There’s a rumor going around town. A new drug dealer has moved in. You soon find out… the rumor is about you. You are the new drug dealer in town. How? Let’s find out.
It is important that dentists know and understand that issues related to controlled substances can be quite devastating. I will demonstrate. First, a few questions:
- Are your prescription pads and sedation drugs maintained under lock and key at all times? Who has access to them? If you print prescriptions using your dental software what safeguards do you have to prevent your employees from printing forged prescriptions? While they may be liable for forging prescriptions you may be liable for failing to limit their opportunity to do so.
- Do you or have you any written prescription to any person other than for patients of record and only for dental purposes?
Warning: The names in the following scenario have been changed to protect the innocent. All suspects are innocent until proven guilty, which doesn’t take much depending on your political, professional and personal affiliations, financial status and likely other factors, which (frankly) we will not discuss.
Dr. Jones wrote a prescription to an employee for an antibiotic one morning after she arrived at the office complaining of having a kidney infection. She told you she gets them frequently and neither of you can afford for her to take time to go to her family physician, so you write her a prescription for amoxicillin. Your employee runs next door to the pharmacy. She gets the prescriptions filled and returns to the office to assist you with a busy day.
A month later the same employee is caught filling a forged prescription for hydrocodone. The pharmacy called to verify the prescription and you just happen to intercept the call from the pharmacist. It turns out this employee has been calling in prescriptions for herself during much of her three year employment with your practice without your knowledge. She is your trusted assistant and handles much of your business including preparing your patients’ prescriptions in your dental software. Had you checked your software you would have seen that she blatantly wrote prescriptions for herself and her boyfriend.
You realize that you have no choice but to terminate the employee and swiftly do so. A few weeks later she files an unemployment claim and a complaint with the Board of Dentistry that you write unlawful prescriptions. You deal with the Labor Board over the unemployment claim. Win, lose or draw there is no real winner because you still have to answer to the state board about the allegation of unlawful prescribing practices.
A quick check of your state’s Prescription Monitoring Program (now available to dentists in almost every state) shows you have written prescriptions (perhaps one or two) to your spouse, but it shows you have written many to the employee who filed the complaint. The employee was a patient of record. Your record does not (cannot) account for every prescription filled for the employee.
LET’S BREAK IT DOWN
- Regardless of the number of prescriptions you have written to patients or non-patients there is evidence you wrote at least one for non-dental purposes and you are guilty of a crime.
- Unlawful prescribing (controlled prescription drugs or otherwise) is a crime punishable by fine and/ or imprisonment.
- Unlawful prescribing (drug diversion) is also violation administrative rules of the Drug Enforcement Agency, your state controlled substance authority (if applicable) and the Dental Board. Those agencies communicate with one another and each can discipline a dentist independently for the same (one) violation.
- Fines typically range from $20 (Louisiana Dental Board) to $10,000 per violation this can add up in a hurry, especially when compounded by each agency’s fine structure.
- In these situation dentists may (likely) lose their authority to write prescriptions or utilize controlled prescription (sedation) drugs in the course of their practice of dentistry.
- Disciplinary actions are reported to the National Practitioner’s Data Bank (NPDB). Liability insurance carriers tend to drop dentists from their policies for being what they consider ‘high-risk’. There are high risk insurance carriers that will gladly charge you between $10,000 and $30,000 (more likely more) a year for liability insurance. In states you can practice without liability insurance, but that’s just foolish. Why would you do that?
- Many dental services organizations and hospitals check the NPDB prior to employing or credentialing dentists or extending dental privileges.
You can clearly see how one issue can throw your dental career off course, way off course. Compliance should not be something that makes you cringe but something that you appreciate like an attractive lifeguard at the beach. The compliance lifeguard for you and your practice has an important job in making sure the issues I have just described (and many others) do not happen to you or within your organization. Your patients depend on your care. Your employees depend on you for their continued employment. Your family depends on you to provide for their lifestyle.
Your efforts toward compliance with these and hundreds of other rules and regulations you have to follow are as optional for you and your decision of whether to come to a complete stop for a stop sign. Should you decide to roll the stop sign California-style and you get caught you will suffer the consequences. The stakes are high for you. What will you decide for your practice and your career?
Be well. Do good. Be blessed.
Dental Compliance Specialists helps make dental offices safer for patients, dentists and their employees. We help our clients develop and maintain their compliance programs including OSHA/Infection Control, HIPAA, DEA regulations and prescribing practices, Radiation Safety, OIG/Medicaid Compliance, Record Auditing, and more by providing actionable systems, easy-to-use tools, robust training, and accountability. Most of our clients have never been in trouble and want to keep it that way. Sometimes, though, dentists call when they are in trouble. In either case, we are there to make a meaningful difference. If you need help call us at 817-755-0035.
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