[NP-Clinical] Narcotics, HIPPA and the Law

Wed Aug 1 20:13:20 PDT 2007

Calif NP, Windy, and other legal lurkers can probably give the definitive
answer as I certainly don't have it. However, there are a couple of
principles here: 1. The patient essentially becomes a threat to himself by
taking many times the prescribed amount of medication, and 2. forging
prescriptions for controlled substances and practicing medicine without a
license are illegal. Contact your practice lawyer for the applicable laws in
your state; your lawyer will know how to proceed (this is why you should
have a lawyer on retainer) and what information can or can't be divulged in
the process of reporting the patients to the authorities. Bottom line: they
should be reported to protect you AND your patients. Please keep us
informed; I know this is an area I need to learn more about. We don't have
prescriptive privileges for narcs in Missouri, which is a blessing in cases
such as these. The worst I've had happen so far (that I know of, anyway!) is
a patient who made multiple work excuses for herself with my name forged on
all of them..

Diane Dito, NP

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of David Mittman
Sent: Wednesday, August 01, 2007 9:59 PM
To: NP Clinical
Subject: Re: [NP-Clinical] Narcotics, HIPPA and the Law

Barbara:
It's been awhile since I looked at patients rights but I know that forging
prescriptions is not one of them. These people are addicts and I feel for
them. With no other offences I would presume but do not really know, that
they would get probation as long as they submitted to a treatment program.
Making copies of RXs is illegal.
Dave
On 8/1/07 10:49 PM, "Barbara C. Phillips" <bphillips at olderwiserwomen.com>
wrote:

What would you do?

1.       You are treating a 67 year old man for chronic back pain after
several failed surgeries. You see that his pain is not adequately
controlled, yet he does not want to increase is medication (Vicodin).
Several months later, you find out he was some how making copies of your
prescriptions and taking them to various pharmacies around town.never
hitting the same one more than once a month (getting about three times what
you prescribed). He agrees to go to treatment. He gets no further pain
medication - at least not from you.  Would you have reported this to the
police?

2.      59 year old man with chronic pain and PKD has been on oxy's for
several years and is documented by his previous providers as having no
problems with medications. Documentation includes formal pain assessment,
stating treatment is appropriate. You get a call today from a pharmacy 2
hours away that he just filled a prescription - "brand name please" (and
paid cash). However, when investigating, he just got that script at the
appropriate pharmacy the day it was written.in town. And it turns out he
filled a script for nearly the same medication from a physician 3 hours away
(we had a nice long chat). Further investigation shows multiple pharmacies,
providers and three counties. In this last incident (today), I've notified
all involved pharmacies and providers, and faxed a copy of the discharge
latter to the nephrologists. But do I notify the police?

Does a patient retain the right to confidentiality in these scenarios? I do
have medication contracts for controlled substances, but you know.it does
not say anything about legal action if it is violated (which I will correct
immediately). 

I feel like not doing something essentially allows the patient to see the
next provider and start all over again.  

I'm looking forward to your comments.

Barbara C. Phillips, NP
www.NPBusiness.ORG  <http://www.npbusiness.org/>
<http://www.npbusiness.org/>  

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