Prescribing meds while on vacation in a different state - legal?

[DXM1]

What do you do if you are traveling to other states during vacation and have to cover your own outpatients? Are we legally able to give medication refills to patients who reside in the state we usually treat them in?

For example, if I work in state X, but am temporarily physically located in states Y, N, or M, am I able to refill my patient's meds who are still in state X legally? Or are we required to have licenses in each of these other states?

Just wondering how you guys go about your coverage.

---

Members don't see this ad.

 

[calvnandhobbs68]

Yes. What matters is the state the patient is in, not you. This applies to telemedicine visits as well.

I cover my own outpatients from different states all the time, otherwise I'd never be able to go on vacation lol

 

[PsyDr]

Exceptions:

1) If you are outside the US and its territories, you cannot bill Medicare/Medicaid.
2) If you are in the EU, there is the potential that you are violating EU data security laws.

 

[Candidate2017]

For what it's worth, American Psychological (not psychiatric) Association says you must be licensed where you are AND where the patient is (#5):

What to know about doing telehealth in a different state

Answers to commonly asked questions about practicing telehealth across state lines.

www.apaservices.org

Your state of licensure only cares that the patient is located in your state of licensure. But I can't see why your vacation state will give up its right to regulate all physicians physically within its borders.

I'd call the med board where you will vacation for clarification.

Though the risk is small that anything happens, your malpractice could refuse to cover you or plaintiff's lawyers could sue in the vacation state if it's more favorable/doesn't have a cap.

 

[Sushirolls]

I've been hunting, on a mountain, in a wind storm, with trees falling down around me while doing an electronic refill on my phone, in a different state.

Patient was in their home state, where I am licensed, too.

I'm not going to lose any sleep over this chin stroking legal what if. Existing, established patient, routine care, I'm not concerned.

If this is something that is an issue, heck, add this to the list of things why medicine isn't a viable career.

 

[calvnandhobbs68]

I'd call the med board where you will vacation for clarification.

lol I'd absolutely not call the med board where you will vacation for clarification. I'd advise not making big changes in medications, but refilling existing meds or responding to random problems that come up? You're way more likely to get tagged for patient abandonment and there are tons of solo practice doctors that cover themselves all the time. It's not like you're trolling for patients in the new state or seeing new intakes.

If anything, you could just call your malpractice insurance to make sure they'd cover you with this but even that's probably overkill.

 

[Bartelby]

I agree with the above that prescribing while you are on vacation is likely not an issue (though Candidate2017 brings up something I have never heard of before, that could be worth learning more about). The bigger issue comes up when your patient is on vacation. Technically you should not be evaluating or prescribing for them while they are in another state (most often in the form of "I forgot my lithium at home and I'm going to be gone three weeks! What should I do?"). You can always direct them to go to urgent care in those situations if you cannot prescribe for them.

 

[VA Hopeful Dr]

I agree with the above that prescribing while you are on vacation is likely not an issue (though Candidate2017 brings up something I have never heard of before, that could be worth learning more about). The bigger issue comes up when your patient is on vacation. Technically you should not be evaluating or prescribing for them while they are in another state (most often in the form of "I forgot my lithium at home and I'm going to be gone three weeks! What should I do?"). You can always direct them to go to urgent care in those situations if you cannot prescribe for them.

Has anyone anywhere ever actually gotten in trouble for doing this?

 

[calvnandhobbs68]

Has anyone anywhere ever actually gotten in trouble for doing this?

I've never heard of anyone getting in trouble for it, even the prescribing meds in different states. It's not like you're doing telemedicine to those states. Usually it's a pharmacy issue if they won't fill meds from someone out of state.

 

[Candidate2017]

I've been hunting, on a mountain, in a wind storm, with trees falling down around me while doing an electronic refill on my phone, in a different state.

I've never done refills while on vacation, much less heroic refills like this one.

My patients have more than enough meds to make it to their next appointment, and understand additional refills are done inperson. If a patient runs out, it's because they no showed at least once or twice in a row and never bothered to reschedule. Nowadays, I have vacation coverage but I still lay down the same boundaries. It's good for patients to be responsible for their meds.

I'm not going to lose any sleep over this chin stroking legal what if. Existing, established patient, routine care, I'm not concerned.

If this is something that is an issue, heck, add this to the list of things why medicine isn't a viable career.

By the nature of medicine being highly regulated, we probably break 20 nonsensical regulations each day, without much consequence.

But I feel knowledge of licensing issues and knowing the scope of my license are pretty important, as I've invested quite a bit of blood and sweat into achieving and maintaining my license. Not knowing anything or caring about my scope makes me feel like... an NP. And it's not a big deal to email a state board for clarification.

 

[Candidate2017]

I agree with the above that prescribing while you are on vacation is likely not an issue (though Candidate2017 brings up something I have never heard of before, that could be worth learning more about). The bigger issue comes up when your patient is on vacation. Technically you should not be evaluating or prescribing for them while they are in another state (most often in the form of "I forgot my lithium at home and I'm going to be gone three weeks! What should I do?"). You can always direct them to go to urgent care in those situations if you cannot prescribe for them.

