Dr. Marc Siegel: ObamaCare is here for now, but needs to become more effective to survive

In most places across the U.S., Saturday was the last day of the year for signing up for ObamaCare, which provides health insurance to millions of Americans. And after a U.S. District Court judge in Texas ruled Friday that the law is unconstitutional and must be struck down, many Americans are wondering whether this will … Continue reading “Dr. Marc Siegel: ObamaCare is here for now, but needs to become more effective to survive”

In most places across the U.S., Saturday was the last day of the year for signing up for ObamaCare, which provides health insurance to millions of Americans. And after a U.S. District Court judge in Texas ruled Friday that the law is unconstitutional and must be struck down, many Americans are wondering whether this will be the last year for signing up for ObamaCare for good.

The answer is not known. But despite the ruling by Judge Reed O’Connor, nothing is changing right away. The judge’s decision will be appealed and will most likely go to the Supreme Court for a final determination of ObamaCare’s fate.

Judge O’Connor ruled to strike down the entire ObamaCare law because he said the individual mandate is unconstitutional (with the tax penalty zeroed out as part of the new tax overhaul), and that the overall law is not severable from the individual mandate, meaning it cannot stand alone without it.

Legal analysts who contend the other parts of the law can stand on their own believe O’Connor’s ruling is likely to be overturned on appeal.

The federal Centers for Medicare and Medicaid Services sent an email to millions of Americans Saturday stating that the case O’Connor ruled on is “still moving through the courts.” The email added: “The marketplaces are still open for business, and we will continue with open enrollment. There will be no impact to enrollees’ current coverage or their coverage in a 2019 plan.”

While Saturday was the last day for signing up for ObamaCare through healthcare.gov for 2019, people can still enroll through state exchanges in Rhode Island until Dec. 23 and enrollment ends in January in California, Colorado, Massachusetts, Minnesota, New York and Washington, D.C.

Nearly 12 million people have signed up for ObamaCare – officially known as the Affordable Care Act – this year. Many have done so through the expansion of the Medicaid program in 36 states and Washington, D.C.

The Medicaid expansion is popular, and most studies have shown that it improves access and quality of health care.

Overall, ObamaCare is popular, primarily because of its mandatory coverage and federal subsidies for pre-existing health conditions. In fact, back in September, an important Kaiser Family Foundation poll found that over 70 percent of Americans favor the Affordable Care Act protections that keep insurance companies from denying people coverage or charging them more based on their medical histories.

This ended up being a big issue in the Nov. 6 midterm elections, and many analysts believe it played a role in helping Democrats win back majority control of the U.S. House of Representatives.

Whether or not it is ultimately deemed unconstitutional, the Affordable Care Act must evolve into something more effective and actually affordable or it will not survive.

But though covering pre-existing conditions is very popular it is also enormously expensive. And the individual mandate requiring people to have health insurance is not popular and has not been very effective.

About 6.5 million people paid a penalty for not buying health insurance in 2016, with total penalties amounting to about $3 billion. And many people waited until they got sick before signing up for health insurance under ObamaCare, putting a big burden on insurers. Many fled the state exchanges.

The individual mandate hasn’t worked for doctors or for our patients, either, because it creates enormous unfulfilled expectations for access to services that are either not always available or blocked by burgeoning deductibles.

The average deductible on the most popular type of ObamaCare plans is almost $4,000 this year. This has blocked access to many basic and essential services that I want to order for my patients but that they can’t necessarily afford.

As ObamaCare heads back in the direction of the U.S. Supreme Court – where the battle is sure to center on whether certain parts of the law can be preserved without the individual mandate – the question from my perspective is: What works best for America’s patients?

The answer is that forcing people to pay for a product that often fails to provide what it promises goes against the American spirit of free enterprise – so it’s a good thing that the individual mandate is now gone.

At the same time, Americans want to ensure basic coverage for all major health problems and pre-existing conditions, so no matter what emerges from the ObamaCare cauldron, it must include this subsidized kind of coverage.

Further, the Medicaid expansion is popular and effective at helping to close the coverage gap in rural and poor urban areas of our country, so it too must be maintained.

But all of the above is incredibly costly, especially with the growing costs of technology and personalized health solutions that a one-size-fits all insurance like ObamaCare was never intended to cover.

This is why I agree with the Trump administration’s decision to add more choice in terms of so-called “skinny plans” and association plans that provide less health insurance coverage at a much lower cost.

Expanding health savings accounts and other tax incentives is another idea whose time has finally come.

Forcing everyone to pay for top-heavy policies loaded with so-called “essential” benefits – but including high deductibles and narrow networks of health-care providers – doesn’t work. No one in the health-care sector is happy with the current ObamaCare plans – not doctors, patients, hospitals or insurers.

It could help to go in the opposite direction – the way the Trump administration is doing – by introducing more scaled-back health insurance policies that are geared to a healthy person’s basic health needs. I call them Chevy-style policies, as opposed to the Cadillac-style policies that cover more types of care that most people will not require.

In addition, we need more patients in the health insurance pool with fewer regulations about the type of insurance they must have. Policies that are more geared to a patient’s particular needs could increase the overall number of insured in the long run. I wouldn’t be opposed to a requirement that everyone has to have at least catastrophic coverage.

With genetic-based personalized health-care solutions on the horizon, coverage needs to be more flexible, not less. ObamaCare was already out of date by the time it was signed into law by President Obama in 2010. Whether or not it is ultimately deemed unconstitutional, the Affordable Care Act must evolve into something more effective and actually affordable or it will not survive.

Marc Siegel, M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He has been a medical analyst and reporter for Fox News since 2008.

