Apparently Mayor Bloomberg is now a doctor:
Some of the most common and most powerful prescription painkillers on the market will be restricted sharply in the emergency rooms at New York City’s 11 public hospitals, Mayor Michael R. Bloomberg said Thursday in an effort to crack down on what he called a citywide and national epidemic of prescription drug abuse.
Under the new city policy, most public hospital patients will no longer be able to get more than three days’ worth of narcotic painkillers like Vicodin and Percocet. Long-acting painkillers, including OxyContin, a familiar remedy for chronic backache and arthritis, as well as Fentanyl patches and methadone, will not be dispensed at all. And lost, stolen or destroyed prescriptions will not be refilled.
City officials said the policy was aimed at reducing the growing dependency on painkillers and preventing excess amounts of drugs from being taken out of medicine chests and sold on the street or abused by teenagers and others who want to get high.
“Abuse of prescription painkillers in our city has increased alarmingly,” Mr. Bloomberg said in announcing the new policy at Elmhurst Hospital Center, a public hospital in Queens. Over 250,000 New Yorkers over age 12 are abusing prescription painkillers, he said, leading to rising hospital admissions for overdoses and deaths, Medicare fraud by doctors who write false prescriptions and violent crime like “holdups at neighborhood pharmacies.”
But some critics said that poor and uninsured patients sometimes used the emergency room as their primary source of medical care. The restrictions, they said, could deprive doctors in the public hospital system — whose mission it is to treat poor people — of the flexibility that they need to respond to patients.
“Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians and senior vice chairman of emergency medicine at Lehigh Valley Health Network in Eastern Pennsylvania. “It prevents me from being a professional and using my judgment.”
When I broke my shoulder, it was eight days from my trip to the emergency room until I saw my specialist who would perform my surgery (and then another week until the surgery was done). If I had been given only three days of painkillers, which five of the eight days it took to see a doctor does Bloomberg think I should have been in excruciating pain?
Omnes Omnibus
Cole, you know you would have just sold the drugs. Everyone who shows up at an ER is just exhibiting drug seeking behavior. You just took it to an extreme.
pillsy
Bloomberg is just Giuliani with better press.
reflectionephemeral
Characteristically underinformed blunderbuss overreach.
Not fascism, though.
Commenting at Balloon Juice since 1937
This story can not be true. In the US, there is no waiting, ever, for our exceptional health care.
ThatLeftTurnInABQ
That’s Herr Doktor Mayor Bloomberg to you, buddy!
Violet
Days 4-15, obviously.
Comrade Dread
Look, John, we’re already decided that it’s better that a few people have their doors incorrectly kicked down in the middle of the night accompanied by flashbangs and possible death of themselves, their loved ones, or their pets than for a few goddamn hippies to get high.
So if a few thousand folks have to suffer needlessly praying for death to stop the hippies that’s just the price we’re going to pay.
Eggs, omelets, you know?
Betty Cracker
This an another offshoot of the stupid “War on Drugs” mentality. Of course people abuse prescription painkillers, and great harm arises from it. But idiotic restrictions like this just increase the suffering of people in real pain.
ruemara
Then, there’s these rich guys. Who think they know every fucking thing. Which is why when people were bemoaning him not running for Prez as a ‘more progressive than Obama’ Republican, I wanted to slap them.
Machine-Gun Preacher (formerly Ben Franklin)
Psychotropic drugs are a bigger problem. If they don’t stop using them merely as control mechanisms for children with their bullshit blanket diagnoses, we will continue to have emotionally under-developed adults go barmy.
We need a stimulus bill advocating for Public Schools to fulfill their mandate.
They don’t have the extra money to spend on special ed curriculum and instruction, so they pretend it doesn’t exist. Get to the root of the problem, instead of shining the rotten apple.
John Cole
@reflectionephemeral: I fully believe Mayor Bloomberg is a fascist.
Violet
Can someone please arrange for Mayor Bloomberg to please have only three days worth of whatever medications it is that he takes? He needs to go back to the doctor every three days for another prescription. No, he can’t send a flunky. No, he can’t get a special appointment with the doctor. Call and wait for the next available one. Sit in the waiting room like everyone else. Once he’s done that for a month or two, we can revisit this discussion.
BGinCHI
@John Cole: Hmm, racial/national purity deficit, don’t you think?
Plus no facial hair.
burnspbesq
@Betty Cracker:
Any suggestions?
JPL
@John Cole: Well duh!
Earlier today someone mentioned that Sam is a big brother. Can you please post a baby picture when Kitten sends you one.
Maude
@ruemara:
Bloomberg plays king a lot. He has 11 houses. He needs to go to one of them and keep quiet.
He is okay on gun violence even though he tried to school Obama. Apparently, that fizzled out.
BGinCHI
It would be nice if between Romney and Bloomberg people in this country came to the conclusion that Big Rich Businessmen make dangerously stupid politicians.
True also of women. See Fiorina, Carli and Whitman, Meg.
PsiFighter37
John, you wouldn’t have any problems with your health care if you were a U.S. Senator.
Just sayin’, in light of this morning’s news…
ThatLeftTurnInABQ
I wonder how well that 3-day period would have worked in the Hurricane Sandy aftermath? Certainly nobody would have experienced any problem keeping their scheduled appointments, correct?
Mnemosyne
@Machine-Gun Preacher (formerly Ben Franklin):
Hey, I thought you’d be all in favor of Bloomberg’s ban. After all, these patients must be faking their pain just like psychiatric patients are faking their psychiatric problems. They should just tough it out and think happy thoughts and everything would be fine.
Violet
@John Cole: Whole thread below devoted to getting you to run for Senator now that Rockefeller is retiring.
reflectionephemeral
@John Cole: Reasonable people can disagree!
Maude
@burnspbesq:
The mayor should stay out of it. He doesn’t know what he is talking about. Doctors are able to detect drug seekers.
Hunter Gathers
In Soviet NYC, the Mayor is your doctor!
Cassidy
I’m curious what the percentage of illegal prescription pills is that comes from legit sources vs. smuggled in?
