Physicians should never examine a patient without a chaperone present

When examining a patient, a physician should always have a chaperone present in the room.  The policy of the Medical Board has been to require a chaperone in the room when examining a patient of the opposite gender and when examining a patient in intimate areas of their body (such as a breast or vaginal examination).

However, after representing physicians before the Medical Board for nearly twenty years, I recommend that physicians have a chaperone present in the room during any patient examination. The chaperone is there to witness the examination. The chaperone represents the physician.

Often, I have had physicians tell me that they do not have a chaperone in the room because the patient brought a parent, spouse, friend or child with them to the examination. This is a mistake. If the patient alleges inappropriate conduct on the part of the physician, the friend or family member will not defend the physician and will support the statements of the patient.

Often, physicians tell me that they do not have the staff support to have a chaperone with them at all times when examining patients. My advice to them is that they cannot afford to NOT have a chaperone present.

If a complaint is made to the Medical Board by a patient that a physician touched them in an inappropriate manner during a medical examination, the Medical Board will open an investigation. The investigation can span many months or even many years (there is no statute of limitations for a Medical Board investigation).  Without a chaperone present to testify on behalf of the physician, it is a simply a case of “he said – she said”, which is difficult for a physician to defend.

Patients have also been known to file police reports and to press criminal charges against physicians for conduct that took place during an examination, as well as filing civil law suits against physicians.

Physical examinations can be intimidating, embarrassing and occasionally uncomfortable for patients. It is always best to continue to explain to the patient what is taking place during the examination to alleviate their fears and concerns. However, it is also imperative that the physician have a chaperone present in the room to observe the conduct of the physician AND the patient.

The name of the chaperone should also be noted in the patient’s file as evidence that they were present during the examination. It is also recommended when conducting examinations of patients in a hospital setting to have a floor nurse present in the room during the examination.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please contact one of the attorneys at the Collis Law Group, LLC (formerly Collis, Smiles & Collis, LLC) at 614-486-3909 or contact me at beth@collislaw.com.

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.