#PriorAuthorization Should be Illegal

They harm patients and steal valuable resources for third-party profit. 

A recent example:

A patient needed an MRI. The physician spoke to @evicorehc @Aetna @MedicareGov to get #Precertification.

Dr. M called back for a “peer to peer” and approved the procedure.

A half-hour later the doctor was called by Vanessa V, who said “the peer to peer was for educational purposes only. The procedure was denied and, since it was a Medicare Advantage patient, no appeal was possible.”

The doctor then spoke with supervisor Christine H. at Evicore and she echoed the same. The doctor explained to Christine that she was practicing medicine without a license, harming the patient, and consuming valuable patient care resources.

The doctor demanded approval for the MRI and hung up. 

 #free2care #nomiddlemen #disintermediate #healthcare  #medicare

Personal Health is a Personal Responsibility to Enable National Health

By Paul Kempen, MD, PhD

It really amazes me as a physician and health care expert,  that while the government and general population EXPECT doctors, Nurses-yes ALL hospital employees down to the janitor (Health care workers=HCW)- to go to work  EVERY day to care for severely and clearly infected patients, the expectation that  the general population cannot even perform daily tasks in low risk environments seems severely misplaced. Being out of doors has of recent note, apparently even become “illegal”.  We have seen the country “closed for business” and production capabilities, lives and personal welfare, decimated. If all HCWs are able to work in clearly infected environments, why are citizens unable to protect themselves in low risk environments? Why are there not clear and effective educational and production mechanisms for ensuring regular daily living activities promoted in all media at this time? I have NEVER seen a public educational clip on HOW to correctly wear a mask-but  have repeatedly seen “experts” without and improperly wearing masks. Are factories and businesses still (really) unable to provide PPE and distancing between workers? WHY? If we can put a man on the moon……….we cannot provide education and PPE?

 Of course, the LACK of Personal Protective Equipment (PPE) has been the serious issue. Government/CDC/WHO “Expert Action” has been unable to address to date THE singular outstanding shortage of N95 masks and hand disinfectant, or provided ACCURATE and specific instruction/education on PERSONAL protective measures. Instead, concentrating on ventilator production (to TREAT disease) and “Testing” to identify infections remains “the answer”. In Medicine, we typically test to identify infection based on symptoms-as a healthy, negative tested individual is not protected by the test and can become infected by those providing tests to hundreds per hour!

The overwhelming mismanagement of the COVID-19 Crisis

By Paul Kempen, MD, PhD

We saw SARS and MERS as severe Corona infections in the past, and COVID19 is also known as SARS-2:

The 2002–2004 SARS outbreak was an epidemic involving severe acute respiratory syndrome (SARS) caused by SARS-CoV. The outbreak was first identified in Foshan, Guangdong, China in November 2002. Over 8,000 people from 29 different countries and territories were infected, and at least 774 died worldwide. We watched it in Torono, Canada, just across the border.

Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Most MERS patients developed severe respiratory illness with symptoms of fever, cough and shortness of breath. About 3 or 4 out of every 10 patients reported with MERS have died. Health officials first reported the disease in Saudi Arabia in September 2012.  https://www.cdc.gov/coronavirus/mers/about/index.html

The past epidemics didn’t kill enough Americans to create enough interest in solving the problem. The current SARS or COVID19 pandemic was first documented on January 10, 2020, while the name itself identifies the pandemic as starting in 2019. We are now 3 months INTO the epidemic, with an anticipated death rate of 5% and are still only reacting! Instead of closing down the country, we should have been ramping up industry to provide for THIS EXPECTED pandemic and providing the PPE, drugs material and manpower. The current plan to “self-quarantine” serves only to spread out the ultimate number of infections over time,  to allow the available facilities to be able to “cope” with the expected severe infections. But please remember, that the USA has been reducing total numbers of hospital beds and closing hospitals for decades. It will also remain to be seen if this COVID19 pandemic will equal or exceed the deaths from those yearly Flu season’s infections (epidemics) which KILL 30-60 THOUSAND each year in the USA.