Obama pushes for ObamaCare enrollments after Texas judge deems law unconstitutional

Barack Obama took to social media Saturday to urge people to sign up for health care on the final day of Affordable Care Act enrollment. His appeal came a day after a Texas judge struck down the former president’s signature legislation as unconstitutional.

Aside from reminding people that Saturday would be the final day to enroll for affordable health care for 2019, Obama appeared to play down the significance of the ruling. 

“You might have heard about a federal court decision on a Republican lawsuit trying to strike down the Affordable Care Act in its entirety,” he said in Facebook post. “As this decision makes its way through the courts, which will take months, if not years, the law remains in place and will likely stay that way.”

The ruling, he said, “changes nothing for now.”

U.S. District Judge Reed O’Connor dealt a blow to Obama’s 2012 health care initiative on Friday after 20 states, including Texas, argued that they had been hurt by a jump in the numbers of people utilizing state-backed insurance.

“The remainder of the ACA is non-severable from the individual mandate, meaning that the Act must be invalidated in whole,” O’Connor, whose District Court is based in Texas, wrote in a 55-page opinion, according to Bloomberg.

OBAMACARE RULED UNCONSTITUTIONAL BY TEXAS JUDGE

President Trump immediately tweeted following the ruling, urging Congress to pass a “strong” health care bill that would cover pre-existing conditions — a component that Democrats have long criticized Republicans for ignoring.

“A lot of good people are fighting to ensure that nothing about your care will change. The ACA protects your pre-existing conditions, no matter how you get your insurance,” Obama said Saturday.

“But all of this should also be a reminder that Republicans will never stop trying to undo all that. If they can’t get it done in Congress, they’ll keep trying in the courts, even when it puts people’s pre-existing conditions coverage at risk.”

California and other several other stated with opposing views on ObamaCare are likely to challenge the new ruling through an appeal to the United States Court of Appeals for the Fifth Circuit.

Fox News’ Matt Richardson and The Associated Press contributed to this report.

Paulina Dedaj is a writer/ reporter for Fox News. Follow her on Twitter @PaulinaDedaj.

Obamacare ruled unconstitutional by Texas judge

The Affordable Care Act, also known as Obamacare, was struck down by a Texas judge on Friday, a move that could suddenly disrupt the health insurance status of millions of Americans. The decision comes amid a six-week open enrollment period for the program.

Texas, along with 19 states, had argued to U.S. District Judge Reed O’Connor that they had been hurt by a jump in the amount of people utilizing state-backed insurance. When Congress cut the tax penalty from the program in 2017, the states claimed, it essentially undercut the Supreme Court’s reasoning for finding former President Barack Obama’s signature legislation constitutional in 2012.

“The remainder of the ACA is non-severable from the individual mandate, meaning that the Act must be invalidated in whole,” O’Connor wrote in a 55-page opinion, according to Bloomberg. O'Connor is a conservative Republican appointee who previously blocked other Obama-era policies.

"As I predicted all along, Obamacare has been struck down as an UNCONSTITUTIONAL disaster," President Trump tweeted following the ruling. "Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions. Mitch and Nancy, get it done!"

In a second tweet, the president declared the ruling to be "great news for America!"

California and other states ruled against by the judge will likely challenge the decision by appealing in the United States Court of Appeals for the Fifth Circuit.

“Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the A.C.A.’s consumer protections for health care, on America’s faithful progress toward affordable health care for all Americans,” Xavier Becerra, California’s attorney general, said in a statement, according to The New York Times. “The A.C.A. has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court.”

“Obamacare has been struck down by a highly respected judge," White House press secretary Sarah Sanders said in a statement.

"The judge’s decision vindicates President Trump’s position that Obamacare is unconstitutional," Sanders continued. "Once again, the President calls on Congress to replace Obamacare and act to protect people with preexisting conditions and provide Americans with quality affordable healthcare. We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place.”

OBAMACARE ENROLLMENT PORTAL BREACHED, DATA OF 75,000 COMPROMISED, OFFICIALS SAY

Democratic leaders, meanwhile, reacted harshly to the decision.

"The ruling seems to be based on faulty legal reasoning and hopefully it will be overturned," Senate Minority Leader Chuck Schumer, D-N.Y., tweeted. "Americans who care about working families must do all they can to prevent this district court ruling from becoming law."

“While the district court’s absurd ruling will be immediately appealed, Republicans are fully responsible for this cruel decision and for the fear they have struck into millions of families across America who are now in danger of losing their health coverage," House Minority Leader Nancy Pelosi, D-Calif., said in a statement. "When House Democrats take the gavel, the House of Representatives will move swiftly to formally intervene in the appeals process to uphold the life-saving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.”

The Associated Press contributed to this report.

Matt Richardson is an editor for Fox News. Follow him on Twitter @MRichardson713.

Despite federal judge’s ruling, Obamacare exchanges are open for business, CMS official says

A spokesperson from the Centers for Medicare & Medicaid Services told Fox News early Saturday that open enrollment for Affordable Care Act’s health insurance will continue despite the federal judge's ruling that the law is unconstitutional and must be "invalidated in whole.”

U.S. District Judge Reed O'Connor, a federal judge in Texas appointed by President George W. Bush, ruled that last year's tax cut bill knocked the constitutional foundation from under Obamacare by eliminating a penalty for not having coverage. The rest of the law cannot be separated from that provision and is therefore invalid, he wrote.

The decision came on the evening before the Dec. 15 deadline for Americans.

The spokesperson from CMS told Fox that the judge’s decision, which was applauded by President Trump, is still working its way through the courts and is not the final word on the matter.

"There is no impact to current coverage or coverage in a 2019 plan," the spokesperson said.

