Cosigning prescriptions for controlled substances

I work in a small community clinic that provides low-cost prescription medications to patients. These patients also see consultants who write prescriptions for controlled substances. In order for patients to get the medications at reduced cost, a clinic physician must cosign the prescription using his Drug Enforcement Administration (DEA) number. I am uncomfortable cosigning these prescriptions. Your comments, please.
—MOHAMMED ASHRAF, MD, St. Louis

First, I want to thank you for your service in helping our underserved population. The question you raise, if I may rephrase it, is, "Can I get in trouble with my medical board or the DEA by simply cosigning these prescriptions?" To protect yourself and your colleagues, I recommend that you document a good faith medical examination before cosigning these prescriptions. That documentation should include an independent medical judgment that, based on your evaluation of the diagnosis, the prescription rendered seems reasonable in type and quantity. This, along with the fact that the patient had an independent evaluation by a specialist should provide ample protection. If you discover, however, that the prescribing "specialist" is overprescribing or prescribing inappropriately, you cannot justify the prescription based on your own independent evaluation. In that instance, I would not cosign.
—John Davenport, MD, JD
(129-8)
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