TAMPA The tough restrictions in a new state law regulating pain
clinics include a seemingly simple provision: Limit the number of
prescriptions for powerful, controlled drugs a physician can write
in one day.
But it's easier said than done.
Members of the state medical boards met Thursday in Tampa to
devise a cap that left no one completely satisfied.
The proposal: Each physician working full time in a pain clinic
could write a maximum of 150 prescriptions per day three per
patient, on average for narcotics such as OxyContin and
hydrocodone, and the antianxiety drug Xanax. Part-time doctors'
totals would be limited, based on hours worked.
"There are going to be holes in this that people will find.
They'll slither their way through," said Dr. Lisa Tucker, a
Pensacola ob-gyn on the Board of Medicine, noting that state
inspectors can't know a part-time doctor's hours. "If they lie,
they lie."
The medical board objected to the caps before they became law.
Their concerns include what happens when a physician meets the
daily limit, then gets a last-minute visit from a sick patient.
But the general provision took effect this month with the new
law, and it's the regulators' job to define it. So if people have
problems with it, Board of Medicine attorney Ed Tellechea said,
they need to talk to legislators.
"I think it's completely unworkable. It makes no sense," he
said. "There's a million loopholes in it."
Doctors say the new law and the boards' regulations impose
considerable burdens on their practices.
"Nothing that you are doing today is going to be easy for
anyone who practices this specialty to implement," Dr. Carissa
Stone, an anesthesiologist at Gulf-to-Bay Integrative Pain and
Rehabilitation in Tampa, told board members.
The sweeping law, aimed at addressing a drug abuse crisis that
kills an average of seven Floridians a day, already has drawn a
legal challenge.
Pain doctors and a patient are objecting to a requirement that
only a 72-hour supply of these controlled drugs can be dispensed to
customers who pay in cash. They also have issues with the law's
definitions and the training requirements to practice in pain
clinics.
The training issue remains a lightning rod for the state medical
boards, which have spent more than a year developing their pain
clinic regulations. The Board of Medicine says pain practices
should be limited to anesthesiologists, neurologists and
neurosurgeons, psychiatrists and those with specialized training in
pain medicine or physical medicine/rehabilitation. Many physicians
already in practice are grandfathered in.
But the Board of Osteopathic Medicine wants osteopaths to open
their pain clinics to general internists, family physicians,
orthopedists, gerontologists and those trained in hospice and
palliative medicine.
The medical doctors have not decided how to address the
discrepancy, which could make it harder to defend their rule.
Times researcher John Martin contributed to this report. Letitia
Stein can be reached at lsteinsptimes.com or (813) 226-3322.
c.2010 St. Petersburg Times