What Should I Do When a Patient Lies to Me About Drug Use?

Carolyn Buppert, MSN, JD

Disclosures

August 31, 2016

To submit a legal/professional nursing question for future consideration, write to the editor at syox@medscape.net (Include "Ask the Expert" in subject line.)

Question

What Should I Do When a Patient Lies to Me About Drug Use?

Response from Carolyn Buppert, MSN, JD
Healthcare attorney

After we posted an Ask the Expert column about a forged prescription, a nurse practitioner wrote in with another conundrum involving a dishonest patient:

I discovered that a patient I had been seeing for slow detoxing from an anxiolytic lied to me about her use of benzodiazepines. I discovered on the prescription drug monitoring program (PDMP) website that she was obtaining the drug from which I was tapering her, from two or three other physicians, using insurance and cash to pay for them at three different pharmacies.

What is my legal obligation? Is this something that should be reported to the police? The action I took was to notify the other physicians and post an alert on the PDMP. This patient left my practice when I confronted her with this and expressed her desire to be admitted as an inpatient for detox.

You did the right thing. You can't report this patient to the police; that would be a HIPAA violation. HIPAA limits a clinician's authority to communicate patient information to what is needed for treatment, payment, and healthcare operations. Reporting to the police does not fit with treatment, payment, or healthcare operations.

There are exceptions to HIPAA privacy requirements, but to qualify for an exception, the patient has to be a serious and imminent threat to him- or herself or others. These facts are serious but there is no imminent threat. Also, it is not clear that the patient has committed a crime. Lying to a healthcare provider is not a crime. One could argue that the patient obtained the prescriptions by fraud, but that would be difficult to prove. Filling a prescription is not a crime.

You acted appropriately by notifying the other prescribing clinicians. That is related to treatment, so it would be allowed by HIPAA. And you appropriately terminated your service to the patient and referred her to an appropriate service. You have no obligations or legal responsibilities to do anything other than what you have done.

This case points out the importance of developing a contract with a patient before prescribing controlled drugs and the importance of PDMPs. Before prescribing opioids or benzodiazepines, have the patient sign an agreement with the following provisions:

  • To set goals of treatment (specify the goals);

  • To obtain prescriptions only from you or your substitute at the practice;

  • To use only one pharmacy;

  • To give you 72 hours' notice before refills are needed;

  • To be honest about symptoms, side effects, dosing, effectiveness, and other medications or street drugs being taken;

  • To safeguard the medications (keep away from family members or visitors);

  • To submit to urine drug screens; and

  • To agree that the prescriptions are a trial, that the clinician does not agree to continue to prescribe the medication indefinitely, and that the clinician may discontinue the medication at the clinician's discretion.

Here are links to sample contracts between patient and clinician:

Through state PDMPs, clinicians can find out which providers are prescribing for a patient, the medications being prescribed, and where the patient is filling prescriptions. (However, note that methadone programs do not report to PDMPs.) Recently, several states have enacted laws requiring prescribers to check the state's PDMP before prescribing controlled drugs.

For laws about PDMPs, visit these questions and answers from the Drug Enforcement Administration. State-by-state reporting requirements and exemptions are found here.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....