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Tennessee
63-6-1101.
Short title
This part may be known and cited
as the “Intractable Pain Treatment Act.”
63-6-1102. Definitions
For the purposes of this part:
(1)
“Board” means the board of medical examiners.
(2)
“Chemical dependency” means:
(A)
The abuse of alcohol or a controlled substance;
(B)
A pathological use of alcohol or a controlled substance that chronically
impairs the applicant’s ability to competently provide legal advice or
services; or
(C)
A physiological or physical dependence on alcohol or a controlled
substance.
(3)
“Intractable pain” means a pain state in which the cause of the pain
cannot be removed or otherwise treated and which in the generally accepted
course of medical practice no relief or cure of the cause of the pain is
possible or none has been found after reasonable efforts.
(4)
“Physician” means a physician licensee of the board of medical
examiners or an osteopathic physician.
63-6-1103.
Legislative declarations
The general assembly finds
and declares all of the following:
(1)
The state has a right and duty to control the illegal use of opiate
drugs.
(2)
Inadequate treatment of acute and chronic pain originating from cancer or
noncancerous conditions is a significant health problem.
(3)
For some patients, pain management is the single most important treatment
a physician can provide.
(4)
A patient suffering from severe chronic intractable pain should have
access to proper treatment of such patient’s pain.
(5)
Due to the complexity of their problems, many patients suffering from
severe chronic intractable pain may require referral to a physician with
expertise in the treatment of severe chronic intractable pain.
In some cases, severe chronic intractable pain is best treated by a team
of clinicians in order to address the associated physical, psychological,
social, and vocational issues.
(6)
In the hands of knowledgeable, ethical, and experienced pain management
practitioners, opiates administered for severe acute and severe chronic
intractable pain can be safe.
(7)
Opiates can be an accepted treatment for patients in severe chronic
intractable pain who have not obtained relief from any other means of treatment.
(8)
A patient suffering from severe chronic intractable pain has the option
to request or reject the use of any or all modalities to relieve such
patient’s severe chronic intractable pain.
(9)
A physician treating a patient who suffers from severe chronic
intractable pain may prescribe a dosage deemed medically necessary to relieve
severe chronic intractable pain as long as the prescribing physician is in
conformance with the provisions of this part.
(10)
A patient who suffers from severe chronic intractable pain has the option
to choose opiate medication for the treatment of the severe chronic intractable
pain as long as a physician has first determined that such treatment is
appropriate and medically necessary and the prescribing is in conformance with
the provisions of this part.
(11)
The patient’s physician may refuse to prescribe opiate medication for a
patient who requests the treatment for severe chronic intractable pain.
However, that physician shall inform the patient that there are
physicians whose primary practices are the treatment of severe chronic
intractable pain with methods that include the use of opiates.
63-6-1104.
Pain patient’s bill of rights
a)
This section may be known and cited as the “Pain Patient’s Bill of
Rights.”
b)
A patient suffering from severe chronic intractable pain has the option
to request or reject the use of any or all modalities in order to relieve such
patient’s severe chronic intractable pain.
c)
A patient who suffers from severe chronic intractable pain has the option
to choose opiate medications to relieve severe chronic intractable pain without
first having to submit to an invasive medical procedure, which is defined as
surgery, destruction of a nerve or other body tissue by manipulation, or the
implantation of a drug delivery system or device, as long as the prescribing
physician acts in conformance with the provisions of this part.
d)
The patient’s physician may refuse to prescribe opiate medication for
the patient who requests a treatment for severe chronic intractable pain.
However, that physician shall inform the patient that there are
physicians who specialize in the treatment of severe chronic intractable pain
with methods that include the use of opiates.
e)
A physician who uses opiate therapy to relieve severe chronic intractable
pain may prescribe a dosage deemed medically necessary to relieve severe chronic
intractable pain, as long as that prescribing physician is in conformance with
this part.
f)
A patient may voluntarily request that such patient’s physician provide
an identifying notice of the prescription for purposes of emergency treatment or
law enforcement identification.
g)
Nothing in this section shall do either of the following:
(1)
Limit any reporting or disciplinary provisions applicable to licensed
physicians and surgeons who violate prescribing practices or other provisions
set forth in this chapter or the regulations adopted thereunder; or
(2)
Limit the applicability of any federal statute or federal regulation or
any of the other statutes or regulations of this state that regulate dangerous
drugs or controlled substances.
63-6-1105.
Physician authorized to write prescriptions
Notwithstanding any other provision of law, a physician may prescribe or
administer dangerous drugs or controlled substances to a person in the course of
the physician’s treatment of a person for intractable pain to provide adequate
pain treatment.
