Being Nice---Can Put you On Ice

[surgblumm]

Being Nice------Can put You on Ice

                                         Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus

 

 Prescribing for a friend

              Healthcare providers have a tendency to be warm and compassionate and also altruistic.  Sometimes the qualities that make our profession respected and loved can also make us unintentional targets of the plaintiff’s attorney. Your best friend has been stricken with Gout after a weekend of gathering with old military friends and eating large amounts of steak and drinking many mugs of beer. This is his first attack and the pain has become unbearable. He calls his best friend, Tom, the PA and asks if there is anything he can prescribe to alleviate his condition. Tom, being a loyal and faithful friend calls in a prescription for allopurinol which gives the relief he had hoped for. On day three of the treatment he developed a severe rash, took Benadryl and some steroids that he had at home and never contacted his PA friend Tom. By the end of the week this patient had expired with Stevens-Johnson Syndrome secondary to Tom's prescription and his wife had no recourse other than to bring suit against Tom for wrongful death. Tom had no patient chart, no written information, had not warned his friend of potential side effects and was now culpable.

Prescribing for a family member

          Heather wrote a prescription for her cousin who had all the symptoms of a severe Strep throat. She had not examined or cultured him and was a GYN PA, not as familiar with general medical illnesses and had no chart. Her cousin who had received a prescription for high dose Augmentin, developed severe angioedema and had an anaphylactic reaction and died. Heather's cousin’s wife brought suit against Heather who regretted ever answering the phone that morning.

 Prescribing for fellow healthcare workers

         Fifteen years ago, a recovery room nurse requested that I write her a prescription for a nonscheduled medication. I took out my trusty pad to write the prescription when my chief of surgery, Dr. Gallagher, stated Bob, put your pad away. He said what you are doing is illegal, she has no chart, is not in your specialty and is not your patient. This would be one of the most stupid things you could do. He spoke with me in the locker room and said that the nurses used to ask him and his colleagues for a prescription and in the name of public relations, some gave in but most refrain from the practice now. They have perpetrated their actions by asking the PAs. He told me that I was a leader and that I should lead by example and tell my colleagues likewise.

 

          So here I am tonight, writing this little missive to proclaim a warning to my fellow PAs; don't break the law and don't allow yourself to become vulnerable.  Your future and your practice demand that you stay ever vigilant and that you are protected from the mysterious problems that can enter into your professional practice.

 

[Cideous]

Boy everyone should read and re-read this post.  It happens EVERY SINGLE DAY and don't think for a second that your family member or close friend's significant other would think twice about suing you into oblivion.  Just don't do it.  Tell them you would love to help, but it is illegal and you must protect your license.  If they don't understand, they are not worth the time in your life to begin with.

I played golf with a next door neighbor for 5 years almost every week.  We were even in a men's prayer group together.  He called me up one day and asked me to prescribe anti-anxiety medicine for his son....in another state.  When I said no, he said..."So you're refusing to help us?"  I told him that I could not prescribe in the other state even if I wanted to, and that I had never actually seen his son in my office, even prior to this event.  After 5 years of friendship he basically never spoke to me again.

People can suck.

[mgriffiths]

My understanding is that in MI it is illegal to prescribe to a family member, even if they are your "patient."  Doesn't matter whether you chart, see them in clinic, etc. as it is considered a conflict of interest and/or unethical.  They are constantly looking for offending providers and they catch a few every year...

[mjl1717]

Great  essay  Bob!  There  are  many  ways to  get  in trouble  in  this  field.

[surgblumm]

Thanks. Unfortunately there are too many to count, which is why I write these articles. Our joint experience can help the new generation of PAs.

[SCPA]

Sadly, Tom was doubly wrong for also choosing allopurinol for this acute gout flare : / 

[Guest ERCat]

 Thank you for posting this article. I initially had huge anxiety about prescribing for friends and family when I first started practicing. However, after noticing that most of my colleagues do it I have gotten somewhat desensitized. I have written prescriptions for several people in my immediate family, all medications that they have had before...Not many Rxes written, but a few. While I have not had any bad outcomes, after being reminded of the risks with this article, I don’t think I will do it again.

[Boatswain2PA]

I do it very rarely.  I have permission from one of my SPs.  And I write a note and file it in my locked desk at home.  And I carry my own malpractice.

I don't think I'm breaking any laws, nor being immoral or unethical.

 

[Reality Check 2]

Another reason I left a prior job - the doc did things for his mom but PUT THEM IN MY NAME. The result, request or refill would come to my computer queue and I would have no idea why. No notes in the chart. Nothing. He thought I would be kosher with it.....

He also took care of his own kids and didn’t chart a thing. Including stitches and a controlled ADHD Med.

I stopped prescribing for friends and avoided family like the plague. Not worth it. 

Stay the high road.

[surgblumm]

I am not judging you Boatswain but opening up another window for you. I have been a PA for 46 years and am, at this stage of my career, no longer enamored by physicians. Your doc saying you can do it and documenting this is not enough. Your doc, no matter what he thinks of himself, is not above the law and particularly when it comes to your actions. I would just tell him that you can no longer do this and show him the article. Reality check is an example of what some Doc's think they can do and with an EMR , it's easy.  just said NO! My doc did the same, and I said, sorry Jerry, NO Can do.. The explanation was enough. Why should he worry about personally breaking the law and yet say it's OK for you? Just my two cents. 

