Oklahoma State SealOklahoma State Seal
Oklahoma Board of Medical Licensure and Supervision
Issues and Answers - November 2001

Issues and Answers

November 2001
Vol 12 No 2

Who's Treating Your Patients

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

At the Board, we recently received a copy of a "Natural Care Consultation Record." The stated purpose says, "This consultation is intended to improve the use of natural products, prescription, nonprescription medicines and products, non-drug approaches to self-care and/or referral to other health care providers."

Information to be noted on the four-page record includes blood pressure, pulse, UA, blood sugar, resistance/reaction (time?), saliva ph, zinc tally, Chvostek, MSQ (?), height and weight. Services to be rendered after this evaluation are numerous but include menopause treatment, prostate health, pain management, laboratory screenings, detoxification, anti-aging, and so on ad infinitum.

Now you may wonder whether the Mayo Clinic or some similar prestigious medical institution has come to Oklahoma City. Instead, all these medical miracles are being done by a "Lifestyle Education Assistant" under the supervision of a pharmacist.

Since the forms are worded carefully to avoid the use of terms like diagnosis and/or treatment (instead it uses "plan" and "assessment"), the Pharmacy Board allows and/or encourages this activity.

Aside from stirring up your ire and splenic juices, there is a purpose to this disclosure. It behooves all medical practitioners to inquire fully and repeatedly of our patients what over-the-counter or "natural" health products they are taking. The stew pot of herbs and chemicals available in health food and grocery stores as well as pharmacies has the capacity to chew up a liver or flatten out a brain in world-record time.

You can rest assured that when a drug incompatibility does occur with disastrous results, the malpractice lawyer will not be suing a grocery clerk. The target will be the same deep pocket the attorneys always explore.
"You can rest assured that when a drug incompatibility does occur with disastrous results, the malpractice lawyer will not be suing a grocery clerk."

The Board adopted the following policy on Internet prescribing in their January meeting. NOTE: these guidelines, although formulated locally, accurately reflect national standards adopted by many state medical boards.

Don't Jump Yet!

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

Before leaving office, President Clinton signed into law, "The Children's Health Act of 2000" (CH.R. 4365) and section 3502 which sets forth the "Drug Addiction Treatment Act of 2000". (What drug addiction has to do with children's health may be a mystery but so are many acts of Congress.) This section will permit private office-based treatment of opiate addiction with opiate medications as opposed to mandating such treatment in so called methadone clinics.

Before rushing into this perhaps lucrative field, one should examine section 3502 carefully and at length. There are numerous requirements now and regulations and guidelines will be forthcoming. Presently the new law allows "Qualified physicians" (defined in Section 3502 (2) (G) (ii) (I) _ (VII)) to apply for a waiver to utilize Schedule III, IV or V narcotics for long-term treatment or supervised withdrawals as long as the drug has been approved by the FDA for this purpose. Herein lies the Catch 22 since currently there are no approved medications that meet this requirement, although the use of buprenorphine in this manner is expected soon.

The Federation of State Medical Boards has proposed development of policy guidelines in association with other interested groups. The Federation has strongly supported adequate and proper use of opioids (their guidelines are in line with OSBMLS rules on use of narcotics for chronic non-cancer pain) but has also always urged strict standards for licensing and discipline.

Policy on Internet Prescribing

The Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act (Title 59 O.S. 480 _518) also known as the "Medical Practice Act" defines the practice of medicine in part as "A physician that for a fee or any form of compensation diagnoses and or treats disease, injury or deformity of persons in this state by any allopathic legend drugs, surgery, manual, or mechanical treatment" (Section 492 A). Physicians rendering care to patients in Oklahoma must be licensed in Oklahoma.

Further, the Medical Board was established to protect the health, safety, and well-being of the citizens of Oklahoma by investigating complaints and disciplining physicians (MD) for unprofessional conduct as set out in the Medical Practice Act and corresponding Administrative Rules. Unprofessional conduct includes "prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician/patient relationship" (Section 509-13).

