Is Dr. required to give pt. prescription for othotic devices

What is the name of your state? Kansas

My orthopedic physician routinely prescibes an ROM boot (removable cast) for ankle fractures after some weeks of being in a plaster cast. He writes a script on a form provided by the orthotic and prosthetic supply store next door to his office. He bypasses the patient with the prescription, so the patient never knows to go shopping for a better price for the same thing.
I had a plaster cast removed and a guy shows up and gets my size and returns with an ROM boot. I thought it had been paid for as a part of the lump amount they said I owed them for the usual course of treatment after my first visit.

A week or so later, I get a bill in the mail for $295. Is a doctor required to at least waive the prescription under the patients nose, or even advise the patient that the cast will be required at some point in treatment, so that he can go shopping for something and not be at the mercy of the supplier next door?

The orthotic supply place sued me for the $295 bill. I counterclaimed under the Kansas Consumer protection act alleging that the prescription routine between the doctor and the orthotic supplier is a deceptive practice. It went to a trial, and I called doctor as witness. He and the orthotic supplier admitted that this was their usual prescription procedure.

The non-lawyer judge (it was a limited action proceeding) ruled against me. I want to know if I should appeal, so if anyone knows if this practice is forbidden by any law, or regulation, or AMA guideline, or whatever, please speak up. I have had several persons tell me that it is their understanding that the patient is supposed to get a script, but I have been unable to find any authority.

itchwitch
You were not prevented from telling the MD at the time of your appointment that you wished to shop around for the best price. You were not prevented from telling the supplier that you did not want their product without price comparisons from other suppliers in the area. You were not prevented from refusing the appliance. You were not prevented from finding an appliance somewhere else and having that supplier get the Rx from the supplier used by the MD.

I don't see where you have a right to appeal; but, I am not an attorney.

EC

Orthotic Device and the Good 'Ol Boys Ride again

do you by any chance live in a small town?
anyway, yea, yea, i read the reply, by ellencee, BUT, you had good faith and trust in your physician, which perhaps was misguided in regards to his motivation in treating you.
eyes wide open
I believe that this practice is not ethical. The prescription for this device might be something that practically could be used to prove that your insurance company would be liable to pay for the appliance in the amount that your plan allows for.
But, practically, this method was not sympathic to one who hasn't the insurance to pay for the appliance not the means to pay for it, nor the desire to throw his/her money away, (or donate it to their doctor and his prosthetic supplier buddy)
Do I sound like an RN? 30 yr's ....not surprised

The practice of orthopedic MD and supplier is quite common and not the slightest bit unusual. The same is true for an orthopedic MD and a physical therapy provider. It's done every day, all over the US, and is not unethical. It is efficient in being both fast and in reducing errors. Most patients appreciate being able to go next door and not having to drive all over the place between MD and orthodic appliance provider.

Patients' rights are posted in every healthcare provider's facility. I'm sure the OP's MD and the associated orthodics supplier have a Patients Rights poster in plain view for all to read.

The OP didn't have any problem using the appliance and benefiting from it, just has a problem with paying for it and is looking for a way out of paying his medical bills. That sounds familiar!

Way to go for hanging with nursing for 30 years! I'll reach that anniversary much sooner than I'd like to believe.
EC

Orthotic referral

There's a difference between morally and ethically correct and legally correct. Reasonableness is also an issue. The situation as described by the patient sounded a bit underhanded to me. But that's only my opinion. Many of the physicians who I choose to be associated with, keep in mind their patient's ability to pay when prescribing things for them. Not to mention their patient's overall welfare should come before their own.

