Prescription Drug Monitoring Program Under Attack

The Florida Prescription Drug Monitoring Program is under attack. Launched in 2011 to track controlled substance prescribing, the database was designed to shut down pill mills and stop doctor shopping. According to Attorney General Pam Bondi the database is an important tool against drug abuse and that prescription drug-related deaths have declined for the first time in nearly a decade. But according to a law suit filed in Volusia county the Florida's prescription drug monitoring database program violates the state's constitution, invades the privacy of residents and subjects them to unreasonable searches. The constitutional challenge is part of a growing legal battle over how the State Attorney's Office for the 7th Judicial Circuit wound up with the prescription records for an estimated 3,300 residents and why that information was provided to five of six defense attorneys representing defendants related to a prescription fraud investigation. The American Civil Liberties Union said this week it could file federal complaints with the Department of Justice and the Department of Health and Human Services related to the disclosure of the prescription information. As a physician, supporter and PDMP user I submitted a letter to the editor to the Miami Herald which was published on 07/15/2013 pointing out that it was the illegal use of data obtained by an attorney which triggered this debate and that the PDMP does NOT violate patient privacy. I wholeheartedly agree with State Attorney Pam Bondi that "there are strong safeguards in place to protect people's prescription drug information within the Prescription Drug Monitoring Program by limiting access to that information, and those safeguards have not been compromised." These facts should be taken into consideration before attempting to dismantling the PDMP which is an essential tool to safe lives and protect the public from prescription opioid abuse and diversion. Yours Bernd

PDMP on Life Support

Attached a link to an article published in today’s Miami Herald titled “Statewide pain-clinic database may be abolished” focusing on efforts to shut down the Prescription Drug Monitoring Program (PDMP)in Florida. On Monday, the Florida Department of Health will hold a workshop in Tallahassee to discuss further limiting access to records of who writes and fills prescriptions for the most addictive drugs. The meeting comes in response to allegations last month that medical data for 3,300 Floridians had been “leaked.” The American Civil Liberties Union of Florida demanded a federal investigation, and critics pointed to the incident as evidence that the system was fundamentally flawed and had allowed an inevitable breach of privacy. It also proved a rare point of agreement between the ACLU and conservative lawmakers who have opposed the database for years, even as Florida gained a reputation as ground zero of a deadly prescription drug abuse epidemic. “I think this leak by the PDMP proves it is a risk for patients,” said state Rep. Rob Schenck, R-Spring Hill. “We should do away with the whole database.” But the leak is not due to a design flaw of the PDMP but the inappropriate use and misuse of data downloaded from the database. In this case a DEA agent queried the program for names of the doctors’ patients and got about 3,300 in return. That request led to six arrests, seven people whose identities had been stolen and 63 fake names used to get fraudulent prescriptions. The names of all those patients, including those not under investigation, were provided on computer discs to prosecutors and to the defense attorneys of those charged. They included clear warnings that the records were confidential. But one of those defense attorneys recognized a name on the disc — fellow lawyer Michael Lambert — and gave him a copy of all the names, despite the confidentiality warning. Lambert filed a lawsuit, alleging that law enforcement should never have received information about innocent patients. He demanded an injunction and asked the court to determine if the program is “an unconstitutional infringement upon the fundamental rights of the plaintiff and other Florida citizens.” In a subsequent complaint to the U.S. Department of Health and Human Services, the ACLU of Florida echoed Lambert’s objections. But no one asked an obvious question: was the “leak” made by the agent who included the names on the disc, or by the attorney who gave the disc to Lambert? As a result of this data leak Florida legislators and the ACLU are calling for the dismantling of the PDMP. Would Florida lawmakers also call for the dismantling of the electronic banking system because bank employees have access to financial data and some may even abuse this privilege? Lets not forget that the program is already on life support receiving a measly $500,000 annual funding out of a $74 billion budget, which was only granted in the final night of the 2013 session. In my professional experience the PDMP provides for accountability and transparency in the prescribing process for controlled substances. In my medical practice I identified at least a dozen patients who received controlled substances from several physicians and NONE of those colleagues were aware of it. Several of those prescriptions, if not identified, could have triggered accidental overdose and death. Instead of dismantling the system we should expand the program, fund an awareness campaign to educate physicians on how to use the program and to increase security measures to ascertain patient privacy. Now is not the time for rash decisions but rational thought and measured decision making. Lets not throw out the baby with the bath water. The PDMP save lives! Yours Bernd

Florida Gun Laws and Common Sense

Gov. Rick Scott signed a gun control bill Friday to close a loophole in firearm sales to some mentally ill people. According to the press release "Mental health and second amendment advocates worked together to produce this bill that does not affect persons voluntarily seeking mental health exams or treatments but rather closes a loophole in current law that could potentially put firearms in the hands of dangerous, mentally ill individuals who are a threat to themselves or others as determined by a court." The bill addresses a gap in Florida law that has allowed people who voluntarily commit themselves to a mental institution to buy a gun once they are released. The new law requires that before agreeing to voluntary treatment under the state’s Baker Act, individuals receive written notice that if treated, they may be prohibited from buying a gun or “applying for or retaining a concealed weapons or firearms license” while they’re deemed a danger to themselves or others. Their names are then added to a national data base that informs retailers of people prohibited from buying a gun. People who are involuntarily committed are already added to that list. A judge and a physician have to concur that an individual is no longer a danger to themselves or others to have their name taken off the national database. Scott said that since 2002, "just under 100,000 individuals have been disqualified from purchasing a firearm based on court adjudications of mentally defective or mental commitments." I applaud the Governor to his sudden realization and insight that " common sense parameters balance the rights of individuals to purchase firearms with society's reasonable expectation of public safety." I hope that he will apply the same parameters to allow physicians asking their patients if they store their guns safely to avoid an accidental shooting death within the confines of their home and family. Meanwhile, he continues to litigate in federal court seeking to prevent physicians asking their patients these common sense question. Yours Bernd

