Thursday, March 3, 2016


 A fight over the use of telemedicine rages behind the scenes at the Mississippi Board of Medical Licensure.  Telemedicine is used by tens of thousands of patients in Mississippi as its growth has exploded over the last few years.  However, emails and other correspondence show the Board has been waging its own war on telemedicine as it seeks to control the market and limit its use.  One board member even calls his employer "shameful" for offering telemedicine to its employees. The Executive Director chews out the board attorney for daring to offer an opinion whether some forms of telemedicine are legal. Other emails show the lengths the board has gone to to regulate the market while avoiding the rules it must follow in doing so.   JJ obtained emails through a public records request. 

Governor Phil Bryant talks to Dr. Randy Easterling
 Should the practice of telemedicine be limited to video-conferencing in a doctor's office or expanded to the use of telephones and smartphones is the  key issue in the fight between the Board and telemedicine providers.  The use of telemedicine has exploded over the last few years as telemedicine providers use smartphone apps, videoconferencing, and store & forward technology* to offer medical services to patients.  Health insurance companies and employers like the service because it offers medical evaluations for non-serious conditions at a fraction of the cost of a visit to a doctor's office or the emergency room. However, the medical lobby has its own thoughts about the use of telemedicine in Mississippi.  Proposed rule changes and internal emails show the Board wants to limit the practice of telemedicine to the use of videoconferencing in a doctor's office. The Board's position just happens to coincide with the telemedicine services offered by UMMC and the position advocated by doctor's lobbies in Mississippi.   See earlier post for an explanation of the telemedicine fight in Mississippi.  

That was the background, now its time to look at some emails.  One  heated exchange took place when Merit Health decided to offer MDLive to its employees at its Vicksburg hospital. MDLive is Merit's telemedicine service. The email posted below promotes the use of MDlive to Merit Health's River Region Medical Center.

Well, Board member Dr. Randy Easterling took great offense to this email.  The word "conniption" comes to mind when reading his reaction.  He fired off his own email in response that was um, rather strident in nature. Keep in mind that he is chewing out the CEO of River Region.  

Then there is the matter of the Board attorney.  River Region asked MBML attorney Ellen O'Neal for an opinion on whether telephone-only telemedicine was legal.  Ms. O'Neal is actually an Attorney General staff attorney assigned to represent the Board.  She told River Region it was legal:

Big mistake.  Big.Huge.Mistake. MBML Executive Director Dr. Vann Craig told the her to hush up and let him speak for the Board. Oh, and by the way, we don't think your telemedicine is legal, now get lost.

Not even telemedicine angel Dr. Kristi Henderson of UMMC was immune to the Board's meddling on all things telemedicine.  Dr. Jauvert heard there might possibly be an audio-only UMMC telemedicine kiosk at Jackson Prep.

Remember the history of this fight as it has taken place over the last year.  The Board announced it was going to amend its telemedicine regulations to ban the use of telephone-only telemedicine.  There would be no hearings nor an analysis on its economic impact on patients and telemedicine providers.  This action generated some heat because there is a rulebook for making rules.  The rulebook contains antiquated ideas such as due process, notice, and a cost/benefit analysis.  Senate Public Health Committee Chairman Dean Kirby told the Board in an April 13, 2015 email that it needed to hold a public hearing on its proposed rule changes:

The Board took the hint and held a hearing in May.  More than a few interested parties showed up to comment on the proposed rule changes that were not rule changes (sarcasm).  The Board withdrew the proposed amendment in June but this was only a respite from the telemedicine war as the Board sought to "clarify" the rules in October.  Why change rules when a government agency can just reinterpret or reimagine them?

The telemedicine providers and others protested that the Board was again rule-making without conducting a cost/benefit analysis.  An agency is supposed to determine whether a new regulation or policy will "help or hurt" before it adopts the new rule. The Board relented and hired Dr. Mimmo Parisi at Mississippi State University to conduct the analysis.  Dr. Kristi Henderson recommended the use of Dr. Parisi.  However, the economic impact statement is not complete.

