How do doctors/hospitals get prescription drugs for their clinic?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

wayves

Full Member
7+ Year Member
Joined
Aug 14, 2014
Messages
53
Reaction score
47
Let's say I'm a board certified Emergency Medicine doctor. I'm also a volunteer with my local ambulance service. Would it be legal for me to get prescriptions/narcotics for my jump bag to give to patients? How do doctors get them?

How do hospitals get drugs to give to patients?


Disclosure: It might seem like this is a really creepy question, but I'm honestly curious about how the administrative process works.

Members don't see this ad.
 
Docs dont typically carry meds on them except for use in emergencies. Ive really only seen anesthesiologists actually carry IV pain meds on them.

For ambulances and such, they usually have a med box.
 
I know I'm an EMT. But can a doctor carry a medbox in the back of his car for instance? Like a paramedic. If so how would they do it. How do paramedics get med boxes?
 
Members don't see this ad :)
I know I'm an EMT. But can a doctor carry a medbox in the back of his car for instance? Like a paramedic. If so how would they do it. How do paramedics get med boxes?
You should know. You're an EMT.
 
  • Like
Reactions: 4 users
But I'm not a paramedic...
 
You can't get a box of narcotics for your own personal car stash "in case of an emergency." End of story.
Well it's a different story if OP is talking about a board certified EM doc who run regularly with an accredited ambulance service. It is uncommon in the United States, but it does happen sometimes... Especially in rural areas where doctors sometimes volunteer for rescue squads. Keep in mind that this can raise insurance issues though. If your hospital covers your malpractice, it's only while you are using their facilities. Riding on an ambulance would make you legally vulnerable. Some places like New Jersey have actually changed their insurance policies to allow docs to roll with the ambulance.

I can't really answer your question about the legality of a physician stocking a "jump bag" with pharmaceuticals. I know in movies and TV doctors carry around bags that just happen to have all of the necessary drugs to miraculously save someone's life, but that's not really how things work in the real world.
^Example: Dr. Hank Lawson from "Royal Pains".

Hospitals and clinics order pharmaceuticals through medical supply companies usually. Companies such as medline.
 
What kind of man talks to the DEA? No man, no man at all.
 
  • Like
Reactions: 1 user
Let's assume you aren't talking about narcs. I've seen a doctor bring out local anesthetic to suture a wound for a friend/family member. He had a small collection of various (some slightly expired) medications in a cute little black satchel. Where did he get the drugs? Knowing the doc in question, I assume he just took them home without asking. Kinda like taking post-its or pens from the office. Not something I'd be okay with doing, but since (all that I saw) was unscheduled stuff, he is unlikely to ever get in real trouble for it.

I have also been curious about the legitimate means by which a doctor could obtain a small supply of useful meds. I don't think it would make a lot of sense for an individual to carry a large or varied supply, under any circumstances. Drugs do expire. Zombie apocalypse and extreme sports aside, it is highly unlikely that anyone qualified to prescribe a drug will ever find themselves in a situation where they can't obtain it fresh from a pharmacy in a reasonable amount of time. And in the event of zombie apocalypse, it is highly unlikely that the little bit of lido in your backpack is going to matter much.
 
Last edited:
Let's assume you aren't talking about narcs. I've seen a doctor bring out local anesthetic to suture a wound for a friend/family member. He had a small collection of various (some slightly expired) medications in a cute little black satchel. Where did he get the drugs? Knowing the doc in question, I assume he just took them home without asking. Kinda like taking post-its or pens from the office. Not something I'd be okay with doing, but since (all that I saw) was unscheduled stuff, he is unlikely to ever get in real trouble for it.

I have also been curious about the legitimate means by which a doctor could obtain a small supply of useful meds. I don't think it would make a lot of sense for an individual to carry a large or varied supply, under any circumstances. Drugs do expire. Zombie apocalypse and extreme sports aside, it is highly unlikely that anyone qualified to prescribe a drug will ever find themselves in a situation where they can't obtain it fresh from a pharmacy in a reasonable amount of time. And in the event of zombie apocalypse, it is highly unlikely that the little bit of lido in your backpack is going to matter much.
Things like lidocaine are easy to get; we order from a vendor and it is delivered to our office. Same with Tylenol, "freeze spray" Neosporin, etc. We do not keep narcs in the office for obvious reasons but the other things we use daily so makes sense to have (and won't expire). PCPs will often get limited free samples from reps.

I'm not sure why the OP is interested; medications are expensive so doling them out to patients doesn't make financial sense, charging for them complicates billing (and can create DEA, theft problems). Not worth it, just write a script.
 
