Expand Pharmacist Roles to Reduce ER Visits

Photo: Alef Perez
Our ERs are vast improvement over this kind of
third world medicine illegals get in their own countries.

As I have recently experienced during a recent ER visit in northern Virginia, many cases presenting themselves are cases of sniffles of illegal aliens and their children who use the ER as their primary physician because ER visits are free to them, paid for by the U.S. taxpayers.  

A seven-year study just released on January 10, 2019, by the University of Waterloo in Canada found that pharmacists could dramatically reduce ER visits by “incorporating them with an expanded scope into the community or hospital emergency departments,” thus reducing the overcrowding of emergency rooms (ERs).

Wasem Alsabbagh and Sherilyn Houle found that “almost one-third of non-urgent Emergency Department (ED) visits in Ontario were for conditions that could potentially be managed by pharmacists with an expanded scope of practice – available in other jurisdictions in Canada.”

“Overcrowding in EDs is a concern most Canadians can relate to, and we know that it can lead to increased mortality and a higher rate of patients who leave without receiving treatment,” said Wasem Alsabbagh, a professor at the Waterloo School of Pharmacy.

He added, “Our findings support that we need to see more pharmacists working with expanded scope in community practice or based in the ED. This may reduce crowdedness and free more resources in EDs to care for more acute patients.”

After the researchers examined data from 2010-2017 of all Ontario hospital Emergency Department (ED) cases, they found that one in five patients who sought emergency care had non-urgent health concerns. Such unnecessary visits could have been potentially managed by a pharmacist.

To ascertain the percentage of non-urgent care, the authors of the study used standard scales that measured the severity of the patients’ symptoms and used statistics to determine which cases could have been managed by pharmacists “working with an expanded scope.”

In the last decade, various provinces in Canada have allowed pharmacists to write prescriptions for minor ailments. Such is the case of Alberta where, since 2007, pharmacists were allowed to write prescriptions for minor illness, to renew prescriptions, to administer injections, and to give vaccinations.

In Ontario, in 2012 and then in 2016 pharmacists’ roles expanded and they could renew prescriptions and administer flu vaccines and others.

“Our study included all expanded scope services in use across Canada when assessing which Emergency Department (ED) cases pharmacists could manage,” said Alsabbagh. “Over the seven years of the study period, we found that pharmacists with an expanded scope could potentially have managed nearly 1.5 million cases in Ontario.”

What conditions could a pharmacist with an expanded scope of practice treat? According to this study, skin-related problems like dermatitis, coughs, and inflammation of the ear canal, nasal passages, and throat were some of the cases that could have been managed by a pharmacist.

The Journal of Research in Social and Administrative Pharmacy published Wasem Alsabbagh and Sherilyn Houle’s study called “The Proportion, Conditions, and Predictors of Emergency Department Visits That Can Be Potentially Managed by Pharmacists with an Expanded Scope of Practice.”https://uwaterloo.ca/pharmacy/news/pharmacists-could-dramatically-reduce-er-visits

As more doctors retire in this country, less students study medicine due to its difficult, long, and expensive training, nurse practitioners’ and physician assistants’ roles expand, and more doctors are brought from third world countries and medical schools, could pharmacists’ roles fill the vacuum and expand beyond vaccinations in the United States where Emergency Rooms (ERs) are equally crowded by minor cases? How would they define minor cases? What would the medical licensing boards and medical schools do under such circumstances? Would pharmacist training and medical liability have to change?

 

 

 

Replacing the EPA

“It’s time for the national EPA to go. The path forward is now clear and simple: A five-year transition from a federal government bureaucracy to a Committee of the Whole composed of the 50 state environmental protection agencies.

Jay Lehr, Ph.D.
Photo: Ileana Johnson 2015

To those who say this would fail to adequately protect the public’s health or the environment, I urge you to reflect on the poor job currently being done by EPA, and then to meet some of the men and women staffing state EPA offices and see for yourself the sophistication, commitment, and resources they have to do the job. You will not remain doubters for long.”                 -  Jay Lehr, Ph.D.

 

Dr. Jay Lehr, Science Director at the Heartland Institute, gave a speech at the Doctors for Disaster Preparedness conference in Ontario, California, on the topic of “Replacing the EPA.” The author of more than 500 articles and editor of 30 books captivated the audience with his bold proposal to eliminate and replace the mammoth Environmental Protection Agency with a smaller organization composed of a committee of six individuals chosen from all 50 states. He called his plan “Addition by Subtraction.”

In his opinion, the 15,000 employees based in Washington, D.C. and in regional offices around the country “do not do useful work whatsoever.”  Dr. Lehr names himself the “most competent person on the planet” to write a proposal for the elimination of the EPA, saving the taxpayers $6.2 billion annually and improving the environmental protection” because he is the “only scientist alive that played a major role in establishing the EPA.”

