ISSUES & ANSWERS

March 2002

No Grace Period

by Gerald C. Zumwalt, MD
Board Secretary/Medical Advisor

Oklahoma law (Title 59 O.S. § 491 & 492) is clear. Except for a very few exceptions (§ 492D), it is unlawful to practice medicine in Oklahoma without a medical license. Violation of this section is a misdemeanor and subject to a fine ($1000 - $5000) for the first day of offense and both a fine and imprisonment (30 –180 days) for each succeeding day of offense. What constitutes the practice of medicine is defined in § 492 A & C. Section 495b prohibits practicing without a current renewal and carries both a fine (not less than $1000) and states such practice shall constitute grounds for the revocation or suspension of the license.

Recently there have been a number of MDs who have not been allowed to renew their license due to legal regulations of the Oklahoma Tax Commission. Some have continued to practice while coming into compliance with the OTC and after their licenses have expired. This practice is illegal.

There also has been misunderstanding of the 60-day “grace period” allowed by § 495d. This section does not allow practice during this two-month period but only allows the reinstatement of the license on payment of the original plus a late fee. After this 60-day period the reinstatement requires a payment of $400 and providing original college medical school transcripts, proof of residency training and reports from all other pertinent sources, just as if no Oklahoma license had ever existed.

To repeat, in order to practice medicine in Oklahoma you must have an Oklahoma license. When or before it expires (as shown on your wallet card) it must be renewed. Without a current renewal, you cannot practice. THERE IS NO GRACE PERIOD FOR PRACTICING.

Who Will Bell the Bells?

by Gerald C. Zumwalt
Board Secretary/Medical Advisor

In developing the long-term strategic plan for this Agency, one goal is to decrease unactionable complaints. Currently, approximately 40-50% of public complaints we receive concern actions that do not fall within the scope of definition in the Medical Practice Act. Many of these are reports of telephone calls being ignored, unduly delayed, or handled in a rude or insulting manner.

Many of us have had the unpleasant and totally frustrating experience of calling the IRS or Social Security Administration or even some large chain drug stores and being put through a multitude of “touch-tone choices” before (if ever) finally reaching a real and even occasionally knowledgeable person. One false touch of the dial pad, or even a reasonable hesitation to decide which of several inappropriate alternatives that have been offered, and suddenly you can be out in the virtual street pounding on the virtual front door again.

As frustrating and apparently time consuming as these encounters can be to you - an intelligent, educated and technically sophisticated professional - think how it must be to your patients, some of whom are virtually illiterate, sight impaired and all of whom are in pain, real or imagined.

Try a small experiment (doing experiments might even make you feel college-aged again). Pick up your home phone and call your office. Be ready to use a feigned accent. See how long the phone rings before it is answered. Count how many choices have to be made before an appointment person can be reached. Consider how friendly, helpful and accurate the person answering is, and then decide if making some changes in phone procedures might reduce the number of public complaints your patients send to us. Ponder if phone politeness and promptness might elevate the public’s view of our profession. And for goodness sake, please return calls to patients and fellow physicians when a promise to do so has been made.

After all, “. . . never send to know for whom the bell tolls; It tolls for thee.” (John Donne)

Board Meetings

November 8, 9, 2001

The Board met in regularly scheduled session on November 8 and 9, 2001. Multiple items were considered. Three full and one special training licenses were issued after personal appearances. One special training license was not reconsidered after previous denial. One Respiratory Care applicant was denied licensure due to use of false information on the application. One MD was denied reinstatement for failing to fulfill the requirements of mandated drug abuse treatment.

One medical license will be reinstated after a 90-day suspension due to practicing without a current renewal. One license was suspended until the physician obtains the required CME hours. One license was suspended until his Idaho license is reinstated following a conviction of sexual misconduct there. One license was suspended for one year and it was mandated that an evaluation and treatment, if indicated, for sexual disorder be accomplished during that time. One license was suspended for 90-days to be followed by a five-year probation under standard terms for personal substance abuse and violation of narcotic laws. One reprimand was issued for failing to report a misdemeanor charge on the annual renewal form. Two licenses were surrendered in lieu of prosecution, one for over prescribing and prescribing without need of CDS and one for personal substance abuse. One license was revoked for conviction of a felony in another state.

