Zij zijn niet verzekerd en staan twaalf uur in de rij voor gratis zorg: “They are not insured and stand in the queue for free care for twelve hours”

Dateline October 23, 2017.

Dutch coverage of Remote Area Medical of Virginia in Grundy. Remarkable photography by Victoria Sarno Jordan. Text by Maartje Somers. Our translation is below with restricted photo reposts. See the original post for all at https://www.nrc.nl/nieuws/2017/10/23/twaalf-uur-in-de-rij-voor-een-gratis-tandcontrole-13631898-a1578293#photo=LTE3NzI. See the original The Guardian (UK) Sarno photo essay this post is based on at https://www.theguardian.com/artanddesign/gallery/2017/oct/10/virginia-remote-area-medical-mobile-clinic-in-pictures

PHOTO VICTORIA SARNO JORDAN / AFP PHOTO

TITLE: “They are not insured and stand in the queue for free care for twelve hours”

UNITED STATES

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Initially, auxiliary organization RAM focused on poor countries like Haiti or Guatemala. In the meanwhile, it mainly helps Americans without health insurance.

MAARTJE SOMERS
23 OCTOBER 2017

Not only do they come from the wide area of Grundy, a village of a thousand inhabitants in Virginia, known as “America’s sickest place”. They also come from neighboring states. Kentucky. Tennessee. The mobile clinics of Remote Area Medical of Virginia offer free eye and dental care. Free advice on diabetes, relief from opiate addiction and relief for the lung diseases that so many people suffer from in these coal mining areas. Waiting a whole night is not a problem.

“Often cars are in the parking lot when we arrive the night before,” says Vicki Weiss, eye doctor and one of the volunteers of RAM Virginia. From three o’clock in the morning, sequence numbers will be issued, early in the morning the treatments will begin. People must choose between an eye check or a dental check. “Most people choose a dentist. For some, it’s been years since they saw one, “says Weiss.

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Mobile clinics in remote areas – it sounds almost like doctors without borders in Africa. Originally, Remote Area Medical was intended for countries with low-skilled healthcare, such as Haiti or Guatemala. But now RAM works mainly in the US. In villages like Grundy, where these photos were taken, in the heart of Virginia’s silent coal industry.

Strictly speaking, Grundy is not ‘distant’: for example, it’s just six hours drive to Richmond, the elegant capital of Virginia, which also has a good hospital. The distance between Richmond and Grundy residents is socio-economic. “We treat the people who fall through the meshes in the American care system,” says Weiss. “They are uninsured, cannot pay for care, and can or do not want to meet requirements for a regular doctor.”

28 million Americans remain uninsured. Before Obamacare came into operation, it was 44 million. The number of uninsured people now rises through the chaos in Washington around the care. Almost one-third of Americans are covered by government insurance programs like Medicare and Medicaid, but they do not provide or do not provide for dental and eye care.

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And then there are other problems. A healthy lifestyle is far away in many parts of the Appalachians. In Virginia, 65 percent of adults are overweight, almost half have heart or vascular problems. Information and prevention are usually lacking and are poor. “Some people we see,” said Weiss, “do not even know they have a chronic illness”.

And then there are the opiates. Last year, the addiction epidemic claimed 800 lives in the state. In RAM, volunteers have been trained in dealing with Narcan for two years, the drug that can neutralize the effects of overdose.

At the presidential elections in 2016, Grundy chose Donald Trump, the man who wants to revitalize the coal industry, who recently launched a presidential decree to break down Obamacare without a replacement care system.

As a volunteer of a relief organization, Doctor Weiss wants to be above the parties, she says. “But radical improvements in the US care system are needed. We have great medical care in the US. But far too few people have access. The meshes in the grid are far too wide.”

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A STRIPPED HEALTHCARE SYSTEM

*44* Million Americans did not have health insurance before the previous government-Obama introduced a new health insurance scheme.

*28* Million citizens remained uninsured after the introduction of ‘Obamacare’.