Congress is unlikely to act while the case remains in the courts. Numerous high-ranking Republican lawmakers have said they did not intend to also strike down popular provisions such as protection for people with pre-existing medical conditions when they repealed the ACA's fines for people who can afford coverage but remain uninsured.

Xavier Becerra, the California attorney general, vowed to appeal the decision in the U.S. Court of Appeals for the Fifth Circuit in New Orleans.

"Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the A.C.A.’s consumer protections for health care, on America’s faithful progress toward affordable health care for all Americans," Becerra said in a statement, obtained by The New York Times.

Rep. Nancy Pelosi, D-Calif., who is expected to become House speaker in January, vowed to fight what she called an "absurd ruling."

Trump tweeted his support for the ruling, saying, "Obamacare has been struck down as an UNCONSTITUTIONAL disaster!" He continued, "Now Congress must pass a STRONG law that provides GREAT healthcare and protects pre-existing conditions."

About 20 million people have gained health insurance coverage since the ACA passed in 2010 without a single Republican vote. Currently, about 10 million have subsidized private insurance through the health law's insurance markets, while an estimated 12 million low-income people are covered through its Medicaid expansion.

The White House said late Friday that it expects the ruling to be appealed to the Supreme Court. The five justices who upheld the health law in 2012 in the first major case — Chief Justice John Roberts and the court's four liberals — are all still serving.

The Associated Press contributed to this report

Edmund DeMarche is a news editor for FoxNews.com. Follow him on Twitter @EDeMarche.

Heart surgeon given near-fatal dose of painkiller at hospital he worked for 30 years, family’s lawsuit claims

The family of a prominent heart surgeon is suing the Florida hospital where he was chief of cardiovascular surgery over claims that staff gave him a lethal dose of painkillers following back surgery that left him in a vegetative state. Dr. Lance Lester’s daughters claim their 74-year-old father suffered a severe brain injury and now can’t walk or talk due to staff negligence at JFK Medical Center in Atlantis, Fla., WPBF 25 reported.

But the hospital, where Lester was employed for over 30 years, told the news station that the family’s claims are false.

“Dr. Lester was a longtime and valued member of the JFK Medical Center family, and this is a tragic situation for all of us who have known him and worked with him for many years,” the hospital said in a statement sent to WPBF 25. “While our hearts go out to his family, friends and colleagues, we disagree with allegations in the suit and we will present our side through the legal process.”

HEALTH EXPERTS OFFER SOLUTIONS FOR UNINTENDED CONSEQUENCES OF OPIOID CRACKDOWN

The $15 million lawsuit contends that following Lester’s May 9 back surgery, he was given several medications and narcotics for pain relief, including a patient-controlled pump to deliver Dilaudid intravenously.

(Courtesy of WPBF)

“Since Dr. Lester was still in pain from the surgery, Dr. Jusino, a pain management physical on the medical staff at JFK Medical Center, ordered that Dr. Lester be given more Dilaudid,” the lawsuit claims. “Dr. Jusino ordered a 4 mg dose of Dilaudid to be injected directly through his I.V., in addition to the maximum limit dose of up to 3 mg of Dilaudid that he was already receiving through his PCA pump and to increase the PCA maximum limit dose to 4 mg per hour.”

The lawsuit contends that a nurse, Joanna Robinson, administered the painkiller in one dose and “left before monitoring the effects of this massive dose of Dilaudid on Dr. Lester.” It alleges that within minutes, Lester went into respiratory arrest, but that staff failed to respond quickly and that more than 15 minutes passed before Narcan, an opioid antidote, was administered to reverse the effects of Dilaudid.

“The window of opportunity to rescue Dr. Lester was lost,” the lawsuit claims.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

Lester’s family told WPBF 25 that he had sought the surgery so that he could play with his 2-year-old grandson pain-free. Lindsay Stortz, Lester's daughter who is a nurse in North Carolina, told the Palm Beach Post that even though he was friendly with top surgeons at the University of Miami's health center, he insisted he had the procedure done at JFK Medical Center.

Stortz said the hospital also failed to notify the Florida Department of Health.

According to the news outlet, Lester had sued the hospital in 2005 claiming that it had conspired to ruin his career and defame him after JFK Medical Center temporarily suspended him over "quality of care issues" in 2003. The hospital had claimed that Lester's mortality rate was too high, which he contested due to the high-risk nature of his work. He was reinstated after a hospital committee found his mortality rates were "acceptable."

“He’s just the type of person that loves life, loves his family, loves to be around people,” Stortz told the news outlet. “And it’s just so horrifically sad that now he’s not able to enjoy any of those things.”

Lester spent a month at an undisclosed hospital in Miami, and then was moved to a rehabilitation center in Boston. The family plans to move him again to a facility in Houston to continue treatment, while attorney David Spicer has asked for an expedited trial date.

“Unfortunately in Florida, if Dr. Lester passes away the lawsuit ends,” Spicer told WPBF 25.

Federal court blocks Trump administration birth control coverage rules

A divided federal appeals court blocked the Trump administration Thursday from enforcing a series of revised ObamaCare rules that would have enabled more employers to opt out of providing contraception coverage to workers over religious or moral objections.

The 2-1 ruling by the 9th Circuit Court of Appeals found that a group of five states were likely to succeed in claiming that the changes to the Affordable Care Act were made without the required notice and period of public comment.

ObamaCare originally required most companies to cover birth control at no additional cost, though it included exemptions for religious organizations. The Trump administration's new policy allowed more categories of employers, including publicly traded companies, to opt out of providing free contraception to women by claiming religious objections. It also allowed any company that is not publicly traded to deny coverage on moral grounds.

California filed a lawsuit to block the changes and was joined by Delaware, Maryland, New York and Virginia. The state argued that the change could result in millions of California women losing free birth control services, leading to unintended pregnancies that would tax the state's health care and other social programs.

