State Medical Board of Ohio, Uncategorized

Medical Board Investigators Carry Guns Now?

I recently learned that Ohio Medical Board investigators now carry hand guns while on the job. I had heard that the Board was considering allowing their investigators to carry firearms, but recently I learned first hand that an investigator had entered a private medical practice carrying a firearm.  I find this practice intimidating and unnecessary.

Isn’t it intimidating enough when an investigator appears in the medical office or hospital, often unannounced, flashes his credentials and demands to speak with the physician (who is most often seeing patients) and then requests to immediately see and take original patient files? My question is, why must they also carry a firearm?

I went back to the Board’s minutes to review the Board members’ rationale for this decision. In August 2011, the Board reviewed the issue of investigator safety. Of course, I found that this new aggressive move by the Board comes down to the heightened investigation of pain clinics in Ohio. The argument was that pain clinic waiting rooms may be filled with patients, who may be also carrying weapons.  The Board members were advised, on occasion, investigators were confronted with people hanging around the parking lots and “drinking alcohol” and on one occasion an investigator’s car was blocked by another car and they could not leave the parking lot. http://www.med.ohio.gov/pdf/Minutes/2011/08-11minutes.pdf

Based on concern for the safety of the investigators, the Board members approved a policy that would require investigators to undergo a minimum of 40 hours of training at the Ohio Peace Officers Academy and obtain re-certification annually.

I would never want to put the lives or safety of the Medical Board investigators at risk. However, we have a trained police force available in Ohio that investigators can call at any time for assistance. In addition, if the investigator has reason to believe that they are going into a dangerous area, they can always alert the local police in advance and even have an officer accompany them to their appointment. However, to allow an administrative board investigator to carry a firearm after simply 40 hours of training into all medical offices for all appointments is intimidating and unnecessary for the overwhelming majority of investigations conducted.

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

State Medical Board of Ohio, Uncategorized

The truth..the whole truth and nothing but the truth

In order for your attorney to provide you with the best possible counsel, you have to tell them the truth .. the whole truth and nothing but the truth. This seems obvious, however, I find clients (or often potential clients) either don’t tell me the truth or fail to tell me the “entire story.”   The only way to effectively work with an attorney is if you tell them the entire story. It is the attorney’s job to work their way through all the information and determine what is important and what is not important information in your case.

Most of my clients are medical professionals. They have been trained to take a patient’s history and physical. They know the importance of getting the entire story from the patient. The approach the physician takes when treating a patient is largely determined by the information obtained directly from the patient.  This is exactly the same scenario in working with an attorney. If you don’t tell the attorney the truth and the ENTIRE story … their ability to help you is limited.

In addition, you should be readily forthcoming with the information for your attorney. You can’t expect your attorney to cross-examine you to get the story out or to make assumptions based on the limited information that you have provided to them.

If you are not comfortable telling your own attorney the entire story, then you need to find another attorney who you are comfortable telling the entire story. In addition, if you fail to tell your attorney your entire story, you run the risk of the information coming out in a deposition or on cross-examination, which could leave your attorney blindsided and unable to assist you.

The truth is always the best policy, especially when working with your own attorney.

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

State Medical Board of Ohio, Uncategorized

Do you have balance in your life?

Doctors …. do you have balance in your life?

In the past, I have written about the three main areas where the State Medical Board in Ohio takes disciplinary actions against physicians: (1) for submitting false information to the Board, (2) for violating a professional boundary with a patient and (3) for issues related to drugs or alcohol (see previous post entitled, “What the Medical Board Really Cares About – Sex, Drugs and Lies”).  Recently, I looked at many of the cases before the Medical Board to determine if there are similar warning signs or red flags that may have been present before a complaint is filed with the Board. What I found is that in many instances the physician had been living a life that is out of balance.

Physicians are trained to look for signs of health (or disease) in their patients, however, too often they do not look for those warning signs in themselves. I often see that the complaint with the Medical Board is just the “final straw” in a year (or years) of a physician living an unbalanced life.  I find that, in many cases, physicians are overworked, overweight, stressed out, and living meaningless and angst filled lives. Many are taking medications to help them sleep and then other medications to help them get through their work days. Many eat out too often, haven’t seen the inside of a gym in ages (or ever), and are living meaningless, spiritless lives.

In terms of boundary violations, they rarely happen  to physicians who are in loving, supportive marriages or relationships. Many times, a physician will find themselves immersed in a Medical Board investigation when they are also in the middle of an ugly divorce or professional partnership that has taken a turn for the worst.

As physicians, you worked hard in school to put yourself in a position where you would have choices. Choices about where you work and what type of work you would like to engage in on a daily basis. Now is the time to exercise those choices and put yourself in a work environment that you find interesting, fulfilling and enjoyable.

