Tag: Chemical dependency

State Medical Board of Ohio, Uncategorized

The Ohio Medical Board’s “slip rule” and when to contact the Ohio Medical Board if you relapse

Happy New Year!

I am often asked what Ohio physicians who are under probation with the Ohio Medical Board should do, if they relapse on drugs and/or alcohol or if they believe they have inadvertently been exposed to alcohol or a drug that may cause impairment.

If you are licensed to practice medicine in the State of Ohio, the Ohio Medical Board may take an action against your professional license if it has reason to believe that you are impaired in your ability to practice medicine (OAC 4731-16-01).  In such event, typically, a physician will enter into a Step I Consent Agreement with the Ohio Medical Board in which the physician’s medical license is suspended while they seek treatment for substance or alcohol abuse or addiction.

Once the physician has completed treatment and the Ohio Medical Board determines they are fit to resume practice,  the physician will be offered a Step II Consent Agreement, which reinstates the physician’s medical license subject to probationary terms.  Once a physician’s license is reinstated, they are generally placed on probation for five years. During probation, they are typically required to maintain abstinence, submit to random drug and/or alcohol testing, complete aftercare treatment, attend AA (12 Step) meetings, and complete other monitoring conditions.

During probation, the physician is not permitted to consume any alcohol and/or ingest drugs (except as prescribed).  The physician will be subjected to random alcohol and/or drug testing that is highly sensitive and can detect even incidental exposure.

What should the physician who is under probation with the Ohio Medical Board do if they consume alcohol or a drug to which they have not been prescribed or  believe they have been inadvertently exposed to these substances? 

A relapse is defined in Ohio Administrative Code 4731-16-01(B) as follows:

“Relapse” means any use of, or obtaining for the purpose of using, alcohol or a drug or substance that may impair ability to practice, by someone who has received a diagnosis of and treatment for chemical dependency or abuse, except pursuant to the directions of a treating physician who has knowledge of the patient’s history and of the disease of addiction, or pursuant to the direction of a physician in a medical emergency. An instance of use that occurs during detoxification treatment or inpatient or residential treatment before a practitioner’s disease of addiction has been brought into remission does not constitute a relapse.”

If a physician relapses on alcohol or a drug to which they have not been prescribed, the Ohio Medical Board may take further action against their professional license, including but not limited to suspending their license and/or requiring them to seek additional treatment.  However, if the physician is experiencing a first time relapse by consuming alcohol (or a drug) for less than one day, the Ohio Medical Board may determine that it will not take further action, if the physician immediately seeks treatment, self reports to the Ohio Medical Board within 48 hours of the relapse and follows all other requirements of OAC 4731-16-02(D).

OAC 4731-16-02, commonly known at the “slip-rule”, may prevent a physician from having their Ohio medical license suspended or being subjected to further discipline by the Ohio Medical Board in the event of a relapse. However, the physician must meet all of the requirements of the rule.  If you are a physician who is subject to monitoring by the Ohio Medical Board for alcohol or drug addiction or abuse, you should be familiar with the requirements of OAC 4731-16. http://codes.ohio.gov/oac/4731-16

As always, if you have any questions about this post or about the State Medical Board of Ohio in general, 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.

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

Failing to request a hearing can be a very costly mistake.

Today, I attended the monthly meeting of the State Medical Board of Ohio.  I was surprised to see that in all six cases handled by the Board, the licensees had failed to request a hearing.  Despite the fact that the Board may impose any sanction, ranging from dismissal to permanent revocation of a license, in each case where the licensee failed to request a hearing, the Board either revoked or permanently revoked their licenses.

The Board Members expressed concern that if these licensees had not requested a hearing or attended the Board meeting, these licensees were not interested in maintaining an Ohio license.  Therefore, the Board revoked their licenses.  By failing to request a hearing, the Board is often left with unanswered questions.

Often, professionals will tell me that do not want to request a hearing or appear before the Board because they have already submitted documentation in support of their case and they believe they have, “no other information to provide to the Board”.

