Medical practice in Ohio – Ohio Medical Board Defense Counsel Blog

Medical Board, Medical practice in Ohio, State Medical Board of Ohio, Uncategorized

Ohio Counselor, Social Worker, and Marriage and Family Therapist Board Responds to Corona Virus

In connection with the Corona Virus, we have received numerous inquiries from our Ohio counselor and social worker clients concerning teletherapy services.

The Ohio Counselor, Social Worker, and Marriage and Family Therapist Board (“CSWMFT Board”) recently posted the following information on its website:

The Board’s rules regarding providing teletherapy are established in Ohio Administrative Code Chapter 4757-5-13. Licensees who are considering offering services via teletherapy should be mindful of the following:

Independent licensees (LISW, LPCC, IMFT), dependent licenses (LSW, LPC, MFT) working under supervision, and trainees (SWT, CT, MFTT) working under supervision, can all provide teletherapy provided they have training and experience in teletherapy. Examples of training include the completion of continuing education, supervised experience, and peer consultation.
Services must be provided to ensure the highest level of confidentiality. Video-conferencing software should be HIPAA compliant.
Licensees should carefully consider whether teletherapy is an appropriate means of providing services to individual clients.
Licensees must be mindful that ORC 4757 and OAC 4757 apply regardless of how services are provided.
Licensees who voluntarily choose to suspend providing services must properly terminate with clients and provide referrals as required in the rules. If a licensee is suspending services in response to a public order to do so, the licensee or their employer is advised to provide information, for example on outgoing voicemail messages or websites, regarding resources in the event a client is in crisis.
Insurers establish which services are eligible for reimbursement. Be sure to verify whether you can bill for teletherapy before providing services to a client. The Board has no authority to direct insurers to pay for teletherapy services.
Agencies and practices may set their own rules regarding teletherapy. The Board can exercise no authority over these employment/business related decisions.

While the Board staff want to be as helpful as possible, we are not able to provide specific guidance regarding implementing teletherapy. Please consult with peers and supervisors. Additionally, Board staff cannot recommend specific software, nor can the Board recommend specific training programs.

As the State of Ohio’s response to COVID-19/Corona Virus evolves, the Board will share information with licenses.

PLEASE ALSO NOTE: The CSWMFT Board also recently posted the following update on its website:

Teletherapy Update – Emergency Rule in Progress

The CSWMFT Board is working with Governor Mike DeWine’s office as well as other State agencies on an emergency rule that will provide flexibility for licensees who are seeking to provide teletherapy. We anticipate the proposed rule will be issued soon and will align with the rules being proposed by the Ohio Department of Medicaid and Ohio Department of Mental Health and Addiction Services. Once the rule is issued, we will provide an update and additional guidance.

Below are some additional resources about teletherapy and COIVD-19:

State of Ohio

https://coronavirus.ohio.gov/wps/portal/gov/covid-19/

https://cswmft.ohio.gov/Home/COVID-19

Counseling

AMHCA Code of Ethics
http://www.nymhca.org/AMHCACodeofEthics.pdf

NBCC
https://www.nbcc.org/Assets/Ethics/NBCCPolicyRegardingPracticeofDistanceCounselingBoard.pdf

ACA
https://www.counseling.org/knowledge-center/mental-health-resources/trauma-disaster/mental-health-professional-counseling-and-emergency-preparedness

ACA
https://www.counseling.org/knowledge-center/mental-health-resources/trauma-disaster/working-with-your-clients?utm_source=informz&utm_medium=email&utm_campaign=covidresources

CACREP
https://www.cacrep.org/for-programs/updates-on-covid-19/

Social Work

NASW Ohio Chapter
https://www.naswoh.org/page/telehealth2020

NASW
https://www.socialworkers.org/Practice/Infectious-Diseases/Coronavirus

NASW
https://www.socialworkers.org/includes/newIncludes/homepage/PRA-BRO-33617.TechStandards_FINAL_POSTING.pdf

NASW
https://naswassurance.org/malpractice/malpractice-tips/treading-through-teletherapy-treatment-topics/