I recently read that in tough financial times many people start to step back from their jobs (or job searches) and consider what they can do to make their overall lives better. Many have found that by spending more time with family and friends, exercising more often, and taking “control” of their lives they have found the energy and spirit to be more successful in work or in their job searches. Despite the tough economy, gym memberships were up in 2011 and many more people participated in Weight Watchers and other programs to improve the overall quality of their lives.

Doctors … look at your lives. Are you healthy, happy and fulfilled? If not, now if the time to reclaim your life and the direction of your professional career.

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

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.

State Medical Board of Ohio

Time to renew your Ohio Medical license – not something that should be delegated!

Depending on the first initial of your last name, it might be time to renew your Ohio medical license. This can be done on-line by going to the Medical Board’s website http://www.med.ohio.gov/.  If it is your renewal time, you should have been sent instructions from the Medical Board with your login information to complete your renewal application on-line. Or, you may request that the Board send you a paper renewal form to complete and return to the Board. Whether you choose to renew online or to complete the paper renewal form it is important that you take a few quiet minutes to yourself to complete the form on your own!

Often, physicians think they are too busy to take the time to personally complete the renewal form. I am often told by physicians that they allow the “girl” (their assistant) to complete the renewal forms for them. This is a mistake.  Does your assistant know that you were arrested in college for disorderly conduct or an open container violation?  Does your assistant know of the reckless operation of a vehicle charge that you plead guilty to on the way home from your sister’s wedding? Probably not.

However, by signing the renewal application you are certifying to the Medical Board that all information contained in the application is correct and complete. The Medical Board reviews all original applications for licensure and renewal applications very seriously and will take a disciplinary action against a licensee who fails to provide the Board with correct and complete information.

It is important to read all the questions on the renewal application carefully and to provide the Medical Board with clear, complete, honest and correct answers to their questions. If you do not understand a question, you may call the Medical Board staff and ask  – however, the staff is unable to give legal advice.

If you provide the Medical Board with an incorrect or incomplete answer or if you omit information called for in a question, the Board may take a disciplinary action against you based on a violation of Ohio Revised Code 4731.22(B)(5), “for providing false, fraudulent, deceptive or misleading statement … to obtain certification of registration from the Board.”

The Medical Board’s disciplinary guidelines permit the Board to impose a minimum sanction of an indefinite suspension (minimum one year) to a maximum penalty of permanent license revocation if a licensee provides, false information to obtain anything of value.  http://med.ohio.gov/pdf/meddis.pdf

When completing an initial application or submitting your renewal application to the Medical Board, complete the form yourself and take the time to answer all the questions with complete, clear, concise and correct answers.

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

Uncategorized

Medical Board actions are public and posted on Board’s website!

I am often asked by physicians, if a disciplinary action taken by the Medical Board against their license will be available to the public. The answer is Yes.  Under the Ohio Public Records law, R.C. 149.43, any official action taken by a governmental agency is a public record. http://codes.ohio.gov/orc/149.43

What does this mean? Prior to the internet, to obtain a public record from a governmental agency, a written request was required for the document. You can still do that today.  Now, however, all Medical Board disciplinary actions are posted on the Medical Board’s website.  Interested persons can go to the link on the Medical Board’s website to obtain information about a particular licensee, enter their name and they will be presented with a summary list of any discipline against that physician. A person can click on the “view documents” box (which is in bright yellow) and download the entire disciplinary record (copies of Citation letters, Consent Agreements, Adjudication Orders or any Court appeals documents).  To find information about your medical license or to look up another physician, go to: https://license.ohio.gov/lookup/default.asp?division=78

Information about a medical diagnosis or medical condition that might have formed the basis of a disciplinary action is not redacted and is included in the public record.  All the information, including any medical diagnosis, criminal conviction, boundary violation, the factual and legal basis for the action and the disciplinary action taken against the licensee is all included in the public record on the Medical Board’s website.

As a follow-up question, I am often asked whether the disciplinary action is taken off the website and out of the public record once the licensee completes any suspension or probation period. Unfortunately no. Once a disciplinary action is taken, it is on the professionals’ “permanent record” and will not be sealed, removed or redacted. Even in cases where the basis for the disciplinary action is a criminal action that has been sealed or expunged, the Medical Board is not required to seal or expunge any information available to the public.

The argument given for including all disciplinary actions of the Medical Board in the public record is that consumers should be able to know if their medical professional has been the subject of discipline by the Medical Board.

However, only proposed disciplinary actions and final actions (be it a Consent Agreement or Adjudication Order) are made public. Complaints submitted to the Medical Board and any Board investigations are confidential. Under R.C. 4731.22(F)(5), investigations of the Medical Board are confidential and are not open for public disclosure. However, this restriction  also pertains to the licensee and their legal counsel. When a complaint is filed with the Medical Board, the licensee may be notified of the general nature of the complaint, but they will not be provided with a copy of the complaint or even given the name of the person who filed the complaint. This rule however does not prevent the Medical Board from sharing any part of its investigation with other governmental agencies such as a police department or another Board.

