OPSC 2015 ANNUAL CONVENTION SYLLABUS · OPSC’ 54 a onven a p a 42 WEDNESDAY 4 2015: 4:00pm -...

2015 OPSC Annual Convention

syllabus

February 4-8, 2015 Hyatt Regency Mission BaySan Diego, California

WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm

Professionalism: The Relationship with State Medical Boards and Their Disciplinary FunctionPresented by Joseph Zammuto, DO

OPSC’s 54th Annual Convention and Exposition Syllabus 35

PRESENTATIONLearning Objectives andSelf ASSESSMENT questions

LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONS1. Describe the composition and responsibility of the board

2. Describe the licensing and disciplinary process

3. Identify ways to avoid attention from the board

4. Provide resources for additional information on future changes

1. What is the OMBC composition? a. 10 DOs and 10 Public b. 4 DOs and 2 Public c. 5 DOs and 4 Public

2. How was the OMBC established? a. Statute b. Lottery c. Initiative

3. What year was the OMBC established? a. 1921 b. 1922 c. 1923

4. Who does the OMBC protect? a. Nurses b. Doctors c. Patients

5. Which is not a Physician Competency? a. Patient Care b. Medical Knowledge c. Practice-based learning and improvement d. Interpersonal and communication skills e. Professionalism f. Systems-based practice g. ICD-10

6. Which is not unprofessional conduct? a. Professional misconduct b. Substandard care c. Inappropriate prescribing

d. False advertising e. Discharging a patient from your practice

7. What is the greatest source of complaints? a. Anonymous b. Family member c. Patient d. Malpractice e. Other


WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO

Professionalism: The relationship with state medical boards and

their disciplinary function

The Osteopathic Medical Board of California

Current and New activities for the Future.



Goals/Objectives

• Describe composition and responsibility of the board

• Describe the licensing and disciplinary processes

• Identify ways to avoid attention from the board

• Provide resources for additional information



OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA

• Board composition– Nine members– Three Year Length of term– OSTEOPATHIC PHYSICIANS regulated by

the board– FIVE Physicians/FOUR Public members– Gubernatorial appointment



OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA

• The Board was not established by statute, rather by an Initiative Act.

• Established by Osteopathic Initiative Act of 1922

• * Amended by the State electorate in 1962• Mission of the board is to protect the

public.• Duties & responsibilities of the board



Teaching on medical licensure and regulation

Source: 2007 LCME Annual Medical School Questionnaire

126 LCME-accredited medical schools

Number of US Medical Schools Teaching on Medical licensure/regulation

Included in required course Included in elective course

70 19

Good News: 71% of medical schools report teaching on the topic of medical licensure and regulation



Teaching on medical licensure and regulation

Source: 2007 AAMC Medical School Graduation Questionnaire

Question# 11; 12,512 respondents

Do you believe that the time devoted to your instruction in the following area was inadequate, appropriate or excessive?

Medical licensure/regulation

Inadequate Appropriate Excessive

61.4% 38.3% 0.3%

Bad News: Most medical students feel inadequately informed on issues relative to medical licensure and regulation



Licensure Evaluate applicants’ fitness to practice

— Medical education and training— Examination of cognitive and clinical skills necessary for the independent

practice of medicine— Character— Prior disciplinary action

Regulation Establish standards for physician licensure and practice

Discipline Take appropriate action against individual physicians’ licenses for

unprofessional, incompetent or unlawful practice of medicine

State Medical Boardsa triad of functions for public protection



Professionalism


Question# 16: Indicate whether you agree or disagree with the following statement about your preparedness for beginning a residency training program; 12,524 respondents

“I understand the ethical and professional values that are expected of the profession.”

Strongly Agree Agree No Opinion Disagree Strongly Disagree 56.2% 41.1% 2.4% 0.2% 0.1%

Graduating medical students are confident in their understanding of the tenets of the medical profession



Physician Competencies(Source: ACGME/ABMS)

1. Patient Care2. Medical Knowledge3. Practice-based learning and improvement4. Interpersonal and communication skills5. Professionalism6. System-based practice



Definitions

• Medical practice (defined)• Unprofessional conduct (defined)

– Professional misconduct– Substandard care– Inappropriate prescribing– False advertising– Etc.



Statistical Data

• Licensees: 15,000• Number of complaints: 700• 4.6%



Disciplinary Process

Complaint

Investigate CloseContinue Investigation

Warning

Resolve by ConsentSummary Suspension

Investigation Committee

Consent Parameters

Decision

Hearing

Optional Appeal: Administrative Review Board



Disciplinary Process

Complaint received

Investigation/review

Dismissal Charges filed/Formal complaint process

Dismissal Board action



Complaint Process

• Outline of the Board’s complaint process



History of Complaints

10000

12000

14000

16000

18000

20000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

0

100

200

300

400

500

600

700

800

900

1000

Licensees

Complaints



Sources of Complaints

24, 3%108, 13%

339, 41%101, 12%

257, 31% AnonymousFamily MemberPatientMalpracticeOther



Complaint categories

Other jurisdiction 39 1.8%Incomp. / Unethical 706 33.3Unprofessional 700 33.0Illness 56 2.6Non-jurisdictional 20 0.9Medical records 99 5.0Addiction 34 1.6Prescribing 287 13.5Sexual misconduct 35 1 6



Case Studies



Impaired Physicians Program (IPP)

• Contracted Vendor: Maximus, Inc.(800) 522 9198 Phone• Osteopathic Medical Board, Diversion

Evaluation Committee(3) three licensed D.O.’s

• California Code of Regulation; Title 16, Division 16, Article 12.5, Sections 1660,1660.2,1660.4,,1661,1661.2,1661.4,1662



Medical board goal

“Rehabilitate, when possible, persons who are impaired or who practice medicine unethically or below minimal standards of care, and prohibit persons who have not been rehabilitated from practicing medicine.”

