Tuesday, June 5, 2012

Lousiana HB 126: Poor Guidelines and Covering Tracks

I've been tracking things in Louisiana over the last several weeks.  I'll be down in Baton Rouge in about 10 days to talk about prescription drug abuse and what can be done about it...
In the course of my preparation, however, I've come across a very disturbing confluence of events that deserves a bit more attention than its getting. 

Back in 2009, the Louisiana state legislature did an enlightened thing and instructed the Office of Workers' Compensation (OWC) to adopt medical treatment guidelines that met very specific criteria, including reliance on systematic medical literature review, published criteria for rating studies and strength of medical evidence, use of contemporary studies, and evidence of adoption by at least one other state - in short, evidence-based guidelines. 

Long story short - the OWC appointed a Medical Advisory Council to evaluate guidelines and recommend which should be chosen.  The OWC/MAC promptly ignored the statutory mandate and began a rather obvious and pronounced drift toward consensus-based guidelines.
I couldn't get anyone to go "on the record" for me regarding the the undue influence of outside stakeholders, but suffice it say that it appears likely that the pharmaceutical and/or medical device industry could have had significant input on the guidelines through the MAC.

And then it gets worse...

Herbert Dixon (D - Alexendria) and Chris Broadwater (R - District 86) of the Louisiana State House of Representatives have sheperded a bill through the legislature and onto the governor's desk (HB 126 can be found here) that completely absolves members of the Work Comp Advisory Committee and Medical Advisory Committee of any accountability whatsoever regarding their work.  Specifically, the bill states that members of these committees "shall not be subject to civil or administrative subpoena for his recommendations or exercise of judgment as a member of the council, including subpoena seeking his oral or written testimony at trial, discovery, or other proceeding, and a subpoena duces tecum seeking documents, inspections, things or information in electronic or any other form." 

Leaving aside the clear overstep of legislative authority (is this even constitutional?), let's just focus on the what this means:  A doctor in Louisiana can accept an appointment to the Medical Advisory Committee, do the bidding of the pharmaceutical and medical device industries, develop guidelines that absolutely do NOT adhere to the legislative mandate of SB303, leave the state work comp system in worse shape than it was already in... and all records, emails, transcripts, etc. connected to their work can be hidden from the light of day and they can never be called to testify in any forum to defend their judgment? 

I spoke to both Dixon and Broadwater.  Broadwater told me that the intent of HB 126 is to protect voluntary participation on the part of medical experts on such committees from inappropriate harassment.  Further, his position is that the rule-making process, public comment period, and ongoing opportunity to amend the medical treatment guidelines provide sufficient transparency in the system that knowing exactly who is influencing the MAC isn't relevant. 

I respectfully disagree.  If these people really are the "experts," I want assurances that their judgment, their expertise, and their counsel isn't being clouded by drug and device manufacturers.  Let's be realistic: the MAC may not have any rule making authority at all, but their advice (as experts) defines the default rules for public consideration.  How do we know we're starting off on the right foot? 

So, to sum up...

Dear Governor Jindal,
Don't sign this bill into law.
All of us out here who think responsibility and accountability are fundamental tenets of government.

On Twitter @PRIUM1

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