[NP-Clinical] Police Response - Narcotics, HIPPA and the Law

Fri Aug 3 05:58:42 PDT 2007

One issue here is that not all of us use the same pads, same forms.  Some use plain white, some use a blue security that shows "copy" when copied, some use a green that shows "illegal".  

There are some that have a heat sensitive strip that you rub, it disappears and then reappears.  But the main point here is that unless the pharmacist knows that you use security pads and checks for the safety features they will likely fill anything that looks legitimate.

I can see the logic behind requiring all of us to use a single type of security pad.   But I'm also certain that it will be a matter of time until those seeking to forge prescriptions will find a way around that, too.

And then there are the mail order pharmacies who warn that the security Rxs don't fax well.  

And what about calling in Rxs?  I had a patient call in a refill for herself.  I would not have known had the pharmacist not called to tell me about a potential drug interaction. 

Laura, NP, Missouri

Marilyn Dean <marilyn.dean at mchsi.com> wrote:     v\:* {  BEHAVIOR: url(#default#VML) } o\:* {  BEHAVIOR: url(#default#VML) } w\:* {  BEHAVIOR: url(#default#VML) } .shape {  BEHAVIOR: url(#default#VML) }   st1\:* {  BEHAVIOR: url(#default#ieooui) }   @font-face {  font-family: Comic Sans MS; } @font-face {  font-family: Tahoma; } @page Section1 {size: 8.5in 11.0in; margin: 1.0in 1.25in 1.0in 1.25in; } P.MsoNormal {  FONT-SIZE: 11pt; MARGIN: 0in 0in 0pt; FONT-FAMILY: "Comic Sans MS" } LI.MsoNormal {  FONT-SIZE: 11pt; MARGIN: 0in 0in 0pt; FONT-FAMILY: "Comic Sans MS" } DIV.MsoNormal {  FONT-SIZE: 11pt; MARGIN: 0in 0in 0pt; FONT-FAMILY: "Comic Sans MS" } A:link {  COLOR: blue; TEXT-DECORATION: underline } SPAN.MsoHyperlink {  COLOR: blue; TEXT-DECORATION: underline } A:visited {  COLOR: purple; TEXT-DECORATION: underline } SPAN.MsoHyperlinkFollowed {  COLOR: purple; TEXT-DECORATION: underline } P {  FONT-SIZE: 12pt; MARGIN-LEFT: 0in; MARGIN-RIGHT: 0in; FONT-FAMILY: "Times New
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 Our  scripts if photocopied will copy with" illegal" on the copy. Do they have  someway to get around that also?
 Marilyn Dean
    -----Original Message-----
From:    np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]On    Behalf Of Barbara C. Phillips
Sent: Thursday, August 02, 2007    11:04 PM
To: 'NP Clinical'
Subject: [NP-Clinical] Police    Response - Narcotics, HIPPA and the Law 

      This morning I had quite a conversation    with our local detective. It seems in this community, I was a rarity to    contact the police. Most often they hear from the pharmacies, but rarely the    providers. They told me that providers do not want to be involved and    “usually” don’t care what happens to the individual.  I was also informed    that prescription drug abuse was the biggest problem in our area. Kids are    apparently now crushing and snorting Xanax (yes, I’m still on my kick to rid    the west coast of that vile drug
too many    problems).

   They also told me that there is nothing    they can do unless they arrest the guy while he is picking up the forged    script. They need to catch him red handed – with both the drugs and the    script.

   In Colorado and in Arizona, and probably other states, there is    a system/data base in place where you can get a clue as to who some of your    frequent flyers and what they look like. WA has no such database, and the    pharmacies and police had no idea how we can get    one.

   I reviewed my updated pain contact with    the officer, but they are essentially worthless (from a legal point of view)    other than giving us an our when we want to discharge those that violate the    agreement. He also wasn’t that encouraging about the use of “tamper proof    scripts” – there is no such thing.  

   I’ll put my “Medication Agreement” on the    blog this weekend for anyone who wants to see it.

      Barbara C. Phillips,    NP
   www.NPBusiness.ORG    

---------------------------------

   From:    np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net] On Behalf Of Kay Schoeller
Sent: Thursday, August 02, 2007 4:18    AM
To: NP Clinical
Subject: Re: [NP-Clinical] Narcotics,    HIPPA and the Law

      We just ran into that here in our clinic.  Both    offenses are felonies and, according to our legal adviser who specializes in    pain and narcotic issues, NOT reporting CAN be considered aiding and    abetting.  We reported to the police and 3 people are now in jail.     HIPPA does not protect from legal issues when committing a    felony.

      Kay Schoeller

"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 

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