Problems (Serious) in Clinic Where I work

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edieb

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I am working in a clinic where the clinic owners (who only have GEDs) who are also the administrators, have a courier service in which they secure patients' permission to pick up their medications and the patients, in turn, pick them up at the clinic. However, there are several things worrying me about the clinic:

1) The literally leave Schedule II and IV drugs out in the open, on a table, for hours at a time They are NOT behind a locked door and in an open room right next to the waiting room. They are also completely unmonitored. I have documented this

2) They will not let me have my Rx Pad when I finish work; however, they leave it unlocked all the time in a place where the MAs and, likely patients, could steal it.

3) If patients do not show up to their appointments, they refuse to allow me to write refills, even enough to make it to the next appt. I am worried that a patient will have a seizure when coming off a benzo. and sue me.

4) They leave drug samples in unlocked cabinets. They used to lock them up in a cabinet in my office but thought I was being too generous with samples so they put them in unlocked cabinets where they could see me distribute them.

I have brought this to their attention several times; however, they do not take me seriously and just start screaming at me and threatening me ("you're under contract; if you try to leave we will sue you")

I spoke to a colleague and she told me to get out ASAP but I am worried that will be patient abandonment and they will sue me. If I have all this well documented (and I d0), do you think I am firm legal ground to leave? I am gonna talk to a lawyer ASAP tomorrow
 
Yes, they did. This is why I am taking immediate action after they refuse to fix the problems; thus, so I guess I am trying to quiet my mind and get as much input as possible before the bope calls me and i meet with w a layer tomorrow Thanks!
 
You should leave. Send a letter to your patients explaining that you are leaving the clinic and instructing them to make followup. You should try to give them reasonable notice where possible. Ideally the clinic will oversee the transition, but use your clinical judgment and try to do the right thing by your patients on your way out the door. If you stick around for any length of time, though:

1 - Send your prescriptions to a pharmacy. If the owners don't like it they can fire you!

2 - Take your prescription pad wherever you want.

3 - Send refills when clinically appropriate. Again, what are the clinic owners going to do, fire you?

4 - Meh, who cares about drug samples?

Remember that your license is on the line, so if your employer tells you to do something that you believe is malpractice refuse to do it. You shouldn't act that way just to be petty about clinic rules, but you have to stand up for yourself and your patients if things get bad. It sounds like taking the job was a mistake. Learn from it and move on (with the key being move on)!
 
GroverPsychMD said:
You wanted to make money according to your posts op...
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TBH, your posts aren't adding anything to the discussion and come across rather much like a bully. You have not even bothered to give advice. Logically, I want to make money but not in this manner.
 
This is very interesting in that I didn't know prescribing psychologists could prescribe benzodiazepines (or other controlled substances for that matter). When I first heard about the idea (when it was being theoretically tossed around and my psychologist mentioned his thoughts on it), it sounded like they would be using SSRIs. Regardless, I imagine the laws must be on the side of aiding a patient rather than following a protocol. If a patient dies from withdrawal that's obviously more serious than breaking something in a contract.
 
You might consider reporting the clinic and the pharmacy to the state medical board and to the state pharmacy board for these violations as you prepare to move on. These violations would cause a serious investigation. Hopefully you would have some whistle blower protection, especially if your patients haven't been harmed yet. You should probably discuss this with an attorney who has experience representing physicians first.
 
Btw, you can leave the job. Give 90 days notice (or whatever the contract specifies) and a list of alternative practitioners in your area and you're covered.
 
1) call a lawyer
2) call the pharmacy board
3) quit being bullied. Physically put your pad in your hand and walk out the door. If they stop you, call the cops and report you are being held against your will.
4) What do you mean they won't let you write a prescription? They can't physically restrain you from doing so. Write one. Fax it. Hire a courier. Walk it over if you have to.
5) who gives a crap if they sue you? Imagine how this will play out in front of a judge. "Yeah, your honor they were trying to force me to practice in an unsafe way, and they had clear kickback bs going on, so I quit." Cue judge laughing.
6) get a patient list, send the necessary refills, and certify mail termination letters.
 
By complying with these clinic rules, you are significantly raising your liability and potentially breaking board laws yourself. A disciplinary committee could investigate you merely for complying. You have typed that you know it is wrong, but you haven't left. Are these rules in a clinic handbook? I would bet that many of these rules are verbal (I.e. No written proof). Currently outsiders could view you as being in agreement with such policies.

Your current stance appears to me that you are more afraid of breaking a contract than medical harm or losing your license. This will not go well for you. Get out.
 
