Doctors get all sorts of messages from their patients or caregivers. Sometimes they get the “dreaded list,” where an otherwise healthy individual unfolds a laundry list of symptoms, issues and grievances. While the “worried well” represent a small fraction of patients, the bigger concern is with those folks who say nothing at all.
A case in point occurred with my ailing father. I accompanied him to one of his doctor’s appointments and was astounded afterward when he did not divulge any of his symptoms that were troubling him. When I asked him why, he said, “Doctors are paid to figure things out, so let them figure out what’s wrong with me.” As a soon-to-be-graduated physician, I could only scratch my head at his retort. I suppose his thought or belief was that doctors do not need much of a patient history to make a diagnosis. Years later into my career, I became so impressed with colleagues who make a diagnosis almost entirely from a patient’s history. These doctors really know how to ask the right questions, a skill that eludes many modern-day providers whose “go to” communication with the patient seems to be, “let’s get a scan.”
Not to make light of conversations about medical diagnostics, a key point is that these discussions need to be clearly coupled with what matters most to the patient and their functional status. As an example, a health care provider might reflexively order a screening mammogram for an older woman who would not want surgery or chemotherapy should a breast mass be found. One of the rules of thumb we teach our medical students is to not order a bunch of diagnostic tests if the patient does not want to act on abnormal findings.
Knowing patient preferences and health care goals are so important to patient-centered health care. Yet, questions about health care goals are seldom asked or documented in the clinical setting. To address this gap in provider-patient communication, the Geriatric 4M framework for hospitals and clinics puts front and forward the 4M of What Matters Most to older adults. The goal is to firstly ask the older adult What Matters Most, document it, and then share What Matters across the care team. Thereafter, the health care team aligns the care plan with What Matters Most.
So, how do health care providers ask older patients What Matters Most to them?
When asked directly, one patient responded, “Gee, I don’t know, no one has ever asked that question before.” Reworded, “If there is one part of your health that we could focus on, what would that be so we could help you do (fill in the blank) better? In this instance, a quick response ensued, “well, I want to keep up better with my grandchildren if I could only not get tired so quickly.” With that quick response, the health care provider immediately knows that the symptom of fatigue needs to be medically addressed and it stimulates a bunch of possible health considerations. The point is that by asking "What Matters Most" the health care action plan can be more precisely fine tuned to the needs of the older adult. It’s the other side of the coin for the evolution of Precision Medicine!
Ultimately, questions about What Matters Most need to clarify how medical or surgical treatment could help or perhaps thwart an older adult’s ability to do things they enjoy.
Questions also should focus on a specific time frame and with appreciation of remaining active life expectancy. The term “active life expectancy” is the time when older adults can live in good health, free from disability and chronic illness. This time period often ends by about 2-3 years before “absolute life expectancy” or the definitive end of life. The 2-3 years between active and absolute life expectancy are recognized as a time of increasing disability and frailty. Most people don’t prepare for this transition. Furthermore, many health care providers under-appreciate the assessment and management of this transitional phase. Indeed, studies show that most people vastly overestimate their remaining life expectancy by several years even in face of a terminal chronic condition. Thus, a necessary part of the What Matters conversation needs to fairly evaluate how many years an older adult is expected to live in health and how they should prepare for dwindling health that invariably precedes death.
Under the Age Friendly Health Care framework, the practical application of What Matters Most within a clinical encounter between a health care provider and older adult patient has several options. The Institute for Healthcare Improvement and several other health care websites provide a list of options for health care providers to gather information about What Matters Most to their older adult patients. The simplest and most straightforward way to ask What Matters Most are icebreaker questions such as:
1. “What are your priorities for your health and well-being as you age?”
2. “What are the most important things you want to be able to do or continue doing as you age?
3. “What are your goals for your care and treatment as you grow older?”
4. “What is important to you in terms of your quality of life as you age?”
5. “What are the things you value most and would like to maintain or Improve as you age?”
You do not need to wait for your health care provider to ask these questions. You can jot down your answer and hand the note to your primary care provider. Alternatively, you can go the website for the Stanford (not Sanford, ahem) Letter Project and complete a Letter to Your Doctor: https://med.stanford.edu/letter/letters-in-other-languages.html
The Stanford Letter is a nicely designed template that helps others understand your strategic plan for living now and at the end.
Speaking of the end, not one of my favorite topics, it is very useful to convey to others, including your health care provider, what your wishes might be if you should be in a terminal or near terminal situation. This is where Advance Care Plans (ACP) and Physician Orders for Life Sustaining Treatment (POLST) come into play. Once you have these documents completed and added to your medical record, health care providers can do a better job of honoring your wishes.
As a side comment, research shows that about 85% of people will reverse their end-of-life preferences when confronted with an emergency event. So, the practical application of Advance Care Directives is to be considered as a fluid and ongoing process. Where the process gets gummed up is if and when memory impairment occurs. For this reason, it is important to get your wishes known before there is a loss of judgment and insight.