Oddly enough, we never have seen this sort of  PPE response to the flu in  spite of the significant mortality-so why are we treating COVID19 as if it were EBOLA, when it is a respiratory infection just like the FLU? Or will we now be responding to flu seasons like the Covid-shutting down the country, especially if the flu actually kills more people than the covid virus? Why are nurses suddenly utilizing PPE with such high level of protection, exceeding that required for flu season? Why are we seeing nurses crying on TV that “they never signed up for this”. “This” comes EVERY YEAR! The vast majority of flu and COVID patients do NOT die, as many have minimal or no symptoms, especially the young and healthy. Yes, be safe, but in which “War” did this country shut down the industries? Most workers in industry are easily 6 feet from each other.

The LAST place anyone should be going now-if they are healthy, is to a HOSPITAL -why join the infected if YOU are not-stay home!!! All this wasted “news” on testing has been counter-productive. A Test does not save anyone, it does not insure citizens are not infective for a number of reasons-more importantly, you could BECOME infected getting the test in a hospital. Getting yourself tested in your car from a person who is reaching into test hundreds of patients an hour is not someone I want to encounter as they may be infected. Why risk to “see” if I am infected driving up and opening my mouth and possibly GETTING the virus (my test will be negative and I will be positive a day later).  The emphasis on daily declarations of the total number of “cases” rather than DEATHS serves to maintain the hysteria in the population, facilitating and exploiting the fear, to force all citizens to comply with whatever the “Current recommendation” is issued,  being true or false. Testing only provides access for numerators and denominators in the tracking of epidemiology-but this is also an effective way to scare the populace into “following orders”. No person without symptoms needs testing as a matter of acute care. The overwhelming of facilities with hysterical people wanting testing and treatment for “possible” (not probable or symptomatic disease) is counterproductive, helping to spread the disease and tying up those health care workers and facilities need to care for the sick.

The CDC has failed us by stating “civilians should not wear masks”, and should be reversing this statement soon,  because it is WRONG. If it is useful to doctors and nurses, why would it not be true for citizens out in public? Sure, the statement was a political based decision and NOT a doctor-patient decision. The CDC wanted to conserve PPE. Sure, the epidemiologists also have “recommended” for decades to change your face mask after EVERY use before the Covid hit (i.e. every time you leave the operating room)-but no one does this in real life because THAT too is wasteful and excessive. Now we are reusing and prolonged using of PPE because of a shortage, which after 3 months since the first warning, should NOT have occurred.

We as health care professionals-Doctors KNOW what masks do and this is important and is NOT being disseminated via the news. Surgical masks contain YOUR secretions during normal operations from falling into the wound. N95 masks are not the same and prevent other’s aerosol infections from being transmitted to you! A Mask is NOT “a mask”. There are different types, uses and functions. Hand made cloth masks are NOT N95 and protect those around you from your secretions but do not reliably protect you from theirs. Everyone should be wearing surgical masks in public, and “high risk” civilians should have N95 if they NEED to leave their homes to go to the doctor or grocery store. People should not need to reuse masks, but they could be disinfected with rubbing alcohol 70% in a plastic bag overnight and air dried (or even baked at 200 degrees) prior to reuse.

I have YET to see any information on the “NEWS” to explain the use of masks to the public to date. Yet, every hospital health care worker must comply with OSHA guidelines and submit to an “N95 Fitting session” to LEARN how to use this type of “duckbill” N95 mask for PPE!  Because of the misinformation presented on the “daily news” it is high time for these issues to be presented. It is high time for EVERY person appearing on TV to WEAR a surgical mask, whenever there are more than 2 people present! We need the RIGHT messaging sent out to the population and the right example projected!

I have personally Worked on the USNS Comfort twice during missions to South America, once after the Haiti earthquake. ALL patients were screened for Tuberculosis-a  severe respiratory infection- to insure no one with TB was brought onto the ship, because of the danger of widespread infection once on board. The current presence and use of these warship hospitals appear to me to be primarily one of “reassurance” or some political statement in this pre-election period. In this PANdemic however, the likelihood that COVID patients will NOT become apparent onboard-even if they bring only “non-covid tested patients onboard to “relieve landside facilities” is highly unlikely.,  After the 800 workers and first 800 patients are brought onboard, the infection may become apparent after days.  Testing is not able to exclude latent infection and the COVID is extremely infectious-especially if the patients are coming from a high risk zone=i.e. a HOSPITAL. The size of patient bays on those ships is small, the ventilation is “common” and cross infection will be a given, after the first Covid infection manifests onboard. Our experience with quarantine on cruise ships and COVID is,  well…….. nobody is going on a cruise until Covid is over! The resources (personnel and materials) of these two hospital ships would be better placed landside, in a converted mall or convention center with adequate space and ventilation. The shortage is one of material and personnel-NOT floating sardine cans,  which are known to be at risk for dissemination of respiratory infections. These military health care workers should be used landside in this “War on Covid”. We need an army and not a navy today.

