Is ADHD within scope of practice for an Ob gyn?

[Old Timer]

You're still charging ahead, citing "logic" and what not.

There you go, if you can't have an argument and use logic and facts, then you are just making stuff up. You are a member of the biggest club in America. Pharmacists who invent rules to follow that do not exist, except in your imagination.

Here is my scenario, you blanket refuse to fill a seizure medication because the MD is a specialist and the patient has a seizure.

Your scenario is the MD (father of the patient, who by the way has to be certified by IPLEDGE before he can prescribe) falsifies IPLEDGE reporting that certifies a pregnancy test was done in the last seven days The patient his daughter also went to the IPLEDGE site and certified she had a pregnancy test in the last seven days and is using two methods of birth control. Now the daughter gets pregnant and you will be sued and cited by the board because he is a surgeon with valid license to practice in his state and you did not determine that both the Doctor and the patient falsified their information in IPLEDGE.

I'll leave it to the audience to decide what scenario is more fanciful. Is Robert Muller investigating you too? You seem to like alternate facts.

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[Rockinacoustic]

As a residency trained pharmacist it's outside my scope of practice to verify 30 days fills for outpatient prescriptions. Sure i did this as a P4 student, but lord help my patients if I get one of those crazy new diabetes meds...

 

[CetiAlphaFive]

There you go, if you can't have an argument and use logic and facts, then you are just making stuff up. You are a member of the biggest club in America. Pharmacists who invent rules to follow that do not exist, except in your imagination.
Here is my scenario, you blanket refuse to fill a seizure medication because the MD is a specialist and the patient has a seizure.
Your scenario is the MD (father of the patient, who by the way has to be certified by IPLEDGE before he can prescribe) falsifies IPLEDGE reporting that certifies a pregnancy test was done in the last seven days The patient his daughter also went to the IPLEDGE site and certified she had a pregnancy test in the last seven days and is using two methods of birth control. Now the daughter gets pregnant and you will be sued and cited by the board because he is a surgeon with valid license to practice in his state and you did not determine that both the Doctor and the patient falsified their information in IPLEDGE.
I'll leave it to the audience to decide what scenario is more fanciful. Is Robert Muller investigating you too? You seem to like alternate facts.

I'll post these in big letters so that maybe you can actually read what I'm writing and what I've written more than once.

It is legal for any MD to write any prescription for any medication.
It is not a good idea if the medication is high risk, such as a C-II.
Just because something is legal doesn't make it a good idea.
It has nothing to do with Scope of Practice.
It has nothing to do with any rule or law.


Was that Reader's Digest-y enough for you? I don't know why you can't stop bringing up points I never made.
Do you need a nap?

Again, I'll point out once again that a pharmacist has absolutely zero duty to fill any prescription, seizure medicine or not.
If that were the case, patients could demand medications without paying anything and sue the pharmacy if they were refused the med.
You are willfully ignorant of the concept of duty at this point.
It would take you maybe 5 minutes to look up and understand.

You are literally responding to the portion of my post where I criticize you for not understanding that no, a pharmacist does not have a duty to provide any prescription.

The fact that you're arguing that I should have filled the Claravis prescription is mind boggling.
I, for one, am a professional with a working brain, and I have a conscience.
I suppose I could give you the benefit of the doubt and assume you just didn't read or comprehend the post.

Literally all of your posts could be applied to red flags for opioids.
"How do you know the patient isn't being prescribed Xanax and Oxy 30 for a valid reason? What does it matter that the clinic is 3 hours away from your pharmacy.
The doctor has a valid DEA number and wrote the prescription"

Your argument is so one dimensional that you can't wrap your head around the fact that I'm promoting critical thought and careful consideration of prescriptions.
Not a single time have I said that it's against a rule, law, regulation, blood pact, or writ madmaxus.

Not all of us are CVS drones without the ability to reason. I don't have a district manager that does all of my thinking for me, so I'm able to make logical conclusions.

 

[Old Timer]

It is legal for any MD to write any prescription for any medication.

Ok, we agree.

It is not a good idea if the medication is high risk, such as a C-II.

WTF does that mean? You don't fill any high risk meds such as a C-II?

Just because something is legal doesn't make it a good idea.

Who said it was a good idea. I said it's legal to write it and you have the duty to check it out if you have concerns.

It has nothing to do with Scope of Practice.

Since the thread is about scope of practice and that is the title of the thread. It shocks me not at all that you think it has nothing to do with that.

It has nothing to do with any rule or law.

Of course, we don't have to pay attention to rules or laws. We just make up our own when we feel like it.

Was that Reader's Digest-y enough for you? I don't know why you can't stop bringing up points I never made.
Do you need a nap?

You wouldn't understand readers digest. Way above you.

The fact that you're arguing that I should have filled the Claravis prescription is mind boggling.
I, for one, am a professional with a working brain, and I have a conscience.

First you have a complete lack of understanding of IPLEDGE. You have neither of the other things your mentioned.

I suppose I could give you the benefit of the doubt and assume you just didn't read or comprehend the post.

The pot calling the kettle black.

