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House: No on Pain Rules, Database

By: Jim Saunders, Health News Florida
By: Jim Saunders, Health News Florida

THE CAPITAL, TALLAHASSEE, March 10 2011 --

A top House committee on Thursday, March 10 voted to eliminate state regulations on pain clinics, repeal the drug database law and stop doctors from dispensing drugs.

The votes by the Health and Human Services Committee put the House at odds with a Senate committee, which Wednesday started moving toward approving new rules for pain-management doctors.

The Senate Health Regulation Committee introduced a bill that would ratify clinic rules approved by the Florida Board of Medicine. The House bill would eliminate such regulations.

"There's no doubt that the Senate and House have very different approaches,'' said former Sen. Dave Aronberg, special counsel to Attorney General Pam Bondi on the pill-mill issue.

House HHS Committee members voted 13-5 to approve the bill dealing with dispensing and regulations, despite objections from an orthopedic-surgeon group and the state's former top drug-policy official. The measure on the drug-database repeal, which is being pushed by Gov. Rick Scott, passed on a similar 12-5 vote.

Bruce Grant, former director of the state Office of Drug Control, said the rules that the House wants to eliminate include registration and inspection of pain clinics. The rules also ban felons from owning the facilities.

"The problem is the pill mills are not legitimate medical practices,'' Grant said. "They are criminal enterprises.''

But Chairman Rob Schenck, R-Spring Hill, said the key to the bill is banning doctors from selling drugs directly from their offices --- an approach he described as cutting "the head off the snake.'' If pill mills cannot dispense drugs, he said, it would alleviate the need for regulations.

"I would argue that this is a huge first step,'' Schenck said.

That step is in the wrong direction, according to Sen. Mike Fasano, who has led legislative efforts to fight pill mills. After the vote, he sent out a release saying he is "extremely disappointed" in his fellow Republicans. “While I understand that it is early in the process, I am saddened that no member of my party had the courage to stand up and vote against these two bad bills.”

He added that 34 other states have successful Prescription Drug Monitoring Programs in place. “That is why people come here for their drugs," he said.

Orthopedic surgeons also were unhappy with the bill, objecting to the ban on in-office dispensing. They suggested the bill would hurt legitimate dispensing physicians, while not eliminating prescription-drug abuse.

Fraser Cobbe, executive director of the Florida Orthopaedic Society, said there is a "fine line" between legitimate dispensing physicians and criminal physicians. Dispensing drugs can increase revenues for doctors, but Cobbe said it also is a convenience for many patients.

"A lot of time our patients are immobile,'' Cobbe said. "They might have fractures (and are) coming from the emergency room.''

But committee member John Wood, R-Winter Haven, questioned that argument, saying patients could get their prescriptions filled at pharmacies.

"Is it legitimate to say that people will not have access --- immediate access -- to these drugs by getting a prescription?'' Wood said.

House Republican leaders also have targeted the drug database because they say it would be an invasion of privacy for legitimate patients, while doing little to stop abuse of prescription drugs.

"I believe the database only tracks the problem,'' Schenck said. "It doesn't solve it.''

But database supporters say it is a critical tool in stopping doctor shopping among addicts. Rep. Mark Pafford, D-West Palm Beach, said Republican and Democratic lawmakers worked for years on the database issue before approving it in 2009.

"It (the bill that passed Thursday) is a complete change of philosophy,'' Pafford said.

Adding to the political stew, drug-maker Purdue Pharma offered Wednesday to provide $1 million over two years to help operate the prescription-drug database. Purdue makes OxyContin, one of the painkillers blamed for the state's pill-mill problem.

But even with the offer, Scott reiterated his opposition to the database because of privacy concerns.

"I don’t want to be participating in things that are only funded for a very short time and then (have) the expectation that the state pick up the tab," Scott said.

The governor's opposition to the database has reopened a wide-ranging debate about how the state should crack down on clinics that have become notorious for supplying dangerous drugs to addicts and traffickers.

After years of effort, lawmakers approved regulations in 2009 and 2010 requiring clinics and physicians' offices that treat many pain patients to register as pain clinics and undergo state inspections. They directed the medical board to come up with rules governing the conduct of clinic doctors.

Those rules --- and many other types of state regulations --- have been on hold because of a new requirement that they receive legislative ratification before they can take effect.

The Senate Health Regulation Committee introduced a bill Wednesday that began that ratification process. Procedurally, the bill will have to come back to the committee for a vote before advancing further in the Senate.

Committee Chairman Rene Garcia, R-Hialeah, shares Scott's opposition to the prescription-drug database because of privacy issues. But he said he backs the Board of Medicine rules and other regulations that lawmakers have approved.

"I still have issues with the database,'' Garcia said. "With all (of the) other components of what we're trying to do with the pain clinics, I'm totally in favor of that.''

Kimberly Case, a legislative aide to the attorney general, said Bondi also thinks ratifying the Board of Medicine rules is "critical.''

"Right now, basic standards are not in place at pain clinics,'' Case told the Senate committee.


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