Orthotic devices

You could look up the state law. Look under Medical, then look up medical devices. I know that in Florida, my orthopedic surgeon sometimes will just tell us to go get a sling or whatever we need at Wal Mart's.
There are many different sorts of devices, such as heart valves, artificial eye implantable lenses, to orhthotic devices. I don't know where the line is drawn. But, it seems to me, logically, (which has no bearing on reality sometimes), there are many adjustable type splints that we can get at the druggist. But the ones that are especially fitted would have to be made by a special orthotics trained person. The doctor would decide whether you need this one or that one. In the operating room, we often just take adjustable splints off the shelf that come in small, medium and large.
Hint, does it say on the pkg, must only be sold on prescription by physician?
The physician would have to have a reasonable andcustomary excuse for a specially fitted orthotics device in your special case. The question would be, was his decision "reasonable and customary" in deciding that you would need a specially fitted splint/cast. device

Prescribing Orthotic Devices

It just came to mind that in Florida there's about 5 pages of Florida Law in the Medical Section on Orthopaedic Surgeons which deal with prohibiting them from being affiliated with Rehabilitation Hospitals and Devices. In the past, alot of that had been going on and it was decided to be unethical and led probably to inappropriate medical decisions.
You might gain by calling your state congressman or senator (one who might be of the opposite political affiliation than your surgeon is might be of some additional benefit, I might add....)

Florida's not the only state with those laws; I think federal law prohibits actual affiliation--but, think about the way things are really done. For example, at my least favorite store in the whole world, WalMart, there is an office where you can get your eyes examined and next door to it, a place to buy eye glasses and contact lenses. I see the same thing in every mall, every shopping center. Around each hospital are pharmacies, medical equipment suppliers, etc. Although no true affiliation exists, you can bet that referral by close proximity increases the sales of those businesses. Some home health companies are owned by, or under the management services of, the same company as a hospital but there is no true affiliation. When home health is ordered during discharge, a list of providers is given to the patient; but, when 'General Hospital' is where the patient is and General Home Health' is on the list, who do you think the patient most often chooses?!

To my knowledge there is no restriction about having a preferred provider of supplies or equipment or doing exactly what the OP's orthopod did.

People who can't afford medical care, prescription meds, orthodic supplies, etc. often receive these services through indigent care or some other program and it is the healthcare provider who most often assist the patient in gaining these benefits. It's part of the job, part of the duties of the healthcare provider.

I don't think OP falls into the category of persons who do not know their rights or did not have the mental ability to shop around if that is what he wanted to do. I think the OP is simply trying to get out of paying a legitimate bill and is willing to injure the party who had the nerve to sue him for the balance owed.

I know that medical malpractice and nonethical things go on in healthcare. I also know that too many people perceive the healthcare industry as being an easy target for free money and they are willing to harm healthcare providers just to get some extra cash, hopefully millions of dollars of extra cash. I don't think those persons understand how physically, mentally, and emotionally difficult/consuming it is to be a healthcare worker. I don't think those persons understand that people who are doctors and pharmacists, etc. and have large incomes would be just as financially successful in whatever career they chose.
In cases such as the OP's, and many others who have posted here seeking a way to sue healthcare providers, I think the motivation is greed or jealousy or a combination of the two.

Thanks for the chat!
EC

This boot was a size small. It came in S M L. The fitting of it was determined by my shoe size. Not a lot of expertise needed there.

There are federal laws which prohibit physicians referring patients to businesses that the physician owns a significant chunk of. And there is federal law which prohibits "kickbacks". The orthotic sales guy can't give the physician a cut. I have no evidence that either of these things has occurred. But they have a lot of nice Christmas parties, I notice.

The doctor testified, briefly, that he refers patients to next-door-orthotic-place because he believes they provide a unique service, to him. I'm sure it is rather practical. But. I didn't have insurance, the orthotic place didn't give me an invoice when they delivered it, I didn't realize I was dealing with anyone other than the doctor's employee, I thought it was already paid for, and nothing alerted me to the fact that I was going to be expected to pay $295 for the thing.

