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About LMV

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    Hive Mind Worker Bee
  1. In the past JCAHO could grant Medicare certification but Medicaid was more complex in some states. That changed in 2010 with MIPPA. CMS is now the Medicare authority. Medicaid is still regulated largely at the state level and several states do not recognize JCAHO for state facility licensure.
  2. My husband actually did the bulk of Thanksgiving this year. I worked a physician overnight shift in the ED 11/22 into 11/23. It was a really busy night and pretty much everyone truly needed to actually be in an ED (or ICU). Somehow everyone survived. I left the hospital and went to run a Turkey Trot with our daughters. I came home, showered, and went to sleep. DH did pretty much all of Thanksgiving Dinner except some of the pies I made ahead of time. Also when I got up and felt human again I pulled together a quick spinach lasagna to go along with the rest of the meal (a tribute to my Italian
  3. I'm sorry for whatever else is difficult and complicated in your life. I think I would impose consequences for taking/destroying her sister's things. In our family, while we encourage sharing and helping, we do respect our children's right to have choose not to share some possessions and in some contexts and situations to choose not to help. Generally they do choose to share with and help their siblings. For example, when our current DD17 and our eldest daughter were both living at home they did share clothes some [as possible---our eldest is quite tall so some things were just not sharea
  4. We have adopted through foster care and we had guardianship of my husband's godson (his late father was one of DH's best friends) while he aged out of foster care in our home. Having said that, I truly see myself as a mother of ten. Although I have different connections to and special relationships with all of my children I see that as the reality that they are all unique and special individuals. Each of them bring something different, yet very beautiful, to the fabric of our tightly woven family. Half of our children are my biological offspring, 60% of our children are my husband's biologica
  5. We have a large walk in pantry off of the kitchen. Our chest freezer is in there. We also have a smaller chest freezer in our root cellar.
  6. I agree that you can be grandparents without taking custody. Our DD13 and DD9 have a strong relationship with their biological MGF who has really become a part of our extended family [ie he was recently here to celebrate our biological daughter's second birthday with the rest of the family]. This grandfather actually briefly raised DD13 when she was four right after her parents' death and then in quick succession after the death of his wife and her grandmother. He had a MI and many complications and as there really wasn't any other family to care for her she went into emergency foster car
  7. To verify board certification check with the relevant board. In your case, this would be the American Board of Psychiatry & Neurology. If the physician happens to be a DO then they may be boarded through the Osteopathic board (although many DOs are allopathically boarded or also allopathically boarded). In 2020 all GME will be fully merged everyone finishing residency then and beyond should be allopathically eligible.
  8. 1.) I have never looked at reviews. Verify no disciplinary action and current board certification if it is an unfamiliar physician sure. I personally also make sure that my child will be seen by a physician at least for part of the visit. [so I am ok with physicians who do use NP/PA as physician extenders but still examine all patients and sign off on the plan but not physicians who supervise only retrospectively.] 2.)If I had personal safety concerns with the area then I would avoid for that reason. Otherwise, no, my eldest daughter's unsung hero of a pediatrician worked in an FQHC and wa
  9. With all of the push for independent practice from NPs (and even PAs sadly) I don't think this is a safe assumption. Regardless unless the physician is also seeing the patient on the same day then the supervision is retrospective and will be more on the order of identifying mistakes after the fact rather than ensuring quality care is delivered in real time. Additionally if the supervising/collaborating physician never sees the patient at all but just looks at the NP/PA documentation then it may look like acceptable care but in reality the diagnosis may be completely incorrect and critical exam
  10. Tapentadol works on the Mu opiate receptors so addiction issues are certainly a concern and a reality for some. I think the DEA was doing the right thing when they classified it as a schedule 2 drug.
  11. Oral ketorolac does exist and actually has been shown to have similar/superior in some studies efficacy to hydrocodone/acetaminophen.
  12. Statistically where I practice this is the case but the issue is a bit more complicated and multifaceted than that. A lot of communities now are also seeing heroin contaminated with fentanyl, and carfentanil which are increasing the overdose and death rate.
  13. I can agree with a lot of your post. Unfortunately, I do not think Suboxone is the answer so many believe it will be. I do not favor increasing suboxone caps or allowing non physician members of the healthcare team to prescribe.
  14. I had one cesarean section and four vaginal births. Three were VBACs. I didn't take narcotics after any of my births. I think that was probably a bit atypical in the initial twenty four hours after my cesarean and I won't say I wasn't in pain but it was manageable albeit not completely eliminated with non narcotic options. Interestingly after the birth of our final daughter a little under two years ago the nurse I had in post partum was aghast that the only thing my OB had written for pain was ibuprofen. She made a big deal of paging and "advocating" for me to get something (while ignoring my
  15. We have never belonged to HSLDA because some (ok, probably most, or even all) of their views, values, and political agendas contradict our Christian faith and approach to raising our children. Beyond that, my attorney husband believes that they have committed legal malpractice in a few cases in a few states he is admitted to the bar.
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