BILL WOULD LOOK CLOSELY AT DOCTORS

RX Records Could Be Compared

FRANKFORT - Doctors who prescribe high volumes of narcotics or work in
communities notorious for pill abuse could face special scrutiny under
proposed legislation that would go before Kentucky lawmakers early next
year.

Yesterday, a task force created by the 2003 General Assembly outlined six
recommendations for legislation aimed at fighting the state's worsening
prescription-drug abuse problem.

Two key measures, if passed by the 2004 legislature, would significantly
expand the current use of the Kentucky All-Schedule Prescription Electronic
Reporting system. The statewide database, called KASPER, keeps track of who
writes and who receives drug prescriptions.

Under the proposals hammered out yesterday, state health officials would
receive wide discretionary powers to seek out -- without being asked by law
enforcement -- possible improper prescribing by doctors. Such prescriptions
are considered a major source of pills for the illegal market.

Since KASPER was created in 1998, the public health department, which runs
the system, has operated under strict rules that demand formal complaints
before any investigations are opened. The system's role in law enforcement
has been largely as a tool for assisting in criminal investigations when
there was already cause to think someone was breaking the law. (Doctors also
use the system to make sure patients aren't seeking the same types of drugs
from various physicians.)

One task force recommendation would require health officials to use KASPER
"proactively" to analyze prescribing data, with an eye toward spotting
doctors and patients engaged in illegal activities before serious problems
surface.

Under the recommendation, officials would also use the data to chart trends
and to pinpoint regional hot spots of pill use.

A second proposal would allow the medical board to expand an investigation
of one doctor to others in the same practice or the same community, without
filing additional complaints or opening separate formal inquiries.

Recently, five doctors in South Shore who had all worked in the same clinic
at one time or another were charged with writing illegal prescriptions. In
at least one case, the Kentucky Board of Medical Licensure didn't open a
case until after an overdose death.

"We don't want to go on a witch hunt, but we'd like to do a little more,"
said Dr. Danny Clark, a Somerset physician who heads the medical board. The
proposals would allow both the board and the state Cabinet for Health
Services to use KASPER more aggressively.

"We want to find those pockets where a number of physicians are prescribing
inappropriately rather than find them one at a time," Clark said.

But the idea of expanding the reach of KASPER and access to its 35 million
personal prescription records wasn't universally cheered.

For example, one proposal would have restricted the system's use rather than
expand it. Mount Vernon defense lawyer Jerry Cox, a member of the task
force, urged a change to make law officers obtain search warrants before
getting KASPER reports on suspects.

"Not all of law enforcement are the intelligent, well-dressed people we have
here," Cox said. He said some officers might improperly seek reports for
political or other motives. His proposal was rejected.

Cox later warned that reopening KASPER legislation in the 2004 session could
backfire. "We run the risk of endangering the whole program by refusing to
institute due process."

Despite such debates, the proposal authorizing greatly expanded use of data
drew little comment.

In support, Dr. Rice Leach, public health commissioner, submitted a paper
that envisioned effectively profiling "high-risk" physicians and patients by
using KASPER to measure the frequency, purchasing methods and drug
combinations associated with improper activities.

Health officials could then refer cases that matched the high-risk
measurements to health regulators or law enforcement for possible
investigation.

House Majority Leader Greg Stumbo, D-Prestonsburg, co-chairman of the task
force, called some of the recommendations "radical," but predicted passage
in part because of the support of doctors. "That's a tremendous benefit," he
said.

The task force is scheduled to make its final report Oct. 1.