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Pill mills migrating to Indiana?

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Indiana Lawyer Focus

In national news reports about pain clinics and prescription drug abuse, Indiana is usually not mentioned.

Florida, Tennessee, Washington and Kentucky are often at the center of the conversation concerning a growing epidemic of doctors and so-called pill mills that prescribe narcotic pain medications in such high doses that patients are either addicts or soon will be. The stories emerging from these hotspots tell of patients standing in a line that curves around the pain management clinic, parking lots filled with cars sporting out-of-state license plates and a rate of prescription writing that indicates the physician spent five minutes or less evaluating the patient.

grooms Grooms

But the problem of over-prescribing of controlled substances and prescription drug abuse is escalating in Indiana. Awareness is growing, and calls for action are becoming louder.

The Indiana General Assembly has established the Health Finance Commission to study among other things, the regulation of pain management facilities and prescribers of controlled substances and may recommend legislation in 2013.

Members from the medical and legal professions are hesitant when asked if the Statehouse is the best place to find a solution to pill mills. Laws being enacted in other states are having unintended consequences and causing some physicians to quit prescribing pain medication altogether.

Sen. Ron Grooms, R-Jeffersonville, is a member of Health Finance Commission and, having spent his career as a pharmacist, has seen the problem up close. He emphasized he is not on a witch hunt and knows some people have debilitating pain that needs treated. However, he raised the question: Isn’t it somebody’s duty to make the medical community treat the patients rather than maintain their addiction?

Across state lines

The Clark County Wellness Clinic LLP, which recently started operating in Grooms’ hometown of Jeffersonville, highlights his concern of what could happen. Indiana has so few regulations related to pain-management facilities that as neighboring states clamp down, Grooms expects these operations will migrate across state lines to the Hoosier heartland.

In the case of Clark County Wellness, the clinic relocated from Georgetown, Ky., shortly after the Kentucky General Assembly enacted new legislation targeting pill mills. Activity at the clinic has neighbors worried that it could be a pill mill.

“Everything they’re doing is legal,” he said. “I think it’s a situation that provides medication to clientele whose medical issues need to be addressed rather than maintained.”

While the specter of migrating pill mills looms, the Indiana attorney general’s office and members of the medical community have noticed a growing problem of opioid prescribing among providers already in the state.

More and more physicians are being investigated by the Indiana attorney general and facing disciplinary action before the Indiana Medical Licensing Board for over-prescribing controlled substances.

From 1999 to 2009, unintentional poisoning, which would include prescription drug overdose, skyrocketed 502 percent in Indiana, according to a data presentation Dr. Joan Duwve of the Indiana State Health Department made to the commission. Over the decade, unintentional poisoning became the leading cause of injury death, outpacing unintentional motor vehicle accidents, suicide with a firearm, and homicide with a firearm.

Gabrielle Owens, director of the Licensing Enforcement Unit and Homeowner Protection Unit at the attorney general’s office, is unsure why complaints regarding pain medications are increasing. Either more doctors are over-prescribing or more people are aware of the issue and recognize drug abuse in their families and colleagues.

The reasons why physicians abuse their prescription pads vary, Owens said.

“We feel in some cases they were greedy. They were in it for the money,” Owens said. “Others, we

think, wow, they kind of got duped by drug addict patients who pulled the wool over their eyes.”

Still, she noted, the duped physicians had a responsibility to connect the dots.


 

No welcome mat

Whether the Legislature passes a “pill mill” law next session is uncertain. Yet, Grooms is confident if any bill emerging from the study commision gets a hearing before a committee, it will receive a passing vote.

The senator envisions any potential law as regulating both the facility and the physician. He said legislation could require pain clinics to have a special license and be owned by a licensed physician. Also, the treating doctors would possibly have to follow specific protocols such as taking a medical history, performing a physical exam, offering alternative care options, and offering to coordinate additional care with physicians from other specialties.

Pill-mill bills passed in Ohio and Kentucky are raising concerns among doctors in those states who say the laws are confusing and having unintended consequences. Indiana may be experiencing a similar situation with its law that regulates the treatment for weight loss and obesity.

This law – like the bill Grooms outlined – regulates the steps physicians must take before prescribing a controlled substance to overweight and obese patients. However, the law has not been well publicized and some doctors are getting tripped up, Brian Betner said.

