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Florida doctor voices concern for organ transplant ‘rationing’ for Medicaid patients to American Medical Association

Outcry against government making health care decisions

Earlier this week, on Monday June 17, 2013, a Florida delegate to the American Medical Association (AMA) as well as St. Petersburg City Council Candidate, David McKalip M.D., lead the effort to ensure the AMA would stand strongly in favor of organ transplantation for Medicaid patients; and not for rationing such medical treatments because of funds.

“As a doctor, I have long stood against any act of the rationing of medical care by the government.” says McKalip. “I could not stand by while the leadership of my profession at the AMA chose to side with government rationing policies instead of the patient.”

“If the government has promised access to high quality medical care to patients through a government program such as Medicaid, the government should keep their promises.  It is not acceptable to tell a Medicaid patient they may be an organ donor, but not an organ recipient.

The AMA Board of Trustees had previously recommended that they not adopt the policy to the key policy making body of the AMA, the House of Delegates (HOD), requiring McKalip to respond.

The issue: The issue presented itself when Governor Jan Brewer decided that the State of Arizona could not afford to pay for organ transplants for Medicaid patients in 2010. The state ultimately reversed the decision after a large public outcry. The Florida delegation worked to have the AMA stand on the side of Medicaid patients beginning in November of 2011, but no action was taken by the AMA Board until this annual meeting.

The AMA Board of Trustees (BOT) was recommending that the AMA not support expanding Medicaid coverage for organ transplants. In doing so the AMA BOT relied on the New AMA policy “Stewardship of Healthcare Resources” to conclude that Medicaid patients should not receive organ transplants if there were limited resources to fund it.  That 2012 policy states that physicians are “obligated” to be “prudent stewards of shared societal resources,” a policy that was acknowledged to conflict with the need to serve the medical needs of the patient first.

McKalip worked through the process at the AMA House of Delegates to rally unanimous support for his position on behalf of the entire Florida delegation. Others, including Delegations from New York, California, the District of Colombia, joined the call to provide good medical care to patients pointing out that it is duty of the doctors to stand up first for the patient and to let the government determine how it would pay for the costs of the programs it has created. Other colleagues pointed out that the cost of living with organ failure while awaiting an organ transplant or the critical care of dying with organ failure was often more costly than the organ transplant itself.

Thomas Peters, M.D., a transplant surgeon from Jacksonville offered, “It is not appropriate to first do a wallet biopsy of my patient to determine if they are eligible for an organ transplant.”

McKalip concluded, “I am proud of my colleagues at the AMA House of Delegates for standing up for patients and advising their elected leaders on the AMA Board of Trustees that the AMA must stand up for patients, and not participate in rationing. I am humbled by their support on this issue but also happy that I had the opportunity to use my years of experience there and knowledge of health policy to make a difference in the lives of Americans through action at the AMA.”

About Dr. McKalip: David McKalip, M.D. is a Board-Certified Neurological Surgeon of the brain and spine. He has served as the President of the Florida Neurosurgical Society and on the Quality Improvement Committee of the American Association of Neurological Surgeons, as well as the board of the Florida Medical Association. His practice is located in St. Petersburg, Florida and he is currently a candidate for St. Petersburg City Council.

McKalip has represented Florida doctors in the AMA HOD since 2005 and has rallied leaders and delegations from several states and specialties to unanimously overturn the recommendation of the AMA Board on denying organ transplant for Medicaid patients.

http://scrubsreport.com/tampa-news-current.html

Should Medicaid Patients Be Denied Organ Transplants?

Neurological surgeon David McKalip M.D., a Florida delegate to the American Medical Association (AMA), this week lead the effort to ensure the AMA would stand strongly in favor of organ transplantation for Medicaid patients; and not for rationing such medical treatments because of funds.

“As a doctor, I have long stood against any act of the rationing of medical care by the government.” says McKalip. “I could not stand by while the leadership of my profession at the AMA chose to side with government rationing policies instead of the patient.”

The AMA Board of Trustees had previously recommended that they not adopt the policy to the key policy making body of the AMA, the House of Delegates (HOD), requiring McKalip to respond.

“If the government has promised access to high quality medical care to patients through a government program such as Medicaid, the government should keep their promises.  It is not acceptable to tell a Medicaid patient they may be an organ donor, but not an organ recipient.”

The issue presented itself when Governor Jan Brewer decided that the State of Arizona could not afford to pay for organ transplants for Medicaid patients in 2010. The state ultimately reversed the decision after a large public outcry. The Florida delegation worked to have the AMA stand on the side of Medicaid patients beginning in November of 2011, but no action was taken by the AMA Board until this annual meeting.

The AMA Board of Trustees (BOT) was recommending that the AMA not support expanding Medicaid coverage for organ transplants. In doing so the AMA BOT relied on the New AMA policy “Stewardship of Healthcare Resources” to conclude that Medicaid patients should not receive organ transplants if there were limited resources to fund it.  That 2012 policy states that physicians are “obligated” to be “prudent stewards of shared societal resources,” a policy that was acknowledged to conflict with the need to serve the medical needs of the patient first.