As always, if you have any questions about this post or would like me address a particular question, feel free to email me at Beth@collislaw.com or call me at 614-486-3909.

Uncategorized

Ohio Medical Board’s One Bite Rule

Physicians who believe they need to seek medical treatment for drug or alcohol abuse are often concerned about the ramifications they may suffer by the State Medical Board of Ohio if it is determined that they do need treatment. They commonly want to know, “will the treatment be confidential?” or “will the treatment facility or their colleagues and employer who may know of their impairment be required to report them to the Medical Board?”

Physicians who believe they may need treatment should seek an assessment immediately. Your health is the most important consideration.   However, in seeking an assessment for suspected chemical dependency or substance abuse, it is important to submit to an evaluation at one of the State Medical Board of Ohio approved facilities. A list of the facilities approved by the Medical Board can be found at: http://www.med.ohio.gov/pdf/treatment_compliance/TREATMNT.pdf

It is imperative that you seek an evaluation and follow the treatment recommendation of the Medical Board approved treatment facility. Seeking an assessment or treatment at a non-Medical Board approved facility will NOT be accepted by the Medical Board and you will be required to repeat the treatment.  However, if you voluntarily seek treatment and follow the recommendations of an approved treatment facility, you may be able to avail yourself to the Medical Board’s ONE BITE policy.

What is One-Bite?   The One Bite rule allows impaired licensees who seek and complete treatment and aftercare at a Medical Board approved treatment provider to remain in the private sector for monitoring, as long as their acts did not result in a criminal conviction or put patients or others at risk of harm:

Within One Bite:

  • Alcohol only
  • Illegal drug use
  • Taking drugs from sources that did not involve patients
  • Issuing prescriptions for one’s own use in one’s own name

Outside of One Bite:

  • Criminal conviction related to use or abuse of a controlled substance at or near the time the Board is determining if they meet the requirements for One Bite
  • Treatment in lieu
  • Relapse
  • Failure to complete appropriate treatment and aftercare with a Board approved provider
  • Criminal acts that involve the use of another’s name or involve patient’s name
  • Compromised patient care
  • Out of state action

If the Board becomes involved by investigator contact with the licensee or the Board orders the licensee for an assessment the individual no longer qualifies for One Bite.  One Bite is basically ONE chance to voluntarily seek treatment for substance abuse without having to submit to monitoring by the Medical Board.

Are hospitals and colleagues required to report the suspected impaired physician to the Medical Board? Under Ohio R.C. 4731.224 (http://codes.ohio.gov/orc/4731.224) and O.A.C. 4731-15-01 (http://codes.ohio.gov/oac/4731-15-01) licensees and health care facilities are relieved of the obligation to report the impaired physician to the Medical Board IF the individual has sought treatment at a Medical Board approved facility.

As always, if you have further questions, feel free contact me at beth@collislaw.com or at 614-486-3909.

Uncategorized

What to Consider When Hiring an Attorney

When facing a disciplinary action before your state licensing board or when looking for assistance in applying for a license, it is important to find the right attorney to help you through this often cumbersome process. To make an informed decision, you should set an appointment and meet with the attorney in person to gauge the following:

Experience/Expertise: Experience in representing physicians before the State Medical Board of Ohio is a very important factor to consider. It is your professional license that is at stake. While you may have a good friend who is an attorney or a good professional relationship with a criminal defense counsel, often they do not have the experience or expertise to handle your defense before the State Medical Board of Ohio. In addition, many attorneys will claim to represent licensees before the Medical Board. However, you should ask them what percentage of their practice is in the area of licensure defense. You also want to determine how many cases they have taken through the hearing process and on appeal. You don’t want your case to be the first case they have taken to a Board hearing.

Personality/Compatibility/Accessibility: Meet and interview the attorney before you decide to hire them. Do they seem knowledgeable about the investigative or disciplinary process? Did they take the time to meet with you, answer your questions and explain the disciplinary process to you? Do you think the attorney understands your individual circumstances? Would you feel welcome to pick up the phone or to email the attorney with questions and concerns?

Costs/Accounting of fees: You should have a frank discussion with your attorney and make sure you understand their fees and how the fees are to be paid. Does the firm take credit cards? Do they charge late fees or interest on late balances? Does the firm send you a monthly statement that outlines the time spent on your case that month and any fees/expenses charged to you? If you deposit money in the firm’s IOLTA trust account, are you sent a monthly accounting of your money on retainer? Before entering into any relationship with an attorney you should have a clear understanding of their fees and should receive a regular accounting of any fees or expenses for which you will be charged.

As always, if you have any questions, please feel free to contact me at: beth@collislaw.com