Dear Dr. Fairley,

What a great question!  We believe that HIPAA allows this practice and in
doing so, provides patient with privacy protections.

For nearly 2000 years physicians, nurses, and pharmacists (chemists) have
comprised the "treatment" triad.  And especially when treating substance
abuse and addiction, it does take a community to provide a safe and
therapeutic environment: whenever we remove a member of the treatment
community from the process, errors and mistakes may increase and disease
resolution may decrease.  Within this context, the scenario that you
describe (below) fits well within the bounds of sharing PHI for treatment
purposes, and the involved providers will be beholden to the related HIPAA
rules.

I hope that this helps.
 
Your questions are always welcome.
 
Matt
 
Matthew Rosenblum
Chief Operations Officer
Privacy, Quality Management & Regulatory Affairs

http://www.CPIdirections.com
 
CPI Directions, Inc.
10 West 15th Street, Suite 1922
New York, NY 10011
 
(212) 675-6367
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-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] 
Sent: Friday, October 31, 2003 3:54 PM
To: WEDI SNIP Privacy Workgroup List
Subject: is this practice O.K.?

The practice that I am going to describe is quite common in our community
but I am not sure it is acceptable.  I wanted the opinion of the experts on
this list.

Occassionally, we run into a problem with a patient who seems to be doctor
hopping and getting multiple prescriptions for narcotics.  In order for the
patient's principle physician to keep a close watch on the patient's use of
narcotics and to avoid abuse/misuse of narcotics, the physician makes a deal
with the patient.  The deal is "ALL prescriptions for narcotics must be
funneled through one doctor-the primary care physician."  The patient
usually agrees but then (and here is where I am not sure if we are
infringing on privacy)we can send an "Alert" to all the area pharmacies to
alert them that this deal occurred and if the patient shows up at one of the
area pharmacies with a narcotic prescription from someone other than the
primary care physician, the patient is told that they have an order that
they can not fill the prescription unless it comes from the designated
doctor.  

Is this practice acceptable?  Do we need the patient's consent to notify all
heighborhood pharmacies?  Is verbal consent acceptable?  Can the information
be sent to the pharmacies without the patient's specific consent  (that is,
the patient consented to the arrangement that one doctor fills all narcotic
prescriptions but the patient did not consent to the information being sent
to all area pharmacies? )

Thank you
Rich Fairley, M.D.

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you wish to receive an official opinion, post your question to the WEDI SNIP Issues 
Database at http://snip.wedi.org/tracking/.   These listservs should not be used for 
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They also are not intended to be used as a forum for personal disagreements or 
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