metadr

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I have been appreciative of the content and collective wisdom of this forum for a long time. This is my first post.

Considering many patients are not very forthcoming about their prior criminal history on risk assessment forms such as the ORT. I have utilized criminal background checks as a means for risk stratification when deciding to prescribe opioids. I typically use the arrests.org website and screen for drug trafficking charges or pattern of multiple drug/alcohol abuse related arrests (e.g. multiple DUIs). I understand that the website only mentions arrests and not if someone was found guilty for that crime. With that information I ask the patients then, and typically they then admit to the charges. However, my employer is still concerned about the legality to use that website, and doesn't want to be held reliable for accessing someone's criminal records (even though they are public records and are very relevant to my treatment plan with the patient).
 

pastafan

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I have been appreciative of the content and collective wisdom of this forum for a long time. This is my first post.

Considering many patients are not very forthcoming about their prior criminal history on risk assessment forms such as the ORT. I have utilized criminal background checks as a means for risk stratification when deciding to prescribe opioids. I typically use the arrests.org website and screen for drug trafficking charges or pattern of multiple drug/alcohol abuse related arrests (e.g. multiple DUIs). I understand that the website only mentions arrests and not if someone was found guilty for that crime. With that information I ask the patients then, and typically they then admit to the charges. However, my employer is still concerned about the legality to use that website, and doesn't want to be held reliable for accessing someone's criminal records (even though they are public records and are very relevant to my treatment plan with the patient).
Have you checked your employer on arrests.org?
 
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metadr

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Any thoughts? Does anyone else perform background checks on patients? What service/website do you use? Is it ethical? Is it legal? Or, is it a good/better practice standard?
 

Jigsaw

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There was a thread on this in the past. You can use it as a tool but can't actually state you are denying treatment due to someone supposed history.

Basically use it for your own assessment but don't document it or you might get the ACLU or whomever after you.
 

lobelsteve

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There was a thread on this in the past. You can use it as a tool but can't actually state you are denying treatment due to someone supposed history.

Basically use it for your own assessment but don't document it or you might get the ACLU or whomever after you.
Nonsense. Put up some evidence. Tools at our disposal are ours to use. Failure to do so is the problem.
 
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metadr

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Thanks for the posts. I did find the thread from the past discussing similar topic. http://forums.studentdoctor.net/threads/legality-of-what-i-do.999225/

I am glad to see that others too see merit in utilizing such tools. I am not sure on what to do next, my employer gave me an ultimatum to stop using this information to pick out the bad apples (e.g. drug traffickers) for non-narc mgmt as he is fearing future liability. I guess I can always quit the job.
 

Ducttape

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continue to use the information. it is not their license to prescribe opioids, the DEA doesn't give a hoot what your employer thinks.

incorporate it in your own unwritten version of the ORT. obviously, someone selling/using drugs and getting arrested gets 4 points on the standard ORT. I would argue that that should actually be a 9, personal history of substance abuse of illegal and prescription drugs (since they almost always go hand in hand).

don't deny non-narc management, though, for someone with an arrest record. if you have a state that posts arrest records, I fail to see how your employer can refuse to have you monitor government public records.
 
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Jigsaw

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You don't have to write opiates if you don't want to regardless of background check or not. So you say this is MY plan. Now if it is a follow up of your employers patients then his unwillingness is odd
 

emd123

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I have been appreciative of the content and collective wisdom of this forum for a long time. This is my first post.

Considering many patients are not very forthcoming about their prior criminal history on risk assessment forms such as the ORT. I have utilized criminal background checks as a means for risk stratification when deciding to prescribe opioids. I typically use the arrests.org website and screen for drug trafficking charges or pattern of multiple drug/alcohol abuse related arrests (e.g. multiple DUIs). I understand that the website only mentions arrests and not if someone was found guilty for that crime. With that information I ask the patients then, and typically they then admit to the charges. However, my employer is still concerned about the legality to use that website, and doesn't want to be held reliable for accessing someone's criminal records (even though they are public records and are very relevant to my treatment plan with the patient).
Life is never simple. Being a doctor is never simple. You can never reduce med-Mal risk to zero. That's why it's called risk "management" not risk "elimination."

Why don't you ask your employer, which is better,

1-A frivolous, stupid, civil lawsuit that's going to go absolutely nowhere because you did the right thing by recommending non-narcotic treatments to someone with a past history of admitted drug use/abuse/sales, versus,

2-Reckless homicide charges, loss of DEA license and career, AND also the risk of a civil lawsuit for wrongful death when opiates kill because you looked the other way?

Considering choice #1 is basically theoretical (and very defendable and not career ending) and #2 is and has been a reality for many doctors now (not just a "maybe," "could happen," theory by a nervous hospital administrator), is very severe and career ending, I think the choice is pretty clear which is the best choice, but I'll let you decide for yourself.

