California
California Board Notes Jump in Citations and Fines for Unlicensed Activities in 2016
The Medical Board of California reported recently a “spike” in citations and fines for unlicensed activity, noting that the rise was mostly accounted for by individuals who were discovered to be illegally engaged in the practice of medicine during the process of applying for a license.
In 2016 the Board issued 17 citations for unlicensed practice of medicine or aiding and abetting the unlicensed practice of medicine. The number of citations issued in the previous five calendar years were three in 2015, nine in 2014, and three each in 2013, 2012 and 2011.
Examples of unlicensed activity that triggered citations by the Board included international medical school students participating in clinical clerkship training in a California hospital or physician's office when the international medical school and the hospital had not met minimum requirements pursuant to California law; unlicensed individuals performing physical examinations, diagnosing and treating patients; and medical school graduates working in a licensed physician's office and exceeding the scope of a medical assistant.
In addition, there was an increase in physicians in Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs who exceeded the license exemption period pursuant to California law.
The Board noted that it “typically learns that an applicant is performing illegal activities during the application process, when the applicant lists typical duties performed on the job.” The supervising physician may also be asked for a detailed list of activities the applicant performs. In some cases, according to the Board, neither the applicant nor the supervising physician understood that the activities in question involved the unlicensed practice of medicine or aiding and abetting the unlicensed practice of medicine.
The usual citation for unlicensed activity in California results in a $2,500 fine. The maximum fine that can be levied is $5,000. If the citation is upheld, it stays on an individual's record for three years, then it is purged.
Source: Medical Board of California Newsletter, Winter 2017
Minnesota
Minnesota Board Reaffirms Statement of Support for Statewide Culture of Learning, Justice and Accountability
The Minnesota Board of Medical Practice has reaffirmed its formal statement that punitive action in medical regulation must be balanced by a culture that emphasizes greater accountability, learning and justice in health care. Originally passed in 2006, the statement was reaffirmed in January 2017.
The Board's statement holds that in addressing medical errors and patient safety “a punitive environment does not fully take into account systems issues, and a blame-free environment does not help individuals appropriately accountable.”
It goes on to pledge that the Board will strive to establish a culture that “balances the need for a non-punitive learning environment with the equally important need to hold persons accountable for their actions.”
The statement also calls for a regulatory philosophy that seeks to “judge the behavior, not the outcome, distinguishing between human error, at-risk behavior, and intentional reckless behavior.”
The statement calls for an emphasis on promoting continuous improvement, fostering a learning environment that better identifies threats to patient safety, and promotion of a wider range of responses to patient-safety incidents, including coaching, non-disciplinary counseling, education and training, additional supervision and other tools in addition to disciplinary action.
Source: Minnesota Board of Medical Practice website, accessed March 30, 2017
North Carolina
North Carolina Survey of Licensees Yields Data on Issues Such as Burnout and Work/Life Balance
A recent survey of its licensees by the North Carolina Medical Board reveals that significant numbers of physicians in the state are experiencing issues with burnout and work/life balance — mirroring national trends.
In October, the Board sent emails to 10,000 randomly selected licensees requesting their input on topics impacting the practice of medicine, including physician wellness/burnout, longevity in practice, and issues facing employed physicians versus those in private practice. 1,855 licensees responded.
According to survey results, nearly 45% of physicians surveyed indicated that they have experienced burnout that lasted more than three months. Of those who reported experiencing burnout, 67% did not seek assistance. The most frequent reason cited was that burnout is “just part of the job.” The Board reported that rates of burnout were about the same between employed physicians and those in private practice.
COMMON SIDE EFFECTS OF BURNOUT WERE NEGATIVITY, EXHAUSTION, SELF-DOUBT AND ANXIETY, AND 6% INDICATED THEY HAD HAD SUICIDAL THOUGHTS.
Common side effects of burnout were negativity, exhaustion, self-doubt and anxiety, and 6% indicated they had had suicidal thoughts.
