HB466: Workers Comp Reform Proposal Described as Sop to Pill Mills

HNN April 4, 2012: The bill placed on the agenda for a Wednesday meeting of the House Ways Committee, HB466, sponsored by House Labor Chairman Karl Rhoads....

The most striking opposition to the proposal comes from Chris Brigham, senior contributing editor to the American Medical Association's "Guides to the Evaluation of Permanent Impairment." One of the nation's leading experts on the issue, he is a resident of Kailua.

"The bill is ill-conceived and self-serving to certain stakeholders, including treating physicians who provide treatment that is not consistent with practice guidelines and current medical standards," Dr. Brigham says. "Some physicians tragically are using injured workers as pawns for their financial gain."

Dr. Brigham says it is a myth that independent medical examinations are biased or not fact-based, so the bill addresses a problem that does not actually exist. Moreover, he argues, the bill would help doctors who make money prescribing narcotic pain relievers to an extent that is "detrimental to injured workers." He urges lawmakers to "look more closely at the implications of this bill and why certain stakeholders are advocating for its passage."

read … Workers comp rules change criticized by doctors

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Hawaii's (likely) evisceration of the workers' comp system

by Joe Paduda, Managed Care Matters, February 20, 2012

Chris Brigham, MD, has been following what can only be described as an effort to eviscerate Hawaii's workers comp system. He contributes these observations to MCM.

The Aloha State has been friendly to physician dispensing and to certain legislative officials, including Senator Clayton Hee, Chairman of the Senate Judiciary and Labor Committee, receiving funding from individuals and entities associated with physician dispensing companies [Hee's contributors were identified in MCM last week; last week I referenced a physician dispensing cost control bill that would take steps to deal with this issue, however the bill is likely to end up in the Committee and die.]

Physician practices involved in physician dispensing lobbied very actively for another bill, a bill that would effectively thwart the independent medical evaluation process in Hawaii.

HB 466 was passed this week by the State's Joint Committee on Judiciary and Labor (chaired by Senator Clayton Hee) and the Committee on Health (chaired by Senator Josh Green, MD, who has also been the recipient of fund raising by interests aligned with physician dispensing companies.)

...Beware of strategies by certain stakeholders who are attempting to alter the workers' compensation system through legislation to be more "friendly" to them - even if it results in increased costs (human and financial).

Recognize that some of these stakeholders may well be seeking influence through contributions to key legislative decision makers; Money talks.

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HB1243: Pill Dispensers Buy Access to Clayton Hee

(EDITOR’S NOTE: In this May 20, 2012 article the Star-Advertiser overlooks the Josh Green connection and overlooks the HB466 issue completely. This is, of course, a purely accidental oversight.)

SA May 20, 2012: In the six months leading up to this year's legislative session, no state legislator came close to raising as much in campaign contributions as Sen. Clayton Hee.

His $65,000 total more than doubled the amount raised by the next most prolific fundraiser.

About $35,000 of Hee's total came from people and entities, including several in Florida, linked to companies in the physician-dispensing medication business, according to campaign spending records and Joe Paduda, a mainland consultant who works for workers' comp insurers….

Employees and others linked to Florida-based Automated HealthCare Solutions, which helps physicians dispense drugs, and Quality Care Products, which sells repackaged drugs to physicians, gave almost solely to Hee in the six months leading up to the session, according to the spending records.

House Bill 1243, the price-cap measure, passed the House last year and carried over to this year's session, one of numerous bills pending before Hee's committee….

Cathy Wilson, regional director of Automated HealthCare, said she gave money to Hee's campaign to get access to the legislator and to tell her company's story to counter the misinformation spread by insurers. Wilson contributed $3,500 in December, according to state records

read … Bought and Paid For

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The Hawaiian political charade

by Joe Paduda, Managed Care Matters, February 21, 2012

I received an email from an individual who attended a "hearing" on a workers comp bill in Hawai'i. It's compelling for two reasons - it clearly illustrates the comp system's vulnerability to manipulation by those seeking ever-greater profits and ever-lesser oversight, and the weakness and inadequacy of employers' and insurers' efforts to prevent that manipulation.

Here's the perspective of Charlie Donovan - and no, Mr Donovan is not an insurance guy; in fact he works for a group of physicians that serve workers comp claimants.

"I was bothered by the fact that one of the biggest supporters of the [IME] bill, and from my understanding one of the most active participants in fundraising for Senator [Josh] Green [orthopedic surgeon and drug dispensing physician], was not only given the chance to testify, but was called upon again to answer questions in front of the committee.

I was incensed that there were 2 orthopedic surgeons with over 50 years of combined experience treating patients, performing surgery, and conducting IMEs sitting 10 feet in front of Sen. Green who were not given the time of day.

And it seemed so blatantly unfair that an injured worker who had driven in "all the way from Waianae" was given a chance to testify, but that a neurologist with over 30 years of experience who flew in from Maui to give testimony was not afforded the chance to speak.

