Would you fill this C2?

[Hulkbuster333]

A patient came in with Norco 7.5 #20 for 7 days. I checked the PDMP and found that he gets #150 a month at another pharmacy. It was prescribed by the same doctor. However, he got his last #150 on 2/1. Patient states he fell and hurt his hip a week ago so he is out and needs more. He also tells me the 150 is for his workers comp and this is for his hip and I explain that the MD wrote for the same pain medication that he has been taking. By my calculations if he had been taking 5 a day for about 2 weeks, that would have used up 70 of the 150 and he would have had 80 left. So he would have been taking 11-12 a day for the last week to be out which is close to 4g APAP a day but not quite there.

I contacted the MD (not a pain doctor but a primary care physician) and his office said he wanted the patient to have it but I wasn't comfortable with it. I contacted the state medical board for advice and was told I have a right to refuse (which I knew). It also seemed like they wanted me to report the MD.

I told the patient he shouldn't be out and I wasn't comfortable putting my license on the line and he could take his prescription to his usual pharmacy where he gets his pain medication and see if they would fill it. I'm curious what others would have done.

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[Old Timer]

A patient came in with Norco 7.5 #20 for 7 days. I checked the PDMP and found that he gets #150 a month at another pharmacy. It was prescribed by the same doctor. However, he got his last #150 on 2/1. Patient states he fell and hurt his hip a week ago so he is out and needs more. He also tells me the 150 is for his workers comp and this is for his hip and I explain that the MD wrote for the same pain medication that he has been taking. By my calculations if he had been taking 5 a day for about 2 weeks, that would have used up 70 of the 150 and he would have had 80 left. So he would have been taking 11-12 a day for the last week to be out which is close to 4g APAP a day but not quite there.

I contacted the MD (not a pain doctor but a primary care physician) and his office said he wanted the patient to have it but I wasn't comfortable with it. I contacted the state medical board for advice and was told I have a right to refuse (which I knew). It also seemed like they wanted me to report the MD.

I told the patient he shouldn't be out and I wasn't comfortable putting my license on the line and he could take his prescription to his usual pharmacy where he gets his pain medication and see if they would fill it. I'm curious what others would have done.

I would have called the doctor and asked for documentation on how he consumed 7 pills per day for the last 3 weeks and why is giving him more.
I would have refused to fill the medication as he should have some left.
I WOULD NEVER CALL THE MEDICAL BOARD

 

[Hulkbuster333]

I would have called the doctor and asked for documentation on how he consumed 7 pills per day for the last 3 weeks and why is giving him more.
I would have refused to fill the medication as he should have some left.
I WOULD NEVER CALL THE MEDICAL BOARD

I didn't give the doctors name to the medical board and I didn't actually report it. I wanted advice from an authority because I had an annoyed doctor's office and angry patient to deal with.

 

[BlackDiamond277]

If I may ask, what would be wrong with calling the medical board and/or reporting the MD?

I'm a student, so please forgive me if this is a stupid question! Just curious.

 

[wagrxm2000]

Send him to his usual pharmacy. I would not fill it. All you need to do is tell the patient you got this on 2/1 with a higher daily quantity, if you need it filled, you need to stick with the same pharmacy.

Shocking I know.

The only way this should be filled is if it was an increase in directions and way closer to their next fill date. Md shouldn't be giving a script to add on to his usual script. One of these days mds will learn, don't just tell patients to increase their dose. There's also a reason why they are coming to you, the other pharmacy probably said no.

I would only call the board if the MD gets way out of hand which luckily has never happened.

 

[BigBoss]

What’s worse is that stuff like this is common.


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[Deja]

I would have called the doctor and asked for documentation on how he consumed 7 pills per day for the last 3 weeks and why is giving him more.
I would have refused to fill the medication as he should have some left.
I WOULD NEVER CALL THE MEDICAL BOARD

I'm curious too, why would you never call the medical board? I have reported one doctor in all my years working

 

[Dr Wario]

Pt did not go to his regular pharmacy because that pharmacy already told him no. I would send this one packing.

 

[Old Timer]

I don't report people to the Medical Board. First, unless you think it's a doctor selling rxs or doing something shady, don't make waves. I was reported to the State Board once and who needs that aggravation. An investigator shows up and it's a real mess. If you think the guy is selling rxs call the DEA. BTW, I was exonerated by the State Board after being accused of practicing Medicine w/o a license by an a-hole dr......

 

[Sine Cura]

If prescribers are being hostile about a legitimate issue (like writing 360 oxycodone every month with no end in sight, then they give you lip when you question their treatment "plans") then I absolutely report them. Who else is going to hold them accountable? Yes if you report to a licensing board other than pharmacy they are probably going to ask for your records too.. so it's more work for you but I think it's worth it if the prescriber is negligent or a fraud.

I cannot control whether *******es will report me to the BOP so I don't concern myself with the possibility. When/if it comes I am perfectly fine defending myself. I've done the whole action plan crap, mitigation plan crap etc with BOP...

 

[Rouelle]

I didn't give the doctors name to the medical board and I didn't actually report it. I wanted advice from an authority because I had an annoyed doctor's office and angry patient to deal with.

You call the medical board to report a dr (you’ll possibly/probably go your entire career without doing this). If you want “advice from an authority” related to virtually any aspect of your job, your BOP is where to start.

 

[CetiAlphaFive]

I don't report people to the Medical Board. First, unless you think it's a doctor selling rxs or doing something shady, don't make waves. I was reported to the State Board once and who needs that aggravation. An investigator shows up and it's a real mess. If you think the guy is selling rxs call the DEA. BTW, I was exonerated by the State Board after being accused of practicing Medicine w/o a license by an a-hole dr......

