Posts published in “Schmidt”

I have only had one occasion to file a complaint against a colleague with the Idaho State Board of Medicine. They rebuffed me with a dismissive, “This is a local standard of care issue, handle it in your community.” My community colleagues had no backbone to address the poor care. I left the community. A year later the person practicing medicine was finally sanctioned for another incident by the Board.

I offer this preface because you need to know, the Idaho BOM and I don’t always see eye to eye. Prior experience tells me this complaint will not be welcome either.

I hereby file a complaint with the Idaho BOM against the Idaho legislature, and our governor, while we’re at it, for the crime of practicing medicine without a license.

It takes quite a bit to get me riled up. I don’t always approve of choices my colleagues make when they provide care, but I can accept that what we do is a “practice”, and the variations within that practice, when studied, can guide us toward best practice.

Indeed, the Idaho Medical Practice Act defines the “practice” of Medicine:

The investigation, diagnosis, treatment, correction, or prevention of or prescription for any human disease, ailment, injury, infirmity, deformity or other condition, physical or mental, by any means or instrumentality that involves the application of principles or techniques of medical science…

Patients come to doctors for many reasons. I do my best to understand their complaints and provide care.

I remember a young woman who came to me with what I thought a trivial complaint. She was young, attractive, but had very coarse and prominent body hair. It darkly covered her forearms. She had a dark mustache she plucked. She said it afflicted all the women in her family, but she had researched an antiandrogenic treatment and asked me to prescribe it. I told her I would study it and get back to her. I did.

The drug blocked the effects of androgens, male sex hormones. It had been developed for the treatment of prostate cancer. But I found studies where it had been used for this young woman’s condition with significant benefit. After a week of study and contemplation, I called her to come back so we could consider this treatment.

I tell you this so you can consider what the Idaho legislature and our governor have just done. They have, by the heavy hand of the law, forbade me from considering a treatment for my patient.

No treatment, other than counseling, for a young person under the age of 18 who suffers from their gender may now be prescribed by a medical practitioner under the penalty of law.

The Idaho legislature and our governor have decided how medicine should be practiced in this state. The Idaho BOM should take heed.

I don’t know the best treatment for gender dysphoria. I have seen patients who struggle with this condition. I do my best to treat them with respect, knowledge, and wisdom. But now, I must also treat them with the consideration of prosecution. Is this the Idaho I love? Is this the community that cares for each other?

There are many issues the struggling youth must address. There are issues their communities must address. But passing laws about what treatments are available doesn’t seem a healthy way to proceed.

The Idaho legislature and our governor have proclaimed they know the best way to practice medicine. The Idaho Board of Medicine needs to assert their authority. Statutes clearly describe the penalties for practicing medicine without a license. Drop that complaint in the Attorney General’s lap. We all know where that would go.

Just because you know the enforcing authority won’t act doesn’t mean you shouldn’t voice your complaint.

 

Our Attorney General is trying for a mulligan from his office in our House of The People down there in Boise. That’s what we get when we elect bullies. They shoot off their mouths, and then expect us to pay for it.

Let me catch you up. An AG’s opinion letter sent to Idaho Representative Brent Crane last month was made public. In it, our new AG, Raul Labrador, stated that a doctor who “referred” a patient across state lines to access abortion care would be guilty of a felony. Further, a doctor who prescribed medication for an abortion for an Idahoan to pick up across state lines would also be felonious.

This “AG analysis” as his signed letter heading indicates, hit the national news and in a few days our AG decides he didn’t really write it. It turns out he, or his staff figured out the analysis was requested by Crane for fundraising, rallying the troops, purposes, so he announced the analysis had never happened. It was “rescinded”.

Still, the alarm bells went off for some folks, mainly the ACLU, and now our AG is spending time defending this letter that he claims was never written in Federal Court. Isn’t that where we want our state’s lawyer spending time? Defending an analysis, he says now he didn’t even write in federal court? I’ll bet some of us do. I doubt AG Labrador serves in the Militia for the Unborn. But I know he wants their votes.

