[NP-Clinical] Narcotics, HIPPA and the Law

[Calif NP]

There remain some confidentiality/provider ethics issues it seems-  and what part do you want in helping a patient with pain management problems get prosecuted and locked up in one of our already overcrowded CA prisons for 40+ years? They get NO treatment there, and they DO come back out- with their drug problems intact, and with a new network of friends/associates and set of inappropriate skills. But, none the less the DEA and California DOJ (Dept of Justice) would certainly say "maybe" you should make a report- they do not have the same appreciation of medical ethics.  It is not a perfect world, and it should not be any surprise that many folks with legitimate pain issues are not adequately treated.  Over half of CA's prison inmates are there for NON-Violent offenses, and some 70% have drug&alcohol addiction, and some 50% of the inmates are dually diagnosed with d&a addiction together with significant mental illness(es).  CA parole system is a total joke (if one could find anything remotely amusing about it) with does virtually nothing to put people into treatment, jobs, or transitional housing! 

Each agency actually has a form that all prescribing providers can use to make an 'inquiry' regarding a patient of the requesting provider as to that individual patient's pharmacy history with all current/recent providers. This then amounts to a backwards sort of way to draw attention of the DEA/DOJ to your 'concern' - which amounts to making a report- they will get right on it!  The "CURES Program" in CA operated by the CA DOJ, Bureau of Narcotic Enforcement, monitors controlled substances prescriptions filled in CA for potential abuse by patients. When one provider makes an 'inquiry' that provider and all other providers get a full copy of the pharmacy history with names of all other providers.  The DOJ letter response with the pharmacy history/provider history or list, says "We trust that well-informed practitioners can and will use their professional expertise, to evaluate their patients who may be abusing controlled substances. .......please feel free to contact the CURES Program at (916)319-9062."   etc etc.   So, their letter(s) to providers do not state a "Yes", but defer to provider wisdom to a very large extent.  They recognize that they (DOJ,DEA) are part of a huge failed system!
  ----- Original Message ----- 
  From: Theodore Scott 
  To: 'NP Clinical' 
  Sent: Wednesday, August 01, 2007 8:23 PM
  Subject: RE: [NP-Clinical] Narcotics, HIPPA and the Law


  The California BRN and the DEA would no doubt answer "yes" to both scenarios

   

  Ted Scott, NP-C

   


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  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 

   



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