The emails show a government board is trying to restrict the use of telemedicine and is cheered on by a few groups who have a vested interest in limiting competition.  The Mississippi Medical Association immediately comes to mind.  The fight has expanded to the Mississippi legislature as the Senate takes up HB #1178.  Stay tuned.  

* "store and forward” means the transmission of a patient’s health care information from the location of a patient to a physician or supervised provider at another location over a secure connection that complies with state and federal security and privacy laws.


Anonymous said...

Please don't lump physicians trying to do the right thing in with these clowns. The only thing marginally less efficient than UMMC is the VA and the IRS.

Anonymous said...

There is a very simple low-cost solution. Community Paramedics. A Paramedic that has had many years of experience gets additional training and goes out to the patients, not in an ambulance, but in a non-emergency vehicle. They visit the patient, consult with a doc, can get e-scripts called in by a doc, etc.
It reduces 911 abuse, emergency room overcrowding, costs less, reduces Medicare/Medicaid fines to hospitals for readmission rates for certain types of patients and gives the older more experienced paramedics that have had their bodies beat up after 10 or more years crawling in and out of a truck a way to continue to serve in a different manner.
The last line of the last email illustrates the need.
It's already being done in other states with tremendous success.

Anonymous said...

Kingfish, Was Mimmo Parisi employed as a private individual, or was he employed as director of NSPARC, a taxpayer owned division of Mississippi State University?

Anonymous said...

Follow the money. Just like the airport. Just like anything the legislature touches. Follow the money.

Anonymous said...

Wow, KF, great reporting here. This is a shame.

Madison Doctor said...

Leave the practice of medicine up to doctors-- these guys know what they are doing and need to be regulating this. If you have not gone to medical school, you should not be speaking on this subject--that includes you Kingfish.

Anonymous said...

Typical Mississippi. The shakedown HQ for these United States.

Anonymous said...

Didn't they just fire the Executive Director listed above? Word is that this is among the issues that got him canned.

Anonymous said...

Wait until president trump allows low-cost drugs from Canada, forces hospitals and doctors to competitively price their more ten dollar tylenols at the hospitals...

de-regulate the health care industry i'm sick of paying all that insurance for minimal care.

Kingfish said...

You heard from 10:25: Everyone needs to shut the hell up unless you have an M.D.

Anonymous said...

I guess your MD caused your head to be jammed so far up your ass that you can't read the writing on the wall on the direction medicine in going in this country. Nor could your arrogant a$$ comprehend that my statement was that the community paramedics can be the link between the MD's and the patient, using telemedicine. As a "doc", think about how many patients you could bill for using that method while you sat at home in Reunion in your PJ's polishing your pineapple.
You're a prime example of why things don't work. We can't be progressive and do things to benefit patients because of doctors specifically like you.
But I tell you what, since your the medical God, be sure to keep your own Lifepack at your house for the day that SA Node checks out and you can pace yourself. You wouldn't be able to make it half a shift in the back of a rig in Jackson before you'd be crying for your brick bridges and only seeing patients in your environment, not in theirs where you don't know who's behind the next door or you gotta intubate someone on the side of the interstate in the dark while traffic goes by at 70+ mph.
Guess you forgot your oath you took douche nozzle.

Anonymous said...

Madison Doctor go suck an egg. Technology is catching up and you old bastards managing healthcare blowing up the costs of healthcare need to pass on. It is going to be an interesting day when you are replaced with IBM's Jeopardy machine. It is already doing lifesaving research. So why don't you go find a pineapple to put on your porch you four flushing twit.

Anonymous said...

@ Madison Doctor - what's your specialty?

-W said...

These same fuck faces punished an 88 year old doctor for helping the poor in a parking lot. Face to face exam but it did not happen in a room. This is why everyone of them needs a pineapple shoved up their ass.

Anonymous said...


