The Associate's After-Hours Prescriptions
Dr. Rivera is a new associate in a six-dentist group practice in Detroit. Over three weeks the office manager notices that Dr. Rivera arrives late, has pinpoint pupils, and has written hydrocodone prescriptions for two people who have no appointments in the schedule. One is Dr. Rivera's brother-in-law. The office manager also finds a bottle of codeine cough syrup in Dr. Rivera's lab coat. When confronted, Dr. Rivera says he has chronic back pain and that 'Michigan lets dentists prescribe for themselves and family in an emergency.' He asks the office manager not to tell the owner, who is on vacation. The office manager calls you, the practice's compliance consultant, and asks what to do. The practice has a DEA registration and a locked controlled-substance cabinet; Dr. Rivera has his own DEA number and access to the cabinet.
1. Is Dr. Rivera correct that Michigan law permits dentists to prescribe controlled substances to themselves or family members? Explain.
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No. Michigan law prohibits a prescriber from prescribing a controlled substance to himself or herself or to immediate family, except in a bona fide emergency when no other prescriber is available and only for the limited duration of the emergency. Chronic back pain is not an emergency. A brother-in-law is not within the narrow exception, and in any event Dr. Rivera has not established a bona fide dentist-patient relationship with him: there is no examination, no dental diagnosis, and no treatment record. Writing prescriptions in the names of patients who have not been seen is prescription fraud, not legitimate prescribing. The cough syrup in the lab coat suggests personal use or diversion. Dr. Rivera's claim that Michigan permits self-prescribing for family is wrong. The conduct implicates the Public Health Code's controlled-substance provisions, the Board's rules, and federal DEA rules. It can support felony charges, license revocation, and permanent loss of DEA registration.
2. What reporting and notification obligations arise for the office manager and the practice owner, and what are the risks of delay?
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Michigan's reporting rules are a mix of mandatory and permissive. There is no general mandatory duty for a colleague to report every impairment, but the practice owner and the office manager should act because patients are at risk and because the practice holds a DEA registration. Suspected diversion should be reported to the DEA and to LARA's Bureau of Professional Licensing; the Health Professional Recovery Program is the confidential treatment route for impaired licensees. The owner should be notified immediately, not after vacation. Delay risks patient harm, continued diversion, a DEA audit, and discipline for failing to supervise. Retaliation against the office manager for good-faith reporting is prohibited. The practice should document the observations factually, preserve the prescriptions and the lab-coat evidence, and avoid confronting Dr. Rivera in a way that destroys evidence. If a patient has been harmed, disclose as required.
3. What immediate safeguards should the practice put in place regarding Dr. Rivera's prescribing and access to controlled substances?
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Immediate safeguards: suspend Dr. Rivera's prescribing privileges and his access to the controlled-substance cabinet; retrieve keys, DEA 222 forms, and prescription pads; change alarm and cabinet codes; audit all controlled-substance prescriptions written under his DEA number and the practice's registration; notify the DEA and LARA as counsel advises; and arrange coverage for his scheduled patients. Do not let him treat patients while impaired. Refer him to HPRP and give him written notice of the restrictions. The practice should also check MAPS for prescriptions written in his name and for the brother-in-law, preserve the records, and consider an interim suspension pending investigation. If the practice bills Medicare or Medicaid, self-disclosure may be required for fraudulent prescriptions. Finally, document every step and consult health-law counsel before making public statements.