Florida Board of Medicine: Florida Board of Medicine: Update and OverviewUpdate and Overview

Jason J. Rosenberg, M.D., FACSJason J. Rosenberg, M.D., FACS

DATEDATE

OverviewOverview Who is the Board of MedicineWho is the Board of Medicine Licensure Statistics Licensure Statistics Accessing InformationAccessing Information Committees, Councils & MeetingsCommittees, Councils & Meetings Licensure RenewalLicensure Renewal Practitioner ProfilesPractitioner Profiles Expert Witnesses Expert Witnesses Disciplinary Process & ImplicationsDisciplinary Process & Implications Board’s ActivitiesBoard’s Activities

Pain-management Registration and Inspection ProgramPain-management Registration and Inspection Program Office Surgery Registration and Inspection Program Office Surgery Registration and Inspection Program Maintenance of Licensure Maintenance of Licensure Wrong site surgery/person/procedure Wrong site surgery/person/procedure Re-entry into practice Re-entry into practice

Who is the Board of Who is the Board of Medicine?Medicine?

Mission: To promote, protect and Mission: To promote, protect and improve the health of all people in improve the health of all people in Florida.Florida.

JudgeJudge Enforce legislationEnforce legislation Define qualityDefine quality

LicenseLicense Communicate Communicate

Medical Board StructureMedical Board Structure

The Medical Board is a group of volunteers The Medical Board is a group of volunteers who are charged with upholding the who are charged with upholding the Medical Practice Act for the State of Medical Practice Act for the State of Florida.Florida.

Twelve physician membersTwelve physician membersThree consumer membersThree consumer members

All Members of the Board are appointed by All Members of the Board are appointed by the Governor.the Governor.

LeadershipLeadership

Rick ScottGovernor

H. Frank Farmer, Jr. M.D., PhD, FACPState Surgeon General

Jason J. Rosenberg, M.D.Chairman

Board of Medicine

Lucy GeeDivision Director

Medical Quality Assurance

Licensure Decisions

Probable Cause Determinations

Discipline Decisions

Practice Standards

Licensure/Exam Services

Complaint/Investigation Services

Prosecution Services

Licensure Statistics Licensure Statistics

ProfessionProfession # of licensees# of licensees

Medical PhysiciansMedical Physicians 67,45567,455

Anesthesiologist Anesthesiologist Assistants Assistants 6060

Physician Assistants Physician Assistants 5,1085,108

Statistics taken from the MQA Annual Report July 1, 2010 – June 30,Statistics taken from the MQA Annual Report July 1, 2010 – June 30,20112011

Accessing Information Accessing Information

Board of Medicine web pageBoard of Medicine web page http://www.doh.state.fl.us/mqa/medical/http://www.doh.state.fl.us/mqa/medical/ Board of Medicine Interested Parties List Board of Medicine Interested Parties List

(Mailman)(Mailman) Go to website above to sign upGo to website above to sign up

Address, telephone, fax and email Address, telephone, fax and email 4052 Bald Cypress Way, Bin C03, Tallahassee, FL 4052 Bald Cypress Way, Bin C03, Tallahassee, FL

32399 32399 (850) 245-4131(850) 245-4131 (850) 488-9325(850) 488-9325 MQA_Medicine@doh.state.fl.us MQA_Medicine@doh.state.fl.us

Board CommitteesBoard Committees

Major standing committees include: Major standing committees include: • Credentials CommitteeCredentials Committee

• Interviews license applicants whose prior history, Interviews license applicants whose prior history, including malpractice cases, raises questions of concern including malpractice cases, raises questions of concern regarding the ability to practice with skill and safety, or regarding the ability to practice with skill and safety, or questions about an applicant’s performance in medical questions about an applicant’s performance in medical school or prior practice in other jurisdictions school or prior practice in other jurisdictions

• Rules/Legislative CommitteeRules/Legislative Committee• Develops recommendations for amendment of Board Develops recommendations for amendment of Board

rules or creation of new rules, to clarify practice rules or creation of new rules, to clarify practice standards or to impose requirements to strengthen standards or to impose requirements to strengthen patient protection and quality of care. This committee patient protection and quality of care. This committee also makes recommendations for Florida’s annual also makes recommendations for Florida’s annual legislative session legislative session

Board Committees Board Committees continued . . . continued . . .

