Tag: Antitrust

Think Licensure is a good idea? Think again.

jmacmidwife

As I study the latest Louisiana midwifery rules and regulations, for the test which will satisfy the third sanction that the LSBME has bestowed upon me i.e. “Ms. Macaluso shall demonstrate her understanding of the Board’s rules and regulations regarding Midwife practice in this state, in a manner determined by the Board,” I wonder how in the world did these updated rules get promulgated?

Read rules here:
https://www.lsbme.la.gov/sites/default/files/documents/Rules/Individual%20Rules/Midwife%20Dec%202016.pdf

*side note, I wanted to demonstrate my understanding of the Board’s rules in either an interpretive dance or a book report, but apparently those suggestions were shot down in favor of a boring test. The Board obviously lacks humor. LOL But seeing that the LSBME has spent tens of thousands of dollars on computer software and equipment in the past few years, its not surprising that they want to use that technology. Oh, wait…I am still waiting for my test “to be put online” according to my compliance officer. That was in October. They must’ve been taken advantage of if they paid that much and can’t email a test to me or put it online, but that is a whole other post.

Back to the rules….Is anyone paying attention? Did anyone read these new rules? They are that insane. There are so many examples, but I’ll start with the one in Chapter 23 under statute 2315 (Effect of Application) B. By submission of an application for licensing to the board, an applicant shall be deemed to have given his or her consent to submit to physical or mental examinations if, when and in the manner so directed by the board and to waive all objections as to the admissibility or disclosure of findings, reports, or recommendations pertaining thereto on the grounds of privileges provided by law. The expense of any such examination shall be borne by the applicant.

Let me tell you what that says in plain English: THE LSBME CAN REQUIRE MIDWIFE APPLICANTS TO HAVE A MENTAL AND PHYSICAL EXAM AND THE APPLICANT HAS TO PAY FOR THE EXAM. HOLY BLEEP!

The LSBME is calling midwife applicants crazy! While I have to admit I felt this whole witch hunt has been nothing short of crazy since the beginning, I never imagined these unbelievable rules would grow out of the Board’s unbridled lack of oversight. It is like a runaway train with no stop in sight. So one has to ask oneself—self, why would the Board institute such a rule? A rule which will undoubtedly frighten potential midwifery applicants, especially ones with any preexisting conditions. I mean, the Board does not describe what it will do with that information, so how will applicants know if their heart murmur or Hashimotos or depression will affect their application process? How does this rule not discriminate against applicants with preexisting conditions? How is this not antitrust? This seems like a rule ripe with restrictive capabilities to practice ones trade. And as someone who has been denied a license in another state, let me tell you how hard that makes getting a job or other licenses (again, another post). So, potential applicants will think they are going to start this new profession as a midwife in Louisiana, take all the classes, do all the training, take all the tests, pay the application fees, pay for a mental evaluation and may still get denied? Yes, yes, I know its a privilege to have a license, but this is ridiculous. Not only will it scare away potential applicants, but why would I want the medical board to have my medical records? That is invasive and wrong. And do you think the Board won’t implement that rule? hahahahahahahahahahahahahahahahahahahahahahahahahahahahaahahYes, yes they will use it. How do I know this? Oh, because my first sanction is ordering me to get a mental/physical evaluation. No big deal right? Seems legit as they should make sure healthcare providers are relatively sane and healthy enough to do their jobs, but there is a catch. There is always a catch. Do you think they will allow you to go to just any doctor for this evaluation? I highly doubt it. Why am I so skeptical you say? Oh, it might stem from the fact that I have to go to a “physician or group of physicians who have been pre-approved in writing by the Board and be deemed competent to resume the practice of midwifery.” Ms. Mouton, the ex-executive director of the cartel, err I mean LSBME, so graciously offered me a list of five drug and alcohol rehabs to choose from to get my evaluation, but Ms. Mouton apparently does not know that a person cannot just go get an evaluation for no reason. The rehabs will not evaluate someone without a demonstrable problem. I know that seems obvious right? Not for the corrupt medical board as they don’t care about doing anything legal. Physician Health Programs (PHP) (like the drug and alcohol facilities list provided by Ms. Mouton) and medical boards make strange bedfellows until you realize they are both benefiting. The medical boards provide a steady stream of victims, err customers, err patients at the tune of $5-10,000 and four days of your life followed by “recommendations” for treatment which might mean several tens of thousands of dollars and months spent in a facility for absolutely no reason at all. There are many reports of the corruption surrounding PHPs and licensing boards. It was not until the admissions counselor at PineGrove in Mississippi reached out to my compliance officer that suddenly I was a perfect candidate for an extensive psych evaluation, even though after previously reading my court documents she had stated that I needed something their facility couldn’t provide. Sounds fishy because it is!

It is interesting to note that the LSBME has included this rule into most of the healthcare professions it oversees. So, doctors could be subject to this requirement of having an evaluation too. However, I could not find the rule associated with clinical laboratory personnel, acupuncturists, and X-ray techs. See list of professions below:

In a letter to the British Medical Journal, Dr. Manion states: “A compulsory forensic psychiatric evaluation of a physician is, by all understandings, a form of involuntary mental commitment whose unlawful use is banned by the Fourth Amendment to the US Constitution prohibiting unlawful search and seizure by a government agency. Without rigorous oversight, a PHP can get away with utilizing what one court euphemistically referenced as “relaxed diagnostic criteria.” The extreme danger of crafting one’s own illness criteria sets, not to mention – especially in the context of refusal of provision of their report – falsely adding non-existent symptoms to embellish a case history to support a diagnosis and achieve desired outcomes (e.g. to appear to justify costly referral to a PHP preferred program), ought to alarm every physician.” https://www.bmj.com/content/353/bmj.i3568/rapid-responses

