Tag: substance abuse

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

Ohio Physicians considering retirement should make the decision voluntarily and prior to being compelled to retire by the State Medical Board of Ohio

Questions often arise as to when it is appropriate to retire from the practice of medicine.  In many instances, physicians who are happy and healthy do not want to consider retirement.  Many physicians have told me that they have devoted their entire life to their medical practice and that, because they do not have any other hobbies, skills, or interests, they desire to continue to practice medicine. Additionally, physicians have told me that they are concerned that they may not have the financial means to stop working. Finally, many physicians are concerned that they will miss the daily interaction with their staff and their patients.

The State Medical Board of Ohio (“Medical Board”) does not have a specific retirement age.  A Physician with a valid license to practice medicine in Ohio may continue to do so for so as long as they are mentally and physically fit to practice and comply with Medical Board laws and rules.  However, if the Medical Board has reason to believe that a physician is unfit to practice medicine, the Medical Board has the legal authority to order a physician to a medical or mental health evaluation.

Ohio Revised Code Section 4731.22(B)(19) provides:

“(B) The board, by an affirmative vote of not fewer than six members, shall, to the extent permitted by law, limit, revoke, or suspend an individual’s certificate to practice or certificate to recommend, refuse to issue a certificate to an individual, refuse to renew a certificate, refuse to reinstate a certificate, or reprimand or place on probation the holder of a certificate for one or more of the following reasons:

(19) Inability to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness, including, but not limited to, physical deterioration that adversely affects cognitive, motor, or perceptive skills.

In enforcing this division, the board, upon a showing of a possible violation, may compel any individual authorized to practice by this chapter or who has submitted an application pursuant to this chapter to submit to a mental examination, physical examination, including an HIV test, or both a mental and a physical examination. The expense of the examination is the responsibility of the individual compelled to be examined. Failure to submit to a mental or physical examination or consent to an HIV test ordered by the board constitutes an admission of the allegations against the individual unless the failure is due to circumstances beyond the individual’s control, and a default and final order may be entered without the taking of testimony or presentation of evidence.

For the purpose of this division, any individual who applies for or receives a certificate to practice under this chapter accepts the privilege of practicing in this state and, by so doing, shall be deemed to have given consent to submit to a mental or physical examination when directed to do so in writing by the board, and to have waived all objections to the admissibility of testimony or examination reports that constitute a privileged communication. (emphasis added)

If the Medical Board has reason to believe that a physician is unable to practice according to acceptable and prevailing standards of care by reason of mental illness or physical illness, a formal disciplinary action may be commenced.  This action may include (but is not limited to) ordering the physician to undergo a mental and/or physical examination.  Failure to submit to a mental and/or physical examination as ordered by the board constitutes an admission of the allegations against the physician, unless the failure is due to circumstances beyond the physician’s control.

On the basis of the mental and/or physical examination, the Medical Board can require the physician to submit to care, counseling, or treatment by physicians approved or designated by the Medical Board as a condition for reinstatement to practice.  The physician will receive an opportunity to demonstrate to the Medical Board their ability to resume practice in compliance with acceptable and prevailing standards under the provisions of the individual’s certificate.

In order to suspend a physician’s medical license, or to recommend retirement, the Medical Board must find that the physician’s continued practice, “presents a danger of immediate and serious harm to the public.”

In the past few years, we have seen the Medical Board order certain physicians to submit to a mental and/or physical examination. Based on the result of those examinations, the Medical Board has either suspended the physician’s license or requested that they enter into a “voluntary” permanent retirement of their medical license.

As always, if you have questions about this post or the State Medical Board of Ohio in general, please feel free to contact one of the attorneys at the Collis Law Group LLC at 614-486-3909 or email me at beth@collislaw.com.

State Medical Board of Ohio, Uncategorized

The Ohio Medical Board’s “slip rule” and when to contact the Ohio Medical Board if you relapse

Happy New Year!

I am often asked what Ohio physicians who are under probation with the Ohio Medical Board should do, if they relapse on drugs and/or alcohol or if they believe they have inadvertently been exposed to alcohol or a drug that may cause impairment.

If you are licensed to practice medicine in the State of Ohio, the Ohio Medical Board may take an action against your professional license if it has reason to believe that you are impaired in your ability to practice medicine (OAC 4731-16-01).  In such event, typically, a physician will enter into a Step I Consent Agreement with the Ohio Medical Board in which the physician’s medical license is suspended while they seek treatment for substance or alcohol abuse or addiction.

Once the physician has completed treatment and the Ohio Medical Board determines they are fit to resume practice,  the physician will be offered a Step II Consent Agreement, which reinstates the physician’s medical license subject to probationary terms.  Once a physician’s license is reinstated, they are generally placed on probation for five years. During probation, they are typically required to maintain abstinence, submit to random drug and/or alcohol testing, complete aftercare treatment, attend AA (12 Step) meetings, and complete other monitoring conditions.

During probation, the physician is not permitted to consume any alcohol and/or ingest drugs (except as prescribed).  The physician will be subjected to random alcohol and/or drug testing that is highly sensitive and can detect even incidental exposure.

What should the physician who is under probation with the Ohio Medical Board do if they consume alcohol or a drug to which they have not been prescribed or  believe they have been inadvertently exposed to these substances? 

A relapse is defined in Ohio Administrative Code 4731-16-01(B) as follows:

“Relapse” means any use of, or obtaining for the purpose of using, alcohol or a drug or substance that may impair ability to practice, by someone who has received a diagnosis of and treatment for chemical dependency or abuse, except pursuant to the directions of a treating physician who has knowledge of the patient’s history and of the disease of addiction, or pursuant to the direction of a physician in a medical emergency. An instance of use that occurs during detoxification treatment or inpatient or residential treatment before a practitioner’s disease of addiction has been brought into remission does not constitute a relapse.”