• Probationers CommitteeProbationers Committee• Monitors compliance of licensees who have been disciplined Monitors compliance of licensees who have been disciplined

and placed under conditions or probation; reviews required and placed under conditions or probation; reviews required reports of compliance and requires personal appearances reports of compliance and requires personal appearances from probationers as part of the ongoing monitoring, until from probationers as part of the ongoing monitoring, until such time as the conditions of probation are fulfilled such time as the conditions of probation are fulfilled

• Surgical Care/Quality Assurance CommitteeSurgical Care/Quality Assurance Committee• Determines necessary and appropriate revisions to the rule Determines necessary and appropriate revisions to the rule

to strengthen patient safety and minimize the risk factors to strengthen patient safety and minimize the risk factors that contribute to adverse patient incidents; addresses that contribute to adverse patient incidents; addresses issues related to quality of care and standards of practice; issues related to quality of care and standards of practice; formulates policy recommendations for the full Board’s formulates policy recommendations for the full Board’s consideration, studies quality of care issues as they arise, consideration, studies quality of care issues as they arise, and organizes and conducts symposia on special topics and organizes and conducts symposia on special topics (e.g., treatment of obesity, disruptive physician). (e.g., treatment of obesity, disruptive physician).

Board Committees Board Committees continued . . . continued . . .

North and South Probable Cause North and South Probable Cause PanelsPanels Review investigations of complaints filed against Review investigations of complaints filed against

licensees and determine whether the licensees and determine whether the investigation materials reflect probable cause investigation materials reflect probable cause that the licensee violated regulatory that the licensee violated regulatory requirements, including requirements relating to requirements, including requirements relating to standards of care and misconduct. When standards of care and misconduct. When probable cause is found, disciplinary action is probable cause is found, disciplinary action is initiated by the panels for final action by the full initiated by the panels for final action by the full Board, after the licensee is afforded due process Board, after the licensee is afforded due process rights rights

Other Committees Other Committees Finance & Statistics CommitteeFinance & Statistics Committee

Review the Board’s budgetary standing and to Review the Board’s budgetary standing and to create/track statistics that assist the Board in create/track statistics that assist the Board in making policy decisions making policy decisions

Expert Witness CommitteeExpert Witness Committee Approves expert witnesses to be used by Approves expert witnesses to be used by

investigators and probable cause panels in investigators and probable cause panels in reviewing complaint investigations for a reviewing complaint investigations for a determination that standards of care were violated determination that standards of care were violated

Joint Anesthesiologist Assistant Committee (MD’s and Joint Anesthesiologist Assistant Committee (MD’s and DO’s share responsibilities)DO’s share responsibilities) Approve applicants for licensure as well as making Approve applicants for licensure as well as making

recommendations for rule creation and/or changes recommendations for rule creation and/or changes relating to the regulation of this profession relating to the regulation of this profession

..

Other Committees Other Committees ContinuedContinued

Communication, Education and Information CommitteeCommunication, Education and Information Committee This committee is tasked with developing proactive This committee is tasked with developing proactive

communication strategies in an effort to educate and communication strategies in an effort to educate and inform applicants, licensees and the public about the inform applicants, licensees and the public about the roles and activities of the Board of Medicine and the roles and activities of the Board of Medicine and the laws and rules and ethics regulating the practice of laws and rules and ethics regulating the practice of medicinemedicine

Councils under the Board Councils under the Board Purview Purview

Council on Physician AssistantsCouncil on Physician Assistants Council’s duties:Council’s duties:

Certification of applicants for licensureCertification of applicants for licensure Development of rules regulating physician assistantsDevelopment of rules regulating physician assistants Making recommendations to the Board regarding all Making recommendations to the Board regarding all

matters relating to physician assistantsmatters relating to physician assistants Board’s duties:Board’s duties:

Approve and adopt identical rule language recommended Approve and adopt identical rule language recommended by the Council, or return the recommendation to the by the Council, or return the recommendation to the CouncilCouncil

Disciplinary actions against licenseesDisciplinary actions against licensees

Councils under the Board Councils under the Board Purview continued . . . Purview continued . . .

Dietetic-Nutrition CouncilDietetic-Nutrition Council Council’s duties:Council’s duties:

Certification of applicants for licensureCertification of applicants for licensure Development of rules regulating the practice of Development of rules regulating the practice of

dietetics and nutrition counselingdietetics and nutrition counseling Making recommendations to the Board regarding Making recommendations to the Board regarding

all matters relating to the practice of dietetics all matters relating to the practice of dietetics and nutrition counselingand nutrition counseling

Board’s duties:Board’s duties: Approval and adoption of administrative rulesApproval and adoption of administrative rules Disciplinary action against licenseesDisciplinary action against licensees

Councils under the Board Councils under the Board Purview continued . . .Purview continued . . .

