From: Diana King Handwriting Expert , Diana King : 785-309-0997
Prescription Forgery
By Diana G King; RN, LNC, FDE; Class of 2007
www.DianaGKing.com
Technologic Measures to Thwart Prescription Forgery
While the classification of Drugs by the Controlled Substances Act issues from the federal level, the control of prescription physical characteristics (paper and ink), the required textual content, and security safeguards are proscribed by each individual state. Just as states vary in the degree of punishment for prescription forgery, states have mandated a varied range of security measures related to these documents. Following are some of the measures being used that bear implications for document examination:
Some states have advocated the elimination of handwritten prescriptions altogether, and computer-printed prescriptions are becoming increasingly common in some places. However, in the United States, computer-printed prescriptions cannot be used to prescribe Schedule II medications; prescriptions for these medications must be in the physician's handwriting, or typewritten, and actually signed by the physician.
Some doctors will use prescription pads that contain similar security measures as checks to make photocopying prescriptions harder. These security measures may be mandated by law.
Alternatively, legislation may mandate that only certain printers may print prescriptions. New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks."
Figure 6 - New Jersey State-Approved Prescription Blank
Prescribers can make it harder for amount forgeries by writing out the amounts in words. Again, this may be mandated by law.
Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs. Blank triplicates are only available from the regulating agency and are individually numbered. The doctor retains a copy, the second and third copies are given to the patient to give to the pharmacist. The pharmacist retains the second copy and the third copy is submitted to the regulating agency. The regulating agency can issue lists of stolen prescriptions that pharmacists can check. In this example, the prescription's validity is further limited to 72 hours from issuance.
Implications and "Pearls" for the Document Examiner
Indeed, the textual component of medical prescriptions may appear to many examiners to be a "foreign language", but the very essential and practiced skills of handwriting identification are what, in fact, comprise the instrumental components in prosecuting this crime. Although, large institutions employing multiple practitioners are increasingly employing computer-driven prescription writing, the systems – both regulatory and technological, have yet to accept a substitute for the handwritten signature.
Unquestionably, the crucial inroad for prescription document examination lies in the hands of pharmacists and pharmacies – they are the prescription forgery "first-responders". When forgery is suspected, pharmacists will call the doctor to verify the prescription and will attempt to detain the suspect pending arrival of authorities.
Remember: Forged prescriptions are no longer considered medical documents and doctor-patient confidentiality rules no longer apply!
It is from this juncture that a potential case may evolve. Thus, in addition to the more-often-thought-of law enforcement agencies, document examiners interested in this particular niche of work may do well to provide the pharmaceutical industry with resumes, lists of services and related materials that illustrate their essential role in the prosecution cycle.
In fact, these are a few "red flags" contributed by pharmacists (that may seem familiar) as raising suspicion when examining a prescription:
Characteristics of Forged Prescriptions 1
- Prescription looks "too good"; the prescriber's handwriting is too legible or "professional;
- Prescription written in different color inks or written in different handwriting;
- Quantities, directions or dosages differ from usual medical usage;
- Prescription does not comply with the acceptable standard abbreviations or appear to be textbook presentations;
- The directions are written in full without typical abbreviation;
- The quantity dispensed or the number of refills appears unusually large;
- Markings on the prescription appear to have been erased or "whited out";
- Prescription appears to be photocopied (dust and other particles appear as faint black dots on the copy);
- Evidence that the entire prescription has been photocopied with a color copier; for example the parts written in ink do not smudge
- The prescriber writes prescriptions for antagonistic drugs, such as depressants and stimulants, at the same time. (Drug abusers often request prescriptions for "uppers" and "downers" at the same time.)
Recommended Resources
Literature:
- Dictionary of Commonly Accepted Medical Abbreviations (any)
- Physician's Desk Reference (lists prescriptive medications by trade/generic name with their classification of use, usual dosage, and forms supplied.)
- State Administrative Code governing Prescriptive Procedures and Documents
Online:
- List of Controlled Substances Schedule (U.S. Dep't. of Justice)
http://www.deadiversion.usdoj.gov/schedules/alpha/alphabetical.htm
- A Pharmacist's Guide to Prescription Fraud (U.S. Dep't. of Justice) http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm#char
(1) Characteristics of Forged Prescriptions - ww.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm#char
Want more information about Document Examination, call the author
Diana King : Tel: 785-309-0997 Fax: 785-309-0935 .
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