The New York American College of Emergency Physicians exists to support quality emergency medical care and to promote the interest of emergency physicians.

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Memo in opposition I-STOP

Memorandum in Opposition

S.5720-A, Lanza and A.8320, Cusick
Enacts the Internet System for Tracking Over-Prescribing (I-STOP) Act

AN ACT to amend the public health law, in relation to creating an on-line real time controlled substance reporting system to monitor the prescribing and dispensing of certain controlled substances

The New York American College of Emergency Physicians (New York ACEP) is opposed to this legislation (S.5720-A/ A.8320) to create an on-line real time reporting system to monitor prescribing and dispensing of certain controlled substances in New York State.

New York ACEP represents nearly 2,200 emergency physicians across the state with a shared mission to provide the highest quality emergency medical care for every patient that enters the emergency department, 24 hours a day, 365 days a year, regardless of their ability to pay for care. We support the spirit and intent of this legislation and recognize the need to address the serious issues with drug abuse and diversion in this state. However, we have reservations about how this legislation would impact emergency department operations and our patients. We respectfully request that the bill be amended to waive the reporting and monitoring requirements for emergency physicians providing all emergency care in the state.

We recognize that the legislation does provide for some exemptions from the reporting and monitoring requirements on prescribers including cases of emergency oral prescriptions, oral 5-day prescriptions and those filled by institutional dispensers. In addition, S.5720-A waives the requirements for prescribers providing emergency medical service to a patient (defined as initial emergency medical assistance including but not limited to, the treatment of trauma, burns, respiratory, circulatory and obstetrical emergencies) for a 5-day supply or less of the controlled substance medication. However, we continue to have a number of concerns as described below and request an exemption from the reporting and monitoring requirements for all care provided in emergency departments.

The operational availability, reliability and efficiency of the proposed internet portal must function at a very high level in order to maintain patient flow and patient safety in the unfailingly hectic and interruption-driven emergency department environment of care.

  • The number of emergency department patients who require pain control above and beyond what can be treated with non-controlled prescriptions is significant. The vast majority of these prescriptions are written for patients with acute illnesses and injuries, such as cancer pain and fractures. A “mandatory review of the database before prescribing or dispensing” for such routine patients in obvious need is unnecessary and time consuming, detracting from the care of other patients.
  • Emergency physicians in New York State are already accessing Regional Health Information Organization (RHIO) data in real time when the clinical need exists or there is a suspicious circumstance.
  • This law will require many hospitals to reorganize their internet policies and equipment, as many now block access to internet portals for security and employee productivity reasons.
  • The number of data elements to be entered (15) will be time consuming and prone to error if done manually by a multi-tasked emergency physician or other busy emergency department staff.
Further, New York ACEP has concerns that the practice and behavior of well intentioned emergency practitioners who treat pain well will be inhibited by this law. The concern is that pain will be less adequately treated and patients will suffer due to fear of profiling or punishment or simple avoidance of a cumbersome process. We believe the purpose of this legislation is to provide a resource for practitioners and pharmacists to recognize drug-seeking behavior and manage it appropriately. Mandating real time reporting and monitoring and including fines and other punishments in this manner are both unnecessary and counter-productive. There are other applicable laws already in place that are very clear and understood by patients, pharmacists and practitioners.

Finally, by creating a system which mandates data entry and tracking of a vast number of patients looking for a problem with a relatively low incidence, there is a high likelihood that data entry error and interpretation bias will erroneously attribute trends and blame to patients, pharmacists and practitioners. This, in turn, is likely to result in patients seeking emergency medical care who have a legitimate medical need for pain medications being refused or unable to access the treatment that they need in an emergency. This is an unacceptable situation for both the patient and the emergency physician.

For these reasons, New York ACEP respectfully requests that this legislation be amended to waive the reporting and monitoring requirements for emergency physicians providing all emergency care in the state.