*3* Attempts made by Republicans this year in the Senate to abolish Obamacare. In vain.

Behind the Scenes with Stan circa 1978!

Stan Silver Springs pic

In the late 70s Alyse Lounsberry (now a published author) wrote this feature for a Florida newspaper about Stan’s world of adventure. Stan was a liaison between Florida and California filming of an Ivan Tors (Executive Producer) underwater fantasy-comedy TV movie called ‘Danny and the Mermaid’ (released in 1978) starring Ray Walston. Alyse interviewed him during a break in the action at the Silver Springs Florida film set. He reminisced about his early life in the UK, young adulthood in British Guiana amongst the Wapishana Indians and while working on the Dadanawa cattle ranch, and then working with Marlin Perkins and ‘Wild Kingdom’! Then, as now, Stan would like to get back to the wilderness!

Read the article in full below – click on the image to enlarge.

Stan FLA Behind the scenes

Teresa Gardner Tyson and Paula E.S. Hill on first meeting Stan

Virginia’s The Health Wagon, begun by Sister Bernie Kenny as a mobile clinic in the form of a converted Winnebago camper, has had a long connection with Stan Brock and RAM. Back in the late 90s, a pivotal clinic was held in Mountain City TN which Kenny and nurse practitioner Teresa Gardner (as well as other key personnel like Dr Vicki Weiss) attended. That clinic led to the creation of the Wise County clinic, which remains a key collaboration  between RAM and The Health Wagon to this very day.  During our visit to the Wise clinic, we spoke with both The Health Wagon’s Executive Director Teresa Gardner Tyson and Clinical Director Paula E.S. Hill about their first meetings with Stan.

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Teresa, how did you first become aware of Stan Brock?

 

When did you first meet him?

 

What were your first impressions of Stan?

 

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Paula, when did you first encounter Stan?

 

How have Stan and RAM worked with you and how have they helped The Health Wagon since you first met?

 

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Kay’s Corner: Visiting the RAM vet clinic in Bradenton FL

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Before beginning work at the 2016 RAM Manatee County clinic , core RAM volunteer and animal lover Kay Sisco visited RAM’s veterinary clinic in Braden River High School on Thursday, November 10th (the “human” clinic  proceeded at Manatee Technical College from November 11-13). Not only was it a first for Bradenton, it was a first for Kay as well! She took some photos, shot some video, and wrote about the experience for her first official guest blog for us, ‘Kay’s Corner’ … 

Kay Visits the RAM Vet Clinic in Bradenton, Florida

I think that RAM doing vet clinics is a wonderful thing. This is actually the first vet clinic that I’ve seen since I began volunteering for RAM three years ago. I was amazed at the turnout and also how well-behaved all the animals were. Apparently there were small fights, but there was plenty of room to walk the animals, and they were well watered (volunteers carried bowls of water). They also had a swimming pool full of water so that the dogs could have plenty to drink.

I didn’t get to see any of the animals being treated at the vet clinic because the doctors did not actually allow strangers in the room. This I can understand, because animals get very nervous. But I did talk to a lot of people outside who attended – some were there just because they couldn’t afford to have their animals treated elsewhere.

There was plenty of room for people to spread out if their dogs were acting aggressive toward another animal or just needed some space away from big dogs. I got a picture of a huge gray cat that looks like it has different color eyes but it’s actually blind in one eye.

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I talked to one lady who said they had a two-month-old baby at home and had it not been for the clinic her family wouldn’t have been able to get any of the services that were provided at Braden River High School .

One of my pictures is of a grown cat with a kitten which I thought was mother and baby.  Actually the people who were bringing in the adult cat had found the kitten on the side of the road and brought it in as well. Unfortunately I wasn’t able to follow up to see if they took the kitten home. I hope that they did.

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There were lots of Chihuahuas there! Yes I’m a little biased because I own Chihuahuas but I’m guessing a third or more of the dogs that were there were either pureblood Chihuahuas or some kind of Chihuahua mix.

