FLORIDA BOARD OF MEDICINE Laws and Rules for

Healthcare Professionals

Onelia G. Lage, M.D.Professor Vice Chair of EducationDept. of Humanities, Health and SocietyFIU Herbert Wertheim College of MedicineFlorida Board of Medicine Member 2005-2015, Chair 2010

Overview

Introduction to the Board of Medicine

Laws & rules every physician should know

Licensure and Disciplinary Process

Practitioner Resource Network

Prescription Drug Monitoring Program

Board of Medicine Mission

Promote, protect and improve the health of all people in Florida.

This is done through licensing qualified health care practitioners, enforcing health care standards and sharing information.

Board of Medicine Structure The Medical Board is a group of volunteers

who are charged with upholding the Medical Practice Act for the State of Florida. Twelve physician members Three consumer members

All Members of the Board are appointed by the Governor.

Accessing Board of Medicine Online WHY? Because you can quickly access: Messages New Laws New Rules Schedules of Board and Committee Meetings Agendas and Minutes of Board and Committee

Meetings

Board of Medicine Web Site: www.FLboardofmedicine.gov

Finding Laws (Statutes) www.leg.state.fl.us

Health Care Regulation Chapter 456

Medical Practice Act Chapter 458

Licensure Renewal Florida physicians must renew their license every two

years. Renew ONLINE at www.doh.state.fl.us/mqaservices To renew a Florida license physicians are required to

obtain a minimum of 40 hours of continuing medical education. 2 hours in prevention of medical errors 38 hours of general CME Every third renewal: 2 hours Domestic Violence, 2

hours prevention of medical errors and 36 hours of general CME

Licensure renewal (continued) The Preventing of Medical Errors course

has specific requirements including a study of root cause analysis, error reduction, prevention and patient safety, and the 5 most mis-diagnosed medical conditions in Florida during the previous biennium .

LAWS & RULES EVERY PHYSICIAN NEEDS TO KNOW

You Must Update Changes To Your Profile Within 15 Days This means changes in: Address Staff privileges Medical malpractice history Financial Responsibility Board certification Education Disciplinary/criminal history[section 456.042, F.S.]

Before You Move To A New Practice, Notify the Board No current Address is a crisis at renewal time

Practicing on an inactive license is a criminal offense

[sections 456.035, 458.319(3) and 458.327(2)(e), F.S.]

Relocation Case Physician closed his practice and left control of his

medical records with a registered nurse; failed to notify his patients in accordance with Board rule; left medical records in control of an RN instead of another allopathic physician or osteopathic physician.

Action taken: Letter of Concern $2,000 fine $1,441.72 costs Laws and Rules Course

When Relocating Your Practice? Did You Know That: You are responsible to hold patient records 5 years.

You must notify patient in letters or sign where to pick up records.

You must also place a notice in newspapers and notify the Board of Medicine 30 days before you move.

And do not forget to complete your hospital charts if leaving the area!

[Rule 64B8-10.002, F.A.C.]

Do Not Pre-Sign Prescriptions Board of Medicine Guidelines provide a

maximum penalty of:

Reprimand $5,000 fine 2 years probation

[section 458.331.1(aa), F.S.]

Internet Prescribing Prescribing without a history and physical is both a

standard of care violation and a violation of board rule

Physicians have been disciplined for this with penalties ranging from revocation to suspension, reprimands and fines.

DO NOT JEOPARDIZE YOUR LICENSE-DON’T PRESCRIBE ON THE INTERNET!

[Rule 64B8-9.014, FAC]

Telehealth

Physician treating a patient within the state of Florida is allowed to use telehealth technology

Pre-Approve Any Advertisement of Your ServicesWhy? Because your

competitors read them.

They check for: accuracy board specialty

credentials statutory disclaimers

There are limitations in advertising yourself as a “specialist.”

Not every specialty recognizing agency is recognized by the Board of Medicine. (ABMS)

If you offer free or discounted fees, there is special language you must include in the ads

The details are at [Rule 64B8-11, F.A.C., and section 456.062, F.S.]

