Doctors at the federal veterans hospital in Augusta will face penalties if they don’t meet a July 1 deadline to wean patients down to lower levels of prescription opioid medication, the state says.
But a hospital administrator says that state regulations don’t apply to the federally operated VA Togus Medical Center, and that the hospital has been working for nearly two years to taper its patients down and align with the state’s new rules, which go into effect July 1.
“Our goal is by July 1 to get as many people as possibly below that 100 [morphine milligram equivalents],” said Dr. Stephen Sears, VA Maine Healthcare System chief of staff. “Will we be able to get absolutely everybody? I’m not sure you can do that. There are going to be some people you may not get to that point because of their medical problems.”
“We could pull the trump card, but that is not what we’re doing in this case,” Sears said. “We knew the law was coming and our plans are to follow the law as closely as we can. Trying to cut down on opiate use for chronic pain is better for all patients, and that includes veterans.”
About 16 months ago, the Veterans Administration of Maine sent letters to all its members letting them know about the VA’s major initiative to reduce opiate medications.
The new rules “make sense from both a medical standpoint and a public health standpoint,” Sears said. “There is really strong data that says this is healthier.”
In the last year, the VA has been able to reduce prescriptions for chronic pain by about 21 percent and has cut in half the number of the patients on prescriptions over 100 morphine milligram equivalents, Sears said. There were around 160 VA patients over the 100 mme limit in March 2016.
“Now, there are around 82, and we have a tapering plans for most of those already in place,” Sears said.
The number of patients that could remain above the 100 mme limit on July 1 is unknown at this point, he said.
The new law includes exemptions for cancer patients, those in end of life care, palliative care and other special circumstances. But it does not include veterans, according to the Department of Health and Human Services.
“If a VA doctor overprescribes they would be held accountable like all other providers,” said DHHS spokeswoman Samantha Edwards
That means that doctors or pharmacists who break the state’s rules face a fine of $250 per violation, not to exceed $5,000 per calendar year.
“They are not going to be penalized in our system, but outside that might apply,” Sears said, referring to doctors who write prescriptions in a private practice setting outside of the VA. He added that the rules were not written with the VA, an independent healthcare provider that has its own pharmacies, in mind.
“There are a lot of nuances in the law that just don’t fit,” Sears said.
Sears argues that the Veteran’s Administration cannot be regulated by state laws due to the supremacy clause of the United State Constitution that ensures federal laws take priority. And the Maine Medical Association agrees, according to a Q and A posted on the group’s website about the new prescription rules.
Parts of the law — which was passed last year as emergency legislation — took effect in January. The 100 mme limit for chronic pain goes into effect on July 1.
Almost all of the VA doctors in the state are also licensed to practice medicine in Maine, Sears said. VA Maine serves about 45,000 of the state’s veterans.
“We also recognize our veterans have duel care, with private providers, and we need to all be working off the same book,” Sears said, listing another reason why the VA is aligning with the state rules. “We’re trying to be compassionate and empathetic in providing treatment to people and balancing all the aspects of their lives.”