Doctors to set limits on pain clinics
By Carol Gentry
7/28/2009 © Health News Florida
Seven doctors recently appointed to a state panel aimed at controlling pill mills have only a few weeks to decide how pain medicine can legally be practiced in Florida.
The new law that allows for an electronic database for prescription narcotics also requires pain practitioners to register with state health authorities by early January, so rules about qualifications and the forms needed to apply must be ready well before then.
"We're under the gun," said internist Fred Bearison of Valrico, one of the seven.
The Florida Boards of Medicine and Osteopathic Medicine created a joint committee to handle the rule-making, with five members from the medical board and two osteopaths. They plan to hold an organizational meeting next month and begin hearings in September. The committee must accomplish a long list of tasks rapidly if the Department of Health is to have applications for pain doctors ready by Jan. 4.
“This is really exciting,” said Bearison, who chairs the Board of Medicine. He said it reminds him of the effort involved in crafting rules for free-standing surgery centers in the early 1990s.
Other members of the committee from the Board of Medicine include three M.D.s -- Fort Lauderdale cardiac surgeon Robert Cline, Miami pediatrician Onelia Lage and West Palm Beach dermatologist Steven Rosenberg -- plus consumer member John Beebe of Pompano Beach. The two doctors of osteopathy on the committee are Allan R. Escher, an anesthesiologist from Land O'Lakes, and Bradenton family practitioner Robert McCann.
The committee’s work will flesh out part of a new law, SB 462, signed by Gov. Charlie Crist on June 18. That’s the law that authorizes an electronic database system to monitor prescribing and dispensing of controlled drugs, so that addicts and drug-dealers won’t find it as easy to “doctor-shop” to collect large quantities of pills.
But DOH can’t set that up until another source of funds – either a federal grant or a private donation – is found. Meanwhile, DOH is implementing the other parts of the law.
It requires state registration and inspection of all privately owned clinics that advertise pain-management services or employ a physician to treat pain who prescribes or dispenses controlled drugs.
The committee will develop an application for clinics that want to register with the state. It will decide health and safety requirements, the kinds of data clinics will have to report, how inspections will be conducted and what the fees will be.
One potentially touchy subject is the minimum qualifications of the staff at the clinics. Will they have to have certain kinds of training and certification? Will they be barred from working in pain clinics if they have been disciplined for excessive or illegal prescribing?
In March, reporter Bob LaMendola of the South Florida Sun-Sentinel wrote about pain clinics in Broward and Palm Beach counties attracting addicts and street dealers from all over the South and even the MidWest. In April, he followed with a report that of 100 pain clinics he checked, 18 had doctors who had been disciplined for professional violations or convicted of crimes.
The law requires that the prescribing physician actually work at the clinic. One of the problems that led to its passage was the common practice of non-medical employees giving patients prescriptions pre-signed by doctors who were rarely on-site.
The Medical Quality Assurance division of DOH has set up a page on the state Web site where hearing dates and application forms will be available.
--Carol Gentry can be reached at 727-410-3266 or by e-mail.