Should I do this ?

[nicktahoe]

I have an old friend, a psychiatrist, who has a private practice for over three decades now.
For the pass several years, he has been dealing with a couple of penalties from the medical board.
He is currently not allowed to write prescriptions while on probation and taking courses/classes to resolve the issues.
So in the meantime he is still seeing patients but that’s it.
He has asked me to help him by seeing his patients and writing prescriptions for them. This would mean that I would have to use my DEA and see his patients a few hours a day.
My question is if I do help him for a month or maybe more, am I risking anything that could jeopardize my own license?
I’ve only worked at institutions post grad so maybe my question may sound naive or stupid.
Thanks for any helpful advice.

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[AnnoyedByFreud]

No. This sounds like a terrible idea.

 

[Jules A]

Hard NO. In my state those who actually get sanctioned have egregious prescribing habits. The average terrible doc never even hits the board's radar. And for >30 years ugh. You don't want even the tiniest serving of the mess he has created.

 

[clausewitz2]

A board sanction that involved taking away his ability to prescribe probably involves irresponsible use of controlled substances. Why on earth would you volunteer your DEA number for the effective use of someone who has demonstrably poor judgment with respect to use of DEA numbers?

If your friend has a suspended license for DUIs, you don't let them borrow your car to go out for the evenning. That is not actually being much of a friend.

 

[calvnandhobbs68]

I have an old friend, a psychiatrist, who has a private practice for over three decades now.
For the pass several years, he has been dealing with a couple of penalties from the medical board.
He is currently not allowed to write prescriptions while on probation and taking courses/classes to resolve the issues.
So in the meantime he is still seeing patients but that’s it.
He has asked me to help him by seeing his patients and writing prescriptions for them. This would mean that I would have to use my DEA and see his patients a few hours a day.
My question is if I do help him for a month or maybe more, am I risking anything that could jeopardize my own license?
I’ve only worked at institutions post grad so maybe my question may sound naive or stupid.
Thanks for any helpful advice.

Uh yeah you are risking yourself unless you agree with the crazy benzo/stimulant/hypnotic/opioid combos he must have these people on to have resulted in sanctioning from the medical board.

like they said above, most terrible prescribers never even hit the boards radar. You have to do something pretty ridiculous (or a lot of ridiculous somethings) to actually get prescribing rights taken away.

 

[birchswing]

Uh yeah you are risking yourself unless you agree with the crazy benzo/stimulant/hypnotic/opioid combos he must have these people on to have resulted in sanctioning from the medical board.

like they said above, most terrible prescribers never even hit the boards radar. You have to do something pretty ridiculous (or a lot of ridiculous somethings) to actually get prescribing rights taken away.

It's not always the regimen. In fact when I've read the state board decisions I'm not sure I've seen one based on a bad regimen.

Like I had a PCP who, in his mind, in the service of poorer patients asked patients to bring in meds they were not using, and he would dispense those himself (including controlled substances). He was sort of running his own pharmacy. He got sanctioned. I also saw a case where it was for the duration of prescribing: prescribing a controlled substance for a year by dating the scripts in advance because the physician was going to be out of the country. Or maybe the above case was about self-prescribing. Like ones where a doctor prescribes a controlled substance to a patient, friend, or employee and expects it to be given back to them for personal use. Those are cases I've come across when I read the state board decisions. I haven't really seen any that are just for bad regimens.

The question is: What happens to these patients? Hopefully they have PCPs.

 

[TexasPhysician]

I’m not exactly sure what you are proposing. If you enjoy addictions and would enjoy providing 2nd opinions/tapers, filling in for a doc on suspension may be a great public service.

If you are being asked to cover and continue the regimens for a few months, you may be next under investigation. More details are needed.

 

[Mass Effect]

I haven't really seen any that are just for bad regimens

You're not a physician.

 

[nicktahoe]

I will be seeing his patients and continuing the regimen albeit providing documentation that I’m consulting his patients and recommending weaning or offering a different regimen. I don’t think patients should be abandoned and taken off their usual dose abruptly. However, I understand the concern of helping my friend out.
This psychiatrist friend of mine is under financial stress and his wife is currently undergoing radiation for stage 3 uterine cancer. If I make sure I document everything and allow continuity of patient medications with suggestions of weaning and modifications, could I manage to safely help him out ?

 

[AnnoyedByFreud]

Why is he in trouble with the medical board?

 

[nicktahoe]

Why is he in trouble with the medical board?

I don’t know all the details. He is a bit of a maverick so to speak. Other than being in trouble with the board, I’ve seen him with his patients and he is a very good psychiatrist.

