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Oklahoma Board of Medical Licensure and Supervision
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ISSUES and ANSWERS

Vol 10 No 2
May 1999

Your Own Y2K Problem

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

Sands of timeHands on a ClockTurning of Calendar Pages

Choose whatever simile you desire but be forewarned, the requirement for Continuing Medical Education to acquire and sustain a medical license in Oklahoma becomes effective July 1, 2000.

We previously published the rule but, physicians being the professional procrastinators that they are, we are reprinting it now.

435:10-15-1. Continuing medical education

(a) Requirements.

(1) Effective July 1, 2000, each applicant for licensure, re-registration of licensure or reinstatement of licensure shall certify that he/she has completed the requisite hours of continuing medical education (C.M.E.).

(2) Requisite hours of C.M.E. shall be one hundred fifty (150) hours within the preceding three (3) years of which sixty (60) hours will be Category I as defined by the American Medical Association/Oklahoma State Medical Association/American Academy of Family Physicians or other certifying organization recognized by the Board.

(b) Exceptions/verification.

(1) Exceptions from the requirement shall be:

(A) Medical Doctors in residency and fellowship programs.

(B) Medical Doctors in a Physician Emeritus status.

(C) Holders of current American Medical Association Physician Recognition Award (A.M.A.P.R.A.) or its specialty equivalent or recertification by specialty group whose program for the certification has been found by the Board to be equivalent to the Physician Recognition Award.

(2) The Board staff will, each year, randomly select applications for verification that all C.M.E. requirements have been met. Physicians choosing to use programs other than the A.M.A.P.R.A. must submit additional documentation on request as evidence that the compliance with C.M.E. requirements have been met in the specified time period.

(c) Compliance.

(1) Failure to maintain such records rebuts the presumption that C.M.E. requirements have been completed.

(2) Misrepresenting compliance with C.M.E. requirements constitutes a fraudulent application.

[Source: Added at 14 Ok Reg 1413, eff. 5-12-97]

The mechanism for reporting compliance with this requirement will be short and simple and be a part of the annual reregistration form. If there is any question as to need to comply or what courses or material may be pertinent, now is the time to inquire.

So "gather thee rosebuds while ye may" but don't follow the path of the unicorns to the Ark.



Practitioner, heal thyself _

Advice by W. Walter Menninger, MD

"These are stressful times for clinical practitioners. . . . At the Menninger Clinic fewer staff are treating more patients for shorter periods of time."

Although the focus of this paper (available at our office in its entirety) is toward psychiatric personnel, the descriptions of stress and resultant advice are pertinent to all heath providers. Dr. Menninger describes both the stresses imposed on the practitioner by himself and by others. "Absorbing information about suffering. . . includes absorbing suffering itself. . ."

Physicians tend to be perfectionistic, inpatient, demanding workaholics. "Many physicians don't get much fun out of life." Trying to control the uncontrollable leads to a sense of failure.

Symptoms of stress can be psychological—anxiety, worry, fear, irritability, loneliness; physical—various aches, GI problems, insomnia, sexual dysfunction; behavioral—overeating and smoking, repetitive body movements, procrastination; or interpersonal—temper, decreased tolerance toward others resulting in marital and family problems.

He gives strategies for coping, including healthy defense mechanisms: sublimation, suppression, anticipation, altruism and humor. Taking adversity less personally and finding activities outside practice are recommended as is looking for support in those close to us. "Finally, we must acknowledge our limits and take time to put things into perspective."

He quotes the well known A.A. Serenity Prayer and then Walt Kelly's Pogo, "We has met the enemy and it is us."


CME FAQs

Frequently asked questions about the new continuing medical education requirements.

How many hours do I need? —150 total hours with at least 60 in Category I obtained within the preceding three years.

When do I have to report my hours? —Reporting starts in July 2000 as each physician renews his/her license within the time period of July 2000 to June 2001 and every three years thereafter.

How do I report my hours? —Questions on the annual renewal form will ask if you have met the CME requirement and how you have met it (i.e., the A.M.A.'s Physician Recognition Award, self-tracking, residency training, etc.). A certain percentage of physicians will be selected for an audit and will provide proof of CME at that time.

Are there any exemptions? —Yes. Physicians in residency programs and fully retired physicians, including those in the Physician Emeritus status, who do not renew annually.


From Other Climes

Legal Medicine Perspectives (Vol 5, #6) reports a case recently decided by the Idaho Supreme Court (Shabinaw vs. Brown) which reiterates a generally accepted standard for informed consent:

"A valid consent must be preceded by the physician's disclosure of such pertinent facts to the patient that s/he is sufficiently aware of the need for, the nature of, and the significant risks ordinarily involved in the treatment to be provided, in order that the giving or withholding of consent be a reasonably informed decision. The requisite pertinent facts to be disclosed to the patient are those which would be given by a like physician of good standing practicing in the same community."


