State Member Board Briefs

Legislative changes contained in SB 1950 (Figueroa, Chapter 1085, Statutes of 2002) allow physicians who work in medically underserved areas to supervise up to four physician assistants. (Physician assistants, or PAs, are health care professionals licensed to practice medicine with physician supervision.) During Sunset Review hearings held in 2001, the Department of Consumer Affairs and the Joint Legislative Sunset Review Committee (JLSRC) supported a recommendation from the Physician Assistant Committee to increase the number of PAs that a physician may supervise. Both the department and the JLSRC noted, “As California’s population continues to grow, the need for health care providers, particularly in hard-to-recruit areas, also increases. Many primary health care providers in these areas already rely on physician assistants to expand the number of patients they can care for on a daily basis.”They also noted that implementation of this change will increase the number of Californians receiving care in these communities. The Physician Assistant Committee commented that “Given a PA’s training and the fact that many PAs come from a diverse and multi-cultural background, they are particularly suited to assist physicians in medically underserved areas of California.” Legislation creating this change will be reviewed by the JLSRC at the next Sunset Review hearing for the Physician Assistant Committee in 2005. For further information, please call the Physician Assistant Committee office at (916) 263-2670.Reprinted from Volume 89 of the Action Report, published by the Medical Board of California.Frequently, complaints against physicians reveal systems errors or communication breakdowns rather than physician incompetence or negligence. The Colorado Board of Medical Examiners is sharing some of these stories with you. We suggest you review these stories and use this information to eliminate the potential for these problems in your practice.A female patient presents to the emergency department (ED) complaining of severe abdominal cramping. She was physically evaluated in the ED and a urinalysis and urine pregnancy test was performed and were both negative. However, a serum pregnancy test was also ordered but the patient was discharged from the ED before the results of that test returned and were reviewed. This test was positive. The patient subsequently presented to a different ED 20 days later and was diagnosed with an ectopic pregnancy.If tests are ordered, it is imperative that timely follow-up of the results occur. In the situation above, it may have been reasonable to discharge the patient prior to the availability of the serum pregnancy test results, but it is incumbent upon the treating physician to assure there is a reliable system in place to obtain the test results and bring any abnormal or concerning results to the physician’s attention.The board has seen a number of cases in the past several months in which critical diagnoses were made but were not personally communicated to the treating physician. This occurs in those specialty areas, such as radiology and pathology, where the diagnosing physician does not have direct patient contact. In the cases that have come to the board’s attention, instead of the radiologist or pathologist calling the treating physician directly, the report was either added to an electronic record that the treating physician could access or a hard copy report was faxed to the treating physician’s office.In those instances when a physician makes a diagnosis, such as cancer, that will be of major significance to the effective and timely treatment of the patient, the board believes it is always the best practice for the diagnosing physician to personally contact the treating physician to assure the test results have been received and understood. If the treating physician is unavailable, at a minimum, the physician should leave an urgent message on voicemail or with the answering service. Finally, it should be clearly documented in the record how the diagnosis was communicated and to whom.In the November 2000 general election, Coloradans passed Amendment 20 and the Colorado Department of Public Health and Environment (CDPHE) was tasked with implementing and administering the Medical Marijuana Registry program. On June 1, 2001, the Registry began accepting and processing applications for Registry Identification cards. Since this program began, there have been numerous questions about how this law impacts physicians in Colorado, especially since it appears to be in direct conflict with federal laws surrounding the prescription of Schedule I substances.It is clear that under Colorado law, physicians are provided protection if and when they recommend the use of medical marijuana for their patients. Specifically, Amendment 20 provides an exception from the state’s criminal laws for a physician who elects to advise a patient and provide them written documentation indicating they believe their patient might benefit from the medical use of marijuana, provided that such advice is based upon the physician’s contemporaneous assessment of the patient’s medical history and current medical condition, and a bona fide physician-patient relationship exists. The physician must also have diagnosed their patient as having a debilitating medical condition that is covered under the current law (cancer; glaucoma; HIV/AIDS; cachexia; severe pain; severe nausea; seizures, including those that are characteristic of epilepsy; or persistent muscle spasms, including those that are characteristic of multiple