 

[Sushirolls]

If it's a friend, then sure, help out. But just be aware it's unlikely to be financially worth it, worth your time, or worth the professional headache.

However, your friend is lucky to have some one like you wanting to help out. Make it clear from the start the arrangement will be a power dynamic similar to that of a resident and attending in the out patient clinic. You will essentially be supervising, and he essentially needs to implement your plans. Without that understanding there will be disaster.

 

[nicktahoe]

If it's a friend, then sure, help out. But just be aware it's unlikely to be financially worth it, worth your time, or worth the professional headache.

However, your friend is lucky to have some one like you wanting to help out. Make it clear from the start the arrangement will be a power dynamic similar to that of a resident and attending in the out patient clinic. You will essentially be supervising, and he essentially needs to implement your plans. Without that understanding there will be disaster.

So given the fact that his patient is currently under his regimen, I can’t just come in and change it entirely.
I would be consulting and continuing his regimen for the most part while making recommendations of my own. Insisting changes where I believe absolutely necessary. It’s a little insulting for him since he has been practicing for so long, he inspired my choice in this profession in fact. The guy is old school, spends a generous amount of time with patients and really cares. Sure he is too maverick at times and it hasn’t served him well.
Given the fact that he is under surveillance with the board, I’m guessing that he is not being too rogue.

 

[TexasPhysician]

So given the fact that his patient is currently under his regimen, I can’t just come in and change it entirely.
I would be consulting and continuing his regimen for the most part while making recommendations of my own. Sure he is too maverick at times and it hasn’t served him well.

I wouldn’t do it then. Too risky. If you do it, I’d recommend approaching every patient as if you are assuming care and begin making changes as appropriate. Something is flawed. Either have the mindset of correcting every wrong or walk away. The board will be monitoring this closely. Just my opinion.

 

[Sushirolls]

Who cares if its insulting that you change the treatment plans. What this person was doing before obviously wasn't working in the eyes of the state board and something needs to change. The person's career is likely over if you don't step in. Our training process includes years of this type of over sight as a physician, he'll be just fine to flip that switch back into resident mode. If not, he can end his career and venture into his next chapter of life. Who best to dose someone with cold hard truth than a good friend?

This person at this time has no prescriptive authority. The second you start seeing these patients, whatever capacity, and are now writing the prescriptions you are effectively the attending of record. You are the person without restrictions or board sanctions. You are the captain of the ship. If you aren't willing to go down with the ship Captain, don't step aboard.

 

[nicktahoe]

First, thank you all for giving me your professional opinion.
Last question, wouldn’t it be dangerous to come in and just completely change the regimen instead of attempting to wean the regimen instead ? Like I said, he has to be more prudent now that he is being monitored.
I’m meeting him tomorrow after giving him some hope of help on Friday so thanks to all

 

[Nines]

It seems to me that he is asking you to help him keep the clinic in business and help him keep the lights on so to speak. That's a big ask. You have to consider: Are you prepared to pull the plug on the arrangement if you become uncomfortable with the treatment plans, thereby risking him losing his patients and maybe even his business? If not, I would steer clear. It sounds like he is a friend and mentor to you. This kind of arrangement, if it goes poorly, could put your friendship in jeopardy.

 

[TexasPhysician]

First, thank you all for giving me your professional opinion.
Last question, wouldn’t it be dangerous to come in and just completely change the regimen instead of attempting to wean the regimen instead ? Like I said, he has to be more prudent now that he is being monitored.
I’m meeting him tomorrow after giving him some hope of help on Friday so thanks to all

Wean vs change? It’s the same thing. You should be actively, safely adjusting their long-term care.

example: If patients are on Ativan 24mg/day (I’ve seen it), either refer to inpatient addiction or change the plan to reduce Ativan by x every y until discontinued. It isn’t a wait and start in 2 months thing. It is a today thing. Be prepared for agitated patients that may quit treatment or you may need to fire for inappropriate behavior. Be clear that you have the power to terminate care indefinitely. Document the current safety risks, the reason for a taper, and what the end goal will be. Your friend probably won’t like it as you are essentially detailing why returning to current regimen is a bad idea. Returning to the plan would thus look very poorly on him. You are encouraging change.

This is an adversarial role. You won’t be liked in this position. I’d make clear to my friend that this is you being generous to preserve his practice to some degree. The alternative is losing every patient.