An attorney at Hall Render Killian Heath & Lyman P.C., Betner has represented doctors before the Indiana Medical Licensing Board. Sometimes, he said, physicians may make a technical mistake or an innocent oversight that did not impact patient care but was still a violation that puts them at a licensing board hearing. Moreover, the board has little option but to impose disciplinary action which, in turn, can have long-term negative consequences for the doctors.

Michael Whitworth, physician and chairman of the Indiana Pain Society, cautions Indiana against following the lead of other states and hastily crafting a massive, convoluted bill that induces physicians to quit prescribing pain medication and leaves patients who are in chronic pain with no relief.

“We don’t have to rush in and craft a very detailed bill,” he said.

The IPS is proposing the state establish a Controlled Substances Commission, consisting of a variety of medical professionals from physicians to veterinarians. This group would develop regulations and disciplinary rules for opioid prescribing. If after two or three years the death rate from overdoses has not declined, then the state can try another approach.

Based on her work, Owens does not think the solution will come from one source. Instead, it will likely take a collaborative approach with the medical community, law enforcement, health department, Legislature and other groups coming together to formulate policies for Indiana.

INSPECT

The state’s database which tracks prescription narcotics, INSPECT, is universally praised and touted as something that, with wider use, could help combat over-prescribing. The system is the “gold standard” in drug monitoring in the United States, said Mike Rinebold, director of government relations for the Indiana State Medical Association.

Physicians, Whitworth said, should be required to check the database when prescribing narcotics to see if a patient has already been prescribed the drugs from another doctor. However, currently, only about 40 percent of Hoosier doctors with Controlled Substance Registry certification are enrolled in the database.

“That is a tragedy,” Whitworth said. “That means a huge group of physicians are not doing their due diligence when they take out their pens and write a prescription.”

Yet, INSPECT is headed for its own fiscal cliff. A federal grant that provides two-thirds of the funding for the program is set to expire this year.

Tens of thousands of Hoosier medical professionals in private practice, clinics and emergency rooms are impacted by INSPECT every day, Rinebold said. The ISMA has started talking to legislators who are involved in health care to raise awareness of the database and the importance of continuing funding.•

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  • hmmm
    Well that sounds bad and all, but worse were the bad old days in the 1980s when cancer patients and others with chronic pain couldnt get adequate narcotics for their suffering, driving many to extreme grief and suicide. "War on drugs" and all that stuff.

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  1. I have been on this program while on parole from 2011-2013. No person should be forced mentally to share private details of their personal life with total strangers. Also giving permission for a mental therapist to report to your parole agent that your not participating in group therapy because you don't have the financial mean to be in the group therapy. I was personally singled out and sent back three times for not having money and also sent back within the six month when you aren't to be sent according to state law. I will work to het this INSOMM's removed from this state. I also had twelve or thirteen parole agents with a fifteen month period. Thanks for your time.

  2. Our nation produces very few jurists of the caliber of Justice DOUGLAS and his peers these days. Here is that great civil libertarian, who recognized government as both a blessing and, when corrupted by ideological interests, a curse: "Once the investigator has only the conscience of government as a guide, the conscience can become ‘ravenous,’ as Cromwell, bent on destroying Thomas More, said in Bolt, A Man For All Seasons (1960), p. 120. The First Amendment mirrors many episodes where men, harried and harassed by government, sought refuge in their conscience, as these lines of Thomas More show: ‘MORE: And when we stand before God, and you are sent to Paradise for doing according to your conscience, *575 and I am damned for not doing according to mine, will you come with me, for fellowship? ‘CRANMER: So those of us whose names are there are damned, Sir Thomas? ‘MORE: I don't know, Your Grace. I have no window to look into another man's conscience. I condemn no one. ‘CRANMER: Then the matter is capable of question? ‘MORE: Certainly. ‘CRANMER: But that you owe obedience to your King is not capable of question. So weigh a doubt against a certainty—and sign. ‘MORE: Some men think the Earth is round, others think it flat; it is a matter capable of question. But if it is flat, will the King's command make it round? And if it is round, will the King's command flatten it? No, I will not sign.’ Id., pp. 132—133. DOUGLAS THEN WROTE: Where government is the Big Brother,11 privacy gives way to surveillance. **909 But our commitment is otherwise. *576 By the First Amendment we have staked our security on freedom to promote a multiplicity of ideas, to associate at will with kindred spirits, and to defy governmental intrusion into these precincts" Gibson v. Florida Legislative Investigation Comm., 372 U.S. 539, 574-76, 83 S. Ct. 889, 908-09, 9 L. Ed. 2d 929 (1963) Mr. Justice DOUGLAS, concurring. I write: Happy Memorial Day to all -- God please bless our fallen who lived and died to preserve constitutional governance in our wonderful series of Republics. And God open the eyes of those government officials who denounce the constitutions of these Republics by arbitrary actions arising out capricious motives.

