| One-Minute Clinician

Overdose—Risk Mitigation for Practitioners and Patients

When a patient dies from an overdose, the prescriber has some potential liability. It could be a licensing board issue, a licensing board plus malpractice issue, or worse a criminal case. That really depends on the nature of that prescriber’s care. Authorities are looking for things like proper evaluation, proper prescribing, control of drug supply, acknowledgement of risk issues. They’re looking for acknowledgment that with some patients high doses may not be the right thing. They’re looking for acknowledgment that with some patients a combination of medicine may not be the right thing. There’s an examination of the individual patient file but then an even broader examination of the habits and practices of the prescriber.

When a provider is the subject of a licensing board inquiry, the first thing is to take it seriously. Some people will set the letter aside and they won’t answer it. There is actually a deadline in that letter. The next thing that I think the providers should do is probably consult counsel, especially if there is a death allegation in the licensing board’s letter. Normally they’ll tell you that upfront and a lawyer can help you frame your response. We’ve had a lot of experience helping providers write responses to licensing board letters. We have them look at it objectively and then provide a response that shows they are humble, they understand their obligations, and they’re not there blaming it on other people. The lawyer can also help massage over some of the more difficult facts where maybe the provider overlooked something. You’re starting to see efforts by licensing boards and other authorities to differentiate overdose deaths from prescriptions versus street drugs or even suicides, and I think that’s very important. So much is being heaped on the shoulders of chronic pain management professionals and patients.

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