63-6-1106.
Disciplinary action against physicians
a)
No physician may be subject to disciplinary action by the board for
prescribing or administering appropriate amounts, combinations, or durations of
dangerous drugs or controlled substances in the course of treatment of a person
for intractable pain.
b)
The board is authorized to set by rule guidelines to govern treatment
under this part. Such guidelines
may include requirements for documented medical history, written treatment
plans, discussion of benefits and risks of the treatment, periodic review, and
the keeping of appropriate records. Such guidelines may be in addition to specific requirements
for persons with substance abuse issues governed by § 63-6-1107.
63-6-1107.
Treatment of chemically dependent individuals
a)
Notwithstanding any other provision of this part, subsections c and d
shall govern the treatment of persons for chemical dependency by a physician
because of their use of dangerous drugs or controlled substances.
b)
The provisions of this part provide no authority to a physician to
prescribe or administer dangerous drugs or controlled substances to a person for
other than legitimate medical purposes as defined by the board and who the
physician knows or should know to be using drugs for nontherapeutic purposes.
c)
The provisions of this part authorize a physician to treat a patient who
develops an acute or chronic painful medical condition with a dangerous drug or
a controlled substance to relieve the patient’s pain using appropriate doses,
for an appropriate length of time, and for as long as the pain persists.
A patient under this subsection includes a person who:
1)
Is a current drug abuser;
2)
Is not currently abusing drugs but has a history of drug abuse; or
3)
Lives in an environment that poses a risk for drug misuse or diversion of
the drug to illegitimate use.
d)
A physician who treats a patient under subsection c shall monitor the
patient to ensure the prescribed dangerous drug or controlled substance is used
only for the treatment of the patient’s painful medical condition.
To ensure that the prescribed dangerous drug or controlled substance is
not being diverted to another use and the appropriateness of the treatment of
the patient’s targeted symptoms, the physician shall:
1)
Specifically document the:
A)
Understanding between the physician and patient about the patient’s
prescribed treatment;
B)
Name of the drug prescribed;
C)
Dosage and method of taking the prescribed drug;
D)
Number of dose units prescribed; and
E)
Frequency of prescribing and dispensing the drug; and
2)
Consult with a psychologist, psychiatrist, expert in the treatment of
addictions, or other health care professional, as appropriate.
63-6-1109.
Use of physician’s assistants or other personnel – Licensing –
Continued education
a)
Any physician who practices pain management shall also be able to
hire physician assistants to assist such physician’s in such physician’s
practice. Any of these assistants
shall be a licensed physician assistant according to the requirements in § 63-19-105(a) except for any person who meets
the following requirements;
(1)
Is sixty-five (65) years of age or
older;
(2)
Was granted a degree in
pre-medical studies in 1960;
(3)
Was granted a master of science
degree from the University of Tenessee in 1991;
(4)
Was an instructor and assistant
professor during the time period 1977-97 at East Tennessee State University in
Surgical Technology;
(5)
Was an instructor in surgical
techniques and instruments to medical students and surgical residents at the
Quillen College of Medicine at East Tennessee State University;
(6)
Met the standards and
qualifications of the American Association of Physician Assistants in March of
1976 and was rated as “physicians assistant – SP-2”;
(7)
Satisfactorily completed the
postgraduate course “clinical skills for physicians’ assistants V” in
September 1977 from the Hahnemann Medical College and Hospital in Philadelphia,
Pennsylvania:
(8)
Held an “assistants renewal
certificate” issued by the Virginia Board of Medicine from July 1, 1977, to
June 30, 1978; and
(9)
Was recognized as a “certified
surgical assistant” by the National Surgical Assistant Association in May of
1987.
b)
Such person shall be issued a license within sixty (60) days upon
submission of evidence to the board of medical examiners that such person met
all of the above criteria; provided, however, that such person shall only work
under the supervision of one (1) physician who is in the sole practice of pain
management and rehabilitation medicine. Such
person’s duties shall only include helping the physician examine the patients
in the physician’s office, doing diagnostic EMGs, ordering appropriate lab
x-rays studies, seeing the physician’s hospital patients on hospital rounds
and writing orders to be countersigned by such physician, but, at no time shall
this person be allowed to prescribe medicine.
Such person shall also have the ability to work under a physician, who is
in the sole practice of pain management and rehabilitation medicine, while
performing extensive medical missionary trips in underpriviledged countries.
Any continuing education requirements for a person meeting the above
criteria shall not be waived.