_ISSUES and ANSWERS

Vol 9 No 5
December 1998

Captain Hook

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

Recently, the fictional figure of Peter Pan's Captain Hook came to mind when a patient who had filed a complaint against an Oklahoma doctor underwent a deposition by the said doctor's attorney. She later described the attorney as being the "smarmiest" person she had ever met. Since the word smarmy is defined as "sleek or gushingly flattering", she undoubtedly made the wrong choice of words (although it sounds right when said). She actually was describing his reptilian qualities but since the complaint involved allegations of deceit, it may well have pertained to the physician.

One primary point of the defense, successfully asserted, was that "everybody does it." That failure to fully disclose treatment plans and procedures to a patient is acceptable since that is the way it has always been done.

Another example of failing to strictly abide by the law is seen in the too common practice of Physician Assistants beginning work under the supervision of a doctor prior to filing a current application to practice as required by Title 59 O.S., Section 519.6A. This has been done for such a long period that the Form #5 (now being revised and corrected) even had a blank to state when the P.A. began his duties, prior to filing the necessary form.

Leaving aside the admonition of everybody's mother, "If all your friends were jumping off the Empire State Building, would you?", there still stands the question of pride in profession. Has the medical community descended to a level of accepting unethical and/or illegal behavior because "everybody does it"? Citizens may forgive taxpayers for fudging on their income tax because the I.R.S. has acted in a bullying and distasteful manner. Lovers may stretch the truth a bit when questioned about fidelity. Drivers on the highways routinely make a mockery of posted speed limits. Attorneys fog the courtrooms with arguments intended to confuse the jury and obscure the truth. These events tempt even the most quixotic of men to convert to cynicism.

I still choose to believe that our profession, with rare exception, is populated with individuals of nobility and virtue. I still believe that each doctor holds the good of his patient higher than the good of his pocket book. I still believe that medicine is a profession, not a job.

Of course, I also still believe in Santa Claus.

Medical Conduct Across the Sea

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

At the recent Third International Conference on Medical Registration, there was a 20 page booklet handed out by the British General Medical Council on the subject of "Medical Conduct." The opening passage read, "Being registered with the General Medical Council gives you rights and privileges. In return you must fulfill the duties and responsibilities of a doctor as set by the GMC."

Paragraphs followed requiring and defining good clinical care, and adequate diagnoses and treatment, including adequate records. There was listed the obligation to refer patients and to observe your own competence. There was the duty to treat emergencies even in other's patients, to maintain current, ongoing medical education, to train others and not abuse patient's trust.

There then followed a section not covered in Oklahoma law but which possibly should be—to be polite to patients and respect them as people. There was the admonition to be honest in advertising and prudent in accepting gifts from pharmaceutical and equipment companies.

As in our law and guidelines on sexual misconduct, there was the prohibition on improper personal relationships including borrowing money or otherwise abusing the doctor/patient status for financial gain.

The doctor was required to maintain personal health so as to cause no danger to the patient and to arrange cover when not available. There was the need to sign certificates promptly .

There was even the requirement to treat colleagues well.

The last section set forth the rules on using humans in research.

The overall gist was, not surprisingly, that the duties and responsibilities published by the United Kingdoms Medical Council dovetail snugly with what we in Oklahoma and the rest of the United States expect of our physicians. Standards of good medical practice are universal and temptations to cut treatment and ethical corners are obliquitous.

  Interestingly enough in the November 2, 1998 issue of the American Medical News (Vol 41, #41) on page 14, there was a long ethical discussion on "Should a physician recruit patients for a business deal?"

The short answer was "no".

What Would You Do?

A doctor had been on probation for two years due to personal use of drugs when it was found that he had written prescriptions for Vicoden using names of fictitious patients and obtained the pills for himself. Numerous attempts to locate the doctor were unsuccessful. A hearing was held and his license was revoked without the physician present.

Six months later the doctor notified the Board that he had been in a drug rehabilitation program and had been discharged with glowing letters of recommendation from the facility's directors.

At the hearing on reinstatement the Board attorney presented the past history of drug abuse, violation of probationary terms and failure to keep the Board notified of change of address.