The panel's ruling barred enforcement of the rule changes in those states but also vacated part of a preliminary injunction issued last year by a California federal judge that barred the rules from being enforced nationwide.

KAVANAUGH CASTS DECIDING VOTE AS SUPREME COURT REJECTS REVIEW OF MEDICAID FUNDING FOR PLANNED PARENTHOOD

"The scope of the [preliminary] injunction is overbroad," Senior Judge J. Clifford Wallace wrote in the majority opinion.

The Department of Justice said in court documents that the revised rules were about protecting a small group of "sincere religious and moral objectors" from having to violate their beliefs. The department had no immediate comment on Thursday's ruling.

NAPOLITANO: THE CHIEF JUSTICE TAKES ON TRUMP

Trump has criticized the 9th Circuit after its judges have dealt him a series of legal setbacks on immigration and other White House policies.

The Associated Press contributed to this report.

Health experts offer solutions for unintended consequences of opioid crackdown

This is the third of a three-part series on the nation's struggle to address its crippling opioid crisis, and the unintended victims left in its wake. Read Part 2 here: Doctors caught between struggling opioid patients and crackdown on prescriptions

Many Americans today will attend several funerals before they get their first gray hair.

That’s in large part because of drug overdoses, now the leading cause of death among Americans aged 50 and younger. More than 70,000 people in the U.S. last year died from overdoses, most of which involved illegal opioids.

The overdose problem – and a rise in suicides, another byproduct of the drug epidemic — is so pervasive it’s being blamed for a drop in U.S. life expectancy.

The crisis has led to a rush of public health and law enforcement initiatives at all levels of government. The federal government has vowed to cut prescription opioids by a third. More than 30 states have passed some type of legislation aimed at attacking the opioid epidemic.

“Defeating this epidemic will require the commitment of every state, local, and federal agency,” President Donald Trump said in a March speech in New Hampshire. “Failure is not an option. Addiction is not our future. We will liberate our country from this crisis.”

We’re targeting the most vulnerable and sickest people who have been on opioids a long time.

— Dr. Stefan Kertesz, addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

The government response to the epidemic has many medical professionals, patients and their families welcoming the long overdue debate about the risks vs. benefits of opioid use. But it has also set off alarm bells for many of the millions of Americans with chronic pain who legally take opioids, under their doctor’s supervision, and are suffering a range of unintended consequences that have left them undertreated, ignored, and desperate for alternatives.

The root of the problem, according to dozens of pain patients, doctors, scholars, and others who spoke to Fox News for this story, are the Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that were issued in 2016. While the guidelines are credited with focusing attention on prescribing practices, critics say they’ve been adopted by too many as hard and fast rules that must be enforced across the board, rather than serve their intended advisory purposes.

“We’re targeting the most vulnerable and sickest people who have been on opioids a long time,” said Dr. Stefan Kertesz, an addiction specialist and professor at the University of Alabama at Birmingham School of Medicine.

TOUGH NEW OPIOID POLICIES LEAVE SOME CANCER AND POST-SURGERY PATIENTS WITHOUT PAINKILLERS

Striking the right balance between getting control of the overdose epidemic and protecting access to treatment that brings relief to pain sufferers is a public health imperative.

The failure to do so threatens to exact a heavy price on the tens of millions of Americans whose pain is severe and disabling, and who are not driving the drug overdose epidemic.

Neglect of this large population of patients has the potential to prompt many to seek illegal opioids, or to become another statistic in the crisis of the rising U.S. suicide rate. Some have told Fox News that they have traveled, or plan to go to another country to obtain prescription opioids from doctors or pharmacies — a risky move for manifold reasons.

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So what’s the solution? Medical professionals, patients and others familiar with the opioid crisis and the fallout from the government crackdown have offered a variety of ideas.

RESETTING CDC GUIDELINES

Many believe the most urgent need is to address misunderstandings about the CDC guidelines. Clinicians and health experts say the CDC needs to make clear, in a high-profile way, what the guidelines were – and were not – meant to address. A letter signed by more than 300 health professionals, including former drug czars in the Clinton, Nixon and Obama administrations, calls on the CDC to examine the impact of the guidelines and publicly clarify them.

“Many doctors and regulators incorrectly believed that the CDC established a threshold of 90 MME as a de facto daily dose limit,” the letter said. “Soon, clinicians prescribing higher doses, pharmacists dispensing them, and patients taking them came under suspicion.”

The letter said that because the guidelines do not offer alternative pain care options, “patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use. Others have experienced preventable hospitalizations or medical deterioration.”

The letter added: “We urge the CDC to issue a bold clarification…particularly on the matters of opioid taper and discontinuation.”

Richard A. Lawhern, a prominent advocate on behalf of chronic pain patients and co-founder of the Alliance for the Treatment of Intractable Pain, goes even further, suggesting the CDC should scrap its guidelines, and write new ones.

"The resulting document is fatally flawed,” Lawhern said, “and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.”

CLARITY ON LEGAL PAINKILLERS

Many have acknowledged the need for better data about opioid use, on everything from the precise role that legal vs. illicit drugs have played in the national overdose crisis to more accurate information on the effect of dosage changes.

Over the summer, a U.S. Health and Human Services special task force on pain management formulated a draft report of recommendations for the guidelines and noted muddled data on deaths involving illegal opioids vs. prescribed drugs.

“The national crisis of illicit drug use along with overdose deaths are confused with the appropriate therapy of patients who are being treated for pain,” the draft report said. “This confusion has created a stigma that contributes to barriers to proper access to care.”

