Legislature(2013 - 2014)BARNES 124
03/19/2014 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HCR15 | |
| HB370 | |
| HB152 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HCR 15 | TELECONFERENCED | |
| *+ | HB 370 | TELECONFERENCED | |
| += | HB 152 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 370-AWCB CONTROLLED SUBSTANCE PRESCRIPTIONS
3:34:33 PM
CHAIR OLSON announced that the next order of business would be
HOUSE BILL NO. 370, "An Act relating to employer drug testing;
requiring the Alaska Workers' Compensation Board to adopt
regulations relating to the prescription of controlled
substances to employees; and limiting the prescription of
controlled substances to employees."
3:34:40 PM
ANNA LATHAM, Staff, Representative Kurt Olson, Alaska State
Legislature, stated that HB 370 requires Alaska Workers'
Compensation Board (AWCB) to adopt regulations relating to
limiting controlled substances to employees. Section 1 would
authorize employers to drug test injured workers for controlled
substances prescribed to the employee listed in schedule IA
under AS 11.70.140 if the employee has been prescribed a
controlled substance for more than 90 days as the result of a
workers' compensation claim.
MS. LATHAM related that Section 2 requires the Workers'
Compensation Board to adopt regulations relating to the
prescription of controlled substances to implement Section 3.
Section 3 would limit a physician's prescription of a controlled
substance listed in schedule IA under AS 11.71.140, or a
controlled opium substance in schedule IIIA under 11.71.160, or
schedule VA under AS 11.71.180. She stated that HB 370 will
discourage the use of long-term opioids by restricting the
prescription to a 30-day supply. In addition, the bill would
allow employers to drug test employees who have been prescribed
schedule 1A controlled substances for more than 90 days,
primarily to see if the prescription is being diverted.
Statistics show that one in four prescriptions are used by
someone who has not been prescribed the medication. These
prescriptions are paid for by the employer, directly or through
insurance premiums.
MS. LATHAM stated that the drugs referred to in HB 370 are
synthetic versions of opium derived drugs. Under AS 11,
controlled substances are classified into six categories, with
schedule IA having the highest degree of danger to the public
and Schedule VI having the lowest degree of danger. For
example, morphine is classified as a schedule IA drug, marijuana
is classified as a schedule VI drug, and schedule IIIA and VA
drugs are considered opioid derivatives that vary in strength,
including drugs such as codeine. The use of higher dosage can
lead to addiction, increased disability, work loss, and even
death. She referred to statistics in members' packets on
workers' compensation claims.
3:37:51 PM
MS. LATHAM stated that last year, approximately 200 deaths due
to opioid abuse were a result of workers' compensation claims.
Not only is prescription drug abuse a public health and safety
issue, prescriptions are also a "cost driver" for workers'
compensation premiums. Alaska has the highest workers'
compensation insurance premiums in the nation. In 2011,
prescription drugs comprised almost 20 percent of medical costs
for workers' compensation claims in Alaska. Prescriptions were
covered by workers' compensation in 90 percent of the cases of
workers who missed a week or more of work. Sixty to 80 percent
of workers' compensation injured workers received opioids as
part of their prescribed medicines. Alaska, along with many
other states, has been working to address the overuse and misuse
of opioids, and many states have also implemented reforms. Some
states have restricted physician dispensing practices,
implementing pain management guidelines and restricting the
dosages and length of time that opioids can be prescribed.
Additionally, there has been an increase in the use of random
drug testing in workers' compensation claimants who use long-
term narcotics.
3:39:19 PM
MS. LATHAM shared statistics in members' packets from the
Lockton report [August 2012]. In a 2011 report, based on a
sample of 939,000 screenings, 71 percent of workers'
compensation claimants on chronic opioid therapy are not taking
their pain medication as prescribed due to misuse or abuse; 38
percent of patients were found to have no detectible level of
prescribed medication in their system; 29 percent had
nonprescribed medication; 27 percent had drug levels that were
higher than expected; and 11 percent had illicit drugs in their
system. These 2011 statistics were based on a sample of 939,000
screenings, she said. She emphasized that the statistics
reiterate the need for opioid prescriptions and allowing
employer drug testing in workers' compensation claims.
