[NP-Clinical] Narcotics, HIPPA and the Law

[David Mittman]

It¹s not an open question if you are forging Rx¹s.
Dave
On 8/2/07 12:48 PM, "Calif NP" <np at c-zone.net> 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 <mailto:tedscott59 at cox.net>
>>  
>> To: 'NP Clinical' <mailto:np-clinical at nurse.net>
>>  
>> 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 <http://www.npbusiness.org/>
>>  
>>  
>>  
>>  
>> 
>>  
>> 
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> 
> 
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