But when testimony was closed, I looked at my watch and saw that barely 40 minutes had expired since the hearing was gaveled to order. With easily 2 dozen more people anxiously waiting to have their opinions heard, it was over.

Epiphany!!! The entire hearing had been a charade. The members of the committees who graced us with their presence (all 6 of them) were not interested at all in being educated, or in hearing what the "public" had to say. Passage of that bill was a "done deal" before anyone walked into the room, and the hearing was nothing more than an inconvenience for the committee members.

I suppose that I was naïve for thinking that "public testimony" really mattered, that years of experience, statistical data, and the opinions of other professionals would trump fundraising donations. I suppose that somewhere down deep I knew that politics was a dirty business, and that "public service" was a catch-phrase of absolutely no significance. But part of me didn't want to admit it, until it was rammed down my throat in the most transparent piece of kabuki I have ever seen.

So while facts comes before fundraising in the dictionary, I must now begrudgingly admit something that I probably already knew - that the order is obviously quite different in the world of politics.

Like wandering behind a horse and getting kicked, this is a lesson that will not have to be taught twice."

What does this mean for you? 

Insurers and employers better get real, and fast. You are going to get your heads handed to you if you don't stop dissembling and focus on these issues.  

Workers comp is a very, very soft target for profiteering physicians and the various businesses that have sprung up to suck money out of employers' premium checks. They are organized, very well-funded, and aggressive.

Meanwhile, insurers and employers are sitting idly by while these bad actors use your dollars to buy political influence.

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Pill Mills Migrate From Florida to Hawaii—Watch the Dates on the Following Four Articles

Palm Beach Post, June 3, 2011: Laws regulating prescription, dispensing of pain pills in Florida now tougher

As Gov. Rick Scott performed a ceremonial signing of a new law cracking down on pill mills Friday, Hellene Grundler sat in the front row ...  Grundler said her son had long suffered from a drug abuse problem and just two days before his death a local doctor had given him 150 oxycodone pills for no good medical reason. She said she began agitating "that same day" for tougher laws against pill mills.

This week her efforts paid off, as did those of others around the state, including The Palm Beach Post, which since 2009 has written about the escalating number of pain clinics in South Florida, and has exposed several founded by convicted drug dealers and other criminals.

Scott signed the pain management bill (HB 7095) into law Thursday in Tallahassee, then staged ceremonial signings Friday in Fort Lauderdale, Tampa and Orlando.

The new law toughens reporting requirements for a statewide prescription drug monitoring database, penalizes doctors who overprescribe painkillers, requires pain clinics to register with the state, tightens the regulations for running pharmacies and obliges drug wholesalers and pharmacists to report people who try to make questionable purchases....

"I am proud to sign this bill, which cracks down on the criminal abuse of prescription drugs," said Scott, speaking at Fort Lauderdale Police Department headquarters. "This legislation will save lives in our state and it marks the beginning of the end of Florida's infamous role as the nation's pill mill capital."

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Kauai Garden Isle Feb 6, 2012: Florida ‘pill mill’ owner, family arrested

Former Florida “pill mill” owner and seven-time world champion wake boarder Darrin Shapiro and his father and brother were in police custody on Kaua‘i Monday pending extradition to Florida.

The Florida Metropolitan Bureau of Investigation enlisted Kaua‘i vice officers in the investigation and arrest of Shapiro, 38, of Princeville, his brother, Jarrett Shapiro, 42, of Kalaheo and their father, Lewis Ray Shapiro, 65, of Princeville, on charges of racketeering, conspiracy to commit racketeering and money laundering.

Darrin Shapiro was arrested on Feb. 2 in Princeville. Lewis Ray and Jarrett Shapiro were arrested on Feb. 3 at Lihu‘e Airport after turning themselves in to authorities, Kaua‘i police said.

Investigators said that in Florida — a state known for its oxycodone (Oxycontin) epidemic — Darrin Shapiro’s Florida clinic, Pain Relief Orlando, was probably the worst “pill mill.” In the fourth quarter of 2010 alone, it prescribed more oxycodone than the entire state of California....

Within days of the June raids in Florida, Darrin Shapiro opened Kaua‘i’s only opioid-prescribing and marijuana card-issuing pain management clinic, Kaua‘i Chronic Pain Center, run by Dr. Sian Evans.

Kauai Chronic quietly closed down last month. The closure occurred a week or two after a group of local high school students staged a peaceful picketing demonstration outside the clinic protesting its existence in their community.

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Kauai Garden Isle November 12, 2011: Former ‘pill mill’ owner opens Kaua‘i clinic

Dr. Graham Chelius of West Kaua‘i Medical Clinic said patients who he has been seeing for years are now getting their pain pills through Kaua‘i Chronic.

“We have a legalized drug dealer in town,” Chelius said.“(Evans) is not a chronic pain specialist. Because she’s not a centralized doctor, there’s no tracking. It’s essentially a carbon copy of the problem in Florida.”