  • Like
Reactions: 1 user
True but if someone just got their leg amputed in a car accident you can't just "write a script" lol. It would be convenient to be able to give them narcs in the field.
 
I do a fair amount of wilderness type stuff (caving, BC skiing, etc) and keep a well-stocked first aid kit. I've often thought about how I could augment it as a physician and where I would potentially get suture kits, lidocaine, etc. Seems like a natural thing to think about.
 
Members don't see this ad :)
True but if someone just got their leg amputed in a car accident you can't just "write a script" lol. It would be convenient to be able to give them narcs in the field.
OLD-GRAND-DAD-MED.jpg

"...or I've just had my leg amputated."

There, problem solved.
 
  • Like
Reactions: 1 users
Federal law requires that physicians have separate registrations for every location (at a business address in each state where practicing)) where they store, distribute, or dispense controlled substances. Doctors can not take scheduled drugs "out in the field" without having a specific amount for a specific use, and they are not allowed to carry any controlled substances for use in an emergency or in any bulk amount.

Administrative action for each violation of federal law concerning professional use of most scheduled drugs can be severe. The DEA has been asked by several state governments to exercise discretion when investigating mobile or ambulatory practices in rural areas-- but no substantial changes to drug laws enforcement to are to be expected, as those laws would have to be modified by congressional act.
 
  • Like
Reactions: 1 user
If you're the medical director for the service you're in charge of authorizing the bulk purchases of narcotics. You're also in charge of determining how these drugs are managed, stored, and stocked in service so you could just add your POV to the list.
 
  • Like
Reactions: 1 user
True but if someone just got their leg amputed in a car accident you can't just "write a script" lol. It would be convenient to be able to give them narcs in the field.
I'm sure it would be but if someone's leg was just amputated, as a surgeon, I'd rather you focus on controlling the bleeding , stabilizing the patient and getting them to the trauma bay than giving them narcotics. LOL

But yes with an unrestricted medical license and DEA number, you may purchase narcotics to be used in such situations with the limitations as noted by my friend Dr. Danbo above.
 
Last edited:
A doctor on an ambulance could certainly use some of the pharms from a paramedics medbox (if he/she lets you). Examples:
  • Methylprednisolone
  • Diphenhydramine
  • Ipratropium/Albuterol
  • Epi
  • Magnesium Sulfate
  • Certain Benzos (Midazolam, Lorazepam, etc.)
  • Prochlorperazine
That being said, I'd let the paramedic do his job for insurance reasons. I'd obviously help out if I thought the paramedic was incompetent or if helping would clearly save the patient's life. Let EMS do their jobs.
 
Yes. For example, could I stock a bag with some non addictive low street value meds?
 
I'm pretty sure that if you're the medical director you can do whatever you want, and if you want to carry narcs you just have to have an accountability system in place. If you're just a doctor who happens to run with a service it would depend on how well you get along with the medical director. If you're just a random doctor this whole thing would be weird and I would hate you for showing up on my scene.
 
I'm pretty sure that if you're the medical director you can do whatever you want, and if you want to carry narcs you just have to have an accountability system in place. If you're just a doctor who happens to run with a service it would depend on how well you get along with the medical director. If you're just a random doctor this whole thing would be weird and I would hate you for showing up on my scene.
Okay two things:

First - I think OP means a doctor that actually runs with the ambulance service ie in the ambulance.

Second - Even if "some random doctor" showed up on scene, who do you think would have medical authority in this situation? Obviously the physician. As a former EMT myself I have a great deal of respect for the few doctors that would "show up on scene" to help out in our rural service area. We even supplied them with radios so they could listen for incidents to go to if they wanted to. They were probably part of what inspired me to go into medicine, to be honest.


Edit: Oh... also... it's not "your scene".
 
  • Like
Reactions: 1 users
Okay two things:

First - I think OP means a doctor that actually runs with the ambulance service ie in the ambulance.

Second - Even if "some random doctor" showed up on scene, who do you think would have medical authority in this situation? Obviously the physician. As a former EMT myself I have a great deal of respect for the few doctors that would "show up on scene" to help out in our rural service area. We even supplied them with radios so they could listen for incidents to go to if they wanted to. They were probably part of what inspired me to go into medicine, to be honest.


Edit: Oh... also... it's not "your scene".

When I get dispatched somewhere yes it is "my scene." If a doctor I don't know is trying to take control I have in the past politely told them to leave if I or my actual command physician deem it appropriate. For example, a doctor from out of the area driving through the state who comes upon an MVA is welcome but taking over care is questionable, or a gynecologist trying to assist a cardiac patient.
 
