State Member Board Briefs

Alabama has passed three new laws intended to curb the state's growing prescription drug abuse problem by focusing on prescription monitoring, pain management clinics and “doctor shopping.”

Included in the package of bills which became law on August 1, 2013, a prescription drug monitoring program (PDMP) now allows physicians to give their staff members access to the state's PDMP on their behalf. The bill also allows the state Medicaid agency to access the PDMP to check the controlled substance prescription medication history of patients enrolled in Medicaid.

The pain management bill strengthens regulation of pain management clinics where drugs are prescribed for chronic, non-malignant pain. The new law stipulates that pain management clinics must be registered with the Alabama Board of Medical Examiners and must have a medical director who is a physician licensed in Alabama. Also included are provisions that allow the board to issue subpoenas while investigating clinics.

The “doctor shopping” bill strengthens punishments for lying to physicians about similar prescriptions in order to get more drugs. Under the new law, lying to a physician to get drugs is a Class A misdemeanor, with convictions punishable with up to a year in jail. After four convictions, the offense becomes a Class C felony, which is punishable by a sentence of up to 10 years.

In 2011, the Centers for Disease Control and Prevention identified Alabama as being among the top 20 states nationally in the number of drug overdose deaths.

Source: National Association of Boards of Pharmacy website, August 2013

The Medical Board of California has notified licensees that it will begin contacting those who are delinquent in tax obligations, warning them that their medical licenses may be suspended if they do not pay or begin a payment plan within 90 days.

State law authorizes the medical board to deny an application for licensure and to suspend the license of any licensee who has outstanding tax obligations due to the Franchise Tax Board (FTB) or the State Board of Equalization (BOE) and who appears on either the FTB or BOE's certified lists of top 500 tax delinquencies over $100,000.

Physicians who fail to either pay their obligations or begin a payment installment plan with taxing agencies will have their licenses denied or suspended until the board receives a release from the FTB or BOE. The form for requesting a release will be included with the preliminary notice of suspension.

The law prohibits the Medical Board of California from refunding any money paid for the issuance or renewal of a license where the license is denied or suspended.

Source: Medical Board of California website, September 2013

New regulations announced recently in California tighten safety precautions for cosmetic procedures involving lasers or pulsing light.

Under rules implemented July 1, 2013, a “properly trained physician” must be immediately available whenever a licensed health care provider engages in a cosmetic procedure using a laser or an intense pulse light device. “Immediately available” is defined by the Medical Board of California as meaning that the physician may be reached by electronic or telephonic means without delay.

Source: Medical Board of California website, September 2013

Legislation recently passed in the District of Columbia will allow pharmacists, through a written agreement with a physician, to initiate or modify drug therapy for a patient. The boards of medicine and pharmacy in the District of Columbia will jointly develop and promulgate regulations to help pharmacists and physicians understand and implement the requirements of the “Collaborative Care Expansion Act of 2012.”

The boards of medicine and pharmacy in the District of Columbia are already working on regulations to allow expanded authority for pharmacists to administer immunizations.

Source: District of Columbia Board of Medicine Newsletter, Summer 2013

The Georgia Composite Medical Board has approved and released new guidelines for the licensing of the state's pain management clinics, strengthening oversight in an effort to reduce illicit clinics there.

The new guidelines were implemented in response to a dramatic rise in pain management clinics operating in the state between 2010 and 2012 — estimated by the Wall Street Journal to be an increase of 1,300% — following a crackdown on illicit pain clinics in neighboring Florida.

Application for a license to open a pain management clinic now includes a $500 application fee, a criminal background check of each person with an ownership interest in the clinic, affidavits and other documentation.

Under new regulations in Georgia, all pain management clinics must be licensed by the board and must renew their licenses periodically. The board can deny, suspend and revoke licenses if it finds that the licensee or a physician practicing at a licensed pain management clinic has furnished false information on the application, has been convicted of a crime relating to controlled substances, has had their DEA registration suspended or revoked, or has violated any provision of the state's new pain clinic regulations.

The new regulations also stipulate that clinics not operating before July 1, 2013, must be owned wholly by physicians. Clinics or practices owned or operated by hospitals are exempt from licensing, but must file annual notifications with the board.

In addition, all pain management clinics that dispense controlled substances or dangerous drugs must be registered with the Georgia State Board of Pharmacy. Any person who operates a pain management clinic without a license in the state is now guilty of a felony.

When it passed its new requirements, Georgia became the ninth state in the nation to require pain clinics to be licensed or registered and to be owned by physicians.

Source: Georgia Composite Medical Board Newsletter, July 2013

The Illinois Department of Financial and Professional Regulation has filed a complaint against a physician in Illinois for including the names of former patients in a lawsuit.

The physician, Mahesh Parikh, MD, sued the patients for defamation over their claims that he engaged in sexual misconduct with them. As a part of his suit, he requested an injunction against the patients.

The Illinois Department of Financial and Professional Regulation contends that Dr. Parikh violated the state's Medical Practice Act, which prohibits breaching patient confidentiality and protects those who contact regulators under the act from civil liability.