That's sad and part of the reason we are in the middle of an opioid problem.

You're saying "Don't rock the boat" in the middle of a storm.

 

[Old Timer]

That's sad and part of the reason we are in the middle of an opioid problem.

You're saying "Don't rock the boat" in the middle of a storm.

The DEA is where I go, not the Medical Board

 

[CetiAlphaFive]

The DEA is where I go, not the Medical Board

Well sometimes I'm wrong. LOL


However, there are a lot of stupid things MDs do that violate standard of care, yet aren't even close to illegal.

 

[VA Hopeful Dr]

Well sometimes I'm wrong. LOL


However, there are a lot of stupid things MDs do that violate standard of care, yet aren't even close to illegal.

Yep. Now if we violate SOC and it results in harm that you can prove, most medical boards will take action of some kind. That can be tough to prove however. Especially since so much of what we do doesn't make a huge difference in the short term.

 

[KennethCool]

I told the patient he shouldn't be out and I wasn't comfortable putting my license on the line and he could take his prescription to his usual pharmacy where he gets his pain medication and see if they would fill it. I'm curious what others would have done.

In my pharmacy law class, they told us to NEVER refer a patient to another phamaracy if you are refusing a fill for a narcotic. Not only are you legitimizing an illegitimate Script through social proof, but you are opening yourself to liability.

 

[dblock05]

In my pharmacy law class, they told us to NEVER refer a patient to another phamaracy if you are refusing a fill for a narcotic. Not only are you legitimizing an illegitimate Script through social proof, but you are opening yourself to liability.

You tell the person you cannot fill it due to it being too early for a refill, give them back the prescription and they can choose to do whatever they want from there.

 

[KennethCool]

Exactly. What you don't do is say "try xyz pharmacy, maybe they'll fill it."

 

[Hulkbuster333]

In my pharmacy law class, they told us to NEVER refer a patient to another phamaracy if you are refusing a fill for a narcotic. Not only are you legitimizing an illegitimate Script through social proof, but you are opening yourself to liability.

I didn't think I was legitimizing it when I was telling him I wouldn't fill it and he could have the rx back. The guy was yelling at me over the phone for "overriding the medical doctor's orders" and demanding a solution so I told him maybe try your original pharmacy because he obviously didn't go there for a reason. He didn't even come to pickup the rx anyway.

 

[KennethCool]

In class they told us the case law behind this is pretty clear. If I remember correctly, some pharmacist said "I won't fill that, try XYZ pharmacy" and the patient went to XYZ pharmacy to fill a C2. The patient overdosed and the pharmacists from BOTH pharmacies were found liable. If you recommend another pharmacy, that is a "professional endorsement" and you are putting your license and your financial future on the line. You're also being a jerk to other decent pharmacists by trying to push unnecessary problems onto them.

 

[owlegrad]

In class they told us the case law behind this is pretty clear. If I remember correctly, some pharmacist said "I won't fill that, try XYZ pharmacy" and the patient went to XYZ pharmacy to fill a C2. The patient overdosed and the pharmacists from BOTH pharmacies were found liable. If you recommend another pharmacy, that is a "professional endorsement" and you are putting your license and your financial future on the line. You're also being a jerk to other decent pharmacists by trying to push unnecessary problems onto them.

Eh, I am no lawyer but I am not convinced that saying "take this to your regular pharmacy" is the same as referring to a pharmacy that is known for filling sketchy scripts.

Also who on earth would admit to referring someone to a known sketchy pharmacy to get their script filled? How on earth did the prosecution prove the pharmacist referred the patient anywhere?!

 

[thecoolpharmboi]

I have similar instances where I came across this problem. I would have refused to fill it. They need to go back to their original pharmacy to fill. I would have also reported the doctor. It doesn’t seem like normal to be prescribing like that.

I’ve had a doctor write two norco prescriptions of 30 days supply each for a patient (one for traveling and one for home)....each have different directions but same day supply. I do not attempt to understand that and I refused it. That doctor never did it again.

 

[wagrxm2000]

In class they told us the case law behind this is pretty clear. If I remember correctly, some pharmacist said "I won't fill that, try XYZ pharmacy" and the patient went to XYZ pharmacy to fill a C2. The patient overdosed and the pharmacists from BOTH pharmacies were found liable. If you recommend another pharmacy, that is a "professional endorsement" and you are putting your license and your financial future on the line. You're also being a jerk to other decent pharmacists by trying to push unnecessary problems onto them.

You've got to give more to this story, who would ever willingly admit to that? Also even if they did, how would that be the pharmacist fault? That would be like a doctor referring a patient to a pain clinic and the patient overdosed so the referring doctor is liable since they sent the patient there.

Side note, no one is saying go back to your usual pharmacy. What I generally say is, you need to stick to one pharmacy when filling your medications. It's hard to keep track of interactions if you go to different places.

 

[BidingMyTime]

In class they told us the case law behind this is pretty clear. If I remember correctly, some pharmacist said "I won't fill that, try XYZ pharmacy" and the patient went to XYZ pharmacy to fill a C2. The patient overdosed and the pharmacists from BOTH pharmacies were found liable. If you recommend another pharmacy, that is a "professional endorsement" and you are putting your license and your financial future on the line. You're also being a jerk to other decent pharmacists by trying to push unnecessary problems onto them.

Telling someone they should go back to their usual pharmacy, isn't the same as telling them to go to some XYZ pharmacy. The idea being, I don't have their pharmaceutical or medical history, so I'm don't feel safe filling their prescription,....but if I did have their history, maybe I would feel differently. So they should go back to the pharmacy that has their history.