Machine-Gun Preacher (formerly Ben Franklin)
@Mnemosyne:
Hey, I thought…..
Sorry. I have to stop you right there.
Violet
@ThatLeftTurnInABQ: Thought about that when I saw this above:
Superstorm Sandy destroyed your prescription? Too bad! Add it to your List of Suffering.
RossinDetroit, Rational Subjectivist
Agreed in principle, but I think the phrase “legislative medicine” sounds like a shady rhetorical gambit.
scav
Catch up, if a few abuse painkillers, it justifies putting strict and draconian measures against people getting some in the name of public welfare, unlike guns, because only shooty thing that kill people are mentioned in the Nation’s founding documents, shooty things with medicine don’t count (because what the fuck could medicines ever have to do with life).
dr. bloor
@Violet:
He’s trying to address a real problem, and doesn’t cover regular care. The problem is that NYC’s ERs are now going to be even more crowded with drug-seeking patients returning every three days.
David Hunt
Well that’s just silly, John.
BillionairesNormal people never have trouble getting the medication that they need to function in daily life.John PM
This makes perfect sense. Studies show* that no patients who treat at private hospitals abuse opiates.
*Studies were no available at the time of this comment.
Higgs Boson's Mate
Hizzoner didn’t seem to think of the consequences of increasing the frequency of visits to an already overburdened ER system.
Comrade Dread
@scav: No, no, we can’t pass gun control legislation because then Uncle Sam may turn evil and we won’t have guns to protect ourselves. Instead the proper response to a few people abusing their guns is to post armed agents of the government at the entrances to our schools.
What’s that? Cognitive dissonance? Look, hippie, I ain’t no P-sychiatrist.
Also, this.
Rafer Janders
What’s the problem? So you can’t take any trips longer than three days. It’s not like anyone in pain would ever like to take a week’s vacation to Florida or California to visit the grandkids, for example, or have to take an extended business trip.
And say, in the remote instance, that someone does take such a trip. Can’t they just suck up the pain for four to six days until they get back?
aimai
@Maude:
Yeah, and this is why the medical staff have to waste half their time checking you out, in the ER and trying to determine whether you are drug seeking and behaving in a hostile manner to you. In some ways it makes sense to lower the propensity of ER doctors to be able to hand out major drugs if it makes coming to the ER worthless for drug seeking patients. In addition this law seems to be aimed at trying to make the drugs less available to theft.
I am not saying I support this stupid mayoral interference in medical practice–I don’t. But the entire handling of this stuff is horrible and they are trying to deal with a very real problem which is that in a fractured medical system which handles (as a byproduct) valuable narcotics you are going to have a huge proportion of scammers to real patients, and even scammers using real patients (that’s why those “lost” scrips and “destroyed” scrips are an issue in the law).
The sensible thing to do would be to obviate the need for this weird fixation on the ER by creating and maintaining full service local clinics who would take on local people and given them primary care so that fewer people go to the ER in the first place and more people have their chronic pain managed sensibly by someone who knows them. Then you regulate the hell out of the doctors to make sure they aren’t the main pipeline for drugs going into the illegal market.
aimai
WereBear
Ideally, from their point of view? All of them.
Just what is so horrible about not being in a constant state of pain?
Of course, I’m a radical: I think people take drugs because of pain. Physical pain, emotional pain, psychic pain. They are all pain.
It’s only human to seek relief.
Cassidy
@Rafer Janders: I don’ think you’re reading this correctly. I read “public hospital patients” as ER patients. I would imagine that anyone seeing their GP or a Pain Clinic would still get their routine dose/ treatment of pain medications.
JCT
This is, of course completely consistent with Bloomberg’s usual “decree” from a position of ignorance approach. Of course it will explode ER visits at our already crushed public hospitals. But then again, to the best of my knowledge he has never darkened the door of one of “those” facilities.
On a much less significant level, people have been screaming about the sorry state of the NYC airports forever. Bloomberg could easily get his rich pals together to spearhead something, but since he doesn’t use LGA or JFK he could give a fuck less.
taylormattd
Isn’t this is just referring to what is kept at the hospital?
If the ER doc gives you a prescription for more, you go to the pharmacy.
gvg
Sleezy doctors are the problem, well addicts too. Also the AMA doesn’t do a good job of self policing. 3 days is probably too tight but according to my doctor sister, patients seeking prescriptions are a real problem, and certain docs are know easy sources. Florida recently tightened up some regulations which may help. Previously people came down here to get prescriptions.
Sister has been researching where to open an independant practice. there is one small town, pretty good income levels, chronically in need of a doctor but she is leery of starting there because it has a history of doc after doc being shut down for selling prescriptions etc and she is afraid it would damage her reputation to open there plus at first she would have scads of angry patients wanting meds they shouldn’t have….
All very well to think it should be left to the Doc but it hasn’t actually worked out to leave it totally to the docs. It only takes a few bad apples, and those few get rich while the honest ethical docs can’t stop it. A Doctor board that advises the rule makers would be a better choice.
japa21
There is little doubt that prescription opioid use is a major problem. The question is what to do about it. In a world where everybody had a primary physician what Bloomberg is proposing would not really be much iof an issue. ER docs almost always do a consult with a ptient’s PCP if there is one and if, based upon that consult, the PCP agreed with the opioid being prescribed, the PCP could go ahead and arrange for a prescrition for the patient to be available when the three days are up.
However, we don’t live in that world yet. As dr. bloor noted, this policy is likely to result in a larger ER capacityy problem and not solve the actual problem. I don’t have a solution.
Tone in DC
@BGinCHI:
True dat.
Strandedvandal
Who gave the mayor of a city unlimited power to do whatever the hell he wants?
J.A.F. Rusty Shackleford
@PsiFighter37:
Yeah, that’s a great idea. On the day John Cole would be sworn in as Senator he would slip and fall down the steps of the capitol while carrying Lily and bust his other shoulder.
scav
@WereBear: Pain and suffering is a gift from GOD, funny how that came up with Mother T just last night. How dare you infidels get in the way of GOD’s special gift to you, just like that little rape baby. (and, yes there are a few dragging the legitimate rape out of its coffin again, some of those repubs have this serious necrophiliac thing for positions.)
