Pain clinics are taking extraordinary steps to dodge state regulations that aim to slow the proliferation of prescription narcotics in West Virginia, according to state health officials.
Some pain clinic operators are encouraging patients to bring along friends - who see doctors but don't get pain pills - during office visits to drive up patient numbers and exempt clinics from regulations. Other clinics are affiliating themselves with medical schools to avoid state inspections.
"We were made aware that certain operators of these clinics were becoming adjunct professors with a medical school, and then utilizing that affiliation to exempt their pain clinics from the regulations," said Delegate John Shott, R-Mercer.
On Wednesday, the House of Delegates voted 95-3 to pass legislation (HB 4537) designed to close those loopholes. The state Department of Health and Human Resources requested the tighter regulations after spending the past two years trying to rein in rogue pain clinics that prescribed excessive numbers of opioids.
"These changes are to make certain there aren't multiple interpretations, and that everyone is on the same page and understands the definitions, rules and law," said Jolynn Marra, who heads DHHR's Office of Health Facility Licensure and Certification.
To stay in business, pain clinics must secure a state license if more than half of patients receive prescriptions for chronic pain.
But some clinics were ducking that rule by inflating their patient rolls with people who didn't require treatment for chronic pain, Marra said. That exempted the clinics from inspections and regulations.
The new legislation seeks to stop that practice and close the loophole.
"We've had a couple of clinics try to circumvent the rules by having patients bring a friend that don't need pain medication," Marra said. "That helps dilute their calculation to less than 50 percent."
Under existing rules, pain management clinics aren't subject to regulation if doctors primarily prescribe pain pills to patients diagnosed with a "progressive disease ... that may result in a terminal condition."
The legislation makes clear that the patients must have a terminal disease like cancer for clinics to be exempt from the rules.
"We had some physicians who were claiming life is terminal and we're all going to die, so no patient should count toward the calculation," Marra said. "It was a bit of an absurd argument, and it ends up wasting everybody's time."
In addition to pain clinic doctors signing up for part-time professorships at medical schools, clinics have executed dubious agreements with the schools to avoid licensure requirements.
The House bill eliminates that exemption. Thirteen West Virginia pain clinics have recently affiliated with medical schools.
"We've received complaints about those clinics, but they fell outside our jurisdiction," Marra said. "They just had to sign up with a medical school and agree to take a student for training. The medical schools weren't providing any oversight."
The pain clinic legislation next moves to the state Senate.
Over the past two years, the state has denied licenses or shut down a dozen pain clinics.
For years, West Virginia's pain clinics essentially went unchecked unless a patient filed a complaint against a doctor or nurse through a state medical licensing board. State officials have estimated that nearly 60 pain clinics could be operating in West Virginia, but only six have licenses.
Several pain clinics have sparred with DHHR officials over the rules. Some disputes have landed in court.
Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.