FRANKFORT — Physicians and others in the state’s health care community told a legislative oversight committee Wednesday that the “pill mill bill” passed this year could unintentionally hurt patient care.
“I don’t come before you today to criticize House Bill 1,” Lexington Clinic physician Dr. Robert Bratton, MD, told the 2012 Special Session HB 1 Implementation and Oversight Committee of the legislation, which establishes prescribing and dispensing standards for controlled substances and sets new licensing standards for pain clinics. “Rather I am here to offer suggestions on how we can improve the existing legislation and its associated regulations to better protect patients and provide reasonable…guidelines for physicians.”
The system, called KASPER (Kentucky All Schedule Prescription Electronic Reporting), has been in place for years, but its use has not been widespread. Under HB 1, practitioners and pharmacists must use the system to check the medical history of patients before prescribing controlled substances containing hydrocodone and to report dispensing of most controlled substances.
Bratton said he and other physicians at Lexington Clinic would like clarification on under what circumstances HB 1’s new rules will apply and how noncompliance will be “effectively and fairly enforced.” Among other things, he said physicians need to know which medications will be monitored under HB 1, and whether a requirement in the law that requires physicians to perform a complete history and physical on a patient receiving such drugs applies to specialists that typically don’t do physicals.
“An eye doctor who performs a procedure probably has not used a stethoscope since they left residency,” said Bratton.
Dr. Michael Harned, MD, a pain specialist at the clinic and consultant on severe pain to the state Board of Medical Licensure, said HB 1 could leave patients in legitimate pain without treatment. “I’m here not to dispute the necessity of this important legislation… Frankly, I’m already doing what HB 1 and the Kentucky Board are now requiring. My concern with HB 1 is that it will likely limit access to care.”
Harned said the law is sending to his practice many patients with “relatively low and stable doses of opiod pain medications (like hydrocodone). … The referral of this patient to my takes up another slot on my schedule that should be reserved for a patient who truly needs specialized care.”
HB 1, as passed, is also forcing physicians to view some patients with suspicion, said Harned.
“HB 1 and its accompanying regulations are causing primary care physicians to become too wary of legal liability to continue prescribing these medications,” he told the committee.
Other professionals testifying before the committee included Dr. Shawn Jones, MD, the president of the Kentucky Medical Association. Jones said the KMA has received some reports of physicians finding it difficult to prescribe not only pain medicine, but drugs for Attention Deficit Disorder (ADD), testosterone medication for a variety of conditions and even medications administered following surgery.
“Because of its licensing structure, the bill has gone a long way toward shutting many illegitimate pain clinics—something the medical community has long supported,” said Jones, who said KMA also supported upgrades to KASPER in the HB 1 and other parts of the bill. But Jones expressed concern with the many steps a physician must take before prescribing controlled substances.
He said missing one step opens a physician up to criminal activity.
“I believe this is having an impact on good patient care,” he said. He asked the committee to consider working with the medical community to amend and simplify regulations of concerns in HB 1.
Others scheduled to speak before the committee included representatives of the Kentucky Hospital Association, Kentucky Coalition of Nurse Practitioners and Nurse Midwives, Kentucky Pharmacists Association among others.
The committee is monitoring the implementation of HB 1 throughout the 2012 legislative interim.