Edited Because I Don't Want to Get Fired

[allantois]

lol yeah either the lawyers are *****s or the place just doesn't want to rustle any feathers. I'd love to know on what exactly ruling/regulation they're basing that opinion on.

If that advice isn’t legal malpractice, idk what is.

Unfortunately this is what happens when psychiatry gets reduced to unable to concentrate = Adderall; anxiety = Xanax by other specialties. No one would think to start rx ing chemo out of their scope

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[Candidate2017]

lol yeah either the lawyers are *****s or the place just doesn't want to rustle any feathers. I'd love to know on what exactly ruling/regulation they're basing that opinion on.

The organization has lawyers to protect itself from liability, not render a legal opinion as to whether OP should or should not report. They could care less about medical ethics, medical boards, or liability to OP for not reporting. OP exists, for them, to crank out dollars.

There is no financial harm to the organization if OP does not report Dr. Hubby, and the organization itself has no obligation to report. There is potential liability/costs to the organization in the form of privacy lawsuits if OP reports. Hence, their conclusion that OP should not report. This is the same reason why organizations require a signed release from patients, even though it is not necessary for coordination of care.

Ironically, if there is a duty to report, then the CMO is probably obligated to report since he now has knowledge (assuming you've gvien him the relevant info, PDMP, etc.). However, CMOs work for The Man. They've sold their souls and aren't interested in being physicians or retaining their license. So OP, if you're going to report, might as well go ahead and report the CMO too.

 

[WisNeuro]

May be worth a call to your liability carrier to get a consult about the situation. If its a good carrier, they can give you both the ethical and legal points of view.

 

[TexasPhysician]

May be worth a call to your liability carrier to get a consult about the situation. If its a good carrier, they can give you both the ethical and legal points of view.

Most will not comment on this. The issue to report or not does not relate to malpractice by the OP.

 

[TexasPhysician]

Yeah I agree.

But if I was going to report, I should have done it without asking the chief medical officer of the company first. I think I asked him in part because I wanted to defer to his judgement, consciously or subconsciously. The interim medical director for this location, has not provided any response, likely because the CMO sits above her anyway.

Whether or not this is the correct outcome, I believe this is what I will be doing. Or is the correct thing to do ask my CMO, he asks legal, they say don't report... so he says don't report, and then report anyway? Just made it harder for myself. To be honest I don't want to rustle jimmies at a place I will be at for 6 months, being paid as a 1099, with plans to go to fellowship after.

Alternatively, for my state, a complaint could have been made anonymously. Should have just done that, but it opts you out of updates if you do.

The husband in question is a radiation oncologist for the hospital system that is a financial partner with this company at this location. I'm sure he makes some cash for this health system. Shouldn't matter but that's also related.

The CMO has a duty to the organization. They’ll always aim to protect themselves. Now that the CMO knows that you are identifying risks to the organization, you have put yourself at risk. You are possibly rocking their boat. Depending on the CMO’s personality and level of interest in the organization, you may be scrutinized more, written up, etc to gain leverage in the business world. Workplace retaliation is real.

I would ask myself if the amount and doses could cause serious harm in the short-term. If the answer is yes, I’d still report. There would be a large regret if someone died because i did nothing. If the answer is no, I’d probably wait until 1-2 months before I plan to leave the job. I could always run more queries to monitor in the interim. Once the CMO discovers that their rad onc is dealing with a med board complaint regarding this matter, I’d want to be on my way out for good.

 

[WisNeuro]

Most will not comment on this. The issue to report or not does not relate to malpractice by the OP.

I have gotten advice on this a few times over the years in terms of issues related to practicing ethics, once from liability carrier, once from board, and another from my board certifying agency. The liability carrier consult was a general question and they were more than happy to go into details and provide a summary for my documentation. May be a difference between specialties/professions.

 

[TexasPhysician]

I have gotten advice on this a few times over the years in terms of issues related to practicing ethics, once from liability carrier, once from board, and another from my board certifying agency. The liability carrier consult was a general question and they were more than happy to go into details and provide a summary for my documentation. May be a difference between specialties/professions.

