California is working to establish an "online databank to crack down on doctor-shopping by narcotics abusers," and Attorney General Jerry Brown on Wednesday expressed his support for the monitoring plan. 
Reporter Jeanine Banca of the San Jose Mercury News writes:
If the online system begins, it would be the largest in the country. Other states with Web-based drug-monitoring include Kentucky, Maine, Ohio, North Carolina, Tennessee, West Virginia, Illinois and Virginia.
It will cost about $3 million to develop and operate the program for three years, according to a 2007 feasibility study paid for in part by Kaiser Permanente. Funds have not yet been identified, but supporters are hopeful health care providers and insurers will foot the bill.
Nationally, prescription drug fraud costs insurers as much as $72 billion a year, according to a 2007 study by the Coalition Against Insurance Fraud.
So is this monitoring plan, called the CURES Program, a law enforcement effort to protect public health, or is it a business effort to target insurance abuse? Apparently it's a little of both. Neither one is necessarily a bad idea, particularly because of the serious health risks that prescription drug abuse poses to users, but I'm baffled about how doctor-patient confidentiality fits into this scheme. Banca writes:
Kathy Ellis of the Department of Justice said details about law enforcement access to California's system have yet to be worked out. Access likely will be granted on a case-by-case basis to prevent "fishing" in the system, she said. "They'd have to identify what their need is. I don't see a patrol officer having a direct need for that information."
When I read passive sentence constructions like that -- "access likely will be granted" -- I just get a little nervous. A lot turns, as we have seen in connection with the FISA debate on the national level, on who grants access and under what circumstances.
I just wrote about the same program and found yours on a search. The program has been around for a couple of years now and reports of patient activity also have been available but not in real time. I work in an ER and if we get patients repeatedly visit who arouse our suspecion of doctor shopping for Narc's we can fax a request for patient activity and usually get a report back within 3-5 days. Not good for real time use but it helps the next time the person shows up and puts them on notice. We usually do not see them after that. They also dont get a new prescription refill of whatever their drug of choice. It no more violates confidentiality than reviewing any other aspect of a patients medical history as long as there is a medical indication. Some providers would rather not even deal with the issue and find it easier to just write the script to get the person out of the ED but that just prepetuates the problem.
Posted by: ERMurse | July 04, 2008 at 10:33 AM