Frankfort – Building on his previous work as a state legislator and as Attorney General, House Speaker Greg Stumbo filed legislation today that would make it easier for law enforcement to target and then stop prescription drug abuse.
“This epidemic truly knows no bounds, and it’s poised to get much worse if we do nothing,” said Speaker Stumbo, D-Prestonsburg. “My approach will help us end the deadly flow of these drugs both now and however the battlefield may change in the future.”
Under his legislation, the state’s nationally recognized KASPER program – which stands for Kentucky All Schedule Prescription Electronic Reporting – would be moved from the Cabinet for Health and Family Services to the Attorney General’s office. In turn, that office, the Kentucky State Police and the state’s medical licensure boards would be called upon to work closely together and share any reports of abuse they discover.
Commonwealth’s Attorneys and County Attorneys would be added to the list of professions that could also access KASPER, and Medicaid would monitor prescribers in their program as well.
All prescribers would be required to register with KASPER, too. According to the Cabinet for Health and Family Services, less than a third of prescribers and less than a fourth of pharmacists had accounts as of 2010. Once registered, prescribers will be required to run KASPER reports on all new patients and periodic checks on those they already see.
To help stop the proliferation of pain clinics, Speaker Stumbo’s legislation would require these businesses to be owned by a licensed physician. Prescribers charged with abusing their prescription privileges, meanwhile, would be barred from providing medicine, and those found guilty – either here or in another state – would see their prescription privileges stripped.
Elsewhere in the legislation, all schedule II and III drugs – which includes powerful pain medicine like Hydrocodone and Oxycontin – would be limited to 30-day supplies. In all cases where overdoses are suspected in a death, coroners would be required to verify whether that was the exact cause.
“Over the last decade, both when I was House Majority Leader and then Attorney General, I have worked to strengthen KASPER and to effectively shut down internet pharmacies from shipping prescription drugs into the state with little to no regulation,” Speaker Stumbo said. “In recent years, however, the problem of prescription drugs has proliferated within our own borders, which is why I took the Kentucky Board of Medical Licensure to task last summer.
“Thankfully, KBML has since become much more involved, and hopefully this legislation will give it and law enforcement even greater authority to find where abuse is taking place and stop it,” he added. “We’re seeing hundreds of Kentuckians lose their lives every year to this disease and thousands of others caught in the death spiral of addiction. We cannot afford to wait another year to act.”
KASPER BILL OUTLINE
Attorney General to operate KASPER system. It is essential to ensure that KASPER is operated by a law enforcement entity with a proven track record of cracking down on drug diversion. This will serve as an essential counterbalance to the licensing boards, which are not well suited to focusing on law enforcement issues. The bill provides that within 90 days of passage, the entire KASPER system shall be transferred to the Office of the Attorney General. This includes computer systems, data, contracts and any unexpended funds. The Attorney General may also determine which KASPER employees are to be transferred along with the program. The Cabinet for Health and Family Services is fully cooperating in this transfer. (Non-codified language.)
Governor to appoint pain and addiction specialists to licensing boards. Recognizing that the licensing boards require additional expertise in the areas of pain treatment and addiction risks, the Governor will appoint certified specialists in these fields to both the Kentucky Board of Medical Licensure and the Kentucky Board of Nursing. (Non-codified language.)
Kentucky State Police, Office of the Attorney General, and Licensing Boards to share reports of improper prescribing. In order to ensure that all appropriate enforcement authorities are promptly apprised of drug diversion complaints, the Kentucky State Police, the AG and the licensing boards must share any such reports within three (3) days of receipt. This will eliminate cases in which actions are proceeding in one forum while others with enforcement authority are unaware of the case.
Licensing Boards required to act promptly on complaints. Immediately upon receipt of an improper prescribing complaint, the appropriate licensing board shall initiate an investigation, seek any needed expert assistance, and issue a report within sixty (60) days determining whether appropriate medical practices have been followed. This report shall be transmitted to KSP and OAG.
Administrative suspension of prescribing privileges required in appropriate cases. The licensing board shall immediately suspend prescribing privileges in any case where public safety (or the health and safety of a patient) is compromised, and promptly conduct a full disciplinary hearing. This rapid response will ensure that the public is protected from dangerous prescribing practices by administrative action without delay.
Report of charges against prescribers. When any medical professional authorized to dispense controlled substances is indicted, arrested or charged with a felony relating to controlled substances, the prosecutor shall report same to the appropriate licensing board within three (3) days. This will ensure that prompt appropriate action is taken by the licensing board, which shall within five (5) days suspend prescribing privileges until the conclusion of the criminal proceedings.
