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Hospice pain med bill dies in committee

On the long list of legislation that died in committee this session is one Rep. Becky Currie, R-Brookhaven, is passionate about as a nurse. Currie’s House Bill 1460 would have allowed directors of hospices to prescribe pain medication to terminally ill patients without an in-person visit.

Current regulations require physicians and other healthcare providers to perform a “good faith prior examination” before prescribing pain meds. The rules specifically say: No physician shall prescribe, administer or dispense any controlled substance or other drug having addiction-forming or addiction-sustaining liability without a good faith prior examination and medical indication therefore.

The change is necessary, Currie said, because sometimes a hospice patient’s condition deteriorates quickly and a change in medicine may be needed to keep the patient comfortable.

Currie told the story of a young cancer patient who was discharged to hospice. He was sent home with pain medication but soon became unable to swallow the drugs and was in terrible pain. It was in the middle of the night, and a doctor was able to fax in a prescription for pain meds in drops to a pharmacy.

“They were able to keep this patient comfortable and he died a few days later peacefully in the arms of his family,” she said. “Under the regulations now this would not be possible.”

The regulation that a doctor see a patient before prescribing medications has been in place for at least a decade, according to Dr. Kenneth Cleveland, executive director of the state Board of Medical Licensure.

“The notion that the board is now specifically requiring a ‘face-to-face’ examination by a physician for hospice patients is simply false,” he said.

Cleveland said the licensure board is not aware of a physician being penalized for writing an emergency prescription for a legitimate hospice patient. It is the referring doctor’s responsibility to send terminally ill patients to hospice with a 30-day supply of all necessary medications, including controlled substances, he said.

Currie argues that is sometimes not enough to keep patients comfortable.

“When their condition deteriorates, different medicine may be needed,” she said. “But what the Board of Medical Licensure did when they put regulations on doctors for prescribing pain medicine was they put a burden on physicians taking care of hospice patients that have decided with their families to pass away at home. The regulations state that a medical director for hospice has to do a face-to-face visit with the patient before he can prescribe pain medicine to them. That wouldn’t seem so hard but the average stay in Mississippi for a hospice patient is 14 days.

“The only thing that we are asking for is the exemption of the face-to-face visit for dying patients only,” she said.

Cleveland said nothing has changed when it comes to regulations for prescribing pain medications.

“Considering that this language has been in the regulations for at least over a decade, physicians working for a hospice are not required to do anything differently today than they have been required to do for years,” he said. “Hospice patients are some of the most vulnerable patients that physicians treat. However, even a patient that is terminally ill deserves the basic standard of care. The ‘good faith prior examination’ is not required to be done ‘face-to-face’ by the physician. It can be done through a collaborating healthcare provider (nurse practitioner) or through the use of telemedicine. Additionally, there is no regulation that states that a physician or appropriate level provider must see a patient every time a controlled substance is prescribed.”

Tiwana O’Rear, with Louisiana-Mississippi Hospice Palliative Care Organization, said the regulation is burdensome and results in more visits to emergency rooms, which is costly for the healthcare system.

“The patient could be in pain or without proper medication before a physician can make a visit,” she said. “They won’t stay like that. They will end up in the ER.”

The Board of Medical Licensure did adopt new requirements to help combat opioid abuse, but Cleveland said there are no new requirements for hospices under those rules.

Currie said there is a chance her legislation could be revived in another bill, but as of now it appears dead. It died in the Public Health and Welfare Committee in the Senate, which is chaired Republican Sen. Dean Kirby of Pearl. He did not respond to a request for more information about the bill and why it died in his committee.