Is Professional Courtesy Dead among Physicians?

Going back to the time of Hippocrates, physicians have provided medical treatment to their colleagues and their colleagues’ family members without charge. The rationale was to discourage physicians from treating themselves and their family members and also to encourage professional courtesy among physicians.

It is rare today that physicians have the time, desire, or financial means to take on patients without charge. However, if a physician is in position to do so, the rules of the game still apply. You still need to treat a pro bono patient EXACTLY as you would treat a paying patient.

You need to do a physical examination and document in the patient’s chart all the medications you prescribe and the treatment plan. Too often, I have had physicians tell me in my office that they did not create a chart because they were “not billing insurance.” This is improper. The State Medical Board of Ohio does not have different rules for the treatment of patients who you charge and those you do not charge. The Medical Board never even asks if you were paid for the treatment. This is not the standard.

The American Medical Association has also drafted an Opinion on Professional Courtesy and it states that while “professional courtesy is a long-standing tradition in the medical community, it is NOT an ethical requirement”. The Opinion also warns physicians that they should be aware that accepting insurance payments while waiving patient co-payments may violate AMA Opinion 6.12 “Foregiveness or Waiver of Insurance Co-Payment .” American Medical Association Opinion 6.13.  In addition, in Ohio, it is against the law to waive an insurance co-pay for a patient or to advertise that you will waive an insurance co-pay. Ohio Revised Code 4731.22(B)(28)(a) and (b).

If you want to provide medical treatment to another for free you may do so as a professional courtesy. However, you may not bill insurance and waive the co-payment to the patient.  You must provide treatment to this patient in the same manner and in accordance with the same medical and legal laws, rules and standards applicable to all other patients.

As always, if you have any questions about this post or about the State Medical Board of Ohio, you may contact any of the attorneys at Collis, Smiles and Collis in Columbus, Ohio at 614-486-3909.

Physicians .. Do your CMEs or face Ohio Medical Board discipline

Each month I attend the monthly meeting of the State Medical Board of Ohio.  This past week, at the Board’s monthly meeting, I was stunned to hear that the Board had voted to accept the permanent surrender of four physician’s licenses for failure to comply with their Continuing Medical Education (CME) requirements! This means four physicians in the state of Ohio chose to permanently surrender their medical licenses for failure to comply with the Board’s CME requirements. While many of these physicians may be older doctors who no longer want to practice, I was saddened to hear that they chose to permanently surrender their licenses under such circumstances.

All physicians in Ohio are required to complete 100 hours of CME credits every two years. 40 hours of that 100 must be Category A approved hours and the remaining 60 hours can be completed by simply reading medical journals. There are many on-line or in person locations that you can obtain CME approved hours. You may contact your local medical association or the Ohio State Medical Association for approved credit hours.  https://www.osma.org/education/continuing-medical-education-requirements.

You are required to maintain documentation of your meeting attendance. Each year, the Medical Board conducts random audits and requests that selected physicians submit proof of completion of their CME hours.

Failure to respond timely to an audit can result in a Reprimand to your professional license. If you are unable to provide evidence that you completed the required CME credits during your two-year renewal period, the Board may issue for a first time offense a Reprimand and a fine ranging from $1000-$5000. The Board may also indefinitely suspend your medical license until you have completed all your CME hours.

For a second time offense, the Board can impose a sanction of a fine from $3000-$5000 and can suspend your license for an indefinite period of time ranging from a 60-90 day suspension.

Keep track of your CME credits. Keep copies of all meetings you attend and journals you read. It is not worth the risk of discipline to your professional license including a fine, Reprimand or Suspension for failure to complete your required CME hours.

As always, if you have any questions about this post or the State Medical Board of Ohio, you may contact any of the attorneys at Collis, Smiles and Collis in Columbus, Ohio, 614-486-3909.

Medical Residents, Be Advised

As July 1 quickly approaches and medical Residents prepare to start their residency programs, it is imperative that Residents know the limits of their Training Certificate. For instance, many Residents question whether they are authorized to prescribe non-controlled medication to family and/or friends pursuant to a Training Certificate. The answer is, no.

The holder of a Training Certificate is not authorized to write non-controlled medication prescriptions to family members and/or friends unless the care being delivered to the family member is under the auspices of the Residency Program for which the Training Certificate was issued.

