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Oklahoma Board of Medical Licensure and Supervision


Vol 11 No 1
March 2000

Chasing the Impossible

by Gerald C. Zumwalt, M.D.

I saw a man pursuing the horizon;
Round and round they sped.
I was disturbed at this;
I accosted the man,
"It is futile," I said,
"You lie," he cried,
And ran on.

Stephen Crane

Last year, a panel discussion was held at Tulsa University concerning the under-treatment of pain in the elderly. There was a general consensus that there is needless suffering, particularly in inhabitants of nursing homes, due to under prescribing of opioids.

Many theories concerning factors in treatment decisions were advanced. These included inarticulation of the amount of pain on the part of the patients or reluctance of nursing home staff, hospital personnel and families to administer adequate timely doses of prescribed painkillers. Other factors included inadequate education on the subject of proper medications and/or proper dosing of medications and physicians' fear of prosecution by various regulators for prescribing the correct amount of narcotics or other pain altering products.

There is currently a bill, passed in the U.S. House of Representatives and set to be discussed for compromise with similar legislation adopted in the Senate, which prohibits physician-assisted suicide but encourages adequate addressing of patient pain. Two bills passed through the Oklahoma Legislature in the last session that individually spoke of these subjects. Conversely, here at the Board we continue to see cases where doctors carelessly, or for profit, prescribed narcotics without medical need, sustaining and encouraging addiction and/or street distribution.

Oregon recently became the first state to discipline an M.D. for under treatment of pain. All state boards, through the Federation of State Medical Boards, have encouraged practitioners to follow practice guidelines and provide necessary medications for pain of all types. Copies of the Federation guidelines and our Board's rules on treatment of intractable pain are available at this office. The Agency for Health Care Policy and Research (US Dept. of Health and Human Services) has published clinical practice guidelines for Management of Cancer Pain (AHCPR Publication #94-0592) and Acute Pain Management (AHCPR 92-0032).

In Stephen Crane's poem, the man chasing the horizon has an unattainable task. It is possible that practitioners and regulators may never achieve the perfect balance between the needs of the individual and the protection of the public. But, it is essential that both groups grope toward the best compromise in compassionate and educated deliberation.

"There was a general consensus that there is needless suffering . . . due to under prescribing of opioids."

"Conversely, . . . we continue to see cases where doctors have carelessly, or for profit, prescribed narcotics without medical need . . . ."

Board Meetings

November 4, 5, 1999

Five licenses were approved after personal appearances by the applicants. Two medical license applications were denied — one for failure to supply requested information and one for multiple exam failures.

One Respiratory Care Practitioner (RCP) application was approved with an agreement to monitoring for substance abuse. Another RCP application was denied based on the applicant knowingly practicing for three years without making application for licensure.

One special license for training was approved but, due to multiple exam failures and poor residency performance, the license was limited to one year. The applicant then must make another appearance before the Board prior to renewal.

One Physician Assistant license was reinstated under terms of probation after a one-year suspension for filing a fraudulent application and fraudulent prescribing of controlled drugs for self and others.

A disciplinary hearing for sexual misconduct resulted in acceptance of one Voluntary Submittal to Jurisdiction with terms of probation including evaluation, counseling and continued education on sexual boundaries.

Other disciplinary hearings resulted in the revocation of two medical licenses. One case involved multiple violation of narcotic laws and unlawful use of an unapproved drug (laetrile). The second case was based on diversion of Demerol intended for patients.

January 20, 21, 2000

One special training license and one special license were issued.

Five full medical licenses were issued. One physical therapy license was granted under terms of an agreement that included psychological counseling and the presence of a chaperone on any professional encounter with females. Two applications were denied. One due to nonappearance by the applicant and one due to multiple licensure exam failures and filing a fraudulent application.

One appeal for reinstatement of a license previously revoked for sexual misconduct was denied.

What's In A Name?

In most states, and in Oklahoma in the past, the agency that issues medical licenses and imposes discipline on those licenses is called the Board of Medical Examiners. In Oklahoma this was changed to the Board of Medical Licensure and Supervision in part because the receptionist tired of answering inquiries as to where to send the bodies.

Title 63, Section 931-954 of Oklahoma law establishes the Board of Medicolegal Investigations and Office of the Chief Medical Examiner. Although this primarily is of interest to those involved with forensic medicine, there are sections that state the duties of all practitioners in notifying the proper authorities and handling bodies.