3:40:36 PM
CHAIR OLSON reported on other bills the committee has been
working on including one that will address physician dispensing
of opioids, including one for possible introduction next year to
address best practices for pain management that will tie in with
this issue and a fee schedule bill. He reported that many
jurisdictions are working on bills similar to HB 370, which is
having a significant impact on workers' compensation. He said
if patients are not taking their medication they may not be in
pain and may have found a new job. He said the intention of
this bill is not to step between the doctor and the patient, but
to support the belief that doctors should see their patient more
often before providing automatic refills on drugs such as
Oxycontin.
3:42:32 PM
REPRESENTATIVE JOSEPHSON asked whether the goal is to look for
criminal misconduct.
MS. LATHAM answered no; however, the main intent of the bill is
to lower costs for workers' compensation premiums. Thus, one
way to cut costs is to restrict insurance from paying for opioid
prescriptions that patients have not been taking.
3:43:11 PM
REPRESENTATIVE JOSEPHSON understood that patients may take too
many or too few pills. He asked whether she could identify the
stronger goal.
MS. LATHAM answered that the sponsor is particularly concerned
with prescriptions that are not being taken by patients. The
reason she mentioned the widespread abuse due to widespread
prescription drug abuse and that topic could render some
familiarity for members. The intent of the legislature is to
monitor workers' compensation patients taking opioids and ensure
that employers do not pay for prescriptions being paid for under
workers' compensation if the patients are not taking the drugs.
CHAIR OLSON commented that urinalysis (UA) has been used in a
number of occupations for a variety of reasons. In this
instance, if the urinalysis test comes back "clean" and the
patient is still collecting prescriptions, it is automatically
assumed the injured worker is ready to go back to work or they
have a new profession and the drugs are being diverted to
someone who is not the patient.
3:44:34 PM
REPRESENTATIVE JOSEPHSON reported that four major U.S. Supreme
Court cases and at least one major Alaska Supreme Court Case
have been issued [regarding drug testing]. These are considered
searches under the fourth amendment [of the U.S. Constitution].
That doesn't mean that the testing can't sometimes be done, but
there is a "special needs" test required. He asked whether
anyone has vetted this bill with the legislative legal counsel
on whether the "special needs" test has been met.
MS. LATHAM answered no; however, the statute that this bill
falls under is within employer policies so it would allow
employers to recognize that drug testing will be part of the
condition for employment.
3:45:42 PM
REPRESENTATIVE JOSEPHSON related a scenario in which the
patient/workers' compensation claimant simply didn't want to
develop a habit and made the decision not to take the
prescription. He asked whether it can be inferred that the
patients must be "dealing the drugs."
MS. LATHAM answered absolutely not. She indicated that if the
patients are restricted to a 30-day supply and the employees
chose not to take the drugs, there wouldn't be any reason for
the employees to obtain more than a 30-day.
CHAIR OLSON added that the doctor can renew the prescription,
but the bill requires some oversight and not allow the patient
to have over three months of prescription drugs.
MS. LATHAM offered her belief that approximately 15 states have
enacted something similar.
CHAIR OLSON also added that it has been "court-tested" in those
states.
3:46:54 PM
REPRESENTATIVE JOSEPHSON referred to a 2001 EPD decision, which
emphasizes the privacy clause. He asked whether this would
result in more workers' compensation litigation because
employers and their insurance companies said, "You're not truly
injured. You couldn't because you're not taking your meds.
Your pain must not be that great. Therefore, you're healed."
He wondered if there is any concern that this could create other
sorts of problems.
MS. LATHAM did not believe that HB 370 would lead to increased
litigation, but it most likely will stop extra prescriptions
from being written and not being taken by the patients.
CHAIR OLSON noted the departments could also testify.
3:48:02 PM
REPRESENTATIVE MILLETT related her recent experience with a
series of back problems, noting she was shocked at the amount of
a 90-day supply of opioids, including Valium and Xanax.
Obtaining a 90-day supply meant that she didn't need to see her
doctor during that period. Although she acknowledged that she
is not on a workers' compensation claim she also recognized a
distinct need to keep workers' compensation claims costs down.
