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Oklahoma Board of Medical Licensure and Supervision
Issues and Answers - December 1997


Volume 8, No. 7
December 1997

Ads Sans Excellence

by Gerald C. Zumwalt,
Board Secretary/Medical Advisor

"There are men and classes of men that stand above the common herd: the soldier, the sailor, and the shepherd not infrequently; the artist rarely and rarelier still, the clergyman; the physician almost as a rule. He is the flower (such as it is) of our civilization."

Robert Louis Stevenson

Each month the AMA News carries an Ethics Forum. In the October 27, 1997 (Vol 40, #40) issue there is a question and resultant discussion concerning ethics of advertising or solicitation.

In times past, the answer would have been short and easy. It was proper and allowed to run a two column, two inch announcement for seven days in the local newspaper on opening a practice in a new town and perhaps the same space when changing locations in the same town.

All of this has changed, primarily due to the "public protecting (?)" efforts of the Federal Trade Commission and their vigorous antitrust division.

Today, as Cole Porter once opined, "Anything Goes." Perusing periodicals such as the Oklahoma City Gazette, one views ads that would make even manufacturers of underarm deodorant blush. Although separated by pages from enticements for "Christie's Toy Box", they are scarcely less explicit. Freedom of expression seems to have become freedom from good taste.

Other than marking me as an old fashioned prude, is there any reason for taking notice of these public notices? There is the private reason of pride in self and profession. Somewhere in the dim distant Norman Rockwell past is the vision that encouraged us to take up medicine even with its difficult entry requirements, its brain numbing and sleep depriving course of study and its years' deferring achievement of financial stability and independence. Surely most of us chose this path, at least largely, because of a desire to do something to better those around us or even society as a whole.

And what of society as a whole's current view of our profession? Certainly there has been a change from the paternalistic "Doctor knows best" view of medicine from past doctor and patient partnerships to a present view that doctors are servants of patients, hospitals and/or managed care organizations. Malpractice suits are brought over trivial and/or ridiculous matters. The negation of practicing medicine being the highest of calling was demonstrated in the Massachusetts "Nanny (au pair) murder trial" where public talk shows were bombarded with phone calls vehemently criticizing the mother because she chose to practice opthalmology three days a week instead of staying home to care for the child.

Is there a connection between the public's degraded perception of physicians and the slimy, sleazy ads a few doctors choose to run? Is the loss of physicians' pedestals just one aspect of the

What Would You Do?

A doctor in a metro area was cited for failing to maintain an inventory of controlled drugs, failing to turn in unused order forms following discontinuance of practice, and personal use of controlled drugs.

Testifying for himself, he admitted using amphetamines at times and obtaining them from his own supplies. He remarked, "Who is better able to handle drugs than a physician?" He stated he felt he had done nothing wrong but wouldn't do it in the future anyway.

Results in next issue.

From last time...

The Case of the Disappearing Doctor

Concerning the doctor who left the state while on probation and did not notify the Board of his location, it was decided to toll the remaining time of his probation until he returned to Oklahoma. If and when he did return and seek reinstatement of the license, the same terms would apply until the remaining time had expired. This then was adopted as a rule on any discipline imposed on a licensee who is outside the state where compliance with terms cannot be verified.

Hair Today — Gone Forever?

by Lyle R. Kelsey, CAE
Executive Director

One of the newest advertised medical services today is laser hair removal. A number of questions have been raised to the Medical Board about the use of lasers in hair removal because we license both medical doctors and electrologists. The Electrology Practice Act does not allow electrologists to utilize laser technology. Electrolysis is very narrowly defined in the law to the use of "electric current."

Medical doctors can use the new lasers for hair removal in their practice and can also hire a person and train them to utilize the laser under supervision. The supervision does not allow for a remote site operation away from the doctor's oversite. Medical doctors can hire electrologists but not to use a laser to remove hair, as that is outside electrologists' scope practice.

Another issue is that of "permanent" hair removal. Electrolysis does accomplish permanent hair removal by "destroying the germinative hair cells" but there is still scientific debate on whether hair removal by laser is permanent.

Advertising and yellow page listings need to reflect the current scientific information about the use of lasers and "permanent" hair removal and should not be connected with electrology. If you need any further information, please contact the Medical Board office at 405/848-6841 and press 5.

Board Meeting - November 20, 21, 1997

Licensing activity on these two days included issuing ten full, unrestricted licenses after personal appearances by the applicants. Five applications were tabled, primarily due to the applicants inability to appear. Two applications were denied, one due to revocation of another state's license because of drug abuse. The other denial was based on the school of graduation not being equivalent to the University of Oklahoma and multiple licensing exam failures. One application for Special Training License was denied due to multiple licensing exam failures.

Two requests to reconsider previous denial of applications were made. One was denied and the other tabled for more information.

Results of disciplinary hearings included one month-long suspension followed by permanent probation with standard terms for drug abuse. One existing probation was continued with the addition of mandatory psychotherapy due to alcohol use relapse. One Physician Assistant was placed on probation with standard terms for drug abuse and no practice in a remote setting. One Occupational Therapy Assistant was placed on indefinite bodily fluid monitoring. One charge of unauthorized use of opiates was dismissed.

