Sunday, December 24, 2017

"Stop the nonsense, talk to real doctors"

Posted below are letters sent to the Mississippi Board of Medical Licensure in response to the proposed opioid amendments.  The Board approved the amendments recently at a meeting that was held after notice of the meeting was posted less than 48 hours before it took place.  No mention was made during the discussion of what the medical community in Mississippi thought of the proposed regulations.  One wouldn't have guessed that over 150 people attended the November hearing that was held on the opioid amendments or that the vast majority of a horde of letters submitted by doctors opposed the new regulations.

Well, JJ obtained a copies of all of the letters and is posting them in batches so readers can more easily digest them. JJ is going to rub the noses of the legislature and Occupational Board in what the real medical professionals have to say about this issue instead of the REMFs who populate Lakeland Drive and Woodrow Wilson. It goes without saying that these letters will not be seen anywhere else in the media.

Most of the protests center around three proposals:

  1. Limit the prescription of opioids to seven days for acute non-cancerous pain. This will not apply to terminal patients or nursing homes.  The patient must return to the doctor for another seven day prescription.  
  2. A Prescription Monitoring Program report (PMP) must be run for each patient receiving an opioid prescription.  The report must be printed out and added to the chart.  
  3. Point of service drug testing must be done each time a Schedule II medication is written for the treatment of non-cancer pain (Rule 1.7 (K)).  Drug testing must be done every 90 days for patients prescribed benzodiazepines for chronic medical and/or psychiatric conditions as well.
More information about the proposed changes can be found at this earlier post.


Stop the nonsense and talk to real doctors

To whom it may concern, my name is chad hosemann and i'm an orthopaedic surgeon at capital orthopaedic in flowood. I am writing to request a full stop to the nonsense that is being proposed by the board for schedule 2's. As I write this, my rather large clinical staff is working frantically to keep up with scanning and filling in all of the redundant information into our brand new "streamlined" emr. They certainly are already strapped for time and my overhead is stifling due to all the regulations put into place on us already. We are barely making it out here in the "real world". You guys need to take a long hard look at the redundancy and ridiculousness of the policies you have proposed and think about it's impact on us little guys out here, the actual doctors....Having my nurse run a PMP on every patient every time and scanning it into the chart is ludicrous. This information is readily available online, why do I need it in my chart? Who exactly is going to do my point of service drug tests for me? I don't have a lab or any way to quality control that???! If you prohibit a orthopaedic post op patients to 7 days narcotic, there are going to be a lot of people riding around on the streets of Mississippi in slings and casts trying to get to my clinic to get more narcotic in severe pain.There is so much wrong with that policy I cannot even go into it. If you have ever had orthopedic surgery then you would understand. Many of my patients live 2 hours away.

This is a rural state with little medical care outside of the major cities. If they are in pain management clinics then their pain management physician is expecting me to write their postoperative narcotic. Therefore they will be getting on the road about every 5 days to try to get up here to get it as they will be in continued pain that is quite severe for the first few weeks.This is obviously extremely dangerous.

We are so incredibly regulated at this point. Why don't you guys take a break from the regulations and let us do our jobs that we went to school for a decade to do. I have been in practice for 6 years now as an orthopedic surgeon. I probably right more narcotic than most doctors in Mississippi. I cannot recall 1 of my postoperative patients that ended up with a significant narcotic problem. We get them off their pain medication within 90 days If that does not work, we will get them to the appropriate pain management clinic. Most people are off narcotic within just 4-6 weeks and we keep close tabs on it trust me. Please take a step back and rethink this proposal. This is not the answer you are looking for...go back to the drawing board, talk to real doctors on the front lines, and then come up with some realistic and innovative policies.

Chad Hosemann, MD

Harassment

Here we go again! Some abusers causing problems for those who sincerely need the medications. Which means, it will be harder for them to get the meds they actually need. I have a brother with Psoriatic arthritis & sister who has titanium rods in her spine due to degenerative arthritis. How much more difficult will obtaining their meds become? It’s such a shame that those who actually need these meds should have to be subjected to such harassment.