Federal data on overdose deaths generally do not offer specific statistics on how many involved patients who were prescribed opioids, though other data – such those compiled by states – indicate they account for a small minority.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

In November, a data and software company serving emergency medical services, fire departments and hospitals, released national opioid overdose data based on approximately 15,000 records collected between January and October of this year, and found that 94 percent of opioid overdoses involved illicit drugs, with only 4 percent being prescribed.

But that hasn’t stopped political leaders from developing policies and initiatives around cutting prescriptions as well as the supply of opioids. Trump vowed to cut opioid prescriptions by 30 percent over three years.

And many state and government officials are boasting about opioid prescription reductions, giving a misleading impression, Kertesz said, that progress is taking place in the drug overdose epidemic.

The [CDC opioid guideline] document is fatally flawed and needs to be withdrawn for a major revision in an open public process by qualified experts in community practice for chronic pain treatment, assisted by representatives or advocates from chronic pain communities.

— Richard Lawhern, co-founder of the Alliance for the Treatment of Intractable Pain

Many medical groups and health researchers also are calling for the CDC to address the fallout – such as reports of pain patients suffering withdrawals — from misguided implementation of its guidelines.

Kertesz, a lead author of the letter to the CDC, said that the many anecdotal reports of suicides and suicidal plans coming from pain patients who are being undertreated or cut off by doctors must be studied by the agency.

“It’s a large number of anecdotes,” he said, adding that if forcibly tapering or cutting off patients from opioids is leading to suicidal thoughts, “who will stand up to defend that policy, would we be ethically comfortable with that?”

The American Medical Association (AMA) recently released a resolution critical of the CDC guidelines that said: “We urge the CDC to follow through with its commitment to evaluate the impact by consulting directly with a wide range of patients and caregivers, and by engaging epidemiologic experts to investigate reported suicides, increases in illicit opioid use and, to the extent possible, expressions of suicidal ideation following involuntary opioid taper or discontinuation.”

In an interview with Fox News in 2017, Richard Baum, then-acting director of the Office of National Drug Control Policy, said the dialogue about the opioid epidemic has been misleading.

“This is framed as an opioid epidemic. But when you look under the hood at the report of people who overdose on fentanyl and heroin, they often have other drugs on board – cocaine, methamphetamine, other pharmaceuticals,” Baum said. “So we have a multi-drug threat that’s complicated. It means people often aren’t using [just] heroin, fentanyl, they’re also using cocaine.”

“Sometimes we inadvertently simplify it,” Baum said, “[saying] that it’s only one drug that’s causing the problem, but a lot of drug users use multiple drugs so we absolutely have to focus and are focusing on heroin and fentanyl and the opioids as the number one threat.”

LOOKING BEYOND DOSAGES

Health experts say the Drug Enforcement Administration (DEA) and state authorities must not be so narrowly focused on quantity and dosage when looking at prescribers who might require disciplinary action.

“No entity should use [morphine milligram equivalent] – thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids,” according to the AMA.

The DEA and other authorities told Fox News they are judicious when taking action against prescribers, stressing the number who face punitive measures are just a small part of the more than 1 million registered with the agency to handle controlled substances.

Ronald Chapman II, a Michigan attorney who represents doctors accused of overprescribing, said sometimes a prescribing problem doesn’t rise to the level of a crime, and should be addressed administratively. Many prescribers trigger so-called “red flags” by errors or omissions in pain patients’ medical records, he said, and shouldn’t automatically be treated as sinister.

“We have a lot of hammers out there looking for a nail,” Chapman said.

Physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.

— American Medical Association

John Martin, the DEA’s administrator of the Diversion Control Division, said his agency has taken steps to reach out to pharmacists and clarify how investigators go about opening cases.

“I’m sure there are doctors … out there that are afraid” to prescribe opioids now, Martin said, “but that’s part of our responsibility in communication. We had that issue with pharmacists over the years.”

Martin said DEA officials have met with more than 15,000 pharmacists and pharmacy technicians “to educate them on proper prescribing on the regulations, diversion and so forth.”

Martin said the agency is undertaking a similar effort aimed at doctors.

“We’re making them aware of what we’re actually looking for, so ways that they can reduce diversion and education so they understand the different regulations out there, what they can and can’t do,” he said.

But when prescribers are targeted by authorities, sometimes they lose access to their patients' medical records, and either are forced to stop treating them because they lose their controlled substance prescribing rights or their medical license through suspension or revocation. Often, their patients are left to scramble, with nothing to fill the void of a doctor taken out of commission, and an abrupt loss of a medical treatment plan. Pain patient advocacy groups, and health care experts, say that authorities undertaking an investigation or disciplinary action  must have a plan in place for patients who are under the care of such health care providers.

Health professionals also argue that regulators and law enforcement authorities must stay in their lane, so to speak, and not interfere in the doctor-patient relationship in an effort to address the largely illegal opioid crisis.

"The key is to get the government out of medicine entirely," said Dr. Kenneth W. Fogelberg, who specializes in obstetrics and gyneacology. "Let the politicians and lawyers do what they do and let us practice medicine. We have licenses and DEA certificates and most of us know what we're doing."

"In 2006, we were required to take a course in pain management. The thrust of the course was that we were underprescribing and our patients were in pain. If a patient said she had pain  I was expected, by the patient and the hospital nurse, to medicate. If I did not, I was written up. She might be sitting in bed reading a comic book but, if she said, 'my pain is an 8' (out of 10) she was to be medicated."

"Now, MDs are blamed for overprescribing," Fogelberg said. "Pain is subjective and I only can judge by what a patient tells me, but we are pretty good at separating legitimate pain from drug-seeking behavior. If the governments, both state and local, would let doctors doctor, we could handle this, but with their insatiable thirst for control of everything, the situation just keeps getting worse."

