A bill to allow the electronic monitoring of patients' prescriptions championed by Florida Gov. Jeb Bush and the federal drug war establishment as a model for other states was withdrawn from consideration in the Florida House April 30 when it became apparent that it did not have enough votes to pass. The failure to pass the prescription monitoring bill is a political setback for Gov. Bush, who publicly called the bill his number one legislative priority.
It is also a blow to US drug czar John Walters, who announced in March that he was declaring war on prescription drug abuse. Walters announced that the Office of National Drug Control Policy (http://www.whitehousedrugpolicy.gov) would spend $10 million this year to expand prescription monitoring programs to an additional 10 or 11 states beyond the 20 that currently have such programs (http://stopthedrugwar.org/chronicle/327/full.shtml#budgetpain). Florida was supposed to be the first out of the gate this year, but it didn't happen despite the best efforts of Jeb Bush, John Walters, and his Sunshine State mini-me, Florida drug czar James McDonough.
Electronic monitoring of prescriptions is touted by supporters as a means of detecting, halting, and prosecuting patients who seek pain medications from different doctors or doctors who indiscriminately dispense pain medications.
This year's effort to pass a bill in Florida, however, did not initiate with concerned physicians, but with conservative politicians, state law enforcement and health officials, and a pair of crusading newspapers, the Orlando Sentinel and its sister publication, the Ft. Lauderdale-based South Florida Sun-Sentinel. The former newspaper published a sensational and poorly-reported series on Oxycontin deaths, editorialized loudly in favor of a prescription monitoring bill, and proudly trumpeted its role in prodding Gov. Bush to push such a bill. The latter paper published a series focusing on the "abuse" and "over-medication" of Medicaid patients being prescribed Oxycontin and other opioid pain relievers.
Gov. Bush and his drug czar, James McDonough, argued that the measure would save lives, with McDonough telling the Sun-Sentinel for good measure that it would also pay for itself by reducing Medicaid costs. Bush appointed a task force of state law enforcement and health officials to promote prescription monitoring, and it was they who pushed to get the bill passed.
"Lives are being lost," said state Attorney General Charlie Crist in a December news conference. "We have to do what we can to make sure this new era of drug dealing discontinues."
"It's about taking the bad guys down to protect the good guys," said John Agwunobi, secretary of the state's Department of Health, as he warned of "doctor shopping," "pill mills," and other efforts to obtain pain medications.
There was some support for the measure in the medical community. Dr. Charles Levi, chief medical examiner for Brevard County, told the Sun-Sentinel in November he supported prescription monitoring. "During the first half of the year, we were just getting hammered with prescription-drug deaths. We've become a society of pill pushers," Levi said. "I think having the system would make people be more responsible."
The Florida Medical Association, the state's largest physicians' group, initially opposed the bill, but its board of governors reversed course after winning concessions on privacy, according to its web site.
But while prescription monitoring had support from state officials, and to a lesser extent, physicians, critics of such measures view them as an intolerable invasion of patient privacy and the patient-doctor relationship. They also worry that information made available through such programs would fall into the hands of law enforcement, which could use that information injudiciously.
Unfortunately for Jeb Bush and the bill's sponsor, Rep. Mike Fasano, Paey just happened to be a resident of Fasano's district. "There was the embarrassment factor," said Siohban Reynolds, director of the Pain Relief Network (http://www.painreliefnetwork.org), a patient advocacy group that worked to defeat the bill. "Rep. Fasano, the legislator who introduced the bill, represents Richard Paey's district. The publicity from Richard's case generated all kinds of calls to Fasano. Richard really deserves credit for bringing the situation of pain patients to light at this critical time. We've got the truth on our side, and no politician wants to be near to the injustice that happened to Richard Paey."
Still, Fasano and House leader Rep. Johnny Byrd (R) acceded to pressure from Gov. Bush to bring the bill to the floor last week, only to pull it from consideration when it became clear the votes weren't there. The monitoring system in the bill would have allowed doctors, pharmacists, designated medical assistants and law enforcement personnel to review the pharmacy records of adult patients in an effort to crack down on "doctor shopping," or patients seeking multiple prescriptions of pain medications, such as Oxycontin and Percodan, as well as other popular prescription drugs, such as Xanax and Valium.
During debate in the House few lawmakers spoke up for the bill, while opposition came from both sides of the aisle. Typical of legislators' remarks were those of Rep. Dan Gelber (D), who warned that the bill would infringe on the liberty of Floridians. "This goes far in violation of [constitutionally protected] liberties," said Gelber. "It has some advantages, but we'd have to accept some other deprivations of liberty that I don't think we should tolerate."
Opponents of the measure pointed to a variety of reasons for its defeat. "It was a combination of things," said PRN's Reynolds. "The citizens of Florida were rightly suspicious of what the government might do with that information, and that was important. And then you had Richard Paey standing up on principle. His situation, and the media coverage it received, really brought to life the realities facing patients in pain," she argued. "When you put those two things together, the Paey case and the distrust of government intrusion, you have a real one-two punch."
