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ephman55

Signing an NPs charts?

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Started working at a men's hormone clinic...yup TRT. I love the job, very low stress compared to my orthopedic days. 

We have 2 clinics, I oversee mine. The other is overseen by an NP. Colorado law states NPs cannot distribute medications for patients to take with them. That can only be done by MDs or PAs. So the owners have asked me to sign off on the charts at the other clinic when the patient takes his shots with him to administer at home. 

I am very wary of this. I have never physically seen these patients. I have no say in how they are managed and I am not notified if there are issues. I have already found some glaring problems with how the NP is managing things. 

What do you all think? Is it illegal to sign someone else's charts? It seems to me I would be opening myself up to some liability by doing this. 

 

 

Edited by ephman55
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1 hour ago, ephman55 said:

Is it illegal to sign someone else's charts?

If you mean signing off as in you did the work...absolutely illegal.  You aren't doing the evaluation and the point of you signing off is stating that you have done the work to bill the insurance AND the treatment is YOUR plan.  If you mean co-signing, similar to what an MD/DO does with PA/NP then that would depend on your state laws.

 

1 hour ago, ephman55 said:

It seems to me I would be opening myself up to some liability by doing this. 

Assuming that signing or co-signing the chart is legal (questionable at best), then at a minimum this is true.  Again, by putting your name on the chart you are signing off on the history, ROS, PE, and Assessment/Plan.  If there is a bad outcome you definitely would be party to any malpractice lawsuit and likely as an "over-signer" (made that one up) would be the main person targeted.

 

Bottom line from my perspective, I would not do this...hard stop...end of story.

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If one of the NPs patients gets prostate, liver, or breast cancer, let alone polycythemia, MI, or stroke and your name is associated with it you'll be named in the litigation.  Honestly if I was a medical malpractice lawyer, I'd have ads on TV targeting low-T clinics.  If the NP didn't disclose all risks/benefits or if she was targeting a testosterone level that's beyond what most urologists/endocrinologists consider standard-of-care for TRT then you'll have to settle.  As you're not a collaborating or supervising physician and not the owner of the clinic, you really should strive to keep your name off the NP's charts.  Not to mention you feel the clinical decision making by the NP is dubious.  

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1 hour ago, ventana said:

get the clinic to fire the NP and hire a PA

 

Nope no way I would sign their charts

They employ and MD and this is their roll

Your blunt candor is equal parts entertaining, refreshing and downright cutthroat. 

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On 12/4/2019 at 8:40 PM, Sed said:

Your blunt candor is equal parts entertaining, refreshing and downright cutthroat. 

said to provide levity and to make a point...

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I agree with all of you. Looks like my time here is going to be short. I am refusing to sign any more charts at this point. 

I was a major sceptic of TRT for many years but after working in the field for a year I have been converted. There are many men who desperately need this treatment and are turned away by their PCP. I have seen it make a major difference for so many of my patients. 

 

 

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Not unlike other comments, unless you actually see the patient and know the problem, you would be a damn fool to sign her or his charts. Listening to this you can see why physicians dislike the idea of signing our charts . As a caveat, For one year I was the Manager of Operations for Minute clinic on Long Island, NY. After that time , they discovered that NYS law says that a PA cannot supervise an NP. I was moved to headquarters and became a Regional Training Manager. My job soon was eliminated as I differed on my opinions of good medical care in such areas as if they should do sports physicals. Bad experience and potentially a worse experience for you if the initial exam was substandard and you take the blame. check your state laws.

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I agree with all of you. Looks like my time here is going to be short. I am refusing to sign any more charts at this point.  I was a major sceptic of TRT for many years but after working in the field for a year I have been converted. There are many men who desperately need this treatment and are turned away by their PCP. I have seen it make a major difference for so many of my patients. 

 

 

 

Off topic but regarding TRT:

 

The key term in TRT is "REPLACEMENT" but some pts want above NL levels so they can juice up. I used to be an HIV specialist and had many pts with Low T because of the virus or their meds. I REPLETED a lot of pts and kept them at NL levels usually with topicals that prevented peak and trough effects. A few wanted to get juiced but I would educate them and tell them I was not there for them to look like an Adonis but to restore normal testosterone levels. I would routinely check T levels and adjust the dose or hold med if they were too high. The topicals were good for this if they stayed within the dose. If a Pt was on injection then I switched them to gel, some would complain because they don't get that initial boost from the injection (which usually comes because they were in a trough level the few days before the next injection) but they would not have the trough effect either so I would educate them on why they don't get the "testosterone high."

 

Sent from my SM-G975U using Tapatalk

 

 

 

 

 

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I would not do this.  I'm in Pennsylvania, and PAs here can't write for more than a few days of Sch IIs.  Back when I was practicing in surgery, and a patient required a script for longer, the group said the NPs (there were 2 of us) would help the physicians and write the scripts for the PAs - even if it was a patient we weren't involved with at all.  We refused.  The surgeons were the supervising physicians.  Not us.  That is their "burden".  

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