Marriage and Family Therapy

AAMFT
http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx

AAMFT
https://www.aamft.org/Events/Coronavirus-Event-Status-Updates.aspx?WebsiteKey=8e8c9bd6-0b71-4cd1-a5ab-013b5f855b01

NIMH
https://www.nih.gov/health-information/coronavirus

APA
https://www.apa.org/practice/programs/dmhi/research-information/social-distancing

American Telemedicine Association
http://www.americantelemed.org/resources/telemedicine-practice-guidelines/telemedicine-practice-guidelines#.VS_Go40tGUk

http://www.gpo.gov/fdsys/pkg/FR-2011-05-05/pdf/2011-10875.pdf

Medicaid
https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-telehealth-services.pdf

HHS
https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html

Medicare
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

In consideration of the rapidly-changing situation in which we find ourselves, we recommend and encourage Ohio counselors, social workers, and marriage and family therapist licensees to frequently visit the CSWMFT Board website. As always, if you have questions about this post or the CSWMFT Board, please contact Todd Collis or Beth Collis.

Disciplinary Action, Medical Board, Medical practice in Ohio, physicians, reporting, Uncategorized

Physicians: Pay Attention to Supervision Agreements

A supervision agreement must provide that the physician agrees to supervise the physician assistant and the physician assistant agrees to practice under that physician’s supervision.

A supervision agreement must provide that the supervising physician is legally responsible and assumes legal liability for the services provided by the physician assistant.

A supervision agreement must be signed by the physician and the physician assistant.

a. If a physician assistant will practice within a health care facility, the supervision agreement must include terms that require the physician assistant to practice in accordance with the policies of the health care facility; and/or

Collis Law Group, Disciplinary Action, License suspension, Medical Board, Medical practice in Ohio, Revocation, State Medical Board of Ohio, Uncategorized

The Differences Between Suspension, Permanent Revocation and Non-Permanent Revocation of a Medical License by the State Medical Board of Ohio

The State Medical Board of Ohio (“Medical Board”) is authorized to take disciplinary action against a licensee based on a violation of Ohio Revised Code Section 4731.22(B). Discipline can include, but is not limited to, suspension, permanent revocation and non-permanent revocation of a medical license.

A suspension results in the loss of the license to practice medicine for either an indefinite or a specified period of time. The licensee may apply for reinstatement of the medical license following completion of all terms and conditions required by the Medical Board for reinstatement of the license.

A non-permanent revocation results in the loss of the license to practice medicine. The licensee may re-apply for licensure.

A permanent revocation results in the loss of the license to practice medicine. The licensee is forever barred from being licensed to practice medicine.

The Medical Board’s Disciplinary Guidelines provide maximum and minimum penalties for certain offenses: http://med.ohio.gov/Portals/0/Disciplinary%20Guidelines%20rev.%2006-13-2018.pdf?ver=2018-06-13-143928-823. However, the Medical Board is not bound by the Disciplinary Guidelines and may impose any sanction authorized by law including, but not limited to, permanent revocation.

Although a licensee whose license to practice medicine has been non-permanently revoked may re-apply for licensure, a non-permanent revocation is viewed as a higher level of discipline than a suspension. The Medical Board typically imposes non-permanent (and permanent) revocation for the most serious violations of its laws or rules.

The Medical Board meets the second Wednesday of each month and reviews all disciplinary matters in an open forum. The Medical Board’s monthly Agenda can be found at the Medical Board’s website at: http://med.ohio.gov/The-Board/Board-Meetings-Minutes.

If you have any questions about this post or the State Medical Board of Ohio in general, please feel free to contact one of the attorneys at Collis Law Group LLC at (614) 486-3909 or email me at Beth@collislaw.com.

Collis Law Group, Disciplinary Action, Investigation, Medical Board, Medical practice in Ohio, State Medical Board of Ohio, Uncategorized

Attorney Beth Collis quoted in Medscape article on Medical Board investigations

Attorney Beth Collis, of Collis Law Group LLC, was quoted in a Medscape article titled “The Dangers of a Medical Board Investigation: How to Protect Yourself”. In the article Ms. Collis addresses the 9,000 complaints that the State Medical Board of Ohio receives each year. “Many are minor or frivolous, such as allegations that the doctor or his staff was rude to the patient or family, billing questions, being forced to wait too long for an appointment, etc. The Board generally doesn’t take action in these cases and may not even inform the doctor of them.”

