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Oklahoma Board of Medical Licensure and Supervision


Vol 11 No 3
September 2000

Death Certification

By Fred B. Jordan, M.D.
Chief Medical Examiner
Office of the Chief Medical Examiner

One of the functions of this office is to review all death certificates filed in the State of Oklahoma. It seems as if we are more frequently encountering situations in which the immediate cause of death is given as trauma and the manner of death is certified as natural without ever referring the case to our office for investigation. These cases then must be followed up often at times long after the patient has died. This makes the gathering of information particularly difficult and, if a civil or criminal charge should subsequently occur, puts all of us in a difficult position with regard to presenting pertinent evidence to the justice system.

The new Oklahoma death certificate offers two opportunities for certification. One is by the attending physician and the other is by a medical examiner. Only physicians specifically appointed by this Agency to serve their communities as medical examiners may certify in that category. Item #24a of the State of Oklahoma Certificate of Death serves notice to the attending physician that this certificate should be signed only for a natural illness for which he/she has followed the patient. Oklahoma Statutes clearly define the types of death in our state which must be reported to the medical examiner.

These include the following:

  • Any violent or unnatural death irregardless of the time interval between the injury and death.
  • Any deaths under suspicious, unusual, or unnatural circumstances.
  • Any deaths which might constitute a threat to public health in which the infecting organism is unidentified.
  • Deaths of any individuals unattended by a licensed medical or osteopathic physician for a fatal or potentially fatal disease.
  • Deaths of any individuals after unexplained coma.
  • Deaths that are medically unexpected and occur in the course of a therapeutic procedure.
  • Deaths of any prisoner in any place of penal incarceration.
  • Deaths of any individuals whose bodies are going to be cremated, buried at sea, or transported out of state.

Simply stated, if you have not followed the patient for a natural disease from which it appears that he or she has died, the case should be reported directly to the medical examiner's office.

Once again, only duly appointed medical examiners can legally sign any death certificate in which the death is not natural and attended. For physicians practicing in the western two-thirds of Oklahoma or at any time a question arises, please call (405) 239-7141. In the eastern one-third of Oklahoma, physicians may call (918) 582-0985.

Simply stated, if you have not followed the patient for a natural disease from which it appears that he or she has died, the case should be reported directly to the medical examiner's office.

The Office of the Chief Medical Examiner for the State of Oklahoma is staffed 24 hours a day seven days a week. We are anxious to assist you with any questions that you may have and to promptly institute investigations in any case in which we are required by law to generate both a Report of Investigation and death certificate. Please do not hesitate to call at any time should you have questions.

Oklahoma State Board of Medical Licensure and Supervision



[Adopted by the Board July 27, 2000]

These Guidelines are intended to assist Oklahoma medical doctors who are considering or currently practice ambulatory surgery or other invasive procedures which require anesthesia, analgesia or sedation in an office setting. These recommendations focus on quality care and patient safety in the office. These are minimal guidelines and may be exceeded at any time based on the judgment of the involved physicians. Minor procedures in which unsupplemented local anesthesia is used in quantities equal to or less than the manufacturer's recommended dose adjusted for weight, are excluded from these guidelines. Nevertheless, it is expected that any practice performing office-based surgery regardless of anesthesia will have the necessary equipment and personnel to be able to handle emergencies resulting from the procedure and/or anesthesia.

The OSMBLS wants physicians to be aware that compared with acute care hospitals and licensed ambulatory surgical facilities, office operatories currently have little or no regulation, oversight or control by federal, state or local laws. Therefore, physicians must satisfactorily investigate areas taken for granted in the hospital or ambulatory surgical facility such as governance, organization, construction and equipment, as well as policies and procedures, including fire, safety, drugs, emergencies, staffing, training and unanticipated patient transfers.

The following issues should be addressed in an office setting to provide a high standard of patient safety and to reduce risk and liability.

1. Quality of Care

  • A. All health care practitioners and nurses should hold a valid license or certificate to perform their assigned duties.
  • B. All personnel who provide clinical care in the office-based surgical setting should be qualified to perform services commensurate with appropriate levels of education, training and experience.
  • C. Policies and procedures should be written for the orderly conduct of the facility and reviewed on an annual basis.
  • D. The facility should be under the supervision and control of a qualified physician.
  • E. All surgical personnel must wear suitable operative attire.

Definitions of Supervision

Adopted by the Board
July 27, 2000

Supervise _ to oversee for direction. Supervision implies that there is appropriate referral, consultation, and collaboration between the supervisor and supervised, with the physician/patient relationships remaining intact.

Direct Supervision _ requires the physical presence of the supervising physician in the office or operating suite before, during and after the treatment or procedure and includes diagnosis, authorization, and evaluation of the treatment or procedure with the physician/patient relationship remaining intact. "Direct Supervision" and "Supervision and Control" are synonymous in this law and these rules.

Reporting to the National Practitioner Databank and the Medical Board

Attention Hospital Chiefs of Staff

In the last year, the Medical Board has begun reporting electronically to the National Practitioner Databank (NPDB) all adverse actions against its licensees. All other entities, including hospitals, also have begun reporting in the same manner.

