PAINKILLER LAW: Physician (and Physician’s Assistant), Heal Thyself

Recent Texas Medical Board actions bear mention just before the holidays, and are of particular interest to physicians’ assistants and their supervising MD’s or DO’s.  The TMB just handed down license revocation/suspension penalties against three PA’s and their supervisors, in cases of alleged “pill mills.”  Either the PA was accused of inappropriately prescribing, or the supervisor accused of inadequate supervision, or both.

Head into 2013 with the following tips in mind, if you work in a clinic or medical group that could, by virtue of its very existence, become a target of official inquiry:

For PA’s:

1)   Make sure your Delegated Services Agreement is up to snuff and up to date. Check with your state’s licensing authority as well as professional advocacy organizations or statewide trade groups to make sure the language of your DSA complies with the law of your state, and with federal law.

2)  DEA Number:  If you are authorized to write scrips, are you DEA-current?  Expiration dates can sneak up on you.  Whether you or the office staff keeps track of these matters, give it a year-end check just to be sure.

3)  Is your supervisor actually doing his or her job of reviewing your files at least as often as required by your state’s law?  In California, a supervising MD or DO is supposed to review all PA files every 7 days, especially when Schedule II – V prescriptions have been written.  If you don’t think your supervisor is in compliance, get on him or her to get with the program.  If they balk, weigh your options and always err on the side of staying in compliance with the law, whether it’s at that clinic/office, or another one.

For Supervising MD’s/DO’s:

1.   Don’t fall short in checking charts regularly and thoroughly.  If you are not in compliance with this basic requirement of PA supervision, achieve and maintain compliance immediately in order to (a) ensure patient safety, (b) be a helpful and responsible employer who invests in your employees, and (c) take an easy “find” away from investigators should you come under official scrutiny.

2.   Chart it, chart it, chart it.  Make sure charts are up to date with any advice/feedback/correction given to a PA by you upon chart review.  Again, patient safety will be enhanced, and regulators and investigators will see your diligent efforts to comply and properly supervise.

3.   Make sure your office’s and staff’s efforts and procedures for utilizing your state’s Prescription Drug Monitoring Program are current, understood and practiced every day.  You can’t catch every doctor shopper, and to be sure, PDMPs’ technology leave a lot to be desired, but you still need to do all you can.

4.    Create and nurture an environment of collaboration and communication with PA’s in your office, on all subjects of patient care but especially about Schedule II through V prescriptions.  A culture of candor and compliance is readily apparent to an inspector, investigator, regulator or law enforcement agent.  There are lots of ways to this, but it all starts with office culture, and that starts with you.

And with that, friends, Merry Christmas, happy holidays, happy new year to everyone, and PAINKILLER LAW will be back after January 1.


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