The government has made many decisions to allow “compassionate care” approval of drugs. It has been STANDARD PRACTICE to allow doctors to prescribe medicine for “off label” use-prescription for  conditions other than those formally studied and allowed to be advertised under FDA “labeled” guidelines. Almost ALL use of drugs in children was initiated as “off label” for decades. IN the face of an epidemic, the use of hydroxychloroquine had been curtailed and in spite of information from as early as 2004,  suggesting effectiveness in slowing viral reproduction in SARS as a treatment and therapy. Of course the scientists at the CDC “want further study”………….but people are DYING NOW. But the political agenda is to now build thousands of ventilators, instead of releasing drugs. The drugs are quickly and easily marketed, are very low risk in the young and healthy, but alias, as generics these drugs were unlikely to find the financial incentives noted with complex machine products. They may well be able to specifically prevent and treat the disease,  as opposed to fight the symptoms of disease (with ventilators). SARS is not new-it has been there for study for over a DECADE. The lessons of the flu season (epidemics) EVERY YEAR are the same as COVID. Are we learning or even asking these questions? Why not?

Many questions remain in this War and cannot be answered until addressed, unlike most of the preceding matters discussed. Because the young, healthy population is resistant to severe symptoms, should they be restricted from service in this war? Should the elderly and infirm?  Should ALL TV persons be WEARING MASKS to promote the “war effort”? When will educational, instead of hysterical “news” be screened to teach the population what is TRUE and effective? Why are the drugs not in high priority production and dissemination for prescription by physicians to PATIENTS who desire them?

COVID19 is a form of virus (Corona), one which usually causes about 20% of the yearly common colds.  We have not developed testing or immunization for corona virus in the past BECAUSE it is benign. Are children and non-geriatric people less affected, because of their yearly exposures to the similar, yet innocuous corona virus? We know that immunizations for Smallpox, polio and other viral disease prevented these serious diseases by inoculations of similar and less deadly live virus. Infections are typically one pathogen and competition with others may reduce pathogen’s  disease-we know eugenic bacteria exist in the bowel and if destroyed by antibiotics, allow pathogens to become deadly there.  Should we be passing out “Common cold virus” now to compete and possibly prevent severe COVID? Can it “compete” in cell cultures or animals/humans? Should we stop publishing daily “Corvid cases” on the news channels-sticking to deaths and promulgation of useful information like safe and correct mask use for all?

It is time for medical and not political decision making. We should be anticipating needs for now AND the next decade, and not be awaiting each crisis.

Pau Kempen, MD, PhD

213 Vista Dr
Weirton, WV 26062

412 860 6827

“Gee, Jim, I wish I would have run for congress after graduating high school like you! I could have saved myself 12 years of grinding medical education to become an expert in health care like you and your many colleagues in congress!”                                                       From a late night joke on TV

Head of China CDC: 

“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact.”

https://www.sciencemag.org/news/2020/03/not-wearing-masks-protect-against-coronavirus-big-mistake-top-chinese-scientist-says

A physician in Michigan sent this to me last night. 

And separately these Korean modelers concluded that these strategies were working:

“To early end of the COVID-19 epidemic, efforts to reduce the spread of the virus such as social distancing and mask wearing are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through efforts by the quarantine authorities.”

https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2020011

“Estimating the reproductive number and the outbreak size of Novel Coronavirus disease (COVID-19) using mathematical model in Republic of Korea

Sunhwa Choi Choi  , Moran Ki ,  Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea, Goyang, Korea

COVID-19 Mortality Statistics

By Kelly Victory, M.D., President, Victory Health, LLC.

Like essentially every American with a pulse, I have spent countless hours over the past weeks listening to both politicians and “experts” reporting the “data” and “statistics” on COVID19. Most people now appreciate that testing has been spotty at best and fraught with false negatives, and that therefore, we have likely woefully under-estimate the true number of cases of the virus. 

