1/9/2014 Terry McAuliffe: Governor Sleepless?
The Leg.Up Local, state and national news of interest to the physician community January 8, 2014
Mark B. Monahan, MD Virginia Urology
Richard A. Szucs, MD Commonwealth Radiology
Ritsu Kuno, MD Pulmonary Associates of Richmond
In This Issue Terry McAuliffe: Governor Terry McAuliffe: Governor Sleepless? Sleepless? Gov.-elect Terry McAuliffe has been a busy man, reports Dr. Marcella Fierro in PBS The Washington Post, and though he's been "governor-in- Documentary waiting... He is no good at waiting. So he is hiring. Phoning. Ethics Reform Coming? Meeting. Schmoozing. Strategizing."
Deeds Seeks Mental He typically only sleeps about four hours a night. Health Reform "I just wish I didn't ever have State Senate Balance of to sleep," he says. "But it is Power Uncertain what it is. It is the human Will Ocare Actually body." Increase ER Use? The man who will be sworn in Sebelius Says Ocare as Virginia's 72nd governor Working Saturday "has always been a Writing Contest for Med man in a hurry," starting a https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 1/11 1/9/2014 Terry McAuliffe: Governor Sleepless? Students and Residents driveway-sealing business at 14, using an old truck that he wasn't legally able to drive. He reportedly has raised $1 Mental Health Webinar for million for Saturday's inaugural shindig. PCPs Chippenham Crisis Center Over the past week, he's been busy making cabinet Christened appointments, mostly of "experienced Richmond hands," including Anne Holton as Secretary of Education. Holton In Congress, Shrunken is the daughter of former GOP governor Linwood Holton, Ambitions the wife of Sen. Tim Kaine, and a former Juvenile and Domestic Relations Court judge in Richmond. Study: Rates Increase
When Surgeons Sell While Judge Holton's appointment was praised by many Implants Democrats, the party's "left flank" has been upset with other IUD Comeback? Cabinet choices. This includes the decision to reappoint Dr. Bill Hazel, Gov. Bob McDonnell's secretary of health and Dave Barry's "Year of the human resources, to the state's top healthcare job. Zombies" What's Coming Up on RAM "Some abortion rights activists have bristled over McAuliffe's Calendar? choice because Hazel did not object to strict new abortion limits enacted during McDonnell's term," reports the Post.
Click here to read for "things to watch in the 2014 General Assembly," especially how well McAuliffe's "charm offensive" will go over with Republicans.
But even as he cobbled together his cabinet and senior staff, McAuliffe has "already gotten a lesson in legislative prerogative on the state budget," reports the Times- Dispatch.
It seems that Del. S. Chris Jones, R-Suffolk, the next chairman of the House Appropriations Committee, "informed the incoming governor last month that the panel would not consider amendments proposed by the new administration to the two-year budget Gov. Bob McDonnell submitted on Dec. 16."
Jones said this was based on an earlier precedent set by former Appropriations Chairman Lacey E. Putney, an independent from Bedford.
Jones said this is "not anything new for McAuliffe," adding, "He seems fine with it." The two plan to meet soon, Jones said.
But House Minority Leader David J. Toscano, D- Charlottesville, said Jones' decision is all about Republicans' flexing their "legislative prerogative."
Neither the state constitution nor the state code obligates the General Assembly to consider budget amendments offered by the governor until the reconvened "veto" session that takes places after the assembly adopts a budget.
The Times-Dispatch also reports that the 2014 General Assembly that starts today would be a "60-day sprint to adopt a two-year budget and make weighty policy decisions https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 2/11 1/9/2014 Terry McAuliffe: Governor Sleepless? on issues ranging from expansion of Medicaid to changes in ethics, rules, mental health policy and the Standards of Learning."
Despite the often fractious partisanship of last year's General Assembly, Republican state Sen. Thomas K. Norment, R-James City, told the Newport News Daily Press, "I think it's going to be a productive, civil session, with plenty of continuity from the McDonnell administration on issues involving jobs and the economy."
Businesses are telling the Republican leadership "that they've got to moderate their image if they're going to continue to get business support," said Quentin Kidd, a political scientist at Christopher Newport University.
