Candy Man Situation

[SCPA]

Here for advice: 

Family medicine.. 

NEW SP hired to replace previous SP is doling it out HEAVY -- even seemingly pushing narcs on people. "you need pain meds." She's full of theories that piss all over conventional wisdom on the matter. 

Found out a big box pharmacy won't fill her scripts -- apparently she's flagged in the system

I'm not doing anything wrong, i'm quite scrupulous about prescribing,  and obviously my Rx habits will not change  but I really worry my association to this person(she is my SP afterall)   will bring unnecessary attention from governing bodies, not to mention the unsavory seekers that are about to start lining up.. 

I really do not want to leave this job. 

WHAT'S A PA TO DO? 

 

[EMEDPA]

In most states, if she loses her DEA you lose yours too, because she can no longer delegate services that she herself does not have the ability to provide. run away.

[rev ronin]

Ugh. Sorry to hear you're in this situation.  You LIKED the job, unfortunately, because with a new SP, everything changes.

[Boatswain2PA]

Emed- please give more info on a PA losing DEA because of SP?  I've never heard of such thing.  Is that state DEA?

To the OP:  "Conventional wisdom" is usually wrong....VERY wrong.  We are in the midst of a media-hyped (and yet real) opioid crisis because of the last "Conventional wisdom" that "pain is the 5th vital sign" and if your patient didnt have a perpetual pain score of zero (as per the "stoned but smiling" face on the nursing pain rating visual score) then you were failing.

 

[quietmedic]

What about speaking to the practice owner?  Are you on good terms with him/her?

Honestly, if you really think she is a risk, you are better leaving a job than getting sucked into a lawsuit I would think...but I definitely understand the struggle.  

See what headway you can make with the owner of the practice, i.e. whoever hired her.

Out of curiosity, how do you know about her being flagged?

[Cideous]

Where is she located....I need a new PCP.

 

 

LOL

[GetMeOuttaThisMess]

Emed- please give more info on a PA losing DEA because of SP?  I've never heard of such thing.  Is that state DEA?

To the OP:  "Conventional wisdom" is usually wrong....VERY wrong.  We are in the midst of a media-hyped (and yet real) opioid crisis because of the last "Conventional wisdom" that "pain is the 5th vital sign" and if your patient didnt have a perpetual pain score of zero (as per the "stoned but smiling" face on the nursing pain rating visual score) then you were failing.

 

In TX, DEA is tied to practice location. If you have a DEA number and change practices this has to go through DEA for a modification before you can use, assuming that the SP at new location has delegated controlled substance prescribing.

[Boatswain2PA]

Just now, GetMeOuttaThisMess said:

In TX, DEA is tied to practice location. If you have a DEA number and change practices this has to go through DEA for a modification before you can use, assuming that the SP at new location has delegates controlled substance prescribing.

Wow...federal DEA or separate state DEA?

[EMEDPA]

this is from the WA PA regs:

Prescriptive Authority:

This delegation agreement allows the PA to prescribe, to order, to administer and to dispense legend drugs

and Schedule II-V controlled substances. If a supervising or alternate MD’s prescribing privileges are restricted, the PA will be deemed similarly restricted. The PA must be registered with the DEA to prescribe controlled substances.

 

[Boatswain2PA]

2 minutes ago, EMEDPA said:

this is from the WA PA regs:

Prescriptive Authority:

This delegation agreement allows the PA to prescribe, to order, to administer and to dispense legend drugs

and Schedule II-V controlled substances. If a supervising or alternate MD’s prescribing privileges are restricted, the PA will be deemed similarly restricted. The PA must be registered with the DEA to prescribe controlled substances.

 

Interesting.  I guess that makes sense since we arent supposed to be able to do anything our SP isnt supposed to be able to do.

It's a broken system.

[EMEDPA]

2 minutes ago, Boatswain2PA said:

Interesting.  I guess that makes sense since we arent supposed to be able to do anything our SP isnt supposed to be able to do.

It's a broken system.

I think this is also a safeguard against hiring a pa  to write narcs if a doc loses their dea.

