In “Alice’s Adventures in Wonderland,” Alice chases the White Rabbit down a hole, “never once considering how in the world she was to get out again.”
It seems that’s how we got House Bill 1, the so called “pill mill bill” that Kentucky enacted earlier this year. For those of you who haven’t yet experienced this particular rabbit hole, allow me to explain my jaded view.
State officials said the law was designed to shut down the so-called “pill mills” handing out prescription painkillers willy-nilly. But its administrative regulations are coming under fire from doctors and patients statewide, who argue the law treats everyone like a potential felon.
Besides tighter controls on pain clinics, the law established new regulations all Kentucky doctors have to follow when prescribing controlled substances — which in addition to painkillers include the sleeping pill Ambien, anti-anxity drugs like klonopin and Valium, and some drugs used to treat attention deficit disorders.
Those regulations include mandatory checks of patients’ histories through the state’s drug-tracking system. Doctors also have to do physical exams of patients — not just review their medical records — and complete a slew of extra paperwork.
Many have simply stopped prescribing any of the drugs covered by the law.
My family fell under the scope of House Bill 1 soon after it took effect in July. One of my relatives has used prescription painkillers for several years to help manage the symptoms of rheumatoid arthritis. At her annual visit with her local physician in July, she learned he’s partially retired his prescription pad.
Instead he referred her to an out-of-town pain clinic — then warned it would likely be a couple of months before she could get an appointment.
Try watching someone you love suffer needlessly for weeks, and you’ll likely start feeling less charitable toward the regulations causing it. I’d love to have Gov. Beshear explain how this wasn’t “burdensome” to her.
Once she did get to visit the clinic, the paperwork nearly drove her right back out the door. In addition to having to agree to both regularly-scheduled and random urine tests, she had to agree to allow clinic representatives to conduct random “pill counts” to make sure she was following the prescribed dosage.
And there are no more annual or semi-annual office visits; under House Bill 1, she has to return to the clinic monthly for some time. Adding to the Wonderland elements, the pain clinic can’t just prescribe the drug that was working — its doctor has to follow a series of steps, prescribing different drugs until he finds the lowest dosage of the weakest drug that brings her “acceptable” relief.
So far we’ve made two trips to the clinic. The first time, the other people in the waiting room included a couple who had to be in their late 80s, and a woman in a wheelchair. Since she had a neck brace and casts on a couple of limbs, I’m guessing she wasn’t a long-term drug user. The clientele was pretty similar at our next visit.
Busting shady clinics and doctors is a good thing, as is trying to cut off the supply of prescription narcotics hitting the streets. But there has to be a more sensible way of doing it — one that doesn’t create unnecessary hardships for patients and expenses for the rest of us.
For our family, it’s more of an inconvenience heading out of town to visit the clinic. I’m usually drafted as the ride-along buddy because I have somewhat flexible working hours and understanding colleagues. We can handle the extra gasoline expense by cutting back a little here and there. And since my relative’s on Medicare, we aren’t paying out-of-pocket for the office visits and urine tests — at least yet. She’s assuming she’ll be hit with a co-payment at some point in the process.
I can’t help but wonder about those folks not as fortunate as my family. Are they getting in trouble with their bosses for the sudden monthly absences? Are they skipping meals to afford the gas, the insurance co-payments, the testing fees?
The Kentucky Department of Insurance has already had to step in, telling insurance companies that the urine tests are “medically necessary” expenses after scattered reports of patients’ coverage being denied. The state has no idea how many patients may be subjected to the urine screenings — or even what those tests should cost.
So in the end, we’ll all be footing the bill due to the added and often unnecessary charges to Medicare, Medicaid and private insurance.
Playing King of Hearts to Beshear’s Queen, state lawmakers and the medical board are already saying they expect some changes in the regulations to be enacted next year. Maybe that will mark some return to sanity for the legitimate patients caught in the law’s web.
To quote Alice: “It would be so nice if something would make sense for a change.”