Ms. Collis also addresses how it is necessary for physicians to respond to Board investigations or inquiries. Ms. Collis warns physicians against ignoring inquiries from the Board, or from talking to the Board without counsel. “No complaint is too minor. Too many physicians think they don’t need a lawyer and can just talk the Board investigators into dropping the complaint. Doctors may sincerely want to help but they don’t understand the rules and pitfalls. They are often too chatty and explain things that weren’t even asked.” Legal counsel is recommended for any physician in connection with any Medical Board investigation or disciplinary action.

Read the article, written by Mark Crane, by clicking on the following link: https://www.medscape.com/viewarticle/899247_2

As always, if you have any questions about this blog or the State Medical Board of Ohio, please feel free to contact one of the attorneys at Collis Law Group LLC at (614) 486-3909 or email me at Beth@collislaw.com.

Confidential monitoring program, Disciplinary Action, Medical practice in Ohio, Notice of Opportunity for Hearing, State Medical Board of Ohio, Uncategorized

Ohio Medical Board Proposes Confidential Monitoring Program for Licensees With Mental or Physical Illness Other Than a Substance Use Disorder

The State Medical Board of Ohio (“Board”) has proposed rules for a new confidential monitoring program, which, if approved, is anticipated to be implemented later this year and the rules for which would be contained in OAC 4731-28, Mental or Physical Impairment.

The proposed program would be non-disciplinary and voluntary. The licensee’s participation in the proposed program would be governed by a written contract (called a participation agreement) between the licensee and the Board. The Board’s intent of the proposed program is to enable licensees, who would otherwise be subject to formal discipline, to avoid formal discipline for issues related to mental or physical illness.

Eligibility criteria for the proposed program includes, but is not limited to:

1) The Board may conduct any investigation necessary to evaluate the totality of circumstances, including requiring a physical or mental examination;

2) The individual must provide continuing authorization for the disclosure and release of information between the Board, the individual, and any other persons or entities involved in the evaluation, treatment or monitoring of the individual;

3) The individual must be willing to begin treatment or demonstrate that they have been significantly compliant with their established treatment plan;

4) Any individual that has been issued a Notice of Opportunity for Hearing that is pending is not eligible; and

5) There is no information indicating that allowing the individual to participate in the proposed program will create a substantial risk of potential harm to patients.

As proposed, OAC 4731-28-04 authorizes the Board to disqualify a participant from the proposed program for any alleged violation of their participation agreement, as determined by the sole discretion of the Secretary and Supervising Member, and shall constitute grounds for the Board to take a public disciplinary action against the licensee.
Finally, as proposed, OAC 4731-28-05 outlines the conditions that the participant must complete to have the participation agreement terminated.

The full draft of the proposed rules may be found at the Board’s website at: http://med.ohio.gov/Laws-Rules/Newly-Adopted-and-Proposed-Rules/Confidential-Monitoring-Program.

Disciplinary Action, Fail to Report, Gunshot wounds, Medical practice in Ohio, Misdemeanor conviction, State Medical Board of Ohio, Uncategorized

Ohio Physicians: Do you know the Reporting Requirements?

Did you know that in Ohio, if you give aid to a sick or injured person, the failure to report to law enforcement any gunshot or stab wound that you have treated or observed, or any serious physical harm to a person that you know or have reasonable cause to believe resulted from an offense of violence, could result in a misdemeanor criminal charge and conviction?

Ohio Revised Code 2921.22(B) provides:
“Except for conditions that are within the scope of division (E) of this section, no person giving aid to a sick or injured person shall negligently fail to report to law enforcement authorities any gunshot or stab wound treated or observed by the person, or any serious physical harm to persons that the person knows or has reasonable cause to believe resulted from an offense of violence.”

Many are unaware of this reporting requirement. However, ignorance of the law is no defense.