Hospitals and clinics that strive to be Age Friendly Healthcare Systems have a lot of good options for gathering information on What Matters Most. One option is to send a message out to older adult patients to complete a pre-visit questionnaire. NDSU School of Pharmacy is trialing a pharmacist-provided checklist of What Matters and the other 4Ms. The Stanford Letter template is a great example of pre-visit “homework” for the patient to complete. Alternatively, the Medicare Annual Wellness exam (it's free, folks) can be the moment when What Matters Most is discussed or revised with your health care team. In my clinical setting, we explored the use of a team-based Annual Wellness exam where patients see different health professionals for various elements of the exam. We are getting great feedback on this unique clinical approach.
The annual wellness exam sets the stage for future dialogue on What Matters Most to the older patient and allows primary care providers and other team members to align the health care plan to what was revealed in the What Matters Most response. In several certified Age Friendly Health Care systems, the What Matters Most documentation automatically pops up at the top of the patient’s medical note, thus emphasizing its importance to the health care provider’s assessment and action plan for their patient at every point of contact.
Not everyone is prepared to engage in “What Matters” conversations. Some folks feel the weightiness of end-of-life Topics that are included in, but not exclusive to, the What Matters dialogue. Others may want to avoid evoking a death spirit, bad luck or connotations about “careful what you wish for.” Clearly, a wide range exists regarding the comfort level, readiness and expectations among older adults about sharing their goals and preferences for their health care. Recognizing these variations, a savvy health care provider utilizes each interaction with older adults as a moment to further advance the What Matters conversation, one step at a time.
For those highly committed to their health, the What Matters conversation can help sharpen their strategy for living a full and highly functional life. For those familiar with the newly launched Blue Zones project in Grand Forks, the term “la vida” is the phrase used to embrace living with a mission which in turn anchors the What Matters Most dialogue.
In short, the conversation between older adults and health care providers needs to include, “What matters to you?” along with “What is the matter?”
Dr. Donald Jurivich is professor and chairman of Geriatrics at the UND School of Medicine and Health Sciences. He holds the endowed chair established by Eva Gilbertson, M.D., who was the first woman graduate of UND Medical School. Jurivich is the principal investigator for the HRSA funded Dakota Geriatrics Workforce Enhancement Project that supports Age Friendly and Dementia Friendly Health Care. Any opinions expressed in this article are strictly those of the author and do not reflect the opinion of UND or HRSA.
February 15, 2023 02:00 PM
February 15, 2023 05:36 AM
February 11, 2023 06:57 AM
Last week, after we explained how Kentuckians can access medical marijuana under Gov. Andy Beshear’s now-effective executive order, several readers wrote to us with questions about protections for workers, insurance coverage and more.
In this piece, we explore those questions and answer them in-depth.
Further, to help you get a better understanding of the limits of the executive order, we’ve consulted an attorney who specializes in medical marijuana and cannabis law as part of his legal practice. Here’s what to know.
Kentuckians can now possess medical marijuana. Here’s how accessing it works
Are there protections for workers who use medical marijuana in KY?
Some of our readers wrote to us with questions about whether a worker could be terminated from their job if they tested positive for marijuana – even if they’re using it for a medical purpose laid out in the executive order.
The answer to that question is yes, and to get at the reason why we need to delve a little deeper into how the governor’s executive order works.
Attorney Michael Bouldin of Covington deals with medical marijuana and cannabis law as part of his legal practice.
In his response via email, Bouldin highlighted an important aspect of how Beshear’s executive order works: It remains illegal in Kentucky to buy, sell or even possess marijuana. What the governor did is declare he will grant a pardon to anyone convicted of possession, provided they meet all of the conditions laid out in his executive order.
As a review, those conditions include the following:
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The cannabis must be lawfully purchased in the U.S. from a state where the purchase is legal, and the receipt of that purchase must be kept by the individual.
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The amount purchased and used must not exceed 8 ounces. This is the difference between a misdemeanor and a felony possession charge in Kentucky.
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The person using the cannabis must have a certification, which to be clear is not the same as a prescription or “medical marijuana card,” from a licensed health care provider attesting that person has been diagnosed with one of the health conditions laid out in the executive order.
In his response to the Herald-Leader, Bouldin noted Kentucky remains an employment-at-will state.
This means an employer can hire or fire you for any reason that is not illegal. Protected classes include race, religion, national origin, age and other immutable characteristics.
“Therefore, if you have been charged, you can be fired,” Bouldin noted. “What (the executive order) will do is allow that individual that meets the requirements to have the case not only dismissed, but a pardon will have it expunged off your record.”
“Interestingly, Kentucky already has a law on the books that does this for a first offense, possession case anyway,” Bouldin further noted. “If a person undergoes misdemeanor diversion, they can then get the charge removed. Alternately, if plead or found guilty, they can have the case sealed if they complete a marijuana education course under KRS 218A.276.”
Is 2023 the year Kentucky lawmakers finally legalize medical marijuana? Senate holds the key
What medical conditions qualify me to use medical marijuana in KY?
