Maine Drug Law PL488: A Multitude of Problems…Part 3

Maine Drug Law PL488: A Multitude of Problems…Part 3

HIPAA is a privacy law enacted, passed by Congress and signed by President Clinton in 1996. A state (Maine) cannot implement the law at will to supersede federal because federal laws take priority over state laws due to the supremacy clause of our Constitution.

Under the Privacy Law there are Covered Entities and Business Entities; however, neither list includes veterinarians. The American Medical Association’s web page has this description of HIPAA on it today. Note, this description is on the website of the American Medical Association, which represents human medicine,  not the American Veterinarian Association (AVMA) which represents that of animals. Plus neither veterinarians nor their designated staff is bound by HIPAA regulations. How can pet owners who agree to have their personal prescriptions reviewed by someone from a veterinary practice be assured that whatever is seen will remain confidential? They can’t. Whereas in human medicine any HIPAA violations are dealt with appropriately. I think this places an extra burden on a practice, especially a small one. Plus I believe they are as uncomfortable viewing a humans prescriptions as we are knowing the law requires them to.

That gives rise to the question, how can Maine residents be sure their personal data is safe? On March 22, 2017, it was announced that a hacker had breached the Maine Department of Labor’s Job Link, a job matching service. While the service was outsourced to a Kansas company in July 2016, it was reported that the Maine DOL’s computer system is antiquated therefore indirectly played a part in the breach. Officials say the hacker was able to view names, social security numbers, and birth dates of site users. Since July, over 12,000 Maine residents have utilized the site and to date the number of users affected is unknown. So how do we know if the Maine PMP is secure? It’s disturbing alone that a veterinary practice staff member is required to look at consenting humans drug records and that a 5-year window of prescription activity is accessible on the PMP. Now we must also wonder about the security of the electronic system.

 

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Email sent by Maine DOL on March 24

 

Secondly, the state is mandating that veterinarians operate outside their scope of practice since pharmacology is often vastly different between the species. They are expected to make a judgment call when reviewing the owner’s (or anyone picking up the animal) prescription drugs on the PMP database and determining if prescribing a controlled drug for the animal would enable the owner to “potentially” exceed the mandated daily limit of 100 MME. This alone is requiring a doctor trained in animal physiology to understand human physiology. Would you expect your dentist to prescribe medications for your cat’s seizures? Or expect your veterinarian to know how much Vicodin you need following major orthopedic surgery? What if a veterinarian makes the wrong judgment call simply based on the numbers? A pet could be denied much-needed medication. Do legislators really have the power to make such laws where one’s medical privacy is violated and their pet possibly left in pain or distress?The inclusion of veterinarians in this hasty bill is not the answer to the opiate epidemic. Perhaps stricter sentencing should be considered. Recently in my Maine community, during the same court session, a drug trafficker was given a suspended sentence and allowed to freely exit the building whereas someone who embezzled money was sentenced to jail hence escorted out by deputies. The drug he trafficked was Suboxone which is both addictive and has the potential to be fatal  if combined with certain other drugs. While I’m certainly not defending someone who embezzled money, as a nurse who worked in a large city teaching hospital, I’ve never heard of someone dying because of it. The stark contrast in sentencing was disturbing and reinforced my belief that including veterinarians in PL 488 is not going to stem the opiate epidemic; appropriate sentencing is.

As a Maine resident who refuses to allow my HIPAA rights to be violated, and as an animal owner who does not want my pet to suffer, I  reached out to my elected officials and Augusta, the state capital, multiple times since February 2017 in an attempt to express my concern. My communications have been completely ignored with the exception of Senator Thomas Saviello who was initially helpful but once I began asking more focused questions regarding PL 488, he no longer responds. This is certainly not the reaction I expected from my elected officials nor is it one I’ve experienced while living in other states.

Next ~ Who else is adversely affected by Maine’s PL488?

