Provided by:  Jennifer Kirschenbaum, Esq.

May 23, 2023

Hi Jennifer,

A patient died and the police called because a bottle of hydrocodone I had prescribed was in the patient's home. The prescription was warranted.  The patient was suffering severe acute pain from end of life cancer. Do I have anything to be worried about?  How do I know if I am prescribing "too many opioids?"

Thank you. 
Dr. L

Police follow up on a death is routine. With the limited information presented, my instincts tell me your involvement is not totable and any inquiry is likely cursory.  Perhaps the patient medical record will be requested. (Note here, do not release any patient record without a properly executed authorization - government or family issued.  There is no reason to invite HIPAA liability.)  There is not a high likelihood this inquiry will amount to much, but, if you are concerned there may be or you know there is in fact more to the story, do not engage directly and insert counsel now, even for the preliminary inquiry. Round about information access may lead to a licensure review. 

I am not qualified to answer whether you are prescribing "too much" because that is based on medical judgment and each individual patient. I can answer from a macro viewpoint and share a recent US Attorney press release related to overprescribing. Here, a Texas family practitioner plead guilty and has been sentenced to 40 months in prison for "conspiracy to distribute and dispense controlled substances". From 2017 on, the physician's practice prescribed 370,000 dosage units of hydrocodone "outside the usual course of professional practice and without legitimate medical purpose."  The doctor was not in office most of the time - he was traveling - and RNs paid on a percentage of billings were seeing patients and prescribing, and billing directly under the doctor's Provider ID. 

Since the above summary is from the US Attorney press release, only 1 side of the story is being presented. The dosage units of course, are being presented in the US Attorney press release to read as compelling as possible. The incentive comp and use of his Provider ID are interesting factors to consider.  

If you have a concern you are prescribing too frequently and too much, we can help facilitate a confidential assessment of your practice, and assist with development of practice protocols to ensure you are operating appropriately. We can also assist, if need be, in terminating dependent patients. Reminder to always check the Prescription Monitoring Program prior to prescribing, or its equivalent, if you are not in NY.