AB193: Bill Text

LRB-1848/1

MDK:kjf:jf

2003 - 2004 LEGISLATURE

2003 Assembly BILL 193

March 25, 2003 - Introduced by Joint Legislative Council. Referred to Committee on Health.

AB193,1,4 An Act to amend 448.02 (3) (a); and to create 115.357 and 448.35 of the statutes; relating to: requiring physicians to provide certain information when issuing prescription orders to treat children with attention deficit hyperactivity disorder.

Analysis by the Legislative Reference Bureau

This bill is explained in the Notes provided by the Joint Legislative Council in the bill.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

Prefatory note: This bill was prepared for the Joint Legislative Council's special committee on use of prescription drugs for children.

REQUIREMENT FOR A PHYSICIAN ISSUING A PRESCRIPTION ORDER FOR A CHILD FOR TREATMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER TO PROVIDE CERTAIN INFORMATION

Treatment of Attention Deficit Hyperactivity Disorder With a Prescription Drug

The bill requires any physician who diagnoses a child (any person less than 18 years old) with attention deficit hyperactivity disorder (ADHD) and issues a prescription order for treatment of the disorder to provide certain information to the parent or guardian of the child or to an adult who is with the child at the time the prescription order is issued, if any. If the child is 14 years of age or older, the physician must also provide the information to the child.

If a physician treats a child for ADHD with a prescription drug on a long-term basis, the physician must provide the information when issuing the initial prescription order and at least once every 2 years thereafter. A physician is not required to provide the information in an emergency or if the physician reasonably believes that another physician has issued a prescription order for the child for the same prescription drug within the past year.

Under the circumstances described above, a physician must provide all of the following information:

1. An explanation of the method of diagnosis used, including the results of any tests or evaluations.

2. Information on alternative modes of treatment, as provided in s. 448.30, stats., which provides as follows:

"448.30 Information on alternate modes of treatment. Any physician who treats a patient shall inform the patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments. The physician's duty to inform the patient under this section does not require disclosure of:

(1) Information beyond what a reasonably well-qualified physician in a similar medical classification would know.

(2) Detailed technical information that in all probability a patient would not understand.

(3) Risks apparent or known to the patient.

(4) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

(5) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

(6) Information in cases where the patient is incapable of consenting.".

3. A printed copy of the informational materials pertaining to the assessment and treatment of ADHD prepared by the department of health and family services (DHFS). The requirement for DHFS to prepare those materials is described below.

Treatment of ADHD With a Schedule II Controlled Substance

In addition to providing the materials described above, a physician who diagnoses a child with ADHD and prescribes a Schedule II controlled substance for treatment of the disorder must provide a printed copy of any materials pertaining to the substance which have been prepared by DHFS.

A physician who is required to provide any of the information (as described above) must obtain certification in writing from the parent or guardian of the child or the adult to whom the information is provided, if any, that the physician has provided all of the required information.

Penalty for Failure to Provide Information; Exemption

Under current law, a physician who, after investigation and a hearing, is found guilty of unprofessional conduct is subject to disciplinary action by the medical examining board. The bill provides that an allegation that a physician has failed to provide the required information or obtain the required certification is an allegation of unprofessional conduct. However, the bill provides that it is not unprofessional conduct for a physician to fail to provide the informational materials prepared by DHFS, if the physician made a reasonably diligent effort to obtain the materials from DHFS and DHFS did not make materials available at the time the physician was required to provide them.

PREPARATION OF INFORMATIONAL MATERIALS BY DHFS

Materials Pertaining to the Assessment and Treatment of ADHD

The bill requires DHFS to prepare informational materials on the assessment and treatment of ADHD. These are the materials which must be provided by a physician who prescribes any prescription drug for the treatment of ADHD in a child. The materials must contain the following:

1. A summary of the practice parameters for the assessment and treatment of children and adolescents with ADHD published by the American Academy of Child and Adolescent Psychiatry.

2. A statement that a parent or guardian may seek treatment other than prescription drugs for a child with ADHD.

Materials Pertaining to Schedule II Controlled Substances

In addition to the materials above, the bill requires DHFS to prepare informational materials on certain Schedule II controlled substances. These are the additional materials that must be provided by a physician who prescribes any Schedule II controlled substance for treatment of ADHD in a child. DHFS must, in consultation with the State Medical Society of Wisconsin, determine which Schedule II controlled substances are routinely prescribed by physicians in this state to treat ADHD in children. For each of these substances, DHFS must prepare materials containing the following information:

1. A statement that the substance is a Schedule II controlled substance under s. 961.16.

2. A summary of information included in the labeling of the substance required by federal law pertaining to the safety and effectiveness of the substance when used to treat ADHD in children, including any information relating to the potential for abuse or development of dependence upon the drug.