Forum Transmitted Disease
3 days? Shit, in Ohio (relative is a firefighter/EMT there) you get three pills. Period, the end.
Said the addict thing was getting so out of hand they were having people call up and use the ambulance as a free taxi ride to the ER just to get some oxy or Vicodin. The ER docs finally had enough of this.
No, I don’t know how you fix this, it’s so fucked up I don’t even know where to start. Former best friend of mine decided to embark on a career as a pillhead/junkie. She was like the fucking Terminator. You could not stop her. She was going to get her dose, and she had to steal your firstborn child and sell it’s organs for some oxy, well that’s what was going to happen and she’d do it or die trying.
Drug addiction was always an abstract thing for me before that. I was pretty libertarian about it – let em have what they want. Don’t know how I feel about that now. Addicts are the living dead. Yeah, it looks like the person you knew. It ain’t. And they never get better. They may get sober but they don’t recover, if you get my drift.
Jibeaux
If we can ever fix our health care delivery system, at that point I wouldn’t find this problematic, but for now there are people who use EDs as primary care docs because they have no choice. There are, however, a lot of drug seekers out there, which is part of what has made docs so jaded. It hurts people who need narcotics, and it increases insurance costs for everyone.
Petorado
There’s a strong correlation between people dressed in very expensive suits and activities in New York City’s financial sector that trashes our economy, throw people out of their homes, and make retirement savings vanish. Please Mr. Bloomberg, ban well tailored suits in your city. It’s the least you can do to stem this problem.
trm
@Commenting at Balloon Juice since 1937: Especially now that Obozocare has kicked in. Praise be to the Anointed One.
jp7505a
There was a recent article that part of the reason these drugs are being over prescibed is BIG Pharma created some fake studies that it used to convience doctors that the drugs were safe. Doctors were cautious about using them in the past because of the risk of addiction . Once Pharma was done with it’s advertising campaign they made it sound like the drugs were as harmless as sugar pills. Profits over people – the american way.
SatanicPanic
@Machine-Gun Preacher (formerly Ben Franklin): Are psychotropic drugs the new GMOs/Vaccines/Gluten/Flouride? Just curious, I don’t want to get behind.
handsmile
Ah, here’s the tell (from the penultimate paragraph of the NYT article):
“Dr. Farley said the city lacked the regulatory authority to impose the new guidelines on its 50 or so private hospitals. ”
This is a classic Bloomberg rat-fuck. NYC public hospitals (a number of which have closed or merged during his reign as Emperor) are absolutely desperate for stabilized city and state funding, and are thus politically constrained from actively opposing this initiative.
NYC’s private hospitals (which are only slightly less desperate for both public and private funding), have hereby been afforded a potentially significant new source of revenue. Their administrators will be thrilled by this edict; ER, ward, and clinic doctors and staff rather not so much.
Amir Khalid
This seems a clumsy approach. Is NYC within its authority to intervene in the doctor-patient relationship like this? Plus, I have no idea how Bloomberg expects this action to address the problem of people sticking up the neighbourhood farmasi. Did any doctors have a say in drafting this policy?
D. Mason
Another problem with this kind of thinking is that it makes doctors hesitant to prescribe pain meds when needed. I know a guy who broke one of his hips in a 4-wheeler accident when he was a teen, hes in his mid 20’s now. He has chronic pain and they can see the lack of cartilage in his hip joint but because he is so young it is assumed that hes just trying to get high all the time. Doctors all over town have denied him medication which adds to the problem because now hes a “shopper” and they suggest OTC pain killers. He’s talking to a lawyer about SS disability because he can’t work without meds and can’t get meds even though he has “Cadillac” insurance through his decent paying job. It’s disgusting.
RossinDetroit, Rational Subjectivist
My dad is a Republican and a Pharmacist. Used to work at a public hospital. I’d like to hear his views on this.
Maude
@aimai:
Only in public hospitals. That’s the key point. Rich people who go to a private ER can get their drugs. He isn’t picking on them.
My point is that Bloomberg is playing King. He thinks it’s fine for him to tell poor people what to do.
This isn’t about solving a prescription drug problem at all.
It’s about power and class.
The drug problem is a whole other topic.
If you ever need to go to the ER in NYC, ask to be taken to Bellevue. That’s where they’d take a president.
catclub
@John PM: Actually, I am more on the side of Bloomberg. It does make sense. He has control over public hospitals. He does not have the same control over private hospitals.
If drug seeking individuals now start going to private rather than public hospital ER’s that will show
a) there was a problem and b) he reduced it at the public hospitals.
Violet
@dr. bloor: I’m well aware of the real problem. My point was more that the Mayor doesn’t really know how real people live. If he had to deal with even a small inconvenience for something he needs, he might have a bit more empathy.
I’m not sure if the Mayor’s solution is a good one. I know ER docs are frustrated with how many addicts clog up their ERs and prevent patients who need actual help from getting it.
Maybe this is a solution worth trying. A patient with a legitimate need for more could provide the contact info for his or her regular doctor. The ER doc could coordinate with that doctor to get the patient more. If the patient doesn’t have a GP, then I guess someone on staff at the hospital would have to play that role. It’s more admin, but it’s a way to cut down on dishing out a bunch of drugs.
WereBear
Of course, I’m not saying “addiction is okay.”
I’m saying that instead of tying ourselves in knots trying to keep addicts from their various drugs, why don’t we take a leaf from the Big Book o’ Lessons from Prohibition.
We could spend a fraction of what we spend on the Drug War to treat addicts AND give them a path to creating a satisfying life, free of their various mental and physical ills.
Why don’t we do that?
Origuy
My housemate, who has Ehlers-Danlos Syndrome and arachnoiditis, takes methadone pills to be able to function at all. MediCal has forced her to switch doctors to one in this county, where she has found it almost impossible to find one that takes MediCal and can prescribe methadone. She doesn’t know why the one she’s going to now cannot.