MORE RESEARCH ON RISKS – AND BENEFITS

Most health experts agree more studies are needed on the effectiveness and dangers of opioid use.

“In medical school in the 1990s, it was taught that dosage does not matter if you go up slowly,” Dr. Deborah Dowell, lead author of the CDC guidelines, told Fox News. “Now we know there is an increased risk of opioid overdose.”

In an editorial in the “Annals of Internal Medicine,” Dowell noted “little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.”

Other agencies, such as the Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA), are moving ahead with their own guidelines on opioid prescribing and pain management. In August, FDA Commissioner Scott Gottlieb referred to the CDC guidelines as a commendable initial step, and said that his agency was working on developing evidence-based guidelines that would look at opioid prescribing.

In a rare acknowledgment of the depth of desperation among pain patients whose long-time opioid treatment had been abruptly cut down or cut off, Gottlieb expressed concern about suicides.

"In select patients and for certain medical conditions, opioids may be the only drugs that provide relief from devastating pain," Gottlieb said in a statement on the agency's website. "We’ve heard from some of these patients, and listened carefully to their concerns about having continued access to necessary pain medication. We’ve heard their fear of being stigmatized as a person with addiction, and the challenges they face in finding health care professionals willing to work with patients with chronic pain."

"Tragically, we know that for some patients, loss of quality of life due to crushing pain has resulted in increased thoughts of or actual suicide," Gottlieb said. "This is unacceptable."

Little evidence has been available to help weigh the benefits and harms of reducing or discontinuing opioids in patients already receiving long-term therapy or to guide clinicians in how to taper opioids safely and effectively.

— Dr. Deborah Dowell, lead author of the 2016 CDC guidelines on opioid prescribing

And this fall, Trump signed into law a bipartisan measure that calls on the FDA to assess “existing opioid…guidelines, examine how these guidelines were developed and any potential gap” in data.

Some experts say more should be done in the classroom to help better educate health professionals on treating pain.

“We have to look at our culture and attitude toward people with pain – and people with addiction – but mostly with pain,” said Dr. Lynn Webster, former president of the American Academy of Pain Medicine and author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” “In our medical schools, there are less than seven hours on average of education about pain. Even though it affects more people than any other problem, it is the number one public health problem. But we’ve spent little on research to try to find a solution to this. We need to make pain and addiction a core of our medical education curriculum.”

RESEARCH INTO NON-OPIOID ALTERNATIVES

Webster has called for major funding in alternative pain treatment, which could offer relief with fewer risks and side effects. There’s also a need for quicker treatments for patients in urgent need of relief.

Stricter pre-authorization policies for prescription and non-opioid treatments, such as physical therapy, many times mean delays that leave patients in pain.

Several physicians told Fox News they’ve had to wait several days, or longer, for prescription pre-authorization. They also said there is much more paperwork required now in connection to pain management, leaving more room for error and, by extension, more potential for red flags that could lead to disciplinary action.

Most people interviewed by Fox News agreed there should be a concerted move toward a multi-faceted, more comprehensive way to treat pain. And, they stressed, because severe, unrelenting pain can lead to anxiety and depression, mental health must be an important part of treating the condition.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“There is a lack of multidisciplinary physicians and other health care providers who specialize in pain,” the AMA noted. “These physicians and other health care providers include pain specialists, addiction psychiatrists, psychologists, pharmacists, and others who are trained to be a part of the pain management team.”

Among the AMA recommendations was “Expand graduate medical residency positions to train in pain specialties including adult pain specialists, pediatric pain specialists, behavioral health providers, pain psychologists, and addiction psychiatrists,” and “expand availability of non-physician specialists including, but not limited to, physical therapists, psychologists, and behavioral health specialists.”

Some physicians and pain patients would like to see medical marijuana legalized in more states, and on the federal level. Military veterans who get their medical treatment from Veterans Administration health facilities say that even if they reside in states where cannabis is legal for health reasons, they cannot get a prescription because it is not legal on a federal level.

"My patients have benefitted by many opiate alternatives," said Montana-based Dr. Mark Ibsen, who stopped prescribing opioids after running into trouble with state medical officials and the DEA over allegations, which he said were untrue, that he was unjustifiably giving high doses to pain patients. "Eighty percent of my patients on opiates got off with cannabis."

Ibsen, whose license was reinstated, and who was never charged, said: "The key is to create a context for healing, which empowers the patient to interact with pain and their life in the most effective manner possible, and let go of what no longer works."

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Dr. Daniel Alford, the associate dean at Boston University’s School of Medicine’s Office of Continuing Medical Education, is on a mission to ensure that the next generation of doctors are better equipped to make decisions about safe opioid prescribing.

"We've been over-reliant, too opioid-centric in terms of our prescribing for chronic pain," Alford said. "Opioids shouldn't be the first choice, they should really be the last choice. But if opioids are to be prescribed, how do you do it in a way that maximizes risk to that patient. We should try to minimize dose escalation."

A prioirty, Alford said, is to improve the patient's quality of life.

"It's important to acknowledge and appreciate a person's pain, for them it's real," Alford said. "Until we have some method to say 'This is exactly where [the] pain is, our responsibility is to say 'I believe you.'"

Most of the time, he said, there's "zero percent risk" of being deceived by the patient.

"Based on their risk profile, to the best of your ability, you think about what treatment is best for them," he said.

If tapering is necessary, "I'm going to taper over a long period of time, I'm going to try to keep the patient engaged and I'm going to try to do what's really really hard, I'm going to try to get the patient into other forms of treatment," Alford said, adding that multi-modal treatment plans, combining medication and other therapy, often are successful.

