Maine Medicine Weekly Update - May 6, 2019
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MMA and Leading Medical Associations Hail Ruling in Maine Case Over Medication Assisted Treatment in Jail

The Maine Medical Association and other leading national and New England-based medical associations joined together to applaud a federal appeals court ruling that a Maine jail must provide a woman with medication assisted treatment for her substance use disorder while she serves a 40-day sentence. The ruling from the U.S. Court of Appeals in Boston upheld an earlier ruling from the federal district court in Maine.

 

Leading national and New England-based medical associations joined together to applaud a federal appeals court ruling that a Maine jail must provide a woman with medication assisted treatment for her substance use disorder while she serves a 40-day sentence. The ruling from the U.S. Court of Appeals in Boston upheld an earlier ruling from the federal district court in Maine. The Maine Medical Association also joined in the amicus curiae brief for the trial court.

Over a dozen leading medical associations asked to file an amicus brief in support of the lawsuit. The appeals court affirmed the lower court ruling without the need for oral argument or further briefing.

Medical experts and addiction specialists from those associations hailed the appeals court decision, calling it an incredibly important step in the fight to end the opioid crisis that will reduce pain and suffering and save lives. Citing this momentum, they called on corrections facilities around the nation to begin providing necessary care to people in their custody who have substance use disorders.

Robert Schlager, MD, President of the Maine Medical Association:

“The Maine Medical Association is very pleased with the decisions of both the US District Court and the Court of Appeals. Both Courts recognize the fact that substance use disorder is a major health problem that requires ongoing treatment. Any withholding of necessary treatment from a person involved in the process of recovery is not good for the individual nor does it further the goals of the correctional system. We thank the ACLU for their excellent work on behalf of evidence-based health care in Maine.”

Barbara L. McAneny, MD, President of the American Medical Association:

“The American Medical Association strongly supports treatment decisions being made between patients and their physician. Patients with the chronic relapsing disease of opioid use disorder deserve comprehensive, medically based care — whether in the community or in a correctional setting. The ruling in Maine is a victory for ensuring patients receive that care.”

Maryanne C. Bombaugh, President of the Massachusetts Medical Society:

“Persons in Massachusetts with a history of incarceration have a 120 times higher risk of opioid-related overdose death than the general population. To then appreciate the lack of comprehensive treatment in these settings, we knew that we must think broadly and creatively about all options to urge expanded treatment for substance use disorder. We are thankful to all collaborators on this and other related cases to move towards our vision for full-spectrum, low-barrier treatment for all vulnerable populations with substance use disorder, including those in incarcerated settings.”

Paul Earley, MD, DFASAM, President of the American Society of Addiction Medicine:

“The American Society of Addiction Medicine is thrilled that the U.S. Court of Appeals for the First Circuit affirmed a preliminary injunction granted by the District Court of Maine to allow an individual to continue to receive medication to treat her opioid use disorder while incarcerated. It is incredibly important to offer all forms of medications for the treatment of addiction to patients in the criminal justice system who are diagnosed with an OUD to improve patient outcomes and reduce overdose deaths.” 

Audrey Kern, MD, FSAM, President of the Northern New England Chapter American Society of Addiction Medicine:

“As we work to end the opioid crisis, now the worst epidemic in US history, we have to acknowledge addiction as a brain disease, not a moral failing, and as worthy of treatment as other medical illnesses. This ruling will go a long way toward ending stigma, and provide care by meeting those in need of treatment where they are, ultimately saving countless lives.”

Michael F. Bierer, MD, MPH, President of the Massachusetts Society of Addiction Medicine:

“Denying necessary care to people with substance use disorders risks pain, suffering, and even fatal overdose. Having experienced the professional and personal heartache of these consequences all too often, we support efforts to assure humane and effective care for people with substance use disorders who become incarcerated. This decision will effect lasting positive changes on our patients' health and lives.”

Joel Goloskie, Senior Counsel, and Meagan Thomson, Associate Counsel, at Pannone Lopes Devereaux & O’Gara LLC, who authored the amicus brief on behalf of the medical associations:

“We cannot overstate the contribution of these 13 prestigious institutions, both in the research they’ve provided and the gravitas they’ve brought to this cause. We are honored to have their support.”     

The American Medical Association, American Society for Addiction Medicine, Maine Medical Association, Connecticut Society for Addiction Medicine, Connecticut State Medical Society, Maine Association of Psychiatric Physicians, Massachusetts Medical Society, Massachusetts Society of Addiction Medicine, New Hampshire Medical Society, Northern New England Society for Addiction Medicine, Rhode Island Medical Society, Rhode Island Society for Addiction Medicine, Vermont Medical Society, and several individual experts all filed motions for leave to file an amicusbrief in the case.

More about the case, including the appeals court ruling, is here: https://www.aclumaine.org/en/cases/smith-v-aroostook-county


 

 

Eat, Sleep, Console Update

QC for Kids and the Perinatal Quality Collaborative for ME (PQC4ME) have received some additional funding from the Hannaford's Community Relations Giving Program to support the implementation of Eat, Sleep, Console in Maine.  