When Ms. Mouton was taken off her thrown at the LSBME and Dr. Cresswell stepped into her small stilettos, he, not surprisingly said, well of course you do not have to go to a drug and alcohol center as there is no basis for it in your case. Yeah, no shit. Dr. Cresswell suggested I find a doctor in my neck of the woods to conduct the evaluation. So, just go find a physician, right? There are 17,000 of them in Louisiana according to the 2018 census from the National Federation of Medical Boards. http://www.fsmb.org/advocacy/news-releases/fsmb-releases-2018-u.s.-medical-regulatory-trends-and-actions-report/

Well, it seems that in order to call a doctor and ask if you can have an evaluation by said doctor, one must have a diagnosis or something that needs testing. Ok, so ask the Board what they want tested. Go ahead. Ask. Oh, they won’t tell you what you need to have tested? Shocking. It is so shocking that the Board would create a sanction that is illegal. There is no legal basis for me to get a mental/physical evaluation. In fact, they will have to make something up in order for me to ethically have a mental evaluation. Yes, they will have to lie or the could remove that sanction as it really is not legal. But no, instead of looking like the incompetent fools they are, the Board would rather tell me to go find a doctor, then I am supposed to tell the doctor to call the board and ask what needs to be tested. UHHHHH. That is so shady.

I have been waiting and asking repeatedly for over a year to have the LSBME tell me what needs to be mentally evaluated as I cannot go get this sanction accomplished without more information or lies, whatever is considered ethical to the LSBME. The LSBME has caused me great stress and prohibited me from working. Oh, and let’s not forget, because I cannot get a job because my suspension comes up in a background check, I cannot afford health insurance to get my cancer removed. I will continue to wait patiently and suffer knowing that my cancer may be spreading and affecting my health.

The Board is purposefully obstructing justice. I believe that is called maleficence, but I am not an attorney. Is it truly that shocking that the Board would obstruct justice like this? No. The LSBME continues to violate ethics, harm midwifery by placing burdensome and egregious requirements on its applicants, which will undoubtedly limit choices for consumers in the state of Louisiana and continue its disgusting deathcare spiral killing mothers along the way. Killing mothers, you say? Isn’t that a little harsh? No, no it isn’t. There is a maternity crisis in Louisiana and throughout the US. https://adams.house.gov/media-center/press-releases/congresswoman-adams-introduces-bill-address-maternal-mortality-racial

We do not have enough providers to give safe and effective maternity care. The South lags behind the rest of the country in maternal mortality especially for women of color. In fact, women of color in Louisiana are dying at a rate of 73/100,000 compared to 27/100,000 of white women. HOLY BLEEP. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/LA

Read that again– for every one white woman who dies in Louisiana almost three black women die. UHHHHHH. Something tells me doctors and hospitals are doing something wrong, very wrong. How do you know its doctors providing bad care? Because there are 17,000 of them in Louisiana compared to the 20 midwives practicing and licensed midwives do not work in hospitals. Doctors are killing women, not midwives. The LSBME needs to focus its investigations inward to truly achieve its mission statement of protecting the citizens of Louisiana. https://www.cnn.com/videos/health/2017/11/13/mother-birth-america-louisiana-orig.cnn

The limiting of safe out of hospital providers by the competition needs to end. We need to be making more midwives not less. According to one study, Louisiana ranks as the worst place to have a baby because hospitals are not following safety measures. “The report also breaks down a state-by-state ranking of maternal harms and deaths. In Louisiana, the state with the highest maternal death rate, there were 58.1 deaths per 100,000 births over the course of the study period from 2012 to 2016.” https://www.cbsnews.com/news/best-and-worst-states-to-give-birth-usa-today-investigation/

Tell me again how out of hospital midwives are incompetent and dangerous. I’ll wait. Oh, you have no statistics to back up that claim? It is because midwives are beyond safe. We provide one-on-one care and are able to assess women constantly because of our philosophy and model of care. Sure it takes time and is cost prohibitive for the provider, but cost effective for insurance companies and Medicaid, and you know what–our women and babies are alive, happy, and grateful at the end of the day. And you know what is better than money—safety, lives, and an investment in future generations. If healthcare providers got into the healthcare field to help make a positive change in lives then it would be seem intuitive to promote midwives on the basis of evidence-based care alone. https://mana.org/blog/home-birth-safety-outcomes

The LSBME needs to follow the spirit of the law in order to rehabilitate its licensees and promote the welfare and health of its citizens by encouraging more midwives, if that is truly its intentions, and not harass, extort, and financially drain them out of existence. No one should be above the law especially a board who creates the very laws they are violating. And it would behoove them to adopt some ethics while they are at it.


My story…the short version

jmacmidwife

A pathologist, nephrologist, and urologist walk into a boardroom…

Though this sounds like the start of a joke, what happened next was hardly funny. These three doctors, who are on the Louisiana State Board of Medical Examiners (LSBME), decided to indefinitely suspend my midwifery license.

What Happened?

Nothing. Other than a normal homebirth, where an 11-pound baby was safely delivered, nothing happened. There were no injuries. The mom and baby were not transported to the hospital before,during or after the birth. In accordance with the law, this mother’s obstetrician stated five times in her medical record that she was low risk and healthy for a homebirth.

On Christmas Eve in 2014, as I was leaving to a holiday party, I received a certified letter.  It stated that the Louisiana State Board of Medical Examiners summarily suspended my midwifery license under the guise of protecting Louisiana citizens, from what I am not sure.  While the news of being unable to attend any further births put a damper on my holiday, it pales in comparison to the experience of one of my other clients. She gave birth three days later without a healthcare provider by her side because she could not find a midwife to replace me in that limited amount of time and the LSBME, with blatant regard for this woman and her baby’s safety, refused to allow me to continue care.

