Dr. Clinton Collins Case: Must Doctors Urine Test Opiate Rx Patients?
The Medical Board of California mandates that doctors conduct urine tests on patients to ensure they are consuming the prescribed opiates. If the urine tests come back negative, the doctor is required to cut off the supply.
This requirement is randomly applied to some doctors and not others. It leads to Accusations targeting good doctors who focus on patient care and who believe their patients. It is part of the War on Drugs and has become a War on Doctors.
This requirement challenges the traditional doctor-patient relationship, where trust is paramount. Discrepancies between urine tests and reported consumption can sometimes be obvious. However, when patients engage in criminal behavior, holding doctors responsible for identifying abuse can be problematic.
Watch Medical Attorney Daniel Horowitz' Video Warning Doctors - PAIN MEDICATION PRESCRIPTION DANGER TO DOCTORS
If you are a doctor who frequently prescribes opiates, read this Journal Article on the Use of Drug Screening Urine Tests
Dr. Clinton Ruhl Collins' Case
Recently, Dr. Clinton Ruhl Collins of Cameron Park, California (30 miles east of Sacramento) faced an accusation. We find the Accusation unfair as it makes the doctor a police officer and punishes him for the potential wrongdoing of others.
The Accusation is lengthy but for our purposes we focus on the allegations that shift police responsibility unfair to the doctor:
April 2017 Incident:
Patient A requested a switch from Percocet to Norco due to sickness.
Urine test results showed Patient A was negative for all drugs except THC.
Dr. Collins did not address this aberrant result and prescribed Norco, also refilling gabapentin.
Norco (hydrocodone) is considered less potent than Percocet (oxycodone). The patient's report of sickness could explain the negative urine test result, as Percocet generally clears from urine within 48 hours, or up to 96 hours with more sensitive tests.
Multiple Instances:
Similar situations occurred with this patient and another patient.
The final patient had an amphetamine CURES report for Adderall, which can be easily obtained online without an in-person examination. Despite this, Dr. Collins faced criticism for improper prescribing.
The Bigger Picture
The accusation overlooks the majority of patients treated by Dr. Collins who received uncriticized care. Two or three potentially abusive patients out of hundreds is a good track record. Doctors are not police, and patients can and will find ways to obtain medications they shouldn't have. This applies to antibiotics, plastic surgery, and other physician-controlled items. We believe this is a police matter, and Dr. Collins is being used as a scapegoat.
Physician Beware
Physicians must order urine tests and act on the results, even if it is painful and difficult. Cutting off patients who test negative, even if lab errors or rational explanations exist, is crucial (e.g., "I ran out because I doubled up for a few days").
Daniel Horowitz is the premier physician defense lawyer in California, providing aggressive and expert defense in all licensing matters.