Lee Rudolph
@RossinDetroit, Rational Subjectivist: Absolutely. This is an instance of executive, not legislative, medicine.
Culture of Truth
violent crime like “holdups at neighborhood pharmacies.”
This will make that number go down?
Forum Transmitted Disease
@John Cole: Anyone who decides to control via legislation and the force of law how much soft drink a person can consume has crossed that line a long time ago. Couldn’t agree more.
Emma
@aimai: The sensible thing to do would be to obviate the need for this weird fixation on the ER by creating and maintaining full service local clinics who would take on local people and given them primary care so that fewer people go to the ER in the first place and more people have their chronic pain managed sensibly by someone who knows them. Then you regulate the hell out of the doctors to make sure they aren’t the main pipeline for drugs going into the illegal market.
You’re being logical and sensible again, Aimai. Bloomberg, on the other hand, just wants to screw the poor a little more.
gnomedad
What we need is more drugs in the hands of the good guys.
Violet
@WereBear: What are you, some soshulist? Coddling those criminals won’t help anything!
catclub
@WereBear: “Why don’t we do that?”
That would be like not punishing sluts for having sex.
No fun for the moral scolds.
Michael Finn
Yeesh, the problem with pain killers is that people are so scared of becoming addicted that they don’t take the when needed. Then they just sit around asking to be either stolen or abused because what else are you going to do with them? There are little if any recycling places around.
Finally, the only people who should determine whether or not pain is bad enough for those drugs are the patients. I studied nursing and it was damned frightening how much prejudging there was. One woman who had knee replacement was only given Naproxen (Aleve) for the pain because she had a history of drug abuse (not opiates) and they didn’t tell her. Her son had brain cancer at the time of her drug abuse so I can only imagine what she went through.
If this mayor wants policy then he should have to watch the results for the patients out there. Not everything is about the drugs.
Michael Finn
Yeesh, the problem with pain killers is that people are so scared of becoming addicted that they don’t take the when needed. Then they just sit around asking to be either stolen or abused because what else are you going to do with them? There are little if any recycling places around.
Finally, the only people who should determine whether or not pain is bad enough for those drugs are the patients. I studied nursing and it was damned frightening how much prejudging there was. One woman who had knee replacement was only given Naproxen (Aleve) for the pain because she had a history of drug abuse (not opiates) and they didn’t tell her. Her son had brain cancer at the time of her drug abuse so I can only imagine what she went through.
If this mayor wants policy then he should have to watch the results for the patients out there. Not everything is about the drugs.
piratedan
@burnspbesq: yeah, have doctor’s write legibly so we can reduce script fraud or handle these transactions electronically, so if you’re gonna abuse the prescriptions, you also have to be a hacker.
Cassidy
@Michael Finn: Naproxen was a good choice. I might have gone with Robaxin and Ibuprofen, but I see nothing wrong with that.
catclub
@Forum Transmitted Disease: That epitaph starting with “First they came for big gulps…”
Just does not have the same anti-fascist ring to my ear.
Culture of Truth
this is not my field, so forgive me if I’m way off, but don’t addicts have a l’egitimate need’ too? If not a medical condition requiring pain relief, a medical condition requiring the drug itself, or ideally, a way to get off the addiction. Telling them to go away because they’re faking my apply to some, but surely not to all or even most.
Ridnik Chrome
November 2013 can’t come soon enough…
aimai
@WereBear:
I’m all for this. A certain number of people are going to become addicts–the problems society has are that they have to steal and lie and cheat to fill their illegal addictions. I guess I’ve come around to thinking that putting them on a quick, even subsidized, road to early death is a better way to go than spending society’s time and money trying to fend off their death wish.
Mr. Aimai was in the hospital two years ago, twice in the ER in two days, because of crippling back pain that left him prone on the floor for *six hours* the first time (I include that fact because actually being prone that way apparently leads to some serious complications all on its own and is also an indication that people who aren’t in it for the drugs tend to head to the ER as a last resort, rather than a first resort so the subsequent suspicion and delaying tactics accorded to your particular patient are even more injurious.)
They released him from the ER the first night with insufficient pain killers because they don’t have the right to actually give you the prescription and I couldn’t fill it until morning. He ended up right back in the ER because of this medical decision which was entirely based on fears that the generic middle aged white guy with unexplained pain symptoms is probably drug seeking and should be delayed in treatment to prove his bona fides. He wound up in the hospital itself, as an admitted patient, on mega doses of pain killers and muscle relaxants, for four days.
My point is that even private hospitals and their ERs are forced to treat all their patients sceptically because of some people’s drug seeking behavior.
Violet
@Forum Transmitted Disease:
Technically he didn’t do that, did he? He legislated the size of the container holding the soft drink. People can still buy 20 of those smaller containers, should they so desire. They can still drink as much as they want, it’s just more of a hassle.
Suffern ACE
@Violet:
I’m not going to say anything. But the addicts might have regular doctors more often than we’d like to think. The patients in the ER at the public hospital? Well, those folks need regular physicians. That’s probably why they are in the ER at the public hospital to begin with.
cckids
@Forum Transmitted Disease: Drug addiction was always an abstract thing for me before that. I was pretty libertarian about it – let em have what they want. Don’t know how I feel about that now. Addicts are the living dead. Yeah, it looks like the person you knew. It ain’t. And they never get better. They may get sober but they don’t recover, if you get my drift
Imani Gandy (ABL)
this is fucking stupid. what qualifies bloomberg to make these judgments? kerrrist.
Hob
@gvg: Either you didn’t read the article, which is talking about emergency rooms, or you have some funny ideas about emergency rooms. Yes, some doctors are “skeezy” and will write prescriptions for money on the side. But you can’t just walk into an ER and ask for a particular doctor who you know is corrupt. The concern in this case is that some docs are a soft touch, not that they’re doing it for pay.