This doctor asked a bunch of boards. Some allow you to see your patients who are vacationing out of state. Some do not. The New York response is hilarious.

Policies on Legality of Telemedicine Across State Lines | BehaveNet

For years doctors have, without a second thought, engaged in telemedicine across state lines when patients traveling away from their home states needed to talk to their physicians by telephone about symptoms, treatments or side effects. In recent years however some states have tightened their...

www.behavenet.com

 

[calvnandhobbs68]

This doctor asked a bunch of boards. Some allow you to see your patients who are vacationing out of state. Some do not. The New York response is hilarious.

Policies on Legality of Telemedicine Across State Lines | BehaveNet

For years doctors have, without a second thought, engaged in telemedicine across state lines when patients traveling away from their home states needed to talk to their physicians by telephone about symptoms, treatments or side effects. In recent years however some states have tightened their...

www.behavenet.com

"The idea that practice of medicine occurs where the patient, not the doctor, is located has gained general acceptance."

 

[comp1]

Wow, most states are pretty cool! That said, this is interstate commerce, it should be handled federally. I know it's not, but it should be.

 

[FlowRate]

Our GC has opined on this, I don't have the email on it handy. The real short version is that actions that continue a plan of care that was established while a patient was in-state are likely extremely low risk regarding licensure. (Esp if the pt is only temporarily out of state.) Making big changes, establishing a new patient-doctor relationship, managing crisis situations, etc. is relatively high risk. (Esp if the patient is going to be out of state for an extended period or especially if permanently located out of state.)

 

[DXM1]

If anything, you could just call your malpractice insurance to make sure they'd cover you with this but even that's probably overkill.

My malpractice insurance states that the only thing that matters is that we are licensed to provide care where the patient is located (I.e state of patient's physical residence).

I wanted to be sure that this is kosher with state medical boards, and wouldn't put one at criminal or civil liability.

 

[calvnandhobbs68]

My malpractice insurance states that the only thing that matters is that we are licensed to provide care where the patient is located (I.e state of patient's physical residence).

I wanted to be sure that this is kosher with state medical boards, and wouldn't put one at criminal or civil liability.

As New York said "Who would know"? As long as your malpractice is going to cover you for the civil liability from a malpractice suit if the patient ends up bringing one at some point, who's gonna report you, the patient? And again those questions are primarily around a patient going on vacation, not the doctor. As also noted on that webpage (and is generally accepted practice) what matters most is the state the patient is located in. You could actually feasibly think of a way the medical board could find out if some enterprising pharmacist noted that your NPI was located out of state and sent something to the medical board. For the reverse, your NPI and DEA address will be in the state and so it's pretty hard for me to think of a way someone figures out you're out of state.

 

[DXM1]

As New York said "Who would know"? As long as your malpractice is going to cover you for the civil liability from a malpractice suit if the patient ends up bringing one at some point, who's gonna report you, the patient? And again those questions are primarily around a patient going on vacation, not the doctor. As also noted on that webpage (and is generally accepted practice) what matters most is the state the patient is located in. You could actually feasibly think of a way the medical board could find out if some enterprising pharmacist noted that your NPI was located out of state and sent something to the medical board. For the reverse, your NPI and DEA address will be in the state and so it's pretty hard for me to think of a way someone figures out you're out of state.

Thanks for the contribution has been very helpful.

 

[deleted1100659]

I've been hunting, on a mountain, in a wind storm, with trees falling down around me while doing an electronic refill on my phone, in a different state.

The mental picture I got from this sentence was intense.

 

[whopper]

FOR NOW ON ALL PATIENTS WILL WEAR GPS TRACKERS. DEA AGENTS WILL MONITOR WHERE THE PATIENT IS.

In all seriousness while the patient needs to be in the state of your license while you practice, they can, for example, cross over to another state and pick up meds in the other state. The real issue is if it's a controlled substance, some states, very few in fact, have laws that you can't prescribe a controlled substance unless you too are in that state. As far as I know only TX and California do this, but I don't keep up with all 50 states' laws all the time so there may have been changes.

Several doctors work close to a border where patients live in the neighboring state where the doc might not have a license. This is not something radical or new. This has been going on for several decades without a problem. I wouldn't lose any sleep over this.

 

[Merovinge]

FOR NOW ON ALL PATIENTS WILL WEAR GPS TRACKERS. DEA AGENTS WILL MONITOR WHERE THE PATIENT IS.

In all seriousness while the patient needs to be in the state of your license while you practice, they can, for example, cross over to another state and pick up meds in the other state. The real issue is if it's a controlled substance, some states, very few in fact, have laws that you can't prescribe a controlled substance unless you too are in that state. As far as I know only TX and California do this, but I don't keep up with all 50 states' laws all the time so there may have been changes.

Several doctors work close to a border where patients live in the neighboring state where the doc might not have a license. This is not something radical or new. This has been going on for several decades without a problem. I wouldn't lose any sleep over this.

Yup, I recently saw a patient who came from the neighboring state and the home state pharmacist (where I am not licensed) had zero issue filling level 2 controlled sub (Adderall). They didn't ask a single question, even though I did alert the family their might difficulty despite the encounters taking place in the state I am licensed.