House Strips LSU Of Medical Center
Written by: BayouBuzz Staff
The Louisiana House
on Monday night approved removing LSU from control of the Medical Center of
Louisiana in New Orleans.
The House supported in a 102-0 vote legislation supported
by House Speaker Jim Tucker, R-Terrytown. The legislation creates a new nonprofit
organization managing the hospital
LSU along with other colleges and universities in the area
would have only one seat on the new board.
Other universities who might be on the board are Tulane, Delgado Community College, Xavier, and Dillard
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Mission in Peril
New Orleans CityBusiness |
by Richard A. Webster
Editor’s note: This is the final installment of a report
on New Orleans Medical Mission Services
New Orleans Medical Mission Services has performed more
than 787 surgeries in Nicaragua,
Ecuador and Panama in its six-year history, but not one in
where free health care is desperately needed.
Nearly four years after Hurricane Katrina, Charity Hospital,
the provider of health care to the indigent and uninsured, has sat empty
and community leaders battle over plans to build a $1.2 billion medical
The delay replacing Charity has enraged Mandissa Moore, who oversees the New Orleans Women’s
Health Clinic and sees first-hand on a daily basis the urgent need for
medical care among the city’s poorest citizens.
“I’m talking about a hospital, caring for people who are
sick and dying, and y’all are talking about business and economic
development,” she lashed out at LSU officials during a September public
meeting. “You need to do what’s right, stop thinking about money and start
thinking about providing health care to the people who need it.”
Fred Mikill, CEO of NOMMS, knows
what people like Moore must think: Why is he
so worried about the needs of Third World countries when the people of New Orleans are
The truth is there is nothing Mikill
would love more than to provide free procedures such as hysterectomies, joint
replacements and laparoscopic operations to the residents of his hometown.
But the United States has
created a perfect storm of bureaucratic red tape and legal pitfalls that make
it impossible for organizations such as NOMMS to do at home what they do in Central America.
The biggest impediment is the threat of medical
malpractice lawsuits, said Dr. Thomas Kennedy, a surgeon at East Jefferson
and NOMMS founder. In Latin America, people have yet to catch onto the
litigation cash cow but in the United States, “ambulance chasers
are forever lying in wait, ready to pounce once a doctor makes a mistake,”
“Litigation may not be the root of all evil, but it’s the
root of a lot of evil. If anything goes wrong you’re going to get sued,”
Kennedy said. “We’d love to go to poor areas like the Appalachians
and do surgeries, but can you imagine what would happen if something went wrong?”
Insurance coverage is a must given the threat of lawsuits.
But it is impossible to find an insurance company willing to underwrite
surgical missions in the United
After Katrina, Mikill thought
NOMMS assistance would be invaluable. He had a team of experienced doctors
and nurses armed with medical supplies prepared to go into the field.
He contacted the city to see if it could provide liability
insurance for the doctors or a waiver against damages.
“They said no, that we had to have our own insurance.”
Mikill then called ADP Insurance
and four weeks later a representative of the New Jersey company told him they could not
find anyone to underwrite the mission. The risks involved with volunteer
doctors performing invasive surgery were too high, they told Mikill.
Stan Brock, founder of the Remote Area Medical Volunteer
Corps based in Knoxville,
Tenn., echoes Mikill’s frustrations. The threat of litigation in the United States
is ever-present and the cost of insurance is prohibitive. But since its
inception 20 years ago, Brock’s group has held hundreds of U.S. missions regardless of the
Since the Remote Area Medical Volunteer Corps can’t afford
to purchase insurance as an organization, Brock leaves it up to the
individual volunteer physicians to purchase coverage for themselves.
This leaves the organization exposed, but they have no
other choice, Brock said. Luckily, they have never been sued in their 20-year
“The people we help are so incredibly grateful because
we’re giving them something they could never afford,” Brock said. “Suing
someone is the farthest thing from their minds.”
The big difference between the two groups is that NOMMS
performs invasive surgery while the Remote Area Medical Volunteer Corps
provides dental work, eye exams and X-rays. Brock said he isn’t aware of any
medical missions that provide free surgery in the United States.
“We do the same types of surgery in Guyana and India
(that NOMMS does in Nicaragua),”
Brock said. “But there’s no way we could do that here. It would require a
hospital to provide the room and in most cases they are not willing to do
that for free. That’s the big impediment.”
The barrier that causes British-born Brock the most
frustration is that doctor’s licenses are not recognized from one state to
another. Louisiana temporarily waived this
restriction following Katrina, but Tennessee
is currently the only state that allows out-of-state doctors to practice with
Brock doesn’t buy into the argument that states may have
varying medical standards.
“They say they want to make sure they have the proper
qualifications and that they’re good doctors. What a damn silly attitude.
