Tag: Collis

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.

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

Rich Doc/Poor Doc

In my practice of representing physicians who are under investigation by the State Medical Board of Ohio, DEA, local law enforcement, and/or their employer, I have seen many professionals struggle with multiple issues.  Recently, I have noticed  that far too many physicians are in disastrous shape financially.  Many physicians have poor money management and/or business management skills that have led them to entering into risky contracts or taking on jobs that they otherwise would have not considered.

Most physicians do not have the time, training, or education to be good money managers and, therefore, generally, many make poor financial decisions.  Many physicians enter the practice of medicine deeply in debt with student loans.  Many residents live beyond their means in the belief that once they complete their residencies, they will be given lucrative employment contracts.  Often, young physicians are so far in debt after completing their training, they are forced to accept work in undesirable practices to pay their debt.

Too often, physicians are also seen as “easy targets” for unscrupulous people.  I am always surprised to learn of highly educated physicians who enter into risky business dealings or fail to perform due diligence when purchasing property or entering into a business venture.

I have seen numerous instances in which physicians who are strapped with debt make unwise decisions as to where they will work and who they choose to associate themselves with in their medical practice.  Often, these physicians will seek ways to save money in their medical practice that leads to poor patient care or that is contrary to law.  Last year, the State Medical Board of Ohio disciplined a number of physicians who (in an effort to save money) purchased non-FDA approved medications from outside of the United States to administer to their patients.  These physicians did not realize that they were violating the law by purchasing these medications.  Nevertheless, these physicians were each subjected to disciplinary action by the Board.

I have also seen physicians continue to work for high volume practices in which they are constantly pushed to order expensive tests to ensure that the practice is highly compensated.  Often, these physicians tell me that they felt trapped in these jobs because the high salaries allow them to pay their debts.  I have also seen physicians take “moonlighting” jobs in areas outside of their specialty in an effort to repay debt only to find themselves investigated by the Board or DEA for practicing or prescribing outside of their scope of expertise.

The best way to have choices as a physician is to live within your means and to take the time and effort to do research before joining a particular practice or entering into a particular business dealing.  Physicians who are financially strapped risk making poor personal and business decisions that can lead to discipline by the Board or another agency.

A qualified accountant can be of assistance regarding your taxes.  A relationship with an attorney can be of benefit when researching a particular job or business venture.  A financial planner can offer guidance as to investments.   Utilizing these types of individuals allows you as a physician to do what you do best…to practice medicine.

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

State Medical Board of Ohio

The Hippocratic Oath: A Blueprint For Certain Legal Requirements Applicable to Ohio Physicians

The Hippocratic Oath (“Oath”) is arguably the most widely known ancient Greek medical text.  The Oath governs ancient Greek physicians’ professional and ethical behavior.  Although written approximately 2,500 years ago, certain standards in the Oath are reflected in current legal requirements concerning Ohio physicians’ medical practice and behavior.

This is a literal translation of the original version of the Oath:

I swear by Apollo Physician and Asclepius and Health and Panacea and all the gods and goddesses, making them witnesses, that I will make complete this oath and this written covenant according to my ability and discernment: 

–To regard my teacher of this art as equal to my parents and to share my livelihood (with him), and to make a contribution to him when he is in need of a debt, and to judge his offspring as equal to my brothers in manhood, and to teach this art – if they want to learn it – without wage and written covenant (to them), to make an imparting of the set of rules and lecture and all the rest of instruction to my sons and those of my teacher, and to those pupils who have been indentured and who have taken an oath according to the medical law, but to no one else. 

-I will use diets for the assistance of the sick according to my ability and discernment; but also to keep away injury of health and injustice. 

–I will neither give any deadly drug, having been asked for it, nor will I guide the same advice. Similarly, I will not give an abortifacient pessary to a woman. In purity and in holiness I will maintain my life and my art. 

-I will not use the knife, not even on those suffering from the stone, but I will give way to those who are practitioners of this work.

–And as many houses as I may go into, I will go in for the assistance of the sick, being free from all voluntary injustice and mischief and the rest, even abstaining from sexual pleasures of both female and male persons, both free and slaves. 

-That which I may see or hear during treatment, or even outside of treatment concerning the life of men, which must not in any way be divulged outside, I will not speak, regarding such things to be unutterable. 