Section 938 lists the types of deaths that must be investigated by the medical examiner. It includes:

  • By violence
  • By suspicious, unusual, or unnatural means
  • After unexplained coma
  • Unattended by a licensed medical or osteopathic physician (attended does not necessarily mean physical exam but does require assuming responsibility for medical care)
  • Medically unexpected and occurring in the course of a therapeutic procedure
  • While in penal incarceration (state, county or city and including residents of state mental institutions and state run veterans' centers)
  • Related to disease that might constitute a threat to public health
  • Body to be cremated, buried at sea, transported out of state, or made unavailable for further pathological study

Section 941(a) gives the time period following death (three hours) after which the body must be released, upon demand, to the legal heirs and the three instances in which this limit does not apply.

Section 941(b) mandates the preservation by the attending physician of evidence that might be needed by the Medical Examiner.

Of academic interest is Section 944.1, which treats the pituitary gland as a unique object in the law. No other body part has its own section.

Five licensees appeared with Voluntary Submittals to Jurisdiction imposing five-year probations under standard terms for substance abuse. One had additional terms involving sexual misconduct. Three had previously been suspended for three to six months. One additional Voluntary Submittal to Jurisdiction was adopted providing for a two-year term of probation for sexual misconduct.

One hearing was conducted for charges of criminal violations of narcotic laws and substance abuse. A four-month suspension was imposed to be followed by a five-year period of probation.

One license was surrendered in lieu of prosecution for violation of probation concerning substance abuse.

One allegation of sexual misconduct was not proven by a clear and convincing level of evidence.

Another word about Late Renewal Fees

Every year the Board gets a few angry phone calls and letters from physicians who have failed to renew their license on the due date. Many have very legitimate reasons for missing the date but are upset to find out that they owe an additional $125 late fee. Obviously, they are no happier when they find out that the late fee can not be waived.

Briefly, here is the renewal process:

  • The renewal reminder and form are sent approximately two months in advance to the most current mailing address in the physician's file. The Medical Board should be notified of any change in practice or mailing address. In order to avoid the late fee, the renewal form needs to be postmarked on or before the first (1st) day of the renewal month. Renewals received on the 2nd day of the month are considered late and will be assessed a late fee.
  • Physicians whose renewals are received on the 2nd day of the month will be notified that the license is temporarily suspended until the late fee is received no later than sixty (60) days from the due date. NOTE: the license is technically inactive during this time until the total fee $ 275 ($150 + $125) is received.
  • If the license is not renewed within 60 days after the due date, the physician has to go through the complete reinstatement process as a brand new license application with a fee of $400. This can often be a lengthy procedure and the license is suspended during the reinstatement process.

In summary, the Medical Practice Act is very specific that a physician can renew anytime before the due date up to the day the license is due but after that the license is in suspension and the physician is practicing without a valid Oklahoma Medical License. The physician has 60 days to complete the renewal form and pay the normal $150 plus $125 late fee to renew their license

The nine-member Medical Board has been unswayed by the various reasons for failure to renew a license on time. The Board will not waive the late fee. Some physicians have asserted that they didn't receive a renewal statement from the Board in the mail. Rule 435:10-7-10-(b) says, "It shall be the affirmative duty of each licensee to comply with re-registration requirements. No grace period beyond that provided by law shall be allowed. The Board will not hear requests for extensions for re-registration or exemption from any re-registration requirement that the licensee did not receive re-registration materials." [Emphasis added.]

This article is written to inform physicians that they need to re-register (renew) their license early and not to depend on someone else in the office to do it as the consequences can be embarrassing and expensive. The Board Staff will continue to look for ways to help physicians meet their license requirements such as other reminders and future Internet use. However, the license to practice medicine is significant enough that each physician needs to be aware of the renewal process. Please contact the Board if you have any questions.
Board Meetings

Read Your Journal

by Gerald C. Zumwalt, M.D.

The JAMA (Sept. 1, 1999, Vol. 282, No. 9) contains several interesting and provocative articles concerning the questionable impact of formal continuing medical education and the even more questionable effectiveness of medical schools teaching of professionalism ("constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest"). Several articles address concerns as to how sufficient any teaching is in imparting the essential mind set and attitudes of professionalism since these are shaped by multiple influences including "interactions with faculty, house officers, patients, staff and other students." Since the entire issue is dedicated to education, it does not address the situation of possible deterioration of professionalism that may develop in long time practitioners.

Other interesting aspects printed in this issue include enrollment by school of male and female students, now approximately three males to two females, and current cost of tuition and fee per year of medical schools. The highest cost was at Boston University, a private school, at over $34,000. The lowest private school was Baylor at $7500, although they charge this only to Texas residents with outsiders paying $16,000. The highest state related school rate is at Temple in Philadelphia at $23,000 for residents and the lowest is East Carolina at $3000 ($23,000 for nonresidents). By way of comparison, the University of Oklahoma charges $10,000 for residents and $24,000 for nonresidents.