He has made calls to the Narcotics Enforcement Division in Honolulu and the DEA, he said, and has receives calls from physicians, wives and husbands asking how they can put a stop to it.

“Heroin and oxycodone work the same way,” he said. “It’s so easy to smoke an oxy, it’s almost like the drug company designed it to be abused. The underbelly of Kaua‘i has a real dependency problem. We’re going to have people end up dead.”

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Kauai Garden Isle November 13, 2011: Pill abuse presents legal challenges

Some 250 crimes involved forged prescriptions, and Kamita said this is encouraged by legal loopholes that allow “dial-a-doc” physicians to prescribe more liberally.

The “Spear bill” — named for Harold Spear III, a physician arrested in Kaua‘i and Alabama for dispensing drugs without his presence in consultation — would tighten loopholes on prescription laws.

“This makes into law the things we take as common sense, such as having to physically examine a patient,” Kamita said.

County Prosecutor Shaylene Iseri-Carvalho said the Prosecuting Attorney Association, the State Attorney General and other county prosecutors are helping to shape that legislation.

They are also working to reestablish electronic tracking of narcotic prescriptions to alert law enforcement when people try filling them through several physicians.

The database maintenance positions were eliminated two years ago because of funding, she said. 

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Chicago Tribune September 28, 2011: Popping pills — out of a machine

The machines offer more than 1,000 drugs commonly prescribed for acute illnesses and injuries, such as antibiotics, antihistamines and inhalers. Controlled medications such as oxycodone, known as Schedule II drugs, can also be dispensed, depending on a state's laws.

To use InstyMeds, patients enter a code their physician has given them on the machine's touch-screen monitor and then swipe their debit or credit card to pay. Patients pay the same amount as they would at a pharmacy. The machine then dispenses the medication in a prepackaged, labeled container.

The machines perform a triple bar-code safety check and allocate medications in about two minutes, said Emily Theisen, marketing manager for InstyMeds. The machines accept most private insurance plans and cash payments. Acceptance of Medicare and Medicaid prescriptions varies by state.

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WaPo, October 30, 2007: Doctor? Or Druggist?

Less than 10 percent of U.S. physicians sell prescription medications to their patients, according to the journal Physicians Practice. But Mark Bard, president of Manhattan Research, a health-care market research firm in New York, says that figure could reach 25 percent in the next five to 10 years….

One incentive for doctors to move into the drug-selling business is that any profits fall outside the control of managed care, which has been putting the squeeze on reimbursement rates. Doctors generally charge more for drugs than a pharmacy does….

Although some drug-dispensing firms promise doctors annual profits of $50,000 or more, such figures are not realistic, says Purkinje medical director Thomas Doerr. He says doctors who buy drugs from his company are more likely to average $15,000 profit per year….

Although physicians' groups such as the American Medical Association and the American Academy of Pediatrics generally support a physician's right to sell medications in the office, patient advocates have qualms. "It's a system that's ripe for abuse," says Michael Cohen, president of the Institute for Safe Medication Practice, an advocacy group that aims to prevent medication errors and promote safe drug use.

The two largest firms selling drug-dispensing packages to doctors are Allscripts, a Chicago company that earned about $50 million from its dispensing business last year, and St. Louis-based Purkinje, which does not disclose its sales. Allscripts sells generic and brand-name drugs, while Purkinje sells only generics.

Doctors who sign up with QuiqMeds, a Philadelphia drug-dispensing firm, get vending machines stocked primarily with generic drugs as well as some nonprescription drugs such as cough medicines. Physicians sell them to patients, profiting about $5 per prescription and $3 per nonprescription product

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PMSI: Physician Dispensing and Repackaged Medications

A worrisome trend has emerged in workers’ compensation, as a growing number of prescribing physicians (led by companies specifically marketing capabilities to physicians) are repackaging and dispensing medications normally dispensed by retail pharmacies. These repackaging and dispensing physicians inject cost and challenges to the system which include…

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Kevin MD: Why dangerous? For a number of reasons

One, physicians still grapple with the perception that it is improper for a physician to make money from the delivery of care from business ventures. Two, profit-making from prescription writing might induce physicians to write unnecessary prescriptions. Three, prescriptions for profit might lead to conflict with pharmacists. Four, Some states prohibit physician office dispensing, and more dispensing might lead to other states prohibiting the practice. Five, there is also a fear that such a physician business venture carry significant risk relative to government regulation.

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ScripNet: The Problem with Drug Repackaging and Physician Dispensing

US Dept of HHS: Overview of State Regulation of Physicians Dispensing Drugs

HB1243 HD2 SD1: Price Controls on Physician-Dispensed Pharmaceuticals

SB2262 SD1: “Clarifies that the medical use of marijuana is considered to be consistent with the pain patient's bill of rights.”

HB466 HD3 SD1: Full Text, Status

SA May 20, 2012: Same pill, bigger bill: Physicians' markups of medication can far exceed the pharmacy price, and insurers want to close the gap