Diagnosis for 8.9.22: Checking the pulse of Florida health care news and policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

There’s a fresh effort to legalize recreational marijuana jump-started with help of one of the state’s dominant medical marijuana companies, joined by country music duo The Bellamy Brothers.

A new political committee, Smart & Safe Florida, has drawn up a proposed citizen initiative that would allow adults 21 and older to possess and purchase marijuana.

“More than 140 million Americans already have the freedom to partake in responsible cannabis use and it is past time for Florida to provide its law-abiding adults the same privilege,” Howard and David Bellamy said in a video announcing the push to make the ballot.

If organizers can gather nearly 900,000 signatures from registered voters, as well as get clearance from the Florida Supreme Court, the citizen initiative would be on the 2024 ballot which is also a presidential election year. But it would also require 60% of voters to say yes for the proposal to become law.

If approved, the amendment would take effect six months after the November 2024 elections.

Trulieve, which operates in 11 states including Florida, plans to help bankroll the campaign with a $5 million contribution. The Bellamy Brothers have previously partnered with Trulieve to produce of cannabis products.

In 2016, Florida voters overwhelmingly approved the use of medical marijuana; however, recent attempts to ask voters to approve recreational marijuana floundered due to the state Supreme Court. The high court last year rejected two proposed constitutional amendments by maintaining that the wording of the proposals was misleading to voters, including that one proposal did not make it clear that marijuana would remain illegal under federal law.

The proposed amendment would allow adults to smoke or ingest marijuana, but it would not allow individuals to possess more than 1 ounce of marijuana. It does not.

To watch the announcement video, click on the image below:

I welcome your feedback, questions and, especially, your tips. You can contact me by emailing me at [email protected] or call me at 850-251-2317.

Baby got back

A state medical board wants to require physicians to use ultrasound equipment while performing Brazilian butt lifts and limit the number of procedures Florida-licensed physicians can perform a day to make the procedure safer for patients, who are mostly women.

But some plastic surgeons say the new rule could make the procedure riskier, not safer, contending the Board of Medicine should not limit the number of procedures a surgeon can perform daily.

The Board of Medicine Rules Committee agreed at its meeting in Ft. Lauderdale last week to move ahead with the new rule. The board wants the rule in effect before a similar emergency rule expires in September.

The 90-day emergency rule limits the number of procedures that can be performed daily to three, it also requires the use of ultrasound. But the emergency rule stops there. The permanent rule the state medical board is considering would also require the so-called “surgeon of record” to perform the entire procedure.

Board staff is working on the language and a copy wasn’t available at the Rules Committee meeting.

But Stephen Menton, an attorney representing Surgeons for Safety, said it could be problematic because physician extenders are commonly used in surgical procedures regardless of the setting. But the board could pursue a rule that makes clear that only the surgeon of record can inject the fat.

After newspaper reports highlighted the substantial number of deaths occurring in Florida from Brazilian butt lifts, the Florida Board of Medicine passed a rule in 2019 stating that doctors could no longer inject fat into the muscle.

In addition to new rules, the Florida Legislature passed a law later that year requiring the Board of Medicine to better regulate and discipline doctors when patients die.

The board moved ahead with an emergency rule earlier this year after learning that there were more deaths from Brazilian Butt lifts in 2020.

In comments submitted to the board Surgeons for Safety said to improve safety the board should propose a rule that prevents a surgeon from having more than one patient under anesthesia at the same time. Additionally, the group said the board should appoint a task force that’s charged with making recommendations to the board or legislature about educational materials and training physicians should have. Lastly, the organization recommended that the committee also should perform an analysis of the benefits of drawbacks of using ultrasound as part of the procedure.

In its written comments Surgeons for Safety also maintained that requiring an ultrasound may be unsafe because surgeons weren’t trained to use it while performing the procedure. “The introduction of an ultrasound requirement without proper education, training and appropriate technology takes away one of the surgeon’s hands, forces the surgeon to take eyes off the patient to monitor a screen, and interrupts the cadence of the surgery,” the written comments state.

In pushing for limits on how patients could be placed under general anesthesia at one time the group argued that the rule could be enforced by unannounced spot inspections.

“Now you have a rule that hits the nail on the head,” he said.

Board Rule No 2

The BBL rule isn’t the only new regulation the board is pursuing.

Members of the BOM voted to move ahead with rule-making that would set up a Florida-specific standard of care for gender-affirming care.

Pushed by Gov. Ron DeSantis’ administration, State Surgeon General Joseph Ladapo attended the Ft. Lauderdale Board of Medicine to discuss the need for the proposal.

Ladapo’s recommendations are “aligned with the truth,” he told reporters.

“By truth I mean truth in science, in terms of what we actually know versus what people want to happen,” Ladapo said stressing that he maintains there’s no science that supports the efficacy of the treatment.

