Month: March 2012

State Medical Board of Ohio, Uncategorized

Physician/patient relationship = power imbalance

The State Medical Board of Ohio addressed two cases at its March meeting concerning the physician-patient relationship.  http://www.med.ohio.gov/pdf/Agenda/Agenda%20-2012/03-12agenda.pdf

In one case, the Medical Board suspended the license of a physician for 180 days after a hearing based on the finding that the physician had engaged in a sexual relationship with an indigent patient after providing the patient with “free” medical care and “free” medicine. From the physician’s perspective, she honestly believed that she was providing a medical service to the patient that he could not otherwise afford and that she should not then be “punished” for providing this care.   The physician did not comprehend that having a personal (read: sexual) relationship with the patient violated the physician/patient relationship.  Regardless of the fact that the medical care provided to the patient without charge, a physician-patient relationship was created.  The Board suspended the physician’s license for 180 days for the boundary violation.

In the second case, the State’s attorney offered for Board approval a Consent Agreement  for a physician who had engaged in a sexual relationship with a patient, which proposed to impose no active suspension on the physician’s license. The rationale given by the State’s attorney for no suspension was the fact that the patient was also the corporate attorney for the medical practice and therefore the legal staff did not believe that there was the same imbalance of power between the physician and the patient that usually leads to physician discipline. The state’s attorney argued that the physician and attorney/patient were on a more even footing.  The state’s attorney argued there was no imbalance of power and consequently no suspension should be imposed on the physician’s license.

The Board members did not agree with this argument. In a rarely seen move by the Board, the proposed Consent Agreement, was rejected by the Board.  While this is a very unusual fact pattern, it clearly shows the Board believes strongly about the inherent imbalance of power in a physician-patient relationship.

As always, if you have any questions about this post or about the medical board in general, please feel free to call me at 614-486-3909 or email me at beth@collislaw.com.

State Medical Board of Ohio, Uncategorized

What the Medical Board really cares about – sex, drugs & lies

Today is the State Medical Board of Ohio’s monthly Board meeting. It is always scheduled for the second Wednesday of the month. Decisions on disciplinary actions are always scheduled on the 1pm docket. It is a  cattle call. All disciplinary actions are deliberated and final decisions are voted on in open session. Members of the public, including medical students, and the press are welcome to and do attend.

The first question I am always asked by physicians is “What will get me in trouble with the Medical Board”.  While the Medical Board can discipline a licensee for a wide range of things, there are three areas that seem to be of their highest concern: Sex, Drugs and Lies.

Sex. The Board typically takes disciplinary action against a licensee who has sex with a patient. However, the Board is also concerned with boundary violations with patients. Have you employed a patient in your office or loaned money to a patient or signed a car note or credit card application for a client? The line in the sand between a doctor and a patient should be clear. There should be no overlapping of a doctor/patient relationship and a personal relationship.

Drugs. Nearly half of all disciplinary actions handled by the Medical Board each year involve impaired physicians. Physicians who have been diagnosed with drug or alcohol problems. The Medical Board is also very concerned about the prescribing habits of physicians. Has the physician prescribed to the mother of a patient as opposed to the patient because only the mother has insurance? Has the physician prescribed a controlled substance to a family member?  Has the physician prescribed a drug to a patient for other than legitimate medical purposes?

Lies. The Medical Board does not like to be lied to. If you complete an application and fail to give clear, concise and accurate information to the Board, you will likely face a disciplinary action. Similarly, if you are the subject of discipline by another state and fail to tell the Ohio Board, you will likely be subject to discipline in Ohio not just for the “sister state discipline” but also for failing to disclose the action to the Ohio Board.

At the Board meeting today, the Board will consider final discipline in four cases. One involves practicing below the standard of care in the prescribing of medications to four patients that also resulted in felony and misdemeanor convictions; two cases relate to alcohol abuse or addiction and relapse and one involves an inappropriate sexual relationship with a patient. http://www.med.ohio.gov/pdf/Agenda/Agenda%20-2012/03-12agenda.pdf

Off to the meeting….

As always, if you have any questions about this post or about the State Medical Board of Ohio, feel free to email me at beth@collislaw.com or call me at 614-486-3909. I look forward to your questions.

State Medical Board of Ohio, Uncategorized

Prescribing for self and family members – never a good idea

On Friday, I am scheduled to speak to a group of third year medical students in Ohio about the Medical Board disciplinary process. I have given this talk several times, but for this particular group of students I thought I would look up some recent Medical Board disciplinary actions and try to highlight an area that might not be an obvious violation to most physicians.  One area that often surprises physicians is the prohibition against prescribing for self and family members.

The standard of care requires physicians to be able to use detached professional judgment in treating patients. This can not be done when prescribing to yourself or for a close family member.   The Medical Board in Ohio has a specific rule that prohibits the prescribing of controlled substances by physicians to themselves and to close family members. http://codes.ohio.gov/oac/4731-11-08

Physicians may only use controlled substances to treat a family member in an emergency situation. However, even in these instances, the physician needs to take the same care with the family member that they would with any other patient. The physician must conduct a physical examination and maintain a clear written medical record.  Physicians may not prescribe controlled substances to themselves. The physician may obtain an over the counter Schedule V controlled substance for personal  use, but must follow all state and federal laws that a non-physician would be required to follow.

Physicians may prescribe to family members in an emergency situation. However, when prescribing to a family member, the prescription must be for a short period of time until the patient can schedule an appointment with their regular treating physician. Prescriptions with multiple refills for family members are not considered for an “emergency” basis and will violate the Board’s rule.

Physicians have been disciplined by the Medical Board of Ohio for prescribing controlled substances to family members that have been initially prescribed by other doctors, for prescribing medications with multiple refills, and for failing to take and maintain an adequate medical record.

Although, OAC 4731-11-08 specifically addresses controlled substances, the Medical Board also does not approve physicians writing prescriptions to family members for non-controlled substances, such as birth control pills unless the physician has conducted a physical examination and also maintained a medical record.  The AMA has also addressed this issue in AMA Ethics Opinion 8.19, which discourages the treatment of self or family members. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion819.page

It is never a good idea to prescribe to yourself or to family members. You and your family members should always seek treatment from your own treating doctor.

As always, if you have any questions about this post or any other questions about the State Medical Board of Ohio, feel free to send me an email at beth@collislaw.com or call me at 614-486-3909.