The American Civil Liberties Union of Florida on Monday asked the state Department of Health to tighten rules to prevent the accidental release of confidential information from a state prescription-drug database.
The database was created to curb "doctor shopping" by drug abusers who visit multiple physicians and pharmacies to get powerful painkillers. But the program in recent weeks has come under heavy scrutiny --- and faces a legal challenge --- since the disclosure of confidential prescription records for roughly 3,300 people in the Volusia County area. The information was disclosed to defense attorneys involved in a drug case.
Now the ACLU is recommending that law enforcement agencies be required to get search warrants in order to access the database.
Failing that, Pamela Burch Fort of the ACLU said the Department of Health should limit law enforcement's access to the database to prevent "fishing expeditions." Burch Fort was the only member of the public who spoke during a rule-making workshop Monday at the department headquarters in Tallahassee.
"Requiring law enforcement agencies to obtain a warrant or a court order is a change that must come from the Legislature and not DOH," Burch Fort said. "But we want to stress that such an amendment to (state law) is critical."
The database was created in 2009, after Florida became known as a magnet for drug abusers and dealers to get powerful --- and sometime deadly --- pills. According to the Department of Health, since the database began operations two years ago, Florida has seen a nearly 18 percent drop in deaths due to Oxycodone abuse and a 58 percent drop in "doctor shopping" cases.
Under the law, pharmacies and other health professionals who dispense certain painkilling drugs must report the name of the prescriber, the date the prescription was filled and the name, address and birth date of the person to whom the drug is dispensed – all information that was compromised in the Volusia case. But that does not mean physicians have to check the database before writing prescriptions for the drugs.
"The (database) is not a research tool," Burch Fort said. "It is a collection of highly sensitive information to which law enforcement should only have access after a neutral third party has examined the asserted grounds for need (and) determined that the law enforcement agency is targeting specific individuals or entities for specific crimes, supported by probable cause."
The ACLU also recommended that the results of law enforcement queries be redacted to remove the names and personal data of those who were not under investigation, and that the Department of Health ensure the results remain confidential and notify those whose personal information has been breached.
But Lorri Abramowitz, a former detective in the pharmaceutical drug unit of the Duval County Sheriff's Office, said the ACLU recommendations would undermine the state's successful effort.
"Having to get a subpoena or a search warrant to obtain that information would totally slow down the process and put us going backwards rather than forwards," Abramowitz said. "Doctor-shopping cases are down, at least in Duval County. It is working."
Abramowitz also said more checks by physicians and pharmacies would reduce the need for law enforcement agencies to access the database.
In a report dated Dec. 1, 2012, the Department of Health found that physicians and pharmacists had used the database 2.6 million times since it began operations in September 2011. Law enforcement officers had used it more than 20,000 times in criminal investigations involving controlled substances. Five thousand pharmacies had entered 56 million controlled-substance prescriptions into the database.
Abramowitz, who helped Attorney General Pam Bondi draft the legislation cracking down on pill mills, said limits on use of the database could force law enforcement officers to contact dozens of pharmacies individually.
Florida Sheriffs Association executive director Steve Casey pointed to a Sarasota County case in which one person obtained 178 prescriptions for Oxycodone and Hydrocodone from 56 different medical providers, filling them at 26 different pharmacies over two years.
"The subject went to dentists, walk-in clinics, emergency rooms, urologists, psychiatrists and other providers every few days to obtain small quantities of the potent drugs in an attempt to go undetected," Casey said. "That worked until two pharmacists finally consulted the database and alerted investigators… This case exemplifies why the (database) can only be effective if it is checked by medical professionals prescribing or dispensing these powerful prescription drugs."
Casey said statistics show the database is working, and that as more medical professionals begin using it, the state will continue to see a decrease in prescription-related deaths and "doctor shopping" cases.
During the 2013 session, measures by Sen. Denise Grimsley, R-Sebring, and Rep. Mike Fasano, R-New Port Richey, would have required doctors to check the database before prescribing controlled substances, but they failed --- in part due to opposition from physicians' groups.
Florida Medical Association General Counsel Jeff Scott said in an email his organization was instrumental in passing legislation to crack down on pill mills, but "arbitrarily requiring all physicians --- regardless of patient population or specialty --- to consult a database before prescribing a (drug covered under the law) is not the answer. This puts patients with legitimate pain needs in limbo and makes it more difficult for physicians to treat their patients."
Scott also said the FMA has serious concerns about patient privacy in light of recent leaks of patients’ personal data. "Until those issues are resolved, forcing physicians to use the database is not good public policy," he said.
A Department of Health spokeswoman said the ACLU's recommendations and any written comments submitted by July 22 will come up for discussion at another workshop, as yet unscheduled, in August.