McKalip worked through the process at the AMA House of Delegates to rally unanimous support for his position on behalf of the entire Florida delegation. Others, including Delegations from New York, California, the District of Colombia, joined the call to provide good medical care to patients pointing out that it is duty of the doctors to stand up first for the patient and to let the government determine how it would pay for the costs of the programs it has created. Other colleagues pointed out that the cost of living with organ failure while awaiting an organ transplant or the critical care of dying with organ failure was often more costly than the organ transplant itself.

Thomas Peters, M.D., a transplant surgeon from Jacksonville offered, “It is not appropriate to first do a wallet biopsy of my patient to determine if they are eligible for an organ transplant.”

McKalip concluded, “I am proud of my colleagues at the AMA House of Delegates for standing up for patients and advising their elected leaders on the AMA Board of Trustees that the AMA must stand up for patients, and not participate in rationing. I am humbled by their support on this issue but also happy that I had the opportunity to use my years of experience there and knowledge of health policy to make a difference in the lives of Americans through action at the AMA.”

http://www.physiciansnews.com/2013/06/21/should-medicaid-patients-be-denied-organ-transplants/

Alternative treatment helps with chronic back pain patients – ABC Action News with Linda Hurtado and Dr. Sara Rizk (Dr. Sara Atalla) of Start to Finish Spine Care

ST. PETERSBURG, Fla. – For those of us who suffer chronic back pain, we are always looking for new ways to alleviate the pain. There is an alternative treatment, a different type of prescription that doesn’t come in a bottle. Continue reading “Alternative treatment helps with chronic back pain patients – ABC Action News with Linda Hurtado and Dr. Sara Rizk (Dr. Sara Atalla) of Start to Finish Spine Care” »

International Quality of Life Month – One Woman Gets Her Quality of Life Back

From excruciating pain to virtually pain free – one woman shares her voyage in getting the quality of her life back with the help of a local neurosurgeon

(St. Petersburg, Fla.) January 13, 2010 – You’re only 47 years-old. You’re fairly healthy, with no severe medical issues. You’ve never been in an accident or experienced serious injury. Yet, you lay in bed having your meals fed to you because it’s too excruciating to move your body beyond the distance of your bedroom to your restroom. This was Christine Barone’s life. An average 47-year-old, East Lake resident who would have done anything to have the quality of her life back. Continue reading “International Quality of Life Month – One Woman Gets Her Quality of Life Back” »

Pinched Nerve? Ruptured Disc? Get a Doctor quickly, get the right treatment and get your spine in shape.

Many people may have heard of a “pinched nerve” but what is it exactly?  Why does it cause pain and what can be done to help?

Most commonly a “pinched nerve” refers to pressure on a nerve in the spine of the neck or the lower back.  The nerves start as microscopic cells in the brain or at the ends of the tissues like the skin, tendons or joints.  They travel in and out of the brain through the spinal cord and enter the spinal cord as nerve roots.

A nerve is typically pinched if it exits the spine. Pinching can occur from a disc that is bulging or herniated, an overgrown joint or thickened ligament.  This typically causes pain and symptoms that travel in very discrete patterns. For instance, a nerve pinched by a disc herniated at C5/6 on the right will nearly always cause pain, numbness and tingling into the thumb and index finger and sometimes weakness in the biceps of the arm or a particular forearm muscle.

The good news first – most pain from a pinched nerve goes away by itself, WITHOUT SURGERY! The goals then are to:

  1. Make sure you get an accurate diagnosis from a doctor to ensure this is a not a dangerous problem.
  2. Treat the pain and help you remain as functional as possible while you heal on your own.
  3. Help you develop a spine fitness program to prevent further occurrences in the future.

In rare cases, surgery will be needed but it should only be as a last resort or for special circumstances that permanently endanger your nerve function.

Getting an Accurate diagnosis – are you seeing a doctor, or a nurse?

The first step is to get an accurate diagnosis – what is the cause of your pain? Is it really a pinched nerve? Is it coming from the spine, the brain or the nerves in the arms or legs? Could there be something growing outside your spine, or an infection? A visit with an experienced doctor is designed to answer these questions. At Start To Finish Spine Care, you will see a doctor first. On your first visit, you will see a spine specialist who will spend 45 minutes with you to understand your medical history and make sure you are safe. At most other spine clinics, you will often see a nurse for 95% of your visit and a doctor will spend perhaps 5 minutes with you. That is the difference between other spine clinics and Start to Finish Spine Care.

Nurses and physician’s assistants are not trained, experienced or able to make an accurate diagnosis and come-up with a treatment plan for you. Nor is this position able to ensure ruling out the more rare causes of pain that may be more serious. Make sure you see a doctor who spends their time with you. You are paying the same – why not get the best? Even better, you can usually get an appointment to see an experienced spine specialist within a few days or the same day at Start to Finish Spine Care. Such a quick visit with a specialist is a rarity these days (except at Start to Finish Spine Care).