And so may it be to me making complete my oath and not making it of no effect that I enjoy the benefits of my life and art and be honored by all men for time eternal; but may it be the opposite of this to me transgressing and swearing falsely. 

The Oath taken today has been revised from the above original text.  Although there are portions of the original Oath which are no longer applicable or sworn to by physicians, there are interesting parallels between certain standards in the original Oath and the present-day laws in the Ohio Revised Code (“ORC”), pertaining to Ohio physicians’ medical practice and behavior, the violation of which subjects a physician to disciplinary action by the State Medical Board of Ohio (“Ohio Medical Board”).

No Harm To Patients

The Oath provides: “I will use diets for the assistance of the sick according to my ability and discernment; but also to keep away injury of health and injustice.”  I interpret this provision generally to require the ancient Greek physician (i) to use dietary regimens to assist people who are sick, (ii) not to harm their patients, and (iii) not to do any injustice to their patients.

ORC §4731.22 authorizes the Ohio Medical Board to discipline a physician based acts would could result in patient harm including but not limited to:

ORC §4731.22(B)(2): Failure to maintain minimal standards applicable to the selection or administration of drugs, or failure to employ acceptable scientific methods in the selection of drugs or other modalities for treatment of disease;

ORC §4731.22(B)(3): Selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes;

ORC §4731.22(B)(6): A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances (whether or not actual injury to a patient is established); and

ORC §4731.22(B)(18): Violation of any provision of a code of ethics of the American medical association; and/or

ORC §4731.22(B)(29): Failure to use universal blood and body fluid precautions established by Ohio Medical Board rule.

No Injustice To Patients

ORC §4731.22 also authorizes the Ohio Medical Board to discipline a physician based on an act which evidences an injustice to a patient including but not limited to:

ORC §4731.22(B)(1): Permitting one’s name or one’s certificate to practice or certificate of registration to be used by a person, group, or corporation when the individual concerned is not actually directing the treatment given;

ORC §4731.22(B)(5): Making a false, fraudulent, deceptive, or misleading statement in the solicitation of or advertising for patients; in relation to the practice of medicine and surgery;

ORC §4731.22(B)(7): Representing, with the purpose of obtaining compensation or other advantage as personal gain or for any other person, that an incurable disease or injury, or other incurable condition, can be permanently cured; and/or

ORC §4731.22(B)(8): The obtaining of, or attempting to obtain, money or anything of value by fraudulent misrepresentations in the course of practice.

Although the requirement of the Oath to, “keep away injury of health and injustice” is phrased more broadly than the specific requirements in the ORC, a parallel between the requirements of the Oath and the ORC is apparent.  The dictates imposed by both the ancient Greek caregivers and the Ohio legislature evidence important standards that a physician do no harm to the patient and promote the just (ie, honest and truthful) relationship between the physician and the patient.

Sanctity Of Life 

The Oath provides: “I will neither give any deadly drug, having been asked for it, nor will I guide the same advice. Similarly, I will not give an abortifacient pessary to a woman. In purity and in holiness I will maintain my life and my art.”  The requirements (i) not to give or recommend any deadly drug, (ii) not to induce an abortion, and (iii) for the physician to hold his or her own life in purity and holiness, individually and collectively, support the notion that ancient Greek physicians held human life as sacred.

ORC §4731.22(B)(3) authorizes the Ohio Medical Board to discipline a physician for selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes.  Additionally, assisted suicide is against public policy in Ohio (ORC §3795.02(A) and is required to be enjoined by a Court of Common Pleas (ORC §3795.02(B)).  Consequently, ORC §4731.22(B)(37) authorizes the Ohio Medical Board to discipline a physician for assisting suicide.

Subject to certain express conditions and exceptions in Ohio law beyond the scope of this article, ORC §4731.22(B)(23) authorizes the Ohio Medical Board to discipline a physician for performing or inducing an abortion upon a pregnant woman.

No Sexual Misconduct

The Oath provides: “And as many houses as I may go into, I will go in for the assistance of the sick, being free from all voluntary injustice and mischief and the rest, even abstaining from sexual pleasures of both female and male persons, both free and slaves.

OAC §4731-26-02(A) authorizes the Ohio Medical Board to discipline a physician for engaging in sexual misconduct with a patient.