She suggested limiting the aforementioned prescription drugs to
a 30-day supply, which should be sufficient for injured workers
in an ongoing workers' compensation claim.
REPRESENTATIVE MILLETT said she was astonished this [limit]
hasn't been previously put in place since one problem the police
encounters is the sale of illegal prescription drugs. One of
her prescriptions got stolen, noting insurance will not pay for
it unless the theft was reported to police. She reiterated her
surprise at the amount of opioids in a 90 day supply, noting
that some of drugs cost upwards of $2,000. She emphasized the
importance to have control over that process to have patients
see their doctors for continuation of care, with the outcome and
goal to have the workers' compensation claimant go back to work.
She appreciated HB 370, especially due to the understanding she
gained from her own experience with chronic back problem since
it helped illustrate the quantity of drugs. She emphasized that
this bill attempts to try to keep illegal drugs off the street
and ensure that workers' compensation claimants are using the
drugs in an efficient manner with the goal to get workers'
compensation claimants back to work, since medical costs is one
of the biggest expenditures for employers and the state.
3:52:03 PM
REPRESENTATIVE SADDLER asked for the level of accuracy of the
"UA" or drug tests.
MS. LATHAM offered to report back to the committee.
REPRESENTATIVE SADDLER anticipated some court challenges and
thought the accuracy would be important.
3:52:59 PM
REPRESENTATIVE CHENAULT said this has the makings of a good
bill. He offered his belief that some people will commit murder
to obtain a 90-day supply of drugs. He has observed illicit
drugs become a problem in his community. The legislature needs
to do what it can to ensure the drugs are legally used. He did
not object to "UA" use for some people. He questioned what
happens to full drug prescriptions if the workers' compensation
patients are not taking them. He recalled an instance in his
family, in which a family member had a prescription for
oxycontin that led to excess prescription drugs in the family
member's house. Certainly, there must be a way to control drugs
from getting into the open market, he said. Although [penalty
provisions] are not in the bill, he concluded that if the drugs
are being sold on the street that the sellers need to be held
accountable. In response to a question, he affirmed that
patients possessing a 90-day supply of drugs could be in danger.
3:55:49 PM
REPRESENTATIVE HERRON echoed that this is a good measure. He
found a normal range to be 30-day supply of drugs; however, he
asked if this limit is rigid and impractical for some.
MS. LATHAM answered that the contact with the physician is not
defined in the bill so prescriptions could be filled by an
office visit or by phone. She related his understanding that
mailing prescriptions to small communities is also possible.
3:57:05 PM
REPRESENTATIVE HERRON asked to have on the record that doctors
need to know if the pain medication is necessary, but abuses can
occur if patients are not taking their medication and are
selling the prescriptions. Again, just for the record he wanted
to ensure there are "smart ways" exist so patients don't have to
submit to a physical contact due to the size of the state and
the remoteness of some communities.
CHAIR OLSON welcomed any suggested language changes.
REPRESENTATIVE HERRON respected having a "rigid process," that
limits the amount of drugs prescribed, but at the same time he
recognized in a lot of ways it might be impractical.
3:58:50 PM
REPRESENTATIVE JOSEPHSON asked whether the sponsor has seen any
evidence that abuse of opioids is greater among workers'
compensation claimants than all the other segments of society.
MS. LATHAM answered she not seen specific statistics that have
shown abuse on workers' compensation claims are higher than the
widespread abuse. She said the trends tend to mirror each other
in terms of the national statistics and are similar to workers'
compensation in terms of abuse.
3:59:28 PM
REPRESENTATIVE JOSEPHSON asked whether a wise amendment would be
that this principle should apply to all Alaskans.
MS. LATHAM offered her belief that would be a tough sell, but
the bill will be brought back up for consideration.
