Pain Clinic =
Crackdown Comes=20
Amid New Law
Printer-friendly=20
format
By: DAVID=20
ROSENFELD
Posted:=20
Monday, July 12, 2010 2:10 pm
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A Massive Sting Involving Prescription Drugs Highlights =
the=20
Problem for State Leaders
The Orlando-area received a wake-up call last month =
that it has=20
a serious prescription drug abuse problem when the Florida=20
Department of Law Enforcement announced June 3 it had =
arrested 172=20
people in "Operation Pain Killer."
The five-month sting stretched across five counties and =
resulted in the seizure of more than 20,000 prescription =
pills.=20
Among those arrested were two physicians who ran pain =
clinics and a=20
68-year-old grandmother selling pills out of her suburban =
Winter=20
Garden home.
The crackdown in Orlando comes amid an overall effort =
across=20
Florida to gain control over the rampant growth in ad-hoc =
pain=20
management clinics dubbed pill-mills, which up until now =
have=20
operated under little to no specific regulations.
In May, Gov. Charlie Crist signed Senate Bill 2272, =
which=20
established strict new guidelines for pain clinics that=20
predominantly prescribe and manage medications. Among the=20
requirements that take effect Oct. 1, physicians may no =
longer=20
prescribe more than three days worth of medication if a =
patient=20
doesn't have insurance.
Paul Sloan, who heads the Florida Society of Pain =
Management Providers, believes this provision violates the =
state's=20
Patient Bill of Rights, so his group is suing the state over =
it.
"We support 98 percent of the bill, but we don't =
support the=20
disenfranchisement of the uninsured, the poor, the working =
class=20
from the ability to get their medications genuinely at a=20
significantly lower price and more convenient from their =
doctor,"=20
Sloan said. "It's the predominant point in the bill of =
rights, that=20
you can't differentiate on service based on race, color, =
creed, sex=20
or source of payment."
Sloan operates two pain clinics in Venice that serve =
entirely=20
self-paying patients. He said his clinics serve a huge need =
in the=20
community where so few physicians see uninsured patients or =
those=20
with Medicaid.
Part of the law also requires physicians practicing at =
a=20
registered pain management clinic receive a pain medicine =
fellowship=20
or accredited residency in pain medicine by July 2012. Until =
that=20
date, according to draft rules by the Florida Medical Board, =
physicians at pain clinics will need to complete 20 hours of =
continued medical education in pain management within six =
months=20
after the rules go into effect.
Sloan believes the accreditation requirements are =
"ludicrous"=20
and together with the ban on cash payments will force =
clinics like=20
his out of business.
Eugene Avery Melvin Jr., MD, an interventionist who's =
practiced=20
at the Pain Center of Central Florida since 1996, supports =
the law=20
and the rules currently drafted by the Florida Board of=20
Medicine.
The rules establish more specific guidelines related to =
the new=20
law, such as the physical appearance and location of pain =
clinics.=20
Such detail is aimed at restricting practices that currently =
might=20
be selling medications from a residential home or nightclub =
like=20
several cases in the news recently uncovered.
Melvin estimates the majority of physicians running =
pain=20
clinics are not board certified in pain medicine.
"The legitimate physicians that treat pain, the ones I =
know in=20
Central Florida are all interventionists," Melvin =
said. "We do=20
interventions to control pain and utilize other services =
such as=20
physical therapy other than just prescribing pure pain=20
medications."
Although Melvin can prescribe a full range of =
controlled=20
substances, his clinic does not have to register with the =
state as a=20
pain clinic because it does not prescribe drugs to more than =
half=20
the patients, nor does he advertise as a pain clinic that =
prescribes=20
pain medicines.
"The state basically wanted to identify those =
facilities who=20
are just prescribing pain medicines and only pain =
medicines and=20
put in place safety measures and quality assurance=20
parameters in order to reduce the risk of =
prescribing=20
controlled substances to the citizens of Florida," =
Melvin=20
said.
Beginning in October 2010, registered pain =
clinics must=20
comply with the following regulations:
- Inspections =E2=80=93 Law enforcement will no longer =
need a search=20
warrant or permission to examine patient record files, and =
every=20
clinic will be inspected annually. Only physicians with =
clean=20
records can serve as director.
- Enforcement =E2=80=93 State regulators could close a =
clinic=20
immediately and impose third-degree felonies and fines up =
to=20
$5,000 per day for violations.
- Physical exams =E2=80=93 Doctors will be required to =
examine a patient=20
before prescribing medications. Based on draft rules with =
the=20
Florida Board of Medicine, doctors must also see patients =
every=20
three months.
- Urine testing =E2=80=93 Patients prescribed =
medications must undergo=20
an initial urine test where results are sent to an outside =
certified laboratory. Any in-office testing device must =
meet=20
certain requirements. Currently most clinics use in-office =
tests=20
that have high rates of error.
- Self-pay =E2=80=93 Patients paying out-of-pocket =
without insurance can=20
only receive up to 72 hours worth of medication while the =
rest=20
could be gained at a pharmacy.
- Advertising and appearance =E2=80=93 Clinics may not =
advertise that=20
they sell prescription painkillers. According to the draft =
rules,=20
clinics must also have clear signage that they exist as a =
pain=20
management provider and abide by a number of guidelines =
meant to=20
keep appearances in line with generally acceptable =
practices of a=20
medical office.
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