 

Eat, Sleep, Console Update

QC for Kids and the Perinatal Quality Collaborative for ME (PQC4ME) have received some additional funding from the Hannaford's Community Relations Giving Program to support the implementation of Eat, Sleep, Console in Maine.  The opioid epidemic in the United States has resulted in an increased number of infants born substance exposed who are at risk for developing neonatal abstinence syndrome (NAS),  Historically, these infants have been treated with the introduction and weaning of pharmaceuticals.  Recently, a new model called Eat, Sleep, Console (ESC) has been developed that focuses on the comfort and care of infants born substance exposed by maximizing nonpharmacologic methods, increasing family involvement in the treatment of their infant, and prn or "as needed" use of pharmacologic interventions.

QC in partnership with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) and Maine Medical Center is offering the following training opportunities:

1. QC is offering additional opportunities for coaching around ESC implementation over the next year around ESC.  The Coaching Schedule will be 12-1pm via zoom (https://zoom.us/j/5211733487 or 14086380968,,,5211733487#) on:

  • Thursday, September 12 from 12-1pm
  • Thursday, December 12 from 12-1pm

2. QC is hosting an all-day in-person training of Eat, Sleep, Cole on Tuesday, June 4th with one of the Gold Star Trainers from Dartmouth.  You can register at the following link: https://events.r20.constantcontact.com/register/eventReg?oeidk=a07eg7lsr3ue6f665c9&oseq=&c=&ch=. The training will be held at the University of Maine in Augusta from 9:00am to 3:30pm.  Consider attending in teams of three for hospital teams.  We ask that participants register by May 17, 2019.  There is limited space for attendance of 50 people.

3.  Kelley Bowden and Ann Boomer are available to do local trainings on ESC with teams who attended the October 30 ESC training as part of their work with the Maine CDC Perinatal Outreach, Education and Consultation Services. 

  • Contact Kelley Bowden bowdek@mmc.org directly with requests for groups that would refer to MaineHealth or CMMC hospitals.
  • Contact Ann Boomer aboomer@northernlight.org directly with requests for groups who would refer to Northern Light hospitals/EMMC.

For more information, contact Kayla Cole at Quality Counts 620-8526 x1027 kcole@mainequalitycounts.org.

Tick Aware and Tick Alert - May is Lyme Disease Awareness Month in Maine

Lyme disease remains the most common tickborne disease in Maine.  Providers reported over 1,400 cases in 2018 (preliminary data as of 3/25/19). While ticks can be active at any temperature above freezing, they are most active in warmer months. May is Lyme Disease Awareness Month in Maine, and the Maine Center for Disease Control and Prevention (Maine CDC) is asking health care providers to help stress the importance of tick education.

 

Lyme disease remains the most common tickborne disease in Maine.  Providers reported over 1,400 cases in 2018 (preliminary data as of 3/25/19). While ticks can be active at any temperature above freezing, they are most active in warmer months. May is Lyme Disease Awareness Month in Maine, and the Maine Center for Disease Control and Prevention (Maine CDC) is asking health care providers to help stress the importance of tick education. Specifically, please encourage patients to be “Tick Aware and Tick Alert” when spending time outdoors.  This includes:
  1. Using caution in areas where ticks may be found;
  2. Wearing light-colored clothing that covers arms and legs;
  3. Using EPA approved repellents; and
  4. Performing daily tick checks after being outdoors on themselves and any pets.  Taking a shower after exposure to a tick habitat is an effective way to wash off any unattached ticks and provides a good opportunity to do a tick check.

Important to Remember

  • Lyme disease is preventable by avoiding contact with infected ticks and tick infested areas.
  • Lyme disease is caused by the bacteria Borrelia burgdorferi, which is transmitted through the bite of an infected deer tick (Ixodes scapularis). The tick must be attached to an individual for 24-48 hours before the bacteria that causes Lyme disease can be transmitted.
  • The most common early symptom of Lyme disease is an erythema migrans (EM), a “bull’s eye” rash that appears 3-30 days after transmission (seen in about 60 to 80 percent of cases nationwide). Other early symptoms include: fatigue, fever, headaches, arthralgia, and myalgia.
  • Disseminated symptoms include: arthritis including joint swelling, Bell’s palsy and other cranial neuritis, encephalitis, lymphocytic meningitis, radiculoneuropathy, and second- or third-degree atrioventricular block.
  • Antibiotic therapy is effective for the treatment of Lyme disease.  Clinical treatment guidelines are available at the Infectious Diseases Society of America (IDSA)’s website.

Lyme disease is not the only disease that can result from a bite by Ixodes scapularis. Anaplasmosis, babesiosis, Borrelia miyamotoi, and Powassan are other tickborne infections found in Maine. In 2018, the number of human anaplasmosis cases decreased to 477, the number of human babesiosis cases decreased to 101, the number of human cases of Borrelia miyamotoi increased to 8, and there were zero identified cases of Powassan (preliminary data as of 3/25/19).   The decrease in cases is likely the result of the hot and dry summer Maine experienced and should not be taken as an indication that the threat of tickborne diseases is diminishing.  The majority of tickborne illnesses occur during the summer months when ticks and humans are active outdoors. 

Thank you for your invaluable help in the prevention and early identification of tickborne diseases here in Maine.

Resources:


 

Trump Administration Reveals New Refusal Options for Healthcare Personnel

President Trump has announced a new DHHS rule allowing health providers, insurers and employers to refuse to provide or pay for services claimed to violate certain religious beliefs.

