BILL ANALYSIS �
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THIRD READING
Bill No: SB 62
Author: Price (D)
Amended: 4/22/13
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP. COMM : 10-0, 4/15/13
AYES: Price, Emmerson, Block, Corbett, Galgiani, Hernandez,
Hill, Padilla, Wyland, Yee
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/13
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
SUBJECT : Coroners: reporting requirements: prescription
drug use
SOURCE : Author
DIGEST : This bill requires coroners to transmit reports to
various regulatory boards, in the event that a coroner
determines that a contributing factor in a cause of death is
related to the toxicity from a Schedule II, III, or IV drug.
ANALYSIS : Existing law, the Health and Safety Code,
establishes the California Uniform Controlled Substances Act
which regulates controlled substances:
1.Specifies that a prescription for a controlled substance shall
only be issued for a legitimate medical purpose and
establishes responsibility for proper prescribing on the
prescribing practitioner.
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2.Establishes the Controlled Substances Utilization Review and
Evaluation System (CURES) for electronic monitoring of
Schedule II, III and IV controlled substance prescriptions.
CURES provides for the electronic transmission of Schedule II,
III and IV controlled substance prescription information to
the Department of Justice (DOJ) at the time prescriptions are
dispensed.
3.Requires health practitioners who prescribe or administer a
controlled substance classified in Schedule II to make a
record containing the name and address of the patient, date,
and the character, name, strength, and quantity of the
controlled substance prescribed, as well as the pathology and
purpose for which the controlled substance was administered or
prescribed.
4.Requires prescribers who are authorized to dispense Schedule
II, III or IV controlled substance in their office or place of
practice to record and maintain information for three years
for each such prescription that includes the patient's name,
address, gender, and date of birth, prescriber's license and
license number, federal controlled substance registration
number, state medical license number, National Drug Code
number of the controlled substance dispensed, quantity
dispensed, diagnosis code, if available, and original date of
dispensing. Requires that this information be provided to DOJ
on a monthly basis.
Existing law, the Business and Professions Code:
1.Establishes various Acts that provide for the licensing and
regulation of health practitioners.
2.Provides that a certified nurse-midwife or nurse practitioner
may furnish or order drugs or devices, including controlled
substances, in accordance with standardized procedures or
protocols, as specified.
3.Establishes the Pharmacy Law which provides for the licensure
and regulation of pharmacies, pharmacists and wholesalers of
dangerous drugs or devices by the Board of Pharmacy within the
Department of Consumer Affairs (DCA).
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4.Specifies certain requirements regarding the dispensing and
furnishing of dangerous drugs and devices, and prohibits a
person from furnishing any dangerous drug or device except
upon the prescription of a physician, dentist, podiatrist,
optometrist, veterinarian or naturopathic doctor.
5.Requires a coroner to report to the appropriate regulatory
board within the DCA when the coroner determines that a death
may be the result of a physician and surgeon's, podiatrist's
or physician assistant's gross negligence or incompetence.
Provides that this report shall be confidential and removes a
coroner, physician and surgeon or medical examiner from
liability in any civil action as a result of complying with
the reporting requirement.
Existing law, the Government Code, requires coroners to inquire
into and determine the circumstances, manner, and cause of all
violent, sudden, or unusual deaths; unattended deaths; deaths
where the deceased has not been attended by either a physician
or a registered nurse, who is a member of a hospice care
interdisciplinary team; and any deaths reported by physicians or
other persons having knowledge of death for inquiry.
This bill:
1.Clarifies that a board-certified or California licensed
pathologist, rather than board-eligible pathologist, provides
findings to a coroner indicating that a physician's gross
negligence or incompetence may be the result of a death.
2.Clarifies that, in addition to the requirement for coroners to
provide reports to the Medical Board of California (MBC) in 90
days when a physician's gross negligence may be the result of
a death, coroners may provide reports as soon as possible once
the coroner's final report of investigation is complete.
3.Requires coroners, when he/she receives information based on
findings of a board-certified or California licensed
pathologist indicating that a contributing factor in a cause
of death is determined to be related to the toxicity from a
Schedule II, III, or IV drug, to file a report with the MBC.
Provides that, when known, the report shall include the name
of the decedent, date and place of death, attending
physicians, podiatrists or physician assistants and all other
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relevant information including any information available to
identify the prescription drug(s), prescribing physician(s)
and dispensing pharmacy.
4.Clarifies that coroners shall also provide the coroner's
report, autopsy protocol and all other relevant information
within 90 days or as soon as possible once the coroner's final
report of investigation is complete.
Background
Currently, the law only requires coroners to report to the MBC
when the coroner determines that the death may be the result of
physician gross negligence or incompetence. In Fiscal Year
2011/12, the MBC only received four of these reports, and
according to them, only one indicated a drug-related death. The
MBC reported that while numerous deaths have occurred in
California, which may be directly related to prescription drug
overdoses, it is difficult for them to obtain a complaint which,
in turn, would trigger an investigation.
Coroners' reports vary from county to county and there are
currently no specified standards for the format of reports
throughout the state. Coroners do not have a uniform category
for prescription drug deaths that allow the death to be
automatically determined as caused by a prescription drug.
