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Oklahoma Board of Medical Licensure and Supervision
Issues and Answers - January 1997


Volume 7, No. 10
January 1997

Changing Directions

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

Several years ago I was asked to talk at a local kindergarten on "A Visit to Your Doctor." When I arrived the children were scattered over the room on various play things. On the floor in one corner were plastered pieces of tape with each child's name. The teacher clapped her hands and announced that they were to sit on their assigned tapes. About half the children sat facing the east and the rest sat facing the west. Rather than talk to the back of heads I asked the children to turn around and be reseated. Promptly each child stood up, turned around, and sat back down with the result that those who had previously been facing east were now facing west and those who had been facing west were now facing east.

That there are problems in medicine there is no doubt. Doctor distribution, continuing competency, uninsured populations, under served areas and overpopulated specialties, failure to assume responsibility by professionals, patients and insurance companies, unprofessional conduct in all its ugly manifestations, and a general decline in the public's faith in doctors' integrity and dependability. The list goes on. The system is sick. The solution is to apply effective but not injurious medicine. If a change in direction is to be made, let it be made in the right direction.

We all saw the bureaucratic catastrophe that was proposed by the Clinton administration when the financial aspects of healthcare was studied by a group which was remarkable for the very few representatives of medicine and virtually absent representation of any actual practicing physicians.

Currently the same problems can be seen in the wide spread and serious consideration being given to the contents of the PEW Commission report (which likewise is void of physicians). I have previously, and again herewith, urged all professionals associated with healthcare to be cognizant of the contents of this first and, soon to be presented, second report and the effect they may have on, particularly, congressional action.

This time of the year it is a toss up which is more frightening - Halloween costumes or the possible outcome of the upcoming elections. (I know, by the time this is published both will be long over and all we will be left with are bitter memories of bad candy and broken promises.)

The easy thing to say is all these problems are too big and too far away for any one person to have any effect. The hopeful truth is that only if each one person stays alert to proposed changes and voices support for proper change and opposition to bad change from the courthouse to the White House level, will our profession stay effective and proficient.

Remember _ "Every reform is only a mask under cover of which a more terrible reform, which dares not name itself, advances." — Ralph Waldo Emerson.


Dear Dr. Zumwalt:

This letter is intended to address several concerns which were expressed in the article "R.N. Lite," "Medicine in Oklahoma" Issues and Answers.

The purpose of the Oklahoma Nursing Practice Act is "to safeguard the public health and welfare" [59 O.S. 567.2] by monitoring and regulating nursing practice and education within the state. Furthermore, one of the Board's philosophical beliefs is that "issues related to health care must be evaluated for actual or potential harm to the public and appropriate actions implemented" (OBN [Oklahoma Board of Nursing] Statement of philosophy, 1995).

Unlicensed assistive personnel are not new phenomena. However, in today's cost-conscious, healthcare environment, unlicensed assistive personnel are being used in increasing numbers in all settings to perform tasks that, until recently, were thought to be the exclusive province of licensed nurses.

Unlicensed assistive personnel working in long-term care and home health are regulated by the Oklahoma State Department of Health. Assistive personnel employed by physicians are exempt from Board of Nursing regulation based on 59 O.S. 567.11.6.

The Board's concern is that unlicensed assistive personnel in acute-care settings are currently not regulated by any entity and are performing tasks dictated by job descriptions in the facilities which employ them. There is no consensus regarding which skills may be safely and appropriately delegated. Levels of training vary enormously. There are no standardized competency validation methodologies and no mechanisms for discipline. Licensed nurses must assume responsibility and liability for determining the tasks that are appropriate and safe to delegate without valid, dependable guidelines for determining the competency of these individuals.

Point one of the article asks, "Who is responsible for the actions performed?" The licensed nurse is responsible and accountable for nursing care rendered including "execution of the medical regime including the administration of medications and treatments prescribed by any person authorized by state law to so prescribe." [59 O.S. 567.3.2] The 1994 Oklahoma Nursing Practice Act allows both registered nurses and licensed practical nurses to delegate "such tasks as may safely be performed by others, consistent with educational preparation and that does not conflict with this act." [59 O.S. 567.3.3g and 59 O.S. 567.3.4.d] Unlicensed assistive personnel do not have a defined scope of practice but are responsible and accountable to perform those tasks delegated to them in a safe and ethical manner.

The following letter was sent by Sulinda Moffett, MSN, R.N., Executive Director of the Oklahoma Board of Nursing in response to the article

"R. N. Lite" published in the December 1996 issue of this newsletter.

"It is neither appropriate nor customary for physicians to issue orders to unlicensed persons unless those persons are employed by the physician and `under the direct supervision and control of a licensed physician.'"
Point two concerns recognition of the UAP's limitations. It is neither appropriate nor customary for physicians to issue orders to unlicensed persons unless those persons are employed by the physician and "under the direct supervision and control of a licensed physician." [59 O.S. 567.11.6]

The issue of "surprise" and concern about notification cannot be clarified. Senate Bill 537 was initially introduced in the Legislature in 1995. Several articles have been published in local newspapers. The subject has been discussed in meetings of the OBN Advisory Council which are attended by representatives from both the Oklahoma State Medical Association and the Oklahoma Osteopathic Association.

The list of functions which may be performed by advanced UAPs has been developed by a working committee composed of representatives of the Oklahoma State Department of Health, Oklahoma State Regents for Higher Education, Oklahoma Department of Vocational and Technical Education, Oklahoma Board of Nursing, Oklahoma Hospital Association, Oklahoma Nurses Association, the Nursing Home Association of Oklahoma, Oklahoma State Association of Licensed Practical Nurses and the Oklahoma Home Care Association.

