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A panel of doctors met for the first time last week with a single mandate: Decide how to punish physicians who prescribe too many opioids.
This was a sticking point in Gov. Bill Haslam's opioid plan — dubbed TN Together — approved by the legislature this year. The new policy restricts how long doctors can prescribe opioids, but the Tennessee Dept. of Health and the Tennessee Medical Assocation couldn't agree on what should happen to doctors who violate the law.
Most patients are now restricted to a three-day prescription of opioids. Physicians can go to 10 days if they complete a little more paperwork. For patients who've just had surgery, the limit is 20 days. And there is still a way to give a 30-day prescription, but only with a written justification that could be questioned by state regulators.
Balancing The Punishment
The health department wanted a minimum five-year ban on prescribing opioids for anyone found in "significant deviation" of "sound medical judgment" — terminology that is not clearly defined in the law.
Physicians, nurse practitioners and physician assistants don't want such a tough punishment for first offenses. They say a five-year prescribing ban has been among the harshest penalties used in the past.
"I think the concern would be somebody who maybe a complaint was filed [against them] and they [were] ignorant of the rules, a certain situation where they've been treating a patient for a number of years," said Dr. John Hale, a family physician from Union City. "We don't want to throw the baby out with the bath water."
Hale was named to a task force that grew out out of a negotiation between the health department and the Tennessee Medical Association. The panel, which met for the first time last Wednesday, has a singular duty in establishing the minimum penalties for practitioners who overprescribe under Tennessee's new guidelines.
"We want to be appropriately regulatory, but we don't want to be inappropriately heavy-handed," said task force member Michael Wieting, a professor of osteopathic medicine at Lincoln Memorial University in Harrogate, Tennessee.
Time-Limited Action
In a letter, doctors say they oppose any "uniform minium disciplinary action" and prefer to allow the boards that oversee physicians or nurse practitioners to determine punishment on a "case-by-case" basis.
"It sets a bad prescedent and represents a complete distrust of the licensing boards," writes Yarnell Beatty, TMA's vice president and general counsel.
Groups representing those medical professions — led by the Tennessee Medical Association — have charted out a much more lenient system: A first offense would only restrict prescribing privleges until the doctor completed a continuing education course on opioids. A five-year ban would only come after a third offense.
But the tiered system will also take longer to work out the details. If this task force fails to agree on a system by April, the five-year ban would become the state's minimum penalty — even for a first offense.
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