The Board has received calls from hospitals asking if it is still necessary to send the Medical Board a copy of the report sent electronically to the NPDB. In checking with the NPDB, each reporting entity still is required by law to send the Medical Board a copy of the confirmation received from the Databank. The confirmation can be faxed or e-mailed as an attachment to the Department of Investigations.

Web Site: www.osbmls.state.ok.us
e-mail: investigations@osbmls.state.ok.us

Board Meetings

May 11, 2000

During a regularly scheduled meeting of the Board on May 11th, three full medical licenses were issued after personal appearances by the applicants. Two special licenses were approved _ one for residency training and the other limiting practice to the Indian Health Service Clinics. Two special licenses were denied _ one for residency training due to failure to produce requested information and the other due to lack of any unique contribution to Oklahoma health. Two applications for full medical licenses were tabled, the first so that a disciplinary report from a hospital could be obtained and the second so the applicant could produce a current psychiatric evaluation.

Two licenses were reinstated. One had been in suspension for five years and, after successfully passing the SPEX exam, was issued under terms of an agreement wherein the licensee agreed to continue in counseling and treatment, work in a controlled environment and not prescribe scheduled drugs. The other had been revoked for over one year and was reinstated under terms of agreement wherein the licensee agreed to continued counseling, monitoring of practice, testing upon the Board's request, and to have a chaperone present when treating female patients.

One Voluntary Submittal to Jurisdiction (VSJ) was accepted containing a reprimand for failure to establish a doctor/patient relationship prior to prescribing. One VSJ was accepted imposing a reprimand for prescribing controlled dangerous substances without establishing medical need and required the licensee to

[Reprinted with permission from the Alaska State Medical Board Fall 1999 BoardNews]

New Data Bank Goes On Line

Think there are enough folks out there keeping track of physicians? Well, think again and add another acronym to your vocabulary. With the passage by Congress of the Health Insurance Portability and Protection act of 1996, a new data bank was created. Meet HIPDB: Healthcare Integrity and Protection Data Bank. Reporting to HIPDB is mandated to begin November 1, 1999; reports dating back to 1996 must be reported retroactively.

While there are some similarities to the National Practitioners Data Bank (NPDB), there are several important differences. The charts below give a comparison between the two data banks.

Comparison of Current NPDB and New HIPDB Reporting Requirements
Type of Action NPDB HIPDB
Licensure Actions Physicians/Dentists All licensed health care practitioners, suppliers and providers
Clinical Privileges
(including panel membership)
Voluntary on other licensed providers
Not Collected
Professional Society Membership Physicians/Dentists
Voluntary on other licensed providers
Not Collected
Medical Malpractice Payments All licensed providers Not Collected
Medicare/Medicaid Exclusions All licensed providers All licensed health care practitioners,
suppliers, and providers
Criminal Convictions
(health care related)
Not Collected All licensed health care practitioners,
suppliers, and providers
Civil Judgments Not Collected except Malpractice All licensed health care practitioners,
suppliers, and providers
Other Adjudicated Actions Not Collected All licensed health care practitioners,
suppliers, and providers

Who Reports and Who Queries – NPDB vs. HIPDB
Mandated Reporting Organizations:
Medical malpractice payers
Other health care entities (including managed care)
State medical and dental boards
Professional societies
HHS Office of Inspector General (exclusions)
Mandated Reporting Organizations:
Health plans
Federal agencies
State agencies
Organizations Mandated to Query:
Organizations Mandated to Query:
Organizations Who May Voluntarily Query:
Other health care entities (including managed care)
State medical and dental boards
Other state practitioner licensing boards
Professional societies

Organizations Who May Voluntarily Query:
Health Plans
Federal Agencies
State Agencies

Board Meetings,

July 27, 2000

At the July Board meeting, seven applications for full medical licensure were approved after personal appearances by the applicants. Three special licenses for training were approved with one being issued under standard terms of agreement for history of substance abuse during medical school.

One Voluntary Submittal to Jurisdiction was accepted following loss of hospital clinical privileges. The VSJ imposed a formal reprimand and prohibited the practice of anesthesiology. One license was surrendered in lieu of prosecution after a resident resigned from his training program.

The Board adopted two important items - the Definitions of Supervision and Guidelines for Office-based Surgery and Other Invasive Procedures. Both are contained in this newsletter.

There were two surrenders of medical licensure in lieu of prosecution. One was for repeated relapses of chemical abuse. The other involved sexual misconduct, fraudulent application, falsely reporting a crime, fee splitting and violations in prescribing controlled dangerous substances.

June 23, 2000

In a meeting primarily devoted to licensing of incoming residents, the Board issued twenty-two Special Licenses for training and nine full licenses. One special license for an organ transplant team member was approved.

One special license for training was denied after it was established that the applicant had supplied false information concerning exam history.

Four applications were tabled pending additional information. One application was tabled until the applicant completes treatment for chemical abuse.