CALIFORNIA
DIVERSION PROGRAM
The Diversion Program is a statewide, five-year monitoring and rehabilitation program. It is administered by the Medical Board of California to support and monitor the recovery of physicians who have substance abuse or mental health disorders.
The Diversion Program was created by statute in 1980 as a cost-effective alternative to discipline by the board. Diversion promotes public safety by encouraging physicians to seek early assistance for substance abuse and mental-health disorders in order to avoid jeopardizing patient safety.
Physicians enter the Diversion Program by one of three avenues. First, physicians may self-refer. This is often the result of encouragement by concerned colleagues or family members who want the physician to seek help. Second, physicians may be referred by the Enforcement Program in lieu of pursuing disciplinary action. Finally, physicians may be directed to participate by the board as part of a disciplinary order.
During the fiscal year ending 02/03, 47 physicians were accepted into the program by the Diversion Evaluation Committee, signed a formal Diversion Agreement, and entered the program. Of those, 41 physicians had no open cases with the board, four physicians were diverted from discipline, and an additional two physicians entered as a result of disciplinary orders.
During fiscal year ending 02/03, the Diversion Program monitored a total of 399 physicians. Of the 51 who left the program, three are deceased and 10 were unsuccessful, while 38 successfully completed five years, with a minimum of three years of continuous sobriety and a change in lifestyle that would support ongoing recovery.
DIVISION OF MEDICAL QUALITY
The board’s mission of public protection prompted thoughtful assessment of how the board processes incoming complaints. This past year, the board’s Central Complaint Unit was reorganized into two sections to assure quality of care cases receive the highest priority and level of review. One section is the Quality of Care Section, and is responsible for reviewing complaints that may directly relate to patient harm caused by provider negligence or incompetence. The other section is the Physician Conduct and Affiliated Healing Arts Section, and is responsible for cases involving professional misconduct, technical violations and Affiliated Healing Arts cases. Although these cases may be serious, they do not pose an immediate danger to the health and safety of patients. This new design has resulted in a more timely review of quality of care cases and more education for the physician on cases involving non-quality of care and technical violations. SB 1950 (Figueroa) was a major piece of legislation for the board and became effective January 1, 2003. It affected a number of areas of operation at the board and impacted many sections of the Medical Practice Act, which governs the medical profession. The new law added two public members to the Division of Medical Quality and called for the appointment of an Enforcement Monitor to review the operations of the Enforcement Program. It also added new information about physicians for disclosure on the board’s website, e.g., physicians’ medical specialty certifications and certain malpractice settlements. The penalty that can be imposed for criminal violations of unlicensed practice was increased. Complaints involving quality of care must now receive an initial review by a medical expert in the same field of practice as the issues raised in the complaint. For the first time, investigative priorities of the board are reflected in statute: 1) negligence/incompetence resulting in serious bodily injury or death; 2) substance abuse during practice resulting in patient injury; 3) excessive prescribing or prescribing without a good faith exam; 4) sexual misconduct during treatment; and 5) practicing while under the influence of alcohol/drugs. Many of the provisions of this law have been implemented; however, to achieve full compliance, board staff continues to make program changes.
The hiring freeze, which affected all state agencies, prevented replacement of investigative staff that retired or left the board. This reduction is reflected in the fewer number of investigations opened. The Central Compliant Unit’s careful analysis of incoming complaints has assisted in reducing this number, while ensuring other appropriate actions are taken, such as citations and fines and advisory letters. Budgetary constraints will continue to place limitations on the board’s resources; however, staff will continue to seek efficient methods to process the work received, being ever mindful of the board’s public protection mission.
Reprinted from the October 2003 issue of the Action Report, published by the Medical Board of California.
COLORADO
NEW POLICIES
The Colorado Board of Medical Examiners has adopted several new policies, presented here in an abbreviated version. Please note that all board policies may be accessed online at www.dora.state.co.us/medical.
