Pill-mill bill does not pass as legislative session ends in failure; special session starts Monday

Though it's considered by experts as the most important bill needed this year, the Senate failed to pass a measure that would crack down on so-called pill mills before the end of the legislative session last night. Gov. Steve Beshear, above, called a special session that will begin Monday to give legislators more time to consider the bill, as well as approve funding for a $4.5 billion road-building plan — which was the main cause for the legislative gridlock.

Beshear wasn't happy, and blamed Senate President David Williams: "His rank partisanship, his obstructionist attitude, have caused numerous special sessions and cost the taxpayers millions of dollars of unnecessary expenses." The special session will cost more than $60,000 per day. "He's Senate president. I can't do a thing about that," Beshear said. "But what I can do is make sure that the people of this state know very loudly and clearly what damage he is causing to Kentucky."

Beshear even criticized Williams in his agenda for the special session, which included "legislation to enhance and expand tools and resources critical to Kentucky's continuing efforts to address the scourge of prescription drug abuse that plagues our citizens."

Negotiators on the prescription-drug measure, House Bill 4, came up with a compromise that pleased the Kentucky Medical Association, which opposes moving the state prescription-drug monitoring system to the attorney general's office from the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure. The compromise would still make that move, and still limit ownership of pain clinics to physicians, but dropped a requirement that all physicians pay $50 to use the system.

Beshear railed against the impasse. "Sen. Williams willfully ignored the visible misery of our communities and allowed this essential bill to die," he said in a press release. "Why? Because of his road projects." Some lawmakers said another factor was House Democrats' refusal to override any of Beshear's budget vetoes, in spite of what Williams said was House Speaker Greg Stumbo's pledge to override. Stumbo denied making such a pledge.

On the road issue, "Williams wanted Beshear to sign the transportation projects list into law before the Senate voted on the bill authorizing the road construction money. Without the funding bill, those projects couldn't get started," reports Ryan Alessi of "Pure Politics" on cn|2, a cable-company news service. "Williams didn't want to give Beshear the ability to veto the project list and be able to unilaterally decide how to spend the $4 billion in federal and state road and bridge construction money."

According to Beshear, $288 million was allotted in the funding plan for Williams' district, $130 million of which would have been funded in the near future. But Williams "made some last-minute fine-print changes that moved an additional $155 million of those projects in his district ahead of those in other communities around the state." (Read more)

Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Legislature passes bill on personal-care homes but stalls on one to regulate pill mills as doctors lobby hard

By Al Cross
Kentucky Health News

The effort to quash "pill mills" that feed one of Kentucky's worst problems, prescription drug abuse, stalled on the next-to-last day of the General Assembly's session and faces cloudy prospects on April 12, when the legislature returns to conclude its business. But the legislature gave final passage to a bill aimed at limiting the admission of mental patients to personal-care homes.

The snag in the pill-mill bill stems from the Kentucky Medical Association's opposition to moving the state's electronic prescription-tracking system to the attorney general's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has been found to go easy on them, compared to other states. The bill includes several other measures, including a requirement that pain clinics must be owned by doctors.

After Sen. Carroll Gibson, R-Leitchfield, failed in a parliamentary maneuver to make the bill more difficult to pass, and Senate President Pro Tem Katie Stine, R-Southgate, ruled that his motion had lost on a voice vote, Majority Floor Leader Robert Stivers, R-Manchester, "said it might be better to consider the bill April 12, but Sen. Ray Jones, D-Pikeville, said delaying a vote on it would give its opponents more time to try to kill it," report John Cheves and Jack Brammer of the Lexington Herald-Leader. "Stivers called for party caucuses to meet to discuss the issue. After the caucus meetings, the Senate adjourned and Stivers said lawmakers would work on the bill for possible consideration April 12."

The session's final day is scheduled to give the legislature a chance to override any vetoes by Gov. Steve Beshear, so a bill passed then could be killed by a veto. That might seem unlikely, since Beshear has been among those pushing for stronger action against pill mills. However, if he were unhappy with a bill the legislature sent him, he could veto it and call a special legislative session to pass one more to his liking. That possibility, and his power to set the agenda of a special session, could make him a player in the negotiations between now and April 12.

The bill’s sponsor, House Speaker Greg Stumbo, D-Prestonsburg, downplayed the problem. He blamed it on "confusion over a provision that limits the amount of drugs that may be supplied to a patient at any one time," Mike Wynn of The Courier-Journal reports. "Some lawmakers feared that limits on prescriptions would cause more patient co-pays, but a simple fix to the bill’s language could allay those concerns, Stumbo said."

Also on Friday, the legislature sent Beshear a bill that would "require potential residents at personal-care homes to be screened for brain injuries by medical professionals," the Herald-Leader reports. "Personal care homes provide long-term care for people who do not need full-time nursing care but need some assistance."

