President's Message

As your representatives from Polk County, your PCMS board and members have been busy advocating for you and your patients on many fronts over the past couple of months.  We have been involved in all levels of representation: national, state and local.  In the last issue of the Bulletin, we showed you in words and pictures how we were advocating on the national level; we also continue to be busy working at the state and local level.

At the Iowa Medical Society meeting, PCMS brought forward two resolutions.  The first resolution supported the development of legislation that allows formation of a tax-free liability trust fund within your practice.  This would allow practices to allocate money over time (tax free) for covering high malpractice deductibles even to the point of self-insuring.  The House of Delegates approved this concept and will bring it forward to the AMA.  The second resolution was on improving communication between IMS and the county Medical Societies.  This was referred back to the board for resolution.  Dr. Steve Richards, the new IMS President, has pledged to facilitate a meeting with the staffed counties to resolve these concerns.

At the state and local level, your board met with Kevin Concannon, Director of the Department of Human Services, about the Iowa Medicaid initiative (House File 841) and how it would overhaul and possibly expand Medicaid coverage in Iowa.  Since this plan involves transferring tax money from Polk County to the state and assigning patients to Broadlawns hospital for care, the board had a number of pointed questions and concerns on how the plan would work.  Mr. Concannon pledged to look into our concerns.

Also at the statehouse, we have been advocating for changes in House File 722 (now HF 833), a bill that would establish a state-wide internet drug database.  The Board of Pharmacy has received a grant of $350,000 to set up a database to track Scheduled drug prescriptions: what was prescribed, to whom, by whom, how much, new or refill, date prescribed, date filled, prescription number, and how it was paid for.  Although we feel that some form of a drug database is likely since the Federal Department of Justice is encouraging states to set up these systems with grants, we feel the way this bill is currently written is inadequate. 

Your PCMS board has concerns regarding patient confidentiality, access, security, and how the system will be used and possibly misused.  Patients would have to pay a fee if they want to check the database for errors.  We feel that if the State is collecting this type of sensitive medical information, patients should have some sort of mechanism to check that their information is correct.  The pharmacy board feels that by charging a fee, it will discourage patients from accessing their own information.

Whenever you start to collect data, someone is going to try and access the information, legally or illegally.  The drug database will be an internet-based reporting system from every pharmacy in the state with potential access sites from every doctor’s office.  This many access points make the system inherently risky for illegal access to sensitive (HIPPA covered) information.  The money allocated to this project is unlikely to cover the costs of a truly secure system.  Nor has it been determined whether this system is HIPPA compliant or what it would cost to make it so. 

Access to the database is restricted, with penalties for illegal access; however law enforcement may access the database “pursuant to a probable cause determination or warrant”.  This language leaves open the possibility of “mining” the database, looking for patients that are receiving certain drugs, or doctors who are prescribing certain drugs.  In other states, the drug database laws require an open criminal investigation for law enforcement access.

This database was initially presented as a way to find persons who are “doctor shopping” and help refer potential drug abusers for treatment, not as a law enforcement tool. The language of this bill carries no method for referring persons for help, only to law enforcement or licensing agencies.

There are other problems that we would like to see addressed.  Therefore, we are advocating for defeat of the current bill and to work with the Pharmacy Board drafting a more workable piece of legislation for the 2006 Iowa Legislature.  Again, it is likely that some form of a drug database will be passed, however; we would like to see these concerns addressed. 

We know that our members cannot follow each bill that affects the practice of medicine at the local, state, and national level.  That is why advocacy through our PCMS board, lobbyist, and staff is an important and ongoing commitment we make to you.  The PCMS will continue to work on your behalf and that of your patients so that the practice of medicine is represented and our united voice is heard.