Monday, July 21, 2014


"California cuts number of uninsured" was the headline for the San Jose Mercury News Editorial on July 15, 2014." The editorial iself stated that California "has cut the percent of residents without health insurance in half since last summer, from 22 percent to 11 percent of the population." The editorial then blurts out that "the percentage of uninsured Americans has dropped from 18 to 13.4 percent in the same time"and "would have dropped even more if all the states were taking advantage of the Affordable Care Act's health exchange program."

Comment: these statements show how correctly quoted statistics can cause misunderstanding and to all intents and purposes lie outright. I personally queried ten doctors at a local hospital. It turns out that none of them accept Covered California since the plan sticks it to them

Sunday, July 13, 2014



So far we've put our focus on legislation with numbered bills, e.g., AB 1340 or SB 1215, and on the Troy and Alana Pack Safety Act, the malpractice initiative now known as Proposition 46, which is expected to galvanize autumn politics in California. We also recently spent nearly a full day attending hearings in Sacramento on healthcare politics and funding, now coming home to roost in California as Proposition 45. Watch for our stories on Proposition 45 which also promises political fireworks.  . -- Robert L. Weinmann, MD, Editor

Tuesday, July 1, 2014


AB 1805 (Skinner & Pan), which would restore the 10% cut in Medi-Cal reimbursement for Medicaid patients in California, is bogged down, mired in the mud of the Assembly Appropriations Committee where it is being held hostage. The 10% cut was imposed by the state budget in 2011 and recently was denied restoration by Governor Brown's recently revealed budget for 2014. It is clear that the Governor isn't going to do much to help Medi-Cal recipients or their treating doctors. Even if the bill passes, it'll have to survive his Gubernatorial veto. Readers interested in the survival of this bill will be obliged to rely on the democratic process, i.e., they'll need to call their elected state reps.

AB 2400 (Ridley-Thomas), sponsored by the California Medical Association, which would have allowed providers the ability to negotiate changes unilaterally made by health plans and their insurance companies, or to terminate the contract if agreement could not be reached, has bitten the dust. The tilt of the current administration, like the one that preceded it, is towards big business and against hapless patients and their beleaguered providers. This bill was residing uncomfortably in Senate Health Committee. Now it rests in not so peaceful repose. Readers interested in this bill will need to try to restore interest and build a wider coalition in 2015 than they had this year.

SB 492 (Hernandez) which would allow optometrists to practice aspects of ophthalmology that they are not currently licensed for has had better success. This bill passed Assembly Business and Professions Committee. It is opposed  by the California Medical Association, the Union of American Physicians and Dentists, the California Neurology Society, and a host of professional organizations whose weight in this case is negligible since their combined opposition is regarded as turf protection. 

One success is the failure of SB 1215 (Hernandez) to clear the Senate Business and Professions Committee. This bill would have eliminated the in-office exception for specific procedures such as physical therapy and advanced imaging including CAT and MRI scanning, ultrasound, and other procedures, thereby sending patients on a perpetual run-around. Readers can learn  more about this bill on the Advocacy and Legislation sections of the California Neurology Society website. The CMA, UAPD, CNS, et al were opposed and were part of a wide coalition in opposition.

An aulde lesson in these bills is the importance of coalitions not all of whose members need necessarily have a stake in the outcome. Protection of public welfare still plays a role albeit not as much as many of us would like.

ALERT: The trial lawyers' malpractice initiative has now been officially designated as Proposition 46 while the campaign against it, which we support, will be known as the No on 46 Campaign. The idea is to add Proposition 46 to our list of flame-outs lest its carelessness and callousness burn irreparable damage into California's health care.

Monday, June 30, 2014

Malpractice and drug testing: Pee Pee Politics (PPP)

We've been asked several times to provide the dates of our posts on the Pee Pee Wars, namely,  the trial lawyers' attempt to disguise advantageous malpractice reform in their favor while making it seem as though they want to protect the public by testing doctors for drug abuse. The Triple P moniker arises from the method of testing, namely, micturition into little cups. Here's the dates of our posts: 6/25/14. 5/28/14, 4/27/14, and 4/24/14. - RLW, editor

P.S. The trial lawyers' initiative, The Troy and Alana Pack Safety Act,  has now been officially designated Proposition 46. Accordingly, we recommend support for the NO on 46 campaign. - rlw, ed.