When I get dispatched somewhere yes it is "my scene." If a doctor I don't know is trying to take control I have in the past politely told them to leave if I or my actual command physician deem it appropriate. For example, a doctor from out of the area driving through the state who comes upon an MVA is welcome but taking over care is questionable, or a gynecologist trying to assist a cardiac patient.
Thank god you're not a doctor with that kind of attitude. You don't own a scene. You can't claim possession of a scene. You can feel free to ask politely, but a physician is more than welcome to refuse. Docs have seniority over you in the medical world, like it or not.
 
  • Like
Reactions: 1 user
When I get dispatched somewhere yes it is "my scene." If a doctor I don't know is trying to take control I have in the past politely told them to leave if I or my actual command physician deem it appropriate. For example, a doctor from out of the area driving through the state who comes upon an MVA is welcome but taking over care is questionable, or a gynecologist trying to assist a cardiac patient.

What.

Strong everything.
 
Thank god you're not a doctor with that kind of attitude. You don't own a scene. You can't claim possession of a scene. You can feel free to ask politely, but a physician is more than welcome to refuse. Docs have seniority over you in the medical world, like it or not.

A physician with nothing to do with your medic service should take commands from the medic service, unless that doc has something very special to offer that is immediately needed, even if the command is crowd control, thank you for your assistance now go away, or something else. There are exceptions, but they are limited.
 
Things like lidocaine are easy to get; we order from a vendor and it is delivered to our office. Same with Tylenol, "freeze spray" Neosporin, etc. We do not keep narcs in the office for obvious reasons but the other things we use daily so makes sense to have (and won't expire). PCPs will often get limited free samples from reps.

I'm not sure why the OP is interested; medications are expensive so doling them out to patients doesn't make financial sense, charging for them complicates billing (and can create DEA, theft problems). Not worth it, just write a script.
The ortho clinic I scribed at had their own mini-pharmacy. They had a crapton of pain meds (though no morphine or dilaudid) and were essentially running a minor long-term pain management clinic for their elderly or worker's comp patients, on top of the ortho stuff. They did shockingly little paperwork for it, too (I was doing the paperwork on the front end, so I know that part. Not sure what they had to do to get the drugs or account for them behind the scenes).
 
When I get dispatched somewhere yes it is "my scene." If a doctor I don't know is trying to take control I have in the past politely told them to leave if I or my actual command physician deem it appropriate. For example, a doctor from out of the area driving through the state who comes upon an MVA is welcome but taking over care is questionable, or a gynecologist trying to assist a cardiac patient.

You don't own a scene. You can't claim possession of a scene. You can feel free to ask politely, but a physician is more than welcome to refuse. Docs have seniority over you in the medical world, like it or not.

State by state laws affect this situation...

but...

In general, no doc is going to ever take over a scene from an EMT. The EMS crew is operating under the license of the medical director who directly interfaces with the state agencies and as such has some liability shielding. Any doc who claims to be "in charge" on an EMS scene is assuming liability. And that's something no doc is going to do. Your insurance doesn't cover you in this environment, and if there's a bad outcome, you can bet you'll be sued. Plaintiff's attorney's slide #1: this doc showed up and interfered with the local EMS protocols (even if you did everything right).
 
  • Like
Reactions: 1 users
Well here are some examples that should clear things up:

Assume you are state licensed (Pennsylvania, for examples) and board certified in EM for all examples.

Example #1: EMS is dispatched to your neighbors house. You walk over and find that the patient (your neighbor) is anaphylactic. You notify EMS personnel that you intend to administer epinephrine. The EMT tells you no, because he's a whacker and wants to do it himself. Guess what? The doctor is more than welcome to administer the epinephrine to the patient without the "consent" of an EMT. Why? Because the doctor is operating within his authority to practice emergency medicine within the state of Pennsylvania. Who is liable in this case? If the EMT actually physically tried to block you from doing your job, he's liable. Otherwise the doctor is liable (but I would laugh at a lawsuit for administering epi... have fun paying my legal fees :))

Example #2: You physically attempt to prevent the EMTs from doing their jobs. Who's liable? Obviously you are, but it doesn't matter that you're a physician. Anyone would be liable in this situation, including other EMTs.

As a board certified EM physician licensed in the state of Pennsylvania, I could practice emergency medicine wherever I want in Pennsylvania. EMTs can try to tell me otherwise, but grow up. That's not how the world works. There are some exceptions though:

  • Can't practice in private domiciles without permission from the owner. Unless it's clearly life threatening. Neither can EMTs but when people call 911 it can be considered implied consent.
  • Can't practice in hospitals where I don't have privileges.

