Group Purchase of Prescription Drugs • Tracking Medical Record Releases • Terminating Disorderly Patients

QUESTION: Can a corporation of physicians purchase prescription drugs as a group and deduct the fees from each physician's paycheck based on the amount each physician dispenses?

ANSWER: Drugs may be furnished by a physician only to his or her own patients (Business & Professions Code §4170; Health & Safety Code §111500.) The Board of Pharmacy has interpreted the law to mean that physicians in group practice may not dispense drugs from a common stock unless a specific exception applies. The Board adopted 16 C.C.R. §1783, which it interprets to prohibit manufacturers or wholesalers from furnishing prescription drugs or devices to a medical group; rather they must be forwarded to "a physician."

Although many attorneys disagree with the interpretation of the Board of Pharmacy and find no statutory authority for the conclusion that physicians in group practice may not receive or dispense drugs from a common stock, physicians who fail to follow the Board of Pharmacy's interpretation may be subject to referral to the Medical Board of California for investigation. For further information, consult CMA ON-CALL document #0505, "Drug Dispensing (Not Schedule II-V Drugs)," available free to SDCMS-CMA members at http://www.CMANet.org.

QUESTION: Should our office track every time we release any medical records to a patient or third-party agency?

ANSWER: Yes. Among the requirements imposed by the HIPAA Privacy Rules is the requirement that physicians covered by HIPAA provide patients or their legal representatives on request an "accounting" of certain types of disclosures of that patient's protected health information (PHI) the physician has made. This obligation extends to the disclosures made by the physician's "business associates," that is, outside contractors who act on the physician's behalf with respect to a function or activity involving the use or disclosure of PHI. To ensure compliance with the accounting requirement, the HIPAA Privacy Rules also require the maintenance of a disclosure accounting log that contains the mandatory elements that must be included in the accounting. A sample "Disclosure Accounting Log" and further information may be found in CMA ON-CALL document #1122, "Accounting of Disclosure," available free to SDCMS-CMA members at http://www.CMANet.org.

QUESTION: How do we terminate a disorderly patient who uses foul language to the staff and threatens to sue if he is unable to see the physician?

ANSWER: The physician should send a written notice to the patient by certified mail, return receipt requested. The letter should instruct the patient as to how to obtain the medical records compiled during the patient's care (whom to contact, how, and where) and inform the patient that, upon the patient's written authorization, the physician will send a copy of the patient's medical record to the new provider or that, alternatively, the physician will provide the patient with a copy of the record or a detailed summary.

In order to reduce the risk of liability, you should treat the patient until the patient has had a reasonable time to find an alternative source of care. The Medical Board of California advises that physicians must provide patients with at least 15 days of emergency treatment and prescriptions before the termination. For further information, consult CMA ON-CALL document #0805, "Termination of the Physician-Patient Relationship," available free to SDCMS-CMA members at http://www.CMANet.org.