Online Access to Prescription Medication History

I saw a headline this morning that the California attorney general is moving to provide instant access to a patient's prescription history for doctors and pharmacists (regulatory boards and law enforcement organizations currently have ready access to this info).  

State Atty. Gen. Jerry Brown unveiled a plan Wednesday to provide doctors and pharmacists with almost instant Internet

 access to patient prescription drug histories to help prevent so-called doctor shopping and other abuses of pharmaceuticals.

Brown told a Los Angeles news conference that the state's prescription monitoring is a "horse-and-buggy" system that needs significant improvements because it now can take healthcare professionals weeks to obtain information on drug use by patients. That delay can allow some patients to get large quantities of drugs from multiple doctors for personal use or sale.

"If California puts this on real-time access, it will give doctors and pharmacies the technology they need to fight prescription drug abuse, which is burdening our healthcare system," Brown said.

The database, known as the Controlled Substance Utilization Review and Evaluation System, contains 86 million entries for prescription drugs dispensed in California.

I have mixed feelings about this issue.  Maryland passed a similar bill this past session to study such a program.  There is a very serious problem with abuse and diversion of controlled medications, such as Percocet, OxyContin, Lortab, and Xanax.  It is indeed very easy to get scripts from duped physicians and nurse practitioners and PAs, get it filled, and then sell it on the street for a 1000-5000% profit.  We need methods to control this.

The flip side is the risk of privacy violation.  Patients could have their privacy breached.  So, how much are we as a society willing to give up to combat this problem?

My suggestion:  Build in banking-level protections, provide patients access to their own histories, provide patients the ability to permit or deny access on an individual basis (so that they have control over access), and permit patients to see who has accessed their records.  Also, provide protections to prescribers and pharmacists which allow them to not prescribe or fill a medication if the patient refuses access to their history.

This provides a greater amount of control over access to personal info, while still providing the ability of prescribers and pharmacists to exercise careful judgment about the medications they write or fill.

I'm not totally sold on this solution, but it does seem to be a better compromise than the big brother approach.  I'd like to hear your thoughts on this difficult problem.  Please add your comment below.

Community in Uproar After California Psychiatrist Fired

This is an interesting story, not because of the controversy of a psychiatrist being fired and the poor communication about her replacement, but because of the way the community has had so much involvement in the discourse about the whole thing, by way of the Comments section of the local newspaper's online version.

Where? SCHC, Redding, California, in Shasta County. Here's the first few paragraphs from the May 2 story in the Record Searchlight:

A Redding health clinic that serves mostly low-income residents has fired one of its two psychiatrists, leaving hundreds of her patients scrambling to find other care.

The Shasta Community Health Center terminated the contract of clinical psychiatrist Lynne Pappas on Friday, Chief Executive Officer Dean Germano said. A former Shasta County psychiatrist, Pappas had been with the clinic for about four years.

Neither Pappas nor Germano would say what led to her dismissal, but patients said they were told by clinic employees that Pappas had been escorted from the building several weeks ago and suspended after an argument with her supervisor, medical director Dr. Ann Murphy. Murphy did not return a call Tuesday seeking comment.

“It’s an employment matter and the only thing I can say is it was just not working out,” Germano said Monday. “I will say Dr. Pappas in my judgment is a fine physician. It has nothing to do with her competency or care of patients.”

What follows the story is more than 60 comments from the community, mostly skeptical about the reason for the firing, suggesting politics or unwillingness of the departing doctor to cut corners.

You should go read some of the comments; it's really quite an outpouring of support for Dr. Pappas and concern for their family member's follow-up care.

California is currently going thru an evolution in forensic mental health care after a recent court order and prisoner class action lawsuits have required the prisons there to increase the wages paid to forensic mental health providers in order to encourage them to take these jobs. As a result, salaries for psychiatrists in West Coast correctional settings have gone through the roof. This has caused some docs working in community clinics and hospitals to play a Go To Jail card, taking up some of these new positions, which had previously gone unfilled. This is resulting in more difficulties in finding psychiatrists and other mental health professionals to fill community positions, resulting in higher salaries being offered, and breaking county and state budgets.

Lawyers for mentally ill prisoners will ask a federal judge today [Apr 23] to force the state to take drastic action to stem a staff exodus from California's mental hospitals that has jeopardized patient safety and left psychotic inmates to languish in jails and prisons without proper treatment. U.S. District Judge Lawrence K. Karlton in February ordered the state Department of Mental Health to formulate a plan to reverse a staff exodus from the state's beleaguered hospitals in recent months. The staff departures occurred after the same court had ordered raises for prison mental health staff that made prison jobs more attractive than those at hospitals. ... "The plan … is akin to placing a Band-Aid over a gaping hole in an almost empty bucket of water, while doing nothing to refill the lost water," lawyers for the prisoners wrote, calling the approach a "wait, see, and hope for a miracle" strategy that "is reckless and must be immediately addressed by this court."

It doesn't sound like this current firing has much to do with these dynamics, but it is important to understand the occupational landscape in CA.

Back in Shasta County, a second newspaper article triggered additional community support and dismay...

Kathryn Ranken, a private therapist in Redding who sees some of Pappas' clients, said it was "unethical" for the clinic to dismiss Pappas without having a plan in place for treating her hundreds of ailing patients.

...followed by yet a third article yesterday...

Pappas wasn't hit by a meteor; she apparently was suspended a few weeks ago after an argument with the clinic's medical director, and she was fired Friday. That left time to make the best of what was bound to be a rocky transition, yet this week the clinic's managers and Shasta County Mental Health were still figuring out how to handle referrals of Pappas' patients.

And we're not talking about just a few people. Pappas and the health center's one other psychiatrist had more than 2,000 patients...

Sounds like Clink's caseload.

It's just really good to see the paper, and reporter Tim Hearden, use Tim's blog as a way of holding a kind of virtual town hall meeting to help resolve this crisis in the community's ability to meet the mental health needs of its members.

(And... this really is Roy... I know the topic sounds real Clinkshrinky.)