Prescribing for direct family members in Georgia Pharmacy Law

[shaq786]

Georgia Law Question...

Can a doctor write controlled substances for their direct family members(wife, kids)?

Last time i read the law, it said this is unprofessional conduct subject to disciplinary action in pharmacy law. I assume this was directed at the pharmacist.

I just recently checked pharmacist letter and they say it is unprofessional conduct subject to displinary action when they self prescribe or prescribe for direct family members but then it goes on to say that in emergency situations it is ok to fill an controlled substance for the direct family member.

I dont ever remember reading anything about getting the okay to fill it in emergency situations.

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[Carboxide]

Georgia Law Question...

Can a doctor write controlled substances for their direct family members(wife, kids)?

Last time i read the law, it said this is unprofessional conduct subject to disciplinary action in pharmacy law. I assume this was directed at the pharmacist.

I just recently checked pharmacist letter and they say it is unprofessional conduct subject to displinary action when they self prescribe or prescribe for direct family members but then it goes on to say that in emergency situations it is ok to fill an controlled substance for the direct family member.

I dont ever remember reading anything about getting the okay to fill it in emergency situations.

Short general answer: No.

Long answer: No, but. There are situations where a patient has a specific circumstance that would lend itself to this being okay.

For example: A physician's wife has cancer and fills all her meds at your pharmacy. You know that she has cancer from her medication history and talking to the patient. She comes in on a weekend with a short-term (3 days or less) Rx for Norco written by her husband and explains to you that she is out of her previous prescription, which she is according to the days supply limit (she is not early). In that situation, I would fill.

Not okay example: A physician writes her husband a prescription for lorazepam for insomnia. This is not an urgent, medically necessary treatment.

 

[JoBreeze]

Not okay example: A physician writes her husband a prescription for lorazepam for insomnia. This is not an urgent, medically necessary treatment.

How do you know that said physician and husband aren't severely impoverished and unable to obtain care elsewhere?

 

[rph3664]

If it's legal to do that outside an emergency situation in any state, I'm not aware of it.

 

[eagles22]

How do you know that said physician and husband aren't severely impoverished and unable to obtain care elsewhere?

Still doesn't making prescribing non-urgent controlled meds to your family member OK.

 

[BenJammin]

Most states, I believe, follow the standard that the first and second degree of consanguinity are off limits so they cannot write a script for their child, wife, husband, mother, father, brother, sister, grandchildren, or grandparent. That also applies to relation by marriage so your brother-in-law is viewed as if he was your brother.

 

[BenJammin]

And on the subject of emergencies, it's usually okay if no other medical doctor is available and it is an amount to get them through the emergency period.

 

[JoBreeze]

Still doesn't making prescribing non-urgent controlled meds to your family member OK.

So when the options are treatment from his wife vs. no treatment, he should get no treatment, correct?

 

[eagles22]

So when the options are treatment from his wife vs. no treatment, he should get no treatment, correct?

The context of this is it ok for a doc to rx controls for his wife? No, it is not unless it's an emergency. The way I think about this in my training is that with regards to my family, I am not a doctor. even in emergencies (in which there is someone else to provide care) because my judgement will be clouded seeing the ones I love in distress. I will give no one medical advice other than to seek treatment from another doctor. I would imagine most others in the field act the same way.

This hypothetical situation you posed would not happen in real life. Antibiotics, not a great thing to be doing but understandable. Controls? Another story and almost never ok to rx. What controls are really emergently needed anyways? If you have time to call in to a community pharmacy and pick it up, then it's probably not emergent. Destitution does not grant one release from professional ethics and the law by the way.

What if aliens came down and forced him to write for her controls?

 

[JoBreeze]

The context of this is it ok for a doc to rx controls for his wife? No, it is not unless it's an emergency. The way I think about this in my training is that with regards to my family, I am not a doctor. even in emergencies (in which there is someone else to provide care) because my judgement will be clouded seeing the ones I love in distress. I will give no one medical advice other than to seek treatment from another doctor. I would imagine most others in the field act the same way.

This hypothetical situation you posed would not happen in real life. Antibiotics, not a great thing to be doing but understandable. Controls? Another story and almost never ok to rx. What controls are really emergently needed anyways? If you have time to call in to a community pharmacy and pick it up, then it's probably not emergent. Destitution does not grant one release from professional ethics and the law by the way.

What if aliens came down and forced him to write for her controls?

So then you deny the destitute husband his prescription?

The answer to your hypothetical situation depends on the functionality of the laser cannons.

 

[Ackj]

So then you deny the destitute husband his prescription?

The answer to your hypothetical situation depends on the functionality of the laser cannons.

How many physicians are destitute? If they truly couldn't afford it, I'm sure they could have a colleague do a gratis evaluation of their spouse.

 

[CUninja]

So then you deny the destitute husband his prescription?

