prescribing medication without seeing patient

and risky. Thanks to a legislative effort known as the Interstate Medical Licensure Compact, it’s becoming easier for you to obtain licensure in multiple states — and that means better “access to health care for patients in underserved or rural areas” who can now “more easily connect with medical experts through the use of telemedicine technologies.”. He had never even met the guy! However, thanks to telemedicine platforms that allow patients to see online doctors, patients can legally get a prescription without having to physically visit a doctor's office. Malpractice insurance will not cover you for “friendly prescribing.” 3. Here are three things to know before you get started. It has happened in urgent care clinics. C. Dispensing or prescribing a prescription product requires a VCPR. The doc writes the prescription and . Are you willing to commit to all of that? The good news? For example, states that allow prescriptive authority in some form include Florida, Utah and Pennsylvania. All they need is access your office via a secure telehealth platform — one that allows you to conduct a live, online video call with YOUR patients. You are putting your medical license at risk when you give medical advice to someone who is not your patient. Your email address will not be published. You don’t have to charge your co-worker or friend a fee, so if your friend is asking this favor because of a lack of insurance or funds, by all means, don’t charge! What is your opinion of online services for birth control etc? 1. I have decided that I will not issue any “friendly” prescription medications that I would not prescribe in my regular practice. Is it illegal for a doctor to prescribe medication without seeing the patient - Answered by a verified Lawyer We use cookies to give you the best possible experience on our website. Perfect! Malpractice insurance will not cover you for “friendly prescribing.” 2. The short answer: it's illegal to prescribe without an appropriate examination. Please comment! Also, all prescription medications have side effects and potential negative effects. Keep fighting the good fight. The problem I have now is nurses helping themselves to drugs without telling me, as they know I will refuse. Has it ever caused any problems? There was no chart. It is a good idea to decide before hand what “Friendly Prescriptions” you will not give under any circumstances. The Center for Connected Health Policy is an excellent resource to learn more about telehealth and reimbursement laws within your state. They may be able to obtain a prescription without leaving the comfort of their home — and it will take less time and be less stressful. It is -not- a pain medication, a controlled substance, or anything that could be abused. The patient’s prescription cannot stay there. and risky. Some of them are pretty weak in their therapeutic knowledge and are putting themselves at risk. Controlled substances? When your patients are sick, the last thing they want to do is go anywhere. But if they need a prescription medication they have no choice but to drag themselves into your office, right? Note the patient's age, medical histor… The American College of Correctional Physicians is the professional organization for correctional practitioners. But do generate a chart and in every other way treat them like a real patient. I have no more refills and my doctor charges $100.00 for a visit just to get more!” Or perhaps it is a detention deputy who asks, “Can I get a few Ambien from you? Here, for example, is a summary of New York’s policy on prescribing controlled substances . 2. In other words, federal policy does not outright forbid medical providers from evaluating their patients using an online technology — but it doesn’t outright allow it, either. Let’s say you do an exam and document that they look ok and give them a 3-month refill. This shift work kills me and I need them occasionally.” Or “Can I get some Augmentin? The physicians would write prescriptions for the nurses or correctional officers, and then they’d expect me to fill them, not only a violation of ethics but also of our policies and procedures. For example, the administration at one of my jails, after considering the medico-legal risk, the hassle of how and where to store charts and the strain of deciding what could be prescribed and what could not, decided in the end that they did not want the jail employees seeking friendly prescriptions at the jail medical clinic—at all. Vicodin, OxyContin, and morphine are all examples of opioids. Take, for example, the patient who wants a refill of a simple hypertension medication, let’s say lisinopril. Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user, no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [ 21 U.S.C. The practice of “friendly prescribing” without seeing the patient is bad medicine . . But, the rules governing the manner in which the doctor conducts that evaluation — that is, in person or via telemedicine — differ at the state level. You would say, “I’m happy to, but you need to come see me. They would never sue me!” Well, you might think this but you would be wrong. In fact, that is why the outside doctor insists on seeing the guy once in a while—so she can make sure that the medication is actually doing what it is supposed to do—lowering the blood pressure—as well as checking for those insidious complications that people with hypertension sometimes develop. prescriber, who would never be in a position to see the patient, you are available to treat in person if required. Some states require an initial physical exam while others do not stipulate whether that relationship can be established via a telemedicine visit. An hour later, she approached me, smirking in triumph, and said, “The doctor said Zithromax would help me, so he gave me a box. He is the Medical Director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho. So, what makes a prescription valid? She asks the doc if he will write a prescription for Zoloft for her husband—just enough for a month until she can get him into a psychiatrist. The final essential legal point you need to know is that it is illegal in most states (42 out of 50, to be exact) to prescribe controlled substances without physically examining the patient . Why not? If you have not done a formal history and physical exam, you are prescribing blind—you do not know for sure whether the patient really has the condition they are telling you about. I’ve been a pharmacist in correctional facilities for the past 18 years, and “friendly prescribing” for me is not so friendly. This was not one of his patients. Does he understand that he should never, ever drink and take Ambien because this is quite dangerous (though commonly done to get high)? And are you really going to take the time to explain all of this to him while you are standing in a public hallway? Be very careful when giving advice to a friend and error on the side of sending them to their doctor if you are not sure. You have the authority, based on your state nurse practice act, to prescribe medications for the patients for whom you provide care. ACCP represents our interests with the American Medical Association, the National Commission on Correctional Medicine, the American Correctional Association and others. I suspect that this is a universal phenomenon in health care. Stop providing new prescriptions without a doctor's visit for the highly diverted drug classes: opioids, sedative-hypnotics, stimulants and antibiotics. 3. Hmmm. “[A] physician shall not prescribe, dispense, or otherwise provide, or cause to be provided, any controlled substance to a person who the physician has never personally physically examined and diagnosed.” We took a stool sample to the vet and they prescribed the panacur without seeing the dog again. Smoking cessation medicines? The ER doc was on his own. And you probably will not fulfill your responsibilities as a prescriber to explain diagnosis, treatment and potential complications of therapy. Providing treatment, rendering a diagnosis, or prescribing medications based solely on a patient-supplied history that a physician licensed in this state received by telephone, facsimile, or electronic format. As you probably have gathered already, the main problem with friendly prescribing is not doing a history, a physical exam and creating a chart—in other words, not treating the friend like a real patient. Involve the patient in decisions about their care and respect patient autonomy. . Opioids are a class of drugs that are derived from the opium poppy (or, in the case of pharmaceuticals, made synthetically) and bind to nerve cells, inhibiting pain signals. Have any questions? He was treated but they came back. She is a monitor, consultant, trainer and speaker with expertise in mental health, crisis management, self-injury reduction and trauma-informed care. For example, does the patient who asked for Ambien know that Ambien is a controlled substance (DEA schedule IV, the same as benzodiazepines)? ano other person with the legal right to prescribe is available to assess and prescribe without a delay which would put your, or the patient’s, life or health at … It is illegal in most states to prescribe controlled substances without a face-to-face meeting and examination. How about anti-depressants or other psych meds? It is bad medicine to dispense prescription medications without examining the patient. 3) Know what state your patient is in before seeing and prescribing. Once a vet has an established relationship with the patient they may prescribe medications that have worked in the past. And remember the guy who asked for a prescription for Ambien to help him with his shift work? That is just good medicine. Anyway, this doctor has since retired, and we have been moved to a new building, where the doctor doesn’t have access to the pharmacy without my permission. This requirement (Business and Professions Code section 2242) existed long before the Internet was created and is the cornerstone of why Internet prescribing is illegal when a legitimate physician-patient relationship does not exist. As a nurse practitioner, you must know legal obligations when prescribing medications. Pharmacists, practice nurses and other healthcare professionals … For me, this includes sleeping aids and almost all controlled substances. For you to circumvent that practice—well, that’s not so good. Not me. I warn my parients away from them and give them resources on where to go more cheaply in person, but it is a hard sell. So you are practicing bad medicine. The encapsulates a