sweetlenovo88

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Got offered a locums gig doing this part time. I have a full CA license. While telemedicine is permitted in CA, I cannot find any guidelines permitting or denying suboxone via telemedicine. Any insight? I assume there will be medical ancillary staff onsite at this clinic.
 

wolfvgang22

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I know there is no problem with it on the federal level. Don't know about California specifically.
 
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sweetlenovo88

sweetlenovo88

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How does the Ryan Haight Act affect this? May be illegal.


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From my understanding, if the clinic is registered with the DEA (in general, not necessarily for suboxone) it is legal federally. States can have their own guidelines. In addition, the DEA is supposed to issue a special exception rule this year for telemedicine and controlled substances.
 
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TexasPhysician

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From my understanding, if the clinic is registered with the DEA (in general, not necessarily for suboxone) it is legal federally. States can have their own guidelines. In addition, the DEA is supposed to issue a special exception rule this year for telemedicine and controlled substances.
When will the exception occur?

When I investigated the DEA issue, they require a special issued certification which has only been approved for state/federal facilities - no private clinics or hospitals have obtained it.


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sweetlenovo88

sweetlenovo88

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When will the exception occur?

When I investigated the DEA issue, they require a special issued certification which has only been approved for state/federal facilities - no private clinics or hospitals have obtained it.


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If you google DEA special registration for telemedicine, they were/are supposed to issue an exception to Ryan Haight in 2017.

Can you point me to a link where the DEA does not allow the registration of a private clinic? I was not aware that currently, private clinics could not be registered. An attorney advised me it is possible. I have worked at nonprofit community mental health centers via telemedicine where I have called in benzo prescriptions to pharmacies. I do not know if they were registered. Is there a way to check a particular clinic?
 

TexasPhysician

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If you google DEA special registration for telemedicine, they were/are supposed to issue an exception to Ryan Haight in 2017.

Can you point me to a link where the DEA does not allow the registration of a private clinic? I was not aware that currently, private clinics could not be registered. An attorney advised me it is possible. I have worked at nonprofit community mental health centers via telemedicine where I have called in benzo prescriptions to pharmacies. I do not know if they were registered. Is there a way to check a particular clinic?
When I looked in 2016, only large state facilities were granted the designation in Texas. When I looked and called in 2016, the state and federal response was that they haven't developed an application to apply for private clinics. They did not anticipate offering any. An attorney I used also couldn't get anyone to provide an application.

Only major state facilities were given the designation. Even smaller state facilities were not able to apply, so telepsychiatry child patients were transported hours by bus for a 10 min session with me at a major designated facility for their low dose stimulant refills.

If you find a way to apply, please let me know.


Most clinics are ignoring Ryan Haight and practicing illegally. They don't have the designation.
 

keifernny2

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You could fly to CA for a few days and do a whole bunch of new evals in person, then follow ups via telemed. Well, if you like that part of California.
 
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"
Providers are prohibited from prescribing or dispensing
dangerous drugs or dangerous devices on the Internet
without an appropriate prior examination and medical
indication.
Source: CA Business & Professions Code Sec. 2242.1(a).
"

Seems that if someone else is doing an in person examination and diagnosis, then you can go ham. Let me know how this goes :).
 

Bartelby

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"
Providers are prohibited from prescribing or dispensing
dangerous drugs or dangerous devices on the Internet
without an appropriate prior examination and medical
indication.
Source: CA Business & Professions Code Sec. 2242.1(a).
"
Although telepsychiatry interviews are accepted within the field, so maybe they would be considered "an appropriate prior examination" and could establish medical indication? It sounds like something worthwhile to run by an attorney.
 
Dec 9, 2017
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Although telepsychiatry interviews are accepted within the field, so maybe they would be considered "an appropriate prior examination" and could establish medical indication? It sounds like something worthwhile to run by an attorney.
I am by no means an expert, but medical law is governed by civil law, which means that illegality is governed by past cases, not like criminal law where things are mostly ironed out by existing laws. When venturing into new territory like telemedicine and gray areas, whether something is legal or not is more like "don't get in trouble and it wont become illegal", but yes, run it by an attorney. I would also be interested in what they say. I wonder if anyone in CA has been sued yet for doing a initial eval for suboxone through telemed. But if that becomes the norm, it's only a matter of time before someone has some freak accident with some weird combination, then the patient sues, and it becomes illegal, and you don't want to be that first guy.
 

michaelrack

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I am by no means an expert, but medical law is governed by civil law, which means that illegality is governed by past cases, not like criminal law where things are mostly ironed out by existing laws. When venturing into new territory like telemedicine and gray areas, whether something is legal or not is more like "don't get in trouble and it wont become illegal", but yes, run it by an attorney. I would also be interested in what they say. I wonder if anyone in CA has been sued yet for doing a initial eval for suboxone through telemed. But if that becomes the norm, it's only a matter of time before someone has some freak accident with some weird combination, then the patient sues, and it becomes illegal, and you don't want to be that first guy.
The issue isn't so much malpractice, it's the state medical board or Feds (DEA) cracking down on you and taking away your medical or DEA license.... and the DEA could also pursue federal criminal action against you.
 

TexasPhysician

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I am by no means an expert, but medical law is governed by civil law, which means that illegality is governed by past cases, not like criminal law where things are mostly ironed out by existing laws. When venturing into new territory like telemedicine and gray areas, whether something is legal or not is more like "don't get in trouble and it wont become illegal", but yes, run it by an attorney. I would also be interested in what they say. I wonder if anyone in CA has been sued yet for doing a initial eval for suboxone through telemed. But if that becomes the norm, it's only a matter of time before someone has some freak accident with some weird combination, then the patient sues, and it becomes illegal, and you don't want to be that first guy.
See Ryan Haight and subsequent laws as I mentioned above. There is already precedent.
 
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