ALABAMA
EMERGENCY RULE ADOPTED
On Jan. 17, 2008, the board adopted an emergency rule that removed the limitation on physicians in surgical specialties to have no more than two physician assistants registered to the physician. For more information, visit the Alabama Board of Medical Examiners website www.albme.org
Reprinted from the Alabama Board of Medical Examiners website.
ALASKA
PRACTICING A SPECIALTY WITHOUT BEING BOARD CERTIFIED IN THAT SPECIALTY
In Alaska, a physician may practice any specialty without being certified by any specialty board.
However, it is the exception of the Alaska State Medical Board that physicians meet the “standard of care” in any field they choose to practice. This means that the care rendered must be that which is reasonably expected of an appropriately trained physician in the setting involved.
Board certifications neither guarantees that such standards are met, nor does lack of board certification mean that these standards would not be met. It means that at some time, the physician undertook and successfully completed a formal course of training (residency) and passed an examination administered by the board of that specialty.
Reprinted from the Alaska State Medical Boards online BoardNews Bullets 8.
ARKANSAS
FOR SUPERVISING PHYSICIANS AND PHYSICIAN ASSISTANTS
Physician assistants must notify the Arkansas State Medical Board immediately when they disassociate from a working relationship. They may do so by sending notification on letterhead with their signature by fax, letter or email. Failure to do so could result in non-compliance with the Physician Assistant Advisory Committee, as their license is considered “inactive” when they do not have a supervising physician. Code 17-105-111(b) - A physician assistant shall notify the board of any changes or additions in supervising physicians within ten (10) calendar days.
Reprinted from the Number 36, Winter 2008, issue of Newsletter, published by the Arkansas State Medical Board.
CALIFORNIA
LEGISLATIVE UPDATE (SELECTED)
Board-sponsored Restructuring
AB 253 (Eng, Chapter 678) Restructuring of the Medical Board of California combines the two divisions of the board into one board effective Jan. 1, 2008. Revises the decision-making authority of the board by allowing the board to delegate to the executive director the authority to adopt default decisions and stipulations to surrender a license in disciplinary proceedings. Reduces the board membership from 21 members (12 physician members and nine public members) to 15 members (eight physician members and seven public members), effective Jan. 1, 2008, to 17 members, and, on Aug. 1, 2008 to 15 members.
Chaptered Legislation
AB 3 (Bass, Chapter 376) Physician Assistants allows a physician assistant to administer, provide, or issue a drug order under general protocols for Schedule II through Schedule V controlled substances without advanced approval by a supervising physician for each specific patient if the physician assistant completes specified educational requirements. Increases the number of physician assistants a physician may supervise from two to four (making this consistent with the number supervised in underserved areas). Specifies the services provided by a physician assistant are included as a covered benefit under the Medi-Cal program.
AB 329 (Nakanishi, Chapter 386) Chronic Diseases: Telemedicine allows the board to establish a telemedicine pilot program. Authorizes the board to implement the program by convening a working group of interested parties. The board is required to make recommendations to the Legislature within one calendar year of the commencement date of the pilot program.
AB 682 (Berg, Chapter 550) HIV/AIDS Testing deletes the provisions that prohibit testing a person's blood for evidence of antibodies acquired immunodeficiency syndrome (AIDS) without written consent of the subject. Instead, requires a medical care provider, prior to ordering a test that identifies infection with human immunodeficiency virus (HIV), to inform the patient that the test is planned, provide information about the test, inform the patient regarding specified treatment options, and advise the patient that he or she has the right to decline the test. Requires that the person engaged in prenatal care of a pregnant woman ensure follow-up care for the mother and infant should the mother test positive for HIV antibodies. Strongly encourages providers to seek consultation with specialists who provide care for these women and their infants.
AB 1226 (Hayashi, Chapter 693) Medi-Cal: Provider Enrollment provides, as of July 1, 2008, that a physician practicing in an individual physician practice, and enrolled and in good standing in the Medi-Cal program, and who is changing locations of that practice within the same county, is eligible to continue enrollment at the new location by filing a change of location form in lieu of submitting a completed application package. Also requires the State Department of Health Services to provide notice to the physician of receipt of the application package or the change of location form.
AB 1302 (Horton, Chapter 700) Health Insurance Portability and Accountability Act Extends the Health Insurance Portability and Accountability Implementation Act of 2001 (HIPAA) to July 1, 2010, when it will become inoperative, unless extended by statute.
