Scared of being successfully sued

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So, I am still a bit irritated and anxious at what just happened the other day. Without violating HIPAA,

I am an NP and was having a phone consultation with a patient that wanted a refill on a benzodiazepine since the coronavirus case had cause our clinic to close temporarily and to operate on telemedicine.

That person has a hx of drug abuse and has been clean for a year and was receiving this benzodiazepine from another provider who also works at this clinic I am at. I saw this patient once and reviewed my prior note and remembered not feeling comfortable sending a prescription for benzodiazepine, but because he has been taking it for so long, the risk of withdrawal was high so I refilled it at the time.

This time, I told them that I do not feel comfortable refilling this med over the phone, and since I cannot evaluate that patient in person, they need to talk to the other provider who knows them more and manages their care more than I do. They got really angry, yelled, and threatened to sue and file grievance. I told them you can say whatever you want, but I am not going to refill your medication.

Did I do the right thing? How likely am I to get sued for this? I already called my manager and they said don't worry, but honestly things like this gets me really flustered

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Specializes in Psychiatric and Mental Health NP (PMHNP).

Sue you for what? They just had a temper tantrum. You did the right thing. The patient needs to talk to their regular provider.

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The chances of you getting sued for not prescribing a benzodiazapene over the phone to a known addict with two different providers in the same clinic (one new the other historically known) during the coronavirus pandemic of 2020 when the whole United States is shut down is probably a no. ?

Curious though, can you call the other provider and possibly come to a resolution since he/she knows the patient better?

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1 hour ago, HiddenAngels said:

The chances of you getting sued for not prescribing a benzodiazapene over the phone to a known addict with two different providers in the same clinic (one new the other historically known) during the coronavirus pandemic of 2020 when the whole United States is shut down is probably a no. ?

Curious though, can you call the other provider and possibly come to a resolution since he/she knows the patient better?

I did actually. I called my co-worker and she phoned it in for the patient, so at the end of the day the patient got what they wanted....

I warned my co-worker tho to still be careful. This patient was on benzos for >1 year which pretty much creates a textbook benzo dependency. I didn't want any part in the management of that patient since I would not prescribe benzos for that long of a duration/

I just hate that feeling of being yelled at, but I refuse to cave in when I know the evidence is against the patient's choice. I'm glad everyone else agrees, but it's still very flustering LOL

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Specializes in Psychiatric and Mental Health NP (PMHNP).

Something to remember if a patient threatens to sue:

The patient must find a lawyer. Lawyers only take cases they think they can win, since most medical malpractice cases are done on contingency. On contingency cases, lawyers only get paid if they win.

With regard to addictive drugs like benzos and opioids, there is a possibility a patient can go through withdrawal, which can be dangerous for some patients. You should be checking your state's database when prescribing these drugs. If the patient has indeed been receiving them on a regular basis, then don't just d/c them or refuse to prescribe them. If their provider works in the same clinic, then for goodness' sake, just ask their regular provider. If that is not an option that can be completed in a timely manner, then you can phone in a small prescription to tide them over until they can see their regular provider.

It is NOT up to you to suddenly d/c someone's medication. If it needs to be d/c, then a taper must be done.

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A few things I would have done different. Since you previously filled these meds, you now technically have a working relationship with them. Under circumstances where there’s a controlled substance I’m uncomfortable with, I heavily impress the side effects of long term use, the alternative medications available, and recommend tapering of these. Sometimes it works. If they don’t choose to, I give them one week supply With a UDS, promise to fill the rest when results are in, and encourage them too follow up with their regular provider. I wouldn’t go so far as to educate the other provider as I’m sure they more than understand the reality of addiction with these meds. Some providers just don’t care or don’t want the fight. If you felt inclined to justify to them your choice then maybe.

You’re never obligated to maintain another providers therapy. But you do have some obligation to reduce the risk of withdrawal. With either a tapered dosing or arranging an alternative appointment. By all intents though, this is a patient in a shared clinic. Presuming you and the other provider are mid levels and your previous history treating this patient, you already own their outcomes. You likely won’t be sued at the end of the day though.

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Specializes in ICU, LTACH, Internal Medicine.

He can threaten you all the way he likes. His chances to even get it to some degree of legal movement, providing will be HIS business to secure legal representative (read: to tell a lawyer the whole truth and nothing but it vs. to lie and then let the lawyer to discover it all including history of abuse) are nil and zero.

Next time:

- never cave for yelling/pleading/forcing/etc. of absolutely nobody telling you something along the line "it is YOUR patient!". "This gentleman/lady sees Dr. X., only Dr. X. can write his scripts and I cannot do it over his head", repeat as needed ad nauseatum.

If the Dr. X. is sick/on vacation/otherwise not available, then it is HIS business to arrange for cross-coverage. The policies for this should be in place in every practice. Until Dr. X. personally tells you to cover for him for certain dates and approves you writing scripts for controls and you have his written note stating this, you do as above and nothing else.

- please let this provider about patient's behavior STAT so he could consider firing the patient as soon as possible.

- to fulfill your obligation to reduce risk of withdrawal, it is more than enough to write script for 3 to 7 days with following appointment with his regular provider and UDS. If patient throws tantrum at that, no script, direct him to the nearby ER.

- at least check previous UDS as they are available and document it, if you do not gave quick one and cannot do it before writing script

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Hey!

I think you did the right thing by not refilling it. The only thing I might have done differently is that I might have stated that I will be in touch with the prescribing provider to get back to the patient rather than giving a blanket call back advice since there are many clinics who do give patients a run around (not saying yours is necessarily) so he may have attempted to get his provider and they put him in touch with you. Even if he is not your regular patient, he is a patient of the clinic so there does need to be some coordination among co-workers to provide care while transitioning to new systems. I would just document the call as such and document that I spoke with the provider in my note.

I wonder about the structure of your telemedicine service at this time though (this is not your fault, just some food for thought to bring up to change the admin structure). Is this provider currently available or are they out sick? If they are available, patients should really be directed to their current provider for telemedicine visits, particularly for controlled substances, for continuity of care. After hours calls should be clearly advertised to patients as being for urgent visits only with no med refills (controlled or otherwise) being issues at that time. Your clinic can even continue to set up appointments and do either phone consultation or video chat via Doxy.me or even Zoom at this time (some states require video consult though so check with your state). I think setting clear guidelines will save both providers and patients a lot of frustration.

However, if your clinic had already done this and he was just calling random providers after hours then just note this in his chart and talk to the provider who is rxing. IMHO the benzo should be done by a psych provider with an addiction speciality if it is going to be done at all.

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