Call to Order and Roll Call
The 5th meeting of the Interim Joint Committee on Licensing and Occupations was held on Friday, October 14, 2011, at 10:00 AM, in Room 129 of the Capitol Annex. Representative Dennis Keene, Chair, called the meeting to order, and the secretary called the roll.
Present were:
Members: Senator John Schickel, Co-Chair; Representative Dennis Keene, Co-Chair; Senators Tom Buford, Denise Harper Angel, Jimmy Higdon, Paul Hornback, Dan "Malano" Seum, Kathy W. Stein, Damon Thayer, and Robin L. Webb; Representatives Tom Burch, David Floyd, Dennis Horlander, Wade Hurt, Reginald Meeks, Charles Miller, Michael J. Nemes, Darryl T. Owens, Ruth Ann Palumbo, Carl Rollins II, Arnold Simpson, and Susan Westrom.
Guests: Van Ingram, Executive Director, Kentucky Office of Drug Control Policy; Mary R. Begley, Inspector General, Cabinet for Health & Family Services; Tom Martin, Lexington Area Music Alliance; William Swope, Jr., State Fire Marshal; Sergeant Clayton Roberts, Lexington Fayette Urban County Police Department, Assistant Chief David Mattingly, Lexington Fayette Urban County Fire Department; Vito Casullo, III and Jennifer Jean Casullo, Vito's Fireworks.
LRC Staff: Tom Hewlett, Bryce Amburgey, Carrie Klaber, Michel Sanderson, and Susan Cunningham.
Licensing of Pain Control Clinics
Van Ingram, Executive Director of the Kentucky Office of Drug Control Policy, said prescription drug abuse in Kentucky is a significant problem. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) survey, approximately 6.5 percent of Kentuckians have used prescription drugs non-medically in the past year. The demographic shows that 16.1 percent of 18 to 25 year olds have used prescription drugs for non-medical purposes. Kentucky is number three in the nation with 8 percent of Kentuckians using Xanax or Valium non-medically; the average is 6.4 percent nationally.
In even-numbered years, Kentucky has a Kentucky Incentives Prevention (KIP) survey with eighth, tenth, and twelfth grade students, to understand their attitudes toward drug use. Due to public education and schools increasing awareness about the risks of prescription drug abuse, numbers of students using prescription drugs for non-medical purposes has gone down from 3.1 percent to 2.4 percent. While there have been decreases state-wide in non-medical prescription drug use, there are areas where there have been increases in drug use among high school Sophomores. In eastern Kentucky where drug use is more widely known the percentage is trending down. This is attributed to work done with Operation UNITE and other anti-drug coalitions in eastern Kentucky. Oxycontin use by tenth graders is continuing to trend down; however, in the Barren River and Kentuckiana areas, the numbers are increasing.
One of the most significant issues to be resolved is the rise in deaths from drug overdose. In 2010, according the Kentucky Medical Examiners report, there were 674 overdose deaths in the Commonwealth, of which 546 were ruled accidental overdose. Multiple drug toxicity, typically mixing Xanax and Oxycodone in combination with alcohol and marijuana, is often found in the blood stream of overdose victims. Hospitalizations and emergency room visits due to drug overdoses have also been on the rise since 2008.
The Kentucky All Schedule Prescription Electronic Reporting (KASPER), a prescription monitoring program, is one of the most effective tools the General Assembly has provided. It was not designed to prevent prescribers from doing their job, or to reduce the amount of prescriptions written. Instead, the system was developed as a means of identifying opiate addiction in patients. Law enforcement is able to identify people diverting drugs as well as drugs being over-prescribed. Ninety-three percent of reports run are by prescribers, with only four percent run by law enforcement. Fears of privacy abuse have not been founded. In 2005, the system was updated to "enhanced" eKASPER, giving reports in real time. Prescriptions are entered into the system every 24 hours. The most prescribed drug in the system is Hydrocodone. There is a large disparity between the number and location of doctors writing prescriptions for controlled substances and the patients using controlled substance prescriptions. Most prescriptions are written in Louisville, central Kentucky, and northern Kentucky. Most of the patients filling those prescriptions live in southeastern and eastern Kentucky.