^It should be noted that technically you can be sued for anything, but that doesn't mean that there will be a negative outcome for you. I could sue a physician I've never met if I wanted to, but that doesn't mean anything's going to happen other than my having to pay for his/her legal fees. It's actually pretty rare that a physician successfully gets sued. Especially in tort reform states.
 
I'm not disagreeing with your premise; that if the patient wants the doc to be involved, then the EMT can't step in and block it.
But the liability of the situation would (and should) prevent most docs from doing this.

Example #1: EMS is dispatched to your neighbors house. You walk over and find that the patient (your neighbor) is anaphylactic. You notify EMS personnel that you intend to administer epinephrine. The EMT tells you no, because he's a whacker and wants to do it himself. Guess what? The doctor is more than welcome to administer the epinephrine to the patient without the "consent" of an EMT. Why? Because the doctor is operating within his authority to practice emergency medicine within the state of Pennsylvania. Who is liable in this case? If the EMT actually physically tried to block you from doing your job, he's liable. Otherwise the doctor is liable (but I would laugh at a lawsuit for administering epi... have fun paying my legal fees :))

Despite your best intentions, the administration of the anaphylaxis dose of epinephrine exacerbates your neighbor's heart condition, sends them into cardiac arrest. Despite your best effort they die.
When the family sues you, their lawyer's questions for you will be: 1) why were you there? you weren't the one called. 2) did you have a patient/physician relationship with this person? 3) please show us your documentation of the patient's medical record which then led you to administer a medication to them. Oh... no paperwork? That never looks good in court. The EMT has a run sheet with the patient's heart condition clearly listed. And a note at the bottom saying they asked you to stand down.
Meanwhile your insurance carrier will be nowhere to be found in the courtroom because you were practicing outside of the area where you were insured and you aren't covered.

Even when you do the right thing you get screwed. That's why a lot of docs stopped getting out of their cars at accident scenes, and stopped identifying themselves on airplanes. Good samaritan only gets you so much protection, and becomes very murky when the EMTs (the state designated scene medical entity) don't want you there.

It should be noted that technically you can be sued for anything, but that doesn't mean that there will be a negative outcome for you. I could sue a physician I've never met if I wanted to, but that doesn't mean anything's going to happen other than my having to pay for his/her legal fees. It's actually pretty rare that a physician successfully gets sued. Especially in tort reform states.

Until you've been sued, either frivolously or legitimately, don't write it off as such a benign thing. The very act of being sued is a negative outcome. There are countless threads in the EM forum detailing how impactful this can be.
 
  • Like
Reactions: 1 user
Well here are some examples that should clear things up:

Assume you are state licensed (Pennsylvania, for examples) and board certified in EM for all examples.

Example #1: EMS is dispatched to your neighbors house. You walk over and find that the patient (your neighbor) is anaphylactic. You notify EMS personnel that you intend to administer epinephrine. The EMT tells you no, because he's a whacker and wants to do it himself. Guess what? The doctor is more than welcome to administer the epinephrine to the patient without the "consent" of an EMT. Why? Because the doctor is operating within his authority to practice emergency medicine within the state of Pennsylvania. Who is liable in this case? If the EMT actually physically tried to block you from doing your job, he's liable. Otherwise the doctor is liable (but I would laugh at a lawsuit for administering epi... have fun paying my legal fees :))

Example #2: You physically attempt to prevent the EMTs from doing their jobs. Who's liable? Obviously you are, but it doesn't matter that you're a physician. Anyone would be liable in this situation, including other EMTs.

As a board certified EM physician licensed in the state of Pennsylvania, I could practice emergency medicine wherever I want in Pennsylvania. EMTs can try to tell me otherwise, but grow up. That's not how the world works. There are some exceptions though:

  • Can't practice in private domiciles without permission from the owner. Unless it's clearly life threatening. Neither can EMTs but when people call 911 it can be considered implied consent.
  • Can't practice in hospitals where I don't have privileges.

^It should be noted that technically you can be sued for anything, but that doesn't mean that there will be a negative outcome for you. I could sue a physician I've never met if I wanted to, but that doesn't mean anything's going to happen other than my having to pay for his/her legal fees. It's actually pretty rare that a physician successfully gets sued. Especially in tort reform states.

PA has protocol 904 for this in their BLS protocols.

http://www.portal.state.pa.us/portal/server.pt/document/1324791/statewide_bls_protocols-2013_pdf

Basically the doc on scene has to get permission from the actual command physician because it's EMS's scene since they were called to it. Sorry, but being a doc on holiday doesn't mean you're God's gift to medicine and automatically know what's best for a patient, particularly prehospital. A home-state EM doc (with a good attitude) would be welcome in most cases but that's rarely the case.