Ladapo continued by telling reporters hormonal clockers and surgeries are “really a distraction.”

“A distraction away from more effective therapies for individuals dealing with this. And part of that is absolutely emotion, mental spiritual counseling. That is a part of that turns out to be part of the treatment for many conditions that we all suffer from. But sometimes for whatever reason things that sorta are more effective and less glamorous … just kinda take a back seat to more radical treatments,” he said.

When asked later for the science showing that therapy was the proper route Ladapo said: “Basically all of us could benefit from emotional, mental, physical and spiritual therapy. I mean that’s just a fact. That’s just a general truth. in terms of this specific condition, those types of therapies before the introduction of these hormonal therapies, these surgical remedies were recommended. And there’s evidence those are beneficial.”

He said that his review of the data shows the incidence of trauma is high in people with gender dysphoria. “Who’s experienced childhood trauma who would not benefit from therapy?”

Board Rule No. 3?

As the Board of Medicine considers changes to BBL rules, it is also asked to consider defining the difference in rules between physicians’ offices — where surgeries are located and ambulatory surgical centers (ASCs).

The board heard from managers that there are times they walk into physician’s offices which have more than a dozen rooms where surgeries are being performed.

The Department of Health has oversight over physician’s offices but it’s the state Agency for Health Care Administration that regulates ambulatory surgical centers.

The Rules Committee was told the DOH has just six investigators to inspect doctor’s offices in 67 different counties.

FMA showdown

The showdown for the “heat and soul” of the Florida Medical Association wrapped this weekend with the House of Delegates delving into some of the thorniest issues it’s been asked to consider and somehow finding a way to remain, as several attendees said, neutral.

The Florida Medical Association does not disclose how the House of Delegates votes on resolutions, said Christina Johnson, on behalf of the organization. Delegates were asked to consider resolutions addressing abortion, gender-affirming care, and constitutional carry.

“They were all discussed. Some passed, but in modified form, that was more akin to ‘The FMA will oppose legislation that allows the government to intrude upon the patient-physician relationship or words to those effect,’ said someone familiar with the discussions.

A resolution to oppose constitutional carry, which would put the FMA at odds with DeSantis, went through several amendments and iterations before evolving into a resolution that had the organization supporting current requirements.

Observers noted Douglas R. Murphy, who served as FMA president for the last year, delivered a conciliatory speech where he reminded members that the organization is dedicated to the protection of the profession and advocating for the patient. He said getting involved in issues that don’t directly affect the profession distracts the FMA from its primary purpose.

“It really set the tone for the weekend,” said one attendee.

— ROSTER —

The FMA at its annual meeting last week in Orlando affirmed the following positions in the organization for the next year.

— President Dr. Joshua Lenchus, D.O.: Broward Health

— President-Elect Jason Goldman, M.D.: Internal Medicine, Coral Springs

— Vice President Lisa Cosgrove, M.D.: Pediatrics, Jacksonville

— Treasurer Charles Chase, D.O.: Anesthesiology, Winter Park

— Speaker Ashley Norse, M.D. — Emergency Medicine, Jacksonville

— Vice Speaker Mark Rubenstein, M.D.: Physiatry, Jupiter

— Secretary Alma Littles, M.D.: Family Medicine, Tallahassee

— Immediate Past President Douglas Murphy, Jr., M.D.: Obstetrics/Gynecology, Ocala

— ETC —

Jared M. Torres with the Southern Group registered to lobby for Autism Speaks

Kevin Comerer with Rubin, Turnbull & Associates, registered to lobby for Hospital Corporation of America

Slater W. Bayliss and Chris Chaney, with The Advocacy Group at Cardenas Partners LLC, registered to lobby for the American Academy of Anesthesiologist Assistants

Robert M Blair, Bethany McAlister, Will Rodriguez, Jacqueline A. Corcoran, and Michael C. Corcoran, with Corcoran Partners, registered to lobby for Florida Chiropractic Coalition, Inc.

Jorge Chamizo with Floridian Partners LLC registered to lobby for Elevance Health, and its affiliates.

— ICYMI —

In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.

—Spreading: The first case of monkeypox has been identified in Leon County, the Florida Department of Health in Leon County announced. According to the Centers for Disease Control and Prevention (CDC), the monkeypox virus is part of the same family as the virus that causes smallpox. The first human case of monkeypox was discovered in 1970. While the symptoms of monkeypox are similar to smallpox symptoms, monkeypox is not related to chickenpox.

—No licenses for Black farmers Nearly six years ago, the Florida Legislature set aside a medical marijuana license for a Black farmer like John Allen to join the burgeoning industry. But the license still has not been issued by the Florida Department of Health, which regulates the industry, the Lakeland Ledger reported. Twenty-two licenses have been issued but none so far to a Black farmer, despite the aim of the Legislature in 2016, according to the Ledger’s report. In the intervening years, the licenses have generated enormous revenues from some of the license holders — frustrating the Black farmers who wonder how they can catch up.