One reader, who reports suffering from chronic pain, wrote to us with a question about qualifying under the governor’s executive order.
Under the order, “severe and chronic pain” and “intractable pain” are conditions listed as qualifying.
The full list laid out in the order is as follows:
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Cancer
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ALS or Lou Gehrig’s disease
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Epilepsy
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Intractable seizures
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Parkinson’s disease
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Crohn’s disease
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Multiple sclerosis
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Sickle cell anemia
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Severe and chronic pain
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Post traumatic stress disorder
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Cachexia or wasting syndrome
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Neuropathies
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Severe arthritis
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Hepatitis C
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Fibromyalgia
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Intractable pain
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Muscular dystrophy
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Huntington’s disease
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HIV or AIDS
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Glaucoma
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A terminal illness
Notably, Bouldin pointed out, “depression and anxiety, the most common diagnoses leading to prescription of marijuana, are not included” in the executive order.
According to a 2017 study published by the National Institutes of Health that surveyed 9,000 respondents, “the most common medical reasons for marijuana use were anxiety (49%), insomnia (47%), chronic pain (42%), and depression (39%).”
Who can use medical marijuana in Kentucky? Here’s what to know about the requirements
Can I obtain a medical marijuana certification through an online provider?
There’s nothing in the executive order that precludes someone from obtaining their medical marijuana certification through an online provider.
What is required is the health care provider “is licensed to practice medicine in the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence,” according to the order.
This provider must also be “in good standing with the appropriate licensure board within the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence.”
We posed the question to Scottie Ellis, deputy communications director for Gov. Beshear’s office, and received the following response: “Unfortunately scams often take place with new programs, which is why we encourage Kentuckians to refer directly to the Executive Order (EO) which states what must be in the document from a doctor, including that the individual has been diagnosed with one of 21 conditions listed in the EO.”
Where is weed legal? How Kentucky compares to 37 states that allow medical marijuana
Will insurers cover medical marijuana in Kentucky?
A few of our readers wrote to us with questions about whether health insurance providers, such as Medicare, will pay for cannabis purchased in compliance with the governor’s executive order.
Older state residents, who may be living on fixed incomes, might not be able to afford frequent trips out of state to make their purchases, they noted.
However, coverage by an insurance provider isn’t likely because medical marijuana is not legal under federal law. Given that, Kentuckians shouldn’t expect insurers to risk exposure to cover medical cannabis products they purchase under the terms of the order.
Last October, President Joe Biden made headlines when he announced he would grant pardons for simple marijuana possession convictions and encouraged every state governor to do the same.
However, under federal law, medical marijuana is still classified as a Schedule I drug under the Controlled Substance Act. This means the federal government still considers it to have no medical value, as explained by the American Bar Association.
Government officials may have taken some limited actions regarding marijuana reform, but the federal government at large is still out of step with states, meaning insurers will want to avoid the legal headache and steer clear.
Do you have a question about marijuana in Kentucky for our service journalism team? We’d like to hear from you. Fill out our Know Your Kentucky form or email ask@herald-leader.com.
© Provided by LA Times Nora Burlingame, 3, is held by her mother, Dina Burlingame, as she attempts to fist-bump nurse Luann Majeed after getting a COVID-19 vaccine shot at a clinic in Seattle last year. (Ted S. Warren / Associated Press)
For the record:
3:59 p.m. Feb. 16, 2023: A previous version of this article identified Erin Shields as chief life specialist at Children’s Hospital Los Angeles. Her title is child life specialist.
An ear thermometer sent Rita Ho-Bezzola's 1-year-old daughter into a crying fit when a nurse tried to take the little girl's temperature.
Afterward, Ho-Bezzola decided to buy a thermometer from a local CVS retailer and play pretend doctor with her child. Through that interaction, she said, her daughter learned how the tool would be used.
When the toddler returned to the doctor's office for a checkup six months later, the sight of a thermometer didn't upset her.
Ho-Bezzola was a new mother then. She now realizes that her daughter couldn't say, "I don't know what that thing is," and express her fear of the unknown object.
This is just one of many experiences that motivated Ho-Bezzola and her co-founders at Piper + Enza, an online resource for parents navigating the healthcare system, to learn more about how negative medical experiences affect pediatric patients and their families.
Fellow co-founder Taraneh Arhamsadr said that when the organization was defining its mission and goals in 2021, its work was largely shaped by a 2018 poll conducted by the C.S. Mott Children's Hospital at the University of Michigan.
The nationwide poll, which surveyed parents of children between the ages of 2 and 5 who were afraid of visiting the doctor, found that children's fear affected their parents' interactions with healthcare providers. About 22% of parents said it was hard to concentrate on what the doctor or nurse was saying, and 9% said they would sometimes forget to ask questions or raise concerns because their child was scared or upset during the visit.
The poll also found that almost 5% of parents either postponed getting a vaccine for their child or canceled or delayed an appointment due to the child's fear of going to the doctor.
