The patient, who became the plaintiff, suffered from a defective hip replacement. He needed medication to manage his pain. He tried to fill his prescription at a local pharmacy. The pharmacist believed the man was pill-seeking and turned him away.
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medriskinstitute.comMichael J. Sacopulos is an attorney who has been educating and advising physicians how to identify and reduce liability risk for more than 20 years. Known for his sharp wit, common sense guidance, and ability to turn mundane legal topics into entertaining educational sessions, Michael speaks nationally on privacy, security, and compliance issues.
4 thoughts on “Pharmacy Refuses to Fill (Then Confiscates) Valid Opioid Prescription. Lawsuit Ensues.”
Doctors who prescribe opioids for pain control must have a pre-existing list-style format that justifies each opioid prescription they write.
I have worked on several which I intended to make public prior to the Pandemic. This would contain a timeline as well as previous and present non-opioid methods of attempts at pain control.
Each specialty has different parameters. The “single act” of writing an opioid is totally inadequate. This is the new world.
Michael M. Rosenblatt, DPM
Pain is not adequately treated. Too many parties interfere with the doctor-patient relationship. The pharmacist has a duty to verify that the prescription comes from a licensed clinician for a legitimate reason before dispensing the opioid. Once verified the pharmacist has a duty to dispense the opioid unless there is suspected opioid abuse or does not deem it appropriate to dispense the opioid to the patient. If the pharmacist does not have sufficient proof of abuse or cause then the confiscation of the prescription should not have occurred. The prescription is the property of the patient. It should be returned with the comment that the pharmacist does not feel it is appropriate to dispense opioids.
The PDMP programs REMS and CURES are designed to allow the pharmacist to verify validity of the prescription and the prescribers integrity. A call to the prescribing clinician is entirely appropriate.
I bring this up because I had long term patients on greater than 90 MME which is above the 2016 CDC guidelines. It takes me several months to taper high dose opioids from chronic pain patients often just dropped off in my clinic. Rapid tapering increases the chance opioid overdoses, suicide, and relapse abuse. I was called too often by pharmacists and often suspected of being a “pill mill doc”.
I developed a solution I would like to introduce is the iPill dispenser – a secure storage device with cloud-based medication adherence monitoring, active control dispensing, & destruction of unused pills upon tampering and prescription end. Only the person prescribed can access opioids at only the prescribed dose and time.
Happy to discuss
J Hsu MD
In my last comment, I described a form that you could install in patients’ charts when you prescribe opioids. This is rather long, but I think it will give you an idea where I am going. I have others. Readers of Medical Justice are free to use this and post it in your charts. All we ask is that you identify it as “Digital Chart Audit (TM)”
The purpose of the audit is to clarify a “point value” to your treatment program. That would be used as a “prospective defense” if you are audited by any Governmental organization. Governmental auditors would not expect you to have anything nearly as complete and definitive.
Digital Chart Audi™ Back Pain Audit
Name of Patient: Date:
Pregnancy________________________________________________________________________Pts_________
Pain tied to traumatic event(s) _______________________________________________________Pts_________
Request Old records________________________________________________________________Pts________
Search for diagnosis, therapy, treatment program____________________________________Pts_________
Request advice/referral_____________________________________________________________Pts__________
Inadequately controlled_____________________________________________________________Pts__________
Worsening/not responding as expected_________________________________________________Pts__________
Significant Co-morbidity potential_____________________________________________________Pts___________
Contradictory laboratory/test results__________________________________________________Pts___________
Lifestyle exacerbation______________________________________________________________Pts__________
Identification of unexpected patterns__________________________________________________Pts__________
Referral/decision of invasive test or procedure___________________________________________Pts__________
Immediate risk of death or true medical emergency____________________________________Pts_________
Time factor/co-ordination of care, floor time____________________________________________Pts_________
Patient education (includes forms for patient) family consult and other factors_______Pts__________
Referral to Rehab__________________________________________________________________Pts___________
Comments:
Readers of Medical Justice know that the “best defense against catastrophe” is located in the thoroughness of your chart notes and in the case of opioids, communicating to Government that you are not abusing your prescriptive ability.
This suggests the lasting value of a three-pronged defense:
1. Notify Medical Justice that you are under investigation
2. Enable “Digital Chart Audit (TM)” for all patients you prescribe opioids
3. Contact Dr. Hsu and purchase his ipill dispenser program and learn how he sets it up
When the authorities send you a certified letter informing you of your “Miranda Rights” and you are now under investigation for diversion, it may already be too late.
The best defense is a “prospective defense.” That is actually the purpose of Medical Justice, in their “enduring efforts to see that you stay out of trouble.”
Jeffrey Segal, MD, JD is a board-certified neurosurgeon and lawyer. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country's leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Doctors who prescribe opioids for pain control must have a pre-existing list-style format that justifies each opioid prescription they write.
I have worked on several which I intended to make public prior to the Pandemic. This would contain a timeline as well as previous and present non-opioid methods of attempts at pain control.
Each specialty has different parameters. The “single act” of writing an opioid is totally inadequate. This is the new world.
