WSR 07-11-058

PERMANENT RULES

DEPARTMENT OF HEALTH


(Board of Osteopathic Medicine and Surgery)

[ Filed May 11, 2007, 1:08 p.m. , effective June 11, 2007 ]


Effective Date of Rule: Thirty-one days after filing.

Purpose: The rules are established to set standards when prescribing and treating acute, chronic and intractable pain patients. By establishing rules under treatment of chronic pain may be reduced and access to care enhanced. The rules will alleviate the legal concerns and apprehensions of providers when managing pain patients with opioid therapy.

Statutory Authority for Adoption: RCW 18.57.005, 18.130.050.

Other Authority: Chapters 18.57, 18.18.57A [18.57A] RCW.

Adopted under notice filed as WSR 06-22-103 on November 1, 2006.

Changes Other than Editing from Proposed to Adopted Version: WAC 246-853-520 and 246-854-130, in both sections a paragraph before subsection (1) was inadvertently left out of the proposed rule that clarifies that the guidelines referenced in subsections (1) through (4) are the September 13, 2002 "Guidelines for Management of Pain" approved by the board. Correcting this omission clarifies the rule without changing its intended effect.

A final cost-benefit analysis is available by contacting Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4945, fax (360) 236-2406, e-mail arlene.robertson@doh.wa.gov.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

Number of Sections Adopted on the Agency's Own Initiative: New 8, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 8, Amended 0, Repealed 0.

Date Adopted: May 11, 2007.

Blake T. Maresh

Executive Director

for Daniel Dugaw, DO

Board Chair

OTS-8007.3


NEW SECTION
WAC 246-853-510   Use of controlled substances for pain control.   (1) Purpose. The board of osteopathic medicine and surgery recognizes that effective pain management is an essential component of quality medical care and that no single approach to the treatment of pain is exclusively correct.

(2) The board wishes to reassure osteopathic physicians that they need not fear disciplinary action from the board for prescribing, dispensing, or administering controlled substances, including opioids, when treating pain so long as the care provided is consistent with currently acceptable osteopathic medical practice. This includes acute, chronic, and intractable pain (RCW 69.50.308(g)) patients.

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NEW SECTION
WAC 246-853-520   What specific guidance should an osteopathic physician follow?   The osteopathic physician should consult the Guidelines for Management of Pain approved by the board of osteopathic medicine and surgery effective September 13, 2002.

(1) The board has adopted guidelines for the management of pain in order to acquaint osteopathic physicians with recognized national standards in the field of pain treatment.

(2) These guidelines specifically address the patient evaluation and treatment plan, informed consent, periodic reviews, use of consultations, and the necessity for maintaining accurate and complete medical records.

(3) These guidelines may be revised from time to time to reflect changes in the practice of pain management.

(4) Osteopathic physicians who cannot, or choose not to, treat patients who have complex or chronic pain conditions should offer appropriate referrals for those patients.

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NEW SECTION
WAC 246-853-530   What knowledge should an osteopathic physician who elects to treat chronic pain patients possess?   Osteopathic physicians treating pain should be:

(1) Knowledgeable about the complex nature of pain;

(2) Familiar with the pain treatment terms used in the board's pain treatment guidelines; and

(3) Knowledgeable about acceptable pain treatment modalities.

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NEW SECTION
WAC 246-853-540   How will the board evaluate prescribing for pain?   The osteopathic physician's treatment will be evaluated by a review of the provided care to see if it is clinically sound and in accordance with currently acceptable osteopathic medical practice regarding the treatment of pain.

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OTS-8008.3


NEW SECTION
WAC 246-854-120   Use of controlled substances for pain control.   (1) Purpose. The board of osteopathic medicine and surgery recognizes that effective pain management is an essential component of quality medical care and that no single approach to the treatment of pain is exclusively correct.

(2) The board wishes to reassure osteopathic physician assistants that they need not fear disciplinary action from the board for prescribing, dispensing, or administering controlled substances, including opioids, when treating pain so long as the care provided is consistent with currently acceptable medical practice. This includes acute, chronic, and intractable pain (RCW 69.50.308(g)) patients.

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NEW SECTION
WAC 246-854-130   What specific guidance should an osteopathic physician assistant follow?   The osteopathic physician assistant should consult the Guidelines for Management of Pain approved by the board of osteopathic medicine and surgery effective September 13, 2002.

(1) The board has adopted guidelines for the management of pain in order to acquaint osteopathic physician assistants with recognized national standards in the field of pain treatment.

(2) These guidelines specifically address the patient evaluation and treatment plan, informed consent, periodic reviews, use of consultations, and the necessity for maintaining accurate and complete medical records.

(3) These guidelines may be revised from time to time to reflect changes in the practice of pain management.

(4) Osteopathic physician assistants who cannot, or choose not to, treat patients who have complex or chronic pain conditions should offer appropriate referrals for those patients.

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NEW SECTION
WAC 246-854-140   What knowledge should an osteopathic physician assistant who elects to treat chronic pain patient possess?   Osteopathic physician assistants treating pain should be:

(1) Knowledgeable about the complex nature of pain;

(2) Familiar with the pain treatment terms used in the board's paid treatment guidelines; and

(3) Knowledgeable about acceptable pain treatment modalities.

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NEW SECTION
WAC 246-854-150   How will the board evaluate prescribing for pain?   The osteopathic physician assistant's treatment will be evaluated by a review of the provided care to see if it is clinically sound and in accordance with currently acceptable medical practice regarding the treatment of pain.

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Washington State Code Reviser's Office