Sunday, January 21, 2018
Opinion

Column: "No-brainer" legislation is harder to pass than it looks

The Florida Legislature convenes next week for a two-month session. Hundreds, perhaps thousands, of bills will be addressed, with a small number making it to the governor's desk to sign. This year it seems the hot topics are medical marijuana, texting and, now, liability changes related to abortions performed by doctors, up to a limit of 10 years.

Much debate goes on, pro and con, for most of the bills, with passage of those that show enough compromise by both parties for the welfare of Florida citizens. I learned about the process firsthand when I came up with a proposal that I thought would be a no-brainer to improve the health of all Floridians. The Hillsborough County Medical Association meets with our local politicians and their staffs at a luncheon before the legislative session. Two years ago, I brought something to the attention of the legislators and staff at the meeting, and Rep. Janet Cruz agreed that it was something that needed the attention of the Legislature.

It was simple. To me, it was a no-brainer. But with the experience of having been in the House of Representatives, Dr. Ed Homan cautioned about counting my chickens.

I practiced general medicine in South Tampa for 37 years and retired in late 2013, but I remain active in the Hillsborough County Medical Association, serving on the executive council and being editor of our Bulletin. When I was in practice, patients would often come in with prescription bottles, filled with generic white tablets, with the instructions to "take one daily." They'd often have three or four bottles. So it was easy for them to mix up what they were taking them for — high blood pressure, cholesterol, thyroid, diabetes, etc.

I thought it would be an excellent proposal to pass legislation mandating that doctors place, in the directions, the disease entity for whatever the prescription was treating. It might be a little more trouble for the doctors, but with electronic prescribing it wouldn't be a big deal, and for the patient's safety it would be invaluable.

Rep. Cruz drew up a bill, HB 1611, but the head of the Health Quality Committee, Rep. Cary Pigman, never let it come up for discussion. I was disappointed for sure with the fate of my no-brainer proposal.

I was later told that the pharmaceutical industry was against it since insurance companies would not pay for the prescription if they felt it was being used for an "off-label" purpose. In other words, if your doctor was prescribing an antidepressant, which could be used for pain, but wasn't developed for that purpose, they might not pay for it. But then again, there were insurance companies not paying for prescriptions unless the medical condition was included in the directions.

You can't have it both ways. I was even told that including the patient's medical condition would violate HIPAA privacy laws. Really? And what pharmacist doesn't know what someone's Viagra is for, or any medicine for that matter? Or maybe it's to protect their privacy in case you go snooping through their medicine chest.

This matter won't be resolved until the insurance companies stop practicing medicine and leave patient care to the physicians and capable licensed physician extenders. Not only Floridians, but all citizens, should have their health protected by this no-brainer idea. When you read your prescription, you should know what you're taking it for. What's in your medicine cabinet?

Dr. David Lubin was a general practitioner in South Tampa for 37 years before retiring from practice in 2013. He remains active as editor of the Hillsborough County Medical Association magazine, the Bulletin. He wrote this exclusively for the Tampa Bay Times.

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