POLITICS CRIPPLES A CRIME FIGHTER

Budget Snafu Slows Prescription-Abuse Tracking System

FRANKFORT - Political haggling in Frankfort has crippled a plan to beef up
one of Kentucky's chief tools for fighting prescription-drug abuse.

Lawmakers, who return today to try to craft a state budget after more than
a year of gridlock, will be asked again to pay for improving a system that
collects information on every controlled-substance prescription filled in
Kentucky.

The $1.5 million request would buy and support new computer equipment to
speed up the system -- and perhaps give state officials faster warning of
widely abused drugs.

That kind of capability might have tipped off state officials to widespread
abuse of the painkiller OxyContin before it was linked to dozens of
overdose deaths in Eastern Kentucky.

Federal data show that more prescription drugs per capita flow into parts
of Eastern Kentucky than anywhere else in the nation. And the state's
prescription-tracking system, nicknamed KASPER, has been buried under
requests for information from doctors, pharmacists and law-enforcement
agencies as they try to identify possible drug abuse.

As a result, the agency that operates KASPER has too little time, staffing
and computer power to analyze the data for prescribing patterns that might
spell trouble -- rapid increases in certain drugs, for instance, or unusual
volumes of prescriptions in certain counties.

"We're getting a lot of criticism that we are reactive, not proactive,"
said Danna Droz, who supervises KASPER.

Upgrade In Limbo

The Kentucky All-Schedule Prescription Electronic Reporting system is one
of 18 such state systems nationwide, and it's considered a national model.

Gov. Paul Patton's original budget last year would have made it better
still, by upgrading its hardware and related items used by the Department
for Public Health to run the database, which contains 32 million files.

In 2002, lawmakers switched the proposed financing from cash to bonds, but
then failed to pass any budget -- effectively freezing the effort. The
governor has power to spend money, but not to issue debt.

The plan is now in financial limbo until there's a formal budget -- far
from a certainty in the session that begins today.

"While we're playing games, drug abuse is continuing to rise," said state
Rep. Jack L. Coleman Jr., D-Burgin, who sponsored the original bill
creating KASPER.

"We've got a huge problem and people are madder than hell about it," he
said. "I'm hoping the leadership in both houses will get this in."

That might not happen, said Sen. Tom Buford, R-Nicholasville, vice chairman
of the Senate Health and Welfare committee.

Buford said he doesn't doubt the merit of the plan to pay for $1 million
worth of equipment and its upkeep, but he added, "let's look at it in
another year or two. Not now."

Unless, he quipped, state bureaucrats can "find 14.28 principal assistants
to lay off at $72,000 each." Republican leaders have criticized the number
of such appointees on state payrolls.

The Need For Speed

Doctors and pharmacists use KASPER to see whether patients are getting
prescriptions from too many sources or too frequently. Law enforcement
officers use it to investigate such patients, or doctors and druggists
suspected of distributing pills improperly.

The immediate impact of the plan to improve the system's hardware would be
to shorten the response time for such queries. Currently, five state
employees work full time fielding and answering an average of 450 requests
a day, mostly on paper. The average reply takes four hours.

The added computer power would make that process entirely electronic, and
cut the time to minutes.

At least three employees freed from routine paperwork could then turn their
attention to analyzing data in KASPER, said Droz, the manager of the Drug
Enforcement and Professional Practices Branch of the state health department.

They could produce statistical reports to alert doctors and law officers to
the rising use of certain pills or abnormal regional patterns of prescriptions.

Under state law, such analyses could not be aimed at identifying
individuals. When KASPER was created, Droz said, lawmakers took pains to
protect patients' privacy by limiting its use. Doctors and druggists can
look only into their own clients. Law officers who use the system must be
working on specific cases -- and must have a good reason to examine
individual records.

The only other legal users are grand juries, courts, Medicaid officials and
professional licensing agencies such as the state physician-licensing
board. Disclosing KASPER records to unauthorized people is a felony.

Nobody can use KASPER to "fish" for individual lawbreakers. But that might
not prevent officials using it to find highly prescribed drugs or identify
cities or counties that have high rates of prescriptions, Droz said.

"Maybe we could have seen the rise in OxyContin use" and warned doctors
before abuse of that drug became epidemic, she said.

Such work might require a policy change. Droz's boss, Dr. Rice Leach,
acknowledged that KASPER could probably help focus enforcement efforts on
drug "hot spots" without invading patients' privacy -- an effort he
compared to mapping leaky septic tanks or abandoned coal mines.

But "the question is whether we want to," said Leach, head of the state
Department for Public Health. He called for a "public discussion" on the
question.

Possibilities And Privacy

The idea of souping up KASPER is gathering support.

"There's no question that all of us would like to see it stronger" --
specifically faster, said Attorney General Ben Chandler in an interview
last fall. Chandler, now a Democratic candidate for governor, led the 1997
task force that proposed the system.

House Majority Leader Gregory Stumbo, D-Prestonsburg, sees KASPER as "the
way we strike at the heart of the drug problem. We should use it to the
fullest advantage possible."

Stumbo, a Democratic candidate for attorney general, said he wants to
compel doctors and pharmacists to use KASPER regularly to screen patients
and customers. Use is currently optional. He added that he hopes the
current session will produce a budget, and that it will include money for
KASPER.

Dr. Emery Wilson, dean of the University of Kentucky medical school and a
member of the Kentucky Board of Medical Licensure, said KASPER should be
made even more vigilant.

He proposes software that would constantly survey the database and
automatically "identify people who are out of bounds" in terms of
prescriptions used, written or delivered. At that point, investigators
would check whether the prescriptions were justified.

He conceded that a new law would be needed to achieve that level of
scrutiny. Such a proposal would almost certainly trigger opposition on the
grounds of patient privacy.

But Wilson called drug abuse "a new disease, if you will, that many
physicians aren't prepared to tackle."