AB 1687 (Brownley, Chapter 552) Confidential Information provides that for purposes of allowing medical information to be disclosed to providers of health care, and for the purpose of diagnosis and treatment of a mental health condition of a minor, a provider may disclose medical information to any person who is legally authorized to have custody or care of a minor. This is for coordinating health care services and medical treatment provided to the minor. Prohibits those who are legally authorized to have custody or care of a minor who receive medical information from further disclosing that information unless the disclosure is for the purpose of coordinating health care services and medical treatment of the minor and the disclosure is authorized by law. Provides that if a provider determines that the disclosure of medical information concerning a minor is reasonably necessary for the purpose of assisting in coordinating the treatment and care of the minor, that medical information may be disclosed to any other person who is legally authorized to have custody or care of the minor.
SB 472 (Corbett, Chapter 470) Prescription Drug Labeling Requirements requires the state Board of Pharmacy to promulgate regulations that require a standardized, patient-centered, prescription drug label on all prescription medication dispensed to patients in California. The board is required to hold special statewide public meetings to seek information on the label requirements. Requires the Board of Pharmacy to report to the Legislature on or before Jan. 1, 2010, on its progress and to report to the Legislature on or before Jan. 1, 2013 on the status of implementation of the requirements.
SB 620 (Correa, Chapter 210) Dental: General Anesthesia removes the Jan. 1, 2008, sunset date on the permitting process for physicians who administer general anesthesia for dental patients.
SB 767 (Ridley-Thomas, Chapter 477) Drug Overdose Treatment: Liability authorizes, until Jan. 1, 2011, a licensed health care provider, who is permitted to prescribe an opioid antagonist, when acting with reasonable care to prescribe, dispense or distribute an opioid antagonist in conjunction with an opioid overdose prescription and treatment program without being subject to civil liability or criminal prosecution. Requires that local health jurisdictions operating opioid overdose prevention and treatment training programs collect specified data and report it to the Legislature.
SB 850 (Maldonado, Chapter 661) Vital Statistics : Certificate of Still Birth enacts the Missing Angels Act, which requires the local registrar of births and deaths of the county in which a fetal death, where the fetus has advanced to or beyond the 20th week of uterogestation, to issue upon request, to the father or mother, a Certificate of Still Birth. This would be done on a form prescribed by the State Registrar of Vital Statistics. Defines stillbirth for this purpose to be delivery of a fetus where there was a naturally occurring intrauterine fetal death that occurred after a gestational age of not fewer than 20 weeks.
SB 1048 (Senate Business and Professions Committee, Chapter 588) Healing Arts: Omnibus This bill has several provisions. Some impact statutes governing the Medical Practice Act. The first provision, amending B&P Code section 2177, allows an applicant who obtains a passing score on Step III of the USMLE in more than four attempts and who meets the requirements of section 2135.5 to be eligible for a physician's license. The second provision, amending B&P Code section 2313, makes current the language to reflect that references to B&P Code section 801 now refer to section 801.01. It also revises language on collecting information on complaint forms as it is no longer practical to report on forms sent by mail, as many are printed from the website.
FREE ONLINE CME FOR INTIMATE PARTNER VIOLENCE
A free online CME course, Respond to Domestic Violence, offers California physicians the opportunity to earn up to 16 AMA PRA Category I credits or 16 AAFP Prescribed credits. The program is available at www.RespondtoDV.org.
Intimate partner violence (IPV) is more common than most physicians may believe and studies have shown that experienced physicians have trouble recognizing and responding to IPV in their practices. California physicians may not be aware that they and other health care practitioners are required to report to local law enforcement authorities the names of persons whom they treat for injuries that are the result of assault or abuse, including abuse by a spouse or cohabitant (California Penal Code § 11160).
In 2006, Blue Shield of California Foundation decided to help California physicians to better recognize IPV. The foundation teamed up with a group of national experts, led by Zita Surprenant, M.D., of Kansas University, and an Arizona company specializing in online CME, to provide a customized IPV CME program for California physicians.
The program uses an interactive case-based teaching approach. It emphasizes the practical management of IPV and explains California's reporting requirements. The program has been shown in two published studies to improve physician confidence in managing IPV.
Since its launch in July 2006, more than 1,700 California physicians have enrolled in the online program, earning 6,000 CME credits. Physicians who complete the program have been enthusiastic, with 90 percent of them rating the program “above average” or “excellent.” Almost three quarters of physicians expect to change their practice based on what they learned from the program.
According to Dr. John Harris, president of Medical Directions, the company that developed the program and hosts the www.RespondtoDV.org Web site, the online program will provide free CME to licensed California physicians at least until July 2008. “We believe this is a worthy project,” Dr. Harris said. “We plan to promote the IPV program this winter and are seeking support to keep it available beyond July.”