Possibly. Many psychiatry carriers will also not assist if it is a board complaint against you the policy holder. Board complaints are not malpractice, so many carriers will refer you to an attorney and wish you luck.

 

[WisNeuro]

Possibly. Many psychiatry carriers will also not assist if it is a board complaint against you the policy holder. Board complaints are not malpractice, so many carriers will refer you to an attorney and wish you luck.

Weird, mine actually has a rider, very cheap, that you can get to add additional money for legal defense in case of board complaints. But, there is a standard amount of board complaint coverage included in the basic policy.

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[Geraltofrivia]

Yeah I agree.

But if I was going to report, I should have done it without asking the chief medical officer of the company first. I think I asked him in part because I wanted to defer to his judgement, consciously or subconsciously. The interim medical director for this location, has not provided any response, likely because the CMO sits above her anyway.

Whether or not this is the correct outcome, I believe this is what I will be doing. Or is the correct thing to do ask my CMO, he asks legal, they say don't report... so he says don't report, and then report anyway? Just made it harder for myself. To be honest I don't want to rustle jimmies at a place I will be at for 6 months, being paid as a 1099, with plans to go to fellowship after.

Alternatively, for my state, a complaint could have been made anonymously. Should have just done that, but it opts you out of updates if you do.

The husband in question is a radiation oncologist for the hospital system that is a financial partner with this company at this location. I'm sure he makes some cash for this health system. Shouldn't matter but that's also related.

This could potentially qualify as professional misconduct, which could be worse than going to the medical board

 

[i-doctor]

The state only cares about controlled meds. They know that docs prescribe family members antibiotics, BP meds, etc on the side all the time due to convenience.

In this particular case, it is only Kosher if the husband did an “exam” and has a chart note.
Chief Complant “Insomnia”, some exam findings, and Plan is “Benzo’s to aid sleep”. Then he’s fine. The Adderall is more problematic here though.

I wouldn’t report him. He didn’t commit murder here. I myself would call him personally and ball him out for improperly prescribing and in fact affecting your management of his wife’s problems. And threaten to report him if it doesn’t stop.

 

[Merovinge]

In all, I think legal is a lazy bunch of f*cking boomer clowns, just like most at this organization, who don't want to do work, who want to opt for the easiest thing to do currently, which is not report.

This is how almost the entirety of the business world works. It's mostly about not rocking the boat and collecting the gravy train. Certainly not unique to your organization.

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[allantois]

I would agree about not calling the husband especially without patient's consent. I am actually very surprised the pharmacy got the scripts filled. I am guessing patient and husband have different last names but also if he has pads out of scope prescribing should have raised red flags

 

[i-doctor]

Honestly man, I don't think any medical board or the DEA would consider husbands prescribing controlled medications in a variety of classes to their wives for several months, kosher in any sense, whether there was a chart or not, unless it was a true emergency situation. Non-controlleds are a different story.

I think personally calling him would be a terrible idea. And one in which I will certainly not be doing, for a multitude of reasons.

Again, I think you’re overreacting. No major harm as you said. Refills on a long term medication to fill in the cracks isn’t the end of the world. Neither is short acting benzos for sleep disorder. Probably 40% of the population is on a sleep medication. (Just tell your PCP you can’t sleep and they dispense them automatically). And maybe he is essentially his wife’s PCP. Bad medicine of course, but you’re reacting like he’s a drug dealer.

 

[allantois]

What’s the excuse for an MD to “fill in the cracks” for his wife? Not being able to afford to get in with a PCP or psych? Ask a colleague for professional courtesy ffs

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[i-doctor]

Jus bored at work. Cancellations due to snow. Sometimes look around. Sorry
Almost went into psych. Probably a good thing I didn’t, I suppose.

 

[ObsequiousAplomb]

Triazolam 0.25 mg daily, #30 for 30 days
Adderall 20 mg BID, #60 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Ambien 5 mg (2x QHS), #60 for 30 days
Oxycodone 5 mg, #30 for 5 days
Klonopin 0.5 mg TID, #90 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Klonopin 0.5 mg TID, #90 for 30 days

If I prescribed these to my wife or my best friend, I'd expect the DEA and medical board up my ass.
None of these are long term medications prescribed by other providers, aside from Adderall.

