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this pharmacy- and physician-friendly so that it can be more easily and more widely utilized.” A mandate is also impractical for

physicians and for the system, adds Dr. Schade, who pilot-tested PAT before its launch. “It’s like saying everybody has to

have a lab test because somebody might be sick. Is it more logical that all physicians check every time for the 99 percent of patients who are good, or that the computer, like other states, looks for the 1 percent who are bad? Which one works well, and which is cost effective?” he asked. “And it’s a fact: The system will crash if every- one queries it. It’s not robust enough to handle that volume of traffic, and it makes it expensive.” Nor would transferring oversight

of PAT to the pharmacy board inter- fere with any of DPS’ law enforcement authority, Ms. Dodson says. The board still could provide information to DPS to aid in relevant investigations. But for the most part, “the medical board and the pharmacy are doing that, and we have stepped up and are doing a good job of policing and talk often.” During hearings, TMB Executive

Director Mari Robinson told lawmak- ers that existing laws have enabled the board to prosecute legitimate criminal activity, levying roughly 100 actions over the past two years for nonthera- peutic prescribing. She also cautioned that simply

running a report on the volume of ev- ery physician’s prescribing does not present the whole picture. Physicians working with hospice or terminal can- cer patients, for example, are likely to be higher prescribers. “What we are doing is working, but

we have to continue doing it and try- ing to improve it as best we can,” she said. “We are on to the next genera- tion of how do we make the system work for regulators and for physicians who are trying to do the right thing, which, remember, is 99 percent of the population.” Senator Schwertner called manda-

tory use the wrong path. “Physicians can get into a cycle of continuing to write for prescription drugs and un- knowingly facilitate a bad situation. So we do need checks and balances, and this [PAT] allows us to have that information,” he said. “But we already have tremendous amounts of hurdles and regulations and issues we have to face in our challenge to treat patients as best we can. Education and utiliza- tion are very important. But making it mandatory is not the right path.”

CSR FRUSTRATIONS PERSIST Instead, to encourage use, the Senate health committee report recommends automatically registering physicians and other users in PAT when they re- new their CSR permit. But many physicians remain frus-

trated with the CSR process, pointing to the bureaucratic bungling of earlier red-tape reduction efforts to stream- line the requirements and help avoid care interruptions. In response to persistent backlogs

at DPS, the TMA-backed HB 1803 from last session was supposed to make the process part of physicians’ biennial online medical license re- newal at TMB starting Jan. 1, 2014. TMB made the necessary technologi- cal updates, but DPS has yet to follow through. The agency says programming

changes are under way and has since offered a temporary solution to au- tomatically renew CSR permits at no charge. But physicians seek a long-term

solution that would completely elimi- nate the hassles that have caused some to lose their prescribing authority and hospital privileges. Texas physicians’ ability to prescribe medications hing- es on a valid state CSR, which is also necessary to obtain a prescribing per- mit from DEA. Dr. Schade, speaking on his own

behalf, called the duplicative state process “outdated,” adding many states require only a DEA license to prescribe.

March 2015 TEXAS MEDICINE 41

And the delays at DPS have noth-

ing to do with quality of care, and in- stead impede it, adds Dr. King. “This has nothing to do with determining whether you [physicians] are com- petent to prescribe narcotics. This is because DPS hasn’t cashed your check to pay a fee.” At press time, lawmakers had not

proposed legislation to eliminate the CSR permit. Instead, Senate Bill 196 by Sena-

tor Schwertner seeks to synch CSR renewal for advanced practice regis- tered nurses and physician assistants with their respective license renewal processes, similar to what HB 1803 did for physicians in 2013. n

Amy Lynn Sorrel is associate editor of Texas Medi- cine. You can reach her by phone at (800) 880- 1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at

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