This militia is well organized. I remember getting called out of a room when I first started to practice long ago in Idaho by my nurse. “There’s somebody on line 4 that wants to talk to you.” It was the old days, and I could recognize a long-distance call by the static on the old land lines.

“Doctor Schmidt, will you be providing abortions?”

She waited for my answer.

This last week in the clinic where I work now there were two people scheduled to see me whom I did not know. The reason for the visit was in the computer as “discuss family planning”. I wondered, were they sent to entrap me? Did they want to get me to mention a clinic across state lines where they could access the care unavailable to them in this state? And then would they share this information with our state Attorney General? And would the state troopers roll up as I’m having a beer with dinner?

When asked to clarify his “analysis” by reporters, our Attorney General refused. He did not say this analysis was wrong, he just said it hadn’t happened.

I guess that’s how my fellow Idahoans want this to play out. Only legislatively approved care can be provided by doctors. Really?

It’s going that way with all the hot button issues. Abortion, transgender care, what is next? What kind of personal care will come under the scrutiny of our legislature and the analysis of our AG?

Could a twenty-year-old man request a vasectomy?

Can a 42-year-old woman request fertility treatment?

Can a 95-year-old man get Viagra?

I understand the passion of the Militia for the Unborn. They see the lives to be saved. And what’s a little arson, or a sniper round to save these fetuses?

And now, we have the full power of the government, the state, the marble-halled Capitol, the Peoples House, coming into this conversation.

I talked with the young women about their choices for family planning. I tried to understand their needs, their situation. I decided not to fear that I might be prosecuted. But I considered this going into the room.

 

The wind out of the west was chill and biting on Dale’s face. He pulled the collar on his camo coat up. Patrol could be boring, but they’d gotten an alert about a grey van possibly heading their way.

Dale looked back west at the roadblock, manned by his fellow militiamen. This two-lane highway didn’t have a lot of traffic. But it headed west to a heathen state, so the Militia for the Unborn patrolled it. He was here to save lives.

He regretted missing his son’s basketball game that night. But when he’d joined the Militia, and the legislature gave them the marching orders, he knew this cause was righteous. He accepted the sacrifice. He’d known this cause was worthy all along, but now they could act.

That time they’d crossed the border and set fire to that abortion clinic had been an unofficial act. He knew they were breaking a law in that neighboring heathen state, but Dale believed there were higher laws than the laws of man. Still, when the laws of man sanctioned their actions, he did feel a warm comfort. It felt good to be in a righteous state where he could serve the unborn.

His alert gaze swept back east as he saw a grain truck approach. He radioed down to his comrades. They got up and stood by their barricades in a semblance of attention as the semi barreled past.

Nothing for a while. The property taxes coming due filtered into his mind. How was he going to pay them? Maybe sell that old snowmobile. Might get enough if Craigslist panned out.

He couldn’t get anybody to help with the plumbing business, so that money had been getting short. Doug, his old helper was doing a rider for meth, and he couldn’t get anybody to do the crawlspace work. Dale looked down at his girth and sadly smiled. That belly ain’t getting under a house. He patted it fondly. Hell, it even made kitchen sink repairs tough.

Still nothing coming.

Jenny had said she’d take the three little ones and go to Hiram’s game. He needed the support. The other parents would accept Dale’s sacrifice. Maybe not all of them. He got a sense some thought he was not doing God’s work out here on patrol. Their weakness didn’t trouble him too much.

A red sedan came into view, and he radioed to his comrades. They put up the barricade and shouldered their arms. The sedan slowed. Dale watched from the hill, ready to provide back up. He hoped to be on the barricade next tour. They were due to be relieved tomorrow by the Freedom Militia.

He watched the commander approach the driver’s side as the other two brought their weapons to ready. He couldn’t hear anything from this distance and the wind was just enough to whistle in his ears. Nobody got out. The barricades moved back with the commander’s signal, and the sedan moved on slowly. I guess no one of childbearing age was inside.

