[MCOH-EH] Accessing state PMP for safety sensitive job applicants and DOTs

[Thanassi, Wendy]

From: Cook, Jacqueline
Sent: Thursday, January 30, 2020 9:50 AM
To: Thanassi, Wendy <Wendy.Thanassi at va.gov<mailto:Wendy.Thanassi at va.gov>>
Cc: Tacoronti, Rudolph V. <Rudolph.Tacoronti at va.gov<mailto:Rudolph.Tacoronti at va.gov>>
Subject: RE: [EXTERNAL] Re: [MCOH-EH] Accessing state PMP for safety sensitive job applicants and DOTs

Hi Wendy,
Yes, this is a good point to mention. This is true of most states - state prescription monitoring program (PMP) laws and regulations conventionally restrict access to treating healthcare providers. There have been cases (including to the level of the Supreme Court) in which individuals were convicted of PMP misuse as the individuals queried were not patients of the PMP user. With agency-directed medical examinations such as fitness-for-duty examinations or pre-placement examinations, recall that these individuals under these specific circumstances indeed are not patients, as there is not a treating provider-patient relationship, and so it is recommended not to use state-based PMPs to query prescriptions in these cases.


PMP misuse has been a concern in the MRO world as well. MROs have used PMPs to verify prescriptions, and again, it is recommended not to do so as the MRO can be accused of PMP misuse.



HHS cites in the MRO Manual,

"A prescription may be verified by means such as:

*                     Photos sent by text, e-mail, or fax showing enough angled shots of the bottle label that the MRO can verify the name of the donor on the label, prescription number, name of the drug, prescribing physician, date filled, number of pills in the prescription, number of refills, and the pharmacy name, address, and contact information.

*                     A verification call to the pharmacy (after the MRO has verbally obtained the information in the item above from the donor and documented it on the MRO record).

*                     A copy of a pharmacy printout showing the medication dispensing history.

*                     A signed statement from, or phone discussion with, the prescribing physician. In all cases, the MRO should verify that the contact was with the prescribing physician. For example, the MRO may request the DEA number or state license number. For additional security, the MRO may obtain the physician's telephone number from another source (e.g., online search) and call the individual to verify identity."

Jacqueline M. Cook, MD, MPH, FACOEM
Medical Advisor, Office of Occupational Safety, Health and GEMS Programs (10NA5B)
VHA Central Office MRO Consultant/Headquarters MRO
Assistant Professor, Yale University School of Medicine
Tel: (203) 932-5711 x7749;   Fax: (203) 937-4885
E-mail: jacqueline.cook at va.gov<mailto:jacqueline.cook at va.gov>; jacqueline.cook at yale.edu<mailto:jacqueline.cook at yale.edu>

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From: Thanassi, Wendy <Wendy.Thanassi at va.gov<mailto:Wendy.Thanassi at va.gov>>
Sent: Wednesday, January 29, 2020 6:47 PM
To: Cook, Jacqueline <Jacqueline.Cook at va.gov<mailto:Jacqueline.Cook at va.gov>>
Cc: Tacoronti, Rudolph V. <Rudolph.Tacoronti at va.gov<mailto:Rudolph.Tacoronti at va.gov>>
Subject: FW: [EXTERNAL] Re: [MCOH-EH] Accessing state PMP for safety sensitive job applicants and DOTs

Hi Jackie,
I thought maybe you'd be interested in weighing in..

I'll be in CT the first week of March. Let's get a meeting on the books!

Wendy

From: MCOH-EH <mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net<mailto:mcoh-eh-bounces+wendy.thanassi=va.gov at mylist.net>> On Behalf Of Natalie Hartenbaum
Sent: Wednesday, January 29, 2020 2:29 PM
To: MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Subject: [EXTERNAL] Re: [MCOH-EH] Accessing state PMP for safety sensitive job applicants and DOTs

This is the way it is for MANY states.  There is actually RISK for OM providers checking the PDMP to evaluate routine fitness for duty, even in safety sensitive positions. Essentially if doing so, should do so for ALL applicants/employees.


If being asked to evaluate FFD because of OBSERVED findings, then it is reasonable to contact ALL treating providers and ask them to review the PDMP and work WITH you in evaluating FFD.


Natalie P.  Hartenbaum, MD, MPH, FACOEM
President and Chief Medical Officer
OccuMedix
PO Box 197
Dresher, PA 19025
215-646-2205
occumedix at comcast.net<mailto:occumedix at comcast.net>

On Jan 28, 2020, at 9:52 PM, Teichman, Ron F <Ron.Teichman at bannerhealth.com<mailto:Ron.Teichman at bannerhealth.com>> wrote:

Hi all,

My newly adopted state of Arizona has a Controlled Substances Prescription Monitoring Program, but restricts access to treating providers and dispensing pharmacists, thus making it illegal for occupational health providers to access the information with regards to post-offer pre-placement exams, fit-for-duty exams, return to work exams, firefighter and other public safety exams, and DOT exams. I am trying to ascertain whether other states with similar programs/registries allow access for the protection of public safety. Obviously nobody wants providers, nurses, pharmacists, residents, law enforcement, truck drivers and others working in safety sensitive positions to be working while impaired, but this important resource is closed to providers in AZ.

TIA for whatever information you can share,
Ron

Ron Teichman, M.D., M.P.H., FACOEM, FACP
Division Medical Director
Banner Occupational Health and Wellness
1300 N. 12th Street, Suite 610
Phoenix, AZ 85006
602-747-7294
Ron.teichman at bannerhealth.com<mailto:Ronald.teichman at bannerhealth.com>

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