According to Nemours Children's Health, children's worries about medical exams include being separated from their parents, experiencing pain, having a bad interaction with the doctor, and having a more serious problem than their parents are letting on.
Piper + Enza is working to Improve the experience that pediatric patients and their families have in doctor's offices, clinics and hospitals. With the collaboration of early child educators, child life specialists, pediatricians and child psychologists, the organization offers guidance from professionals in the field. It's also raising awareness about child life specialists, who are supportive medical staff members available to parents and guardians when their children go to the hospital.
Prepping for a doctor visit
Parents, prepare yourselves. When you're making an appointment for your child, whether it's a checkup or an inpatient procedure, ask questions and get an understanding of what the procedure will be like so you can prepare your child.
Ho-Bezzola and Arhamsadr said they've learned through their research that an open and honest conversation with your child can make the medical visit a more positive experience. If a child is going to the doctor for an immunization or bloodwork, for example, Kaiser Permanente says you should tell that to the child. Like adults, most children fear needles, but kids may cope better if they know what to expect. It suggested saying to your child, "You will need to get medicine through a small needle to stay healthy, and it may feel like a pinch or a sting." Not telling your child the truth can result in anxious feelings, or worse, your child may learn to not trust what you say.
UCLA Health suggests talking to children under 5 a day or two before the medical experience. Older children should have a few days to a week of advance notice. Guardians should always encourage their children to discuss their feelings and ask questions during this time, while also validating those feelings.
Ahead of the medical visit, supplement the conversation by playing doctor, practicing books and doing art activities that incorporate medical themes, such as using bandages, cotton balls and gauze to make flowers or a collage. All of these activities can help the child understand what the doctor visit will be like, especially role playing with a toy doctor kit. Piper + Enza published a book for parents and children, "The Difference Between Needles and Noodles," that helps kids learn more about why people get shots, ways they can prepare and useful coping strategies. The book also includes a parents guide from certified child life specialist Katie Taylor.
If your child is going into the doctor's office for a vaccine, give them a simple choice to either sit in your lap or sit by themselves.
Ho-Bezzola and Arhamsadr's biggest piece of advice for parents is to stay calm. The less anxious you are, the calmer your child will be.
What's a child life specialist?
Coping with a serious illness, injury or treatment can be challenging and stressful for children and their families, said Keri O'Keefe of the Assn. of Child Life Professionals. A visit to the hospital is when a child life specialist can step in to provide support.
The goal of a certified child life specialist is to ensure family-centered care. The specialist is working with and checking on all immediate family members supporting the patient — who can include parents, guardians, siblings and grandparents.
Erin Shields, child life specialist for Children's Hospital Los Angeles, said she once went into a hospital room and was informed by a grandparent that the doctor was talking to the child's guardian. Shields let the grandparent know she's there to support the whole family.
"And you see that physical change in posture and that sigh of relief of, 'You're right, this is really scary for me too, and I'm allowed to have those really hard feelings,'" she said.
A specialist supports everyone by providing therapeutic play, preparation for the procedure, and education that reduces fear, anxiety, pain and suffering for patients and their families.
For example, Shields said, she held virtual meetings with parents earlier in the COVID-19 pandemic to offer guidance on how to talk about a diagnosis with the siblings of a patient.
"It's never the same technique for every family, so we really like to work with them in that process to create a foundation of trust," she said.
Alleviating the anxiety that family members may feel empowers them to believe that they can "do this" and get through whatever treatment or procedure their family member is undergoing, added Carol Hamamoto, child life manager at Children's Hospital Los Angeles.
Shields added that this helps parents find their voice because "they are the most important person on their child's medical team." A guardian is also the child's advocate, so a child life specialist helps them to feel empowered to speak up and to share their concerns.
O'Keefe said these specialists support young patients by introducing coping strategies to help children with the anxiety and stress of hospitalization, preparing them for procedures or treatment using developmentally appropriate language, and providing support and distraction during medical procedures. Their duties also include offering opportunities for play and expressive activities to encourage normalcy and continued growth during their treatment or hospital stay.
An evaluation of one child life program published by the journal Pediatrics in 2021 found that the interventions resulted in less emotional distress, better overall coping during the hospital stay, a clearer understanding of procedures, and a more positive physical recovery and post-hospital adjustment for children who were enrolled.
Other studies cited in the journal article found that child life specialists play a major role in calming children's fears and result in higher parent satisfaction with the entire care experience.
These specialists typically lend their services in the emergency department, intensive care and cardiac units as well as in the fields of oncology, bereavement, anesthesiology and radiology.
There are 613 child life specialists in California, a figure that O'Keefe said was the highest number in the country. Texas comes in second with 595.
A caregiver can request support from a certified child life specialist, but there might not be one available at all hospitals. The majority of specialists in California work in larger hospitals such as Cedars-Sinai Medical Center, Children's Hospital Los Angeles, Loma Linda University Children's Hospital and UCSF Benioff Children's Hospitals.
If you want to know whether your child's hospital or care team has a child life specialist on staff, Hamamoto said you can call and ask. If you're coming from a pediatric office, she said, you can always have the doctor write in "the parents (or guardians, as the case may be) would like to request child life services if available."
