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Patient asking for child's antipsychotic medication from another state

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  • #31
    Technically you are supposed to prescribe medications only in the state(s) where you hold medical license. But most pharmacists will accept prescriptions for non-controlled prescriptions in the state you are not holding a license provided it appears kosher ( your previous patient who is vacationing or moved and has yet to find a physician). I use e-prescribe or my DEA in such instances.

    The problem here is the various risks the OP is getting into.
    1. Getting sued in case something goes wrong.
    2. Getting into a long term prescribing without establishing a direct patient care in the first place.
    3. Not having a end plan and just going with one more prescription and one more ..... Just like the loan forgiveness we talked about, the longer you let something slide the more difficult it is to get back on track and play by the rules.
    4. Risk of censure by the state licensing boards and jeopardizing the license in case something goes wrong with the patient or the parents complain to the licensing authorities.

    One prescription is fine. The second one with a warning to find a local prescriber is the max I would do.

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    • #32
      Originally posted by StateOfMyHead View Post

      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.
      Yes, the OP's patient but only if they come to the clinic in that state. If both the original prescribing physician and the patient and his/her parents have moved out of state, they are no more his patients.If the patient wants to come every 3 months to the OP's office to be seen but live the rest of the time out of state that would be acceptable.

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      • #33
        Sounds like the parent probably more the problem than the "autism." Not uncommon..

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        • #34
          Originally posted by Lithium View Post
          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?
          Originally posted by Sigrid View Post
          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.
          I know several people that have or are currently practicing in areas that border two states. There has never been an issue with prescribing medicine in one state and it getting filled in the other even though the physician doesn't have an active license in that state.

          It isn't unusual for this to be the case. Kansas City, St. Louis, Memphis, Texarkana, Bristol, Augusta, Fargo, etc.

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          • #35
            i'm not a legal expert but i don't think you need a state license to rx meds in that state, might be different for controlled.

            as others have said the STL/KC thing is pretty obvious.

            i'm probably a bit more generous than some with ED refills of meds. it's hard to get into doctors sometimes. and for a lot of stuff there isn't much magic about a visit other than a very understandable source of revenue for the doc.

            antipsychotics for a kid w/ autism would make me a little nervous tho.

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            • #36
              Originally posted by CordMcNally View Post



              I know several people that have or are currently practicing in areas that border two states. There has never been an issue with prescribing medicine in one state and it getting filled in the other even though the physician doesn't have an active license in that state.

              It isn't unusual for this to be the case. Kansas City, St. Louis, Memphis, Texarkana, Bristol, Augusta, Fargo, etc.
              This is what I thought, but at the same time I hear a lot of screeching about how it's practicing without a license to prescribe medicines to someone if you're not licensed in that state. I've looked to try to find statutes that address this but always comes up empty. I have no control over where patients are when they call me or where they take paper rx's to be filled, and it's not as if we don't have enough liability to worry about already.

              I know that controlled substances are a whole different kettle of fish.

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              • #37
                So if, hypothetically, we told the patient in the OP that we can't help them only because it would be 'practicing in a state we aren't licensed in', would that be a true or false statement?

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                • #38
                  Originally posted by Lordosis View Post
                  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.
                  We should start a new topic. Opinion on this? Lawyers and insurance say no not ok. Do people do it?

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                  • #39
                    Originally posted by AR View Post
                    So if, hypothetically, we told the patient in the OP that we can't help them only because it would be 'practicing in a state we aren't licensed in', would that be a true or false statement?
                    That's a gray area. I think it's better to give the actual reason why you aren't 'helping' them instead of hiding behind something out of your control.

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                    • #40
                      Originally posted by beagler View Post

                      We should start a new topic. Opinion on this? Lawyers and insurance say no not ok. Do people do it?
                      All the time.

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                      • #41
                        I've done it and I really doubt that by itself, sending non-scheduled meds out of state for an actual patient is at all problematic.

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                        • #42
                          Originally posted by CordMcNally View Post

                          That's a gray area. I think it's better to give the actual reason why you aren't 'helping' them instead of hiding behind something out of your control.
                          Yeah, I agree with second sentence, but I'm not that interested in this specific case. I'm interested in the more general question of what qualifies as practicing medicine out of state. It's clear that it is gray to us, but I can't tell if that because no one really knows or if because the law itself is not clear.

                          There are all sorts of related issues that come up. For example, I occasionally take patient calls when I'm traveling out of state and the patient is in the state. What about that?

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                          • #43
                            Originally posted by AR View Post

                            Yeah, I agree with second sentence, but I'm not that interested in this specific case. I'm interested in the more general question of what qualifies as practicing medicine out of state. It's clear that it is gray to us, but I can't tell if that because no one really knows or if because the law itself is not clear.

                            There are all sorts of related issues that come up. For example, I occasionally take patient calls when I'm traveling out of state and the patient is in the state. What about that?
                            I don't think it's ever really been brought up because it really isn't a big issue.

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                            • #44
                              Originally posted by CordMcNally View Post

                              I don't think it's ever really been brought up because it really isn't a big issue.
                              Yeah, I'm not afraid of doing it. I am quite curious about what the correct answer is, though.

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                              • #45
                                Originally posted by AR View Post

                                Yeah, I'm not afraid of doing it. I am quite curious about what the correct answer is, though.
                                I can only speak towards an ED viewpoint but I see no difference if a patient I see and write a script for fills the script in the same state or drives two states over to fill it. Just like when I see someone who is from out of town and is traveling back home and chooses to fill their script back home. I don't write for a lot of narcotics but I've never had any issues. I imagine the issues arise when you start writing narcotics for patients you don't have an established relationship with. I also suspect it's irrelevant if the physician/patient are in the same state or not in that situation.

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