Your Doctor is Just a Click Away


On July 7, 2015, Delaware became the 29th state to enact a new Telemedicine Act (HB69). Telemedicine is very futuristic and allows patients to communicate with their doctor without actually having to be with the doctor. This Act has unanimous support from both Delaware’s House and Senate. The text of the Act provides this will go into effect immediately, however it may take licensing boards sometime to actually implement regulations called for by the Act.

Telemedicine is described as “a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the state, while such patient is at an originating site and the health care provider is at a distant site.” Telehealth is “the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.”

Establishing a doctor-patient relationship with telemedicine can be established by, but is not limited to: fully verifying and authenticating the location and, to the extent possible, identifying the requesting patient; disclosing and validating the provider’s identity and applicable credential(s); obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including informed consents regarding the use of telemedicine technologies; establishing a diagnosis through the use of acceptable medical practices, including patient history, mental status examination, physical examination (unless not warranted by the patient’s mental condition), and appropriate diagnostic and laboratory testing to establish diagnoses, as well as identify underlying conditions or contra-indications, or both, to treatment recommended or provided; discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; ensuring the availability of the distant site provider or coverage of the patient for appropriate follow-up care;and providing a written visit summary to the patient.

There are some exceptions, and some services may be provided without a doctor-patient relationship. Those include: informal consultation performed by a physician outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation; furnishing of medical assistance by a physician in case of an emergency or disaster if no charge is made for the medical assistance; or episodic consultation by a medical specialist located in another jurisdiction who provides such consultation services on request to a person licensed in this state.

In the instances where the doctors can not diagnose or treat the person with out a face-to-face appointment, they must do at least one of the following: an appropriate examination in-person; have another Delaware-licensed practitioner at the originating site with the patient at the time of the diagnosis; the diagnosis must be based using both audio and visual communication; or, the service meets standards of establishing a patient-physician relationship included as part of evidenced-based clinical practice guidelines in telemedicine developed by major medical specialty societies, such as those of radiology or pathology. Any prescriptions made online are subject to the same standards as traditional prescriptions. Only a doctor who has formed a relationship with a patient may prescribe him or her medicine. A physician is not allowed to prescribe medicine to a person solely an the basis of an internet questioner or phone or internet consult. All medicines may be prescribed to a proper patient via telecommunications, including controlled substances in some cases.

The practice of telemedicine is not just limited to primary care doctors either. Other health care professionals can utilize this service too, including: psychologists, physician assistants, nurses, pharmacists, genetic counselors, chiropractors, respiratory care practitioners, podiatrists, dentists, occupational therapists, optometrists, mental health counselors and chemical dependency professionals, dietitians and nutritionists, and clinical social workers.

Many hospitals around Delaware are already using telemedicine to some extent. The new laws that Delaware are enacting will help guide the practitioners who already use this service and open the doors for many more. Surveys reveal that healthcare executives are optimistic about about the benefits offered by these teleservices.

There are many pros to having teleservices. These include: convenience, cost efficiency, less waiting time, quick transmission of x-rays, etc. to another doctors for a second opinion, and everything is privet because telepractice is subject to the same HIPAA standards as traditional practice. On the down side telemedicine is subject to technological glitches, inadequate assessments, resistance from physicians, and intrusion by hackers. Telemedicine is a great thing, but it should never and could never replace traditional medical services.

Obamacare Saved Again By an Unlikely Hero


The conservative Chief Justice John Roberts delivered the opinion for the majority in the 6-3 decision that upheld the tax subsidies in the Affordable Care Act. In King v. Burwell, the petitioners argued that the ACA only provided eligibility for tax credits to the people in the states that used state-operated exchanges. The Court found the text to be ambiguous and decided to resolve this issue by looking at Congress’ intentions in passing the Act, rather than applying the Chevron test. The Court found that if the Act was meant to be interpreted the way petitioners describe, the tax credits would not apply and the coverage requirement would not apply in a meaningful way because many people would be exempt from it without the tax credit. The Court states that this would cause the same problem Congress was trying to resolve when passing the ACA. The Court held that Congress intended to apply the tax credits in all states nationwide, regardless if it is a state of federal exchange.

In his dissent, Justice Scalia called the Courts reasoning “jiggery-pokery.” He further ridiculed the opinion by stating that Obamacare should be renames SCOTUScare because the supreme court has saved the ACA so many times. Even the Chief Justice had to chuckle at that remark. Regardless, it looks like the ACA is here to stay.