common encounter perfectly! When providing drugs to patients without a formal prescription 20 (e.g. Dr. Keller is available for consultation on any aspect of Correctional Medicine, program development, and system analysis. One of the jail nurses comes to you and says “Will you call me in a prescription for my hypertension meds? Now I have ammunition to handle more appropriately! By law, a doctor or nurse must be consulted in order to receive a prescription for a medication. This is good advice and something that I have seen repeatedly as long as I have been a nurse and I have been guilty myself of asking for a prescription for antibiotics on occasion from a doctor or PA. A. Jail employees are told to see their own doctors or the established workman’s comp clinic. Hippocrates' advice'primum non nocere'- First, do no harm - still holds today. you the prescription. Just so you know.” So after I said no, the doctor came into the pharmacy and helped himself to a box of Zithromax, and handed it off to her. Give us a call!844-693-8474, How to Get a Prescription Without going to a Doctor. Or whether instead they have wheezing and would benefit more from albuterol instead? That wasn’t proper medical practice! Even though it is not illegal, if the Board finds out that you have been doing it, you can be sanctioned or otherwise disciplined. Prescribe only where necessary, and consider benefits versus risks. You did no physical exam. In the vast majority of cases, for a prescription to be considered valid, the practitioner issuing it must perform at least one medical evaluation of the patient. These are my co-workers and friends! The prescription of these medications involves the weighing of potential benefit vs. potential harm, and one job of the medical prescriber is to explain this to the patient. Specify the Therapeutic Objective. There was no history or exam. Similarly, does the friend who asked for Augmentin know that, according to the CDC, almost all “bronchitis” is viral and no antibiotic should be prescribed? “If this topic is not discussed, patients discovering that their medication contains animal products may stop taking it, with potentially life-threatening consequences,” practitioners said in “Ethical and Practical Considerations in Prescribing Animal-Derived Medication” published in BMJ. So, while you’re thinking about it request a demo of eVisit, speak with one of our virtual care consultants and learn how providing virtual care will delight your patients in the years to come. The way it works is this: a friend calls you up and asks for a friendly prescription. I personally won’t, because phentermine is a DEA schedule 2 amphetamine with a high abuse, addiction and side affect profile. two weeks later, the husband commits suicide. Note this quote: “A practitioner must examine a patient every time he/she prescribes controlled substances.” So giving out a friendly Ambien prescription is not only bad medicine, it is illegal! Are you going to explain this to him during the “friendly prescription” request encounter? If you don’t believe me, call your insurance company and check! Sharen Barboza is a licensed clinical psychologist who has worked in the field of correctional mental health for over 20 years. There are laws to consider when assessing any prescribing issues which include, but are not limited to: 1) a physician cannot prescribe without an appropriate prior exam and a medical indication for the prescription, and 2) an adequate and accurate medical record relating to the provision of services to the patient and documenting the medical need for the prescription … Notify me of follow-up comments by email. It is bad medico-legal practice.  All of these need to be considered. Some states still require a face-to-face encounter prior to prescribing controlled substances to treat a patient. I will discuss that later. It probably would be worthwhile to discuss “friendly prescribing” practices at your facility! So here is the obligatory medico-legal horror story that I heard about through Risk Management Monthly. That the FDA recently required manufacturers to reduce the dosage recommendations because of this, it is illegal in most states (42 out of 50, to be exact) to prescribe controlled substances without physically examining the patient, New York’s policy on prescribing controlled substances, Correctional Medicine conferences twice a year. The practice of “friendly prescribing” without seeing the patient is bad medicine . As for the ethics, yes, it probably is not ethical to write prescriptions for people whom you do not have a doctor-patient relationship, because writing a prescription implies you are assuming such a relationship. drug samples), physicians must continue to meet all of the relevant requirements that apply to prescribing and dispensing drugs generally 21, including those related to patient assessment, documentation, and prescription monitoring. An egregious example from a couple of years ago: a nurse asked me for an antibiotic, as she’d been suffering from a cold, and her symptoms had mostly abated, but she continued to suffer from a lingering cough. The Board of Medicine in many states, including my home state of Idaho, have also formally condemned the practice of giving out any prescriptions, even those that are not controlled substances, without