MAINE

NEW LAWS

The first session of the 122nd Legislature established a number of important new laws which became effective Sept. 17, 2005.

Ch. 24, PL 2005 allows a physician to serve as the IME for a disputed claim even though the physician has examined the employee during the previous 52 weeks for an insurance claim, if agreed by the parties to the claim.

Ch. 94 Resolves 2005 Reminds professional associations and practitioners that agents of patients appointed through a power of attorney are entitled to the same information as the patient and HIPAA does not apply to protected health information given to principals or their agents.

Ch. 99 PL 2005 authorizes PAs and certified NPs to submit sworn testimony in workers compensation proceedings.

Ch. 162. PL 2005 updated the medical practice act:

  • PAs shall be disciplined under the same statute as M.D.s.

  • The postgraduate training requirement will become 36 months for medical school graduates after 2004. Physicians in Maine residency programs with unrestricted program endorsement are eligible for license after 24 months.

  • Physicians over age 70 who maintain an active license will pay a biennial registration fee. No fee has yet been established by the board.

Ch. 221 PL 2005 requires more specific information reporting from hospitals and other providers regarding adverse credentialing actions. This will assist the board to act timely to review.

Ch. 359 PL 2005 permits APRNs to complete the medical certification of death.

Ch. 363 PL 2005 establishes a waiver of ACGME-accredited postgraduate training requirements for foreign medical graduates in some instances. Rules for implementation will be adopted.

Ch. 376 PL 2005 Allows the M.D. to express sympathy for outcomes without it being used in malpractice litigation. This is an important tool for physicians to strengthen patient communication.

CONFIDENTIALITY REQUIREMENTS: WHAT EVERYONE SHOULD KNOW

Recently, the board has seen an increase in licensees, who are the subject of a complaint, sending copies of the complaints and/or their responses to other physicians and entities, such as hospitals or health systems. This action is not appropriate. Pursuant to Title 10 M.R.S.A.§8003-B, all complaints and investigative records and materials are confidential until the conclusion of the investigation. In addition, Title 24 M.R.S.A.§2510 (I) designates as confidential any reports, information or records received or developed by the board during an investigation. Title 24 M.R.S.A.§2510 (3) prohibits a person who receives such information from disclosing it. This prohibition continues even when the complaint is dismissed or otherwise completed. Title 24 M.R.S.A.§2510 (4) makes it a Class E crime (punishable by a fine of up to $1,000 and six months incarceration) to disclose this information. In addition, inappropriate disclosure of this information may result in disciplinary action against a physician’s license. All complaint materials should be kept strictly confidential and responses should be sent only to the board. If physicians store information regarding a complaint in a patient’s medical chart, they must make sure that this information is not included when records are sent to other practitioners.

Reprinted from the Maine Board of Licensure in Medicine website.

NORTH CAROLINA

POLICY COMMITTEE CONTINUES REVIEW OF POSITION STATEMENTS

The Policy Committee of the North Carolina Medical Board is continuing its review of the board’s various position statements. The board’s licensees and others interested in the subjects dealt with by the statements are invited to offer comments in writing to the board, by e-mail or post, for consideration as part of the review process. Comments should be addressed to the Policy Committee of the North Carolina Medical Board and posted to P.O. Box 20007, Raleigh, NC 27619, or e-mailed to info@ncmedboard.org. The Policy Committee will discuss the statements scheduled for consideration in public sessions during regularly scheduled meetings of the board. Interested parties are invited to attend those sessions as observers. The results of each review will be published on the board’s website and in the Forum, and further written comments will be invited to assist the Policy Committee in preparing a final version of the statement for board action. The schedule currently set for statement review is noted below, though changes to the review schedule will occur from time to time. Those wishing to attend should check dates and times on the board’s agenda, which is posted on the board’s website several days before each meeting. They may also telephone the board’s office for information concerning meeting times.

March 15, 2006

“Sexual Exploitation of Patients”

“The Physician-Patient Relationship”

“Care of Surgical Patients”

May 17, 2006

“Retention of Medical Records”

“Medical Record Documentation”

“The Retired Physician”

Results of November 16 Review

The Policy Committee of the North Carolina Medical Board met Nov. 16, 2005, and completed initial review of two position statements. It made the following recommendations on the statements. Those interested in offering the Committee comments on its recommendations may do so as noted in the first paragraph above.

  1. The Committee recommended no change be made to the Position Statement titled “Prescribing Legend or Controlled Substances for Other Than Valid Medical or Therapeutic Purposes, with Particular Reference to Substances or Preparations with Anabolic Properties.” The current text may be found in the full list of Position Statements published in the Volume 10, Number 4, of Forum, published by the North Carolina Medical Board.

  2. The Committee recommended the Position Statement titled “Sale of Goods from Physician Offices” be amended. The proposed change appears below, with deletions and additions indicated.

Sale of Goods from Physician Offices

The Physician-Licensee patient relationship constitutes a fiduciary relationship with the patient. In this capacity, there is a duty to place the financial or other interest of the patients above their own.

Inherent in the in-office sale of products is a perceived conflict of interest. On this issue, it is the position of the North Carolina Medical Board the following instructions should guide the conduct of physicians or licensees.

Sale of practice-related items such as ointments, creams and lotions by dermatologists, splints and appliances by orthopedists, spectacles by ophthalmologists, etc., may be acceptable only after the patient has been told those or similar items can be obtained locally from other sources. Any charge made should be reasonable.

Due to the potential for patient exploitation, the Medical Board opposes licensees participating in exclusive distributorships and/or personal branding, or persuading patients to become dealers or distributors of profit making goods or services.