 

[from AMA Morning Rounds]

The Washington Post (5/2, Cha, Bailey) reports that on Thursday, “President Trump announced a new rule allowing health providers, insurers and employers to refuse to provide or pay for services such as abortion, sterilization or assisted suicide that they say violate their religious beliefs.” Conservatives welcomed these necessary “protections,” but “LGBT and women’s groups warned the rule would lead to discrimination and drastically reduced services since providers might refuse to perform certain treatments, or to treat gay and transgender people.” The final “rule expands the powers of HHS’ Office for Civil Rights – requiring health-care entities to maintain records and report and cooperate with OCR requests.”

The AP (5/2, Alonso-Zaldivar) reports that the rule “requires hospitals, universities, clinics and other institutions that receive funding from federal programs such as Medicare and Medicaid to certify that they comply with some 25 federal laws protecting conscience and religious rights.”

Alfond Leaders Program Seeking More Applicants for Student Debt Relief - Applications Being Accepted Through May 15

The Harold Alfond Foundation and the Finance Authority of Maine (FAME) opened another application cycle to provide student loan debt relief for Maine residents who are employed by a Maine-based business in the STEM-related fields of science, technology, engineering, and math. Applications can now be accepted through May 15, 2019.

 

The Harold Alfond Foundation and the Finance Authority of Maine (FAME) opened another application cycle to provide student loan debt relief for Maine residents who are employed by a Maine-based business in the STEM-related fields of science, technology, engineering, and math. Applications can now be accepted through May 15, 2019.

The Alfond Leaders program assists Maine employers in attracting and retaining talented STEM professionals by providing student loan debt relief of up to $60,000 per recipient. The grants are awarded through a competitive application process and, to date, ninety-two applicants have been selected to become Alfond Leaders. Cumulatively, awards now total over $2.9 million and the average award is $31,600.

Applicants will be recruited from across the nation and internationally, and current Maine residents are eligible and encouraged to apply.

An Alfond Leaders Advisory Committee assists in the selection of applicants and recommends candidates. Applicants can apply by visiting alfondleaders.org.

Who is eligible?

  • Maine residents or persons who will become Maine residents upon being hired by a Maine-based employer;
  • A person employed, or who will be employed, by a Maine-based employer in a designated STEM occupation;
  • An applicant must have a higher education degree or certificate;
  • An applicant must have outstanding student loan debt;
  • Candidates must submit an application, including a written essay and resume, a statement of intent to live and work in Maine for six years; an employment certification by a Maine-based employer; and disclosure of the amount, source, and terms of the student loan indebtedness.
  • Those selected to become Alfond Leaders will receive debt reduction payments made on their behalf, paid in two disbursements after three and six years, respectively, of qualifying employment.

To learn more about the program or to apply, please visit: AlfondLeaders.org

Funded by the Harold Alfond Foundation, the Maine program aims to stimulate economic growth in key industries by attracting and retaining STEM graduates

###

About the Harold Alfond Foundation

The Harold Alfond Foundation furthers the legacy of Harold Alfond by investing in education, healthcare, youth development, and other philanthropic charitable causes that hold the promise of making enduring transformative contributions to the community and state of Maine.  To learn more about the Harold Alfond Foundation, please visit www.haroldalfondfoundation.org.  

About the Finance Authority of Maine

FAME is a quasi-independent state agency that expands business and educational opportunities to help Maine people and businesses succeed. FAME helps to lead the creation of good paying jobs by working at the nexus between economic development and workforce development. To learn more about FAME, please visit www.FAMEmaine.com.


Federal Judge Agrees with AMA, Strikes Down Gag Rule

A federal judge in Oregon has ordered a national ban, striking down the administration's gag rule intended to limit what physicians can say to their patients about family planning and other reproductive health matters.

 

[from AMA Advocacy Update]

“This is madness,” wrote U.S. District Judge Michael McShane in Portland, Oregon, in a scathing rebuke of the Trump administration’s new Title X regulations that includes a gag rule dictating what physicians must and must not say to their patients in the Title X program about family planning.

“The gag rule prevents doctors from behaving like informed professionals,” McShane wrote. “At the heart of this rule is the arrogant assumption that government is better suited to direct the health care of women than their medical providers.”

McShane’s ruling detailed how the regulations would violate the AMA Code of Medical Ethics, damage public health and state economies with it, and violate provisions of the Affordable Care Act and Administrative Procedure Act without explaining what problem the new regulations seek to address.

The Oregon lawsuit was led by the AMA, Planned Parenthood and its local affiliates, and the Oregon Medical Association, but the case was consolidated with another lawsuit and the ruling covers the plaintiffs in both cases. That includes 20 states, the District of Columbia and individual health professionals.

McShane said a nationwide ban was appropriate because Planned Parenthood operates in 48 states, AMA members reside in all 50 states, AMA members provide counseling to pregnant women served by the Title X program, and that there was “ample evidence” of potential harm to public health across the nation.  

This Week's Public Health Updates from the AMA

Click through for a brief update on recent public health issues, provided by the American Medical Association's electronic publication, Morning Rounds. [This article is updated weekly.]

 

Cocaine deaths rising in U.S., says CDC

The AP (5/2, Stobbe) reports that overdose deaths related to cocaine rose by over a third between 2016 and 2017 in the U.S., according to Centers for Disease Control and Prevention researchers. The increase “at least partly reflects trends in deaths from heroin, fentanyl and other opioid drugs,” as nearly “three-quarters of the deaths involving cocaine in 2017 were among people who had also taken opioids,” though deaths involving solely cocaine also increased. Some data from the CDC indicate that “deaths from cocaine continued to rise early in 2018 but may have leveled off last summer.”