4:00:10 PM
LORI WING-HEIER, Acting Director, Division of Insurance (DOI),
Department of Commerce, Community & Economic Development,
related that workers' compensation is a Department of Labor &
Workforce Development statute but the employers tend to fund
their obligation under the statute by purchasing insurance. The
DOI sets those rates. In terms of cost, the DOI's rates are
impacted by the cost of prescriptions through workers'
compensation claims. As members know, Alaska has the highest
workers' compensation rates in the nation. She provided a
ranking of the cost and number of claims, noting Alaska ranks 43
of 46 on medical claims and 39 of 46 for indemnity claims -
typically the longer term claims with a higher injury.
Historically, in reviewing claims for the past five years,
Alaska should expect to have 4,800 claims for every 100,000
workers. Of those 4,800 claims, 1,400 would represent long-term
claims and these are the claimants who will have long-term
prescriptions. The costs have steadily increased with the
average amount of $190 per claim in 2007 having risen to $265.
Most injured employees are receiving up to six prescriptions for
an injury, not including renewals. The top ten drugs being
prescribed are for pain medications with 25 percent being for
oxycontin. She characterized the statistics as being staggering
and employers are paying for these through the workers'
compensation costs. The division has been trying to work with
the DLWD to reduce costs to an affordable level. She hoped
members would consider HB 370 to help reduce workers'
compensation insurance rates and costs.
4:03:07 PM
REPRESENTATIVE JOSEPHSON remarked that when he hears that the
average injured worker has been prescribed six medications, that
the medical community is absolutely complicit in the problem.
He asked whether she agreed.
MS. WING-HEIER answered that she would not disagree with that
statement. The statistics prove that prescription drugs are
overprescribed and often for 90 days for convenience. She
offered her belief that overprescribing is an issue.
4:04:24 PM
REPRESENTATIVE MILLETT said Aetna insurance members are limited
to 90-day supply at a time before refills are authorized. She
said that Aetna insurance doesn't allow for prescriptions for a
longer timeframe.
MS. WING-HEIER said that limit refers to the personal employer-
sponsored health plan. She did not know of any limitation
within the statutes with respect to workers' compensation
prescriptions, but deferred to the DLWD to respond.
4:05:23 PM
REPRESENTATIVE MILLETT asked whether doctors can prescribe up to
a year under the workers' compensation plan.
MS. WING-HEIER said she was unsure. She said she has not heard
of up to a year timeframe, but has heard of prescriptions for
some large amounts.
4:05:59 PM
REPRESENTATIVE CHENAULT asked if the average was for six
different prescriptions.
MS. WING-HEIER answered that the average prescription is for six
different kinds of medications.
4:06:27 PM
REPRESENTATIVE CHENAULT remarked he has never been in the
workers' compensation system. He asked whether it is odd that a
doctor would not want to see a patient within 90 days to assess
if the patient is healing or getting worse. He offered his
belief that in his own community some doctors write too many
prescriptions. He asked whether any tracking occurs to compare
the average number of prescriptions to the number of
prescriptions doctors write for a specific drug.
MS. WING-HEIER answered she was not aware of any study.
Unfortunately, prescription drug abuse represents an epidemic
throughout the nation that has negatively impacted the state.
She said she hopes this bill will start to address this, in
particular, due to the costs.
REPRESENTATIVE CHENAULT commented that if the state is concerned
about workers' compensation costs, but the first thing that
happens is an injured employee is given a 90-day prescription it
could be that "we are the problem."
MS. WING-HEIER offered her belief that it would be best
practices for the physicians to see their patients more often.
REPRESENTATIVE CHENAULT said he does not want to make
disparaging remarks about doctors, but it does seems odd. He
suggested that checking back with the patient seems important,
although he wondered if the initial prescriptions were for
prescriptions for a shorter timeframe.
4:09:30 PM
REPRESENTATIVE HERRON described his own experience at a heart
institute, noting he has been prescribed non-opioids for his
heart condition, typically for a ten-month timeframe. When it
comes to opioids, the patient sees the claimant's doctor. He
wondered whether the solution is to require mandatory visits,
with a maximum spacing of three months and for the doctors to
prescribe three 30-day prescriptions for tighter controls.
MS. WING-HEIER did not disagree that tighter controls would be
better to reduce rates. She wasn't sure if that is possible but
she thought it might reduce rates.
