Tag Archives: florida

DEA disciplines Fla. physicians; state allows them to continue practicing

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for Health News Florida, Brittany Davis shows the importance of following up on a disciplined caregivers story. In February, the DEA released the names of 32 Florida doctors whose prescriptions, they say, were fueling the state’s notorious pill mills. The DEA suspended the narcotics licenses of those doctors at the time.

In her follow-up, Davis finds that at least four of the physicians are still practicing, five have been arrested, at least 12 have shuttered or moved their practices, and a full two dozen still have clear Florida medical licenses despite the federal action. The disconnect between state and federal agencies, she found, may come down to simple communication problems.

pills
Photo by somegeekintn via Flickr.

[DEA spokesman David Melenkevitz] said the DEA focuses on enforcement, not outreach, and may not necessarily pass on its findings to the [state Department of Health].

“We’re a federal agency and they’re a state agency,” he said. “We work together but operate separately.”

Pat Castillo, of the United Way Broward County Commission on Drug Abuse, said she is “concerned about the disconnect” between the DEA and the DOH.

She’d like to find a way to fill in the gap and help patients get the most updated information on whether their doctors have been in trouble, she said.

“If their DEA licenses are taken away, certainly that’s a red flag,” Castillo said. “Having that kind of information is critical.”

A spokesperson for the state’s Department of Health said that the agency may not “know about the DEA suspensions, or the agency may be conducting its own investigation.”

Herald reports on failures of assisted living system

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Miami Herald‘s yearlong “Neglected to Death” series on abuse and violations in assisted living facilities is expansive, but I recommend starting with this explanation of how the story came together. In short, the crux of project, reported by Rob Barry, Carol Marbin Miller and Michael Sallah, is a huge database, which never had been made public, the paper obtained from state regulators. An accompanying editorial from Aminda Marques Gonzalez details its somewhat unique provenance.

At the heart of the reporting is a rich database of hundreds of thousands of records that includes all inspections and complaint investigations by the Florida Agency for Health Care Administration, the sole regulatory agency for ALFs [assisted living facilities]. Layered in: a decade of complaints filed with the State Department of Elder Affairs and public records including police reports, death certificates and autopsy reports.

The paper has made the database searchable and open to the public.

The Herald reports on a facility where violence is so commonplace that incidents have prompted more than 1,200 calls to 911 in the past five years. It’s important to note that, while we usually think of assisted living for the elderly, there are such facilities for those who have mental illness and other disabilities.

Other stories tell of residents suffering from sores that went untreated, homes and caretakers that failed to keep medical records, facilities that did not protect vulnerable residents from those with a criminal background, a failure to track patients with dementia and more.

A timeline helps explain how and why the assisted-living facilities became a part of the Florida system and their growth.

Health reform battle entering a new phase

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, has been AHCJ’s topic leader on health reform and curated related material at healthjournalism.org. Follow her on Facebook.

As I try to figure out what AHCJ members most need as they cover health reform in year two of the Affordable Care Act, I tried to see if I could detect themes at the AHCJ conference in Philadelphia. That unified theory of health reporting plan went out the door as I heard questions ranging from very basic queries about pre-existing conditions to far more technical inquiries about accountable care organizations.

My next plan was to blog about the “reporting on health reform” session.  A conference fellow  beat me to that – (also see the tip sheets Covering health reform issues, Health care reform: Litigation update, Three health reform issues to watch in the states).

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The repeal and replace stage of the health wars isn’t over. But I think we are entering another phase. The dominant national discussion topic is the deficit and the debt – and that leads into Medicare, Medicaid and other entitlements.  I’ve done a tip sheet on Medicare and “premium support.” Medicaid is next up.

The proposals in the House-passed version of the budget are not brand new; Medicaid block-grant proposals have been around since at least the Reagan years, and they were definitely part of the Gingrich era. I remember hearing about variants of premium support and/or Medicare vouchers in the late 1990s, and I suspect they were around before that.

We don’t know every detail of what the Ryan plan would do; the budget plan is a federal framework, and the details aren’t filled in. And of course the Ryan budget won’t be accepted by the Democratic-controlled Senate or President Obama.  But this idea isn’t going to go away. We need to watch how it plays into reforms being considered at the state level, and see what kind of steam it picks up (or loses) after 2012.

If your governor or state legislature favors block granting Medicaid, it’s time to start asking questions.

  • What would Medicaid look like under a block grant?
  • Who would still get it?
  • Would there be enrollment caps and waiting lists?
  • How much of the costs would be shifted to the beneficiaries and families?
  • Would providers get paid less?

States can already get waivers for Medicaid, and that can allow for innovation in red and blue states alike.  States will have a lot more flexibility under some of the ACA provisions in the next few years, including ways of doing a better job caring for people with chronic disease and the “dual eligibles” on Medicaid and Medicare.

Here are a few articles I’ve seen recently that describe some of what the states are already doing – or considering – as they confront rising Medicaid costs today.

Looking at the coverage

Carol M. Ostrom of The Seattle Times had an April 17 piece: “Doctors: State plan to limit Medicaid ER trips risks lives.”