When the General Assembly addressed the problem of internet pharmacies in 2007, a large number of pain clinics opened in Florida, and large numbers of people started traveling from Kentucky to that state. In 2008, 12.6 million oxycodone pills were dispensed from three south Florida counties. In 2010, more oxycodone was dispensed in Florida than in all other states combined. In 2009 Florida passed the Prescription Monitoring Plan (PMP) and through efforts from the Florida Office of Drug Policy, they have obtained funds to have the program operational in the near future. This past year Florida put in place tighter restrictions on who can own and operate a pain clinic there. This has caused a reduction in prescriptions written for oxycodone and pain clinics are closing.
Strategies for controlling pain clinics and prescription abuse that have worked for other states include requiring prescription monitoring accounts for all prescribers. Of the 8,000 prescribers in Kentucky, approximately 23 percent have a KASPER account. Additionally, pain clinics should be defined by statute and licensed so the state knows who and where they are. There should also be a certain level of expertise required to operate a pain clinic, with required continuing education in the field. Regulations should require that pain clinics be physician-owned by a board certified physician. Additionally, if a physician has had a license suspended or revoked for abuse in another state, the physician should be denied a license to operate a pain clinic in Kentucky.
The University of Kentucky, College of Pharmacy, has performed a study on the KASPER system to recommend making the program better. Recommendations included having all pharmacies report data within 24 hours, require all controlled substance prescribers to have a KASPER account, and change language in statutes to allow KASPER to send a letter to prescribers when a patient has been identified as using multiple physicians for the same drug, allowing physicians to change their treatment plan for that patient. Governor Beshear created the Prescription Advisory Council to recommend guidelines to determine irregular prescribing habits through KASPER. These guidelines will better enable KASPER administrators to identify unusual prescribing habits and report them to the KBML or the appropriate medical licensure board for review.
In response to a question from Representative Floyd, Mr. Ingram said his office fully supported legislation that was introduced in the 2011 session, adding that physician owned pain clinics reduce the ability for prescription abuse. In response to a question from Senator Schickel, Mr. Ingram responded there are two possibilities to regulate prescription drug abuse: license and regulate pain clinics through the Board of Medical Licensure, or allow the Cabinet for Health and Family Services to write Administrative Regulations to deal solely with pain management clinics. Senator Higdon commended Mr. Ingram on his work and told the committee that he has pre-filed a bill for the 2012 Regular Session.
In response to a question from Senator Stein, Mr. Ingram said there is a threshold that drugs must meet in order to show on a KASPER report. He added that the cost benefit ratio for the purchase of pseudoephedrine versus buying methamphetamine would prohibit pseudoephedrine from entering the market in illegitimate ways. Senator Buford commented that any new legislation should require any physician with a DEA license to register with KASPER. Mr. Ingram responded that pharmacy's report to KASPER adding that it was doubtful a physician looks at KASPER reports before prescribing to a patient. In response to a question from Representative Westrom, Mr. Ingram said Senator Hal Rogers is working with VA Hospitals to require them to report to the states' prescription monitoring program. In response to a question from Senator Seum, Mr. Ingram said that ideally, if a pain clinic is not owned by a physician, it should be owned by a hospital, hospice, or other health-related entity. A group of general investors would be prohibited from owning a pain management clinic.
Mary R. Begley, Inspector General, Cabinet for Health and Family Services told the committee that KASPER provides valuable information to prescribers, dispensers, the judiciary system, and law enforcement. There is great concern about the abuse of controlled substances. There are individuals in the Commonwealth that have legitimate pain who are entitled to and need a controlled substance to get by on a day-to-day basis, or during an acute episode. KASPER allows the cabinet to team up with the Kentucky Board of Medical Licensure (KBML) to share information when complaints are received. This has led to closing pain clinics that do not follow evidence-based practice relative to prescribing pain control medication or controlled substances, thus saving lives. Currently, the Office of Inspector General's licensure regulation for special health clinics, adopted in 1988, is the regulatory standard utilized for pain clinics.
The Office of Inspector General encourages citizens to report illegal pain clinics or what is perceived as being an illegal prescribing habit to the office of Inspector General or the KBML. Recently staff produced a reporting form that has been distributed to the Kentucky League of Cities in response to their concern about entrepreneurs coming into the state to set up a pain clinic, or a physician operating outside of his practice. There is an on-line form, and a complaint can be registered anonymously. There is also a hot-line: 1-800-372-2973. When a community is struggling with a facility they can send complaints to the office for investigation and appropriate action. The office looks forward to working with the General Assembly as this issue moves forward.
