Iain1028 Posted July 8, 2017 Share Posted July 8, 2017 Question: I am not in pain mgmt but in Rheumatology. If our SP is away or at another office, myself and the other PA are expected to sign for his pain meds if they stick in our folder of stuff to sign. Well, I am big time getting people down and off pain meds and sending to pain mgmt. Ever since we started getting our Board of Pharmacy (Arizona) report cards last year, my numbers are higher than I would like or feel comfortable with ( High but still in normal range, not outlier thank God). I have inherited patients from a couple other docs no longer there, so that didn't help my numbers. The SP has a lot, lot of pain med pts, stuff I would never prescribe in my own patients, MS, Fentanyl, Methadone, higher dosages of Oxy, lots of Tramadol, and all kinds of dedicated pain mgmt type meds. The thing is: He never really takes time off and that really helps, and don't have to sign that often, but if he is ever gone for whatever reason....we (me and the other PA) are expected to sign for this stuff. The other doctor in the practice does ZERO pain meds (very occasional Tramadol at most) ever since she got her first AZ pharm board report early last year. So that is one less person to help with scripts if needed. I guess my question is: what are the legal ramifications of signing pain meds for your SP? I can't find anything, I did read a very small legal article by an attorney wearing a bow tie, that one should never sign for your SP pain meds, but not much more. I am on a big time no pain med kick, but when I sign for the SP or the other PA when he is on vacation (in fairness, they do sign for me), those numbers go to the pharm board and is added to my count as if it was my patient. I like my job, lots of autonomy, $ is good, very fast paced and I like that. But this is a stressor, and I want to know about legal ramifications signing for your SP? Any thoughts? Will e-prescribe that we will be transitioning in the future, help avoid having to sign for other people's stuff? Thank you! Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted July 9, 2017 Administrator Share Posted July 9, 2017 Have the conversation. When I was in a similar situation, I simply waited for the SP to get back to sign any controlled substances where I had not seen the patient. If I had personally laid eyes on the patient and agreed with the plan and dosing? Sure, I'd sign 'em. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted July 9, 2017 Share Posted July 9, 2017 This is one of the reasons I am leaving my current practice. My SP is somewhat of a candy man. His average refill load for a week is between 80-100 controls - benzos, narcotics, soma, ambien, add meds (not always used for ADD...). When he is gone he fully expects us 2 PAs to sign ALL his refills. It takes a great deal of time and is mentally overwhelming and discouraging. He might see the patient frequently enough to be kosher but he is mixing benzos and narcotics, no MEDs are calculated. Drugs screens aren't always done. Patient smoke weed and drink and take all these drugs. One patient was on Soma, Narcotics, benzos, ADD meds AND ambien. Not lying. Lived life in a foggy cocktail of counteracting drugs. We were told we are HIS PAs and will do his bidding - pretty much a quote. He told me I treated these patients like criminals and thought little of them. I countered that I actually cared a great deal and was concerned for safety and liability and bad habits. Pretty much blew me off and told me to do as told. Doesn't matter if I disagree with the cocktail, find the patient to exhibit questionable behaviors or anything else - I am expected to shut up and sign. Not going to do that anymore - leaving in early August. That is yet another reason I want PAs to have independence for their actions - more power to just say NO in questionable situations when the "boss" doc can make life miserable or threaten employment. I would say that unless the PA or another doc or NP has actually seen the patient and knows the circumstances - don't sign. Bad habit. Bad Medicine. Link to comment Share on other sites More sharing options...
mgriffiths Posted July 9, 2017 Share Posted July 9, 2017 Haven't been in the situation, but the way I see things is my supervising physician can tell me what not to do, but cannot tell me what to do. He/She can offer advice and so forth, but if I disagree with their medical advice then I am not going to do it. If I believe it is warranted I would sign the script, but how can I know that if I haven't seen the patient? Link to comment Share on other sites More sharing options...
Febrifuge Posted July 9, 2017 Share Posted July 9, 2017 Functionally, our group works as a team, and we all sign for each other. We also question one another and verify or clarify as needed. If I get a request to refill something and I don't like what I think I'm seeing, I am expected to ask about it, consult with whoever else is there that day, and decide what to do based on my own judgement. If I told one of the docs, even my SP of record, "I just signed it because I thought you would expect me to," they would look at me funny. I'm not an extender or an assistant; I'm one of the clinicians on this team. Link to comment Share on other sites More sharing options...
airslant Posted July 9, 2017 Share Posted July 9, 2017 I sign the controlled meds I'm comfortable with and not the others. She does the same. In my state I'm limited to schedule III and down.Sent from my SM-G955U using Tapatalk Link to comment Share on other sites More sharing options...
Iain1028 Posted July 10, 2017 Author Share Posted July 10, 2017 Interesting responses, thank you, yes of course; part of the team and all. But, it affects my pharmacy numbers. What are the legal ramifications for signing narc scripts for your SP? I know you are covered under your malpractice, but some of these patients, I personally have never seen before, nor will ever see...... Link to comment Share on other sites More sharing options...
UGoLong Posted July 10, 2017 Share Posted July 10, 2017 In the end, it's you that is signing. General life rule: don't sign anything you're not comfortable with. That's your gut telling you that something is wrong. Link to comment Share on other sites More sharing options...
DizzyJ Posted July 10, 2017 Share Posted July 10, 2017 It could be appropriate to do a refill for one of the docs patients as you have access to their medical record and are in the same office. What I would do is write a note in the chart that I am covering for Dr. so and so and have reviewed the chart to confirm medication dosage and will RX refill for ONLY the amount needed to get the patient through until Dr. so and so came back to then do whatever their normal refill was. Of course, if it was a cocktail that was dangerous/medically contraindicated, then it is my right to refuse to refill. Link to comment Share on other sites More sharing options...
d2305 Posted July 10, 2017 Share Posted July 10, 2017 Most rheumatology patients have chronic pain. Come to think of it, that's where I seen quite a few "difficult" patients. Link to comment Share on other sites More sharing options...
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