That said, one of the numbers most frequently reported (daily) — and the one piece of data most commonly cited as a veritable certainty — is the number of deaths from COVID. Well here’s the sobering reality: The numbers being reported by the CDC are wrong. In fact, they are very, very wrong – and here’s why:

We now know that the vast majority (likely greater than 80%) of individuals who contract COVID-19 have minimal if any symptoms. A small percentage (perhaps 5%) go on to have severe illness and may ultimately require supplemental oxygen and/or hospitalization.  Physicians — including the CDC’s own Dr. Anthony Fauci — agree that if and when death occurs as a result of COVID-19, it happens due to “overwhelming cytokine storm and resulting pneumonia and/or ARDS.” In layman‘s terms, people who die from COVID-19 die from pneumonia or from Acute Respiratory Distress Syndrome (ARDS) which is a “pneumonia equivalent“.

In doing a deep dive analysis of the data on the CDC website, I found that only 40% of the patients who have reportedly died of COVID19 actually had evidence of pneumonia. Hmmm.  Only 40%! So, what was the actual cause of death in the majority — the other 60%?? Presumably, it was complications from underlying medical conditions including diabetes, cardiovascular disease, cancer, infection unrelated to COVID19, etc. — In other words, not from COVID-19 at all!

Furthermore, buried in the fine print, I found that in order to be reported as a “death from COVID19”, the patient need not have actually tested positive for the virus; they only needed to have “clinical signs and symptoms consistent with COVID19”. For those who haven’t been bludgeoned with the non-stop public service announcements on the topic, that means fever, cough, headaches, body aches and possibly shortness of breath — symptoms remarkably similar to Influenza and a number of other viral illnesses. 

Given that the “experts” —and the politicians relying heavily on their advice — are making potentially life-altering decisions based on the “growing number of deaths from this virus”, Americans deserve to know what those numbers actually are. Therefore, any patient whose death is being attributed to COVID19 should be required to have documented evidence of both pneumonia and a positive test for COVID19. Anything less represents a continued gross mis-representation of the facts.

https://pjmedia.com/trending/no-the-united-states-does-not-lead-the-world-in-coronavirus-cases-or-deaths/

PETITION: Tell NJ Governor to Rescind Order Blocking Patient Access to Hydroxychloroquine (609) 292-6000

NEW ACTION ITEM: Sign the petition to NJ Governor Murphy to repeal his prohibition of physician prescriptions for patients impacted by the #COVID19 #Coronavirus #Pandemic.

https://www.change.org/p/phil-murphy-covid-19-nj-gov-murphy-cease-your-prohibition-of-physician-prescriptions

After you sign the petition: Call New Jersey’s governor Murphy (609) 292-6000 to rescind his rule restricting early treatment of COVID-19 coronavirus patients. His rule is dangerous and likely would make people sicker and worsen the death toll. Call him, email or web page contact him and demand he reverse his rule. Let doctors be doctors.

Email: constituent.relations@nj.gov

https://www.nj.gov/governor/contact/

Join the physicians who are speaking out! The below letter from physicians explains the urgency for this request.

---

Doctor’s Letter to Governor

Dear Governor Murphy,

Based on the current circumstances of an extremely contagious deadly COVID19 virus that is creating chaos in our state and the world, your order to restrict physicians from writing prescriptions to treat their patients with Hydroxychloroquine (HCQ), we believe, is contrary to the best practices of medical care. We, as perhaps you, believe in the sanctity of the patient-physician relationship in personalized individual management and care, and that it must lie in the knowledge and wisdom between those two entities and not artificially imposed by others.

Your administration’s order of restriction to use HCQ, prevents patients’ access to a potential life-saving medicine, especially when administered in the early phase of the disease. (1) Creating such a mandate may risk the lives of many New Jersey residents.

Timely access to these medications may mean the difference between life or death for patients facing the battle of their lives. We respectfully suggest that working with New Jersey’s robust pharmaceutical industry to increase the supply of these drugs, both for NJ and the rest of America would benefit the residents of New Jersey and across the country.