Other restrictions also include, but are not limited to: the holder of a Training Certificate is not authorized to practice medicine, including writing prescriptions, except as may be required by or incidental to the holder’s Residency Program. In addition, the holder may not practice outside of the Residency Program hospital or facilities for which the Training Certificate was issued. Thinking of picking up part-time medical work an a hospital or office setting on weekends? You will need to have a full Ohio medical license to work outside of your training program.

Lastly, the Training Certificate may be revoked if the holder practices medicine, including writing prescriptions, outside of the Residency Program. Residents, don’t overlook formalities and be aware that there are limitations to follow while working under your Training Certificate!

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

Physicians .. have you read the rules?

The practice of medicine in Ohio is outlined by one statute section, Ohio Revised Code 4731, and one set of rules drafted by the Medical Board, Ohio Administrative Code 4731. This Code section and these rule outline the requirements to be licensed as a physician, podiatrist, massage therapist or physician’s assistant in Ohio and also define the scope of practice of medicine in Ohio. However, I am always surprised that most physicians with whom I speak have no idea that these laws and rules even exist.

Ohio Revised Code Chapter 4731 is the law governing the practice of medicine in Ohio. The Ohio Administrative Code is drafted by the Medical Board members and is reviewed and approved through a rule making process. Physicians in Ohio are required to know, understand and follow the guidelines established in these laws and rules.

These laws and rules can be found at the Medical Board’s website at: http://www.med.state.oh.us. You can also follow the following link to find these sections: http://codes.ohio.gov/orc/4731
or for the administrative rules go to: http://codes.ohio.gov/oac/4731

Pertinent sections of these laws and rules include:

Basis for disciplinary action can be found at R.C. 4731.22(B) which can be found at: http://codes.ohio.gov/orc/4731.22.

To learn more about licensing and continuing education go to: OAC 4731-10, which can be found at: http://codes.ohio.gov/oac/4731-10.

To learn more about prescribing of controlled substances go to: OAC 4731-11, which can be found at: http://codes.ohio.gov/oac/4731-11.

To learn more about the Medical Board’s hearing process go to: OAC 4731-13, which can be found at: http://codes.ohio.gov/oac/4731-13.

To learn more about the duty to report to the Medical Board go to: OAC 4731-15, which can be found at: http://codes.ohio.gov/oac/4731-15.

To learn more about what to do if you believe you suffer from  chemical dependency go to: OAC 4731-17, which can be found at:  http://codes.ohio.gov/oac/4731-17.

As practicing medical professionals in Ohio, you are required to know, understand and follow the laws  and rules in ORC 4731 and OAC 4731. Take the time to read the rules and, if you have questions, contact experienced legal counsel to assist you.

As always, if you have any questions about this post, please feel free to contact me at beth@collislaw.com.

Physicians .. do you need a vacation?

I have written about work/life balance in the past (see “Do You Have Balance in your Life,” April 18, 2012) however, as the holiday season approaches, I think it is important to consider whether this is a good time to suggest taking a break from the hectic pace of your practice. In the news again today, there was a story about how Americans are given less vacation days per year than any other major industrial nation (10 days vs. 30 days for most Europeans) and that Americans rarely use all their vacation days. http://today.msnbc.msn.com/id/3041440/vp/50068545#50068545

Many people think that they are too busy to take a vacation or that if they leave for even a few days they will return to even more work than when they left. In some cases, Americans are afraid that if they do take a few days off their bosses will recognize that they are dispensable and may re-assign their work and their job to others. Despite whatever real or imaginary fears you might have about taking a break from work, the reality is that everyone needs to rest, relax and step back from the stress of their daily lives so that they have the energy to return to the workplace prepared to work. Physicians are no exception. Physicians deal with extremely stressful situations on a daily basis. Failure to take the appropriate breaks from your practice can lead to weight gain, depression, additional stress and poor decision-making.

As noted in previous posts, stress can lead physicians to make poor decisions related to patient care or can lead to them making poor personal decisions such as drinking and driving, committing a boundary violation with a patient, or seeking unacceptable ways to relieve stress such as sharing personal information with patients or “friending” patients on social media sites.  Ultimately, failure to implement appropriate stress management tools, including taking a vacation, can lead to future professional problems.

Whether you choose to stay home for a “staycation” or take that long-awaited trip, give yourself (and your practice) a break. It will do you a world of good.

As always, if you have any questions about the State Medical Board of Ohio or this post, please feel free to call me at (614) 486-3909 or email me at beth@collislaw.com.  My office will be closed from December 24, 2012 to January 3, 2013 to give everyone at CSC a much needed break.

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.

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.

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.

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.

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.