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Of course there were some big dogs – I heard that six great Danes showed up for treatment!   Unfortunately, I was not at the clinic when they were there.

As a pet owner one of my key impressions was the clinic offered all you could want and I thought it was fabulous. Pet owners are like parents. Parents are an important part of the family and pets become just that – part of the family. If you can’t get them the treatment that they need just like another family member might need it, it’s very sad for the family.

 

I took another of an older lady sitting with a little black-and-white puppy whom she’d adopted when her daughter passed away in June.  They were totally lost and they got this puppy about six weeks ago.  Her daughter’s middle name was Rose so they name the puppy Rosie.  They said that she said that this dog had really become part of their lives since their daughter passed.

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There were just so many amazing people at both the people clinic and the vet clinic – including the patients and those that were working.  I spoke to two young ladies who were in pre-med and but who ended up also working the vet clinic. They’d come to volunteer for the people clinic, but both had decided because of the Bradenton vet clinic they were now thinking about becoming vets instead!

RAM had stepped away from the veterinary portion of the clinics for a while, but is ramping up again to get this portion of their services back to the people who need it.

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Editor’s note:

Thanks to Kay for this story. And as she notes, it does indeed look like Stan plans to ramp this aspect of RAM clinics up again, having already tweeted about it since the New Year!

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Den syge side af USA (The Sick Side of the USA)

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Den syge side af USA (The Sick Side of the USA)

Back in September 2016, Danish features writer Peter Krough Andersen covered a RAM clinic in Northern Nevada. Thanks to Healthy Communities Coalition of Lyon and Storey for letting us know about some exceptional coverage accomplished by the Danish team  during the Silver Springs clinic!

You can see the published piece in its entirety with many more photos and in Danish at  http://www.dr.dk/nyheder/webdok/ram

We present some translated excerpts from Andersen ‘s text and related photos by Aron Schnobrich below.

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Desperate Americans sit in line for hours and days every week to get the chance to see a free doctor or a dentist.

[A 72 year old patient with a two-year tooth abscess, Kathleen Keys] steps out of her car on a cold, half-lit parking lot in Silver Springs in Nevada’s northern mountainous desert, on a Friday morning in September [to attend a RAM clinic] .

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Out here live some of the 30 million poor and elderly Americans who are still under-insured in spite of Obamacare and other insurance schemes. And today a hundred of them have already turned up to get free treatment from Remote Area Medical, a charity that comes out to the US remote areas, where the money is small, and the doctors are few.

Despite ailing health and an oxygen cylinder to assist her breathing, Kathleen Keys has driven 40 kilometers from her home to get to Silver Springs.

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She wept as she sat in the car this morning, because she’s been waiting for this day for a year.

“I’m so happy”,  says Kathleen, while a woman pushes her in a wheelchair toward the entrance to the sports hall at Silver Stage High School. Kathleen gets extra oxygen through a nasal cannula due to voice problems. She has taken two oxygen cylinders to the clinic because she didn’t know how long she would have to wait.

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Remote Area Medical has transformed a local sports hall and basketball court into a dental clinic, the boys locker room into an eye clinic and the girls’ locker room into a general practice/surgery area.

Over the next three days, volunteer doctors, dentists, dental assistants and students will look after the locals. Free.

The first patients queue in their cars from early evening. They want to be sure that they get a number when these are assigned by volunteers at 3am on a first-come first-served basis.

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WOW! What a fun night!

Guest blogger RAM Volunteer Kay Sisco looks back on RAM’s 800th Expedition Gala in Columbia

KAY

On Friday July 15th Remote Area Medical officially celebrated the opening of their 800th Expedition. The clinic took place in Columbia, TN at Whitthorne Middle School.  The host group did us proud!

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The Filipino American Association in Maury County of Tennessee hosted their second RAM clinic.  The first was two years ago.  I was not working with RAM at the time of the first clinic.  I heard it was great and a lot of fun.  That was an understatement.

