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Casual Care, Serious Consequences: How Informal Prescribing Can Trigger Medical Board Scrutiny

The lesson for health care practitioners is that regular review of the regulatory requirements can ensure compliance and that casual prescribing may be in violation of state regulations if the necessary components are not met. Consider the following scenario: in December 2025, a medical provider renewed a prescription for a long-standing telemedicine patient receiving a Schedule II controlled dangerous substance. This was not a violation of the New Jersey Administrative Code. Another provider doing the same action for an equally situated patient in March 2026 would be in violation. The casual prescriber who is not aware of newer regulatory requirements may have a more difficult time responding to a medical board complaint. Medicine is a highly-regulated helping profession. Without addressing the merits of this regulatory burden, the practice of medicine continues to see drastic changes impacting the everyday life of patient and provider. Telemedicine, COVID-19, and other advances and roadblocks, present a challenge to those saving lives while attempting to comply with the rules of practice. Physicians often discover—through real cases and the lens of regulatory expectations—that even well-intentioned informal help can be reinterpreted as stepping outside mandated professional boundaries, and seemingly harmless actions can be construed as deviations from required practice standards specifically outlined in Title 13, Chapter 35, Subchapters 7.1A of the New Jersey Administrative Code. Title 45, "Professions and Occupations," of the New Jersey code governs the practice of medicine, nursing, optometry, pharmacy, and many other professional occupations. Section 9 specifically addresses the state board of medical examiners and allows for the creation of rules and regulations in Section 45:9-5.3. These regulations can be found in the New Jersey Administrative Code Title 13, Chapter 35. While broad in scope, Chapter 35 contains a subchapter dedicated to the administration and dispensing of prescription drugs. Such knowledge will arm physicians with the tools they need to prevent a negative outcome if a medical board complaint is filed. Likewise, attorneys must be familiar with these regulatory requirements when advising and defending providers. In New Jersey, N.J.A.C. Section 13:35-7.1A(a) requires that a practitioner conduct an examination and appropriately document the same within the medical record before dispensing drugs or issuing prescriptions. The examination must include an "appropriate history and physical examination," a diagnosis based upon the examination and any testing consistent with good medical care, the formulation of a therapeutic plan discussed with the patient, and the availability of appropriate follow-up care. There are only six exceptions to this requirement: In admission orders for a newly hospitalized patient For a patient of another physician for whom the practitioner is taking calls For continuation medications on a short-term basis for a new patient prior to the patient's first appointment For an established patient who, based on sound medical practice, the physician believes does not require a new examination before issuing a new prescription For a patient examined by a healthcare professional who is in collaborative practice with the practitioner When treatment is provided by a practitioner for an emergency medical condition Emergencies are also limited to situations where someone's health is in serious jeopardy, there is serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. During the COVID-19 pandemic, then New Jersey Governor Phil Murphy issued an executive order declaring a public health emergency and a state of emergency that allowed authorized prescribers to prescribe Schedule II controlled dangerous substances via telemedicine. The order was terminated when he left office earlier this year and the state reverted to the requirement of an initial in-person examination and quarterly in-person visits. With this return to prior regulatory requirements, practitioners subject to the jurisdiction of the board of medical examiners may benefit from a refresher on the regulatory limitations on their practice now that the pandemic-era flexibilities have ended. This new requirement may create confusion for prescribers and lead to casual prescribing of medication in violation of the regulations, even in the setting of recurrent telemedicine appointments as noted in the example above. Casual prescribing can take many forms: filling a prescription request from a friend or family member without an examination or contemporary medical record; using telemedicine to expand your practice without proper in-person appointments or documentation in the medical record; failing to ensure appropriate follow-up care for a "one time" prescription; etc. Although not all board complaints end in a publicly available opinion, serious deviations from regulatory requirements can shine a light on practices that will require action by the board if a complaint is received. Consider the following cases: In October 2025, the board issued a final consent order in an administrative action where a doctor provided opioids without examination and his license was permanently revoked. In re Robert Dela Gente, D.O., N.J. State Bd. of Med. Exam'rs Oct. 21, 2025. Criminal charges were filed (though that is not always the case). In a September 2025 consent order, a physician was reprimanded for "prescribing opioids several months in advance without the proper patient follow-up..." and explained that they did so for "patients who can not pay for multiple visits to refill medications." In re A/an E. Schultz, M.D., N.J. State Bd. of Med. Exam'rs Sept. 25, 2025. Another physician was suspended and placed on probation in a consent order for prescribing three patients the weight-loss medication "Ozempic" via text messages through a website called "Push Health" and without any further communication with the patients or taking a medical history. In re Laura E. Purdy, M.D., N.J. State Bd. of Med. Exam'rs Aug. 29, 2025. A June 2025 interim consent order required a "full evaluation and assessment of [a physician's] general knowledge and skill, with specific emphasis on his knowledge of and ability to safely prescribe [controlled dangerous substances]" due to his failure to review a patient's prior medical history and medical record, assess and review the prescription monitoring program before prescribing CDS, and conduct random urine screens on a patient that tested positive for CDS upon admission to his practice because "he trusted the patient." In re Donald Oh, M.D., N.J. State Bd. of Med. Exam'rs June 2, 2025. Each of these examples demonstrate a failure to follow strict procedure regardless of the intention. Failing to follow procedure secondary to good intentions, such as considering a patient's financial constraints, trust in the patient, or utilizing a new telemedicine service platform, will not be a defense to a board complaint. Especially when practicing via telemedicine, practitioners must ensure they are adhering to the appropriate regulatory standard. A provider who calls in a prescription for a traveling friend or family member or agrees to prescribe medication for individuals using the newest phone app will have a hard time meeting the requirements of N.J.A.C. Section 13:35-7.1A. Even if a history was taken, a "therapeutic plan" was created, and "follow up care" was provided, the prescriber would still not be in compliance with the regulation without an in-person examination. In our opening hypothetical, the prescriber's behavior did not change between December and March; however, the legal shift in the regulatory landscape made once acceptable behavior a violation as a required examination did not occur. When complaints are made with regard to informal prescribing, the board has discretion to employ measures to encourage compliance in lieu of formal proceedings such as a private, written warning; suspending fines subject to continuing compliance; medical or professional treatment as may be necessary; medical or diagnostic testing and monitoring; skills assessment; corrective training; participation in outreach programming; or contribution to the consumer fraud protection fund. The lesson for health care practitioners is that regular review of the regulatory requirements can ensure compliance and that casual prescribing may be in violation of state regulations if the necessary components are not met. Even compliant providers who had not conducted an in-person examination for telemedicine patients during the COVID-19 emergency would be in violation of the regulations as of January 2026 for the same practice. Practitioners should be diligent in adhering to the prescribing rules to avoid sanctions related to casual care. Likewise, attorneys advising or defending practitioners before the board must be aware of the in-person examination requirements for prescribing in New Jersey whether the care in question took place in-person or in a telemedicine setting. Reprinted with permission from the April 22, 2026 issue of the New Jersey Law Journal. ©2026 ALM Media Properties, LLC. Further duplication without permission is prohibited. All rights reserved.

