Free Health Screening – A Service to our Community’s Health

Last weekend I had the privilege of supervising University of Miami Miller School of Medicine students at a free public health screening in Pompano Beach, Florida.  The screening was sponsored by the medical school, with the assistance of community leaders, and held in a local public school. The program organization, recruitment of student and faculty volunteers and management of the program was undertaken and implemented by the students. It is one of several programs of this nature undertaken by these students in Dade, Broward and Palm Beach County Florida.

Stations were set up to screen for vital signs, weight, body mass index, glucose and cholesterol. A women’s center with breast exam, cervical pap smears and dexa heel bone density tests was available. There was an ophthalmology station with physicians from Bascom Palmer Eye Institute. A dermatology section was available with fellows from the world class dermatology program at the University of Miami. Pediatric and neurology sections were available as well as mental health screening. The program was enhanced by the participation of the Broward County Health Department and numerous other community organizations.

After the patients rotated through each station they exited at a checkout area manned by students and faculty. The students organized all the data for the patient participants, explained what their exam findings meant and established mechanisms for the patients to receive follow-up care in the Public Health setting.

This was the fifth year I have participated as a voluntary faculty member. I noticed the patients were younger, sicker and presenting with more social and health problems than in previous years. Several times during the screenings, the fire rescue squad was called to transport individuals to the hospital because their initial entry into the health system detected a serious enough condition to require immediate hospitalization. The patients were proud, hard working American citizens of all races, colors and creeds who were devastated by the recession with loss of jobs and health insurance benefits.  For many, this screening was their first trip to the doctor in years. Although well received, this screening was the most rudimentary of safety nets available for this community from the health care field.

Some 225 patients were examined in an eight hour period. I was proud of the students for a job well done. After it was over I went home and took time to read the local newspaper. There was a front page article about how our new governor had just proposed a budget which cuts all funding for primary medical care at Public Health Facilities. I wondered how many of those patients we referred for follow-up to Public Health facilities would now have to wait until next year’s screening program to obtain it?

I wish those Tea Party and righteous cost cutting conservative politicians and our governor had spent the day interviewing, examining and counseling the patients I saw today. I wonder how they would react to a frightened fifteen year old hoping to get a pregnancy test and too poor to afford a store bought test?  I wonder what they would say to a 5th grade teacher who had lost her home to foreclosure and couldn’t afford to pay an ophthalmologist in the private setting to check her glaucoma. I wonder what Governor Scott and the Tea Party would say to a 50 year old former triathlon performer who lost his construction and landscape business during the recession, lost his health insurance, gained forty pounds due to the stress of life and was now unemployed, diabetic and hypertensive with no access to health care?

It’s easy to pontificate about the flaws of health care reform until you sit down with the sickest and most vulnerable and realize they are no different than you and I.

NICA, Florida’s Newborn Injury Compensation Act – 2010

In the early 1980’s there was a major medical malpractice insurance crisis in my home state of Florida.  Obstetricians and gynecologists could not afford to purchase medical malpractice insurance at the price it was being offered at, when it rarely was being offered. The fear was that an Ob-GGYN would deliver a deformed or injured child while performing his hospital required emergency department coverage and be sued for a staggering sum to pay the medical costs and damages for the infant for the rest of his or her life. Obstetricians stopped agreeing to see and treat pregnant women because of the risk involved.

The Florida State Legislature then came up with the idea of creating the Newborn Injury Compensation Act which created a fund to pay for the medical care and damages associated with injuries occurring during the childbirth process.  This fund was supposed to keep obstetricians out of court. This compromise legislation was initially supported by the Florida Medical Association as a short term solution to a problem. Every doctor in Florida was fined, or taxed, $250 per year to pay for birthing injuries while obstetricians paid $5000 per year. The first thing that happened after this was signed into law is that the Florida Trial Lawyers Association found away around it so they could continue to sue obstetricians for medical malpractice.  The second thing that has occurred in the twenty some odd years since its inception is that the NICA fund has never paid out anything to an injured party.

NICA is essentially an additional $250 per year tax on physicians for the privilege of practicing medicine in the State of Florida. The Legislature has decided that expectant mothers who live on a diet of barbecue potato chips, pineapple soda pop and Marlboro’s and has their first pre natal visit when in their ninth month and crowning are the legal responsibility of doctors only. The Florida Medical Association has been so busy with so many issues that it has not had the time or resources to work for the abolition of this unfair tax on physicians.

It’s time this unfair tax is repealed. Reproductive education, prenatal care and visits to a doctor when pregnant are not only the responsibility of the physicians’ community alone but of the public at large.