Reprinted from the Vol. 105, January 2008, issue of the Medical Board of California Newsletter, published by the Medical Board of California.
NEW MEXICO
STATEWIDE CRIMINAL HISTORY SCREENING
The primary mission of New Mexico Medical Board is to protect the health, safety and welfare of the public. In the interest of fulfilling that mission, the board will join the majority of other states in the country by requiring all licensees undergo a state and nationwide criminal background screening.
On July 1, 2007, the board began requiring all applicants for initial licensure and reinstatements to submit fingerprints for a state and national criminal background check.**
Beginning with the 2008 renewal cycle, every licensee seeking to renew their license will be required to submit fingerprints for a state and national criminal background check.**
**In accordance with the provisions of 61-6-11(G) of the Medical Practice Act and Title 16, Chapter 10, Part 2, Part 7 and Part 15 of the rules and regulations.
Reprinted from the New Mexico Medical Board website.
NORTH CAROLINA
MULTIPLE PRESCRIPTIONS FOR SCHEDULE II DRUGS
Current federal law prohibits refills of Schedule II drugs. However, can a prescriber lawfully issue multiple prescriptions for Schedule II drugs to be filled sequentially, for the same schedule II controlled substance, with such multiple prescriptions having the combined effect of allowing a patient to receive, over time, up to a 90-day supply of that controlled substance (often accomplished by using the “do not fill before …” language)?
As many prescribers are aware, there has been some confusion regarding whether this is appropriate. A few years ago, the U.S. Department of Justice, Drug Enforcement Administration (DEA) issued an opinion that this practice did not violate the prohibition against refills. Soon thereafter, DEA reversed its decision. The overwhelming negative reaction to that reversal resulted in a proposed rule, published in September 2006, which would, if approved, reinstate the above policy.
The vast majority of comments from a wide variety of individuals and organizations supported adoption of this rule citing the time and money saved due to less frequent visits to prescribing practitioners, and the reduced physical toll resulting from the reduced visits. The proposed rule, with minor modifications, became effective Dec. 19, 2007.
In announcing its decision, the DEA reiterated its interest in ensuring that controlled substances are prescribed for legitimate medical purposes by prescribing practitioners acting in the usual course of professional practice and preventing, as much as possible, the diversion and abuse of controlled substances.
Note: Please remember that all prescriptions issued pursuant to the new rule must be dated the date the prescription was issued even though some prescriptions will not be filled until a later date.
For more information, go to www.deadiversion.usdoj.gov/fed_regs/rules/2007/fr1119.htm.
Reprinted from the Number 4, 2007, issue of Forum, published by the the North Carolina Medical Board.
SOUTH CAROLINA
PHYSICIAN ASSISTANTS ELIGIBLE TO REQUEST PRESCRIPTIVE AUTHORITY
Physician assistants (PAs) in South Carolina are now eligible to request prescriptive authority for controlled substances in schedules III through V from the South Carolina Board of Medical Examiners. Prior to submitting a request to the board, a PA must complete additional CME requirements, register with the S.C. Department of Health and Environmental Control, Bureau of Drug Control, and register with the Drug Enforcement Administration. Numerous state PAs, physicians, physician assistant educators and members of the South Carolina Board of Medical Examiners were involved in the drafting of the new PA Practice Act. As part of the initial expansion, PAs must provide the board with documentation of at least 15 Category I CME hours related to appropriate prescribing of controlled substances acceptable to the board. Thereafter, to maintain expanded prescriptive authority, each PA must obtain an additional four Category I CME hours related to appropriate prescribing of controlled substances every two years upon renewal.
The Medical University of South Carolina is currently offering a course to meet the CME requirement at www.musc.edu/chp/pa/pacme/pac.htm.
The board's application and a detailed description of the expanded prescriptive authority are available online at www.llr.state.sc.us/POL/medical.
In addition to expanded prescriptive authority, physician assistants are eligible for a temporary license prior to the personal interview. Temporary licenses are issued up to 90 days. The physician assistant and his/her supervising physician must contact a board member or board designee for the personal interview within the 90-day temporary period. Temporary licenses cannot be extended or renewed. A physician assistant with a temporary license is not eligible for prescriptive authority. The board is confident these recent regulatory changes will both enhance the quality and increase the access of health care services for South Carolinians.
Reprinted from the December 2007 online version of The Examiner, published by the South Carolina Board of Medical Examiners.
VERMONT
CDC REPORT PROVIDES SNAPS HOT OF VERMONT PUBLIC HEALTH PREPAREDNESS
A Centers for Disease Control and Prevention (CDC) report “Public Health Preparedness: Mobilizing State by State” published Feb. 20, 2008, provides a snapshot picture of progress and challenges faced by each state, including Vermont. The report examines three key public health preparedness capabilities: disease detection and investigation, public health laboratories, and overall response capabilities.
