When the Legislature approves a bill and the governor signs the measure into law, it’s not the end of the road.
In fact, a critical part of the journey is just beginning — the writing of rules that can have a significant influence on how a law works.
On Wednesday, in a nondescript meeting room at the state Department of Health, Washington Medical Commission members convened to hash out the rules for SB 5380, which the Legislature approved at the request of Gov. Jay Inslee. The new law requires the commission and four other state panels to adopt or amend rules that require patients to be notified about the dangers of opioids.
The goal is to “reduce the number of people who inadvertently become addicted to opioids and, consequently, reduce the burden on opioid treatment programs,” the commission said.
Before physicians write a prescription for an opioid, they are required under the new law to notify patients that they can refuse an opioid prescription, inform patients about the risks of dependence and overdose, and discuss alternatives to opioids to manage pain. If a patient does not want to use an opioid, the physician or a medical assistant must document the patient’s refusal.
The commission proposed four exemptions to the patient notification requirement, including for when the patient’s pain represents a significant health risk, procedures involving the administration of anesthesia, or when the patient is unable to grant or revoke consent.
“Will someone from the Legislature come back at us and say, `we didn’t intend for you to have any exemptions’ ?” asked commission member Dr. Robert Small.
“I don’t know how to answer that,” replied Dr. Alden Roberts, the commission’s chairman. “I think we can expect anybody to have an objection at any time. I think our reasons for the exemptions are valid. We have to be able to practice medicine.”
The commission struggled with the working of an exemption that the Legislature included in SB 5380. The law says the patient notification requirement “does not apply to the administration of an opioid in an inpatient or outpatient treatment setting.”
“When I read this, I assumed it was excluding everybody from everything in the bill,” Roberts said.
Roberts said the exemption actually refers to the administration of opioids, not the prescribing of them.
“If I were doing an outpatient surgery and I gave somebody Fentanyl and I was in my office and all set up to do this, that’s exempted because I’m administering it and not writing a prescription,” he said.
Small said another interpretation is the Legislature wanted to exempt physicians at substance abuse disorder treatment programs, where patient notification may not be possible.
“We’re guessing here,” he added.
In the end, the commission rewrote the proposed rule to try to address both scenarios. The revised rule says the exemption covers “procedures involving the actual administration of an opioid or anesthesia” and “medically-assisted treatment for substance abuse disorder.”
The bill’s lead sponsor, Sen. Annette Cleveland, D-Vancouver, couldn’t be reached for comment.
The next step is for the entire commission to review the changes to the proposed rules. A hearing likely will be held in November for a final vote and if approved, the rules would take effect Jan. 1. The 21-member commission, whose members are appointed by the governor, is a regulatory authority that handles licensing, rule making, education and discipline for physicians.
After the meeting, Roberts said in an interview that he believes the new law reiterates what’s already on the books.
“That’s what the informed consent law is all about. It bothers me a little bit that we have separated out opioids from all other parts of medicine. It’s important for people to recognize they can refuse anything we have to offer,” he said.