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Hey doc, want to moonlight for the state?

By Jim Saunders
11/12/2010 © Health News Florida

Florida's new program to inspect pain-management clinics has hung a help-wanted sign: It will pay doctors $100 an hour to go into clinics and help review patient records.

The Department of Health this week sent a memo to doctors seeking applicants for inspection teams, which are an outgrowth of a recently passed law aimed at cracking down on pill mills.

(Also, DOH has published a proposed new rule governing physicians who practice pain medicine. The rule, which requires certification by one of two boards, is scheduled to go into effect Nov. 28.)

Department spokeswoman Eulinda Smith said in an e-mail that inspections started this month, though the president of a pain-clinic industry group said he was unaware of them beginning. Under the law, clinics will face annual inspections.

Doctors on the inspection teams will fill out a "check sheet" about whether required material is in patient records, according to the memo. They will not provide opinions about the quality of care or standards of care in clinics.

Smith said no doctors had been hired as of late Wednesday, and the Florida Medical Association said it had not heard whether its members are interested in taking part in the teams.

"If it will help to put illicit pill mills out of business, we would certainly be in favor,'' said Jeff Scott, general counsel for the state's largest physician association.

But Paul Sloan, a Southwest Florida clinic operator and president of the Florida Society of Pain Management Providers, questioned whether doctors on the inspection teams could be biased against pain clinics.

Sloan said a "turf war" exists between doctors who are board-certified in interventional pain management and other physicians who work in pain clinics. He said he is concerned that doctors on the inspection teams will be those who are critical of clinics.

"It's going to be very hard to find neutral, independent physicians,'' Sloan said.

The help-wanted memo comes amid a flurry of activity as the Department of Health and medical boards try to carry out pain-clinic laws passed in 2009 and 2010. At the same time, local governments and law enforcement are grappling with notorious clinics that are blamed for supplying highly addictive painkillers to drug abusers.

A critical part of the effort, creating a statewide prescription-drug database, will miss a Dec. 1 deadline for starting to operate. The database is intended to prevent addicts from being able to go from doctor to doctor to get prescriptions. But it has become tangled in legal fights about bidding for a private contractor.

The Department of Health held a hearing this week about rules that will spell out how the database will work --- a process being closely watched by groups such as pharmacies and doctors. It will hold another meeting on the rules Dec. 3.

Donna Erlich, senior assistant general counsel for the department, said after this week's hearing that it remains unclear when the database will start operating. Sloan, who has closely followed efforts to carry out the 2009 and 2010 laws, said he thinks it might take until June for the database to fully work.

Meanwhile, a lawsuit is pending in federal court in Tallahassee that seeks an injunction against the pain-clinic law that the Legislature passed this spring. The case, filed in September, is wide-ranging and charges that the law "provides draconian measures that arbitrarily restrict patient access to health care as well as the lawful practice of medicine.''

The state last week filed a motion to dismiss the case, arguing that the law could not be challenged in federal court. A judge has not ruled on the motion.

Pain clinics have become a major issue in Florida during the past two years, with addicts coming from as far away as Kentucky and Ohio to get supplies of drugs such as oxycodone. The problems were initially centered in South Florida but have spread to other areas such as Jacksonville.

Some details of the laws have drawn criticism from Sloan and others who say they operate legitimate pain-management businesses. Also expressing concerns are groups such as the Florida Society of Neurology, which says this year's law is too broad and "lumps neurologists with the pain-management clinics."

Dr. Daniel Kantor, president of the society, said many neurologists will be subject to the inspections and restrictions on such things as advertising of pain-management services. Kantor said he also is concerned about part of the law that, at least in some circumstances, allows seizure of patient records without subpoenas or patient authorization.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at