Patient asking for child's antipsychotic medication from another state

[Tuxedo]

I will refill over the phone once, maybe. More likely if prior doc left suddenly. With that refill I tell them to make an appointment. If they don't attend that appointment we are done.

If their doc gave them a heads up about her departure and family "had other priorities" and did said family did not make arrangements they likely will need to attend an appointment before I could consider refilling.

I am always amazed at how the number of doses left changes over multiple back and forth phone calls on the same day. "He's out." "He only has two pills left and then he is out." "He's been taking his dad's med but now dad is going to run out early if we dont get a refill."

I can squeeze anyone in the same day. Families who really need the med make it happen and are grateful.

[CordMcNally]

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.

I'm glad you ended up doing what you feel most comfortable with. I will say that typically the best way forward is to end the conversation/interaction then when you've announced you decision in these situations. Nothing good comes from continuing the conversation/interaction.

[VentAlarm]

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.

You’re a better man (or woman) than I. I’d of said “nope, not licensed in that state. Can’t practice medicine without a license.” Click.

Maybe this is why I treat people on ventilators.

[eyecandy]

legobikes I think you did the right thing in the end. I also try to be helpful to known patients esp when moving because I know it can be hard to find docs in short order. But here's my real question - why are you even spending your valuable time talking on the phone to this person who is not your long-term established patient? This would go 100% through my technician, decline and all. Your time is precious and shouldn't be wasted.

[Hank]

The title of this topic is inaccurate. First, this person isn't your patient. Second, it's the parent of someone else's patient who is asking (cursing and demanding?) that you practice medicine without a license in another state. Hard pass.

[G]

threatening me with a lawyer

you left that out of the initial post. your approach: no refill, no conversation, CPS referral. for me in the ER: 30 days, no conversation, CPS referral.

[Kamban]

The moment any patient even hints of a legal action they have lost all sympathy from me.

I document and will send a 30 day discharge notice. In youe case it is not even your patient so I would not even worry about cutting off completely with no notice.

[Hank]

you left that out of the initial post. your approach: no refill, no conversation, CPS referral. for me in the ER: 30 days, no conversation, CPS referral.

Who is your patient and who is not your patient? What do you need to do to obtain your medical license and what must you do to retain your medical license?

This isn’t even a matter of whether you’re trying to be a jerk or not. You don’t have a medical license in this other state. Almost certainly you haven’t registered with the federal DEA to prescribe controlled substances in this other state where you don’t have a medical license.

You are a mandatory reporter. Here is a custodial parent with a psychotic child. The parent refuses to get a doctor’s appointment for necessary medical treatment and isn’t treating the child’s ongoing severe mental health needs. Yep, that’s worth a call or two to CPS, if only for CYA.

[AR]

Is this whole "can't practice medicine in another state" only an issue because OP never saw the patient in the office himself?

Forget this case for a second. Imagine a patient that you've seen many times calls you from out of state for a refill to keep them from running out until they return to see you (which you are confident they will do). Is prescribing that practicing medicine in another state?

[legobikes]

Yeah 'patient' in the title of the thread was a slip. I meant to put 'parent'. As far as that child being my patient - well the kid was in the same practice, i.e. a patient at the same clinic I am employed at. If I had never prescribed the patient anything it would be easier to refuse now. On the other hand, the parent twice not showing up also made it easy to refuse.

eyecandy they worked their way onto my schedule as a tele visit.

I'm glad you ended up doing what you feel most comfortable with. I will say that typically the best way forward is to end the conversation/interaction then when you've announced you decision in these situations. Nothing good comes from continuing the conversation/interaction.

Yes you're right, but it goes back to trying to really consider the truth of the situation. I don't mean just the facts, but what is fair. Even though the were cussing and uncivil, I was willing to hear them out to see if they could make enough of a case for themselves.

Kamban said a patient loses all sympathy if they're threatening a lawsuit, and from my perspective I guess what the patient loses is my willingness to go with the spirit instead of the letter - to make allowances. Because it tends to be easier to just go by the book, but I try to be vigilant about sliding into the sort of state where I might not balance what is just and what is merciful. In this particular situation the more this person alternately ranted and cajoled, the more objectively I felt I saw them. They might be a bit borderline, they might be shirking - or skirting - responsibility to some degree, but I didn't feel they were much worse than many other parents who have not landed in whatever situation was in this person's sob story. They were fooling themselves as much as they were trying to fool me. If I can see that much, then I am obligated to be 'the adult'. This person piled on all kinds of insults, and played up how they were the victim and how I would be responsible for 'anything happening' to their child. It just slid off my back. What was decisive to me, however, apart from all these considerations, was the simple fact that there was no satisfactory answer to 'what happens when you run out next time?'


Edit: Also interested in the answer to the whole 'out of state' question.

[G]

Who is your patient and who is not your patient? What do you need to do to obtain your medical license and what must you do to retain your medical license?

This isn’t even a matter of whether you’re trying to be a jerk or not. You don’t have a medical license in this other state. Almost certainly you haven’t registered with the federal DEA to prescribe controlled substances in this other state where you don’t have a medical license.

You are a mandatory reporter. Here is a custodial parent with a psychotic child. The parent refuses to get a doctor’s appointment for necessary medical treatment and isn’t treating the child’s ongoing severe mental health needs. Yep, that’s worth a call or two to CPS, if only for CYA.

Maybe you're misreading my tone or vice versa. Op should cut off immediately, particularly with that new info. The first post asked what I'd do in ER. In ER, if I pick up the chart, it's my patient, so I refill and call CPS. (CPS will still need meds)

It sounds like the parent has a personality disorder, blended with good ol American entitlement.

[Lordosis]

I would refuse on this particular case for the many reasons stated above.

But as for prescribing on another state that is no big deal. I do it all the time for the Florida snowbirds. I am not sure about controlled substances because I really do not deal with too many but in this case I did not hear that it was a control.

[Lithium]

So you are a practicing physician in Kansas City, MO. Your established patient calls you with a question from Kansas City, KS where she lives and you render medical advice. You have a license in Missouri, but not Kansas. Is this practicing medicine without a license?

[Sigrid]

Or you see the patient in Kansas City, MO and write a prescription and the patient fills it in Kansas City, KS. Now I'm really curious about the answer to this question.

[StateOfMyHead]

The title of this topic is inaccurate. First, this person isn't your patient. Second, it's the parent of someone else's patient who is asking (cursing and demanding?) that you practice medicine without a license in another state. Hard pass.

It is OP's patient the minute they take on their care, via an office mate which is lousy but OP's patient none the less.