[NP-Clinical] Narcotics, HIPPA and the Law

Fri Aug 3 08:43:01 PDT 2007

Re: [NP-Clinical] Narcotics, HIPPA and the LawRight- forged prescriptions are a different story, but shouldn't this be pointed out to the pharmacist first & allow them to take the lead with the DOJ Investigators/Police (they must have DOJ on their tel speed dial in our area), that way the provider is simply indicating "I didn't write that, it appears to be a forgery, if the police question the legitimacy of that prescription I can attest to the fact that it has been altered after it left my practice by someone, not me".  Health care providers do their best work as 'non-combatants' don't you agree. 
  ----- Original Message ----- 
  From: David Mittman 
  To: NP Clinical 
  Sent: Thursday, August 02, 2007 6:56 PM
  Subject: Re: [NP-Clinical] Narcotics, HIPPA and the Law

  It's not an open question if you are forging Rx's.
  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

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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 <http://www.npbusiness.org/>  

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