Portrait of Thomas Glassman. Text: Joining our Cincinnati Office as a Shareholder in the Casualty Department

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Marshall Dennehey Adds Shareholder Thomas F. Glassman in Cincinnati, Expands Casualty Practice in Ohio and Kentucky

Thought Leadership

SIDEBAR: News and Happenings

We are pleased to share that attorneys from our health care team have been selected to the 2026  New Jersey and Pennsylvania Super Lawyers and Rising Stars lists. Their dedication to clients and commitment to high-quality work continues to strengthen our firm! Please join us in congratulating: NJ Super Lawyers: Robert T. Evers and Justin F. Johnson NJ Super Lawyer Rising Stars: Nataliana A. Guida  2026 Pennsylvania Super Lawyers: Alyson J. Kirleis and Gary M. Samms 2026 Pennsylvania Rising Stars: Holli K. Archer and Daniel Dolente Victoria Scanlon (Scranton) was a faculty presenter at the 2026 American Roentgen Ray Society (ARRS) Annual Meeting in Pittsburgh. She participated in the “Resident Symposium: Producing Quality Reports,” focusing her presentation on “How to Write a Great Report: Malpractice Lawyer’s Perspective.” Vicky, the only attorney presenter for this two-hour segment, was joined by several health care professionals including diagnostic radiologists, an interventional radiologist, an internal medicine physician, and a radiologist turned AI entrepreneur expert.  Matthew Keris (Scranton), President of the Pennsylvania Association for Health Care Risk Management (PAHCRM) and shareholder in our Scranton Health Care Department, presented an important and timely session titled “Keynote Address: A Conversation with RaDonda Vaught on Criminalizing Errors” at PAHCRM’s Annual Meeting in April. RaDonda is a former Tennessee nurse widely known for being criminally convicted in 2022 of negligent homicide and gross neglect after a 2017 fatal medication error at Vanderbilt University Medical Center. Her case gained national attention because she was criminally prosecuted rather than just facing licensing board action, sparking debate over blaming individual nurses for systemic healthcare failures. Matt and RaDonda’s conversation explored one of the most consequential issues in health care risk management today—how systems respond to human error, and what it means for patient safety, accountability, and the professionals who serve on the front lines. Gary Samms was a panelist for a podcast hosted by the Medical Liability Monitor, “From Outliers to Pattern: The Increasing Predictability of Megaverdicts in the Med-Mal Industry – and How to Reduce the Likelihood of Getting Hit with One.” Gary discussed the changing megaverdict landscape and why “outlier” verdicts are becoming structural, in addition to how plaintiffs turn weaknesses into megaverdicts (including building emotional narrative and jury psychology). Thank you to our clients who joined us for our Trends in Health Care & Health Law seminar on May 14. Led by our Health Care Department Director and Assistant Director, Robin Snyder and Donna Modestine, the session explored key issues that are currently shaping outcomes in health care litigation. We owe a debt of gratitude to our esteemed guest speaker, Mary Ellen Nepps, Esq., Senior Counsel, University of Pennsylvania, who presented “Medical Malpractice Litigation: Driving Another Health Care Crisis in Pennsylvania.” And special thanks to our attorneys who presented and shared their insights, including John J. Hare and Holli Archer who discussed “Highlights in PA Medical Malpractice Law;” David Drake for his presentation, “From Claims to Courtroom: Key Trends in NJ Medical Malpractice Litigation;” and Matthew Keris with an “Update on Health Care Tech Discovery.” Thank you to all of our clients for entrusting us with your health care litigation. We are proud to partner with you as we defend your interests and navigate legal landscapes together.

