The ISMA is advising members to familiarize themselves with laws pertaining to controlled substances. As evidenced by recent actions, the Office of the Indiana Attorney General (OIAG) is focusing significant attention on physician prescribing practices for controlled substances.
The Crowley example
Last month, Diane Crowley, M.D., a board certified family medicine physician employed at a pain clinic, Med 1st Evansville, agreed to a 90-day summary suspension of her medical license in response to allegations of dangerous prescribing practices and spinal interventional procedures.
|Gain confidence in your pain management prescribing
The ISMA’s December pain management CME program is archived online; visit here.
Watch for further details about a May 10 pain management program and another during the ISMA annual convention, Sept. 20-22.
After a raid of Med 1st by the U.S. Drug Enforcement Administration (DEA) and the OIAG’s Medicaid Fraud Control Unit, the attorney general filed a petition seeking an emergency suspension of Dr. Crowley’s medical license. The petition included allegations that Dr. Crowley, the clinic’s only physician, pre-signed blank prescription pads with her DEA number that were used by mid-level providers and chiropractors to issue more than 500 controlled substance prescriptions to patients.
The prescriptions were all dated at a time when Dr. Crowley was hospitalized and could not have been present to personally examine or diagnose patients. Pre-signed prescription forms were found at the clinic.
The petition further asserted Dr. Crowley and the clinic had administered “facet block injections.” However, Dr. Crowley does “not have the appropriate education, training or experience to administer these intricate interventional procedures.” Also, she was “failing to utilize the appropriate standard of care in the performance of these procedures.”
In addition, the OIAG claims “laughing gas” was used to consciously sedate patients during these procedures.
At the Feb. 28, 2013, meeting of Medical Licensing Board of Indiana (MLB), the doctor agreed, in absentia, to a 90-day summary suspension of her medical license. If she had not agreed, the state would have held a hearing to decide whether the state proved Dr. Crowley would “represent a clear and immediate danger to the public health and safety if allowed to continue to practice medicine.”
Absent another agreement, the MLB will decide at a future hearing whether to take permanent action on Dr. Crowley’s medical license.
Indiana law highlights
Make certain you are familiar with state laws, the ISMA advises. For instance, every prescription must be dated and signed by the prescriber on the day it is issued. While prescriptions may be prepared by a secretary or agent for a practitioner’s signature, the practitioner is ultimately responsible if the prescription does not meet all necessary requirements.
“For these reasons and others, physicians cannot – and should not – pre-sign prescriptions,” noted Julie Reed, ISMA general counsel. Also, physicians generally cannot prescribe or dispense any prescription medications to patients they have never physically examined and diagnosed. Limited exceptions exist for institutional settings, on-call/cross-coverage situations and collaborative arrangements with advance practice nurses.
As a reminder, Reed said physicians working with nurse practitioners (NPs) are expected to follow the terms of their collaboration agreement and review a portion of the charts and medications prescribed by the NP. At a minimum, NPs should provide for physician review a random sample of 5 percent of their charts and prescriptions every seven days.
“Physicians working with physician assistants (PAs) must exercise more oversight diligence, as articulated in a supervisory agreement,” advised Reed. PAs may not prescribe or dispense a schedule II controlled substance in an outpatient setting. For schedules III, IV and V, a supervising physician may delegate to a PA only the authority to prescribe controlled substances in an amount not exceeding a one-time 30-day supply. If a patient requires an additional prescription, it may be prescribed only by a physician.
Finally, Reed explained, “The MLB can discipline a physician not only for their own compliance with state and federal laws and professional standards of care, but also for their collaborative and supervisory relationships – and the conduct of all their employees.”
Call ISMA’s legal department if you have questions; and learn more about the MLB here.