Prescribing for the Optometrist's Own Child
A Bangor optometrist's 14-year-old daughter wakes with a red, sticky right eye. At the kitchen table, the OD diagnoses bacterial conjunctivitis, calls in polymyxin B/trimethoprim drops to the family's pharmacy under the daughter's name, and does not open an office record, charge a fee, or submit insurance. The OD mentions the episode to a colleague, who later files a Board complaint after a disagreement about an unrelated referral. The complaint alleges prescribing without a patient record and treating an immediate family member. The OD responds that it was after hours, the eye was uncomfortable, and the daughter was not really a 'patient.' The pharmacy record shows the prescription was authorized by the OD. The Board investigator asks whether the Prescription Monitoring Program or any special documentation was required.
1. Does Maine permit an optometrist to prescribe for an immediate family member in this situation?
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Routine prescribing for an immediate family member is a conflict-of-interest area the Board scrutinizes. Even if Maine's rules contain a narrow exception for true emergencies, this was not one: a 14-year-old with sticky red eye had time for an office visit, urgent care, or referral, and the OD had no documented inability to obtain care. The OD's intention to help does not create authority. The defensible course was to direct the daughter to the OD's office with a record, or to another licensee; if the OD did treat, the file should show the relationship, the limited setting, and the plan. The phone-in prescription without any record is the more serious problem because it defeats Board review and continuity. A prescription is part of practice, not a favor.
2. What record-keeping obligation applied, if any, and how should the OD respond to the Board?
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Every patient encounter, including a no-fee family encounter, requires a record. The record should include date and time, identity, chief complaint, history, exam findings, diagnosis, drug/dose/sig, counseling, and follow-up. The absence of a record is an independent violation even if the prescription was clinically appropriate. It also makes the OD unable to rebut the complaint. The OD should not create a record now and call it contemporaneous; if the Board allows addenda, label them late and explain. The OD should cooperate with the Board, provide the pharmacy record, and avoid discussing the matter with the complainant. The response should address both the family-prescribing issue and the missing record rather than arguing only that the child was not a 'patient.'