Health & Medicine

Doctor says Legislature’s prescription sends message: ‘We’ll fix you for complaining’

OxyContin, in 80 mg pills, in a 2013 file image. A recent trial suggests opioids had no pain-relieving adventage over common painkillers in a yearlong trial. (Liz O. Baylen/Los Angeles Times/TNS)
OxyContin, in 80 mg pills, in a 2013 file image. A recent trial suggests opioids had no pain-relieving adventage over common painkillers in a yearlong trial. (Liz O. Baylen/Los Angeles Times/TNS) Los Angeles Times

Gov. Gavin Newsom signed into law on Monday a bill meant to give doctors, pharmacists and the California Department of Justice more time to implement new security measures for prescriptions of controlled substances such as opioid pain medications.

However, the new law known as Assembly Bill 149 adds a new requirement: that serial numbers on the prescription pads be readable as bar codes by Jan. 2, 2021. Doctors will have to order new prescription forms to comply with that law, but AB 149 does allow them to use prescription forms valid this year and those valid at the end of 2018 through Jan. 1, 2021.

Dr. Richard Buss, a physician who practices in Amador County was frustrated to see yet another change in the forms.

“Because we complained about new prescription pads, now they’re telling us we have to get ‘new, new prescription pads,’” Buss said. “It’s almost like they’re punishing us. ...Yeah, we’ll fix you for complaining about your new prescription pads. You’ll have to order a whole new set of pads.”

Since initially publishing this article, The Bee has learned that Buss is on probation with the California Medical Board as a result of an investigation into the 2007 death of a patient. Buss said he faced a malpractice lawsuit in the case and that it was settled in favor of the patient’s survivors.

The board’s records state that Buss prescribed the woman multiple addicting substances in excessive amounts on multiple occasions in an extreme departure from the standard of care. Buss’ record shows no other disciplinary action since his five-year probation began in 2015.

Buss said he feels horrible about the death of his patient and still cringes that his treatment caused her to die. As a result of his settlement with the medical board, he had to take courses in prescribing practices, medical recordkeeping, ethics and professionalism and clinical practice.

He said he did not run the kind of “pill mill” that fed the opioid crisis, a clinic where prescriptions were sold to dozens of people a day without any physical exam. His concerns about the prescription-form legislation, he said, stemmed from calls he received from patients, from seeing a colleague’s frustration at not being able to help a patient manage pain just after surgery and from witnessing his own daughter’s prescription be denied after she had her wisdom teeth taken out.

Buss was among the many doctors who had to get new prescription pads in January and complained that they had not received timely notification that they must start using the new prescription forms by Jan. 2. Pharmacies had begun rejecting their prescriptions because they didn’t have the new security measures. Some patients, they said, were leaving surgery but could not get pain medication.

Those new measures were part of AB 1753, carried by Assembly member Evan Low. The 2018 law required that each prescription form have a unique serialized number for tracking. It also allowed the California Department of Justice to restrict the number of companies authorized to print prescription drug forms.

After hearing that patients were having trouble getting medication, Low and Assembly member Jim Cooper worked to fast-track AB 149 to ensure that patients would receive the pain medication they needed and that pharmacists and doctors got more time to integrate the new pads.

“Unfortunately, there are often unintended consequences when Legislation is implemented,” Cooper said in a prepared news release. “I applaud Governor Newsom for acting quickly and approving this measure to ensure patients can immediately start obtaining their medications.”

When new measures are implemented in 2021, prescription pads will have undergone changes in three out of four consecutive years, Buss said.

“In theory, it’s more difficult to forge a prescription,” Buss said, “but it makes it more difficult for doctors who are legitimately prescribing pain medication to keep doing what we’re doing..”

Buss’s frustration is less about the expense, he said, and more about the annoyance of having staff spend time continually updating the forms when he’s not convinced the changes effectively deter people abusing the prescriptions. It feels like bureaucratic red tape, he said.

“The purpose of a bureaucrat is to justify his existence,” he said. “If they don’t make up new rules and regulations, there’s no purpose for them existing.”

Editor’s note: This story was updated March 14 to note that the California Medical Board put Dr. Richard Buss on probation in 2015 as a result of an investigation into the 2007 death of a patient. The causes cited for the five-year probation were gross negligence, negligent acts and incompetence.

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Cathie Anderson covers health care for The Bee. Growing up, her blue-collar parents paid out of pocket for care. She joined The Bee in 2002, with roles including business columnist and features editor. She previously worked at papers including the Dallas Morning News, Detroit News and Austin American-Statesman.
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