The PDMP – Colorado’s Prescription Drug Monitoring Program PDMP – What you should know

As most doctors are aware, the Colorado Board of Pharmacy maintains the Prescription Drug Monitoring Program (PDMP), which provides a database of controlled substance prescriptions dispensed by Colorado pharmacies. Access to the PDMP is limited to a defined set of circumstances. This is important because a provider who improperly accesses the database is subject to significant penalties, including fines and criminal charges. Specifically, a person who improperly obtains information is subject to a civil fine of up to $10,000 each. Violators may also unknowingly commit a class 6 felony under Colorado’s theft of medical record statute. Finally, providers may be subject to discipline by their respective licensing boards for unprofessional conduct.

The PDMP is an on-line database that is available to pharmacists, and to licensed Colorado health care providers with prescriptive authority, such as physicians, dentists, physician assistants, podiatrists, veterinarians, nurses with prescriptive authority, and optometrists. The PDMP is intended to be a “mechanism whereby practitioners can discover the extent of each patient’s requests for drugs and whether other providers have prescribed similar substances…” § 12-42.5-401. A PDMP report shows the date prescriptions are written, the date filled, the controlled substance, the prescribing provider, the amount, refills and pharmacy used.

Because of the potential penalties involved, it is important for doctors, nurses, dentists, and others to understand the circumstances under which they can properly access PDMP data. As it relates to prescribing doctors, PAs, nurses, dentists and other providers, access to the PDMP is limited to inquiries related “to a current patient of the practitioner to whom the practitioner is prescribing or considering prescribing any controlled substance.” § 12-42.5-404(3)(a). Prescribing providers should understand the following:

1) PDMP queries are limited to current patients. In some circumstances, doctors or others who are responding to either malpractice or Board complaints are tempted to look up former patients. If no current practitioner-patient relationship exists, PDMP queries are not permitted.

2) PDMP access is limited to patients. Physicians, nurses and others are not permitted to look up themselves, their staff, or their families on the PDMP.

3) PDMP is limited to providers who are prescribing or are considering prescribing controlled substances. Thus, for example, an allergist should not look up patients for whom he or she would not be prescribing a controlled substance.

Any provider who deems it necessary to obtain his or her own PDMP history may do so, but should make direct request through the Board of Pharmacy rather than through a direct PDMP search. Other providers, such as pharmacists and addiction specialists, engaged in a legitimate program to monitor a patient’s drug use are also permitted to access the PDMP. Additionally, law enforcement agencies may obtain reports related to specific patients or practitioner, and regulatory boards, such as the Board of Medicine, Board of Nursing or Dental Board may also access information related to a specific individual practitioner, where the request is part of a bona fide investigation and accompanied by a court order or subpoena.

Colorado Extends Transparency Act To All Licensed Health Care Providers

In 2007, Colorado enacted the Michael Skolnik Transparency Act, which directed Colorado’s Department of Regulatory Agencies to create a database of information on physicians. The stated purpose of the Act was to provide transparency to the public regarding the competency of their doctors and to permit Coloradans to make informed health care decisions. The Skolnik Act was one of the first of its kind in the country, and required doctors to make public a broad range of information, including previously confidential information such as involuntary hospital privilege restrictions and malpractice settlements.

In 2010, the General Assembly enacted new legislation to expand the scope of the Transparency Act to include not only medical doctors, but most licensed or registered health care provider within Colorado. The Act covers audiologists, acupuncturists, podiatrists, chiropractors, dentists, dental hygienists, hearing aid providers, physician assistants, mid-wives, nurses, optometrists, physical therapists, psychologists, social workers, professional counselors, marriage and family therapist, addiction counselors and unlicensed psychotherapists.

As a practical matter, the new Medical Transparency Act goes into effect for non-physician health care providers July 1, 2011. For all licensing/registration cycles after July 1, 2011, these health care providers must provide certain information to their respective regulatory agencies. The information that must be provided includes such things as Board certifications and specialties; affiliations with or clinical privileges held at hospitals or health care facilities; health care-related business ownership interests; disciplinary actions in other states or countries; health care-related employment contracts; DEA registration surrenders; criminal convictions and malpractice settlements and judgments. Penalties for non-compliance include administrative fines of up to $5,000, and discipline for unprofessional conduct.

The precise reporting requirements for each board will vary and will be generally dictated by DORA policies, and will be dependent on individual circumstances. While at the attorney general’s office, I co-authored the Medical Board’s policy compliance with the Transparency Act.

The entire Medical Transparency Act of 2010 can be viewed here.

Copyright Miller | Kabler, P.C., Attorneys-at-Law