They’re all taking the same exam whether in one state or another. That
argument doesn’t hold water.
“Free medical care is so desperately needed by so many
Americans and yet there are so many barriers preventing people who want to
provide it. And it’s the poor who suffer.”
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Medical officials are trying to sell technology that the
city is developing locally.
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Shreveport Times | 05.20.09
In a state with serious health issues among its children, Louisiana officials
ought to be knocking down barriers to get them into dentists' chairs.
Instead House Bill 687 was in the evening spotlight
Tuesday night in a move to limit mobile dental clinics, particularly at
Proponents cite safety concerns as motivation for the bill
but it seems more about turf protection by some in the dental community.
Enough lawmakers balked at this counterproductive health care effort to
narrowly stop the bill on the House floor, though it could come up again.
Mobile clinics have increased since last year when
lawmakers raised Medicaid rates to make it profitable to treat children of
poor families who lacked access to care.
Before being passed out of the Health and Welfare
Committee for full consideration of the House, Dr. Herb Flood, a Mandeville
dentist, testified that the bill would reduce access to care for the more
than 400,000 Louisiana
children who qualify for free care under Medicaid. He rejected concerns that
"invasive procedures" shouldn't be done in schools, saying they are
limited to filling cavities and pulling teeth. Of the 17 Medicaid providers
in his area, only two are seeing new patients, he said.
Barry Ogden, executive director of the Louisiana Board of
Dentistry, testified that there have not been any problems associated with
school-based mobile clinics and that the 13-member licensing body is in the
process of updating regulations.
That's where any regulations ideally belong — in the hands
of professionals rather than in the special-interest driven realm of the
One amendment did make exceptions for mobile clinics
operated by state or parish governments, or those tied to federally qualified
health centers that already are providing dental services. It also would
allow school-based clinics in areas designated by the state dentistry board
as being underserved, if local superintendents approve. But opponents argue
that the amendments still create barriers.
The Louisiana Primary Care Association and the Louisiana chapter of the American Academy
of Pediatrics both oppose HB 687 by Rep. Kevin Pearson, R-Slidell.
Mobile dental clinics have provided care to thousands of
poor "dentally homeless" Louisiana
children on school campuses, as one bill opponent put it. The state
Department of Health and Hospitals reports only 37 percent of
Medicaid-eligible children in Louisiana
have seen a dentist.
The new dean of the school of dentistry at LSU Health
in New Orleans,
Dr. Henry Gremillion, didn't take sides in a
meeting with The Times Editorial Board last week, but he did note that access
to dental care was a serious concern.
As Dr. Flood told the House Health and Welfare Committee,
"When we cannot get children to the care, we have to get the care to the
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Louisiana Medical News | 05.20.09
By: LYNNE JETER
The number of the nation's nearly 40,000 clinically active
emergency physicians is not adequate to treat the growing number of people
who visit emergency departments every year, according to the recently
released National Study of the Emergency Physician Workforce.
Medical schools are not turning out emergency physicians
fast enough, and shortages are predicted to persist for decades.
The grim news does not bode well for the South, which is
largely rural, where shortages in emergency physicians already exist. The
growing reluctance of emergency physicians to practice in rural areas is a
particularly disturbing trend. Of emergency physicians who graduated more
than 20 years ago, 15 percent are practicing in a rural area. By contrast, of
emergency physicians who graduated within the past five years, only 5 percent
are practicing in a rural area.
"States in the Deep South had the lowest access to
both emergency medicine trained/board certified emergency physicians and any
emergency physician in the country," said Adit
Ginde, MD, of the Department of Emergency Medicine
at the University of Colorado-Denver School of Medicine, and lead author of
According to the most recently released National Hospital
Ambulatory Medical Care Survey, 227 visits are made every minute to emergency
departments nationwide. However, only 3.3 percent of active doctors are
"It's difficult to satisfy completely the current
demand for emergency physicians with emergency medicine board certified
physicians, especially in rural areas," said Ginde.
"We need to improve access to high quality emergency care for all
Nationwide, emergency physicians are moving into
retirement with the rest of America's
"As older emergency physicians retire, the pronounced
shortage in rural areas may even worsen," cautioned Ginde,
who collaborated with the Emergency Medicine Network at Massachusetts
General Hospital to
analyze the 2008 American Medical Association Physician Masterfile,
which contains data on all 940,000 U.S. physicians.
Of the nation's 39,061 clinically active emergency
physicians, 57 percent were board certified in emergency medicine; this
percentage climbed to 69 percent when all emergency medicine trained
physicians were included. Nearly all (98 percent) of emergency physicians who
graduated within the last five years were emergency medicine trained or emergency
medicine board certified, compared to only 44 percent of emergency physicians
who graduated more than 20 years ago.