Of those who responded to the survey, 40% indicated they have plans to retire in the next 10 years. Employed physicians, physician assistants (PAs), and 35–54 year olds reported higher dissatisfaction with work/life balance than other age groups. Of the employed physicians reporting dissatisfaction regarding work/life balance, 60% were women.
Source: North Carolina Medical Board website, accessed March 28, 2017
Northern Mariana Islands
Commonwealth of the Northern Mariana Islands Implements Uniform Application
The Commonwealth of the Northern Mariana Islands has become one of 27 state medical boards to implement the FSMB's Uniform Application for State Licensure (UA). Several other states are in various stages of implementation.
Through the UA, medical boards utilize common application elements while capturing unique state requirements in an addendum customized to meet a state's specific needs. More than 75,000 physicians have successfully submitted their application for licensure utilizing the Uniform Application to date.
Source: FSMB eNews, October 28, 2016
Ohio
OSU Medical System Now Participating in State's Controlled Substance Tracking Database
A major medical system in Ohio has linked its electronic medical record (EMR) system directly to Ohio's statewide database for tracking the dispensing of controlled substances — the latest in that state's extensive effort to address opioid abuse.
The Ohio State University (OSU) Wexner Medical Center is now implementing a direct feed from the Ohio Automated Rx Reporting System (OARRS) to improve and streamline efforts to decrease opioid abuse and addiction.
The OARRS database tracks the dispensing of controlled substances from retail pharmacies in Ohio. Health care professionals who write prescriptions for controlled substances are required to check the database in various situations.
By linking the OARRS feed directly into the medical center's electronic medical record system, it is now easier for OSU physicians and nurses to fulfill the state's tracking requirements, without having to log into a separate system and search for patients.
Through OSU's “Community Connect” model, the direct connection to the OARRS database will also be available at three other hospital systems in the region that purchase electronic medical record services from Ohio State Wexner Medical Center.
The State Medical Board of Ohio has been a partner in Ohio's statewide effort to address opioid abuse, which has included the Ohio Board of Pharmacy, state and local government agencies, law enforcement and various health care organizations and associations.
“Ohio is a national leader in increasing the use of its prescription monitoring program through direct integration with electronic medical records and pharmacy dispensing systems. By increasing the use of OARRS, Ohio health care professionals have more opportunities to intervene when they see warning signs of addiction in order to get Ohioans the help they need,” said Steven W. Schierholt, executive director of the Ohio Board of Pharmacy.
Source: OSU news release, February 1, 2017
Oregon
OMB Executive Director Recognized for Public Service
Oregon Medical Board Executive Director Kathleen Haley, JD, was recently named the 2016 recipient of the Ben Shimberg Public Service Award. The national recognition from the Citizen Advocacy Center was presented for Haley's “two decades of nurturing, supporting, and encouraging full and effective utilization of public members of the board.”
Haley was presented the award by Barbara Safriet, Professor of Health Law and Policy at Lewis and Clark Law School, and David Swankin, President and CEO of Citizen Advocacy Center. The mission of the Citizen Advocacy Center, which was founded in 1987, is enhancing the effectiveness and accountability of health professional oversight bodies. The Center offers training, research, and networking opportunities for public board members and the boards on which they serve.
Source: Oregon Medical Board Report, Fall 2016
Oregon Releases Annual Medical Licensing and Disciplinary Statistics
The Oregon Medical Board reported in its annual report of licensing statistics that as of December 31, 2016, it had 21,541 licensees. Of that number, 18,966 held active licenses to practice in Oregon. Another 902 individuals had licenses of other kinds.
Active licensee categories included doctors of medicine (MDs), 14,170; doctors of osteopathy (DO), 1,260; podiatric physicians (DPMs), 192; physician assistants (PAs), 1,830; and acupuncturists (LAcs), 1,514.
