Comment from steven mannon on VA-2026-VHA-0166-0001

Public Comment Opposing Proposed Rule RIN 2900-AS73 — Expanding Access to State Prescription Drug Monitoring Programs I oppose this proposed rule as written. I support appropriate PDMP review by treating clinicians for patient safety. But this rule goes far beyond a prescriber or pharmacist checking controlled-substance history for an individualized treatment decision. VA proposes to expand PDMP access to broad categories of “delegates,” including administrative associates, program analysts, technical support specialists, researchers, contractors, and VA automated systems. The rule also contemplates automated queries triggered by appointments, emergency-room check-ins, and cohort reports for groups of covered patients receiving controlled substances. That is not merely safe prescribing. That is a surveillance architecture. The proposed rule would allow querying, viewing, accessing, processing, and storing PDMP data according to VA’s need. It would also allow PDMP data and analytics to be incorporated into VA clinical workflow through electronic health records, health information exchanges, e-prescribing, and other automated systems. Yet the rule does not provide enforceable protections to ensure PDMP data is not combined with disputed or subjective VA behavioral records. That omission is critical. VA maintains internal systems that can label veterans as aggressive, disruptive, threatening, noncompliant, or excessive. These include DBRS, Disruptive Behavior Committee records, Violence Risk Assessment Instruments, Behavioral Patient Record Flags, Orders of Behavioral Restriction, VA Police reports, PATS/PATS-R Patient Advocate records, and VHA 1112 “no reply” handling. If PDMP data or analytics are combined with these internal behavioral records, veterans can be unfairly targeted for tapering, restriction, flagging, denial of care, or law-enforcement escalation without meaningful notice or correction rights. The proposed rule also expressly preempts conflicting state laws and says states may not restrict the querying process or limit the data contained in the query for VA providers or delegates acting under the rule. If VA intends to preempt state privacy and access protections, VA must replace them with stronger federal protections. This proposal does not do that. At minimum, VA should revise the rule to require: PDMP access only for treating clinicians or directly supervised clinical delegates with a patient-specific care need. No routine patient-identifiable PDMP access for administrative associates, program analysts, technical support specialists, researchers, contractors, or automated systems. No automated cohort querying for individual adverse action, tapering, flagging, restriction, DBRS referral, VA Police referral, or no-reply handling. A prohibition on using PDMP reports, PDMP analytics, Narx-type scores, or overdose-risk scores as the sole basis for medication reduction, denial of controlled-substance treatment, dismissal from care, behavioral flagging, or restriction. A prohibition on combining PDMP-derived data with DBRS, DBC, PRF, OBR, VA Police, PATS-R, or VHA 1112 records unless the veteran receives notice, access, correction rights, and an explanation of how the information is clinically relevant. A veteran-facing audit trail showing every PDMP query, who or what system made the query, the reason for the query, and any VA record or decision that used the result. A correction and statement-of-disagreement process for PDMP-derived records stored or used by VA. Annual public reporting on PDMP queries, automated queries, cohort reports, delegate access, and adverse actions following PDMP review. PDMPs can support safe prescribing when used carefully and in context. But this proposed rule would authorize broad VA access, storage, automation, analytics, delegate use, and state-law preemption without adequate veteran protections. VA should not finalize this rule as written.