How to Handle Suspicious Prescriptions from Elderly Prescribers

I was sad to read a recent article about an 84-year-old prescriber, who indicated that she was treating every problem, disease, and condition that her patients were suffering, with no referrals to specialists. No doubt, when this physician started her practice, she had to treat all issues herself because specialties, such as those in pain management, were nonexistent. Decades later, great efforts were being made to persuade her that retirement was in her best interest, because she was not acting in her patients’ best interests.

More serious situations can and do occur when elderly physicians dole out prescriptions that they perhaps should not.

We in law enforcement encounter these types of situations from time to time, and I never had a good feeling about the results of any of the subsequent investigations. Often, the prescriber in question was beloved in the community by many residents, who had been seeing the physician for decades and liked the care and personal touch they received.

People came out of the woodwork whenever we were forced to try to accelerate the retirement of a physician. The news media would seek out community members, who would enjoy their 15 seconds of fame by telling the press that the police were shutting down the only medical professional they had ever trusted and that they would surely die, now that the doctor in question could no longer practice.

There were many reasons that these physicians came to the attention of law enforcement. One of the most common was when they appeared to be running pill mills. They also originally prescribed controlled substances at a time when doctor shopping and trafficking in prescription drugs was not common. This, unfortunately, made them easy marks for drug seekers and allowed them to be duped and intimidated by patients. Continuing education was not one of their priorities, either, as many of these elderly practitioners felt most comfortable staying in their own world and treating patients in much the same way they did when they started their practices decades earlier.

Many of these doctors are clearly in violation of the law, with the question being whether they had criminal intent. In most cases, the answer is that in their mental state, they likely did not have that intent, or it would be impossible to prove anyway.

The problem with elderly physicians running pill mills typically arose because many patients were not receiving adequate medical care, so a practitioner would violate criminal laws and state regulations that others were mandated to follow. This was our dilemma many times, so attempts initially were made to persuade an elderly physician to retire. When that did not work, we would solicit the children or spouse of the practitioner to assist us, which would usually get the job done and shut down the practice.

I want to make it clear that age alone does not necessarily reflect an ineffective or bogus medical practice. I have an elderly physician friend who is well into his 80s and still runs a very effective practice. He not only educates himself about the latest in medical science but also teaches his peers about some of these breakthrough findings and methods.

The question for pharmacists is what they do when they suspect that a practitioner who is prescribing drugs is senile or incompetent in some way. My guess is that more than a few pharmacists have encountered this issue with a prescriber or even with another pharmacist.

Pharmacists must remember their corresponding responsibility to not fill a suspected bogus prescription. They must not put themselves in the position of knowingly enabling senile prescribers by continuing to fill their prescriptions, because doing so could put their license in jeopardy or make them vulnerable to civil liability.

The long-term solution is a call to the state medical board or whatever board in a particular state regulates the prescriber. This can be anonymous and should generate an on-site visit by a board investigator if the concern is deemed valid. Proper steps can be taken to shut down the physician’s practice. Although it can be sad to force a trusted member of the community out of business, it may ultimately be the best course of action for all.

Cmdr John 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 rxdiversion.com.