The next three months following my suspension consisted of being at the mercy of the LSBME.  The LSBME’s idea of following the law included lying, withholding evidence, and purposefully manipulating the rules and regulations. In the end, the LSBME accused me of deviating from midwifery standards of practice, exhibiting incompetence as determined by local midwifery standards, and fraud and deceit in connection with services rendered. None of these allegations are true.

The LSBME allowed a videographer, who attended the birth, to file a complaint against me.  Ironically, while the labor was caught on video the actual birth was not, yet I was still accused of not delivering a baby correctly. However, I did not know who filed the complaint or what the allegations were until the day before my adjudication.  Of course this allowed me no time to prepare for her coached and rehearsed untruthful testimony.  Not only did this single, childless videographer lack medical training, her complaint was based on untrue allegations.  Her dishonesty was propagated by a local midwife and obstetrician, who coincidentally opened a new birth center located five miles from my home. Can anyone say competition? I can.

The videographer, without the birth parents consent, showed the video to this competing midwife and obstetrician. Coincidentally this was the same obstetrician my client, the mother, was transferring care from when she decided to have a homebirth with me.  The videographer worked closely enough with the birth center that they exclusively listed her photography services on its website.

Healthcare providers should be petrified that a videographer/photographer was allowed to file a complaint against their license especially when no one was injured.  Though anyone should be allowed to make credible complaints against anyone’s license, the allegations should be truthful.  None of the videographer’s allegations were proven to be anything but her opinion. Had the LSBME consulted with a noncompeting midwife, the charges would have been dropped.  Instead, I was judged by three doctors (a pathologist, nephrologist, and urologist). They did not understand what was happening at this homebirth nor could they imagine what was normal because management of a homebirth is vastly different than a doctor-led hospital birth.

Likewise, the LSBME could have interviewed any of the other four adults present in the room during the birth. This included a nursing student and doula with more knowledge and experience with normal births than the videographer, which would have laid the videographer’s false allegations to rest. The parents testified on my behalf,explaining to the board that they were overjoyed with my careful, quality of care and would do the same birth all over again with me as a provider. The parents even asked me to attend the birth of their next child, but because my license is indefinitely suspended, I was unable to attend. This mom went on to have another 11-pound baby in a hospital setting, attended by another midwife without judgment on her license.

No one can control how a birth is perceived. It all depends on the persons’ perspective. The people with the most important perspective are the parents. They thought the birth was perfect, not at all traumatic as indicated by the LSBME. Homebirth is raw,natural, messy and organic.  It’s hardly the same as a hospital birth. So of course a nephrologist, urologist, and pathologist who have never seen an out-of-hospital birth might perceive the normal sights and sounds of a homebirth as traumatic. Nothing unlawful or malicious happened at this birth or post-partum.

The LSBME was the investigator, accuser, judge, and jury in my case. In fact, the Lead Investigator was also the Executive Director of the LSBME—further evidence of injustice and conflict of interest. The Executive Director’s behavior, widely-known to be abrasive, abusive, and hostile did not lend itself to any professional negotiating or understanding. Under her direction, the LSBME acted like a soap opera; she allegedly had an affair with an attorney who worked with the LSBME to prosecute its victims, then hired his niece as part of the investigative staff, as evidently nepotism doesn’t apply to Louisiana. You just can’t make this stuff up.

Additionally, I didn’t have adequate access to the testimony nor appropriate peers to sift through the false allegations. Even though no one was hurt, injured, died, and no transfer to a hospital occurred, my livelihood was stripped from me because of competition. There was no oversight to this board. It screams of antitrust. Louisiana law states that a board of midwives serving underneath the LSBME would oversee any midwifery complaints. However, that board of midwives was dismantled years previously, evidently due to budgetary constraints.

In Adam Crepelle’s article, Guest column: Louisiana licensing rules stifle free market, he noted that “by making it harder to enter a profession, licensing can also reduce employment opportunities and lower wages for excluded workers, and increase costs for consumers.” The report notes that licensing is particularly burdensome on those required to move for work,like military families. It also asserts licensing hits the poor the hardest because they are often unable to afford licensing’s training costs.Furthermore, the report concludes that “most research does not find that licensing improves quality or public health and safety.”

Also, according to Alden Abbott of the Heritage Foundation, “In recent years, however, there have been signs that the Fourteenth Amendment ‘rational basis’ test that applies to economic regulation may be applied more expansively by the courts when it comes to analyzing anti-competitive licensing restrictions and related affronts to one of the most basic civil rights of all: the right to earn a living.”

Off the record, I consulted several midwives who are expert witnesses in other states and they agreed that my case was biased and unfounded, but I could not utilize their testimony because the prosecution set the tone of the courtroom, whereby doctors were used to defend midwifery rules and regulations. This is something doctors cannot adequately do because, well, they are not midwives and do not understand what occurs at a homebirth. Midwifery rules and regulations, especially for autonomous, out-of-hospital midwives are, and uniquely designed for, complete,continuous independent care of low-risk, healthy mothers. The mother whose baby I delivered was low-risk and healthy, as indicated five times in her medical records by the obstetrician she was seeing during the pregnancy. The LSBME told me that this obstetrician was “wrong.”

Why didn’t I appeal the decision?

Unfortunately I didn’t have the available funds. This was my second client in Louisiana as a licensed midwife,so my income was minimal. My attorneys were flabbergasted at the railroading that occurred at my hearing. Initially, they thought these allegations would not amount to anything close to a suspension because license suspensions are usually only given when a practitioner does something horrific like operates on the wrong leg, practices under the influence of drugs or alcohol, or prescribes medications illegally, not during a birth where no one was hurt or injured.