Unless you have completed a residency program in emergency medicine, trauma, or surgery, you might have never heard of this reporting law. We are not aware that medical schools in Ohio routinely address this reporting law.

Often, patients who have been involved in or have been a victim of a crime, or an incident involving a gunshot or stab wound or serious physical harm, are unwilling or unable to truthfully explain to their medical professional how the injury occurred. In certain instances, it may be difficult to determine if an injury is the result of a crime of violence. Physicians should be aware that a patient who has been involved in a crime might try to tell the physician that they were “accidently” injured (for example, while hunting or by mistake).

If you have reasonable cause to believe that a gunshot or stab wound or serious physical harm resulted from an offense of violence, the failure report to law enforcement could result in criminal charges and conviction for misdemeanor, Failure to Report a Crime, and the conviction could result in a disciplinary action against your Ohio medical license (R.C. 4731.22(B)(11)).

As always, if you have any questions about this post or the State Medical Board of Ohio, please feel free to contact one of the attorneys at the Collis Law Group LLC, or contact me at beth@collislaw.com or 614-486-3909.

Certificate to Recommend, Medical Marijuana, Medical practice in Ohio, State Medical Board of Ohio, Uncategorized

Medical Marijuana Control Program Update

On September 8, 2016, Ohio House Bill 523 legalized medical marijuana in Ohio. The Medical Marijuana Control Program will allow patients, with certain medical conditions and upon the recommendation of an Ohio-licensed physician, to purchase and use medical marijuana. The Ohio Medical Marijuana Control Program takes effect on September 8, 2018.

Physicians may recommend, but not prescribe, medical marijuana to patients who suffer from certain medical conditions. A physician in Ohio who wants to recommend medical marijuana for a patient must first apply for a Certificate to Recommend through the State Medical Board of Ohio. Applications are available on the Medical Board’s website at http://www.med.ohio.gov.

Ohio physicians applying for the Certificate to Recommend medical marijuana must hold an active and unrestricted Ohio Medical license. Prior to applying for the Certificate, a physician must complete “two hours of continuing medical education” related to diagnosing and treating patients with medical marijuana among other requirements. (See O.A.C. Section 4731-32-02 for more details, and a complete list of Application requirements.)

Prior to recommending medical marijuana for a patient, O.A.C. 4731-32-03 requires that a physician must perform tasks including but not limited to:

• Establish and maintain a bona fide physician-patient relationship;
• Create and maintain a medical record;
• Examine the patient;
• Inquire about the patient’s medical history and any current medications; and
• Include in the patient’s record a diagnosis of the patient’s condition.

There are certain qualifying medical conditions for recommending medical marijuana including but not limited to Parkinson’s disease, ulcerative colitis, fibromyalgia, and cancer. (See R.C. 3796.01(A)(6) for full list of medical conditions).

Qualifying patients must first register with the Ohio Board of Pharmacy. Prior to recommending medical marijuana, a physician must determine from the medical marijuana patient registry whether the patient has an active registration for medical marijuana. O.A.C. 4731-32-03. Only patients who are registered with the Ohio Board of Pharmacy may receive a recommendation for medical marijuana.

Physicians may recommend medical marijuana to minors with the consent of the minor’s parent or legal representative. O.A.C. 4731-32-03(C)(5).

You can find the Ohio Medical Board rules regarding the Medical Marijuana Control Program at: http://codes.ohio.gov/oac/4731-32.

Medical practice in Ohio, Practice closure, retirement, State Medical Board of Ohio, Uncategorized

Medical Practice Closure Considerations

We receive questions concerning the steps that are required or necessary in connection with the closure of a medical practice. Typically, a physician who has devoted their entire life to the day-to-day practice of medicine is faced with numerous legal, accounting, and administrative tasks, some of which extend beyond the actual shut-down of the practice. Planning, organization, communication, and administration are key elements to avoid issues after the closure.

Practice closure matters include but are not limited to:

Staff Notification: Staff of the practice should be notified of the closure. A physician may have to prepare to hire temporary staff if employees leave prior to closing date.

