As has been widely reported, the Idaho Board of Medicine recently sanctioned a physician for prescribing a common antibiotic over the phone without a prior examination or established patient relationship. This short alert will, hopefully, clear up some of the misunderstanding caused by the media reports.
General Prohibition. Idaho Code § 54-1733 states:
a prescription drug order for a legend drug is not valid unless it is issued for a legitimate medical purpose arising from a prescriber-patient relationship which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment. Treatment, including issuing a prescription drug order, based solely on an online questionnaire or consultation outside of an ongoing clinical relationship does not constitute a legitimate medical purpose.
(Idaho Code § 54-1733(1)). As in other states, the Idaho statute was passed to address standard of care concerns resulting from internet pharmacies and "tel-a-doctor" companies. A violation of the statute constitutes unprofessional conduct which may subject the practitioner to adverse licensure action. (Id. at § 54-1733(5)).
Exceptions. Section 54-1733 does contain several important exceptions, including but not limited to the foregoing:
- Writing initial admission orders for a newly hospitalized patient;
- Writing a prescription for a patient of another prescriber for whom the prescriber is taking call;
- Writing a prescription for a patient examined by a physician assistant, advanced practice registered nurse or other licensed practitioner with whom the prescriber has a supervisory or collaborative relationship;
- Writing a prescription for medication on a short-term basis for a new patient prior to the patient's first appointment;
- In emergency situations where life or health of the patient is in imminent danger;
- In emergencies that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak;
- If a prescriber makes a diagnosis of a sexually transmitted disease in a patient, the prescriber may prescribe or dispense antibiotics to the infected patient's named sexual partner or partners for treatment of the sexually transmitted disease as recommended by the most current centers for disease control and prevention (CDC) guidelines.
(Idaho Code § 54-1733(4)). Despite the concerns raised by the Board's recent actions, Idaho practitioners are unlikely to face Board scrutiny so long as their prescriptions are (1) consistent with the appropriate standard of care and (2) result from an established practitioner-patient relationship involving a documented evaluation or one of the foregoing exceptions.
Telemedicine Task Force. During this past legislative session, the Idaho Legislature passed House Concurrent Resolution No. 46 directing the Department of Health and Welfare to convene a task force to develop a comprehensive set of standards, policies, rules and procedures for the use of telemedicine in Idaho. The task force will presumably address § 54-1733 as part of its review of telemedicine law.