The decision the LSBME made in my case was unprecedented. A regulatory board like the LSBME is responsible for “protecting the public from unsafe practitioners,” but clearly it overstepped its jurisdiction because it did not have any oversight. It took advantage of its intended purpose and instead applied irrational, unreasonable, arbitrary, and burdensome requirements to unduly limit my individual constitutional liberties. Due to institutional corruption, an appeal was looking unfavorable, and it would cost me an additional $30,000. Unable to get the upper hand and find additional funds, I had to cut my losses and regroup. Besides, my family needed me.

I spent the next two years helping to care for of my 86-year old grandmother, while my mother took care of her dying husband, all while going through a divorce. Additionally, I found out I have thyroid cancer. Last year, I attempted to find some gainful employment doing something, anything that would help me afford health insurance. I live in a ‘red state,’ so even Medicaid insurance would cost me hundreds every month. I applied to about 50 different jobs from department stores to libraries. I couldn’t get past the background check with a suspended license on my record,despite having had a midwifery license in Wisconsin that was never acted upon and had no lawsuits. I chose not to renew my Wisconsin license, as I did not live there. I was fortunate enough to maintain my skill set in midwifery by working as an assistant midwife and birth assistant, but the pay is not as steady nor much as it would be if I were an independent midwife.  I could not afford to keep paying my health insurance premium of nearly $700 a month.

I moved to Florida in the spring of 2018 to work at a birth center where I would have a more steady income as an office assistant and birth assistant. I took a second job house sitting so that I would have a place to stay. After realizing that my first application for midwifery licensure in Florida should not have been denied, I chose to reapply after completing the in-state requirements. But once again, the suspended license in Louisiana is somehow preventing the Department of Health in Florida from granting me a license, even a temporary one, in the underserved area where I live. Although Florida has a Council of Midwives who assist the Department of Health in making decisions regarding midwifery rules and regulations, the Council was not given the ability to have any input on my application. Likewise, if my allegations were true and I was adjudicated in Florida, my sanctions would be at most a fine of a few hundred dollars and a few months of probation compared to an indefinite suspension.

The stipulations required to lift my suspension and place me on probation include paying the LSBME nearly$18,000 in fees (which the LSBME didn’t calculate until 11/2017), going to the LSBME’s handpicked rehab in Mississippi, completing three courses, demonstrating my understanding of the Louisiana midwifery rules and regulations (which the LSBME will elaborate only after I go to rehab), and paying a $300 fine. According to an email from my compliance officer on November 13, 2017, the LSBME accepts cash or money orders only. They do not take credit cards, have payment plans, or will agree to community service in lieu of fines or fees.  However,in an email correspondence tonight with the new Director of Investigations, he stated that “the board has been willing to work with licensees in the past if money is the primary reason a person would not be able to comply with orders and sanctions of an administrative hearing.  Paying over an extended period of time has been granted in the past.” Clearly, the LSBME personnel lack consistency and understanding of LSBME policies, procedures, and options regarding payments.

Despite the fact that physical, mental, drugs, or alcohol were never an issue in my case, the LSBME is requiring me to go to one of five rehabs to prove it. Interestingly, two of the rehabs closest to me declined to admit me after viewing my court documents because I do not fit their criteria for admission. Coincidentally, after the Mississippi rehab Pine Grove consulted with my compliance officer at the LSBME,they decided I was a “perfect” candidate. There is abundant information on how Physician Health Programs (PHP) choose to utilize fraud, deceit, and fabrication to go above the law to commit crimes for these boards, whom conveniently give them immunity and a constant flow of “customers.” Furthermore, the LSBME continues to change its requirements. For example, it stated that I could take courses found on the Board of Nursing’s website, but months later were silent on whether those courses that I already completed were adequate.

In a contrary statement, the new Director of Investigations wrote in October of 2018 that he reviewed my file and found that “there is no mention or recommendation of a drug and alcohol treatment facility.  This is not a requirement of the Board and therefore you do not have to commit yourself to a drug and alcohol treatment center.  The Board does require a mental/physical evaluation by a physician or group of physicians who have been pre-approved in writing by the Board.  You must also have an evaluation showing that you have been deemed competent to resume the practice of midwifery.” This sounds confusing because it is. I have several emails from my compliance officer stating the opposite. These boards are notorious for (un)comically being Lucy constantly moving the football so that I, Charlie Brown, can’t kick it.

Likewise, in an even more frustrating turn of events, the new Director also stated in an email from October 2018 that my compliance officer could set up a payment plan for the almost $18,000 fee, but my compliance officer stated that I would have to get preapproval from the LSBME before she could set up a payment plan because she could not guarantee that the LSBME would accept a payment plan even though the Director of Investigations stated to do so. Also, now I am apparently supposed to find my own physician to conduct a mental evaluation but they will not tell me what I need to be evaluating. Once I find someone who I think can do the evaluation I am to have that person contact my compliance officer for specific instructions on what exactly needs to be evaluated. Sound shady? Yes, yes it is.

Why share this story now? Why didn’t I share it three years ago when it happened?

The Supreme Court has finally realized how out-of-control and cartel-like these state boards have become. In 2015, in North Carolina State Board of Dental Examiners v. FTC, the Supreme Court held that when a controlling number of state board members are market participants, the board must be “actively supervised” to be immune from antitrust law. States have three options for complying with this ruling. First, they can choose not to put a controlling number of active market participants on boards. Second, they can actively supervise boards where market participants make up a controlling number of members. Third, they can forgo state action immunity by not actively supervising boards and keeping a controlling number of market participants on boards. Without such changes, state boards may be subject to antitrust liability for actions that are deemed to be anticompetitive.