Wednesday, June 25, 2014

Interim Bill Review: AB 1340, 2400, 1805, 1886, and the thinly disguised malpractice initiative

This post includes late additions to the original posting

Assembly Bill 1340 (Achadjian) that would establish Enhanced Treatment Programs is a life-and-death issue for nurses, technicians, and doctors who take care of the sickest and the meanest among us. For this privilege the trial lawyers would like to force the doctors, but not themselves, to pee in a cup. That's the program the trial lawyers are hiding behind in their shameless effort to get higher malpractice awards for themselves under the guise of the Troy and Alana Pack Safety Act which has as its most likely main benefit for a family of four the opportunity to pay $1,000 more annually for health insurance.

Assembly Bill 2400 (Ridley-Thomas) would level the playing field so that Big Biz insurance companies would not be as able as they are now to drive down access to care for patients with chronic and expensive illnesses. For this privilege the trial lawyers want the doctors to pee in a cup. The trial lawyers who have even gone so far as to concoct bogus statistics actually are the ones who should pee in cups. Their campaign cited a report from March of 2000 by the California Medical Board which said "many believe" that 15% of the general population has problems with substance abuse and that among health care professionals the lifetime level might even be 18%. This rough estimate was a supposition, not a researched statistic. Moreover, this lifetime risk translates to no more than 2% at any one time. The trial lawyers' addled research team that thought this one up should pee in as many cups as can be distributed as quickly as possible.

As for the convicted drunken driver who fled the scene  after running down 10 year old Troy and 7 year old Alana Pack,  it is known that she had three drunken-driver convictions before the accident.  Because she fled the scene and evaded the authorities for two days, a timely blood alcohol test was not obtained. While she was on the run, her apartment was searched. Cocaine was found. She eventually told police she'd taken vicodin prescribed by her treating doctor. Her legal defense at trial was that it was her doctors' fault because they prescribed the medicine for pain relief. She did not assert that they also told her to drive under the influence. Her sentence: 30 years in prison.

Our reward, as doctors whose duty includes the relief of pain, is now supposed to be to pee in cups while prosecutors who get wrongful convictions because they withheld exculpatory evidence from the defense booze it up when what they deserve is to pee in cups and then serve out the time they foisted upon defendants who've since been released because of wrongful convictions. It's a logical next step to have every lawyer,  as he passes through security to enter the courthouse, pee in a cup.

Late flash: the trial lawyers' initiative has been officially designated Proposition 46. The campaign against it will be known as the No on 46 campaign. We support the No on 46 Campaign.

Medi-Cal: we support AB 1805 (Skinner and Pan) which would restore the 10% cut in Medi-Cal remuneration that was installed by the State Budget Act of 2011.  It isn't lost on us that devoted  doctors who take care of the sickest and poorest among us would also be obliged to pee in the trial lawyers' cups. Of course, some might say that Gov. Brown already did that for them when he sent through his recent budget bill which managed once again to give the short end of the stick to the doctors who care for Medi-Cal patients. His having done so raises the ugly spectre of  a possible veto of the Skinner-Pan bill even if it passes handily.

AB 1886 (Eggman): Its original aim, while modified pursuant to amendments obtained by the CMA, remains unchanged, e.g., indefinite posting of disciplinary actions, civil judgments, and arbitration awards against doctors, just enough to make sure that good doctors who  run afoul of one or another disciplinary board become persona non grata to whatever managed care, HMO, or PPO organizations that want to use even minor misdemeanor convictions to ruin careers. It's all about the control and humbling of what used to be an honored profession. Doctors need to learn to say "no" to their would be overseers.
So here are our recommendations: yes on AB 1340, yes on AB 2400, yes on AB 1805, and no on AB 1886 and no, no, no on the Troy and Alana Pack Patient Safety Act, now officially designated as Proposition 46. Accordingly, we urge support for the No on 46 Campaign.