The working committee has been assisted by many interested persons from a variety of settings including representatives from the Oklahoma Physical Therapy Association and the Oklahoma Society for Respiratory Care.

The Board believes that standardized training and competency validation with certification is the most effective way to protect the public from incompetent care-givers and to provide added security to licensed nurses in delegation decisions.

Please consider including this response in your next newsletter.

If you have further concerns, please contact me. Your input and interest in this issue are welcomed.

Honesty is the Only Policy

During the year end holidays there was a flurry of TV and newspaper articles on the financial cost of a first DUI for the general public. Obviously readers of this newsletter do not need another reminder of the price (financial and professional) of drinking and driving, or drinking while performing professional duties.

What may need to be addressed is a curious attitude that consistently recurs concerning applications and previous misconduct of various types. To wit: "If I answer the questions honestly, then nothing should be done about my prior behavior."

The first misconception is that somehow an accurate answer to a required question brings about some type of moral brownie points. Reality is that an inaccurate, incomplete or flat false answer constitutes fraud and is accepted and expected grounds for rejection of an application or revocation of an established license. Indeed in some states the use of fraudulent information in an attempt to obtain a professional license constitutes a misdemeanor/felony.

The second misconception is that all past sins should be forgiven and forgotten by virtue of confession. The stated purpose of this Board is to protect the public and ensure that licensees can practice their profession in a safe and competent manner. The public must have faith that this Board is making all possible efforts to achieve that purpose. These efforts may well exert some inconvenience and even some embarrassment to individual license holders. There is no pleasure nor any punitive motive in establishing monitoring activities based on antedated behavior. Such monitoring serves to bolster the public's reliance on our profession and to remind the professional that there is a price to be paid for missteps.

And of all the missteps, the tallest may be to lie to oneself and to others. Polonius may have been a pompous windbag but there is still a crystal ring to "This above all, to thy own self be true."


Recently received in our office was a summary of the 1996 Member Board Annual Survey conducted by the Federation of State Medical Boards. Only 35 of 64 Boards responded and all did not answer all the questions so that Oklahoma's performance is compared only to those Boards which did report.

Oklahoma had 14.1 investigated complaints per 1000 licensed physicians as compared to an average 35.7 for 30 Boards; but the percentage of prejudicial actions as a result of those complaints was 31.8% versus the overall percentage of 18.7%. This can be explained by the fact that our Board has a "pre-investigation evaluation" of each received complaint and the more frivolous or misdirected complaints are weeded out early.

Oklahoma spent 15% less than the average regulatory dollars per licensed physician. We do have more staff per 1000 licensed physicians than average. The Oklahoma Board does both license and discipline, whereas some other states have separate Boards for those activities. In addition, this Board regulates Physician Assistants, Physical Therapists, Occupational Therapists, Respiratory Therapists, Athletic Trainers, Dietitians and Electrologists.

Obviously, most of the figures are comparing apples to oranges since each state has its own method of trying to insure the integrity of the medical profession.


If your medical license was issued in February, renewal of your license is due by February 1. If your license was issued in March, renewal is due by March 1.

Remember, when completing the renewal application, the questions at the bottom of the front page pertain only to the time "since the last renewal or initial licensure (whichever is most recent.)"


Editor's note: The following questions were compiled by the Sexual Disorders Unit of Del Amo Hospital, Torrance, California. Facilities used by the Board for evaluation and treatment of sexually compulsive behaviors are listed at the right.

Questions which may indicate the need for inpatient hospitalization for sexual acting out behaviors:

1. Are you extremely depressed or hopeless due to your sexual activities?

2. Have you repeatedly lost major relationships or job positions due to your sexual activities?

3. Have you been unable to remain sober from drugs and alcohol related to your sexual behaviors?

4. Have you ever been arrested for a sexual offense?

5. Do you experience debilitating anxiety or panic related to your sexual behavior?

6. Have you lost a credential or right to practice as a professional, due to your sexual behavior?

7. Have you ever been accused of sexual harassment?

8. Do you find yourself unable to stop your sexual behavior despite the severe consequences that it causes?

9. Have you made repeated attempts in therapy or support groups to change your sexual activities (not orientation) only to find yourself unable to change?

10. Have you ever been sexual with a minor?

11. Do you have sexual secrets you tell no one about?

12. Have you ever exposed yourself in public?

13. Do you look in the windows of people's homes or apartments hoping to catch a sexual thrill?

14. Have you ever forced someone into having sex with you when they didn't want to do so?

15. Have you ever crossed "professional boundaries" to be sexual with someone such as a patient, client or parishioner?


A yes answer to any of the above questions may indicate a cause for concern and the need for further evaluation. The assessment team at Del Amo Hospital can be helpful in recommending further action and therapeutic choices.

Facilities for assessment and treatment of Sexual Disorders

The Meadows
1655 N. Tegner St
Wickenburg, AZ 85390
(520) 684-3926

Talbott-Marsh Recovery Center
5454 Yorktowne Drive
Atlanta, GA 30349
(404) 991-6044

Del Amo Treatment Facility
23700 Camino Del Sol
Torrance, CA
(310) 530-5060

Menninger Clinic
5800 S.W. 6th Avenue
Topeka, KS 66601
(913) 350-5728

Elgin State Mental Center
750 S. State Street
Elgin, IL 60123
(847) 742-1040