Lois Jones

Ban them all (or almost all)

Make it illegal for any physician to prescribe opioids except an er doc or pain specialist. This would reduce the amount of paperwork and protect the public from over prescribing doctors.
Richard Bates

Excessive

I think that the rules proposed are somewhat excessive. Using the PMP at each visit for Long term patients is excessive. Please consider at the first 4 visits and then twice yearly. Same for POS drug testing. Also, the rule about benzos with opiates is going to be a problem for the many long term patients who have been managed and are stable on their regimen. How about making the rule that no one on opiates may be given a benzodiazepine and vice versa. This would not penalize all the patients currently prescribed both who have been on them for years. While benzos are certainly not optimal for first line treatment for anxiety disorders, their are some people who legitimately respond to nothing else. Pain and anxiety unfortunately are not mutually exclusive disease states. I also would suggest that doctors get education on using Suboxone and have this included in the 5 hrs of biannual required opioid CME.

Dr. Neal Wanee

Your regulations do make it hard for the patients

As a physician in Picayune, I have a number of patients who have to take pain medicines for chronic pain either due to the severity of their pain or sometimes due to the fact their kidneys cannot tolerate nsaids and as you know, nsaids have cardiovascular risks which in some cases are not acceptable. A fraction of these patients also have chronic anxiety which is not controlled with SSRIs and NSRIs and Buspar alone. These patients are stable on the combination of narcotics and benzodiazepines and while it is a high risk combination and they have been made aware of it and I am aware of it, I genuinely do not believe these patients can function without both medicines. Your new rules would prevent me from being able to continue to care for their needs. I realize I am advocating for probably less than 10 patients in my practice but they are worth advocating for. It is unclear to me what I would do if forced to find a specialist for one problem, whether it would be acceptable to keep treating the other problem.
I actually appreciate specific guidance on urine drug testing preferences for the MS DEA.

It would be nice to document MSPMP checked without having to print it and upload it into the patient's chart. I understand there is a serious abuse or prescription drugs, but your regulations do make it hard for the patients in whom their medications help them function better and they do not abuse their medicines.

Delora Denney, MD

A Prescription Monitoring Report on a 5 year old? Really?

Thank you for your efforts in trying to curtail our current epidemic of opioid abuse in the State of Mississippi. Certainly, some of your proposed changes are well thought out and will be effective. However, in reading the new requirements, I fail to see reasonable considerations for surgical practices, particularly those that involve surgery on pediatric patients. Surgical pain is typically acute and would fall under your current proposal to mandate a prescription monitoring program report. As a pediatric otolaryngologist, I preform some of the most common (and painful) procedures done in this country. I was therefore concerned to see the requirement for the necessity to run a prescription monitoring program report at each encounter when prescribing opioids. As you would expect, the removal of tonsils is an exceedingly painful surgery and frequently requires opioids to control the pain in postoperative pediatric patients. The necessity to run a report on a four or five year-old child is not only unnecessary from an abuse perspective, but produces a real and undue burden on a busy surgical practice. Obviously, there are many other specialties who perform surgery on pediatric patients and would be affected by the new proposals. The purpose of a new bureaucratic requirement should meet its intended goal in virtually every case, however, to introduce a new burden when it fails to serve its intended purpose is nothing more than a complete waste of very valuable time and effort. Please consider any new requirements to be tailored for their intended purpose- the cessation of abuse- not to penalize those who appropriately prescribe or receive necessary pain medications for post-surgical acute pain.

Dr. J. Mark Reed
Chief, Division of Pediatric Otolaryngology (UMMC)

These new regs are not reasonable

I am writing this e-mail to the Mississippi State Board of Medical Licensure as I stand in 'STRONG' opposition to the currently written proposed changes to prescribing regulations by the Mississippi Board of Medical Licensure. The regulations as they are written do not reflect a reasonable understanding of the day to day operations of surgical practices in the state of MS. The burdens that will be imposed on the physicians and their staff are unreasonable and not acceptable to an efficiently functioning surgical practice. I do stand in strong support of regulating opioid prescribing, but the current proposed regulations are only functional for 'in clinic' operations. Again, the duties being asked of the surgeons are not reasonable when they are treating patients in an outpatient surgical setting.