Supreme Court Upholds Use of Lethal Injection Drug

WASHINGTON, DC - MARCH 13:  MedStar Washington Hospital Center is preparing 400, 2 ml dose syringes of Midazolam in their Clean Room on March 13, 2012. About twice a week pharmacists transfer large vials of critical drugs into smaller syringes. (Photo by Tracy A. Woodward/The Washington Post)

June 29, 2015, in a 5-4 decision, the United States Supreme Court upheld the use of the controversial lethal injection drug midazolam. In 2008, the Supreme Court ruled on the constitutionality of the use of another lethal injection drug, sodium thiopenta, finding no constitutional violation. This drug has since been made unavailable as manufacturers refuse to sell it for lethal injections.States like Oklahoma have turned to using midazolam instead, which has caused a few botch executions.

The death row inmates In Glossip v. Gross brought suit against the State arguing that the use of midazolam violated the 8ths amendments ban on cruel and unusual punishment because  it failed to induce a “deep coma like unconsciousness.” The inmates attorneys cited studies showing that although midazolam produced unconsciousness, the inmate can still be jolted awake from the intense pain caused by the second drug administered which causes immobilization.  The State produced its own studies showing that in sufficient doses, midazolam can produce a deep enough unconsciousness  that the person would be unable to feel “even extremely painful stimuli.”

Justice Alito wrote for the majority along with Chief Justice Roberts, Justice Scalia, Justice Kennedy,and Justice Thomas. They found that “the prisoners failed to identify a known and available alternative method of execution that entails a lesser risk of pain, a requirement of all Eighth Amendment method-of-execution claims,” and that “the District Court did not establish that Oklahoma’s use of a massive dose of midazolam in its execution protocol entails a substantial risk of severe pain.”

Justice Sotomayor wrote the main dissent, along with the liberal justices. She accuses the Courts new rule of legalizing torture saying that it would not matter if the State intended to use the drug or actually burn people alive. Justice Beyer, along with Justice Ginsburg wrote a second dissent that seemed to irritate Justice Scalia. In this dissent Justice Breyer outright questions the constitutionality of the death penalty and basically says that all capital punishment is cruel and unusual. Scalia responded directly to Justice Beyer in his concurrence calling their reasoning “gobbeldy gook”

The three plaintiffs in this case are currently back on death row waiting for execution. Glossip, is scheduled for lethal injection September 16, 2015 and the other two inmates are scheduled for October. Some may still argue that the death penalty is cruel but others feel that this is much less cruel and unusual than the fate of these men’s victims. Glossip hired someone to beat his boss to death with a baseball bat and one of the other men murdered his 9 month old daughter by snapping her spine in half.  Some crimes are so heinous that they deserve the ultimate punishment. If the framers of the constitution intended to outlaw capital punishment, they would have. Instead they basically said “hey, we’re going to execute really bad, evil people, but were going to do it as humanly as possible.” Its not like capital punishment has fallen out of favor with Americans either, 70% of Americans do not oppose the death penalty. The Supreme Court did briefly experiment with cancelling the death penalty in the 1970’s but that only lasted 8 years. Either way, it is not likely the Court will outlaw capital punishment any time soon as 7 of the justices still support it.

Is an End to the AIDS Epidemic Near?

Stop AIDS sign.

Stop AIDS sign.

It is estimated that about 1.4 million women with HIV become pregnant worldwide each year. Without treatment, they have a 15% to 45% chance of transmitting the virus to their baby. However, when antiretroviral medicines are given to mothers and children, the risk drops to slightly more than 1%.

The number of babies born with AIDS world wide has decreased substantially since 2009 and in 2013 only 240,000 babies were born with the virus as opposed to the 400,000 in 2009. The World Health Organization hopes to decrease that number even further in 2015 to less than 40,000 babies born with the virus.

Cuba recently became the first country to eliminate the transmission of HIV and syphilis from mother to child. WHO warms that preventative treatment is not 100% effective though. WHO defines “elimination” as a reduction of transmission to a number that is so low that it is no longer a public health problem. In 2013, only two babies in Cuba were born with AIDS. In order to eliminate the transmission of HIV from mothers to children, WHO, along with the Pan American Health Organization used prenatal care, HIV and syphilis testing for pregnant women and their partners, treatment for women who test positive and their babies, cesarean deliveries and breastfeeding substitution. Maternal and child health programs are also integrated with HIV and STD programs.

If WHO wants to reach its goal in decreasing HIV in infants, much work needs to be done world wide. But at least there is hope that it is possible.

Ohio’s Anti-Abortion Heartbeat Bill


Ohio currently has a ban on abortions after 24 weeks gestation, except if the mother’s life or major bodily functions are in immediate danger. If a pregnancy is between 20 and 24 weeks along, a doctor must determine whether the fetus is viable before agreeing to terminate the pregnancy.