And it’s a bullshit concern, because the need to alleviate pain is way more important than the need to make sure no addict ever gets an extra pill. I worked as an RN in public health services for 5 years and saw plenty of drug-seeking behavior– as well as plenty of people who had drug problems and legitimately needed drugs, and were often denied them by doctors who were worried about how it would look. And all I have to say to Bloomberg is FUCK YOU.
Gretchen
Of course this only applies to poor people, who aren’t really people. They’ve made sure that everybody who has enough money to go see a private doctor whenever they want will be fine. Outrageious.
Sly
Sheesh. Everybody knows that draconian measures in the name of drug control policy are ineffective against middle-class white people.
Cassidy
@Culture of Truth: That’s an interesting POV. One of the things that impressed me about the military was how quickly they adopted the attitude that substance abuse and mental illness were medical problems to be solved instead of a lack of personal discipline. That was a huge step and they go hand in hand. Back in the old days, consumption of alcohol was lauded and encouraged, but if you were known as that guy who had a bit too much or was caught doing anything else, you were not promoted or demoted. IN this day and age, if you speak up and say you have problem, before you get caught on a urinalysis or DUI, you will be afforded a very comprehensive recovery program and promotion points upon completion.
Violet
@Suffern ACE: Which was why I said those that don’t have doctors would have to be referred to a doctor at the hospital and the script would have to go through two hands–ER doc can prescribe only three, referred doc or GP can prescribe the rest. Or whatever. I understand that many patients at the ER are there because they have nowhere else to go.
When 2014 arrives and healthcare changes, we might see some shifts in how this all works. Or not.
handsmile
@Maude:
I see you and I (#51) agree on the crucial public/private and class dimensions to this latest decree from the Emperor. Who knew that so many NYC private hospital administrators were NRA members? And would’t you think that wrecking NYC’s public school system would sufficiently occupy Bloomberg?
Picking one small nit, though: New-York Presbyterian Hospital, not Bellevue, is now the preferred dispensary of bandages, leeches, and poultices for the 1%. It has an entire VIP wing (no joke). Recall that Hillary Clinton was just treated there.
SenyorDave
If Bloomberg has to go to an ER it should be written in his medical policy that it has to be a public hospital, so he can get the same degree of care as NY’s poorest citizens.
Sanctimonious Joe
Hey John,
It shouldn’t take more than a short train or bus ride (or several) to get to another hospital where you could get the painkillers you need.
Todd
Just this week, I threw away our household accumulation of overprescribed hydrocodone. See, we only take it a day or two, and then go “meh”. If you get 30 pills for each trip to the promptcare (there was my ribcage bruise from sledding, there was my infected puncture wound in my fingernail that came from an unfortunate stapler accident, a daughter’s sprained ankle, a daughter’s sprained hand), then you too can amass a collection of the damn things.
The problem is in the overprescription, which causes the habit to arise.
Judas Escargot, Bringer of Loaves and Fish Sandwiches
@RossinDetroit, Rational Subjectivist:
My wife’s a farmacy technician, so I get to hear the stories about ‘Seekers’ (within the contraintes of HIPPA, of course) on a near-daily basis. This is in a wealthy, almost-rural burb North of Boston (probably the ‘Whitest’ part of the State, and certainly the most conservative).
From what I’ve been told, it’s a split between unemployed/underemployed 20-somethings on MassHealth (mostly female) who somehow got in the habit during their teens, and older contractor-types on disability who inadvertently got addicted to a legitimate prescription for work-related pain at some point.
These people don’t get a lot of sympathy from the farmacists (for whatever reason, all the farmacists I know are Republican). If anything, the stories tend to be used as anecdotes about “Welfare Scumbags getting high off Obamacare” (direct quote).
(Not my intent to denigrate all farmacists here… Your dad’s views, of course, may differ).
ThatLeftTurnInABQ
@Cassidy:
This isn’t the first time I’ve heard a story like this suggesting that our military takes a very pragmatic, results-oriented approach to a problem that civilians can’t seem to get a grip on. Acknowledging the reality of and planning for the effects of Peak Oil and Global Warming come to mind as well.
Are these just accidental exceptions, or is there something in the military subculture that makes a pragmatic approach easier to pursue?
Maude
@Imani Gandy (ABL):
$
Tonal Crow
Bloomberg should be put on Medicaid, and barred (on pain of prison) from spending more than $1000 per year on uncovered medical expenses or accepting them in gift.
One good turn deserves another.
Hob
@Forum Transmitted Disease: The horrible, heartbreaking experience you had with that person doesn’t justify your dismissal of everyone with an addiction as “the living dead.” I’m not going to argue with you– you clearly don’t care what anyone here thinks of your inflammatory statements– but maybe you’d like to know that I have friends who used to be FAR gone and are now sober, and they’re wonderful, loving, fully alive people, so yes that can happen. You could say they’re not the same person they once were, but that’s not saying much; we all go through shit and are changed.
Punchy
Testing….
Forum Transmitted Disease
@aimai: Easy to say in the abstract. It gets a lot harder when one of them has been a friend, although I might make the argument that my former friend might be better off dead. I don’t know. It’s not like she is going to get any better.
I can’t bring myself to make that argument, but I can acknowledge it as a valid argument.
Maude
@handsmile:
I was talking about the ER at Bellevue. Their triage can’t be beat.
They are very good a diagnosis of strange medical issues.
Hob
@Violet: No offense but it sounds like you aren’t very familiar with hospitals. It’s not possible for an ER doc to just arrange for each patient to get primary care from some other doctor at the hospital. If you’re lucky, there may be a public clinic in your area that may be able to take over your care… but there’s no way in hell that that’s going to happen within three days.
Haydnseek
@catclub: Exactly. Calling Bloomberg’s potential policy suggestion “fascist” is a grave insult to millions of people who have suffered from the policies of real fascists. I’m sure they could tell you what fascism REALLY is. They are the survivors, of course. The dead have no voice, save for those who can tell their stories. Not trying to be a dick, just suggesting that we take care with the other f-word. C’mon Cole, step your game up…you’re better than this.