sclerosis).It is also true that physicians currently have protection under federal law. In October 2003, the U.S. Supreme Court declined to hear an appeal by the Bush Administration regarding a Ninth Circuit Court of Appeals decision pertaining to physician recommendations of medical marijuana. That decision enjoined the federal government from punishing physicians for recommending marijuana to their patients, as First Amendment rights regarding freedom of speech protect this type of communication. Also, the Drug Enforcement Administration (DEA) in Colorado has indicated that as long as doctors are not prescribing marijuana (which, according to the DEA, means using an actual prescription pad), they are not in violation of federal law. The local DEA office has received and reviewed a copy of the physician certification form and has assured the Administrator of the Medical Marijuana Registry that this form does not constitute a prescription, and that it is not something the DEA considers to be in violation of federal law.It is extremely important for physicians to be aware that all information received by the Registry is completely confidential, and physicians’ names are never shared with anyone for any reason. The Administrator of the Medical Marijuana Registry, Gail Kelsey, is available to answer questions, distribute information, and give presentations about the program and discuss its impact on doctors and patients. She can be contacted at (303) 692-2184, or via e-mail at gail.kelsey@state.co.us if you would like further information about this program.Reprinted from the Volume 12, Number 1, issue of The Examiner, published by the Colorado Board of Medical Examiners.Section 16.10.8.9 of the Rules of the New Mexico Medical Board states that the board adopts the ethical standards set forth in the Code of Medical Ethics of the American Medical Association (AMA). This means that the board will follow the guidelines articulated in the Code for issues not specifically addressed in board rules. This category includes issues like the retention of medical records, physician self-prescribing, informed consent, and many others. This column will be devoted to discussing a different issue in each newsletter.There has been some question recently about board policy on reporting laboratory test results to patients. For clarification, the AMA Code of Ethics guidelines are: Physicians should have a consistent policy about the reporting of test results, and patients should be informed of this policy before or at the time of the test.Policies should include when and by whom results will be given to the patient, and under what circumstances. For example, who will deliver the results if the test is negative, and who will speak to the patient if the results are positive.Patients should receive test results within a reasonable amount of time. Any delays that can be anticipated should be discussed with the patient at the time of the test.Test results should be given to the patient in language that the patient can understand, and patients must receive all the information from tests that they will need to make informed decisions about their medical treatment.Physicians should take precautions to ensure that patient confidentiality is maintained. For example, results should not be left on an answering machine or given to a third party without specific patient permission. They should not be sent via e-mail, or sent through the mail on a postcard.Physicians should develop a reasonable office policy that balances the rights and concerns of patients with the needs and circumstances of their practice.The AMA Code of Medical Ethics can be ordered and accessed online at www.ama-assn.org. If you have suggestions for future topics in this column, please call Jenny Felmley, public information officer, at (505) 827-4013 or jenny.felmley@state.nm.us.Reprinted from Volume 9, Issue 1, of Information & Report, published by the New Mexico Medical Board.The South Carolina Board of Medical Examiners introduced a regulation intended to ensure that physicians licensed in this state demonstrate continued competency either through continued medical education or other options provided in the new regulation. The General Assembly passed the legislation, and it was signed into law by Governor Mark Sanford on April 26, 2004.The continued professional competency of physicians holding a permanent license shall be assured in the following manner: For renewal of a permanent license initially issued during a biennial renewal period, compliance with all educational, examination and other requirements for the issuance of a permanent license shall be deemed sufficient for the first renewal period following initial licensure.For renewal of an active permanent license biennially, documented evidence of at least one of the following options during the renewal period:Forty (40) hours of Category I continuing medical education sponsored by the American Medical Association (AMA), American Osteopathic Association (AOA), or other organization approved by the board as having acceptable standards for courses it sponsors, at least thirty (30) hours of which are directly related to the licensee’s practice area; orcertification of added qualifications or recertification after examination by a national specialty board recognized by the American Board of Medical Specialties (ABMS) or AOA or other approved specialty board certification; orcompletion of a residency program or fellowship in medicine in the United States or Canada approved by the Accreditation Council on Graduate Medical Education (ACGME) or AOA; orpassage