And aren't you an optho? What are you doing in here? No wonder your advice was to "I myself would call him personally and ball him out for improperly prescribing and in fact affecting your management of his wife’s problems. And threaten to report him if it doesn’t stop." With respect, no competent psychiatrist would do this.

At least all the benzodiazepine doses are very modest.
The Adderall dose is acceptable.
The Ambien 10 for a woman though, ehhhhhhh.
Throw in the oxy? Well, there's at least one drug that may in some way be related to his field, but also imo the most egregious one here (aside from the Adderall for a spouse) due to the abuse potential. At least the dose is modest.
The combination of having done all of it? Sounds less like filling in the gaps and more like taking over. Especially that there's three things for sleep given. Maybe she really does need to rotate sleep meds to avoid habituation?

But really, why would your spouse do this? It's not hard to ask a colleague in a more appropriate specialty (primary care, sleep medicine, etc) than radiation oncology to see your wife.

I wouldn't call him to threaten him, since I in general don't threaten people. I might consider calling him under the guise of coordination of care and then go "oh, I didn't realize she was your wife!" I'd consider it a lot but most likely would just keep the fantasy where it's best kept.

 

[ObsequiousAplomb]

Jus bored at work. Cancellations due to snow. Sometimes look around. Sorry
Almost went into psych. Probably a good thing I didn’t, I suppose.

Don't be too upset, you made for a nice conversation point for all of us and certainly added to the discussion. Please don't call and yell at me for prescribing ophthalmic atropine solution as often as I do, if you ever come across a chart of mine.

 

[Stagg737]

Triazolam 0.25 mg daily, #30 for 30 days
Adderall 20 mg BID, #60 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Ambien 5 mg (2x QHS), #60 for 30 days
Oxycodone 5 mg, #30 for 5 days
Klonopin 0.5 mg TID, #90 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Klonopin 0.5 mg TID, #90 for 30 days

If I prescribed these to my wife or my best friend, I'd expect the DEA and medical board up my ass.
None of these are long term medications prescribed by other providers, aside from Adderall.

And aren't you an optho? What are you doing in here? No wonder your advice was to "I myself would call him personally and ball him out for improperly prescribing and in fact affecting your management of his wife’s problems. And threaten to report him if it doesn’t stop." With respect, no competent psychiatrist would do this.

Report this clown. You're only planning on working there for 6 months before fellowship anyway. Most boards meet and review things quarterly, by the time this gets back to them you'll be at least halfway through this job anyway if not already in fellowship. Besides, how old is this guy that he's prescribing her Halcion twice? Might as well just throw some Miltown on there while he's at it...

 

[allantois]

Honestly, someone prescribing that much stuff to a wife is probably doing the same to friends or other family members; I would let the boards investigate; hopefully they go after the shady CMO and NP as well

 

[Liquid8]

Triazolam 0.25 mg daily, #30 for 30 days
Adderall 20 mg BID, #60 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Ambien 5 mg (2x QHS), #60 for 30 days
Oxycodone 5 mg, #30 for 5 days
Klonopin 0.5 mg TID, #90 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Klonopin 0.5 mg TID, #90 for 30 days

If I prescribed these to my wife or my best friend, I'd expect the DEA and medical board up my ass.
None of these are long term medications prescribed by other providers, aside from Adderall.

And aren't you an optho? What are you doing in here? No wonder your advice was to "I myself would call him personally and ball him out for improperly prescribing and in fact affecting your management of his wife’s problems. And threaten to report him if it doesn’t stop." With respect, no competent psychiatrist would do this.

I'd report it.

One controlled substance could be a one off, but not that many.

The other possibility that come to mind is that the doctor is prescribing some of those drugs for himself in his wife's name. There are a few ways one could go about establishing this, easiest would be to clarify with the patient what medications they are actually taking compared to what's been dispensed.

