More than 1,000 doctors violating state opioid law

LaSharn Hughes, executive director of the Georgia Composite Medical Board, addressed the Georgia Senate Health and Human Services Committee on Oct. 29, 2018.

Credit: Special

Credit: Special

LaSharn Hughes, executive director of the Georgia Composite Medical Board, addressed the Georgia Senate Health and Human Services Committee on Oct. 29, 2018.

About 1,100 of the state’s physicians are now considered lawbreakers under a Georgia law intended to help put an end to the opioid epidemic, but so far nothing has been done to punish them.

Those doctors were supposed to have signed up by Jan. 1 with the state's Prescription Drug Monitoring Program and started checking it by July 1 before prescribing opioids and certain other drugs. Despite repeated warnings, the doctors haven't even registered.

The Georgia Composite Medical Board has yet to impose any punishment, though.

When the board met Thursday to discuss the non-compliant doctors, some members asked a representative from the Attorney General’s Office what they could do. He said for each doctor they would have to build a case, gathering documents, calling in people to testify and holding hearings.

“We’ve been talking about it in the AG’s office about how to do this with the least amount of impact. We’re talking about 1,100 violations,” Assistant Attorney General Max Changus said.

He also said the law isn’t clear on sanctions.

The inaction has angered the state lawmaker who pushed the legislation on the pill-tracking database.

"Here we are as a state exerting all this money to fight an opioid epidemic, and we have practitioners subverting the work of the assembly," state Sen. Renee Unterman, R-Buford, told The Atlanta Journal-Constitution.

She said she is incensed over the lack of accountability.

"It just makes me believe that they (doctors) think they are held to a different standard,'' Unterman said. "These are people with post graduate education. They know how to do things."

“There is no excuse,” she said.

‘A prank’

For months, the Department of Public Health and the medical board have been sending out letters and making phone calls to try to spur compliance with the law, approved by the legislature in 2017. The goal is to have prescribers use the database to check which patients are receiving multiple prescriptions for highly addictive drugs. Lawmakers said the database will also help identify practitioners who are prescribing dangerous dosages.

To date, a total of 24,000 physicians in Georgia have signed up.

But compliance hasn’t been easy, Sheila Pierce, opioid program coordinator and director of the Prescription Drug Monitoring Program for the Georgia Department of Public Health, told the medical board Thursday.

“We got calls from people who thought the letters from the board were a prank,” Pierce said.

She said when she went for an annual exam in March, she discovered her own doctor hadn’t signed up. “You were supposed to do this in January, and this is March,” she told her doctor. A week later, she called the doctor’s staff to remind them about the law. A few days after that, she said, her physician finally registered.

One popular misconception has been that physicians who don’t normally write scripts are allowed a pass. Not so, Pierce said. State law requires that anyone with a Drug Enforcement Administration number must register.

Others have blamed the lapses on the day-to-day burdens most healthcare providers face. They say it does not reflect on a lack of concern.

“This is like driving a car without a license and telling the officer, ‘I didn’t know I needed a license,’” medical board chairman Dr. J. Jeffrey Marshall told his colleagues.

At least one board member was concerned Thursday about liability if a doctor prescribes a drug to a patient who then overdoses, and later it is discovered that the patient had prescriptions in other states. Pierce said that the goal is for Georgia to share the data with at least 20 states.

No enforcement rules

Unterman raised the issue of the deadlines on Oct. 29, when the Senate Health and Human Services Committee met with the medical board to discuss its budget and physician discipline issues.

Sen. Renee Unterman, R-Buford, has sponsored several bills to address the opioid crisis in Georgia. On the lectern in front of her is a photo of an opiod victim. BOB ANDRES /BANDRES@AJC.COM

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Unterman asked Marshall and board Executive Director LaSharn Hughes how they were handling cases of physicians who hadn’t registered for the pill-tracking database. At that point, 1,400 physicians and physician assistants hadn’t registered, the committee was told.

Hughes said no one had been disciplined. The board first had to wait for DPH to clean up the list of prescribers who had not registered, to make sure it was accurate, she said.

Then, Hughes said, “The Attorney General’s Office has directed the Board of Nursing, the medical board and the pharmacy and dental board to send out a final, final letter to say if you do not respond within 15 days of the letter – and we also came out 30 days ago — then the board will take action.”

The senators were told that the board could issue reprimands, orders or other sanctions to those who still did not comply.

Unterman lost patience. “Here we are in the throes of an opioid epidemic, and 1,400 providers are not adhering to what the law is,” she replied. “They are essentially breaking the law right now as we speak.”

She noted she had sponsored a bill that would have made it a felony not to comply, but the bill was defeated after opposition from the state medical association.

State Sen. Fran Millar, R-Atlanta, also asked where the penalties were. “It’s not going to be just a slap on the wrist,” he told Hughes.

At Thursday’s meeting, Changus said that the law did not set up a mechanism for the board to take summary action against a physician accused of failing to register.

But Changus said that it is possible that Pierce and her office can provide relevant documentation and testify at an administrative hearing to sanction physicians who have not complied. Pierce said she would be open to that.

Unterman believes the public health department and the medical board are dragging their feet and could just turn over the names of the non-compliant doctors to the attorney general's office.

“The AG has not reacted to it because they are waiting on the bureaucracy, and the bureaucracy is DPH and the medical board,’’ Unterman said. She also said that as part of the state’s 2019 budget, more than $10 million was set aside to help fight the opioid epidemic. Some of that money will go to DPH and the medical board to hire more people to administer the database and track physician compliance, she said.

All physician assistants are now compliant, Pierce said Thursday. About 98% of the state’s dentists have complied, she said.

Georgia has had a pill-tracking database since 2011, but it was originally voluntary for prescribers to use it. When few did and the opioid crisis deepened, state lawmakers approved the bill requiring use.