PBS Documentary Features Dr. Marcella Fierro
Dr. Marcella F. Fierro, a longtime RAM member and the former Chief Medical Examiner of Virginia, was among the experts interviewed in a new PBS documentary on the birth of forensic medicine.
Set your DVR for 3 a.m. Thursday (Jan . 9) on WCVE/Channel 23 to record "The Poisoner's Handbook," part of the PBS series "American Experience." Click here to learn more.
Based on Deborah Blum's 2010 book, The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York," the L.A. Times hailed the documentary for offering "a fascinating look back at how the chemical age changed police work." Click here for Blum's blog on the show.
Fierro, reached by phone today, gave the program two thumbs up. She said she was interviewed by its producers last spring in "a lovely old mansion on Long Island."
"I thought it was very interesting," she said of the PBS program "because it talks about the early development of the medical-legal investigation of death in this country, which was previously carried out in New York by people who were not trained and were not physicians."
At that time, "The death investigation did not revolve around establishing the true medical cause."
This changed in Jazz Age New York under a crusading https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 3/11 1/9/2014 Terry McAuliffe: Governor Sleepless? medical examiner, Charles Norris, and Alexander Gettler, who ran his toxicology labs. "This has powerful legal and preventive medicine aspects," Fierro explained, "because you can't develop strategies to prevent death if you don't know the true causes of death. You can't have a just criminal justice system without establishing the true causes of death."
She also liked the PBS production because of its "terrific" archival film, its use of Blum's stories which "are really emblematic of not only criminal justice, but of public health," and how it tied in with the creation of the U.S. Food and Drug Administration.
House Leaders Reach Ethics Reform Deal
Virginia House Republicans and Democrats have brokered a "bipartisan ethics reform agreement that includes a proposed $250 individual gift cap for state legislators, and creates a state ethics advisory commission, along with other measures to tighten the Old Dominion's loose laws on gifting, the Virginian-Pilot reports.
"Lawmakers of both parties are focused on reforming Virginia's ethics rules in the wake of a gift scandal that marred the final year of Gov. Bob McDonnell's tenure," the Pilot reports. Federal and state investigators continue to look into whether the governor sought to improperly aid a donor who was generous to him and his family. To date, however, no criminal charges have been filed.
At Tuesday's press conference, the bipartisan effort began to take shape, reports the Virginian-Pilot. Like all bills, it comes with some fine print, including distinctions of the kinds of gifts that would be covered under the law, reports the Times-Dispatch.
In a joint op/ed piece, Republican House Majority Leader Kirk Cox and Democratic House Minority Leader David Toscano make the case for ending the gravy train for lawmakers and state office holders.
"This issue goes far beyond Republican or Democrats," the House leaders wrote in the TD Tuesday, "and far beyond the actions of any one individual. The citizens of the commonwealth must know without hesitation or qualification that their elected leaders can be trusted to execute their duties with the highest degree of integrity and virtue."
An earlier Times-Dispatch editorial compared Gov. McDonnell's missteps to that of the ancient story of Damocles - the Greek courtier who was lavished with luxuries. A sword hung above his head, a reminder that https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 4/11 1/9/2014 Terry McAuliffe: Governor Sleepless? "wealth and power often entail great peril."
Deeds Back in Richmond with Mental Health Reform in Mind
State Sen. R. Creigh Deeds "returns to the Capitol this week on a mission to fix the state's mental health system," reports The Washington Post.
"Deeds (D-Bath) has proposed two bills intended to address what went horribly wrong in November, when his 24-year-old son, Austin, known as 'Gus,' stabbed the senator and then fatally shot himself."
One of Deeds' bills (SB 260) would extend the period of time that authorities can hold a person under an emergency custody for up to 24 hours, up from the current maximum of six hours.
Senate bill 263 would establish a real-time registry on psychiatric bed availability, while SB 287 would make it a felony to provide a firearm to someone who is prohibited from possessing one.
"It is not clear if that bill has any connection to the tragedy, however," reports the Post, since police haven't revealed how his son obtained the gun with which he shot himself.
Deeds later called the Post to say the gun-control bill has "nothing to do with my son's situation," saying the measure was in line with past efforts to close Virginia's "gun show loophole" which allows private sellers to transfer firearms without conducting the criminal background checks required of licensed gun dealers.
