January 2017 – The Insider

Astros, Nationals suffer minor damage — but not at Ballpark of the Palm Beaches

The Houston Astros and Washington Nationals suffered some minor damage last week in downtown West Palm Beach.

shirts — This frame fell off the wall last Friday and crashed onto the floor.

The Ballpark of the Palm Beaches, the teams’ $148 million spring training complex south of 45^th Street, is doing just fine and remains on schedule to open in a few weeks.

But last Friday, maintenance workers were seen picking up the pieces after a glass frame containing Astros and Nationals jerseys fell from a wall on the sixth floor of the Weisman Palm Beach County Governmental Center.

What caused the frame to dislodge from its mount on a wall outside the County Commission chambers is a mystery. But the crash was so loud it was heard on the first floor of the atrium-style building.

“I would like to tell you that Robert Redford hit a towering home run which shattered the glass,’’ assistant county administrator Todd Bonlarron said, referring to the movie The Natural, “but unfortunately the frame just split.’’

The jerseys were a gift from the teams after the county commission in 2015 approved the facility, which is being financed in part with $108 million in revenue from a county tax on hotels and motels.

The frame was mounted in the lobby of the sixth floor, on a wall next to a door used by commissioners to access their dais in the commission meeting room.

No word yet on when, or if, the frame will be replaced.

Seems like the soonest way to see Nationals and Astros jerseys side by side is Feb. 28 when the teams square off for the inaugural game at The Ballpark of the Palm Beaches.

Will telemedicine work for treating addiction?

The next big thing in drug treatment: Telemedicine.

Among the topics that kicked off the annual meeting of the Addiction Industry Executive Summit in Naples on Monday was using the internet to remotely treat recovering addicts.

Telemedicine allows doctors and therapists to communicate with patients via live video – similar to Skype or Facetime. According to the American Medical Association, 4 out of 5 office visits could be handled without a trip to see the doctor.
Telemedicine is already used to treat common illnesses such as bronchitis, pink eye and urinary tract infections.

But can – and should – it be used for treating addiction? Using telemedicine to treat drug addicts provides unique obstacles for patients, treatment providers and insurance companies.

Telemedicine will allow recovering addicts who live in rural areas, who have no transportation or have child care issues to interact with their treatment team. On the flip side, they won’t be able to use their remote location, lack of transportation or child care as excuses to avoid seeing their treatment providers.

Because psychiatrists and addiction specialists are in such short supply and must be licensed to prescribe buprenorphine – a drug used to wean addicts off opioids – telemedicine could enable more addicts to be treated with buprenorphine.

However, doctors and therapists won’t be able to get a true picture of their patient’s condition without costly video equipment that captures more than just the face of a addict – who may attempt to disguise a relapse.

“I have seen people trying to do it on laptop or itty bitty webcam,” said Dr. Corey Waller, Senior Medical Director for Education and Policy at the Camden Coalition for Healthcare Providers in New Jersey. “If I can’t see patient I can’t see what’s going on. He could be flipping me off under the table.”

Waller, a keynote speaker at the conference, estimates a the cost of a video and audio system that can provide effective and safe treatment at $10,000.

The biggest hurdle is not the cost but licensing requirements. Some states require physicians practicing telemedicine to be licensed in the state where their patient lives. That means a doctor licensed in Florida would not be able to treat a patient via telemedicine in these states without an additional license.

Besides the hardware and licensing, practicing telemedicine requires enhanced security to comply with HIPPA privacy laws. Common live steam platforms, such as Skype, are not secure.

Lisa Merconchini, a Boca Raton clinical psychologist created a secure, web-based telemedicine platform. Her company, Premier Telehealth, uses copyrighted, encrypted software to protect patients’s privacy. Merconchini was the only vendor at the conference offering a telemedicine treatment platform.

Merconchini sees telemedicine as particularly valuable for addicts after they leave residential treatment programs and return to their home and jobs.

“I think typically when they leave treatment they fall out of aftercare,” Merconchini said. “This allows them to stay engaged and follow aftercare.”

Without telemedicine, addicts often must find a new treatment team when they leave rehab. Beyond what is in their medical records, new doctors and therapists know little about the addict.

Telemedicine enables addicts to continue working with doctors and therapists they already know. Because the treatment team’s experience with a recovering addict, they are more likely to identify warning signs of a relapse.

“You already have an established rapport,” Merconchini said. “Because you have had that in-person care, you are familiar with non-verbal cues.”

Florida is among a handful of states that has no laws governing how telemedicine can be practiced. In 2016 lawmakers passed a bill that established a Telehealth Advisory Council within the Agency for Health Care Administration to begin looking at how telemedicine should be practiced in Florida.

No legislation about telemedicine has been filed for the legislative session that begins in March.

Insurance companies want to know how effective telemedicine is but do reimburse for telemedicine.
As of May 2015, 24 states and the District of Columbia have mandated that private insurance plans reimburse for telemedicine at rates equal to an in-person consultation. Forty-eight state Medicaid programs also reimburse for some form of telemedicine via live video.

