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Oklahoma Board of Medical Licensure and Supervision
Issues & Answers - October 1997

ISSUES AND ANSWERS

Volume 8, No. 6
October1997

Keeping Promises

by Gerald C. Zumwalt, M.D.
Board Secretary/Medical Advisor

In October, Promise Keepers rallied in Washington. The Mall was jammed from the Capitol to the Lincoln Memorial. Perhaps even the lonely statue of Albert Einstein (the only scientist with a memorial in DC if you exclude Thomas Jefferson) was visited with some of the overflow.

The thought came to me as to what kind of changes might occur if certain groups started keeping promises they made at some point in their professional lives.

If politicians kept their promises we would now have a balanced budget, lower taxes, smoother roads, better schools, and even, if you remember the political platforms of the '50s and '60s, twice daily mail delivery.

If lawyers were committed to their pledge to render justice and uphold the law, houses' front doors could stay unlocked, people could walk the streets free of fear, conviction appeals would be rare, and sanctimonious denials of felonious conduct would cease poisoning the deliberative atmosphere.

If doctors remembered the pledges they once made (even if only to themselves) that the patient's welfare would be paramount and their efforts would be healing, not selfish, the first result would be virtually total inactivity of this Board's disciplinary arm. Most of our incoming complaining correspondence would cease if physicians lowered their voices and their egos and just listened empathetically. Putting the patient's interest first would halt the squabbles over managed care and who controls the HMO's. Remembering the inherent worth of each individual would slam shut the repellent door of sexual misconduct. Feeling the forgotten joys of making a good diagnosis just for the mental exercise would freeze the frosty charges of fraud.

But then (before alliteration drowns us all) if the tooth fairy were real I would have more quarters and fewer caps.


What Would You Do?

The case of the Disappearing Doctor

A physician was under terms of probation for writing controlled and dangerous drugs to an undercover agent without any type of physical examination and for writing multiple prescriptions for the same drug to the same patient on the same day. After serving two years of the five year probation the doctor was not able to be located by the Board staff and did not notify the Board of his change of address.

The prosecution argued that he was violating the requirement of all licensees, and the specific term of probation, that he furnish to the office of the Board "all current legal addresses and any change of address in writing...."

The defense lawyer argued that since the doctor was no longer in Oklahoma, the Board did not have jurisdiction to take any action.

Results in next issue.


National Licensing Trends

The 1997 edition of US Medical Licensure Statistics and Current Licensure Requirements has arrived in our office. It contains numbers from 1995 licensing activities and compilations of how the multiple state boards are addressing problems.

In 1995, 22,520 physicians received their initial licenses and of these 5,319 (25%) were international medical graduates. Total licenses issued by all boards in 1995 was 51,332. Oklahoma issued 374 of which 228 were initial licenses.

The average fee for initial licensure ranges from a high of $1010 (Florida) to a low of $40 (Indiana). Oklahoma charges $400 whether coming in by exam or by endorsement. Annual renewal fees average $125 with a high of $450 (Connecticut) and a low of $15 (Indiana).

Fifty Boards issue some type of restricted license. These restrictions vary as much from state to state as the fees do. Most states have some type of educational license or certificate. Many have special licenses for working in state hospitals or institutions and one (Maine) has a temporary seasonal camp license.

The full report (84 pages) is available for perusal in our office. Subjects such as visa requirements, telemedicine licensure, licensure in the Department of Defense, and licensing exams also are covered in the book.


Establishing a Doctor/Patient Relationship in Managed Care

The July 1997 issue of Medical Legal Lesson (Vol 5, #3) cites a case of a gate keeper issuing a telephonic denial of hospitalization for a managed care subscriber whom the doctor had never seen (Hand vs. Tavera - Tex Ct App 1993). The appellate court held that this consultation between the ER physician and the gate keeper about a patient created a physician-patient relationship "as surely as though they had met directly."

This decision underlines and supports the requirement that physicians practicing telemedicine and/or rendering treatment affecting decisions be licensed in the state where the patient resides. It also establishes a basis for malpractice suits based on those decisions.


First Aid or No Aid

An interesting question was received recently at the Board from a physical therapist. "May a P.T. render First Aid such as ice, heat or aspirin in a job setting without direct referral from a physician?" The P.T. law states that one cause for discipline to a licensee is, "Practiced physical therapy other than under the referral of a physician, surgeon, dentist, chiropractor or podiatrist...." (Title 59 O.S., 887.13(1)). Thus it appears that measures a lay person on their own may undertake in treatment of an injury may not be utilized by a licensed P.T. in their professional setting sans a referral. Legal opinion has been that a protocol established by one of the listed professionals would not constitute an acceptable referral.

In a similar vein, the Louisiana State Board of Physical Therapy Examiners recently addressed whether a licensed Athletic Trainer could serve under a Physical Therapist rather than under the supervision of a physician as required by the Louisiana Board of Medical Examiners' law.

The two Boards cut the baby in two and stated the athletic trainer could be utilized in a physical therapy setting but only as an "unlicensed supportive person" and could not wear any identification signifying that he/she is an athletic trainer.


Board Meeting - September 11, 1997

A rare one-day meeting of the Board occurred on September 11. Multiple topics were discussed and both applications and disciplinary actions were taken.

Eight full and unrestricted licenses were approved and three Special Licenses for training were approved. One application for full licensure was denied on the basis of previous revocation by another state. Two applications for Special Licenses for training were denied based on quality of medical education, number of failures on licensing exams and/or prior criminal convictions and charges.

Hearings were held on various disciplinary matters. One Voluntary Submittal to Jurisdiction was adopted imposing standard terms of probation for an indefinite period due to relapse of chemical substance abuse. One Voluntary Submittal resulted in a five-year probation due to writing controlled and dangerous drugs without establishing a doctor/patient relationship.

One request to terminate probation due to economic hardship related to HMO membership was denied. Modification of probationary terms for one physician was adopted to allow hospital work and night time call but to remain within a forty hour work week.

One hearing resulted in an increase in the number of mandated urine samples due to an occurrence of one positive sample. One license was reinstated on receipt of previously requested evaluation.

The Board addressed the fact that refunds of late fees are not permissible under State law and rules and requested that this item no longer be put before the Board.


You Too Can Be A World Famous Author

Certainly most of our readers have enjoyed reading the writings of Dr. Zumwalt. But for varities sake, we are soliciting short articles from our licensees on the subject of professional ethics and actions. Please send them to this address in care of Kathy Plant. All submissions will be subject to editing.

RENEWAL REMINDER

If your medical license was issued in November, renewal of your license is due by November 1. If your license was issued in December, renewal is due by December 1.

Remember, when completing the renewal application, the questions at the bottom of the front page pertain only to the time