Sounds like a big mess-up. Like WVU said, Controlled prescriptions can be mailed--obviously unlicensed personnel (USPS, FedEx guy, random semi truck driver etc.) are delivering them. The difference is the controlled prescription issued via a "legitimate" prescription. I haven't been following this and all the details, but it sounds like this is NOT what happened in this case, which indeed could make the physician liable (I'm not sure why pharmD=phakedr thinks a MD would get automatically get off with a fine, Michael Jackson's doctor did jail time for his inappropriate administration of Diprivan.
I'm kidding about MDs being above the law.
I know doctors can get jailed for gross negligence of their professional duty (especially if they are overprescribing narcotics.)
So I've been trying to wrap my head around this story. It's been bothering me since nothing about it seems right.
The doctor is contacted by Prince who is interested in getting treated. The doctor sends his son in his stead to meet Prince. The son is carrying a CIII drug when he is present in Prince's estate when Prince is found unconscious.
I've talked with pharmacists and looked into pharmacy laws about this and this is what I got as of now.
WARNING: THIS IS GOING TO BE LONG.
First, physicians have the right to dispense medications in most states. Some states outright ban this privilege (New York, Montana, Wyoming, Massachusetts, Texas, Utah.) Most other states allow physician dispensing but differ in their regulations. In some states physicians must get permission from the Board of Pharmacy while other states require permission from the Board of Medicine. While some states are lax in what they require a physician to document, others require physicians to adhere to the same strict documentation standards required of pharmacists.
So why are physicians allowed to dispense? Wasn't that the role of the pharmacist?
Traditionally, these physician dispensing privileges were put in place to allow physicians in remote areas (lacking a pharmacy) the ability to get drugs to their patients. However, most physicians do not elect to do so, since keeping a stock of medications in a medical practice can be costly. For the most part, this scheme does not increase revenue since patients will elect to get the same drugs more cheaply at a pharmacy. And nowadays, you can find a pharmacy anywhere in this country. However, medical and pharmaceutical lobbies have fought state BOPs who have tried to take this privilege away and have stopped the introduction of more stringent regulations.
One of the most common specialties in which physician dispensing is practiced is pain medicine.
This is the one medical specialty where keeping a stock of drugs at the clinic is really profitable.
The most abusive form of this practice setup is the pill mills. Unethical pain doctors made boatloads of money using physician dispensing privileges. They would buy pills in bulk, have them prepacked by a third party company, and stuff their vaults with this "candy." Patients would specifically come to these clinics in order to get their fix (Florida was the poster child of this issue several years ago when it had no monitoring of controlled substances). Furthermore, these clinics required payment in the form of cash, since insurance companies would scrutinize a doctor diagnosing every patient with a pain condition. Patients were more than happy to pay cash for these drugs, which were marked up by as much as 300%.
A more legitimate but profitable scheme is pain clinics that manage workplace injuries. Almost all claims are paid for by workman's comp insurance. This setup involved utilizing the less regulated physician dispensing to generate more revenue using dispensing fees. Medications dispensed by a pharmacy are governed by a fee schedule, so a pharmacist can only charge a certain amount for a drug. However, physician dispensing is not limited by a fee schedule, so reimbursement can be billed with significant markups.
Now to my theorizing (I may be totally wrong about this):
In respect to Doctor Kornfeld, I don't get the feeling that he was a "drug dealer." He has a good pedigree (Northwestern University and pain management fellowship) and his practice doesn't look like a pill mill (at least on the surface). That being said, his practice may have been set up so that some revenue was generated by doing physician dispensing. This may be the case given the location and the likelihood that many of his patients were relatively well off and had premium insurance plans that would reimburse physician dispensing fees. This is one possible explanation for why his son had suboxone with him when he met Prince.
Alternatively, his practice may not have utilized physician dispensing as a revenue generator. Instead, the only medication stock he carried may have been samples given to him by big pharma. In that case, he would first dispense these samples to his patients, who would then get the medication filled at a pharmacy. This would explain why only a small sample was brought to Prince when the physician's son was sent to meet him.
Whatever the circumstances, he may have ran afoul of legal statutes when he had the meds transported over state lines.
Physician dispensing is regulated by state and federal law. If he dispensed meds to patients within California, he would only have to follow their regulations. But if he dispensed meds to patients in other states, he would have to follow each individual states' regulations in addition to federal laws concerning interstate transport and storage. His practice would have to be registered and licensed/permitted by other state BOPs/BOMs and the DEA for him to dispense meds outside Cali.
By delivering the drug to Prince in Minnesota, I think the physician would need to have physician dispensing privileges in the state of Minnesota (and also notify the DEA that he has that privilege in respect to controlled substances). If this doctor did not, then he may have violated state and federal laws regarding physician dispensing and possibly the Controlled Substance Act (CSA).
Part of the CSA requires every entity involved in the manufacturing, distribution, prescribing and dispensing to be registered with the DEA. If his son had not been registered with the DEA as an entity that could deliver or transport medications across state lines, then his delivery of suboxone could have been in violation of this statute. Furthermore, without him registered as an entity that could transport controlled medications and without documents that indicated that his son was transporting controlled medications, the physician could be in violation of the statute prohibiting the transfer of the medication to a person other than the patient for whom it was prescribed.
Other parts of the CSA may have been violated when the doctor decided to have his son go meet Prince.
- If the medication was not properly labeled (with such info including patient name, dispensing date, warnings, proper indication that it was a controlled substance, etc).
- If the removal and movement of this medication was not properly documented in his practice.
- If the medication was not properly secured when it was removed from the practice and placed in transport
The truth is, this is physician dispensing. I don't know how much of the CSA applies to it. Consequently, this has been a hot topic with my coworkers.
One pharmacist said "He did nothing
legal."
I'm interested if anybody has heard or found out anything concerning this story. It's just so bizarre.