Senate Bill 115 "stems from the death last year of Larry Lee, a brain-injured resident who disappeared from a personal care home and was found dead four weeks later on the banks of the Licking River, not far from the Falmouth Nursing Home in Pendleton County," the Herald-Leader notes. "There are about 2,500 to 3,000 people in 82 free-standing personal care homes across Kentucky," and many are mentally disabled or mentally ill. Kentucky Protection and Advocacy, a watchdog state agency, released a report last week saying that said placement of the mentally ill in personal-care homes violates federal disability laws. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Makers of Sudafed, similar cold medicines again lead in legislative lobbying expenses, and that doesn't count their radio ad campaign

The Consumer Healthcare Products Association, which is fighting legislation that would limit the amount of pseudoephedrine that could be bought without a prescription, remained the leading spender among lobbying interests at the General Assembly in February, the state Legislative Ethics Commission said in its monthly newsletter.

CHPA, which represents manufacturers and distributors of over-the-counter medicines, spent $192,985 on lobbying in February, and a total of $388,000 for the first two months of the session. Those amounts do not include an extensive radio advertising campaign, which from all indications has cost more than the spending that had to be reported.

Other health-care interests were among the top spenders in February. Ranking second through 11th were the Kentucky Hospital Association ($38,422, for a two-month total of $74,543); the Kentucky Chamber of Commerce ($30,056, two-month total $63,404); Altria (Philip Morris) Client Services ($28,129, two-month $50,434); the Kentucky Farm Bureau Federation ($24,805, total $38,655); AT&T ($24,199, total $47,432); the Kentucky Medical Association ($21,958, total $42,731); the Kentucky Education Association ($21,629, total $45,249); the Kentucky Retail Federation ($21,191, total $45,452), which also opposes the meds-for-meth bill; Kentuckians for the Commonwealth ($18,317, total $34,188) and the Kentucky Optometric Association ($18,227, total unavailable).

House panel OKs "meds for meth" bill; chair predicts passage

The bill to limit purchases of the cold medicine used to make methamphetamine cleared another legislative hurdle Monday, and the chairman of the committee that approved it predicted that it will become law despite a heavy lobbying effort by over-the-counter drug makers.

By a 10-4 vote, the House Judiciary Committee approved a version of Senate Bill 3 that differs slightly from the version passed by the Senate. Rep. John Tilley, a Hopkinsville Democrat and the committee’s chairman, predicted the revised SB 3 will pass on the House floor. "Tilley said Senate leaders have signed off on the changes the House committee made," Jack Brammer reports for the Lexington Herald-Leader. The House version clarifies "language regarding prescriptions" and would ban "criminals convicted of meth-related offenses from purchasing pseudoephedrine for a five-year period," Mike Wynn of The Courier-Journal reports.

The core of the bill would allow consumers without meth records to buy 7.2 grams of medicines with pseudoephedrine each month, approximately a two-week dose, and up to 24 grams per year, without a prescription. Another 7.5 grams a month or 90 grams a year could be available with a prescription. "Experts have testified that those amounts are adequate for most cold and allergy sufferers, and more than 90 percent of all purchasers use dosages that fall below the proposed thresholds," Wynn reports. "State law already limits purchases to 9 grams per month, with a yearly cap of 108 grams, and purchasers are required to present a photo ID and sign a log at the point of sale."

The bill would not apply to gelcaps, which are more difficult to use for meth, or liquids, which are used for children. (Read more)

Group fighting meds-for-meth bill says it spent nearly $200,000 in January on lobbying, and that apparently omits radio buys

The group fighting a bill that would make the key ingredient for making methamphetamine available only by prescription spent more than $194,000 last month alone to lobby lawmakers, far more than any other lobbying interest at the General Assembly.

The Consumer Healthcare Products Association "reported spending more on Frankfort lobbying for the month than the next eight largest groups combined," reports Tom Loftus of The Courier-Journal. "That's almost an obscene amount of money to be spending on one month on one issue," said Senate Majority Leader Robert Stivers, R-Manchester. Stivers is sponsoring the bill, which would require a prescription for cold and allergy medicine that contains pseudoephedrine.

The group with the second highest spending was the Kentucky Hospital Association, at $36,120.

CHPA "is a group of manufacturers and distributors of over-the-counter medicines whose members include Bayer Healthcare, GlaxoSmithKline and Johnson & Johnson," Loftus reports. In a statement Monday, the group said it is again "efforts by some legislators to deny law-abiding citizens nonprescription access to certain cold and allergy medicines they depend on."

The $194,957.76 spent on lobbying apparently does not include what the CHPA spent on broadcast advertising, which it does not have to report. As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations, the only ones that have been checked by Kentucky Health News and its journalistic partner, Jonah Engle. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cumulus Broadcasting, another major owner of stations in Kentucky.

As for lobbying expenses, more than $12,000 was spent on salaries for three lobbyists, plus nearly $4,000 for food, lodging, beverage and transportation expenses. More than $150,000 was spent "for professional and technical research and assistance," plus nearly $27,000 for "educational and promotional items."