Failing to request a hearing can be a very costly mistake.  There is no more powerful information than the personal testimony of a license holder.  Boards typically like to see that an individual understands the gravity of charges against them, that the individual accepts responsibility for their conduct, that the individual expresses remorse for their conducts, and how the individual will handle a similar situation in the future.

Often, I find that cases appear to be far more serious on paper and that once testimony is provided from the licensee and by those who support the licensee, the Board is able to have their questions answered and view the case in a much less serious light.  In some instances, I have also seen that the sanction the Board imposes after a hearing is less harsh than the Board was contemplating prior to the hearing.

Failing to request a hearing can be a very costly mistake.  It is recommended that a licensee request a hearing and to present testimony in your defense.  If you want to retain your medical license, you need to fight for it.

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

State Medical Board of Ohio, Uncategorized

Sanctions Against Physicians on Probation Increase in Severity

In 2012, I wrote a blog post about how the State Medical Board of Ohio was cracking down on physicians who were on probation. See “On Probation with the Medical Board? Beware, There is a New Sheriff in Town.” When writing that post two years ago, I could not have anticipated the changes that would take place and how these changes are affecting physicians who are under probation.

At any one time, the Ohio Medical Board monitors over three hundred physicians who are subjected to probationary terms. Many are on probation for substance abuse or alcohol abuse problems.  These individuals are required to call into a lab testing site daily and to submit to random OBSERVED urine screen anywhere from 2-4 times per month. They are also required to notify their doctors of their addiction, notify the Board of all medications they have been prescribed, and in many cases they are required to keep a log of all controlled substances they prescribe. They are required to attend AA or NA support meetings and personally report to the Board on a quarterly basis. All of these requirements are on top of their daily work assignments and while juggling family commitments.

In the past, minor violations of these requirements were accepted by the Board. You might miss a call in for a drug screen or one AA meeting. However, these seemingly minor violations are now the basis for additional discipline by the Board against the physician.

I recently learned that a physician’s probation was extended for 30 days for failing to call into the testing site on ONE occasion (and they were not even selected to provide a sample on that day). In the past year, I have also handled three cases where the Board has proposed to discipline a physicians for technical violations of their Consent Agreements, a few missed calls or a few missed AA meetings (even in cases where there is no evidence of a positive drug screen).

So, beware. Minor violations will not be taken lightly. Regroup. Set your priorities in place and be 100% compliant with the terms of your Consent Agreement, or you could face further Board discipline.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to call my office at (614) 486-3909 and ask to speak with one of the attorneys or email me at beth@collislaw.com.

 

State Medical Board of Ohio

Social media can be a dangerous pastime for medical professionals

You have probably seen the “news” reports in the past two days of a naked Prince Harry having a good time in Las Vegas. These clandestine photos were obviously taken when Prince Harry believed that  he was in a private setting. However, they were secretly released to the press and quickly went viral to the great embarrassment of the Royal Family.

You may wonder what this has to do with physicians and the medical profession? We are now in a world where virtually everyone is carrying a camera/video camera on their phones with the ability to take and upload photos and videos to the internet and to the world in moments.  Behaviour that professionals may have engaged in that they thought was private may now be published to the world.

I have not seen a case yet where the Ohio Medical Board uses video footage of a physician “acting badly” as evidence of impairment or inability to practice medicine, however, in my opinion it is just a matter of time. Physicians need to be aware that the Medical Board can take an action against a physician for their conduct, even if it is not related to the practice of medicine. You do not need to be “falling down drunk” at work to be disciplined by the Medical Board. A photo or video of you clearly impaired at a bar taken at 2am when you are scheduled for surgery at 7am could serve as the basis for discipline.

Social media can also be evidence of a boundary violation with a patient. Do you “friend” patients on Facebook? Do you have photos of yourself and a patient taken in social settings? These could all constitute boundary violations with patients.