I cannot possibly imagine that this contract is remotely enforceable if you have been restricted from taking safe care of your patients, communicated and documented this, and been met with no change.
 
To me this is a good example of why midlevels should not have independent practice rights. As a psychologist, I am sure that the OP is on much more solid footing as to what is ethical or not and steps to take to deal with a conflict within our scope of practice. I see very similar problems with midlevels therapists who are being told how to practice by unqualified administrators. I'm not being critical of OP personally and it sounds like they are doing what they need to do.

As far as managing of medications goes, at a place I worked, the RN (who worked for me) was responsible for safe management and administration of medications as that was completely within the scope of her license and many times I had to support her authority to do so against administrators who didn't. She understood very well that her scope of practice was to follow physicians orders and not to deviate because administrators put pressure on her. I ended up leaving that place of employment partially because clinical decisions within my own scope of practice were being taken out of my hands.
 
WisNeuro said:
Turf wars generally bring out the best in people.
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That's true. This is also a great example of a huge problem with RxP. It's such low hanging fruit fro Grover that I can see how it is hard to resist.
 
It appears to be more of a legal/ethical problem rather than a problem with RxP training, such as pharmokinetics, interactions, etc. Something that could be a problem for any prescribing provider who is worried about patient care at an institutional level.
 
Bartelby said:
1 - Send your prescriptions to a pharmacy. If the owners don't like it they can fire you!

2 - Take your prescription pad wherever you want.

3 - Send refills when clinically appropriate. Again, what are the clinic owners going to do, fire you?

4 - Meh, who cares about drug samples?
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yes, yes, yes, and yes!

sounds like you're working in a pretty, let's call it 'unpleasant', place.

may be worth having an attorney send a resignation letter on your behalf stipulating that you'll assist with transfer of care for 30 days until your patients can find a new doc

or do what i did- copy you patient charts, start up your own clinic, call every one and let them know of your new location
 
they can not force you to practice unethically.

I'm more curious about how these two with a GED own and operate this practice.
 
WisNeuro said:
It appears to be more of a legal/ethical problem rather than a problem with RxP training, such as pharmokinetics, interactions, etc. Something that could be a problem for any prescribing provider who is worried about patient care at an institutional level.
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I trust you are not implying that only pharmacokinetics/dynamics, indications, and interactions are required to be able to practice as a prescriber. Understanding your role in the patient's treatment, along with ethical and legal issues, are hugely important to the practice of every psychiatrist and something that is absolutely taught. There aren't exactly a lot of stories of board certified psychiatrists taking jobs where they can't hold onto their own Rx pad.
 
No implication of such was proffered on my part. And, I would imagine some of these professional issues are taught in a very idiosyncratic way, rather than as established doctrine. I can't speak to any stories about the Rx pad, doesn't usually come up in case consultation. however, I can come up with dozens of examples of psychiatrists prescribing my elderly, demented patients, maintenance benzos for mild anxiety, so I'd hardly cite that as proof of competence.
 
TexasPhysician said:
Likely illegal situation in my state
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Not illegal in any state. How they're running it may or may not be illegal, but nothing prevents two GED holders from owning a medical practice. Many Suboxone practices are owned by non-MDs. Too many MDs don't realize they could and/or should own their own practices.
 
Down Home said:
Not illegal in any state. How they're running it may or may not be illegal, but nothing prevents two GED holders from owning a medical practice. Many Suboxone practices are owned by non-MDs. Too many MDs don't realize they could and/or should own their own practices.
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I believe in Texas you cannot have a medical practice that is an LLC or partnership owned by non-physicians. However, non- profit corporations (like most hospitals) have some exceptions to this rule, but still can't be majority owned by non- physicians. Texas makes a big deal about this and so asks about it on the Texas State Jurisprudence exam physicians must pass to get an unrestricted license. Of course it has been a little while since I studied this, so I may be fuzzy on the details.
It is obviously legislated medical profession protectionism under the veil of "patient safety." I'm ok with it, being a physician.
 
I believe in edieb's state, if it is where I think it is, CPOM statutes are ok regarding non-physician ownership, as long as they are not directly interfering in independent medical judgment of the clinicians they are employing. Unless there has been a recent law change.
 
Down Home said:
Not illegal in any state.
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See link posted by another poster. There are still laws in place in Texas that make such practice illegal without exceptions.

I currently work for a Florida company that has to arrange a 2nd corporation to help create an exception.

I am currently a contractor for a corporation that helps create an exception.
 
