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 September Opponents try to sniff out Multnomah County smoking ban A hailstorm of opposition is brewing over an attempt by Multnomah County Commissioners to ban smoking in all work places and restaurants next year. Led by Commissioners Diane Linn and Lisa Naito, the smoking ban will come before the five-member commission later this fall. "Everyone deserves a clean and healthy environment at work," Linn told the Multnomah County Tobacco Prevention Coalition, which is behind the smoking ban. The restaurant and bar industry is already on the warpath, and has gathered more than 1,300 petition signatures to sway the commissioners. "Owners should be free to make a decision about whether they want to cater to a smoking clientele; the decision should be market driven," said Alexander Hamalian, a Portland attorney and co-owner of the Matador Restaurant, who's chairing the Multnomah County Committee for Fair Smoking Policy and is an avid cigar smoker. "I don't want to see my county turn into California." In California, smoking is prohibited in all public places, including bars and taverns. Corvallis adopted a similar ordinance, which was upheld by the voters and the courts. . . Surveys conducted by the tobacco coalition show strong support in Multnomah County for a work place ordinance (77% in favor) as well as restaurants (72% in favor). "Why don't they make cigarettes illegal rather than punish the people that operate businesses that cater to smokers? This is a prefect example of government going too far," said Bill Perry, governmental relations director of the Oregon Restaurant Assn, which represents 1,000 bars and taverns. The smoking ban in Corvallis has reduced the income in bars by 25%, Perry said. OMA takes tort reform battle to the voters The multi-million dollar tort reform campaign is off and running. Legislation concocted by the Oregon Medical Assn. with the help of Sen. Neil Bryant (R-Bend), who chaired the powerful Judiciary Committee, sent a constitutional amendment flying through the chambers the last few days of the session after the Oregon Supreme Court overturned the $500,000 cap on non-economic damages. The OMA did what's known in political circles as "gut and stuff," using a bill drafted by Rep. Kevin Mannix (R-Salem) that would have regulated nude dancing. If the OMA convinces voters to change the constitution next May, the 2001 legislature will have the power to establish financial limits on non-economic as well as economic damages in liability cases. More than 70 organizations have jumped aboard the OMA's bandwagon - drug companies, insurers, dentists, hospitals, the business community and the long-term care industry. In 1987, the OMA led the march to place a $500,000 cap on non-economic damages, which, it claims, has reduced malpractice premiums by nearly 50%. Without a limit on non-economic damages, communities may encounter difficulty supporting day care centers and little league teams because of the unquantifiable risks faced by insurance companies, said Dr. Richard Kincade, OMA's president. "If we don't have the ability to control the costs of damage awards, we'll be back in the same position we were in the 1980s, seeing rapid increases in premiums," said Kincade. The Oregon Trial Lawyers Assn. intends to wage a vigorous fight. "This is about whether people should have access to a trial by jury or leave that right in the hands of politicians," said Michael Kesten, OTLA's communications director. $6 million at risk from sting operations The Office of Alcohol and Drug Abuse Programs (OADAP) stands to lose $6 million - the equivalent of supporting 3,000 Oregonians in residential treatment for one year - because it experienced a slight increase in illegal sales of tobacco to minors in 1998. The misunderstanding surrounds the Synar Amendment, which requires states to decrease the sale of tobacco to minors through legislation and sting operations. The amendments' ultimate goal is to achieve a target, known as the failure rate, whereby 20% of minors attempting to buy cigarettes succeed. After five years of Synar inspections in Oregon, that number is down to 18.3%. The problem goes back to the Dept. of Health and Human Services' labeling Oregon as a "delayed implementation state." According to those guidelines, Oregon should have reached the 20% rate by 1998, based on its record from the 1997 inspections, when 23.6% of minors were able to buy cigarettes during sting operations. But when that number shot up to 29% in 1998, Oregon was threatened with a $6 million penalty. "It is not fair to be penalized on a technicality," claimed OADAP director Barbara Cimaglio, "when our intention is to do the right thing, and we're in substantial compliance with the law." HMO Oregon's net income shoots up; medical expenses drop Kaiser Permanente almost tied with its leading competitor, Regence HMO Oregon, for having the healthiest net income on June 30 when quarterly reports were filed with the Insurance Division. But Regence had a stunning victory - pulling itself out of the red after reducing medical expenditures by $7 million even though its membership base remained stable. PacifiCare had the poorest record, attributable to obligations at HealthFirst Medical Group and MedPartners, which have disbanded. The for-profit health plan also had the luxury of spending the most on medical expenses, inching way ahead of Kaiser, which has the lowest administrative costs. See the print version of this month's newsletter for financial information comparing the first and second quarter reports for the health plans: Kaiser Permanente, PacifiCare of Oregon, Providence Health Plan, Qualmed Oregon, Regence HMO Oregon, Regence Health Maintenance of Oregon, Advantage Dental Plan, ClearChoice Health Plan, LifeWise, Oregon Dental Service, ODS Health Plan, PacificSource, Regence BCBS of Oregon, United Healthcare, Vision Care of Oregon, Willamette Health Service. Did Physician Partners help destroy the Medford Clinic? No one can definitively say what went wrong, but Medford Clinic is shutting its doors Dec. 31, three years after aligning with Physician Partners, Inc. Now only Corvallis Clinic remains part of what was once the strongest physician management group in Oregon. Last month HealthFirst Medical Group dissolved. Was PPI a mistake? Looking back, Dr. Gerard Livaudais can answer that question with a very strong affirmative. "But you'd have to be clairvoyant to predict what would happen," said Livaudais, medical director and acting CEO of Medford Clinic. "It didn't turn out the way we intended. But there was no way to know how it would turn out. The lesson to learn here for the doctors is that bigger is not always better." On Sept. 2, the 60 doctors voted to dissolve the 53-year-old clinic. The change should cause little disruption for patients because many physicians plan to stay in the same building and practice in small specialty groups. . . Most of the clinic's 450 employees will find work with the same physicians, Livaudais said. The physicians are either joining PrimeCare or Providence Medical Group, which will negotiate insurance contracts on their behalf. Morning-after pill is coming to central Oregon Women may be able to walk into a pharmacy in central Oregon and ask their pharmacist for emergency contraceptive pills - without a prescription from their physician. "This is a totally legitimate use of pharmaceutical expertise," said Helen Noonan-Harnsberger, PharmD, RPh, who sits on the Board of Pharmacy. But legal entanglements must still be ironed out. Currently, physicians and nurses who work at county health departments can dispense contraceptives. That same privilege could be extended to pharmacists. For such a program to work in Crook, Deschutes and Jefferson counties, the Oregon Medical Assn. and the Board of Pharmacy must give their blessing. . . If the OMA does object and pharmacists aren't allowed to dispense contraceptives, nurses are willing to carry a beeper, on weekends, to call in a prescription, said Carol Elliot, family planning coordinator at the Oregon Health Division. Known as the morning-after pill, these drugs prevent ovulation if taken within 72 hours after sexual intercourse. Doctors feel pharmacists will use this dispensing privilege to expand their scope of practice. "We don't want to open the door because pharmacists aren't trained to dispense all kinds of drugs," said Bob Dernedde, the OMA's executive director. Also in this issue...
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