General Question

Judi's avatar

Doctor or Drug Dealer?

Asked by Judi (39826points) May 26th, 2009

Is it ever appropriate for a Rheumatologist to prescribe Ritalin? I know a wealthy person who has made friends with this doctor. She is elderly and complained of being tired. She has arthritis and is on Humeria, but this doctor also has prescribed on going vicodin and Ritalin because she complained of being tired. She is also on prednisone and antidepressants. She has also loaned this guy substantial amounts of money. Is this appropriate? Is it just none of my business (she’s family.) She also has high blood pressure and seems to be showing some early signs of dementia. I don’t know if it’s real or the drugs.

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33 Answers

Buttonstc's avatar

This whole thing just screams “Unethical” all the way from his borrowing substantial amounts of money all the way to the ridiculous mishmash of scripts he is writing for her.

Whether it’s prosecutable or not I think would depend upon the state in which she lives and/or how many others he is inappropriately dealing with.

Can you take legal action? I can’t really say for certain.

Do you have cause for concern? ABSOLUTELY

Kayak8's avatar

I was starting to write a drug-by-drug answer and decided against it. I will say that Ritalin is likely contraindicated by the high blood pressure.

You indicated that the patient is family, but you didn’t name the relationship. If it is a parent/grandparent, you may be able to become involved in a legal way. If it is some other relation, your role may have to be with family members who have a relationship that would legally allow their involvement.

Does she have a primary care doc who is not the rheumatologist? I would go with her to see the primary care doc and share the entire history. If I couldn’t do that, I would call the GP and share my concerns (they can’t talk to you about a patient who isn’t you, but you can talk to them).

An alternative is to call the state medical board, particularly as the rheumatologist has a financial association with a patient for whom he is prescribing narcotics.

Bobbydavid's avatar

Drug dealer. Two operations, countless pescribed medication, injections, physio etc etc still haven’t cured whatever they say is wrong with me and helped with the immense pain. Drug dealer…....£10.00, pain gone!
I know it’s not a cure but after 3 years, surely the fees I pay legally wouldve solved it

Judi's avatar

She’s my mother in law, and the fact that she has money makes it really hard for us to do anything because she’s already paranoid that everyone is trying to get it. We just want her to be healthy and happy.

IchtheosaurusRex's avatar

Borrowing money from your relative is a serious red flag. It crosses the boundaries of a doctor-patient relationship. I don’t know if this doctor’s actions rise to the level of drug dealing, but it would not appear that he is acting in her best interests. I concur with Kayak8 that you need to contact the state licensing board.

augustlan's avatar

Call her regular doc and give them all this information. It seems highly unethical to me. Good luck!

janbb's avatar

I’m not a doctor but I do know that my sister-in-law who has very severe arthritis has been on numerous drugs in combination over the past few years prescribed by rheumatologists. I think ritilan may have been among them. So the drugs may not be inappropriate but I would definitely ask some questions of someone if you are concerned about the doctor.

TheWeedMan's avatar

Hey now a days being a doctor is about business. The entire practice is unethical.

Doctors are pushed to sell drugs by the reps. In exchange they get to go to the Carabian for a week long “seminar” along with a bunch of other kickbacks. You use your medical license to help me reach my quota. You get money and kickbacks and I get money too. What helps me helps you, you see what I mean?

Hell “Pain managment clinics” are the worst. There is a commercial on TV that says “The Medical Pain Managment group uses ONLY the latest FDA approved medication to keep you feeling like yourself….” That is legalized drug dealing. The fiends come in and pay the tax and get what they need for their “pain”

A lot more profitablesafer than peddling pot. The doctor has a medical licence and knows what is best for hisher patient, 150 Oxycontin a month or not.

ubersiren's avatar

Wow, this is completely wrong. No doctor should need a “loan” from a patient. I worked in a pharmacy for a number of years, and all those drugs together sound dangerous. Granted, I’m not a doctor or pharmacist, but that’s my first instinct. I agree 100% with @augustlan that you should call her primary doctor about everything. Include all details. And you’re going to have to be firm with your mom-in-law. Don’t worry about hurting her feelings. Keep reassuring her that you care about her and you don’t want to see her being taken advantage of by some sleazy doctor. Perhaps digging up some dirt on the Dr. would help her see that she’s not in the best hands. You can probably contact the Board of Medicine in your state and see if there’s any monkey business already reported, and if not, you may be able to ask them questions about the situation and see just what is legal, or file a complaint yourself. Maybe not, though because he/she is not your doctor, but it’d be worth a shot.