The findings were published in the CDC’s Morbidity and Mortality Weekly Report.

Men with chronic illnesses may be less likely to seek treatment for erectile dysfunction

Reuters (5/2, Crist) reports researchers found that “men with cancer or other chronic illnesses are less likely to seek treatment for erectile dysfunction, even though sexual health is an important aspect of quality of life.” The findings were published in the International Journal of Impotence Research.

Training program may improve dementia caregivers’ anxiety, depression, study suggests

Reuters (5/2, Carroll) reports a study published in Health Psychology suggests “the stresses and emotional demands of caring for family members with dementia...can be offset by training that helps caregivers focus on the positives of their experience.” Researchers who led a “randomized, controlled trial” involving 170 dementia caregivers “showed that a six-session online training program produced modest improvements in caregiver anxiety and depression,” with participants in the intervention group experiencing “a 7 percent greater drop in depression symptoms and a 9 percent greater drop in anxiety symptoms compared with the control group.”

Girls with infections in childhood at higher risk for developing eating disorders

The New York Times (5/2, Bakalar) reports, “Girls who have serious or repeated infections in childhood are at higher risk for developing eating disorders in adolescence,” researchers concluded after tracking “525,643 girls – every girl born in Denmark from 1989 through 2006” – and recording “all prescriptions that were filled for antibiotics and other anti-infective medications, as well as hospitalizations for infection, through 2012. There were 4,240 diagnoses of eating disorders during that time.” The findings were published online in JAMA Psychiatry.

Antiretroviral treatment prevents sexual transmission of HIV in gay men, study suggests

Reuters (5/2, Kelland) reports a new European study “of nearly 1,000 gay male couples who had sex without condoms – where one partner had HIV and was taking antiretroviral drugs to suppress it – has found the treatment can prevent sexual transmission of the virus.” In an eight-year follow-up, “the study found no cases at all of HIV transmission within couples.” The results “add to an earlier phase of the study which looked at HIV transmission risk for serodifferent heterosexual couples in the same circumstances,” and which also concluded there was “zero risk.”

The findings were published in the Lancet.

Experts Fear Rising Number of Unvaccinated Children Will Lead to More Measles Outbreaks

U.S. health officials are putting all they have into extinguishing measles outbreaks, while battles rage in state legislatures over exemptions from school vaccination requirements.

 

STAT (5/3, Branswell) reported that as U.S. health officials put “all they have into extinguishing measles outbreaks,” there is “a growing amount of tinder afoot, a fact that will make it increasing difficult to battle these blazes, experts fear.” While “the percentage of children who have received one or more doses of measles-containing vaccine has remained relatively stable,” over the past few decades, “the overall size of the population that is either unvaccinated or undervaccinated has been growing.” According to the article, “with each cohort of kids born to parents who distrust or fear vaccines, the number of people susceptible to the measles virus expands,” and “at the same time, there is a growing population of adults who were children in the early days of measles vaccination whose immunity may have worn off.”

 

Free MAT Training at CMMC June 1

Tri-County Mental Health and the United Way are sponsoring free X-waiver training at CMMC on June 1.

 

There will be an 8 hr MAT course at CMMC in Conference Room I on June 1, 2019 from 8a-5p.  All physicians, RNs, nurse practitioners, counselors, physician assistants are invited to attend. 
 
You do not need to be affiliated with Central Maine Medical Center to attend. 
 
This course is presented by Tri County Mental Health Services by a grant from the United Way.  There is no cost for participants taking the course.  This will provide the 8 hrs education for physicians to obtain DEA X waiver to prescribe buprenorphine and the 8 hrs can be used by APRNs and PAs as part of the 24 hrs education required for them to obtain the waiver.

Dr. Kristen Silvia, medical director of addiction services at Maine Medical Center will be the speaker. 

There will be continental breakfast and lunch provided.

Pleas go to the following link to register for the course:

https://www.tcmhs.org/events

This is a Live-in-Person training. There is always lively informative collegial discussion during these in-person trainings, that isn't available if you watch the training online at home all alone. The last live training in Bridgton got rave reviews.



Lawrence B. Mutty, M.D., M.P.H., 1934-2019; MMA President 2004-2005

The MMA family mourns the passing of our friend and colleague, Dr. Larry Mutty, and extends its condolences to Dr. Danielle Mutty and the extended Mutty family.

 

The MMA regrets to advise the membership of the recent death of long-time MMA member and Past President Lawrence B. Mutty, M.D., M.P.H. Dr. Larry Mutty and Dr. Danielle Mutty both were very active members of the MMA for many years and were regular attendees at the Annual Session. Dr. Larry Mutty was a participant in the Edmund Hardy, M.D. Road Race well into his 70s. Larry was an active member of the Maine Association of Psychiatric Physicians (MAPP) and he served the MMA as Chair of the Legislative Committee and then went on to ascend through the officer ranks, becoming President in 2004-2005. Among the highlights of policy advocacy during his Presidential year was the construction of the new State psychiatric hospital known as the Riverview Psychiatric Center, a facility believed by Dr. Mutty and the psychiatric association to have inadequate bed capacity. We extend our sympathies to Larry's wife, Danielle, and his family.