The question now is, will drug treatment providers use it? Some say they would not be comfortable using it in early recovery. However, it could be a valuable tool for follow up care and therapy after an addict leaves treatment and goes home. It also provides a continuity of care, so the addict does not need to find new doctors and therapists back home.

Origins Behavioral Healthcare uses telemedicine but not to treat addicts, said Origins CEO Drew Rothermel. IInstead, Origins uses telemedicine to enable its own doctors to conference in real time across its locations in Florida and Texas.
“There is a vested interest for Florida to have as robust telemedicine as possible,” Rothermel said. “So much of Florida treatment is medical tourism.”

Bills urge help for addicts in ERs and prompt RX drug reporting

Pharmacists and doctors who participate in the state’s prescription drug monitoring program would be required to report every prescription they fill for opiates and other controlled substances within 24 hours under a bill introduced on Friday.

HB 557 was filed by Rep. Nicholas Duran, D-Miami. There is no companion bill in the Senate.

Currently, pharmacists and doctors who participate in the state’s Prescription Drug Monitoring Program have seven days to report controlled substances they dispense.

Although participation in the PDMP is not mandatory, the database improves clinical decision-making and can identify doctor shopping and pill mills.

» Read the Post’s coverage of the opioid epidemic »

Currently, 6,546 pharmacists and doctors input their prescribing data into the PDMP database. Sixty-six percent of participants already report data within 24-hours.

The database contains 37,048,030 prescriptions for 7.3 million Florida residents.

Also on Friday, Republican Sen. Kathleen Passidomo filed SB 558, which would require hospitals to provide additional services to overdose patients. Passidomo, vice-chair of the Senate Committee on Health Policy and Appropriations Subcommittee on Health and Human Services, represents Collier, Hendry and parts of Lee counties – all hard hit by the opioid epidemic.

The bill mirrors HB 61, filed by Rep. Larry Lee, D-Port St. Lucie, which requires hospitals to screen overdose patients to determine the need for additional services and prohibits hospitals from discharging overdose patients to a detox or drug treatment center until the patient is stable.

The bills also require attending physicians to contact the overdose patient’s primary care physician or any other treatment providers who prescribed a controlled substance to the patient.

If the patient is currently in a treatment program, the hospital’s attending physician must also inform the medical director at the treatment center about the overdose.

The bill would also require the hospital to inform an overdose patient’s family or emergency contact about the overdose

Sober home cases in court: More charges, another plea

James Kigar, accused to paying kickbacks for patients at his treatment center Whole Life Recovery, has been arrested again on charges of failing to carry workers compensation insurance.

Kigar’s latest arrest on Jan. 15 was a byproduct of raid by the Palm Beach County Sober Home Task Force on Oct. 25, 2016. Documents seized during a search of Whole Life Recovery in Boynton Beach provided evidence used to charge Kigar with more than 90 counts of patient brokering.

Also during the raid, investigators with the Florida Bureau of Insurance Fraud interviewed two employees who complained that taxes and workers-compensation were not being deducted from their paychecks. Records seized confirmed that Kigar did not have workers’ compensation insurance for his employees.

The arrest is the third for Kigar since Oct. 25, which he was arrested on 5 counts of patient brokering. On Dec. 20, Kigar was arrested again when prosecutors filed dozens more patient brokering charges against him.

Of nine other sober home owners and operators accused of brokering their tenants to Whole Life Recovery, one has accepted a plea deal in exchange for probation.

Circuit Judge Krista Marx has scheduled a plea conference in the case of Bryan Norquist, 26, owner of The Halfway House, on March 7. Norquist’s attorney, Bruce Zimet, said there is not plea agreement and Norquist intends to go to trial.

Norquist’s older brother Patrick has also been charged with patient brokering.

One month from pitchers and catchers, crews scrambling to finish Ballpark of the Palm Beaches

Construction crews are scrambling to finish The Ballpark of the Palm Beaches, which is supposed to open less than a month from now when the Houston Astros and Washington Nationals report for spring training.

Roughly 650 workers are on site every day, many of them working 20-hour days. This video, shot on Jan. 10, shows how busy the site is. But keep in mind that what you see in the video probably looks much different from what the site looks like today.

A lot can get done in a week. But a lot still needs to be done before players and fans start arriving next month.

Rick Greene, the West Palm Beach building official in charge of making sure they facility is safe, said he’s “very optimistic” The Ballpark of the Palm Beaches will open on time.

Worker on a ladder in the Washington Nationals bullpen in the main stadium of The Ballpark of the Palm Beaches, Jan. 10, 2017

He said the Astros and Nationals last week started receiving “stocking certificates” from the city, allowing the teams to move in equipment and furniture to their respective clubhouses. This week and next week, he said, the city could start issuing “TCOs”, known as temporary certificates of occupancy, for different buildings on the 160-acre complex south of 45^th Street.

“They are going for a temporary CO which allows the public or individuals to move into a building because all life safety issues have been addressed,” said Greene, the city’s director of development services.

” That’s not to say there might be some minor things still needed to get final COs but under temporary CO’s our big concerns at the city level are to make sure all life safety issues are addressed – (fire) sprinklers, elevators, handicapped parking, curbs to accommodate wheelchairs…’’

Final certificates of occupancy could be issued later this spring or after spring training, he said.