 

[clausewitz2]

Might as well just throw some Miltown on there while he's at it...

I was so tickled with the one older patient I had at a CMHC who gave me the "the only medication that ever worked" speech but then identified it as "the one that starts with an m, meproba something." It was like a drug-seeking time capsule.

 

[calvnandhobbs68]

Triazolam 0.25 mg daily, #30 for 30 days
Adderall 20 mg BID, #60 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Ambien 5 mg (2x QHS), #60 for 30 days
Oxycodone 5 mg, #30 for 5 days
Klonopin 0.5 mg TID, #90 for 30 days
Triazolam 0.25 mg daily, #30 for 30 days
Klonopin 0.5 mg TID, #90 for 30 days

If I prescribed these to my wife or my best friend, I'd expect the DEA and medical board up my ass.
None of these are long term medications prescribed by other providers, aside from Adderall.

Um yeah this is straight up reportable (in this case). Benzos+oxy+short acting stimulants repeatedly from a family member? I mean, most people would want a good note from psychiatry for justification of this cocktail, especially once you start moving into 2+ different controlled meds. If it was just he gave her a script of adderall + klonopin once or something, I'd have kept it to telling her that he should stop. This pattern is way more than that.

Did the wife also tell you she was taking or had taken that other stuff on your intake? Because I'd be pretty suspicious of diversion for the doctor's personal use too, especially if she conveniently forgot to mention these other scripts.

 

[VA Hopeful Dr]

Um yeah this is straight up reportable (in this case). Benzos+oxy+short acting stimulants repeatedly from a family member? I mean, most people would want a good note from psychiatry for justification of this cocktail, especially once you start moving into 2+ different controlled meds. If it was just he gave her a script of adderall + klonopin once or something, I'd have kept it to telling her that he should stop. This pattern is way more than that.

Did the wife also tell you she was taking or had taken that other stuff on your intake? Because I'd be pretty suspicious of diversion for the doctor's personal use too, especially if she conveniently forgot to mention these other scripts.

Timeline matters. That scattered across a year or two? Bad but I wouldn't do anything except tell the wife that's not OK going forward.

That across 2 months, whole different thing.

 

[ObsequiousAplomb]

Timeline matters. That scattered across a year or two? Bad but I wouldn't do anything except tell the wife that's not OK going forward.

That across 2 months, whole different thing.

Yeah, that's my major concern with this history. If these were all years apart that would be way different than if they were 3 consecutive months.

If the Halcion is for three months years apart from the Klonopin while the treating doctor really wasn't available (given that it was Halcion, presumably they retired or died of old age), that's different than Halcion and Klonopin at the same time. I'd be really hard pressed to understand why the Halcion was coinciding with Klonopin TID.

The Ambien mixed in with it makes me think that it was not consecutive or concurrent, and that maybe the husband really was just writing a bridge between providers who had changed the regimen. Doctor 1 who prescribes Halcion retired, so hubby filled in until doctor 2 said "not gonna do Halcion, but we can try Ambien 10." Then another change and back to Halcion, rinse, repeat.

Maybe hubby got uncomfortable with the Halcion and he was the one who switched to Ambien?

There's also the possibility that the husband wasn't the one calling these in for her. She's just as capable of having taken a prescription pad for the Adderall and Oxy. For the Klonopin and Halcion she could have just called in with his DEA and NPI. Maybe the pharmacy even let the Adderall and Oxy be called in, for all we know.

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[ObsequiousAplomb]

Over the span of 1.5 years. Interspersed.

No other doctor ever prescribed the patient Klonopin, Halcion, Oxy, Ambien.

Only the NP and prior MD at this clinic started Adderall at 5 mg BID, then increased to 10 mg BID. Adderall was never prescribed at 20 mg BID. Klonopins, Halcion, Oxy, Ambien only from husbnad.

I'm going to report him about 1 month prior to when I leave. I'm deciding anonymous or not.

I'd go with anonymous.

Are you sure there weren't any prescriptions from a state that wasn't included in your report?