WisNeuro said:
I can come up with dozens of examples of psychiatrists prescribing my elderly, demented patients, maintenance benzos for mild anxiety, so I'd hardly cite that as proof of competence.
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Im not sure how the above relates to the current conversation, but blanket statements like the above are reasons why we need psychiatrists, not necessarily inappropriate care at all.
 
TexasPhysician said:
Im not sure how the above relates to the current conversation, but blanket statements like the above are reasons why we need psychiatrists, not necessarily inappropriate care at all.
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The statement in question was in response to another non-sequiter, and was not a blanket statement. Dozens is not equivalent to the entire field. Every field has it's terrible practitioners.
 
So I think what needs to be clarified is the word "employed". If a medical practice in Texas doesn't meet the exemption criteria for non-licensed owners, then they have to have an "independent contractor relationship with the physician". In other words, in states with CPOM laws non-MDs can still own a medical practice, but depending on their structure they may or may not be able to employ a physician. If not, they pay the MD as an independent contractor. That's it.
A roughly similar situation is of my wife and sister-in-law who both own a pharmacy. My wife is a pharmacist and SIL is a CPA who does the books. My SIL isn't allowed to go behind the counter of the pharmacy despite being half-owner of everything back there. She could in fact be sole owner and still be unable to go behind the counter of her very own pharmacy, but she'd need a supervising pharmacist in that case.

So yes- Texas and other states can prohibit a non-MD from employing a physican a medical practice. But no, Texas, nor any other state, can prevent a non-MD from owning a medical practice and contracting with a physican to work for them. Even if the non-MD owns 100% of the company regardless of structure. Working for someone and being employed by them are different.

More to the point, the OP is in a sketchy situation whether he's employed or contracted. You spend such a long time and work so hard to get licensed, that you should never work in an environment where you feel something is ethically amiss or that you're sacrificing your principles.
 
Last edited by a moderator:
Down Home said:
So I think what needs to be clarified is the word "employed". If a medical practice in Texas doesn't meet the exemption criteria for non-licensed owners, then they have to have an "independent contractor relationship with the physician". In other words, in states with CPOM laws non-MDs can still own a medical practice, but depending on their structure they may or may not be able to employ a physician. If not, they pay the MD as an independent contractor. That's it.
A roughly similar situation is of my wife and sister-in-law who both own a pharmacy. My wife is a pharmacist and SIL is a CPA who does the books. My SIL isn't allowed to go behind the counter of the pharmacy despite being half-owner of everything back there. She could in fact be sole owner and still be unable to go behind the counter of her very own pharmacy, but she'd need a supervising pharmacist in that case.

So yes- Texas and other states can prohibit a non-MD from employing a physican a medical practice. But no, Texas, nor any other state, can prevent a non-MD from owning a medical practice and contracting with a physican to work for them. Even if the non-MD owns 100% of the company regardless of structure. Working for someone and being employed by them are different.

More to the point, the OP is in a sketchy situation whether he's employed or contracted. You spend such a long time and work so hard to get licensed, that you should never work in an environment where you feel something is ethically amiss or that you're sacrificing your principles.
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Contractor vs employment are completely different situations which are not, theoretically, interchangeable. Nothing the OP described is a contractor relationship. Being a contractor here would bring about even more legal issues, and significantly worsen the liability/board issues.
 
All of this discussion is cool, but it circles back to the basic principle: your first duty is to the ethical and competent care of your patients, and no business environment or law will ever preclude you from this duty. Nothing that anyone writes on paper is meaningful if it keeps you from meeting that duty.
 
Why would you ever accept such a shady job?
 
What everybody else said about getting legal advice promptly and preparing to leave. This is not going to go anywhere good.
Try to get everything in writing, even if it's email: your concerns, their responses.
There are a lot of red flags in your original post; if you have a prescription monitoring program in your state, you might try looking yourself up and see if you are being exploited for your prescription pad or some other illegal activity which would explain all the odd behavior.
 
edieb said:
I am working in a clinic where the clinic owners (who only have GEDs) who are also the administrators, have a courier service in which they secure patients' permission to pick up their medications and the patients, in turn, pick them up at the clinic.
Click to expand...

Man that place sounds shady. Is this where you said you were making >$250K?

thoffen said:
All of this discussion is cool, but it circles back to the basic principle: your first duty is to the ethical and competent care of your patients, and no business environment or law will ever preclude you from this duty. Nothing that anyone writes on paper is meaningful if it keeps you from meeting that duty.
Click to expand...

+++ this. Cross-walk the above to the APA Ethical Principles and Code of Conduct, Standard 1.
 
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