In May 2018, Louisiana Senator John Milkovich introduced a bill to the Louisiana legislature to provide oversight to actively supervise these corrupt boards, like the LSBME. The bill was approved and instituting its requirements have begun, albeit slowly.  Therefore, I finally feel like I have a chance to positively change my circumstances. Louisiana needs to nullify the absurd sanctions placed on me. Please join me in contacting the following agencies and complaining on my behalf at the injustice and the unreasonable restraint on competition violating federal antitrust law that occurred. *However, since this bill was just “dropped on them” as stated by the secretary of the House and Governmental Affairs Committee, at this time, she does not know what a formal complaint should include.  I will update this information as soon as their attorney returns my call.

In compliance with Act 2018-655, the board gives notice to its licensees and applicants of their opportunity to file a complaint about board actions and board procedures. You may submit such complaints to one or more of the following organizations:

  1. Louisiana State Board of Medical Examiners; 630 Camp Street, New Orleans, LA 70130; (504) 568-6820; lsbme@lsbme.la.gov
  2. Committee on House & Governmental Affairs; La House of Representatives; PO Box 444486, Baton Rouge, LA 70804; (225) 342-2403; h&ga@legis.la.gov
  3. Committee on Senate & Governmental Affairs; La Senate; PO Box 94183, Baton Rouge, LA 70804; (225) 342-9845; s&g@legis.la.gov

Conveniently, the media group Gatehouse recently published a series of articles pertaining to out-of-hospital midwifery. They complied a database of all midwives across the US. If we look at Louisiana’s active licensed midwives (and the five midwives who would still be practicing if their licenses were not acted upon) we will find shocking statistics—32% (8/25) have had their licenses acted upon in some capacity. This further underscores the restriction of trade and antitrust issues occurring there. Out of those 20 with active licenses, three have been acted upon by the LSBME for violations and are still practicing in some capacity, whether that is on probation or in a state of undocumented, involuntary suspension. These violations, which midwives carry on their record forever, stem from simple clerical errors to natural occurrences that no one can predict or prevent like stillbirth. Two midwives, including myself have their licenses suspended. One Naturopathic physician was also targeted by the LSBME and had her license to practice midwifery revoked. The data speak for itself: more midwives have inactive licenses in Louisiana than those actively working (26 with two of those licenses having been acted upon). This means that there are more midwives in Louisiana that have, for one reason or another, stopped practicing in Louisiana. Is this because Louisiana unfairly and unjustly monopolizes the practice of midwifery? We can imagine that these midwives who are not practicing anymore or have declined to renew their licenses were dissuaded to do so because of the unethical railroading that occurs there. We can assume they would still be working in the field of midwifery if this Board had oversight and any adherence to the spirit of the law. When 32% of the Louisiana midwives are targeted, no one can claim this field is not being restricted.

According to the NOLA.com article Under Fire from Opponents, Medical Examiners Bill Stripped of Key Provisions, the number of doctors having active licenses acted upon is around 30-50 per year according to Cecelia Mouton then Executive Director of the LSBME. A census in 2016 from the Federation of State Medical Boards states that there are 16,894 active licensed physicians in Louisiana. Louisiana has provided licensure for midwives since 1984. So if we compare the amount of midwives to doctors over the last 34 years and the irrespective disciplinary actions (taking an average of 40 per year for doctors),midwives licenses have been acted upon 32% vs doctors 8%. How is the LSBME not overstepping its administrative function? How is this not a restraint of trade?How is the LSBME able to adequately discipline midwives when it is obviously biased?

The LSBME has traumatized me.From investigators showing up at my house to hand deliver a subpoena to knocks on my door from the mail carrier delivering certified letters—I lived in a constant state of fear of how the LSBME would affect my life. I lost over 20 pounds in two months from the stress. The LSBME combed through social media to use posts against me, forcing me to delete or make private all social media support systems I had established. I was concerned that my husband could lose his job, since he worked for the state of Louisiana. I worried that my daughter would be bullied in school by the obstetrician’s children. I was concerned that a lien would be placed on my property so that I could not move until I paid the fees. No part of my life was untouched by the evilness of the LSBME.

I am an over-qualified, educated, competent midwife, who cannot practice because of a bogus adjudication. I have never lost a mother or baby. I have never had a lawsuit. In the last three years, I have taken over 300 hours of continuing educational units. That’s far beyond any required amount in any state. I would be a valuable asset to any state, city, and community. I have two degrees in the study of midwifery, in addition to a bachelor’s degree. I have completed a course as an EMT. I have several job opportunities awaiting me at birth centers in Florida, but I only need a license. My position as a college midwifery clinical coordinator was rescinded as soon as my license was suspended. I am a preceptor for midwifery students. While I have suffered emotionally, physically, financially, and mentally because of my suspension, ultimately it is consumers seeking midwifery services who have suffered by not having access to one. Likewise, students who need preceptors are suffering from not having one more choice. Therefore, the LSBME is not only hurting me, but also mothers, babies, and future midwives.

Although I have been very blessed in the opportunities I have been given and the kindness and gratitude of my friends and family, it is simply not enough to sustain any lifestyle, especially one where I also need medical care. Please help spread my story to attorneys, organizations, and writers so that I can get the word out on the unconstitutional and biased decision made by the Louisiana State Board of Medical Examiners. Please call and/or write to the LSBME, the LA House, and LA Senate and complain on my behalf towards the goal of nullifying these sanctions so that I do not need to pursue litigation in either state.  Please help me raise the funds I need to overcome all of this and once again provide safe, competent, quality midwifery care.

