Prescribers Be Warned: How You Respond to Lab Reports Matters

LAS VEGAS—Prescribers could find themselves in legal peril if they do not respond appropriately to the results of laboratory tests ordered for patients on opioid therapy, according to Jennifer Bolen, JD, a former Assistant US Attorney and founder of The Legal Side of Pain in Knoxville, Tennessee.

Bolen and her colleagues have conducted practice audits showing although laboratory reports are in patients' files, there often is no connection between these reports and patient management, and this could trigger investigations and prosecutions.

Legally, for a controlled substance prescription to be valid, it must be issued for a legitimate medical purpose, “but you must do so in the usual course of professional practice. Part of that usual course definition is handling test reports and integrating them into the care plan of the patient,” she said. According to Bolen, providers' understanding and use of laboratory reports can make or break clinical decision-making and legal cases, including wrongful termination and overdose. The provider's use or nonuse of laboratory results may impact the legal evaluation as to whether the practitioner was prescribing within the usual course of professional practice.

 “Licensing hearing board and jurors, they want to see common sense in what you're doing,” Bolen told listeners. “It's not common sense to them that you ignored somebody's who positive for marijuana or positive for cocaine or methamphetamine or missing the drugs you're  prescribing and you just go on prescribing like nothing happened. That is not common sense, if you don't make the connection, they have every right to question your judgment and be afraid of what you're doing to the people that go and see you.”

Clinicians cannot just stick a laboratory test report into a patient's file and let the expert that reviews the chart try to figure it out “like a rat going through a maze. That's dangerous to you. You have to leave a cheese trail for the rats in order to get to the result that you want. And that cheese trail is some recognition that there's a test result that's appropriate and inappropriate and what you're going to do about it.”

Another consideration is financial. Third-party payers require documentation of medical necessity for services to be reimbursed, and if clinicians fail to provide this documentation for the drug-screening tests they order, they could find themselves receiving letters demanding that money be returned or perhaps facing legal repercussions.

Bolen also advised listeners about the proper way to order drug screening tests. Orders should include a list of the medications to be screened for and the results should be matched against that list. In addition, she emphasized that only clinicians ordering a drug screen, and not laboratories, should interpret test results (such as determining whether a patient is compliant or noncompliant with drug therapy) because only they know all of the facts pertaining to the patient.