I think if you stick to legitimate websites of public records from government sites, confirm it with the patient, and do what's in the best interest of the patient, you'll be reducing your legal risk as much as you can. Looking the other way, prescribing to known addicts and dealers because you're worried about some technicality, is not the right thing for the patient, or anybody for that matter, medically, morally or legally. We're not taking about turning off people's ventilator oxygen here. We're talking about a treatment with lots of risks and a less than ideal track record of evidence of even working very well.

But like anything else, you'll have to make your own decision, which makes you more comfortable, and what allows you to sleep easy at night.

Personally, if feel pretty good about getting in front of a jury, and defending a prescription not prescribed to an admitted addict or dealer, regardless of how I got that information, and especially if the patient confirms it. That's infinitely more defendable than trying to explain a prescription written, to an addict or dealer, that led to someone's death, because you were advised to look the other way.

Also, have your legal people go trough this very, very, very long list of DEA actions against doctors:

http://www.deadiversion.usdoj.gov/crim_admin_actions/

Also, read it yourself as we all should. Then have them draft a list of doctors that have had severe consequences or actions against them as a result of NOT writing an opiate RX, that are even remotely close to the loss of license and criminal charges listed here against these doctors for prescribing opiates, in these numbers.

If you find any in the past 10 years, not related to untreated end-of-life pain, please post them here when you find them. Overprescribing, in my humble and little opinion, carries risks greater than under prescribing (though not zero), by a ratio of 1000 to one, in our current practice environment.

You're in the big leagues now. Make a choice and stand by it. No one said it would be easy.
 
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geauxg8rs

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I think I missed something somewhere, but where does it say anywhere that someone has to have opioids? With or wIthout a criminal record? Can't a doc
Just say no drugs for you? Why do you need to defend yourself in so many ways? Just tell the patient I don't think you are a candidate for xyz but you could benefit from abc. If they say I only want hysrosaxanax, you tell them to hit the road? You can always offer pt/hep, some non opioid med, possible shot, acupuncture, referral to psych/surgeon/priest. There is always something to offer, not necessarily what the customer wants. Too bad, this ain't burger king.
 
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metadr

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Thank you for all the responses. I too am a big believer of multimodal pharmacotherapy & multidisciplinary treatment without opioids. My employers reasoning was to not piss off referring providers and also the legality of background checks. I like the response by @emd123. I cannot in good faith rx narcotics who have drug trafficking charges. That's why after the ultimatum from my employer and his unwillingness to reason, I resigned today.
 

emd123

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My employers reasoning was to not piss off referring providers
You've clearly identified the fact that their interest is money above all else, at your (and the patients') risk. Like always: Follow the money and you'll find your answer.

I cannot in good faith rx narcotics who have drug trafficking charges. That's why after the ultimatum from my employer and his unwillingness to reason, I resigned today.
Good for you. Let them hire someone else to be DEA-bait.

Standing ovation:
 
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Tenesma

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we routinely check public records for criminal data ---
i think multiple DUIs, multiple forged checks, multiple controlled substance arrests --- speaks a lot to what you will be dealing with in the office

however, when i see arrests for child molestation/child sex assault - i get very uncomfortable.
 
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Stim4me

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Surf your local state/city/town websites as well.... We find patients gone awry now and then... I Give credit to my PA for his hard investigative work daily...
 

gasorrad

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Thank you for all the responses. I too am a big believer of multimodal pharmacotherapy & multidisciplinary treatment without opioids. My employers reasoning was to not piss off referring providers and also the legality of background checks. I like the response by @emd123. I cannot in good faith rx narcotics who have drug trafficking charges. That's why after the ultimatum from my employer and his unwillingness to reason, I resigned today.
Hats off to you!! We need more pain physicians like you. That being said if I'm not mistaken you are currently looking for a job and I am sure somebody in this group is looking for ethical docs like you. The practice you left has limited days anyway and its only a matter of time DEA comes knocking on their doors.
 
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metadr

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Hats off to you!! We need more pain physicians like you. That being said if I'm not mistaken you are currently looking for a job and I am sure somebody in this group is looking for ethical docs like you. The practice you left has limited days anyway and its only a matter of time DEA comes knocking on their doors.
I still love helping patients and I have to pay the bills. So, I am exploring job opportunities.
 

jabreal00

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How is checking public records any different than checking prescription databases or doing urine tests to risk stratify. If someone has illicit or non prescribed controlled substances in their urine that is a red flag. Similarly if someone has multiple controlled substances from multiple providers from a short period of time that's a red flag. Arrests for drugs, DUIs or trafficking I'd say is a contraindication to chronic opiate therapy. Now if someone broke a leg or was injured and needed short term pain control, that is a different story. You are a physician with a medical and DEA license. If you deem someone high risk for chronic opiate therapy you are not obligated to start said therapy. You can offer non-opiates. You can do interventions. You can offer to refer to complimentary medical therapy (acupuncture, CBT, meditation therapy etc). Your employer doesn't need to know that you are checking the website and it does not need to go in their clinical note that you checked the website.