Electrolysis Council Electrolysis Council Council’s duties: Council’s duties:

Certification of applicants for licensureCertification of applicants for licensure Development of rules regulating the practice of Development of rules regulating the practice of

electrolysis electrolysis Making recommendations to the Board regarding Making recommendations to the Board regarding

all matters relating to the practice of electrolysisall matters relating to the practice of electrolysis Board’s duties:Board’s duties:

Approval and adoption of administrative rulesApproval and adoption of administrative rules Disciplinary action against licenseesDisciplinary action against licensees

MeetingsMeetings

The Board of Medicine meets 6 times The Board of Medicine meets 6 times per year to handle hearings and per year to handle hearings and Board business (February, April, June, Board business (February, April, June, August, October, December)August, October, December)

All meetings are open to the public All meetings are open to the public and physicians may receive CME and physicians may receive CME credit for attending one of the Board credit for attending one of the Board Meetings. Meetings.

Licensure RenewalLicensure Renewal

Florida physicians must renew their license every two Florida physicians must renew their license every two years. years.

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

obtain a minimum of 40 hours of continuing medical obtain a minimum of 40 hours of continuing medical education.education. 2 hours in prevention of medical errors2 hours in prevention of medical errors 38 hours of general CME38 hours of general CME Every third renewal: 2 hours Domestic Violence, 2 hours Every third renewal: 2 hours Domestic Violence, 2 hours

prevention of medical errors and 36 hours of general CMEprevention of medical errors and 36 hours of general CME Physicians practicing in Pain-management Clinics that are not Physicians practicing in Pain-management Clinics that are not

Board certified as outlined in Rule 64B8-9.0131, FAC are Board certified as outlined in Rule 64B8-9.0131, FAC are required to have 15 hours CME in pain-management per year. required to have 15 hours CME in pain-management per year.

Recent reduction of renewal fee to $391 (includes Recent reduction of renewal fee to $391 (includes background check fee and unlicensed activity fee)background check fee and unlicensed activity fee)

Licensure Renewal Licensure Renewal

The Prevention of Medical Errors course has specific requirementsThe Prevention of Medical Errors course has specific requirementsincluding a study of root cause analysis, error reduction, including a study of root cause analysis, error reduction,

prevention prevention and patient safety, and the 5 most mis-diagnosed medical and patient safety, and the 5 most mis-diagnosed medical

conditions inconditions inFlorida during the previous biennium and those conditions are:Florida during the previous biennium and those conditions are: 1. Diagnosis of cancer1. Diagnosis of cancer 2. Diagnosis of surgical complications2. Diagnosis of surgical complications 3. Diagnosis of acute abdomen related conditions3. Diagnosis of acute abdomen related conditions 4. Diagnosis of pregnancy related conditions4. Diagnosis of pregnancy related conditions 5. Diagnosis of neurological conditions5. Diagnosis of neurological conditions

This list is subject to change every two years. Be sure to read Rule This list is subject to change every two years. Be sure to read Rule

64B8-13.005, FAC for the most recent changes to the rule. 64B8-13.005, FAC for the most recent changes to the rule.

Renewal of Licensure Renewal of Licensure continued . . .continued . . .

Retired status – if you elect to place Retired status – if you elect to place your license in a retired status, you your license in a retired status, you are not permitted to practice are not permitted to practice medicine at all, including the writing medicine at all, including the writing of prescriptions of prescriptions

Practitioner Profiles Practitioner Profiles

Must be updated within Must be updated within 15 days15 days of any of any change change [s. 456.042, F.S.][s. 456.042, F.S.]

Mandatory fields:Mandatory fields: Primary practice addressPrimary practice address Secondary practice addressSecondary practice address Staff privilegesStaff privileges Other state licensureOther state licensure Year began practicing Year began practicing Education and trainingEducation and training Other health related degreesOther health related degrees Professional and postgraduate training Professional and postgraduate training Academic appointmentsAcademic appointments Specialty certificationSpecialty certification Financial responsibility Financial responsibility Criminal OffensesCriminal Offenses Final disciplinary action (multiple categories)Final disciplinary action (multiple categories) Actions on staff privilegesActions on staff privileges Liability claims Liability claims

Practitioner Profiles Practitioner Profiles continued . . .continued . . .

