Indianapolis Medical Society

Medical Reporting Requirements

Collaborative effort of the Marion County Prosecutor's Office and the Indianapolis Medical Society

Prescription Abuse

A major portion of abused drugs in Indianapolis are obtained by the use of prescriptions which have been forged, signed under duress or obtained by misrepresentation. Individual addicts, as well as organized drug rings, obtain these prescriptions from physicians who have left themselves vulnerable.

Fake Patients and Symptoms

Drug abusers will attempt to fool a physician into prescribing unnecessary drugs by faking symptoms, creating false stories and depending upon a physician's compassion and sympathy.

WHAT to Look for:

1. "New patients" who
   • do not have an appointment
   • come in with another patient and request assistance
   • are from "out of town" or "just passing through"
   • are one of several "new" patients within a short time period and have the same or similar symptoms, or request same type of drug
2. Patients who
   • bring in previous medical records suggesting an instant diagnosis
   • self diagnose
   • request a specific drug
   • request counteracting drugs such as uppers and downers
   • request drugs to "keep going" or "get through"
3. Patients who avoid actual physical examinations or tests.
   Common stories include:
   • new insurance not effective yet
   • no money for tests
   • appointment with a different doctor at a later date
4. Avoid calls from stress or diet clinics who request prescriptions for their "patients" with non-existing medical conditions.

HOW to Protect Yourself:

1. NEVER sign a prescription without seeing the patient.
2. Treat your prescription pads like your checkbook.
   Always lock them up in a safe place or keep them in your pocket.
   • NEVER sign blank prescription pads to be filled in later
   • NEVER leave prescription pads in an examination room
   • Do not use prescription pads to write memos or notes or use erasable materials
3. Write out prescription quantity in words and Arabic numerals to discourage alterations (ex.: twelve (12))
   • use a check-off box indicating quantity (ex: 1-25/26-50)
   • clearly indicate number of renewals, if any
   • prescribe least amount of drug necessary
4. Order your own prescription pads on colored paper - do not use preprinted pads.
5. Never call in prescriptions unless it is an emergency situation (then follow-up with written information within 72 hours)
6. When a pharmacy calls to verify a prescription,
   • give patient's name, prescription amount, directions and renewal information
7. Be cautious when you carry prescription pads in your medical bag

WHAT to Do:

If you are suspicious about a patient's medical needs or prescription request:

1. INSIST on examining the patient before prescribing any drugs
2. Wait to prescribe until after medical tests have been taken and received
3. Take a thorough medical history
   • if patient claims he is seeing another doctor, verify this and any other medical information
4. Prescribe an extremely limited amount of the drug to be used in the interim
5. Call and report suspicious activities: Your assistance need not go any further than a phone call

WHO to Call:

Indianapolis Metropolitan Police Department, Narcotics Division -
Fraudulent Prescription Investigation Unit

Sgt. Carol Johnson

(317) 317-4476
Pager: (317) 368-1943

Det. Smith

(317) 327-3379
Pager: (317) 592-7058

Barb Johnson

(317) 327-3657
Pager: (317) 592-7012

(IMPD will act as a clearing house and refer calls to other law enforcement agencies as appropriate.)

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Child Abuse

Any individual who has reason to believe a child is the victim of abuse or neglect is required by law to report such abuse (IC 31-6-11-3)

A physician's duty to report child abuse is firmly endorsed by the Judicial Council of the American Medical Association. Clearly stated in the Principles of Medical Ethics (1.02), the ethical obligation of the physician may even exceed the statutory legal requirements.

Although both the suspected offenders and victims will often plead with the physician to keep suspicious injuries "quiet" or "confidential," reporting child abuse is not a breach of privileged communications or conflict of interest. The physician's duty is to his patient, the victim, and non-reporting could result in additional abuse.

WHAT to Look for:

1. Obvious physical injuries, bruises, lacerations, chipped teeth, etc. (a child wearing heavy, long-sleeved garments in very warm weather may indicate an attempt to conceal injuries)
2. Refusal to explain physical injuries
3. Multiple office visits
4. Medical signs of venereal disease
5. Irregularity, bleeding or bruises in genitalia
6. Conflicts in the parents' report of an accident
7. Reluctance of parents to explain an accident
8. Parents reaction to injury not appropriate for type of injury
9. Signs of neglect, such as poor skin hygiene, malnutrition, withdrawal
10. Unusual fear or defensiveness in child while in the presence of parent or other authoritative figure
11. A history of abuse in the family
12. Parent or guardian abuses alcohol or drugs

WHO to Call:

Marion County Child Protection Service

(317) 968-4379 or (800) 800-5556 (Indiana - County directed)

If you report child abuse incidents in good faith, you will be immune from any civil or criminal liability which otherwise might be imposed (IC 31-6-11-7).

