Lawmakers Seek Tighter Control of Pain Clinics

Feb 13, 2010

Dara Kam

Palm Beach Post

Six people a day in Florida die from overdoses of prescription drugs, three times more than the number who die from all illegal drugs combined, according to some estimates.

Many of those deaths are linked to South Florida pain management clinics, the largely unregulated cash-and-carry operations that some critics say are little more than junkie havens fueling an illegal drug trade that spreads from South Florida to Kentucky.

Work on a series of measures that would crack down on the clinics and the addictive drugs they hand out daily is under way as state lawmakers prepare for the legislative session that begins March 2.

At least four legislators are proposing bills that would toughen pain clinic laws passed last year. Those laws require the clinics to register with the state Department of Health and require the state to create a database of all prescriptions of addictive drugs so it can track those prescriptions. Neither registry is running yet, but once they are, they will do little to regulate who can own or operate a clinic or to allow the state to shut down clinics.

Citing Palm Beach Post reports that some clinic owners are felons convicted of drug smuggling and other drug-related crimes, state Sen. Dave Aronberg, D-Greenacres, is sponsoring a bill (SB 646) that would restrict who can own or operate the clinics to doctors in good standing.

"This is like the wild, wild West," said Aronberg, who is running for state attorney general. "It's an industry where people of questionable backgrounds enter it to make a quick buck. In many cases, it's legal drug dealing."

Aronberg has had the controversial clinics in his sights for a decade, since he was an assistant attorney general going after the manufacturer of OxyContin, a pain medicine. Powerful narcotics such as OxyContin and RoxyContin, which are similar to morphine and sometimes injected like heroin, are popular at the 900 pain management clinics throughout Florida, including more than 100 in Palm Beach County.

Under Aronberg's bill, not only would clinics have to be owned by a doctor, they would have to have a doctor or pharmacist on the premises when the narcotics are dispensed.

But that doesn't go far enough, says another bill sponsor, because many of these clinics already involve doctors, who reap huge profits — at least $100,000 a month in one Palm Beach County case.

Sen. Dan Gelber, a former prosecutor who is running against Aronberg in the Democratic attorney general primary, is sponsoring a bill (SB 804) that would prohibit anyone convicted of a felony of owning or operating a clinic and would require the Department of Health to revoke the person's registration if he or she has such a record.

"The problem with the pill mills is that it's very hard to regulate them unless you decide you're going to put them under the Department of Health and regulate them," said Gelber, D-Miami Beach.

Rep. Kelly Skidmore, D-Boca Raton, who sponsored last year's law requiring the reporting of prescription drug sales, is pushing a bill (HB 671) that goes further. It would require the Department of Health not only to register all pain management clinics but also to set standards for them, inspect them annually and refuse or revoke their permits if their owners are convicted of a felony.

Rep. John Legg, R-Port Richey, would take a different route by limiting the amount of drugs that some clinics could dispense.

His bill (HB 225) would prohibit doctors who have dispensing licenses from dispensing more than 72 hours' worth of dosages for the narcotics. Some clinics operate by hiring such doctors, while other clinics include a pharmacy, which would not be affected by Legg's proposal.

Legg said his bill would help reduce drug-related crimes, which he said jumped in his county, Pasco, by 200 percent in 2007 and 2008.

"That 72-hour dispensing ban cuts the head off the serpent," he said. "If we want to do this, we need to do it and be serious about it. The regulation will make their lives miserable, but the 72-hour ban will shut them down."

But pain clinic owner Paul Sloan, head of the Florida Association of Pain Management Providers, said Legg's bill would cripple businesses like his that use doctors and often offer cheaper prices on medicines, while allowing other businesses that use pharmacies to continue whether or not they are bad.

Sloan, who is not a doctor and owns clinics in Venice and Fort Myers, suggests a type of regulation different from anything lawmakers are offering. He points out that clinics like his are regulated by the state Agency for Health Care Administration because they accept insurance, whereas clinics that do not accept insurance are not covered by that agency.

Requiring all clinics, whether or not they are covered by insurance, to report to the health care agency would put nefarious operators out of business because they would have to pass intensive background checks just as he does, he said.

"I want the pill mills gone. I want the bad doctors gone," Sloan said. "They make my life miserable. I can't even tell people what I do without them looking at me like I'm scum of the earth."

Legg said he is working with the Florida Medical Association, a powerful doctors lobby, in hopes of getting his bill passed.

But association spokeswoman Erin VanSickle said the group opposes the 72-hour ban but supports restricting ownership of pain clinics to doctors.

The bills in both chambers are still being developed.

"I would be open to anything," said Aronberg, who saw his other attempts at drug clinic regulation die in 2003, 2004 and 2007. "I just want to get something done."

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