YARNLADY's avatar

I would call the National Center on Elder Abuse right away 1–800-677–1116.

La_chica_gomela's avatar

I would listen to the advice of other flutherites, but proceed with caution. I had an elderly aunt that was in a somewhat similar situation. She was on a lot of medications including vicodin, which was for serious chronic pain though, not “tiredness” (never heard of vicodin for that, many claim it helps them “calm down and focus”, but whatever, my point is) another healthcare provider, kind of a vigilante stepped in and slashed all her prescriptions because she believed the original doctor was out of line in prescribing them. My aunt went into serious withdrawals from having all her prescriptions changed so drastically all of the sudden and never really recovered from it. Nothing about her underlying condition really changed, but she died soon afterward. Also, I know from personal first-hand experience how horrible the withdrawls from prednisone can be. I was weaned off of over an entire month, 2 mg at the time, and it was still miserable.

If it becomes apparent that she should be on a different medication regimen, please please PLEASE be mindful of withdrawls and wean slowly!

Judi's avatar

@La_chica_gomela ; Part of the dilemma is, when do we have a right to intervene and when do we have a responsibility? She’s been on prednisone for 20+ years, at this point, we are considering, “why should we put her through it?”
Her primary doctor knows she sees the rheumatologist and I believe he knows about the other meds. I just wish that she would either be completley sane or obviously out of it so it would be clear weather or not we should get involved.

YARNLADY's avatar

@Judi At least call the NCEA with your concerns. They can give you advice based on their expert knowledge and experience.

La_chica_gomela's avatar

@Judi: Yeah, you’re in a really tough spot. But the whole loaning him money thing is really suspicious. I would really try to do something about that, if I could. Not to drag up the same story again, but we had issues with the same elderly aunt and her nurses. We found out after her death that they had been robbing her blind, basically. They would dope her up with vicodin and then ask her for a “christmas check” of 10 grand or so, write the check, and say “just sign here”. That’s what this makes me think of.

Judi's avatar

10 grand is a drop in the bucket for her. The last loan we heard about was for 50,000 and when my sister in law expressed concern she was shut down quick. Mom was much better then. She won’t tell us what he owes her now.

CMaz's avatar

Still a Doctor. Because, he is operating within the confines of the law.

La_chica_gomela's avatar

@Judi: Well, from what we can tell this wasn’t a one-time or two-time thing, it was what you might call a “regular thing”.

@ChazMaz: Not necessarily, if she’s making the loans while she’s under the influence of drugs he’s prescribed that can be classified as a felony under the new elder abuse laws, as @YARNLADY has already pointed out, I believe.

augustlan's avatar

Yeah, it’s the meds combined with the loans that is so troubling…

VS's avatar

I see appeals regularly on people who are in prison for similar activity – it’s called abuse of a vulnerable adult. The whole money thing just smacks of wrong and couple that with the mis-prescribing meds and you are looking at a felony. Is your husband her son? Have him contact an attorney about the best ways to protect this woman before it is too late.

RedPowerLady's avatar

Completely unethical and can get in trouble if you contact HIPAA officials in your state/county. I’d report him. If the drug prescriptions don’t do it then I know the loaning him money will.

TheWeedMan's avatar

@La_chica_gomela That law is fucked up.

Old people may make lones because they are senile and demented. Although the practice is unethical as I said earlier you can NOT tie a doctors hands. Doctors will then be afraid to prescribe medication out of fear of being sued/jailed. You can not blame them. It is a trade off.

Let me tell you though, no one is making that woman down those pills but her and her alone. She (or her family) has to take the initiative to find the REAL ansewrs to her problem. The only way to balance this trade off in your favor is to take initiative. Seek out other doctors, use google.

GL

YARNLADY's avatar

@TheWeedMan Spoken by a truly insensitive, uneducated person. Since protection for the elderly is so necessary I, for one, am glad there is a government agency set up for us.

ubersiren's avatar

@TheWeedMan : Do you know what the Hippocratic Oath is?

TheWeedMan's avatar

@YARNLADY Aww thats real cute. People need to get off their ass and stop waiting for others to protect them. If a doctor is abusive, who the hell says she has to go to that doctor. I could see if she was forced to go. I could see if she had no family and is an easy target for manipulation. She has you all to protect her though

@ubersiren Yes I do. It is something docotrs should follow, but sadly don’t. M

Stop waiting for protection, for bailouts, for help, for free money, for the govt. Educate yourself and take your own initiative. You think elder abuse is bad now? Think what they would do back in the day to old and crazy people???