Anonymous said...

Clearly they need to do the analysis and publish the results and not break the rules and pretend to be dictators. That having been said, does anyone think that filling out a form or otherwise just talking in the phone - with no exam or vital information collection - should count as medicine? That's not telemedicine, that's a phone call or submitting a form. Now if the normal exam measurements can be taken remotely through new technologies and the doctor/nurse practitioner can then communicate with the patient, that's real telemedicine and would help a lot to cover remote areas. Should doctors be reimbursed the same for that as a doctor with an office, staff, etc., though? If so, who would ever choose to have a building and staff?

Anonymous said...

Time to get with the times. I don't want to sit in a doctors office for 1 1/2 to 2 hours to only see a doctor for less than 5 minutes.

Anonymous said...

I think the Ed board needs more legislative attention than the airport board.

Call Me In The Morning said...

A paramedic? I think not. Riding in a box on wheels with flashing lights, regardless of number of calls, is not a qualifier for medical diagnosis and counseling.

A better alternative might be nurses on wheels, like Home Health uses. Degreed, licensed nurses who then consult with doctors and facilitate treatment, including follow-up. If it works for Medicare patients, why not the general public.

PS: Rule of thumb ~ Avoid, at all costs, anybody who wants to shut people up. That includes sons of bitches with all sorts of letters following his/her name.

Anonymous said...

Great work on bringing this into the sunshine, Kingfish.

"You've done a man's job, sir." --Gaff

$Just Saying said...

This is all interesting because if you check the sign out at the old Meadowbrook Mart it indicates UMMC is involved with a Telemedicine facility that is proposed for that property. I wonder why they would be getting deeply involved if they won't be allowed to actually use telemedicine?

Madison Doctor said...

I am a Family Practice doctor. Serving poor patients, daily. Once again, until you practice medicine you will not know what it is like to handle patient care.

Anonymous said...

@11:58 - you obviously do not know what goes into the education of paramedics. Go do a ride along before you judge and then make an educated opinion. Education training and experience ARE qualifications for making a diagnosis because you can't treat until you diagnose something.
This specific topic is why colleges across the country, and yes here in this state, have started developing Community Paramedic programs that is additional education, training and clinical hours beyond the 2 yrs already spent becoming a medic.

Anonymous said...

@ 12:06., because their model is what the Board of Medical Licensire wants. It has patients come into a healthcare facility and utilizes videoconferencing. Other options include using telephone only from home (and to a nurse). Telemedicine is the future and can help MS. The fighting is over how it will best work or best serve Mississippians.

Anonymous said...

The continuing education requirements and recert intervals for medics is way more stringent than for nurses and docs too. Every two years you have to be refresh advanced cardiac life support, pediatric life support, airway, OB/GYN, Medical, behavioral, trauma etc. Also no criminal convictions. None of this - I get to still practice under a limited license because I took a little of this and that from the acudose or I'm chewing on pain patches or had a standoff with a SWAT team after I beat my wife.

Anonymous said...

Heck, Easterling and Bryant even look alike.

Anonymous said...

Lookit: Everyone needs to listen to Madison Doctor. All physicians are in the practice of medicine to serve the public good alone. Financial gain plays no part in any physician's motivations in any way. Doctors should be allowed to practice any way that they see fit, and should only answer to other Doctors from a regulatory perspective. Anyone without an MD degree has nothing to add to any argument regarding patient care. If any ideas, programs, regulations or restrictions are introduced into the practice of medicine by someone who does not have a medical degree, patient care will certainly be compromised and people will die! Do you really want that? Do you want people to die? I think not! Thus, physicians must and will have the first and final word in any decisions regarding the delivery of care.

Case closed. Kingfish needs to shut down any further posts to this entry.

Anonymous said...

@ Madison Doc - please let us know where your practice is so we make sure not to go there.

Anonymous said...

@12:06- thanks, Dr Easterling. Helpful to have the Board's position.