View the View the Practitioner’s Guide to Practitioner’s Guide to Completing and Updating the ProfileCompleting and Updating the Profile at at www.doh.state.fl.us/MQA/profilingwww.doh.state.fl.us/MQA/profiling

Are you interested in serving Are you interested in serving as an Expert Witness?as an Expert Witness?

The Department of Health is looking The Department of Health is looking for certified physicians, in a wide for certified physicians, in a wide range of specialty areas to serve as range of specialty areas to serve as experts in a volunteer or paid status. experts in a volunteer or paid status.

For more information, contact the For more information, contact the Irene Lake at (850) 245-4444 Irene Lake at (850) 245-4444 extension 8212 extension 8212

Disciplinary Process Disciplinary Process

Grounds for disciplinary actionGrounds for disciplinary action S. 458.331(1), Florida Statutes S. 458.331(1), Florida Statutes S. 457.072(1), Florida Statutes S. 457.072(1), Florida Statutes http://www.leg.state.fl.us/statutes/http://www.leg.state.fl.us/statutes/

index.cfmindex.cfm

Disciplinary guidelines Disciplinary guidelines Rule 64B8-8.001, Florida Administrative Rule 64B8-8.001, Florida Administrative

Code Code https://www.flrules.org/Default.asphttps://www.flrules.org/Default.asp

DISCIPLINARY PROCESSDISCIPLINARY PROCESSComplaint

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 Disciplinary Statistics

4,8384,838 complaints filedcomplaints filed

1,631 1,631 found legally sufficientfound legally sufficient

229 229 resolved through Finalresolved through FinalOrdersOrders

200 200 resolved through citationsresolved through citations(1(1stst citation is not discipline) citation is not discipline)

MQA Annual Report July 1, 2010 – June 30, 2011MQA Annual Report July 1, 2010 – June 30, 2011

Implications of Disciplinary Implications of Disciplinary ActionAction

If you have licenses in multiple states and have If you have licenses in multiple states and have had action on a license in one state, you should had action on a license in one state, you should report that action to the other states. report that action to the other states.

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

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

Tips to avoid disciplineTips to avoid discipline

Update profile Update profile [s. 456.072, F.S.][s. 456.072, F.S.] Notify Board before you move or close Notify Board before you move or close

your practice your practice [s. 456.035, 458.319, 458.327, Rule [s. 456.035, 458.319, 458.327, Rule 64B8-10.002]64B8-10.002]

Do not pre-sign prescriptions Do not pre-sign prescriptions [s. 458.331(1)(aa][s. 458.331(1)(aa] Maintain medical records on friends, family Maintain medical records on friends, family

and employees and employees [s. 458.331(1)(r), 458.331(1)(m)][s. 458.331(1)(r), 458.331(1)(m)] Patient boundaries Patient boundaries [s. 458.329, 458.331(1)(j)][s. 458.329, 458.331(1)(j)]

Tips to avoid disciplineTips to avoid discipline

Do not Internet prescribe Do not Internet prescribe [s. 458.331(1)(t), Rule 64B8-[s. 458.331(1)(t), Rule 64B8-9.014]9.014]

Pre-approve any advertisement of your services – Pre-approve any advertisement of your services – disclaimer required disclaimer required [s. 456.062, Rule 64B8-11][s. 456.062, Rule 64B8-11]

Know the fees you can charge for copies of Know the fees you can charge for copies of medical records medical records [Rule 64B8-10.003][Rule 64B8-10.003]

Know the legible prescription laws Know the legible prescription laws [s. 456.43, s. 668 [s. 456.43, s. 668 and Rule 64B8-3.005]and Rule 64B8-3.005]

Know the controlled substance prescribing laws Know the controlled substance prescribing laws [s. [s. 456.42, and Rule 64B8-9.013]456.42, and Rule 64B8-9.013]

Notify patients of adverse incidents Notify patients of adverse incidents [s. 395.0197, [s. 395.0197, 395.1051, 456.0575]395.1051, 456.0575]

Help for impaired & Help for impaired & rehabilitation for disable rehabilitation for disable

physicians physicians The Board has an excellent evaluation and The Board has an excellent evaluation and

rehabilitation program that is a phone call rehabilitation program that is a phone call away: Professional Resource Network away: Professional Resource Network (800) 888-8776(800) 888-8776

For most practitioners, this is and remains For most practitioners, this is and remains a confidential process that offers help a confidential process that offers help

Program recently expanded to include Program recently expanded to include medical students medical students

What’s on the Board’s What’s on the Board’s Radar? Radar?

