As I see it, SB74 decreases the quality of medical care for Alaskans, by going from a hands-on, in-state telemedicine system to an out-of-state telehealth system, where no physical exam of the patient is required to provide prescriptions.
This bill will force the closure of Alaskan providers and practitioners’ businesses, since it outsources medical care to providers in other states. That means fewer jobs for Alaskans and less access to local medical care.
This bill does not address the abuses in the Medicaid System, as discussed by the Medicaid Reform Advisory Group. It adds more administrative costs to state government at a time when we need to seek to streamline expenses not add more to our budget.
The biggest concern of mine is that this bill will unduly put many Alaskans on the controlled substance database, which is an unnecessary breach of patient privacy and a huge liability to the state.
The way the bill is written right now, the Alaskans that would end up on this database include:
- a) children with seizures on phenobarbital;
b) a senior on lyrica for shingles nerve pain;
c) men with low testosterone;
d) people with diabetes on weight loss meds like phentermine;
e) people traveling on sleeping meds like lunesta;
f) a person with pertussis on 5 days of tussionex cough medications;
g) adults and children with ADD/ADHD on ritalin or concerta;
h) someone with a migraine on one day of fiorinal;
i) someone with nausea on marinol;
j) someone on meds like provigil for shift work;
k) someone who needs 2 pills of anti-anxiety medicine for an MRI or an airplane flight;
l) a teenager with wisdom tooth removal who needs two or three days of pain medication.
All these people and thousands more Alaskans, who don’t need to be, will end up on this controlled substance database.
Instead, we need to focus on narcotic/opiate users and limit this mandatory reporting to anyone over the age of 18, who gets more than five days of narcotics. This would be a reasonable goal for reporting, if the state wants a controlled-substance database. The main problem is illegal heroin or large prescriptions of narcotics, not infants with seizures, or men who need testosterone, or women with migraines, or teens with ADD/ADHD.
This database is a huge liability for the state if it is breached. Federal HIPAA rules are strict. The private personal data to be collected from passage of this bill could give criminals, who breach the database, knowledge of whose houses to rob. It raises concerns about physician-patient confidentiality, about who will have access to this data since this is administered with federal grant money, and about how this data could be used against people in the future.
This database will have to be larger, more secure, with faster access than even the PFD databank, as 1200 physicians and over a thousand pharmacists, veterinarians, and nurse practitioners will have to be able to access all 700,000 Alaskan patient’s data at any moment.
We need to focus on where the problem is now, opiates, and not penalize thousands of Alaskans with ordinary medical problems that are seeking modern medications to help them function.
Telemedicine has been used for decades in Alaska and provides a welcome and necessary service. Let us keep it close to home, not outsource it, as the telehealth component of this bill will do.
This bill will decrease the quality medical care in Alaska, because the telehealth system requires no physical exams and no long term physician-patient relationship. Besides, it will outsource Alaskan jobs.
SB74 is not an Alaskan friendly bill and deserves to be defeated.
Dr. Ilona Farr is a family medicine doctor in Anchorage, Alaska. She received her medical degree from the University of Washington School of Medicine and has been in practice for more than twenty years.