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Other Reporting Required by Law

1. Elderly Abuse:
   If you have reason to believe that elderly person(s) are the victims of battery, exploitation or neglect, this must also be reported. (IC 35-46-1-13).
   
   Call: Adult Protective Services (317) 327-1403
2. Sexually Transmitted Diseases:
   Suspected cases of the following sexually transmitted infections also must be reported to the Marion County Health Department.
   • Chancroid
   • Chlamydia
   • Gonorrhea
   • Granuloma Inguinale
   • Lymphogranuloma Venereu
   • Syphilis
   Call: Marion County Health Department - Sexually Transmitted Disease Program (317) 221-8300 (Bell Flower Clinic)
3. Report of Communicable Disease:
   Sec. 7-201 Any physician or other health care professional who has knowledge of or diagnoses or treats a communicable disease case, and every superintendent or manager of an extended care facility, hospital, charitable or penal institution, dispensary, military installation, or educational and child-care facility in which there is a communicable disease case shall report such case or suspected case to the Health and Hospital Corporation of Marion County, Division of Public Health, Marion County Health Department, Communicable Disease Control Program in accordance with Sec. 7-202.
   
   Sec. 7-202 All cases and suspected cases of the diseases listed below shall include the full name, address, telephone number, age or date of birth, sex, race and ethnicity, date of onset, diagnosis, and the name, address, and telephone number of the attending physician. Cases reported by identifying data to the Health Officer shall be confidential and shall not be disclosed except by: (1) court order; or (2) upon receipt of a written and signed request of the patient, parent or legal guardian. Information from such reports will be utilized for epidemiological investigation as warranted and without personal identification for statistical purposes only. Such report shall be made on the official report form prescribed and furnished by the Indiana State Department of Health or by telephone or other instantaneous means of communication. Those diseases marked by an asterisk (*) must be reported by telephone to the Marion County Health Department as soon as the diagnosis is suspected.
   
   Those diseases marked by two asterisks (**) must be reported within 24 hours. Other diseases are to be reported within 72 hours.
   
   
   • Acquired immune deficiency syndrome (AIDS)
   • Animal Bites **
   • Anthrax *
   • Babesiosis
   • Botulism *
   • Brucellosis
   • Campylobacteriosis
   • Chancroid
   • Chlamydia trachomatis, genital infection
   • Cholera *
   • Cryptococcosis
   • Cryptosporidiosis
   • Cyclospora *
   • Diphtheria *
   • Ehrlichiosis
   • Encephalitis, arboviral, Calif, EEE, WEE, SLE, West Nile, VEE*
   • Escherichia coli, infection (including E. coli 0157:H7 and other enterohemorrhagic types) *
   • Gonorrhea
   • Granuloma inguinale
   • Haemophilus influenzae, invasive disease *
   • Hansen's disease (leprosy)
   • Hantavirus pulmonary syndrome *
   • Hemolytic uremic syndrome, postdiarrheal *
   • Hepatitis, viral, Type A Igm+ *
   • Hepatitis, viral, Type B
   • Hepatitis, viral, Type B, pregnant woman (acute and chronic) or perinatally exposed infant *
   • Hepatitis, viral, Type C
   • Hepatitis, viral, Type Delta
   • Hepatitis, viral, unspecified
   • Histoplasmosis
   • HIV infection/disease
   • HIV infection/disease, pregnant worman or perinatally exposed infant *
   • Legionellosis
   • Leptospirosis
   • Listeriosis *
   • Lyme Disease
   • Lymphogranuloma venereum
   • Malaria
   • Measles (rubeola) *
   • Meningitis, aseptic
   • Meningococcal disease, invasive *
   • Mumps
   • Pertussis *
   • Plague *
   • Poliomyelitis *
   • Psittacosis
   • Q Fever *
   • Rabies in humans or animals (confirmed & suspect animal with human exposure) *
   • Rabies, postexposure treatment
   • Rocky mountain spotted fever
   • Rubella (German Measles)
   • Rubella, congenital syndrome *
   • Salmonellosis, other than typhoid fever
   • Shigellosis *
   • Staphylococcus aureus, Vancomycin resistance level of MIC = 8 ug/mL *
   • Streptococcus pneumoniae, invasive disease and antimicrobial resistance pattern
   • Streptococcus, Group A, invasive disease
   • Streptococcus, Group B, invasive disease
   • Syphilis
   • Tetanus
   • Toxic shock syndrome (streptococcal or staphylococcal)
   • Trichinosis
   • Tuberculosis cases, suspects and individuals with LTBI
   • Tularemia *
   • Typhoid fever, cases and carriers *
   • Typhus, endemic (flea-borne) and epidemic (louse borne)
   • Varicella (resulting in hospitalization)
   • Variola (smallpox) *
   • Viral hemorrhagic fevers *
   • Yellow Fever
   • Yersiniosis

Emerging Diseases, such as SARS and Avain Influenza are reportable under Sec. 7-204.

