California
California's Operation Safe Medicine Unit Cracks Down on Circle Contact Lens Sales
The Medical Board of California recently launched an aggressive effort to counter the growing incidence of unauthorized sales of circle contact lenses — a new kind of contact lens that has gone mainstream in Asia but is still illegal in California.
The board's Operation Safe Medicine unit, made up of four investigators who investigate allegations of unlicensed practice of medicine, set up several undercover buys from unlicensed individuals who were selling circle contact lenses. Working collaboratively, board investigators and the Los Angeles Police Department arrested nine unlicensed individuals selling circle contact lenses and the cases were referred to the Los Angeles City Attorney's Office for prosecution.
Circle contact lenses are usually colored and make the eyes seem larger, covering the iris and part of the white portion of the eyes. Though the lenses are popular in other countries, health and safety concerns have restricted their use in the United States. Poorly fitted lenses can scratch the cornea, cause infections and lead to serious problems, including loss of vision and loss of an eye.
Despite being prohibited by law in California, circle contact lenses are easily available on the Internet and from some public vendors. California's Business and Professions Code stipulates that contact lenses may be sold only upon receipt of a written prescription or a copy of a written prescription and in quantities consistent with the prescription's established expiration date and the standard packing of the manufacturer or vendor.
California's Operation Safe Medicine unit set up several undercover buys from Southern California vendors — including some who were selling the lenses outdoors. Among the charges the vendors face are failure to obtain a patient history, failure to perform an examination, and illegally obtaining and reselling contact lenses without a prescription.
Source: State Medical Board of California website, October 2010
State Medical Board of California Annual Report Notes Improvements in Results
The State Medical Board of California's recently published Annual Report for 2009–10 indicates progress on a number of statewide initiatives, as well as improvements in key measurements used to assess results in state physician investigations.
Notably, the California board's Enforcement Program reported that it reduced the average time to complete investigations and increased the number of cases referred to the Office of the Attorney General for disciplinary action and public letters of reprimand in 2009–10, according to the report.
The board also noted in the report its progress on a new system, implemented late last year, which allows licensing applicants to look up the status of their application online; a licensing outreach program aimed at hospitals and physician recruiters; and its new program that requires California physicians to notify their patients that they are licensed and regulated by the board.
The board's Enforcement Program reduced the average time to complete investigations, from the receipt of a complaint through the entire disciplinary process, by 21 days. As a result of its focus on enhanced efficiency, the program referred 119 more cases to the Office of the Attorney General in 2009–10 than in the previous year.
The program also reported that administration outcomes resulting in the surrender of a license more than doubled, suggesting an improvement in the quality of cases being referred for prosecution.
According to the report, the Enforcement Program's issuance of public letters of reprimand increased by 43 percent during 2009–10. The program attributed much of this increase to the passage of AB1070 — California legislation that allows an administrative law judge to recommend that a licensee be issued a public reprimand, including additional requirements for education and training.
The Enforcement Program opened 1,312 cases in 2009–10, compared with 1,123 cases in 2008–09. It closed 1,290 cases in 2009–10, compared with 1,100 in 2008–09. The program reported that consumer inquiries were up significantly, from 15,699 in 2008–09 to 20,447 in 2009–10.
Administrative outcomes by case type were highlighted in the Annual Report, with the majority of cases involving gross negligence or incompetence, followed by unprofessional conduct, drug and alcohol abuse and inappropriate prescribing (see table).
Administrative Outcomes by Case Type in California
The report notes that the board's new online application-status system is fully operational. Launched in December 2009, the new system allows licensing applicants to view documents required for licensure at a secure website. An applicant-information screen tells the applicant which documents have been received by the board and indicates those that are missing.
The new system, which the board says was implemented to “streamline and expedite the licensing process,” also informs applicants of any documents that have been found to be deficient as well as those that have been approved.
During the fiscal year, California expanded its licensing outreach program, according to the report, reaching out to more teaching hospitals and beginning an effort to connect with physician recruiters. The new outreach initiative includes direct contact from board representatives, who explain the licensing process and how applications are reviewed, and offer to assist with any questions or problems system-users encounter.