Pain ManagementPain Management Office Surgery RegulationOffice Surgery Regulation Maintenance of LicensureMaintenance of Licensure Wrong site/person/procedures Wrong site/person/procedures Re-Entry into Practice Re-Entry into Practice Communication, Education and Communication, Education and

InformationInformation

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

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

The Board continues to support the prescription The Board continues to support the prescription drug monitoring program [eForcse]. drug monitoring program [eForcse].

The Board has met several times with the Boards The Board has met several times with the Boards of Osteopathic Medicine, Pharmacy and Nursing of Osteopathic Medicine, Pharmacy and Nursing along with other stakeholders to address issues along with other stakeholders to address issues involving patient deaths related to prescription involving patient deaths related to prescription medications medications

The Board, in conjunction with the Federation of The Board, in conjunction with the Federation of State Medical Boards (FSMB), is attempting to State Medical Boards (FSMB), is attempting to obtain funding to send FSMB’s publication obtain funding to send FSMB’s publication “Responsible Opioid Prescribing, A Physician’s “Responsible Opioid Prescribing, A Physician’s Guide”Guide” to all physicians licensed in our state. to all physicians licensed in our state.

Office Surgery Registration Office Surgery Registration ProgramProgram

Every licensed physician who holds Every licensed physician who holds an active Florida license and an active Florida license and performs Level II surgical procedures performs Level II surgical procedures in Florida with a maximum planned in Florida with a maximum planned duration of more than five (5) duration of more than five (5) minutes or any Level III office minutes or any Level III office surgery, as fully defined in Rule surgery, as fully defined in Rule 64B8-9.009, F.A.C., shall register the 64B8-9.009, F.A.C., shall register the office with the Department of Health. office with the Department of Health.

Office Surgery Registration Office Surgery Registration ProgramProgram

Total number of facilities registered = Total number of facilities registered = 411411

Total number of physicians registered = Total number of physicians registered = 641 641

From Board of Medicine Annual Report for Fiscal Year 2010-2011From Board of Medicine Annual Report for Fiscal Year 2010-2011

Wrong site Wrong site surgery/procedure/person surgery/procedure/person

statistics statistics The Board of Medicine recently held a Wrong site The Board of Medicine recently held a Wrong site surgery/procedure/person (WSS) workshop. Results indicate that most surgery/procedure/person (WSS) workshop. Results indicate that most of the cases result from a breakdown of the process of communication of the cases result from a breakdown of the process of communication between doctor, patient and staff as related to the between doctor, patient and staff as related to the time outtime out procedure procedure and do not necessarily reflect any lack of skill or judgment on the part and do not necessarily reflect any lack of skill or judgment on the part of the operating surgeon. We will continue to explore better ways to of the operating surgeon. We will continue to explore better ways to educate physicians and staff on more effective ways to perform the educate physicians and staff on more effective ways to perform the time outtime out and and pausepause prior to beginning the procedure in order to help prior to beginning the procedure in order to help eliminate this recurring but preventable problem.eliminate this recurring but preventable problem.

During fiscal year 2010-2011, 4,838 complaints were filed. During fiscal year 2010-2011, 4,838 complaints were filed. Of those complaints, 1,631 complaints were found to be legally Of those complaints, 1,631 complaints were found to be legally

sufficientsufficient Of those, the Board took 229 disciplinary actions against Of those, the Board took 229 disciplinary actions against

physicians. physicians. Of the 229 disciplinary actions taken, 19 were based on Of the 229 disciplinary actions taken, 19 were based on

wrong site/procedure/person violationswrong site/procedure/person violations The Board is currently reviewing the Pause Rule [Rule 64B8-9.007, The Board is currently reviewing the Pause Rule [Rule 64B8-9.007,

FAC] to continue addressing Wrong Site cases. FAC] to continue addressing Wrong Site cases.