Source: State Medical Board of Ohio



0

5

10

15

20

25

30

35

40

45

50

2002 2003 2004 2005 2006 2007

Impairment Actions

Impairment Action



0

5

10

15

20

25

30

35

Negligence /IncompetenceFraud

Impairment

Other

InappropriateprescribingSexual misconduct

Records

Violation of P/O

Final Disciplinary Actions by Type of Misconduct in 2007

Source: State medical board of ___.

As

% o

f all

final

dis

cipl

inar

y ac

tions



Compliance Monitoring

• Over 40 licensees currently monitored by the Board (On Probation)

• Currently 16 Participants in Diversion program. Primarily impairment cases

• Usually monitored for a minimum of 5 years for diversion participants.



Reporting Requirements

• Reference Business and Professions Code 800 for Reporting Requirements.

• http://leginfo.legislature.ca.gov/faces/codesdisplayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=1.&article=11.



Serious Misconduct

• Negligence/Incompetence• Impairment• Sexual abuse• Fraud• Inappropriate prescribing



The Investigation

• Medical Records– Medical Coordinator review

• Interview• Background Checks• Expert Opinions• Closed• Investigation Committee



Investigation Committee

Possible recommendations1. Closure2. Further investigation3. Administrative warning4. Impairment review5. Hearing6. Summary suspensionConsent Parameters



Board Hearings• Hearing committee of 9• Administrative law judge• Court reporter• Attorneys• Parties• Witnesses/evidence

• Not bound by strict evidentiary rules

• Standard of proof:– Identify preponderance, clear

and convincing or other

ACTORS

PROCESS



Board Decisions

• Censure and reprimand• Suspension (actual/stayed)• Probation (monitoring)• Limitation of license• Revocation• Monetary fine• Education/Training • Community Services• Dismissal



Administrative Review Board

• Established by…• Review board composition Board has

medical Consultant who reviews complaints. If further review necessary, case sent to specialty expert.

• Expert Reviewers under contract with Board.

• Process: Refer to Osteopathic Medical Board’s Complaint Process.



Physician Participation

• Board chair, board staff (if applicable)• Board members• Adjudicatory committees• Medical coordinators• Expert consultants• Administrative warning• Physician monitoring/supervision



Specialties at Risk

• Internal Medicine• Family / General Practice• Psychiatry• OB / GYN

Source: ___ board. Based upon disciplinary sanctions taken for sexual violations, 1997-2007



Communications

Graduating medical students are confident in their ability to communicate effectively


Question# 16: Indicate the degree of preparedness for entering a residency training program. 12,527 respondents

“I have the communication skills necessary to interact with patients and health professionals.”

Strongly Agree Agree No Opinion Disagree Strongly Disagree

60.6% 36.6% 2.3% 0.3% 0.1%



National Data: Board Actions by Type, 1991-2006

336 39

9 626

584

584

611 73

975

373

166

764

7 706

640 76

379

170

9

3767

3838

3944

4015 41

69 4590

5502

5344

4867

280

4 2

971

308

1 3

571

381

3 3

821

372

8

0

1000

2000

3000

4000

5000

6000

7000

1991

: 3,14

0

1992

: 3,37

0

1993

: 3,70

7

1994

: 4,15

5

1995

: 4,39

7

1996

: 4,43

2

1997

: 4,46

7

1998

: 4,52

0

1999

: 4,56

9

2000

: 4,61

1

2001

: 4,66

2

2002

: 487

5

2003

: 523

0

2004

: 626

5

2005

: 613

5

2006

: 557

6

Non-Prejudicial Prejudicial

Total Actions

Source: Federation of State Medical Boards



1024.7974.2

929.1

697.5

514.1

316.4236.1

25

125

225

325

425

525

625

725

825

925

1025

Unprofessional Conduct NegligenceSubstance Abuse Controlled Substance ViolationsFraud Sexual MisconductFailure to Maintain Adequate Medical Records

National Data: Basis for Board Actions against Physicians, 1997-2006

Neg

ligen

ce

Unp

rofe

ssio

nal C

ondu

ct

Subs

tanc

e Abu

se

Con

trol

led

Subs

tanc

e V

iola

tions

Frau

d

Sexu

al

Mis

cond

uct

Failu

re to

Mai

ntai

n A

dequ

ate

med

ical

Rec

ords

Source: Federation of State Medical Boards



How Often Do Physicians Get Disciplined by State Licensing Boards?

~750,000 licensed physicians in the U.S.

2,250 physicians disciplined annually (0.3%) – over a ten year period



Grounds for Discipline

Grounds for action, including…• Standard of care violations• Inappropriate prescribing• Breaching professional ethics

Source: Identify relevant statute/code



Source: Teherani A, Hodgson C, Banach M, Papadakis M. “Domains of Unprofessional Behavior During Medical School Associated with Future Disciplinary Action by a State Medical Board.” Academic Medicine 2005; 80(10):S17-S20

Behavioral domains associated with subsequent discipline by a state medical broad

• Poor reliability and responsibility

• Lack of self-improvement and adaptability

• Poor initiative and motivation



For further information

• Board website: www.ombc.ca.gov• Board phone numbers:

phone 916 928 8390; fax 916 928 8392• Email contact: [email protected]• Board’s physical address: 1300 National Drive, Suite 150 Sacramento, CA 95834-1991



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