NonyNony
@ThatLeftTurnInABQ:
The military has a top-down authoritarian structure as well as a (fairly) well-defined goal that that structure is supposed to work towards. Both of these things make pragmatic approaches easier to implement – do a cost-benefit analysis, convince some top-level people that what you’re proposing is a good idea and it gets done.
Neither of those attributes are things that I would want to emulate outside the military.
Also – that kind of structure also makes it easy to implement really ridiculous boondogles because, well, all you have to do is a convincing cost-benefit analysis, convinces some top people that what your proposing is a good idea and it gets done. For examples, see the USAF (among others).
Cassidy
@ThatLeftTurnInABQ:
Yes, the first reason is simple: someone up high orders it, everyone complies.
But to dig deeper, at least from my experience with the Army, the Combat Arms Officers have gotten smarter. I’m going to dance around it, because I’m not sure exactly how to explain it. They read more. They seem to have a more liberal education. This doesn’t stop them from being conservative, but the education seems to be very broad. What that has lead to is that they’re smart enough to know they should listen to experts. That segues into military medicine being top notch. You’d be amazed at the level of education and professionalism military HCP’s have, but even more importantly, the vast amount of research they do. And, it’s easy to gather data. They create the surveys, have a captive audience, and then go to point 1 up top. It is unbelievable how much research our clinicians do. Almost everything that comes through the doors of a military hospital is categorized into someone’s research data, somewhere.
In the end, we have professional research conducted with good data by subject matter experts and then reccommendations are pushed out to decently educated people who are smart enough to know they should listen.
Maude
@handsmile:
Sorry, I had a reading fail.
Didn’t mean to shout you down.
I get what you mean and you are right.
waratah
Just when I decide I need something stronger for my lower back pain.
Violet
@Hob: That’s not how it works now. But things do not always stay the same. Hospitals have more requirements on hand washing and other things they require staff to do to avoid transmitting infection. Some of those are new just in the last five years. If you go back sixty years or 100 years, the procedures would be quite different.
If the law can be changed regarding pain medication, it can be changed to require referral to a secondary doctor or something like that. I understand that is not how it works now, but hospital procedures change. I also understand that requiring such a referral would be an additional burden on doctors and hospitals, but if it became required, it would end up just being part of the routine.
As I also said above, I am curious how the process will change once 2014 arrives and healthcare procedures and requirements change.
Forum Transmitted Disease
@cckids: Well, they don’t seek medical attention in the early stages. Or the late stages. My friend (and others I’ve seen go through this) don’t want help, or to get sober, or to stop, they just want more oxy/heroin/meth. They only go for help when circumstances (running out of money/running out of people to steal from/going to jail) force it.
Fuck if I know how to fix that. I don’t even know where you start.
@Hob: Good for you. I have not been so lucky. I know quite a few in recovery/sobriety. They get along. However, they are not “loving, fully alive people”, some not even after forty years, so I have doubts that such a degree of recovery happens for most folks, but I’m very, very glad that has happened for you.
D. Mason
@Haydnseek: The man has authoritarian ideas in his head, you can tell because they occasionally spill out of his mouth or onto paper. Just because our government system stops him from crushing poor/brown/different people under his jackboot on national TV doesn’t mean he wouldn’t love to do just that or that he doesn’t do so in private.
I think it honors people who suffered under fascists when “free” people stand up to budding authoritarianism. The first step to standing up to such a thing is calling it out. Shutting your mouth in the face of daily direct interference in peoples lives form the government is the grave insult from my POV, not just to those who have suffered under fascism, or just to those who have died fighting it after it took root but to the entire notion of freedom and democracy.
matt
I guess Bloomberg heard about this Pain Caucus and wanted to build some credibility in it.
scav
@Cassidy: Yes, by the bowels of Christ, let us not lose the fading memory that conservatives were not always anti- knowledge, science or expertise. They could even at one point, gasp! seem to cooperate in governing, when a majority or minority. Intelligent people could disagree. I sound like a toothless elder describing the lost golden age, back when you’ld call the phone company to get the correct time. Ah hell, I’m going to go gum some coffee or something — I’ve clearly lost it.
Maude
@D. Mason:
#102 This.
Darkrose
I’m kind of bitter about this at the moment. I have a prescription for Vicodin because Imitrex doesn’t work for me if I already have the migraine. It’s a last resort, because it not only makes me sleepy, it usually makes me throw up. I don’t like taking it, and so I last had a refill in early August. I have a new doctor, who apparently doesn’t believe in looking at existing records, so when I requested a refill last week, I got a call from Kaiser. As it happened, I was home with a pounding migraine. The call went something like this:
Me (picking up the phone): H’llo? /fumbles around for glasses.
Nurse: Yes, Doctor ________ would like to know why you’re taking narcotics.
Me: Huh? /comprehension slowly breaks through the fog of pain
Me (does not say): Because right now I’m in so much pain I’m considering buying a gun and shooting myself in the head, which even in California would be a fuckton easier than getting this fucking prescription filled you stupid bint!
Me: Umm….because I have migraines? Like, you know, right now? And Imitrex doesn’t work unless I take it before I see the aura, and so I’m IN A LOT OF PAIN. LIKE, RIGHT NOW.
Eventually, I find out that the doctor has deigned to approve the refill, with a note that it MUST LAST FOR 60 DAYS. Keep in mind that my medical history shows that I’ve been prescribed this stuff for several years, and I get it refilled every 4-8 months. Clearly, if I’m an addict I’m doing it wrong.
I appreciate that they do have to check, but the accusatory tone is what bugs me. Being pre-emptively accused of being a junkie trying to pull a fast one makes me that much less likely to actually go to the doctor for anything short of a debilitating injury.
Cassidy
@Darkrose: Have you tried Midrin?
For NYC people here, is it possible that he really thinks that he can correct these issues through gov’t regulation? I don’t think it’s so much altruism, but more a “if they won’t do what’s right for them, I’ll force them to” kind of thing.