Maine: Passed A Law That Could Harm Animals And Their Veterinarians…Part 1

Maine: Passed A Law That Could Harm Animals And Their Veterinarians…Part 1

Like nearly every state, Maine is dealing with an opiate and heroin epidemic. In 2015, Maine experienced 272 overdose related fatalities.

In an effort to combat the opiate epidemic, the Maine Legislature enacted   P.L. 2015, ch. 488 (An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program) which became effective January 1, 2017. PL 488 affects nearly all facets of healthcare by establishing specific rules for prescribing and dispensing controlled medications. It defines the protocols that must be followed and sets prescription limits on how much opiate a patient may legally be prescribed to take per day. This is called the Aggregate Morphine Milligram Equivalent and the total daily amount allowed is 100 Morphine Milligram Equivalents (100 MMEs).

PL 488 mandates that whenever a medical provider prescribes a controlled substance, they first check the PMP (Prescription Monitoring Program) to review the MME for the patient, what controlled drugs the patient is currently taking, who prescribed them and the pharmacy that filled the prescription. They must calculate if the drug they want to prescribe will, when added to the patient’s current daily MMEs, increase the allowed 100 MMEs and if so, not prescribe it. They must note if there are multiple prescriptions, providers or pharmacies. If the provider notices anything in the patients PMP profile that raises a red flag, they are required by law to report it to the PMP Coordinator. There are of course many other components to PL 488 but I only want to touch on the highlights and how it impacts Maine residents who are pet owners in addition to veterinarians. Yes, that’s correct ~ veterinarians because Maine’s Legislatures have determined that the inclusion of veterinarians in PL 488 will help reduce the opiate epidemic. I disagree because including veterinarians in PL 488 creates two major violations. First, however, I’d like to walk you through a veterinarian’s education.

If a young person thinks they want to become a veterinarian, they should begin preparing in high school by paying attention to their performance in science courses, such as chemistry, biology, and physics. This same attention applies to math courses; trigonometry, geometry, and algebra. After high school graduation the student attends a 4 year college to earn their bachelor’s degree where they take the prerequisite courses for admittance into veterinary college.These consist of many advanced science courses, such as biochemistry, organic and inorganic chemistry, and physics. They are necessary to prepare the student for the vigorous coursework in veterinary college. Prospective veterinarians must complete a doctor of veterinary medicine degree. Typically, a doctorate in veterinary medicine takes four years to complete. Of these four years, three are spent on classroom training where students take courses in animal anatomy and physiology. They also take courses on disease diagnosis, prevention and treatment. After completing three years of classroom training, students take another year left to complete their degree in veterinary medicine. The fourth year is typically spent getting practical, hands-on training. This takes the form of a one-year clinical rotation in a veterinary medical center or veterinary hospital to gain experience in a variety of areas of veterinary medicine. After graduating with a doctorate in veterinary medicine, veterinarians are not yet able to open a practice. Before practicing veterinary medicine, graduates must pass the North American Veterinary Licensing Examination and any applicable state exams. Their path is definitely not a short one but throughout it is focused primarily on one thing ~ animal anatomy, physiology and wellness. 

Maines’s new PL 488 and its impact on veterinarians is such. If an owner takes their pet to be seen and the veterinarian feels it necessary to prescribe a narcotic or benzodiazepine for your pet, they must first do a check on the owner with DHHS to determine if the owner is taking a controlled substance. As I previously mentioned I still need to clarify the parameters but the fact that a veterinarian or perhaps his staff has the power to access a person’s prescriptions is a huge HIPAA violation. But I digress. Let’s use a hypothetical situation. The owner has an anxiety disorder for which he takes Valium on a daily basis. He also has a severe back issue (long-term) so is on hydrocodone for pain control. His cat is hit by a car and taken to the vet where she undergoes successful emergency surgery but because her injuries are severe, the vet prescribes a pain medication; hydrocodone. Would the fact that the owner is on hydrocodone prohibit the vet from prescribing it for the cat’s postoperative pain? If so, would he be allowed to prescribe a different pain medication such as tramadol which also falls in the opiate category? Is he is prohibited from prescribing any narcotic because the owner is on two (2)?  Or is it only if the owner is on the same drug? If his prescriptive powers are limited because the owner is taking a controlled substance, what criteria is used to determine if the animal can or cannot get a prescription?