Dr. Jason Murphy (General Surgeon)

Draconian

There are enough regulations governing the knowledge and prescribing of medications. These rather draconian rulings will further complicate and obfuscate the already difficulties of delivering good treatment to patients.

Dr. John White

EXTREMELY BURDENSOME

Hello. I am a family physician in Meridian, MS. Your proposed rules for prescribing narcotics are EXTREMELY burdensome. Do you realize how much time it takes to sign into the PMP system, look up a patient, get their file in a printable format, print the report and then scan it into the patient's EMR chart? I believe doctors have a pretty good idea of which patients try to abuse/override the system and we routinely look into their PMP file anyway---without your mandate---and there is no need to print it out if the patient is compliant and not doctor/pharmacy shopping. Most of my narcotic patients are older adults with poor kidney function who cannot take NSAIDs and whose lives would be miserable as they suffer from pain, thus increasing their depression and inactivity and therefore morbidity and mortality. I also worry about withdrawal from narcotics and benzos because if your proposals are adopted and medications are stopped, patients who have been on them for years would definitely withdraw and with benzos, this could lead to seizures! So I am begging you, as a representative of my colleagues and for my chronic pain patients, to not punish us by passing these prescribing laws. I propose you go "back to the table" and rethink how burdensome these will be for physicians who are already strapped by governmental regulations like meaningful use. Mississippi is already an underserved state...imagine how difficult it will be to attract physicians here with such demanding restraints on prescribing. I think the focus should be on patient education, perhaps through media outlets, and I'm already seeing PSA commercials about it on TV. This is working as my patients are increasingly asking me about weaning off their medications and engaging me in conversations about it.

Dr. Elizabeth Vereen Farrar

Concerns about methadone restrictions

I agree with placing some restrictions on the prescribing of methadone. However, I do not feel that pain fellowship trained physicians or board certified pain physicians should be unable to prescribe Methadone for any type of chronic pain. This opioid causes less euphoria when compared to other long-acing opioids for the treatment of chronic pain. Also, this medication is not expensive and reduced the financial healthcare burden for patients. This medication is on formulary and is often required by many insurance companies as step therapy prior to trying other mediations for chronic pain therapy. This medication can also be used as a sole agent for the treatment of chronic pain without using any short-acting agents for breakthrough pain. It is also a good option for pain control in patients who have had issues with substance abuse (alcohol, illicit drugs, etc...) in the past who suffer from chronic pain caused from a variety of diagnoses. I do agree with NOT allowing physicians who are NOT pain fellowship trained physicians or board certified pain physicians to prescribe methadone for non-cancer, chronic pain. This medication can be used safely and effectively by practitioners who are trained to manage and prescribe this medication. I have included some literature citations below for your review concerning the safe and effective use of methadone for the treatment of chronic pain.

Dr. Lori Hill Marshall
  
Earlier posts
 It would be nice if we could do this behind closed doors.
 Medical Board approves opioid regs with little notice.
Never let a good crisis go to waste.  
Board of Medical Licensure calls meeting yesterday to discuss opioid regs tomorrow.
State Health Officer warns of unintended consequences 
 Mississippi doctors on proposed opioid regs: "dangerous", "Ill-conceived", "idiots" (Letters from MD's)
How much pain will proposed opioid regs create for doctors?  (Regs analyzed)
Can medical weed fight opioids?  
Opioids prescription: Mo' taxes, mo' spending, mo' jail (Gov.'s task force recommendations)

Kingfish note: This is what happens when law enforcement is allowed to govern health care.  In effect, Marshall Fisher, John Dowdy, and that crazy police chief in Oxford are taking over the health care profession in Mississippi. 



26 comments:

Anonymous said...

Ha. “Barely making it out here” written from his mansion in the country club.

Family Med Doc said...

Easterling and his Stepford wives on the MBML are a misguided disgrace. The proposed regs do nothing for the actual opiate problem and do everything to hurt our patients and add ANOTHER layer of bureaucratic nonsense to impede us from taking care of our patients. We now spend more time dealing with the damned government and insurance busywork than with actual patient care. These rules are more about politics and power than medicine.