an examination. For a long time, my prescriptions just automatically refilled, but now my doctor's office manager is insisting that my prescription refill cannot be authorized because it's illegal to refill a prescription without having seen the patient for a period of time. Also, amphetamine driven rapid weight loss is controversial and, at best, requires frequent monitoring. I said I couldn’t give out meds to staff, and probably her symptoms were viral and an antibiotic wouldn’t help anyway. Would a simple lisinopril prescription be appropriate in that case? There is one exception in the federal law— physicians may use patient prescriptions in the office when they are registered with DEA to treat opioid addiction The widow now sues the ER doc for malpractice, alleging that the ER doc failed in his responsibility to inform her that one well recognized complication of Zoloft is that it may increase suicide risk early on, especially in adolescents and young adults, like her husband. As you know, an online visit may not be enough for you to accurately diagnose a patient’s chief complaint, but many common conditions including urinary tract infections, flu, allergies, rashes, sore throats, and respiratory infections are good candidates for telehealth evaluation and prescription. If not, you may want to make this clear: “Since you are in a bind, I will refill this prescription once, but it is very important that people with high blood pressure are followed in a systematic fashion, and I don’t do that in this clinic. ACCP needs you! ], may be dispensed without the written prescription of a practitioner, except that in emergency … 4. You might think, “I’m OK! This list is never ending and the more willing you are to “help” the more you will be called on to do. How to Get an Online Prescription with Telemedicine - GoodRx Well stated, Denise! Even though I know that I probably shouldn’t give out prescription medications in this manner, these are co-workers and friends. All rights reserved. ACCP needs your expertise! Evaluate and Clearly Define the Patient's Problem. 5. Needless to say, the ER doc’s malpractice company refused to cover this event. Giving them the prescription would be easy for me. I have Bronchitis.”. Save my name, email, and website in this browser for the next time I comment. Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of emergency medicine practice experience before moving full time into his “true calling” of Correctional Medicine. You did nothing that would identify them as patients of yours—so if something does go wrong, you are on your own. What are you going to say when they ask for another refill 3 months from now? You did no history. Writing a prescription to treat a mental health disorder is easy, but it may not always be the safest or most effective route for patients, according to some recent studies and a growing chorus of voices concerned about the rapid rise in the prescription of psychotropic drugs. A patient may bring you their prescription so that you may administer it immediately, but the pharmacy cannot send . No matter where I have worked in my career, co-workers have asked me for prescription favors like this. The first is exactly which prescriptions you are willing to prescribe in a friendly fashion and which you are not. And there’s the liability issues, as we are mandated only to provide care to inmates, and not staff. . Because these people are not your patients! This is the reason these medications are not over-the-counter. So you really need to get back in to see your regular doctor.”. Weight loss meds? For the majority of drugs, a physician may refill a prescription over the phone without seeing the patient in person. I have been called at home by family, friends and even casual acquaintances asking for prescriptions for themselves–or even for family members! They often want free medical advice or a diagnosis for themselves or family members. 4 A to the practitioner /1/2017 Prescribing after 30 days A practitioner who prescribes a CS to treat pain for more than 30 days must, not later than 30 days after issuing the initial prescription, enter into a Prescription Medication Agreement with the patient. Here’s another situation to give some thought to: What about other chronic disease states that should be followed, well, chronically? Here is the single most important thing that you need to know about the medico-legal risk of friendly prescriptions: Your malpractice insurance policy does not cover them! But don’t forget other “favors” people ask of doctors and nurses. ACCP provides these services: Membership is not expensive. It is illegal in most states to prescribe controlled substances without a face-to … This is not just a phenomenon in corrections. It seems to me a disaster in the making, with deaths, malpractice suits, improper medication mixing etc. The moral of this story is: No Good Deed Goes Unpunished. Each state’s definition of the patient-provider relationship is different. Required fields are marked *. . The State Board of Medicine requires it. Join Here! On November 1, 2011, the Centers for Disease Control and Prevention (CDC) issued a press release stating that overdoses from prescription … Just my addendum to add to Dr. Keller’s excellent article.

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