Kentucky doctors say pain-pill law hurting legitimate patients

jcheves@herald-leader.comAugust 15, 2012 

FRANKFORT — Doctors complained to state legislators Wednesday that legitimate medical care is getting entangled in the new law meant to shut down "pill mills."

Lawmakers hoped to cut off the flow of prescription pain pills to addicts this year through House Bill 1 and emergency regulations approved by Gov. Steve Beshear.

However, as an unintended consequence, the law forces doctors to jump through needless hoops, sometimes while they rush to provide medical care in hospitals, witnesses told a panel of Senate and House members studying the implementation of HB 1.

Attention deficit disorder medications for children, testosterone for various ailments and post-operative pain medicine all are affected, they said. Criminal penalties are included in the law.

"Unfortunately, I've heard some physicians say, 'Well, I'll just quit prescribing controlled substances,'" said William "Chip" Adams, an attorney for Murray-Calloway County Hospital. "While that may be a laudable goal, there are people who need controlled substances."

The General Assembly is hearing a lot of criticism, and that will bring changes in the law next winter, said House Judiciary Chairman John Tilley, D-Hopkinsville.

"I would suspect we'll return to the topic," said Tilley, a member of the panel that met Wednesday.

The law already contains some exemptions — such as drugs provided during end-of-life care at hospices — that doctors might not fully be aware of, Tilley said.

"There will be a need for some further tweaks and some clarifications," Tilley said. "We understand. But we hope the (medical) community understands that we have a problem in Kentucky where we're ground zero for prescription drug abuse."

Doctors, nurses, pharmacists, the Kentucky Hospital Association and other medical advocates told the panel they sympathize with the law's good intentions.

But they also have complaints, including a requirement that doctors complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief.

That isn't realistic in an emergency situation, doctors said. Also, specialists, such as proctologists or ophthalmologists, don't perform physicals outside their area of focus. And some Kentuckians — such as the very young, the very old and the very poor — are less likely to possess a photo ID, but they might need treatment for pain.

Additionally, doctors said, KASPER is useful for detecting large clusters of prescriptions for controlled substances, but it isn't perfect.

Among other problems, they said, the database doesn't collect information from mail-order pharmacies, which many people use.

Dr. Michael Harned, who practices pain medicine at the Lexington Clinic, told lawmakers that he had two "wildly different" KASPER reports for the same patient, obtained on consecutive days. Lawmakers urged him to report that problem to state officials running KASPER.

Random urine tests required of patients to check for drug abuse will be costly and burdensome, hurting patients on fixed incomes and further taxing the Medicaid program, said Dr. Gregory Hood of the Kentucky chapter of the American College of Physicians.

"We are already beginning to see predictable consequences of the barriers to access, care and prescriptions caused by the July 20 implementation" of the law, Hood said. "Patients are already embracing alcohol to self-medicate their pain or anxiety."

Earlier this summer at a news conference to discuss the law, Beshear denied that it would prevent doctors from providing necessary care.

Several pain clinics closed in the days before the law took effect, Beshear said.

"Let me be very clear," Beshear said at the time. "If you need a prescription, you will get your medicine. If you prescribe with the right intent, you have nothing to fear."

John Cheves: (859) 231-3266. Twitter: @BGPolitics. Blog: bluegrasspolitics.bloginky.com

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