But the approach won’t go very far if insurers won’t cover non-opioid or multidisciplinary treatments, health experts said.

“Insurance won’t pay for many evidence-based treatments,” said Michael Schatman, a clinical psychologist who runs Boston Pain Care, which uses an array of programs – including exercise, psychotherapy as well as prescription painkillers—to treat pain. “My program loses money every year.”

“Some patients need to be tapered, some need to be taken off opioids, they’re not good for everyone, but there’s a void because of our health care system,” he said.

At Boston Pain Care, patients go through multiple treatments simultaneously. Shatman claims it is more effective than the status quo approach, which often involves trying one treatment, perhaps two, which may not work. Often, patients are pressed to try different therapies, one at a time, until one offers some improvement.

“Sequential pain management is an incredible failure,” Schatman said. “As long as we have a for-profit insurance agency, it’s not going to get much better. We’re seeing the devolution of the profession of pain medicine to the business of pain medicine.”

MORE DIVERSE VOICES IN DISCUSSIONS ABOUT SOLUTIONS

The debate over opioids and pain management has become emotional, with the overdose crisis and the dearth of reliable data fanning the flames.

Some of the leading voices on different sides of the debate are calling for unity toward working on finding solutions to both pain management and the overdose crisis.

Schatman said he would like to see health experts who are firmly opposed to opioids sit at a table with peers who are supportive of them as a beneficial treatment and bat around ideas.

Many pain experts and health researchers say that committees for agencies such as CDC should include specialists in pain and pain patients.

Dr. Stephen Gelfand, a rheumatology consultant from South Carolina, was quoted in OpioidInstitute.org saying that forced tapering is concerning. But, he added, “there is also a significant percentage of these patients who actually have the disease of addiction and need addiction treatment services including medication-assisted therapy.”

And so, he said, “we also need to have victim advocates who have survived and overcome the scourges of addiction as the result of opioid overprescribing to sit on these patient advisory boards at every level of decision-making.”

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Tough new opioid policies leave some cancer and post-surgery patients without painkillers

Despite protestations that new federal and state hard lines on painkiller prescriptions do not affect cancer patients or people fresh out of major surgeries, many of those in health care’s trenches feel differently.

Dr. Dan Laird was treating an elderly man in Nevada who, despite efforts by the physicians and other doctors to save his leg, ended up having to undergo an amputation. “He lost the battle, his leg was cut off,” Laird said.

The surgery took place on a weekend in the fall. On Monday, the man called Laird in agony and desperation. He had been discharged from the Valley Hospital Medical Center in Las Vegas during the weekend, with no painkiller prescription.

DOCTORS CAUGHT BETWEEN STRUGGLING OPIOID PATIENTS AND CRACKDOWN ON PRESCRIPTIONS

“No pain medication!” Laird told Fox News in an interview. “Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. He had unimaginable, horrific pain. I was so mad, I called the hospital.”

“They said that the new [Nevada] law means we can’t prescribe to patients when we discharge them,” Laird said, recalling what he said he was told.

But Laird is also a malpractice attorney – and knew the state law chapter and verse.

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Laird said confusion over national and state policies and regulations concerning opioid prescribing is common among health practitioners. “The state law is ridiculously long. I’d prescribed my patient opioids for months, and because he had been receiving opioids from another physician," a hospital doctor did not prescribe any painkillers.

A spokesperson for the hospital contacted by Fox News did not offer comment for the story.

AS DOCTORS TAPER OR END OPIOID PRESCRIPTIONS, MANY PATIENTS DRIVEN TO DESPAIR, SUICIDE

Nevada’s opioid law, which took effect in January, limits the first prescription of opioid for acute pain to seven days and increases the amount of paperwork that must be filed for preauthorization for long-term painkillers.

In his 25 years of practicing medicine, Laird said, “I’ve never seen anything like this, an environment where it’s acceptable to mistreat chronic pain patients, where there’s an animus toward chronic pain patients.”

No pain medication! Having a limb amputated is one of the most painful things you can have done. And the tibia is one of the most painful parts of the leg. [The patient] had unimaginable, horrific pain. 

— Dr. Dan Laird

Like many health care providers, Laird said it’s right to take a hard look at opioids, and prescribing practices that needed tightening.

“Opioids are dangerous drugs. They have to be prescribed with extreme caution,” he said. “But for people who’ve had their leg cut off, or someone who has cancer, or has been in a bad car crash, there’s nothing worse than leaving them in pain.”

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“There’s anticipatory panic, (among physicians)” Laird said. “Doctors perceive a liability for prescribing opioids.”

In Michigan, Dr. Fran Van Alstine, a specialist in palliative and hospice care at the Munson Medical Center, has also seen how far the long arm of the war on opioids can reach.

HEALTH EXPERTS OFFER SOLUTIONS FOR UNINTENDED CONSEQUENCES OF OPIOID CRACKDOWN

The state has a 14-day day limit on opioid prescriptions, even for patients like his, who have advanced cancer, chronic lung disease, congestive heart failure.

He said he recently had to jump through hoops to get a painkiller refill for a terminally ill patient who was released from a hospital, and about to enter hospice care. The insurer denied the prescription because the man’s medication record showed “red flags” – opioids prescribed by more than one doctor, at high dosages.

“Our patients have been in and out of hospitals. They get prescriptions from different doctors, they have serious, life-limiting illnesses,” Van Alstine said. “They’re actively dying and in pain. We put in a diagnosis in his records, so there’s no question what we’re using the opioids for. [The restrictions] are an exercise in silliness. In hospice, addiction is the last of our concerns.”

The man died 24 hours after finally getting a refill – spending his final days in pain.