  3. From back in the day before secularism got a stranglehold on Hoosier jurists comes this great excerpt via Indiana federal court judge Allan Sharp, dedicated to those many Indiana government attorneys (with whom I have dealt) who count the law as a mere tool, an optional tool that is not to be used when political correctness compels a more acceptable result than merely following the path that the law directs: ALLEN SHARP, District Judge. I. In a scene following a visit by Henry VIII to the home of Sir Thomas More, playwriter Robert Bolt puts the following words into the mouths of his characters: Margaret: Father, that man's bad. MORE: There is no law against that. ROPER: There is! God's law! MORE: Then God can arrest him. ROPER: Sophistication upon sophistication! MORE: No, sheer simplicity. The law, Roper, the law. I know what's legal not what's right. And I'll stick to what's legal. ROPER: Then you set man's law above God's! MORE: No, far below; but let me draw your attention to a fact I'm not God. The currents and eddies of right and wrong, which you find such plain sailing, I can't navigate. I'm no voyager. But in the thickets of law, oh, there I'm a forester. I doubt if there's a man alive who could follow me there, thank God... ALICE: (Exasperated, pointing after Rich) While you talk, he's gone! MORE: And go he should, if he was the Devil himself, until he broke the law! ROPER: So now you'd give the Devil benefit of law! MORE: Yes. What would you do? Cut a great road through the law to get after the Devil? ROPER: I'd cut down every law in England to do that! MORE: (Roused and excited) Oh? (Advances on Roper) And when the last law was down, and the Devil turned round on you where would you hide, Roper, the laws being flat? (He leaves *1257 him) This country's planted thick with laws from coast to coast man's laws, not God's and if you cut them down and you're just the man to do it d'you really think you would stand upright in the winds that would blow then? (Quietly) Yes, I'd give the Devil benefit of law, for my own safety's sake. ROPER: I have long suspected this; this is the golden calf; the law's your god. MORE: (Wearily) Oh, Roper, you're a fool, God's my god... (Rather bitterly) But I find him rather too (Very bitterly) subtle... I don't know where he is nor what he wants. ROPER: My God wants service, to the end and unremitting; nothing else! MORE: (Dryly) Are you sure that's God! He sounds like Moloch. But indeed it may be God And whoever hunts for me, Roper, God or Devil, will find me hiding in the thickets of the law! And I'll hide my daughter with me! Not hoist her up the mainmast of your seagoing principles! They put about too nimbly! (Exit More. They all look after him). Pgs. 65-67, A MAN FOR ALL SEASONS A Play in Two Acts, Robert Bolt, Random House, New York, 1960. Linley E. Pearson, Atty. Gen. of Indiana, Indianapolis, for defendants. Childs v. Duckworth, 509 F. Supp. 1254, 1256 (N.D. Ind. 1981) aff'd, 705 F.2d 915 (7th Cir. 1983)

  4. "Meanwhile small- and mid-size firms are getting squeezed and likely will not survive unless they become a boutique firm." I've been a business attorney in small, and now mid-size firm for over 30 years, and for over 30 years legal consultants have been preaching this exact same mantra of impending doom for small and mid-sized firms -- verbatim. This claim apparently helps them gin up merger opportunities from smaller firms who become convinced that they need to become larger overnight. The claim that large corporations are interested in cost-saving and efficiency has likewise been preached for decades, and is likewise bunk. If large corporations had any real interest in saving money they wouldn't use large law firms whose rates are substantially higher than those of high-quality mid-sized firms.

  5. The family is the foundation of all human government. That is the Grand Design. Modern governments throw off this Design and make bureaucratic war against the family, as does Hollywood and cultural elitists such as third wave feminists. Since WWII we have been on a ship of fools that way, with both the elite and government and their social engineering hacks relentlessly attacking the very foundation of social order. And their success? See it in the streets of Fergusson, on the food stamp doles (mostly broken families)and in the above article. Reject the Grand Design for true social function, enter the Glorious State to manage social dysfunction. Our Brave New World will be a prison camp, and we will welcome it as the only way to manage given the anarchy without it.

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