Danielle provided the following obituary.

Captain Lawrence Barry Mutty, MD, USNR MC, MPH died peacefully at home on Tuesday, April 23rd in his beloved adopted hometown of Castine while in the care of the love of his life, Danielle. A mass of Catholic burial will be celebrated on Monday, May 6 at the Our Lady of Holy Hope in Castine. Following the mass there will be a reception at the Manor Inn from 12:00 to 3:00. As the church is quite small, the family understands that some might choose to attend just the reception. In lieu of flowers the family suggest donations in Lawrence’s memory to Free the Kids (ESPWA) 5704 West Market Street #8947, Greensboro, NC 27419 or www.FreeTheKids.org.

Lawrence was born on January 14, 1934 in Manchester by the Sea, Massachusetts to Dr. Lawrence T. Mutty and Margaret (Deasy) Mutty and spent his childhood in Melrose, MA. When he was young, he fashioned himself the “Boy Drummer,” playing in jazz combos, frequenting many of the jazz clubs in Boston, where he listened to and got the autographs of many of the greats. Later in life, he resumed drumming and was a stalwart member of the Castine Town Band for over a decade. Additionally, he was known to amaze friends and family by launching into drum solos at gatherings using only spoons and furniture.

A life long learner, Lawrence pursued an education in and out of classrooms throughout his life. He graduated from Boston College High School where the Jesuit beliefs of caring for one’s fellow man and being a contemplative in action, beliefs that animated so much of Lawrence’s life, were first instilled. He then attended Loyola College of Montreal (now part of Concordia University) where he met the remarkable Danielle Villeneuve, and together they pursued their medical studies and a romantic relationship: Danielle later became his wife. Lawrence then attended  The University of Ottawa medical school and completed his residency and served as a teaching fellow at the Harvard Laboratory of Community Psychiatry and the Boston City Hospital. This commitment to community psychiatry was to be a cornerstone of his professional career, and it was the focus of his Masters of Public Health degree at Johns Hopkins University.

Maybe more importantly, Lawrence was a passionate and meticulous reader throughout his life, and he always had a book he wanted to discuss with you, a book which he had almost certainly underlined and annotated. Lawrence was also a world traveler, and in their retirement, he and Danielle reveled in learning about the world’s cultures through travel, visiting, in particular, China, Russia, Cuba and India. Lawrence also self-published his own book that focused on General John Burgoyne and the battle for northern New York State during the Revolutionary War.

Always feeling a deep sense of commitment to his country, Lawrence joined the US Navy Medical Corps in 1960 where he completed his internship and began his residency. Although he left active duty after 6 years, he enlisted in the Naval Reserves in 1982 serving with great pride in the 27th Mobile Naval Construction Battalion (the “Skibees”) stationed in Brunswick (ME). He always strove to embody the Seabee’s “Can Do” spirit. He retired with the rank of Captain after 16 years. Lawrence also proudly served as President of the Penobscot Council of the Navy League and on the Commission to Study Maine’s Homeland Security Needs.

While Lawrence’s work was focused on helping those who struggled in life, it was never only a job for him; it was a vocation. He furthered his devotion to service in many ways including volunteering for two months as a civilian physician in Vietnam in 1968 and as an EMT on the Castine’s ambulance for several years in his retirement. Lawrence and Danielle also had a special commitment to medical missions and the ESPWA orphanage in Les Cayes, Haiti. For over ten years, Lawrence and Danielle not only provided free medical services, but they also secured and delivered many donations of supplies and medicines to the orphanage. They were particularly proud of the fact that their children and grandchildren accompanied them on many of these trips. Lawrence also wielded a mighty pen, sending articulate letters to the editor about causes for which he cared, such as the need for a high fence on the Augusta (ME) bridge, the building of which demonstrated the communities’ commitment to supporting people with depression, many of whom resided in the nearby state hospital.

During his professional career, Lawrence served as the Chief of Psychiatry at the Glens Falls (NY), Augusta (ME) and Veterans Administration (Togus, ME) hospitals. Earning the respect of his colleagues for his professional acumen and uncommon good sense, Lawrence was also elected president of both the Maine Medical Association and the Maine Psychiatric Association, and was a life fellow of the American Psychiatric Association. During his work life, he fought selflessly to create support services for individuals who had been left behind by society and to curb the commercial forces that were making these services less accessible.

Lawrence embodied the spirit of men sana in corpore sano and was an enthusiastic athlete and outdoorsman. He ran track in high school and resumed running in his forties, becoming a regular participant in the Castine 4th of July Road race well into his 70s. Lawrence also learned to ski and sail in his adulthood and spent many happy hours on the slopes of Sugarloaf and at the helm of the Flicker in which he competed for several years in the Maine Retired Skippers Race. Lawrence also enjoyed hiking and was particularly proud of summiting Mount Katahdin with one of his sons and grandsons when in his 70s

At the very center of Lawrence’s life was his family. In particular, his beloved wife Dr. Danielle V. Mutty was his soulmate, workmate and stalwart supporter; he deeply loved Danielle and was eternally grateful for his good fortune in marrying her. Lawrence was predeceased by his father Dr. Lawrence T. Mutty, his mother Margaret D. Mutty, and his dear daughter Nicole M. Mutty to whom he was especially devoted. Although Lawrence lost his own dad when he was 8, he was a caring and committed father, grandfather and role model to his surviving children and their families: Lawrence H. Mutty and his children Alex and Deasy; Paul B. Cyr-Mutty, his wife Jo, and their children Sarah and Aaron; and Monique (Mutty) Brown and her husband Jay and their children Carolyn and Katie. Lawrence is also survived by his ebullient sister Moira Amato of Burlington (MA). Additionally, Lawrence was an affectionate uncle to his nieces and nephews who visited Lawrence and Danielle frequently in Castine.