Patient Notification: The State Medical Board of Ohio (“Ohio Medical Board”) has laws and rules pertaining to the notice that a physician is required to give patients. These laws and rules include, but are not limited to, when notice must be given, the information that is required to be included in the notice, and how notice must be given.

Government/Payor/Agency Notifications: Notice concerning the closure of the practice must be coordinated and given to entities including, but not limited to, the DEA, Medicare, Medicaid, private insurance payors, hospitals, professional associations, and the Ohio Medical Board. Each entity may have different requirements.

Professional Liability Insurance: If necessary, extended reporting professional liability insurance (so called, “tail coverage”) should be obtained, which provides coverage against claims reported after the liability policy expires.

Medical Records: The storage or transfer of paper and electronic medical records in compliance with Federal and State law including, but not limited to, HIPAA must be completed. An address or PO Box to receive, and procedure to respond to, medical records requests after the closure of the medical practice must be established and followed.

Service and Supply Providers: Notice concerning the closure of the practice to providers including, but not limited to, providers of ancillary services, medical supplies, and other services and supplies should be coordinated and given. Accounts with such providers should be closed.

Business Entity Issues: Termination of any Lease Agreement(s), termination of utilities services, collection of accounts receivables, sale of medical and office equipment, dissolving the medical practice legal entity with the Ohio Secretary of State, and filing of final Federal, State, and local tax returns must be coordinated and completed.

If you have any questions about this blog or the State Medical Board of Ohio, please feel free to contact one of the attorneys at Collis Law Group LLC at (614) 486-3909 or email me at Todd@collislaw.com.

Disciplinary Action, License suspension, Medical practice in Ohio, State Medical Board of Ohio, Uncategorized

Ohio physicians: Suspension of your medical license may be just the start of your troubles

The State Medical Board of Ohio has the authority to take a disciplinary action against a physician’s professional license ranging from a Public Reprimand, to suspension, probation, or revocation. In addition, as noted in a previous post, effective September 29, 2015, the Medical Board was granted the authority by the Ohio General Assembly to issue a monetary fine against physicians (or Physician Assistants) found to be in violation of the Medical Practice Act (R.C. 4730 &4731). (See January 11, 2017 blog post about monetary fines).

In addition to a Medical Board disciplinary action, physicians should also be aware that if they are subjected to discipline by the Medical Board, they may also face additional repercussions to their professional practice and livelihood including, but not limited to:

• Public Record: All final actions of the Medical Board constitute a public record. The general public will be able to review a summary of the disciplinary action and a copy of the Notice of Opportunity for Hearing, Consent Agreement, or Adjudication Order with Report and Recommendation at the e-license verification page located at: https://elicense.ohio.gov/OH_HomePage.
• NPDB: Disciplinary actions of the Medical Board are reported to the National Practitioner Data Bank (NPDB). While the NPDB is not available to the general public, the following eligible entities have access to information on the NPDB: The Department of Health and Human Services, hospitals, health centers, health plans, medical malpractice payors, and state licensing boards. A health care organization can run a continuous query on practitioner reports. Therefore, as soon as you receive discipline from the Board, it is likely your employer will learn about it.
• DEA action: A physician’s Drug Enforcement Administration (DEA) license will be suspended during any period of medical licensure suspension. Criminal fines and/or imprisonment are available for any person who knowingly or intentionally (i) possesses a listed chemical with the intent to manufacture a controlled substance without proper registration; (ii) possesses or distributes a listed chemical with knowledge or a reasonable belief that the listed chemical will be used to manufacture a controlled substance; or (iii) evades the Controlled Substance Act’s recordkeeping and reporting requirements by receiving or distributing listed chemicals in small units. Violators of the aforementioned provisions may also be enjoined for up to ten years from handling listed chemicals. The physician must apply to have the DEA reinstated after his or her medical license is reinstated;
• Hospital Privileges: Hospital privileges could be suspended or revoked;
• Board certifications: Board certifications that the physician has may be limited, suspended, or revoked;
• Sister State Discipline: Other state medical boards in which the physician is licensed can institute disciplinary actions based on the Ohio matter;
• Medicare/Medicaid participation: A physician’s participation as a Medicaid/Medicare provider may be subject to revocation, thereby excluding them from obtaining reimbursement for services rendered to Medicare/Medicaid patients;
• Third Party Payors (Insurance Company participation): Participation as an approved provider for private insurer(s) could be terminated, thereby excluding the physician from obtaining reimbursement for services rendered to patients insured by such insurer(s); and
• Bureau of Worker’s Compensation: The BWC can revoke a physician’s certification in the Health Partnership Program—where they participate in a managed-care program for injured workers—if the provider has a misdemeanor committed in the course of practice, involving moral turpitude, or a conviction that is either a felony, cited under the Controlled Substances Act, or is an act involving dishonesty, fraud or misrepresentation. OAC 4123-6-02.2(B)(5).