If a physician relapses on alcohol or a drug to which they have not been prescribed, the Ohio Medical Board may take further action against their professional license, including but not limited to suspending their license and/or requiring them to seek additional treatment.  However, if the physician is experiencing a first time relapse by consuming alcohol (or a drug) for less than one day, the Ohio Medical Board may determine that it will not take further action, if the physician immediately seeks treatment, self reports to the Ohio Medical Board within 48 hours of the relapse and follows all other requirements of OAC 4731-16-02(D).

OAC 4731-16-02, commonly known at the “slip-rule”, may prevent a physician from having their Ohio medical license suspended or being subjected to further discipline by the Ohio Medical Board in the event of a relapse. However, the physician must meet all of the requirements of the rule.  If you are a physician who is subject to monitoring by the Ohio Medical Board for alcohol or drug addiction or abuse, you should be familiar with the requirements of OAC 4731-16. http://codes.ohio.gov/oac/4731-16

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 one of the attorneys at the Collis Law Group LLC at 614-486-3909 or email me at beth@collislaw.com.

State Medical Board of Ohio, Uncategorized

Sanctions Against Physicians on Probation Increase in Severity

In 2012, I wrote a blog post about how the State Medical Board of Ohio was cracking down on physicians who were on probation. See “On Probation with the Medical Board? Beware, There is a New Sheriff in Town.” When writing that post two years ago, I could not have anticipated the changes that would take place and how these changes are affecting physicians who are under probation.

At any one time, the Ohio Medical Board monitors over three hundred physicians who are subjected to probationary terms. Many are on probation for substance abuse or alcohol abuse problems.  These individuals are required to call into a lab testing site daily and to submit to random OBSERVED urine screen anywhere from 2-4 times per month. They are also required to notify their doctors of their addiction, notify the Board of all medications they have been prescribed, and in many cases they are required to keep a log of all controlled substances they prescribe. They are required to attend AA or NA support meetings and personally report to the Board on a quarterly basis. All of these requirements are on top of their daily work assignments and while juggling family commitments.

In the past, minor violations of these requirements were accepted by the Board. You might miss a call in for a drug screen or one AA meeting. However, these seemingly minor violations are now the basis for additional discipline by the Board against the physician.

I recently learned that a physician’s probation was extended for 30 days for failing to call into the testing site on ONE occasion (and they were not even selected to provide a sample on that day). In the past year, I have also handled three cases where the Board has proposed to discipline a physicians for technical violations of their Consent Agreements, a few missed calls or a few missed AA meetings (even in cases where there is no evidence of a positive drug screen).

So, beware. Minor violations will not be taken lightly. Regroup. Set your priorities in place and be 100% compliant with the terms of your Consent Agreement, or you could face further Board discipline.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to call my office at (614) 486-3909 and ask to speak with one of the attorneys 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.

Uncategorized

Ohio Medical Board’s One Bite Rule

Physicians who believe they need to seek medical treatment for drug or alcohol abuse are often concerned about the ramifications they may suffer by the State Medical Board of Ohio if it is determined that they do need treatment. They commonly want to know, “will the treatment be confidential?” or “will the treatment facility or their colleagues and employer who may know of their impairment be required to report them to the Medical Board?”

Physicians who believe they may need treatment should seek an assessment immediately. Your health is the most important consideration.   However, in seeking an assessment for suspected chemical dependency or substance abuse, it is important to submit to an evaluation at one of the State Medical Board of Ohio approved facilities. A list of the facilities approved by the Medical Board can be found at: http://www.med.ohio.gov/pdf/treatment_compliance/TREATMNT.pdf

It is imperative that you seek an evaluation and follow the treatment recommendation of the Medical Board approved treatment facility. Seeking an assessment or treatment at a non-Medical Board approved facility will NOT be accepted by the Medical Board and you will be required to repeat the treatment.  However, if you voluntarily seek treatment and follow the recommendations of an approved treatment facility, you may be able to avail yourself to the Medical Board’s ONE BITE policy.

What is One-Bite?   The One Bite rule allows impaired licensees who seek and complete treatment and aftercare at a Medical Board approved treatment provider to remain in the private sector for monitoring, as long as their acts did not result in a criminal conviction or put patients or others at risk of harm:

Within One Bite:

  • Alcohol only
  • Illegal drug use
  • Taking drugs from sources that did not involve patients
  • Issuing prescriptions for one’s own use in one’s own name

Outside of One Bite:

  • Criminal conviction related to use or abuse of a controlled substance at or near the time the Board is determining if they meet the requirements for One Bite
  • Treatment in lieu
  • Relapse
  • Failure to complete appropriate treatment and aftercare with a Board approved provider
  • Criminal acts that involve the use of another’s name or involve patient’s name
  • Compromised patient care
  • Out of state action

If the Board becomes involved by investigator contact with the licensee or the Board orders the licensee for an assessment the individual no longer qualifies for One Bite.  One Bite is basically ONE chance to voluntarily seek treatment for substance abuse without having to submit to monitoring by the Medical Board.

Are hospitals and colleagues required to report the suspected impaired physician to the Medical Board? Under Ohio R.C. 4731.224 (http://codes.ohio.gov/orc/4731.224) and O.A.C. 4731-15-01 (http://codes.ohio.gov/oac/4731-15-01) licensees and health care facilities are relieved of the obligation to report the impaired physician to the Medical Board IF the individual has sought treatment at a Medical Board approved facility.

As always, if you have further questions, feel free contact me at beth@collislaw.com or at 614-486-3909.