By Alison Knopf
A bill winding its way through the Tennessee legislature would make opioid treatment programs (OTPs) liable for any injury or death caused by a patient who had just received methadone. This is similar to laws that hold restaurants and bars liable for injuries or deaths caused by people driving drunk after consuming alcohol at their establishments.
Under the bill, the defense to liability would be:
- Offering to call a friend, relative, or taxi to transport the patient; or
- Immediately notifying law enforcement personnel that an employee of the OTP has either observed the patient leave treatment by driving in an impaired state or heard the patient’s stated intent to drive while in an impaired state
OTPs say the proposal is unfair because it doesn’t take into account the fact that the accident may be caused by the other person, or by something unrelated to methadone.
“We work very hard to ensure that our patients are not impaired in any way,” said Deb Crowley, past president and board delegate of the Tennessee Provider Group. “We take every precaution to make sure they do not walk out impaired. We have onsite drug testing. We have them see the doctor. We have more steps in place than dentists or regular physicians. We call taxis.”
Methadone Patients Aren’t Sedated; Bill Assumes They Are
Patients treated with a therapeutic dose of methadone are not sedated. What is distressing about the bill is that it assumes that they are, OTPs say. “Someone could be completely functional, not impaired in any way, and if someone else hits them, it would put the treatment center in a liability situation,” Ms. Crowley told AT Forum.
“Our patients don’t even receive take-homes,” said Ms. Crowley. “We do a mini-assessment every time they come in.”
State Representative Micah Van Huss is the author of the bill, which is still in various committees in the House of Representatives. “It’s similar to what we currently do here in Tennessee with bars,” Representative Van Huss said, the Johnson City Press reported. “If bars let people go intoxicated, then they are held partially liable if someone gets in an accident.”
The bill includes a defense to liability if the clinic tried to prevent the patient from driving, and according to Representative Van Huss, applies only if the driver was impaired.
Tennessee is sorely in need of more OTPs. The legislation was drafted because there will soon be more OTPs—including a jointly operated program to open in Gray, run by Mountain States Health Alliance and East Tennessee State University (ETSU).
“People with these issues certainly need medical assistance, and that should be provided in a medical environment,” said Danny Sells, head of the Citizens to Maintain Gray. “However, Mountain States, ETSU, and Johnson City cannot expect our community to relinquish our expectation of safety, either personally or from the traffic hazard this will cause, in providing those services to these individuals.”
OTPs: Bill Discriminates Against OTPs and Stigmatizes Patients
Behavioral Health Group runs 10 of the 12 OTPs in the state, and Derek Walsh, vice president of operations, testified against the bill at the committee hearing in early April. “If the logic around the bill is that we’re going to punish health care providers that provide narcotics to patients, and hold them accountable for patient actions after they leave, that shouldn’t be singularly affecting the 12 opioid treatment programs in the state of Tennessee,” Mr. Walsh said, according to the Johnson City Press.
“There are lots of places that gives patients narcotics. If we’re going to apply a rule, it should be fairly applied to anybody who dispenses narcotics.” Mr. Walsh added that OTPs already conduct the procedures the bill cites as defenses to liability. “I’ve personally taken patients’ keys before to keep them from driving,” he added. OTPs take issue with the bill because it treats them as the only providers of opioid treatment, he said.
Mountain States Vice President Lindy White called the bill “discriminatory” and said it would create more stigma for patients.
Here is the most recent text of the bill (House Bill 1033): A nonresidential substitution-based treatment center for opiate addiction, as defined by § 68-11-1602, shall be liable for damage or injuries caused by a patient who, upon leaving the treatment center after receiving treatment, commits driving under the influence under § 55-10-401, vehicular assault under § 39-13-106, aggravated vehicular assault under § 39-13-115, vehicular homicide under § 39-13-213(a)(2), or aggravated vehicular homicide under § 39-13-218, and the patient’s impairment is due to the treatment provided by the center. (b) It shall be a defense to liability under subsection (a) that the nonresidential substitution-based treatment center for opiate addiction took reasonable efforts to prevent the patient from driving while impaired. Reasonable efforts include, but are not limited to: (1) Offering to call a friend, relative, or taxi to transport the patient; or (2) Immediately notifying law enforcement that an employee of the center has either observed the patient leave treatment by driving in an impaired state or heard the patient’s stated intent to drive while the patient was in an impaired state.
The bill would take effect July 1, 2017. The Gray OTP is set to open in August.