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Oklahoma Board of Medical Licensure and Supervision
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January 2003

First On-Line Renewal takes place in the Medical Board Office

As a means of testing the new Internet On-line Service, Dr. Paul Wright agreed to be the first physician to renew his license interactively. With his trial run and suggestions, we were able to ensure a reasonably smooth process. As of the end of December, there have been 40 doctors renew their licenses on-line and 2790 update their personal and practice information. The on-line method is more timely and accurate.

As a reminder, there are several things to keep in mind when using the on-line update.

1. Internet Access: Physicians are required to complete an “On-Line Transaction Agreement” in order to obtain a Personal Identification Number (PIN). The agreement is reprinted in this newsletter or available on the website (www.osbmls.state.ok.us). This step allows the Medical Board to have a “signature on file” BUT does not obligate the physician to any requirements that are not already required by the paper process. (The paper process will continue simultaneously for some time)

2. Physician Information: Once a PIN has been received, doctors are eligible to go into their personal files and make any necessary changes any time throughout the year. Physicians can update information on their practice locations, office hours, hospital affiliations, etc. This information will be available to the public when looking for a physician.

3. License Renewal: As with the paper process, physicians can renew their licenses on-line as early as (60) sixty days prior to the license anniversary date. On-line renewals are posted every 24 hours. The information on-line is essentially the same as the paper renewal and there is electronic space provided to give additional explanations to any “yes” answers.

There are several reasons that a doctor may not be able to renew on-line (or by paper):
a. Non-compliance with the Oklahoma Tax Commission (OTC). Oklahoma Statutes (Title 68) prohibit the medical board from renewing a professional license if the licensee is not in compliance with the OTC.
b. Failure to meet the CME requirement either by answering “no” or through an audit.
c. Rejection of renewal payment.

Board Meeting

November 21, 2002

At the regularly scheduled meeting of the Board multiple rule changes were adopted and probation reviews and modifications were effected.

Five full and unrestricted medical licenses were issued after personal appearance and fifteen were issued after review without appearance. One Special Training License was issued after a personal appearance. One license was reinstated with terms of probation, terms of which included practicing only in a group setting and with a mentor reviewing charts. Two applications were tabled with one applicant being required to take and pass the SPEX exam and the other required to be reassessed at the Colorado Personalized Education for Physicians program or an equivalent professional evaluation center. One Special Training License application was denied based on problems the applicant had in medical school and residency.

Two Respiratory Care Practitioner licenses were issued under agreements that required 12-Step Program participation and included other standard terms for monitoring for substance abuse.

One Physical Therapist Assistant license was revoked due to fraudulent billing and timesheets.

Three medical licenses were suspended. One was suspended indefinitely due to the license being suspended in another state for incompetent quality of care. One was suspended indefinitely secondary to forging narcotic prescriptions for personal use. One was suspended for six months and 240 hours of community service imposed due to narcotic law violations in pain management. The suspension was followed by a permanent restriction from practicing other than hospital-based anesthesiology.

The Staff of Life

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

While listening to Ed Kelsay explain at a PLICO sponsored lecture that a happy, befriended patient is not apt to file malpractice charges against their doctor, I reflected on the number of complaints this Board receives from angry, ignored patients.

Of the roughly 350-400 public complaints we receive annually, approximately half concern rudeness by either the physician or his employees. Sometimes the offended relate stories of verbal abuse but even more often they are upset because they have been promised a return phone call and it never occurred. Relatives of hospitalized patients often are unable to even discover when rounds are to be made and progress reported. Procedures are scheduled and done after no, or hurried non-understandable, explanations are made. Even when necessary and proper transfer of patients from one specialist to another is made, relatives are left in the dark as to who is in control and who should be consulted as to the patient’s progress.

There seems to be a constant misunderstanding as to how a patient is to be discharged from a doctor’s practice. Apparently, all too often this announcement is made by the front office personnel when the patient arrives at the receptionist’s desk. There is no doubt that patients may choose to change doctors at their whim. And doctors likewise may refuse to see a patient but, once a doctor-patient relationship has been established, only after giving adequate notice and offering to provide necessary emergency and ongoing medical necessities during the time essential for a patient to acquire a new provider.

It is also agreed by medical ethicists that the making of an appointment obligates the physician to see the patient. It is proper to turn away a scheduled patient only if the patient has been adequately informed of conditions that must be met prior to the visit (whether co-pay, past debt, dress code or hair style).

As we have previously recommended, a physician or a trusted ally occasionally should test the telephone or front desk manners of his staff and himself. When we ponder why physicians are not the teddy bear loved characters of the past, it is wise to remember Pogo’s statement, “We have met the enemy and he is us” or even Shakespeare’s advice to Horatio that the fault lies not in the stars but in ourselves.

O Brother, Where Art Thou?

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

Scanning Internet websites one finds opportunities to purchase all manner of products. Surprisingly enough, even Controlled and Dangerous Drugs are available to be ordered “from the comfort of your home.” These medications include some that actually are frequently abused. These very real dangers to the health, safety and public welfare explain the reason why the Board adopted a policy on Internet prescribing.

One drawback to websites is the anonymity of the persons involved and the location of those persons. This particular ad states “ . . . one of our board certified US physicians will issue a prescription for an FDA approved medication.” If the doctor is located outside Oklahoma, prescribing to Oklahoma residents and does not have an Oklahoma medical license, the doctor is violating the Oklahoma Medical Practice Act (e.g., practicing medicine without a license (Title 59 O.S., Section 491A)). Enforcement of this section must be done by District Attorneys.

If the doctor has a valid Oklahoma medical license, he is guilty of unprofessional conduct (Section 509 (13) “Prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician patient relationship.”)

The Policy on Internet Prescribing adopted on November 2, 2000, states four minimum requirements to prescribe medications:

1. Verifying that the persons requesting the medications are 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.

These requirements cannot be met without an initial face to face encounter with the patient. Enforcement of this policy and possible discipline for the unprofessional conduct will be done by this Board.

Subutex and Suboxone

The Food and Drug Administration (FDA) has sent out an announcement of the approval for office-based use of Subutex (buprenorphine hydrochloride) and Suboxone (buprenorphine hydrochloride plus nuloxone hydrochloride) in the treatment of opiate dependence. These preparations are to be used sequentially for primary treatment and maintenance.

This announcement lists expected side effects and dangers of the treatment. Buprenorphine will be a Schedule III CDS.

Although this medication is to be utilized outside licensed clinics, it must be prescribed by “specially trained physicians” and the provisions of the Drug Abuse Treatment Act (DATA) of 2000 limits the number of patients any individual physician can treat as well as requiring special DEA registration.

This announcement is headed as T02-38 and consumer inquiries may be addressed to (888) INFO-FDA. The report is available at our office.