4:11:06 PM
REPRESENTATIVE MILLETT, with respect to Representative Herron's
question, asked whether the workers' compensation regulations
require patients to see their doctors every 30 days. She did
not understand why the workers' compensation division couldn't
require claimants to have more visits to track the injured
worker's progress, which could reduce workers' compensation
costs. She further wondered if after 30 days rest, whether
doctors could release their patients.
MS. WING-HEIER answered that workers' compensation has a third
party adjuster who works with the patient and doctor. She was
unsure of any requirements since the adjuster is directly
involved with the injured worker. She suggested that it is
possible in long-term injury workers' compensation cases that
the patient might not see the doctor every 30 days. She said
that this activity would be monitored by the adjuster.
4:13:11 PM
REPRESENTATIVE JOSEPHSON asked whether the division has any data
relative to costs associated by requiring more doctor office
visits. He offered his belief this requirement would drive
costs up. He recalled the motivation for a telemedicine bill
before the legislature was to decrease the number of office
visits and for patients to be able to quickly obtain
prescriptions in order to reduce medical costs. He asked
whether telemedicine approach will work or if increasing office
visits to better monitor injured people is the answer.
CHAIR OLSON answered that the goal is to get injured workers
back to work. He offered his belief that the cost savings will
occur once the injured worker is back to work and off drugs such
as oxycontin, which is a drug that was developed for end-of-life
terminal cancer patients that later became a painkiller. He
said that drugs like OxyContin are being overprescribed and
reiterated that the intent is to get the employee back to work,
which saves the state, the worker, and the employer money. He
cautioned that once injured workers are on opioids for a lengthy
period of time, workers typically don't go back to work.
4:15:00 PM
REPRESENTATIVE MILLETT remarked that the committee is not
advocating telemedicine for workers' compensation claims.
REPRESENTATIVE JOSEPHSON said he was unsure.
CHAIR OLSON agreed telemedicine is not being advocated.
4:15:27 PM
MICHAEL MONAGLE, Director, Central Office, Division of Workers'
Compensation, Department of Labor & Workforce Development
(DLWD), with respect to an injured workers needing to see the
doctor on a regular basis, answered that there is a provision in
law that an employer can require an injured worker to see the
doctor at least once every two weeks. He acknowledged that most
of the time claims are managed by a claims administrator;
however, a claims adjuster typically handles over 100 cases.
These adjusters tend to pay more attention to serious indemnity
claims than a medical only claim. He reiterated that an
employer can direct an injured worker to see the doctor semi-
monthly. In the event an injured worker has surgery and the
normal recovery time is six to eight weeks, it may not make
sense to see the doctor any earlier. In response to the
question regarding whether problems are more prevalent in
workers' compensation than in the general population, he
reported that a study by the Workers' Compensation Research
Institute indicates the average number of workers receiving
opioids for a time-loss claim is over 75 percent.
4:17:19 PM
MR. MONAGLE did not find it unreasonable for patients with
strains or breaks to have a need for pain prescriptions. He
pointed out that in workers' compensation cases, the problem is
that the longer the injured workers are on pain medications, the
longer they miss work and for those on pain medications for more
than 90 days, the duration of the disability is 30 percent
higher than in non-opioid prescription cases. He has
encountered some injured workers with serious disabilities who
have been on opioids for two to three years. Doctors recognize
these patients become addicted, that their doses are increasing,
and that the person may be suffering mental disabilities due to
prolonged use of the drugs. In addition, patients may encounter
physical disabilities, yet the drugs are the only remedy so
doctors keep prescribing the drugs. He said the Centers for
Disease Control uses the term "epidemic" which is not at term
that is used lightly. He said that workers' compensation cases
are a reflection of the general health care system, but he
suggested that there may be more pronounced problems within
workers' compensation than in the general population.
CHAIR OLSON commented that this bill is a result of a meeting
put on by Workers' Compensation Research Institute in fact,
about 90 percent of the meeting was used to address this issue.
He remarked that fatalities involving drivers using opioids is
close to surpassing "drunk driving" fatalities so it is a
serious problem.