"Although an increasing number of emergency
physicians are now emergency medicine trained or board certified in emergency
medicine, 31 percent of practicing emergency physicians were neither,"
Medical schools across the country graduate approximately
1,400 new emergency physicians annually.
"The good news is that the increased public access to
emergency medicine trained and emergency medicine board certified physicians
demonstrates the growth of our specialty in a very short time, "said
Nick Jouriles, MD, president of the American College of Emergency Physicians (ACEP). "But the news on continued shortages of emergency
medicine specialists is sobering, particularly in rural areas."
The 2009 National Report Card on the State of Emergency Care, prepared by the ACEP, gave the United States a C-, with individual state
grades ranging from the highest, a B in Massachusetts,
to the lowest, a D- in Arkansas. Even though the grade of C- is
the same as that reported in the 2006 report card, the two editions are
significantly different and not directly comparable, said Jouriles.
"The 2009 report card provides a more extensive
evaluation of the nation's emergency care system and confirms its tenuous
condition," he explained.
In the South, Alabama, Arkansas, Kentucky,
and Louisiana all received Ds.
Carolina, South Carolina, Tennessee and Virginia
each received a C. No southern state merited a B grade.
Concerning access to emergency care, three southern states
flunked: Florida, Georgia
and South Carolina.
In quality and patient safety environment, Arkansas
failed. Kentucky and North Carolina received an F for medical
liability environment. Bottom performers for public health and injury
prevention included Alabama, Arkansas, Louisiana, Mississippi, South Carolina,
all of which received an F. Arkansas and Tennessee were among the lowest ranked
states for disaster preparedness.
"The states with large rural or frontier areas,
including low population densities and large distances to medical facilities,
face greater challenges regarding healthcare access and health status generally,"
said Jouriles, an attending physician at Akron General Medical
Center in Ohio. "Data confirm that people
living in rural areas are more likely than their urban or suburban
counterparts to report being in poor health, and are more likely to have
higher rates of chronic diseases, poor nutrition, cigarette smoking, and
deaths from injuries.
"Rural populations, on average, tend to be older than
those in urban areas and suffer from greater levels of poverty and
unemployment. They are also more likely to be geographically isolated and
lack access to transportation, a regular health provider, and health
services. Many rural areas also face major shortages of healthcare providers.
For example, though 20 percent of America's
population lives in rural areas (Mississippi's
population, by comparison, is 55 percent rural), those areas are home to only
9 percent of the nation's practicing physicians."
Bottom line, emergency care is a national priority, said Jouriles.
"We need to train more emergency medicine
specialists," he said. "This is a critical concern as lawmakers and
the nation take up healthcare reform."
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By Jan Moller
BATON ROUGE -- A bill to ban most school-based dental
clinics failed to win approval from the full House late Tuesday amid concerns
from lawmakers that it would reduce the services available to poor children.
The 51-37 vote on House Bill 687 by Rep. Kevin Pearson,
R-Slidell, was two short of a majority in the 105-member lower chamber, and
Pearson indicated he would bring the bill back for another vote.
Pearson brought the bill on behalf of the Louisiana Dental
Association, which is trying to curb the recent proliferation of private
dental clinics that treat poor children in school settings such as cafeterias
and libraries. The clinics have been a growing presence in Louisiana since the Legislature last year
increased the rates paid to dentists who see Medicaid patients.
Critics of the mobile clinics said children should be
treated in a dental office, and that school-based care discourages parental
"We would like to see the same level of care offered
to every citizen in the state, every child in the state, instead of having
two levels of care," Pearson said.
But opponents of the bill said the clinics are needed
because more than 400,000 Medicaid-eligible Louisiana children did not see a dentist
last year, and that the mobile clinics have so far failed to generate any
"There are thousands of children that if they do not
see a dentist at the school under the current law then the risk is very high
that they will not see a dentist at all," said House Speaker Pro Tem
Karen Carter Peterson, D-New Orleans.
Critics of the proposed ban include the Federal Trade
Commission, which wrote a letter recently charging that the bill is
anti-competitive and would reduce access to care.
The head of the Louisiana Board of Dentistry told a House
committee last week that there have not been any problems associated with the
mobile clinics, but that the 13-member licensing body is in the process of
updating its regulations to reflect the changes represented by school-based
In its original form, the bill would have outlawed
virtually all school-based clinics. But amendments added in committee carved
out exceptions for mobile clinics owned or operated by the state or parish
governments, or that are operated by a federally qualified health center that
has an existing mobile clinic.