Thank you.  

Jacqueline Macaluso

10/22/2018

http://narm.org/

https://apps.lsbme.la.gov/disciplinary/DocViewer.aspx?decision=true&fID=115520

http://www.soundoffla.com/?p=1750

file:///C:/Users/Macaluso/Downloads/DH-MQA%205015%20(09.2015)%2064B24-8.002%20[REVISED%20post-adop’n].pdf

https://www.physicianrights.net/?r_done=1

https://ij.org/pillar/economic-liberty/

http://gatehousenews.com/failuretodeliver/explore-the-database/#midwives

https://harvardlawreview.org/2015/11/north-carolina-state-board-of-dental-examiners-v-ftc-2/

Senate Bill 286 attempts to rein in dictatorial actions of State Board of Medical Examiners, runaway investigators

https://aapsonline.org/louisiana-needs-to-rein-in-unaccountable-medical-board-states-aaps/

http://copylinemagazine.com/2016/05/18/louisiana-state-board-of-medical-examiners-accused-of-racism-in-firing-of-african-american-employees/

https://www.heritage.org/report/constitutional-constraints-federal-antitrust-law#_ftn46

https://www.theadvocate.com/baton_rouge/opinion/article_46e02ba4-5fee-11e6-9b9d-e754e5adc4b6.html

https://regproject.org/

http://static1.1.sqspcdn.com/static/f/624306/26552206/1442864215407/SLLC+NC+Dental+Board.pdf?token=WVQM%2FK4rEWquAxF4AXLEp53fwvM%3D

https://www.arkansasonline.com/news/2018/oct/06/lawsuit-seeks-to-lift-midwife-restricti-1/

Click to access 162-U-Pa-L-Rev-1093.pdf

https://www.ftc.gov/system/files/attachments/competition-policy-guidance/active_supervision_of_state_boards.pdf?utm_source=govdelivery

https://www.newsmax.com/janeorient/ct-lsbme-management-mri/2018/05/09/id/859361/

http://woundedhealersnc.net/

Physician Health Programs (PHPs) are not above the law; They just think they are

http://thepsychologytimes.com/2017/05/08/meaningful-oversight-task-team-recommends-supervision-for-boards/

http://jmronline.org/doi/abs/10.30770/2572-1852-102.4.7?code=fsmb-site

Click to access la.pdf

Click to access 2%20February%202016%20Minutes.pdf

https://www.nola.com/politics/index.ssf/2015/06/louisiana_medical_examiners_le.html

Click to access 2016census.pdf

Doctor Feldman

jmacmidwife
http://www.soundoffla.com/?p=1750#comment-789

It is not often that I see eye to eye with physicians. It isn’t that I do not like them, but usually our philosophies and approaches are vastly different. You’d think having the commonality of wanting to serve others would be enough to unite us, but sometimes it isn’t. Thankfully this is not the case this time. Despite our working environments being surgical suite vs. living room, Dr. Feldman, an anesthesiologist, and I have had a more similar plight through licensure land. Sure, his care revolves around easing the pain of laboring women while mine involves encouraging them through it, but our hearts, souls, and minds all focus on helping people through life’s difficult journeys. The first time I read about Dr. Feldman, his wife, and staff, was on a WordPress blog post from Sound Off Louisiana. I have attached the post below. http://www.soundoffla.com/?p=1750#comment-789

I could feel the frustration and anger in his quotes. I could see his passion in the accompanying video. Our style of healthcare may not be similar, but our plight with this medical board is—Dr. Feldman also lost everything because a competing doctor wanted him gone. This is all too similar to my situation where obstetrician Dr. Dickerson and fellow midwife Sherri Daigle, my two main competitors in Baton Rouge, encouraged and coached a naive photographer to turn me into the board. Were these allegations even true or fair? No, in both of our cases. Were both of us railroaded out of practice unable to find work anywhere else? Yes. Have both of us faced unimaginable hardships and continued backlash from the board who does not want to see us practicing again? Yes. Removing healthcare providers for antitrust issues does nothing to protect the consumers. For cases like mine where I had to discharge a client three days before she gave birth–she chose to have her baby alone because she did not have time nor money to set up an alternate plan. Likewise, Dr. Feldman was forced to leave his clients without access to pain management. Does anyone know how hard it is to get into see a doctor? Sometimes it takes months if you are a new client. Dr. Feldman is a world-renowned anesthesiologist who has been reduced to sleeping in his RV in Wal-Mart parking lots—all because of a board that lacks oversight and refuses to bow to the law.

Finding Dr. Feldman has been a blessing. His energy is palpable. His desire to see justice served is as important as seeing no one else harmed by the medical board. It isn’t as lonely knowing there is someone else out there in the same boat, and as I continue to fight the board, it is nice having his expertise on my side. Though we have yet to meet, we plan to soon and will eventually file a lawsuit against one of these states. And perhaps one day we may actually work together toward making births better.

Sen. John Milkovich’s close on his “physician’s bill of rights” draws sharp rebukes from many of his House colleagues and leads to attorney Jack Stolier being escorted out of the meeting.

May 6, 2018

Louisiana State Sen. John Milkovich, D-Shreveport

At the Louisiana House Committee on Health and Welfare meeting of Wednesday, May 2, 2018, Louisiana State Sen. John Milkovich presented his physician’s bill of rights.  Video highlights of that event follow:
Milkovich’s heated closing, which led to numerous rebukes by House Committee members and to the ouster (not captured on video) of New Orleans attorney Jack Stolier, who, according to one source in attendance, charged directly at Sen. Milkovich upon him having uttered that Stolier engaged in an affair with the director of investigations of the Louisiana State Board of Medical Examiners.

