to alleviate severe pain for patients, especially patients in emergency or palliative care situations.

View of seven hydrocodone pills Wednesday Nov 20, 2013 in West Palm Beach. (Bill Ingram/Palm Beach Post)
Under a new state law, nurse practitioners can now prescribe painkillers to patients. (Bill Ingram/Palm Beach Post)

The bill expands the categories of health providers who may prescribe controlled substances for various illnesses, including cough relief, anxiety, neurological conditions and general pain, to include advanced registered nurse practitioners.

“We are proud that our legislative efforts were instrumental in the passage of this bill,” DuBois said.

A nurse practitioner is a registered nurse who has acquired the expert knowledge base, complex decision-making skills, and clinical competencies necessary for expanded practice. Nurse practitioners are required to have national certification and must hold a master’s of science degree in nursing.

Blocked! Feds could usurp Florida’s new abortion law

The federal government and Florida may be on a collision course over a new state law seeking to ban Medicaid funding for services at clinics that offer abortions, such as those run by Planned Parenthood, according to a News Service of Florida story.

The federal government has prohibited such bans on Medicaid funding when such laws have been put into place in other states, said Elizabeth Nash of the Guttmacher Institute, which researches abortion issues and supports abortion rights.

With the Capitol dome in the background, Mary Elizabeth Burke, of Washington, participates in a pro choice rally near the Supreme Court, Wednesday, Jan. 22, 2003. Opponents and supporters of abortion rights rallied at the nation's symbols of freedom Wednesday, energized on both sides by Republican hopes of curbing the procedure 30 years after the Supreme Court legalized it. (AP Photo/Susan Walsh) ORG XMIT: SAW101 ORG XMIT: MER0705021207182794

“You cannot exclude a provider from Medicaid because you don’t like the services they provide,” Nash said.

Florida has already been put on notice by the U.S. Centers for Medicare & Medicaid Services, the News Service reports.

The agency notified Gov. Rick Scott administration, “reminding them of the state’s obligation to ensure Medicaid beneficiaries continue to have access to services provided by any willing provider,” according to a CMS spokeswoman.

While only government-funded abortions can be obtained through extreme circumstances, women can obtain other medical services through Medicaid, the News Service reports. Indiana tried to do the same thing in 2011 and found it could not.

One of the sponsors – Rep. Colleen Burton of Lakeland – said they were aware that the state would have to apply to the federal government for a waiver.

“We knew that,” Burton said. “And we’ve said it in committees — I’ve said it on the floor of the House — that we are aware that this portion of the bill requires a waiver from the federal government.”

WASHINGTON, DC - JUNE 26: Pro-life activists gather outside the U.S. Supreme Court June 26, 2014 in Washington, DC. The court overturned today a Massachusetts law barring protests within 35 feet of abortion clinics. (Photo by Win McNamee/Getty Images)

Scott spokeswoman Jackie Schutz would not confirm that the administration was considering requesting  a waiver.

“The bill doesn’t take effect until July 1, and we’re working with our agencies on it, and looking at our options,” Schutz said.

Read the whole News Services story by clicking here.

Gov. Scott signs guardianship reform law to protect seniors

More than four years ago, concerned families went to lawmakers for the first time with their stories of how professional guardians were ransacking the estates of the elderly.

Groups such as South Florida-based Americans Against Abusive Probate Guardianship talked about how unethical guardians appointed by judges were isolating seniors from their families, over-medicating them and then taking their money through frivolous fees.

On Thursday, Florida Gov. Rick Scott signed a bill giving the state its first regulatory authority over professional guardians who are appointed by courts to take over the lives of incapacitated senior citizens. The bill was one of 25 Scott signed into law.

The new law creates an Office of Public and Professional Guardians and requires the office standardize practices and create rules for professional guardians. It also gives the office enforcement power, including the ability to revoke a guardian’s registration.

It follows in the wake of a guardianship reform bill signed last year by Scott that imposed criminal penalties for exploitation or abuse of a senior in guardianship among other changes.

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Sheila Jaffe (left) and Natalie Andre (right), President of FACTS (Families Against Court Travesties), protest last month with a group of people about the state of guardianship outside the South County Courthouse in Delray Beach. (Lannis Waters / The Palm Beach Post)

Guardianship reforms are not just happening in Tallahassee.

Following The Palm Beach Post’s series Guardianships: A Broken Trust in January on how judges are complicit in allowing the savings of seniors to be soaked by guardians and their attorneys, the chief judge acted.

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James Vassallo with his father, Albert. Vassallo claims professional guardian Elizabeth Savitt – wife of Judge Martin Colin – took money without court approval and failed to account for all of his father’s assets.

Palm Beach County Chief Circuit Judge Jeffrey Colbath transferred Circuit Judge Martin Colin out of the Probate & Guardianship Division.

Colin’s wife, Elizabeth “Betsy” Savitt, works as a professional guardian, compiling complaints from families for taking tens of thousands of dollars in fees without court approval. The chief judge required the south county judges to recuse themselves from her cases and instituted other reforms, as well.

 

James Vassallo’s father was in a Savitt guardianship. He said the new law signed by Scott could be the right remedy.

“Nobody was looking at the professional guardians watching what they were doing,” he said. “They are abusing their guardianship privileges.”

Dr. Sam Sugar, co-founder AAAPG, said the passage of this law is clear progress.

“We look forward to being intimately involved – as promised in the legislation – in the development of rules and regulations of this new department as advocates for victims of abusive guardianships,” he said.

 

 

Senate holds fate of Florida Surgeon General

It’s been a tough year for Florida Surgeon General Dr. John Armstrong.

Gov. Rick Scott’s head of the Department of Health is having trouble getting reconfirmed.

dr-john-armstrong
Florida Surgeon General Dr. John Armstrong

A Senate’s Ethics & Elections Committee is scheduled Tuesday to consider again the confirmation after a previous hearing was postponed partly out of fear Armstrong didn’t have enough votes.

It looks a bit better for him today as in the last week some medical groups have offered a show of support. Of particular concern among  AIDS groups  was Armstrong’s response to a spike in HIV cases in the Sunshine State. Armstrong has made HIV prevention a priority issue in the last few months.

He has also received questions about a drop in the number of people receiving services from county health departments as staff has been slashed.

Armstrong narrowly escaped an earlier panel – the Senate Health Policy Committee – when it voted 5-4 to approve the surgeon general’s nomination

Late last year, Armstrong announced he had colon cancer, undergoing surgery. Gov.  Scott issued a statement of support on Monday:

“Dr. John Armstrong is a fighter. Not only is he currently fighting against colon cancer, but he has continued to fight for the well-being of everyone in our state – whether it is against epidemics like Ebola and Zika, or illnesses like cancer or AIDS that are still affecting far too many in our state.”

The 2016 session is the final opportunity for confirmation or he will be forced to step down. Armstrong was appointed in 2012.