The members of the Oklahoma Medical Board have interpreted that a "sufficient examination" and "establishment of a valid physician/patient relationship" can NOT take place without an initial face to face encounter with the patient. In other words, it requires at a minimum:

1. Verifying that the person requesting the medication is who they claim to be;

2. Establishing a diagnosis through the use of accepted medical practices such as a patient history, mental status exam, physical examination and appropriate diagnostic and laboratory testing by the prescribing physician;

3. Discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and

4. Insuring availability of the physician or coverage for the patient for appropriate follow-up care. Appropriate follow-up care includes a face to face encounter at least once a year and as often as it is necessary to insure safe continuation of medication.

Complete management of a patient by Internet, e-mail, or other forms of electronic communications is inappropriate.

The Oklahoma Medical Practice Act does provide for a physician to physician consultation (in-state or out-of-state) on an occasional basis that would not have to meet the aforementioned four (4) requirements. (Section 492-D-8)

(Adopted 11/02/00, Ratified 01/25/01)

Board Meeting Results

January 25, 26, 2001

Four full and unrestricted medical licenses were granted after personal appearances. In addition, one license was approved with an agreement that practice specific CME would be obtained and that cases involving high-risk obstetrics would be reviewed by a Board Certified consultant. One reinstatement was granted with an agreement that only Ritalin in Schedule II would be used and that any diagnosis of new disease in patients would trigger an immediate notification of the primary care physician. One license was renewed with an admonition concerning the doctor practicing after his prior license lapsed. One license was denied due to multiple exam failures.

Two training licenses were approved. One Special licensure application was denied when the Board found there was no unique benefit to the public.

Disciplinary actions included a revocation due to aiding and abetting the unauthorized practice of medicine. Two licenses were surrendered in lieu of prosecution—one followed a conviction of medical fraud and the other was a result of obtaining her license by fraud (failure to report a previous felony mail fraud conviction).

One license was suspended until treatment for substance abuse could be completed satisfactorily.

Reprimand and probation were imposed on three doctors—one for failing to report disciplinary action taken in another state, one for violating a term of probation requiring any medication taken to be ordered by a treating physician, and one for practicing impaired while under the influence of a prescribed drug and self-medicating with an addictive drug.

Actions on Physician Assistants included one case dismissed and four cases proven. A reprimand was issued for falsely reporting a doctor as supervisor. Reprimand and probation were issued to two PAs for writing CDS without DEA certificates. Reprimand and probation were issued for sexual misconduct.

One electrologist was reprimanded for practicing beyond the legal scope of practice.

March 15, 16, 2001

Two applications for full licensure were denied due to failure to produce requested information. One license was reinstated following a four year absence from clinical practice with an agreement that all hospital admissions would be reviewed by a Board Certified surgeon and the first 25 surgeries performed would be with the assistance of a Board Certified surgeon. One Occupational Therapist license was issued under standard terms allowing monitoring for personal chemical use.

One motion for modification of probation terms involving prescribing of CDS was allowed and one was denied. One Respiratory Care Practitioner was placed on a five-year probation under standard terms due to personal chemical abuse. One Respiratory Care Practitioner license was surrendered due to personal chemical abuse. One MD license was suspended for 60-90 days to be followed by an indefinite probation due to relapse in alcohol abuse. One MD license was suspended until a disciplinary matter is resolved in another state.

The next Board meeting is scheduled for May 3, 4, and 5, 2001.

435:1072. Use of Board certification

Allopathic physicians in Oklahoma who may lawfully claim to be "Board Certified" or "Certified by" or a "Diplomat" or "Fellow" are only physicians who have presented to the Oklahoma State Board of Medical Licensure and Supervision evidence of successful completion of all requirements for certification by a member Board of the organization of American Board of Medical Specialties as listed by the American Medical Association, or by any other organization whose program for the certification requested has been found by the Board to be equivalent thereto.

[Source: Amended at 11 Ok Reg 4535, eff 7-27-94 (emergency); Amended at 12 Ok Reg 1223, eff 5-11-95]

Board Certified?

It has been brought to the attention of the staff by both patients and physicians that some doctors are claiming to be "Board Certified" when the requirements of OAC 435:10-7-2 Use of Board Certification have not been met. Continued violation of this portion of the code may result in disciplinary action against the licensee.

The Oklaho ma State Board of Medical Licensure and Supervision must approve any individual who wishes to claim Board Certification status by a Board that is not an American Board of Medical Specialties Board.

This section of the code is printed to the right. If there are any questions as to interpretation, the staff will respond to written or telephonic inquiries.