Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO:
KRS
218A.172,
218A.202,
218A.205
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
311.410 establishes the Kentucky Board of
Podiatry and authorizes it to make all rules and regulations, not inconsistent
with
KRS
311.390 to
311.510, as may be
necessary to carry out
KRS
311.390 to
311.510.
KRS
218A.205(3)(a) requires the
board to establish standards for prescribing and dispensing controlled
substances.
KRS
218A.172 requires the board to promulgate
administrative regulations governing the prescribing or dispensing of any
Schedule II controlled substance or a Schedule III controlled substance
containing hydrocodone. This administrative regulation establishes the
standards for board licensees prescribing or dispensing controlled
substances.
Section 1. Prescribing or
Dispensing Authority.
(1) A podiatrist
licensed by the board may prescribe and dispense controlled substances
necessary for the treatment of a patient that comes within the practice of
podiatry as defined by
KRS
311.380(2) if the licensee:
(a) Has obtained a registration number from
the Drug Enforcement Administration;
(b) Registers with and uses the Kentucky
All-Schedule Prescription Electronic Reporting System (KASPER) as required by
KRS
218A.202 and related administrative
regulations promulgated by the Cabinet for Health and Family Services;
and
(c) Follows the requirements of
this administrative regulation.
(2) A podiatrist licensed by the board shall
not prescribe or dispense:
(a) With the intent
or knowledge that a medication will be used or is likely to be used for any
purpose other than one that is necessary for medical treatment or therapeutic
use;
(b) With the intent to evade
any law governing the sale, use, or disposition of the medication;
(c) When the licensee knows or has reason to
know that the abuse of the controlled substance is occurring or may result
therefrom; or
(d) In amounts the
licensee knows or has reason to know is excessive, under the
circumstances.
Section
2. Prescribing or Dispensing Process.
(1) This administrative regulation governs
the prescribing and dispensing of controlled substances listed in Schedule II
through V as classified in
902 KAR
55:015.
(2) All prescribing or dispensing pursuant to
this section shall be documented in the patient's file as required by Section 4
of this administrative regulation.
(3) If initially prescribing or dispensing a
controlled substance, a licensee shall:
(a)
Obtain a complete medical history and conduct a physical examination of the
patient;
(b) Complete a written
treatment plan which states the objectives of the treatment and includes an
outline of any further diagnostic examinations, therapeutic, and laboratory
results that may be required;
(c)
Discuss the risks and benefits of the use of controlled substances with the
patient or the patient's legal guardian or health care surrogate, including the
risk of tolerance and drug dependence;
(d) Educate the patient or the patient's
legal guardian or health care surrogate regarding proper use and disposal of
any unused controlled substances;
(e) Verify that the patient is the person
that he or she has identified himself or herself as being by requiring the
person to produce proper government issued identification;
(f) Query KASPER for all data available on
the patient for the twelve (12) month period immediately preceding the patient
encounter and appropriately use that data in the evaluation and treatment of
the patient; and
(g) Obtain consent
for the treatment from the patient in writing.
(4) If continuing a prescription or
dispensing a controlled substance for the same medical complaint and related
symptoms following completion of the initial supply, a podiatrist licensed by
the board shall:
(a) Review the patient's plan
of care at reasonable intervals applying clinically indicated protocols, based
on the patient's individual circumstances;
(b) Provide any new information about the
treatment to the patient; and
(c)
Modify or terminate the treatment as appropriate;
(5) If the course of a patient's treatment
with a controlled substance extends beyond three (3) months, the podiatrist
licensed by the board shall, in addition to the requirements of subsection (3)
of this section:
(a) Obtain and review a
KASPER report for the patient no less than once every three (3) months for all
available data on the patient for the twelve (12) month period immediately
preceding the query; and
(b) Modify
or terminate the treatment as appropriate.
Section 3. Limitations for Schedule II or
Schedule III controlled substances containing hydrocodone.
(1) A podiatrist licensed by the board shall
not issue a prescription for a Schedule II or Schedule III controlled substance
containing hydrocodone for more than a three (3) day supply if the prescription
is intended to treat pain as an acute medical condition, except as provided in
KRS
218A.205(3)(b).
(2) A podiatrist licensed by the board shall
not directly dispense more than a forty-eight (48) hour supply of a Schedule II
or Schedule III controlled substance containing hydrocodone.
(3) If a patient continues to present with
pain after the initial supply has been completed and the podiatrist licensed by
the board believes that an additional amount of a Schedule II or Schedule III
controlled substance containing hydrocodone is medically appropriate, the
licensee shall follow the process established in Section 2 of this
administrative regulation.
Section
4. Records. Podiatric medical records for patients being
prescribed or dispensed controlled substances shall include, at a minimum:
(1) The patient's name;
(2) The patient's date of birth;
(3) The information concerning the patient's
medical history and physical examination required by this administrative
regulation;
(4) The diagnosis of
the patient's condition;
(5) The
procedures and treatments to be undertaken and their objectives;
(6) The date of the procedures or
treatments;
(7) Whether local or
general anesthetics were used, including the type and the amount
administered;
(8) Diagnostic,
therapeutic, and laboratory results;
(9) The findings and recommendations of any
other evaluations or consultations;
(10) All medications prescribed or dispensed
by the podiatrist licensed by the board, including the date, type, dosage, and
quantity;
(11) Any post-treatment
instructions from the podiatrist licensed by the board; and
(12) Documentation that the KASPER query
required by this administrative regulation was completed.
Section 5. Exceptions. The professional
standards established in this administrative regulation shall not apply to a
podiatrist licensed by the board prescribing or dispensing a controlled
substance to a patient:
(1) In an emergency
situation;
(2) As part of the
patient's hospice or end of life treatment;
(3) As part of the patient's treatment of
cancer or pain associated with cancer;
(4) Admitted to a licensed hospital as an
inpatient, outpatient, or observation patient, during and as part of a normal
and expected part of the patient's course of care at that hospital;
(5) Admitted to a long-term care facility
licensed under KRS Chapter 216B;
(6) For a single dose to relieve anxiety,
pain, or discomfort related to a diagnostic test or procedure; or
(7) Qualifying under exemptions set forth in
KRS
218A.172.
Section 6. Violations. Any violation of the
professional standards established in this administrative regulation shall
constitute a violation of
KRS
311.480, which may result in the imposition
of disciplinary sanctions including suspension, revocation, or fines by the
board, pursuant to
KRS
311.490 and
201
KAR 25:051.
STATUTORY AUTHORITY:
KRS
218A.205(3)(a),
311.410(4)
