Legal/Regulatory Update: Taking Control of Your Prescribing

September 8, 2010
Diana Pichardo

Though not typically their favorite part of practicing, pain medicine practitioners need to be on top of legal and regulatory requirements.

If you’re going to play in the arena of pain medicine, you better know the rules of the game. Being familiar with current Drug Enforcement Administration (DEA) policies on prescribing and following the correct protocols are essential components to practicing pain medicine, according to Jennifer Bolen, JD. So is eating a slice of “humble pie” when your practice has been called into question for failing to meet certain standards.

Bolen’s presentation, “Legal/Regulatory Update: Taking Control of Your Prescribing,” was designed to describe a board-registered physician’s responsibility in prescribing controlled substances and preventing abuse and diversion.

“I’m hoping that today we can help you think about creating some policies and procedures,” Bolen said. She highlighted two specific cases dealing with physicians who had their prescribing privileges revoked after failing to meet legal requirements. The criminal cases resulted in two Administrative opinions from the DEA.

The first case involved Dr. Jeri Hassman, a physical medicine and sports medicine physician from Arizona, who was accused of prescribing “exorbitant amounts of pain killers to her patients.” Hassman’s license was suspended after an investigation into her prescribing practices. This case involved overdose deaths as well. The DEA determined that she had generally failed to adequately evaluate patients, failed to conduct clinical physical examinations, and failed to obtain adequate histories. According to the DEA, Hassman had also failed to obtain prior medical records prior to prescribing pain killers to patients. The doctor failed to accept responsibility for any of the findings, Bolen said.

The second case involved Jayam Krishna-Iyer, MD. DEA operatives acted undercover as patients and made appointments at Iyer’s practice to seek pain medication. They concluded that Iyer’s documentation techniques were inadequate and inconsistent. They also concluded that she ignored some warning signs of potential abuse and misuse of pain killers.

Iyer was suspended from practicing medicine. However, she appealed the ruling and after eventually making some active changes to better understand the established rules, she successfully received her license back.

The DEA evaluation concluded that practitioners who ignore warning signs that patients are personally abusing or diverting controlled substances commit “acts inconsistent with public interests.”

A key component in defending against these types of charges is establishing good faith and taking responsibility where it is necessary, Bolen said. Good faith suggests there was an attempt to do the right thing, she said. If physicians can prove they had the right intentions and give adequate reasons as to why protocol weren’t followed in a few instances, they will often have a better chance of defending themselves.

It’s important for physicians to admit where they may have been falling short, Bolen said. Whether it may be in improperly filing paperwork, not performing extensive physical examinations, or taking medical histories. “There has to be a little bit of humble pie,” she said.

For practitioners whose privileges have been provoked who have good intentions, they can still make changes and prove their willingness to cooperate in many instances and once again return to the field. It may take reaching out to colleagues and establishing mentors, enrolling in medical education programs, and more.

But the best thing physicians can do is act proactively, rather than reactively. Learn the rules now, Bolen said, so that you can comply with all local, State, and federal statutes.

Bolen says establishing common well-established procedures such as the Four A’s (Analgesia, Activities of Daily Living, Adverse effects, and Aberrant drug-related behaviors), improving documentation skills, and setting boundaries early on are key components of running a good pain medicine practice that will hold up under the scrutiny of DEA investigation.