Confidentiality 

The Oath provides: “That which I may see or hear during treatment, or even outside of treatment concerning the life of men, which must not in any way be divulged outside, I will not speak, regarding such things to be unutterable.”

ORC §4731.22(B)(4) authorizes the Ohio Medical Board to discipline a physician for willfully betraying a professional confidence.

Conclusion 

The standards in the Oath applicable to ancient Greek physicians to do no patient harm, to have a just patient relationship, to take no act contrary to human life, to abstain from sexual misconduct with a patient, and to protect patient confidential information, are reflected in present-day legal requirements applicable to Ohio physicians’ medical practice and behavior.

That the Oath is recited in medical schools even today (See: http://medicine.osu.edu/news/archive/2012/08/21/reciting-the-hippocratic-oath-a-family-centered-tradition.aspx) is a testament to the enduring verities contained in the Oath.

As always, if you have any questions about this post or the Ohio Medical Board in general, please contact Collis, Smiles & Collis, LLC or Beth Collis at 614-486-3909 or Beth@collislaw.com.

prescribing to family members, self prescribing, State Medical Board of Ohio

Ohio Physicians .. Stop prescribing to self and family members!

Although I have blogged in the past about physicians prescribing medications to themselves and family members, the word is not getting out! (See my previous blog post from March 5, 2012)  Therefore, I thought it best to address the issue again.

In the past month, I have handled several cases where physicians have been investigated by the State Medical Board of Ohio for prescribing to family members.

I also recently had the opportunity to lecture to a group of medical students where the question about prescribing to family members was raised.  During my lecture, I warned the medical students to be aware that as soon as they are awarded their medical license, they will be inundated with requests from family members to refill prescriptions or, in some cases, to take over their medical care.  One student asked me if she could prescribe medications to her child.  In response, I urged the medical student to find her child a pediatrician in order to avoid compromising the physician’s professional livelihood.

The Medical Board recently updated its Position Statement to address the parameters of Ohio physicians prescribing to themselves and family members.  The Medical Board’s updated Position Statement case be found at: http://med.ohio.gov/Portals/0/DNN/PDF-FOLDERS/Laws-Rules/Position-Statements/Statement-on-Prescribing-Controlled-Substances-to-Oneself-or-a-Family-Member.pdf.

Although there are certain very limited exceptions when a physician in Ohio may prescribe to a family member, it is always BEST to seek qualified independent medical care for yourself and/or your family members.  Do not risk a Medical Board investigation into your prescribing practices to yourself or a family member.

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

 

State Medical Board of Ohio

Ohio Medical Board has adopted New Rules Related to Office Based Opioid Treatment

The State Medical Board of Ohio has adopted new rules related to Office Based Opioid Treatment (“OBOT”).  The new news take effect January 31, 2015.  The new rules require specific protocols, pretreatment examinations, and ongoing physician face-to-face examinations, testing and individualized treatment plans.  A copy of the new rules can be found at: http://med.ohio.gov/pdf/rules/NewRules/4731-11-12-eff-1-31-15.pdf.

The new rules include but are not limited to:

  1. Prior to providing OBOT, the physician must conduct an assessment of the patient that meets the requirements of the rule.
  2. The physician must practice in accordance with one of the protocols listed in the rule, and the diagnosis of an opioid disorder must be made utilizing the criteria in the DSM, 4th or 5th edition.
  3. The physician must develop an individualized treatment plan for the patient, require the patient to actively participate in appropriate behavioral counseling or treatment for addiction, and provide ongoing toxicological testing.
  4. The physician’s prescribing of the medication must comply with requirements that include, but are not limited to, prescribing only drugs specifically approved by the FDA for use in maintenance and detoxification treatment, prescribing no more than 16 milligrams of medication daily for a patient unless specified requirements are met, and accessing OARRS for each patient no less frequently than every 90 days.
  5. The physician must complete Category I CME related to substance abuse and addiction every two years, which will be accepted as part of the CME requirement for license renewal.

The above summary highlights certain requirements of the new rules and is not a substitute for the new rules.  The new rules can be found at: http://med.ohio.gov/pdf/rules/NewRules/4731-11-12-eff-1-31-15.pdf.

As always, if you have any questions regarding this post or the State Medical Board of Ohio in general, please contact one of the attorneys at Collis, Smiles and Collis at 614-486-3909 or email Todd@collislaw.com.