Also if the doc has had any alcohol (as is often the case when this happens) they're not doing anything.

I've also told docs on scene they can take over but they have to ride the patient in all the way to the hospital. That usually scares them off.
 
The obvious answer is to keep bullets around and tell them to bite the bullet if you're working on their leg.
 
It should be noted though, that in some cases (the plane example for instance), not acting could also get you into trouble. Pretty clear ethics violation. Unless there was another capable provider handling the situation. EMTs and doctors have actually been fired and lost licenses before for not acting. It's considered negligent.

That is if you get caught.

For a lawsuit to pass, the burden of proof is on the plaintiff. They would need to prove:

1. Physician acted in a grossly negligent manner.
2. Another physician wouldn't have done the same thing.

It's a good thing I live in a tort reform state. Most people I know who have been sued have actually received compensation for legal fees and time wasted.

The Good Samaritan rule does not apply to doctors or other medical personnel, unless they happen to be near the accident or emergency when they are off-duty. In other words, an off-duty doctor that "comes to the rescue" will not be judged by malpractice rules, but by the Good Samaritan rule. If, however, a patient already has a doctor-patient relationship with the rescuing doctor, the fact that the doctor is off-duty at the time generally does not switch the legal standard from medical malpractice to the Good Samaritan rule.

@cidem2065 Do you really think doctors drink that much? You sure know a lot Mr. Pre-Med. Grow up and stop watching so many movies.

I'm actually an EMT myself and have volunteered for my local rescue agency since high school. I only stopped last year for rotations. We are in such a rural area that we know most of the local physicians around and some of them run with us. A lot of the patients know the docs too since it's such a small community.
 
Last edited:
I'm not disagreeing with your premise; that if the patient wants the doc to be involved, then the EMT can't step in and block it.
But the liability of the situation would (and should) prevent most docs from doing this.



Despite your best intentions, the administration of the anaphylaxis dose of epinephrine exacerbates your neighbor's heart condition, sends them into cardiac arrest. Despite your best effort they die.
When the family sues you, their lawyer's questions for you will be: 1) why were you there? you weren't the one called. 2) did you have a patient/physician relationship with this person? 3) please show us your documentation of the patient's medical record which then led you to administer a medication to them. Oh... no paperwork? That never looks good in court. The EMT has a run sheet with the patient's heart condition clearly listed. And a note at the bottom saying they asked you to stand down.
Meanwhile your insurance carrier will be nowhere to be found in the courtroom because you were practicing outside of the area where you were insured and you aren't covered.

Even when you do the right thing you get screwed. That's why a lot of docs stopped getting out of their cars at accident scenes, and stopped identifying themselves on airplanes. Good samaritan only gets you so much protection, and becomes very murky when the EMTs (the state designated scene medical entity) don't want you there.



Until you've been sued, either frivolously or legitimately, don't write it off as such a benign thing. The very act of being sued is a negative outcome. There are countless threads in the EM forum detailing how impactful this can be.

As far as I know and have (not personally) been told by Greg Henry, no EM doc has ever been sued for actions undertaken as a good Samaritan. You should absolutely get out of your car and identify yourself as a doc on airplanes.
 
As far as I know and have (not personally) been told by Greg Henry, no EM doc has ever been sued for actions undertaken as a good Samaritan.

Off the top of my head, I can think of an instance of a friend of mine getting sued under this general sort of circumstance.
A successful suit is another matter.

You should absolutely get out of your car and identify yourself as a doc on airplanes.

I might ID myself on an airplane. But unless a car accident happened right in front of me I'm not going to stop at a scene. Especially if there's already EMS present. They have equipment, I don't. And there's nothing I can do on scene that they can't do.
 
It should be noted though, that in some cases (the plane example for instance), not acting could also get you into trouble. Pretty clear ethics violation. Unless there was another capable provider handling the situation. EMTs and doctors have actually been fired and lost licenses before for not acting. It's considered negligent.

That is if you get caught.

For a lawsuit to pass, the burden of proof is on the plaintiff. They would need to prove:

1. Physician acted in a grossly negligent manner.
2. Another physician wouldn't have done the same thing.

It's a good thing I live in a tort reform state. Most people I know who have been sued have actually received compensation for legal fees and time wasted.



@cidem2065 Do you really think doctors drink that much? You sure know a lot Mr. Pre-Med. Grow up and stop watching so many movies.

So I guess you were one of those EMTs that were just completely oblivious to the world around them. Do you think I'm making this up? Are you really able to say doctors as a whole don't drink?
 
Top