Several local physicians are under investigation for prescriptive practices, and three of them have lost privileges to treat Medicaid patients, according to a report this week. These providers were among the state’s top 10 prescribers of OxyContin and Xanax in combination with psychiatric medications.
Also this month a Kauai physician was sentenced to 12 years in prison for alleged violations in the prescription of controlled substances. In recent years several other Hawaii physicians have lost the ability to prescribe narcotic pain medication, lost their medical licenses or were sentenced to prison.
Fraud, waste and abuse are a serious problem and a tragic loss of scarce government dollars earmarked to provide health care to those most in need.
Unfortunately, there are rare providers who abuse the system for financial gain, without regard for professional standards of care or sincere concern for the patients they claim to treat.
Concerns about inappropriate use of prescription narcotics are by no means limited to the civilian sector. A study done at the San Francisco Veterans Affairs Medical Center just found that "Iraq and Afghanistan war veterans who have psychiatric disorders, especially post-traumatic stress disorder (PTSD), are more likely than mentally healthy vets to use prescription narcotic painkillers." This population also had poorer health outcomes, including more wounds, violent injuries, overdoses and suicide.
The problem is far deeper than needing to weed out "bad apples," whether they are physicians or patients. There are many more excellent doctors who work on the front line and do their best to treat medically complicated, unemployable, often homeless patients with limited insurance resources and onerous reimbursement. Data mining may cause some good physicians to hit the radar based simply on the patient population they are willing to serve.
It is also difficult to easily separate patients who are simply seeking drugs from those with genuine pain resulting from significant trauma and degenerative disease. There is a significant number of people in our island community who grew up as victims of physical, emotional and sexual abuse. While there are many who suffer from PTSD incurred during military service, others with fractured bodies, minds and spirits never left the island.
Since this column last covered overcrowding and misuse of local emergency departments (EDs), we have received fresh reports that the patient volume is causing as many as six EDs to go on "divert" at the same time. This news is gripping because it represents a potential access problem for every resident and visitor.
We need to identify and deal with physicians and patients who mean only to manipulate and defraud the health care system that the rest of us pay dearly in taxes to support. We must also be aware, however, that each time we stop a provider from practicing, a wave of patient refugees ripples through the health care community, suffering from withdrawals and desperately seeking care.
Adequate access to appropriate care through community health centers and EDs can be hard to come by. Many private primary care physicians feel poorly equipped to handle this population and are increasingly concerned about legal risks.
Our nation’s Supreme Court is deliberating whether to strike down new mandates meant to ensure that more Americans have health insurance. We must realize that society is better served when its citizens have access to fundamental health care and preventive services.
Sickness, old age and death are inevitable. They happen to each of us alone, but no one is an island. Instead, we are an island community and part of a great nation with a responsibility to create access to quality health care for more of its citizens. If we do not, human suffering will mount, and the cost to each of us individually and collectively will be far greater.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