Among the many pieces of legislation Dr. Lehr helped write are included the Water Pollution Control Act (later renamed the Clean Water Act, Safe Drinking Water Act, Resource Conservation and Recovery Act, Surface Mining and Reclamation Act, Clear Air Act, Federal  Insecticide, Rodenticide, and Fungicide Act, and Comprehensive  Environmental Response Compensation and Liability Act (now Superfund).

Dr. Lehr admits in his proposal, “Replacing the Environmental Protection Agency,” that “these acts worked well in protecting the environment and the health of our citizens, with the exception of Superfund, which proved to be too overreaching and wreaked havoc with U.S. business as company operating within the law were fined countless dollars and required to pay huge sums after the fact for clean-up of waste disposal that had been within the law at the time of the activity.” (pp. 1-2)

Viewing his plan as penance, Dr. Lehr found it appropriate and fitting that the person who helped form the EPA (December 2, 1970) should contribute to its dismissal via a plan that took him two years to develop. Dr. Lehr was happy to announce that Governor Scot Walker of Wisconsin, presidential candidate, has adopted this entire EPA replacement plan.

EPA regions of the U.S.

Dr. Lehr served on a panel in 1968 which was tasked by the director of the Bureau of Water Hygiene in the U.S. Department of Health to study the potential to expand the bureau’s oversight into a full environmental protection organization.” The panel succeeded and the EPA was created. He wrote that around 1981 “liberal activist groups recognized EPA could be used to advance their political agenda.”

Referring to England, Lehr quoted Samuel Adams, who wrote on Jan. 20, 1772 in the Boston Gazette, “If the public are bound to yield to obedience to the laws to which they cannot give their approval, they are slaves to those who make such laws and enforce them.”

Unfortunately today, it is not just the EPA, but many other agencies whose unelected officials produce endless regulations, Lehr added. We have an “over-criminalization in this country” because of endless regulations people have no idea exist, rules that Americans “probably break at least once a week.” He continued, “There are now in the federal regulatory handbook, 200 volumes of 80,000 laws, and 300,000 regulations written by various agencies with the EPA number one offender.”

James Madison warned us in the Federalist papers that … “laws should be made by men of their own choosing. If the laws are so voluminous that they cannot be read, or so incoherent that they cannot be understood,” then we have a serious problem.

Dr. Lehr believes that we are subjected today to so many laws that few people can track. “Big Business, Big Government, and Big Special Interests collude to make such laws” that give them advantage over the competition. “We have a warped economy,” Lehr said, “where the rich get richer, with the rest having less opportunity because the big three are gaming the system to gain political influence… They get privilege.”

Enabling the big three who handicap competitors and take full advantage of public subsidies, “EPA is all but a wholly owned subsidiary of liberal activist groups." Its rules account for about half of the nearly $2 trillion a year cost of complying with all national regulations in the U.S.” (Wayne W. Crews, Ten Thousand Commandments, Washington, D.C.:  Competitive Enterprise Institute, 2014)

Calling it a “rogue agency,” Dr. Lehr proposed to replace, not fix the EPA, by systematically dismantling it and replacing it with a Committee of the Whole of the 50 state environmental protection agencies. National EPA could be phased out over five years, said Dr. Lehr. “The Committee of the Whole would determine which regulations are actually mandated in law by Congress and which were established by EPA without congressional approval.” (Replacing the Environmental Protection Agency, Jay Lehr, Ph.D., The Heartland Institute, p. 7)

He proposes that “the EPA research laboratories should be left in place at the national level to answer scientific questions, and even these laboratories must be substantially reorganized.” (Ibid, p. 6)

Specifically, 10 regional offices would be established, cutting back the budget from $8.2 billion to $2 billion a year, and reducing staff from over 15,000 to 300 in the national EPA headquarters in Topeka, Kansas. Of the 300 employees working, there will be six delegate-employees from each of the 50 states.

When asked how he would deal with the potential growth of the new EPA, Dr. Lehr admitted that this detail has not been worked out yet. The chairman of the Committee of the Whole would be elected by the 300 delegate-employees to a three-year term.

The drawdown would be:

-          Year One – all employees would be told of the five-year transition period to allow them time for alternate employment; all 300 new employees would transfer, start working, and decide assignments to various subcommittees

-          Year Two – Offices of Policy, Administration and Resource Management, Enforcement and Compliance Assurance will be relocated from Washington and from regional offices to Topeka

-          Year Three – Offices of Air and Radiation and Chemical Safety and Pollution Prevention would transfer to Topeka

-          Year Four – Offices of Solid Waste and Emergency Response, and Offices of Water would be moved to Topeka

-          Year Five – Offices of Chief Financial Officer, General Counsel, Environmental Information, and the Office of the Administrator would also move to Topeka.

Transition members would be assigned periodically to Washington, D.C. and to regional offices to study the activities of the existing branches. If attrition is high early on, transfer of responsibility may be earlier than planned. Each state would be allocated $20 million to augment the new responsibilities.

Dr. Lehr, as one of the founders of the EPA, believes strongly that his plan can be implemented “efficiently and quickly.”