California
Revisions to Guidelines for Prescribing Controlled Substances for Pain
After an 18-month stakeholder driven process, with comments from patients, patient advocates, and those within the medical community, the Medical Board of California (MBC) published its revised Guidelines for Prescribing Controlled Substances for Pain.
Last updated and released in 2014, the MBC created a taskforce and began the process to revise the guidelines in January 2021. Interested parties’ meetings with the public were held in July and November of 2022 to garner feedback.
As the MBC discussed the need to update the 2014 prescribing guidelines, it was emphasized that a change in tone was necessary to provide support and guidance to physicians to prescribe in a way that is effective for their patients and to also have enough flexibility to deal with pain patients that don't fall into the normal guidelines.
Dr. Sean Mackey, professor and chief of the Stanford University Division of Pain Medicine, serves as a senior advisor for the MBC's taskforce and endorsed the revision of guidelines brought forward.
In 2016, the Centers for Disease Control and Prevention (CDC) released their opioid guidelines, which Dr. Mackey noted resulted in untreated and undertreated pain, serious withdrawal symptoms, worsening pain outcomes, psychological distress, overdose through use of illegal drugs, and suicide.
“We recognize the need to ensure patient access to safe and effective pain management treatment, and at the same time, the need to support physicians providing treatment for people with chronic pain,” said Dr. Mackey, who has spent more than 20 years researching pain to develop safe and effective treatments.
The MBC recognizes the need to ensure patients have access to safe and effective pain management treatment and, at the same time, also recognizes the need to support physicians providing treatment to this patient population. Consequently, the guidelines were updated to provide a framework for clinician use while also encouraging the development of treatment plans customized for their patients. The guidelines do not replace a physician's clinical judgment and individualized, patient-centered decision-making.
The guidelines include discussions on recommended practices for the management of patients with pain, special patient populations, and compliance with controlled substance laws.
Source: Medical Board of California Newsletter, Summer 2023
Georgia
New Leaders Elected
During the Board meeting on June 29, 2023, the Georgia Composite Medical Board voted to select William K. Bostock, DO, as chair for 2023-2024. Sreeni Gangasani, MD, was also elected to serve as vice chair.
Dr. Bostock is a family medicine physician with Northeast Georgia Physicians Group and a member of the core faculty with the Family Medicine Residency Program at Northeast Georgia Medical Center.
Dr. Gangasani has been a practicing cardiologist in Lawrenceville for over 20 years with board certifications in cardiovascular disease, echocardiography, nuclear cardiology, and heart failure and transplantation.
Dr. Bostock succeeds Matthew Norman, MD, whose term as chair concluded on June 30, 2023. The terms for Drs. Bostock and Gangasani began on July 1, 2023, and will extend through June 30, 2024.
Source: Georgia Composite Medical Board Summer 2023 Newsletter
North Carolina
NCMB to End PA Site Visit Program
The North Carolina Medical Board (NCMB) recently voted to discontinue its practice of conducting annual random site visits at physician assistant (PA) practice locations to verify compliance with laws and rules related to PA supervision and practice.
The Advanced Practice Provider and Allied Health Committee (APPAHC) recommended ending the site visit program at NCMB's July Board Meeting, noting that the audit had consistently uncovered only minor administrative issues that were corrected during the audit process. NCMB opened just 12 enforcement cases out of 300 PA site visits conducted since 2010, when the program was established. Just 4 cases have been opened since 2014.
NCMB will continue to educate PAs and their supervising physicians about their obligations under state law and administrative rules through the Forum newsletter, presentations, and other forms of outreach.
Source: NCMB News, August 3, 2023
Oregon
Adoption of Mental Health Attestation Model for Applications
The Dr. Lorna Breen Heroes’ Foundation has challenged all medical boards to audit licensure and renewal application questions related to mental health, remove invasive or stigmatizing language, and communicate these changes to licensees.
In response, on April 6, 2023, the Oregon Medical Board (OMB) unanimously voted to remove intrusive mental health questions from all licensure and renewal applications and replace them with an advisory statement and attestation.
The updated language reads: “The Oregon Medical Board recognizes that licensees encounter health conditions, including those involving mental health and substance use disorders, just as their patients and other health care providers do.
The Board expects its licensees to address their health concerns and ensure patient safety. Options include seeking medical care, self-limiting the licensee's practice, and anonymously self-referring to the Oregon Health Professionals’ Services Program (uprisehealthmonitoring.com). “The failure to adequately address a health condition, resulting in the inability to practice your profession with reasonable skill and safety, can result in the Board taking action against your Oregon Medical Board license. I have read and understand the above advisory and agree to abide by the Board's expectation.”
For more information, visit omb.oregon.gov/wellness
Source: Oregon Medical Board Report, Summer 2023
Texas
Case Review Experts Needed
The Texas Medical Board is calling for physicians in all areas of medicine to serve as experts in reviewing standard of care cases. Specific areas of need are in oncology, hematology, anesthesiology, gastroenterology, neurosurgery, general surgery, orthopedic surgery, and complementary & alternative medicine.
As experts to the Board, case review experts’ identities for any individual case will be confidential. Reimbursement for time spent performing case review is offered as is credit towards the continuing medical education requirements for Texas state licensure.
The requirements for serving are:
Active license to practice in Texas or a state that is a member of the Interstate Medical Licensure Compact
Active practice (more than 20 hours per week, 40 weeks per year)
No history of negative peer review action or license restriction
Acceptable malpractice history
I nitial board certification by an organization that is a member of the American Board of Medical Specialties, the Bureau of Osteopathic Specialists, or the American Board of Oral and Maxillofacial Surgery.
For more information, e-mail: [email protected]
Source: Texas Medical Board Bulletin, October 2023
Washington
Report from New Executive Director
The new Washington Medical Commission's Executive Director, Kyle Karinen, JD, LLM, recently released his first report.
He reported that, in the immediate future, the Commission will be involved in a number of issues that affect physicians, physician assistants, and members of the public. These issues include:
Rulemaking: The Commission is currently engaged in active rulemaking around the opioid prescribing rules. The primary focus for this rulemaking effort will be on three recommendations:
Exempting sickle cell disease from the opioid prescribing rules.
Clarifying the rules regarding the possibility that tapering some chronic pain patients may not be clinically indicated.
Clarifying the rules around biological specimen testing.
Implementing initiatives that resulted from a 2022 audit: In 2021, the legislature passed a bill requiring the Commission to contract with the State Auditor's Office to undergo a performance audit with regard to:
The amount of time it takes to license an applicant.
A comparative analysis of the Commission's disciplinary processes to those in other states.
Operations: On the operational side, the Commission has made several changes in the past year.
As many of the public health measures around the SARS-CoV-2 pandemic have largely receded, the Commission has taken the opportunity to significantly reduce its physical office space. The vast majority of the Commission's staff continue to work remotely, and the plan is to continue that practice.
The Commission has moved its policy and business meetings to a quarterly schedule. Meetings will be conducted virtually to maximize the opportunity for interested parties to observe and participate. The goal of these latter changes is to continue to maximize the efficiency of these meetings while also maintaining accessibility.
Source: Washington Medical Commission Update, September 30, 2023