George M. Brown, Jr., MD, McAlester, and long time OSBMLS Board Member was given a special recognition award for his many years of service to medicine and the medical board. The award was presented at the national Federation of State Medical Board's Annual Meeting in St. Louis, Missouri on April 24th. He and his wife Mary were honored at the Federation's 44th Annual Dr. Walter L. Bierring Dinner and Lecture that featured Nancy Dickey, MD, AMA President. Congratulations Dr. Brown.



Board Meeting

March 4, 1999

The Oklahoma State Board of Medical Licensure and Supervision met in regular session on March 4, 1999, to consider license applications and disciplinary hearings.

Three full medical licenses were issued following personal appearances by applicants. Another applicant was granted a full medical license on presenting evidence of having become Board Certified after having previous problems with licensing exams. One special training license was converted to a full medical license under terms of an Agreement mandating continued counseling. One application was tabled until information could be furnished explaining multiple practice moves. One application to return to full licensure after having been in the Physician Emeritus status for over ten years was tabled pending satisfactory completion of the Special Purpose Examination (SPEX).

A request to waive the mandatory supervised practice period for a foreign educated Physical Therapist was denied.

One period of probation and one Agreement for practice were ended.

Two licenses were revoked for sexual misconduct. One Physician Assistant license was suspended and a formal reprimand issued for filing false information on a job application.

Probation of one physician was modified to allow prescribing of Schedule III, IV, and V drugs on serially numbered, duplicate prescriptions.


Once again, ethics

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

Catching up on reading previously received-and-stacked-in-a-corner medical mail, I recently read the October 5, 1998 (Vol. 41, #37) issue of American Medical News which contains the monthly Ethics Forum.

The first scenario involves how to ethically handle an impaired colleague. (Legally this is addressed in Oklahoma Administrative Code 435:10-7-4(42)—Failure to inform the Board of a state . . . of any . . . health professional which constitutes . . . a threat to the public.) The opinion covers the dangers of alcohol consumption by the medical profession and the advisability of personal versus physician recovery program confrontation.

This Board has always utilized and encouraged affiliation with Oklahoma's Physician Recovery Program and maintains a hands off policy for those physicians who undergo evaluation and treatment before they come to the attention of our Board and who maintain satisfactory compliance with the Program.

A second scenario involves the problem of socializing in a small community while still maintaining proper objectivity (the "Northern Exposure" syndrome). The answer is a plea for simple good sense and good judgement.

Both segments are well worth reading and pondering.


Proper Prescriptions

It has long been taught for proper protection that each medication prescription warrants its own page. This reduces the chance for mistakes in filling as well as instructing the patient in the number of medicines to take.

It is now mandated that prescriptions for scheduled drugs must be on separate forms. Oklahoma Administrative Code (Okla. State Bureau of Narcotics and Dangerous Drugs) 475:30-1-4(c)(3) states, "Each scheduled drug shall be written on a single prescription form, and no other prescriptions (controlled or non-controlled) shall be written on the same prescription form."

The Code portion pertaining to the Bureau of Narcotics was amended in 1995. Doctors depending on copies of the Act and Code distributed prior to the revision may find themselves inadvertently in violation.

For current copies, contact the
Bureau of Narcotics and Dangerous Drugs Control
4545 N. Lincoln Blvd., Suite 11
Oklahoma City OK 73105
(405) 530-3131


And Other Reminders

In the October 1998 issue of Medical Legal Lessons there were three questions answered which could affect your practice.

The first was legal concerns associated with the use of e-mail from doctors to patients. Some e-mail programs monitor messages, so confidentiality may be breached. Oklahoma law requires all doctors treating Oklahoma patients electronically to have Oklahoma licenses, and some other states have similar statutes. The extent of diagnosing and treating without personal examination can become material for malpractice suits.

A second matter raised was that of treating relatives. In Oklahoma, it is unprofessional conduct (OAC 435:10-7-4(26)) to supply controlled substances to a family member within the second degree of affinity except where no other doctor is available to respond to an emergency. The AMA Current Opinions regards any treatment of family members (except in emergencies) as unethical. This primarily is due to lack of physician
objectivity and patient autonomy. A lack of patient records also becomes a legal briar patch (OAC 435:10-7-4(41)).

The last question was one which pops up not infrequently among patient letters to this agency. This is the failure of a doctor to advise a patient of abnormal lab results. "Her failure to inquire probably does relieve you of liability. The physician has a fiduciary duty to the patient to make full and fair disclosure of all facts that materially affect the patient's rights and interests." Such failure could present both a malpractice and a licensing problem (OAC 435:10-7-4(11)(15)(36)).