Similarly, some counties may have additional resources or access
to the very limited amount of forensic pathologists throughout
the state and may not investigate the same types of deaths the
same way. For example, in one county, a drug addict's cause of
death may be listed as natural while the death of that same
person may be ruled accidental in another county if they died
from a drug overdose.
Many coroner investigations include the collection of all drugs
found at the scene of the death for a number of reasons as
follows:
Public health reasons . To ensure that somebody does not pick
up controlled substances belonging to the deceased and then
use and/or sell them.
Clues to determine cause of death . Drugs found at the scene
often give the coroner information as to the cause of death,
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such as diseases or conditions being treated with the drug
that the coroner should look for. They are also able to look
at the pill count on the label and compare that with the date
of the prescription and compare that with how many are left in
the pill bottle to determine possible overdose.
Determination of what medication a decedent was taking . The
pill bottle is the source of information about prescriptions
and prescribers and looking at these can also lead a coroner
to ask the decedent's loved ones a standard battery of
questions regarding, for example, whether the decedent had
suicidal indications or mental illness in trying to determine
cause of death.
The drugs found at the scene of a death are typically documented
on a "medication inventory sheet" or a "drug work-up sheet" or a
"property log," as these may be referenced differently from
county to county. The document usually includes the name of the
drug found at the scene of the death, the dosage, the number of
pills prescribed, the number of pills remaining in the bottle,
the dispensing pharmacy (sometimes with phone number and
address), and the prescriber (sometimes with name and address).
A current Los Angeles Times series, "Dying For Relief," has
highlighted the role of prescription drugs in overdose deaths as
determined through the examination of coroners' reports.
Reporters conducted an analysis of coroners' reports for over
3,000 deaths occurring in four counties (Los Angeles, Orange,
Ventura and San Diego) where toxicology tests found a
prescription drug in the deceased's system, usually a
painkiller, anti-anxiety drug or other narcotic; coroners'
investigators reported finding a container of the same
medication bearing the doctor's name, or records of a
prescription; the coroner determined that the drug caused or
contributed to the death. The analysis found that in nearly
half of the cases where prescription drug toxicity was listed as
the cause of death, there was a direct connection to a
prescribing physician. The Times created a database, the first
of its kind, linking overdose deaths to the doctors who
prescribed drugs. They also found that more than 80 of the
doctors whose names were listed on prescription bottles found at
the home of or on the body of a decedent had been the
prescribing physician for three or more dead patients. Their
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analysis found that one doctor was linked to as many as 16 dead
patients. The approach that these reporters have taken is
unique in that they are specifically talking about abuse and
subsequent death to patients taking drugs prescribed by their
doctors.
NOTE: For detailed information relating to the five Schedules
of controlled substances, prescription drug
abuse/deaths/monitoring, and CURES, refer to the Senate
Business, Professions and Economic Development
Committee's analysis.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Ongoing state mandate costs in the low hundreds of thousands
(General Fund). Based on 2008 information from the Centers for
Disease Control, there are roughly 2,000 prescription drug
overdose deaths in the state each year. Assuming that local
coroners spend about one to two hours preparing materials for
each report to the MBC, the statewide annual costs to
reimburse the coroners for their costs will likely be between
$150,000 and $350,000 per year.
Ongoing investigation costs by the MBC, to the extent the
reports from coroners indicate a need for investigation. The
extent of this cost will depend on the reports received and
could be in the hundreds of thousands per year (Contingent
Fund of the MBC).
SUPPORT : (Verified 5/23/13)
Center for Public Interest Law
OPPOSITION : (Verified 5/23/13)
California Medical Association
ARGUMENTS IN SUPPORT : According to the author's office,
coroners' reports are a treasure trove of data that can inform
the appropriate licensing boards about where people are getting
drugs, how much they have when they die of an overdose and
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whether they were under the care of a doctor who may have been
prescribing too much. The author's office believes that this
bill connects the dots and creates a very necessary pathway for
prescription drug overdose deaths to be reported directly to the
boards that can take necessary action against their licensees
who may have been directly involved due to overprescribing or
unsafe, poor prescribing practices. The author's office states
that if boards are receiving reports from coroners throughout
the state, they will be better armed with the necessary tools to
make a correlation to their licensees in overprescribing
circumstances and take action.
The author's office believes that while some doctors may be
negligent in paying attention to signs that their patients are
addicts, in most instances, boards are probably unaware that
there is even any correlation between an overdose death of a
patient and the drugs prescribed by their doctor. Existing law
only requires coroners reports to be transmitted to the MBC in
the event that gross negligence by a physician is determined as
the cause of death, resulting in the board not necessarily
having the right information to begin investigating a licensee
or a licensee's prescribing practices.
The Center for Public Interest Law (CPIL) notes that this bill
will play an important role in helping to identify doctors who
have, either willingly or by negligence, played a role in
prescription drug abuse. CPIL also provides recommendations for
strengthening the bill, including requiring reports to be
transmitted to CURES.
ARGUMENTS IN OPPOSITION : The California Medical Association
(CMA) is opposed to this bill unless it is amended, stating that
since many of these overdose deaths are unrelated to a
physician/patient relationship, the related reports will create
extra work for both already overburdened coroners and the MBC.
CMA believes this bill is overly broad and would encompass more
cases than "rationally intended to meet its goal."
MW:nk 5/23/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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