of the Special Purpose Examination (SPEX) or Comprehensive Osteopathic Medical Variable Purpose Examination (COMVEX); orsuccessful completion of a clinical skills assessment program approved by the board, such as the Institute for Physician Evaluation (IPE), the Post-Licensure Assessment System (PLAS), or the Colorado Personalized Education Program (CPEP).For reinstatement of a permanent license from lapsed or inactive status of less than four years, documented evidence of at least one of the following options within the preceding two years:Forty (40) hours of Category I continuing medical education sponsored by the AMA, AOA or other organization approved by the board as having acceptable standards for courses it sponsors, at least 30 hours of which are directly related to the licensee’s practice area; orcertification of added qualifications or recertification after examination by a national specialty board recognized by the ABMS or AOA or other approved specialty board certification; orcompletion of a residency program or fellowship in medicine in the United States or Canada approved by the ACGME or AOA; orpassage of the SPEX or COMVEX; orsuccessful completion of a clinical skills assessment program approved by the board, such as the IPE, the PLAS or the CPEP.For reinstatement of a permanent license from lapsed or inactive status of four years or more, documented evidence of at least one of the following options:Certification of added qualifications or recertification after examination by a national specialty board recognized by the ABMS or AOA or other approved specialty board certification; orcompletion of a residency program or fellowship in medicine in the United States or Canada approved by the ACGME or AOA; orpassage of the SPEX or COMVEX; orsuccessful completion of a clinical skills assessment program approved by the board, such as the IPE, the PLAS or the CPEP.The act of a physician pre-signing blank prescriptions as a “time-saver” or as a “convenience to staff” is not only unlawful, but can lead to criminal actions by others and result in sanctions against the physician’s medical license.Section 44-53-395 of the South Carolina Code of Laws, as amended, states in part:An recent investigation conducted by the South Carolina Board of Medical Examiners revealed that a physician issued pre-signed blank prescriptions in his office and that an employee used the prescriptions to obtain drugs by fraud to further an addiction. The results of criminal activity by the employee and licensure sanction of the physician could not be justified as either time saving or convenient.Reprinted from the August 2004 issue of The Examiner, published by the South Carolina Board of Medical Examiners.North Carolina’s health care environment is continuously evolving to include a blend of medical providers. This blend includes not only physicians, but also physician assistants (PAs), nurse practitioners (NPs), and, most recently, clinical pharmacist practitioners (CPPs). As allied health care professionals, PAs, NPs and CPPs work alongside licensed physicians, improving access to medical care services necessary to meet the needs of North Carolina and its residents.The state of North Carolina has established regulations the practice of PAs, NPs and be a license or to each is for and with regulations specific to his or are for and a relationship and a physician. This must be and, it is not necessary that the physician be when the is it is the be This public in the of medical care by all and they take for their patients in a of The of that must be in that are consistent with the and and that are to the and is an licensed and the North Carolina Medical Board to medical or under the of a physician licensed by the must have from a physician or program by the on Accreditation of Health Education or its or completion of or his medical and before any medical in North the must obtain a North Carolina This that the the examination of the on of Physician receive of his or to practice with a primary and have a specific practice approved by the all and following by the North Carolina Medical the will be issued a PA’s to practice with his or physician is the most important and before in North is for this which includes the practice and number for both the and the primary physician. of to requirements include having a written practice that the of practice for the This must be clearly in and at each practice The of practice the to the the relationship the has with a primary and the for the PA’s The practice must be signed by the physician and the and, with numerous other must be available to the Board or its upon the of practice is by the and or his it is important to that the primary physician has availability and to a recently a and physician must meet months to other clinical practice However, for PAs in a new practice the and physician must meet for the first must be documented and the record of such must be available for by Board upon may patients with prescription as long as they with North Carolina rules. is to and drugs and medical to include the that there must be a written on in which the physician and the they are both with the laws and regarding The written on prescribing must be reviewed prescription written by a must in to other information, the PA’s practice and license as as the physician’s and of of the North Carolina Medical an currently licensed nurse approved to medical and of the medical performed under an with a licensed physician for be approved to practice as an the must first have an approved of is also necessary or a certification