Healthcare in Florida

In healthcare there seem to exist two parallel universes:the one for normal earthlings crushed by 30% health insurance premium increases and the one for our politicians who pay peanuts for their own insurance. For example, Florida House members will pay just $8.34 a month for state-subsidized health care next year, or $30 a month to cover their entire family. That’s one-sixth of what state senators and most state employees will pay, and one-tenth of the cost to the average private-sector worker, according to the Kaiser Family Foundation. It’s also less than the $25 a month House Republicans wanted to charge poor Floridians for basic coverage such as a limited number of doctor visits or preventive care. Unless we enjoy living in a parallel universe we should NOT let them get away with it!!! Yours Bernd

Insurance Rate Increases

Blue Cross and Blue Shield of Florida (aka Florida Blue) has obtained the approval for a rate increase for several of their individual health insurance policies including BlueOptions-PPO-Individual-16842FL007, MyBasic NetworkBlue-PPO-Individual-16842FL008, BlueChoice-PPO-Individual-16842FL009, BlueSelect-EPO-Individual-16842FL012 and MyBasic BlueSelect-EPO-Individual-16842FL013. According to their web site the average increase will be 15.32% effective July 1st, 2013 and will affect 264,850 people. As a Florida Blue customer my rate increased almost 30% ! The reasons driving the dramatic premium increase include a 189.37% increase in costs for inpatient care compared to a 111.07% increase in outpatient care. It's of interest to note that the current Medical Cost Adjustment - the difference between what the insurer thought it was going to pay for medical services and what it actually paid during the current year - DECREASED by 466.64%! For the final rate determination the Florida Insurance Code requires that all individual and small group carriers obtain approval of their premium rates from the Office of Insurance Regulation (OIR). In addition, the Patient Protection and Affordable Care Act, otherwise known as Health Care Reform, requires that all weighted average rate increases in the individual and small group markets that exceed a stipulated threshold (currently 10%), must be assessed to determine if they are "reasonable". For individual and small group carriers issuing coverage in the state of Florida, the federal enforcement agency for the Patient Protection and Affordable Care Act, Health and Human Services (HHS), has delegated the authority to determine if rate increases are reasonable to the OIR. According to the OIR all Florida Blue's rate increases for individual and small group products either do not exceed the threshold, or have been determined to be "reasonable." Anyone who has received his/her new premium notice might have to get used to the new definition for "reasonable" rate increase. Its probably listed in the alternative Wikipedia published by the healthcare industrial complex which pays our politicians and corrupts our public life. Yours Bernd

Heroin Use On The Rise

Attached a link to an interesting article titled "As pill mills fade away, heroin fills the void" highlighting the emerging trend of heroin use among former Oxycontin abusers. I have noticed a similar uptick of heroin use among my patients seeking outpatient treatment. This is especially worrisome because heroin is cheaper and more potent than ever and it now spreads across all demographic and ethnic boundaries. We need to respond to this trend by developing and aggressive public education campaign about the dangers of heroin, introduction of needle exchange programs and promotion of outpatient treatment programs. Yours Bernd

The Gun Lobby Target Doctors

The gun lobby paranoia seems to have infected all branches of our government, but even I am surprised how far politicians are willing to go to please their NRA sponsors. In today's Miami Herald an article titled " Medical liability bill gets snagged by gun concerns" highlights such an example. According to the article a Senate priority bill to limit the liability of Florida doctors ran into trouble in the House on Monday when opponents suggested that it could be used by insurance companies who represent the doctors to create a private registry of gun owners. The bill, HB 827, would deal with what are known as “ex parte communications” in malpractice cases and would allow lawyers for doctors hit with a malpractice claim to interview any other doctor about a patient’s health record in private. Rep. James Grant, R-Tampa, believes that the provision could open the door to lawyers asking doctors about the gun-toting habits of their patients and, over time, use that information to build a database of gun owners who could be charged higher insurance rates. Grant filed an amendment to the bill Monday that would prohibit doctors from revealing any information about a patient’s gun ownership, as well as any history of child abuse, sexual abuse, substance abuse, mental health and reproductive history unless the patient’s lawyer is present. Just to make sure that we understand this mind-boggling political acrobatic: Rep Grant BELIEVES that insurance companies will mine these records to essentially eliminate potential risky clients, especially gun owners, who then would be charged higher insurance rates. Therefore, according to his amendment, doctors would be prohibited from collecting and revealing such information, unless the patient's lawyer is present. Sounds reasonable? Well, probably in the mind of those who believe that the government is trying to disarm Americans by buying ammunition in large amounts, or those who believe in black helicopters following their every move etc. What is more troubling that those "freedom fighters" are willing to gag doctors and force them to sanitize their medical records in order to please their NRA masters. Why do we vote for these NRA stooges? What happened to our individual freedom from interference in our lives and professions? Its time to expose these so-called politicians as willing executioners of the NRA. Yours Bernd