Your kid or Momma come in with a broken bone and I have to order a $100 drug screen on them before I write pain meds??????????? Of course their insurance is NOT going to pay for the freakin' drug screen and the patient now has another $100 totally unneeded out of pocket expense. Now multiply that $100 cost for every time a legitimate patient needs a script.

As a board certified Family Medicine doc (FAAFP) with 35 years experience I am appalled at the lack of common sense and total disregard for both the doctors and their legitimate patients that has been demonstrated by Easterling, Lippincott, Brunson, and others on the MBML. I know the people and used to have respect for them. TOTAL LUNACY

Anonymous said...

As long as we are so worried about abuse, let us take a look at the excessive consumption of alcohol and food by our elected state senators and legislators paid for by lobbyist. Surely there is not a doctor in the state that doesn't feel like excessive alcohol and food consumption is extremely detrimental to one's health. All one needs to do is look at the ones who "live off of these freebies." Let us add an amendment to this opiate recommendation that disallows freebies for these free loaders. It could be beneficial to these freeloaders.

Anonymous said...

Provide an economic incentive for these guys on the ground to do this.

Make it tax deductible...all efforts and expenses surrounding it.

Doctors make money but this is an insane demand.



Anonymous said...

I agree with all the letters written .
I'm not a doctor, but I've been a caregiver in one form or another. I know you have to get ahead of pain and you have to monitor any medications. Dosages exist for a reason. All medicines can have dire side effects if abused.
But, all you really have to have is some common sense to see that these regulations are obviously absurd.
This board is not qualified for the positions they hold as they are bereft and common sense and are deliberately ignorant. That tells me that they are self-absorbed and thus capable only of knee jerk reactions!

Son of an Old Man said...

I've got an elderly parent (almost 98) that is enrolled in a Hospice plan at an assisted living facility, NOT a nursing home. One of his meds is an opiate for occasional shoulder pain as at 97 years old they are just absolutely worn out. Hospice provides the meds pertaining to his condition of congestive heart failure on a 7 day cycle. He is in the 2nd 90 day enrollment with Hospice. I fully expect him to survive the current enrollment. How this will shake out with regard to the opiate he is prescribed is looking like a damn nightmare. I'm in a profession that is under a State regulatory board that's just the same. Those "appointed" take it as "anointed".

Vito said...

Even the mafia and mobsters regulated their own with a whack to the knee every now and then. That's gotta hurt. Not suggesting or condoning, just pointing out history.

Anonymous said...

I close my eyes and see fat, balding men in togas with twisted crowns of briers adorning their brows. They are grinning and sucking the juice off turkey legs as peons trim their overgrown toe-nails and offer them grapes.

I also see the plebes (letter writers), some of them with professional degree, decrying the decisions made by those in the ornate chairs. But the volume is turned off so that their protests are unheard.

Then I wake to find it wasn't a dream at all. Here we are.

Anonymous said...

I have colon cancer for the second time and most of my remaining colon is going to be removed soon. These administrative quacks want me to recover from such radical surgery with frickin Advil.....???????

Anonymous said...

Bravo, Dr. Hosemann! I am a former patient of his and trust me, he does not overprescribe. He is absolutely correct in his statements about the impact of these regulations. Next time I see him in the halls of JA, I plan to pat him on the back for calling these idiots out. Kudos to all the doctors who have done so. Many people will choose to go t9 another state for surgeries, thus penalizing the doctors who stayed in MS instead of succumbing to the ever increasing brain drain of the best and brightest leaving the state.

Anonymous said...

I would like you get the bar tab for Randy Easterling from his fat ass Pfizer rep buddy. What a hypocrite.

Anonymous said...

I ve been reading JJ for a long time an the comment at DEC 24 @11:48 wins the PRISE for THE SIMPLE TRUTH!!!!!!!
an amendment like that could put TICO'S out of business

Anonymous said...

You people are right in that this will not get much, if any, media coverage elsewhere. The only way would be if it negatively impacted black folk or downtown Jackson.

Anonymous said...