As is obvious from the preceding video, though Stolier was unable to reach Milkovich, it didn’t stop him from yelling several times to Milkovich that “you’re a bald face liar” regarding statements Milkovich made entailing the alleged affair.

Regarding the preceding statements by Milkovich entailing Louisiana Legislative Auditor Daryl Purpera not being provided with access to the investigative files of the Board, that was an interesting point of contention during the meeting as evidenced by the following video clip:
Testimony about the degree, if any, that Purpera has been afforded an opportunity to examine the Board’s investigative files.

Soon after Sen. Gerald Long, R-Winnfield, provided support for Milkovich’s bill, Dr. Greg Stephens provided testimony indicating that he had been railroaded by the Board and that Dr. David Hammond, Medical Director of the Healthcare Professionals’ Foundation of Louisiana, had essentially told him to just suck it up and take it “because you have no due process rights with the Medical Board.”  Hammond, while acknowledging his conversations with Stephens did take place, stated that Stephens was taking his comments “out of context” and presenting them “in a manner that I don’t believe is accurate.”
Sen. Long provides support for Milkovich’s bill, followed by Stephens testifying to his alleged railroading by the Board with Hammond, to some extent, refuting that testimony.

Stephens was accused of not properly safeguarding pre-signed prescription pads and prescribing to family members without adequate documentation in their medical records.  He was also cited for “performing a minor office procedure on a patient in the clinic without appropriately documenting such in the medical record or assuring that the office was able to comply with requirements for any untoward complications.”  He is no longer allowed to practice in Louisiana; however, he is practicing in Arkansas.

There can be perhaps no more public and vocal protestor of the Louisiana Medical Board than Dr. Arnold Feldman, who has directly accused Dr. Michael Burdine, a former direct competitor of his and a former member of the Medical Board, of “conducting an organized campaign to eliminate me, his key competition in Baton Rouge, by having my medical license revoked and shutting me down.”  Dr. Feldman’s testimony, in its entirety, follows:
Dr. Arnold Feldman’s testimony entailing the Louisiana Medical Board’s investigative tactics, along with that of his wife and a former employee whom Feldman insists that he was forced to terminate or face an immediate suspension of his medical license.


Appealing the Florida denial

jmacmidwife

Because applying for licensure shouldn’t be easy right? I mean what value exactly does the Constitution hold if I cannot pursue employment in my field, or any field for that matter, despite never having had anything happen. Its absurd. So, in timely fashion I lawyer up because you know that is where I am at with life. I am blessed to be able to have the ability to pay on credit for decent lawyers in my life (except for my divorce one, but that was because she was literally the only one who would take me, but I digress.) So, I found one, that was honestly perplexed by the Department of Health’s actions. Like I stated previously, the DOH usually allows the applicant the ability to withdrawal an application without harm to his/her record. They are not letting me do this, interestingly. So, my attorney states that he will begin the appeal process under the guise of hoping to make a deal with them for both of us to avoid having to go to a hearing in lieu of having my license withdrawn. Whatever. At this point I am so fed up with midwifery and licensure. In the meantime, I reopen my ongoing battle with my incompetent compliance officer in Louisiana in order to try and get off suspension there before my appeal date in Florida. Tell me why I did not go into dentistry again?

My documents submitted to Florida….

Talbott Center: I don’t fit their Criteria (not surprisingly)

jmacmidwife

In the last six months, I have lost three members of my family. I wish I could go to a therapist, but I am so afraid of the LSBME finding something wrong with me that I don’t really consider going because I do not trust them not to use everything in my medical record to find me incompetent to practice midwifery. I suffer in silence. I try and sleep as best I can. It’s lonely. 

Following my (non) attorney’s advice, I call the closest treatment facility and ask for an evaluation. As expected, once I explain that I do not know why I need the evaluation, the admissions counselor asks me to send her the Board Order so that she could see if I fit criteria for admissions. I am very honest about what I think the order is asking the evaluation to determine. Keep in mind that this facility was one of five LSBME pre-approved drug and alcohol treatment centers I was given to choose from. I have bolded the admissions counselor’s responses. The Board Order that I sent to her follows.

2/7/2018 Talbott Admissions Counselor, Sorry I’ve had a death in the family so I’ve been off line for a few days. It does state the evaluation is for competency in midwifery. If this is something that can be done or is appropriately screened in a three day evaluation can you elaborate on how exactly my competency in midwifery is going to be evaluated? It seems competency is based on skills and not physical or mental criteria but I’m not certain. Thank you again for your assistance and time. JM

2/7/2018 JM, I’m so sorry for your loss.  I’m glad you were able to follow up with me, so hopefully we can point you in the right direction.  I’ve read over your Board Order, and unfortunately, this is not the type of evaluation that would fall within the scope of our assessment here at Talbott. I wanted to at least let you know that, but I am seeing if I can get any referrals for you as well.  That part may take me a little longer, but I will be back in touch if I can get you a name or two.  

Our evaluations are specifically for substance use, and the evaluation that you are recommended for is a mental competency evaluation. They basically want to see if there are any mental health or cognitive issues that would make it unsafe to resume practice.  We do this type of fitness for duty evaluation, but only as it relates to substance use disorders, so I can sort of see why you got to us. I would imagine that your eval would need to include a battery of cognitive testing and an in depth psychiatric interview at the least, but may not require you to admit to a facility to complete.   

I have a colleague that may have some suggestions for you, so as soon as I can speak with him, I may have some leads for you.  However, the LSBME will have to approve the providers that you select BEFORE you are evaluated. So make sure you get that approval first, if the provider is not on a list of approved providers you may already have from the LSBME.  If not approved, they may not accept the eval, and you would potentially have to do it again. 