That was the protocol. Look for the women who could be bearing. They had the pee sticks in their pockets. And they had the bottled water. Sometimes it took twenty minutes for the lady to get the stick wet. Then you read the lines and make your determination. One lady tried spitting on the stick, but now we make them squat in front of the car so we can be sure.

The red sedan was going really slow, not gunning off to make up for lost time. Dale thought that odd. He stared at it too long and didn’t catch sight of the gray van until it was on the straight heading toward the roadblock. The folks from the sedan had gotten out and were going back to the trunk.

Weapons came out.

 

Isn’t it just ironic that President Trump’s greatest accomplishment in his four years of Presidency was something his followers considered folly? It’s a symptom that government has become farce. Theater performs farce. Comedians convey farce. Maybe only government can deliver farce. It should not be.

Think back to when President Trump gets COVID dropped in his lap, like a baby’s diaper spill. He hadn’t drained the swamp; he hadn’t built the wall and now this “China Virus” had his shorts in a twist. Heck, he even got it. And he survived! Old obese man survives the China virus! Maybe we shouldn’t fear this bug.

But then we get Operation Warp Speed. It’s not shining light into all our orifices, it’s not drinking fish disinfectant, it’s not ivermectin for all. It’s dumping tons of money into biofirms that have been sitting on mRNA vaccine technology and getting them to ramp up. They had the capability to make vaccines quickly.

We were seeing deaths mount. Vaccines might help. Give them money to work faster.

And they did.

A vaccine went from innovation to mass production and mass delivery in a matter of months. This had never been done before. This was very new ground. All under the watch of a President whose followers hated the swamp. And huge government funding to Big Pharma is the just filling the swamp, not draining it.

We could all see his discomfort. The press conferences where he waffled, his allusion to possible other treatments. He could not pull off the farce in the face of the mounting deaths. But he tried.

Folks still today hold to the alternative reality. If only everyone had taken ivermectin for a few years, nobody would have died.

But millions did. Even with the vaccine, even with ivermectin, even with mask mandates and state mandated shutdowns. Farce is funny when we can all laugh. It’s not humorous in the funeral parlor.

There is unassailable evidence that vaccines saved lives. A study matching COVID morbidity with vaccine rates is clear. But such evidence does not make converts of the followers. They still line up to cheer for the indicted.

So, why would he agree to send all those billions to pharmaceutical companies if he didn’t believe in the immunization? Was he bought out? Did Donald get corrupted? Were his advisors pulling his strings?

In truth, we’ll never know. Maybe he’s just as dishonest as his Fox News shills.

But the truth is, we didn’t escape the virus. Over a million Americans died from COVID. Over 5000 Idahoans died from the virus. Neither the immunization nor ivermectin saved us. We all went our own way. Theater is supposed to bring us all together in the play. Farce, comedy, tragedy, we should all believe the story before us.

But, as a nation, we don’t do well when farce is the medium. The tragedy of Pearl Harbor united us. The comedy of Bill Clinton’s peccadillo amused us. But COVID was not sold to us as a tragedy. We got the message from our President it was a farce.

Farce makes fun of the prevalent truth.

Then the deaths came.

When the truth has ambiguity, farce has some leverage. Deaths are too solid.

What is truly amazing is that President Trump’s followers haven’t abandoned him for his Warp Speed action. He acknowledged the threat, he acted with decisive action that got immunizations out there for all who wanted. But his followers wanted farce, not tragic death. They didn’t believe the threat.

Now they haven’t rejected his billions to Big Pharma as a sellout. Like they don’t believe his pay off to Stormy was an illegal business deal. This guy has been making business deals to line his own pockets from adolescence. And many people still pay to see his farce. That’s the sad joke.

 

When a majority can pass a law that says broad and powerful things, then ignore those noble sentiments, everybody knows the deck is stacked. That’s how it goes. Everybody knows.

Our Idaho legislature has done such. I ask you to read their noble words. Then ask yourself, was the fight fixed?