The doctor also testified that he always prescribes this particular boot in his course of treatment for ankle fractures. This is after several weeks of being in a plaster cast. He specifies an ROM feature, which consists of a hinge at the ankle which can be fixed at a specific angle, or loosened so the ankle moves up and down when walking. He said that they sometimes loosen the ankle to encourage flexibility.

The ROM feature adds about $200 to the cost of the device. A fixed ankle boot can be purchased from Grogans Health Care supply on the internet for about $90.

As it was, they never instructed me to have the ankle loosened because I quit going when it quit hurting and I could not afford it. I don't know if they would have recommended it if I had continued. The doctor didn't say he always recommended it, just sometimes.

The physicians assistant said, when asked, that I could have gained flexibility by taking the thing off and exercising it. Which is what I did.

So, I ended up with a bill for $295 for a device. Had I known that I was going to have to have one before I went in there, I could have ordered something which would have worked for about $90. I could have purchased one with the hinge feature locally for $169.

I just think the doctor was pretty cavalier with my $130 or $200, depending on if the hinge was really needed, and if I had any choice in the matter.

My state has a consumer protection statute (K.s.a. 50-626 and 50-627) that states that it is a deceptive practice to willfully state an untrue material fact, or omit to divulge a material fact.

The have admitted the referral situation is their usual course of action. Therefore it is willfull. They didn't advise me that I was going to need the boot prior to the time I had to purchase it, even though they always prescribe these, and when it came time to get one, they failed to advise me that ( a. ) I was going to have to pay for it, ( b.) that I was free to shop around, and (c.) that the ROM feature made the thing a lot more expensive and wasn't absolutely necessary.

So it would seem to me to be fairly obvious that the doctor has been guilty of a deceptive act. And since the orthotic supplier knows that the patient never receives a prescription, and he also fails to educate me about the price differences in boots, I believe he might also be liable.

But. Since they are being so cavalier about it, it makes me wonder if there is something I'm just not seeing.

You seem to be a very intelligent person. I can't help but wonder why you didn't accept the responsibility of discussing all of the costs and the treatments with your physician at the time of your appointments.

The ROM feature is great. A fixed boot could have led to loss of flexibility in the ankle and required (time and expense) of physical therapy to overcome the loss of flexibility (ROM) of the ankle. Without either the ROM feature or the physical therapy if you had received the fixed boot, you could have a permanent, or at least a long lasting, impaired ability to walk. If you had developed a limp due to loss of ROM in the ankle, then your knees and hips would have been out of alignment when you walked, and you could have developed costly problems with these other joints. And, your spine! It could have suffered from the lack of proper body alignment, stress on the knee and hips joints, and you could have developed a herniated disc or degenerative changes in the vetebrae! If you compare the costs of treatments for these other related and very real possible complications, isn't the $200 for the ROM feature worth the cost? Didn't the physician actually make the right decision in prescribing a boot with ROM feature instead of a boot that could have led to costly and debilitating complications?

Just some food for thought...
EC

As it was I never used the ROM feature. Part of the reason I didn't want another plaster cast was because I wanted to be able to take the thing off and stretch it out. I did a lot of stretching and I put weight on in gingerly if it didn't hurt much. They got all kinds of upset about this, but it felt right, so I did it.

The NP said I had a fracture she would characterize as a 7 on a scale of 1 - 10, 10 being the worst. Its been about 16 months, and my ankle seems to be fine. It doesn't hurt, it isn't weak, and I can move it in all directions as well as the other one.

They wanted me to have physical therapy, which I couldn't afford. The NP showed me some excercises, which I did on my own.

The bottom line is that I couldn't afford any of this expense, and I needed to be able to solve my ankle problem with the least expense. The system as it is does not seem to be terribly sympathetic to my walmart budget. I just wanted a fixed ankle without any frills. The medical system does not seem to be very attuned to that view.

Orthotic device

But still, the bottom line still remains...
This young lady did not have the freedom to choose.
They physician took it upon himself to make the choice for her.
He never gave her the prescription.
He gave the prescription to his partner.