Board Phone Numbers:


for Licensing press 1 (Information on licensees, renewals, applicants, and the application process)

for Investigations press 2 (complaints, probation, disciplinary action, information/process)

for Business Office press 3

for Data Processing press 4

for Executive Dept. press 5 (General information including continuing education, Board/Committee

Hired Guns

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

In the September 1997 issue of the Journal of Legal Medicine (Vol 18, #3), there is an article "Medicine on Trial, Physicians' Attitudes About Expert Medical Witnesses." It covers opinion surveys of Family Practitioners and Emergency Room physicians.

Admittedly the survey was taken in Iowa, probably not a hotbed of liberal philosophy but would most likely reflect Oklahoma thinking.

A modest majority (59.4%) hold that giving expert testimony was practicing medicine. A larger percentage (76.6%) thought the testimony should be subject to medical peer review and an overwhelming number (83%) thought witnesses should be subject to discipline by licensing boards if fraudulent testimony was given.

When state medical boards were queried about rendering expert court testimony, 25% considered it to be practicing medicine, 34.4% did not and 40.6% were uncertain. Only 18.8% of the replying boards had ever disciplined a physician for fraudulently testifying.

An interesting aspect which was not asked was whether a doctor would have to be licensed in the state where the testimony was given. Although to practice medicine usually and routinely requires licensure, most states have provisions for "occasional" or "rare" consultations without licensure and virtually all boards allow emergency (albeit uncompensated) treatment without licensure.

The full article is available at our office.

Privacy in Private Practice

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

Several issues back, we ran a short article on Oklahoma State laws concerning access to patients' records. Physicians Management magazine, October 1997, pages 11-14, has a discussion on Federal regulations concerning privacy (or more exactly the lack of same) of medical records.

The article probably contains little that will surprise or shock medical personnel but might encourage doctors to have serious thoughts on what should and should not be written down in patients' records and/or reported in diagnoses and insurance claims. There is the real dilemma of new federal requirements on justifying each and every lab test ordered, the ethical consideration that such diagnosis may be unjustly and permanently attached to a patient, and that information may be disseminated inappropriately.
ABMS CertifiedDoctor Web Site

The American Board of Medical Specialties is offering a new service that allows consumers to check physicians' credentials on the Internet free of charge. The service also will search for subscribing Board Certified Specialists using only a zip code and specialty or subspecialty. This is the most heavily traveled healthcare site on the internet, with over six million users since May 1997.

By inserting the correct spelling of a doctor's name, matching physician names will appear confirming certification status. Only the doctor's name, state, and specialty(ies) will appear.

By inserting the zip code of the desired geographical area and highlighting a specialty, all subscribing board certified doctors that meet the search requirements requested will appear along with any links to doctors' homepages and hospitals. The program also can develop web pages for physicians and hospitals.

The service is found at www.certifieddoctor.org. For more information on subscribing to appear in the search component, contact David at 1-800-733-2267 extension 158.
Doctor's Info On-Line

The Board's web site (osbmls.ok.state.us) has information on all actively licensed physicians practicing in the State. Information includes practice address, specialty, any board certifications, license number and date license was issued. The information is updated weekly. Physicians whose licenses aren't currently active or who aren't practicing in Oklahoma are not listed on the web site.

Other information available on the website includes the agenda for up-coming Board meetings, results of the last Board meeting and forms for ordering applications for licensure and renewal.

The address for e-mail is osbmls@osbmls.ok.state.us.

Update on CME Availability

The AMA News, November 10, 1997 (Vol 40, #42) announced that Category I credit will be given for reading specified articles in the JAMA. This service begins with the November 5, 1997 issue. Credit also is available through the Archives of Family Medicine.

CME Reminder #3

by Lyle R. Kelsey, CAE
Executive Director

The Oklahoma initial license and re-licensure application in the year 2000 will ask if you possess the AMA-PRA (American Medical Association Physician Recognition Award). If you do, that will suffice for the CME requirement (you will not have to send in the PRA Certificate). If you do not have an AMA-PRA, then you will need to verify that you meet the 150-hour CME requirement. The Board will audit randomly a number of licensees to verify that they actually have met the requirements.

The rule requiring 150 hours of CME every three years is in effect now (July 1, 1997) but is not reportable for licensure until the year 2000. Between now and 2000, physicians need to accumulate 150 hours (at least 60 in Category 1) in any specialty topic. While 150 hours appears onerous, there are many sources for acquiring hours at reasonable cost such as hospitals, specialty societies, O.U. Health Science Center, the internet, Audio Digest, JAMA and the AMA. Magazines like the Physicians' Travel & Meeting Guide list a large number of CME courses. Likewise, there are a significant number of commercial entities that offer CME.

You may contact the following for further information:

OUHSC-Dept. of Continuing Medical Education
800 NE 15th Street
PO Box 26901, ROB 202
Oklahoma City OK 73190
Phone 405/271-2350
FAX 405/271-3087

Email - cme@uokhsc.edu

AMA Web Page (free to AMA Members) -

http://www.ama-assn.org under CME courses and residency programs

AMA-PRA information is also on the AMA web page under Medical Science &