Though heartbroken at his loss, Lawrence’s family encourages all who read this to celebrate his life by devoting their intelligence and energy to making the world a better place for us all and particularly for those who struggle and suffer.

 

MMA Legislative Call Tuesday, May 7th

The Maine Legislature is in full swing, with over 1660 bills printed. All committees are holding public hearings and work sessions and voting on bills. That means there's lots of work to do on the MMA Legislative Calls. The next call will be Tuesday, May 7th, at 8 p.m.

 

MMA Legislative Committee Chairs Jay Mullen, M.D. and Lindsey Tweed, M.D. welcome you to participate in the weekly conference calls of the MMA Legislative Committee.

The last MMA Legislative Committee weekly conference call for the First Regular Session of the 129th Maine Legislature will take place Tuesday, May 7th, at 8:00 p.m.

Legislative Committee members and specialty society legislative liaisons are strongly encouraged to participate. Any physician, practice manager, or other staff member who is interested in the MMA's legislative advocacy also is welcome to participate. It is not necessary to RSVP for the calls. To date the Legislature has printed approximately 1700 bills, and as the deadline for committee consideration is approaching the number of bills printed each week is beginning to dwindle. While that makes the work of the legislative call shorter, it also allows for more in-depth discussion of significant matters.

Please use the following conference call number and passcode. These will remain the same for every weekly call during the session.

Conference call number: 1-603-766-5646

Participant ID - 699139#

The purpose of the weekly conference calls is to discuss the MMA's position on bills printed the previous week, to hear the views of specialty societies on the new bills or their concerns about any current health policy issues, and to discuss the highlights of legislative action of the week. The calls rarely last longer than an hour.

The following are bills of interest to the physician community printed last week. (For those not familiar with the term, a "concept draft" is a bill that contains only a title and a brief description of what it is intended to do. It does not contain the actual bill text.) We will discuss the priority bills marked with an asterisk (*) first.


Following are the bills of the week: 

May 7, 2019

*LD 1672,  An Act Regarding the Admissibility of Certain Health Care Records as Evidence. Simplifies the admission of medical records in court, without testimony.

*LD 1673,  An Act To Prohibit Prescription Drug Advertising. As stated, makes ad untair trade practice with daily violation. Includes broadcast, print, internet.

LD 1674,  An Act To Amend the Laws Concerning the Retired County and Municipal Law Enforcement Officers and Municipal Firefighters Health Insurance Program. Rules for enrollment in group health insurance.

LD 1678,  An Act To Authorize the Commissioner of Corrections To Designate Additional Employees of the Department of Corrections To Collect Biological Samples. Any trained DoC staff may collect non-blood biological samples, not just facility employees.

LD 1679,  An Act To Establish the Maine Climate Change Council To Assist Maine To Mitigate, Prepare for and Adapt to Climate Change. As stated. Requires 80% of electricity be from renewable resources after 2029, 100% after 2049.; updates greenhouse gas emissions laws; state climate action plan to be updated every 4 years.

*LD 1688,  An Act To Protect Original Birth Certificates.Repeals requirement of new birth certificate upon adoption and sealing of original. Does not affect persons born in foreign country or persons born before 10/1/19. Requires amendment of birth certificates to include adoptee’s new name and adoptive parents’ data.

*LD 1689,  An Act To Address the Opioid Crisis through Evidence-based Public Health Policy. Expands needle exchange programs to include naloxone distribution, HIV and Hep C testing, counseling. Removes criminal penalties for possessing and furnishing needles.

*LD 1694,  An Act To Amend the Mental Health Insurance Coverage Laws. Requires filing of mental health and SUD parity reports by insurers, HMOs, hospitals, and medical service organizations. Limits prior authorization and step therapy for SUD treatment.

LD 1696,  Resolve, Regarding Legislative Review of Portions of Chapter 101: MaineCare Benefits Manual, Chapter III, Section 28: Allowances for Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, a Late-filed Major Substantive Rule of the Department of Health and Human Services. Provides as stated.

 

Vaccine Vote Drama and Other State House Highlights of the Week

Please see a summary of the MMA's legislative advocacy at the Maine State House last week.

 

After the previous week's House vote on the vaccine exemption bill, LD 798, it was the Senate's turn last Thursday. The drama was high as the halls were filled with advocates for both sides of the issue. The Senate met on other matters, then broke for party caucuses on the issue. When they returned, there was impassioned floor debate, and then the vote: 20-15 in favor of the bill. But the work was not finished. Senator David Miramant (D-Knox) moved an amendment to reverse part of the action and retain the religious exemption. The vote was 18-17 in favor of the amendment, with four Democrats joining all of the Republicans. The story is not over yet, since the bill must now go back to the House which passed a different version. Watch this space next week to see what happens.

