Rxs when a patient is away from home
Q: A patient I saw recently in the office called me from out-of-state, when she was on vacation. She'd misplaced her blood pressure pills and wanted me to phone in a refill to a pharmacy near her. I'm not licensed in that state. Am I at any legal risk if I comply? In general, should I prescribe medications to patients who become ill while on vacation?
A: Refilling the blood pressure medicine shouldn't be a problem since this is an established patient on a longstanding regimen and you've recently examined her. Question the patient to find out whether there have been any changes in her condition or if there's any other information you'd need to know. When you phone in or fax the refill to the out-of-state pharmacy, make sure to provide your Drug Enforcement Administration number.
Enforcement of out-of-state prescribing is generally left to the individual states. If the patient is in a state where you don't have a license, you could be prevented from prescribing certain types of drugs, such as controlled substances. But there's generally no problem for routine medications.
You can get into legal trouble, though, if you try to be too accommodating or don't ask enough questions. Suppose a patient calls from another state and complains of a cough and sore throat. You might think you're doing him a favor by prescribing antibiotics and cough medicine. But then, say, the patient winds up hospitalized for pneumonia. You can just see the elements of a potentially valid malpractice claim taking shape because you prescribed without examining the patient.
Whenever you receive a call from a vacationing patient, use your best judgment to assess the degree of medical urgency. If the drug the patient needs refilled could have severe side effects or the patient's health is precarious, instruct him to see a local physician or go to the emergency department. Advise him to go directly to the ED if you have any concern that he could be in a seriously compromised condition.
Medication-related malpractice claims can often be averted by careful documentation. Always chart every medication you prescribe, all authorized refills, and the date, dosage, and how it's to be taken.
If you prescribe any medications over the phone, you should discuss in detail the patient's symptoms, the possible treatment options, and instructions on how to take the drug and when to call you if there are problems. Get and document informed consent when prescribing medications with potentially significant complications and side effects. Get specific drug allergy information for antibiotics, nonsteroidal anti-inflammatories, anticonvulsants, and diuretics.
You should also follow up with the patient to monitor for drug side effects. Ask the patient to call you to report at a specific time, and get the patient's phone number so you can call if the problem is serious.
Finally, consider ordering only a short supply of the medication. And have the patient make an appointment to come in as soon as he returns home.
The author, who can be contacted at 2402 Regent Drive, Mount Kisco, NY 10549, or at firstname.lastname@example.org, is a health care attorney who specializes in risk management issues. This department answers common professional-liability questions. It isn't intended to provide specific legal advice. If you have a question, please submit it to Malpractice Consult, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. You may also fax your question to 201-722-2688 or send it via e-mail to email@example.com.
Lee Johnson. Malpractice Consult. Medical Economics 2002;19:130.