Tag: medical records

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

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, 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.

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.