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By Bill Barrow
BATON ROUGE -- In a mild rebuke to the Louisiana Family
Forum, the House of Representatives on Tuesday passed a considerably limited
bill to protect some medical providers who decline to perform certain
procedures based on their personal beliefs.
As it moves to the Senate after the 82-13 vote, House Bill
517 by Rep. Bernard LeBas, R-Ville Platte, pertains
to a short list of procedures and would apply only to public employees,
leaving out Catholic and Baptist health facilities around the state.
Employees of public health entities could decline to
provide abortions, distribute "abortifacient drugs," work on human embryonic stem
cell research or cloning, or participate in euthanasia or physician-assisted
The affected employees would have job protection and
immunity from civil lawsuits.
Before an amendment from Rep. John Bel
Edwards, D-Crowley, the list of services was much wider, including artificial
insemination, sterilization, artificial reproductive technologies, fetal
experimentation and "dispensation of drugs affecting the reproductive
The committee-passed version covered both public and
Edwards' 65-33 floor victory on the amendment was a
decidedly different outcome than the 10-3 vote he lost in committee on the
Without his amendment, Edwards said the bill was vague and
certain to cause unforeseen problems.
An example, he said, might be an insurance company
employee refusing to process an insurance claim for a vasectomy or a pharmacy
technician refusing to fill a birth control prescription.
Besides patients being denied services, he said, private
employers would be unable to deal with uncooperative workers.
LeBas, a pharmacist, offered
only a mild argument against Edwards. "This is a very personal
bill," he said. "I ask you to look in your heart and support the
bill as is."
Gov. Bobby Jindal's administration
supported the bill in committee, though state Health Secretary Alan Levine
told lawmakers the initial language was broad.
The debate comes amid a similar policy skirmish at the
President Barack Obama earlier this year rescinded a
late-hour executive order from President George W. Bush touted by social
conservatives as strengthening the "conscience protections" for
Bush's order would have cut off federal financing for
thousands of state and local governments and health care entities if they did
not accommodate workers who refuse to participate in care they felt violated
their moral or religious beliefs.
Various church leaders and the Family Forum backed the
version that LeBas pushed initially, saying that Obama's
action makes a stronger state law necessary.
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By MICHELLE MILLHOLLON
Advocate Capitol News Bureau
Debate on a bill that would allow health-care workers to
opt out of medical services led to talk about condoms, erectile dysfunction
and Viagra on Tuesday in the House.
House Bill 517 would allow a health-care worker to refuse
to participate in any medical service “that violates his conscience.”
Conscience is defined as religious belief or moral conviction.
The bill would apply to but “is not limited to, abortion,
dispensation of drugs affecting the reproductive process, artificial
insemination, sterilization, artificial reproductive technologies, human
embryonic stem cell research, human embryo cloning, fetal experimentation,
euthanasia, or physician assisted suicide.”
State Rep. John Bel Edwards,
D-Amite, said HB517 is too broadly written. “Right now in its present form,
this bill couldn’t be worse,” he said.
Edwards said a urologist could
cite a moral objection to treating someone with erectile dysfunction.
Health-care workers also could refuse to dispense Viagra
or perform sterilizations, Edwards said.
He proposed an amendment to limit the health-care services
to abortion, abortion-related drugs, stem-cell research, human embryo
cloning, euthanasia and physician-assisted suicide.
The bill’s sponsor, state Rep. Bernard LeBas,
D-Ville Platte, objected to the amendment but the House adopted it anyway.
The House voted 82-13 in favor of sending the legislation
to the Senate.
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Shreveport Times | 05.20.09
By Mike Hasten
BATON ROUGE — The Louisiana House of Representatives
closed loopholes Tuesday in legislation opponents feared would allow medical
service providers to legally discriminate against some patients.
Now an amended version of House Bill 517 is headed for
debate in the state Senate.
Rep. Bernard LeBas, D-Ville
Platte, told the House his proposal would protect health care workers from
having to perform a procedure they object to because it violates their
The main thrust of the legislation is to "protect
doctors who refused to perform abortions" and other services that go
against their "deeply held beliefs," LeBas
said. It would apply to "religious convictions they held for some
time," he said.
But opponents said the bill went much further because it
said the primary purpose is to protect health care providers "from
liability, discrimination and employment action for refusing to provide
certain health care services."
Rep. John Bel Edwards, D-Amite,
told the House "in its present form, this bill couldn't be worse. It is
far too broad. It can be anything" a person objects to doing because, as
LeBas said, it went against a "sincerely
The House should tighten the language in the proposal
since LeBas wanted to affect pro-life measures,
Edwards said. His amendment, which was approved 65-33, says health care
services that can be objected to are limited to "abortion, dispensation
of abortifacient drugs, human embryonic stem cell
research, human embryo cloning, euthanasia or physician-assisted suicide."