The answer to your hypothetical situation depends on the functionality of the laser cannons.

The monetary status of the person in question is irrelevant to the original question, which is "Is it ok for prescribers to prescribe controls to themselves or family members?"

If state law specifically says it is not lawful, then it is not lawful. If state law does not specifically say that it isn't lawful, then use your own professional judgment.

Myself, I can think of no truly emergent situation (resulting in loss of life, limb or eyesight) which would preclude a prescriber from contacting a colleague to have them call it in.

 

[eagles22]

So then you deny the destitute husband his prescription?

The answer to your hypothetical situation depends on the functionality of the laser cannons.

What is so difficult to understand "it's almost never ok for a doctor to rx for his spouse"? And what don't you get about the complete implausible nature of your scenario? If he's destitute, how can he afford the medication? Again, being poor is not a reason that you get to throw away legal and professional obligations. The Hippocratic oath doesn't begin with "unless for some reason I become really poor...".

If you're going to fall for every sappy story and give in because you feel bad, you're going to violate a lot of laws and professional standards.

 

[JoBreeze]

What is so difficult to understand "it's almost never ok for a doctor to rx for his spouse"? And what don't you get about the complete implausible nature of your scenario? If he's destitute, how can he afford the medication? Again, being poor is not a reason that you get to throw away legal and professional obligations. The Hippocratic oath doesn't begin with "unless for some reason I become really poor...".

If you're going to fall for every sappy story and give in because you feel bad, you're going to violate a lot of laws and professional standards.

It's a hypothetical situation. I'm asking for opinions.

To make the situation more plausible what if it's just an extended family member, aunt, cousin etc.? How does your discretion change if it isn't a control?

It has nothing to do with the hippocratic oath.

 

[Carboxide]

It's a hypothetical situation. I'm asking for opinions.

To make the situation more plausible what if it's just an extended family member, aunt, cousin etc.? How does your discretion change if it isn't a control?

It has nothing to do with the hippocratic oath.

Prescribers are free to write for themselves or family members if it is not controlled. Extended family I would also not accept an Rx for a controlled for, if I was aware (could be different last names).

End story - there is no reason certain meds need to be prescribed by a family member. I can not think of a SINGLE TIME in which zolpidem needs to be prescribed as an emergency. Pain medications are only acceptable IMO for:

1). Very short-term day supply (3 days or less)
2). Not for oneself, ever.
3). For a well-established patient who has a known condition resulting in severe pain (cancer, e.g.)
4). The patient is NOT early as compared to their previous fill, either by insurance or otherwise (e.g. if they were given a 30 day supply of Norco 28 days ago, I would refuse to fill - because they should have 2 days left at home, even though insurance would probably cover it).

 

[Ackj]

Prescribers are free to write for themselves or family members if it is not controlled. Extended family I would also not accept an Rx for a controlled for, if I was aware (could be different last names).

End story - there is no reason certain meds need to be prescribed by a family member. I can not think of a SINGLE TIME in which zolpidem needs to be prescribed as an emergency. Pain medications are only acceptable IMO for:

1). Very short-term day supply (3 days or less)
2). Not for oneself, ever.
3). For a well-established patient who has a known condition resulting in severe pain (cancer, e.g.)
4). The patient is NOT early as compared to their previous fill, either by insurance or otherwise (e.g. if they were given a 30 day supply of Norco 28 days ago, I would refuse to fill - because they should have 2 days left at home, even though insurance would probably cover it).

How about this one: family owned dentist office. Father and son are dentists. The wife/mother needs a tooth pulled and pain meds. Both dentists would be family members of this patient. No reason to send her to a different dentist for that. If state law doesn't say it's not allowed, I am alright with this situation.

 

[All4MyDaughter]

How about this one: family owned dentist office. Father and son are dentists. The wife/mother needs a tooth pulled and pain meds. Both dentists would be family members of this patient. No reason to send her to a different dentist for that. If state law doesn't say it's not allowed, I am alright with this situation.

If there is a legit doctor/patient relationship and there's a chart, appropriate documentation, etc. it's fine. At least in this state.

 

[BidingMyTime]

If there is a legit doctor/patient relationship and there's a chart, appropriate documentation, etc. it's fine. At least in this state.

I think that is the crux of the issue. is there a real doctor/patient relationship between the family members? I have seem some totally out of scope of practice prescriptions written for family members of the prescribers--ie eye doctor writing for phentermine, dentist writing Norco for hysterectomy pain (um yes, he didn't even pretend that he was writing it for tooth pain.)

To the OP, if your state prescriber's writing for their family members (and I think most states do to a certain extent), it can be a real judgment call. I would recommend being careful to document everything if you decide to fill the RX (ie verified with dentist that he has just pulled 2 of his son's teeth and is prescribing Norco for tooth pain.)

Edited to add: expect a prescriber to get very upset & offended if you do refuse to fill their prescription.