Michigan Commission Release New Opioid Treatment Recommendations
Last month, Michigan’s Prescription Drug & Opioid Abuse Commission released new opioid treatment and prescribing recommendations for physicians and dentists. These new guidelines supplement the package of opioid laws signed earlier this year (see our January 9, 2018 Pulse Newsletter), many of which go into effect June 1, 2018, and are directed to surgery departments, emergency departments and dentists. The recommendations are not binding, but physicians and dentists should familiarize themselves with the guidelines to avoid disciplinary action.
Among the various recommendations, physicians and dentists are encouraged to address pain through clinical intervention rather than opioid pain relief and advised to pursue non-opioid therapies as the primary treatment. Significantly, both physicians and dentists are reminded the prescription drug monitoring program must be accessed online before prescribing controlled substances.
The Board of Medicine has been increasingly active in disciplining physicians who prescribe a high number or high doses of opioids. In light of the new recommendations and new package of opioid laws, all prescribers should review their opioid prescribing practices and consider revising applicable policies and procedures to:
- Properly counsel patients regarding the risks of opioid addiction, expectations regarding recovery and pain management and non-pharmacologic therapeutic options;
- Educate patients and parents or guardians regarding safe opioid use, non-opioid treatment options, addiction treatment and the dangers of combining opioids with alcohol or sedative medications;
- Access the prescription drug monitoring program online prior to prescribing controlled substances;
- Enter into opioid treatment agreements; and
- Document education efforts, opioid treatment agreements, attempts to taper opioids and the clinical justification for prescribing long term opioid therapy and high doses of opioids.
Michigan Court of Appeals Holds Unprofessional Behavior Affects Patient Care
On April 17, 2018, the Michigan Court of Appeals issued an opinion upholding a hospital’s decision to discipline a physician based on unprofessional behavior. In El-Khalil v. Oakwood Health Care, Inc., a podiatrist sued a hospital after the medical executive committee refused to renew his hospital privileges. The podiatrist argued the hospital violated its Medical Staff Bylaws when it refused to renew his medical staff privileges. The podiatrist argued the Bylaws prohibited denying staff privileges for reasons unrelated to the delivery of quality patient care and professional ability and judgment. The Court rejected this argument, noting the many complaints against the podiatrist for harassing and threatening behavior. According to the Court of Appeals, “how a doctor interacts with staff may serve as the basis for a reasonable belief that the quality of health care is being affected, regardless of his or her record as a doctor in general.” This is the first time the Michigan Court of Appeals has explicitly held unprofessional behavior affects patient care and justifies taking disciplinary action against an otherwise good physician.