Anonymous said...

@1:29 I think you mean @12:29

Anonymous said...

Here's Madison Doc's logic:
He's fine with a paramedic being able to diagnose a heart and be able to specifically pin point specifically which artery is involved, pierce a needle through someone's chest to decompress a collapsed lung, differentiate between rhales, wheezes, rhonchi and stridor in the lungs and know what disease processes are involved with each, and be able to administer 100's of different medications keeping in mind the indications, contraindications and relative contraindications of each drug and how one drug will effect the body on a cellular level and how different drugs will interact. He's fine with them being able to intubate his or her spouse, parent or child and understanding how capnography works to evaluate everything from cardiac function, respiratory function and the pH of the body. He's ok with a medic being able to draw blood, or start a large bore IV in someone's neck or drill an needle into their leg or shoulder to deliver medicine. All this without having to consult a doctor because they are standing orders. That he is ok with. And he's ok that a medic may have to all this in dark, in a dangerous situation, with the help of one person or sometimes no one, and making these decisions in the matter of minutes. That's all fine and dandy.
But go to someone's house for a cold or flu or any number of minor medical conditions that they would go to their primary care physician for, evaluate them, then teleconference with a doctor while they are still with the patient to present a full patient history along with signs and symptoms and have that doctor make the decision on the course of treatment --- nope, can't have that! Especially at half the cost for a nurse to do it. Absolutely not. (That is not a jab at nurses. Many nurses do a jam-up job. Medics are just cheaper.)
Guess what ya pineapple polishing pill popper, PEOPLE ARE ALREADY USING MEDICS FOR THIS!!! They call 911 because they can't get into a doctor's office or they are on Medicare or Medicaid and an ambulance doesn't charge a copay. They are filling the ER's with stuff that you should be handling. You want to know why it takes so long for an ambulance to get somewhere sometimes? It's because the people that should be seeing their family doctor are filling the ER's and ambulances are stuck with patients on stretchers for over 2 hours waiting on an ER bed because the ER's can't keep up.

Anonymous said...

Poor Dr Craig , they are using him as the out on this issue. Are the four most anti-competitive members of the Board the four horsemen of the apocalypse? Or is it five? Or six?

Nurse said...

No surprise here, Easterling has run the Board for years. We have been trying to work with this Board to simply provide more access to patients we serve daily. Easterling has shut us (Mississippi nurses) out for years--even when we have simply asked for small changes to help more access. It is time this Board has some real examination by our state instead of letting them continue their damning stances on simple issues.

Elizabeth Joseph said...

I have not posted any comments on this site. Someone has commented posing as me on both this post and the previous telemedicine article.

Anonymous said...

Go to most doctors with anything that is a little out of the
ordinary and a misdiagnosis is guaranteed. We need layered care with a large bottom layer shucking the routine, a middle layer shucking patients as they are able and doctors at the top letting their nurses tell them what is wrong with the harder ones.

Anonymous said...

10:22, Dr. Parisi is a first rate social scientist who has worked at MSU (I assume he is still at the SSRC).

An impressive guy in a field where not everyone is.

Anonymous said...

To " Shut up, I'm an MD"
Some of us have higher IQs, better tests scores in college and on graduate level testing and just didn't choose to go into medicine.
As a result, we may have more expertise in our field than you do in yours and if you weren't so arrogant, you might understand that medicine is also about the patient.
As someone who has to have been a patient off and on for 69 years and who worked with hospital and doctors over the course of my career, I have been appalled in the deterioration of medical care and practices.
While technological advancements have improved medicine, patient care has not improved and we are declining statistically world wide in major areas .
A hospital is now the most dangerous place to be in this Nation because of medical mistakes!
Doctors used to be professionals and now far too many are behaving like merchants!
This series of emails is appalling.
Really smart people are smart enough to know what they don't know! And, you would benefit by , at least, listening to what other experts in related fields have to teach YOU!

Anonymous said...

