Back in rural NC when I was running five medical facilities, I had a nemesis. A locum tenens physician who was from the old school and had zero tolerance for policies and procedures. Unfortunately, until we were able to recruit new physicians for all the clinics, Dr. Aggressive was the temporary medical director. I can honestly say that I have not put all my management skills to such good use since his tenure.
In order to store controlled substances in a clinic you have to follow stringent rules. When Dr. Aggressive was going through medical training back in the day, the rules were not very strict. He told me time and time again that medicine was much simpler before the emergence of Managed Care. I never disagreed with him but it really had nothing to do with current day medical practice management.
Controlled substances must be stored in a locked container with the keys being available to the medical director and his/her designate. Dr. Aggressive and I had the keys for our lock box containing injectable Valium for seizure control and cough syrups containing codeine. Anytime these drugs were ordered, dispensed or destroyed, they had to be clearly documented. Every ounce had to be accounted for, no exceptions. These policies and procedure are governed by none other than the DEA. The DEA can drop into any facility at any time and go through the controlled substance log. The are penalties are steep, physician licenses can be suspended or revoked, clinics can be shut down. In principle, you really don’t want to piss off the DEA.
Because we were in such a small town, Dr. Passive Aggressive did not feel the need to follow any of these rules. He would pick up a couple of vials of Valium from the hospital’s pharmacy and tell the pharmacist to get the paperwork from me later. The pharmacist was not too pleased with this method but would generally go along with the city-slicker attitude of this visiting medical director. During Dr. Aggressive’s tenure the hospital pharmacist and I became close acquaintances. Dr. Aggressive continued taking many liberties with the controlled substance rules to the point where the pharmacist called the DEA for intervention. The pharmacist’s license and reputation were on the line as well. Luckily I was made aware of the covert operation and had my end of the paperwork in order.
The DEA agent showed up in the middle of a very busy day. She asked to speak with the medical director and the administrator. Before I went into Dr. Aggressive’s office, I brought the controlled substance log with me along with my copies of the signed order forms. The order forms are numbered and need to be used in numerical sequence; if not, it is considered a red flag. Dr. Aggressive handled the meeting in his typical aloof manner.
Here is the exchange between the DEA agent and Dr. Aggressive:
DEA: Why are the prescriptions being used out of order?
Dr. PA: I grab whichever one is handy at the moment, I don’t pay attention to it. My administrator must be responsible.
DEA: Really? Does she write the prescriptions?
Dr. PA: Of course not, I do.
DEA: Who keeps the prescription pad?
Dr. PA: I do.
DEA: Why are they being used out of order? Where is prescription form 1123? I won’t leave here until you produce the missing form.
Dr. PA: Well in that case, let me arrange for you to get a hotel room in town as I have no idea where that form is.
DEA: I have a better idea. I’ll just take you to our Charlotte headquarters where we may be able to jog your memory. (Charlotte is a good 2-hour drive from our location)
At that point I was dismissed from the room. An hour later, Dr. PA and the DEA agent left to go to Charlotte. One week later, we replaced Dr. Passive Aggressive with another locum tenens physician. Luckily for me, one who enjoyed following all policies and procedures.
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6 comments:
I never realized that doctors could be hauled off to DEA headquarters. It makes sense, though. Most physicians must follow the rules because the odd ones who don't end up in the newspaper.
There was a newspaper article not too long ago about a doctor in Northwest Indiana who was making strange prescriptions. He ended up getting in trouble after neighbors saw scruffy people driving to his house at all hours. It didn't help that patients arriving at a certain ER for overdoses were saying the doctor was their physician.
Deliberate Chaos
You do make a valid point and I loved the creative title and reference.
When push comes to shove, usually the "who needs rules" folks get caught up to eventually.
(I also like your idea of injecting common sense, on my recent post - good idea!)
Enjoy the weekend...
Boy! Docs can be such PITA's! Actually your post reminded me of one of the exercises we went through in orientation. I'm a new Grad Practical Nurse going back for my RN in the fall, and for our criterion based skills assessment for nurses through our local hospital we had to write responses to what this doctor said, the proctor, or whatever, said none of our responses could be "Bite Me!" Dr. Richard Cranium, in the video(that's just what my friend and I called him)said something to the effect about not caring about policy. Too bad it was just a video, I would have liked to seen his butt hauled off the screen!
Actually I should say some docs... not EVEN some... namely the doc that you mentioned, the one from my video, and some of the ones I will have the pleasure of working with(already encountered them in clinicals, they really dislike students like me sometimes, but there's only like 3 of them that I've seen)
I can't say that I was upset with the DEA's actions against Dr. Passive Aggressive. Although I also can't say that I was not terrified with the whole process. I was raised to play by the rules in all apsects of life and continue to be amazed by those who willingly do not. I wonder how they sleep at night?
Thank you for all your comments.
He's an idiot.
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