Some risk factors and/or Some risk factors and/or causescauses

Breakdown in communicationBreakdown in communication Surgical site not marked or not marked properlySurgical site not marked or not marked properly Patient records, X-rays or other diagnostic studies not Patient records, X-rays or other diagnostic studies not

available in OR for verificationavailable in OR for verification Incomplete pre-op assessmentIncomplete pre-op assessment Staffing issues and/or other distractionsStaffing issues and/or other distractions Emergency casesEmergency cases Unusual time pressuresUnusual time pressures Multiple patient surgeries scheduled on same day with a Multiple patient surgeries scheduled on same day with a

cancellationcancellation Multiple procedures on same patientMultiple procedures on same patient X-rays reversed X-rays reversed Pause is performed and surgeon subsequently leaves the Pause is performed and surgeon subsequently leaves the

roomroom

Areas of improvement:Areas of improvement:

Pause Rule Pause Rule 3 R’s Poster Campaign 3 R’s Poster Campaign Executive Director and Board Members presents Executive Director and Board Members presents

information about preventing wrong site surgery information about preventing wrong site surgery at training programs, hospitals, universities, at training programs, hospitals, universities, medical organization and other entities medical organization and other entities throughout Floridathroughout Florida

Meeting with parties who have a goal to improve Meeting with parties who have a goal to improve patient safetypatient safety Patient Safety CorporationPatient Safety Corporation Florida Medical AssociationFlorida Medical Association Board of NursingBoard of Nursing Board of Osteopathic MedicineBoard of Osteopathic Medicine

64B8-9.00764B8-9.007 Standards of Standards of Practice – The Pause Rule.Practice – The Pause Rule.

The Board of Medicine interprets the standard of care The Board of Medicine interprets the standard of care requirement of Section 458.331(1)(t), F.S., and the requirement of Section 458.331(1)(t), F.S., and the delegation of duties restrictions of Section 458.331(1)(w), delegation of duties restrictions of Section 458.331(1)(w), F.S., with regard to surgery as follows:F.S., with regard to surgery as follows:

(1) The ultimate responsibility for diagnosing and treating (1) The ultimate responsibility for diagnosing and treating medical and surgical problems is that of the licensed doctor medical and surgical problems is that of the licensed doctor of medicine or osteopathy who is to perform the procedure. of medicine or osteopathy who is to perform the procedure. In addition, it is the responsibility of the treating physician In addition, it is the responsibility of the treating physician or an equivalently trained doctor of medicine or osteopathy or an equivalently trained doctor of medicine or osteopathy or a physician practicing within a Board approved or a physician practicing within a Board approved postgraduate training program to explain the procedure to postgraduate training program to explain the procedure to and obtain the informed consent of the patient.and obtain the informed consent of the patient. It is not It is not necessary, however, that the treating physician obtain or necessary, however, that the treating physician obtain or witness the signature of the patient on the written form witness the signature of the patient on the written form evidencing informed consent.evidencing informed consent.

(2) This rule is intended to prevent wrong site, wrong side, wrong (2) This rule is intended to prevent wrong site, wrong side, wrong patient and wrong surgeries/procedures by requiring the team to patient and wrong surgeries/procedures by requiring the team to pause prior to the initiation of the surgery/procedure to confirm pause prior to the initiation of the surgery/procedure to confirm the side, site, patient identity, and surgery/procedure.the side, site, patient identity, and surgery/procedure.

(a) Definition of Surgery/Procedure. As used herein, (a) Definition of Surgery/Procedure. As used herein, “surgery/procedure” means the incision or curettage of tissue or “surgery/procedure” means the incision or curettage of tissue or an organ, insertion of natural or artificial implants, electro-an organ, insertion of natural or artificial implants, electro-convulsive therapy, endoscopic procedure or other procedure convulsive therapy, endoscopic procedure or other procedure requiring the administration of anesthesia or an anesthetic agent. requiring the administration of anesthesia or an anesthetic agent. Minor surgeries/procedures such as excision of skin lesions, moles, Minor surgeries/procedures such as excision of skin lesions, moles, warts, cysts, lipomas and repair of lacerations or surgery limited warts, cysts, lipomas and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of local anesthesia not involving drug-induced alteration of consciousness other than minimal pre-operative tranquilization of consciousness other than minimal pre-operative tranquilization of the patient are exempt from the following requirements.the patient are exempt from the following requirements.

(b) (b) Except in life-threatening emergencies requiring immediate resuscitative measures, once the patient has been prepared for the elective surgery/procedure and the team has been gathered and immediately prior to the initiation of any procedure, the team will pause and the physician(s) performing the procedure 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. The medical record shall specifically reflect when this confirmation procedure was completed and which personnel on the team confirmed each item. This requirement for confirmation applies to physicians performing procedures either in office settings or facilities licensed pursuant to Chapter 395, F.S., and shall be in addition to any other requirements that may be required by the office or facility.