References, 4/29/14, Oppose AB 1886 (Eggman) Unless Amended, and California Medical Association Legislative Hot List, 6/02/14 (author accepted CMA's amendments , CMA now neutral);, 6/24/14, AB 2400 (Ridley-Thomas), Deserves Support plus an amendment;, 6/23/14, AB 1340 (Achadjian), Deserves Safe Passage;, 6/18/14, AB 1805 (Skinner & Pan), Supporting Medi-Cal and 6/16/14, Medi-Cal Patients Snubbed by State Budget;, 4/24/14, Random Drug Testing for Lawyers and 5/28/14, Drug Testing for Lawyers and Pharmaceutical Executives

Tuesday, June 24, 2014

AB 2400 (Ridley-Thomas) deserves support plus an amendment

AB 2400 (Ridley-Thomas), sponsored by the California Medical Association, deserves support. As matters stand now, certain Goliath-like health plans force physicians to accept  contract terms that are harmful to patients, for instance, contractual terms that are adverse to patients with chronic diseases who are more expensive to maintain than healthy 30 year olds. The idea is to force physicians to drop their sickest chronic patients to reduce corporate expenses and increase executive compensation. This bill would put a stop to the perfidious corporate healthcare practice of dropping doctors who insist upon trying to negotiate contract terms or who refuse to accept unilateral material changes in existing contracts. This corporate practice is known as "take-it-or-leave-it."

This bill would allow changes in health plans only if the provider has negotiated or agreed with the provision and if the provision is in accordance with state or federal laws and regulations. Otherwise, the provider will be enabled to opt out of the contract even though it was previously agreed upon. This bill is aimed at the unfair and heavy-handed practices imposed upon patients and their physicians by group health plans and PPOs. It is expected to spill over into Workers Comp, e.g., Coventry (Aetna), Anthem/Blue Cross, etc.

Meanwhile, here's the latest heavy-handed move to inconvenience injured workers and their treating physicians: Travelers Indemnity Company and Constitution State Services, quoting CLC 4600.2, have informed their providers that starting June 20th "all prescriptions for workers compensation related medications and medical supplies must be filled by a network pharmacy ... no payments will be made  for prescriptions or medical supplies provided by a non-network pharmacy, clinic, or medical  office after July 31, 2014."

A provision to take down this latest dictate should be amended into AB 2400 by the authors.

Monday, June 23, 2014


Assembly Bill 1340 (Achadjian) deserves favorable consideration: here's why.

Today, in my day-to-day role as a physician specializing in neurological injuries and diseases, I examined a nurse who in the course of trying to take care of a mentally unstable patient, got so badly beaten up that her head and neck injuries preclude her from returning to work in almost any capacity. Could her injury have been prevented?

Sadly, the answer is yes. Luckily, the same answer portends better for others in a similar position in the future.

About 4 years ago at Napa State Hospital (NSH) Psychiatric Technician Diana Gross was killed. Further less dire incidents have happened since then at NSH and other mental health facilities. At Atascadero State Hospital (ASH) one mentally unstable patient killed another. All this despite increased guard patrols and police attention.

Psychiatric technicians, nurses, and doctors are now calling for preventive measures in the form of AB 1340 (Achadjian) which would mandate intensive treatment for high risk patients. The bill would require that Enhanced Treatment Programs (ETPs) be set up in California by State Hospitals and would enable state hospital psychiatrists and psychologists to refer patients to ETPs as needed, i.e., when it is determined that a patient is potentially dangerous to himself or others because of impaired mental status when there is evidence of proclivity to violence. The bill would require professional forensic medical evaluations.  Patients could then be assigned to an ETP for up to a year but with provision for re-evaluation within one year.

Psychiatric technician Linda Monahan was quoted in BUSINESS WIRE as having said "Legislators need to understand that we struggle to provide the best patient care possible under extraordinarily dangerous conditions. Some of our patients' mental illnesses make them predatory or sociopathic. Those few are responsible for the majority of the violence we endure. We need specialized programs to provide those patients with more effective treatment while also making hospitals safer for other patients and staff."

It is probably true that the civil rights of these violent patients may be obliged to play second fiddle to their mental health needs until such time as they're enough better to accept treatment in traditional and less supervised environments. Managers of these programs will be obliged to ensure that a proper balance is struck.

My patient today, a devoted nurse who'll probably not work again because of her injuries, is among the lucky ones. She's still alive.

We owe it to her and her colleagues to give them more protection in the form of safer working environments where their skills as doctors and nurses won't depend upon the ability to duck a punch, a kick, or a weapon.


Napa, CA., BUSINESS WIRE, 6/09/14

CAPT (California Association of Psychiatric Technicians), 6/06/14

AB 1340 is sponsored by the Union of American Physicians and Dentists (UAPD) and is co-sponsored by the American Federation of State, County and Municipal Employees (AFSCME)