Read our laws:

It is hereby declared that the public policy of the state of Idaho, consistent with our constitutionally recognized and inalienable rights of liberty, is that every person within the state of Idaho is and shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty by the federal government of the United States of America. 39.9003(2)

Our majority legislature has nobly stated this freedom of healthcare. But I guess it doesn’t apply to those they don’t consider deserving. Maybe it’s just a law they and we can ignore. The poor stay poor, and the rich get rich, that’s how it goes. Everybody knows.

The trans youth or their parents, the young woman, and her pregnancy, through further laws they want to pass, cannot have these freedoms. That’s how it goes.

This law was put into our Idaho Code when Republicans were feeling assaulted by the Affordable Health Care Act, way back in 2010. They needed to defend us from the assault of federal laws, and our Idaho freedoms needed defense. They declared every person shall be free to choose or decline any mode of…health care services. But the health care service of addressing gender or pregnancy, in their eyes, should be the decision they choose, the state legislature. That’s how it goes. Everybody knows.

This law was crafted to combat the Affordable Healthcare Act. Back in 2010, when we had a black Democratic President. The ACA was an assault on our Idaho freedom. So, these noble words were adopted into our code. But maybe not taken to heart. So, it goes. Everybody knows.

Wyoming went too far. They took this American Legislative Exchange Council (ALEC) template too much to heart and adopted this freedom into their state constitution. Their citizens joined the anti ACA mob. The Wyoming Constitution was amended.

Idaho was less enthusiastic and only made it a law. So maybe it can be more easily ignored. Ain’t that how it goes?

This last month a judge in Wyoming cited their state Constitutional language and blocked Wyoming’s abortion ban. That’s how it goes.

But here in Idaho, we have the law on our books, designed to protect us from Obamacare, but no such constitutional mandate. The Idaho legislature has made it secure that you will be protected from any federal restriction on your healthcare choice, but not the decisions of our legislators. If this state chooses to enforce their laws on you, a health care provider, you can go to jail. That’s how it goes. Everybody knows.

This right, so nobly stated in our law: every person shall be free to choose or decline to choose any mode of securing health care services without penalty or threat of penalty…does not apply to you.

If you are a young person struggling with your gender identity.

That’s how it goes.

If you have an early pregnancy you fear, whatever your reasons, you must submit to the will of the old men and women in the Capitol.

That’s how it goes.

I watch the Idaho legislature make its statements of purpose, its “intents”, in so many bills it passes and then puts into our thick book of Idaho code and wonder, do they really mean what they say?

Healthcare freedom should be in our Constitution.

But maybe they just mean the freedom they think you should have, not the freedom you want for yourself.

Everybody knows it’s coming apart.

Take one look at this Sacred Heart

Before it blows

Everybody knows.

Thank you, Leonard Cohen.

 

It was always a question for me when the House would have the guts to actually kill the Medicaid budget. Every year it would sneak though by 5-10 votes. This year, they actually killed it.

Lead by their wise Speaker, Mike Moyle, just over half the House Representatives wished away health insurance for Idahoans in poverty. It’s like spanking your stepson. What is your point? Other than to demonstrate your authority, or maybe your lack of generosity, or maybe your fealty to the Freedom Foundation?

Make no mistake, Medicaid is a Federal/State health insurance program for low-income people. The trouble is, Wayne Hoffman and most Idaho Republicans think these low-income folks don’t deserve health insurance. I can just see their bluster.

“I have health insurance because I work for it!” They thump their proud, inflated chest. Yeah, you have a ¼ time, taxpayer funded job with full medical coverage, also at the taxpayer’s expense. This stepson sees some hypocrisy.

“I voted against the Medicaid budget because we must control the costs!” comes the other cry of outrage. Well, addressing that problem will take more than a simple no vote. Does the average Idaho Republican legislator know that Medicaid annually costs the taxpayer less per enrollee than their plush state health insurance benefit? Does even the best-informed Idaho Republican legislator know the main mechanism used to control Medicaid costs is to pay hospitals and doctors less? When you take your sick legislative runny nose to your doctor, the state Insurance pays that doctor about three times what the poor person’s Medicaid pays. Do you like that method of cost control? Then I can see why you might think a “no” vote would control Medicaid costs.

