Attention Indiana Psychiatrists:

Although this is not a case involving a psychiatrist, many of you collaborate with or supervise licensed providers such as nurse practitioners and physician assistants. We want to alert you to a case that involves the importance of adhering to state regulations, particularly in a supervisory or collaborative role, and the potential for liability risk despite the absence of a doctor-patient relationship.

In this case, the physician had a contractual relationship, through a collaborative practice agreement, with a nurse practitioner who owned her own medical practice.1 In Indiana, nurse practitioners cannot prescribe a legend drug without a collaborative practice agreement with a licensed physician. According to their agreement, which was consistent with Indiana state law, the physician was to collaborate with the nurse practitioner and oversee her prescriptive authority by reviewing at least 5% of her medical records on a weekly basis. The physician did not fulfill this obligation.

Upon review of some of the nurse practitioner’s notes, the physician determined that the nurse practitioner was prescribing, in excess, narcotic medications. The physician recommended that the nurse practitioner attend a narcotic-prescribing seminar. The nurse practitioner never attended the seminar and the physician never followed-up to ensure that the nurse practitioner abided by his recommendation. The physician failed to evaluate whether the nurse practitioner’s prescribing practices had changed.

A patient was being treated by the nurse practitioner for depression and died as a partial result of mixed drug intoxication. The physician never evaluated the patient and never reviewed the medical records of this particular patient; nor was he required to do so. Interestingly, both the defendant and plaintiff in this case agree that no physician-patient relationship existed between the physician and the deceased patient. The case was decided by the Trial Court and the Appeals Court affirmed the finding that the physician owed a duty to the nurse practitioner’s patients to fulfill their contractual obligations with reasonable care despite the absence of a physician-patient relationship. Certainly, there may be public policy considerations in this case.

The full decision is available online if it is of interest.

Attention Florida Psychiatrists: Another Chapter in the Docs v. Glocks Litigation

A majority of a United States Court of Appeals for the Eleventh Circuit three judge panel recently affirmed two prior court rulings that the Florida Firearm Owners Privacy Act, a state law prohibiting physicians from asking patients about gun ownership, is constitutional.1

Attorneys representing the physicians challenging the laws have twice asked for the full court to review the case, but both requests were pre-empted by the panel’s decision on its own to review the issue. The attorneys acknowledged that they will seek the full court’s review for a third time.2

By way of review, under the Act, Florida physicians may only ask patients about gun ownership/possession if the physician in “good faith believes that this information is relevant to the patient’s medical care, or safety, or the safety of others.”3 Additionally, Florida physicians may not discriminate against a patient solely upon the patient’s exercise of the constitutional right to own and possess firearms or ammunition.4 Psychiatrists are encouraged to consult with their attorney or risk management professional for additional clarification.

Attention South Carolina Psychiatrists

Beginning April 1, 2016, South Carolina will join twenty-nine other states that require physicians or pharmacists to consult a prescription database in certain circumstances. Specifically, South Carolina’s law will require any physician who bills for reimbursement through Medicaid or the state health plan to use the South Carolina Reporting & Identification Prescription Tracking System (SCRIPTS).1 In preparation for the new law, numerous improvements were made to the already existing database. The new improvements allow physicians to register online and set up an account for a delegate, such as a nurse, to run the inquiries. Additionally, the system now summarizes a patient’s prescription history, calculates their daily opioid dose and generates an alert if his prescriptions already exceed the recommended amount.2

Attention Indiana Psychiatrists

  1. John Collip, M.D. v. Vickie Ratts, et al., Court of Appeals of Indiana, Opinion 49A05-1501-CT-1, (2015).

Attention Florida Psychiatrists

  1. Bloomberg News, Pazanowksi, MA., “Physicians Lose Again in Docs v. Glocks Case,” (12/16/15).
  2. Id.
  3. Fla. Stat. § 790.338(2) (2011).
  4. Fla. Stat. § 790.338(5) (2011).

Attention South Carolina Psychiatrists

  1. Insurance Journal, Adcox, S., “South Carolina Prescription Drug Database Mandate to Take Effect April 1,” (1/7/16).
  2. Id.