I really enjoy receiving phone calls from Dentists with questions about how to handle (or avoid) certain situations. This week, in the Dental Compliance Specialists office, I’ve had a few really good calls to share with you. Here’s one to whet your whistle. I’ll share the others later since this one will take some time. Enjoy!
Question: I have a friend who is asking me to write him a prescription for a weight-loss drug. My gut tells me “No!” but my friend keeps nagging me. Can you talk to me about this?
Answer: First, let’s consider this…it may start innocently enough, but where could it end up? Honestly, with all the new laws allowing for licensed personnel to write ‘scrips for medical marijuana where else could this eventually lead? Let’s take a look at the implications more closely:
1. Always trust your gut! In my law enforcement days that “gut” feeling saved my life and I learned to hone into and trust my “gut” with my life (Lord knows, my gut feeling earned my undivided attention, which is a whole other story). Bottom line…your gut is seldom (if ever) wrong!
2. Dentists are subject to federal laws enforced by the Drug Enforcement Administration (DEA). Federal fines and penalties really suck considering they usually start at higher threshold amounts than many state penalties (about $10K). Plus, the feds are not so fun to deal with when you are on the receiving end of the “stick.” Federal law prohibits drug diversion, which is allowing, aiding or abetting the illegal use of prescription drugs.
3. Every state has laws that are more restrictive than federal law when is comes to the use of prescription drugs during the course of your practice as a Dentist. Most states (probably all) only allow Dentists to write prescriptions for patients-of-record and then only for Dental-related issues. Any other use falls into the category of drug diversion.
4. There is a paper trail with every prescription you write. If the prescription is for a controlled drug, then the paper trail includes an entry into a readily-searchable database that you, your colleagues and the government can search to find your “naughty” ‘scrips.
5. Everybody writes a ‘scrip or two every now and again – you know, for a spouse and/or girlfriend for birth control, for Viagra, for a little testosterone, maybe a sleeping pill for the wife, or an antibiotic for an employee who isn’t feeling well. Remember what your mother always said: “Just because everybody is doing it, doesn’t make it less wrong.” Just because other people don’t get busted for it, doesn’t mean you won’t. Let’s say you write a prescription for someone. Later they become angry with you and turn you in. You would have no right to be angry with anybody but yourself when you get in trouble because you gave that person the ammunition to use against you – the silver bullet.
6. Say you DO decide to write a prescription for this weight-loss drug and your friend becomes permanently ill or dies. Can you guess who is on the hook for criminally negligent homicide (or worse)? I can tell you in about two seconds how much legal representation you will get from your liability insurance carrier for this crime – ZERO! Malpractice is one thing, but when you commit a crime…you’re on your own, buddy.
7. When a Dentist or healthcare provider gets into trouble over drug diversion, which is what this issue is called, the provider can get visits from three DIFFERENT agencies:
a) The Ghost of Dentists Past (DEA),
b) The Ghost of Dentists Present (State Agency – DEA counterpart, if there is one in your state), and
c) The Ghost of Dentists Future (Dental Board) who can take away your license.
Dentists can effectively face three separate legal actions for one violation and it would not be double or triple jeopardy because each agency will prosecute or discipline you under their own administrative regulation (or associated law). Each of the agencies can (and do) communicate with one another. Each can levy fines and penalties and can revoke or suspend your authority to write prescriptions for controlled drugs.
The Dental board, as you know, can suspend your license. In the case of a criminal conviction, if you end up in prison, you can kiss your Dental license goodbye FOREVER. The feds have no problem charging Dentists criminally for drug diversion issues. Roll over and place nice? Sure thing! Say they drop their criminal charges, you surrender your ability to write prescriptions or use controlled drugs in the course of your practice and then they may settle with you for “just” Civil Monetary Penalties in the six-figure range.
I was involved with the Department of Public Safety and the DEA on some Drug Diversion cases. They are super-simple cases to work because the Dentists provided all the evidence! All investigators have to do is log-in to “the system,” save the paper trail and write a warrant (there are a few other steps, but they’re not important).
I know, you’re not a common, street-level, drug dealing thug. And before you even go down the “But, I’m licensed and authorized to write prescriptions” path…ask yourself, is it worth all THIS just to do a friend a “favor” and write a prescription you should not write? No matter whether you’re doing business in an upscale office park or in the sketchiest part of town on a street corner, it’s all illegal! So, how would YOU answer this Dentist’s question?