The evening opened with all attending singing The Star Spangled Banner, our national anthem.  Then members of the host group from the Philippines sang their national anthem in their native tongue.  It was a special moment.

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After a few general announcements, short speeches and acknowledgements for major contributors…

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…we pigged out…literally!  We had Filipino Lechon (roasted pig). The meat was amazing…tender and tasty!  They also cooked the skin.  I did not try it but heard it was wonderful.  There was rice with spices and seafood, rice noodles in a fabulous sauce, salad and fruit.  While we were eating, some of the Filipino ladies entertained us with native Filipino dancing.  These were beautiful dances with umbrellas decorated with flowers and other flower arrangements.

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So now that we are all waddling around the floor, DJ Sally starts the dance music.  Several attendees hit the dance floor.  I do not dance so I was not on the floor but I was taking pictures and videos.

 

After some line dancing, DJ Sally said she had a special request.  She started the music and went over to Stan Brock, invited him to dance and led him to the dance floor.  Sally sang to Stan and danced with him.  No one had ever seen this side of Stan.  It was the highlight of the evening!  Besides Sally, there was a gentleman who also sang. He sang a couple of Elvis songs.

 

Then RAM COO Chris Hall made Expedition 800 official by giving us our commemorative pin.  I am so proud of mine!

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After all this, the line dancing started again.  As the crowd drifted away, music was still playing and folks still dancing.  But those of us who needed to be on duty at 5 am on Saturday needed some sleep.  We must be ready to serve the patients!

Opioid Addiction Discussion at RAMWise 2016

It’s no secret that the US now suffers from acute opioid addiction – some say it is a national epidemic. According to American Society of Addiction Medicine (ASAM) figures, drug overdose is the leading cause of accidental death in the US, with 47,055 lethal drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014: http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf.

The current opioid epidemic plagues the entire US, and in particular is rampaging through the Southeast - while hitting Alabama, Tennessee and West Virginia hardest. West Virginia had the highest drug-overdose death rate in the US in 2014, according to a recent CDC report. Business Insider Magazine published their top 10 for states prescribing the most opioid painkillers in March:

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Just this week West Virginia leaders suggested that the FDA review prescription drug supply to curb opioid addiction: http://wvmetronews.com/2016/08/09/w-va-leaders-suggest-fda-reviews-prescription-drug-supply-to-curb-opioid-addiction/.

The National Institute on Drug Abuse (NIDA) argues that the abuse of and addiction to opioids such as heroin, morphine, and prescription pain relievers is a serious global problem that affects the health, social, and economic welfare of everyone, and is most acute in the US because opioid prescription keep rising. It is one of the three main broad categories of medications that can constitute abuse liability, with the other two being stimulants and central nervous system depressants.

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NIDA says the total number of opioid pain relievers prescribed in the US has skyrocketed since Purdue Pharma introduced their blockbuster pain bill OxyContinin. The number of prescriptions for opioids (e.g. hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the US their biggest consumer globally, accounting for almost 100 percent of the world total. RAM California director Dr Jim Keany has spoken out about the dangers of emergent opioid super-painkillers with five to ten times more power than Vicodin! This has many ER doctors worried about overdoses and deaths. A documentary film about the prescription drug abuse problem in Orange County, ‘Behind the Orange Curtain’ says the same. Its producer Natalie Costa said: “It’s heroin in pill form. It is far more dangerous than anything we have on the market right now.”

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It is impossible to argue against strong opioid use by patients with serious or terminal illnesses but since the West Virginia Supreme Court of Appeals ruled in May 2015 that prescribers and pharmacies can be sued for causing or contributing to a patient’s addiction to controlled substances, there has been more scrutiny over casual or inappropriate use, overuse, or abuse - http://www.ncpa.co/pdf/pqm-faq-on-risks-inappropriate-opioid-prescribing.pdf.