Social media can be a wonderful tool to reconnect with old friends and to share photos with family members and friends. But, it can also lead to trouble for professionals if not used wisely. As physicians, your conduct needs to be professional 24/7.

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

State Medical Board of Ohio

Are you resilient enough to be a physician?

As most physicians will tell you, it takes a lot more than understanding chemistry or being a good test taker to be a good physician. It takes being willing to work hard, being able to face adversity, and staying calm in a crisis situation. It takes being resilient.  I often wonder if medical students and medical residents are being challenged and taught the appropriate skills to be an accomplished physician.

In my practice, I represent physicians who are being investigated by the State Medical Board.  I also regularly represent residents who face discipline in their residency program or who are seeking licensure for the first time.  For most of my clients, an investigation in their practice by the State Medical Board may be the first time they have ever been questioned by a person in authority or “called on the carpet” for their actions.   Based on this new experience, it is interesting how they react.

A Board investigation is an incredibly stressful time for the physician. Their entire professional livelihood is on the line and any discipline that is imposed by the Board will have significant ramifications to their job, hospital credentialing status, third-party payor status, board certifications and may affect other state licenses.

Investigations by the State Medical Board do not have a statute of limitations and, once the Board starts an investigation, it is not limited to just the scope of the complaint.  The Board may review all aspects of the physician’s practice. In addition, while conducting an investigation, the Board can order the physician to undergo a chemical dependency evaluation or a mental or medical evaluation to determine if they have a condition that may affect their ability to practice medicine.

In order to get through a Medical Board investigation, the physician needs to be patient, cooperative and still maintain the same level of professionalism in their practice while seeing patients. This calls for resiliency on the part of the physician.

Physicians hold patients’ lives in their hands. They need the intelligence, executive function skills, and downright grit to maintain their composure in an ever-changing medical field. So, before entering medicine or if you are a practicing physician, I think it is important to consider .. are you resilient enough to be a physician?

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

State Medical Board of Ohio, Uncategorized

On probation with the Medical Board? Beware .. there is a new sheriff in town

Physicians who are on probation with the State Medical Board of Ohio related to alcohol or chemical dependency or abuse are generally required to submit to monitoring conditions during probation, including submitting to random urine drug tests, attending weekly AA meetings, completing 104 aftercare sessions, attending quarterly Board appearances,  and having a physician monitor their practice.

In the past, as long as a physician on probation did not have a positive alcohol screen, i.e. illegal substance or prescription medication without  a valid prescription, the Board generally did not always require perfect compliance with all other probationary terms. Again, generally,if a physician failed to submit a quarterly declarations of compliance or failed to attend all required AA meetings, the Board would customarily  address the issue at their quarterly meeting or would send the physician a “friendly” letter advising them that they were not in compliance and requesting that steps be taken to ensure compliance.

Under the direction of former Board Member, Mr. Albert, the Board rarely charged a probationer with failure to comply with the terms of their Consent Agreement, unless they tested positive for drugs or alcohol.  Most recently, however, the Board has taken a much stricter position on probationers who are not 100% in compliance with ALL the terms in their Board Orders or Consent Agreements.

Recently, the Medical Board issued a Notice of Opportunity for Hearing to a physician who had been on probation with the Board since 2005.  Despite the fact that all of the physician’s urine screens were negative, the Board proposed to discipline the physician for allegedly failing to comply with the following terms of the physician’s Consent Agreement: failure to submit quarterly reports to the Board in a timely manner; failure to submit AA logs to the Board; failure to seek Board approval for required courses and for a monitoring physician. Despite no evidence of relapse, the Board voted at its June meeting to revoke this physician’s medical license for failure to be 100% in compliance with the Board’s Order or Consent Agreement.

If you are under probation, please beware. The terms and conditions of Board Orders or Consent Agreements are mandatory. Failure to strictly comply with all terms and conditions of the Board Order or Consent Agreement can serve as the basis for further Board disciplinary action.

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

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.