“The teams’ goal is to have folks walk on that site Feb. 18,’’ Greene said, referring to the date when the public will be allowed to watch players work out for the first time.

Washington Nationals dugout in main stadium at The Ballpark of the Palm Beaches, Jan. 10, 2017.

The first game is Feb. 28.

Issuing temporary COs and then final certificates at the last minute is not unusual for a big project.

“We went through the same thing with the Palm Beach Outlets,’’ he said, referring to the outlets mall that opened in 2014 on the old Palm Beach Mall site on Palm Beach Lakes Boulevard just east of Interstate 95.

“We were issuing COs on the night of the grand opening,’’ Greene said.

“We’ve been down this road before. It’s actually a little bit easier because we’re dealing with just two ball teams unlike the mall.’’

Is there a chance the facility will look vastly different in spring 2018 than it will look this March?

“It may not be radically different,’’ Greene said. “It may not be perceptible from this year to next.’’

Sober home report calls for more regulation, stricter enforcement

The Palm Beach County Sober Home Task Force overseen by State Attorney Dave Aronberg has submitted its final report to the Legislature.

As The Post reported on Dec. 20, the report calls for more oversight of sober homes, licensing of so-called “marketers” and enforcement measures to help police.

“Our primary goal is to protect the vulnerable patients who have been abused by unscrupulous actors in the industry,” Aronberg said. “Right now, there is no oversight of recovery residences, and very little oversight of the providers. Rogue operators are able to thrive in the current environment.”

The report, a six-month effort, can be found on the state attorney’s web site under the sober homes task force link.

The Legislature gave Aronberg $275,000 for the three-pronged effort, which included a law enforcement arm that has made 11 arrests focused on patient brokering, in which treatment centers pay sober homes for providing a steady stream of patients.

Sober homes, which have proliferated under a nationwide heroin epidemic, are supposed to be safe places where recovering addicts support one another while learning to remain sober. Most go to treatment centers for medical services where they are tested to make sure they are still sober.

Fraud has undermined the industry in Palm Beach County and elsewhere as insurance companies are soaked for huge charges for largely unnecessary drug tests.

The task force continues, with its next meeting at 1 p.m. Monday at the West Palm Beach Police Department on Clematis Street.

Heroin crisis hits most age groups hard; already deadlier than gun homicides

A fresh report from the Centers for Disease Control and Prevention shows that heroin overdose deaths have quickly increased across five age groups between 15 and 64.

Across the nation, heroin deaths have spiked in those age groups since 2010. The hardest-hit group, ages 25 to 34, is also seeing the rate of deaths accelerating. The rate of death rate went from 2.2 for every 100,000 people to 9.7 in that age group, the CDC reported.

That jibes with The Palm Beach Post’s findings in its Heroin: Killer Of A Generation series, which found that most heroin-related overdose deaths in Palm Beach County in 2015 were people under the age of 35.

What does this mean? In 2015, some 12,989 people died of heroin overdoses. That’s about 2,000 people more than were killed in gun homicides a year earlier. Put another way, for every five times someone was shot to death by another person, six people died of heroin overdoses.

The Post tallied 216 deaths from heroin-related overdoses in 2015 in its reporting. Here, for every person who was slain by any manner, two people died of a heroin-related overdose.

Lawmakers cite Post’s investigation as motive for change

Local lawmakers agreed on Wednesday to cross the aisle and work together on passing legislation to address the opioid crisis and corruption in sober homes.

During a brief presentation at a meeting of the Palm Beach County Commission and its Legislative Delegation, Democratic Senator Jeff Clemens of Lake Worth urged his colleagues to support a bill soon to be proposed by Republican Rep. Bill Hager of Boca Raton that will address sober home regulation.

Palm Beach County Mayor Paulette Burdick praised the Palm Beach Post for its investigation of corruption in the drug treatment industry and the opioid epidemic.

“We as elected officials work hard in the community and have created task forces but the media, in particular our local Palm Beach Post, has done a wonderful job with presenting the faces of the addiction problem and the health care issues statewide that effect all of us,” Burdick said, referring to a recent article that estimated the cost of the opioid epidemic at Florida hospitals at $1.1 billion.

Assistant County Administrator Todd Bonlarron, formerly the county’s top lobbyist, said he has sent “dozens” of articles from the Post’s series to the White House National Office of Drug Control Policy, hoping to show the extent of the problem.

“We really have struggled in Congress to make the case that we are dealing with a crisis,” Bonlarron said. “This really is a priority issue for us.”

Clemens said he will seek money to continue funding the Palm Beach County Sober Home Task Force, created by Palm Beach County State Attorney Dave Aronberg. The task force has made 9 arrests and drafted proposed legislation.

Clemens and Hager have led the 4-year-long battle to reign in sober homes and succeeded in passing a bill that prohibits treatment centers from referring patients to sober homes that have not been certified by the Florida Association of Recovery Residences.

The county will also seek more money for the Southeast Florida Behavioral Health Network, which is contracted by the Department of Children and Families to oversee drug treatment providers.