The state of Virginia has been a frontrunner since 26, 2014, when Governor Terry McAuliffe signed Executive Order 29 establishing the Governor’s Task Force on Prescription Drug and Heroin Abuse to help find new ways to overcome the problem (US VP hopeful Tim Kaine is with VA Sec of Health Bill Hazel  to the left in the signing photo below).

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It was also positive to see Virginia’s Lieutenant Governor Ralph J Northam (himself an MD) hosting a round table on opioid addiction with regional experts, including the Virginia Department of Behavioral Health & Developmental Services at RAM Wise last month, who reported that over 400 people trained on using Naloxone, a medication used counteract opioid overdose, at Wise. Sessions were led by REVIVE! which is is the Opioid Overdose and Naloxone Education (ONE) program for the Commonwealth of Virginia.

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Naxolone training from REVIVE! at Wise

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LG Ralph Northam hosting a RAMWise round table

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Gov McAulifee with Teresa Gardner of the Health Wagon & Stan Brock.

The Health Wagon, which hosts RAMWise with RAM Virginia, has offered integrative substance abuse resources for several years now.

Kay Sisco reports on Buster, service chihuahua!

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We’ve posted pictures elsewhere of Buster and his master as well as Buster with RAM volunteer Kay Sisco – now here is Kay’s video report on the little service chihuahua who has gotten to be a bit of a celebrity at recent RAM clinics in Tennessee!

RAMVA at Zion Family Ministries’ 1-day ‘Mini Wise’!

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According to Dr Vicki Weiss, head of Remote Area Medical of Virginia, a one-day health fair concluded this week (April 13th) at Zion Family Ministries in Norton and organized by the Health Wagon was like a “mini Wise County clinic”.  This fair was followed the next day (14th) by another at Valley View Freewill Baptist Church – a small church in Clintwood, Dickenson County.

Another feature which made the Norton clinic “mini Wise” like was the presence of pulmonologist Dr. Joe Smiddy for chest x-rays. Urologist Dr. Ike Koziol was also available at Zion Family Ministries to see patients suffering from urinary tract problems.

Dr Weiss worked vision for RAM in Norton with a strong team of volunteers. In the first photo below, she’s pictured with Linda Horne – long term RAM Virginia volunteer who helped with out vision referrals:

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Here’s Linda Horne again with long term Lions Club volunteer Jennifer Jolliffe who helped with pre-testing for vision:

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And lastly, two happy patients sorted out in Norton – including a boy whose specs were his first! He had amblyopia in one eye:

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Vision also included retinal scans and glaucoma testing.

Annual free health fairs are growing in popularity and for these the Health Wagon was able to link area health care providers with local consumers and with information targeted to the prevention of health problems through community agencies and local service providers. The health fairs also saw annual participation of the medical staff and students of the Quillen Dishner College of Medicine of East Tennessee State University. Medical personnel provided individual assessments by taking complete medical histories and physical exams.

Sports physicals, school physicals, nail and foot care for diabetes sufferers, blood work, pap smears, breast exams, prostate and testicular exams, blood pressure checks, height, weight, pulse, pulse oximetry, EKGs, urinalysis, pulmonary function testing, skin cancer screenings and hearing tests were all available.

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RAM of VA now has just one more clinic in  Smyth County on April 29th-May 1st before they’re back in Wise for the big Fairgrounds clinic in July.

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Keep up with RAM of Virginia via Facebook and Twitter at:

https://www.facebook.com/Remote-Area-Medical-of-Virginia-1123215304395674/

https://twitter.com/RAMofVA

 

 

 

Stan Brock & State Lines Update!

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With the most recent and final domestic RAM clinic of the year just completed in Bradenton FL, it is worth taking a look at the state of the union with respect to states permitting doctors to cross state lines to help those in need at free medical clinics.

