Florida Senate - 2015 SENATOR AMENDMENT
Bill No. CS for SB 816
Ì455740"Î455740
LEGISLATIVE ACTION
Senate . House
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Floor: NC/2R .
04/23/2015 10:50 AM .
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Senator Bradley moved the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 85 and 86
4 insert:
5 Section 3. Subsection (3) of section 456.44, Florida
6 Statutes, is amended to read:
7 456.44 Controlled substance prescribing.—
8 (3) STANDARDS OF PRACTICE.—The standards of practice in
9 this section do not supersede the level of care, skill, and
10 treatment recognized in general law related to health care
11 licensure.
12 (a) A complete medical history and a physical examination
13 must be conducted before beginning any treatment and must be
14 documented in the medical record. The exact components of the
15 physical examination shall be left to the judgment of the
16 clinician who is expected to perform a physical examination
17 proportionate to the diagnosis that justifies a treatment. The
18 medical record must, at a minimum, document the nature and
19 intensity of the pain, current and past treatments for pain,
20 underlying or coexisting diseases or conditions, the effect of
21 the pain on physical and psychological function, a review of
22 previous medical records, previous diagnostic studies, and
23 history of alcohol and substance abuse. The medical record shall
24 also document the presence of one or more recognized medical
25 indications for the use of a controlled substance. Each
26 registrant must develop a written plan for assessing each
27 patient’s risk of aberrant drug-related behavior, which may
28 include patient drug testing. Registrants must assess each
29 patient’s risk for aberrant drug-related behavior and monitor
30 that risk on an ongoing basis in accordance with the plan.
31 (b) Each registrant must develop a written individualized
32 treatment plan for each patient. The treatment plan shall state
33 objectives that will be used to determine treatment success,
34 such as pain relief and improved physical and psychosocial
35 function, and shall indicate if any further diagnostic
36 evaluations or other treatments are planned. After treatment
37 begins, the physician shall adjust drug therapy to the
38 individual medical needs of each patient. Other treatment
39 modalities, including a rehabilitation program, shall be
40 considered depending on the etiology of the pain and the extent
41 to which the pain is associated with physical and psychosocial
42 impairment. The interdisciplinary nature of the treatment plan
43 shall be documented.
44 (c) The physician shall discuss the risks and benefits of
45 the use of controlled substances, including the risks of abuse
46 and addiction, as well as physical dependence and its
47 consequences, with the patient, persons designated by the
48 patient, or the patient’s surrogate or guardian if the patient
49 is incompetent. The physician shall use a written controlled
50 substance agreement between the physician and the patient
51 outlining the patient’s responsibilities, including, but not
52 limited to:
53 1. Number and frequency of controlled substance
54 prescriptions and refills.
55 2. Patient compliance and reasons for which drug therapy
56 may be discontinued, such as a violation of the agreement.
57 3. An agreement that controlled substances for the
58 treatment of chronic nonmalignant pain shall be prescribed by a
59 single treating physician unless otherwise authorized by the
60 treating physician and documented in the medical record.
61 (d) The patient shall be seen by the physician at regular
62 intervals, not to exceed 3 months, to assess the efficacy of
63 treatment, ensure that controlled substance therapy remains
64 indicated, evaluate the patient’s progress toward treatment
65 objectives, consider adverse drug effects, and review the
66 etiology of the pain. Continuation or modification of therapy
67 shall depend on the physician’s evaluation of the patient’s
68 progress. If treatment goals are not being achieved, despite
69 medication adjustments, the physician shall reevaluate the
70 appropriateness of continued treatment. The physician shall
71 monitor patient compliance in medication usage, related
72 treatment plans, controlled substance agreements, and
73 indications of substance abuse or diversion at a minimum of 3
74 month intervals.
75 (e) The physician shall refer the patient as necessary for
76 additional evaluation and treatment in order to achieve
77 treatment objectives. Special attention shall be given to those
78 patients who are at risk for misusing their medications and
79 those whose living arrangements pose a risk for medication
80 misuse or diversion. The management of pain in patients with a
81 history of substance abuse or with a comorbid psychiatric
82 disorder requires extra care, monitoring, and documentation and
83 requires consultation with or referral to an addiction medicine
84 specialist or psychiatrist.
85 (f) A physician registered under this section must maintain
86 accurate, current, and complete records that are accessible and
87 readily available for review and comply with the requirements of
88 this section, the applicable practice act, and applicable board
89 rules. The medical records must include, but are not limited to:
90 1. The complete medical history and a physical examination,
91 including history of drug abuse or dependence.
92 2. Diagnostic, therapeutic, and laboratory results.
93 3. Evaluations and consultations.
94 4. Treatment objectives.
95 5. Discussion of risks and benefits.
96 6. Treatments.
97 7. Medications, including date, type, dosage, and quantity
98 prescribed.
99 8. Instructions and agreements.
100 9. Periodic reviews.
101 10. Results of any drug testing.
102 11. A photocopy of the patient’s government-issued photo
103 identification.
104 12. If a written prescription for a controlled substance is
105 given to the patient, a duplicate of the prescription.
106 13. The physician’s full name presented in a legible
107 manner.
108 (g) Patients with signs or symptoms of substance abuse
109 shall be immediately referred to a board-certified pain
110 management physician, an addiction medicine specialist, or a
111 mental health addiction facility as it pertains to drug abuse or
112 addiction unless the physician is board-certified or board
113 eligible in pain management. Throughout the period of time
114 before receiving the consultant’s report, a prescribing
115 physician shall clearly and completely document medical
116 justification for continued treatment with controlled substances
117 and those steps taken to ensure medically appropriate use of
118 controlled substances by the patient. Upon receipt of the
119 consultant’s written report, the prescribing physician shall
120 incorporate the consultant’s recommendations for continuing,
121 modifying, or discontinuing controlled substance therapy. The
122 resulting changes in treatment shall be specifically documented
123 in the patient’s medical record. Evidence or behavioral
124 indications of diversion shall be followed by discontinuation of
125 controlled substance therapy, and the patient shall be
126 discharged, and all results of testing and actions taken by the
127 physician shall be documented in the patient’s medical record.
128
129 This subsection does not apply to a board-eligible or board
130 certified anesthesiologist, physiatrist, rheumatologist, or
131 neurologist, or to a board-certified physician who has surgical
132 privileges at a hospital or ambulatory surgery center and
133 primarily provides surgical services. This subsection does not
134 apply to a board-eligible or board-certified medical specialist
135 who has also completed a fellowship in pain medicine approved by
136 the Accreditation Council for Graduate Medical Education or the
137 American Osteopathic Association, or who is board eligible or
138 board certified in pain medicine by the American Board of Pain
139 Medicine or a board approved by the American Board of Medical
140 Specialties or the American Osteopathic Association and performs
141 interventional pain procedures of the type routinely billed
142 using surgical codes. This subsection does not apply to a
143 physician who prescribes medically necessary controlled
144 substances for a patient during an inpatient stay in a hospital
145 licensed under chapter 395 or for a resident in a facility
146 licensed under part II of chapter 400.
147
148 ================= T I T L E A M E N D M E N T ================
149 And the title is amended as follows:
150 Delete line 15
151 and insert:
152 the review; amending s. 456.44, F.S.; revising the
153 application of provisions specifying requirements for
154 standards of practice for certain controlled substance
155 prescribing; providing an effective date.