POLICY NUMBER: 20-17
Title: Issuing letters of concern for DUI, DWAI Referral of Applicants to the Colorado Physician Health Program for Evaluation Related to DUI, and DWAI Charges
Policy
It is the policy of the Colorado Board of Medical Examiners that any physician-applicant reporting that he or she has been charged within the last five years with driving under the influence (DUI), or driving while ability is impaired (DWAI), either drug or alcohol related, will be required to undergo evaluation or, at minimum, receive a letter of concern from the board. In such cases it shall also be the policy of the board to refer the physician to the Colorado Physician Health Program (CPHP) for evaluation. The CPHP evaluation of the physician applicant will be instrumental in determining whether a letter of concern is sufficient or if more serious action should be considered by the board.
POLICY NUMBER: 40-13
Title: Physicians and Physician Assistants’ Use of Alcohol and Other Mind-Altering Substances While On-Call
Policy
The Colorado Board of Medical Examiners advises against using any mind-altering medication not prescribed by the licensee’s treating doctors, and advises against the use of alcohol by licensees when on call. Although the use of these substances while on-call is not specifically defined in section 12-36-117, C.R.S., as a violation of the Medical Practice Act, the board is obligated to carefully review any allegation of alcohol/substance use by on-call physicians and physician assistants which affects the quality of patient care. The board, at its discretion, may determine if a licensee’s use of a mind-altering substance or alcohol was unprofessional. In such an instance, the board may conclude that a violation of the practice act occurred, and it retains the right to initiate disciplinary action against the licensee’s ability to practice medicine or to practice as a physician assistant.
POLICY NUMBER: 20-13
Title: Ability of Unlicensed Physician Assistants to Provide Delegated Medical Services Pursuant to 12-36-106(3)(l), CRS.
Issued: August 10, 2000; Revised August 9, 2001; Revised November 14, 2002.
Purpose
To provide guidance to applicants and staff regarding the board’s position with respect to unlicensed physician assistants providing delegated medical services pursuant to 12-36-106(3)(l).
Policy
Graduates of physician assistant programs who have not yet taken the certification examination and, thus, are not qualified for licensure, may perform delegated medical services pursuant to section 12-36-106(3)(l), CRS, until such time as they have been notified that they have passed the certification exam and are eligible for a Colorado license.
Reprinted from the Volume 11 Number 1, issue of The Examiner, published by the Colorado Board of Medical Examiners.
IDAHO
DEA REGISTRATION
The Board of Pharmacy continues to have questions from practitioners who hold a Drug Enforcement Administration (DEA) registration in Washington and want to know if they can prescribe controlled substances to patients they see in Idaho. The simple answer is no. A physician must have a DEA registration in each state in which the physician administers, dispenses or prescribes controlled substances. Even if the physician does not “maintain an office” in a state where they administer, dispense or prescribe controlled substances, federal law requires a separate DEA registration based on the fact that a physician must be licensed and/or registered to handle controlled substances in each state in which the physician administers, dispenses or prescribes controlled substances.
The only exception is a “Locum Tenens” physician who has a DEA registration in one state and who temporarily substitutes for a physician in a different state for a period not to exceed 60 days at the other physician’s DEA registered location.
In addition to the federal DEA requirements mentioned above, the Idaho Board of Pharmacy also requires a state controlled substance registration for any applicant prior to administering, dispensing or prescribing any controlled substance prescriptions in Idaho.
Compliance by physicians with the provisions of federal law with respect to all registration requirements also entitles them to be registered under the Idaho Controlled Substance Act.
In Idaho, a physician is required to have both a DEA registration issued to an Idaho address and an Idaho Controlled Substance registration prior to prescribing controlled substance prescriptions to patients they see at any practice location in Idaho.
Reprinted from the Summer 2003 issue of the Idaho State Board of Medicine Newsletter, published by the Idaho State Board of Medicine.
NEW MEXICO
BOARD CHANGES NAME TO NM MEDICAL BOARD
Senate Bill 171 made changes to the Medical Practice Act during the legislative session that ended in March. Probably the most obvious is the change in name from the New Mexico Board of Medical Examiners to the New Mexico Medical Board. The new name will be phased in as we reorder envelopes, stationery, etc. The primary reason is that we are constantly confused with the Office of the Medical Investigator, and we receive numerous calls each week concerning the location of bodies and the results of autopsies. In addition, we have not given an exam in years because everything is now done at the national level.
Other changes include the addition of a physician assistant (PA) member to the board. This will give PAs a “voting” member, instead of the Advisory Committee they have had for the past several years.