Not all of us are CVS drones without the ability to reason. I don't have a district manager that does all of my thinking for me, so I'm able to make logical conclusions.

Having never worked with me, you understand my motivations completely.....

Whatever. You never address what I actually and you never come clean with what you say. I prefer clarity to agreement. Nobody does my thinking for me.

I address everything you say, but since I use facts, logic and whatnot you wouldn't understand.
It's best I place you on ignore.

 

[CetiAlphaFive]

Ok, we agree.
WTF does that mean? You don't fill any high risk meds such as a C-II?
Who said it was a good idea. I said it's legal to write it and you have the duty to check it out if you have concerns.
Since the thread is about scope of practice and that is the title of the thread. It shocks me not at all that you think it has nothing to do with that.
Of course, we don't have to pay attention to rules or laws. We just make up our own when we feel like it.
You wouldn't understand readers digest. Way above you.
First you have a complete lack of understanding of IPLEDGE. You have neither of the other things your mentioned.
The pot calling the kettle black.
Having never worked with me, you understand my motivations completely.....I address everything you say, but since I use facts, logic and whatnot you wouldn't understand.
It's best I place you on ignore.

I provided specific examples of legal concepts that you're getting wrong, and encourage you to look them up.

Again, please learn to read and understand context.
I don't fill any high risk meds that I have reason to believe a physician is not familiar with. I believe that this increases the risk for negative outcomes.

Since you love citing "facts and logic", please list, specifically, one fact that you've posted that contradicted my posts.
Please quote the section of my post that your fact directly contradicted.


You should actually know how iPledge works if you're going to start an argument about it.
iPledge requires the Pharmacist to know that a female patient of child bearing age has to have had a blood or urine pregnancy test administered by the prescriber within 7 days of picking up the prescription.

There's a reason that the pharmacist training for iPledge consists of more than just the question "Do the ipledge number doctor-man give you work? If it work, fill the pills"

Retail drones like this are why the profession has reached the lows it has.
Someone is literally arguing that I should've filled an extremely high risk prescription that I doubted the legitimacy of.


You're getting dunked on super hard with specifics and just providing low energy insults in return.

 

[Apotheker2015]

Need to call. I called to document why and the OB/GYN just wrote one time for the patient until her next appointment with her psychologist.

This is probably a case of post partum depression(?). It's possible. I didn't read the whole thread. I am not going to. What old timer said below is true. Physicians may write a prescription for any drug AND for any use. This is one way off-label uses get to be acknowledged as off-label uses.
The physician should be able to at least cite a case study from the New England Journal of Medicine if the use is not even listed as off-label use. You are either comfortable with it or not.

 

[W19]

@CetiAlphaFive

You seem to be moving the goal post in every single post...

 

[CetiAlphaFive]

@CetiAlphaFive

You seem to be moving the goal post in every single post...

It's almost as if conversations between two sentient beings are dynamic

Please elaborate.

You seem to think that I've deviated from my original post in the thread:

*insert the video from literally ANY deposition here so that people don't listen to this horrible, dumb advice*

**except the part where he says you should call.of course.

 

[W19]

It's almost as if conversations between two sentient beings are dynamic

Please elaborate.

You seem to think that I've deviated from my original post in the thread:

I guess you guys weren't arguing about the same thing...

 

[gwarm01]

This is the hottest thread on these forums right now.

My take: legally an MD can prescribe anything they damn well please. In that sense, the prescription is valid. However, there's also the problem of it being within their usual scope of practice. That makes it legal but unusual, and would warrant a call. I'd say the final call on dispensing would depend on the conversation I had with the doctor... or how busy it was at the pharmacy. What the hell do I know, I've never worked retail a day in my life. I'd probably break out into a cold sweat then start seizing.

 

[Old Timer]

You should actually know how iPledge works if you're going to start an argument about it.
iPledge requires the Pharmacist to know that a female patient of child bearing age has to have had a blood or urine pregnancy test administered by the prescriber within 7 days of picking up the prescription.

According to the FDA:
Isotretinoin sponsors will ensure isotretinoin is only dispensed by pharmacies that are certified. To become certified, the pharmacy must become registered and activated in the iPLEDGE program. To become registered and activated, each pharmacy must identify a “responsible site pharmacist” who completes the Pharmacy Enrollment Form and agrees to do the following before dispensing an isotretinoin prescription:

i. Affirm that all pharmacists will comply with all iPLEDGE requirements:

1. Know the risk and severity of fetal injury/birth defects caused by isotretinoin.
2. Dispense only FDA-approved isotretinoin products and obtain isotretinoin only from iPLEDGE registered wholesalers.
3. Do not sell, borrow, loan, or otherwise transfer isotretinoin in any manner to or from another pharmacy.
4. Dispense only to qualified patients determined via authorization from the iPLEDGE web- or voice-based system for every isotretinoin prescription.
5. Document the Risk Management Authorization (RMA) number on each prescription.
6. Dispense no more than a 30-day supply (no refills).
7. Dispense the isotretinoin Medication Guide with each prescription.
8. Dispense prior to the “do not dispense to a patient after” date provided by the iPLEDGE program.
9. Return to the manufacturer (or delegate) any unused product if registration is revoked or if the pharmacy chooses to not reactivate