In 2016, the Board issued more new licenses than ever before. During the year, 1,696 new medical professionals were granted licensure in Oregon, compared to 1,544 in 2015, 1,425 in 2014 and 1,322 in 2013.
The Board received approximately 3,000 inquiries in 2016 — 1,987 by phone, and more than 1,000 via website or email. Of these, the top category of complaint was unprofessional conduct (36%) followed by inappropriate care (28%).
The Board opened 711 investigations in 2016, compared to 764 in 2015 and 778 in 2014. It closed 680 investigations in 2016, compared to 729 in 2015 and 741 in 2014.
Source: Oregon Medical Board Report, Winter 2017
Pennsylvania
Pennsylvania becomes 18th state to join Interstate Medical Licensure Compact
Pennsylvania has adopted legislation to become the 18th state to join the Interstate Medical Licensure Compact (IMLC), which aims to increase access to health care by expediting licensure for qualified physicians who wish to practice in multiple states.
The legislation was unanimously passed by Pennsylvania's House and Senate and was signed into law by Gov. Tom Wolf.
The IMLC offers a voluntary, expedited licensing process for physicians interested in practicing medicine in multiple states. It is expected to expand access to health care, especially to those in rural and under-served areas of the country, and facilitate the use of telemedicine technologies in the delivery of health care.
THE IMLC...IS EXPECTED TO EXPAND ACCESS TO HEALTH CARE, ESPECIALLY TO THOSE IN RURAL AND UNDERSERVED AREAS OF THE COUNTRY.
Pennsylvania joins 17 other states that have enacted legislation to expedite multi-state medical licensure since 2015. The states include Alabama, Arizona, Colorado, Idaho, Illinois, Iowa, Kansas, Minnesota, Mississippi, Montana, Nevada, New Hampshire, South Dakota, Utah, West Virginia, Wisconsin and Wyoming.
Source: FSMB news release, October 26, 2016
Rhode Island
RI Licensing Statistics Released
The number of newly licensed physicians rose significantly in Rhode Island in 2016, according to the Annual Report of the Rhode Island Board of Medical Licensure and Discipline.
New licenses were issued to 471 physicians in 2016, compared to 377 in 2015. The Board reported that, due to modifications made to its licensing process in 2015, the average number of days needed to receive a physician license dropped from 29.5 in 2015 to 25 in 2016.
Rhode Island issued licenses to a total of 4,616 doctors of medicine (MDs) in 2016, compared to 4,836 in 2015. It issued licenses to a total of 316 doctors of osteopathic medicine (DOs) in 2016, compared to 335 in 2015.
The Board received 514 complaints in 2016, compared to 422 in 2015. It opened 168 investigations in 2016, compared to 200 in 2015. Of actions taken against licensees, seven were voluntary agreements not to practice medicine or surrender a license; four were license reinstatements/activations with disciplinary actions; 18 were reprimands and related sanctions; and one was a license revocation.
The three most common reasons for disciplinary action in the state in 2016 were for controlled substance reporting, medical records and documentation, and doctor-patient boundary issues.
Source: Rhode Island Board of Medical Licensure and Discipline 2016 Annual Report
Wisconsin
Wisconsin Deploys PDMP Program
The Wisconsin Department of Safety and Professional Services (DSPS) deployed the new Wisconsin Enhanced Prescription Drug Monitoring Program on January 17, 2017, in an effort to more effectively address prescription drug misuse and abuse in the state.
As of April 1, 2017, prescribers in Wisconsin are required to review patient records in the drug monitoring program prior to issuing most controlled substance prescription orders to their patients.
Wisconsin has provided a number of exceptions to this requirement, including if the patient is receiving hospice care; if prescriptions are intended to last three days or less and are not subject to refill; if the monitored prescription drug is administered directly to the patient; in emergency situations that prevent the practitioner from reviewing drug monitoring program records; and technological failures that cause the program to be inoperable.
Source: Wisconsin Medical Examining Board MED Board Newsletter, Spring 2017
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