By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Shelby Root
Physicians are frequently asked by their family and friends to refill prescriptions. However, there are legal and ethical issues associated with prescribing to self, family or friends. A physician may prescribe to family and friends but the medical standards and regulations for prescribing still apply. A physician must perform a physical examination, and maintain adequate and complete medical records and obtain a history from any patient before prescribing. Although there is no law prohibiting physicians from prescribing uncontrolled substances to themselves, this is not recommended due to ethical reasons. State laws governing physicians vary significantly from state to state. In Florida there are disciplinary actions taken if a physician does not prescribe within the physicians professional practice.
Disciplinary Action under Section 458.331, Florida Statutes.
Under the grounds for disciplinary action, Section 458.331(q), Florida Statutes, has listed; “Prescribing a legend drug, including any controlled substance, inappropriately or in excessive or in inappropriate quantities is not in the best interest of the patient and is not in the course of the physician’s professional practice, without regard to his or her intent.” Based on this statute, self-prescribing or prescribing to an individual who is not actually a legitimate patient, which is determined by a valid patient record or chart, will not be considered part of a physician’s professional practice. To view the entire statute, click here.
Pharmacist are Liable for Physicians Self-Prescribing and Prescribing to Family.
Section 465.016(s), Florida Statute, which applies to all pharmacists, states: “Dispensing any medicinal drug . . . when the pharmacist knows or has reason to believe that the purported prescription is not based upon a valid practitioner-patient relationship,” this is grounds for denial of a license or taking disciplinary action against a license. Therefore, based on this statute a pharmacist within Florida is also at risk when he/she dispenses medication to a physician who has prescribed to themselves or family. To view the entire statute, click here.
Arguments For and Against Self-Prescribing and Prescribing to Family.
Supporters of self-prescribing and prescribing to family argue that much of the information and literature on the subject is focused primarily on controlled substances, while non-controlled substances, such as antibiotics and contraceptives, are in the gray area. The counter argument is that due to a lack of objectivity and professional distance that is usually found in a practitioner-patient relationship non-controlled medications should not be prescribed.
From a legal standpoint, self-prescribing and prescribing to family who are outside of the valid physician-patient relationship is against Florida law. From an ethical standpoint, the risks related to a lack of objectivity resulting in poor health should inevitably be a deterrent. To view an article on the guidelines for prescribing in Florida, click here.
American Medical Association’s Opinion on Self-Treatment and Treatment of Family.
Opinion 8.19 of the Code of Medical Ethics of the American Medical (AMA) states: “It is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members.” The AMA is a supporter of educating professionals on the pitfalls of self-prescribing and prescribing to family and friends. The AMA is working to deter physicians from this practice unless it is an emergency situation.
The AMA recommends that physicians do not treat themselves or members of their immediate family. Professionalism may be compromised when a family member of the physician is the patient. A physician’s relationship with the patient may unduly influence his/her professional medical judgement. Therefore, the physician may fail to ask sensitive questions when taking medical history or may fail to perform intimate parts of the physical exam. The patient may be in the same position, they may feel uncomfortable disclosing sensitive information or undergoing an intimate exam when the physician is a family member. To view Opinion 8.19 in its entirety, click here.
Comments?
What are your thoughts on self-prescribing and prescribing to family and friends? Please leave any thoughtful comments below.
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Sources:
American Medical Association. “Opinion 8.19 – Self-Treatment or Treatment of Immediate Family Members. (June 1993). From
http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion819.page?
Fla. Stat. § 458.331.
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0458/Sections/0458.331.html
Fla. Stat. § 465.016.
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0465/Sections/0465.016.html
“Ohio Physicians Stop Prescribing to Self and Family Members!” Ohio Physicians Advocate. (May 18, 2015). From:
https://ohiophysiciansadvocate.wordpress.com/2015/05/18/ohio-physicians-stop-prescribing-to-self-and-family-members/
Shands at the University of Florida. “The Legality and Ethics of Self-Prescribing.” Drugs & Therapy Bulletin. (July/Aug. 2006). From:
http://professionals.ufhealth.org/files/2011/11/0706-drugs-therapy-bulletin.pdf
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
Shelby Root is a summer associate at The Health Law Firm. She is a student at Barry University College of Law in Orlando.
KeyWords: Florida, Florida Statutes 458.331, Florida Statutes 465.016, prescribing, self-prescribing, American Medical Association, AMA, Code of Medical Ethics, Opinion 8.19, physician, pharmacist, disciplinary action, controlled substances, defense lawyer, defense attorney, health law attorney, The Health Law Firm
“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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Great article
As a prescriber in primary care I always tell family and friends that I am not allowed to write prescriptions without having an established patient chart , if they want something they have to come to my practice and establish themselves as patients and have a patient chart otherwise I give them nothing