Early treatment is crucial for keeping patients out of the hospital and off ventilators. Delaying treatment results in the opposite, more sick patients ending up in overburdened facilities.
HCQ prevents the virus from gaining access to the human cell and in doing so it prevents the infection. Additionally, in those patients who already have infection in their system, HCQ prevents access to the cellular structure called Endoplasmic Reticulum where it replicates. Preventing such replication, reduces the viral load and hence allows the human immune system to fight off the infection. Without this drug, many valuable human lives will be cut short with such an order as proposed and promulgated by your administration. (2)

Other State Governors of Nevada and Michigan formulated similar mechanisms of restrictions to the use of Hydroxychloroquine but seeing the burgeoning loss of life quickly reversed course. If restriction is to prevent hoarding of the medication, then perhaps using the Texas model of limiting the drug dosing for 10 days (20 pills) might be more appropriate. It prevents harm to our vulnerable, sick and infirmed patients. (3)

HCQ has many decades of history as used in the care of patients with Malaria and Rheumatoid Arthritis. Knowing its very low toxicity and it poses very little if any threat to the patient, clinicians in New York, Kansas, elsewhere are reportedly preventing deaths and ARDS/ventilator dependent long ICU stays. Waiting for placebo-controlled trials is not a wartime battlefield strategy, given the urgency of treatment.

As physicians it is our duty to treat patients with the best available therapy and available evidence to circumvent disease at its earliest phase, so as to prevent the loss of life and any future morbidity. It is with that wisdom and acquired knowledge that we respectfully ask you to reconsider this restrictive mandate.

That these drugs are effective against COVID-19 has been proven in laboratory experiments. (4) And now evidence is mounting that these drugs are working to decrease viral load in patients. Decreased viral loads means patients not only avoid the hospital but are less infectious to others.(1) There is growing evidence that early administration even in mild cases of COVID-19 prevents progression to worse disease, likely attenuating the need for ventilators and ICU beds and improves symptoms. (5) This will decrease the burden on the healthcare system and upon the doctors and nurses that bear the ultimately responsibility of the patient’s care.

The information available from across the world suggests that the prudent course of action is not to put hurdles in the path of patient care by restricting most valuable medications that can protect a human life. In fact, India is officially recommending health care professionals and family members of sick patients prophylactically take HCQ. (6) The New York Times reports of a recent study: “Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug.” (7)

We respectfully ask that you review this decision, given the influence of such overwhelming evidence to the contrary. It is with great respect and urgency that we ask you to reconsider this decision that can potentially cause a significant loss of life in the state of New Jersey. Each patient care decision is unique to an individual and their own personal situation and value system. Patients and their physicians must carefully weigh the risks and benefits of every potential intervention. The confidential patient-physician relationship must be held sacrosanct for this purpose.

Best health,

Craig M. Wax DO, Family Medicine
Parvez Dara, MD, Hematology/Oncology
Jim Thomas, MD, Interventional Radiology
Theresa Thomas, MD
Joeseph J. Fallon, Jr., MD, Endocrinology
Carl J. Minniti Jr., MD Medical Oncology & Hematology
Charles Dietzek, DO Vascular Surgery
Indrani Sen Hightower, MD, Neurology
Alieta Eck, MD, Family Medicine
Kelly Victory, MD, Trauma and Emergency Medicine,
Disaster Preparedness and Response
Christine Saba, MD, Pediatrics
Kim Legg Corba, DO, Family Medicine
Marion Mass, MD, Pediatrics
Katerina Lindley, DO, Family Medicine
Theresa Thomas, MD, Internal Medicine
Thomas W Kendall, MD
Family Medicine
Robert Campbell MD
Anesthesiology
Pain Management
Jane Hughes, MD, Ophthalmology
Kris Held, MD, Ophthalmology
Michael J. A. Robb, M.D., Oto-Neurology

Marilyn M. Singleton, MD, Anesthesiology

Kenneth A. Fisher, M.D. Nephrologist

Marlene J. Wust-Smith, M.D., Pediatrician

Leah Huston, MD, Emergency Medicine

Karladine Graves, DO, Family Medicine

Elaina George, MD, Ear Nose Throat

Scott Stevens, MD, Ophthalmology

N. Lois Adams, B. Pharm, MBA, CRPh

Joel L. Strom, D.D.S.,M.S., General Dentistry
Independent Physicians for Patient Independence

References:

1. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
2. COVID-19 Drug Therapy – Potential Options
3. Gov. Whitner reverses course on coronavirus drugs
4. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro
5. Efficacy of hydroxychloroquine in patients with COVID-19
6. Recommendation for empiric use of hydroxy-chloroquine for prophylaxis of SARS-CoV-2 infection
7. Malaria Drug Helps Virus Patients Improve, in Small Study

https://www.senatenj.com/index.php/pennacchio/growing-number-of-doctors-agree-with-senator-pennacchio/47292