Several of the Florida papers have had pretty good coverage of Gov. Rick Scott’s plans to transform Medicaid. But a solid hour of Googling didn’t net me one good big clear step-back story (it may be out there somewhere … send it if you see it) that tells out-of-state readers the whole story. But I still found work by John Kennedy and Stacey Singer at The Palm Beach Post (here’s one) and Marc Caputo of The Miami Herald (click here – you have to read down a bit to get the state overview) helpful.

The Oregonian has been taking a look at some of Gov. John Kitzhaber’s agenda, which should be worth watching as he has a track record as an innovator (and knows CMS administrator Don Berwick quite well).  And of course we’ve all heard a lot about Arizona.

A lot of the stories I looked at from around the states were written by state capitol reporters, not health beat folks, so they were heavy on process and “Republican said X, Democrat said Y” kind of coverage. They didn’t always do a great job of getting beyond a fusillade of quotes.  I guess if I’ve been Googling for more than an hour and can’t find a really solid health overview story, I should stop here and invite you to send me any you’ve seen (or written).

Don’t forget about Medicaid

Medicare is getting an awful lot of ink – after all, old people vote, and most of us expect to get old someday and need Medicare. We’ve got to look harder at Medicaid which covers poor kids and their parents, some of the disabled and mentally ill, some of the HIV population, and lots of the residents of nursing homes. That isn’t who votes. That isn’t who decides what reporters cover. And it’s certainly not a benefit most of us hope to use someday.

Last comment for today – and you’ll probably hear me return to this theme frequently because, to me, it’s some of the most interesting reporting we’ll be able to do in the coming years:  Remember the Affordable Care Act, the health reform law, isn’t only about coverage and insurance exchanges. It makes countless changes to Medicare and Medicaid – changes that will affect the current fee for service model, changes that affect the private managed care sections of it and changes that will add new dimensions as we explore new ways of delivering care (medical homes, ACOs, a number of Medicaid programs aimed at getting people care in the community, not just nursing homes).

Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

Fla. group home’s sex policy raises questions

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

St. Petersburg Times reporter Justin George has painstakingly assembled the story of a group home for developmentally disabled adult men in Florida which, George writes, “enacted a bold and unorthodox policy permitting sex between residents.” Many of the men in the home were sex offenders and, according to experts, the policy created “a sexually charged atmosphere that may have encouraged sexual assaults.”

While this may sound more like a story for the crime and justice beat, keep in mind that the center “received approximately $100,000 in Medicaid funding per person annually for most residents,” despite reports that it is in an advanced state of disrepair.

George pulled hundreds of records from numerous government agencies and conducted more than 40 interviews over the course of two years. It shows in his reporting. You should read the full story to understand the breadth and complexity of the issue at hand, but I’ll summarize for the time-challenged.

Center officials regard sex as a basic human right (as the World Health Organization declared in 1975) and, in one 2005 case, “staff wrote that they could not evaluate whether Kevin was learning appropriate sexual behavior because his mother wouldn’t let him have sex with other campus men,” George found.

Compounding the problem, the state agency that oversees HDC (the group home) did not object to the policy until a whistle-blower complained to a state legislator. An investigation documented multiple instances of improper sexual activity between residents.
HDC officials say that banning sex is not the answer. It would deny basic rights and simply sweep the issue under the rug, a response they say is all too common when dealing with sex abusers.
But two years later, the state still has not written an official policy concerning sex in group homes. The whistle-blower was fired, and the mentally disabled man at the center of the controversy is stuck in a facility that he — like other men there — is desperate to leave.

After it learned of George’s investigation, the state finally set out to draft a policy for sex in state-run group homes, and perhaps for private homes as well.

A draft of one policy would ensure that sexually aggressive residents don’t room with anyone else, but it doesn’t prohibit sexual activity in group homes unless the disabled are children. Prohibiting adult sex might violate civil rights, Palecki said.
The Human Development Center’s revised policy on sexual behavior states it will not promote sexual activity among residents. Condoms will still be available, but only if competent adults ask for them.

George also tells the stories of two women who lost their jobs after speaking out about the situation and suspicions that a resident has been unable to move to a different home because his mother has cooperated with an investigation.

Florida addicts priced out of private rehab

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In the St. Petersburg Times, reporter Leonora LaPeter Anton attempts to reconcile a local paradox: The state has suffered from epidemic of prescription drug abuse, yet Florida’s numerous private drug rehab centers remain empty. Why aren’t supply and demand coming together? The short answer, she found, is price.

… few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.

The problem is cost. Those with insurance quickly exhaust meager benefits and most don’t have $5,000 to $20,000 a month for round-the-clock rehab.

And the long answer? It comes back to insurance, then takes a sharp turn toward federal legislation. Insurers are reluctant to cover even 30-day treatment stays these days, Anton writes. “The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.”

It’s a gap that the newly implemented Mental Health Parity and Addiction Treatment Act was designed to overcome. The new laws require that issues like substance abuse be covered at the same level that classic “medical” problems are.

Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won’t change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.

Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.