Elizabeth Llorente is Senior Reporter for FoxNews.com, and can be reached at Elizabeth.Llorente@Foxnews.com. Follow her on Twitter @Liz_Llorente.

Childhood cancer survivor becomes nurse at hospital that helped save her

A childhood cancer survivor has spent the last three years working alongside some of the staff who helped save her over 22 years ago thanks in part to the National Children’s Cancer Society (NCCS), which provided her with a scholarship for her four years of college.

Jennifer Toth, who beat hepatoblastoma as a toddler, said she always knew she wanted to work with childhood cancer patients and their families in some capacity, but it wasn’t until she shadowed nurses and nurse practitioners during a summer program in high school that she knew she found her home.

“[The program] made me think back to the role that nurses and NPs (nurse practitioners) played during my time as a patient,” Toth, 26, told Fox News.

She said that while her entire medical team at Children’s Hospital of Pennsylvania (CHOP) helped support her and her parents who had just learned that their 2-year-old had a softball-sized mass on her liver, it was Pat Brophy, a nurse practitioner who has since died, who stuck out the most.

DAD'S PICTURE OF SLEEPING TODDLER CAPTURES FRIGHTENING CANCER SYMPTOM 

“Thinking about the nurses who I had known made the decision to become a nurse, and hopefully someday a nurse practitioner, an easy one,” Toth said.

She had learned about the NCCS’s Beyond the Cure Ambassador Scholarship Program through her survivorship program and applied when she decided on University of Pennsylvania’s nursing school. Now back in grad school at UPenn, she said that part of the school’s appeal was the close proximity to several hospitals where she could complete her clinical rotations, including CHOP.

“I always thought that it would be amazing to come full circle and work at the same hospital where I had been a patient,” Toth said.

SURGEONS REMOVE MASSIVE CANCEROUS TUMOR FROM MAN'S JAW

She accepted a position at CHOP on a surgical unit for a few months before transitioning to her role on the inpatient oncology unit. She said that while she doesn’t hide that she’s a cancer survivor, she only shares her story with her patients and their families when appropriate, such as when they notice her hearing aids and she explains that hearing loss was a side effect of chemotherapy.

“Even when I don’t explicitly share my own diagnosis with my patients, I hope that my experience as a patient and a survivor shapes my nursing practice in a way that conveys deep empathy and understanding,” she said. “Hearing my parents talk about their experience having a child with cancer has also given me more perspective than I would otherwise have into what my patients’ parents experience, which impacts how I interact with parents.”

Belgium investigates doctors who euthanized autistic woman

Belgian officials are investigating whether doctors improperly euthanized a woman with autism, the first criminal investigation in a euthanasia case since the practice was legalized in 2002 in the European nation.

Three doctors from East Flanders are being investigated on suspicion of having "poisoned" Tine Nys in 2010. The 38-year-old had been diagnosed with Asperger's syndrome, a mild form of autism, two months before she died in an apparently legal killing by a doctor that she had asked for.

Belgium is one of two countries, along with the Netherlands, where euthanasia of people for psychiatric reasons is allowed if they can prove they have "unbearable and untreatable" suffering. Among Belgians euthanized for mental health reasons, the most common conditions are depression, personality disorder and Asperger's.

Many experts — in Belgium and beyond— dispute whether autism should be considered a valid reason to be a euthanasia candidate.

AUTISM RATE NOW 1 IN 40 US KIDS, STUDY FINDS

Last year, The Associated Press reported that after Nys' family filed a criminal complaint, alleging numerous "irregularities" in her death, her doctors attempted to block the investigation.

"We must try to stop these people," wrote Dr. Lieve Thienpont, the psychiatrist who approved Nys' request to die — and one of the doctors now facing charges. "It is a seriously dysfunctional, wounded, traumatized family with very little empathy and respect for others."

Sophie Nys, one of Tine's sisters, told the AP that the doctor who performed the euthanasia asked her parents to hold the needle in place while he administered the fatal injection, among other fumbling efforts. Afterward, the doctor asked the family to use a stethoscope to confirm that Tine's heart had stopped.

Belgium's Chamber of Indictment "presumes that there are sufficient indications in this particular case" and the doctors involved have been referred to the Court of Assize in Ghent.

They will now face trial "due to poisoning," said Francis Clarysse, a Ghent prosecutor. It is unclear when a trial might begin and the doctors could still appeal the decision. The charge of poisoning carries a maximum penalty of a lifetime sentence.

Concerns have previously been raised in other cases about whether Thienpont, Nys' psychiatrist, too easily approved euthanasia requests from patients with mental illnesses.

The AP previously published documents revealing a rift between Thienpont and Dr. Wim Distelmans, who heads Belgium's euthanasia review commission. Distelmans voiced fears that Thienpont and his colleagues may have failed to meet certain legal requirements in some euthanasia cases — and wrote that he would no longer accept referred patients from Thienpont.

CASES OF MYSTERIOUS POLIO-LIKE ILLNESS HIGHEST IN US SINCE 2016

"I think this (trial) has symbolic importance in the sense that it sends doctors a message…that you could be accused of a very serious crime and prosecuted if you don't comply with the legal requirements for euthanasia," said Penney Lewis, a law professor at King's College London. "The prospect of criminal investigation may act as a mechanism to make doctors more careful."

In the 15 years since doctors were granted the right to legally kill patients, more than 10,000 people have been euthanized. Only one case has previously been referred to prosecutors; that case was later dropped.

Lewis said because Belgium does not routinely publish details of worrisome euthanasia cases, it was difficult to know if there might be a more widespread problem.

Earlier this month, Dutch officials announced they would also prosecute a doctor who euthanized a woman with dementia, also marking the first time the Netherlands has charged a physician for possible wrongdoing in performing euthanasia.