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Danville's Bob Pack On Verge Of Seeing Legislative Dream Come True

THE MERCURY NEWS
http://www.mercurynews.com/health/ci_30294511/danvilles-bob-pack-verge-seeing-legislative-dream-come

DANVILLE -- For more than a decade, Bob Pack has been haunting the hallways in and around the state Capitol, knocking on doors of California lawmakers, lobbyists and doctors' groups, hoping his family's tragic tale would persuade them to pass legislation that might stop his nightmare from recurring.

At every meeting and legislative hearing, the Danville father pulls out two color photos of his smiling children: son Troy, 10, and daughter Alana, 7, as they were in 2003 -- before the fateful October day when a drunk and drugged driver, hooked on prescription painkillers, killed them after obtaining Vicodin prescriptions from six different Kaiser Permanente doctors, all unaware of each other's prescriptions.

Now, Pack is on the verge of victory: Senate Bill 482, which would require doctors to check a database for a patient's prescription history before prescribing opioids and other potentially dangerous drugs, unanimously passed the California Assembly this week and is expected to get final clearance from the state Senate before heading to Gov. Jerry Brown's desk.

At the same time, the 61-year-old tech entrepreneur, who lives with his wife Carmen, 57, and their 10-year-old daughter Noelle, in the Danville home where they raised Troy and Alana, feels emotionally torn between hurt and hope.

"I cannot help but think that had something like SB 482 been in place back then, most likely that woman would not have been driving under the influence of those narcotics" and his two children would still be alive, Pack said. "But then, I think on the positive side: there will be a lot of families in California that won't have to suffer some of these tragedies from overdose and accidental deaths.''

Factors Pack said weren't prevalent before now are aiding his quest, including the adoption by at least 24 other states of similar mandates for prescribers to check a state-based prescription drug monitoring system. New York reported a 75 percent reduction in "doctor shopping" for opiates after the first year, while Kentucky saw opioid prescriptions fall by 8 percent.

More important is the crush of media attention surrounding the nation's opioid epidemic, highlighted by the recent opioid overdose death of rock superstar Prince, among other celebrities. The epidemic now causes more than 1,000 emergency room visits and kills 78 people every day.

Calling it "the health crisis of our generation," U.S. Surgeon General Vivek Murthy on Thursday took the unprecedented step of mailing letters to the 2.3 million prescribers in America urging them to take a pledge and help tackle the problem.

The Packs are certainly doing their part.

After their children died, the couple was stunned to learn that doctors weren't required to check patients' prescription histories for information they could use to safely prescribe opioids, manage dependence and prevent abuse.

They discovered there's been a state database since 1996 that has been overseen by the California Department of Justice and used by pharmacists, who were required to mail in their prescriptions for certain kinds of narcotics, which then had to be inputted into a computer.

Over the years, working with legislators like then-state Sen. Mark DeSaulnier, D-Concord, the couple pushed to improve and upgrade the database to be real-time, and ensure its continued funding from a dedicated portion of physicians's annual license fees.

Doctors could then voluntarily check before writing prescriptions for Schedule II, III and IV controlled substances, such as painkillers, muscle relaxants and amphetamines.

But to the Packs and other advocates, including bill cosponsors such as the Consumer Attorneys of California and California Narcotics Officers' Association, all these efforts were meaningless unless doctors were actually required by law to use the database before prescribing.

Proposition 46, which would have mandated they do so, as well as impose random drug testing for physicians and increase the cap on medical malpractice awards, was soundly rejected by voters in 2014.

In 2015, Pack went back to the Capitol, where he found Sen. Ricardo Lara, D-Bell Gardens, willing to take up the challenge, despite continued opposition from the powerful California Medical Association and other physicians groups.

They argued that the computer system was too clunky and that law enforcement would be able to access information that would identify over-prescribing doctors. Many doctors said they simply didn't like the Legislature telling them what to do.

But advocates insisted that many of those fears were overblown.

"This bill is not trying to tell doctors what decisions to make,'' said Carmen Balber, executive director of Consumer Watchdog, a Santa Monica-based consumer advocacy group. "This bill simply requires that they have all the information they need to make that choice.''

After a series of amendments over the past two years -- for example, doctors are exempted from the mandate if they cannot access the database because of internet problems, and they can have their staff check the database for them -- the CMA on Monday agreed to take a neutral position on the bill. Still, the organization continues to have outstanding concerns about what it calls "the database's inadequate privacy.''

The lone opposition remains oncologists, who have asked to be exempted from the law altogether, saying that addiction and abuse of the drugs is uncommon with cancer patients -- and that having to check the database is an unnecessary burden.

Lara has refused their request.

"We have collaborated with CMA to make sure the technology is ready, we've provided the appropriate protections and restrictions so doctors don't fear that this is another requirement that they have to do themselves,'' said Lara. "We've reached a good compromise."

Yet, even if SB 482 is signed into law by Gov. Jerry Brown, there is no guarantee that doctors will follow the mandate, a weakness even Pack and the bill's advocates acknowledge.

They say the only way the state Medical Board would learn that a doctor has not complied is if it finds out that a patient died from an overdose or an incident occurred like the one that led to the Pack's tragedy.

Lea Ann Tratten, a lawyer and political director for Consumer Attorneys of California, pointed out that the number of opioid deaths has gone down in other states where similar laws are in place.

If nothing changes in California, she noted, it would indicate that doctors here are balking.

"This is a first step. If we find out they are not using it, we can come back and figure out some other solution,'' Tratten said.

"I would like to think that doctors will do this not because they are afraid of the liability (from not checking the database), but because they want to take care of their patients.''

And under the bill, pharmacists would no longer be required to check a person's prescription record, something Pack said he would like to remedy in the future as a reinforcement for the doctors.

But for now, Pack is praying Brown will signed the bill.

Should it be vetoed, the father promises, he will be back in Sacramento next year -- and every year after, until he achieves his singular mission.

"I just keep marching slowly forward, for my children. I don't worry about time. If it takes one more year, or 8, or 10 years, I will keep pushing," Pack said. "People can say anything they want (against the bill) -- it's not going to hurt me. I've already been to the lowest depths of hurt. There's nothing anybody could do to make me turn in the other direction.''

Contact Tracy Seipel at 408-920-5343. Follow her at Twitter.com/taseipel.