 

[Mass Effect]

I will be seeing his patients and continuing the regimen albeit providing documentation that I’m consulting his patients and recommending weaning or offering a different regimen. I don’t think patients should be abandoned and taken off their usual dose abruptly. However, I understand the concern of helping my friend out.
This psychiatrist friend of mine is under financial stress and his wife is currently undergoing radiation for stage 3 uterine cancer. If I make sure I document everything and allow continuity of patient medications with suggestions of weaning and modifications, could I manage to safely help him out ?

I don't understand. Would you be actually starting the taper? Or would just be refilling their regular dose and then recommending a taper? If the former, I think that's fine and likely welcomed by the medical board. If the latter, you're screwing yourself over. Keep in mind many patients are not going to want to change their regimen so you just offering a taper, but continuing the same regimen when they say no is not good. I'm all about patient choice, but if they're on such a bad regimen that your friend lost his license, I'd say your refill practices should not be based on what the patients choose.

 

[Bartelby]

The above is spot-on, it is not wean OR change but wean TO change. If you were to take (for example) people on high dose benzos and send them immediately into potentially lethal withdrawal, then of course that is the worst possible option. The unfortunate thing is that you will be stuck making tough calls about what to change, if anything, in that window. I suspect it will be an unpleasant challenge because patients and your friend may believe nothing is wrong with these unusual regimens.

Your doing this would be a huge favor for your friend, but be ready for a stressful several months (or longer if he does not get back that license).

 

[birchswing]

You're not a physician.

In my state at least all of the board decisions are public information, and they include minutes of the meeting with the physician and details of the relevant care and what the board's decision is. You can read what the relevant regimens were, but most of the time it's not about the regimen. In reading them, which I haven't in a while but used to, I did not come across many that were what the board considered to be bad regimens but rather for more explicitly unethical/illegal behavior. Regardless of my opinion on the regimen, the board remarks on whether the regimen was appropriate or not in its report, if that is a relevant issue. But as I said, I've come across decisions that are more about how medicine was prescribed (to oneself, for too long of a period of time, etc.) more than I have what was prescribed.

All of that was to my point that this particular doctor may not have had his license suspended because individual patients had bad regimens (they may or may not have). Maybe I missed something in what the OP wrote, but I didn't see that they indicated that. The reason why the OP's friend had his prescribing authority taken away is missing (at least from what I read).

I do also read restaurant health inspection reports (not regularly, but on occasion), and I'm not an epidemiologist or a fellow restauranteur.

 

[Mass Effect]

Again, you're not a physician. We see these terrible regimens, whether or not the board has taken action and whether or not someone has turned them in. You have the experience of reading your own state's medical board page. Big deal.

 

[Candidate2017]

- Patients agree to taper because no one else will continue their regimen.
- Over months, they give various excuses and refuse to taper.
- You terminate them.
- Original psychiatrist goes out of business and/or does not get license back.
- Patients get angry no one is continuing their regimen, blame you the interloper.
- Abandonment lawsuits roll in, as well as DEA.

 

[AnnoyedByFreud]

The idea of seeing back to back patients on inappropriate benzo/stimulant/z-drug regimens, starting tapers, and having to have painful taper conversations over and over again sounds like torture to me... all while trying to preserve your mentor's dignity. I hope you get paid $400/hr or more to do this.

 

[birchswing]

I am really curious now what these regimens are. It seems like everyone is assuming they are really bad.

Maybe others can intuit more from the word "maverick" than I can. Maverick makes me think of really unusual things, unusual as in exotic.

 

[thepoopologist]

No way would I ever agree to a situation like this, regardless of who was asking me.

 

[Jules A]

No way would I ever agree to a situation like this, regardless of who was asking me.

This.
OP it sounds like you are protective of your friend and minimizing what he has done.
Some of the nicest psychiatrists I know have also been among the most terrible prescribers. The kind souls can become become enmeshed with their patients discomfort. I have seem those who feel they can be a savior, those who don't have the stones to push back when people insist XYZ is the only medication that will work regardless of how inappropriate or the worst of all those who are in it for the cash grab. "Old school" also means outdated and I don't have respect for that in the ever changing world of medicine. Your staunch defense of him will likely change if you decide to take on the risk of attempting to clean up his work while both he and his patients vilify you for it.

 

[nicktahoe]

I’ve decided to withdraw my offer of assistance. I’ll be meeting with him this week and I feel bad for having to disappoint him.
Aside from helping me during my early medical school days, he is currently undergoing so many personal difficulties. But I can’t take the risk, even if it was minimal. My friendship may change with this but oh well.
Thank you for giving me your honest feedbacks.