"Nobody in the state of Louisiana is required to do any of these
things today," Edwards said.
But LeBas wanted them in the
bill, which originally also included "dispensation of drugs affecting
the reproductive process, artificial insemination, sterilization, artificial
reproductive technologies and fetal experimentation." Edwards' amendment
took those services out of the bill.
The original bill would have allowed discrimination on
numerous fronts and "go beyond the federal law on discrimination,"
said Rep. Patricia Smith, D-Baton Rouge.
The example she offered took aim at LeBas,
a pharmacist who stands about 5 feet tall. She said if she were a pharmacist
and "if I don't like short people, I don't have to fill their
Among the opponents were Parent, Families and Friends of
Lesbians and Gays (PFLAG) and Forum for Equality, members of which lobbied
lawmakers before the vote.
The bill's original form would have allowed "people
to exercise their prejudice when deciding whether to provide medical
treatment," said Joey Collins, PFLAG chapter director in Lafayette. "It's
amazing in the medical field the ignorance about HIV/AIDS, so a nurse who
might not feel comfortable could refuse to provide any medical service."
The bill also would have left "the door wide
open" for any form of prejudice based on racial, sexual or religious
grounds to be excusable, he said.
After Edwards' amendment was adopted, Collins said,
"it was a victory for our community."
David Wilburn, statewide coordinator of New Orleans-based
Forum for Equality, interpreted the original bill to say "if you
disagree with anybody's morals, you can refuse service."
Wilburn said he considers himself a Christian but
"politics are the works of man; religion is the work of faith" and
they sometimes don't mix well.
Collins and Wilburn said they see no reason for the bill
because medical providers already can refuse to perform abortions and related
services, and several of the "medical services" named in the bill —
like euthanasia and assisted suicide — are illegal.
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By SARAH CHACKO
Advocate Capitol News Bureau
A House committee narrowly approved legislation that would
let a nonprofit organization run a state-run nursing home and rehabilitation
With significant budget challenges expected over the next
few years, “we want to make sure this remains a viable facility for people in
the community and maintains quality of service for people living there,” said
state Rep. Rick Nowlin, R-Natchitoches, and sponsor
of House Bill 783.
State Department of Health and Hospitals Secretary Alan
Levine said he could not promise that the John J. Hainkel
Jr. Home and Rehabilitation Center in New Orleans “would even be proposed to
be open next year” without finding another organization to take it off the
state’s hands. An average of 108
people stay in the home and 35 people use its adult day health-care center, Nowlin said. The facility employs 130 state workers, he
HB783 was approved on a 9-7 vote by the House Health and
Levine said privately funded parts of the Hainkel Home are in better shape than the publicly funded
areas, he said.
“We systematically under-capitalize our public
facilities,” Levine said.
Fiscal analyst Myra Lowe explained that the state pullout
would cost $1.1 million in employee termination and other expenses for
2010-11. But there will be savings because the state will be paying a private
provider lower Medicaid reimbursement rates than is charged to the facility
today. The savings would be about $625,000, she said.
So, for the first year, it would cost the state about
$475,000 as it gets out of the operation, Lowe said.
In subsequent years, the costs would be about $425,000 but
the state Medicaid savings are estimated at $810,000. That means about
$385,000 in state general funds would be saved, according to the fiscal note.
But state Rep. Neil Abramson, D-New Orleans, said that
since no deal has been made, it is unclear what the actual costs to the state
Also, the Hainkel Home’s
revenues have been in excess of expenditures and the department has been
using the extra money to plug holes in its budget, Abramson said. When that
money is gone, more state general funds will have to be used, he said.
Levine argued that, like other nursing homes, the Hainkel Home should be allowed to reinvest its excess
earnings in the facility. Hainkel Home residents
and officials testified against the bill, citing concerns that a change in
operation would be a change in the quality of service.
HB783 would allow the state to lease the Hainkel Home to the New Orleans Home for the Incurables,
called NOHI, which was the original home’s owner in the 1800s.
Attorney Kell Riess, who was representing NOHI, said the home was
formed in 1895 but fell into disrepair. The home was sold to the state, and
NOHI became its supporting nonprofit organization, he said. The home’s name was changed to
honor former legislator the late John J. Hainkel
HB783 seeks to lease the Hainkel
Home to NOHI. NOHI can then sublease it to another entity.
But NOHI does not want to participate in that process, Riess said. “As politely as we can, we decline.”
Levine said he would work with NOHI, residents and
families of the Hainkel Home to find an appropriate
organization to manage the facility.
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By SARAH CHACKO
Advocate Capitol News Bureau
Legislation that would ban smoking in bars and casinos
narrowly passed through a House committee Tuesday.