The Ohio House of representatives passed an anti-abortion bill, known as the Heartbeat Bill in mid-March 2015. If this Bill is approved, it will make Ohio one of the most restrictive states when it comes to a woman obtaining an abortion. The Heartbeat Bill would make all abortions illegal after a fetal heartbeat is detected. This could be as early as six weeks into gestation, before most women even know they are pregnant. There is also no exceptions for incest and rape. Any doctors found guilty of violating this law would face imprisonment.

But will the Bill actually pass? This is the third time this Bill has come before the House. The first time was in 2011, where the Bill was passed in the House but died in the hands of the Senate. The second time the Bill did not even survive the House Vote. Now the Bill is currently waiting in the hands of the Senate to see if it will pass. Even if the Senate passes the bill, which is unlikely due to lack of support from some republicans, a very skeptical Gov. John Kasich would have to be convinced enough to approve the bill.  There are very good reasons why even people who are on the “pro-life” side of the debate do not support this bill.

If the Bill is passed, it will likely be challenged in the courts. Supporters actually welcome this challenge and hope to appeal the case to the United States Supreme Court so they can challenge the decision in Roe v, Wade, which allows abortions up until the viability of the fetus, normally around 24 weeks gestation. Although the Court has, in more recent years, tended to uphold certain abortion restrictions, it is unlikely that the Court will go as far as to define “viability” at a time before the women knows she is pregnant. This would cause an undue burden on the woman’s right to receive an abortion and would seriously hinder the lives of victims of rape and incest by forcing them to give birth to a child conceived from crime and abuse. Some pro-life supporters fear that bringing cases such as these to the Supreme Court would actually have a detrimental affect on abortion laws and cause the Court to take a less restrictive stand. Instead of overruling Roe, they fear the Court could expand it and make abortion restrictions more lenient.

In December, Ohio Right to Life openly opposed the Bill. Instead the pro-life group endorsed another Ohio Bill, which would ban abortion after 20 weeks gestation, when the fetus can feel pain. They claim that this Bill is an effective challenge to Roe v. Wade and has the best chance of overturning the decision, or at least further reducing the time a woman could have an abortion. Thirteen states currently have laws that prohibit abortion at the point at which the fetus can feel pain. Two of those laws are being challenged in lower courts. Pro-Choice activists claim that this restriction is just as unconstitutional as the Heartbeat Bill because it underminds the supreme courts viability of the fetus test.

April is National Minority Health Awareness Month


The theme for this year’s National Minority Health Awareness Month is “30 Years of Advancing Health Equity; The Heckler Report: A Force for Ending Health Disparities in America,” This year marks the 30 year anniversary of the release of the “Report of the Secretary’s Task Force on Black and Minority Health.” For years, former Secretary of Health and Human Services, Margret Heckler observed that blacks and other minority populations had more health problems than their white counterparts. In 1984, she decided to organize a powerful task force to investigate the reasons for these disparities and and to give recommendations to the federal government on how to fix the problem. The report, now known as the “Heckler Report” was first released in 1985. The Heckler Report has been a driving force for the monumental changes in research, policies, programs and legislation to advance health equity.

Although 30 years of research and policy changes has helped the health disparities among whites and non-whites, the fact is that these disparities still exist and they need to be taken seriously. All minorities are at a higher risk for many diseases than whites, however the disparity is the greatest between non-Hispanic African Americans and non-Hispanic whites.

In 2012, it was reported that African Americans were 20 times more likely to have asthma than whites and in 2013 it was reported that they were three times more likely to die from an asthma related cause. Between 2003 and 2005, African American children were seven times more likely than white children to die from an asthma related condition and were three times more likely to be admitted into a hospital for asthma.

African Americans have the highest mortality rate of any racial and ethnic group for all cancers combined and for most major cancers including stomach, lung, colon, pancreatic, prostate, and breast cancer. Statistics from 2009 show that African American women were 10% more likely to develop breast cancer than white women, yet were 40% more likely to die from it.

Among African Americans, chronic liver disease is a leading cause of death. African American men are 70% more likely to have liver and IBD cancer than white men and African American women are 1.4 times more likely to die from this than white women. The cause is not always known, some cases can be initiated by conditions such as chronic alcoholism, obesity, and exposure to Hepatitis B and C viruses (African Americans were twice as likely to develop Hepatitis B, in 2011, than the White population and had the highest rate of Hep B than any other ethnic group.)

African Americans are twice as likely to be diagnosed with diabetes as whites, and African American Adults are 70% more likely to be diagnosed with diabetes by a physician than whites. They are also more likely to suffer complications from diabetes, such as end-stage renal failure and amputations. Although African Americans have the same or lower rate of high cholesterol as their non-Hispanic white counterparts, they are also more likely to have high blood pressure.

In fact, African Americans are 40% more likely to have High Blood pressure and are 30% more likely to die from it than whites.