Michael M. Rosenblatt, DPM
Pain is not adequately treated. Too many parties interfere with the doctor-patient relationship. The pharmacist has a duty to verify that the prescription comes from a licensed clinician for a legitimate reason before dispensing the opioid. Once verified the pharmacist has a duty to dispense the opioid unless there is suspected opioid abuse or does not deem it appropriate to dispense the opioid to the patient. If the pharmacist does not have sufficient proof of abuse or cause then the confiscation of the prescription should not have occurred. The prescription is the property of the patient. It should be returned with the comment that the pharmacist does not feel it is appropriate to dispense opioids.
The PDMP programs REMS and CURES are designed to allow the pharmacist to verify validity of the prescription and the prescribers integrity. A call to the prescribing clinician is entirely appropriate.
I bring this up because I had long term patients on greater than 90 MME which is above the 2016 CDC guidelines. It takes me several months to taper high dose opioids from chronic pain patients often just dropped off in my clinic. Rapid tapering increases the chance opioid overdoses, suicide, and relapse abuse. I was called too often by pharmacists and often suspected of being a “pill mill doc”.
I developed a solution I would like to introduce is the iPill dispenser – a secure storage device with cloud-based medication adherence monitoring, active control dispensing, & destruction of unused pills upon tampering and prescription end. Only the person prescribed can access opioids at only the prescribed dose and time.
Happy to discuss
J Hsu MD
In my last comment, I described a form that you could install in patients’ charts when you prescribe opioids. This is rather long, but I think it will give you an idea where I am going. I have others. Readers of Medical Justice are free to use this and post it in your charts. All we ask is that you identify it as “Digital Chart Audit (TM)”
The purpose of the audit is to clarify a “point value” to your treatment program. That would be used as a “prospective defense” if you are audited by any Governmental organization. Governmental auditors would not expect you to have anything nearly as complete and definitive.
Digital Chart Audi™ Back Pain Audit
Name of Patient: Date:
Causes: Mechanical: Apophyseal Osteoarthritis/Facetal Osteoarthritis, Diffuse idiopathic skeletal hyperostosis, Degenerative discs, Scheuermann’s kyphosis, Spinal disc herniation (slipped disc), Spinal Stenosis, Spondylolisthesis and other congenital abnormalities, Leg length difference, Restricted hip motion, Misaligned pelvis – pelvic obliquity Inflammatory: Seronegative spondylarthritides, ankylosing spondylitis, Rheumatoid arthritis, Infection: Epidural abscess or vertebral osteomyelitis, Neoplastic: Bone Tumors, Primary/metastatic, Intradural tumors, Metabolic: Osteoporotic Fx,,Osteomalacia, Ochronosis, Condrocalcinosis, Paget’s, Other:
Patient contributory: Smoking, Lifting/pushing, Improper bending, heavy load movement, standing long hours, sneezing, coughing, Postural, long air/auto travel, sex, twisting, Obesity, exercise induced, golf, excessive stretching, Other:
Classification: Psychogenic, Emotional Stress, Advantage to disability (financial/attention seeking), Vascular, Viscerogenic, Kidney stone, Digestive disorder, kidney disease, Hip disorder, Gun-shot, Abdominal aneurysm, Sciatica, Fx, Strain, Facet osteoarthritis, Pseudo stenosis, Stenosis, Post back surgical, weakness, urinary symptoms, Movement pain, Twisting pain, Weakness, numbness, Projection into extremities, Other:
Non-narcotic treatment(s): Rest/inactivity, Bed rest, Heat/Ice, Chiropractic/osteopathic manipulation, Exercise, Bracing, ROM therapy, TNS, Massage, PT, Spinal epidural corticosteroid injection, Muscle relaxant meds, Spinal surgery, Lower back pain surgery, Education/counseling, NSAIDS, Cortisone dose pack, Cannabinoids, Acupuncture, Spinal stimulator, Other:
Pregnancy________________________________________________________________________Pts_________
Pain tied to traumatic event(s) _______________________________________________________Pts_________
Request Old records________________________________________________________________Pts________
Search for diagnosis, therapy, treatment program____________________________________Pts_________
Request advice/referral_____________________________________________________________Pts__________
Inadequately controlled_____________________________________________________________Pts__________
Worsening/not responding as expected_________________________________________________Pts__________
Significant Co-morbidity potential_____________________________________________________Pts___________
Contradictory laboratory/test results__________________________________________________Pts___________
Lifestyle exacerbation______________________________________________________________Pts__________
Identification of unexpected patterns__________________________________________________Pts__________
Referral/decision of invasive test or procedure___________________________________________Pts__________
Immediate risk of death or true medical emergency____________________________________Pts_________
Time factor/co-ordination of care, floor time____________________________________________Pts_________
Patient education (includes forms for patient) family consult and other factors_______Pts__________
Referral to Rehab__________________________________________________________________Pts___________
Comments:
Readers of Medical Justice know that the “best defense against catastrophe” is located in the thoroughness of your chart notes and in the case of opioids, communicating to Government that you are not abusing your prescriptive ability.
This suggests the lasting value of a three-pronged defense:
1. Notify Medical Justice that you are under investigation
2. Enable “Digital Chart Audit (TM)” for all patients you prescribe opioids
3. Contact Dr. Hsu and purchase his ipill dispenser program and learn how he sets it up
When the authorities send you a certified letter informing you of your “Miranda Rights” and you are now under investigation for diversion, it may already be too late.
The best defense is a “prospective defense.” That is actually the purpose of Medical Justice, in their “enduring efforts to see that you stay out of trouble.”
Michael M. Rosenblatt, DPM