Governor LePage vetoes Narcan bill against best practices evidence

Since when did somebody appoint Governor LePage as the director of who lives post drug overdoses? Obviously, the Governor's concern about Maine's opioid addiction epidemic doesn't include saving the lives of the hundreds of young people who could be saved from death, if Narcan were more accessible. Thank you Senator Angus King for caring about victims of overdose, and their families, by supporting greater availability. Unfortunately, Governor LePage doesn't even consider the municipal cost of responding to opioid related calls, because Narcan could reduce the volume of calls and, thereby, make EMS more available to help at other incidents.

Access to over the counter Narcan can reduce municipal emergency transport  costs

If anybody suggests that political leadership "doesn't much matter', there couldn't be more evidence to disprove that misstatement than the leadership of Governor Paul LePage. In spite of best practises supported medical experts, Governor LePage has proclaimed himself the ultimate authority about the life saving intervention provided to victims of drug overdose with his veto pen- again!

AUGUSTA, Maine —Gov. Paul LePage of Maine has vetoed a bill that would have provided Mainers with the drug naloxone without a prescription. Naloxone, sold under the brand name Narcan, can reverse the effects of opioid overdose. Many Maine police and fire departments carry the drug.

The governor vetoed the bill Wednesday.

“Naloxone does not truly save lives; (OMG!) it merely extends them until the next overdose,” LePage wrote in his letter to the Legislature. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

Overdoses claimed the lives of more than 200 Mainers last year alone.

Health care professionals said the antidote is cheap, easy to administer and has no negative side effects.

Assistant Majority Leader Sara Gideon, D-Freeport, sponsored the bill.

“If we have the chance to save even one life, we must seize it,” Gideon said. “Putting this proven life-saving medication into more hands will save lives and spare families the unthinkable loss of a loved one to a preventable overdose.”

Hopefully the Maine Legislature will override the Governor's ill informed veto

NARCAN (naloxone) is indicated for the complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids, including propoxyphene, methadone and certain mixed agonist-antagonist analgesics: nalbuphine, pentazocine, butorphanol, and cyclazocine. NARCAN (naloxone) is also indicated for diagnosis of suspected or known acute opioid overdosage.

In fact, the Maine Legislature will reconvene next week to take up any bill the governor vetoed. Hoping the Governor's veto will, like dozens of previous ones, be over-ridden.

Sen. Angus King, I-Maine, wrote a letter to CVS earlier this year, asking the company to make the drug available over the counter in Maine, as it has done in 16 other states.A helpful on line resource for Narcan use to prevent overdose morbidity, and mortality and to prevent further incidents is at the link here.

Illinois has information posted on a Good Samaritan Overdose law posted here.

Ebola is an infectious disease: American health care workers are front line experts

Although the etiology of the Ebola virus and longitudinal studies about the disease are ongoing, one aspect of treatment for the disease includes isolation of victims and strict infection control procedures to prevent the spread. America's health care workers are well trained to respond to an individual who presents with an infectious disease. Indeed, infection control procedures are included in all hospital personnel orientations, even among clerical staffs. Nevertheless, America's health care systems are not totally prepared to handle an epidemic of Ebola. One of the biggest problems isn't related to the causation of the disease, at all. Rather, the problem is ethical. Who will receive the most effective treatments?  Even worse, who will receive transport to a hospital for treatment?

America's health care workers are as much at risk for contracting Ebola as those who work with victims in developing countries in Africa. Most at risk are the emergency responders, who are likely the first ones called when a person becomes incapacitated by critical illness, like Ebola. Emergency providers are likely most at risk for being exposed to an Ebola outbreak, should one occur. 

Yet, there are a very limited number of ambulances available for transporting patients to a hospital or emergency treatment facility during an infectious disease outbreak, like Ebola.  

Transporting an Ebola patient puts the ambulance out of service until it's completely bathed in a chlorine disinfecting solution - twice. There are only a few transports any emergency medical transport will be able to accommodate, given the risk of Ebola exposure to the EMS responders. An additional risk of exposure includes the people cleaning the ambulance and equipment, following the transports.  

Therefore, when US public health officials are speaking confidently on national media about how Ebola will be managed, they're speaking about the disease process. They're not addressing the systems crises that will erupt as a result of the disease spreading. 

There's justifiable confidence in America's ability to respond to an isolated Ebola outbreak. Of course, the treatment of the victims will be expensive because of the intensity of the treatment of the isolated patient and the follow up "contact tracing" of those who are exposed.

It was just a matter of time before Ebola showed up in the USA. Indeed, it seems like our US health care system may have been victims of the "someplace else" delusion, like it would never happen to them. Now, it's here.  

The "someplace else" syndrome will be debunked. Health care systems will certainly pull out those pandemic policies from the years when H1N1 "bird flu" was supposed to cause a worldwide pandemic.