examination by a national as noted an may practice for months to take the examination or the test it is necessary that an receive written of to practice from the North Carolina Board of and the North Carolina Medical for may be status the the processing of his or The practice of an with status is to several there are prescribing all in patient must be within two and there must be documentation of with the primary physician. with may practice for a period not to an who has all other requirements for to practice but who is of completion of the national certification may be In an has including review and of by the physician on patient contact within days for the first with the physician for a and, for a of 1, is for a of Any approved to practice for the first time is to the guidelines for an have a in change primary physicians, or change written or is to follow the status guidelines for a of months and to both of the as with PAs, there must be a practice that is and as a in the of the must include a and and a for a clinical practice issue not in the practice the and the physician are to and the practice must be reviewed On by the North Carolina Board of and the North Carolina Medical the must also demonstrate the to the medical in the the further a to be reviewed The and physician must develop a that includes the of a clinical of the treatment and a to the and the including the should be signed by both and for review by the upon are health professionals in state by the to provide to patients under the of a licensed physician. a must obtain from both the North Carolina Board of and the North Carolina Medical PAs and CPPs are to a signed with their as as a copy at each practice The shall be specific in to the patient, and In the the must the diagnosis and by the patient’s any that may be and tests that may be In must be to review and all for the must a North Carolina license and must meet one of the following or may be by the Board of be a or have an American of Health System residency program with two years clinical approved by the or may the of of with years clinical approved by the or may the of of in with years clinical approved by the and have two or approved certification of an and an by the North Carolina Board of is with and, as noted a signed physician The physician is for and of the performed by the and shall review and each written by the within NPs and CPPs make a to the and health care of the In each an to practice may be or should the board or has the related laws and that these professionals must an their professional North Carolina Code states it is and to as a an licensed and approved by the North Carolina Medical Board may or as a physician and as a for physician who are in training or training are not to supervise PAs, NPs or a of physicians are not only for their but for the actions of the practitioners they supervise. In North all practitioners are to practice within the standards of care in to in with any in of the Medical or may result in the board an investigation against the practitioners are to and all who change their of practice public or must the board within days board may a current In all practitioners in these health care are for hours for continuing for specific requirements for as as information on and can be on board at from the Number issue of published by the North Carolina Medical Board.The board the following changes that were published in the of Medical of and new regarding the requirements for physicians who supervise medical in to regarding general up of the and changes to and the licensure consistent with the of and of the to and regarding and general up and to and and new concerning medical The the for medical and of and requirements of the Health and as The new of the requirements concerning or of medical to regarding biennial by with review and of The of the will be into the new Chapter to regarding for training and to regarding that would allow active physicians, holding at medical to be for review and to and that will make the consistent with the requirements of by the reporting in regarding information, and the for the following the of and to and regarding biennial for for physician for physician and and for and for of continuing education and New consistent with regarding reporting for against whom a health care has been and a has been New concerning for and of In Chapter of this to was and the regarding the for was into this new of and new regarding a system of for the investigation of of New regarding the use of consistent with the requirements of The new will qualifications and of these professionals as and to the to and and new concerning written in medical and continuing to regarding examination requirements for to and regarding biennial and continuing education and of and regarding related to the renewal of and of The were added to Chapter to and as of the changes to Chapter to and the Physician Assistant to issue and concerning a to supervise a physician to and the of and concerning the for or of or of for and for licensure of and new new and new regarding guidelines in licensure and review and to and regarding general of the and the of a for biennial consistent with to and regarding the of as by of the and applications for and of the was added regarding and of the use of review of Chapter to and of and new regarding general and of the of a Medical to for general up of the from the 2004 issue of the Medical Board published by the Board of Medical you like for information from your board to be for in the If e-mail and to at or via to

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