This story originally appeared in Los Angeles Times.
On Thursday, the Florida High School Athletic Association (FHSAA) board — which oversees high school sports across the state — voted 14-2 during an emergency meeting to axe the questions from the 2023-2024 school year medical forms.
Under the new setup, student athletes in Florida will only be required to submit one page of a four-page packet linked to the medical evaluation that determines whether they’re healthy enough to play their respective sport. The remaining pages, which will be kept by parents or healthcare providers, still contain an in-depth health questionnaire, though the section about female students' menstrual cycles has been eliminated.
Previously, the board was considering following an FHSAA medical committee's plan to make student athletes answer a series of questions about their menstrual health including "When was your first menstrual period?" and "How many periods have you had in the last year?"
The questions about students' menstrual history had been optional for more than two decades.
She says that the response from board members is the "perfect example" of the power of advocacy.
"Schools and sports organizations do not need details about a person’s bodily functions to understand that a medical professional certified their ability to participate in sports," Duesterhaus wrote in a statement. "We applaud executive director Craig Damon for being receptive to the concerns of experts, elected officials, and citizens across the state."
The FHSAA board is made up of 14 men and two women; 12 of the members are elected representatives of schools and school districts, while three are appointed by Florida’s education commissioner, who is handpicked by the governor and also sits on the board.
According to an agenda item for Thursday’s meeting, the board said that while it recognizes the role that medical history plays in a pre-participation physical exam, it understands that it is “vital” to protect the privacy of student athletes.
A number of detractors, including physicians, students, parents, and advocacy groups, spoke out after the FHSAA sports medicine committee, which is composed of doctors and athletic trainers, proposed last month to include the menstrual health questions as mandatory elements of health evaluations. Some critics felt the measure was part of a larger effort to stigmatize transgender students in school sports, while others simply called it an invasion of privacy. (In 2021, Gov. DeSantis signed a bill barring transgender female students from playing on public school sports teams with players identified as female at birth.)
The association’s spokesperson told media outlets that its reversal was not in response to concerns about transgender athletes in women’s sports, as some had previously expressed.
During the public comment portion of the meeting, the board read aloud emails from more than 150 people, many of whom blasted the board over the proposal and urged it to remove the menstrual health questions.
Board member Doug Dodd said during the Thursday meeting that if the association were to mandate these questions about menstrual history, he'd have a "real problem" with it as a parent.
"As a father of three daughters who all played middle school and high school sports…I really understand the concern over making these questions mandatory,” Dodd said, noting how he and his family previously chose to not answer such questions on health forms because they felt they were intrusive.
Board members Chris Patricca and Charlie Ward cast the two opposing votes.
Patricca said that while she didn't support the removal of the questions –– asserting that they were an essential part of health evaluations –– she concurred that the information should remain private.
Florida’s governing body for high school sports voted on Thursday to remove all questions about menstruation from medical forms required for student athletes, after an uproar that reflected anxieties about digital and reproductive privacy.
Officials said that the form had been used for about 20 years, but the optional menstruation questions were spotlighted after Roe v. Wade was overturned and Florida introduced new restrictions on how gender identity and sexual orientation could be discussed in schools.
An October report in The Palm Beach Post highlighted the questions, which included “When was your most accurate menstrual period?” and caused controversy on social media. Some critics thinking about the implications for reproductive rights, and others, including parents, were more broadly thinking about the privacy of their children’s data.
After months of backlash, the board of directors of the Florida High School Athletic Association held an emergency meeting on Thursday and voted 14 to 2 in favor of a proposal to remove the menstruation questions from a four-page medical history questionnaire.
Under the proposal, the first three pages of the form will be kept by the student’s health provider and not shared with the school. The fourth page will be shared with the school and shows only whether a doctor determined the student was medically eligible to play sports.
According to a board agenda item, the changes to the form were intended to protect “a student-athlete’s privacy while including pertinent medical information a health care provider at a member school would need access to.”
The association, which represents 800 public and private schools, said the changes would take effect in the 2023-24 school year.
The requirement that a primary care physician sign off on a student’s participation in school sports is standard across the United States. The Florida form was developed by the Florida High School Athletic Association and is used by more than 60 school districts across the state.
Florida, Texas and Iowa are among a dozen states that ask questions about menstruation on participation forms that are kept on file with schools. Physical education forms in Colorado, California, Georgia and Maryland ask about menstruation but advise that information should be kept with the physician in the student’s medical chart.
The American Academy of Pediatrics recommends that doctors collect menstruation data from student athletes, but says that the only form that should be submitted to schools or sports organizations is one that indicates whether a doctor has determined that the student is medically eligible to play sports.
Concerns about the medical form were raised in August at a more than three-hour Palm Beach County School District meeting. The parents there did not take issue with the menstruation questions, but some challenged the district’s use of new athletic department software, called Aktivate, to collect the students’ medical forms.