Meanwhile, in my opinion, the Ebola patient who traveled from Liberia to Texas before he exhibited symptoms of the illness, simply can't be an isolated incident. Not knowing who else may present as a result of the 21 day incubation time of the virus is, frankly, more dangerous than the disease itself.  

Health care workers can isolate, and treat the Ebola patient, and clean the transport and treatment equipment. 

What we can't do is predict who might be carrying the virus and where they might be located.  Therefore, the health care community isn't prepared to respond to an Ebola outbreak of more than a few people, unless a great deal of money is made available to pay for the training for a response to the disease. 

As with all infectious diseases, the most important response is prevention.  

Hand washing is the first line of defense for all infectious  diseases and more important than ever to help prevent Ebola.

America's health care providers are experts at handling infectious diseases and practicing infection control procedures. Nevertheless, the care givers and first responders are not systems analysts. 

In my opinion, our our US health care and emergency responder "systems" are not prepared to respond to an infectious Ebola outbreak.

Romney Wrong on Emergency Medical Services and Health Care- Bill Kristol Acknowledges President Obama Inherited Financial Disaster

Two take-aways from the weekend presidential campaign news cycle- (a) Conservative Bill Kristol says President Obama really did inherit a financial disaster and (b) Governor Romney told Scott Pelley how emergency medical services is the safety net for acute medical care.  

Dear Governor Romney, Emergency Medical Services is expensive!  Don't expect EMS to be the safety net for acute care when you intend to revise Medicare and Medicaid- because EMS, as we know it, won't be there at the end of your reforms.

Governor Romney wrongly spoke on 60Minutes with Scott Pelley about how reforming Medicare can save it.  Why fix something that's not broken?  

Medicare is a health insurance policy, many experts are available to recommend actuarial adjustments to the system.  Moreover, don't expect emergency medical services to pick up the pieces when the health care system won't be able to handle the capacity of an aging population if capped health care reimbursement becomes a barrier to health care.

Reforming Medicare does not mean that Emergency Medical Services will be availabe to transport people who need access to acute care.  Among the many mis-statements Romney made on 60 Minutes, he should be held accountable for leaping to the assumption that emergency medical services will be the safety net between sick senior citizens, poor people and death.

Not only is EMS not the right medical care for critical care but the Governor wants to reform Medicare and Medicaid- a source of reimbursement for EMS!  In fact, there won't be any EMS available if senior citizens and poor people must pay for transport with vouchers. EMS is not bundled into any payment system that I know of, so any reform of Medicare or Medicaid will likely exclude emergency care, unless it's trauma related.  I sincerely hope EMS providers get involved in educating their communities about how wrong minded it is for the safety net to acute care services to be supported by emergency medical services- it's expensive, it's not preventive, it's not what emergency medical services providers are trained to do. Assuming EMS will be there as the point of access to acute care, this will require insurance companies to guarantee payment- including Medicare and Medicaid.  It's important for media to point out how wrong Romney was on answering this question.

  

http://www.huffingtonpost.com/2012/09/23/mitt-romney-60-minutes-health-care_n_1908129.html

WASHINGTON -- Downplaying the need for the government to ensure that every person has health insurance, Mitt Romney on Sunday suggested that emergency room care suffices as a substitute for the uninsured. "Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

http://thinkprogress.org/election/2012/09/23/894341/bill-kristol-obama-has-turned-around-the-financial-meltdown-pretty-well/

On the political front, the weekend news shows were loaded with skeptics with advice for Governor Romney- including conservative pundit Bill Kristol, editor of the Weekly Standard.

Republican Bill Kristol admits President Obama turned around the financial meltdown of former President Bush "pretty well".

Weekly Standard editor Bill Kristol says that Republican presidential nominee Mitt Romney is going to have a tough time winning if the election is a referendum on President Barack Obama’s first term. “If this election is just about the last four years, that’s a muddy verdict." The conservative columnist told Fox News host Chris Wallace on Sunday "Bush was president during the financial meltdown, the Obama team has turned that around pretty well,” he explained.

Romney was aggressive on the 60-Minutes interview, but his responses were loaded with huge assumptions that sounded like schemes he concocted to win the presidential election.  

Perhaps the most telling remark Romney gave on the Pelley interview was when he admitted it was his decision to speak about 47 percent of Americans as being "victims".  

http://www.cbsnews.com/8301-18560_162-57518495/campaign-2012-obama-vs-romney/?pageNum=6&tag=contentMain;contentBody

Romney: That's not...that's not the campaign. That was me, right? I-- that's not a campaign.  Pelley: You are the campaign--
Romney: I've got a very effective campaign. It's doing a very good job. But not everything I say is elegant. And I want to make it very clear, I want to help 100 percent of the American people.

So, the bottom line is that Romney knows he is the campaign and his response to Pelley about his leadership is the only true comment the Governor can stand behind.  Yes, he is the campaign and it's not going well.  There's no reason to believe his leadership as a President would be any different.