Tag Archives: pdmp

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.

Waller Can’t Defend Pay Lawsuit, PDMP

17 May

Jefferson County Executive Ken Waller has always had difficulty providing a persuasive argument for his preferred policies, instead usually resorting to “because it is best and those who oppose me are dumbheads.” But he had even more difficulty giving a sufficient explanation to Fox 2’s Elliott Davis as to why he’s suing JeffCo taxpayers to get more salary for himself:

Oh, no, you see, it isn’t about getting more money in his pocket! He just wants clarification from the judge! If the judge decides I need more money, what can I do? *chuckles* If that’s the case, then Waller should come out right now and say that he will refuse to accept any extra money if he wins his lawsuit. I mean, if all he wants is a legal clarification, that should be an easy pledge to make and it would put people’s minds at ease that this isn’t about personal enrichment. We’ll be waiting.

PDMP Fails

The proposal for JeffCo to join a multi-county prescription drug monitoring program (PDMP) to fight opioid abuse failed at the April 24 council meeting by a 4-3 vote, according to the Leader. The roll call was:

  • Don Bickowski – no
  • Renee Reuter – no
  • Bob Boyer – no
  • Charles Groeteke – no
  • Jim Kasten – yes
  • Dan Stallman – yes
  • Jim Terry – yes

Waller moped afterwards:

“It’s sad that people just don’t do the right thing, and that (allowing the county to join the database) was the right thing to do. The bottom line is that it didn’t pass, and more people are going to die and they’re not going to do anything about it.”

This was the extent of his argument for this bill, along with his single-minded focus on PDMP instead of a multi-pronged approach to the opioid/heroin problem, as was advocated by Boyer. No data, no facts, just demonizing. Waller also suggested he would go to Jefferson City to lobby for a statewide PDMP (which did not pass, but could come up in a special session). I doubt he would win over any votes there, either.

May Legislative Update

8 May
  • Sen. Gary Romine (R, 3rd district, Farmington) has been under heavy criticism for his role sponsoring SB43, a bill to change the legal standard in discrimination lawsuits from “contributing factor” to “motivating factor” (a higher bar to clear). This would prevent frivolous suits like the one filed by Arnold police chief Bob Shockey. Romine is under fire because a business he owns is being sued for discrimination. But this law would even not affect his case; since the suit is already in progress, it would proceed under the current rules. And people who are actually discriminated against can still win lawsuits under SB43, their claims just have to have some merit to them. Remember how Dianne Critchlow has threatened to sue the Fox district now that feckless prosecutors have let her off the hook? I guarantee her suit will include a baseless gender discrimination claim if it is filed under the current standard. As a business owner, Romine knows about the issues Missouri has with frivolous lawsuits, and is trying to address the problem. The House would need to approve this bill this week in order to send it to the governor.

Romine: “Rather than seeing this bill for what it is — one of the most significant economic development measures to come along in years — the media has been more interested in eliciting the opinions of trial attorneys, SB 43’s only real opposition and a group of people who generally stand to lose from any significant progress on the tort reform front.”

  • Sen. Paul Wieland (R, 22nd, Imperial) briefly held up the passage of HB 130, the bill to allow rideshare services like Uber to operate statewide. He thought, misguidedly in my opinion, that Uber drivers would drop their personal auto insurance since Uber provides coverage while you are working. He had other concerns as well. But three weeks later, Wieland’s concerns were satisfied and the bill was passed and signed into law.

“I just wanted to make sure we protect the public and we keep the number of uninsured motorists to a minimum and I believe this bill will do that,” Wieland told The Missouri Times Thursday.

  • Rep. Rob Vescovo (R, 112th, Arnold) was the House sponsor of SB 182, which eliminates project labor agreements in public construction projects. This bill, which has passed both houses, ends requirements that non-union contractors pay union wages and stops local governments from giving preferential treatment to union contractors. This bill will reduce the cost to taxpayers of public projects. Reps. Vescovo, Shaul, and John McCaherty (R, 97th, High Ridge) voted yes; Reps. Elaine Gannon (R, 115th, DeSoto), Becky Ruth (R, 114th, Festus), and Ben Harris (D, 118th, Hillsboro) voted no; and Roden voted present (weak).

“Some would say it’s an anti-union legislation, and I disagree,” Vescovo said after the House adjourned for the week. “I would say it’s pro-worker and it allows the other 86 percent of the workforce to bid on projects and work on projects without being signatory. That’s very important.”

  • Rep. Dan Shaul (R, 113th, Imperial) ticked off teachers, according to the Leader,  with his vote for HB634, which would allow for the expansion of charter schools in the state. Shaul also serves on the Windsor school board. Charters currently exist only in St. Louis and Kansas City. Teachers claimed Shaul has a conflict of interest, which I don’t buy. Some teachers turned their back on Shaul as he was sworn in for another term at the April 12 board meeting, which is quite juvenile. It doesn’t look like this bill will get a Senate vote. McCaherty, Roden, and Vescovo also voted yes on this bill.

“I would disagree with the assumption that my vote on HB 634 was a conflict of interest,” Shaul said. “The vote I took on 634 was to ensure that all kids throughout the state of Missouri have the same opportunity that kids (who) go to Windsor have.”

  • Along with SB43, other much-needed legal reforms have been advancing through the legislature, and our county reps have voted for them along party lines. However, Rep. Shane Roden (R, 111th, Cedar Hill) voted no on HB460, which would limit out-of-state plaintiffs who bring their cases in St. Louis in hopes of winning big verdicts. This is why you hear all those ads from lawyers about talcum powder and cancer on the radio or see them on billboards. Those plaintiffs don’t even live here.
  • Sen. Romine took to the Senate floor during debate over the budget to offer an amendment to fully fund the state’s foundation formula for education for the first time. It was a bit unusual to do this on the floor after the Appropriations Committee already put the budget bill together, and it caused a split between Senate leadership and some GOP senators as the amendment passed. Romine voted yes on this, Wieland voted no. The House also voted to fully fund the formula.
  • The issue of whether to join a prescription drug monitoring program (PDMP) has been roiling county government here for months, but such a plan is also advancing at the legislature, and if it passes it would make the JeffCo debate moot. The House and Senate will be going to a conference committee to iron out their differences, but with only one week left, it seems unlikely this will get done. In the House, representatives McCaherty, Roden, and Vescovo voted no on the PDMP bill, HB 90, as did Sen. Wieland.
%d bloggers like this: