Case Study
Andre J. Hopp
HCS/335
September 24, 2013
Frieda Taylor

Case Study
Today’s health care system is larger and busier than ever. Increased demand for services coupled with a limited number of providers, creates unique demands on an already strained system. Medical practices rely heavily on staff members to perform a myriad of function, both clinical and administrative. Occasionally, staff members may be asked by either physician or patients to perform duties that fall outside their scope of practice. Should an unqualified employee choose to operate outside his or her scope of practice, they run the risk of committing both negligent and criminal acts. In the case study of Jerry McCall, an office assistant with limited medical training, one sees a clear case of negligent and criminal conduct.
The case study presents a scenario where an office assistant in a private physician’s office is asked by a patient to authorize a prescription for a Schedule III controlled medication. Additional information reveals that he is currently the only person in the office. Although Jerry is a Licensed Practical Nurse and medical assistant, his training does not permit him to prescribe medications of any type. Medications may only by prescribed by licensed providers who hold a valid registration with the Drug Enforcement Administration. This is typically limited to physicians, physician assistants, and nurse practitioners. There does however, exist a situation win which it would be permissible for Jerry to provide the patient with a valid prescription. This would require him to be acting as an agent of a physician who either wrote or verbally communicated a prescription order. According to the statutes in title 21 of the Federal Code of Regulations, “Communication by Facsimile or Oral Communication of a Valid Prescription for a Schedule III, IV, or V Controlled Substance May be Delegated to an Authorized Agent” (Drug Enforcement Administration, Department of Justice, 2010). Unfortunately, this scenario is not applicable to this case study, as it is clear that Jerry is acting on his own and not as an agent of a delegating prescriber..
In this case study, Jerry is asked to provide a prescription for a controlled substance to a patient who claims to be in a hurry and needs the medication right away. To stay within his scope of practice and within the bounds of the law, his only way to help this patient without a legal prescriber present would be to direct him or her to an urgent care, or perhaps a local pharmacy if the medication in question is something which has been prescribed to the patient in the past. Pharmacists are legally allowed to use their professional judgment and discretion to provide a limited emergency supply of medication under certain specific conditions. This authority is granted the pharmacist under California Business and Professions Code, section 4064 (a). It reads, “A prescription for a dangerous drug or dangerous device may be refilled without the prescriber's authorization if the prescriber is unavailable to authorize the refill and if, in the pharmacist's professional judgment, failure to refill the prescription might interrupt the patient's ongoing care and have a significant adverse effect on the patient's well- being” (California State Board of Pharmacy, n.d.)

By providing the patient with an unauthorized prescription, Jerry is essentially forging a prescription and would be subject to criminal prosecution. In addition, he would also be responsible for civil liability, particularly if the patient was harmed as a result of receiving the medication. The doctrine of respondent superior, which asserts that one’s employer maintains liability for negligent actions on the part of employees, does not afford any protections to Jerry in this case. Because Jerry is clearly acting on his own, he incurs all of the potential liability risks. Unfortunately, due to the litigious nature of society today, his employer will likely also be sued in civil court (Fremgen, 2009).
It is clear that in the case study discussed herein, Jerry has not authority to grant the patient’s request for a medication prescription. By doing anything other than referring the patient to a provider who is authorized to prescribe and or dispense medications legally, he is committing an illegal and unethical act. The scenario he is presented with only has one viable option – politely decline the request. By doing so, Jerry not only protects himself and the physician for whom he works, he is acting the best interest of the patient.

References
California State Board of Pharmacy. (n.d.). Guidelines for the Emergency Dispensing of Dangerous Drugs and Devices. Retrieved from www.pharmacy.ca.gov/publications/emer_disp_guide.pdf
Drug Enforcement Administration, Department of Justice. (2010, October). Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies. Retrieved from http://www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr1006.htm
Fremgen, B. F. (2009). Medical Law and Ethics (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.