Pain Clinic Crackdown Comes Amid New Law on Orlando Medical News

Pain Clinic Crackdown Comes Amid New Law

By: DAVID ROSENFELD

Posted: Monday, July 12, 2010 2:10 pm

Pain Clinic Crackdown Comes Amid New Law

A Massive Sting Involving Prescription Drugs Highlights the Problem for State Leaders

The Orlando-area received a wake-up call last month that it has a serious prescription drug abuse problem when the Florida Department of Law Enforcement announced June 3 it had arrested 172 people in "Operation Pain Killer."

The five-month sting stretched across five counties and resulted in the seizure of more than 20,000 prescription pills. Among those arrested were two physicians who ran pain clinics and a 68-year-old grandmother selling pills out of her suburban Winter Garden home.

The crackdown in Orlando comes amid an overall effort across Florida to gain control over the rampant growth in ad-hoc pain management clinics dubbed pill-mills, which up until now have operated under little to no specific regulations.

In May, Gov. Charlie Crist signed Senate Bill 2272, which established strict new guidelines for pain clinics that predominantly prescribe and manage medications. Among the requirements that take effect Oct. 1, physicians may no longer prescribe more than three days worth of medication if a patient doesn't have insurance.

Paul Sloan, who heads the Florida Society of Pain Management Providers, believes this provision violates the state's Patient Bill of Rights, so his group is suing the state over it.

"We support 98 percent of the bill, but we don't support the disenfranchisement of the uninsured, the poor, the working class from the ability to get their medications genuinely at a significantly lower price and more convenient from their doctor," Sloan said. "It's the predominant point in the bill of rights, that you can't differentiate on service based on race, color, creed, sex or source of payment."

Sloan operates two pain clinics in Venice that serve entirely self-paying patients. He said his clinics serve a huge need in the community where so few physicians see uninsured patients or those with Medicaid.

Part of the law also requires physicians practicing at a registered pain management clinic receive a pain medicine fellowship or accredited residency in pain medicine by July 2012. Until that date, according to draft rules by the Florida Medical Board, physicians at pain clinics will need to complete 20 hours of continued medical education in pain management within six months after the rules go into effect.

Sloan believes the accreditation requirements are "ludicrous" and together with the ban on cash payments will force clinics like his out of business.

Eugene Avery Melvin Jr., MD, an interventionist who's practiced at the Pain Center of Central Florida since 1996, supports the law and the rules currently drafted by the Florida Board of Medicine.

The rules establish more specific guidelines related to the new law, such as the physical appearance and location of pain clinics. Such detail is aimed at restricting practices that currently might be selling medications from a residential home or nightclub like several cases in the news recently uncovered.

Melvin estimates the majority of physicians running pain clinics are not board certified in pain medicine.

"The legitimate physicians that treat pain, the ones I know in Central Florida are all interventionists," Melvin said. "We do interventions to control pain and utilize other services such as physical therapy other than just prescribing pure pain medications."

Although Melvin can prescribe a full range of controlled substances, his clinic does not have to register with the state as a pain clinic because it does not prescribe drugs to more than half the patients, nor does he advertise as a pain clinic that prescribes pain medicines.

"The state basically wanted to identify those facilities who are just prescribing pain medicines and only pain medicines and put in place safety measures and quality assurance parameters in order to reduce the risk of prescribing controlled substances to the citizens of Florida," Melvin said.

Beginning in October 2010, registered pain clinics must comply with the following regulations:

Inspections – Law enforcement will no longer need a search warrant or permission to examine patient record files, and every clinic will be inspected annually. Only physicians with clean records can serve as director.
Enforcement – State regulators could close a clinic immediately and impose third-degree felonies and fines up to $5,000 per day for violations.
Physical exams – Doctors will be required to examine a patient before prescribing medications. Based on draft rules with the Florida Board of Medicine, doctors must also see patients every three months.
Urine testing – Patients prescribed medications must undergo an initial urine test where results are sent to an outside certified laboratory. Any in-office testing device must meet certain requirements. Currently most clinics use in-office tests that have high rates of error.
Self-pay – Patients paying out-of-pocket without insurance can only receive up to 72 hours worth of medication while the rest could be gained at a pharmacy.
Advertising and appearance – Clinics may not advertise that they sell prescription painkillers. According to the draft rules, clinics must also have clear signage that they exist as a pain management provider and abide by a number of guidelines meant to keep appearances in line with generally acceptable practices of a medical office.

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