Forged Scripts

via KevinMD, this advice on dealing with them from OnThePharm:

General Prescription PadsEveryone has their own preferred method of dealing with forged prescriptions. Ryan at EclecticEsoteric recently asked what I would do. It so happens that Andrew at PharmCountry has a related post, so it seems an opportune time…

When you’ve got a forged or altered prescription, there are two basic things you SHOULD do.

1) Contact the prescriber. Verify that it has been forged or altered.
2) Initiate a PharmAlert, the details of which can be obtained by contacting your state’s board of pharmacy. I believe this is how such an alert is usually initiated anyway — I’d say “always” but I haven’t worked in every state, so that’s impossible for me to know.

Prescription alteration and outright forgery comes up sometimes in the ED, and I’ve had several kinds happen.

Right after I moved to this job (about 5 years ago) I started getting calls from pharmacies to verify called-in prescriptions for phenergan with codeine. This immediately raised my eyebrows, as I prescribe that maybe 4 times a year, and we don’t typically call in prescriptions. All the pharmacies I called back said the caller had the rap down, knew exactly what to say, had my DEA, etc.

Interestingly, the pharmacists had a hunch, despite the good call-in rap, that there was something fishy so they called to verify (experience counts). I thanked them all, then asked they call the cops if someone actually showed up to pick it up, as I’d had a bunch of these calls. I never heard more about it, and it tapered off over about 3 weeks. The caller no doubt just got someone else’s’ DEA number. (And what a weird drug to abuse…)

The big winner in this category goes, though, to this exchange:

Charge Nurse: Gruntdoc, did you write a prescription for Marinol to a patient recently?

Me: No, why?

CN: Well, there’s a parole officer on the phone who has a parolee whose drug screen came back positive, but has a prescription for Marinol on one of our pads with your name on it. As an excuse.

Me: Heh. Nope, I’ve literally never written a prescription for marinol in my life.

This was relayed, and in short order I got a fax of the prescription, and it was fairly good: the writing style looked hurriedly-efficient, there was a written-out quantity, the Sig line was what you’d expect. My signature wasn’t anywhere close, and the really interesting part was the DEA number didn’t follow one of the really basic tenets of how they’re encoded. Any pharmacist would have picked it up in less than a second, so this was never presented to be filled, it was written to attempt to stay out of jail.

CN: They wanted you to type out a letter, on official letterhead whether or not this is your prescription. I told them we were too busy for that, so they agreed on a hand-written response.

Me: (Again noting our CN’s are very smart) Thanks!

So, some scribbles and my real signature later, off went my reply. I never heard any more about it, though I wonder if it’s a crime to carry around a forged prescription if it’s never presented to fill a medication (I doubt it). It probably is a crime to use a forged script to stay out of jail on a probation violation, but then they wouldn’t need any kind of forgery charge, I’d think, they’ve got all the evidence they need in the little jar.

And, it’s 2007! Why are we hand writing things on little slips of paper and giving them to patients to then literally hand-carry to pharmacies? I’m going to gripe my head off when the EMR comes to my ED, but if it comes with an automated way to transmit scripts to pharmacies I’ll gripe a little less loudly.

Some background on prescription fraud, from a defense-attorney site (good info).


Comments

  1. Promethazine/Codeine cough syrup is mixed with Sprite to make Purple Drank, a nice little sedating concoction popularized by Houston rappers. There’s even a wikipedia entry!

  2. The most egregious one I had was an RN that changed the 10 Vicodin I wrote for to 100. The pharmacy called and I talked with the RN on the phone — the excuse, “you meant to write for 100.” VOID and report to the nursing board. We have about 1 a month at my place.

    >And, it’s 2007! Why are we hand writing things on little slips of paper and giving them to patients to then literally hand-carry to pharmacies.

    Healthcare is plain and simple stupid!

  3. > Healthcare is plain and simple stupid!

    Now, there’s a sentence in which punctuation makes all the difference. I note there’s none in the original.

  4. TheNewGuy says:

    I get these on occasion… I advise the pharmacist to call the police immediately. Our local LEOs are more than happy to prosecute these jokers.

    I also use a couple of tricks when I write my scripts that help me determine whether the script is mine… and I won’t reveal them here. No strategy freebies for the drug seekers.

  5. Digital scripts?

    That’d be just silly.

    You get 10 American Healthcare System demerits for that!

  6. At a county hospital that I work at a patient brought a script to pharmacy that simply said:

    Mofine
    1 kilo

  7. With our system, your DEA number is still on the script, but script pads are gone for good which is a very good thing.

  8. When I get a call from a pharmacist asking “You didn’t write a script for a hundred Oxycontin 80’s did you?’, in addition to saying no I usually ask if they have video survillience in their pharmacy (they always do), and then I ask them to remove the tape and hold it until the police arrive…Forgery is a serious offense in most areas, and in Canada diverted narcotics are a huge problem the police are quite happy to involve themselves in….a taped photo of the forger goes a long way towards any successful prosecution.
    These fellows are usually unmasked by the fact that they shoot for the moon and try for a large quantity of drug thats often a flag to the pharmacist….pretty predictable behavior in the world of addiction…

  9. What a bunch of killjoys… :)

  10. this has worked well for me at our facility. get a specially made embosser with your hospital’s name on it or whatever. then, when you sign the scrip emboss over it.

    double protection: embosser is hard to duplicate and once the local druggist knows your embosser that’s one layer. layer two, always emboss over the signature as this is another way for the perp to fail.

    cheers.

  11. We had a couple of DEA agents arrest someone in our waiting room one day — that’s pretty interesting.

  12. Well I’m sure you know this, but my experience with military medicine is that they don’t write prescriptions; it’s all computerized. Of course, when I’ve gotten them it’s always been going to the hospital pharmacy for me to pick up. I’m not entirely sure of the last time I saw a written prescription, but it was when Tricare sent me to a civilian doctor. I guess I’m going to have to get used to it again.

    The MTF where I had two of my kids was careless with narcotics in other ways, though. After my first c-section they sent me home with a bottle of 30 Vicodins I had tried telling them not to give me–I tried one in the hospital & it didn’t help, so I’d been taking nothing but ibuprofen most of the time–and told me not to sell them.

  13. Jack Coupal says:

    As a newly-minted pharmacist in a chain pharmacy, I had a perky young woman present me with a script for 100 Valium 10 mg tabs when that was a relatively new product.

    The alarm bell rang in my head, and I phoned the so-called prescriber, who claimed he’d never written it. Upon hearing that, I called the local police.

    Very shortly thereafter, an police officer arrived, talked to her, and handcuffed her. Behind her back. As GregP says, it’s an interesting sight.

  14. DOandGO2011 says:

    I’ve been working with a flashy new electronic health record, and even it prints out prescriptions that are given directly to the patient. You’d think after millions of dollars were spent to create this monstrosity, they would have included a way to send it to a pharmacy electronically. Unfortunately, the prescriptions are easier to forge than ever. All you need is a word-processor. So much for technology.

  15. Most MDs have the capability to send directly to pharmacies if you have any type of EMR software program. The question is: are you signed up with SureScripts? http://www.surescripts.com. They are the huge gatekeeper in getting connected electronically. Of course, there’s a fee. Currently, from what I’ve read only about 1% of all rxs prescribed are done so electronically. The government is tyring to push to get it to about 10%. Hopefully, you can contact the powers that be in hospital admin and get connected. Then you can just select pt, prescribe order and send to pharmacy of your choice. Unfortunately, it is against the law to send an e-Rx electronically to pharmacies. (It can be printed off and sent with pt or faxed).

  16. beachdoc says:

    In my urgent care practice (I got tired of nights and holidays 11 years ago) we use A4 (Allscripts) EMR. The program transmits either by email or by fax all prescriptions to the pharmacy. All are printed. Schedule II’s must be printed locally and signed with a pen and provided to the patient.

    I now avoid (seemingly) 10 calls a day from pharmacists that could not read my handwriting and have only had one (actually three from the same patient) forged prescription in 18 months. Yep, it was for percocet.

    EMR is a great time saver IF it is customized appropriately by the end user. That takes a significant amount of time.

  17. civilianannie says:

    Total civilian here: non-medical; non-military (although Mother was USMC/WR, WW2 and Dad was WW 2 Army MD later in practice as general surgeon). Something that drives me nuts: any comments? Insurance companies with insistence on filling three-month prescriptions ostensibly to save the consumer money and extra trips to the pharmacy…I don’t care what the drug is, in a household with kids or elderly folks, that’s just too much of anything to have around. Have gone around the block with at least three mail-order companies on this one–my consumer comment is that I just don’t think it’s safe. Yeah, rationally I know that a 30-day supply may not be 100% safe either, and it’s my job to teach my kids; look after my elderly, etc., but in my bones, I don’t like the three-month supply policy. My scripts may pretty run of the mill, but I know there are hairy ones out there. Have reluctantly gone along with it until recently, but have decided that the savings aren’t that significant, and since I don’t live in the boondocks it’s just as easy to go to my local pharmacy. In the future, it’s the old 30-day refill for me. Do you guys have any thoughts?

    Oh: separate topic–in my attic I have absolutely exquisite artifacts from the offices of both my Dad and his GP father: including a nearly 100-year old microscope and a little black notebook filled with the handwritten “recipes” from the days when GP’s of the horse-and-buggy era mixed their own compounds. Docs and nurses are my personal heroes (maternal grandmother nursed through the 1918 flu epidemic…) I grew up with a Dad who did a lot of “service” rotations through the ED before EM became a specialty: he was an absentee Dad a lot of the time, but he taught me more about aesthetics than any other human being ever has: his heart-to-heart discourse to a young daughter about his personal aesthetic and life in medicine has enriched my entire life. This is a great site: blessings on you all: ars longa… From a grateful patient: thanks. From the heart, forever: thanks.

  18. Isn’t calling the cops on someone who is ostensibly suffering from the “disease” of addiction, more than a little on the cruel side? That’s if you believe the prevailing medical establishment view that drug addiction is an illness, then isn’t there something in your Medical or Pharmacists Oath (or whatever) where you’ve sworn to help the sick and to ease human suffering to the best of your ability? If someone is threatening, that’s another story. But, is throwing a peaceful customer into a metal cage now considered a civilized “standard of care” for addiction? Why not give the “offender/patient” a mini-lecture and call their doctor for them? Or is it just way too much fun to call the cops, and then kick back to watch the crazy humiliation scene unfold? So it would seem, to judge from the comments of some of the so-called “medical professionals” on this thread. Just remember that with such well-known occupational temptations, one day you might be that offender/patient in need of a break……?

  19. …and the guy robbing the bank, he’s just down on his luck, just give him the money…

    Seriously, did you even think about that tiresome non-argument? It’s just silly beyond belief. I was going to delete it for you, but will leave it as an example of actual looney commenting.

  20. LTJ, are you kidding???? If we indulged every dirtball coming in for drugs, sick people couldn’t wade through the masses to reach my receptionist to get care.

    Please!

  21. we just refuse to fill them, we never call the cops. i had a woman try to fill a dexedrine script on a regualar non-C2 pad the other day and we just gave it right back. jail is not the solution needed. how can they get good jobs and lead productive lives after going to jail, getting a record, and being exposed to true criminals

  22. cristina says:

    How about the fact that some of these forgeries are being brought in, not by addicts, by drug dealers, or those working for them. They then turn around and sell these drugs illegally. And for those of you sending them on their way without filling the prescription, you should be stamping the back of the prescription at the very least to take it out of circulation. It is important to report these offences to the authorities, precisely because it is an addiction issue and they need treatment.

  23. Being a recovering addict with many years clean under my belt I would think LTJ that the call made to send that person to jail while yes it may cause them withdrawals in some cases which jail doc will give them some ibuprofen to deal with it and in some cases maybe even a clonidine or something to help them through the rough patch.
    However that call may turn out to be the bottom that the addict needs to trigger them to give up drugs. So essentially that call to police will in fact maybe be the help they need after all.

    Of course remember most will see a commissioner and be bonded out or given personal recog. within hours and be right back out there doing the same thing. IF it was a perfect world they would be arrested and placed in a rehab for a mandatory 6 months when arrested and are PROVEN to be addicted. I add the proven part because sadly many dealers who do not in fact get high themselves have discovered the loophole of telling the judge they have an addiction and being sent to a treatment program and left back out really soon. So I think anyone locked up on any drug charge should be forced to give a urine at time of arrest Just to be sure from now on so that these jerks taking the beds that real addicts need could be weeded out.

    That would however be that perfect world where the powers that be are not worried on the cost because most addicts i know have long lost family ties and are not likely to be working or have any insurance. And last time I heard the state only covers I think it is 30 day stay now It was once 7 days back when i was actively addicted but again that was ages ago. At least they did raise it to 30 though that still is not too helpful it only gives most addicts time to fatten up get rested and be sent back to the same environment they were in with no job or money so they will in effect return to the same life.

    Sorry to go off topic.

    Bay

  24. ChrisRyan says:

    Lets not forget that over 50% of prescription drug abusers where thought to be over-prescribed in the first place. Drug addiction is a serious personal health problem. And while you guys are acting so perfect, how about the doctors that provoke this type of behavior by running pill farms, or having girls strip or do other things in trade for prescriptions? The point im making is nobody is perfect EVERYONE has there DEMONS. I have battled addiction with pills, I will tell you half of you guys write scripts for personal gain, and the just about the rest of you try to play GOD without really recommending solutions, you like to just say “I know your addicted” out of my experience I can think of 2 doctors that have taken the time to reach out and help! Being completely honest. 2 Doctors in 3 years… Thankfully I have gotten help and am currently being treated. You would be surprised at how many people around you are using or have used drugs. Youve that Great Education of yours and Try to HELP people.
    If someone is resorting to this type of behavior, they need help!

  25. If someone has a drug problem and asks for help they should get it. It’s not easy to get, but it is obtainable.

    If someone breaks the law and engages in prescription forgery, that’s not asking for help, that’s breaking the law for personal gain, and it’s no different than any other criminal activity.

    Want help? Ask for it. Want to forge scripts? No.

  26. I used to be a software developer that worked on a product that could detect doctor shoppers or people forging high numbers of prescriptions. We would scan through the claims for a given insurance company and using pretty simple statistics we could tell if there were a high number of certain drugs scripts being written out for a given member. Pretty cool stuff. We also had other rules that we ran for fraudulent prescribers and providers. Your post brought back memories.