Prescribe for Family, Friends, or Colleagues? Why Not?

Carolyn Buppert, MSN, JD

Disclosures

April 23, 2018

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

Question

Questions about prescribing are among the most common we receive from advanced practice nurses. A nurse practitioner (NP) with prescriptive authority asked a question we've heard before: how to handle the common, yet sometimes uncomfortable situation when a friend or colleague asks for a prescription. The NP added:

It might be a refill for a medication they are already taking, or it might be a new prescription for a medication they've taken before, like an antibiotic for a new sinus infection. Is there any problem with this legally?
Response from Expert Carolyn Buppert, MSN, JD
Healthcare attorney

Yes. I am assuming that you are seeing family, friends, or colleagues out of the office. There are problems inherent in writing prescriptions for friends, family, or colleagues, and when they aren't being seen in the office, they are not treated the same as your patients who are not family, friends, or colleagues. Ask yourself:

  1. Are you conducting and documenting an evaluation? If you haven't taken a full history, performed an appropriate examination, and documented what you have done, you aren't following the standard of care.

  2. Are you going to follow up with the family, friend, or colleague just as you would with a patient you see in the office? If not, you aren't meeting the standard of care. If the individual has a bad outcome, the individual can sue you for malpractice, and you won't have a strong defense. And it is unlikely that your insurer would cover you.

  3. Have you communicated with the individual's primary provider? Did you send the primary provider your documentation of your evaluation and treatment? If not, you are leaving the primary provider out of the loop. Perhaps that provider had a plan to wean the patient off the medication. Perhaps the provider would not opt for an antibiotic. It is reckless and inconsiderate to intervene in the care provided by someone else without the other provider's knowledge and approval.

  4. If you don't have full practice authority in your state (meaning, you need a collaborative agreement with a physician in order to practice), then prescribing outside of the practice environment for individuals who aren't registered with the practice is unlikely to be authorized by your collaborative agreement. If that is the case, then you don't have the legal authority to prescribe for family, friends, or colleagues.

  5. What prescription form are you using? If you are using your employer's prescription blanks but you are treating patients who are not enrolled with the practice, then that could be considered fraud.

  6. If you prescribe a controlled drug for a family member, friend, or colleague, you are at risk of being accused of diverting controlled drugs or, at minimum, inappropriate prescribing. You won't have a strong defense.

An NP recently lost her license for prescribing for family, friends, and colleagues, and then a prosecutor charged her with reckless endangerment. Don't risk that. It won't help you to argue that you were just trying to be helpful.

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