According to the report, this “helps applicants identify potential problems they may face and assists the board's staff by promoting the receipt of more properly prepared applications, again expediting the application process.”
Highlighted in the report is a summary of a new provision in the California Code of Regulations, implemented in late June of this year, which requires all California-licensed physicians to notify their patients that they are licensed and regulated by the State Medical Board of California.
To fulfill this requirement, the state's licensed physicians must display the board's toll-free phone number and website address. Physicians must display a sign with this information “prominently” or give the information in writing to each of their patients. According to the report, the new requirement “serves the public by informing consumers where to go for information or to complain about a California medical doctor.”
The report also provides statistics on California's total pool of licensed physicians, which now stands at 122,451. Of these, 98,816 are based in California and 23,636 are out of state but licensed in California (excluded are those in an inactive, retired, or disabled license status).
The state's heaviest concentration of licensed physicians is in Los Angeles County, with 27,255; followed by San Diego County, 9,365; Orange County, 9,177; Santa Clara County, 6,967; San Francisco County, 5,858; Alameda County, 4,425; and Sacramento County, 4,264.
During the fiscal year, the state's Licensing Program received 5,964 new physicians' and surgeons' applications and issued 5,110 licenses. This compares with 6,169 applications received in 2008–2009 and 4,688 licenses issued.
In addition to the licensing of physicians, the Medical Board of California's Licensing Program licenses non-nurse midwives, research psychoanalysts, spectacle and contact lens dispensers and registered dispensing optician businesses. It also approves accreditation agencies that accredit outpatient surgical centers in which general anesthesia is being used.
Source: State Medical Board of California 2009–10 Annual Report
Florida
Prescription Drug Monitoring Program Awarded Federal Grant
The Florida Department of Health (DOH) was awarded a $400,000 enhancement grant — the maximum amount possible — from the Harold Rogers Prescription Drug Monitoring Program for an electronic system to monitor the dispensing of controlled substances in Florida. When Florida's Prescription Drug Monitoring Program (PDMP) is in place, it will be a repository of data about every dispensing transaction of a Schedule II, III, or IV controlled substance between a physician, dentist, or pharmacist, and his or her patient.
After years in development, legislation authorizing the PDMP was passed in 2009 and is now law (s. 893.055, Florida Statutes). The law does not allow for any state funding of the program; however, the recently-awarded enhancement grant and the 2009 Harold Rogers Implementation Grant, also in the amount of $400,000, will be used to administer the program.
The primary purpose of the Harold Rogers Prescription Drug Monitoring Program is to enhance the capacity of regulatory and law enforcement agencies and public health officials to collect and analyze controlled substance prescription data and other schedule-listed chemical products through a centralized database administered by an authorized state agency. The program was created by the Fiscal Year 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77) and has received funding under each subsequent year's Appropriations Act. For more information, visit www.doh.state.fl.us/mqa/medical/.
Source: MCQ Today, Florida Department of Health, October 2010
North Carolina
New State Board Committee on ‘Practice Drift’ Begins Its Work
A new North Carolina Medical Board committee on “practice drift” has been established to help produce a position statement on an increasing trend among North Carolina medical practitioners: the outflow of physicians from areas in which they were trained into new areas of practice for which they may not have received adequate formal education or training.
The board recently reported a small but increasing number of physicians ‘drifting’ outside their formal areas of training.
In a news announcement, the board said it “recognizes that the evolution of physician practice is not necessarily negative. However, the board has a duty to protect the public by assuring that physicians treating North Carolinians are competent in whatever fields of medicine or surgery they practice.”
The board's new committee, named the Special Task Force on Practice Drift, began its work in October, inviting a variety of stakeholders to participate in an initial meeting. Invitees included representatives from professional liability insurance companies, physician professional groups representing both specialists and general medical practitioners and others. Twenty one participants attended the first meeting.
Areas into which both primary care and specialty physicians are “drifting” in North Carolina include cosmetic procedures, mental health, and pain management, according to the board.
The Special Task Force concluded its meeting with a consensus vote that a Position Statement be drafted to state that the board expects licensees to ensure that they are competent in the new area in which they are practicing. The Special Task Force aims to have a draft statement prepared in time for the board's regular meeting in January 2011.