The Health & Human Services Committee held work sessions on several bills, among them LD 1616 which would establish a state version of the vaccine injury board. After some discussion, the bill was tabled until tomorrow (May 7). There was a public hearing on LD 1539, a bill to expand the CHIP program to cover more children from families with incomes up to 325% of the federal poverty limit, and a work session will be held on Tuesday as well. On Monday the Committee held work sessions on a number of bills. Notable were: the 11-0 "Ought to Pass" vote on LD 684, a Resolve directing the DHHS to develop recommendations on the treatment and prevention of Neonatal Abstinence Syndrome; the 12-0 "Ought to Pass" vote on LD 699, to provide outreach programs for women at risk of giving birth to substance-exposed infants; the 8-2 "Ought to Pass" vote on LD 40, to establish a study commission on children's mental health; the 9-0 "Ought to Pass" vote on LD 1461 to support early intervention in emerging psychosis; and the 12-0 "Ought to Pass" vote on LD 1548, calling for a review of assisted living facilities that provide memory care for able-bodied persons with dementia. During the upcoming week the HHS Committee will continue with other work sessions, with a few public hearings on substance use disorder, marijuana, and various other issues mixed in.

This coming Friday the Criminal Justice and Public Safety Committee will hold an all-day public hearing session to consider eleven firearm safety bills. The MMA is taking positions in support of the following: LD 379 (safe storage); 810 (background checks); 1276 (background checks) ; 1071 (high capacity magazines) ; and 1099 (waiting periods for purchase). Any member of the MMA wishing to testify on any of these bills is encouraged to contact MMA General Counsel Peter Michaud (pmichaud@mainemed.com) for details, regardless of the position you wish to take.

The Appropriations & Financial Services Committee continues its work on the Governor's proposed SFY 20-21 biennial budget, L.D. 1001. Most of this work is going on in private caucuses, not in public session.

The legislature's work is likely to remain focused in committees (public hearings and work sessions) for most of the month of May before it moves to the floor of the House and Senate where members will debate divided committee reports and process unanimous reports through the consent calendar with a goal of meeting the June 19th statutory adjournment deadline.

 

Upcoming Specialty Society Meetings

Below you will find an on-going list of Upcoming Specialty Society Meetings.  Any questions should be referred to the contact person listed for each specialty.

 

Below you will find an on-going list of Upcoming Specialty Society Meetings.  Any questions should be referred to the contact person listed for each specialty.

UPCOMING SPECIALTY SOCIETY MEETINGS

May 10, 2019
Maine Society of Eye Physicians and Surgeons Spring Educational Program & Business Meeting
Harraseeket Inn – Freeport, ME from 11:30am – 5:00pm
Contact:  Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

May 17-19, 2019
Maine Chapter, American College of Surgeons
Harborside Hotel and Marina – Bar Harbor, ME
Contact: Cathy Stratton at 207-592-5725 or cstratton@mainemed.com

May 18-19, 2019
Maine Chapter, American Academy of Pediatrics 2019 Spring Conference
Point Lookout – Northport, ME
Contact: Dee Kerry at 207-480-4185 or dakerry@aap.net

June 1, 2019
Maine Gastroenterology Society “2019 GI Update”
Hilton Garden Inn – Freeport, ME – Registration 7:15am, Program 8:00am - 3:00pm
Contact:  Gail Begin at 207-588-6619 or gbegin@mainemed.com

June 27, 2019
Maine Chapter, American College of Emergency Physicians Chapter Meeting

Cabbage Island Clam Bake – Boothbay Harbor, ME
Contact: Cathy Stratton at 207-592-5725 or cstratton@mainemed.com

September 7, 2019
The following Specialty Society Meetings are being held in conjunction with MMA’s 166th Annual Session taking place September 6-8, 2019 at the Harborside Hotel & Marina in Bar Harbor, ME

Maine Chapter, American College of Surgeons
Time TBA
Contact: Cathy Stratton at 207-592-5725 or cstratton@mainemed.com

Maine Chapter, American College of Emergency Physicians
Time TBA - Ironbound Room in the Pool House
Contact: Cathy Stratton at 207-592-5725 or cstratton@mainemed.com

Maine Society of Anesthesiologists
2:00pm – 5:00pm – Stave Island Room in the Pool House
Contact:  Lisa Montagna at 207-620-4015 or mesahq@gmail.com

September 20, 2019
Maine Society of Eye Physicians and Surgeons Fall Business Meeting

(Held in conjunction with the 17th Annual Downeast Ophthalmology Symposium)

Harborside Hotel & Marina – Bar Harbor, ME from 10:30am – 11:45am
Contact:  Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

September 20-22, 2019
18th Annual Downeast Ophthalmology Symposium

(Presented by the Maine Society of Eye Physicians and Surgeons)

Harborside Hotel & Marina – Bar Harbor, ME
Contact:  Shirley Goggin 207-445-2260 or sgoggin@mainemed.com

December 11, 2019
Maine Chapter, American College of Emergency Physicians Chapter Meeting

Portland Regency Hotel – Portland, ME
Contact: Cathy Stratton at 207-592-5725 or cstratton@mainemed.com

February 7-9, 2020
Maine Urological Association & Rhode Island Urological Society’s
2020 Winter Program
Sugarloaf Mountain Hotel & Conference Center – Carrabassett Valley, ME
Contact: Dianna Poulin at 207-480-4194 or dpoulin@mainemed.com

April 23-24, 2020
Maine Association of Psychiatric Physicians, 14th Annual Spring Program

Hilton Garden Inn, Freeport, ME
Contact Dianna Poulin at 207-480-4194 or dpoulin@mainemed.com

 

 

 

 

  


 

Cumberland County Physicians: Join the MMA at the Foreside Tavern in Falmouth on Thursday, May 16

Cumberland County physicians are invited to join the MMA for informal conversation with friends and colleagues and to let us know how MMA can better serve you.

