ISSUES & ANSEWERS

May 2003

Volunteer Medical License

A new type of medical license has been invented by the Oklahoma Legislature (House Bill 1140). This is now part of the Medical Practice Act and reads as follows:

Section 493.5 Title 59
A. There is established a special volunteer medical license for physicians who are retired from active practice and wish to donate their expertise for the medical care and treatment of indigent and needy persons or person in medically underserved areas of the state. The special volunteer medical license shall be:
1. Issued by the State Board of Medical Licensure and Supervision to eligible physicians;
2. Issued without the payment of an application fee, license fee or renewal fee;
3. Issued or renewed without any continuing education requirements;
4. Issued for a fiscal year or part thereof; and
5. Renewable annually upon approval of the Board.
B. A physician must meet the following requirements to be eligible for a special volunteer medical license:
1. Completion of a special volunteer medical license application, including documentation of the physician’s medical school graduation and practice history;
2. Documentation that the physician has been previously issued a full and unrestricted license to practice medicine in Oklahoma or in another state of the United States and that he or she has never been the subject of any medical disciplinary action in any jurisdiction;
3. Acknowledgment and documentation that the physician’s practice under the special volunteer medical license will be exclusively and totally devoted to providing medical care to needy and indigent persons in Oklahoma or persons in medically underserved areas in Oklahoma; and
4. Acknowledgment and documentation that the physician will not receive or have the expectation to receive any payment or compensation, either direct or indirect, for any medical services rendered under the special volunteer medical license.

Any rules and forms needed to implement this new type of license will be formulated by the Board staff. All other sections of the Medical Practice Act, particularly the Professional Misconduct laws and rules, will pertain to this new license. Violation of the terms upon which this restricted license is issued will require disciplinary action by the Board.

Late Fees

The cost of renewing a medical license ($150) has not increased since 1991. However, every year, the number of late fees paid by licensees that fail to renew their licenses on time continues to grow. The Board has issued very strict guidelines for failure to renew on time and a late fee of $125 is assessed on the 2nd day of the renewal month. There are no waivers and no refunds. The Board staff continues to look for ways to improve services to help licensees be on time and save money:

1. Be sure to inform the Medical Board of any change in your mailing address
2. The Medical Board sends out, to your mailing address on file, the renewal form 60 days prior to your renewal month and then a reminder card 30 days in advance.
3. The renewal can be done up to 60 days before the 1st day of your renewal month, so give ample mailing time for the renewal to be received and processed.
4. If you wait until the last minute, you can drive to the Medical Board office to deliver the renewal form on the 1st day of your renewal month to avoid the late fee the next day.

OR

1. You can renew on-line and pay with a credit card and update your new mailing address and other pertinent practice information all at the same time. (You will continue to receive the paper notices as well.) Call the office and ask to register to renew on-line. 405-848-6841

Where Lies the Truth?

by Gerald C. Zumwalt, MD

“There are a terrible lot of lies going about the world, and the worst of it is that half of them are true.”
Winston Churchill

Doctors have the reputation for being kind, generous, caring, self-sacrificing individuals. They are reputed to work long hours with little regard for self-health, financial reward, public renown or patient expressed gratitude. When surveys are made and questions asked as to which professions are held in high regard, physicians rank at or near the top (lawyers and used car salesmen near the bottom). Famous paintings are hung with bearded healers thoughtfully sitting vigils at patients’ bedsides. Grateful mothers have been known to name their only child after their obstetrician (pity the child who is the opposite sex of the deliverer). Robert Louis Stephenson wrote that doctors are the flower of mankind.

Here at the Medical Board, we receive public complaints about MDs. After reading these epistles for the past 14 years, I have reached the following conclusions:

• Doctors have the reputation for being rude, stingy money grabbers, uncaring, lazy individuals. They are reputed to work short hours with great regard for quitting early, retiring to golf courses, being touted as godlike and requiring effusive public praise.
• They only return phone calls to their stockbrokers. Their employees are encouraged to degrade and humiliate patients and refuse to fill out needed forms and insurance papers. They are protected by all others of the same profession and are immune to any type of corrective actions.

Somewhere in these two litanies lies truth. Somewhere in these two litanies lies falsehoods. What are you as a member of the medical profession doing to establish that the lies about our “band of brothers” occur in that second, horrible litany of social sins?

Copying Medical Records

The charge for copying medical records for patients and /or their legal representatives has been increased by the legislature to $1.00 for the first page and then $.50 per page. The charge for x-rays or other photographs or images did not change and is limited to $5.00 or actual cost whichever is less. Patients may be charged for the actual cost of mailing the requested records but may not be charged for searching, retrieving, reviewing and preparing the records.

Note: Copies of the patient’s records may not be refused pending full payment of medical services bills or based on some other prior obligation. Most physicians do not charge the patient to send their records to another physician. Records received from another physician on the patient become a part of the patient’s chart and need to be included in the requested copy of records.

