Medication Prescribing Activities Lead to Disciplinary Action: Two Case Studies

Dental board complaints arising from medication prescribing activities can have consequences ranging from mandated continuing education (CE) to license suspension or revocation. The following case studies demonstrate how prescribing decisions that may appear reasonable or patient-centered can nevertheless lead to allegations of improper prescribing and disciplinary action. For more information on license defense considerations and related risk management strategies, see the CNA/Dentist’s Advantage Dental Professional Liability Claim Report: 3^rd Edition and the Dentist Spotlight: Protecting Your License.
 

Case Study 1

Practitioner: General dentist
Risk management topics: Medication prescribing, controlled substances, practitioner-patient relationship, self-treatment, documentation
 

Facts:

This dental board matter arose after a federal Drug Enforcement Administration (DEA) action. A pharmacy notified the DEA of prescribing concerns, leading to the agency’s review of several prescriptions written by a general dentist over a multi-year period. The prescriptions involved controlled substances, as well as antibiotics, prescribed for a family member who resided outside of the United States. A separate episode involved a case in which the dentist wrote a controlled substance prescription for his own post-operative dental pain. As a result of the DEA inquiry, the dentist surrendered his controlled substance registration.
 
The federal inquiry then led to a state dental board investigation. The investigation revealed that the dentist prescribed controlled substances and other medications for a family member over several years. Although the family member allegedly received some dental care while visiting the United States, the dentist was unable to produce supporting records. Therefore, the evidence indicated that the prescriptions were written outside of a bona fide practitioner-patient relationship.  
 
The dentist stated that he prescribed for his family member because he believed the medications available in the United States were more effective. Furthermore, he wished to prevent or relieve dental pain associated with treatment performed abroad. The dentist also personally delivered medications to family members during his overseas visits.
 
The board also considered a separate prescribing event after the dentist underwent an extraction performed by another dentist. The treating dentist reportedly did not have access to the prescribing system or a prescription pad since the procedure took place on a weekend at a third dentist’s office. The patient dentist then used his own prescription pad to write a controlled substance prescription for the treating dentist, who filled it at a local pharmacy. However, the patient dentist ultimately used the medication for his own post-operative pain.
 
The dentist cooperated with the federal and state investigations and maintained that his actions were intended to assist his family rather than circumvent prescribing requirements. Nevertheless, the board focused on two central issues: prescribing medications, including controlled substances, to a family member without sufficient evidence of an active practitioner-patient relationship or supporting records, and writing a controlled substance prescription for another person when the medication was intended for the dentist’s own use.
 

Analysis:

This matter illustrates how prescribing decisions that may appear compassionate or reasonable to a dentist can be viewed very differently by regulators. Prescriptions for family members, particularly when continued over an extended period and involving controlled substances, may raise questions regarding objectivity, documentation, and whether a legitimate practitioner-patient relationship exists. Such concerns are heightened when records are unavailable and the clinical basis for prescribing cannot be verified.
 
The case also demonstrates the regulatory risks associated with self-treatment. Even when a dentist experiences legitimate post-operative pain, writing or facilitating a prescription intended for personal use may be characterized as improper prescribing. Boards generally expect controlled substances to be prescribed only through appropriate practitioner-patient relationships and supported by accurate documentation.
 

Outcome:

The board concluded that the dentist violated state laws and regulations governing dental practice and controlled substance prescribing. The dentist’s license was suspended for a minimum of 12 months, and the board imposed a monetary penalty of $5,000. A proposed alternative to the board’s order allowing earlier reinstatement after additional pharmaceutical CE, implementation of practice monitoring, and restrictions on controlled substance prescribing was unsuccessful. Licensure defense expenses exceeded $7,000.
 

