Tag: Collis Smiles & Collis

State Medical Board of Ohio, Uncategorized

The Digital Age Brings Down Another Prominent Figure

In the past, I have written about the dangers that participating in social media can present to medical professionals (August 23, 2012 post “Social Media Can be a Dangerous Pastime for Medical Professionals”).  The resignation of General David Petraeus yet again demonstrates that the digital age presents significant perils to those individuals who ignore or attempt to circumvent the appropriate use of such media.

I found it interesting that it has been reported that General Petraeus and Paula Broadwell allegedly wrote emails in “draft”, left the drafts in a draft email folder which they could both access and read, but did not send to each other, thereby attempting to avoid creating a trail of emails.

Engaging in social media creates a trail that can be used by employers, governmental agencies, criminal investigators, and State licensing boards as evidence of wrongdoing.  When a professional, like a physician, engages in email, texting, Facebook, Twitter, or other forms of social media with patients, they risk being determined to have committed a boundary violation with a patient.  A physician may not engage in a personal, sexual, or financial relationship with a patient.

In the past, these relationships were more difficult for employers or governmental agencies to prove because, in many instances, cases came down to a “he said – she said” situation.  However, in the digital age, impermissible relationships are documented in emails, texts, photos, videos, Facebook posts, and Tweets.

It is a violation of the State Medical Board of Ohio’s laws and rules to engage in a personal, sexual, intimate, or financial relationship with a patient.  Such relationships subject a physician to discipline by the Board.

As always, if you have any questions about this post or 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

Physician, employer, friend, neighbor, lover … which hat are you wearing? Choose one.

A physician cannot have a sexual relationship with a patient that they are currently treating.  While most physicians will say that they see the “clear line in the sand” when it comes to the prohibition against having a sexual relationship with a patient, they often don’t see the other boundary violations they may be committing.  It is also a boundary violation to engage in a financial relationship with a patient or to prescribe a medication to a friend or employee without conducting a physical examination or maintaining a patient record. Professional boundaries are blurred in many ways aside from the obvious prohibition against sexual involvement with a patient.

It is important to keep in mind what role you play as a physician. If you have a doctor-patient relationship with a person, you should not employ that person in your practice, loan them money, enter into financial arrangements with them, agree to pick medications up for them at the pharmacy, agree to treat them privately for “free off the books” because they do not have insurance or for any other reason. You need to treat all persons to whom you provide medical care to the same. While you may have sympathy for a patient who does not have insurance or may not be able to get an appointment with their “regular treating doctor”, if you elect to treat someone as a patient, you must follow the accepted standards of care for such treatment.

There is no prohibition from a physician treating an employee of their practice. However, the employee needs to be treated exactly like every other patient in the practice. They need to be physically examined and a patient chart needs to be maintained for any treatment or prescribing that is done for the patient. They need to be referred out for consultation or sent for followup tests or evaluations. Their chart should also include the same history, physical and background information that you would include for any patient.

When treating friends or employees, physicians will often fail to maintain a patient record or fail to accurately record the examination and treatment that they provided to the patient. Any written record is better than no written record, however, you should prepare a written medical record for this friend/patient as you would for any other patient in your practice.

Too often, physicians allow themselves to be “cornered” by a neighbor to call them in a prescription over the weekend and then they fail to take the appropriate steps to examine the patient and document their treatment.  I have also seen physicians who have agreed to treat a patient for free and then not maintain any medical record for the patient. They have told me “I wasn’t billing insurance, so I did not create a record”. This is inappropriate. You may subject yourself to disciplinary action by the State Medical Board of Ohio if you do not maintain medical records when you treat a patient. It doesn’t matter if you are not billing insurance for your service. If you provide medical care to a patient, you need to have a medical record showing what treatment you provided.

Know what hat you are wearing. It is never a good idea to have multiple relationships with patients. However, if you choose to treat a friend or an employee, you still need to practice above the standard of care, which dictates that you record a history and physical and document the treatment you provided to the patient.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, feel free check out my website at www.collislaw.com  or email me at beth@collislaw.com or call me at (614) 486-3909.

State Medical Board of Ohio

Ohio Courts will not reverse Medical Board decisions if the sanction seems too harsh

I recently read of a Medical Board disciplinary matter in the State of Illinois, in which the Illinois Medical Board revoked a physician’s medical license for engaging in a sexual relationship with a patient. Then, the Illinois Appeals court reversed the decision and sent the case back to the Illinois Board to issue an alternative sanction after finding the sanction was “overly severe” given the physician’s conduct. William Joel Kafin v. The Division of Professional Regulation of the Department of Financial and Professional Regulation.   I was struck by this case, as this would never happen in Ohio.

In Ohio, under Ohio Revised Code Chapter 119, decisions of the State Medical Board can be appealed to the Franklin County Courts. The Court will then determine if the decision of the Board was based on reliable, probative and substantial evidence and is in accordance with law. Pons v. Ohio St. Med. Bd., 66 Ohio St.3rd 619, 621. However, case-law exists in Ohio that the Courts will not reverse a decision of the Medical Board purely on the belief that the sanction is too harsh. Henry’s Cafe, Inc. v. Bd. of Liquor Control, (1950), 170 Ohio St.233. Even if the evidence is clear that the Ohio Medical Board imposed a sanction that was different or harsher than was imposed in other similarly situated cases, the Courts still not reverse a Medical Board decision.

