ISSUES & ANSWERS

February 2004

A Dichotomy of Reason

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

Has anyone else out here noticed the yin and yang of articles in popular news magazines (e.g., Time or Newsweek) concerning the economics of medical use? One page will feature the supposedly common dilemma of patients having to choose between purchasing prescriptions and buying the essential weekly groceries, or relating the near eternal congressional wrangling over the cost of preservation, strangulation, evisceration or fattening of the Medicare Act. On the opposite page will be the breathless reporting of the latest method of utilizing Botox to rid the world of unwanted wrinkles (is there such an animal as wanted wrinkles?) or the newest hookup of various segments of the intestines to speed the parting guest – surplus calories.

“Junk” scientists have parried with “real” scientists as to whether encapsulated silicon constitutes a health threat with no one asking the vital question, “What happened to the old standby, cotton falsies?”

Much has been written about the cost of developing new pharmaceutical products versus the expense of getting them through the FDA clearance process. Few seem to ask whether there is a real need for sixteen different cephalosporins or twelve antilipemic agents (and this count is from last year’s PDR). Even fewer ask the question as to the practicality of just eating less.

There are justifiably disturbing photos on TV of starving children, both here and abroad, that are followed by featured stories of unbelievably involved and expensive surgeries performed on children who will never be able to live reasonable or meaningful lives. It seems the baseball movie the phrase, “If you build it, they will come,” has been supplanted by “If an operation can be done, it should be done.”

Somewhere, sometime there must be a point where reason supplants miracles, where the apex of attainable health is not beyond the rim of the universe. Is the pinnacle of medicine to be endless life even if it results in Shakespeare’s “sans hair, sans teeth, sans everything”? Will we continue in medicine to construct shiny skyscrapers beside infested hovels?

As Will Rogers wrote even back in the 1930’s, “We’ll hold the distinction of being the only nation in the history of the world that ever went to the poor house in an automobile.”

Board Investigator Retires

After 41 years as a Law Enforcement Officer, Investigator Jim Willis has announced his retirement, effective January 1, 2004.
Mr. Willis began his career as a patrolman for the Oklahoma City Police Department (OCPD) in 1962. Later, he was promoted to Detective and assigned to the Vice and Narcotics division, where he specialized in cases involving registrants and drug dealers who diverted legitimate pharmaceutical drugs into the black market. He also established the first “Rogues Gallery” of those violators to assist other agencies.

In 1979, he was assigned to a multi-jurisdiction Diversion and Compliance Task Force, located at the Oklahoma Bureau of Narcotics (OBN). This was a statewide program designed to combat this growing problem, and much success was attained. In 1982, Jim left the OCPD and was hired full-time by OBN as a Senior Agent, assigned to the newly created Diversion and Compliance division. Later, he was promoted to Agent-in-Charge and supervised the Oklahoma City office, where his duties included auditing expenditures from the evidence fund and establishing the Questioned Documents Section in an attempt to locate and identify those responsible for forging and altering prescriptions.

d on a change of pace in 1992 and joined the Board’s investigative staff as a Senior Investigator, and he proved to be a valuable and capable asset.

We will sorely miss Jim’s experience and calm, professional manner, but we understand his decision to embark on this new phase of life. Our best wishes go out to Jim and his family for this well-earned and well-deserved retirement.

Important News about License Renewal

Note: “Renewal dates have not changed”

The Board will not be sending out paper renewal forms to medical doctorsany longer. Instead, the Medical Board will send out a 60-day and a 30-day reminder notice alerting physicians to renew their licenses. The reminder cards will specify the two (2) options to renew a medical license. One will be to renew completely on-line at www.okmedicalboard.org with a credit card or electronic transfer. The second option will be to go on-line and complete the form as though submitting it on-line but at the point of selecting the payment method, the form can be printed (downloaded), dated and signed and sent to the Medical Board with a check, money order, etc.

The Medical Board will not be sending paper renewal forms in the mail.
You may go on-line at any time and update any practice information such as address, phone number, etc. to keep the board informed and assure that the reminder notices will get to you.

Board Meeting

November 20, 2003

The Board met in a marathon 13 ½ hour session on November 20, 2003 to consider licensing and disciplinary matters.
Two probations were modified – one to allow community service outside the OU Health Sciences Center and the other to allow prescription for Schedule II CDS to be written for outpatients.

stricted medical licenses were issued after personal appearance. Two applications were denied – one due to fraudulent application and the second to a failure to pass any part of a licensing exam. Two applications were tabled to allow the physicians to obtain psychiatric records and a current evaluation by an Oklahoma licensed, Board certified psychiatrist.
One PA license was issued under Agreement with standard terms for a history of alcohol abuse. One Pedorthist license with Agreement was denied since the applicant would not be in this state and therefore could not be monitored.

Two medical licenses were revoked. The first due to violation of probationary terms involving alcohol and the second due to diverting CDS issued for patient use to personal use and for fraudulent applications for licensure and hospital privileges.
Six MD licenses were suspended. The longest set time was for nine months with a mandatory six months of treatment for substance abuse (doctor is already on indefinite probation). An indefinite suspension was ordered for mental incompetency and practicing in another state without that state’s license. Two licensees were given 90-day suspensions. One suspension was for failure to supervise a PA adequately . Additionally, he is restricted from supervising a PA in the future. The other 90-day suspension was imposed for substance abuse and is to be followed with five years probation under standard terms.
Two physicians were suspended for 60 days, one for possession of hallucinogenic mushrooms and marijuana. The suspension is to be followed by drug use evaluation and possible probation should he return to Oklahoma to practice. The other 60-day suspension is to be followed by five years probation and use of duplicate prescriptions due to prescribing CDS via the Internet without patient examination. It should be noted that this light a discipline was influenced by the few times it occurred and the doctor’s self-reporting.

One doctor was placed on five years probation (standard terms) after receiving a DWI in Texas. A PA was placed on five years probation requiring 100% review of patients’ charts by his supervisor prior to the patient leaving the clinic. This was a quality of care issue. One Respiratory Care Practitioner was put on five years probation due to excessive alcohol use.
One case involving fraudulent application in another state was dismissed by the Board after the hearing.

He’s Number One

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

The new law establishing the Volunteer Medical License in Oklahoma became effective on November 1, 2003.
Richard Winters, MD of Poteau filed the first application for this category and on November 20, 2003 the Board issued the license, number V-1. Dr. Winters (OU School of Medicine, 1953) served on this Board from March 1976 to April 1986.
Application forms for this type of license are available from the Board office or on the agency website (www.okmedicalboard.org).

Facts About Fax

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

A complaint was received recently in this office in which a patient alleged that her doctor had sent personal medical information to her employer. Upon investigation, we discovered that the patient had properly filed a request/authorization for release of the records and had given the fax number of her place of work with the instructions that the records were to be delivered via fax.

Unfortunately, the physician’s staff did not honor the enquiry immediately (indeed it was months after the form was filled out) with the result that the records arrived at the spot of employment on a day the patient was not present. Her medical history was handed around the job site while it was being decided where it should be stored for her return.

Other than the tardiness of furnishing the records, it appears the doctor performed as authorized by the patient. This scenario does, however, illustrate the danger of delivering records in this manner. One cannot be sure as to who is on the other end of the line, whether it be a fax machine, voice mail, or answering machine. A wrong number may result in embarrassing information being passed tothe wrong person.

The safest way to furnish requested records is to insist that the person requesting the copies pick them up. A sealed envelope with proper address (perhaps certified to ensure who signs for delivery) would also seem to be sufficiently safe. It’s not just HIPPA – it’s proper.