[Boatswain2PA]

Yeah, that makes sense.  With the explosive growth in PA programs, and the relative inexperience of most new grads, this might be an important barrier to prevent abuse.

[TWR]

Back to the topic,   Get the h.ll out.  Forget what you like.  You are talking about your livelihood which could be taken away from you.  She is probably on someone's radar already.  Run don't walk.  IMHO

[GetMeOuttaThisMess]

Wow...federal DEA or separate state DEA?

We don’t have a state registration/renewal process through DPS for narcs any longer. It’s handled through state board and DEA.

[Cideous]

And can only be assigned to one clinic last time I checked.  What if we work at several clinics?  LOL Texas system is just stupid.

[mgriffiths]

WOW!!!  Some excellent information here that I had never actually thought of, but am so sorry for OP.  That is quite sad/disturbing, but I agree you really need to consider some form of change either within the practice or looking for new employment.

[ventana]

RUN to the practice owner

 

politely demand a new SP - anyone besides her

let her sink her own ship and not pull you down with her...

 

 

[swooshie1]

At our clinic (rural California) all mid-levels have delegation agreements with EVERY doc in our clinic.  works very well for cross-coverage needs, or when a doc decides to leave the clinic, etc.  might be a solution for you, I agree, talk to practice owner or whoever is at the top of the ladder.

[rev ronin]

22 hours ago, swooshie1 said:

At our clinic (rural California) all mid-levels have delegation agreements with EVERY doc in our clinic.  works very well for cross-coverage needs, or when a doc decides to leave the clinic, etc.  might be a solution for you, I agree, talk to practice owner or whoever is at the top of the ladder.

Interesting.  When I worked at Group Health, I had delegation agreements with my primary SP and an alternate, but would see patients empaneled with any of the 20+ MD/DO PCPs in the clinic if needed, even though most of my work was for one "pod"  I can't imagine the hassle of naming all physicians as alternates...

[entpac]

We have several surgeons in our group.  At state level I have one primary and all the others listed as alternates.  This protects me if my SP decides to leave or if I have to go to the OR while on call at night or if a Resident is not available.

[sas5814]

Actually in Texas you can list multiple SPs and locations on one DEA though there is only one  name and location printed on the face of the DEA cert. I have done this for years. If this SP loses her DEA you lose your delegation from her for that location.

That said it is not a good thing to be associated with this doc if she is really all over the place. Whether you do anything wrong or not you will get splattered in the mess.

[GetMeOuttaThisMess]

Actually in Texas you can list multiple SPs and locations on one DEA though there is only one  name and location printed on the face of the DEA cert. I have done this for years. If this SP loses her DEA you lose your delegation from her for that location.
That said it is not a good thing to be associated with this doc if she is really all over the place. Whether you do anything wrong or not you will get splattered in the mess.

True, if one works at multiple locations simultaneously (hard enough at just one for me).

[sas5814]

On 12/8/2018 at 12:41 PM, rev ronin said:

Interesting.  When I worked at Group Health, I had delegation agreements with my primary SP and an alternate, but would see patients empaneled with any of the 20+ MD/DO PCPs in the clinic if needed, even though most of my work was for one "pod"  I can't imagine the hassle of naming all physicians as alternates...

In Texas (here I go again) you don't have to register all the alternates if it is a short term coverage issue. What short term is has not been spelled out specifically but most folks think of it as 2 or 3 weeks or less. For alternative coverage you just need a simple letter of agreement in your file cabinet somewhere that states who will act as alternative SPs if the primary is gone.

[rev ronin]

7 hours ago, sas5814 said:

In Texas (here I go again) you don't have to register all the alternates if it is a short term coverage issue. What short term is has not been spelled out specifically but most folks think of it as 2 or 3 weeks or less. For alternative coverage you just need a simple letter of agreement in your file cabinet somewhere that states who will act as alternative SPs if the primary is gone.

Yeah, the laws really need to reflect that, in a group MD/DO practice, pretty much any physician can assure care is up to quality standards that the pa is, herself or himself, responsible for maintaining in the first place.