One parent who expressed concerns about Aktivate was Jennifer Showalter. She was running for a school board seat in an election that she ultimately lost.
“Parents, like you’ve heard tonight, do not approve of their children’s health data floating in the web because they know breaches happen all the time,” Ms. Showalter said. “And worse, they know their child’s information will simply be sold to other companies as third-party vendors through our school system.”
Aktivate says on its website that it is compliant with the Family Educational Rights and Privacy Act, a federal law that protects student privacy.
After parents raised these concerns, the Palm Beach County School District in August brought back paper options for submitting the medical forms and gave any parent who had submitted the forms electronically the option to have them returned. The school district also said it would encourage the high school association to remove the questions regarding menstruation and to make other changes.
The uproar over student medical records came amid a flurry of Republican legislation related to gender signed by Gov. Ron DeSantis, including a ban on abortions after 15 weeks of pregnancy and the Parental Rights in Education Act — opponents refer to it as the “Don’t Say Gay” act — which, in part, constrains instruction on gender and sexuality. In November, the Florida Board of Medicine also banned gender-affirming care for transgender youth.
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Recognition reinforces strong company culture and employee experience
PLYMOUTH MEETING, Pa., Feb. 17, 2023 /PRNewswire/ -- Harmony Biosciences Holdings, Inc. ("Harmony") (Nasdaq: HRMY), a pharmaceutical company dedicated to developing and commercializing innovative therapies for people with rare neurological diseases, today announced the company has earned the Great Place to Work® recognition for the fifth year in a row. The distinction was awarded to Harmony Biosciences based on survey feedback from Harmony employees that Checked the quality of the company's culture and their employee experience.
"Earning the Great Place to Work® certification again this year underscores our ongoing commitment to fostering a thriving workplace culture that is innovative, empathetic, inclusive and collaborative," said Jeffrey M. Dayno, M.D., Interim Chief Executive Officer and Chief Medical Officer. "Every day, I see our team of experts from a wide variety of backgrounds and disciplines demonstrate their shared conviction and teamwork in bringing hope to the people and communities we serve. This recognition is a testament to our employees across our entire organization and the important work they do, which I am very proud of."
Harmony's employees completed survey questions regarding employee engagement, workplace culture, diversity and inclusion, company management, innovation, communication, team dynamics and available resources. The results were evaluated against pre-determined criteria for great workplaces through the Great Place to Work® trademarked Trust Index™ and Culture Audit® tool. A summary of these ratings, including how they can be measured against other companies, can be found here.
Harmony Biosciences was recognized by Great Place to Work in 2022 as a "Best Workplace in BioPharma" and in 2019 as a "Best Small and Medium Workplace." Recently, the company ranked 4th on Forbes list of "America's Best Mid-Sized Companies in 2023."
About Harmony Biosciences
At Harmony Biosciences, we specialize in developing and delivering treatments for rare neurological diseases that others often overlook. We believe that where empathy and innovation meet, a better life can begin for people living with neurological diseases. Established by Paragon Biosciences, LLC, in 2017 and headquartered in Plymouth Meeting, PA, our team of experts from a wide variety of disciplines and experiences is driven by our shared conviction that innovative science translates into therapeutic possibilities for our patients, who are at the heart of everything we do. For more information, please visit www.harmonybiosciences.com.
About Great Place to Work®
Great Place to Work® is the global authority on high-trust, high-performance workplace cultures. Through proprietary assessment tools, advisory services, and certification programs, including Best Workplaces lists and workplace reviews, Great Place to Work® provides the benchmarks, framework, and expertise needed to create, sustain, and recognize outstanding workplace cultures. In the United States, Great Place to Work® produces the annual Fortune "100 Best Companies to Work For®" list and a series of Great Place to Work® Best Workplaces lists, including lists for Millennials, Women, Diversity, Small and Medium Companies and over a half dozen different industry lists.
Harmony Biosciences Media Contact:
Cate McCanless
202-641-6086
cmccanless@harmonybiosciences.com
Harmony Biosciences Investor Contact:
Luis Sanay, CFA
445-235-8386
lsanay@harmonybiosciences.com
View original content to obtain multimedia:https://www.prnewswire.com/news-releases/harmony-biosciences-certified-as-a-great-place-to-work-for-fifth-consecutive-year-301749343.html
SOURCE Harmony Biosciences
Last week, after we explained how Kentuckians can access medical marijuana under Gov. Andy Beshear’s now-effective executive order, several readers wrote to us with questions about protections for workers, insurance coverage and more.
In this piece, we explore those questions and answer them in-depth.
Further, to help you get a better understanding of the limits of the executive order, we’ve consulted an attorney who specializes in medical marijuana and cannabis law as part of his legal practice. Here’s what to know.
Kentuckians can now possess medical marijuana. Here’s how accessing it works
Are there protections for workers who use medical marijuana in KY?
Some of our readers wrote to us with questions about whether a worker could be terminated from their job if they tested positive for marijuana – even if they’re using it for a medical purpose laid out in the executive order.