January 17, 18, 2002

The Board of Medical Licensure and Supervision met in regularly scheduled open meeting on January 17th and 18th. Six full medical licenses were issued and two medical licenses were reinstated after personal appearances by the applicants. One application was tabled until the applicant takes the Special Purpose Exam (SPEX) due to a long hiatus from practice. One application for a Special license was denied since no unique benefit to Oklahoma was proven.

Results of disciplinary hearings included dismissal of six complaints for failure to obtain mandated continuing medical education after the licensees appeared and produced evidence of satisfactory completion of the required hours. One case of sexual misconduct failed to be proven by clear and convincing evidence. Terms of probation for one MD were modified to allow prescribing of non-narcotic Schedule II medications.

Letters of concern were placed in the public files of a Physician Assistant and his supervising physician for writing CDS drugs without having the required certificates.

One previously imposed suspension was continued indefinitely after the doctor had undergone evaluation for continuing competency. One license was suspended until acceptable evaluation and treatment for substance abuse is obtained. One suspension of 120 days followed by a five-year probation for personal substance abuse was imposed. Following repeated episodes of substance abuse relapse, a suspension of at least one year with reevaluation at an acceptable center during that year was ordered.

Return Required

Pain management utilizes many modalities, including controlled dangerous substances (i.e. all scheduled medications). Patients vary in their response to the various drugs and the dosage of these drugs. To achieve the desired relief from pain while still maintaining safe levels of consciousness and adequate cognitive function often entails a trial and error prescribing of medication.

A fairly standard term in pain management doctor/patient contracts (a necessary and recommended instrument) demands the return to the doctor of any unconsumed medications whenever a replacement drug is issued. This serves the salutary result of preventing overdosing, confusion or diversion.

There is, however, a legislated duty involved when the return occurs. All CDS must be destroyed according to law. Title 63, Section 2-315 (A) states any registered person “ . . . shall submit for destruction all controlled dangerous substances which are out-of-date, which are unwanted, unused or . . . abandoned.” Section 2-215 (B) requires that such substances be inventoried and transported in a manner specifically listed.

All offices involved in handling discarded or out of date CDS need to review these requirements.

In Whose Hands

by Gerald C. Zumwlat, MD
Board Secretary/Medical Advisor

The Oklahoma State Board of Health has published and distributed the 2002 State of the State’s Health Report. Since you as taxpayers paid $7,800 for it, it deserves to be read and considered.

Not surprisingly, the “State of the State’s Health” is not good and compares unfavorably with the United States as a whole. Whether it compares unfavorably with other states that have a comparable mix of population is not addressed in the report.

Although the report has a call to action with listed priorities of acts, it is doubtful that doctors as individuals or as a profession can make much needed change. The three leading causes of disease in Oklahoma (nicotine addiction, obesity, and alcohol addiction) are primarily lifestyles and the only people who can change these habits are those afflicted. Without a sincere desire to change, no amount of preaching, teaching or disapproval will modify one iota of consumption.

The one group action that has proven to be affective (as shown by comparative usage of products in California, Oregon and other states) in reducing nicotine and/or alcohol sales has been raising “sin” taxes enough to make the products cost prohibitive. State legislators, frightened by angry constituents, have declined to take this step.

This is not to say that we as physicians should surrender our efforts to healthily influence our patients. We have a duty to urge abstinence to the user and restraint to those not already hooked. It is just realistic to acknowledge that we will often fail. Foreknowledge of frustration can serve as armor against the pain of these failures.
If you do not have access to the full report, it may be read in our office or on the web at www.health.state.ok.us/board/state/index.html.