Beginning Oct. 1 and every other month following, you could receive an alert from the Indiana Board of Pharmacy INSPECT program about one of your patients.
INSPECT is the Indiana Scheduled Prescription Electronic Collection and Tracking program that monitors all controlled substance prescriptions filled by Indiana patients at retail pharmacies.
With ISMA’s efforts, a law effective in 2007 makes prescription data instantly available online to all registered health care providers. Registration and use are free.
An enhancement to INSPECT now allows it to send prescribers unsolicited Person of Interest Alerts indicating a patient has exceeded dispensing guidelines created by the pharmacy board. The bi-monthly alerts will be sent to INSPECT users and non-users indicating possible patient misuse or diversion of controlled substances.
The alert is not evidence a crime has occurred. Data prompting the alerts comes from dispensing pharmacies, may be incomplete or inaccurate, and should always be verified prior to taking any action.
A patient exceeds dispensing guidelines after receiving controlled substance prescriptions from more than 10 practitioners in a 60-day span. For the top 25 percent of that group, notification is sent by e-mail or mail to every practitioner who wrote a controlled substance prescription for that patient in those 60 days.
The notification will provide patient’s name, date of birth and address. Physicians can then look the patient up in INSPECT to review a prescription history.
Proper use of INSPECT
As a reminder, you may obtain information from INSPECT only to provide treatment or evaluate the need for treatment of a patient. This includes patients making an initial office visit appointment or presenting a prescription to a pharmacist.
You may not request a report on office/pharmacy staff, prospective employees or anyone for whom there is no medical record to review on-site at your office or pharmacy location.
- Register to use INSPECT.
- Ensure your e-mail and mailing addresses are current with INSPECT and the Medical Licensing Board - (317) 234-2060.
In-person training on INSPECT is available in South Bend (Sept. 29) and Fort Wayne (Oct. 6). Find details at in.gov.
Find the Indiana Board of Pharmacy guidance document on interpreting INSPECT reports here.
When an alert comes
Physicians are not required to use INSPECT, but you will need access to research any alert you receive.
Those who use INSPECT are immune from civil liability for injury, death or loss to a person solely due to a practitioner seeking or not seeking information from INSPECT – as long as no gross negligence or intentional misconduct exists.
However, immunity does not apply if the physician receives information directly from INSPECT and then negligently misuses it. Therefore, failure to properly act in response to a Person of Interest Alert may subject a physician to liability.
Verify any alert and INSPECT contents by contacting the dispensers. Then consider your options based on all circumstances. You are permitted by state and federal law to discuss the reports with other treating providers.
Physicians may want to continue treating patients named in alerts, if they think it is legal. For instance, federal law prohibits distribution of a controlled substance outside the scope of professional practice and not for legitimate medical purposes. State law broadly requires physicians to keep abreast of professional theory and practice, and prohibits physicians from knowingly prescribing controlled substances to an addict.
State law permits physicians to terminate patients after certain procedures are followed (see the ISMA website), and patients cannot be terminated for discriminatory purposes. Additionally, the contract with a patient’s insurance company may require taking particular steps.
According to a new state law effective July 1, physicians are immune from criminal and civil liability for good faith reporting to law enforcement any information based on an INSPECT report. However, HIPAA rules must still be followed.
Therefore, an exception, such as reporting a crime, must be met. For more on reporting to law enforcement, see here.
Consider whether the patient may need help for an addiction.
ISMA’s Physician Assistance Program has resources to assist you on the ISMA website.
You may call your malpractice insurance company for risk management advice. Stay tuned to ISMA Reports for more information and guidance. Call ISMA’s Legal Department with questions.