Whilst I understand the opiate epidemic our country is tackling, how can a veterinarian or anyone for that matter be absolutely certain that a person who is taking several controlled drugs is abusing or trafficking? Plus the thought that an innocent animal might have to suffer needlessly because his owner is on a controlled substance is not only abhorrent but inhumane.  I want to know if it’s possible for the check to be done during non-business hours when DHHS is closed. Does the veterinarian’s office have to speak directly to a DHHS employee or is the information accessible online? And if it is accessible online, how can we, the human patient, be assured it’s secure? If the drug check on the owner can’t be done when DHHS is closed, then what happens to the animal who is in pain?  Any pet owner knows that many accidents happen at night, weekends or holidays when government agencies like DHHS are closed; what then?  Going back to HIPAA, who has authority within the veterinary practice to request the DHHS information? Can a receptionist do it? A vet tech? Or only the veterinarian? Finally, I do not understand how PL 488, a state law, can override HIPAA, a federal law enacted in 1996 by Congress and signed into effect by then President Bill Clinton. Under HIPAA an individual’s medical and other health information including prescriptions is private and protected. The Privacy Law sets limits on who can look at and receive our health information such as covered entities and their business associates. As a nurse and former Union representative, I am extremely familiar with HIPAA. In light of PL 488, however, I reviewed it once again and nowhere did I find where veterinarians, veterinary technicians, or veterinary employees of any type are entitled to our records in any form. Additionally, PL 488 is, in essence, requiring veterinarians to understand human medication dosages compared to animals which often differ greatly.

I chose a veterinary team for my German Shepherd based on their reputations and expertise in animal physiology, not human. I value all members of her team despite being in different practices because of their knowledge. Having said that, I expect they keep current with the newest modalities of treatment for my dog. They work long hours yet now the State of Maine expects them to undertake additional training in order to understand and monitor the Prescription Monitoring Program (PMP)?  A program historically used only for humans?

This is ludicrous. There has to be a middle ground, a way the government, human healthcare providers, and law enforcement can work together in an effort to reduce the rampant drug abuse without violating a person’s rights or including veterinarians where there is potential for an animal to suffer because “something” raises a red flag when in reality it could be legitimate.

Veterinary Visits In Maine Just Got Complicated…

Veterinary Visits In Maine Just Got Complicated…

Like nearly every state, Maine is dealing with an opiate and heroin epidemic. In 2015, Maine experienced 272 overdose related fatalities. In January 2017 one of Maine’s media outlets, WMTW, did an outstanding feature entitled Goodnight moon, goodnight mum,’ ‘Chronicle’ investigates Maine’s heroin epidemic. Anchor David Charns did a phenomenal job detailing the pain and heartache of addiction through a series of interviews and videos including one with Oxford County Sheriff’s Office Sgt. Matthew Baker Sergeant who, moments after arriving home from work in February 2015, discovered his 23-year-old daughter Ronni near death in the upstairs bathroom. Despite CPR from her father and several doses of Narcan by paramedics, she died, leaving behind an 11-month-old daughter Claire. Ronni’s daughter, now 2, lives with her grandparents and is the source of the name of the WMTW article:

When Claire asks for her mother, she and her grandfather look up, past that second-floor bathroom, to the sky. “I’ve always told her that that full moon is mum,” Baker said. “We go outside, and she says, ‘Goodnight moon and goodnight mum.'”