4:19:48 PM
REPRESENTATIVE JOSEPHSON referred to U.S Supreme Court cases,
including [Vernonia School District 47J v. Acton, 515 U.S. 646
(1995)], a U.S. Supreme Court decision which upheld the
constitutionality of a random drug testing regimen implemented
by the local public schools in Vernonia, Oregon, and others,
including one related to customs officers and railroad workers
based on a New York State rail disaster. He asked what public
interest is being served with this bill - perhaps reduced rates
and premiums; however, the injured worker at home does not pose
any threat to anyone except himself/herself. He asked whether
Mr. Monagle has discussed the legality of the bill.
MR. MONAGLE answered that he has not discussed this bill with
the agency's attorney general. He offered his belief the
purpose for the drug testing is that states who have adopted
drug testing discovered that up to 30 percent of the injured
workers are not taking the prescribed drugs. Thus, the
assumption is that these drugs are making it on the streets.
Although nothing in the bill requires the employer to prosecute
or take any criminal action, some states have adopted "good
Samaritan or safe harbor laws." In those instances a person
reported to have a substance abuse problem could be subject to
intervention or programs without any criminal charges being
involved. He reiterated that he did not think that criminal
charges were involved in HB 370.
CHAIR OLSON referred to page 1, lines 7 or 8, of the bill. He
pointed out that the language is discretionary, that an employer
"may require an employee to undergo drug testing" after 90 days.
He summarized work taken on the bill, including holding
discussions with legal staff and other legislators. He
characterized the approach being taken in the bill as using a
"scalpel" rather than a "chain saw" in an attempt to address the
workers' compensation injured worker prescription issues.
4:23:18 PM
REPRESENTATIVE JOSEPHSON noticed an absence of ramifications in
the bill for employment, HIPPA issues, and due process. He
asked for the penalty if an injured worker shows a lower use of
opioids.
MR. MONAGLE answered that typically everything in workers'
compensation surrounds the payment of benefits. Thus, if an
injured worker has been prescribed narcotics, but the drugs do
not show up during testing, some states do not continue to pay
for the prescription drug unless convincing evidence indicates
the drugs were stolen or substantial evidence indicates the drug
should be refilled. Therefore the benefit would be cut off,
although it wouldn't impact other aspects of the claimant's care
or disability benefits. In terms of employment provisions,
which he wasn't very familiar with, he understood one provision
provides safeguards from lawsuits being filed against the
employer. He further understood that many employers have zero
tolerance drug use policies; however, he was unsure if other
drugs showed up during urinalysis (UA), whether the employer
could take any disciplinary action.
4:25:51 PM
CHAIR OLSON asked for the percentage of the Alaska workforce is
subject to UAs.
MR. MONAGLE said he was unsure.
CHAIR OLSON understood that anyone in the transportation or
licensed maritime fields would be subject to UAs.
4:26:20 PM
REPRESENTATIVE SADDLER said the bill seems to make sense
especially due to the compelling narrative that has been laid
out. He indicated the benefits seem clear. He recalled that
workers' compensation workers absent from work tend to be those
on pain medications. He asked whether causality is being
confused or is it just that those with serious injuries have
longer claims and are absent from work for a longer period.
MR. MONAGLE explained that part of the issue is related to
patients taking prescribed opioids for a long time; and most of
the medical community concerned about long-term use. The longer
injured workers are on drugs the tolerance to dosage for pain
and discomfort goes up so the patient needs more medication.
The threshold most states use is a 120 milligrams of morphine
equivalent. He agreed that it seems reasonable to have progress
reports. If no functional benefit is derived from that sort of
dosage, something needs to be done to wean the patient off the
drugs. He didn't think the medical and workers' compensation
community was as concerned about 30-day use, which is why the
bill recommends it. He said this bill doesn't address the
overarching problem of drug addiction or other patient issues;
however, the bill does allow the division to put in regulation
some tools to address long-term use of opioids.
4:28:51 PM
REPRESENTATIVE SADDLER said he certainly could see the common
sense for 30-day prescription use. He reviewed the large list
of drugs prescribed. He wondered if the bill should be limited
to schedule I drugs since schedule II drugs include some pain
relievers.
MR. MONAGLE answered that page 2, lists schedule IA, IIIA, and
VA drugs that would be affected under the bill.
