In the midst of an opioid epidemic, the Georgia Legislature has voted to weaken enforcement of one of the investigative tools used against it.
On Tuesday the General Assembly voted to take away the ability of the Georgia Composite Medical Board to discipline doctors who fail to register for an opioid prescription tracking database.
“It weakens the (monitoring) and our fight against the opioid epidemic,” said state Sen. Renee Unterman, R-Buford, who voted against the measure. “This is a major change to something we worked on for years.”
Georgia’s Prescription Drug Monitoring Program was established to assist medical investigators in understanding who might be overprescribing opioids. It was part of “pill mill” legislation the state passed to try to get a handle on the opioid epidemic. The epidemic is widely understood to have started with prescription drugs and then migrated to street drugs.
The monitoring program requires every doctor who has a federal ID number to prescribe opioids to register for Georgia’s database, and when they prescribe, to check it to see whether their patient has been doctor-shopping. Under the law, if they failed to register, they would be disciplined. Doctors have said the database is unwieldy and the program is punitive for doctors who rarely prescribe opioids. Most doctors and physician’s assistants who need to register have done so, but just under 1,000 remain unregistered, officials say.
The discipline would go away under a late-breaking change to House Bill 551, passed by the House on Friday and by the Senate on Tuesday, the final day of the 2019 session.
Instead, the state Medical Board can still levy fines if the doctor or PA fails to register, but they’ll be called “administrative” fines and the board can’t impose official discipline. That means an infraction won’t be reported to disciplinary databases. Until Dec. 31, the board also would have the ability to erase previous discipline for failure to register.
There was a reason: Doctors were getting caught up in the new registration requirement who weren’t operating pill mills but were just new doctors who missed a bureaucratic requirement, or doctors who changed mailing addresses and didn’t receive the notice, or, the amendment’s sponsor concedes, were too “lazy” to see that the documentation was filed.
That didn’t mean they weren’t good doctors, said state Rep. Sharon Cooper, R-Marietta, R-Marietta, who offered the amendment in the House. Cooper, the chairwoman of the House Health and Human Services Committee, and House Majority Leader Jon Burns, R-Newington, were approached by several doctors and hospitals saying innocent practitioners were being caught in the bureaucracy.
The problem, she said, was that the board had no discretion whether to decide a failure to register was intentional or had bad consequences. Instead, she said, good doctors were getting disciplinary records that could cost them insurance networks, fellowships and even jobs.
“Georgia has a critical doctor shortage,” Cooper said. “This was not about patient care. It’s about being lazy.”
Cooper said several Emory University residents had not registered. Also affected were a pediatrician who rarely prescribes and changed addresses, and others who had received incorrect information about registration requirements. A disciplinary action “could ruin their whole career,” Cooper said.
She also said she had been among those that fought for the pill mill legislation, as well as bills to save opioid victims such as the 911 amnesty bill and another bill providing Narcan to emergency responders. She said doctors and nurses who were fueling the epidemic would still be caught.
“Nobody’s trying not to discipline them,” she said. “You still can go after them for being a pill mill doctor.”
The new language also would gives the board no discretion, removing the possibility of discipline for failing to register even if investigators believe the failure was deliberate.
Asked whether she would advocate to give the board that discretion next year, Cooper said she would see whether it was a problem and work to change it if that proves true.
It’s unclear whether the Senate understood what it was doing when it agreed to the House amendment. The measure appeared on the final day of the legislative session, amended to a bill on a different subject, the regulation of the herbal supplement kratom. The kratom bill was sponsored in the Senate by a popular and powerful lawmaker, Senate Rules Committee Chairman Jeff Mullis, R-Chickamauga.
As Mullis presented the bill on the floor, Unterman raised the issue with the amendment, and Mullis sounded apologetic but still asked for support. It passed with Unterman as the lone no vote.
Mullis said afterward that his issue was the kratom issue, and as to the amendment, “If we need to improve (the legislation) next year, I’ll be happy to do that.”
The bill now goes to Gov. Brian Kemp to decide if he will sign it.
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