Wednesday, October 17, 2012

Does PDMP Interfere with Standard of Care, Or Is It The Standard?

Sometimes big issues need to be tackled in small pieces.

Florida has attained infamy in failing to control its prescription drugs distribution and physician dispensing issues, so four counties in the state are moving forward with doing the job on their own.

Osceola County, just south of Orlando, approved an ordinance on Oct. 10 that requires all state-licensed physicians − or other persons authorized to issue prescriptions in Florida − to obtain a "patient advisory report" from the Florida Prescription Drug Monitoring Program (PDMP) before prescribing controlled substances.

The state PDMP has been in effect for 13 months now.

Pinellas, Sarasota and Manatee counties along Florida's Gulf Coast have passed similar ordinances in the past two years.

While 49 states have passed laws creating PDMPs (the hold out is Missouri - see below), only four – Kentucky, Massachusetts, New York and Tennessee – require doctors to consult the databases before prescribing most drugs on the controlled substances list maintained by the U.S. Drug Enforcement Administration (DEA).

Lisa Hurley, public safety advocate for the Florida Association of Counties, told WorkCompCentral that a growing number of counties are debating whether to include a doctor mandate in ordinances that have declared temporary moratoriums on pain clinics and then established licensing procedures for the facilities.

"What we found that is counties started implementing their own pain clinic ordinances and then began requiring that doctors check the PDMP because they didn't believe the state law went far enough," she said.

The Florida Medical Association (FMA) is upset. Their position is that these local ordinances interfere with state-licensed physician practices.

There is debate among physicians in Florida as to whether county ordinances are reasonable or not. According to Assistant County Attorney Dana Crosby-Collier, who served as advisory to an Orange County, Fla. task force on prescription drug abuse, there was a 50-50 split among the doctors.

"Half of them felt that it (the PDMP requirement) was infringing on the standard of care," according to Crosby-Collier, "and the other 50% said this was a standard of care. They felt it was responsible to check the PDMP before you see a patient."

The Osceola County ordinance passed last week takes effect on Oct. 31.

In the meantime lawmakers in Missouri, as the only state to not have a PDMP, will have to try again in 2013 to join the majority.

Sen. Kevin Engler, R-Farmington, whose Senate Bill 710 to create a prescription drug program failed due to a filibuster, will be introducing the measure as Rep. Engler – since he is moving to the House of Representatives after becoming “term-limited” in the Missouri Senate.

SB 710 was targeted – and killed – by an eight-hour filibuster by a group of Republican lawmakers led by Sen. Rob Schaaf, R-St. Joseph. Schaaf is a family physician.

During the filibuster, Schaaf said the bill would allow an unwarranted intrusion by government into individuals’ privacy.

The Missouri State Medical Association does not side with Schaaf. Jeffrey Howell, legal affairs and government relations director for the association that it lobbied for SB 710 and that it will do so again in 2013.

And according to Karen Buschman, communications director for the Missouri Chamber of Commerce and Industry, the chambers big hospital members support implementation of a PDMP.

Maybe Missouri counties should follow the strategy of Florida counties and just start taking matters into their own hands by constricting the approval of pain clinics and other drug prescribing/dispensing businesses pending solicitation of some PDMP or related system.

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