Moratorium Update Pain Management Clinics & Internet Cafes

1. Moratorium UpdatePain Management Clinics&Internet Cafes

2. BACKGROUND-Pain Management Clinics • Flagler County Sheriff’s Office advise and request for moratorium • Ordinance No. 2010-18 (Dec. 21, 2010) • Moratorium expires Dec. 31, 2011 • Included: • No cash only operation • Hours of operation 7 a.m. to 9 p.m.

3. BACKGROUND-Pain Management Clinics • Staff to provide report on findings and recommendations by Aug. 31, 2011

4. Pain Management ClinicsOptions • Repeal moratorium after report on pain management clinic • Do nothing - Let moratorium expire December 31, 2011 • Adopt regulatory ordinance before or after expiration of moratorium

5. Three existing Pain Management Clinics in City (in compliance) • Classified as “Medical and Professional Office” Use and Permitted in all Commercial and Office Zoning Districts including MPD with Mixed-use Future Land Use Map Designation • FCSO recommends continuing moratorium to Dec. 31, 2011 to monitor results of new legislation

6. Pain Management ClinicsFlorida Legislature Action – House Bill 7095 • Regulates activities by: • pain management clinics, • physicians, • pharmacies, and • wholesale drug distributors • Penalties and Database • Enforcement Responsibilities

7. Pain Management ClinicsFlorida Legislature Action – House Bill 7095 • Enforcement Responsibilities • Flagler County Sheriff’s Office • Tri-County Narcotics Enforcement Task Force • Department of Health • State Attorney’s Office

8. Pain Management Clinics - Database • Prescription Drug Monitoring Program (E-FORCSE) (Electronic-Florida Online Reporting of Controlled Substances Evaluation) • Requires dispensing practitioners and pharmacies to report dispensing of controlled drugs to the database

9. Pain Management ClinicsFlorida Legislature Action • Regulation for Pain Management Clinics • Definition • “Pain-management clinic” or “clinic” means any publicly or privately owned facility: • (I) That advertises in any medium for any type of pain-management services; or • (II) Where in any month a majority of patients are prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic nonmalignant pain(pain unrelated to cancer or rheumatoid arthritis which persists beyond the usual course of disease or the injury that is the cause of the pain or more than 90 days after surgery).

10. Pain Management ClinicsFlorida Legislature Action • Require Registration with certain exceptions: • The clinic is wholly owned and operated by one or more board-certified anesthesiologists, physiatrists (D.O.), neurologists, medical specialist in pain medicine, • Licensed as part of hospital, • Affiliated with accredited medical school,

11. Pain Management ClinicsFlorida Legislature Action • Facility and Physical Operations Requirement of Pain Management Clinics: • Located at publicly fixed location, • Sign with name, hours of operation, and address, • Publicly listed telephone number and fax machine, • Emergency lighting and communications, • Reception, waiting area, • Restrooms, • Administrative area, storage, • Exam rooms, treatment rooms • Sign with name and contact information of physician

12. Pain Management ClinicsFlorida Legislature Action • Regulations for Physicians in Pain Management Clinics • Notify applicable board of practice at pain management clinic, • Ensure compliance of facility with health and safety requirements, (location, data collection, reporting, etc.) • Standards for quality of care and appropriateness of care, • Use counterfeit proof prescription pads • Expiration January 1, 2016

13. Pain Management ClinicsFlorida Legislature Action • Pain management clinics where certain violations occur (assault and battery, burglary, theft, unlawful distribution) twice within six months, may be declared a public nuisance and abated pursuant to state statutes (local law enforcement agencies and appropriate state agencies).

14. Pain Management ClinicsFlorida Legislature Action • Regulations for Physicians • Limited authority to dispense controlled substances

15. Pain Management ClinicsFlorida Legislature Action • Regulations for Pharmacies/Pharmacists • Strengthens license requirements for pharmacies • Background checks, fingerprinting • Create policies and procedures to minimize fraudulent acquisition of controlled substance • Reporting requirements • Penalties

16. Pain Management ClinicsFlorida Legislature Action • Regulations for Wholesale Distributors • Perform due diligence in sale of controlled substances • Report sales to Drug Enforcement Agency (DEA) • Report purchase of unusual quantities • Penalties

17. Pain Management Clinics • Staff and FCSO recommend continuing moratorium to Dec. 31, 2011; • to monitor effectiveness of new legislation, • to continue on-going discussions with FCSO, and identify the potential need for local regulations, (separation requirements, on-site dispensing ban, zoning restrictions, etc.)

18. Moratorium UpdateInternet Cafes

19. Internet CafesBackground • Ordinance 2011-10, 180 day moratorium on “internet cafes” (Moratorium began May 10, 2011) • Expires on November 6, 2011 • Option to extend an additional 90 days (February 4, 2012)

20. Internet CafesUpdate on Legal Status • Current Legal Status • Under Florida Statutes • Recent Attorney General Opinion • Regulation from other Counties and Municipalities • No criminal enforcement at this time

21. Internet CafesCurrent Status • 9 active businesses (1 pending occupancy permit) • Classified as “Retail” use and allowed in all Commercial zoning districts (C-1, C-2, and C-3), and Master Planned Development (MPD) with Mixed-use Future Land Use Map Designation • 8 are in C-2, 1 in C-1

22. Location of Existing Internet Cafes

23. Internet CafesOptions • Do Nothing – Let moratorium expire • Moratorium Extension – Allows for monitoring of on-going litigation & potential legislation • Regulatory Ordinance – Code of Ordinances and/or Land Development Code

24. Internet CafesOption – Moratorium Extension • Continue monitoring of on-going litigation (other Counties and Municipalities), and • Allow Florida Legislature to address issue • Action from Florida Legislature and final decision on legislation may occur at a time period beyond the expiration of moratorium extension (90 day extension to February 4, 2012) • Bill filed for 2012 Legislature to prohibit use of simulated gambling devices to conduct or promote game promotions, drawings, & games of chance.

25. Internet CafesOption – Regulatory Ordinance • Amendment of Code of Ordinances and/or Land Development Code to regulate or ban “Internet Cafes”

26. Internet CafesOption – Regulatory Ordinance • Limit number in City • Operation • Fingerprint, background check for owners/employees (include recovery of administrative cost) • Trust/surety bond posted covering amount of announced prices • Software certification for fairness • No alcoholic beverages

27. Internet CafesOption – Regulatory Ordinance • No minors • Security system with cameras, drop safe, silent alarm, armed security guard at night, transparency of windows for law enforcement • Limitation on size of operation including number of machines • Hours of operation • Signage (no image associated with gambling)

28. Internet CafesOption – Regulatory Ordinance • Location (Land Development Code) • Limit to certain zoning districts • Separation requirements • Between internet cafes • Between internet cafes and other uses (schools, churches, bars, etc.) • Regulations need justification • Data and statistics on special conditions related to “internet cafes”

29. Location of Existing Internet Cafes

30. Zoning Limits Com-2 and Com-3 Zoning Districts

31. Zoning Limits Com-3 Zoning District

32. Zoning Limits C-1, C-2, and C-3 Zoning District with 1500 foot distance radius

33. Internet Cafes • Staff recommends extending moratorium and drafting regulations for internet cafes • Discussion