2014 Legislative Report

Medical marijuana bill passes; while many healthcare bills fail

Florida legislators legalized marijuana extract for medicinal use on a limited basis this session, just months before voters will decide whether to allow even broader medicinal uses for the popular recreational drug. The decision came during a session with a historically low number of adopted laws—264 out of 1989 bills, the lowest number of adopted bills since 2001, according to the Florida Medical Association.

The reason for the low count? Health issues were held hostage over a battle about whether to expand the power of nurse practitioners, according to Dr. Sergio Seoane, a Lakeland family medicine/pulmonary disease physician serving on FMA’s Political Action Committee board and a Polk County Medical Association member, speaking on his own behalf. “The whole thing was about the nurses,” he observes.

PASSED: Charlotte Web Law

A growing number of states have expanded legal uses for pot, which still is illegal under federal law. Colorado and Washington have legalized it. While the FMA supported the compromise law allowing treatment for children with epileptic seizures, it does not support the proposed amendment up before voters in November.

“To my knowledge, there are no randomized controlled trials that demonstrate marijuana is superior to current medical therapy for the treatment of any medical condition. There has been no major national medical organization in the United States that has expressed support for legalization of marijuana,” Dr. Seoane says. “Because marijuana has been a ‘schedule I’ classification drug per the U.S. Drug Enforcement Administration (DEA) [which means there’s ‘no medical application,’], it makes it extremely difficult to conduct medical research involving marijuana.”

People United for Medical Marijuana, a political committee chaired by John Morgan of Orlando, is behind the ballot measure facing Florida’s voters on November 4. The United for Care, People United for Medical Marijuana website says marijuana is often helpful in the treatment of acquired immune deficiency syndrome (AIDS), hepatitis C, glaucoma, cancer, multiple sclerosis, and epilepsy, as well as for chronic pain and injuries.

Florida voters will decide whether to allow “the medical use of marijuana for individuals with debilitating diseases,” state records show. If the amendment passes, physicians would be allowed to authorize its use; caregivers would be allowed to help patients use it. The state’s Department of Health would register and regulate centers that produce and distribute pot for medical uses.

Ophthalmologist Dr. Gary Schemmer, president of the Winter Haven-based Fischer, Schemmer, Silbiger, and Moraczewski, says anecdotal cases of marijuana benefits are being highlighted. “It has been made essentially impossible to study any potential medical use in the United States. We thus have little science behind the push to use marijuana for medical purposes,” asserts Dr. Schemmer, who is also a Polk County Medical Association member. “Although marijuana does lower intraocular pressure, the dosing required would probably preclude its usefulness in treating glaucoma, even if legalized.”

Dr. Chris Pittman, president-elect of Florida Medical Association’s Political Action Committee calls medical marijuana “a misnomer. There’s no such thing as medical marijuana. If it was great for patients, we would be doling it out.”

Dr. Seoane calls the proposed Amendment 2 “a poorly veiled method to legalize marijuana by disguising it as valid medical therapy.”

“If the people in the state of Florida want to get high on marijuana for recreational reasons, then make it legal. Do not pretend that marijuana has valid medical uses when no such evidence exists,” Dr. Seoane elaborates. “Smoking anything will cause lung injury. It is absurd to state that smoking tobacco, marijuana, or anything else is anything but injurious to the lungs. The vast majority of the physicians that I speak to realize that the evidence for marijuana as a medical therapy is poor to non-existent.”

Marijuana has more tar than cigarettes, is inhaled deeper, and has as many carcinogens, Dr. Seoane reports, adding it is more potent than marijuana was years ago.

Gov. Rick Scott signed the Charlotte Web law on June 16, legalizing low tetrahydrocannabinol (THC) marijuana for the treatment of severe seizures, cancer, and amyotrophic lateral sclerosis (ALS), a fatal neurological illness also known as Lou Gehrig’s disease. THC is primarily responsible for marijuana’s psychoactive properties. Before doctors can prescribe it, they must complete an FMA course.

FAILED: Health Insurance and Obstetrical Facility Closure Notice

Legislators did not approve the FMA-backed health insurance initiative to cut the hassle factor out of dealing with insurers: Namely, prior authorization of claims, fail first protocols calling for a trial with cheaper medications first, retroaction denials of claims, and bait and switch, which misrepresents the doctors included in medical networks.

“In my own practice, my insurance coordinator is on the phone for 20-40 minutes per patient, or more, trying to determine if the insurance company is going to approve […] a treatment I believe the patient will benefit from,” says Dr. Pittman, medical director of Tampa’s Vein911. After treatment, insurers have 12 months to decide if they’ll let the doctors keep payment, he points out.

Additionally, the legislature rejected a proposal to protect patients from last-minute closures of obstetrical facilities. “The concern about hospital obstetric units closing is that access will become an issue especially in less populated areas. Realize in Polk County, Bartow and Lake Wales hospitals already have closed their obstetrical wards, says Dr. Schemmer. “Although this may not be a severe issue, it has increased travel time of 30 minutes for some women in our county. Hospitals are under tremendous pressure from economics and liability to close ‘underperforming’ units; and are therefore opposed to restricting their ability to choose which services they offer.” The FMA was seeking 120 days of advanced notice, which Dr. Seoane concurs, would have been adequate time for people to “find alternative ways” of getting the obstetrics care that they need.

FAILED: Independent APRNs and Telehealth

The legislature ditched a bill to create an Independent Advance Practice Registered Nurse (APRN) able to work without the oversight of a physician and prescribe controlled substances and narcotics.

Proponents argue there aren’t enough doctors in rural Florida, and nurse practitioners need to be empowered to meet the demand for services. “That is not true,” asserts Dr. Pittman. “With telemedicine, the technology exists to allow physicians to supervise… [it] is not being used as widely as it could be.”

Lawmakers did not approve the proposed a telemedicine law that would have allowed licensed providers in other states to practice in Florida after registering and paying a $150 fee. While patients already can consult with their doctors over the telephone, a House package would have allowed these registered users to offer patient assessment, diagnosis, treatment, and monitoring under the name “telehealth.”

“The fundamental flaw in telemedicine is that the physician is not present. No physical examination can take place. No evaluation of the patient can take place,” Dr. Seoane points out. In some ways, it’s not new at all. “I have a telemedicine system in my office, it is called the telephone,” he observes. “My patients call my office with questions and concerns and I answer their questions over the telephone. This system works great, and it is free to my patients!”

While telemedicine can be good for patients and doctors, Dr. Pittman cautions that it can pose problems if insurance providers skirt local medical caregivers by forcing patients to use discounted services from out-of-state professionals in their networks.

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