[Guest UVAPAC]

I have very rarely prescribed medication to family (never to friends).  I have more or less completely stopped.

My favorite of them all:

Family Member:  I have a UTI.  Can you PLEASE prescribe me an antibiotic.  Otherwise I have to go to an urgent care or my primary care doctor, will get billed $150, and get an antibiotic anyway.  I have no allergies to medications.  

Me:  Ugh, I guess.  But really you should be having a UA and possibly a culture to confirm diagnosis.  Called in Bactim DS BID x 5 days.  

 

1.5 days later... I get a phone call...

Family Member:  I am still having pain with urination.  It is not getting any better.  Do you think I need another antibiotic?
 

Me:  I am not prescribing you another antibiotic.  You need to go see your doctor.  You need to have a proper evaluation.  

 

That afternoon I get a phone call...

Family Member:  I went and saw my doctor.  They said it was a UTI.  They gave me a much stronger antibiotic.

Me:  Oh yeah?  What did they give you?

Family Member:  It's called Sulfamethoxazole/Trimethoprim

 

[jmj11]

On 7/30/2018 at 4:48 AM, surgblumm said:

Being Nice------Can put You on Ice

                                         Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus

 

 Prescribing for a friend

              Healthcare providers have a tendency to be warm and compassionate and also altruistic.  Sometimes the qualities that make our profession respected and loved can also make us unintentional targets of the plaintiff’s attorney. Your best friend has been stricken with Gout after a weekend of gathering with old military friends and eating large amounts of steak and drinking many mugs of beer. This is his first attack and the pain has become unbearable. He calls his best friend, Tom, the PA and asks if there is anything he can prescribe to alleviate his condition. Tom, being a loyal and faithful friend calls in a prescription for allopurinol which gives the relief he had hoped for. On day three of the treatment he developed a severe rash, took Benadryl and some steroids that he had at home and never contacted his PA friend Tom. By the end of the week this patient had expired with Stevens-Johnson Syndrome secondary to Tom's prescription and his wife had no recourse other than to bring suit against Tom for wrongful death. Tom had no patient chart, no written information, had not warned his friend of potential side effects and was now culpable.

Prescribing for a family member

          Heather wrote a prescription for her cousin who had all the symptoms of a severe Strep throat. She had not examined or cultured him and was a GYN PA, not as familiar with general medical illnesses and had no chart. Her cousin who had received a prescription for high dose Augmentin, developed severe angioedema and had an anaphylactic reaction and died. Heather's cousin’s wife brought suit against Heather who regretted ever answering the phone that morning.

 Prescribing for fellow healthcare workers

         Fifteen years ago, a recovery room nurse requested that I write her a prescription for a nonscheduled medication. I took out my trusty pad to write the prescription when my chief of surgery, Dr. Gallagher, stated Bob, put your pad away. He said what you are doing is illegal, she has no chart, is not in your specialty and is not your patient. This would be one of the most stupid things you could do. He spoke with me in the locker room and said that the nurses used to ask him and his colleagues for a prescription and in the name of public relations, some gave in but most refrain from the practice now. They have perpetrated their actions by asking the PAs. He told me that I was a leader and that I should lead by example and tell my colleagues likewise.

 

          So here I am tonight, writing this little missive to proclaim a warning to my fellow PAs; don't break the law and don't allow yourself to become vulnerable.  Your future and your practice demand that you stay ever vigilant and that you are protected from the mysterious problems that can enter into your professional practice.

 

I've mentioned before that I (like all providers) get the Washington State quarterly newsletter from the Medical Quality Assurance board. They list all the MDs, and PAs who have lost their licenses. For physicians, it is mostly over sexual issues. For PAs, it is almost always due to writing Rx for friends and family without documentation.

[SedRate]

4 hours ago, jmj11 said:

I've mentioned before that I (like all providers) get the Washington State quarterly newsletter from the Medical Quality Assurance board. They list all the MDs, and PAs who have lost their licenses. For physicians, it is mostly over sexual issues. For PAs, it is almost always due to writing Rx for friends and family without documentation.

Good to know. Thanks for sharing.

[sk732]

I never prescribe for family (against our College regs here where I work, except in an emergency) - I even go so far as to refuse to cosign outside orders from my mother's out of facility specialist for her outpatient treatments in my facility (one of my secondary/tertiary/ad infinitum duties).  I get nurses asking for Rx's all the time - I tell them if they want me to do anything, they need to check in so there is a paper trail...they go bug one of the docs instead, as even our NP won't do anything without documentation.  Since my Rx's are on someone else's license, I need to protect them as well as myself and that's how I explain it.  When I was in family med, if someone stopped me in the street or the store in the town I worked in and asked about something, I'd tell them to call the office and I'd see them there, since "talking about your gonnorhea in a public place isn't appropriate "...or words to that effect.

I'm actually amazed at how few people really realize that if I'm out for a walk or out for lunch, that I don't want to talk about work, but perhaps the weather or that weird bird I saw flying around, etc. 

SK

[surgblumm]

Great job SK. You have it wrapped up tightly.