Advertisement Case Study Physician placed advertisement in paper: “Present this ad and receive $50 off Laser Hair Removal”

Without including the required statement required by s. 456.062, Florida Statutes: The patient and any other person responsible for

payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination, or treatment that is performed as a result of and within 72 hours of responding to the advertisement for the free, discounted fee, or reduced fee service, examination, or treatment.

Action Taken: Letter of Concern $500 Fine $2,795.35 costs Laws and Rules Course

You Must Keep Charts On The Family, Employees And Friends You Treat A prescription creates a physician/patient relationship.

Records are required.

Good employees can and have forged/altered scripts.

Spouses may become adverse parties. OK to treat family, including yourself

You cannot self-prescribe controlled substances

[sections 458.331(1)(r), and 458.331(1)(m), F.S.)

Fees For Copying Patient Records You cannot condition release of patient records on payment

of fees owed for services, however,

You may condition release of copies of patient records on the reasonable costs of reproducing the records.

Reasonable costs of reproducing copies of written or typed documents or reports shall not be more than the following: for the first 25 pages, $1.00 per page. for each page in excess of 25 pages, 25 cents.

Reasonable costs of reproducing x-rays, and such other special kinds of records shall be the actual costs.

[Rule 64B8-10.003, F.A.C.]

Medical Records Case Failed to provide medical records to the

patient in a timely manner; Given a citation (first offense is not

discipline) Failed to comply with the citation

Action taken: Letter of Concern $1,000 fine Medical Record Keeping Course

Patient Boundaries Board of Medicine has a Zero Tolerance policy on

Physician/Patient Sexual Contact.

Zero Tolerance = Suspend/Revoke.

Remember: A prescription creates a physician patient relationship.

[sections 458.329 and 458.331(1)(j), F.S.]

Patient Boundaries Case Study Physician saw patient in his office as a patient.

Then he started calling her, multiple times, to offer a job. Later he called back and was “breathing heavily and his tone of voice had changed”. He proceed to stated inappropriate things to the patient regarding her body and how he wanted to touch her.

Action taken: Revocation

Wrong Site SurgeryIf you make a mistake: Document it Disclose to patient Do not bill for incorrect procedure Apologize

[section 458.331(1)(t), F.S.]

Wrong Site Case Patient appeared for a right hip replacement and signed

the Consent Form for this procedure. The physician did NOT mark the correct site or side of body and placed the patient on the table with her left hip uppermost. He started the procedure with a 10 cm incision through the subcutaneous tissue before the nurse realized it was the wrong side. A pause was not performed.

Action taken: Reprimand $10,000 Fine $3,858.30 costs Laws and Rules Course

100 Hours Community Service 5 hours CME in Risk

Management 1-hour lecture

Pause RuleThere is a special rule to reduce wrong site cases:

The surgical team will pause and the operating physician will verbally confirm the patient’s identification, the intended procedure and the correct surgical/procedure site. The operating physician shall not make any incision or perform any surgery or procedure prior to performing this required confirmation.

[Rule 64B8-9.007, F.A.C., and section 456.062, F.S.]

Notifying Patients of Adverse Incidents Practitioners, Hospitals, and Ambulatory

Surgery Centers must personally notify the patient who was the subject of an adverse incident that resulted in serious harm to the patient.

[sections 395.0197, 395.1051, 456.0575, F.S.]

CME violations The Department of Health conducts CME audits

following every licensure renewal.

Failing to respond to the audit or failing to provide the requested CME documentation may result in the issuance of a citation.

First issuance of a citation is not discipline.

Help For Impaired PractitionersDo you know a colleague or medical student with drug, alcohol, or psychiatric problems? You can get them help without subjecting them to

disciplinary action.

The Board has an excellent evaluation and rehabilitation program that is a phone call away: Professionals Resource Network (PRN) 1-800 888-8776.

For most practitioners, this is a confidential process that offers help to those willing to change.

The program has recently been expanded to include medical students.

[section 456.076, F.S.]