The doctor will work with you to determine if you need specific tests to help diagnose your problems, such as an MRI, and will then order them and have you come back into the office to explain the results. Many times, extensive and expensive testing will not be needed and can be avoided. This is helpful in times when more and more health costs have to be paid for out of your own pocket. No nurse is going to be able to give you sound advice when it comes to picking the right test and no doctor who spends 5 minutes with you will do it as well as one that spends the entire visit with you.

Treating your pain – without surgery in 95% of cases.

Once you get your diagnosis  – what can be done to help ease your pain – without surgery?

After your spine specialist ensures that there is no danger requiring urgent surgery, there are many options that can help.  First are basic medications like prescription strength versions of drugs like Motrin (called “NSAIDS” – non-steroidal anti-inflammatory drugs).  Muscle relaxants can help, as can mild narcotic pain medications.  Narcotic pain medication must be used with extreme caution and should be used only temporarily when other methods do not work.

Physical therapy is a critical part of recovery to ensure that muscles and joints remain functional and moving.  Pain may cause us to internally splint certain joints so they don’t move. That is a phenomenon that must be guarded against.  Physical therapy can help get the spine moving again and can also help with local pain treatments like deep heat, massage, ultrasound and electrical stimulation.

The spinal muscles of the low back and neck may also spasm or become inactive. This is where “osteopathic manipulation” can come in. The spine can be mobilized by a trained physician with experience in treating patients with pain.  The lining of the muscles may need to be released (“myofascial release”) and certain joints mobilized so they don’t “lock up” and cause further problems.  Our start to Finish Spine Care Osteopathic physician, Dr. Rizk, can help with spinal manipulation to relieve neck, back, arm and leg pain while the body works to heal itself.

When pain is very severe or not decreasing quickly enough, spinal injections may be the next best step.  Small doses of steroids (“cortisone shots” ) can be delivered with great precision right onto the lining of an effected nerve or into a joint lining or ligament that has swollen and is pinching a nerve.  These procedures can be done in minutes in our spinal injection suite right at Start To Finish Spine Care.

In rare cases, surgery will be needed early, or if symptoms are not gone in 6-8 weeks.  At Start to Finish Spine Care, experienced Spine Surgeon, Dr. David McKalip is rapidly available to Dr. Rizk who can consult with him if there is a concern that a surgical visit is needed quickly. During surgery, microscopic-size incisions are made to make a small tunnel to the spine and allow the pressure on the nerve to be relieved. Simple cases can be done in 45 minutes and require a brief stay in the hospital with discharge the same day. More complex cases may require more time and a longer stay.

Keeping your Spine in Shape

So you have gotten through your episode of having a pinched nerve and you never want to go through that again. What now?  It is time to make sure your spine is well supported and our team at Start to Finish Spine Care will help you devise a plan to keep your spine in shape. That means working with the Physical Therapy Department to develop a Home Exercize Program. Perhaps you need multiple physical therapy visits to focus on particular problem areas.  It is vital to develop a program that meets multiple goals:

  1. Strengthen the muscles that support the spine in the abdomen, back and in the fronts and backs of the legs.
  2. Improves posture by focusing on exercise, balance training and perhaps through osteopathic manipulation to mobilize joints and muscles.
  3. Promotes weight loss to allow a lower stress on the spine.
  4. Restore as much lost function as possible from weakness or numbness from any past pinched nerves.

Sometimes it is hard to keep up with a home exercise program, which is why Start to Finish Spine Care is working with partners who offer onsite exercise programs right on the lot next to our building.  Classes now include Tai Chi and basic and advanced Chinese martial arts instruction such as Chi Gong, Ba Gua Zhaung  and Shao Lin Kung Fu.  We are working on bringing partners for Yoga and traditional calesthenics as well.

A pinched nerve can be a painfully memorable experience that can limit function for at least a few weeks.  At Start to Finish Spine Care, we will be there to help you get a diagnosis from a doctor, develop a treatment plan and develop a spine fitness plan to keep you from having repeat episodes in the future.

Call today for an appointment and we will get you in, usually within a few days.

Ask a Doc Radio Show Nov. 20th Featuring Neurosurgeon, Dr. David McKalip

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7 Steps Spine Surgeons Should Take to Prevent Infections – Dr. McKalip speaks with Becker’s Orthopedic & Spine Review

7 Steps Spine Surgeons Should Take to Prevent Infections

Spine surgeons must take all possible measures to decrease infection rates among their patients and produce the best outcomes. Infections can occur for various reasons and when an infection does occur, it takes more time and effort from the patient and the surgeon to resolve, which may or may not be reimbursed. “If you’re not meticulous with sterile technique, you can get in trouble,” says Donald Corenman, MD, of The Steadman Clinic in Vail, Colo. “Prevention is absolutely key because dealing with infections is a tremendous amount of work and it really sets the patient back.” Continue reading “7 Steps Spine Surgeons Should Take to Prevent Infections – Dr. McKalip speaks with Becker’s Orthopedic & Spine Review” »

“Hey Doc, Can I Get a Second Opinion?” Dr. David McKalip featured on Merced Sun-Star.com

merced sun-star

Ask a Doc Radio Show Oct. 23rd Featuring Neurosurgeon, Dr. David McKalip –

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Testimonial 3

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