The answer to that question is yes, and to get at the reason why we need to delve a little deeper into how the governor’s executive order works.
Attorney Michael Bouldin of Covington deals with medical marijuana and cannabis law as part of his legal practice.
In his response via email, Bouldin highlighted an important aspect of how Beshear’s executive order works: It remains illegal in Kentucky to buy, sell or even possess marijuana. What the governor did is declare he will grant a pardon to anyone convicted of possession, provided they meet all of the conditions laid out in his executive order.
As a review, those conditions include the following:
-
The cannabis must be lawfully purchased in the U.S. from a state where the purchase is legal, and the receipt of that purchase must be kept by the individual.
-
The amount purchased and used must not exceed 8 ounces. This is the difference between a misdemeanor and a felony possession charge in Kentucky.
-
The person using the cannabis must have a certification, which to be clear is not the same as a prescription or “medical marijuana card,” from a licensed health care provider attesting that person has been diagnosed with one of the health conditions laid out in the executive order.
In his response to the Herald-Leader, Bouldin noted Kentucky remains an employment-at-will state.
This means an employer can hire or fire you for any reason that is not illegal. Protected classes include race, religion, national origin, age and other immutable characteristics.
“Therefore, if you have been charged, you can be fired,” Bouldin noted. “What (the executive order) will do is allow that individual that meets the requirements to have the case not only dismissed, but a pardon will have it expunged off your record.”
“Interestingly, Kentucky already has a law on the books that does this for a first offense, possession case anyway,” Bouldin further noted. “If a person undergoes misdemeanor diversion, they can then get the charge removed. Alternately, if plead or found guilty, they can have the case sealed if they complete a marijuana education course under KRS 218A.276.”
Is 2023 the year Kentucky lawmakers finally legalize medical marijuana? Senate holds the key
What medical conditions qualify me to use medical marijuana in KY?
One reader, who reports suffering from chronic pain, wrote to us with a question about qualifying under the governor’s executive order.
Under the order, “severe and chronic pain” and “intractable pain” are conditions listed as qualifying.
The full list laid out in the order is as follows:
-
Cancer
-
ALS or Lou Gehrig’s disease
-
Epilepsy
-
Intractable seizures
-
Parkinson’s disease
-
Crohn’s disease
-
Multiple sclerosis
-
Sickle cell anemia
-
Severe and chronic pain
-
Post traumatic stress disorder
-
Cachexia or wasting syndrome
-
Neuropathies
-
Severe arthritis
-
Hepatitis C
-
Fibromyalgia
-
Intractable pain
-
Muscular dystrophy
-
Huntington’s disease
-
HIV or AIDS
-
Glaucoma
-
A terminal illness
Notably, Bouldin pointed out, “depression and anxiety, the most common diagnoses leading to prescription of marijuana, are not included” in the executive order.
According to a 2017 study published by the National Institutes of Health that surveyed 9,000 respondents, “the most common medical reasons for marijuana use were anxiety (49%), insomnia (47%), chronic pain (42%), and depression (39%).”
Who can use medical marijuana in Kentucky? Here’s what to know about the requirements
Can I obtain a medical marijuana certification through an online provider?
There’s nothing in the executive order that precludes someone from obtaining their medical marijuana certification through an online provider.
What is required is the health care provider “is licensed to practice medicine in the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence,” according to the order.
This provider must also be “in good standing with the appropriate licensure board within the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence.”
We posed the question to Scottie Ellis, deputy communications director for Gov. Beshear’s office, and received the following response: “Unfortunately scams often take place with new programs, which is why we encourage Kentuckians to refer directly to the Executive Order (EO) which states what must be in the document from a doctor, including that the individual has been diagnosed with one of 21 conditions listed in the EO.”
Where is weed legal? How Kentucky compares to 37 states that allow medical marijuana
Will insurers cover medical marijuana in Kentucky?
A few of our readers wrote to us with questions about whether health insurance providers, such as Medicare, will pay for cannabis purchased in compliance with the governor’s executive order.
Older state residents, who may be living on fixed incomes, might not be able to afford frequent trips out of state to make their purchases, they noted.
However, coverage by an insurance provider isn’t likely because medical marijuana is not legal under federal law. Given that, Kentuckians shouldn’t expect insurers to risk exposure to cover medical cannabis products they purchase under the terms of the order.
Last October, President Joe Biden made headlines when he announced he would grant pardons for simple marijuana possession convictions and encouraged every state governor to do the same.
However, under federal law, medical marijuana is still classified as a Schedule I drug under the Controlled Substance Act. This means the federal government still considers it to have no medical value, as explained by the American Bar Association.
Government officials may have taken some limited actions regarding marijuana reform, but the federal government at large is still out of step with states, meaning insurers will want to avoid the legal headache and steer clear.
Do you have a question about marijuana in Kentucky for our service journalism team? We’d like to hear from you. Fill out our Know Your Kentucky form or email ask@herald-leader.com.
©2023 Lexington Herald-Leader. Visit kentucky.com. Distributed by Tribune Content Agency, LLC.