In an effort to combat the Maine opiate epidemic, the Maine Legislature enacted Public Law 488 which became effective January 1, 2017. PL488 affects nearly all facets of healthcare except in this law, veterinarians are included. I didn’t have all the exact data on PL488 so reached out to my State Senator, Thomas Saviello. I must tell you, he is the only government official to respond during the two weeks I called and emailed various agencies, elected officials including the State House. A sad indictment against them but a huge kudos for Senator Saviello. 

What I do know about PL488 and its impacts on veterinarians is such. If an owner takes their pet to be seen and the veterinarian feels it necessary to prescribe a narcotic or benzodiazepine for your pet, they must first do a check on the owner with DHHS to determine if the owner is taking a controlled substance. As I previously mentioned I still need to clarify the parameters but the fact that a veterinarian or perhaps his staff has the power to access a person’s prescriptions is a huge HIPAA violation. But I digress. Let’s use a hypothetical situation. The owner has an anxiety disorder for which he takes Valium on a daily
basis. He also has a severe back issue (long-term) so is on hydrocodone for pain control. His cat is hit by a car and taken to the vet where she undergoes successful emergency surgery but because her injuries are severe, the vet prescribes a pain medication; hydrocodone. Would the fact that the owner is on hydrocodone prohibit the vet from prescribing it for the cat’s postoperative pain? If so, would he be allowed to prescribe a different pain medication such as tramadol which also falls in the opiate category? Is
he is prohibited from prescribing any narcotic because the owner is on two (2)?  Or is it only if the owner is on the same drug? If his prescriptive powers are limited
because the owner is taking a controlled substance, what criteria is used to determine if the animal can or cannot get a prescription?

Whilst I understand the opiate epidemic our country is tackling, how can a veterinarian or anyone for that matter be absolutely certain that a person who is taking several controlled drugs is abusing or trafficking? Plus the thought that an innocent animal might have to suffer needlessly because his owner is prescribed a controlled substance is not only abhorrent but inhumane.  I want to know if it’s possible for the check to be done during non-business hours when DHHS is closed. Does the veterinarian’s office have to speak directly to a DHHS employee or is the information accessible online? And if it is accessible online, how can we, the human patient, be assured it’s secure? If the drug check on the owner can’t be done when DHHS is closed, then what happens to the animal who is in pain?  Any pet owner knows that many accidents happen at night, weekends or holidays when government agencies like DHHS are closed; what then?  Going back to HIPAA, who has authority within the veterinary practice to request the DHHS information? Can a receptionist do it? A vet tech? Or only the veterinarian? Finally, I do not understand how PL488, a state law, can override HIPAA, a federal law enacted in 1996 by Congress and signed into effect by then-President Bill Clinton. Under HIPAA an individual’s medical and other health information including prescriptions is private and protected. The Privacy Law sets limits on who can look at and receive our health information such as covered entities and their business associates. As a nurse and former Union representative, I am extremely familiar with HIPAA. In light of PL488, however, I reviewed it once again and nowhere did I find where veterinarians, veterinary technicians, or veterinary employees of any type are entitled to our records in any form. Additionally, PL488 is, in essence, requiring veterinarians to understand human medication dosages compared to animals which often differ greatly.hipaa_violations_by_type_-_pie_chart

I chose a veterinary team for my German Shepherd based on their reputations and expertise in animal physiology, not human. I value all members of her team despite being in different practices because of their knowledge. Having said that, I expect they keep current with the newest modalities of treatment for my dog. They work long hours yet now the State of Maine expects them to undertake additional training in order to understand and monitor the Prescription Monitoring Program (PMP)?  A program historically used only for humans?

This is ludicrous. There has to be a middle ground, a way the government, human healthcare providers, and law enforcement can work together in an effort to reduce the rampant drug abuse without violating a person’s rights or including veterinarians where there is potential for an animal to suffer because “something” raises a red flag when in reality it could be legitimate.

Once I have all the specifics, I’ll revisit this in a future post.

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