Im not insensitive, I am just keepin it real

ubersiren's avatar

@TheWeedMan : You are talking to the wrong person about waiting for the government to give me handouts. The absolute wrong person. See my profile for details. The point I was making is that the doctor has a responsibility to his patients, and if he’s not upholding that responsibility, then the elderly person’s family should use whatever tools available to make sure it stops and doesn’t happen to someone else. That doctor should be ended. I’m not sure how you think calling an agency on the doctor is not taking initiative for one’s self. Just because the agency is government run, doesn’t mean we shouldn’t use it. If they’re stealing taxes from my paycheck, you better be damned sure I’m using them for all they’re worth. This is no handout. This is using the tools provided. If there was no government, I’d beat the shit out of the doctor myself if it was my family.

The Hippocratic oath means that the doctor’s hands SHOULD be tied if they are bringing harm on a patient. And saying that the elderly loan people money because they are demented… how can you possibly say that’s “keeping it real?” Ridiculous. She is going to that doctor willingly because apparently she has become attached to him/her. She isn’t going to, as you say, “get off her ass” because she wants to be there. The family is the one trying to protect her. They are doing something.

Also, you spelled “loans” wrong.

La_chica_gomela's avatar

@TheWeedMan: I, for one, thing that doctors should be afraid to accept loans from patients. That’s unethical. It creates a conflict of interest where the doctor has to weigh their own interests against that of the patient. It’s like a therapist who sleeps with their patient. It’s not right, and it shouldn’t happen.

You obviously have absolutely no experience with healthcare or geriatric patients. From someone who has visited hundreds of nursing homes, long term care centers, home care visits, and from first-person and family experiences with the system, you’re the one that’s fucked up, not elder abuse laws.

YARNLADY's avatar

@TheWeedMan Are you really so unaware of the infirmities of old age you don’t realize that many elderly are totally incapable of making responsible decisions for themselves? Like I said, insensitive and naive as well.

shilolo's avatar

I know this is an “old” Q, but I just saw it. This will be a two part answer:
1. With regards to the ritalin, it is both legal and medically acceptable to prescribe medications “off label” for certain conditions. In this case, the rheumatologist can argue that ritalin or adderal has been used for fatigue in chronic fatigue syndrome as well as other autoimmune conditions, and thus is acceptable (even if medically it is shaky).
2. With regards to accepting a loan from your patient, that is most certainly unethical. First, there is the issue of transference, where the patient may become dependent on the interaction with the doctor. Another is the conflict of interest between caring for the patient and extracting money from them.

I think your best bet is to focus on the loan issue (if you can). The medical side is murky enough (but probably legal) and might not be fruitful to pursue save discussing her polypharmacy (taking multiple medications) with her primary doctor.

Judi's avatar

@shilolo ; Thank-you for your thoughtful response. I was hoping you would chime in. She has definitely become dependant on this doctor. She has his personal cell number (I bet he didn’t know what he was getting into with that!) and she buys lavish gifts for his son and wife. Although I am still a little gray on the concept of transference, I do know that she is UITE dependant on this doctor both emotionally and to get her vicodin and Ritalin. I believe he also prescribed her Humeria and her prednisone. This poor lady is a walking science experiment!

shilolo's avatar

@Judi All of the meds he prescribes for her can be prescribed by another doctor, if needed. The treatment of rheumatoid arthritis is complex, and if she is on humira, it must be severe enough to require a biologic treatment. Also being on steroids is not a surprise, and vicodin for the pain associated with her existing condition also seems legitimate. So, I would conclude (from afar) that the humira, prednisone and vicodin are all within the framework of treatment for RA. Perhaps there is new research on adderal/ritalin for fatigue in RA that I am unaware of which would explain its use. Again, medically it would be difficult to argue management with him (especially since he has been her doctor for years). It may even explain her attachment to him (he’s been taking care of me for years, and made me feel better…). It would be hard to dissuade someone of that. However, for him to borrow large sums of money from his patient seems inappropriate.

janbb's avatar

Just as an additional weigh-in, my sister-in-law has terrible problems with arthritis and has been on all of those medicines, including ritalin, at different times.

augustlan's avatar

@Judi Were you ever able to do anything about this situation?

Judi's avatar

No. I think we have decided that it’s her life and her money. If we did anything she would twist it around I’m sure, that we were trying to control her and her money. She has a CPA who is her co-trustee. Hopefully has been able to convince her to at least get written contracts.
Just watched Grand Torino the other night and thought, “Boy, I hope we are not coming across to her like the son and daughter in law on that show!”

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