Letter from the Executive Director, Karen Pershing

The recent pain management clinic raids in Knoxville and Lenoir City have yet again brought to light the path of death and destruction they not only create, but leave behind.  Many people ask, how in the world can these clinics open and operate in the state of Tennessee?

Although we have made some great strides in creating guidelines and establishing a certificate process for pain management clinics, there are individuals who know how to check the right boxes and operate what appears to be a legitimate storefront.  There is always a struggle between making changes to tighten up through laws and regulations and balancing the need for patients who truly suffer from non-malignant chronic pain to have access to the specialized care they need and deserve.

The Knox County Prescription Drug Task Force conducted a study over a six month period from May-November of 2014 to evaluate our current pain management clinic requirements and those of other states near Tennessee.  As part of this process, the group also looked at indicators that helped demonstrate the effectiveness of other states policies.  Although this took several months, the task force members felt very strongly that the final product would make the biggest difference in changing the landscape of pain management clinics in Tennessee.

In January, HB 1157 and SB 1266 were filed in the General Assembly.  The House bill’s sponsor is Representative Bob Ramsey from Blount County and the Senate sponsor is Senator Ken Yager from Roane County. Both of these legislators have sponsored and fought for prescription drug abuse prevention bills previously and are well-versed in the extent of the problem.  Representative Bill Dunn has served on the task force since its inception in August of 2013 and also helps tremendously in getting the bill sponsors and garnering support among his peers.

HB 1157/SB 1266 raises the requirements for pain management clinic owners and medical directors.  Currently in the state of Tennessee, anyone can open a pain management clinic.  Our recent pill mill bust had an owner who relocated from Florida in 2011, when they cracked down on their pill mills and has no medical background or training.  This bill would require that at least one of the owners has to have a medical license in the state of Tennessee.  If clinics do not operate within the guidelines established by the Tennessee Department of Health, it provides leverage to have medical licensure tied to compliance.  Currently in our state, the only requirement for a Medical Director of a clinic is that they are an MD licensed in the state with an unrestricted license.  In other words, any physician, of any specialty is qualified to run a clinic.

After pulling all the medical directors names off the certification listing with the Tennessee Department of Health, it was incredible to look up the current medical directors and see that we have pediatricians, obstetricians, plastic surgeons, family practice, internal medicine, and rheumatology to name a few.  There are also medical directors out there running very high quality pain management clinics and hold a sub-specialty in pain management and/or have obtain certification from pain management credentialing boards.  If individuals in chronic pain deserve to know that they are receiving treatment from someone who is well-trained in the specialty area.  Right now, a person could walk into a pain management clinic and have no idea that their physician had no additional training in pain medicine.

Tennessee needs to elevate the specialty of pain medicine to that of other specialty areas, such as cardiology, orthopedics, obstetrics, endocrinology, etc…. By changing the requirements of medical directors we improve clinical quality and reduce the likelihood of “pill mill” clinics setting up shop in our state.  The bill states that the Medical Director for a pain management clinic must be American Board of Medical Specialties credentialed with a subspecialty certification in pain management and/or can apply for diplomat status through the American Board of Pain Management by July 1, 2016.  This will allow those physicians who are in pain management for the right reason to do additional training and take certification examinations and to reduce an immediate shortage of providers.  The effective date of the bill itself would be July 1, 2015. The ownership requirements would go into effect at that time.

At the time this article was written, the bill has passed the Senate Health and Welfare Committee and is on the calendar to be heard on the House Health sub-committee.  The goal is to change the landscape of pain management clinics and allow only those who want to offer quality clinical services to operate.  The practice of pain management should be multi-disciplinary and not simply place individuals on powerful narcotics.  Other options should be explored to identify the source of the pain and to identify both lifestyle and interventional changes that may help alleviate pain.  For some patients, opiate therapy may be most appropriate, but patients should be monitored closely to reduce the possibility of addiction and overdose.  Many individuals who have chronic pain have made statements that they feel they are treated like addicts when they go to a pain management clinic due to the rigor of monitoring and testing being conducted.  If individuals are educated on quality clinical care, there would be a greater acceptance and understanding that they are being safely monitored to keep them as functional and healthy as possible.

Let’s finally take a stand in our state and say that we no longer tolerate clinics who are simply after huge profits without regard to patient safety.  By elevating our standards, we can send a clear message to those who are devastating the lives of many Tennesseans that Tennessee no longer welcomes you.