The doctor stated that he had overcome his drug problem by giving his life to God and that his wife and children had forgiven him and accepted him back into their home.

What would you do?

Results in next newsletter.

CME

Just a reminder that beginning with renewals in July 2000, physicians will be asked about continuing medical education efforts. Each physician, by the time he renews, must have 150 CMEs with at least 60 in Category I obtained within the preceeding three years.
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Board Meeting

September 24 &25, 1998

The Board met in regular session on September 24^th and 25^th. Eight applications for full and unrestricted medical licenses were approved after personal appearance. One license was reinstated under permanent probation with terms concerning substance abuse. One applicant for a Special License for training was approved after passing USMLE Step 1.

Three applications were denied due to multiple exam failures. One was denied due to untruthful answers on application questions (fraudulent application). One application for full licensure was denied and the training license was left in place.

Four probations were modified to allow additional privileges based on successful adherence to original terms of probation.

Disciplinary hearings resulted in one acceptance of surrender of license in lieu of prosecution for violation of probationary terms involving substance abuse. One license was revoked due to violation of narcotic laws and sexual misconduct. A previous revocation was affirmed after the case was remanded to the Board by the Oklahoma Supreme Court. One Respiratory Care Practitioner license was revoked due to substance abuse. One Physician Assistant was suspended for one year due to violation of narcotic laws with requirements that inpatient evaluation and treatment be completed prior to applying for reinstatement under terms of probation. One medical license was suspended for thirty days and a five-year probation imposed secondary to violation of narcotic laws.

November 12, 1998

The Board met in regular session on November 12^th. Seven medical licenses were granted after personal appearances by the applicants. One medical license denied in September was granted upon review of additional information. One application for reinstatement of medical licensure was granted.

Three applications were tabled so that the applicants could make personal appearances. One medical license, one Respiratory Care Practitioner license and one Athletic Trainer license were issued under terms of an Agreement with the Board Secretary allowing the Board to monitor for substance abuse.

An application for Special licensure was denied based on exam failures and medical school equivalency issues. One request for modification of Special license limitations to expand work location was denied.

In disciplinary matters, four hearings were continued to the January 1999 Board meeting under specific conditions. One agreed to random drug screens, one will practice only under terms of an aftercare agreement, one agreed not to perform surgical procedures and one agreed to voluntarily surrender licensure.

Three Voluntary Submittals to Jurisdiction were accepted. One, for a P.A. licensee, imposed the usual terms for substance abuse including monitoring. Another resulted in a suspension of a medical license for not less than 90 days for drug prescription violations. During the time of the suspension, the doctor will complete an intensive drug prescribing education course. The suspension will be followed by a five-year term of probation. The other VSJ imposed practice restrictions on a medical license based on action taken in another state.

One hearing for filing a fraudulent renewal application resulted in a 90 day suspension and the physician was given one year to complete 250 hours of community service. One medical license was revoked based on a felony conviction involving sexual misconduct.

One medical license previously revoked was reinstated under terms of a life-time probation including practice restriction to residency training program and other usual terms for substance abuse.

The Board conducted one final probation review for a licensee whose probation expires in January 1999. One request for early termination of probation was granted.

The next meeting of the Board is January 21, 22, 23, 1999.

A Christmas Wish for All Our Licensees

"It is my heart_warm and world_embracing Christmas hope and aspiration that all of us, the high, the low, the rich, the poor, the admired, the despised, the loved, the hated, the civilized, the savage, may eventually be gathered together in a heaven of everlasting rest and peace and bliss, except the inventor of the telephone."

Mark Twain

New Disease

In the July/August 1998 issue of Legal Medicine Perspectives, there is defined a new name for an old phenomenon.

"Advocagenic illness—response to legal counsel or legal system, induced or magnified by the counsel or system itself; usually used for unfavorable responses."

These conditions are influenced by compensation or award dependant on severity and duration of symptoms, advice from counsel on activity and treatment contrary or conflicting with medical advice, exacerbation or recurrence of symptoms after contact with attorney and/or initiation of litigation.

This varies from the long used and somewhat pejorative term "greenback poultice" in that "advocagenic" does not necessarily involve intent on the part of the patient.

Admittedly having a name for a condition does not materially decrease the problem.