Is It a Pill Mill? How Do You Know?

The information here is from "Grand Rounds," a report from the State Medical Board of Ohio. (Special Issue -- May 2011)  

People in Ohio have been arguing for years about the difference between the monikers "pill mill" and "pain management clinic." Thanks to the State Medical Board of Ohio, the public can view a clear definition of a pain clinic. With the passage of HB 93, Medical and Pharmacy Boards will have greater ability to take administrative action against rogue pain clinics (pill mills). Passage of HB 93 is a wonderful step forward - what a great, needed bill.

HB 93 Takes These Important Steps


* Requiring licensure of facilities/practices meeting the definition of "pain management clinic" established in the bill;


* Requiring physician ownership of pain management clinics;


* Limiting the amount of controlled subtances a prescriber may personally furnish to a patient; and


* Authorizing the Medical Board to adopt rules setting standards for prescribing controlled substances.

HB 93 requires a facility operating as a pain management clinic to be licensed by the Pharmacy Board as a terminal distributor of dangerous drugs with a pain management classification.

HB 93 also requires the physician owner/operator of a pain management clinic to supervise the activities of the clinic and the employees working at the facility. Failure to appropriately supervise employees, or failure to meet the practice and operational standards established in HB 93, are ground for disciplinary action by the Medical Board.

HB 93 requires the Medical Board to adopt rules establishing standards to be followed by a physician regarding the review of patient information available through OARRS. While most of the provisions in HB 93 relate to physicians practicing in pain management clinics, the Medical Board's proposed rule (4731-11-11) impacts all physicians who prescribe controlled substances in schedules II, III, IV, and V, and/or drugs containing carisoprodol, or tramadol.

Defining "Pain Management Clinic"

HB 93 defines a pain management clinic as a facility to which the following apply:


* A primary component of practice is treatment of pain or chronic pain;

* The majority of patients of the prescribers at the facility are provided treatment for pain or chronic pain that includes the use of controlled substances, tramadol, carisoprodol, or other drugs specified in rules adopted by the Medical Board; and

* The facility meets any other indentifying criteria established in rules adopted by the Medical Board.


HB 93 exempts hospitals, specified educational institutions/programs; licensed hospice programs and licensed ambulatory surgical facilities from the licensure requirement.


Proposed Rule -- Sets Standards and Procedures For Operation of a Pain Management Clinic

HB 93 requires the Medical Board to adopt rules related to the standards and procedures for the operation of and provision of care at a pain management clinic. The law also requires the Board to establish standards and procedures to be followed by an owner in providing supervision, direction, and control of individuals at a pain management clinic. (Proposed rule 4731-29-01)

The proposed rule requires each physician providing care at a pain management clinic to hold staff membership at a local hospital with admitting or consulting privileges and to hold board certification or meet one of the equivalencies listed in paragraph (D) (5) of the rule.

Doctors who meet the criteria listed in paragraph (D) (2) or (D) (5) of the rule are also required to complete at least 20 hours of Category I CME in pain management every two years.

Further, rule 4731-29-01 requires the physician owner of a pain management clinic to maintain a log of all patients, develop a quality assurance system, verify staff credentials on an annual basis, and maintain billing records and patient records for seven years.

Conclusion

HB 93 is the culmination of the hard work of Ohio legislators, health officials, enforcement agencies, and many others at the grass roots level. Once the problem of prescription drug abuse was identified and carefully studied, the public supplied tremendous support to insure timely passage of the bill in the wake of a terrible health epidemic. Thanks God HB 93 had the benefit of being labeled an "emergency" measure. Thank you, sponsors David Burke, Danny Bubp, and David Burke.

Reading and understanding the requirements, standards, and lawful procedures of a legitimate pain management clinic should be the first step in public awareness concerning rx drug abuse. Understanding the law is essential. The State Medical Board of Ohio protects and enhances the health and welfare of Ohio's citizens through the effective regulation of more than 62,000 licensees.

The knowledge above is extremely important, but each piece of effective legislation requires the charges of vigilance, reporting, and action. To believe that even the most effective legislation will eradicate a problem rooted in greed and deceit is ridiculous. Malpractice will continue. Abuse will continue. Sadly, addiction will continue. 

Armed with the tool of HB 93, Ohio can effectively combat the largest sources of distribution. Still, the citizens of the Buckeye State must stand firm against rx abuse and vow to take measures as individuals to insure a better future, a future that insures safe and prosperous living.

A word of caution should be given. Those who understand the criminal mind also understand that offenders will soon discover new methods to continue their trades. HB 93 is landmark legislation, a huge victory against rx abuse; however, it also is a clearly drawn line that the "bad guys" seek to erase. As people concerned about the common good, we all must re-evaluate strategies and continue to battle the epidemic. Perhaps, as the tap root of the cancer dies, we should double our efforts against other stems of the disease.