OT-ethics issue at mental health clinic - who to report this to?

I hope you can help your friend and I'm sure you can point him in the right direction, but some of the agencies or medical offices may not talk with you about this because of the HIPA laws.  They are really strict.  I agree with calling the media, too, but make sure your friend is okay with all of this.  He is depressed now, it could be problematic for him. 

I hope something can be done and he gets some relief from this incredibly WRONG situation.  It always annoys me when medical professionals take advantage of their patients or patients' families - the very people they taken an oath to help.

Good Luck.

 

They don't need to talk with me about anything protected by HIPPA.  I just need them to tell me if the clinic is supposed to be charging $41 to pick up his free meds.  They don't need to tell me anything about any particular patient.  Just about the legality and ethics of this policy.

I work for a psychiatrist and we get a lot of meds delivered for patients to pick up at our office. We have never charged a patient for a med pick up. We just have them sign and give them the meds. I don't know if it is illegal in anyway but it sure sounds unethical. I would contact JCAHO just to verify if an office is allowed to charge for that service. As far as the meds not always being there, that is unfortunately not uncommon. We have to call the pharmaceutical companies each time the meds need ordered (they don't automatically send them) some of the companies are very good about getting them right out - some of them are not. It really stinks when a patient need their medication and it doesn't come when it is supposed to. Tell your friend to hang onto the office receipts and check with JCAHO or AMA to see if this is an acceptable practice.

Thanks, I assumed most doctors would not charge just for picking up meds.

Living in Canada I wouldn't know who to contact, but alerting the pharmaceutical company would be a good idea as they may not want to deal with that clinic. I wonder how many other clients they do this to also. It is disgusting!!!! The whole idea behind the company giving the meds free is to help someone *****ally needs it and cannot afford it. Have your friend organize and document everything!!! That way you are all set for proof. I wonder what the clinic would do if he asked for copies of all documents and a signed statement from the psychiatrist saying that he has to pay to pick up his meds? Maybe if the. Clinic knew he was accumulating a file on what is going on they may make an "exception" for him and not charge him anymore. I would also have the pharmaceutical company to document he is receiving them for free. Good for you for advocating for mental health patients. They get abused and pushed around all to often.
Ingrid.

I hope he is getting the help he needs with the counseling; that's the most important thing.

He is getting the medication for free which is huge considering the cost that some prescriptions can incur. The provider that is dispensing the script has to make sure that he is in receipt of the correct medication and understands the directions. Medication errors are not uncommon and they are making sure to cover their liability. While it might not make sense to most people that the clinic is charging for the visit it is a charge for time just like a doctor's appointment. They are only charging a portion of a regular office visit which is a good thing; he could be charged for a regular office visit. I work in a pain management clinic and we have patients that routinely come in just to pick up medications. Because we dispense a lot of narcotics we have to be sure that all the documentation is in place; patients signature, dispensing staff member signature, the chart is noted appropriately,etc. These appointments are billed to, and paid by, insurance (Medicare, private insurance and worker's compensation insurance).

Unfortunately, this is most likely not illegal or unethical. There are two scenarios that could make this possibly illegal, both depend on how the MD's office is obtaining your friend's medication.  First, it is illegal to sell free medication sampled to patients. If a doctor gets medication sample free from a drug company then it has to be given to patients for free. Though, technically they aren't charging him for the medication, it sounds like they are calling it more of an administrative fee. Second, the same holds true if your friend is receiving his medication from the drug manufacturer through an indigent or compassion program. Those also cannot be sold. A side note- if he is receiving his meds though a compassion program he can request that the meds are drop shipped directly to his house, or they can provide him with card/coupon to get his meds free at a pharmacy ( the pharmacy gets reimbursed from the drug company) of his choosing, but he would need a written Rx from his Dr. 

Based on what you wrote, I can't think of what bioethical principle would be violated in this situation-maybe justice, but I think that's a stretch.

What is most likely happening, and is common in community health centers, the center has a close door pharmacy (meaning not open to the public) that has a discounted contracted price with the drug company so that the center can afford to have a sliding scale. The administrative fee is used to offset some of that. 

It may have been a while since your friend began going to this center but he should look through his paperwork to see if he was ever notified of this fee. These are the types of policies and practices MD offices are required to notify their patients about in writing. If he was never notified (especially about being charged twice if he has to return) , he might have something there. 

This sounds very unfair, but it is unlikely that it is illegal or unethical.  Sorry.

Thanks for the info.  I am pretty sure he is getting the meds through a compassion program through the pharmaceutical company, but I will check with him (or have him check, if he doesn't know for sure) to make sure it's not a closed door pharmacy deal.

If it is a compassion program he should just get a Rx from the Dr and he can have it filled at any pharmacy he wants (CVS, RiteAid, Walgreens). Then he won't have to going to the Dr. to pick up anything- other than the Rx. If the office gives him any pushback back about changing the set up he should contact the patient assistance line affiliated with the compassion program, they will be able to help him. 

I hope it all works out.

Some of the compassion programs won't ship to the patients' homes, only the doctor's office. It depends on the drug and the program.