Members of the House Health and Welfare Committee rejected
amendments to exclude cigar and hookah bars from the ban before voting 8-7 to
move House Bill 844 to the House floor.
State Rep. Gary
Smith, D-Norco, and sponsor of HB844, said similar bills have been discussed
and it always boils down to the choice for businesses to allow smoking
instead of public health.
“The studies are significant and the studies are
indisputable that secondhand smoke is a health concern,” he said.
Smith listed statistics about secondhand smoke, including
that it is the third leading preventable cause of death in Louisiana and costs the state $1.5 billion
in health care each year.
Smith said the legislation would also “even the playing
field” between bars that serve food but allow smoking and restaurants, where
smoking is currently banned.
Currently, 28 states ban smoking at bars, and 16 of those
states extend bans to gaming facilities, Smith said.
He said states with smoking bans say there is little to no
economic impact. In some cases, the ban improved their economy, Smith said.
The proposed smoking ban would include bars and any gaming
establishment, including facilities that operate video poker, slot machines
and off-track wagering.
State Rep. John LaBruzzo,
R-Metairie, said he was concerned people who want to smoke and gamble will go
where there is currently no ban on smoking in casinos.
Smith said Mississippi’s
Legislature has considered a smoking ban in casinos and gaming facilities.
Though it didn’t pass this year, Mississippi
will likely revisit the issue next year, he said.
Regardless of what Mississippi
and other states do, “I think the health effects of our own citizens outweigh
that,” Smith said.
Tom Weatherly with the Louisiana Restaurant Association
said members of his organization are on both sides of the issue. But the
typical member experiences unfair competition with bars that serve food, he
While HB844 might level the playing field for business
owners, “it could be taking away that choice from customers,” said state Rep.
Rick Nowlin, R-Natchitoches and a former bar owner.
Business owners and employees also testified that their
right to choose where to work would be taken away.
Gil Birman, owner of Hookah
Café, said his business wasn’t terribly profitable but it was an expression
of his own Middle Eastern heritage. A hookah is a water pipe used to smoke
tobacco, often flavored with fruit or herbs.
Birman said he planned to reopen
his business in a few months as a bar but might keep it closed with HB844.
That would also keep his 25 employees out of work, he said.
Birman gave committee members a
copy of a 2009 report from the National Bureau of Economic Research in Cambridge, Mass.,
which states that there is no evidence smoking bans improve health.
Birman said after the meeting
that even if the amendment to exempt hookah bars from the ban passed, he
would oppose the bill. “I don’t disagree with having bars that are
nonsmoking,” he said. “I don’t think you need a bill to do that. I oppose
government telling me what to do with my business.”
Smith said he is sympathetic to the industries that will
be affected. But while some people may choose to work in smoke-filled
environments, not all employees, particularly in the service industry, have a
choice, he said.
Exemptions still stand for outdoor places of employment;
hotel or motel rooms designated for smoking, including those operated by a
gaming operation; and outdoor patios of businesses, whether or not food is
Exceptions are also made for retail tobacco businesses,
which primarily sell tobacco products and accessories. Smith said after the
meeting he needed more clarity on if cigar and hookah bars would fall into
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I have worked for the state for nearly six years. When I
say worked, I mean worked. At the end of the day I am exhausted. After six
years I am at $10.26 an hour. Who would work anywhere starting at $10.26 per
hour, much less after six years?
My work is important to the Department of Transportation
and Development. I help keep the state vehicles on the road. I am a good,
dedicated employee. I do not take days off. I do not call in sick. I do
whatever is asked of me.
My insurance has risen 15 percent every year and is about
to go up again.
I have been affected by discrimination and not said a
Why would any young person want to come to work for the
state? There is no incentive to come or to stay here.
After hurricanes Katrina and Rita, the crews at this
compound in Hammond
left their families to go in and clear the roads so the “first” responders
could help the public. These people slept on concrete floors or in trucks,
ate sandwiches and took “showers” in barrels for weeks. They didn’t know how
their own families were faring. The workers who did not go out in harm’s way
stayed here and made sure these crews had everything they needed to service
Now our grateful state says, no, you don’t deserve a
measly 4 percent raise. Thanks for the slap in the face.
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gets his way
Baton Rouge Business Report | 05.18.09
By John Maginnis
Oh, the world of hurt Bobby Jindal
was supposed to be in by now.
A month ago, his constant coast-to-coast fundraising was
straining the patience of his friends, who wished aloud that he were spending
more time at home dealing with the state’s problems. And there were plenty of
those, mostly linked to a gaping budget deficit, which promised to make his
first legislative fiscal session a miserable one. Add to that, lawmakers,
still harboring grudges for his vetoes of their pay raise and scores of local
projects last year, were said to be lying in wait for payback.
