“What the board is doing right now is cutting off drug dealers’ sources of income.”
.tmb.state.tx.us/professionals/physi cians/licensed/PMClinicRegistration Form01-13-11.pdf to fill out the form. At press time, processing for certifica- tion was typically two weeks after TMB receives the form.
affecting Texas. We’ll always have ad- dicts, but as physicians, we want to treat them, not enable them,” he said.
Law provides balance Dr. Schade testified for TMA in 2009 in support of Senate Bill 911 by Sen. Tommy Williams (R-The Woodlands). The law, which took effect Sept. 1, 2010, directs TMB to adopt rules to ensure quality of patient care and to establish personnel requirements at pain manage- ment clinics. The regulations require the owner of
a pain management clinic to be a phy- sician practicing in Texas with an unre- stricted license who is on site at least 33 percent of the clinic’s operating hours and to review at least 33 percent of the patient files, including files belonging to a clinic employee or contractor autho- rized to care for patients. In addition, the clinic owner must not have been dis- ciplined for inappropriately prescribing, dispensing, administering, supplying, or selling a controlled substance.
Cris Schade, MD, PhD
Senator Wil - liams says acciden- tal poisoning from prescription drugs continues to rise in all parts of Tex- as, with the state’s pharmacies report- ing a 24-percent increase in sales of hydrocodone for the first nine
42 TEXAS MEDICINE July 2011
months of 2010 compared with the same period in 2009. “The misuse of prescription drugs pres- ents enormous costs to Texas since most overdose cases are presented through emergency rooms. Treating physicians first must determine what patients have taken, increasing the cost of treatment. Many of these cases end up in the ICU covered by taxpayers through Medicare, Medicaid, or other government pro- grams,” Senator Williams said. Dr. Schade says SB 911 responded to
a need for a balance between access to quality pain medicine care and prevent- ing narcotic diversion. Before SB 911, TMB had no rules on ownership and op- eration of pain management clinics. “The action taken by TMB under the new law has been very positive. The board is doing an excellent job, and the law is working as we’d envisioned,” he said.
The law applies only to clinics that
issue prescriptions for opioids, benzodi- azepines, barbiturates, or carisoprodol monthly for at least 50 percent of their patients. Suboxone isn’t included. Medi- cal and dental schools, hospitals, hospic- es, and some other entities aren’t subject to regulations. (See “Pain Management Clinic Certification Facts,” page 43.) Dr. Schade says that exemption is es-
sential for surgeons and oncologists, for example, who prescribe controlled sub- stances and pain medicine to many, if not all, of their patients. To register a pain clinic, visit www
Board exercises authority The most severe penalty TMB can levy against a physician for violating pain management clinic rules is revocation of a medical license. At press time, TMB had not revoked any licenses, but Ms. Robinson said it was seeking revocation of licenses for some physicians with tem- porarily suspended licenses. Leigh Hopper, TMB public informa- tion officer, says the board cannot com- ment on revocation cases while they’re in progress. She adds that to perma- nently remove a physician from practice, TMB must either file the case with the State Office of Administrative Hearings (SOAH), or the licensee must sign an agreed order of surrender of the license. In addition to disciplining physicians for violations related to pain manage- ment clinics, the board disciplines physi- cians for nontherapeutic prescribing vio- lations. To date, Ms. Robinson says one physician has surrendered her license because of such a violation. On Feb. 18, a disciplinary panel of
the board temporarily suspended, with- out notice, the medical license of Annie Christine Z. Walker, MD, of Forney. The panel found Dr. Walker inappropriately prescribed controlled substances to seven patients, including one who died from an overdose Jan. 1. Dr. Walker ac- knowledged that she had no medical records for any of the seven patients, ac- cording to TMB. In addition, the board says Dr. Walker
admitted prescribing to her daughter, son-in-law, and grandson, and kept no medical records for them. Dr. Walker, 88, who cannot walk unassisted, saw pa- tients in her home, where she kept pre- scription pads unsecured and charged patients $20 per prescription, according to TMB.
She voluntarily surrendered her li- cense April 8. Ms. Robinson says complaints are the primary way TMB becomes aware of po-
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