Controlling health insurance costs is more complicated than motivating a sullen teenage stepson. Slapping either won’t help. It takes a lot more work than that.

Make no mistake, what we are really talking about here is poverty. I can hear Wayne, and his “vote no” minions scream, “No, it’s about preserving the American Way! People should work for what they get!”

I ask you, Wayne, and House “No” voters, do you know anybody on Medicaid? Do they work? If they don’t, I’ll bet it’s because they are a child, pregnant, a young mother, or taking care of someone. All the Medicaid patients I see are working. But, unlike my three elected Representatives, Medicaid workers don’t get Blue Cross health insurance with their part-time or low pay full-time work. Not all employers are as generous as your voters are.

Don’t complain that they are wasting your taxpayer dollars with their ER visits for runny noses. Doctors’ offices refuse to see Medicaid, where the care would be a third of the cost. Medicaid patients often have the ER as their only choice for care. Doctor’s offices refuse because you, fully insured legislator, have budgeted to pay doctors at a third of the price of what your Blue Cross Special plan pays them.

So, the House finally pulled the trigger and killed the multi-billion-dollar Medicaid budget. And what fiscally responsible substitute solution did they then come up with? The new budget looks a lot cheaper for this year, but there will be a $150M supplemental next year. Kick it down the road.

Nothing wrong with a little posturing, I guess. Maybe that’s all it’s about. Stepsons know posturing when they see it.

I’m going to relent here. There is a plan in the works to study “managed care” as a plan for controlling Medicaid costs. If anybody had been paying attention, they’d have seen the weak results many other states have had with this. I give the legislature a C- for the effort. It’s a mystery to me why Medicaid gets the slapped face, when private insurance costs have beat inflation year over year. Who’s driving this bus?

It's pretty clear the Idaho Legislature doesn’t have their hands on the wheel.

 

 

I am struggling with a plumbing problem. No, it’s not my prostate, though you’d be forgiven for assuming such, given my age and decrepitude. It’s a 350# cast iron bathtub. I asked the plumbers if they could install it. They winced and asked if this summer would work. So, I cut the holes and bought the fittings, but the darn thing just won’t hook up. Tomorrow I’m calling the plumbers. I’ll bring them cookies.

Getting professional help should not be shameful. That’s what the Office of Performance Evaluation does for the Idaho legislature and us citizens. We should all read their reports before turning to Netflix. Or maybe late at night when sleep won’t come.

The reports don’t read like romance novels, but they sure captivated me when I first got elected to the legislature. They had a trove of evaluations and recommendations for fixing our state. So, it bothers me that the Idaho Republican legislature is planning to politicize this independent, nonpartisan, award-winning office. They are working just fine. What are they trying to fix? And for what purpose? This move is unwise.

It shouldn’t surprise me. OPE has provided no studies on pornography in libraries or gender reassignment surgery or the deadly MRNA vaccines. These are the issues our Republican legislature wants to pass laws about. Fixing EMS funding, evaluating Medicaid payments and reducing prison recidivism just aren’t red meat.

The proposal is to dismantle the balanced bipartisan Oversight Committee that directs the proposals and instead leave the direction to the Majority run Legislative council. Representative Blanksma successfully got this change through the House. There were only two Republican votes against it. Her arguments were that the Majority legislative leadership can be as unbiased as a balanced bipartisan committee. Sorry, I just don’t believe it. Democrats, if they were in the majority can be just as biased as Republicans. Be careful how you build things.

However, I am pleased to compliment Representative Blanksma for addressing maternal and child health. Her proposal would expand Medicaid health insurance coverage for children up to 205% of the federal poverty level. We are currently one of two states (Idaho and North Dakota) that doesn’t cover kids at this level.

Her proposal also recommends maternal Medicaid coverage be expanded to 12 months after delivery. It currently shuts off at 60 days. We are with 13 other states with such weak support for our moms. Of course, there is a price tag for this. So I can imagine some strong Freedom Foundation opposition.

Blanksma’s bill is sitting in House Health and Welfare Committee, awaiting a public hearing.