It looked like an ominous session for the governor until
it began, when the scene at the Capitol snapped back to the old reality. In
the first two weeks, the governor’s staff efficiently snuffed out or sidetracked
bills the administration opposed, advanced ones it liked and easily fended
off legislators’ initial budget raids on his economic development megafund.
He also demonstrated a grasp for the art of the deal by
proposing creative terms for a new long-term contract with the New Orleans
Saints while at the same time pushing approval of spending $50 million to
save a chicken processing plant in northeast Louisiana. The two are not connected, but
politically they are wed, with regional support for each neutralizing
opposition to the other. The unspoken linkage of the two makes for a pretty
slick deal worthy of Edwin Edwards, and it’s even legal.
What did Jindal do to reassert
his influence and authority over a resentful Legislature? Why, he showed up,
which is pretty much all that’s needed in a political system that affords so
much power to a governor when he acts like one.
Democrats outnumber his Republicans, especially in the
Senate, but partisanship has yet to come into play in this session. The most
direct challenge to Jindal’s fiscal policy, the
proposed cigarette tax to restore health care cuts, has not unified
They will band together more to challenge his refusal to
accept $98 million in added unemployment benefits from the federal stimulus package,
but supporters concede it won’t be enough to overcome his promised veto.
The issue that is causing Jindal
the most trouble, at least in the public prints, comes at the hands of two
Republicans. He has strongly opposed identical bills by Rep. Wayne Waddell of
Shreveport and Sen. Robert Adley
of Benton to
make public more records in the governor’s office, which is currently rated
among the least transparent in the nation.
The governor’s broad exemption from the public-records act
predates Jindal, but it perfectly suits his
controlling personality that is reflected in his protective, insular staff.
Legislators and his contributors learned quickly not to
expect return phone calls from the governor. He talks to people when he needs
them, not the other way around.
Formalizing any more access to his office is not in his
interest. The legal contortions New Orleans Mayor Ray Nagin
is going through while fighting the release of his schedule and e-mails
probably makes the governor all the more careful to not let down his
Now if legislators were truly seeking revenge for Jindal’s veto of their raise, they would pass a
public-records law opening up his office like a sardine can.
That they haven’t suggests the notion of veto payback is
vastly overstated. Legislators might still resent his nixing their raises,
but some concede he did them a favor. What if they were pulling down
$50,000-plus in total compensation while considering big budget cuts that
would force layoffs in higher education and health care? Half of them would
be facing recall petitions and harboring little hope of re-election. The
mistake he and they both made was in forming their secret pact, which intense
public anger, acting as a force majeure, nullified.
Lawmakers might still pass a public records bill Jindal doesn’t like, or find some other vote on which to
stick him. But most of them, when it gets right down to it, want to stay in
the governor’s good graces, even if he ignores them most of the time.
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The New York Times | 05.20.09
By RONI CARYN RABIN
Older men using a popular drug to treat urinary problems are
more than twice as likely as those who do not to suffer serious complications
after cataract surgery, also a common treatment among older adults, a study
The medication, tamsulosin
hydrochloride, sold under the brand name Flomax, is
believed to relieve urinary problems in men with enlarged prostates by
relaxing smooth muscle in the prostate and bladder. But the drug seems to
have a similar effect on smooth muscle in the iris of the eye, complicating
cataract surgery by causing a syndrome called floppy iris syndrome.
The new study, published in this week’s issue of The
Journal of the American Medical Association, is the first large analysis of
serious adverse events after cataract surgery in patients taking the drug. It
was accompanied by an editorial suggesting that federal authorities consider
a “black box” warning label for the drug.
Dr. Chaim M. Bell, an internist
at St. Michael’s Hospital in Toronto, and his
colleagues analyzed the post-surgical complications experienced by 96,128 men
ages 66 and older who had cataract surgery in Ontario from 2002 to 2007.
Some 7.5 percent of patients who were prescribed tamsulosin hydrochloride in the 14 days before surgery
suffered a serious complication after the operation, compared with 2.7
percent of surgery patients who had not used the drug, the analysis found.
The complications included retinal detachment, a lost lens or inflammation
around the eye.
“The take-home message to the physician is, ‘Before you
put people on this medication, you might want to ask if they are having
cataract surgery soon and might want to consider a different medication,’ ”
Dr. Bell said.
But he did not advise abruptly stopping the use of the
drug before cataract surgery. “We can’t say that that’s a good thing to do,”
A statement released by Boehringer
Ingelheim Pharmaceuticals Inc., maker of Flomax, said the drug patient information insert already
tells patients considering cataract surgery that they should advise their eye
surgeons if they are taking the drug or have done so, and that surgeons
“should be prepared for possible modifications to the surgical technique.”