Based on some of the comments here, those of you that do not work or have never worked within the medical community really have no clue about the true problems associated with this subject. Public safety IS the number one concern and it is very difficult to wave a wand and simply approve Telemed. The MSBML is doing good things, yet they are getting punched in the face by people who do not see the entire picture AND associate everything with greed. There are current Rules and Laws that must be considered before simply giving the approval. There are Federal, State and Administrative Codes in place to PROTECT THE PUBLIC from fly by night operations from opening up shop and this matter MUST be screened to ensure the safety of the patient is being met, potential prescribing laws are met etc. Rule changes, law changes do not happen over night. Legal reviews must be done, crossed checked and vetted. The MSBML is believe it or not, is progressive but bureaucracy sometimes takes time. There seems to be a vendetta against Dr. Easterling, who at times is very vocal. He is also very well versed in the current state of medicine in MS and the US. He is a good doctor and has the citizen's back as does the rest of the MSBML in ensuring everything they do, is done appropriately with again, the safety of the our citizens in mind.

Kingfish said...

There are current Rules and Laws that must be considered before simply giving the approval. There are Federal, State and Administrative Codes in place to PROTECT THE PUBLIC

Yes, that is true and the BOARD HAS NOT BEEN FOLLOWING THEM. Of course if it is to PROTECT THE PUBLIC, rulemaking rules should be damned. I get it. The God complex on total display.

As for lobbyists, you need to read that again. Hiring a lobbyist was not made a headline. Many agencies indeed hire lobbyists. Worthless Worth is doing quite well representing Hinds, Jackson, and JMAA, for example. The section about the lobbyist was more of a jab at lobbyists as there are always more than a few lobbyists looking for work and a shortage of potential clients.

The funny part is most of the good lobbyists will be conflicted out of representing the Board.

Anonymous said...

@7:40: Dr. Easterling, we appreciate your comments. We applaud your hard work. We recognize your importance. We understand you are and always have been the VOICE of medicine in Mississippi. We, however, do not agree with your poorly written progressive stance: "The MSBML is believe it or not, is progressive but bureaucracy sometimes takes time."

By the way, how is the pill mill business in Vicksburg?

xoxo, Mississippi Citizens on your Mind

Anonymous said...

I'm glad 7:40 am learned that the best defense is a good offense.
Sadly, it was apparently not learned that you don't need to be defensive if the facts support your position.

That you nor the board see the potential value of telemedicine ( doctors can no longer gain valuable information from observation of a patient while they are experiencing symptoms?) continues to be shocking.

By the way, I taught doctors and nurses how to use observation.

But, I will tell you that most good mothers can tell when their child is " simply coming down with something" from observation and from a skill that seems lost with doctors these days, simply knowing their patient as a functioning human.

Anonymous said...

This is why the state will always be #51. Worst choice of my life was to move here and try to move the needle

Heddy-Dale Matthias, MD said...

I hope and pray that the MSBML EMBRACES telemedicine as the wave of the future. It is simply a matter of months/time before BP, Pulse, oxygen saturation, glucoses, weights, temps, and stethoscopic transmission of heart and breath sounds occurs from a home to a HIPAA-compliant internet site, complete with face-to-face interviewing. Patients' medications and their pharmacies will all be listed for uploading. Patient histories will be stored in a convenient and easy to understand format.

A board-certified physician may see and talk to a patient from ANYWHERE in the country (or the world, for that matter). Controlled prescriptions will NOT be part of this scenario. A board-certified physician whose only concern at the time, sitting in front of his/her computer at home, will be the patient in front of him with most of the most pertinent information he/she needs to consult. He/she certainly can also tell the patient he/she needs to go to the ER, have laboratory exams performed (and order them), have certain XRays, etc. ordered, and order them.

This portal will become the patients' PERSONAL medical folder, and will be completely PORTABLE to any and all physicians he/she may encounter in the future. It'll be MUCH easier to read and keep up with than the MONSTROUS electronic medical records imposed by our draconian Federal Government. Patients can download their entire medical record for any medical personnel to see.