—Board tackles gender-affirming care: Members of the state medical board have agreed to initiate rules that could ban physicians from providing gender-affirming care to transgender people under the age of 18, while also limiting access to care to adults. The vote by the Board of Medicine on Friday means the Board will begin a several-month process that Chair and Winter Park physician David Diamond said would include public meetings across the state.

—Increased options: Residents in Glades, Hendry and Lee counties will have more than one hospice provider to choose from thanks to a new court ruling. A state administrative judge issued a pair of rulings this week that, in tandem, clear the way for VITAS Healthcare to open a new hospice in Southwest Florida in the coming year.

—More lawsuits: Seven faith leaders from South Florida and Tampa are suing elected attorneys across the state — from Attorney General Ashley Moody to State Attorney Katherine Fernandez Rundle of Miami-Dade County — over Florida’s new ban on abortion after 15 weeks of pregnancy.

— FOR YOUR RADAR —

Aside from coverage by Florida Politics, these stories are worthy of your time.

—”Biden administration planning to extend COVID-19 emergency declaration” via Adam Cancryn and David Lim of POLITICO — The Biden administration is expected to extend the COVID-19 public health emergency once again, ensuring that federal measures expanding access to health coverage, vaccines and treatments remain in place beyond the midterm elections, three people with knowledge of the matter told POLITICO. The planned renewal follows extensive deliberations among Biden officials over the future of the emergency declaration, including some who questioned whether it was time to let the designation lapse.

—“BayCare names Philadelphia health care executive as new CEO,” via Christopher O’Donnell of the Tampa Bay Times — BayCare Health System on Friday named Stephanie D. Conners as its chief executive officer. Conners, 50, began her health care career as a nurse. She currently serves as the executive vice president and chief operating officer for Jefferson Health, a Philadelphia nonprofit health care system. She is expected to join BayCare in October. “I am humbled and honored to lead such a remarkable organization,” Conners said in a statement. “Its legacy of compassionate care is palpable, and I look forward to helping ensure its future success. It is my personal mission to make a difference in the lives of others.”

—“Organ transplant system ‘has failed many,’ AdventHealth leader testifies, via Caroline Catherman of the Orlando Sentinel — Families in need of lifesaving organs have had to trust an organ transplantation system that has failed many, alleged Barry Friedman, executive director of the AdventHealth Vibrant Emotional HealthTransplant Institute, in a Wednesday hearing of the U.S. Senate Committee on Finance. “This system has failed many patients waiting for organ transplant due to lack of oversight and accountability,” Friedman said.

—“Handling of mental health helpline sparks lawsuit in Tampa Bay,” via Sam Ogozalek of the Tampa Bay Times — Tampa Bay Thrives has sued a New York nonprofit hired to take calls for the local mental health group, claiming it failed to do its job. Tampa Bay Thrives launched the “Let’s Talk” helpline last year to aid Hillsborough County residents with mental health and substance use issues. The local nonprofit hired Vibrant Emotional Health, based in New York, to answer confidential Let’s Talk calls, direct people to mental health resources and follow up with those in distress. Tampa Bay Thrives agreed to pay the New York nonprofit about $2.1 million to answer a projected 14,000 calls over a year, records show.

—“Florida ranks 35th in nation for child well-being, says Kids Count report,” via Stephanie Colombini of WUSF — For the third year in a row, Florida ranks 35th in the nation for children’s well-being, according to the latest Kids Count Data Book from the Annie E. Casey Foundation. The report examines challenges that kids and families face across the nation and compared how states did between 2016 and 2020, with the years following the 2008 recession. It found that although Florida has made improvements in recent years when it comes to families living in poverty, it hasn’t kept pace with other parts of the country.

— PENCIL IT IN —

National Health Center Week — Aug. 7-13Tuesday

Happy birthday, Rep. Keith Truenow

Happy birthday, Florida Health Care Association Executive Director Emmett Reed

9 a.m. The Florida Board of Nursing Probable Cause Panel meets. Call (888)-585-9008; participant code 275112502.

2 p.m. The Agency for Health Care Administration holds a meeting on proposed changes to Rules59A-8.0097 Rule 59A-8.0216 59A-8.0219 and Rule 59A-8.0095 on home health agencies. 2727 Mahan Drive. Or call (888) 585-9008; participant code: 998518088. Agenda here.

Wednesday

1:30 p.m. Self-Insurance estimating conference. Room 117 of the Knott Office Building.

Thursday

8 a.m. The Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling meets. Holiday Inn Disney Springs 1805 Hotel Plaza Boulevard Lake Buena Vista.

9 a.m. The Florida Board of Pharmacy holds a disciplinary hearing. Call (888) 585-9008; participant code: 599196982.