Dr. Parikh is subject to indefinite suspension of his license as a result of the sexual misconduct claims. Possible penalties for violating the Medical Practice Act include fines of $10,000 for each violation.

Source: Council on Licensure, Enforcement and Regulation Blog, July 2013; Chicago Tribune, August 12, 2013

The Iowa Court of Appeals recently affirmed the Iowa Board of Medicine's discipline of a University of Iowa Hospitals and Clinics physician for engaging in unethical conduct in the practice of medicine more than a decade earlier.

The ruling was made in a disciplinary action against Adel S. Al-Jurf, MD, who was publicly reprimanded by the board and placed on probation for three years. The board charged him in 2009 with engaging in a pattern of unprofessional conduct, for which he had been terminated by the University of Iowa Hospitals and Clinics.

Dr. Al-Jurf appealed the board's decision, challenging the board's authority to prosecute him for unethical conduct. He also contended that the board had inappropriately issued a news release about the disciplinary matter.

The Appeals Court, in upholding a lower court ruling, said the board's “interpretation of ‘unethical conduct’ was not illogical or wholly unjustified” and that the board had not exceeded its authority in issuing a press release.

Source: Iowa Board of Medicine news release, July 30, 2013

The Kentucky General Assembly approved several pieces of legislation during its 2013 session that impact physicians and other health care providers in the state. Among them:

Naloxone Prescribing: Under new statutory language, physicians are not subject to disciplinary or any other adverse action by the Kentucky Board of Medical Licensure for their acts or omissions prescribing Naloxone either directly or by standing order if the physician acts in good faith and if, in the physician's judgment, the patient is capable of administering the drug in emergency opioid overdose situations.

Physician Assistants: Legislators amended Kentucky state law to give the supervising physician or the credentialing facility oversight of the physician assistant non-separate location practice. Legislators also reduced the waiting period before a newly graduated physician assistant may practice in a separate location from 18 months to three months and makes the three-month waiting period effective until May 31, 2014. After that date, the three continuous months of experience in a non-separate location will no longer be required for a physician assistant to practice at a separate location.

Athletic Trainers: Kentucky law has been amended to require licensure rather than certification for authorized practice by athletic trainers. Athletic trainers in the state will receive wallet cards and wall certificates from the board.

Source: Kentucky Board of Medical Licensure Newsletter, Summer 2013

New legislation passed in Nevada significantly changed the practice requirements of Advanced Practitioners of Nursing (APNs) in Nevada. The new laws became effective on July 1, 2013.

Assembly Bill (AB) 170 changed several aspects of regulation for APNs in Nevada. The title of the APNs in the state has been changed to Advanced Practice Registered Nurse (APRN) and the certificate of recognition that the Nevada State Board of Nursing (NSBN) has in the past issued to APNs has been changed to an APRN license.

The new legislation also deletes the regulatory practice requirement for a formal, written collaborative agreement between the APRN and a physician, unless the ARPN has clinically practiced less than two years or 2,000 hours and intends to prescribe Schedule II Controlled Substances. In this case, the APRN must have a written collaborative agreement to prescribe those drugs until the clinical practice requirement is met.

The Nevada Advanced Practice Nurses Association, whose members include more than 50% of the licensed APRNs in Nevada, advocated for the bill. With the adoption of AB 170, Nevada joined 24 other states in allowing ARPNs full practice authority.

Source: Nevada State Board of Medical Examiners Newsletter, August 2013

Aaron E. Haslam, JD, has been named executive director of the State Medical Board of Ohio.

Since February 2011, Haslam has worked with Ohio Attorney General Mike DeWine as a senior assistant attorney general and chief of the Attorney General's Prescription Drug Abuse Initiative. He has also served as coordinator for the state's Special Prosecutions–Prescription Drug Unit. Halam served previously as the Adams County Prosecuting Attorney.

He earned his law degree from Cleveland-Marshall College of Law and is admitted to practice law in Ohio and the United States District Courts of Ohio.

Haslam's appointment was approved effective July 1, 2013.

Source: State Medical Board of Ohio news release, June 14, 2013

Legislators in Virginia have passed new laws impacting the administration of oxygen by nurses and sexual boundary violations by physicians.

An amendment to the state's Drug Control Act will now allow a prescriber to make oxygen available to registered and licensed practical nurses to possess and administer in emergency medical situations. Authorization is granted “pursuant to an oral or written order or standing protocol issued by the prescriber within the course of his professional practice.”

Virginia has also passed a bill into law that provides for a five-year period of revocation when the Board of Medicine revokes a practitioner's license for a sexual boundary violation.

The new law stipulates that when the practice privileges of any person certified, registered or licensed by one of the state's health regulatory boards have been revoked for a five-year period based on sexual misconduct, the board “shall conduct an investigation and review an application for reinstatement after revocation to determine whether there are causes for denial of the application. The reinstatement of a certificate, registration or license shall require the affirmative vote of three-fourths of the members at a meeting.

Source: Virginia Board of Medicine Newsletter, #72, accessed September 2013.