Louisiana Chronic Pain Treatment Act

PROPOSED MODEL CHRONIC PAIN TREATMENT ACT LEGISLATION
BY THE AMERICAN PAIN INSTITUTE
www.AmericanPainInstutute.org

A BILL

SENATE BILL _______
State of Louisiana
General Assembly
Regular Session, 2004

By Senator ______________________
By Representative __________________

For An Act To be Entitled

AN ACT TO IMPROVE THE TREATMENT OF CHRONIC PAIN;
TO INFORM HEALTH CARE PROVIDERS ABOUT THE AVAILABLE METHODS
FOR TREATING CHRONIC PAIN; AND FOR OTHER PURPOSES.

Subtitle

AN ACT TO IMPROVE THE TREATMENT OF CHRONIC PAIN.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF LOUISIANA:

SECTION 1. Louisiana Code Title __, Chapter __, is amended to add an
additional subchapter to read as follows:

_________. Title.

This subchapter shall be known and may be cited as the "Chronic Pain Treatment Act."
_________. Findings.

The General Assembly finds that:
(1) Pain management plays an important role in good medical practice;
(2) Health care providers should recognize the need to make pain relief accessible to
all patients with chronic pain, and;
(3) Health care providers should view pain management as a regular part of their medical
practice for all patients with chronic pain.

_________. Definitions.

As used in this subchapter:

(1) "Board" means to Louisiana State Board of Medical Licensure, the Louisiana Board of Nursing, the State Board of Dental Examiners, or the State Board of Pharmacy;
(2) "Chronic pain" means pain which persists beyond the usual course of a disease, beyond the expected time for healing from bodily trauma, or pain associated with a long term incurable or intractable medical illness or disease;
(3) “Controlled substance” means any substance defined, enumerated or included in federal or state statute or regulations 21 C.F.R. งง1308.11-15 or R.S. งง 41-29-115 to 41-29-119, or any substance which may hereafter be designated as a controlled substance by amendment or supplementation of such regulations and statutes.
(4) "Disciplinary action" means any remedial or punitive sanctions imposed on
a licensed health care provider by the board;
(5) "Patient" means a person seeking medical diagnosis and treatment;
(6) "Physician" means a licensee of the State Board of Medical Licensure;
(7) “Nurse” means any nurse licensed by the Louisiana Board of Nursing, including nurse practitioners or advanced practice nurses;
(8) “Dentist” means any dentist licensed by the State Board of Dental Examiners;
(9) “Podiatrist” means any podiatrist licensed by the State Board of Medical Licensure;
(10) “Pharmacist” means any pharmacist licensed by the State Board of Pharmacy;
(11) “Health care provider” means a licensed professional defined in paragraph (6), (7), (8), (9), or (10) of this section.

_________. Louisiana State Board of Medical Licensure - Treatment - Prohibitions.

(a)(1) A health care provider shall not be subject to disciplinary action by the
Louisiana State Board of Medical Licensure solely for prescribing controlled substances for the
relief of chronic pain.
     (2) The board shall direct the Pain Management Review Committee to use
the criteria under subsections (d) and (e) of this section to review a
health care provider's conduct in regard to prescribing, administering, ordering, or dispensing
pain medications and other drugs necessary to treat chronic pain.

(b) The board shall:
(1) Make reasonable efforts to notify health care providers under its
jurisdiction of the existence of the "Chronic Pain Treatment Act";
(2) Inform any health care provider licensed by the board investigated
regarding the provider's practices in the management of pain of the existence of the
"Chronic Pain Treatment Act"; and
(3)(A) In a disciplinary hearing, the board shall present opinion evidence
from a full time active health care provider in direct patient care knowledgeable in pain
management.
     (B) The health care provider has the right to present testimony from a full time
active practice health care provider in direct patient care knowledgeable in pain
management.

(c) (1) Only in the event the board finds, after a full hearing, and by
recommendation of the Pain Management Committee, gross and ignorant malpractice
may the board incrementally impose sanctions as follows:
     (A) Monitor prescribing habits of the health care provider not to exceed (6) months;
     (B) Require the health care provider to voluntarily surrender his or her United
States Drug Enforcement Agency registration to the board for a specified period of time
not to exceed three (3) months;
     (C) Suspend the health care provider's license, stay revocation, and require
monitoring of the health care provider's prescribing habits for a specified time; and
     (D) Revoke the health care provider's license, stay revocation, and require
monitoring of the health care provider's prescribing habits for a specified time; and
     (E) Revoke the health care provider's license for serious violations of statutes and
regulations.
(2) With a finding of severe violation of statutes and regulations, the board
may initially impose more severe sanctions.
(3) At any level of sanction, the board may require continuing medical
education hours in proper prescribing habits.

(d) A health care provider may, based on evaluation and management of a patient's
individual needs:
(1) Treat a patient who develops chronic pain with a controlled substance to
relieve the patient's pain;
(2) Continue to treat the patient for as long as the pain persists;
(3) Treat the pain by managing it with controlled substances in amounts or
combinations that may not be appropriate for treating another medical condition;
(4) Administer large doses of controlled substances for pain management if the
benefit outweighs the risk of the large dose; and
(5) Administer a large dose of a controlled substance even if its use may increase
the risk of death, if the purpose is not to cause or assist in a patient's death.

(e) A health care provider may not:
(1) Prescribe or administer controlled substances solely to treat a patient for
chemical dependency, except as provided for in ___________________ (section regulating substance abuse treatment);
(2) Prescribe or administer controlled substances to a person for other than
legitimate medical purposes; or
(3)(A) Cause or assist in causing the suicide, euthanasia, or mercy killing
of any individual.
(B) However, causing or assisting in causing the suicide, euthanasia, or
mercy killing of any individual does not include prescribing, dispensing, or
administering medical treatment for the purpose of alleviating pain or
discomfort, even if that use may increase the risk of death, so long as the treatment
is not furnished for the purpose of causing or assisting in causing the death
of an individual.

_________. Pain Management Review Committee - Membership - Duties.

(a)(1) There is created the Pain Management Review Committee appointed by the
Louisiana State Board of Medical Licensure.
    (2) In lieu of a disciplinary hearing, the board must refer a health care provider
to the committee for review and recommendations.

(b) The committee shall consist of five (5) full time active health care providers in
direct patient care members, two (2) of whom may be board certified pain
management specialists and (3) of whom may be health care providers with significant pain
management in their practices or with a degree in pharmacy, appointed by the board
from a list provided by the Louisiana Osteopathic Medical Association, the
Louisiana Medical Society, and the Louisiana Pain Society.

(c) The committee shall:
(1) In cooperation with the Louisiana Osteopathic Medical Association, the
Louisiana Medical Society, and the Louisiana Pain Society, develop
guidelines for investigations of complaints regarding conduct in violation of this
subchapter;
(2) Review complaints on an individual patient needs basis regarding
health care providers treating chronic pain in violation of this subchapter; and
(3) Provide an objective critique to the board for board determination in a
timely manner and, if determined, before the board's disciplinary hearing.

_________. Scope.

This subchapter does not condone, authorize, or approve mercy killing or
euthanasia, and no treatment authorized by this subchapter may be used for mercy
killing or euthanasia.

_________. Immunity - Criminal prosecution.

No health care provider shall be subject to criminal prosecution for prescribing or
administering controlled substances under appropriate criteria in the course of
treatment of a person for chronic pain.

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