This will hurt doctors and patients, as well as the state economy. When I calculate the costs of monthly doctor visits and drug testing to obtain my two childrens’ ADHD medicine, the same for myself for an as needed, non opioid schedule 2 medication... We can go out of state every 3months, as a group and save money. Not to mention, any surgeries my family has will be in Alabama, at this point. Have a surgery where they open your abdominal cavity or mess with your spine and tell me a week of pain killers is enough. I have had both, plus a few others. Oddly enough, I haven’t taken opioids since I broke a bone in 2014. Shouldn’t I be an addict, since I took them for at least 3 weeks after my worst surgeries?

Anonymous said...



"I close my eyes and see fat, balding men in togas with twisted crowns of briers adorning their brows. They are grinning and sucking the juice off turkey legs as peons trim their overgrown toe-nails and offer them grapes.

I also see the plebes (letter writers), some of them with professional degree, decrying the decisions made by those in the ornate chairs. But the volume is turned off so that their protests are unheard.
Then I wake to find it wasn't a dream at all. Here we are."
December 24, 2017 at 6:03 PM

Here's a happy thought, to help flesh-out your vision ( https://upload.wikimedia.org/wikipedia/commons/3/33/The_Roses_of_Heliogabalus.jpg ): A throng of indolent Roman parasites, being deliberately SMOTHERED, under tons of falling rose petals, for the amusement of the Emperor Heliogabalus. If only WE had such an Emperor.... Instead, unfortunately, all we've got in the Governor's Mansion is a GOOBER.

Anonymous said...

Someone needs to prove that Easterling has proposed these new rules in an effort to make more money at his clinic in Warren County. If someone can prove that, Easterling needs to go to jail for corruption! And yes it is the whole board that is "proposing" these new rules, but we all know Easterling twisted their arm to go along with it...

Anonymous said...

So Solly, 11:41, but it ain't our fault you ran a truck-driver.

Anonymous said...

"So Solly, 11:41, but it ain't our fault you ran a truck-driver."
December 26, 2017 at 4:31 AM

Would you like to try again, 4:31? The above post didn't make any sense at all.

Anonymous said...

We were on the verge of moving our regional business to a less punitive tax environment. This is the tipping point, since I have two autoimmune diseases, as well as degenerative joint problems. Using the holiday to work the details out for a summer relocation. Kiss my tax dollars goodbye, along with my behind; Philbilly and Easterling.

Anonymous said...

Less punitive tax environment? Good luck with that.

Anonymous said...

I’m a MD that has practiced in the Jackson area for 15 plus years. Our practice is IM based. We see a wide range of mainly patients with chronic illnesses. Every experience I have had with our medical board, especially Dr Easterling has been deficient at best. It seems our board speaks only for themselves, not the physicians and patients they claim to represent. The mangled mess the board rushed through will not put a dent in the opioid crisis, but will cause harm to thousands of Mississippians that rely on the patient by patient care given to them by their physicians. I highly recommend that the people of Mississippi call their government representatives and put a stop to what will only be a disaster. Trust me, there is a better way.

Kingfish said...

Lippincott tried to get the psychiatrists exempted from the drug test provision, tried mighty hard, and failed by one vote.

Anonymous said...

@7:57 - I, too, am working on getting the hell out of Mississippi. Just some loose ends to tie up. This state is beyond help with the current leadership, and little appetite for change in the near future.

Anonymous said...

I thought I would get out of Ms. as soon as I retired.
Visited several other places but found out it isn't all bad living in a state where you are one of the intelligent people. Imagining living in a state where you were one of the village idiots.

Anonymous said...

11:57, we are looking at FL, TN, NC and TX. Once we sort out the various issues with moving our business and checking into legal, medical, tax issues. I have spent enough time in 3 of the 4 to be unconcerned about being the village idiot. Plenty of idiots to keep me company, but certainly not the number I am accustomed to.

Phillip Ley MD FACS said...

11:07, there is always at least one of you envious folks out there. There is so much wrong with your mindset, it is unfixable.
12:29, that is a really good question. Suboxone is one dangerous, and profitable, drug.
11:03, I understand your sentiments, but it's nice to feel like part of your community.

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