The answer to that question is yes, and to get at the reason why we need to delve a little deeper into how the governor’s executive order works.
Attorney Michael Bouldin of Covington deals with medical marijuana and cannabis law as part of his legal practice.
In his response via email, Bouldin highlighted an important aspect of how Beshear’s executive order works: It remains illegal in Kentucky to buy, sell or even possess marijuana. What the governor did is declare he will grant a pardon to anyone convicted of possession, provided they meet all of the conditions laid out in his executive order.
As a review, those conditions include the following:
The cannabis must be lawfully purchased in the U.S. from a state where the purchase is legal, and the receipt of that purchase must be kept by the individual.
The amount purchased and used must not exceed 8 ounces. This is the difference between a misdemeanor and a felony possession charge in Kentucky.
The person using the cannabis must have a certification, which to be clear is not the same as a prescription or “medical marijuana card,” from a licensed health care provider attesting that person has been diagnosed with one of the health conditions laid out in the executive order.
In his response to the Herald-Leader, Bouldin noted Kentucky remains an employment-at-will state.
This means an employer can hire or fire you for any reason that is not illegal. Protected classes include race, religion, national origin, age and other immutable characteristics.
“Therefore, if you have been charged, you can be fired,” Bouldin noted. “What (the executive order) will do is allow that individual that meets the requirements to have the case not only dismissed, but a pardon will have it expunged off your record.”
“Interestingly, Kentucky already has a law on the books that does this for a first offense, possession case anyway,” Bouldin further noted. “If a person undergoes misdemeanor diversion, they can then get the charge removed. Alternately, if plead or found guilty, they can have the case sealed if they complete a marijuana education course under KRS 218A.276.”
Is 2023 the year Kentucky lawmakers finally legalize medical marijuana? Senate holds the key
What medical conditions qualify me to use medical marijuana in KY?
One reader, who reports suffering from chronic pain, wrote to us with a question about qualifying under the governor’s executive order.
Under the order, “severe and chronic pain” and “intractable pain” are conditions listed as qualifying.
The full list laid out in the order is as follows:
Cancer
ALS or Lou Gehrig’s disease
Epilepsy
Intractable seizures
Parkinson’s disease
Crohn’s disease
Multiple sclerosis
Sickle cell anemia
Severe and chronic pain
Post traumatic stress disorder
Cachexia or wasting syndrome
Neuropathies
Severe arthritis
Hepatitis C
Fibromyalgia
Intractable pain
Muscular dystrophy
Huntington’s disease
HIV or AIDS
Glaucoma
A terminal illness
Notably, Bouldin pointed out, “depression and anxiety, the most common diagnoses leading to prescription of marijuana, are not included” in the executive order.
According to a 2017 study published by the National Institutes of Health that surveyed 9,000 respondents, “the most common medical reasons for marijuana use were anxiety (49%), insomnia (47%), chronic pain (42%), and depression (39%).”
Who can use medical marijuana in Kentucky? Here’s what to know about the requirements
Can I obtain a medical marijuana certification through an online provider?
There’s nothing in the executive order that precludes someone from obtaining their medical marijuana certification through an online provider.
What is required is the health care provider “is licensed to practice medicine in the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence,” according to the order.
This provider must also be “in good standing with the appropriate licensure board within the Commonwealth of Kentucky or in the jurisdiction of the individual’s residence.”
We posed the question to Scottie Ellis, deputy communications director for Gov. Beshear’s office, and received the following response: “Unfortunately scams often take place with new programs, which is why we encourage Kentuckians to refer directly to the Executive Order (EO) which states what must be in the document from a doctor, including that the individual has been diagnosed with one of 21 conditions listed in the EO.”
Where is weed legal? How Kentucky compares to 37 states that allow medical marijuana
Will insurers cover medical marijuana in Kentucky?
A few of our readers wrote to us with questions about whether health insurance providers, such as Medicare, will pay for cannabis purchased in compliance with the governor’s executive order.
Older state residents, who may be living on fixed incomes, might not be able to afford frequent trips out of state to make their purchases, they noted.
However, coverage by an insurance provider isn’t likely because medical marijuana is not legal under federal law. Given that, Kentuckians shouldn’t expect insurers to risk exposure to cover medical cannabis products they purchase under the terms of the order.
Last October, President Joe Biden made headlines when he announced he would grant pardons for simple marijuana possession convictions and encouraged every state governor to do the same.
However, under federal law, medical marijuana is still classified as a Schedule I drug under the Controlled Substance Act. This means the federal government still considers it to have no medical value, as explained by the American Bar Association.
Government officials may have taken some limited actions regarding marijuana reform, but the federal government at large is still out of step with states, meaning insurers will want to avoid the legal headache and steer clear.
Do you have a question about marijuana in Kentucky for our service journalism team? We’d like to hear from you. Fill out our Know Your Kentucky form or email [email protected].
©2023 Lexington Herald-Leader. Visit kentucky.com. Distributed by Tribune Content Agency, LLC.