Sec. 7-204 Outbreaks of the following shall be reported immediately upon suspension:

• any disease required to be reported under this section;
• diarrhea;
• diarrhea of the newborn (in hospitals or other institutions);
• foodborne or waterborne diseases in addition to those specified by name in this rule;
• Streptococcal illnesses;
• conjunctivitis;
• impetigo;
• nosocomial disease within hospitals and health care facilities;
• influenza-like illness;
• acute respiratory illness;
• multilobar pneumonia, etiology unknown;
• rash illness;
• non-specific meningitis/encephalitis illness;
• jaundice;
• unusual cutaneous lesions;
• unexplained septicemia, paralysis, or death;
• unusual occurrence of disease; and
• any disease or illness that could be considered the result of a terrorist act.

The Tuberculosis Medication Service and Referral form can be found at: http://www.mchd.com/cdc.htm

The entire Health and Hospital Communicable Disease Ordance (Chapter 7) can be found at: http://www.hhcorp.org/HHcode_pdf/07.pdf

Call: Communicable disease reporting needs to be telephoned to the local health department in the patient's county of residence.

Boone Co. Health Department

(765) 482-3942
Fax: (765) 483-4450

Hamilton Co. Health Department

(317) 776-8500
Fax: (317) 776-8506

Hancock Co. Health Department

(317) 477-1128
Fax: (317) 477-1154

Hendricks Co. Health Department

(317) 745-9222
Fax: (317) 745-9383

Johnson Co. Health Department

(317) 736-3776
Fax: (317) 736-5264

Marion Co. Health Department

(317) 221-2117

Communicable Disease Control Program

Fax: (317) 221-2076

After hours

(317) 373-2477

Morgan Co. Health Department

(765) 342-6621
Fax: (765) 342-1062

Shelby Co. Health Department

(317) 392-6470
Fax: (317) 392-6472

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Miscellaneous Reporting

Animal Bites

Marion County Health Department - Special Service Environmental Sciences

Contact: Tom Prendergast

(317) 221-2239

Newly Diagnosed Blindness

Family & Social Services

(877) 241-8144

Tuberculosis

Marion County Health Department T-B Control Program

(317) 221-2110

Gun/Knife Wounds

Indianapolis Metropolitan Police Department

(317) 327-3811

Wounds and injuries from firearms, knives, ice picks or other sharp pointed instruments, or powder burns, must be reported to law enforcement authorities of Marion County. (IC 35-47-7-1)

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Deaths

Deaths to be reported to the Coroner's Office:

• Deaths caused by wound or injury
• Any death with a history of a fracture within a year and day preceding death
• Any sudden unexpected death of a child or due to child abuse
• Deaths involving suspected criminal abortion
• Deaths occurring in the operating room
• Deaths resulting from medical or surgical misadventure
• Deaths occurring within the first 24 hours following admission to a hospital
• Unusual or unexpected deaths
• Any deaths in which the physician declines to sign a Death Certificate

The physician has only the responsibility to report the above listed deaths.

The Coroner will determine if the death will be certified on a Coroner's Death Certificate or if it may be routinely signed by the attending physician.

WHO to Call:

Marion County Coroner's Office (317) 327-4744

Hours are 8:00 A.M. to 4:00 P.M. Monday through Friday.
After 4:00 P.M., weekends and holidays, phone (317) 631-3466.

Permissive Reporting

Effective September 1, 1985, the patient-physician privilege will no longer be applicable to bodily substance samples and test results concerning intoxication or to testimony concerning the facts observed and opinions formed by the attending physician and support staff.

Such information shall be provided to a law enforcement office upon request.

Immunity from criminal and civil liability will be extended to the physician and support staff even if the patient has not consented or otherwise authorized the release of this information. (IC 9-11-4-6).

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Quick Check Telephone Listing

Adult Protective Services

(317) 327-1403

Animal Bites

(317) 221-2239

Bioterrorism Information

(317) 232-6139

Blindness (newly diagnosed)

(877) 241-8144

Child Abuse

(317) 968-4379

Communicable Diseases

(317) 221-2117

Deaths

(317) 327-4744

Elderly Abuse

(317) 327-1403

Injuries from firearms, knives, etc.

(317) 327-3811

Prescription Abuse

(317) 327-3379

Tuberculosis

(317) 221-2110

Sexually Transmitted Infections

(317) 221-8300

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INSPECT

Indiana's Prescription Drug Monitoring Program - http://www.in.gov/inspect/.