Diagnosis For 8.9.22: Checking The Pulse Of Florida Health Care News And Policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

There’s a fresh effort to legalize recreational marijuana jump-started with help of one of the state’s dominant medical marijuana companies, joined by country music duo The Bellamy Brothers.

A new political committee, Smart & Safe Florida, has drawn up a proposed citizen initiative that would allow adults 21 and older to possess and purchase marijuana.

“More than 140 million Americans already have the freedom to partake in responsible cannabis use and it is past time for Florida to provide its law-abiding adults the same privilege,” Howard and David Bellamy said in a video announcing the push to make the ballot.

If organizers can gather nearly 900,000 signatures from registered voters, as well as get clearance from the Florida Supreme Court, the citizen initiative would be on the 2024 ballot which is also a presidential election year. But it would also require 60% of voters to say yes for the proposal to become law.

Trulieve, which operates in 11 states including Florida, plans to help bankroll the campaign with a $5 million contribution. The Bellamy Brothers have previously partnered with Trulieve to produce of cannabis products.

In 2016, Florida voters overwhelmingly approved the use of medical marijuana; however, recent attempts to ask voters to approve recreational marijuana floundered due to the state Supreme Court. The high court last year rejected two proposed constitutional amendments by maintaining that the wording of the proposals was misleading to voters, including that one proposal did not make it clear that marijuana would remain illegal under federal law.

The proposed amendment would allow adults to smoke or ingest marijuana, but it would not allow individuals to possess more than 1 ounce of marijuana. It does not.

To watch the announcement video, click on the image below:

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Baby got back

A state medical board wants to require physicians to use ultrasound equipment while performing Brazilian butt lifts and limit the number of procedures Florida-licensed physicians can perform a day to make the procedure safer for patients, who are mostly women.

But some plastic surgeons say the new rule could make the procedure riskier, not safer, contending the Board of Medicine should not limit the number of procedures a surgeon can perform daily.

The Board of Medicine Rules Committee agreed at its meeting in Ft. Lauderdale last week to move ahead with the new rule. The board wants the rule in effect before a similar emergency rule expires in September.

The 90-day emergency rule limits the number of procedures that can be performed daily to three, it also requires the use of ultrasound. But the emergency rule stops there. The permanent rule the state medical board is considering would also require the so-called “surgeon of record” to perform the entire procedure.

Board staff is working on the language and a copy wasn’t available at the Rules Committee meeting.

But Stephen Menton, an attorney representing Surgeons for Safety, said it could be problematic because physician extenders are commonly used in surgical procedures regardless of the setting. But the board could pursue a rule that makes clear that only the surgeon of record can inject the fat.

After newspaper reports highlighted the substantial number of deaths occurring in Florida from Brazilian butt lifts, the Florida Board of Medicine passed a rule in 2019 stating that doctors could no longer inject fat into the muscle.

In addition to new rules, the Florida Legislature passed a law later that year requiring the Board of Medicine to better regulate and discipline doctors when patients die.

The board moved ahead with an emergency rule earlier this year after learning that there were more deaths from Brazilian Butt lifts in 2020.

In comments submitted to the board Surgeons for Safety said to improve safety the board should propose a rule that prevents a surgeon from having more than one patient under anesthesia at the same time. Additionally, the group said the board should appoint a task force that’s charged with making recommendations to the board or legislature about educational materials and training physicians should have. Lastly, the organization recommended that the committee also should perform an analysis of the benefits of drawbacks of using ultrasound as part of the procedure.

In its written comments Surgeons for Safety also maintained that requiring an ultrasound may be unsafe because surgeons weren’t trained to use it while performing the procedure. “The introduction of an ultrasound requirement without proper education, training and appropriate technology takes away one of the surgeon’s hands, forces the surgeon to take eyes off the patient to monitor a screen, and interrupts the cadence of the surgery,” the written comments state.

In pushing for limits on how patients could be placed under general anesthesia at one time the group argued that the rule could be enforced by unannounced spot inspections.

“Now you have a rule that hits the nail on the head,” he said.

Board Rule No 2

The BBL rule isn’t the only new regulation the board is pursuing.

Members of the BOM voted to move ahead with rule-making that would set up a Florida-specific standard of care for gender-affirming care.

Pushed by Gov. Ron DeSantis’ administration, State Surgeon General Joseph Ladapo attended the Ft. Lauderdale Board of Medicine to discuss the need for the proposal.

Ladapo’s recommendations are “aligned with the truth,” he told reporters.

“By truth I mean truth in science, in terms of what we actually know versus what people want to happen,” Ladapo said stressing that he maintains there’s no science that supports the efficacy of the treatment.

Ladapo continued by telling reporters hormonal clockers and surgeries are “really a distraction.”

“A distraction away from more effective therapies for individuals dealing with this. And part of that is absolutely emotion, mental spiritual counseling. That is a part of that turns out to be part of the treatment for many conditions that we all suffer from. But sometimes for whatever reason things that sorta are more effective and less glamorous … just kinda take a back seat to more radical treatments,” he said.

When asked later for the science showing that therapy was the proper route Ladapo said: “Basically all of us could benefit from emotional, mental, physical and spiritual therapy. I mean that’s just a fact. That’s just a general truth. in terms of this specific condition, those types of therapies before the introduction of these hormonal therapies, these surgical remedies were recommended. And there’s evidence those are beneficial.”

He said that his review of the data shows the incidence of trauma is high in people with gender dysphoria. “Who’s experienced childhood trauma who would not benefit from therapy?”

Board Rule No. 3?

As the Board of Medicine considers changes to BBL rules, it is also asked to consider defining the difference in rules between physicians’ offices — where surgeries are located and ambulatory surgical centers (ASCs).

The board heard from managers that there are times they walk into physician’s offices which have more than a dozen rooms where surgeries are being performed.

The Department of Health has oversight over physician’s offices but it’s the state Agency for Health Care Administration that regulates ambulatory surgical centers.

The Rules Committee was told the DOH has just six investigators to inspect doctor’s offices in 67 different counties.