The only way to obtain relief from a Medical Board decision by the Courts is to show that the Board based its decision on evidence that was contrary to law or was not reliable, probative or substantial. While it is not unheard of to have a Medical Board decision reversed by the Court, it is certainly an uphill battle.

It is the intent of Ohio administrative procedure law that state agencies be given the authority to regulate others in their profession. Arlen v. State Med. Bd (1980), 61 Ohio St.2d 168. Therefore, if a physician is issued a Notice of Opportunity for Hearing (citation letter), it is important to put your best case forward at the administrative hearing before the Medical Board.  The Court will rarely disturb the final decision of the Medical Board.  Unlike Illinois, Ohio courts will not reverse a Medical Board decision because the Court thinks the sanction is too harsh.

As always, if you have any questions about this post or 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 or see our firm website at www.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

Applying for an Ohio medical license…things to know

Applying for a medical license in Ohio is an important step in your career that should not be taken lightly. When you apply for an Ohio medical license, you should know that every aspect of your application will be reviewed under a magnifying glass. The Medical Board takes the application process very seriously and will not grant you a license until the application is complete and every piece of the application has been reviewed.

It is also important to note that EVERY response that you submit to the Board will be reviewed and if any inconsistencies or questions are raised after reviewing your application, the application process will be stopped and you will be asked for further information to supplement your application. Once you submit an application in Ohio you will most likely not be permitted to withdraw the application once it is submitted.

As it is your application, you should also personally complete the application. I have had people tell me that they have had their office manager, spouse or parent complete an application on their behalf. This is a mistake. You are solely responsible for your responses. Any incorrect responses will be held against you. No one knows the details of your professional experience and history better than you.  Does your office manager know that you were arrested while in college for underage drinking? Do your parents know that you were placed on probation in your residency program? Probably not. So, complete the application yourself.

Be open, honest and accurate on your application. If you were suspended from your residency program don’t put on the application that you were “on vacation”.  Be honest. Read the application carefully and if you have any questions about any of the questions, seek the advice of experienced legal counsel to help you prepare your application.

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 (614) 486-3909 or by email at beth@collislaw.com.

State Medical Board of Ohio, Uncategorized

Did you move? Notify the Medical Board of your change of address

If you hold a medical license in the State of Ohio, you are required to notify the State Medical Board of Ohio of any change in your address. This can be done in a number of ways:

1) Go to the following link:http://med.ohio.gov/pdf/OnLineChangeOfAddress.pdf

2) Contacting the CME/Records section of the Medical Board at 614-644-1464 and providing the Board with your change of address; or

3) Go on-line to www.license.ohio.gov and choose the “change address” option to change your address on-line.

Once you change your address, check back to the Board website after about 72 hours to verify that your change of address was properly recorded.

Why is it so important to make sure the Medical Board has your most up to date contact information? If the Board has any questions or concerns that need to be addressed by you, it will send the information to your “address of record”. If you are the subject of an investigation or if you are subjected to a random CME audit, the letters of inquiry will be sent to your address of record.

It is important to note, you are generally provided with a short period of time (generally 30 days) to respond to Board inquiries. Failure to respond may result in an adverse action against your license. For example, in a disciplinary proceeding, if you are notified by mail that the Board proposes to take a disciplinary action against your license for an alleged violation of the Medical Practice Act, under Ohio Revised Code Chapter 119, you have thirty (30) day from the date the notice was MAILED to you to request a hearing. If you fail to request a hearing in a timely manner, the Medical Board will take a disciplinary action (including possibly a suspension or revocation of your license) without considering your side of the story.

In addition, if the Medical Board takes a disciplinary action against a licensee and the Board is unable to provide the licensee with a copy of the final Adjudication Order (ie. if the Board does not have your current address) then the Board is required to PUBLISH the disciplinary action in your local newspaper.

It only takes a minute. You should check with the Board at www.license.ohio.gov to verify that the Board has your current address. If it doesn’t, please follow the prompts listed above to update your address with the Board.

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 (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.

State Medical Board of Ohio, Uncategorized

Do you really need to wear your scrubs everywhere?

I usually try to write on topics related to the State Medical Board of Ohio and issues or problems that can lead to discipline by the Medical Board. Occasionally, however, I will write on a topic that I just find curious for medical professionals. Today, the issue relates to why many medical professionals wear their scrubs out of the hospital?

I have tried to figure out the whole, scrubs as casual wear issue. It makes sense to see medical professionals around the hospital or on the hospital grounds in their scrubs. I don’t find it unusual to see health care professionals grabbing a quick-lunch in their scrubs. However, the wearing of scrubs has gone way beyond that.   Is the rationale for wearing the scrubs that “I could be called to the hospital at any minute, so I need to be prepared?” This might be it. However, yesterday, I saw someone cutting their grass in their scrubs! I hope they don’t wear that same outfit into the hospital if they are immediately called in for an emergency.

My father was a practicing anesthesiologist for over forty years. He left the house before 6am in a suit and tie and returned late each evening in a suit and tie. I can’t say that I ever saw him in scrubs. He certainly never went to dinner or cut the grass in scrubs.

Now, some may ask, “who cares what medical professionals wear”?  While I agree that we live in a much more casual society than even 20 years ago, I do believe that it decreases the level of professionalism and respect for the profession when medical professionals are constantly wearing their “hospital uniform” outside of the work setting. Just something to consider.

(Wearing scrubs out of the hospital, even to cut your grass will NOT lead to discipline by the State Medical Board of Ohio.)

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 614-486-3909 or email me at beth@collislaw.com.

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.