Case Study 2

Practitioner: General dentist
Risk management topics: Controlled substance prescribing, oral sedation, prescription legitimacy, improper delegation to staff, medication diversion
 

Facts:

This board matter began when a physician reviewed his patient's medication history through the state prescription drug monitoring program and identified a controlled substance prescription that appeared inconsistent with the patient's medical needs. Upon further inquiry, the physician learned that the patient, who was employed as a dental office manager, had obtained the prescription on behalf of her employer's dental patient. The physician subsequently contacted the dentist to discuss the circumstances and later filed a complaint with the state dental board.
 
The underlying events involved an adult dental patient who was scheduled to undergo a procedure with minimal sedation. Prior to the appointment, the dentist prescribed an oral sedative and instructed the patient to bring the medication to the office on the day of the procedure. The patient took the medication while in the office before the procedure began. However, additional diagnostic information obtained before the procedure began revealed that the treatment needed to be postponed.
 
To minimize the patient's expense after treatment was postponed, the office manager suggested obtaining replacement medication without requiring the patient to purchase another prescription.
As a result, the dentist wrote a prescription for the office manager, intending that the medication ultimately be used for the patient at the rescheduled procedure. The office manager subsequently filled the prescription, and the dentist secured the medication in a locked office cabinet. Before the procedure could take place, however, the office manager's physician identified the prescription through the prescription drug monitoring program and contacted the dentist. After discussing the matter, the dentist acknowledged that the decision to prescribe the medication for his office manager represented poor judgment. The dentist then decided that the medication should be disposed of. He documented that the medication was never consumed by, or administered to, anyone.  
 
The dentist accepted responsibility for the prescribing decision and indicated that he had already enrolled in CE related to oral sedation and safe prescribing practices before receiving notice of the board’s disciplinary action.
 

Analysis:

Unlike many prescribing-related professional liability or board matters, this case did not involve patient injury, addiction concerns, or diversion for financial gain. Instead, the board focused on a fundamental regulatory principle: prescriptions must be written only for the individual for whom the medication is intended.
Although the dentist's goal was to reduce cost and inconvenience for a patient whose treatment had been delayed, regulators evaluate prescribing decisions based on compliance with legal and professional requirements. A prescription issued in one person's name for the benefit of another creates concerns regarding patient identification, medical necessity, documentation, prescription monitoring records, and controlled substance accountability. The matter also demonstrates that dental board discipline may occur even when no patient harm results and the medication is never used.
 

Outcome:

The board concluded that the dentist's actions violated applicable state law, board rules, and federal prescribing requirements. Rather than imposing a license suspension, probationary period, or monetary fine, the matter was resolved through a consent order requiring completion of CE focused on oral sedation and prescribing practices. The board further ordered that the educational hours could not be applied toward the dentist's license renewal CE requirements. Licensure defense expenses totaled approximately $4,000.
 

Risk Management Considerations and Takeaways

Both cases demonstrate that prescribing concerns do not necessarily arise from malicious intent, substance use, patient injury, or drug diversion. Instead, otherwise well-intentioned decisions may create significant regulatory exposure when they fall outside established prescribing requirements.
Dentists should consider the following risk management principles:

• Prescribe medications only within a legitimate practitioner-patient relationship supported by an appropriate examination, diagnosis, and treatment plan.
• Maintain records that clearly support the clinical basis for each prescription, including the diagnosis, selected medication, dosage, quantity, and patient instructions.
• Exercise caution when treating family members or other individuals with whom a personal relationship may affect professional objectivity.
• Avoid self-prescribing controlled substances and other medications except where expressly permitted by applicable law and regulations.
• Ensure prescriptions are written only for the patient who will receive and use the medication.
• Avoid using staff members, family members, or other third parties as intermediaries in medication acquisition or distribution.
• Follow established procedures when replacing lost, misplaced, or unavailable prescriptions, rather than attempting informal workarounds.
• Recognize that prescription drug monitoring programs and other regulatory tools may identify prescribing irregularities that trigger board investigations.
• Understand that cooperation with investigators and the absence of patient harm may mitigate discipline but does not eliminate regulatory liability when prescribing laws or regulations have been violated.