This pattern is definitely not okay. I'm mostly just morbidly curious at this point. I wonder if the escalating dose was a tactic to extend the prescription to two months?
I'm wondering because the one month Rxs of Halcion make me think it was an as-needed thing used relatively infrequently that was prescribed 3 times over 1.5 years and really taken once a week.

Same thing with Klonopin 0.5 TID. Like, who does that? Sounds like a 90 day supply that was reduced to 30 to save on copays.

 

[Stagg737]

Over the span of 1.5 years. Interspersed.

No other doctor ever prescribed the patient Klonopin, Halcion, Oxy, Ambien.

Only the NP and prior MD at this clinic started Adderall at 5 mg BID, then increased to 10 mg BID. Adderall was never prescribed at 20 mg BID. Klonopins, Halcion, Oxy, Ambien only from husbnad.

I'm going to report him about 1 month prior to when I leave. I'm deciding anonymous or not.

Yea, that's unacceptable, and I'd be concerned about your liability as a treating physician if you don't report this and something happens. Even if this is over 1.5 years, that's over 7 months of prescriptions if none of them overlap and only 1 of those Rx's was ever prescribed by someone other than her husband.

If I were you, I'd report right away. I'd also inform the wife that the situation is unacceptable and that if she obtains any further controlled substances from her husband or anyone else for sleep, anxiety, or any other psych-related issue that you would no longer see her. I would not be willing to continue seeing someone receiving meds like this, especially if it has been done repeatedly.

Same thing with Klonopin 0.5 TID. Like, who does that? Sounds like a 90 day supply that was reduced to 30 to save on copays.

I see this fairly frequently. Mostly it's patients taking it TID when it's prescribed BID, but I do see it prescribed TID at times.

 

[allantois]

And I thought a husband prescribing wife Prozac was bad enough given she wasn’t really doing well and wasn’t transparent with him about it (a case I had)

 

[Ironspy]

Admin want you to keep quiet now but will throw you under the bus for not reporting if she overdoses

 

[ObsequiousAplomb]

Overall from these threads you've posted recently it sounds like your new contract is at a place that isn't really worth the money (however much that may be).

 

[Desired Member]

I'm not really adding anything ground-breaking here, but this is how I would handle -
- NEVER call the husband dr. directly
- anonymously report to the board that I have concerns husband dr. is repeatedly prescribing a variety of controlled substances to a family member. I would make it clear that this concern is based solely on PDMP review and knowing patient's husband's name, and no additional information. (If it was the patient's PCP prescribing these meds over a year and a half, I don't think it would be necessary to report)

- If I was planning to continue Adderall for ADHD, would make it clear to her that I would not prescribe any controlled substances for sleep aids because stimulants can cause insomnia and generally it would be safer to first modify ADHD medication if bothersome insomnia is occurring. I would make her aware of the existence of the PDMP. I would let her know that while I am managing her ADHD, she can only see me for management of ADHD and if she runs out of Adderall or wants a dose change she needs to contact my office for an appointment. I would let her know that if she gets placed on controlled substances from other providers for insomnia, I would no longer feel comfortable prescribing Adderall since insomnia is a side effect of Adderall, and would provide her with a list of alternate psychiatrists.

 

[smalltownpsych]

Whenever one of my patients gets a script for Adderall, I know we are going in a dangerous direction. Reason being, I don’t treat ADHD and this case doesn’t look anything like ADHD to me. Tough to unravel something like this as the medical treatment has become part of the pathology and Is right in the dysfunctional family system. I would try to help them first before going to reporting, but if there is much resistance then anonymous report makes sense.

 

[forchinet121]

Timeline matters. That scattered across a year or two? Bad but I wouldn't do anything except tell the wife that's not OK going forward.

That across 2 months, whole different thing.

I agree with this

 

[yoloswagpoop42069]

Edited Because I Don't Want to Get Fired

 

[allantois]

If they fire you, you'd have a pretty great case for wrongful termination

 

[VA Hopeful Dr]

If they fire you, you'd have a pretty great case for wrongful termination

Doubt it. The instant OP brought this up I guarantee they started getting their ducks in a row so they had a paper trail to get rid of them.