House Bill 263, AN ACT relating to musical performances, 2011 RS
Representative Ruth Ann Palumbo told the committee that HB 263 was about jobs. The bill would have helped promote young, talented, musician entrepreneurs. The bill was about providing an opportunity for those who will be future teachers, doctors, and business professionals. It would have created entertainment destinations. Most local acts are only together during the time that they are in college, before the age of 21. The mix of young people is wide and varied and they need jobs.
Tom Martin, with the Lexington Area Music Alliance, told committee members that the legislation was about a segment of young people who are being stymied in the development of their profession. They need the opportunity to be exposed to as many aspects of operating a band in a working venue as possible. This is very similar to lessons learned in developing a small business. Participating in a band teaches development of a product, learning marketing, and interaction with the management of venues. Learning how to develop and maintain a fan base is critical to the experience. Developing and maintaining partnerships with venues is an important lesson learned during this experience. Bands are expected to deliver a quality product for which they may be paid. Finance and maintaining band equipment, which is expensive, is a lesson as well. Learning the inner dynamics of negotiations is a key part to a successful band. Discipline, being on time, and living up to obligations and promises made also come with the experience of being in a band.
The Lexington Area Music Alliance is an organization that represents the interests of anyone in the central Kentucky area with a stake in the performance or the production of live music. Currently, artists are being held back due to statutes that do not allow for someone under the age of 21 to be in a venue where alcohol is sold, unless it is a restaurant with sales revenue of at least fifty percent in food service. The experience of being on a live stage, in front of a sound system, lights and, more importantly, before an audience are valuable lessons.
In response to a question from Senator Higdon, Mr. Martin said, with some restrictions, changing the age to 18 would ease the situation for musicians to perform in most venues. In response to a question from Senator Schickel, Mr. Martin said, speaking for Lexington, there are some restaurants that also provide live music but for the most part live music venues derive the majority of their revenue from alcohol sales. In response to a question from Senator Buford, Mr. Martin said there could be a restriction added saying that the musician would be limited to a specific area and require the underage musician wear a bracelet for easy identification. Senator Stein commented that this legislation was about jobs and economic development and was especially needed in the new distillery district in Lexington. Representative Palumbo commented that all suggestions for the legislation were welcome. Senator Webb commented that an identifier was definitely necessary to protect proprietors, and should be required in statute. In response to a question from Representative Westrom, Mr. Martin said his group is working with the Office of Alcohol Beverage Control.
Update on House Bill 333, AN ACT relating to fireworks and making an appropriation therefor, 2011 RS
William Swope, Jr., State Fire Marshal, said there were significant changes to fireworks legislation in the 2011 Regular Session. Specifically, legislation changed when fireworks can be sold, and who is able to sell fireworks. The biggest change was in the types of fireworks that could be sold. Kentucky chose to allow the sale of all consumer fireworks. This saw an increase in the number of registrations to sell fireworks from approximately 400 vendors to 674 for the year. There is an anticipation that next year the number will decrease due to local governments enacting ordinances to reduce sales and use within their own jurisdiction. Some local governments are considering additional permits and fees to purchase and operate fireworks. There were no additional fireworks-related injuries or fires. However, local police received more loud noise or nuisance calls. The Department of Housing, Buildings, and Construction is drafting new administrative regulations regarding "display operators," or those who perform professional shows.
Sergeant Clayton Roberts, Lexington Fayette Urban County Police Department, said that nuisance calls during the two-week period around the Fourth of July were up from 200 last year to 700 calls this year.
Assistant Chief David Mattingly, Lexington Fayette Urban County Fire Department, said there was not a significant increase in fires this year. This year had been good for rainfall; however, in the future, in a drought year, there could potentially be problems with grass or mulch fires. Typically, injuries are minor and do not require medical assistance. Therefore, there is little record of increased injuries. There was an increase in seasonal sellers.
In response to a question from Representative Keene, Fire Marshal Swope said his office has not recorded any type of revenue increase. Jennifer Jean Casullo stated that her business has paid approximately $6,000 in sales tax, up $2,000 from last year. In response to a question from Representative Palumbo, Sergeant Roberts said the law, as written, prohibits setting off fireworks within 200 feet of a house or car.
Vito Casullo, III, Vito's Fireworks, said business has picked up this year due to people who previously went to Indiana to purchase fireworks, but who are now buying their artillery shells and larger fireworks in Kentucky. Customers were given information regarding the new statute with each sale. Also, instruction on how to safely use larger fireworks was provided.
Representative Keene announced that the next committee meeting was November 2, 2001, due to the regular meeting day being on Veterans Day. There being no further business to come before the committee, the meeting was adjourned at 11:08 a.m.