[NP-Clinical] Narcotics, HIPPA and the Law

Thu Aug 2 13:36:44 PDT 2007

I'm no expert on how the legal system handles people who have  
problems abusing controlled substances, but I think that those people  
are not being helped by providers who feel sorry for them and don't  
report them.

For one thing, the person may be selling some of their illegally- 
acquired drugs. I hear one Vicodin is worth $25 on the street. Some  
folks on disability because of their chronic pain may also be  
supplementing their lousy disability income--how are you to know what  
they are doing with their stockpile? They could be both treating  
their pain AND trafficking. Since you don't know what they're doing  
with the narcotics, you could be helping perpetuate more than one  
person's drug addiction.

The other thing is that you are assuming a lot in thinking the person  
would end up locked in a prison. An arrest would bring them before a  
judge. The judge could order treatment in lieu of incarceration. The  
person would be less likely to offend again and more likely to get  
treatment if they knew the judge could hand down a harsher treatment  
if s/he didn't comply, or was arrested again and ended up before the  
same judge. And don't forget that most people charged with crimes can  
plea bargain, another way to avoid a prison sentence.

If on the other hand, if, out of feeling inappropriate guilt because  
someone else chose to break the law, instead of turning them over to  
the police, you have a little conversation with the person and they  
promise you they'll go to rehab--then they don't--and go on phonying  
Rx's or narcotics-shop at every doctor in town--you would have done  
nothing but enable them to continue their criminal/dysfunctional  
activity and not get the right help for themselves. And you haven't  
got the authority that the judge has.

Maybe I'm oversimplifying, but I'm all for letting the police and  
judicial system do their jobs.

HIPAA (not HIPPA) rules don't apply to this situation.

Stephanie Walker, FNP

On Aug 2, 2007, at 12:48 PM, Calif NP wrote:

> 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
>
>
>
> 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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