Welcome to my latest installment covering the heated debate going on in Florida over Republican healthcare fraudster and newly-elected Governor Rick Scott's plans to repeal the state's Prescription Drug Monitoring Program.
Previously, I've written on the efforts of House Appropriations Committee Chair Hal Rogers (R, KY-05), Dem. Senators Schumer, Whitehouse, (Bill) Nelson, and Manchin, along w/ Dem. KY-Gov Steve Beshear and Obama's "drug czar" to convince Gov. Scott that Florida's PDMP is needed to cut down on the flow of illegal prescription drugs from Florida's "pill mill" pain clinics to the Eastern seaboard (with devastating consequences in Appalachian regions of Kentucky, West Virginia, and Tennessee) via the "flamingo express." Check my diary history for the back-story.
I've got some news to report out of the Florida legislature, which will lead to some thoughts on Gov. Scott's privacy concern trolling.
Yesterday in Tallahassee, a House committee met to weigh the merits, or lack thereof, for the state's PDMP. Tanya Alanez, of the Tallahassee Bureau for the SunSentinel has the reporting:
Lawmakers explore pros and cons of tracking pain pill prescriptions
Committee chairman Robert Schenck, R-Spring Hill, took no public testimony and closed the meeting with this: "None of these tools are actually stopping the problem. The one simple fact is it's way too easy for these drug dealers, these drug pushers, and these addicts to get these drugs."
snip
Scott has said the database would be an unwarranted intrusion by government into people's medical affairs and that it could cost the state $500,000 a year if private grants can't be found to support it. He said he supports proposals by Attorney General Pam Bondi to crack down on pain clinics, including mandatory suspensions for doctors charged with violating prescribing standards.
But Senate President Mike Haridopolos, R-Merritt Island, backs a database whether it's funded by private or state money. "My opinion is strong," he said Wednesday, adding, "I think we need to make a vigilant stand and lead and make sure that Florida is no longer the pill mill capital of America."
So, the committee held a hearing and took no pubic input. If they had, they would have heard from member of the Narcotics Overdose Prevention & Education Task Force who'd traveled to attend.
"(Schenck) was not interested in what the human side was all about," Perry said. "While I was sharing one of the most intimate parts of my son's story, he was looking up and looking at who might be coming in the door."
So let's take a look at what's built into the law as it pertains to privacy:
From the FAQ page of The Executive Office of the Governor, Prescription Drug Monitoring Program there are several relevant sections:
2. Is the program proposed for Florida in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA)?
Yes. In fact, Florida’s PDMP will meet all the security requirements required of the Florida Department of Health which are more stringent than HIPAA requirements. See chart 3 for required Project Manager validation of request.
3. Isn’t the accessibility to controlled substance prescription data a violation of patient confidentiality?
The entire program will be federal Health Insurance Portability and Accountability Act (HIPAA) compliant. The access of the patient’s prescription history, when a state has authorized a PDMP, is authorized under HIPAA.
The Florida PDMP provides safeguards to protect patient confidentiality and access to controlled substance prescription information through statute. The law prohibits unauthorized access to and use of confidential patient information. Any person who willfully and knowingly violates this law commits a felony of the third degree.
The entire prescription history of all patients in Florida, even beyond the Schedule II – IV drugs specified by the program, is currently available in many different locations in the private sector. Currently complete prescription information quite often resides in the local pharmacy computer database, the pharmacy’s regional headquarters database, and the pharmacy’s national headquarters database. Moreover, the health insurance companies and their agents who pay for medications quite often maintain the same information in a database. The PDMP mandates more stringent controls on prescription history and, in fact, imposes much greater penalties for unauthorized disclosures than anywhere in any of the many private sector databases.
4. Who will have access to the information stored in the statewide database?
1. Health care practitioners (pharmacists and physicians) who have registered with the Department of Health and have been validated as licensed practitioners in the state of Florida
2. The following entities may request access through the database’s program manager (PM). The PM must ensure the validity of the request prior to providing the information to:
* Appropriate medical regulatory board
* Attorney General’s Medicaid Fraud Unit
* Law enforcement (defined as Florida Department of Law Enforcement, Florida Sheriffs’ Offices and Florida Police Departments)
* Patients to verify their prescription history
* Department of Health: non-identifying information for annual report on performance measures
* Implementation and Oversight Task Force: non-identifying information for annual report
See chart 3 for further explanation.
Note: "chart 3" opens as a pop-up window that I'm not tech-savvy enough to incorporate into this diary. It's a flow-chart for how identifying and non-identifying information enters and exits the system.
7. What about children who are prescribed Schedule II drugs such as Ritalin? Will they be registered in the database?
Only patients 16 years and older will be included in the electronic database. This program will not highlight or stigmatize anyone who legitimately receives and uses medications prescribed by a doctor, but it will highlight potential illegal controlled substances diversion and abuse of controlled substances. Ritalin is the brand name of the Schedule II controlled substance methylphenidate. Methylphenidate is a central nervous system stimulant similar to amphetamine in the nature and duration of its effects. In medicine, Ritalin is used to treat Attention Deficit Disorder (ADD) and narcolepsy. In recent years, Ritalin has been increasingly diverted and abused by both youth and adults. Under Federal law, dealing in Ritalin is a felony.
13. What is a Patient Advisory Report and how is it used?
A Patient Advisory Report (PAR) is provided to a health care practitioner that has requested that if any patient is potentially “doctor shopping” that they wish to be notified. The database will have an alert capability that will then provide the practitioner the information. This helps practitioners identify those patients potentially engaged in the crime of "doctor shopping" (which is a felony in Florida). This allows the practitioner to intervene on their patient’s behalf and assist them in obtaining treatment, if they are addicted. See chart 2.
Note: Chart 2 is another pop-up I can't embed. It illustrates the parameters, and concludes with "Expectation: if the patient has a drug problem, the practitioner helps them seek treatment"
Here are the states with operational PDMPs (a mix of red, blue and purple):
Alabama, Arizona, California, Colorado, Connecticut, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Nevada, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Vermont, West Virginia, and Wyoming.
And these have approved a PDMP but the program is not yet up and running:
Alaska, Florida, Kansas, Oregon, Washington and New Jersey and one U.S. territory (Guam)
So I'll ask again, Gov. Scott - who are you protecting?