The Vermont Department of Health was recognized in the report for conducting a full-scale, two-week exercise, Operation Pandemic Flu, in July 2006 and also was noted for its ability to receive and investigate urgent disease reports 24/7 365 days a year, to conduct laboratory testing for an array of chemical and biological agents and to activate its public health emergency operations center.
The public health laboratory routinely tests “unknown” samples from the CDC to assess and maintain competency to detect biological and chemical terrorism agents. However, the report identified areas for improvement, such as testing the emergency response of the network of laboratories around the state, and drilling with key response partners to test communications when power and landlines are down.
“We are working every day to strengthen our ability to respond quickly and effectively to any public health emergency – whether biological, chemical or radiological – and whether the emergency is a natural event like pandemic influenza or a terrorist event like an intentional release of anthrax,” said Health Commissioner Sharon Moffatt, R.N., M.S.N. “But we must keep striving to improve and to meet new challenges.”
Vermont was rated as among the most prepared states in the nation in the 2007 Trust for America's Health Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism report. In that report, based on 10 key indicators to assess health emergency preparedness capabilities, Vermont was rated nine out of 10. Vermont was cited for its readiness to quickly move pharmaceuticals, vaccines, antidotes and medical supplies from national and state stockpiles to clinics and hospitals in the event of an emergency such as pandemic flu, an anthrax attack or toxic chemical spill.
Vermont was one of the few states in the nation in 2007 to achieve a score of 90 or above (out of 100) from the CDC for its Strategic National Stockpile (SNS) emergency preparedness program. SNS is a federal asset that augments local supplies with a large, continuous quantity of medications, vaccines, supplies and equipment delivered to the state within 12 hours of an emergency.
The Burlington Metropolitan Statistical Area (including parts of Chittenden, Franklin and Grand Isle counties) has now joined 71 other cities nationwide in CDC's Cities Readiness Initiative (CRI). CRI is a pilot program to help cities strengthen their capacity to quickly deliver medicines and medical supplies during a large-scale public health emergency such as an airborne anthrax attack. States must develop plans that support mass distribution of medication to 100 percent of an identified population within 48 hours of a possible exposure.
Vermont has exercised its ability to dispense medication quickly to a large population during two large-scale exercises, “Operation Pandemic Flu” in 2006, and “Operation Red Clover” in 2004. “Operation Red Clover” was a three-day scenario that involved a simulated intentional release of pneumonic plague and air delivery of SNS supplies by the Vermont National Guard to public clinics. Also in 2004, during the severe influenza vaccine shortage, the Vermont Department of Health organized community mass vaccination clinics for very high-risk adults that were held in 17 locations around the state on a single day.
An effective response involves multiple state and local agencies and the entire health care community working within the framework of the State Emergency Operations Plan. Key planning and response partners include the Office of the Governor, Vermont National Guard, Department of Public Safety (including Vermont Emergency Management, Vermont Homeland Security, Vermont State Police, Vermont Hazmat), Vermont 2-1-1, Agency of Human Services, Agency of Agriculture, Food & Markets, the Vermont Association of Hospitals & Health Systems Network Service Organization, Fletcher Allen Health Care, hospitals and laboratories around the state, University of Vermont and colleges around the state, Vermont League of Cities & Towns, Local Emergency Planning Committees (LEPCs), local government and planning commissions, schools, law enforcement, refugee community organizations, health care providers, community leaders and the Vermont media corps.
Reprinted from the Vermont Department of Health website.
WYOMING
WYOMING PARTICIPATES IN LICENSE PORTABILITY PROJECT
The Wyoming Board of Medicine currently is participating in a pilot project with grant funds provided by the federal Health Resources and Services Administration (HRSA) to facilitate medical license portability across state lines. The pilot project includes a western group (Wyoming, Colorado, Idaho, Oregon, North Dakota, Minnesota, Iowa and Kansas) and an eastern group (Maine, Massachusetts, Vermont, Connecticut, Rhode Island and New Hampshire), which are working together to find ways to pool data and expedite licensure application processes so that physicians need not re-apply for licensure each time they move to another jurisdiction. Ear marked money in the grant provides for a separate project for Wyoming and Idaho to develop mutual recognition of licensure, a process that could potentially permit physicians to move and practice in either or both states after having obtained a license in one. This project is scheduled for public introduction in FY 2008.
Reprinted from the Volume 1, Number 1, online edition of Wyoming Board of Medicine News, published by the Wyoming Board of Medicine.
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