I will let you know if I come up with anything.  Good luck!! Talbott Admissions Counselor

2/8/2018 Talbott Admissions Counselor, Thank you for the quick reply. I appreciate you looking into the Board Order and discussing with your colleagues what direction will be best for me to take. Also thank you for your candid opinion on what assessments I will be needing. That helps. 

Below is the list of providers the LSBME provided for me. Do you have an opinion on whether they will be in the same boat Talbott is in regarding my assessment being outside of scope? I’m not sure if you work with these facilities as well but figured I’d ask. 

Yes I realize I need to have the facility and/ or provider pre approved which is what prompted my inquiring to LSBME to begin with. Please let me know if you have any suggestions towards pursuing. Thank you again for your time. JM

2/9/2018 JM, They are all very well respected programs, you would be in good hands with any of them. While I cannot comment individually or steer you in a specific direction, I would suggest you look them up online/contact them and see what is the best fit for you.  I think if you are able to better state the nature of the assessment, which is basically reading them that first recommendation, they will be able to tell you quickly if they can help.  Our focus here is just too narrow, as we do our evaluations with the scope of whether substance use was a factor in the problems addressed by the Board. Some facilities have a wider scope of what they evaluate, with regard to the “mental/physical” aspect of the requested evaluation.  Good luck to you, Talbott Admissions Counselor

CEUs: RN.com is better than the MA Medical Society?

jmacmidwife

12/1/2017 JM, Please use the courses from Louisiana State Board of Nurses. The courses you sent are good for continuing education but are not comprehensive enough to satisfy the stipulations of your Order. ES

*Ms. Spooner is referring to the courses I sent her on 11/28/2017 from the Massachusetts Medical Society. (Courses for physicians.) She is saying that these ones are not comprehensive enough, yet the courses from Rn.com, written by virtually anyone, are more rigorous. *Head desk* I email her to clarify, because…. I’m dumbfounded. 

12/1/2017 ES, Just to be clear. These courses are sufficient? And not the ones from Massachusetts? 
https://www.lsbn.state.la.us/Portals/1/Documents/rnp/ResourcesCECourses.pdf
Thank you. Jm

Reaching out to the Federal Trade Commission

jmacmidwife

I am now frustrated, annoyed, and getting nowhere fast with the LSBME. They are bullying me around and preventing me from getting a job and health insurance that I need to get rid of the thyroid cancer. I reached out to many lawyers and public interest groups. However, because there are not many licensed midwives in Louisiana, there are not a lot of people affected or so it seems. One of the reasons for that is the antitrust issues the LSBME presents. It intimidates midwives so that of course there will not be many in the state especially ones who they have deemed disruptive. I wrote to the FTC, but have not heard from them yet. 

12/1/2017 I am certified as a certified professional Midwife (CPM) through the North American registry of midwives (narm). I have an associates degree in direct entry midwifery (non nursing). I had a midwifery license that was unrestricted in WI. 

I would appreciate any help with the Louisiana state board of medical examiners (LSBME). It is beyond corrupt. Two years ago my (non-nurse direct entry) Midwife license was suspended based on their opinion that I was a danger to the community even though no one was hurt or injured. They claimed I delivered a baby incorrectly even though the parents testified on my behalf that nothing went wrong and they’d hire me again. The complaint was from a photographer who didn’t have any medical training. Conveniently that same year a competing birth center opened five miles away from my home in my city. The photographer worked closely with that birth center.  When Home birth non-nurse midwives (certified professional midwives or CPMs) were originally licensed the state rules required a board of Midwives to review licensing complaints. As years passed and the state couldn’t afford to fund the midwifery board because of budgetary constraints it was absolved and combined under the medical board (all physicians). Currently no midwives (nurse or non nurse ones) serve to review complaints. During the adjudication the lsbme held me to an obstetrical standard or a CNM ( certified nurse Midwife) one. I’m not a certified nurse Midwife. 

By suspending my license indefinitely the LSBME limited its citizens access to a home birth Midwife because i had a patient who delivered unassisted without any trained medical provider at Home three days after my suspension because I didn’t have time to petition the Board for a completion of her care as it was a weekend. I had no choice but to stop caring for clients in the middle of their pregnancies even though I was not sure how I was a danger to clients as no one in my care had been hurt or injured or died. I had only had a midwifery license in la for a year. And it was my second delivery. Additionally I had a doctor overseeing all of my clients per la law. The doctor stated in EMR five times that my client was suitable for a home birth. I have an associates degree in midwifery that I cannot use now as my license is permanently suspended. I also have another degree in midwifery from a private school in Florida but I cannot gain licensure there because of my suspended one in la.  I had a license in Wisconsin also which was not affected but I chose not to renew it. Since there are only 10 licensed midwives in Louisiana losing one Midwife can limit access to care for women seeking out of hospital births. Clearly midwives are competition for doctors.

The board is imposing egregious and burdensome requirements for my Suspension to be satisfied. For instance a psych evaluation with no basis for this. And although the order doesn’t state the level of psych evaluation the doctor in charge of the board is making me get an in-depth three-day in-patient  evaluation. Again there is no basis for this as no drugs, no alcohol, nor psych disorders were involved in my case. Likewise the Order doesn’t give a “diagnosis” for the psych evaluation as their isn’t one but nevertheless I need to complete one. 

Please help. I moved to Georgia to continue working as a Midwife because it isn’t regulated in ga. And because I cannot get a job because background checks prevent me from qualifying. 

I tried to link the adjudication from the lsbme website but it is unavailable at this time. Thank you. JM