Physician Assistant Prescriptive Authority

Physician Assistants may issue written and oral prescriptions and orders for medical supplies, services and drugs, including controlled medications in Schedules III, IV, and V pursuant to the Physician Assistant Drug Formulary (435:15-11-2).

Physician Assistants may write an order for a Schedule II drug for immediate or ongoing administration “on site” pursuant to a written protocol and the Physician Assistant Drug Formulary. On site is defined as:

(A) Hospital in-patients;
(B) Emergency room;
(C) Surgicenters licensed by the State Health Department; or
(D) Medical clinics or offices in cases of emergency as defined by
the supervising physician

Prescriptions for non-controlled medications are limited to a 30 day supply with two (2) refills of an agent prescribed for the first time for a patient. For a chronic, stable condition, a 90 day supply with three (3) refills can be written and signed, or called into a pharmacy by the Physician Assistant.

Prescriptions for Scheduled III, IV and V controlled medications are limited to a 10 day supply or 40 dosage units with one (1) refill, whichever is smaller.

Physician Assistants prescribing controlled medications must be currently registered with the Drug Enforcement Administration (DEA) and the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD).

Physician Assistants may not dispense drugs but may request, receive and sign for professional samples and may distribute professional samples directly to patients in accordance with written policies established by the supervising physician.

Physician Assistants practicing in patient care settings that are part of the State Department of Health, State Department of Mental Health, or other special patient care settings designated by the Board are permitted to dispense medications directly to patients as directed by the supervising physician in written protocol, standing or direct order.

Award-winning Website

Administrators In Medicine (AIM), an organization representing executive staff of all medical and osteopathic licensing boards nationwide, has recognized the Oklahoma State Board of Medical Licensure and Supervision for its innovative and user friendly website: www.okmedicalboard.com

AIM presented the Oklahoma Medical Board with an award in recognition for “A Living Professional Directory”. The Directory allows the general public to search for a personal physician based on a number of important factors such as, hospital affiliations, multiple locations, office hours, health plans, foreign languages spoken, and other practice criteria.

The award was presented at the AIM Annual Meeting in Chicago where the Oklahoma Medical Board had a live demonstration of the website. Lyle Kelsey, Executive Director of the Oklahoma Medical Board, accepted the award on behalf of the Board and those involved in it’s development. He recognized Your Oklahoma the Official Web Site of the State of Oklahoma and Netplus, Inc. an Oklahoma based Internet service provider for their work in producing and maintaining the Medical Board’s web site.

Board Meetings

January 16, 17, 2003

The Board issued six licenses after personal appearances by applicants. After a lengthy hearing, one license was reinstated under terms of an indefinite probation. Terms included psychiatric treatment, drug testing and mentoring/monitoring by a peer. One application was denied due to prior discipline in another state. One training license was denied due to previous exam failures and problems in other residencies.

Two licensees had terms of probation modified. One can now prescribe Schedule III, IV and V controlled dangerous substances (CDS) on duplicate prescription pads. The other is now allowed to prescribe and administer Schedule II CDS and return to the practice of anesthesiology.

Two allied profession licenses were revoked. Both involved felony convictions. One, a Physical Therapist, was convicted of lewd molestation of a minor and the other, a Respiratory Care Practitioner, was convicted of unauthorized taking of a credit card.

One suspension of a medical license was imposed with a five year probation to follow. Terms included obtaining CME on record keeping and prescribing CDS and providing 240 hours of pro bono medical services.

One doctor already on probation agreed to a Voluntary Submittal to Jurisdiction imposing an additional term to undergo anger management counseling. The Submittal was occasioned by the Board office receiving a letter containing an unidentified pill during the national anthrax scare in 2002.

March 27, 2003

The Board issued four medical licenses after personal appearances by applicants. Five applications were tabled, two because of non-appearances by the applicants. The Board wanted to review the application submitted to another state by one MD. One physician was required to take the SPEX exam due to time out of practice and one was required to obtain a current psychiatric evaluation due to history of psychiatric behavior. One training license was issued after personal appearance and one was issued under standard terms of agreement for alcohol abuse.

Three licenses were reinstated, one unrestricted and one with agreement limiting practice to WW Hasting Indian Hospitals.

One license previously suspended for failure to obtain psychiatric treatment mandated by the Board was reinstated on court order from Oklahoma County District Court. This order will be appealed.

As a result of disciplinary hearing one reprimand was issued for failure to report an arrest on renewal. The physician also is required to attend a domestic abuse program.

A 30-day suspension for a physical therapist followed by a five-year probation was incurred for failing to follow terms of agreement dictating the presence of a licensed female health provider whenever the PT was attending female patients. Two indefinite suspensions were imposed for continuing substance abuse.

One license was revoked for Internet prescribing without establishing a valid doctor-patient relationship.

One license was surrendered in lieu of prosecution due to sexual misconduct with a patient.

Two probations and one agreement were terminated when it was established that further monitoring was not necessary.