Feb. 4, 2022: State Advocacy Update

With little notice to the Montana Physician Assistance Program (MPAP), the Montana Board of Medical Examiners (BOME), Montana Medical Association (MMA) or the more than 120 participants receiving care under MPAP’s supervision, the state of Montana recently ended MPAP without having a successor organization in place.

“Such a change fails to meet both the spirit and letter of Montana law and will harm both patient safety and the Montana providers in need of these services,” the Montana Medical Association said in a memo to the State Department of Labor and Industry (DLI), which assumed control of the confidential records from MPAP.  

The AMA joined the MMA at a recent BOME meeting to call for the DLI to immediately change course and restore a high-functioning physicians’ health program to Montana. “This action puts the treatment of the over 120 physicians currently in the program in question,” said the MMA. The AMA and MMA made several suggestions, including urging the DLI to quickly begin an RFP or other contracting process to establish a high-functioning physicians’ health program. The BOME passed a motion urging the state to begin that process, although representatives from the DLI and state did not commit to following that recommendation. 

The AMA, MMA and several BOME members highlighted that MPAP—like other effective state PHPs—balance the needs of participants with the public health and safety obligations of the medical board. The DLI, however, does not have the relationships with care providers, confidentiality assurances or trust among program participants that MPAP worked to establish over several decades.  

“Our concern is as follows: if potentially impaired physicians do not trust the DLI to care for their substance use disorder or mental illness, they will not seek care,” wrote AMA Executive Vice President and CEO James L. Madara, MD (PDF). “If current Montana PHP participants do not trust the DLI, they could very well drop out of the program. Both situations would harm the public safety.” 

Destigmatizing mental health care for physicians has the potential to save lives, testified the Arizona Medical Association (ArMA) in support of a bill that would add confidentiality protections when a physician seeks wellness care. As an organization that represents physicians across the state of Arizona, ArMA has worked hand in hand with the bill sponsor to get this important legislation introduced. The legislation, also strongly supported by the AMA, would encourage physicians to seek care when needed in a wellness program that can directly respond to the professionals’ wellness needs. It also would ensure that a record of a physician’s participation in a wellness program is confidential and has additional legal protections that should provide further encouragement to physicians to seek help when needed. 

The bill also “balances the appropriate role of the medical board to protect the public safety for an impaired physician with the public need to encourage physicians to seek help for issues that may be causing high levels of stress that can be successfully addressed through a physician wellness program,” wrote AMA Executive Vice President and CEO James L. Madara, MD (PDF).

The bill is sponsored by Representative Amish Shah, MD, MPH, an emergency physician, and co-sponsored by Representative Joanne Osborne, who chairs the Arizona House Committee on Health and Human Services. The bill passed out of the House by a strong vote of 56-3 and now heads to the Senate.

It is essential to ensure our patients do not overdose unnecessarily, and by decriminalizing fentanyl strips we can avoid the complications that arise when someone takes it unknowingly, testified the New Mexico Medical Society in support last week of a harm reduction bill. The legislation, House Bill 52 (PDF), also strongly supported by the AMA, would help increase access to products such as fentanyl test strips as well as sterile supplies for harm reduction organizations and other entities to help reduce the spread of infectious disease.  

Joining the NMMS to urge legislators to vote “Yes,” the AMA testified that House Bill 52 will help stem the spread of infectious diseases as well as help make people aware that they may be using a deadly supply so they can change their actions to use less or use differently so they do not overdose and die.  

The NMMS effort aligns with the AMA Substance Use and Pain Care Task Force recommendation to “broaden public health and harm reduction strategies to save lives from overdose, limit the spread of infectious disease, eliminate stigma and reduce harms for people who use drugs and other substances.” The NMMS is part of the task force. 

“Decriminalizing fentanyl test strips makes it that much more likely that people will find their way to treatment rather than to the criminal legal system,” wrote Ritu Bhatnagar, MD, MPH, FASAM, to the Wisconsin Senate Committee on Judiciary and Public Safety in support of Senate Bill (S.B.) 600. Dr. Bhatnagar, the current president of the Wisconsin Society of Addiction Medicine, told the committee that she has had patients who previously obtained the test strips from needle exchange programs, but then were “charged with possession of drug paraphernalia when they were trying to be safe about their use.” As a result, wrote Dr. Bhatangar, there were subsequent “legal consequences for them that then prevented them from getting their lives back together when they were ready to find a job,” for example. 

Dr. Bhatangar said that S.B. 600 will provide legal clarity across the state to law enforcement, authorize the state to use federal funds to purchase the test strips and, most importantly, save lives from unintentional overdose. 

The AMA and the Wisconsin Medical Society both support S.B. 600. 

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