(c) The provisions of paragraph (b) shall be applicable to anesthesia (c) The provisions of paragraph (b) shall be applicable to anesthesia providers prior to administering anesthesia or anesthetic agents, or providers prior to administering anesthesia or anesthetic agents, or performing regional blocks at any time both within or outside a performing regional blocks at any time both within or outside a surgery setting.surgery setting.

(3) Management of postsurgical care is the responsibility of (3) Management of postsurgical care is the responsibility of the operating surgeon.the operating surgeon.

(4) The operating surgeon can delegate discretionary (4) The operating surgeon can delegate discretionary postoperative activities to equivalently trained licensed postoperative activities to equivalently trained licensed doctors of medicine or osteopathy or to physicians doctors of medicine or osteopathy or to physicians practicing within Board approved postgraduate training practicing within Board approved postgraduate training programs. Delegation to any health care practitioner is programs. Delegation to any health care practitioner is permitted only if the other practitioner is supervised by the permitted only if the other practitioner is supervised by the operating surgeon or an equivalently trained licensed operating surgeon or an equivalently trained licensed doctor of medicine or osteopathy or a physician practicing doctor of medicine or osteopathy or a physician practicing within a Board approved postgraduate training program.within a Board approved postgraduate training program.

Specific Authority 458.309 FS. Law Implemented 458.331(1)Specific Authority 458.309 FS. Law Implemented 458.331(1)(t), (v), (w) FS. History–New 11-28-91, Formerly 21M-(t), (v), (w) FS. History–New 11-28-91, Formerly 21M-20.015, 21M-27.007, 61F6-27.007, 59R-9.007, Amended 2-20.015, 21M-27.007, 61F6-27.007, 59R-9.007, Amended 2-18-04, 9-18-05, 4-25-06, 5-6-08.18-04, 9-18-05, 4-25-06, 5-6-08.

What can you do to avoid What can you do to avoid this? this?

JCAHO recommendations:JCAHO recommendations:

Visit patient in the pre-op areaVisit patient in the pre-op area Mark the surgical site with the patientMark the surgical site with the patient Verify the records (patient chart, X-rays, Verify the records (patient chart, X-rays,

diagnostic studies, etc) and have these diagnostic studies, etc) and have these available in the ORavailable in the OR

Obtain oral verification in the OR by reading Obtain oral verification in the OR by reading the consentthe consent

Take a time-out to verify 3 R’s and Take a time-out to verify 3 R’s and documentdocument

Monitor compliance with these stepsMonitor compliance with these steps

Making the incision on correct Making the incision on correct site of correct patientsite of correct patient

The Board accepts no excuse for wrong site The Board accepts no excuse for wrong site surgerysurgery

If you make the mistake, document it or the If you make the mistake, document it or the Board will increase the penaltyBoard will increase the penalty

If you make the mistake, advise the patient If you make the mistake, advise the patient and/or the patient’s representative or the and/or the patient’s representative or the Board will increase the penaltyBoard will increase the penalty

Although wrong site/procedure/patient Although wrong site/procedure/patient surgery incidents are a very, very small surgery incidents are a very, very small percentage of surgical encounters, most if percentage of surgical encounters, most if not all wrong site surgery is preventable. not all wrong site surgery is preventable. The cause of a wrong site surgery is a The cause of a wrong site surgery is a breakdown of communication in the breakdown of communication in the preparatory process prior to performing the preparatory process prior to performing the procedure. Careful use of the “Pause or procedure. Careful use of the “Pause or Time-Out” prior to each step in the Time-Out” prior to each step in the preparatory process can and will prevent preparatory process can and will prevent wrong site surgery. wrong site surgery.

Re-entry into practice Re-entry into practice

The Board is concerned about the The Board is concerned about the competency of physicians who do not competency of physicians who do not practice for a period of time for one reason or practice for a period of time for one reason or another and then return to practice. For this another and then return to practice. For this reason, the Board will be conducting reason, the Board will be conducting workshops regarding re-entry into practice workshops regarding re-entry into practice requirements to ensure the safety of patients requirements to ensure the safety of patients in our state.in our state.

Stay tuned to our web page for additional Stay tuned to our web page for additional information and dates for the workshops. information and dates for the workshops.

QUESTIONS? QUESTIONS?