Read the letter concerning SB 2272! - Florida Society of Neurology

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Read the letter concerning SB 2272! - Florida Society of Neurology

Dear FL Neurologist,

Please read this letter as you may need to take immediate actions to ensure that

you are compliant with new Florida State Law.

A new law is going into effect October 1 st , 2010 and it may have great

implications for your practice that will probably surprise you and will force you

to take action and seek legal counsel.

As many of us are aware, there is a “pill mill” problem whereby unscrupulous

practitioners are providing patients with unreasonable amount of narcotics and

benzodiazepenes. The Florida Medical Association (FMA) along with the State

Legislature, helped push through SB 2272 that on the surface seems to protect

patients and prevent unethical practices.

However, this law has the unintended consequence of defining your practice as a

pain management clinic (F.S. 458.3265(1)(a) and F.S. 459.0137(1)(a)) if you:

“advertise in any medium for any type of pain-management services,

or

employ a physician who is primarily engaged in the treatment of pain by prescribing

or dispensing controlled substance medications.”

While some of us fall into the second clause, many (if not a majority) of us choose to

advertise, whether by print, radio, or on the Web (and so forth). This means that if

you even have a bullet point on your website that states that you care for patients

with migraines (or headaches or trigeminal neuralgia or painful neuropathies etc.),

you may be advertising “in any medium” for “any type” of pain-management

services.

This surely seems preposterous to you, but I have spent countless hours discussing

this with attorneys (including the General Counsel of the AAN), FL Attorney General

candidate , legislators, the FL State Surgeon General, the Director of the Division of

Medical Quality Assurance, the FMA, other State Specialty societies and the Board of

Medicine. While everyone (including your Florida Society of Neurology)

recommends that you seek your own legal counsel, it does appear that if you meet

either of the two definitions above (most likely the first), then you are required to


pay $150.00 to register with the State (please visit:

http://www.doh.state.fl.us/mqa/medical/ap_pmcapp.pdf)

According to the Department of Health, the current average time it takes

for registration to go through (if completed in its entirety), is 26 days;

please note that if you practice in a non-registered pain clinic (as defined

above), then you may be subject to disciplinary action by the Board of

Medicine and clinics that are found to be in violation with certain

requirements, may be subject to $5000.00 fines per violation (and if not

fixed, then each fine is daily as well). After registering with the State, your

clinic will undergo inspection (at a cost of $1500.00) to ensure that you

meet all requirements.

In addition, by July 1, 2012, physicians cannot practice “pain” medicine

(currently this includes Headache etc.) unless they have undergone an

ACGME/AOA accredited pain residency or pain fellowship. Currently,

Neurology is not defined as a “pain” residency and even Headache

fellowships are not accredited by the ACGME, but by the UCNS. It is also

unclear from the wording of the law whether there is grandfathering for

those who are already in practice well before 2012.

There are other concerning aspects of the law, such as the lack of due

process: “The department may obtain patient records without patient

authorization or subpoena from any pain-management clinic required to be licensed

….” Each clinic needs to assign a designated physician, and if the clinic’s license is

revoked, then all the physicians in the practice may not be part of another such

clinic for five years. It is a felony of the third-degree to knowingly operate, own or

manage a nonregistered pain-management clinic; it is a misdemeanor of the first

degree to knowingly prescribe a controlled substance in a non-registered painmanagement

clinic. Additionally, controlled substances for the purposes of this law,

include Schedule V medications, such as Lyrica® (Pregablin), which many of us use

to help control forms of neuropathic pain.

Aside from the State Law

You can rest assured that your Florida Society of Neurology (whether you are a

current or future member) is fighting relentlessly to correct the unintended

consequences of this well-meaning law. We are working within the FMA, together

with other State Specialty societies, speaking to legislators, attempting to get the

DOH, Board of Medicine, and Board of Osteopathic Medicine to institute rules that

will avoid the unintended consequences outline above, in order to ensure that you

are protected and that your patients continue to receive excellent care.


In the meantime, the implications of not following this law are grave and because it

has not yet been tried in courts, it is unclear where neurologists fall into it and we

suggest that you seek your own legal counsel.

You are more than welcome to contact me via my work phone (904)834-3007 or by

email: neurologiue@gmail.com.

Sincerely,

Daniel Kantor, MD

President-Elect

Florida Society of Neurology

Medical Director

Neurologique Foundation

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