 

Join the Maine Medical Association at the Foreside Tavern in Falmouth on Thursday, May 16th, 2019 from 6:00 to 8:00 pm.

Cumberland County physicians and their guests are cordially invited to join the MMA for informal conversation with friends and colleagues.  Stop by for an appetizer and beverage on us and share with us your thoughts and opinions.  We would like to hear what's on your mind.  This is a great opportunity for you to let us know how MMA can better serve you.  

Please RSVP to Sarah Lepoff at slepoff@mainemed.com or 480-4191. 

Treatment & Prevention of Medical & Mental Health Emergencies -Substances & Gun Violence -May 17 & 18

Keynote speakers include:

John Rogers Knight, Jr., MD, Physician in Medicine & Psychiatry, Boston Children’s Hospital Associate Professor of Pediatrics, Harvard Medical School - Adolescents & Psychoactive Substances

Joseph V. Sakran, MD, MPH, MPA, FACS, Assistant Professor of Surgery; Associate Chief, Division of Acute Care Surgery; Director, Emergency General Surgery, Johns Hopkins Hospital -Gun Violence in America: #ThisIsOurLane

To view the full agenda and speaker line up and register, visit https://www.maineaap.org/conferences.

 

Quality Counts: Rapid Induction Starting in the ED (RISE) Training, Webinars, ECHO Program

Quality Counts is hosting an education program for hospital Emergency Departments (EDs) with training and technical assistance on initiating buprenorphine in the ED.

 

Rapid Induction Starting in the ED (RISE) Education Program: Training, Webinars, ECHO Program

Quality Counts (QC), in collaboration with BlueWater Emergency Partners and several other partners (MMA and ACEP) is working under a contract with the state of Maine to host an education program for interested hospital Emergency Departments (EDs) focusing on how to initiate buprenorphine in the ED.  During the Rapid Induction Starting in the ED (RISE) project, QC plans to offer a range of learning methods, including both in-person and virtual events, to provide education and assistance on best practices for initiating buprenorphine in hospital EDs for individuals with Substance Use Disorder (SUD) who are willing to engage in treatment during an ED visit.

If your ED is interested in receiving training or technical assistance on initiating buprenorphine in the ED from peer coaches in the field please contact Kayla Cole at kcole@mainequalitycounts.org or tel. 207-620-8526 ext. 1027.

Additionally, as part of our project RISE educational programming, we will offer a four-month ECHO program that will convene a "hub" of faculty experts and clinicians as well as three one-hour webinars.  Our team will engage clinicians and teams from hospital EDs that have and/or are planning to implement MAT in the ED to serve as "spokes", giving them the opportunity to learn together and discuss specific questions and challenging issues through case discussions.  Content for the ED MAT didactic sessions in the ECHO program will reflect key educational topics related to initiating MAT in the ED, with specific content to be developed with input from ED and addiction medicine expert consultants, as well as from targeted ED clinicians and staff around the state.  If you are interested in these educational opportunities please hold the following dates.  If you have questions or would like more information please contact Kayla Cole at kcole@mainequalitycounts.org or tel. 207-620-8526 ext. 1027.

ECHO Dates:

  • May 22, 2019 from 12:00-1:00 PM
  • June 26, 2019 from 12:00-1:00 PM
  • July 24, 2019 from 12:00-1:00 PM
  • August 28, 2019 from 12:00-1:00 PM
Webinar Dates:
  • June 5, 2019 from 12:00-1:00 PM
  • June 12, 2019 from 12:00-1:00 PM
  • June 19, 2019 from 12:00-1:00 PM

 

"Trust Me, I’m a (Certified) Doctor: Innovations and Improvements in Maintenance of Certification” - Thursday, May 23

Learn about changes to the Maintenance of Certification Program and changes being instituted by the American Board of Pediatrics. Presenter: Marshall L. Land, Jr.

 

Thursday, May 23, 2019 at the Maine Medical Association

Learn about changes to the Maintenance of Certification Program and changes being instituted by the American Board of Pediatrics.

Presenter: Marshall L. Land, Jr., MD,  R.J. McKay, Jr., MD Green & Gold Professor of Pediatrics, University of Vermont College of Medicine  &  American Board of Pediatrics, Advisor for Diplomate Outreach and Strategic Planning

Maine Medical Association – Large Conference Room

Registration  5:00pm  -  Program: 5:30pm – 7:30pm  Light dinner provided.

Cost:  $20.00

REGISTER HERE

 

MICIS 2019 Clinical and Legal Opioid Update - May 29 in Brewer, June 5 in Augusta

Choose one of two dates for this three-hour presentation by the Maine Independent Clinical Information Service (MICIS): Wednesday, May 29 at Jeff's Catering in Brewer or Wednesday, June 5 at the Augusta Civic Center.

 

2019 Clinical and Legal Opioid Update