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.

Tips for Ending the Physician-Patient Relationship With Problem Patients

One question I get from time to time is how a doctor may discharge “problem patients” and end the physician-patient relationship. Doctors who terminate the relationship improperly can face disciplinary charges for patient abandonment or worse. Medical Board complaints for patient abandonment are generally the result of poor communication and typically are the product of a doctor moving to a new practice group; the closing of a medical practice; or a physician moving to a new city. I’ll deal with closing and departing from a medical practice in another post. The issue today is the “problem patient” — one who is disruptive, non-compliant, delinquent or simply has a personality clash with the physician or staff. Discharging these patients should be done with care.

The physician-patient relationship is not a life-long commitment for either the doctor or the patient. With the exception of certain requirements of EMTALA (the Emergency Medical Treatment and Active Labor Act of 1986), physicians are not obligated to accept every patient who seeks his or her services. Once the doctor-patient relationship is established, however, a doctor must follow certain guidelines when discharging a patient to avoid abandoning the patient. Colorado Medical Board policy 40-02 sets out the procedural guidelines for discharging a patient. The Medical Board recommends that:

  • Any discharge be in writing and sent to the patient via certified mail;
  • In the discharge letter, the doctor agrees to provide 15-30 days of provisions coverage while the patient finds a new doctor;
  • The physician provide information for referral to new physicians, if possible; and
  • The letter notify the patient that the patients’ records will be sent to the new physician upon receipt of a written authorization from the patient.

Keeping in mind that problem patients are being discharged for a reason, care should be taken to make sure that a physician minimizes the risk of being charged with abandonment or worse by virtue of the discharge. Even where procedural guidelines are followed, physicians must take care that all discharges are for non-discriminatory reasons, not in violation of anti-discrimination laws such as the Americans with Disabilities Act, and do not jeopardize the welfare of the patient. Thus, a discharge letter should also explain the reasons for discharge in clear and concise language, taking care to spell out the non-discriminatory basis for ending the relationship. A properly prepared discharge letter can eliminate many headaches for the doctor down the road.

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