4:29:35 PM
REPRESENTATIVE SADDLER asked whether schedule IA, IIA, and IIIA,
are a matter of drug intensity or if they represent categories
of drugs.
MR. MONAGLE answered that the drugs are various concentrations
of the opioids. He pointed out that class I represents the
greatest threat to life and health, particularly if used in
combination with other drugs.
REPRESENTATIVE SADDLER understood that schedule I is the most
powerful.
4:30:14 PM
REPRESENTATIVE MILLETT related a scenario in which a person has
a serious back injury but doesn't want surgery and continues to
take medications. She understood that it isn't possible to
force someone to have surgery, but ultimately workers'
compensation claim could be never ending if the medical
recommendation is surgery.
MR. MONAGLE said the consensus in the medical community is for
patients to choose to undergo conservative care such as physical
therapy and other types of treatment before deciding on surgery.
He offered his belief that it is not in anyone's interest to
stay on opioids indefinitely. In some states, after a
prescribed period of time, in consultation with the physician, a
plan is put in place to step the patient down to a lower level,
and probably to recommend the patient attend a pain management
clinic to learn other ways to deal with the pain. He agreed
that these drugs were never intended to be long-term drugs and
are intended for short-term use.
4:32:56 PM
REPRESENTATIVE MILLETT asked whether drugs other than OxyContin
have the same effect. She said she is aware of people who move
to disability benefits when the solution might be to have spinal
fusion. She asked how to avoid the path of patients moving to
disability.
MR. MONAGLE answered that those patients represent about one
percent of the cases. Certainly, it is not in anyone's best
interest to stay on these types of drugs for the duration of
their lives. He said that the general consensus for chronic
pain management is for doctors to work with their patients to
minimize the need for these opioid equivalent drugs. In
response to a question, he offered to work with Representative
Millett on the workers' compensation issue to help get the
workers back to work.
4:36:17 PM
SIDNEY SEE stated that she previously worked for procurement for
the University of Alaska, but fell on the ice, had two wrist
surgeries, a shoulder surgery, and ten months later doctors
discovered she had severed her rotator cuff and suffered bad
disc damage. She then had neck surgery. She offered her belief
that the money in workers' compensation goes to adjusters who
have top paid lawyers and require independent medical exams
(IME). She estimated the cost for an IME at $10,000. She said
she was moving boxes and hurt her lower back. She related she
has an excellent doctor who has never prescribed more than 30
days of prescriptions. She signs an annual form and the doctors
perform random drug tests to avoid drug abuse. She
characterized spinal pain as horrific. Fortunately her lumbar
issue on October 31 seemed fine, but Northern Adjusters has
scheduled another IME to fly in a doctor from San Diego. She
said this problem should probably be resolved over time. She
has good treatment, her doctor gives her some injections, and
her goal is to work. She did not think the big cost is
prescriptions. She said she feels knowledgeable and would like
to see the system changed. She offered her belief that patients
get the bottom lawyers whereas the insurance adjusters have
better lawyers. She offered to provide more details on her
five-year recovery from her fall, noting she subsequently had a
disc replacement and two spinal fusions. She concluded by
saying she had a wonderful job in procurement and her boss and
co-workers were very supportive, but she did not find her
insurance adjuster helpful.
[HB 370 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB370 ver A.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB370 Sponsor Statement.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB370 Sectional Analysis.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB370 Fiscal Note-DOLWD-WC-03-14-14.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB370 Supporting Documents-Report Workers Compensation 2012 Issues by Joseph Paduda.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB370 Supporting Documents-Report Lockton & Associates 08-2012.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB152 CS(L&C) Fiscal Note-DOA-DRB-03-14-14.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 152 |
| HCR15 Supporting Documents-Resolution Fairbanks EDC 2014-01.pdf |
HL&C 3/19/2014 3:15:00 PM |
HCR 15 |
| HB370 Supporting Documents-AK Drug Overdose Deaths2008-12.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 370 |
| HB152 Letter-Buck Consulting 3-18-2014.pdf |
HL&C 3/19/2014 3:15:00 PM |
HB 152 |