Ten Minutes and Ninety Seconds
Wednesday, 9/25/13, I testified before the Medical Licensing Board of Indiana regarding the pending Emergency Rules for Physicians Prescribing Opioids for Chronic Pain. The session went on for four intense hours – ten minutes of which had been promised to me.
At my turn, I stated my name, told the Board I hailed from from Indiana’s prescription Ground Zero, gave a brief summary of my credentials, thanked the Board, the American Academy of Pain Management, Lelan Woodmansee (our Greater Louisville Medical Society Executive Director), my staff for working to free me up to come, and most importantly my patients who had been rescheduled to allow time for my trip to Indianapolis.
I explained how Kentucky’s new pain regulations had borrowed language from the Federation of State Medical Board Guidelines but had changed most of the flexible language (ie. “may” and “can”) to inflexible language like “must” and “shall”.
I opined that prosecutor-types prefer inflexible “black and white” language that makes it easier to define a violation. And that Kentucky’s voluminous regulations had motivated many physicians to simply give up on treating pain. And that Indiana should embrace their opportunity to create regulations that would address drug abusers without harming the innocent.
I said in the interest of time I would limit my comments to three areas:
- The threshold for increased surveillance and boundaries;
- Preserving the collaborative health care team; and
- Proper utilization of drug screens.
Then a chill went through me as the Board President looked up from his laptop and said: “You have one minute left.”
I composed myself and tried to get across my three points as fast as I could.
1. I recommended that the regulations kick in when a morphine equivalent dose of more than 60 milligrams per day at any time during three consecutive months is prescribed – as opposed to the draft’s threshold of 15 mgm per day for three consecutive months.
2. I explained that colleagues (including APRNs) often share on-call responsibilities, clinic coverage, and the daily care of their practice’s patients. I recommended that rather than requiring each physician do his or her own detailed initial evaluation, instead…
The initial evaluation of a patient covered by these regulations must be by a provider licensed to prescribe controlled substances. Other providers within the same group who share the responsibility to care for the patient are not required to perform their own separate initial evaluation if they accept the original initial evaluation as clinically adequate and in compliance with this regulation.
Unfortunately my ten minutes expired before I could get to the drug screens.
3. I wanted to ask that the regulation requiring urine drug testing be modified to give deference to the prescriber’s clinical judgment with respect to laboratory analyses used to assess compliance:
At the outset of an opioid treatment plan, and at least annually thereafter, a patient’s evaluation shall include a laboratory analysis to aid in determining compliance with the prescribed plan of care, with consideration of confirmatory laboratory analysis if necessary.
Not to worry. The Board President invited me to come back at the end (approximately 2 hours later) and finish my comments!
Two hours later I was told I could only have 90 seconds.
As I concluded my ninety second wrap up, I challenged the Indiana Board to create regulations that will not make physicians fearful of fulfilling their duty to treat pain.
The Board adjourned, and I waited to see if anyone wanted to speak with me.
I hope my ten minutes and ninety seconds were effective.
I hope the future allows a few more minutes to get this right.
Thank you for giving of your time to read this.
You can review the draft regulations yourself at: http://www.in.gov/pla/2832.htm
If you want to help, please contact the Medical Licensing Board of Indiana c/o: pla3@pla.IN.gov and tell them you support the recommendations of Dr. James Patrick Murphy of Jeffersonville. Ask them for regulations that do not make physicians fearful of treating pain.
Jody Edens, Assistant Board Director
Indiana Professional Licensing Agency
Medical Licensing Board of Indiana
402 West Washington Street, Room W072
Indianapolis, IN 46204
(317) 233-4236 fax
James Patrick Murphy, MD, MMM
James Patrick Murphy, MD, MMM has specialty training in Aerospace Medicine, Psychiatry, Anesthesiology, Addiction Medicine, Pain Management and has earned a Master of Medical Management from the University of Southern California’s Marshall School of Business. A graduate of the Mayo Clinic Pain Fellowship program in Rochester, Minnesota, Dr. Murphy practices in Louisville, Kentucky and Southern Indiana. He is currently the Medical Director of Murphy Pain Center, an Assistant Professor with the University of Louisville, serves on the board of the International Association for Pain and Chemical Dependency, and is President of the Greater Louisville Medical Society.