JeffCo Health Department Does Stealth End Run on PDMP

4 Jun

The Leader‘s Peggy Bess had a good column last week about the lack of openness exhibited by the Fox and DeSoto school boards in response to recent controversies. I think she should add the Jefferson County Health Department (JCHD) to this list for its sneaky passage of a prescription drug monitoring program (PDMP) ordinance on May 25, after the county council rejected such a proposal in April.

While it is true that the Health board has discussed PDMP at its meetings since August of last year, this was in the context of pushing the county council and city councils in the county to pass it. And Health board meetings are quite opaque anyway, as the JCHD does not post agendas or minutes on its website (with the exception of four meeting minutes from late 2015-early 2016) or even list meeting dates and times or who is on the board. [I am told by board president John Scullin that the JCHD will now start posting agendas and minutes.] The most information you can find about JCHD governance is on a state of Missouri web site.

The JCHD relied on a state law that gives health departments the right to make rules “to enhance the public health” to justify its own passage of a legislative ordinance.

“For the health, safety and welfare of the county, (the Health Department) can enact ordinances. It’s not used very often, but they can do it,” said county executive Ken Waller.

However, in early May (after the county council vote) the JCHD director, Kelley Vollmar, seemed to dismiss such a strategy in a comment to the Leader:

As an independent agency, we have the authority to create our own ordinances. But traditionally, independent health departments have been very respectful of county governments and the mandate that they have representing the people. I’m not sure that this is an area where we want to strike out on our own.

But all that went out the window after a special meeting of the JCHD board on May 15 at which Ken Waller appeared. Since JCHD only gives notice about its meetings via postings on the doors to its two facilities and via emails to the Leader, few people would have known about this meeting, where PDMP was the only item discussed. It was at the JCHD board’s regularly scheduled monthly meeting ten days later on May 25 that the ordinance was passed. But the county council was not aware that this vote was going to take place. Waller could have announced the upcoming vote at the May 22 county council meeting, but he kept silent on the issue, instead issuing a veiled threat that he had a press release coming out about councilman Bob Boyer (this press release was promised last week but did not happen). Waller clearly wanted the passage of PDMP to be a surprise, and as such he deprived county residents of the chance to have their say.

Speaking generally, the JCHD board should have been more transparent in this. But when the board was planning to use a rarely used provision of law to counteract the decision of the people’s elected representatives, they had an extra duty to inform the public in advance. But they did not do so, because they did not want publicity or scrutiny.

PDMP Evidence in Illinois

The arguments in JeffCo in support of PDMP were mostly along the lines of “it’s the right thing to do” and “every other state does it.” Not a lot of evidence. Here is a recent article from across the river in Illinois, which has a PDMP, that is interesting:

mad_opi

Hmm. Illinois had a jump in opioid deaths in 2015, while Missouri did not, says the CDC. That year, Missouri was 22nd in the nation in opioid overdose deaths, which is a lot lower than you would expect after hearing the “only state without a PDMP” cry. Here’s another noteworthy item from the CDC:

PDMPs are promising tools for health care providers to see patients’ prescribing histories to inform their prescribing decisions. However, a PDMP is only useful to health care providers if they check the system before prescribing. Some states have implemented polices that require providers to check a state PDMP prior to prescribing certain controlled substances and in certain circumstances, and these policies have significant potential for ensuring that the utility and promise of PDMPs are maximized.

The St. Louis-area PDMP that JeffCo is joining does not require doctors to consult the database when issuing prescriptions, which seems to me to defeat the whole purpose of the database. The PDMP bill that has passed the state House several times is also optional for doctors.

Conflicts with Charter?

There is some question whether the Missouri statute in question here, RSMo 192.300, which gives health departments power to pass ordinances, applies to a charter county like JeffCo. The charter bestows all legislative power in the county upon the council. This question would have to be tested in court, though. Given that the county is currently spending a lot of money defending against lawsuits in which Waller is a plaintiff, the council may not want to incur more legal bills. But, to quote Scullin, the JCHD board president, “there is more than one way to skin a cat.” Perhaps the council can find other ways to fight back.

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2 Responses to “JeffCo Health Department Does Stealth End Run on PDMP”

  1. Greg Zotta June 5, 2017 at 3:16 pm #

    Jefferson County Council should immediately cut funding to the Jefferson County Health Department. They should then challenge the ordinance, because the Council is the legislative body for Jeffco not the Health Department.

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  1. Recall Effort Launched Against Jefferson County Executive | Jefferson County Penknife - June 12, 2017

    […] pay lawsuit that he is a part of. Reason two is his alleged role in the Health Department end-around of the council to pass a prescription drug monitoring plan. Reason three is his behavior towards […]

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