This means looking at states which have, individually, passed laws to permit volunteer doctors to cross state lines for free medical clinics, as well as those which have signed up for a relatively new “Interstate Medical Licensure Compact” being promoted by the Federation of State Medical Boards (FSMB) with the AMA.

According to the FSMB, this compact is meant to be “an expedited licensure process for eligible physicians that improves license portability and increases patient access to care … and represents a national solution built upon, and reinforcing, a system of state-based regulation proven to protect patients and ensure the safe delivery of health care.”

According to Stan, this compact could do a lot more. Elsewhere, Mark Green, a practicing physician who represents Clarksville in the Tennessee state Senate, has described a California Medical Board rep’s fears about licensing standards in California versus other states as ill-founded, provincial and self-righteous of many state licensing bureaucrats. In his Knoxville News Sentinel Op/Ed entitled ‘Let doctors cross state borders for free medical clinics’ he adds: “there is no justification for keeping a duly licensed, practicing doctor from volunteering to become a ‘Good Samaritan’ to the needy patients in another state.”

Is this a state boards revenue issue or more likely a turf issue?

The very same topic is covered in a 2009 Joan Brusnwasser interview with Stan for OpEdNews.com entitled Talking with Remote Area Medical Founder, Stan Brock. When asked whether the issue of state lines is a “turf issue” he replied:

Yeah, a case in point. August 16th, in the David Lazarus column in the Los Angeles Times, during that interview, I raised the issue of doctors not being able to cross state lines and therefore we had a shortage of providers. And that we could have seen many more patients if we had been able to bring them in from out of state.

Well, Mr. Lazarus subsequently, I suppose, interviewed a lady by the name of Candis Cohen, who is a spokesperson for one of the state boards of health and she made the statement which appears in that article in the newspaper tantamount to, if not the exact words, that we don’t want doctors here from places like Texas or Alaska or somewhere. We have very high standards in California.

Well, the truth of the matter is, that everybody expects to have very high standards but to make such a disparaging remark was a slap in the face to medical practitioners throughout the country and I wonder what Ms. Cohen would have thought if she had perhaps been traveling through Texas, which she singled out along with Alaska, and suffered a serious motorcar accident and had her life saved in an Emergency Room by a Texas licensed doctor. So, the argument just doesn’t make any sense.

Ironically, California has since passed a law allowing doctors to cross state lines. Stan, who played an important role in helping Tennessee to its 1995 Volunteer Health Care Services Act (in some quarters called ‘the Stan Brock Law’, the first such US law) now closely monitors where legislation is headed. He says the states which have passed laws to allow the poor and indigent to receive free care from volunteer doctors across state lines, are as follows:

Tennessee
Connecticut
Illinois – Adopted Interstate Medical Licensure Compact as well.
Virginia
Kentucky
Oklahoma
North Carolina
Missouri
Colorado
California
Nevada – Adopted Interstate Medical Licensure Compact as well.
Washington
Ohio allows dentists only.

A look at the map for the Interstate Medical Licensure Compact, tells a different story. BLUE states have enacted (11), ORANGE states have introduced (9), and GRAY states have no status. Of states which have organised individual plans, only Illinois and Nevada have also adopted the FSMB plan.

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Which approach will hold sway and ultimately be most effective remains to be seen. But it would seem that one problem with the Compact is that practitioners have to pay various fees and Stan thinks that those fees and the greater time required to obtain licensure represents a disincentive for the vast majority of volunteers who would otherwise be prepared to venture across state lines. The need is too great and far too urgent.

Which makes the recent clinic in Manatee County seem all the more impressive for numbers served inasmuch as Florida has neither individual state or FSMB scheme status!

Read the Brusnwasser interview at: http://ow.ly/VspqG

Read the Green Op/Ed at: http://ow.ly/VspCD

Read a FSMB Compact Interstate Medical Licensure  Compact PDF at: http://ow.ly/VsqU8 

Thanks to RAM’s Law Clerk & Aviation Assistant Dakotah Brown for liaising with us on this article.