Source: North Carolina Medical Board website, October 2010
Iowa
Board Ad Hoc Committee to Study a Range of Telemedicine Issues
The Iowa Board of Medicine has appointed a committee that will help it determine how to ensure that its policies on a physician's practice of medicine over the Internet and by means other than a face-to-face visit with a patient remain “relevant to the continually expanding use of telemedicine.”
Iowa Board of Medicine Chair Siroos Shirazi, M.D., appointed an ad hoc committee in August that will study the board's 1996 policy statement to determine what changes may be needed. According to the board, the committee's review “will encompass a broad range of medical applications.”
The committee will begin a review of the policy statement and the general topic of telemedicine this fall, but may not complete its work until a parallel nationwide study is completed in 2011, according to the board.
Members of the ad hoc committee include Iowa Board of Medicine members Amber Mian; Colleen Stockdale, M.D.; Joyce Vista Wayne, M.D.; former board member Carole Frier, D.O.; and board staff. The ad hoc committee will likely invite participation by others who have expertise in telemedicine issues.
The board's policy statement is based in part on a 1996 report by the Federation of State Medical Boards. Shirazi said the board's policy statement is not a legally binding opinion, but is only intended to provide guidance to the public. The board may make formal policy only through administrative rules, declaratory orders or contested case decisions.
Source: Iowa Board of Medicine news release, August 2010
Ohio
Physician Licensure Renewal Form Redesigned to Give More Accurate Picture of Physician Workforce
The State Medical Board of Ohio has launched a redesign of its online physician renewal application form that will now include questions related to physician demographics.
The new form includes a series of mandatory demographic questions, which the board said in a news release are intended to provide better data to help state officials as they make decisions related to the physician workforce. In announcing the redesign, the board said the new demographic questions will enable it to gain “a more accurate illustration of the Ohio physician workforce than has ever before been available.”
The state's demographic questions include:
The number of hours per week a physician spends in direct patient care and other activities, and the clinical setting of such activities.
The county and zip code of the location(s) where the physician provides the most patient care.
Whether the physician is a solo practitioner, part of a group practice, or employed by a clinical facility or hospital.
Whether languages other than spoken English are available at the primary practice location.
Board certification status.
All of the demographic questions on the online renewal form can be answered by choosing the appropriate response from a drop-down box. Answers must be provided to the questions in order to continue the renewal process. The average time to complete the online renewal remains 15 minutes or less, according to the board. License renewal notices are sent by the Ohio board six months before the license expiration date.
For more information about the new form, visit www.med.ohio.gov.
Source: State Medical Board of Ohio news release, October 2010
Texas
New Program Assists Health Professionals with Impairment Issues
The Texas Medical Board has established a new, statewide program that aims to protect the public by encouraging health professionals to seek early assistance with drug or alcohol-related problems or mental or physical conditions that present a potentially dangerous limitation or inability to practice medicine with reasonable skill and safety.
The Texas Physician Health Program, or TXPHP, is a confidential, non-disciplinary program for physicians, physician assistants, acupuncturists and surgical assistants licensed by the Texas Medical Board or who have applied for licensure.
TXPHP, launched earlier this year, was created by Texas Senate Bill 292. It is modeled on other states' programs and was a joint effort of the Texas Medical Association, the Texas Osteopathic Medical Association, and the Texas Medical Board. TXPHP is self-funded through user fees, with the cost for participation in the program $1,200 per year.
TXPHP accepts self-referrals as well as referrals from the Texas Medical Board, concerned colleagues, hospitals and others. The program is overseen by experts in mental health and substance abuse issues.
TXPHP recommends treatment for physicians when clinically indicated, and monitors their ongoing recovery. A monitoring program may include random drug screens, written reports from counselors or therapists, self reports provided by the physician in recovery, and written verification of attendance at self-help or support group meetings.
TXPHP is administratively affiliated with the Texas Medical Board, but overseen by an 11-member governing board.
To learn more about TXPHP, visit www.tmb.state.tx.us.
Source: Texas Medical Board news release, September 2010