Although some women take the drug to treat kidney stones,
female patients were not included in the analysis. Surgical complications
were not seen among men who used other drugs in the same class of alpha
blockers, the paper noted.
Nearly three of four men are affected by an enlarged
prostate by age 70, and close to two million cataract surgeries are performed
annually in the United
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Vermont Acts to Make Drug Makers’ Gifts Public
The New York Times | 05.20.09
By NATASHA SINGER
Cracking down on medical industry payments to doctors, the
legislature has passed a law requiring drug and device makers to publicly
disclose all money given to physicians and other health care providers,
naming names and listing dollar amounts.
The law, scheduled to take effect on July 1, is believed
to be the most stringent state effort to regulate the marketing of medical
products to doctors. It would also ban nearly all industry gifts, including
meals, to doctors, nurses, medical staff, pharmacists, health plan
administrators and health care facilities.
In practice, the new law would let Vermonters learn each
year which doctors have been paid, and how much, by the makers of the
brand-name drugs for which they wrote prescriptions — or how much money
certain surgeons have received from the makers of the stents, pacemakers,
artificial knees and such that the doctors implanted.
The action by Vermont
has been watched around the country, as national legislators and medical
groups look for links between industry marketing and health care costs.
already requires drug companies to report payments to doctors. New Massachusetts
regulations limit gifts to health care practitioners and call for disclosure
of any payment or benefit worth $50 or more.
In Congress, Senators Charles E. Grassley, Republican of
Iowa, and Herb Kohl, Democrat of Wisconsin, have sponsored a bill requiring
disclosure of pharmaceutical industry payments to doctors.
has gone further with its new law, which Gov. Jim Douglas, a Republican, is
expected to sign by early next month. It will require public disclosure of
all payments by companies to any health care provider with authority to write
prescriptions for drugs, medical devices and biologics, drugs that are typically
administered by injection or infusion.
The law is also the first to ban all free meals, long a
favorite gift in marketing to doctors. The law also closes a loophole in
previous regulations that had allowed companies to keep specific expenses
private by claiming them as trade secrets.
The required disclosures, though, do not include payments
for clinical research on products under review by the Food and Drug
“This is a much more comprehensive law because it makes
clear — whether devices, biologics or drugs are involved — the issue is
inappropriate gift-giving,” said Sharon Treat, the executive director of a
nonprofit group, the National Legislative Association for Prescription Drug
Pricing, and a Democrat in the Maine House of Representatives.
law promises to provide a window into the considerable efforts and spending
by device and drug makers to woo doctors even in a small state.
Makers of medical products spent about $2.9 million in
fiscal year 2008 on marketing to health care professionals in Vermont, according to
a report last month from the state’s attorney general. Of Vermont’s 4,573 licensed health
practitioners, almost half received remuneration, including payments for
lectures, meals or lodging from pharmaceutical companies in the 2008 fiscal
year, the report said.
“If the drug industry gives $3 million on average for
three years now to physicians in a small state like Vermont, what is
happening in California and New York?” said Ken Libertoff,
director of the Vermont Association for Mental Health, an advocacy group that
supported the law.
attorney general’s report, compiled before passage of the law, provides only
aggregate data because companies declared 83 percent of the payments to be
trade secrets. Even so, without naming names, the disclosed expenses
highlighted a widely used industry strategy of focusing much of the marketing
money on a group of influential doctors.
Of the $2.9 million spent in Vermont, for example, about $1.8 million
went to only 100 health care providers. That meant only about 4 percent of
doctors received 60 percent of the payments, the report said.
A psychiatrist received about $112,000, the highest amount
spent on one person. But specialists in internal medicine, neurology,
endocrinology and diabetes also received more than $100,000 each during the
To reduce the perception of undue industry influence, the
Pharmaceutical Research and Manufacturers of America or PhRMA,
a trade association, instituted a voluntary code in January that prohibits noneducational gifts to doctors and restricts meals.
About 50 manufacturers the code.
With such a code, Vermont’s
new reporting requirements seem redundant, said Marjorie E. Powell, a senior
lawyer for PhRMA.
“We think this is unnecessary, and it is not going to
improve patient care,” Ms. Powell said. “It makes it onerous not only for the
company but also for the physician in Vermont,
because this is going to be on a Web site.”
But the Vermont Medical Society, which represents 65
percent of the physicians in the state, supported the bill.
Peter Shumlin, president pro
tempore of the Vermont
state senate, said he hoped his state would provide a model on marketing
disclosures for the rest of the country.
“Our goal is not to prohibit this practice,” Mr. Shumlin said, “but to have the first system in this
country where providers’ acceptance of this money is on full public record.”
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