Disciplinary Process Grounds for Disciplinary Action S. 458.331(1), Florida Statutes http://www.leg.state.fl.us/statutes/index.cfm

Disciplinary Guidelines Rule 64B8-8.001, Florida Administrative Code https://www.flrules.org/Default.asp

DISCIPLINARY PROCESS

Complaint

Agency

ProbableCause Panel

Selected by therespective

professional board from the

Department of Health

Dismissal/Closure

Case Disposition

ProsecutionAttorney Review

Investigation

Not DisputedFinal Order

ConsumerServices Unit

Closure/Referral to Other Agencies asNon-Jurisdictional OR

Closure as Legally Non-sufficient

Legal Services Section

Agency Director, If No formalProbable Cause Panel Exists

Administrative Complaint FiledWith Department

of Health

Election of RightsBy Licensee

No ProbableCause Found

ProbableCause Found

Findings:

Formal HearingBefore DOAH

(Contests Charges)

Informal HearingBefore Respective Board

(No Dispute)

Hearing WaivedBefore Respective Board

(No Dispute)

Stipulation/Settlementby Licensee to Respective

Board for Approval

Final Board Actionand Disposition

Final Order Imposing Discipline

Filed with Departmentof Health

Appeal ProceduresTo District Court

of Appeals

= Confidential

= Public Record

Citation

Mediation

2d CitationIssued

Disciplinary Statistics 4,019 Complaints Filed

1,055 Found Legally Sufficient

250 Resolved through Final Orders

11 Emergency orders

12 Revocations

MQA Annual Report July 1, 2013 – June 30, 2014

Implications of Disciplinary Action If you have licenses in multiple states and have had

action on a license in one state, you should report that action to the other states.

Disciplinary action is reportable to the Healthcare Integrity Protection Databank, Federation of State Medical Boards, Drug Enforcement Agency and the American Medical Association.

Disciplinary action may have an effect on medical malpractice insurance, HMO coverage, staff privileges and other state licensure.

Physician Reporting ofOut-Of-State Discipline Many of our Florida licensed physicians have

licenses to practice in other states.

If that out-of-state license is disciplined, the Florida licensee must report that to the Board of Medicine within 30 days.

[section 458.331(1)(kk), F.S.]

Professionalism And the Board of Medicine Dress appropriately and be prepared to answer

questions Address board members with respect and speak

only when chair recognizes you Take responsibility for actions and if family member

present treat with respect Be humble Make sure your attorney is professional and

knowledgeable with these proceedings Say please and thank you

Board News Telehealth Medical Marijuana Pain Management Clinics Legislative Issues

Pain Management In 2007, 8,620 drug related deaths (approx 5%

of all deaths in Florida) 2007 Medical Examiners Commission Drug Report

SB 462 (2009 Legislative Session) requires the registration and inspection of all pain management clinics (Boards of Medicine & Osteopathic Medicine) and the creation of a controlled substance monitoring data base (DOH).

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Prescription Drug Monitoring Program

DOH collects controlled substance dispensing information within 7 days of dispensing

Schedule II,III, and IV Pharmacies are required to access the database

while physicians are highly encouraged to do so www.eforcse.com

Administrative Complaints Public

As of January 2010 administrative complaints against all licensees will be published online

For physicians whose cases are dismissed by the board of medicine the administrative complaint will be removed promptly ,ideally within 24-72 hours.

IMPORTANT

If you receive correspondence from the Department of Health or the Board of Medicine . . . Open it immediately. It is imperative that you communicate with the Board and it is also your right to obtain representation if needed.

Conclusion Protect your license: Know your laws and rules Practice ethically and with integrity Build communication skills with other members

of the healthcare team to prevent medical errors and optimize patient care

When in doubt: Contact the Board of Medicine www.FLboardofmedicine.gov

If you get disciplined: Hire an attorney specialized in healthcare law

Thank You

“One of the essential qualities of the clinician is interest in humanity, for the secret in the care of the patient is caring for the patient.”

- Frances Weld Peabody