Maude
@Darkrose:
I know what you are talking about. Being treated as a drug addict isn’t fun.
So sorry about your hear. I hope it eases.
Darkrose
@Cassidy: They don’t make it anymore, apparently. I used to take it, and it was great: I could just sleep it off.
Darkrose
@Maude: Thanks. I’m better today. It’s that horrible combination of hormones and sinus problems that seems to trigger the little guys with the hammers and blowtorches in my skull.
Haydnseek
@D. Mason: Really? He’s really crushing all those people with his jackboots on national TV? Or he would if he could, in private, where no one can see! Why don’t you just go ahead and call him a fascist and be done with it? You’re obviously up on the imagery. Once again, the real victims of fascism might differ with your take. I found the “daily direct interference in people’s lives from the government” statement interesting. That’s the most succinct definition of the concept of government by law and not men that I’ve ever seen. Well done!
Groty
Get used to it. A government official deciding how your doctor can treat you. Sorta like the death panels, er, I mean IPAB, will do with Obamacare.
Forum Transmitted Disease
@Darkrose: Kaiser’s freaking out about the issue. I had the same thing come up when I went for my flu thing last week.
Doc: So, which would you like, the Benzonatate pills or Robitussin AC?
Me: Well, I’m not sleeping and keeping my wife awake, so probably the AC, but whatever you think is best.
Doc: Why did you ask for the AC?
Me: Excuse me? You just asked me which one I’d prefer!
Doc: I’m giving you the tablets.
I declined both and went and got some regular Robitussin from the pharmacy. Benzonatate is really not good for you. But yeah, I definitely got the “wrong fucking answer” vibe off my doc, and that’s a little bit disconcerting when you’ve been baited into it. Kaiser goes through phases, though, hopefully they’ll pull their heads out of their asses on this one.
Forum Transmitted Disease
oh yeah, moderation. FYWP
Violet
@Darkrose: So sorry to hear about your terrible migraines. Have you tried a low carb and/or gluten-free diet? A doctor I visit has done quite a bit of research on the relationship of the intestinal tract (he’s a GI) and its control of hormones. He is sort of a “doctor of last resort” for people suffering with intestinal issues they can’t get treated elsewhere. He’s got patients who visit him from all over the world.
But anyway, his basic prescription to begin with is fairly simple. He’s got a strict diet he puts his patients on that cuts down on the fluctuations in the gut and thus keeps your hormones more balanced. He’s has success with migraine patients because, as you mentioned, migraines can be triggered when hormones get out of balance. There is more to the diet than just low carb or gluten free, but the basis of it is essentially wheat-free and then avoidance of things that contain tyramine.
May not work for you, but thought I’d mention it. Might be worth trying if you haven’t already. It’s a pain, but so is dealing with migraines. I hope you feel better!
Original Lee
@Ridnik Chrome: Can Bloomberg run for mayor again? If he’s mayor of NYC, at least he’s boxed up, not running around trying to be King of the USA. Or, horrifyingly, returning to the Bloomberg family company and trying out his fascist ideas on those poor employees. I think he must still have his finger in the pie, though, because I’ve heard that Bloomberg employees can be fired for posting things that are “too racy” on Facebook.
D. Mason
@Haydnseek: Sure, no problem. Fuck that heavy handed fascist mayor of New York Mike Bloomberg. His repugnance gives government hatchet men a bad name and the fact that he is a celebrated (in some circles) Democrat is not lost on me. He should be run out on a rail.
ETS: Yes I know he’s “Independent” now but some Dems still claim him was my point.
Citizen_X
@John Cole: @Forum Transmitted Disease:
Oh, for fuck’s sake. Ibelieve? And Jonah Goldberg “believes” that liberals are fascists.
Idiot authoritarian != fascist. Read your damn Niewert or Eco to find out what the term really means.
Maude
@Original Lee:
He’s out at the end of his term He already ran and won an extra term.
David Eoll
@ruemara: For the record, Obama is totally down with the War On Drugs. Just sayin’.
Hob
@Violet: “I also understand that requiring such a referral would be an additional burden on doctors and hospitals, but if it became required, it would end up just being part of the routine.”
You misunderstand me. I’m not saying it is physically impossible or in any way undesirable. We just don’t have anywhere near the public health infrastructure to make it happen, and you can’t make that materialize just by “requiring” it, any more than you can make this country put adequate resources into educating by saying “class sizes are now required to be less than 20.”
The PPACA will be helpful, but it won’t fix this. I continue to hope that eventually we’ll see massive political changes that will include a real public health system. Until then, policies like Bloomberg’s are totally irresponsible.
Haydnseek
@Citizen_X: Thank you. If been banging the same drum on this thread. I’m rather sensitive about the meaning of that word. People very near and dear to me experienced it first hand in that little dust-up in Eastern Europe starting in, oh, let me think… 1939 I believe it was. Sept. 1 if I’m not mistaken…When people equate the term “fascism” to soft drink cups, I get angry, but not to worry. People obviously have the right to use the word in any way they choose. I wouldn’t have it any other way.
Tata
One of my cats takes a kiddie version of a steroid every other day. I mix it into her food or whatever she’ll eat. Naturally, this means her prescription runs out pretty quickly. Recently, this happened:
Me: I called in a refill for my cat.
Assistant: You’ll have to speak with the pharmacist.
Me: Hey, what gives?
Pharmacist: It’s not time to refill.
Me: It is. The bottle’s empty.
Pharmacist: It’s too soon.
Me: It is not. This medicine is for a cat. I mix medicine into food. If she doesn’t eat it, we mix up more food.
Pharmacist: (Highly agitated) Does the doctor know you do this?
Me: Of course he does.
She turned her back to me and called the vet. About 10 minutes later, I had a bottle of medicine, but everyone now looks at me funny in the drugstore. Point being: the crazy is strong with these people.
Darkrose
@Forum Transmitted Disease: Ah, so it’s a thing with them. Okay, that’s a relief. I was wondering if maybe a new directive went out the first of the year.