"I'm not surprised they reported so much for lobbying because it's obvious they're doing a pretty good job of getting their message out ... which I believe is a misleading scare campaign," said Sen. Ray Jones, D-Pikeville, who is co-sponsoring the meds-for-meth bill. (Read more)

Law enforcement and allies getting ducks in row in 2nd bid to pass bill to require a prescription to buy pseudoephedrine

By Tara Kaprowy
Kentucky Health News

With police finding 20 percent more meth labs in Kentucky than a year ago, they and others are again encouraging state legislators to make pseudoephedrine less available by requiring a prescription for it. And the senator who tried that last year says he is talking with his colleagues to see what can pass in the 2012 General Assembly.

Supporters of the bill to quash "meds for meth" met in Laurel County last week, where the incidence of meth labs recently became the state's highest, Bill Estep of the Lexington Herald-Leader reports. They unveiled an educational campaign intended to teach people about the dangers and costs of the deadly drug. Their campaign includes a video produced by the Kentucky State Police, Operation UNITE, the High Intensity Drug Trafficking Areas Program and the Kentucky National Guard.

"They're going to try to show that video as often as they can between now and January across the state to try to get a grassroots effort behind this bill," Estep said on KET's "Comment on Kentucky" Friday night. "They didn't start off early enough last time to get that to happen." Meanwhile, the number of reported meth labs in the state climbed to nearly 1,100 in 2010 and is on track to exceed 1,400 in 2011.

Pseudoephedrine is the key ingredient in manufacturing methamphetamine, which can be made by combining a few ingredients in a pop bottle. Last year, Sen. Tom Jensen, R-London, sponsored a bill to make "pseudo" available only by prescription. Jensen told Kentucky Health News Monday he is planning on introducing a bill in the upcoming session that "deals with pseudoephedrine and how to control that." "The details of that are not ready to be sent out yet," he said. "I'm negotiating with some other members to see if we can get support."

Pseudoephedrine is also a main ingredient in cold and allergy medicine. Opponents say making it a prescription-only medicine is unnecessarily inconvenient and could be costly. In a legislative brief, the Kentucky Chamber of Commerce said the proposed law would drive up insurance premiums for Kentucky employers and the taxpayers' cost of Medicaid. Their estimates show the new law would result in 17,000 more doctor visits per year. The chamber and other opponents are backed by the Consumer Healthcare Products Association, which was the top-spending lobby against Jensen's bill.

Only Oregon and Mississippi have passed laws making pseudoephedrine available only by prescription; both have seen the number of meth labs fall sharply. Mississippi, where a ban took effect in 2010, has seen a 66 percent drop, according to the Mississippi Bureau of Narcotics. Oregon has seen a 96 percent drop in meth labs in the five years since its law passed, said Jackie Steele, commonwealth's attorney for Laurel and Knox counties and a proponent of limiting pseudoephedrine access.

Opponents say the drops in Oregon and Mississippi have led to surges in adjoining states, and Steele said "They're probably correct. But I'm looking out for Laurel and Knox and the Commonwealth of Kentucky. I hope that everybody else gets on board so we don't have to worry about shuffling problems to another county or another state."

Though several individual municipalities in Missouri have made pseudoephedrine available only by prescription, Steele said that is not likely to happen in Kentucky counties since there would be "constitutional issues."

At the meeting in Laurel County last week, Abby Hale, co-director of the Laurel County Department of Public Safety and Emergency Management, said cleanup of a meth lab can cost up to $2,100 just in manpower and disposal, reports Nita Johnson of The Sentinel-Echo in London. If meth labs are inside a home, homeowners have to get the building decontaminated at their own expense, which can cost up to $3,000.

Statewide, Steele said the cost of meth is in the millions because of the expense of corrections; local health departments dealing with skin irritations and rashes; loss of learning time for kids in school; and putting children in foster care. "The Kentucky State Police spent $2 million in meth lab cleanups, not to prosecute them, just to clean the toxic dumps up," Steele said. "So you can see that the cost per year is staggering."

Webinar Wednesday will focus on lobbying, advocacy in Health for a Change series

The Foundation for a Healthy Kentucky will host another webinar this Wednesday as part of its Health for a Change training series. This session will focus on the differences between lobbying and advocacy work done by non-profit organizations. The session will be presented by April Carson, a legislative advisor and counsel at Alliance for Justice.

The free, one-hour webinar starts at 3 p.m. EST. To register, click here.

Another training webinar will be hosted at 3 p.m. Wednesday, Aug. 24 and will focus on communication with policymakers. It will help listeners learn about the basic rules needed to figure out how public policy is made in state, county and local governments and how to become involved in the policy-making process.

The Health for a Change training series is geared to community health coalitions, agencies, businesses, advocacy organizations and individuals looking to improve skills, create community participation and create health changes at the local level. The sessions run until December. (Read more)