Over the past 25 years, physicians have faced a distinct change in attitudes on prescription pain medication. Policy discussions in years past to promote more liberal use of narcotics have been replaced by the current war on opioid addiction. To be sure, a physician attempting to assist a patient on long-term pain medication faces special challenges.

To describe homelessness as a “complicating factor” in healthcare is a gross understatement; the homeless die nearly three decades earlier than the general population and their health challenges are innumerable.ⁱ Addiction, mental illness, malnutrition, exposure to a host of infectious diseases related to overcrowding, poor hygiene, a lack of sanitation and IV drug use as well as the threat of violence, routinely undermine the health and wellbeing of this population.  For the homeless, healthcare access is at best-episodic and is often driven by the need for urgent treatment.

Even as the Medical Board of California continues to examine the drug-prescription practices of physicians, the Board often has to convince a court of its right to examine patient records. The key element in whether the courts will permit an MBC request for patient records is whether the Board adequately demonstrates “good cause” for piercing a patient’s privacy. 

California law provides that any adult patient and any minor patient authorized by law to consent to medical treatment, is entitled to inspect and request a copy of their medical record upon written request to the healthcare provider and payment of reasonable costs to make the record available.  (California Health and Safety Code Section 123110)

Notwithstanding the usual suspects that hinder electronic medical record implementation — initial costs, interoperability problems, training burdens, and altered physician-patient dynamics — there’s also the risk of a pure system malfunction. In a malpractice suit after an admitted malfunction, a physician’s actions will still be scrutinized.