cialist C.M. Schade, MD, a past presi- dent and current director emeritus for TPS, says the rule changes were neces- sary to negate the arguments pill mills have used to defend their prescribing practices: that the rule presented only guidelines, not requirements, for pain treatment. “The Texas Pain Society is never in
favor of more mandates, but it’s one of the necessary evils when dealing with something that has street value, which narcotics have,” Dr. Schade said. “So it really ups the game because now it says that you ‘must’ do a history, phys- ical exam, diagnosis, treatment plan, and other requirements in the rule. That means that if you don’t, without proper documentation, you’re in viola- tion of a rule.”
CONSIDERING PAT Not all of the rule changes amounted to merely changing a word or two. One new section requires a physician to “consider” reviewing the patient’s prescription data and history through the state’s prescription monitoring da- tabase, Prescription Access in Texas (PAT), before prescribing dangerous drugs or controlled substances. A phy- sician must also consider obtaining a baseline toxicology screen to deter- mine the patient’s drug levels before prescribing controlled substances. How will the board know whether
a physician actually considered those steps? Rather than hook doctors up to a mind-reading machine, TMB re- quires them to prove they considered it by documenting in the medical re- cord why they didn’t review the pa- tient’s prescription data and history or why they didn’t obtain the baseline toxicology screen. “If you are going to be prescribing
chronic pain drugs to somebody, part of what the board believes you should do is check the prescription monitor- ing program or at least consider doing that,” Ms. Robinson said. During the comment period, TMA
expressed concern about the proposed rule language on a couple of fronts.
September 2015 TEXAS MEDICINE 53
PAIN MANAGEMENT “MUSTS”
Newly adopted changes to the Texas Medical Board’s pain management rules turn numerous chronic pain treatment guidelines into minimum requirements. The rules previously provided guidelines for what a physician should include in the medical record to document the rationale for the patient’s treatment plan. Now, the medical record must include:
• Medical history and physical examination; • Diagnostic, therapeutic, and laboratory results; • Evaluations and consultations; • Treatment objectives; • Discussion of risks and benefits; • Informed consent; • Treatments; • Medications prescribed (including date, type, dosage, and quantity);
• Instructions and agreements; and • Periodic reviews.
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