Hospital Emergency Departments Are Adopting Drug-Use Tracking Systems

It was recently announced that some hospitals in certain states are using a system to track patients who shop hospital emergency departments (EDs). These hospitals’ electronic records use a bright-red indicator to highlight particular patients who repeatedly seek prescription drugs in the ED. This tracking program was initiated due to the excessive amount of scammers visiting US EDs.

ED employees (physicians, nurses, etc) are not surprised by the move, as this practice has been going on for decades. With prescription drug abuse intensifying over the past 10 to 15 years, I am sure the instances have increased to levels higher than ever before. Keeping track of these folks is time-consuming and difficult at best.

Beginning in the 1990s, Cincinnati developed an alert system that used faxes. E-mails, text messages, prescription monitoring programs (PMPs), and other forms of communication were not available yet, so the fax machine was still “king.” As an ED employee was with a patient known to be a drug seeker, a group fax would warn all of the other area hospital EDs that this person was active. As several 24-hour pharmacies in the area were added to the fax list, pharmacists also began to look out for the offenders.

Because of the faxes or an encounter with an identified drug seeker, some of the EDs began to mark the medical records of those involved in the drug shopping. This was a common practice for several years that worked very well in notifying EDs of the violators. Our fax at our police office also was added to the list, so we received this information, as well.

Hospital attorneys put a screeching halt to this practice, however, when they found out what was going on in their EDs. I am not sure if a patient or an employee complained, but legal departments felt that the liability potential was far too great to continue the fax program, especially because providing the information to law enforcement likely violated patient privacy issues.

Legitimate patients suffer because of the actions of drug seekers who shop the ED. Less time can be devoted to them and their wait times ultimately increase as ED staff often have to spend more time with the drug seekers who demand service and their medications. Some drug seekers also become disorderly when staff tell them they are not going to write prescriptions for any controlled substances. The drug seekers may make a scene in front of other patients, hoping that the staff will give in and get them out of the ED.

When EDs decide to write a prescription for a few pills and send the drug seeker on his or her merry way, retail pharmacies need to watch out. If a PMP is not used in the ED or the results are ignored, the next gatekeeper is the retail pharmacist, who could find that it would be unethical or illegal to fill the prescription after checking the PMP. Therefore, knowing the “corresponding responsibility” guideline, the pharmacist could refuse the script. The retail pharmacist then becomes the “bad” person who is just doing his or her job and wanting to protect his or her license!

ED drug shoppers are the epitome of addiction. The mutilation of their bodies and the tricks they pull make even the most veteran ED worker skeptical as to whether they are truly in pain or pulling another scam to gain a few more pills. So, when I read about hospital EDs beginning to develop a tracking system for prescription drug seekers, I started to wonder how long it would last. Don’t get me wrong, I am in favor of it as a practical tool for ED staff and 24-hour pharmacies, but my guess is that liability will rear its ugly head once again and the system will be abolished.

I am not a lawyer, and I never played one on TV, but if the past is any indication, this tracking system will be in jeopardy when the first problem arises. I hope these states, and their EDs and retail pharmacies, have a good PMP they can use on a regular basis, making an ED tracking system unnecessary.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.