Thursday, February 28, 2008

Arizona pols meddling in pediatrics

It's not at all unusual for politicians to consider themselves better stewards of the people's health than the people themselves or the medical providers that people choose to treat their ills. The fact that such meddling isn't unusual doesn't mean you want to encourage it, so I'm passing along an emailed heads-up about two bills being considered today by the Arizona Senate Health Committee that would compromise the privacy of patients and the independence of physicians:

SB 1213 AHCCCS; children; psychiatric medications; information

This is basically the same bill as last year, which we defeated. The bill would require AHCCCS to release an annual report to the legislature and the public containing the following information for all children receiving behavioral health care through the state system including children in the Arizona Long Term Care system and Foster Care and children receiving services through DDD:


The sponsor and the supporters of this bill will testify that they are concerned about the number of children who are receiving multiple medications and this is their way of tracking that information. The problem with that argument is that this information is already tracked by both AHCCCS and DBHS as well as the RBHA's. This information, (without the personally identifying information), is available to the legislature but not the public and should not be made available to the public.


  • The information provided includes personally identifying information (age) as per HIPPAA and therefore would be in violation of Federal and state law.
  • The information would not provide an accurate picture of the treatment plan for the child. The name and dosage of the drug without a diagnosis is useless information. Treatment plans do not consist of drug therapy alone.
  • By making the report public they would be releasing information that, if taken out of context, could be used inaccurately to inflame an already controversial issue thus fueling the further stigmatization that children with mental health disorders and their families have to deal with everyday.
  • Knowing that their child would be included in such a public report could prevent families from seeking needed treatment.
  • Publishing the names of doctors and making them available to the public is wrong for the following reasons:

    • Anyone with a personal agenda or and organization with a national agenda against psychotropic medications would be able to access the names of doctors who are prescribing to young children. This information could be taken out of context and used against the doctors in a public forum.
      Doctor's should not have to defend themselves, to the public, for using evidence based, standard in the industry, medical practices.
    • These doctors treat the medicaid and foster care population. We already have a shortage of pediatric psychiatrists, both state wide and nationally. This type of pubic reporting would prevent doctors from agreeing to treat these very vulnerable populations who have no other options.
    • Primary care physicians and pediatricians who also treat the medicaid population and prescribe psychotropic medications to children would be discouraged from doing so knowing that their names would be published in a publicly accessible report.
    • The state already has a mechanism in place for tracking this information and investigating doctors who may be prescribing inappropriately. The public does not have the knowledge or expertise in these issues and should not become part of this process.

SB 1399 doctors; prescriptions; nonindicated use

This bill would add language to the definition of unprofessional conduct for a licensed medical professional to include the prescribing of medication for "off label" use to anyone under the age of 18 unless that prescription has been confirmed in writing by a consulting physician who must examine the patient and the patient's medical records.

Prescribing of medications for "off label" use (a use other than the FDA approved use) is a common practice among the medical profession. Many drugs are used for purposes they were not originally intended but were later found to be effective treatments for. Such as: Retina A; approved by the FDA as an acne treatment but now also used to correct sun damage and for cosmetic reasons, Beta-blockers for the prevention of migraine headaches and benzodiazepines for the treatment of pain in cancer patients.


1. The bill is too broad

  • The bill does not indicate if the "consulting" physician must be licensed in the same specialty as the original prescribing doctor.
  • Emergency room doctors would also have to comply, which could delay life saving treatment.

2. The bill would create additional expense

  • Requiring a second opinion which includes a physical exam by a second physician would result in additional costs which insurance companies would most likely not cover if the need did not fall under their definition of medical necessity.
  • The state budget for AHCCCS would have to be dramatically increased in order to provide payment to a consulting physician.

3. The bill would create delays in treatment

  • Requiring a second opinion on all off label prescription would delay treatment in a state that is already suffering from a shortage of doctors.
  • Parents would have to take additional time off work to meet the consulting physician requirement.
  • The small towns and rural communities in AZ who often have a shortage of doctors, would be more adversely impacted.
  • Emergency rooms would delay life saving treatment.

4. The Arizona Medical Board already monitors physicians prescribing practices and has rules, as well as punishments for breaking those rules, in place. This additional requirement is not needed.

PLEASE CONTACT THE MEMBERS OF THE SENTATE HEALTH COMMITTEE. (The names with the asterisk before them are especially important.)

* Carolyn Allen, Chairman (Dist 8)
(602) 926-4480

Tom O'Halleran, V. Chairman (1)
(602) 926-5584

* Thayer Verschoor (22)
(602) 926-4136

* Barbara Leff (11)
(602) 926-4486

Meg Burton-Cahill (17)
(602) 926-4124

Amanda Aguirre (24)
(602) 926-4139

* Paula Aboud (28)
(602) 926-5262

If any of these members are your Senator be sure to indicate that you are a constituent in the subject line.

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Blogger Jana said...

Do you really know what evidence based means? It is a euphemism for rubber stamped treatment. It relieves the practitioner from making those difficult and pesky medical judgments. What the hell, a computer could do better.

It is a respectable name for something very un-respectable.

I am surprised to heal a lot of this from a libertarian.

February 28, 2008 9:51 PM  
Blogger Jana said...

Do you really know what evidence based means? It is a euphemism for rubber stamped treatment. It relieves the practitioner from making those difficult and pesky medical judgments. What the hell, a computer could do better.

It is a respectable name for something very un-respectable.

I am surprised to heal a lot of this from a libertarian.

February 28, 2008 9:51 PM  
Blogger J.D. Tuccille said...

And this has to do with letting the government meddle in medicine in what way ... ?

February 29, 2008 7:07 AM  
Blogger J.D. Tuccille said...

Also ...

I don't think that word means what you think it means -- that phrase, anyway.

"Evidence-based" means what it sounds like: that there is a scientific foundation for the use of that practice, rooted in research and data. Evidence may accumulate over time to indicate that previously well-accepted practices are no longer supported by the data, so it's not a guide to the one true way. It is, however, the only logical way to determine what works and what doesn't work. The opposite of "evidence-based" is "fly by the seat of your pants" medical practices, which are a more than a bit chancy, since they're based on nothing concrete.

February 29, 2008 8:32 AM  

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