Unprofessional Conduct

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Unprofessional Conduct

• and Controlled Substance Abuse

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The Basics

• In the United States, medical licensure boards
  are professional boards, rather than
  administrative boards
• 70 boards, some states with separate MD and DO
  boards (Oklahoma), others are combined (Missouri)
• All have an enabling statute that defines the
  powers of the Board, which can and do vary
  significantly across the USA

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Unprofessional Conduct

• Board powers are defined by the Enabling Statute
  and by Rules and Regulations, promulgated by the
  Board
• Rules and Regulations are developed over years,
  based on the experience of governance by the
  Board
• In Oklahoma, a rule is proposed by the Board,
  approved by both the Legislature and the Governor
  of the State, following a public hearing process,
  and has the effect of law
• Board Policy Statements give a sense of the
  Boards use of the Statute and Rules and
  Regulations, but do not have the force of law

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Unprofessional Conduct

• The traditional actions of a licensure board have
  included drug/alcohol abuse, narcotic or
  controlled substance diversion, and sexual
  boundary violations
• Areas such as incompetence, illegitimate business
  practices, abusive behavior and supervision of
  employed professionals or staff have only
  recently become important

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• The public Board Agenda for September 2010 shows
  a typical mix of case allegations

Controlled substances, alcohol, sexual boundary
violations
Quality Assurance, Incompetence, supervision of
staff
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Unprofessional Conduct

• Unprofessional Conduct is defined in the enabling
  Statue Title 59 OS, Section 509 (19 provisions)
  and Oklahoma Administrative Code Title 43510-7.4
  (49 provisions)
• 12/19 of the statutory provisions and 12/49 of
  the Rules and Regulations deal directly or
  indirectly with controlled substances

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Unprofessional Conduct

• From a broad social viewpoint, Unprofessional
  Conduct is divided into two groups
• (1) Drug/Alcohol violations, Fraud/Felony
  convictions and Sexual Boundary violations ,
  which are problems of society at large
• (2) Professional Standards violations, such as
  abusive behavior, negligence, paraprofessional
  supervision, and standards of care, including
  informed consent, confidentiality,
  misrepresentation of skill Quality Assurance
  issues from inside the profession

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Unprofessional Conduct

• The majority of the Boards actions have to do
  with the first group of issues (sex and drugs),
  and violations in these areas are well-defined,
  well understood
• The public at large (and the Legislature) believe
  the Licensure Board deals with Quality Assurance
  issues, wants us to do more in this area than has
  been done traditionally
• Career-long professional competence
• A far more contentious area of enforcement, which
  Licensure Boardsin generaldo less well(See
  Handout, Commentary by Steven Altchuler)

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Unprofessional Conduct

• Controlled substances (legal or illegal) and
  alcohol can be consumed by the physician
  (habitual drunkenness or the habitual use of
  habit-forming drugs), or sold to others
  (diverted) in exchange for a fee (money or goods)
  or sexual contact
• The internet has expanded the ways and degree to
  which such violations can occur

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Unprofessional Conduct

• Federal and State law now govern off-shore and
  interstate prescribing of controlled/addicting
  drugs using the internet
• A recent change in the Oklahoma Rules and
  Regulations impact the use of all medications
• The Face-to-Face Rule

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Unprofessional Conduct

• The Face-to Face Rule 43510-7-4(49)
  Unprofessional Conduct, combined with the
  definition of The Physician/Patient Relationship
  43510-1-4 Definitions are the key provisions
  for deciding the intersection between the
  traditional areas of enforcement (sex and
  drugs) and professional standards violations

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Unprofessional Conduct

• Without a professional relationship, sexual
  boundary violations are absent
• Narcotic Diversion violations normally include
  findings of a sham professional relationship
• A face-to-face encounter impacts virtually all of
  the internet prescribing schemes, illegitimate
  telemedicine practices, and paraprofessional
  supervision violations (franchising schemes)
• Arguably, the final frontier for maintaining
  professional competence and quality health care
  in a very politically motivated legal environment
  

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• A final word to the wise

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The Oklahoma Health Professionals Program
A confidential, effective, compassionate
approach to recovery and treatment for physicians
and medical professionals who are experiencing
difficulty with substance abuse and/or behavioral
issues
Lanny Anderson 405-601-9571
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Unprofessional Conduct

• Thank You