Now, please show me where you are required to know they have had a blood or urine pregnancy test outside of the iPLEDGE system. The only arbiter as per the FDA rules are through the iPLEDGE system. If iPLEDGE says yes, it's a go. If iPLEDGE says no, it's not a go. Show me a REMS statement or any other proof that you are correct. The iPLEDGE system qualifies the prescribers at enrollment and the prescriber is required to show that proof to iPLEDGE. I am not a prescriber, so I don't personally know whether they just check a box that a test was done or if they have to send the proof to iPLEDGE. Any doctor cannot write an RX for isotretinoin. They have to be registered with the program and associated with that patient. If the doctor is also the parent and they go through the steps to enroll and manage the patient, that is not a decision for you to upend. Please show me where I am wrong.

 

[FinallyOnTrack]

Now, please show me where you are required to know they have had a blood or urine pregnancy test outside of the iPLEDGE system. The only arbiter as per the FDA rules are through the iPLEDGE system. If iPLEDGE says yes, it's a go. If iPLEDGE says no, it's not a go.

Exactly what I was thinking. Before you dispense the medication, it is your (the RPh) requirement to make sure the Rx is entered into iPledge - if the Rx is within 7 days of being written AND it's for a female with child-barring capabilities, then the MD has to report to iPledge the prescription along with the pregnancy test results.

Yes, the pregnancy test can be done prior to the prescriber office visit. For females of reproductive potential, the initial screening pregnancy test (1st test) must be conducted on the date of registration or no more than 30 days prior to patient registration. For ongoing monthly pregnancy tests, the specimen must be collected and processed in a CLIA certified laboratory and the date of the specimen collection and the pregnancy test results must be entered to start the patient's 7-day prescription window.


(See Package Insert for timing requirements). The date of the specimen collection for the pregnancy test is Day 1 of the 7-day prescription window for females of reproductive potential.

So back to Old Timers post - the RPh IS NOT required to know the results of the test, nor if the test has been performed. The RPh IS required to report the prescription to iPledge when filling - if it's still valid, then slap a label and let'r go..

Seems like @CetiAlphaFive just set @Old Timer up with a good ol' fashion alley-oop for a slam dunk.

 

[CetiAlphaFive]

So, @FinallyOnTrack and @Old Timer believe that a pharmacist should dispense a medication that they have strong reason to believe could result in harm just because the MD says it's OK?
Do you guys dispense Xanax, Norco, and Soma if the MD tells you "It's OK because I say so!"?

Allow me to present you with a hypothetical scenario:
Patient A, a female of child-bearing age, walks up to the pharmacy and presents you with a Claravis prescription and states loudly "I am not taking any contraceptives and have never had a birth control test.
I am actively engaging in daily unprotected sex!"
As she is standing in front of you, the Post office delivers a Certified Letter from her with a written version of that statement.
You run the iPledge number and it comes back valid.
You both are saying that you would dispense the prescription to Patient A?

What is the difference between the real world example I presented and the hypothetical Patient A?

When you say "IS NOT required", there is an implication that it is not required by an entity. I'm presuming you mean by the REMS program.
I'll ask you to go back and please read the posts in this thread.
Old Timer has been weakly grasping at straws, and the both of you are now attempting to turn this into a "Gotcha!" based on iPledge rules.
Please borrow some critical thinking and careful reading skills from someone so you can note that I was never basing my argument on those.

If you go back, you'll find the word "deposition."
In a deposition, a lawyer will ask you, "But you were required to take the ipledge training, weren't you?
Are you saying that even though you knew or had strong reason the iPledge certification was falsified, that you dispensed a medication that you knew would cause serious harm to my client's child?"


You should both be better than this. Be more than Lick 'n Stick RPhs who piss their pants and agree to dispense meds they know they shouldn't every time a district manager or prescriber raises their voice.

 

[W19]

So, @FinallyOnTrack and @Old Timer believe that a pharmacist should dispense a medication that they have strong reason to believe could result in harm just because the MD says it's OK?
Do you guys dispense Xanax, Norco, and Soma if the MD tells you "It's OK because I say so!"?

Allow me to present you with a hypothetical scenario:
Patient A, a female of child-bearing age, walks up to the pharmacy and presents you with a Claravis prescription and states loudly "I am not taking any contraceptives and have never had a birth control test.
I am actively engaging in daily unprotected sex!"
As she is standing in front of you, the Post office delivers a Certified Letter from her with a written version of that statement.
You run the iPledge number and it comes back valid.
You both are saying that you would dispense the prescription to Patient A?

What is the difference between the real world example I presented and the hypothetical Patient A?

When you say "IS NOT required", there is an implication that it is not required by an entity. I'm presuming you mean by the REMS program.
I'll ask you to go back and please read the posts in this thread.
Old Timer has been weakly grasping at straws, and the both of you are now attempting to turn this into a "Gotcha!" based on iPledge rules.
Please borrow some critical thinking and careful reading skills from someone so you can note that I was never basing my argument on those.

If you go back, you'll find the word "deposition."
In a deposition, a lawyer will ask you, "But you were required to take the ipledge training, weren't you?
Are you saying that even though you knew or had strong reason the iPledge certification was falsified, that you dispensed a medication that you knew would cause serious harm to my client's child?"


You should both be better than this. Be more than Lick 'n Stick RPhs who piss their pants and agree to dispense meds they know they shouldn't every time a district manager or prescriber raises their voice.

He/she never said that...

 

[CetiAlphaFive]

He/she never said that...

Are you chiming in just to practice being wrong and embarrassing yourself, or what?

. As long has he got I-Pledge to approve, what the hell do you care? You will have ZERO liability. .

- if it's still valid, then slap a label and let'r go..

.

 

[W19]

Are you chiming in just to practice being wrong and embarrassing yourself, or what?

You really have a chip on your shoulder...

 

[CetiAlphaFive]

You really have a chip on your shoulder...

I mean, if you're wrong, you're wrong.

If you don't like it, then go to a website that's a certified safespace or stop being wrong.

Is your issue with my aggressive way of pointing it out?
Did I use obscenities or other inappropriate language at any point?

EDIT:

You're right I'm being too rude.

Iapologize; I was listening to young Tupac records.
Lol

 

[FinallyOnTrack]

Are you chiming in just to practice being wrong and embarrassing yourself, or what?

I never once acknowledged whether or not the Rx was within the scope of the MD writing it. I was merely pointing out how you ARE wrong about the whole iPledge thing.. but hey, let’s just assume everything why don’t we.


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[CetiAlphaFive]

I never once acknowledged whether or not the Rx was within the scope of the MD writing it. I was merely pointing out how you ARE wrong about the whole iPledge thing.. but hey, let’s just assume everything why don’t we.


Sent from my iPhone using Tapatalk

I never once acknowledged whether or not the Rx was within the scope of the MD writing it. I was merely pointing out how you ARE wrong about the whole iPledge thing.. but hey, let’s just assume everything why don’t we.


Sent from my iPhone using Tapatalk

My bad, I misinterpreted the post where you said "just slap a label on It and let 'er go" to mean that you'd slap a label on the prescription we were discussing and let 'er go.

How foolish of me to assume you would do what you said you'd do.

 

[FinallyOnTrack]

My bad, I misinterpreted the post where you said "just slap a label on It and let 'er go" to mean that you'd slap a label on the prescription we were discussing and let 'er go.

How foolish of me to assume you would do what you said you'd do.

if it's still valid, then slap a label and let'r go..

Then using your logic, if I deemed the prescription as being VALID, within the scope of the doctors practice and / or have the required documentation to proceed to fill the prescription, then yes, that’s grounds for filling the Dang thing..

How foolish of you to take bits and pieces in and out of context..


Sent from my iPhone using Tapatalk

 

[CetiAlphaFive]

Then using your logic, if I deemed the prescription as being VALID, within the scope of the doctors practice and / or have the required documentation to proceed to fill the prescription, then yes, that’s grounds for filling the Dang thing..


How foolish of you to take bits and pieces in and out of context..
Sent from my iPhone using Tapatalk

I feel like you're trying to make an argument like you would verbally, but you're forgetting that this is written.
You can't attempt to sneakily, retroactively change the way you used "valid".

you used the word valid in reference to the ipledge number.
You literally and explicitly said that if the ipledge number was valid the prescription should be filled, regardless of any potential issues or concerns about the Rx or prescriber.

It had nothing to do with the prescription being valid, which is also irrelevant.
It has nothing to do with scope of practice.
Are you aware that the posts you made in this thread are still there?

Can you and old timer just read your posts before you reply so I'll stop having to hold you to what you wrote?

 

[FinallyOnTrack]

Valid means a number of different checks have taken place.

When I say a prescription is valid, regardless of whatever context you decide to see it in, I mean the prescription is valid on all accounts.. it’s written from a doctor within that scope of practice, it is documented appropriately, it is on the correct prescription pad, it is written for an approved indication, it follows any and all REMS requirements, it’s within proper dating, etc as the list can go on and on..

Regardless of if it was used right after I mentioned i pledge or not - if the script is valid, then I would fill it..

So again, if it passes through ipledge, and it’s “valid”, then fill it..

If you don’t feel comfortable filling the prescription then you have a few choices - 1.) lie to the patient and say you can’t get it 2.) tell the patient you refuse to fill it (and be prepared for a ****storm from the doctors office) or 3.) call the doctor and get the proper documentation for the prescription so that you fee more comfortable filling the Rx.


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[FinallyOnTrack]

The RPh IS required to report the prescription to iPledge when filling - if it's still valid, then slap a label and let'r go..

Just to clarify this - before attempting to report to ipledge, I would assume that you’ve already decided the script was “valid” from the doctor and the only step you had left was to report it..

It doesn’t make any sense to me that you would report a prescription to ipledge before you felt comfortable filling it.. maybe that’s just me..


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[Old Timer]

So, the answer to the statement:

You should actually know how iPledge works if you're going to start an argument about it.
iPledge requires the Pharmacist to know that a female patient of child bearing age has to have had a blood or urine pregnancy test administered by the prescriber within 7 days of picking up the prescription.

I know the rules for iPledge and you don't. Just admit you are wrong.

 

[CetiAlphaFive]

So, the answer to the statement:
I know the rules for iPledge and you don't. Just admit you are wrong.

Why do they include it in the questions in a test that we must pass before becoming ipledge certified if we're not required to know it?

Isn't being required to pass an exam prima facie evidence that the knowledge in the exam is required knowledge?

Did you not take the ipledge test?
Is that where your confusion is coming from?
Are you ignoring the Patient A question because it reveals how pointless and thoughtless this argument is?


My position remains:

A prescription can be within scope of practice, it can meet all REMS and any other requirements, and it can cause me all the inconvenience in the world, but if there's reasonable cause for me to believe that someone will be harmed as a result, I'm going to refuse it no matter what.

Anyone who fills a "valid" prescription they think could hurt someone needs to take a long, hard look at their understanding of ethics.

EDIT:
Actually, my whole argument originally was that it's just a bad idea to fill Rxs for specialists working outside their specialty.

I am now about 20 miles below the crust of the Earth, having followed old timer down this rabbit hole.
The heat is unbearable.
I haven't seen the sun for days.

Valid means a number of different checks have taken place.

When I say a prescription is valid, regardless of whatever context you decide to see it in, I mean the prescription is valid on all accounts.. it’s written from a doctor within that scope of practice, it is documented appropriately, it is on the correct prescription pad, it is written for an approved indication, it follows any and all REMS requirements, it’s within proper dating, etc as the list can go on and on..

Regardless of if it was used right after I mentioned i pledge or not - if the script is valid, then I would fill it..

So again, if it passes through ipledge, and it’s “valid”, then fill it..

If you don’t feel comfortable filling the prescription then you have a few choices - 1.) lie to the patient and say you can’t get it 2.) tell the patient you refuse to fill it (and be prepared for a ****storm from the doctors office) or 3.) call the doctor and get the proper documentation for the prescription so that you fee more comfortable filling the Rx.


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You realize your post is still up there, right?
Like, it's right there.


And I'm confused:

do you or do you not think I should've filled the surgeon's prescription for his daughter?

 

[Old Timer]

Why do they include it in the questions in a test that we must pass before becoming ipledge certified if we're not required to know it?

Isn't being required to pass an exam prima facie evidence that the knowledge in the exam is required knowledge?

Did you not take the ipledge test?
Is that where your confusion is coming from?
Are you ignoring the Patient A question because it reveals how pointless and thoughtless this argument is?

No, you are required to posses the knowledge, see rule number 1 of the REMS. But the REMS I quoted takes all judgement and places it in the hands of the iPLEDGE program. I showed you proof, now own up to the fact you are wrong about which one of us knows the iPLEDGE rules or show me proof that you are correct. We can review the rest of your dreck later. It's clear you need to go with small pieces of data at a time.

 

[CetiAlphaFive]

No, you are required to posses the knowledge, see rule number 1 of the REMS. But the REMS I quoted takes all judgement and places it in the hands of the iPLEDGE program. I showed you proof, now own up to the fact you are wrong about which one of us knows the iPLEDGE rules or show me proof that you are correct. We can review the rest of your dreck later. It's clear you need to go with small pieces of data at a time.

[Day 77, Old Timer keeps burrowing further and further down this rabbit hole.

A week ago we passed a strange subterranean city full of pale, blue lights and pale, blue people. I couldn't tell if the only ones that we saw were children, or if those were the adults and they're all just tiny.

Old Timer is digging at such a furious pace that I didn't have a chance to really look at them.

I hallucinated that we came up in China and I saw the sun.

Alas, it was just the blinding light of Old Timer's cognitive dissonance.

He started shouting, "you need to give them the seizure medicine! I saw it on CNN!" to a passing Earthworm as large as a schoolbus.

He was having an episode again. ]

 

[Old Timer]

[Day 77, Old Timer keeps burrowing further and further down this rabbit hole.

A week ago we passed a strange subterranean city full of pale, blue lights and pale, blue people. I couldn't tell if the only ones that we saw were children, or if those were the adults and they're all just tiny.

Old Timer is digging at such a furious pace that I didn't have a chance to really look at them.

I hallucinated that we came up in China and I saw the sun.

Alas, it was just the blinding light of Old Timer's cognitive dissonance.

He started shouting, "you need to give them the seizure medicine! I saw it on CNN!" to a passing Earthworm as large as a schoolbus.

He was having an episode again. ]

So, you will not accept the obvious fact that you accused me of not knowing the rules of the iPLEDGE program. I then quoted the rules to you verbatim from the FDA web site for the REMS. Yet, your answer is, you refuse to acknowledge the simple fact stated in the REMS. Therefore, we have nothing further to discuss. I'll leave it to the other posters to decide which of us is correct. For now, Ill place you on ignore. You can't have a rational discussion when you fail to accept basic facts as facts.

 

[CetiAlphaFive]

So, you will not accept the obvious fact that you accused me of not knowing the rules of the iPLEDGE program. I then quoted the rules to you verbatim from the FDA web site for the REMS. Yet, your answer is, you refuse to acknowledge the simple fact stated in the REMS. Therefore, we have nothing further to discuss. I'll leave it to the other posters to decide which of us is correct. For now, Ill place you on ignore. You can't have a rational discussion when you fail to accept basic facts as facts.

I thought you already put me on ignore once in this thread? Hahahah.

You're trying to create this false situation where you hold me to an argument that only you are involved in.
You seem to think that I said "the pharmacist must confirm the pregnancy test before dispensing"
I did not.
I said the pharmacist is required to know and understand something for all patients.

"A pharmacist is required to know how to calculate a patient's Framingham score"

Are you going to then say that nowhere in the law does it say that we need to know that before dispensing cholesterol medicine?

To recap:

• You said a pharmacist has a presumed duty to dispense medications. This is false.
• You said a pharmacist has "ZERO" liability for an ipledge prescription where the Patient is harmed. This is so mind numbingly wrong that I honestly thought you were joking or baiting. You are liable for every prescription your initials are on. Notes are only useful to your attorney in making your case. They do nothing to prevent a lawsuit or board action.

You have now created a 2 page argument where you're insisting that it's "inappropriate" to refuse to dispense a medication.
Now youre hung up on ipledge because you know you've been blown out in the actual relevant discussion.
This is also wrong, and the training modules for any retail pharmacy will tell you it's wrong.

My original and correct argument is that filling prescriptions for patients written by a specialist outside of their usual course of practice is unwise and needlessly exposes a pharmacist.
There is literally no reason to fill them outside of doing that prescriber a favor or out of courtesy.

 

[CetiAlphaFive]

So here's a stumper for the believers in "unlimited scope of practice":

Over in the physician forums, there's consensus that the Twerking Dermatologist was operating outside of their scope of practice by performing a tummy tuck that resulted in brain damage.
What gives?
She's an MD.

Is unlimited scope of practice only unlimited when it comes to prescriptions?

Georgia Surgeon Twerks In The OR (And Then Things Get Real)

 

[VA Hopeful Dr]

So here's a stumper for the believers in "unlimited scope of practice":

Over in the physician forums, there's consensus that the Twerking Dermatologist was operating outside of their scope of practice by performing a tummy tuck that resulted in brain damage.
What gives?
She's an MD.

Is unlimited scope of practice only unlimited when it comes to prescriptions?

Georgia Surgeon Twerks In The OR (And Then Things Get Real)

If you're talking about the thread in the anesthesia forum, only one person out of 30+ posts mentions scope of practice.

But to answer your question, no. By law, there is nothing medical that I can't do. If a non-physician does what I do they're going to jail either for assault or practicing medicine without a license.

Now that said, the medical board can punish me if what I do under my license endangers the public. That's why if I, as a family doctor, were to take out your appendix I could lose my license, get fined, or get sued but I wouldn't go to jail. And those things would only happen if something went wrong. The practical side effect of that is that most of us only do things we're trained to do, but we aren't legally bound to do so.

As far as prescriptions, in my state I can dispense any medication that I want. Now as a pharmacist you can refuse my prescriptions all you want, but legally the state doesn't care what I do (outside controlled substances) as long as nothing bad happens.

 

[W19]

If you're talking about the thread in the anesthesia forum, only one person out of 30+ posts mentions scope of practice.

But to answer your question, no. By law, there is nothing medical that I can't do. If a non-physician does what I do they're going to jail either for assault or practicing medicine without a license.

As far as prescriptions, in my state I can dispense any medication that I want. Now as a pharmacist you can refuse my prescriptions all you want, but legally the state doesn't care what I do (outside controlled substances) as long as nothing bad happens.

I think you meant prescribe, though physicians can dispense meds in almost all 50 states as well...

 

[VA Hopeful Dr]

I think you meant prescribe, though physicians can dispense meds in almost all 50 states as well...

Nope, I meant dispense. That takes the pharmacist out of the equation which was part of my point.

 

[W19]

Nope, I meant dispense. That takes the pharmacist out of the equation which was part of my point.

Great point... It seems like a lot of pharmacists have trouble understanding what 'scope of practice' means for physicians.

The poster who's been arguing with 'Old Timer' has the right to refuse to dispense med prescribed by a physician, but if something happens due to his refusal, someone will be liable.

 

[VA Hopeful Dr]

Great point... It seems like a lot of pharmacists have trouble understanding what 'scope of practice' means for physicians.

The poster who's been arguing with 'Old Timer' has the right to refuse to dispense med prescribed by a physician, but if something happens due to his refusal, someone will be liable.

I'm pretty sure that's not true. I mean, a pharmacist could certainly be fired for stuff like that but, in my state, I've never seen anyone get in trouble for refusing to fill a prescription as long as they give the prescription back or are willing to transfer it elsewhere unless they have a good reason not to (like an obviously forged prescription).

 

[CetiAlphaFive]

If you're talking about the thread in the anesthesia forum, only one person out of 30+ posts mentions scope of practice.

But to answer your question, no. By law, there is nothing medical that I can't do. If a non-physician does what I do they're going to jail either for assault or practicing medicine without a license.

Now that said, the medical board can punish me if what I do under my license endangers the public. That's why if I, as a family doctor, were to take out your appendix I could lose my license, get fined, or get sued but I wouldn't go to jail. And those things would only happen if something went wrong. The practical side effect of that is that most of us only do things we're trained to do, but we aren't legally bound to do so.

As far as prescriptions, in my state I can dispense any medication that I want. Now as a pharmacist you can refuse my prescriptions all you want, but legally the state doesn't care what I do (outside controlled substances) as long as nothing bad happens.

Thanks 👍
I don't remember which thread I was looking at, to be honest.

I was speaking rhetorically since a lot of older pharmacists have the bad habit of teaching newbies that all they have to do is write, "Ok per Dr. ________ (their initials) 10:25am 05/28/18", and they're absolved of all responsibilities and risk forever.

This is apparently a difficult subject for them

 

[VA Hopeful Dr]

Thanks 👍
I don't remember which thread I was looking at, to be honest.

I was speaking rhetorically since a lot of older pharmacists have the bad habit of teaching newbies that all they have to do is write, "Ok per Dr. ________ (their initials) 10:25am 05/28/18", and they're absolved of all responsibilities and risk forever.

This is apparently a difficult subject for them

I haven't seen anyone argue that. As a pharmacist you still have a responsibility to the patient, but just because I write for a drug that's not usually something my field uses doesn't immediately make it void.

 

[CetiAlphaFive]

I'm pretty sure that's not true. I mean, a pharmacist could certainly be fired for stuff like that but, in my state, I've never seen anyone get in trouble for refusing to fill a prescription as long as they give the prescription back or are willing to transfer it elsewhere unless they have a good reason not to (like an obviously forged prescription).

It's sad that non-pharmacists have better understanding of a pharmacist's legal duty

I haven't seen anyone argue that. As a pharmacist you still have a responsibility to the patient, but just because I write for a drug that's not usually something my field uses doesn't immediately make it void.

Only one poster did when they wrote "ZERO liability", but that's fair.

In real life, you'd be absolutely shocked at the scary stuff that gets put in a pill bottle and dispensed because a pharmacist either holds that belief or is scared that they can be held liable for refusal.
They might just be scared of plain ol' conflict, too.

You're absolutely right, it's not auto-void.

What I've been posting the entire time is that it increases risk for the RPh.

 

[VA Hopeful Dr]

It's sad that non-pharmacists have better understanding of a pharmacist's legal duty


Only one poster did when they wrote "ZERO liability", but that's fair.

In real life, you'd be absolutely shocked at the scary stuff that gets put in a pill bottle and dispensed because a pharmacist either holds that belief or is scared that they can be held liable for refusal.
They might just be scared of plain ol' conflict, too.

You're absolutely right, it's not auto-void.

What I've been posting the entire time is that it increases risk for the RPh.

Aren't there states where you can't refuse? I seem to recall laws getting passed because some pharmacists were refusing to fill Plan B or something

 

[CetiAlphaFive]

Aren't there states where you can't refuse? I seem to recall laws getting passed because some pharmacists were refusing to fill Plan B or something

Not that I know of.
Some states have laws regarding abortifacients in particular.
As with anything, there are standards that they should adhere to.

Board rules regarding the act of dispensing are one thing. A rule is a rule.

The argument that a pharmacist could be found liable for inaction or refusing to perform/dispense is what I was contesting.

 

[owlegrad]

It's sad that non-pharmacists have better understanding of a pharmacist's legal duty

Eh, pharmacist's often have a better understand of the law than prescribers, so I would say it works out to be a wash. How many C2s have you received that had refills on it? Or didn't have all the required elements? And on and on, the list is endless.

Also, you are the one who does not seem to understand the legal concept of "scope of practice". It's odd because otherwise I agree with your side of most of this discussion. The idea that pharmacists can dispense accutane as long as the iPledge authorizes it with absolutely no risk to the pharmacist when there are huge red flags is laughably absurd. It's akin to saying that the pharmacist has no professional or legal responsibility to insure that medications are being dispensed safely or that some third party REMs program completely covers the RPh from any further responsibility whatsoever. Crazy.

But scope of practice is a specific legal concept with a specific meaning. You seem to be missing that fact. An MD's SOP is 'unlimited'. This is not the same as saying that a pharmacist should fill any script written by any MD. But denying it on the basis of 'scope of practice' is factually incorrect.

 

[CetiAlphaFive]

Eh, pharmacist's often have a better understand of the law than prescribers, so I would say it works out to be a wash. How many C2s have you received that had refills on it? Or didn't have all the required elements? And on and on, the list is endless.

Also, you are the one who does not seem to understand the legal concept of "scope of practice". It's odd because otherwise I agree with your side of most of this discussion. The idea that pharmacists can dispense accutane as long as the iPledge authorizes it with absolutely no risk to the pharmacist when there are huge red flags is laughably absurd. It's akin to saying that the pharmacist has no professional or legal responsibility to insure that medications are being dispensed safely or that some third party REMs program completely covers the RPh from any further responsibility whatsoever. Crazy.