While each case is different and each physician who is subjected to a disciplinary action by the Medical Board may not be subject to any or all of these additional actions, it is important to understand and appreciate that a Medical Board action may not be the end of the issues that a physician faces when subjected to a Medical Board disciplinary action.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to contact one of the attorneys at the Collis Law Group at (614) 486-3909 or email me: Beth@collislaw.com.

Medical practice in Ohio, Notice of Opportunity for Hearing, Respond to Board Letters, State Medical Board of Ohio

Ohio Physicians: Timely open and respond to all letters from the Medical Board

Keep your address up to date

As a physician licensed to practice medicine in Ohio, you are required (under R.C. 4731.281) to maintain your current accurate mailing address with the State Medical Board of Ohio. You may update your address online at: http://med.ohio.gov/UpdateAddress.aspx

The address on file with the Medical Board will be the official address that the Board will use to contact a physician if they become the subject of an investigation, or if the Board proposes to take a disciplinary action against a physician.

Certified Mail

If the Medical Board takes an action against a physician, they will be mailed a letter outlining the charges to their address of record with the Board. Under RC 119.07, the Notice of a Board Order shall be given by registered mail, return receipt requested, and shall include the charges or other reasons for the proposed action, the law or rule directly involved, and a statement informing that the party is entitled to a hearing if the party requests it within thirty days of the time of mailing the notice.

If you receive a certified mail from the Medical Board, it is imperative that you open it! If the Medical Board has mailed a certified letter to a physician, it will include important information and often requires an action to be taken by the physician within a short period of time.

For example, if the Medical Board issues a Notice of Opportunity for Hearing to a physician, the physician is only provided with 30 days (from the date of mailing by the Board) to request a hearing. Failure to timely request a hearing may result in a board-ordered sanction, and the physician would be provided with no means to defend their case. The sanction takes the form of a Final Adjudication Order under RC 119.

Failure to cooperate in an Investigation

Failing to respond to a subpoena request or to respond to Interrogatory questions sent from the Medical Board may also result in a disciplinary action taken against the physician by the Medical Board. R.C. 4731.22(34) provides that failure to cooperate in an investigation conducted by the Board, including failure to answer a subpoena or order issued by the Board, or failure to answer truthfully a question presented by the Board in an investigative interview, an investigative office conference, at a deposition, or in written interrogatories, will result in disciplinary action.

Publication notification

If you fail to accept delivery of certain notifications, the Medical Board has the authority to publish the notification in your local newspaper. If any notice sent is returned for failure of delivery, the agency either shall make personal delivery of the notice by an employee or the agent shall publish the notice once a week for three consecutive weeks in a newspaper of general circulation in the county where the last known address of the party is located. When notice is given by publication, a proof of publication affidavit, with the first publication of the notice set forth in the affidavit, shall be mailed by ordinary mail to the party at the party’s last known address and the notice shall be deemed received as of the date of the last publication.

Refusal of delivery by personal service or mail is not failure to deliver and service is still deemed to be complete. Therefore, it is important to keep your address up to date in order to accept all certified mail that is sent from the Medical Board. Be sure to carefully review all letters from the Board as they often include short timelines in which a response may be required.

If you have any questions about this post or the State Medical Board of Ohio, please feel free to contact one of the attorneys at the Collis Law Group LLC at 614-486-3909 or email me at Beth@collislaw.com.