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PDMP Autopsy: How Rehder’s bill failed to make it to Greitens’ desk


JEFFERSON CITY, Mo. – Before he became the target of dark money attack ads from A New Missouri Inc., before he got into a public spat with Budget Chair Scott Fitzpatrick over the managed care rollout, before he became essentially a central figure in the 2017 legislative session, Sen. Rob Schaaf called an impromptu press conference April 4. He revealed few details of what the press conference would entail, aside from the fact that he had a “major announcement” … on something that he did not wish disclose over email.

The gathered and skeptical press corps quickly raised their eyebrows and dropped their jaws when Schaaf announced that he would end his longstanding opposition to Rep. Holly Rehder’s prescription drug monitoring plan (PDMP) legislation. For years, Schaaf had stood largely as the lone impediment to Missouri becoming the 50th and final state to adopting a statewide framework for a PDMP, and here he stood behind a podium, announcing that aside from one caveat, he would stop his filibuster on the issue.

“Rep. Rehder has worked hard on this issue, and I’m not asking for any single change in her version but the one I’ve mentioned here,” he said that day. “She deserves to have her version become the law.”

Schaaf to back down on opposition to Rehder’s PDMP bill

When Rehder walked into the Senate Mezzanine where the conference was being held, she began speaking with Sen. Dave Schatz, the Senate handler of the legislation. As he told her what was happening, her own face turned to one of shock. The bill she had worked on for so long, a bill she had fought for essentially since she came to the state Capitol, finally had a road to the governor’s desk.

Just a little over a month later, the bill met its usual fate, dying alongside so many other bills unable to make it through both chambers as the House and Senate gavelled out for the final time May 12.

What went wrong? How did something that appeared to be a sure thing fail to make it through the General Assembly?

A new roadblock emerges

Sen. Will Kraus speaks on the Senate floor April 5, 2016. (Travis Zimpfer/THE MISSOURI TIMES)
Sen. Will Kraus speaks on the Senate floor April 5, 2016. (Travis Zimpfer/THE MISSOURI TIMES)

After Schaaf made his announcement that he would stand down on the bill, other opponents in the Senate emerged in force. Sen. Will Kraus especially led a small group of senators, including Sen. Bill Eigel and Sen. Andrew Koenig, roughly a week later April 13 to attach multiple amendments to the bill, some of which ended up being poison pills. The two most contentious amendments to Rehder’s bill were a provision that would purge all stored data from the PDMP after 180-days and it would limit the PDMP to just benzodiazepenes (benzos) and opiates. Rehder’s original bill had no data purge, and included all Schedule II-IV drugs.

That debate occurred the night before Easter Break, and April 18, Rehder moved for the House to take the bill to conference, which it did readily. Rehder had passed the bill out of the House with unanimous support from Democrats and a split Republican caucus, but it had more than enough votes to make it out of the chamber.

After April 18th, however, things went into a standstill.

The Senate dramatics, with Schaaf feuding with Gov. Eric Greitens and his nonprofit, essentially stalled debate for nearly a week, and when the Senate did get back to business, it mainly went into relatively inconsequential legislation. Schatz did not have an opportunity to readily make a motion to go to conference on the bill. Eventually, he finally succeeded and the Senate granted conference, but the conference never occurred. Rehder, Schatz and Kraus could not get on the same page.

House Democrats balk on PDMP

Eventually, the time came when Rehder had to make a decision of whether to continue what appeared to be a fruitless effort to go to conference or go with the Senate version of the bill. On May 10, just days away from the end of the session, she made her choice and dissolved to the conference committee to pass what she acknowledged was a flawed bill.

“By Wednesday, we had spoken with leadership, we spoke with the executive branch… and I had made the decision that it was better to get us past our first hurdle, which was getting a statewide framework approved,” Rehder said. “Even though it was going to be with these two bad amendments… It would be easier to come back next session and work on fixing those two things versus just getting the approval for a statewide PDMP.”

While the contingent of House Republicans opposed to the bill changed little at the new draft, the unanimous support from the Democrats evaporated as the superminority became deeply divided on the legislation. Most Democrats represent areas like St. Louis and Jackson Counties that have PDMPs at the county level. If the statewide framework went into law with those amendments, it would create a statewide system considered even by Rehder to be “less robust” than the programs adopted by most Missouri counties.

The dagger came when House Minority Leader Gail McCann Beatty herself stood up to speak on the bill and said she would not vote for the bill in its current state.

“I really have heartburn tonight,” Beatty said. “I know the lady has put a ton of work into this bill for a while… I was hoping we would get a better product from the conference.”

After that, Democratic support dropped like a brick.

As the debate continued for a few more hours, it became clear that Rehder did not have the votes necessary to get the bill out of the House and it was laid over. All day Thursday, Rehder and Schatz lobbied for counties with programs to accept a statewide program that could provide some benefit to the sizable portion of Missouri citizens not covered by a PDMP.

“We have just a little under 20 counties now signed on, we have 100-some odd counties in this state,” Rehder said. “So our concern is with two people dying a day in Missouri of overdoses is we need to get a system in place statewide ASAP.”

Bill dies… or does it?

However, the counties with PDMP did not budge, and Thursday evening, Rehder moved to take the bill back to conference. Later that evening, she had a bill that was in a better place. The amended version would go back to covering all Schedule II-IV drugs, and it had a two-year data purge, a timetable that is more in line with other states that have similar purges.

Kraus did not sign off on the conference committee report on this new version of Rehder’s bill.

Eventually, the finagling came to an end during a hectic Friday which saw the Senate mired in procedural motions, a previous question, and filibusters that killed plenty of pieces of legislation. Rehder also said she was still working to get counties on board with the plan.

With this week’s upcoming special session, numerous people in the Capitol wondered if PDMP might be one of the topics discussed, though Gov. Eric Greitens specifically limited the session to just Rep. Don Rone’s utility bill for a steel mill in Southeast Missouri. Rehder said she would not be ready for a special session at this time anyway, given tweaks she’s looking to make to language and the need for a few more votes here and there.

However, if Greitens calls another special session during the interim, she hopes that PDMP is a topic he chooses. She and Schatz have continued to do work on the legislation to shore up concerns counties have as well as with physicians who oppose the mandatory use provision Schaaf added.

“I’m working on this and trying to clear up some of the doctor’s concerns and right now, with the committee report bill that we had out,” she said. “Sen. Schatz and I would like to be ready, just in case… we were to have another special and we were to get added to it.”