Gov. Bob McDonnell last week named a task force to begin examining the gaps in Virginia's mental health system.
Addressing the group this week, he said no one in Virginia should go without the clinical care they need in psychiatric emergencies, reports the Times-Dispatch. "This is one of those areas, like homeland security, where we should 100 percent right 100 percent of the time," McDonnell, in one of his last acts as governor, told the Task Force on Improving Mental Health Services and Crisis Response.
Senate's Balance of Power Remains Uncertain
Del. Lynwood Lewis, a Democrat from Accomack on the https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 5/11 1/9/2014 Terry McAuliffe: Governor Sleepless? Eastern Shore, "eeked out a razor-thin victory" of 22 votes over Republican Wayne Coleman in a special election yesterday to fill the state Senate seat vacated by Lt. Gov.- elect Ralph Northam.
The victory would give Democrats a chance to keep the Senate split at 20 Democrats to 20 Republicans. And that would give Northam, a Democrat, a tie-breaking vote, reports the Daily Press of Newport News.
"But the margin is narrow enough that Coleman could ask for a recount," the newspaper reports. "And there will be a special election this month in the Northern Virginia district Attorney General-elect Mark Herring had represented. The Democrats would need to hold on to that seat as well to keep the Senate evenly split."
Will OCare Actually Increase ER Use?
One of the key assumptions of Obamacare - that expanding insurance coverage for the poor would reduce costly ER visits - is being challenged in a wide-ranging study that found "newly insured people actually went to the emergency room a good deal more often," reports The New York Times.
Published in the journal Science, the study "compared thousands of low-income people in the Portland (Oregon) area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance."
The pattern held true across most demographic groups, times of day and types of visits, reports the Times, people who had conditions that were treatable in primary care setting.
The study casts "doubt on the hope that expanded insurance coverage will help rein in" ER costs "just as more than two million people are gaining coverage."
Nearly 25 million uninsured Americans could gain coverage under the law, about half of them through Medicaid. The first policies took effect last Wednesday.
An administration spokeswoman disputed the study's findings - saying it was conducted over too short of a time - and cited a longer-term study in Massachusetts, which saw an 8 percent decline in ER use after the state broadened its coverage in 2006.
https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 6/11 1/9/2014 Terry McAuliffe: Governor Sleepless? Other economists question the emphasis on ER use, saying it accounted for only 4 percent of total health care spending in 2010. Still, the Times adds, "Certain populations, however, like low-income people with chronic illnesses, have much higher rates of use."
One reason for the increased ER use in Oregon, according to one of the study's authors: "Much of the non-urgent ER department use... happened because those patients could not get same-day appointments with their primary care doctors."
Click here to read how Medicaid has expanded its role, covering more members of the middle class.
Sebelius: Ocare is Working
Writing in Times-Dispatch, President Obama's standard bearer (and sometimes punching bag) for the Affordable Care Act, HHS Secretary Kathleen Sebelius says the ACA's provisions that kicked in Jan. 1 "marked a new day for millions of families and individuals throughout Virginia."
She provides the phone number of online signups and the link to the much- maligned HealthCare.gov.
"This is a milestone for the many families who have waited too long for affordable health insurance because of a broken system that was stacked against them."
Meanwhile, 1.1 million Americans reportedly signed up for insurance plans through the federal healthcare marketplace during its initial enrollment period, with more than 975,000 enrolling in December alone.
And while Sebelius and her crew have been scrambling to fix the federal health exchange, a new issue looms: "Churning," that is, people who drop out of federal programs, such as Medicaid, but then re-enroll when their income changes.
"Experts warn that churning will continue to be a problem as patients bounce between Medicaid and the exchanges," reports The Washington Post.
Med Students and Residents Encouraged to Submit Essays for $5,000
https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 7/11 1/9/2014 Terry McAuliffe: Governor Sleepless? Attention medical students and residents: Interested in a chance to win $5,000? Submit an essay about a patient safety event that personally changed you. Six winners will be chosen for The Doctors Company Foundation 2014 Young Physicians Patient Safety Awards. Applications, due Feb. 3, 2014, are available here.
The contest is open to 3rd or 4th year medical students or first year residents in hospital settings.
Past winning essays can be read here. For more information contact Alicia Gomez at [email protected].