Dr. Donna Gillette, owner and operator of the Stress and Pain Management Clinic of North Florida in Tallahassee, who was one of the few practitioners to publicly oppose the prescription monitoring bill and the offensive against pain patients in general, said it may have been a seemingly unrelated issue that helped doom the bill. The state has seen a recent proposal to register gun-owners, and unsurprisingly, that proposal was greeted with howls of protest. "One of the things that really swayed the legislators was when I mentioned the gun bill. Here are law-abiding citizens who own guns and now everyone is screaming about the invasion of privacy. But what about law-abiding citizens taking legal drugs from law-abiding doctors? You want to put them on a list and track them -- and that's not a violation of privacy?" asked Gillette. "That argument had a lot of impact," she said. "It is a huge erosion of privacy."
Gillette has had some practice with politicians lately, she told DRCNet. "I spoke to the governor's statewide symposium on prescription drug abuse a few months ago, and I was the only dissenting voice there," said Gillette. "Everyone else was very much of the opinion that these opiates are terrible things and doctors are pill mills and drug addicts are posing as pain patients, and we've got to crack down and put everyone in jail."
Little wonder. That symposium was essentially a dog-and-pony show designed to gin up support for the looming prescription monitoring bill. With the help of the aforementioned Orlando Sun-Sentinel and its sister South Florida Sun-Sentinel, which lavished extensive coverage on the summit, Bush and his allies hoped to use the confab as a springboard to passing the bill.
What Gillette had to say wasn't exactly what Bush, McDonough, and their guests wanted to hear, though. "People in pain have legitimate reasons to have pain addressed and the first role of the physician is to address suffering," Gillette said. "Why take away the right of that doctor to address pain and suffering? I pressed them very hard on what is doctor shopping? Most all of us have more than one doctor, a cardiologist, a podiatrist, etc. I got no response. How do you define it? No answer. Who will define standards of care? Only 7% of US medical schools teach a course in pain management, and that's an elective. Most MDs aren't necessarily qualified to treat pain. Are the MDs going to define the standard of care, or law enforcement, or politicians? Again, I got no response. But this is important because this is how people are being prosecuted, on the standard of care. There are a wide range of professionals who specialize in this, and they are the ones who should be defining standard of care. The goal is to keep people functional. For some people that means a lot of opiates. If that keeps people employed and with their families, that's a good thing. When pain goes away, they don't take the pills anymore."
Gillette did more than stand up to the assembled drug warriors in Orlando. She also lobbied legislators about the prescription monitoring bill. "My representatives were clueless," she said. "They had no idea about the prosecutions of doctors, the cops barging in waving guns, the little old ladies handcuffed to their chairs in the waiting room, and the police searching people's bras for drugs. Their jaws dropped when I told them about what was going on."
Lobbying legislators was only part of the opposition campaign. "There was also an enormous letter-writing and internet campaign," said Reynolds. "And Dave Borden and DRCNet deserve some credit. The action alert they sent out was a real call to arms, and we were delighted to see it happen because we think this is a real wedge issue," she said.
And then there was Richard Paey, sitting in the Pasco County Jail in his wheelchair with a morphine pump, waiting to go to prison for the next two decades for trying to medicate himself. "I'm not sure how much opposition to the bill there was to start with, said Paey's wife, Linda. "But Richard was in Fasano's district and people could see how police and prosecutors didn't use common sense in his case. The possibility of those same people not using common sense with prescription monitoring was scary," she told DRCNet.
"I couldn't support this bill, and I spoke with reporters and got my opinion aired. I've also been speaking at Rotary Clubs and churches to say I opposed the bill. We tried to meet with Fasano, but he wouldn't see us."
Fasano could run, but he couldn't hide. "They were very aware of us. There were a lot of people calling and writing both Fasano and Bush, the St. Petersburg Times editorialized on our side, and there were a lot of letters to the newspapers," Linda Paey said. "They may have had good intentions with this bill, just like with the trafficking law they used to convict Richard, but there is no doubt in my mind that law enforcement would use this just to get convictions, not in a common sense way."
Whether it was privacy concerns or Richard Paey, in the end, the bill's supporters could not muster the strength to ram it through. "It was read several times, but it didn't even go to a vote," said Reynolds. "They had to acknowledge that the votes weren't there, either on the Democratic side or the GOP side. This was Jeb Bush's number one legislative priority and it was defeated by out-of-state Internet organizations of people who care that horrible things not continue to happen and that political opportunism not fly unchecked."
Reynolds found herself buoyed by the victory. "I was frankly surprised -- and very encouraged -- by the complete lack of support for Bush's bill. For the first time, one of those prosecutor and drug warrior media disinformation campaigns didn't succeed in grabbing another chunk of our civil liberties. Maybe people are beginning to see through these government-created drug panics."