Patient asking for child's antipsychotic medication from another state

[legobikes]

Child with autism put on antipsychotic by colleague, seen twice, ever. Colleague leaves, I refill over the phone twice, both times asking that parent come in for next appointment in person. Parent now in another state, 4 months after last refill, asking for refills.

I'd rather not fill an antipsychotic medication which requires follow up, that I did not start in the first place, for a patient I have never seen, who is no longer local. I am also skeptical how hard parent tried to get patient in to a doctor, but they say they have an appointment next month, yet not sure if they can have the child seen, no insurance, and asking for 3 months of refills. (I looked at their address and they have free clinics in the area.)

Assuming the parent is truthful and the patient has been taking medication this entire time, what would you do, and my other Q: do EDs fill medications - antipsychotics - for little kids in (supposed) emergencies?

[G]

In the ER, for this situation, I would write for 30 days. I get it that life happens and people move and getting a doctor is difficult/expensive/labor intensive.

Depending on parental demeanor and the overall sassiness of my day, I'd also point out that if they don't get their kid plugged in immediately, that they should expect a visit from CPS.

[Craigslist]

If they have an appointment in a month, write it for 30 days. then note it and don't do it anymore.

[Sampter]

They didn't come in for an appointment when you asked twice and you have never seen them and is a dangerous medicine class. I would deny it and recommend seeing acute care/free clinic locally ASAP. Doubt they have an appointment arranged, they are trying to see how far they can go before having to see one.

[CordMcNally]

You've already gone above and beyond for them. I think you've correctly assumed this wouldn't be the last time you'll hear from them if you continue to write the script.

In the ED, I would fill a month's worth in this case (new to the area, etc.) assuming the dosage seemed appropriate based on Epocrates or another resource.

[VentAlarm]

Are you licensed to practice in that state?

[legobikes]

Are you licensed to practice in that state?

Nope.

[VentAlarm]

Nope.

That’s enough for me to pass.

[StateOfMyHead]

Write another 30 days, document risks v benefits due to vulnerable patient that mother understands this is the last refill, need for antipsychotic protocol labs if 2nd generation and turf to your social worker to assist mother in securing an appointment at new location.

[burritos]

1. They're being lazy for not getting another PCP
2. They don't have access(not enough money, not the right insurance, PCP's in the area not accepting new patients)

Does it matter if it's 1 or 2?

[legobikes]

I mean, yeah, to me it does matter whether this is a genuine issue, and I hate sending people to the hospital and I'm usually quite understanding about obstacles to access.

At the same time I don't believe the story. Last refill 4 mos ago for one month, parent says they had enough to last til now but running out this week, which seems very unlikely, they started right off the bat with threatening me with a lawyer for questioning their story, called the workplace and spoke to the office supervisor, story changes regarding when they moved, etc. I spoke to my CMO and he said essentially it was at my discretion.

I think if they have an appointment that can be confirmed I will send them enough medication to tide them over, otherwise, ask them to go to the hospital.

[FIREshrink]

You can make an argument either way. Do what you think is right, document your rationale.

[Sampter]

I mean, yeah, to me it does matter whether this is a genuine issue, and I hate sending people to the hospital and I'm usually quite understanding about obstacles to access.

At the same time I don't believe the story. Last refill 4 mos ago for one month, parent says they had enough to last til now but running out this week, which seems very unlikely, they started right off the bat with threatening me with a lawyer for questioning their story, called the workplace and spoke to the office supervisor, story changes regarding when they moved, etc. I spoke to my CMO and he said essentially it was at my discretion.

I think if they have an appointment that can be confirmed I will send them enough medication to tide them over, otherwise, ask them to go to the hospital.

So, they are also non-compliant (non-adherent if want to be PC) and also threatening you with a lawyer? You are still even considering writing a script?

Fool me once shame on you, fool me twice shame on me, fool me thrice?

[Lordosis]

So, they are also non-compliant (non-adherent if want to be PC) and also threatening you with a lawyer? You are still even considering writing a script?

Fool me once shame on you, fool me twice shame on me, fool me thrice?

Strike 3

[legobikes]

Update: I declined. I got a very long sob story, interspersed with cussing and insults, but got hung up on when I asked what would happen a month down the line when the refill had been depleted.