by Alissa C. Atkins, Esq.

We have recently noticed a trend showing up in medical records where pain management physicians have asked patients to undergo drug testing. In some cases, the patients have refused at the instruction of their attorneys, who may not be aware of a recent change to the Georgia Pain Rule. This rule of the Georgia Medical Board requires doctors to test patients enrolled in a licensed hospice setting when they are being prescribed chronic opiate therapy for more than ninety days in a one-year period. The patient is required to be checked for compliance during this evaluation every ninety days, even if the patient is seen more often.

The compliance evaluation is to include a physical examination, laboratory evaluation (serum, sweat, urine or blood testing), pill counts and interviews. The testing is specifically intended to be done on a random basis, but still needs to be done every thirty days. The Georgia Medical Board recognizes that some patients will only be seen every three months, making it difficult to test a patient randomly. In that case, the Medical Board recommends a patient being called in for a non-clinical visit for this testing or otherwise requiring the patient to be seen on a more frequent basis. Otherwise, the randomness of the testing is lost because the testing dates can be predicted by the patient. This would seem to negate the point of the rule, which requires narcotic providers to ensure that patients are properly taking their medications.

There is a hardship rule exception to the requirement, but we do not see how that would be a bar in most workers’ compensation claims as the employer/insurer would be paying for medical treatment to include the appointment and prescriptions in a compensable claim.

Pursuant to the Georgia Medical Board’s new Rule 360-3-06.2(c), we recommend requiring pain management providers and other doctors who are prescribing narcotics to order this regular testing if there is any question about the claimant’s compliance. While it appears as though the physicians should be requiring this testing anyway, many doctors may not be aware of the rule as it potentially applies to workers’ compensation cases. As long as the doctors are being compliant with the recommendations of the Medical Board, this testing should be done much more regularly and we should be able to confirm that the claimants are taking medications as recommended, which could assist not only in dropping the medical cost in claims, but also enforcing claimants to be compliant with medication usage.