Prescribers to adhere to safeguards prior to dispensing controlled substances. Extensive safety measures are required prior to dispensing controlled substances, including the taking of a complete medical history, conducting a physical exam, discussion of the risk of drug tolerance, and periodic reviews of each patient’s individual circumstances. These safeguards are drawn from recent laws passed in Ohio and Florida, as well as recommendations from the KBML.
KASPER registration and use required. Each person with prescribing authority shall register to use KASPER and shall run a KASPER report on new patients, as well as periodic checks on regular patients, in order to protect patients from inappropriate dispensing of controlled substances. The AG may establish an annual registration fee in an amount sufficient to offset the costs of running the KASPER program.
“Pain Management Clinics” to be owned by licensed practitioner. The growing problem of unaccountable operators of “pill mills” is addressed by requiring a licensed health care professional to own the businesses which primarily prescribe controlled substances. Licensed hospitals and pharmacies are exempted.
Direct dispensing of drugs must be reported. Currently, reporting of direct administration and short term dispensing of Schedule II and III drugs is not required, leading to concern about uncontrolled office dispensing of opioids, as has been reported in Florida and other states. This bill requires such reports within one day.
Commonwealth’s and County Attorneys authorized to request KASPER reports. Access by law enforcement officials to KASPER reports is broadened to include prosecutors who are engaged in drug investigations. This change was specifically requested by prosecutors in testimony before the Judiciary Committee.
Medical professionals may place KASPER reports in patient’s records. KASPER reports may now be included in the treatment records of patients, as requested by medical professionals. A patient may review that record and offer corrections to any incomplete or inaccurate report.
Medicaid Services to monitor and report improper prescribing practices. The problem of tax dollars being misused to support drug diversion is addressed by requiring Medicaid Services to promptly report improper prescribing practices by medical professionals seeking Medicaid reimbursement, and to report suspected improper drug seeking by Medicaid recipients.
Real Time Reporting funding requests authorized. The AG is authorized to seek funding from the United States Department of Justice to create and maintain a real time reporting upgrade to the KASPER system.
Proactive data mining and regular trend reports required. The AG shall use KASPER to seek out improper prescribing practices in cooperation with licensing boards, the Office of Drug Control Policy, and other appropriate agencies. Trend reports shall be published quarterly.
Prescribing thresholds set, notices sent to licensing boards, cooperation required. The AG may establish appropriate prescribing thresholds for drugs of concern, in cooperation with other interested entities including the Governor’s KASPER Advisory Council. When these thresholds are approached or exceeded, appropriate licensing boards and KSP may be notified.
Local hospitals to assist in drug diversion prevention. In order to ensure that hospital employees follow appropriate prescribing practices, the AG and hospitals are directed to work cooperatively in reviewing prescribing data.
Licensing Boards required to adopt procedures for suspending prescribing privileges in appropriate cases. Boards are directed to implement methods of promptly curtailing prescribing authority where the health, welfare or safety of the public or patients is at risk.
Coroners to test for drugs and report; Name and address of decedent not reported. Coroners are directed to test for controlled substances in appropriate cases, and report drug overdoses to the State Registrar of Vital Statistics and KSP.
Mandatory license restrictions resulting from criminal conviction of prescriber. Prescribers convicted of a drug related felony shall have a mandatory minimum license revocation of 5 years. Second felony offense results in permanent revocation. First misdemeanor offense shall result in minimum 6 month revocation, second misdemeanor results in one year revocation.
License suspended or surrendered in another jurisdiction to be reported. Kentucky will no longer allow practitioners who have had a license suspended or surrendered for drug violations in other jurisdictions to be licensed here.
AG to ensure licensing boards performing duties. The AG shall ensure that licensing boards promptly investigate complaints, monitor prescribing practices, educate licensees, and cooperate with law enforcement.
AG may bring civil action to enforce licensing board requirements. The AG is authorized to prosecute civilly any officer or employee of a licensing board who intentionally or knowingly violates board duties.
Person who prescribes in violation of law is guilty of trafficking in a controlled substance.
Boards to accept unsworn complaints. Currently, the KBML requires complaints to be sworn and notarized. This provision deletes this requirement.
Nurse practitioners not to refill Schedule II prescription for six months. Nurses will also review KASPER report to ensure appropriate pain management.
Nurse practitioners required to maintain KASPER account.
Nursing Board must include specialists in pain and addiction management.
Licensing boards must promulgate administrative regulations. Currently some licensing boards prefer to regulate licensee prescribing behavior by means of board opinions. This section requires the issuance of administrative regulations which have the force of law.
Shipments of Schedule II and III drugs limited to 30 day supplies. Pharmacies may accept prescriptions for up to 90 day supplies, but may only ship in 30 day allotments.