Physicians could face issues with House Bill 1

By: Dr. Don R. Stephens, M.D.
Senator R.J. Palmer recently defended passage of House Bill 1-commonly referred to as the “Pill Mill Bill” - and said the law contained “common sense” requirements for physicians who prescribe certain controlled substances. Despite his attempts at defending the bill, however, every physician, medical provider, medical facility and patient knows the law’s mandates have created unnecessary burdens and cost that clearly need to be corrected.
House Bill 1 was designed to shut down so-called “pill mills” and has gone a long way toward doing that, something the medical community has long supported. The law was also designed to have physicians and others use the state’s KASPER system, which lists a patient’s controlled substance prescription history. It’s use in many instances can certainly be helpful to physicians, although Senator Palmer’s statement that KASPER reports can be run in seconds was a stretch.
House Bill 1 also mandates several treatments that must be performed prior to prescribing certain controlled substances, including conducting a physical exam and writing out a “treatment plan” for each new prescription. These requirements present may issues for practicing physicians and are having a dramatic impact on patient care, costs and access to care.
The worst part of these new requirements is that they contain no meaningful exceptions, which makes compliance in every situation nearly impossible. Take the example of a hospital patient to whom a drug has been prescribed to address post-operative pain. The patient has an allergic reaction to the medication, which induces vomiting or other reactions. The surgeon who performed the surgery is unavailable at the moment, but an attending physician- perhaps a hospitalist-is on the scene and could prescribe a different medication immediately. But according to the requirements of House Bill 1, the hospitalist would have to complete all of the mandated and unnecessary treatments first, which would take valuable time. Similar examples abound, which is why the legislature should not mandate how patients are to be treated under any circumstance.
While Senator Palmer seems to imply these treatment mandates are trivial, they put unneeded waste into a medical system that is already experiencing access issues. And having to pay for unnecessary exams and other requirements will tax patients’ pocketbooks, many of whom now pay more out-of-pocket because of increased deductibles.
In addition, the delays in seeing a physician or other professional will only get worse. Physicians who might otherwise be interested in moving to Kentucky will be repelled by nonsensical mandates that force physicians to choose whether to provide the right care or comply with the law. The fact that these requirements have criminal penalties associated with them make it that much worse trying to recruit new physicians to our state.
All of the problems stem from the law passed by the legislature, not the regulations published by the board of medical licensure. In fact, the regulations-while far from perfect themselves-do contain meaningful exceptions to requirements.
Kentucky is losing primary care physicians every year to other states. A major reason is the lack of tort reform to protect our physicians from frivolous law suits. Practically all states have this protection. When we add House Bill 1 to existing problems in our state, attracting new primary care physicians is difficult to accomplish. These two major problems could be solved by legislative action.
The state Attorney General recently said the law should be changed because of problems encountered by physicians and patients. I hope Senator Palmer agrees and makes simple changes that avoid patient pain and suffering. Otherwise, Kentucky will once again be the state that others point to as the example of what Not to do.