Getting advice or recommendations from independent people who study issues in our state is not always welcome nor heeded by our esteemed legislators.

Maybe that’s why the independent Maternal Mortality Review Committee is looking at the axe. This body was established in 2019, with a sunset date of July 2023. The bill to remove the sunset date is also sitting in the House H&W committee.

It’s no wonder they might sunset. They may have delivered some unwelcome news. Maternal deaths have doubled in Idaho since the MMRC was established. Their recommendations were to expand Medicaid coverage for moms to 12 months after delivery. So, Blanksma’s Maternal Child Medicaid Expansion coverage is addressing this recommendation. Good for her. I hope she has as much success getting this health bill through the House as she did with the OPE restructuring.

I know there’s a certain unpopularity about listening to experts. It has been openly expressed in our Idaho legislature. But don’t wait for a cast iron bathtub to convince you. Experience and knowledge are valuable. Wise people don’t shun such advice.

 

Franny was nervous as the ultrasound tech chatted and booted up her machine. The warmed jelly spread over her lower abdomen and the transducer pressed. The screen was facing away, and the technician stopped her friendly chatter.

“What is it?” Franny asked.

“Nothing. I’ll be right back.” And she left the room.

A tall man entered with the technician at his elbow. “What’s wrong?” Franny, now desperate, asked.

“We’re just trying to get better pictures. We don’t want you to worry.” He murmured in a quiet soothing voice.

“Oh, good. I was getting worried. What do you see?”

There was a long bit of silence as the tall man moved the transducer with more force, pressing uncomfortably on her full bladder. He looked up at Franny, then back at the screen and said,” It looks like you have a case of beucephaly.”

“What’s that?”

He paused again. “We can see the heart beating, and the head well formed, but your baby has four legs and a tail.”

“What?”

“It seems you have a horse, maybe a pony growing inside you.”

“Oh,” said Franny. “Will it live?”

He frowned. “We don’t often see cases like this. I recommend you talk with a high-risk pregnancy specialist.”

“Can I see it?”

He spun the monitor screen toward her. The black and white fuzzy screen showed the image of a little, folded up pony. Franny smiled. She had always liked horses.

“Let me see if I can get Dr. Barford to come in. She’s just down the hall.”

Franny listened to the swishing of the heartbeat and studied the image. Some questions were forming as she looked and listened.

The perinatologist came in and introduced herself. She too ran the transducer over Franny’s belly, then wiped off the goo and sat down next to her.

Yes, she confirmed, Franny’s baby was “equine” she said. Meaning, they couldn’t tell yet if it was a horse, or pony, or donkey or mule.

“Will it live?”

These can be very difficult pregnancies, she said frankly, and while it may be born alive, most do not live long after birth. And, she added, the delivery process can be very hard on the mother. Sometimes there is premature labor, sometimes high blood pressure, “eclampsia” she said. And it the fetus survives to term the delivery will need to be by C-section.

“What if I don’t want to keep the pregnancy?” Franny asked. “What if I want it to be over now?”

Here Dr. Barford looked down. Many women might choose that, given this diagnosis, but here in Idaho, that choice is not available to you.

“What?” Franny asked.

No, Dr. Barford explained. Unless you can show a criminal complaint of rape or incest, your pregnancy cannot be terminated, because at this stage it would mean that your um, baby would most surely die.

“But you said it wouldn’t live after birth.”

Yes, but some live for a while. But none have gone on to be full grown horses. Or donkeys. Or any full-grown equine species.

Franny frowned. “Rape or incest? She blushed.

Dr. Barford nodded silently. You would need to show a proper police report.

Franny shook her head. “You mean, I have a pony growing inside me and I have to just carry this pregnancy, even if it means I could get sick, have to have surgery to deliver it, and then it’s going to die before it grows up?”

Dr. Barford nodded. Those are the laws here in Idaho.

Franny heard the swish of the heartbeat from the monitor and remembered the four folded up little legs and the nubbin of the tail. “Has anyone ever had a unicorn?” she asked.

Dr. Barford smiled. I don’t think so. But there’s always a first time.