3. A statement that use of a the Schedule II controlled substance to treat ADHD may affect a person's eligibility to serve in the U.S. armed forces, if the DHFS so finds.

4. A statement that the use of a Schedule II controlled substance to treat ADHD may affect the cost of a person's health insurance.

DHFS must prepare all of the informational materials within approximately 5 months after the effective date of the bill. Physicians are first required to provide the required information beginning approximately 9 months after the effective date of the bill.

Dissemination of Materials by the Department of Public Instruction

The bill requires the department of public instruction (DPI) to disseminate the informational materials prepared by DHFS to appropriate public school staff.

AB193, s. 1 Section 1. 115.357 of the statutes is created to read:

AB193,3,6 115.357 Information on attention deficit hyperactivity disorder. The department shall disseminate to appropriate public school staff the information regarding the diagnosis and treatment of attention deficit hyperactivity disorder and prescription drugs used to treat the disorder prepared by the department of health and family services under s. 448.35 (2).

Note: Requires the DPI to distribute the informational materials prepared by DHFS to appropriate public school staff.

AB193, s. 2 Section 2. 448.02 (3) (a) of the statutes is amended to read:

AB193,4,20 448.02 (3) (a) The board shall investigate allegations of unprofessional conduct and negligence in treatment by persons holding a license, certificate or limited permit granted by the board. An allegation that a physician has violated s. 253.10 (3), 448.30, 448.35 (3), or 450.13 (2) or has failed to mail or present a medical certification required under s. 69.18 (2) within 21 days after the pronouncement of death of the person who is the subject of the required certificate or that a physician has failed at least 6 times within a 6-month period to mail or present a medical certificate required under s. 69.18 (2) within 6 days after the pronouncement of death of the person who is the subject of the required certificate is an allegation of unprofessional conduct. Information contained in reports filed with the board under s. 49.45 (2) (a) 12r., 50.36 (3) (b), 609.17 or 632.715, or under 42 CFR 1001.2005, shall be investigated by the board. Information contained in a report filed with the board under s. 655.045 (1), as created by 1985 Wisconsin Act 29, which is not a finding of negligence or in a report filed with the board under s. 50.36 (3) (c) may, within the discretion of the board, be used as the basis of an investigation of a person named in the report. The board may require a person holding a license, certificate or limited permit to undergo and may consider the results of one or more physical, mental or professional competency examinations if the board believes that the results of any such examinations may be useful to the board in conducting its investigation.

Note: Amends the statute which authorizes the medical examining board to investigate allegations of unprofessional conduct and impose penalties against a physician who is found guilty of unprofessional conduct. Specifically, provides that an allegation that a physician violated s. 448.35 (3), stats., requiring physicians to provide certain informational materials, as created in Section 3 of the bill, is an allegation of unprofessional conduct. Section 3 of the bill also creates an exemption which provides that a physician is not guilty of unprofessional conduct for failure to provide the informational materials prepared by DHFS if the physician made a reasonably diligent effort to obtain the materials from DHFS and DHFS did not make the materials available.

AB193, s. 3 Section 3. 448.35 of the statutes is created to read:

AB193,5,3 448.35 Attention deficit hyperactivity disorder. (1) Definitions. In this section:

AB193,5,4 (a) "Child" means a person under 18 years of age.

AB193,5,5 (b) "Department" means the department of health and family services.

AB193,5,6 (c) "Prescription drug" has the meaning given in s. 450.01 (20).

AB193,5,7 (d) "Prescription order" has the meaning given in s. 450.01 (21).

AB193,5,9 (e) "Schedule II controlled substance" means any substance included under s. 961.16.

AB193,5,11 (2) Informational materials. (a) The department shall prepare informational materials which contain the following:

AB193,5,14 1. A summary of the practice parameters for the assessment and treatment of children and adolescents with attention deficit hyperactivity disorder published by the American Academy of Child and Adolescent Psychiatry.

AB193,5,16 2. A statement that a parent or guardian may seek treatment other than prescription drugs for a child with attention deficit hyperactivity disorder.

AB193,5,21 (b) The department shall, in consultation with the State Medical Society of Wisconsin, determine which Schedule II controlled substances are commonly prescribed by physicians in this state to treat attention deficit hyperactivity disorder and shall prepare informational materials pertaining to each of those substances containing the following information: