On vacation in a different state, can I prescribe?

[unsure1]

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If I'm vacationing out of state ie in California, as part of a group conference and someone gets sick such as a child, can I treat them and prescribe medication if they need?

Obviously I'm unpaid and it would be goodwill. I wouldn't want to apply for a license for the 5 days / week that I'm there on vacation just to help someone in case since I may be the only doctor there and may be asked. I'm actively licensed in NJ.

Thanks

 

[LucidSplash]

If I'm vacationing out of state ie in California, as part of a group conference and someone gets sick such as a child, can I treat them and prescribe medication if they need?

Obviously I'm unpaid and it would be goodwill. I wouldn't want to apply for a license for the 5 days / week that I'm there on vacation just to help someone in case since I may be the only doctor there and may be asked. I'm actively licensed in NJ.

Thanks

If you don’t have a license in that state then no. You can only prescribe and practice medicine in a state you are licensed in. All states regulate the practice of medicine individually.

And there’s no such thing as strictly goodwill in medicine. If you prescribe for someone you are expected to have a chart for them as you are establishing a doctor-patient relationship. While unlikely anything would happen just for prescribing some antibiotics or something, if you don’t have this it can come back on you if that person ever decides to sue you for malpractice. While I’m assuming you are not asking about prescribing controlled substances, you should also be aware that you need a separate DEA number for each state.

 

[GoSpursGo]

Agree with @LucidSplash . Naturally, the odds of you getting caught are relatively low, but it seems like a completely unnecessary risk when the kid's parent should be able to go to an urgent care without burdening you with liability.

 

[unsure1]

If you don’t have a license in that state then no. You can only prescribe and practice medicine in a state you are licensed in. All states regulate the practice of medicine individually.

And there’s no such thing as strictly goodwill in medicine. If you prescribe for someone you are expected to have a chart for them as you are establishing a doctor-patient relationship. While unlikely anything would happen, if you don’t have this it can come back on you if that person ever decides to sue you for malpractice.

So what do I do if I'm with a group and someone gets sick? Do i refuse to see them or treat them? Would this be practicing medicine just seeing them and treating them if needed. I'm not setting up a practice or business. Would I have to get a license and go through all the credentialing if I'm only going for 5 days or a week and may come across someone that gets sick part of the group asking for help.

 

[unsure1]

Agree with @LucidSplash . Naturally, the odds of you getting caught are relatively low, but it seems like a completely unnecessary risk when the kid's parent should be able to go to an urgent care without burdening you with liability.

I get the liability but what about the state law, so being a physician applies to only state licensed in. For example on vacation and a friend or relative asking for help or someone getting sick, would require a license in that state? And going through all the hassle.

 

[LucidSplash]

So what do I do if I'm with a group and someone gets sick? Do i refuse to see them or treat them? Would this be practicing medicine just seeing them and treating them if needed. I'm not setting up a practice or business. Would I have to get a license and go through all the credentialing if I'm only going for 5 days or a week and may come across someone that gets sick part of the group asking for help.

This is called practicing medicine without a license. If someone is sick you send them to urgent care or the hospital.

Like, if you want to look in a kid’s ears or something or push on their tragus to see if they have swimmer’s ear? That’s fine but you can’t prescribe antibiotics. The pharmacy won’t even let you if you don’t have a state license. If you want to tell someone they have a URI that’s fine. I carry zofran with me for personal use and have been known to give it to friends on vacation but I do ask about other meds and cardiac abnormalities. Plenty of us do things like that and while it’s technically low risk if it’s a friend/family it isn’t zero risk.

What kind of thing are you envisioning “treating”? There are nearby urgent cares for expressly this reason. There’s very little you can treat someone for without prescribing power or testing. And yes even if you aren’t charging you are expected to have a chart if it ever comes up for litigation.

We aren’t making up the rules, we are telling you what the rules are. 🤷🏼‍♀️

No one is expecting you to get a license because you’re going on vacation with family for 5 days. I’m in Mexico right now and if my family got sick I can’t treat them. I am on the IMLC and I have 6 state licenses but I wouldn’t get one specifically if I was going on vacation with family.

You may have noticed people on this forum are not allowed to give medical advice, because as a physician that comes with certain legal obligations and responsibilities even if you’re not getting paid.

You’d also want to check for the specifics of the Good Samaritan law in the state you’re in, as they are different in each state. The idea is to protect a physician who responds to an emergency. But there are specific requirements for what constitutes an emergency. And in some places if you accept something in return for your assistance (sometimes airlines or hotels will try to give you something for helping in an emergency), that can run afoul of such protections. Again, state dependent.

Good Samaritan Laws - StatPearls - NCBI Bookshelf

 

[LucidSplash]

Since you’re asking about California, specifically:

Medical Board of California

The Medical Board of California licenses and disciplines doctors, handles complaints against physicians and offers public-record information.

www.mbc.ca.gov

Good Samaritan Law - Health and Safety Code 1799.102 HSC

Emergencies demand immediate action to save lives, and people present during an emergency should be able to render aid without fear of unintended repercussions. Recognizing this, California's Health and Safety Code 1799.102, known as the "Good Samaritan Law," was enacted to....

www.egattorneys.com

You’ll note the requirements for a medical professional under the Good Samaritan law are held to a higher standard than a civilian.

 

[GoSpursGo]

I get the liability but what about the state law, so being a physician applies to only state licensed in. For example on vacation and a friend or relative asking for help or someone getting sick, would require a license in that state? And going through all the hassle.

As stated above, that is practicing medicine without a license. Of course you're a physician, and you can examine and provide your medical opinion if you are so inclined, but you can't prescribe medications or other treatments in a state where you don't have a license. By law.

 

[shaggybill]

Most, if not all, states consider the practice of medicine to take place in the location the patient is physically located. If you are not licensed in the state where the patient is at the time of the encounter, that would be illegal. Just tell your friends and/or family that if the pharmacist looks you up before filling the prescription, they may report you and you would face significant disciplinary action from that state, that states medical board, and your own state's medical board. Takes the spotlight off you if that's what you are looking for.

 

[anonperson]

If you don’t have a license in that state then no. You can only prescribe and practice medicine in a state you are licensed in. All states regulate the practice of medicine individually.

And there’s no such thing as strictly goodwill in medicine. If you prescribe for someone you are expected to have a chart for them as you are establishing a doctor-patient relationship. While unlikely anything would happen just for prescribing some antibiotics or something, if you don’t have this it can come back on you if that person ever decides to sue you for malpractice. While I’m assuming you are not asking about prescribing controlled substances, you should also be aware that you need a separate DEA number for each state.

I have prescribed for a patient who was out of state. Sent the Rx electronically and the pharmacy filled it no problem. I even called the pharmacist to clarify the dosing. Was just some hormonal medication. I didn't have a license to practice in that state.

I'm licensed in CA only and the patient was in the mid west at the time.

 

[shaggybill]

I have prescribed for a patient who was out of state. Sent the Rx electronically and the pharmacy filled it no problem. I even called the pharmacist to clarify the dosing. Was just some hormonal medication. I didn't have a license to practice in that state.

I'm licensed in CA only and the patient was in the mid west at the time.

You can do it, and probably most of the time you could get away with it. But if you do it and something happens, and your prescription catches unwanted attention, it can turn ugly. I had a patient who moved to West Virginia and he wanted me to continue sending his only prescription. He'd been stable on the medicine for years and I only refilled it twice a year. He balked when I explained that I couldn't. He finally relented when I explained that WV law says that if a doctor is found to be prescribing medicine to patients who live in WV (and the patient encounter occurs with the patient physically located in that state), and that doctor does not possess a WV medical license, the state's website says that is considered a felony, he/she will face a $10k fine, up to 5 years in jail, and they would notify my state's medical board of my actions, which comes with a whole other slew of repercussions. Would all that actually happen? Probably not. But nobody in their right mind should take that risk.

Additionally, your malpractice would not cover any lawsuit that results from your prescription.

 

[LucidSplash]

I have prescribed for a patient who was out of state. Sent the Rx electronically and the pharmacy filled it no problem. I even called the pharmacist to clarify the dosing. Was just some hormonal medication. I didn't have a license to practice in that state.

I'm licensed in CA only and the patient was in the mid west at the time.

Like @shaggybill said, sometimes you can get one through but that doesn’t mean it’s legal or defensible in the event of an incident, or in the event that someone takes exception to it. And in the event that someone does take exception, it’s a felony.

 

[RangerBob]

I have prescribed for a patient who was out of state. Sent the Rx electronically and the pharmacy filled it no problem. I even called the pharmacist to clarify the dosing. Was just some hormonal medication. I didn't have a license to practice in that state.

I'm licensed in CA only and the patient was in the mid west at the time.

Did you see the patient in-state? Were they an established patient?

That often changes whether it's kosher or not.
But never trust a retail pharmacist to know anything. About anything. Especially medicines. I get the most ridiculous questions/suggestions from them. "Bethanechol isn't covered by the patient's insurance Dr. Bob, but we have oxybutynin in stock--would you like to substitute with it?"

Yes... lets put our patient with post-op urinary retention/neurogenic bladder into even more retention. (???)

 

[Crayola227]

Frankly you'd be better off seeing if someone licensed in the state of vacation could do it as a professional courtesy, or at least expedite getting seen in their office. If it's not family most physicians aren't going to want to take any risks or give a script without seeing in person & charting. But at least it would be legal. Of course you may not know anyone at all. Sometimes it pays to remember who you went to school or trained with.

 

[anonperson]

Did you see the patient in-state? Were they an established patient?

That often changes whether it's kosher or not.
But never trust a retail pharmacist to know anything. About anything. Especially medicines. I get the most ridiculous questions/suggestions from them. "Bethanechol isn't covered by the patient's insurance Dr. Bob, but we have oxybutynin in stock--would you like to substitute with it?"

Yes... lets put our patient with post-op urinary retention/neurogenic bladder into even more retention. (???)

Established patient. Have been seen before.

 

[Crayola227]

My understanding is that usually diagnosing is considered practicing medicine, so then examination is in that regard is as well, and establishes doctor-patient relationship and all that entails under the law.

The only workaround is if the information you give them can be done such that you can say it wasn't specifically targeting them, it was purely educational, you told them you could not diagnose or treat, and you advised them to seek medical care from their provider. As far as if you physically examine them, in that situation, you'd have to come up with something similar, but I think that's harder to spin that way as not being diagnosis/treatment.

Obviously many of us in real life we give specific opinions to people and put hands on them informally all the time. But just be aware of what the rules are and what you are doing in any case.

The only real exception to the "can't give medical advice" is to tell someone to seek medical attention with their provider or emergent care. (If you suggest the wrong thing here or the suggested person is a quack or any negative thing they can still try to sue). But at least to my knowledge most states do not consider directing someone to a qualified provider as diagnosis or treatment.

Don't forget that "treatment" also includes giving instructions, it isn't just procedures or prescriptions. If I tell you to take tylenol OTC, or that people should take tylenol for headache, that can be argued as treatment. If I tell you that you don't need to go to the ED, that is diagnosis/treatment. If I say with that "but talk to your doctor first" that may or may not be enough to protect you from a claim you were diagnosing/treating.

Most of the time a lot of things that are informal advice like I said, won't be a problem. But someone somewhere got sued so that's my justification of being aware of the rules.

Know the rules, what you're doing, and medicolegally when the board or courts get involved it will be extremely nitpicky.

Note, I'm not a lawyer, I am not qualified to give legal advice, this is not legal advice, and you should consult a lawyer.

I'm just someone who has taken interest in medicolegal aspects of medical practice and interest in these topics specifically.

 

[Crayola227]

Did you see the patient in-state? Were they an established patient?

That often changes whether it's kosher or not.
But never trust a retail pharmacist to know anything. About anything. Especially medicines. I get the most ridiculous questions/suggestions from them. "Bethanechol isn't covered by the patient's insurance Dr. Bob, but we have oxybutynin in stock--would you like to substitute with it?"

Yes... lets put our patient with post-op urinary retention/neurogenic bladder into even more retention. (???)

Doesn't matter. With teleheath the first question asked is always if the patient is still in state, even established ones.

 

[RangerBob]

Doesn't matter. With teleheath the first question asked is always if the patient is still in state, even established ones.

I was speaking in regards to in-person visits. If you have an established relationship with a patient my understanding is most states do allow you to continue to prescribe them prescriptions for a certain amount of time.

It is exceedingly common for physicians to prescribe lost/forgotten meds to their patients if the patient is on vacation in a different state, or if they just moved, etc. Our residency attendings did it a number of times and once case was a major write-up for a journal (there's more to that story, but to stay anonymous here I won't elaborate).

Again, these are for patients with whom the doc as a current established relationship with.

The OP's situation is different, and it would never be a good idea to Rx something out ot state for a friend/family/group member whom you don't have an established reltionship with already.

 

[NotAProgDirector]

I was going to post basically the same thing as @RangerBob. It is a bit messy. Refilling an established prescription for your established patient in another state is not really a problem. Theoretically, you should send the prescription to the local CVS, then have them transfer it to another store. But no one is going to get into problems just refilling someone's HTN/diabetes/eye meds while they are on vacation. Controlled substances - that's a different ballgame.

Where it gets murky is addressing acute new issues for an established patient while someone is in a different state. That's definitely "not OK" legally. Although chance of getting into trouble is slim.

New prescription for someone you don't have an established relationship with - always a bad idea, whether you have an in state license or not. And if you do this, you MUST keep medical records of it, and follow all of the laws required of medical records and privacy / retention.

Perhaps of interest, I have wondered whether the USPS can generate additional revenue by opening telehealth stations. It's illegal to do a telehealth visit with your patient if they are in a state you don't have a license. But, if they are standing in a US post office and on their phone, that's federal property. You can have ANY state license and be legally practicing medicine. The USPS could set up some private rooms with a computer/camera/microphone and internet access, and charge for use for anyone wanting a telehealh visit.

 

[LucidSplash]

I was going to post basically the same thing as @RangerBob. It is a bit messy. Refilling an established prescription for your established patient in another state is not really a problem. Theoretically, you should send the prescription to the local CVS, then have them transfer it to another store. But no one is going to get into problems just refilling someone's HTN/diabetes/eye meds while they are on vacation. Controlled substances - that's a different ballgame.

Where it gets murky is addressing acute new issues for an established patient while someone is in a different state. That's definitely "not OK" legally. Although chance of getting into trouble is slim.

New prescription for someone you don't have an established relationship with - always a bad idea, whether you have an in state license or not. And if you do this, you MUST keep medical records of it, and follow all of the laws required of medical records and privacy / retention.

Perhaps of interest, I have wondered whether the USPS can generate additional revenue by opening telehealth stations. It's illegal to do a telehealth visit with your patient if they are in a state you don't have a license. But, if they are standing in a US post office and on their phone, that's federal property. You can have ANY state license and be legally practicing medicine. The USPS could set up some private rooms with a computer/camera/microphone and internet access, and charge for use for anyone wanting a telehealh visit.

Yeah but to circle back to the OP, none of this applies to the OP’s situation. OP should not be trying to medically manage or prescribe anything for friends/family they do not have a patient-physician relationship with while on a vacation in a state where they are not licensed. Especially not adults as the OP is Peds, but legally not anyone.

 

[gutonc]

Yeah but to circle back to the OP, none of this applies to the OP’s situation. OP should not be trying to medically manage or prescribe anything for friends/family they do not have a patient-physician relationship with while on a vacation in a state where they are not licensed. Especially not adults as the OP is Peds, but legally not anyone.

Paragraph 3 does. New "patient", new prescription, no license in the state.

 

[LucidSplash]

Paragraph 3 does. New "patient", new prescription, no license in the state.

Fair enough.

 

[gutonc]

The bottom line is that we're all in agreement. The OP is nuts to do this.

Also...I can honestly say that I have never gone on vacation and had any interest in playing doctor while doing so. Sure, if I'm on a backpacking trip and we're 50 miles from the nearest road, I'll use what I have in my first-aid kit, but the second we get to a semblance of civilization, that person is going to get appropriate local medical care.

 

[VA Hopeful Dr]

Not likely to get in trouble but you could so I'd avoid if you can.

 

[unsure1]

OP here. But what if I'm only physician/provider there and I'm being asked to help, and assuming nothing in the immediate area or after hours (would also be an inconvenience for them if on vacation to go scattering around in an unfamiliar place trying to find care especially when their kid is sick). If I'm put on the spot, do I just say sorry you're on your own. As it's a group conference and people assume if you're a doctor they can ask you advice or can ask you to take a quick look at their child (ie if they need to be seen immediately or can wait etc).

How long would it actually take to get a CA license? And assuming they don't offer a temporary one.

 

[VA Hopeful Dr]

OP here. But what if I'm only physician/provider there and I'm being asked to help, and assuming nothing in the immediate area or after hours (would also be an inconvenience for them if on vacation to go scattering around in an unfamiliar place trying to find care especially when their kid is sick). If I'm put on the spot, do I just say sorry you're on your own. As it's a group conference and people assume if you're a doctor they can ask you advice or can ask you to take a quick look at their child (ie if they need to be seen immediately or can wait etc).

How long would it actually take to get a CA license? And assuming they don't offer a temporary one.

"It's against the law for me to practice medicine in a state where I don't have a license".

 

[NotAProgDirector]

If it's a true emergency, then you help as you can. Then, you're covered by Good Samaritan laws. But someone's kid having a sore throat is not an emergency.

I'm trying to figure out a case where there's a group of people, no health care to be had around, and that you can actually do something.

Remember that if you do something, you're held to the standard of someone who knows what they are doing. I am not a prediatrician. If I offer medical advice to friends for their kids, my decisions are evaluated against a pediatrician. So you should never stray outside your specialty.

Most states do have temporary licenses -- if you have a license in another state, they will give you one for a limited time. Often used for "camp docs" - someone who comes to a specific event to work as a physician for a short period of time. Getting one of those is usually quick - measured in weeks. A full license is usually months. And you don't want lots of full licenses if you can help it -- the upkeep is a nightmare.

 

[LucidSplash]

California is one of t

OP here. But what if I'm only physician/provider there and I'm being asked to help, and assuming nothing in the immediate area or after hours (would also be an inconvenience for them if on vacation to go scattering around in an unfamiliar place trying to find care especially when their kid is sick). If I'm put on the spot, do I just say sorry you're on your own. As it's a group conference and people assume if you're a doctor they can ask you advice or can ask you to take a quick look at their child (ie if they need to be seen immediately or can wait etc).

How long would it actually take to get a CA license? And assuming they don't offer a temporary one.

California is one of the most difficult states to get a license in. Takes months, often 6-9. And it is not on the IMLC. No idea about a temporary license but also probably not worth it to you for this purpose.

I’m confused. Will you be out in a rural area in the middle of nowhere with hours between you and an urgent care or hospital? Your original post said you’d be at a conference. Those aren’t usually held in isolated areas. What kind of scenario are you envisioning?

Multiple people have already answered your “what if” scenarios and I have posted links regarding the California laws about practicing without a license and what constitutes a Good Samaritan situation in California, e.g. an emergency. I can’t figure out what kind of scenario you might experience where you think it would be useful for you to render treatment that needs a physician beyond basic first aid, that is so much of an emergency that it can’t wait until the next morning but doesn’t need a hospital or an urgent care. You can literally google urgent care near me or look on Yelp so they aren’t difficult to find even if you’re not familiar with the area. Can you describe what situation you are worried about? At this point I’m thinking you might be trolling.

 

[dozitgetchahi]

OP here. But what if I'm only physician/provider there and I'm being asked to help, and assuming nothing in the immediate area or after hours (would also be an inconvenience for them if on vacation to go scattering around in an unfamiliar place trying to find care especially when their kid is sick). If I'm put on the spot, do I just say sorry you're on your own. As it's a group conference and people assume if you're a doctor they can ask you advice or can ask you to take a quick look at their child (ie if they need to be seen immediately or can wait etc).

How long would it actually take to get a CA license? And assuming they don't offer a temporary one.

What I tell everyone is “if I’m off duty, I’m not a doctor”.

 

[Apollyon]

What gets me is the likelihood of this occurring. Like, in my 20+ years of doctoring, for someone else? Never. Not once. For me? Uh, all I can say is, if you're going to Cedar Point, don't forget your insulin.

 

[CopaceticOne]

If I'm put on the spot, do I just say sorry you're on your own

Yes. That is exactly what everyone on this thread has been saying.

And if you are at a conference, then likely you are at a locale that has an urgent care / ED in the area with appropriately licensed individuals to provide proper care with proper resources available.

Also, unless someone has an unrestricted license (aka non-training license) then you are required to have a supervising physician for all treatments. So folks with training licenses should absolutely NOT do what the OP is asking about.