Vermont Board Ruling Encourages Diversion of Buprenorphine

According to this Stipulation and Consent Order of the State of Vermont Board of Medical Practice physician Claudia E. Lee, M.D. ("Respondent") agreed to allow a board approved "practice monitor" to review selected records of buprenorphine treatment of patients in her practice and to attend continuing education classes in "prescribing practices" and protection of patient privacy as a reprimand for her conduct.

The order describes two acts of putative misconduct. In the first case the patient's psychiatrist referred her to Dr. Lee for buprenorphine maintenance asserting that the patient had been obtaining the drug on the street, a fact which the patient apparently confirmed. According to the order Dr. Lee should have independently confirmed that the patient had been using buprenorphine by requiring her to undergo drug screen.

Aside from the fact that I find it offensive that a medical board should require a physician to doubt the word of a colleague and the patient, I argue that the board's recommended approach to such a case in fact encourages illegal conduct on the patient's part. If a patient must test positive for drugs in order to obtain a legitimate prescription for that drug, is it not foreseeable that the patient will obtain the drug illegally in order to pursue treatment which otherwise was apparently quite appropriate. Dr. Lee did precisely what she should have done.

The second act consisted of revealing "protected health information" of a son who was a patient of Dr. Lee to the mother who was also the patient of Dr. Lee in making an unauthorized disclosure that the son had relapsed with drug abuse.

While I agree that this disclosure violates the son's confidentiality, the Vermont Board apparently fails to consider that Dr. Lee, as a family practice physician, will frequently face situations with the potential for such inadvertent unauthorized disclosures. This ever present risk occurs in family psychotherapy and group psychotherapy as well, at least in situations in which individuals encounters take place too. Certainly Dr. Lee knew better, but physicians and other health care providers are human and will err, a fact that all the continuing medical education you can throw at us will never change. This was a cheap shot on the part of the Vermont Board. The only viable solution to the problem? Never treat two family members or other people who know each other in the same practice. I doubt any medical board will have the courage to enforce such a requirement.

The Vermont Board's misconduct, not that of Dr. Lee, should concern the good citizens of Vermont.

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