Hopefully these HIPAA portals will be designed by someone other than the IDIOTs who now design EHRs that physicians hate, patients hate, and make understanding a patient's medical history nearly impossible. I pray that Apple or Google or some Silicon Valley company that wants to make BILLIONS of dollars will usurp the companies that sell EHRs and put them out of business.

These portals will be physician and user/patient friendly, and will, FINALLY, make taking care of the patient and understanding his/her history a pleasure. It will have all sorts of bells and whistles like any commercial website has now that tells me to buy their merchandise that they know I like. It will have PopUps that remind patients they are due for a flu vaccine, and PopUps that will remind a physician a patient is due for a mammogram, or that their hemoglobin has fallen 3 points in the last year.

Physicians and patients will be in medical heaven.

BTW, when was the last time that a patient, other than an OB-GYN actually EXAMINED you by laying on his/her hands?

Call me a BIG FAN of telemedicine. I admit there are some important bugs to work out, the most important of which is the availability of WiFi or internet connectivity to everyone, especially the poor. But these are small technical issues that will soon enough have solutions.

Heddy-Dale Matthias, MD said...

BTW, I encourage nurses, physicians, and other medical providers to PUBLISH THEIR NAMES when posting on this website.


Heddy-Dale Matthias, MD said...

I pray that the MSBML will take up the banner of telemedicine and run with it, improve it, and perfect it.

It is only a matter of time (months) before we have all the technologies together to be able to have IN-HOME transmission of BP, temp, pulse, weight, continuous glucose monitoring, oxygen saturation, face-to-face interface. We will have smartphones that will allow us to listen to a patient's heart and lungs directly at home. This will be stored on a HIPAA compliant website that will include all the patient's medical records, medication, labs, etc.

The patient will have a board-certified physician available at his/her computer/smartphone to devote all his/her time to the patient for viewing and questioning. The physician, in the near future, can be anywhere in the US, or the world, for that matter, as long as language is not a barrier.

If the physician thinks the patient needs to go to the ER, get labs, XRays, etc. he/she may order them. The physician can call an ambulance if required.

The physician can diagnose and prescribe everything except controlled substances.

Hopefully, great technology companies such as Apple, Google, Amazon, etc. will devise these websites that will carry all the patient's personal medical information, and ENHANCE the ability of the physician to treat the patient, unlike the GOD-AWFUL electronic health records (EHLs) we're forced by the IDIOTS IN WASHINGTON, DC to deal with, that actually INTERFERE with providing good medical care.

These companies can make billions of dollars (MORE POWER TO THEM) in devising websites that remind patients and physicians of things that need to be done and checked. Imagine "it's time to get your mammogram" POPUPS?!

These portals will allow complete privacy and portability for patients.

BTW, after 35+ years of practice I can assure you that over 90% of "interfaces" can be done competently this way, and the remainder can be handled with other tests or advice to go to an "in the flesh" physician. "A look is worth a thousand words."

When, BTW, was the last time a physician actually laid hands on you for an exam? I submit that most of us, beyond our OB-GYNs, can't remember.

The stickler, so far, for Mississippi, is devising internet connectivity or WiFi capability that is affordable to all homes, especially to the poorest among us. But that is an easily and financially-solvable problem. Medicaid and other insurers could save billions by paying for this.

I look forward to these advances of in-home consultation and HIPAA-compliant medical records over the internet. It will improve patient care immensely in this state, and all states, especially for those most likely to have difficult access to in-office medical care.

Anonymous said...

Kingfish @ 0839

" Yes, that is true and the BOARD HAS NOT BEEN FOLLOWING THEM. Of course if it is to PROTECT THE PUBLIC, rulemaking rules should be damned. I get it. The God complex on total display. "

Sure they have. Do you think that all of the physicians in the Great State of MS are following all of the rules?

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