HIV/AIDS is extremely disproportionate in the African American Community. Men have 7.8 times the AIDS rate as white males, and women had 23 times the AIDS rate as white females.African American children are twice as likely to be born with HIV as opposed to white children. And both men and women are more likely to die from AIDS/HIV related complications than whites.

There is also a disparity in immunizations and flu vaccines for African Americans over the age of 65, as compared to whites. However, African American children age 19-35 months has comparable vaccination rates compared to white children.

African Americans have 2.3 times the infant mortality rate as whites. They are almost four times as likely to die as infants due to complications related to low birth weight as compared to white infants. Death from SIDS was 2 times higher from African American  infants in 2009 and were 2.3 times more likely to not begin prenatal care until the third trimester.

African Americans are also more likely to suffer from mental disorders. African Americans are 20% more likely to report having serious psychological distress than whites. However, whites are twice as likely to receive a prescription for anti-depressants. And suicide rates for African Americans is actually 60% lower than whites.

African American women have the highest rates of being overweight or obese compared to other groups in the U.S. About four out of five African American women are overweight or obese. In 2011, African Americans were 1.5 times as likely to be obese as whites.

African Americans make up the largest group of minorities in need of an organ transplant.The number of organ transplants performed on African Americans in 2012 was only 14% of the number of African Americans currently waiting for a transplant. The number of transplants performed on White Americans was 27% of the number currently waiting.While 29% of the total candidates currently waiting for transplants are Black American, they comprised 14% of organ donors in 2012. Although the total number of white Americans on organ transplant waiting lists is about 1.5 times greater than that of Black Americans, the number of candidates waiting for a kidney transplant is almost the same between Blacks and Whites.Black Americans have higher rates of diabetes and high blood pressure than White Americans. These conditions are known to put the patient at risk for organ failures.

African American adults are twice as likely to have a stroke as their white adult counterparts. Further, black men are 60% more likely to die from a stroke than their White adult counterparts.

With all of these health disparities that still exist between whites and minorities, it is extremely important to spread awareness about the diseases, what can cause them, and what can prevent them. This is a battle the Health and Human Services and the Center for Disease Control and Prevention have been fighting for 30 years. This is a battle they will continue to fight, and we should all continue to fight, until all heath is equal, despite race or ethnicity. Knowledge is power, and in this case knowledge is life. If you have not already, please take some time out and visit your primary care physician for a yearly check up, make healthy food choices, stay active, limit alcohol and stay tobacco and drug free!

Lethal Injection Drugs are Running Out


The primary method used by state and federal correctional facilities when executing criminals sentenced to death is lethal injection. Lethal injection gained popularity because it was thought to be the most humane and painless method of putting a criminal to death. During this process, the prisoner is injected with a lethal does of the lethal injection drug(s). States in the past have used single drugs, or cocktails of two or three drugs to make the lethal concoction.These drugs normally act to paralyze the prisoner, put the prisoner to sleep and then stop their heart.

Activists against the death penalty were already pressuring pharmaceutical companies to place more restrictions on supplying the drugs used for lethal injections.This was only maximized  when news of many botched lethal injection executions, namely in Oklahoma and Ohio, surfaced. Pharmaceutical companies both in America and abroad are now refusing to supply the lethal drugs to state and federal correctional facilities because they no longer wish to take part in the executions and fear backlash from the activists. Because pharmaceutical companies are refusing to provide the drugs, states are running out of the drugs they need to enforce the death penalty. This is causing some states to use older, alternative methods such as the electric chair, firing squads, and nitrogen gas.

Attorney General, and longer term opponent of the death penalty, Eric Holder, is suggesting all states hold off executions until the Supreme Court decided Glossip v. Gross, which it will hear on April 29, 2015. This case is a challenge to Oklahoma’s lethal injection procedure, and particularly the use of the drug midazolam that was used in 3 botched executions in the state in 2014. The issues presented before the court include “(1) Whether it is constitutionally permissible for a state to carry out an execution using a three-drug protocol where (a) there is a well-established scientific consensus that the first drug has no pain relieving properties and cannot reliably produce deep, coma-like unconsciousness, and (b) it is undisputed that there is a substantial, constitutionally unacceptable risk of pain and suffering from the administration of the second and third drugs when a prisoner is conscious; (2) whether the plurality stay standard of Baze v. Rees applies when states are not using a protocol substantially similar to the one that this Court considered in Baze; and (3) whether a prisoner must establish the availability of an alternative drug formula even if the state’s lethal-injection protocol, as properly administered, will violate the Eighth Amendment.”

This case will likely be decided by June, but until then, states like Texas, Tennessee, Utah, and even Oklahoma are actively looking for other methods to get the job done.