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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17535
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Is it legal for a pain-management doctor to abruptly stop

Customer Question

Is it legal for a pain-management doctor to abruptly stop seeing you after prescribing fentanyl patches and oxycodone for years with no 30-day notice? He has referred me elsewhere but until I can be seen, I am in severe pain and withdrawal on top.
JA: How long have you had the pain? What seems to make the pain better or worse? Anything else in your medical history you think the doctor should know?
Customer: 15 years due to two near-fatal car accidents. The fentanyl patches & Oxycodone helped very much.
Submitted: 21 days ago.
Category: Medical
Expert:  Dr. D. Love replied 21 days ago.

Hello from JustAnswer.

What was the reason for him to stop seeing you?

Customer: replied 21 days ago.
When weather got colder, I began wearing three layers of clothing (no heat in house). My patches rolled up twice during the month and were unusable. I was 6 days away from my next refill and began having what ended up being withdrawal pain. I called my doctor to explain & ask for help.
His office manager made it her business to only tell him I was asking for more medication before it was due without explaining why.
Customer: replied 21 days ago.
She went even further and said I had had a couple of UA results with my Oxycodone not present. That was because the doctor had decreased my pills by 30 due to DEA issues. I was never told that my UA had come back unsatisfactory.
Customer: replied 21 days ago.
Are you there, please?
Expert:  Dr. D. Love replied 21 days ago.

Yes, I am here and typing. I will post it once I am done typing.

Customer: replied 21 days ago.
I had never asked for meds early in the entire three years I've been treated by him.
Customer: replied 21 days ago.
My response, please?
Customer: replied 21 days ago.
Please respond.
Expert:  Dr. D. Love replied 21 days ago.

First, to clarify some terminology. The issue in this situation is whether there is any civil legal liability. When someone asks whether something is legal or illegal, that is usually referencing criminal activity that can result in charges in criminal court. For most medical situations, the issue is whether the care was provided according to standard medical care, regulation, and medical ethics, and a failure to do so may result in being liable in civil court or for disciplinary action being taken by the licensing board.

Although regulations will vary somewhat from one state to another, it is usually defined in regulation that a proper discharge from the practice involves providing proper notice, facilitating transfer of care to another physician, and providing appropriate urgent medical care for the period of time stated in the notice. Most states define that period to be 30 days. The issue becomes the interpretation of what constitutes proper notice and appropriate medical care. Verbal notification may be sufficient notice. The real issue in these situations, though, is whether the doctor can refuse to prescribe pain medicines in such situations.

In situations in which the doctor judges that the patient has not followed the proper process, such as obtaining controlled substances from another doctor, taking the medicine different than prescribed, or diverting drugs, it is considered standard medical care for the doctor to refuse to provide further controlled substances, even if the patient is not discharged from the practice. The doctor may say that the patient can stay in the practice and he will treat the patient with every available treatment other than controlled substances. It is also not considered a violation of medical ethics. In such situations, if the patient is discharged from the practice and the doctor does not refill the controlled substances, that is still compliant with the process for terminating the relationship, because the doctor has decided on appropriate care, whether the patient stays in the practice or not.

As with many issues that are dependent upon physician judgment, there may be different decisions from different doctors, but if the doctor has valid clinical justification for the decision, medical boards have consistently determined that the doctor acted appropriately.

So, the decision to not provide controlled substances when the doctor judges that the patient did not follow the proper process is not a violation of regulation, standard medical care, or medical ethics.

Customer: replied 21 days ago.
Do you know what the regulations are in South Carolina?
Customer: replied 21 days ago.
Hello?
Expert:  Dr. D. Love replied 21 days ago.

I did not know it on the top of my head, but I was able to find it. See http://www.llr.state.sc.us/POL/Medical/Policies/Termination_of_Physician-Patient_Relationships.pdf. It appears that the notice would need to be in writing and the period is 30 days.

Customer: replied 21 days ago.
Do you have another link? The one you gave me doesn't work.
Expert:  Dr. D. Love replied 21 days ago.

When I copy the URL, I get the same link, so I have downloaded the document as a pdf file and attached it.

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