But scope of practice is a specific legal concept with a specific meaning. You seem to be missing that fact. An MD's SOP is 'unlimited'. This is not the same as saying that a pharmacist should fill any script written by any MD. But denying it on the basis of 'scope of practice' is factually incorrect.

Are you really gonna make me quote the post where I wrote that in large text, homie?

 

[owlegrad]

So here's a stumper for the believers in "unlimited scope of practice":

Over in the physician forums, there's consensus that the Twerking Dermatologist was operating outside of their scope of practice by performing a tummy tuck that resulted in brain damage.
What gives?
She's an MD.

Is unlimited scope of practice only unlimited when it comes to prescriptions?

Georgia Surgeon Twerks In The OR (And Then Things Get Real)

Are you really gonna make me quote the post where I wrote that in large text, homie?

Oh, were you including yourself as a believer? My bad homie.

 

[CetiAlphaFive]

I'll post these in big letters so that maybe you can actually read what I'm writing and what I've written more than once.

It is legal for any MD to write any prescription for any medication.
It is not a good idea if the medication is high risk, such as a C-II.
Just because something is legal doesn't make it a good idea.
It has nothing to do with Scope of Practice.
It has nothing to do with any rule or law.


Was that Reader's Digest-y enough for you? I don't know why you can't stop bringing up points I never made.
Do you need a nap?

Again, I'll point out once again that a pharmacist has absolutely zero duty to fill any prescription, seizure medicine or not.
If that were the case, patients could demand medications without paying anything and sue the pharmacy if they were refused the med.
You are willfully ignorant of the concept of duty at this point.
It would take you maybe 5 minutes to look up and understand.

You are literally responding to the portion of my post where I criticize you for not understanding that no, a pharmacist does not have a duty to provide any prescription.

The fact that you're arguing that I should have filled the Claravis prescription is mind boggling.
I, for one, am a professional with a working brain, and I have a conscience.
I suppose I could give you the benefit of the doubt and assume you just didn't read or comprehend the post.

Literally all of your posts could be applied to red flags for opioids.
"How do you know the patient isn't being prescribed Xanax and Oxy 30 for a valid reason? What does it matter that the clinic is 3 hours away from your pharmacy.
The doctor has a valid DEA number and wrote the prescription"

Your argument is so one dimensional that you can't wrap your head around the fact that I'm promoting critical thought and careful consideration of prescriptions.
Not a single time have I said that it's against a rule, law, regulation, blood pact, or writ madmaxus.

Not all of us are CVS drones without the ability to reason. I don't have a district manager that does all of my thinking for me, so I'm able to make logical conclusions.

OOOOHHH, he made me do it to him.

I ain't want to!

 

[owlegrad]

OOOOHHH, he made me do it to him.

I ain't want to!

I can't help that you decided to make a post questioning the legitimately of the concept of unlimited scope of practice. I am still confused why you did it.

 

[gwarm01]

Aren't there states where you can't refuse? I seem to recall laws getting passed because some pharmacists were refusing to fill Plan B or something

It's going to be different from state to state, but generally you can't refuse Plan B on any sort of moral grounds since it prevents a pregnancy rather than abort it.

I don't know of any state where a pharmacist can't refuse a dispense based on a prescription being invalid or clinically dangerous. That's where we start stepping on people's toes, but knowingly dispensing a dangerous prescription will hold the pharmacist liable for any damage.

 

[beautifulrobot]

I'm also pretty sure some states have laws that make it illegal for a pharmacist to refuse to dispense on a discriminatory basis against a protected class, e.g., refuse to dispense some or all medications to black people simply because they are black. This is certainly the case if you/your employer receives any money from CMS or you deal with folks who have health insurance from the marketplace. Maybe that goes without saying, but for completeness sake, that's another situation in which a pharmacist can't (systematically) refuse to dispense without liability.

 

[Farmercyst]

Had a DMD/MD self-prescribing BP meds and glaucoma meds. Had been going on before I got to the pharmacy. Called the office because we got an Rx for an ARB and he was already on an ACE. Found out the ARB was for his wife. Then found out he has an MD degree, but is not licensed as a physician, only as a dentist. When we denied filling his BP and glaucoma meds, we found out the glaucoma meds were actually for his mom. Yikes.

 

[CetiAlphaFive]

Had a DMD/MD self-prescribing BP meds and glaucoma meds. Had been going on before I got to the pharmacy. Called the office because we got an Rx for an ARB and he was already on an ACE. Found out the ARB was for his wife. Then found out he has an MD degree, but is not licensed as a physician, only as a dentist. When we denied filling his BP and glaucoma meds, we found out the glaucoma meds were actually for his mom. Yikes.

Same kinda thing happened to me at CVS and Target.
DDS comes in, introduces himself only as "Dr. ______". Tries to do a verbal for Viagra and Zestril in person. I took it, wrote it down, and somehow or another we had the little "!" to call his usual store. "Yeah, we've told that guy to cut that out. I guess he's trying out other stores."

Another store, I see that a lady's thyroid med has been getting approved by her DDS husband for about 2 years before I got there.
Husband tried to huff and puff to intimidate us into filling it. He got reported HARD.