Result

Unanimous Verdict Obtained in a Medical Malpractice Matter in Bergen County, New Jersey

Thought Leadership

Dental Malpractice

For health care providers and insurers navigating the complexities of dental malpractice risk, Marshall Dennehey delivers a disciplined, end‑to‑end defense built on deep clinical understanding and litigation experience. Our health care litigators routinely represent general dentists, oral and maxillofacial surgeons, prosthodontists, periodontists, and endodontists at every stage of a claim—from early risk assessment and pre‑suit strategy through trial and appeal—helping clients manage exposure while protecting professional reputations. With a strong command of applicable standards of care across both routine and advanced procedures, our team is well positioned to address high‑severity allegations such as surgical complications, permanent nerve injury, infection, missed oral cancer diagnoses, and jaw fractures. We also guide providers through licensing board matters, offering measured, practical counsel aligned with clinical realities. “Our priority is to give providers and their insurers clarity and control from day one,” said Robin Snyder, director of our Health Care Department. “By combining early expert insight with a practical understanding of clinical decision‑making, we are able to defend claims effectively while helping clients achieve timely, favorable outcomes.”

blue facade of a hospital sign against blue sky

Result

Defense Verdict in Complex Medical Malpractice Trial

Result

Summary Judgment Secured, Preserving $750,000 in Coverage for Insured in Major Trucking Liability Dispute

Ray Freudiger and Michael A. Roberts (both of Cincinnati) successfully obtained summary judgment on behalf of their client in a coverage dispute arising from a May 19, 2022, motor vehicle accident. A permissive driver operated a box truck for an interstate trucking company and caused severe injuries to two tort victims. Prior to the accident, the insured had procured a commercial auto policy for the trucking company with stated limits of $1,000,000. Following the accident, the insurer initiated a declaratory judgment action asserting that only reduced bodily injury limits of $25,000/$50,000 applied and later counterclaimed, alleging it would not have insured the driver had he been properly submitted for approval under the policy. After extensive discovery, briefing, and oral argument, the court rejected the insurer’s attempt to shift responsibility for the $750,000 in coverage it was legally required to provide for permissive drivers under Ohio law, granting summary judgment in favor of the insured and preserving $750,000 in liability exposure.

Result

No-Cause Jury Verdict Secured in Wrongful Death Trial

We successfully obtained a no-cause jury verdict in a 13-day wrongful death trial. The decedent, a 59-year-old man, was admitted to the emergency room on February 15, 2019, with complaints of abdominal pain, decreased appetite, and constipation, despite the use of laxatives. The patient did not complain of any nausea, vomiting, or diarrhea. He had a significant medical history including diabetes, hypertension, prior coronary artery stenting, morbid obesity (with past gastric bypass surgery), longstanding ventral hernia, and back pain. A CT scan revealed multiple hernias and a potential closed-loop bowel obstruction, leading to a surgery consultation. Our client, an emergency general surgeon, interpreted that the patient did not have a closed loop or any significant obstruction and recommended non-surgical management. The patient was approved to have clear liquids, and had a vomiting incident shortly after, but our client was not notified. The patient was returned to NPO status, and after improving overnight, he was returned to “clears” and additional medical and renal consults were ordered. Our client did not receive any communications from the residents/nurses of any changes in the patient’s condition. On February 18, 2019, two rapid responses were called due to increased heart rate and vomiting. It is believed that the vomiting resulted in aspiration, causing sepsis, ultimately leading to the patient’s death. During the trial, the plaintiff’s sole medical expert highlighted imaging on the wrong hernia, which called into question all of his opinions in the case. We made key objections related to the expert testimony, limiting what the allegations were, and preventing new allegations from being made. After approximately two and a half hours of deliberating, the jury returned a no-cause verdict. 

News

Stacey R. Gorin Installed as President of the Burlington County Bar Association

News

Tiere J. Phillips Elected to the Judicial Committee of the Allegheny County Bar Association