[NP-Clinical] Narcotics, HIPPA and the Law

[Dena]

Forging RXs for controlled substances is a felony criminal offense. I had an
ex-boyfriend back in the '80s who went to prison for several years for doing
the same thing. I also had a well-known drug-seeking ER patient who one
night got the bright idea to add Dilaudid to a RX that I had written for
some other drugs (Ibuprofen and Hydrocortisone cream, if I'm not mistaken).
The pharmacist got suspicious because all my writing had been traced over
several times (he was practicing my hand-writing-and very stupidly, I might
add). I told her I certainly hadn't RX'd Dilaudid (and never would for an ER
outpatient-and certainly never to him!) and for her to call the police. She
managed to stall him in the pharmacy until the police arrived and they
arrested him, The irony is that all jail medical clearances were done by us
in the Urgent Care/ER so he was brought in for me to clear him. Boy, was he
a little embarrassed!! I received a subpoena to testify at his trial but he
ended up plea bargaining and heading off to prison without any help from me.


 

This is one of the reasons states (Feds?) are going to special water-marked
security RXs for controlled substances so they can't be forged. Many states
also have pharmacies have an alert system for people who are provider and
pharmacy hopping so everyone knows who these people are. Several months ago
I had to confront a chronic pain neurosurgery inpatient when I was trying to
verify her home meds and contacted her various pharmacies-I found out she
was getting over 600 Vicodin a month from 5 pharmacies and 4 physicians! Her
bizarre post-op behavior was finally explained as narcotic withdrawal as she
wasn't getting nearly as much drugs IN the hospital as she was OUT of the
hospital. An alert system would certainly have been beneficial in this
case-and saved me a lot of time playing Nancy Drew!

Dena Galler

 

  _____  

From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Barbara C. Phillips
Sent: Wednesday, August 01, 2007 7:49 PM
To: 'NP Clinical'
Subject: [NP-Clinical] Narcotics, HIPPA and the Law

 

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/>  

 

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