MattR
@Original Lee:
Dude made sure all his employees have top of the line benefits. Lasik was covered for a while when it first came out. The company worked people hard, but they were well paid with bonuses tied into company performance and excellent benefits. It ended up the work I was doing did not interest me, but overall Bloomberg was probably the best employer I had.
PurpleGirl
@Hob: In the case of Elmhurst, it just might. When I first sought health care at the Adult Medical Primary Care clinic at Elmhurst, I was asked if I had insurance. They didn’t have open appointments for people without insurance. I was told to go to the ER and they would be able to get me the appointment I needed (actually at the Diagnostic Clinic). So I did. Please note that I received a prescription for two days of one drug to tide me over to the clinic visit. I was then handed over to the other clinic at Elmhurst for continuing care. If I use the pharmacy at Elmhurst, it will take at least 5 hours over one or two days to pick up my prescriptions — they are that busy.
It would be nice if Bloomberg stopped cutting hospitals staffs and they could take less time to do things like fill prescriptions. (Yes, he controls it as he says what percentage the budget cut will be that HHC has to live with.)
Amanda
Wonderful, another excuse to treat people who come to the ER in excruciating pain like drug addicted liars.
PurpleGirl
@Original Lee: He can’t run again for mayor. I don’t think he’ll return to active running of the company, though. His current stand-ins have done a good job of continuing his policies there.
He is more likely to become a loose-cannon philanthropist, sticking his nose into nonprofits he gives money.
MattR
@PurpleGirl: I have seen what Bloomberg considered his top 5 dream jobs about 15 years ago, either in his autobiography or online somewhere. Mayor of New York was on it. POTUS was not. Wish I could remember the other 4.
Agree that he won’t go back to the company. Would not be shocked if he focused his time and money on guns
Haydnseek
@PurpleGirl: Let me see if I have this right. He gives millions to a non-profit organization. But when he wants to know what’s going on with his money, he’s a “loose cannon,” sticking his nose where it doesn’t belong! Right. Got it.
PurpleGirl
@Haydnseek: No, right now he tends not to get into non-profit operations. He’s busy with the City. But I could see him wanting to be more involved in the operations of the non-profits he gives money to. The reason it would make him a loose cannon is that most non-profits know what they are doing, and are doing the best they can with the resources they have. They do not need someone (anyone) telling them how to change. I’ve seen that being done. (I worked for a non-profit for close to 16 years and a number of foundations/major donors did try to get too involved with our operations, even when we didn’t ask for their help.)
handsmile
@Maude:
Fortunately on these intertube threads, no one can hear you scream (or shout down). Nor in fact did I read that tone from your first reply to me. Happy to infer that Bellevue’s ER provided excellent service to you or a family member/friend. (also too it was never my intention to impugn that hospital’s longstanding reputation.)
Still gonna have to disagree with you about Breathless, though. :)
@scav:
“…by the bowels of Christ…”
Oh lordy, that’s tears-down-my-face funny! Maybe the most hilarious thing I’ve read all week. Many thanks! Hope you don’t mind, coz I’m definitely stealing that one! :)
Haydnseek
@PurpleGirl: I understand what you’re saying, and to a great extent I agree with you after having read your latest post. I was responding to the earlier one. You know far better than I that when you are asking for help, you’re really asking for money. Nothing wrong with that, but don’t be surprised to find out you’ve made a deal with the devil, so to speak. Also, too, there’s an enormous difference between requesting a detailed, accurate accounting of an organizations expenditures/activities and and telling them how to change. If I’m putting up the money, I have a right to the former, if not necessarily the latter. That’s all I’m saying.
MattR
@PurpleGirl: @Haydnseek: IMO, this is the reason that Bloomberg will end up creating his own non-profit rather than working through existing ones.
Ruckus
@WereBear:
Why don’t we do that?
The american/puritanical way. Never look for an answer that may actually fix a problem, just find a way to say no. It’s easier and removes responsibility for the real problem. It’s called kick the can. Short term answer, long term avoidance.
Ruckus
@Darkrose:
Isn’t that level of pain fun? That level that makes you have the thought that killing yourself might be the best recourse.
Have a friend with sickle cell and gets the same response when having an episode. Goes to the same hospital/dr whenever possible(is miles away and there are several on route – has insurance) to avoid hours/days like this.
I believe that part of the ACA is making inroads to electronic medical records. This makes it much easier for checking on addicts and more importantly non-addicts.
Chuck Butcher
So, you’d take this guy seriously about guns? Well then, here
Narcissus
It’s a good thing we have people like Bloomberg around to force us all to be good people*.
*For definitions of good people determined by Bloomberg.
Original Lee
@MattR: The benefits you describe are pretty good. I think he has boundary issues, though, based on talking to people I know who have worked there while he was there. His successors seem to be channeling him pretty well, too. The pantry stocked with “healthy” free food so nobody has to leave the building during the workday, the Big Brother social media policy, etc., are part of the price you pay for the great bennies, though. Not sure I would like that much panty-sniffing.
MJ
This is par for the course for a Mayor who sued the City Council in an effort to block a living wage law for service employees at companies that do business with the City b/c such policies reminded him of “Soviet communism”.
But, though it was okay to ban food donations to homeless shelters because the City is unable to monitor the sodium content of the donated food.
And encourage hospitals to hide baby formula behind locked doors in an effort to encourage (trick) new mothers into breast feeding. (See http://blogs.villagevoice.com/runninscared/2012/07/mike_bloombergs_12.php)
Bruce S
@John Cole:
And, of course, by that standard “Obama is a Socialist!”
Which is idiotic.
danielx
@WereBear:
Because the War On Drugs (and hippies and poor and brown people) functions as the rice bowl for a great many authoritarian assholes – local, state and federal law enforcement agents of every flavor, prosecutors, corrections departments (and companies, give it up for CCA!). Not to mention being a convenient device for pretextual searches, arrests, confiscation of assets, and – oh, yeah, almost forgot – eliminating the right to vote of a great many people, primarily black males. Coincidence, it is not.