Licensees should not sell any non health-related goods from their offices or other treatment settings. (This does not preclude selling of such low cost items on an occasional basis for the benefit of charitable or community organizations, provided the licensee receives no share of the proceeds, and patients are not pressured to purchase.)

All decisions regarding sales of items by the physician or his/her staff from the physician’s office or other place where health care services are provided, must always be guided by what is in the patient’s best interest.

(Adopted March 2001. Amendment proposed in November 2005)

Reprinted from the Volume 10, Number 4, issue of Forum, published by the North Carolina Medical Board.

VIRGINIA

REGULATORY ACTIONS UNDERWAY

M.D.s and D.O.s will soon be subject to new regulations governing the mixing, diluting or reconstituting of drugs in their practices. The regulations are a requirement of law passed in the 2005 Session of the General Assembly. Essentially, there will be certain guidelines to follow whenever two or more sterile products are mixed together to prepare a medication for administration. The regulations are currently under review by the Executive Branch. When they become final, they will be presented in a special edition of Board Briefs, the newsletter published by the Virginia Board of Medicine.

M.D.s, D.O.s, and D.P.M.s are currently required to report certain adverse information on their profiles, including malpractice paid claims. All adverse information is required to be reported on one’s profile within 30 days of occurrence. In the instance of a paid claim, that is 30 days from the date the claim is paid. Also, clarification of what is considered a paid claim is under discussion. The conclusion from that discussion will be memorialized in board regulation. Until that regulation is available, feel free to call the board’s Call Center for information on what is required to be reported. The number is (804) 662-9999. Regulations are being prepared to clearly indicate that physicians who are not anesthesiologists, but are trained and competent to perform major conductive blocks, may perform such procedures in their practices. The request for rule-making in this matter came from the Virginia Society of Physical Medicine and Rehabilitation.

Respiratory therapists petitioned that relevant AMA-approved Category I courses be considered Type I Continuing Education in addition to those courses approved by the American Association for Respiratory Care. This regulation has been approved by the Executive Branch and will be effective Jan. 11, 2006, such that such sources can be claimed by respiratory therapists at the time of their 2007 license renewal.

Radiology Technology Continuing Education Audit

All radiology technologists and radiology technology-limiteds who renewed in 2005 had to attest to having attained 24 hours of continuing education in the two years prior to renewal. At least 12 of the hours must meet the criteria for Category A continuing education as delineated by the American Registry of Radiologic Technology. The Advisory Board recommended and the board approved a 10 percent audit of continuing education from the 2005 renewals. Accordingly, about 250 licensees will receive letters asking for the submission of documentation for their continuing education. Should you receive one of these letters, be sure you respond promptly.

Physician Assistant Supervision

All M.D.s, D.O.s and D.P.M.s who supervise physician assistants should be familiar with their supervisory responsibilities. A supervising physician may only supervise two physician assistants (P.A.s) at any one time. The supervision must be continuous, but that does not necessarily mean being present in person. The supervisor must develop a protocol with the P.A. identifying the P.A.’s scope of practice, delegation of medical tasks, parameters for communication and consultation, and an evaluation process to judge the P.A.’s performance. A supervisor may only delegate to and supervise a P.A. in medical areas/procedures in which the supervisor is proficient. A supervisor may authorize a P.A. to initially evaluate patients in outpatient, inpatient and emergency department settings as long as it is done under the direction, supervision and control of the supervising physician. The supervisor must instruct the P.A. to contact him/her as soon as possible for acute conditions or changes that would warrant communication with the supervisor. The supervisor must instruct the P.A. that any patient seen in the emergency department setting with a lifethreatening condition be immediately transferred to the supervising physician. Additionally, the care given by a P.A. in an emergency department must be reviewed by the supervisor prior to the patient’s discharge. The P.A. also has the responsibility of informing the emergency department physician of the proposed treatment/disposition plan. The supervising physician must be available at all times that he/she is authorizing a P.A. to see patients for him/her in the emergency department. The supervising physician must see and evaluate any patient who presents with the same complaint twice in a single episode of care and has failed to improve significantly. For continuing illnesses, the supervising physician must see the patient at least every fourth visit. And as with the emergency department, the P.A. must alert the supervisor to acute or significant findings with a patient. The supervising physician is responsible for all invasive procedures.

Procedures the P.A. may do under general supervision without board approval are insertion of an NG tube, bladder catheter, needle, peripheral IV catheter and may perform minor suturing, venipuncture and SC, IM and IV injections. Any procedure not listed here is considered invasive and must be done under direct supervision. After a P.A. performs a particular invasive procedure three or more times, and is considered by the supervising physician to be competent to perform it under general supervision, a request can be made of the board for this authority. The supervising physician is responsible for all prescriptions issued by the P.A., both drugs and devices. Supervisors should remain mindful that in his/her absence, an alternate supervisor must be designated for the P.A. A protocol between the P.A. and the alternate supervisor should be in place. P.A.s have the authority to prescribe schedules III–VI controlled drugs and must have the approval of the board and hold a current DEA certificate to do so.

Competency Evaluations and Three Paid Claims

The 2005 Session of the General Assembly enacted a law requiring any licensee of the Board of Medicine who accrues three paid claims in a ten-year period to undergo a competency evaluation. This law became effective July 1, 2005. Therefore, any licensee who accrues his/her third (or greater) paid claim on or after that date will be subject to this law. The board is in the process of developing guidelines for the implementation of the competency evaluations.

Reprinted from the Number 67 issue of Board Briefs, published by the Virginia Board of Medicine.

LET US HEAR FROM YOU

Would you like for information from your board to be published in the Journal? If so, e-mail articles and news releases to Edward Pittman at epittman@fsmb.org or send via fax to (817) 868-4098.