The disciplinary sections of the Act have been combined. Instead of a separate section for physicians, physician assistants, and anesthesiologist assistants, there is one section (61-6-15) that covers all three types of licenses.
The revised MPA updates the duties of the secretary and gives the board authority to hire a medical director. Changes to the licensing process eliminate the mandatory personal interview. To implement this change the board has developed a process to identify applicants with a questionable history who will still be required to interview. Applicants with no gaps in their work or training history and who are “squeaky clean” in disciplinary history will no longer need to interview after July 1. To further streamline licensing a CD-ROM containing orientation material will be mailed to each applicant. They will be required to acknowledge receipt and review of this material as a requirement for licensing. When the license is approved (each application must still be reviewed by the secretary, medical director, or other authorized board member. The board gained the ability to perform criminal background checks, but we have not yet decided how to use this authority.
Of particular interest to practicing physicians may be some of the changes to Section 61-6-15, reasons why action can be taken against a license. Prohibition of sexual contact with patients has been further clarified in paragraphs (31) and (32). Improper management of medical records, including failure to maintain timely accurate, legible and complete medical records has been added (#33), as has failure to provide records on request (#34). Undertreatment of pain (#35) in a cause for disciplinary action, as is disruptive behavior that impacts the quality of care (#36). However, the requirement that a physician pay costs in disciplinary actions has been eliminated to avoid any appearance a Board decision is based on financial reasons. All changes to the Act went into effect on July 1, 2003.
Reprinted from the Volume 8, Issue 1 issue of Information & Report, published by the New Mexico Medical Boarde.
OREGON
PAIN CONCERNS ANSWERED
The board, its counterparts nationwide, and the Federation are committed to helping doctors serve their patients’ best interests regarding treatment for chronic and intractable pain. There are very real concerns about the fine line between underprescribing and overprescribing pain medication, and these concerns often can lead physicians to stop seeing patients with pain.
There is no reason for Oregon’s doctors to use fear of board sanction as a reason not to treat chronic pain patients. Doctors who follow statutes and rules for prescribing pain medication should have no problems with the board as a result.
Besides the letter of the law and rule, the board in 2002 approved a set of core principles for pain management. The first principle states, simply, that people should have access to appropriate and effective pain management. Secondary goals include improved quality of life for those patients who suffer from chronic pain, and lessening of the morbidity and costs associated with untreated or inappropriately treated pain.
Reprinted from the Summer 2003 issue of the BME Report, published by the Oregon Board of Medical Examiners.
WEST VIRGINIA
BOARD OPINION ON PHYSICIANS ACCEPTING LOANS FROM PATIENTS
In response to an inquiry, the board has adopted the following opinion on physicians accepting loans from patients: It is probable that it is a violation of medical ethics for a physician to accept loans of money from a patient and to permit the patient to forgive repayment, and to accept loans of money with knowledge that the debt will be forgiven pursuant to the will of the patient. In the AMA Code of Ethics, Principle VIII is that “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.” The existence of a lender-debtor relationship introduces elements which distract from that paramount responsibility. Further, Opinion 10.015. The Patient-Physician Relationship, states in pertinent part that, “The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self interest...Within the patient-physician relationship, a physician is ethically required to use sound medical judgment, holding the best interests of the patient as paramount.” The existence of a lender-debtor relationship conflicts with this ethical obligation, particularly where a large loan will be forgiven upon death. The existence of the loan and the will forgiving it may also raise questions about the patient's death even where there may be no legitimate medical question.
PHYSICIAN ASSISTANT CONTINUING EDUCATION RULE CHANGE NOW LAW
Every two years physician assistants now must acquire a minimum of 50 hours of continuing education designated as Category I by either the American Medical Association, the American Academy of Physician Assistants, or the Academy of Family Physicians. The former rule required a minimum of 40 hours of Category I continuing education and 60 hours of Category II continuing education. Now the rule requires 50 hours of Category II continuing education. The changes became effective August 1, 2003, in the Rule 11 CSR 1B.
Reprinted from Volume 7, Issue 3 of the West Virginia Board of Medicine Quarterly Newsletter, published by the West Virginia Board of Medicine.
LET US HEAR FROM YOU
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