Mental Health Webinar for PCPs
Is your primary care practice comfortable with diagnosis and treatment of mental health conditions?
If the answer is "not really," you're in good company, says a recent release from the Virginia Health Care Foundation (VHCF), which says that "many, if not most, primary care providers don't feel confident of their competence in this area."
And yet an estimated 25 percent of patients seen in primary care setting will have a diagnosable mental health condition.
VHCF has developed two webinars to address this need for health care professionals, including physicians, nurse practitioners and physician's assistants. The archived webinars will be available for $25 per webinar on its website.
CME or ACPE credits are available for an additional $15 per webinar. Questions? Call 804-828-5804.
Chippenham Crisis Center Christened
Local police and public officials christened the Crisis Triage Center at HCA Virginia's Chippenham Hospital in south Richmond, the Times-Dispatch reports.
"Since opening Oct. 1, the center has handled the mental health evaluation and treatment of 50 people taken there by Richmond or Chesterfield police because of a psychiatric crisis."
The center, one of 11 secure assessment centers operating across Virginia, has emerged as an example of how to avert the kind of tragedy suffered last month by state Sen. R. https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 8/11 1/9/2014 Terry McAuliffe: Governor Sleepless? Creigh Deeds, D-Bath, whose son killed himself just 13 hours after being released from an emergency custody order.
In Congress, Shrunken Ambitions
At the start of a new session of Congress this week, "Lawmakers are struggling to find optimism that 2014 will mark a pivot point for an institution whose historically low approval rating has been at or below 20 percent for three years," reports The Washington Post.
Despite a glimmer of compromise at the end of 2013 - as bipartisan groups in the House and Senate agreed to a budget framework for the next two years - many lawmakers are wondering if the old partisan bickering will continue.
Study: Rates Increase When Surgeons Sell Implants
A federal study provided ammunition "to critics who argue that allowing surgeons to profit from implants leads to higher rates of surgery," reports The Wall Street Journal.
According to the Office of Inspector General at HHS, the rate of spinal surgery at hospitals that purchase implants from physician-owned distributorships, or PODs, "grew more than three times as fast as it did at hospitals overall."
The agency, which is responsible for oversight of the Medicare and Medicaid programs, also found that hospitals that purchased implants from PODs performed 28 percent more spinal surgeries than hospitals that did not.
And the oversight agency "found that the implants sold by PODS cost the same as or more than devices sold by companies not owned by physicians, rebutting the main arguments surgeons involved in PODs have used to defend them."
IUD Comeback?
Remember the Dalkon Shield, the intrauterine device that became the target of highly publicized lawsuits in the 1970s after claims it caused pelvic infection and infertility? Richmond-based A.H. Robins Co. pulled the product from the market in 1974 after more than 300,000 Shield-related https://ui.constantcontact.com/visualeditor/visual_editor_preview.jsp?agent.uid=1116177826599&format=html&print=true 9/11 1/9/2014 Terry McAuliffe: Governor Sleepless? lawsuits.
After the company paid billions to plaintiffs, it filed for Chapter 11 bankruptcy in 1985.
Now, reports The Wall Street Journal, "The IUD is making a comeback." The FDA has approved Bayer HealthCare Pharmaceuticals' Skyla, the first new intrauterine device on the market in 13 years."
Planned Parenthood is pushing the product and other IUDs are coming to market. "The IUD is 20 times more effective than birth control pills, the patch or vaginal ring, according to a 2012 study published by the New England Journal of Medicine. That is because the IUD virtually eliminates the risk of human error."
Today's IUDs differ in design from the old Dalkon Shield. "Today's IUDs are small, T-shaped devices that use either hormones or a copper material to prevent sperm from joining the egg."
Dave Barry's 2013: The Year of the Zombies
Dave Barry's satirical look at 2013 - what he calls "the year of the Zombies" - tracks the fumbling start of the federal health insurance exchange, including this for football fans:
"Alabama wins the football national championship by trouncing Notre Dame, which had been ranked No. 1 by a computer program coincidentally created by the same company that is developing the much-anticipated Obamacare website."
Meanwhile, the Wall Street Journal ran this piece on some poorly timed winter vacations for people charged with getting insurance exchanges up and running: "National Lampoon's ObamaCare Vacation."
What's Happening?
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