NEWSLETTER. Ways to Prevent Having to Appear Before the Board

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1 A r k a n s a s S t a t e M e d i c a l B o a r d W e s t C a p i t o l A v e n u e, S u i t e L i t t l e R o c k, A R NEWSLETTER Fall 2013 Peggy Pryor Cryer Executive Secretary 1401 West Capitol Avenue, Suite Board Members: Joseph M. Beck, II, M.D. Chairman Sylvia D. Simon, M.D. Vice-Chairman Monticello, AR Bob E. Cogburn, M.D. Secretary Mountain Home, AR Harold B. Betton, M.D. Treasurer Omar T. Atiq, M.D. Pine Bluff, AR Steven L. Cathey, M.D. North Jim C. Citty, M.D. Searcy, AR William F. Dudding, M.D. Fort Smith, AR Roger Harmon, P.D. John E. Hearnsberger, II, M.D. Nashville, AR Veryl D. Hodges, D.O. Scott Pace, Pharm.D., J.D. John H. Scribner, M.D. Salem, AR John B. Weiss, M.D. Fayetteville, AR Legal Counsel: William H. Trice, III 211 Spring Street Ways to Prevent Having to Appear Before the Board The charge given the Arkansas State Medical Board is to protect the health, safety and welfare of the people of the State of Arkansas with the goal that all citizens be provided the highest quality health care. In accordance with this protection of the public, ALL complaints received in the Medical Board office must be processed. The majority of complaints, after being thoroughly reviewed, are closed without any action being taken at all. However, some complaints result in the practitioner being brought before the Board, either by the Board s request, or for more serious issues, a disciplinary hearing must be conducted. With that being said, there are ways that a practitioner can prevent having to appear before the Arkansas State Medical Board. The number one way to avoid an appearance is to remain up-to-date with the rules and regulations in the Arkansas Medical Practices Act. As quickly as medicine changes, ignorance of the law is setting yourself up for trouble. Some other simple tactics that could help avoid a Board appearance would be keeping well-documented patient records, being attentive to your patients and, when appropriate, being available for and communicating with the patient and/or the patient s family. Good information diffuses frustrations and reduces lawsuits. If the Medical Board receives a complaint letter from a patient, no matter the subject of the complaint, the Board looks to the practitioner for an explanation. So other preventive measures would be to have clearly stated policies regarding office procedures, such as scheduling appointments, handling of telephone messages from patients and release of medical records. Be familiar with your office personnel and their attitude and interaction with patients. The first contact with your office sets the tone of the visit. Remain up-to-date with current billing methods and insurance procedures. The physician or medical provider is ultimately responsible for all that transpires in his/her office, everything from the front desk to proper billing. Sometimes regardless of the treatment provided or actions of the practitioner, the patient will not be pleased and may file a complaint with the Medical Board. If the practitioner submits a respectful and complete response to the allegations and provides well-documented medical records, in most instances the Board will review and close the matter with no action taken. In conclusion, the vast majority of practitioners in Arkansas are superb medical providers and the citizens of this state should be grateful for them. However, even excellent practitioners often times can get caught up in their busy schedules and lives. It is during these busy times that it would be especially wise to take a breath and not forget to be attentive to your patients. Always remember to treat each patient as you would want you or your family member to be treated. Inside This Issue: Ways to Prevent Having to Appear Before the Board DEA Regulations Pertaining to Destruction of Controlled Substances License Applicants Designated Contacts 2 Board Actions & License Adjustments 3 Proposed Regulation Governing Office Based Surgery 3 New License Applicants 3 Incomplete Profiles 4 NCQA Recertification 4-5 License Renewal Questions 5 Meetings Dates 4 Online Renewals Required for All Licensees in

2 Page 2 DEA Regulations Pertaining to Destruction of Controlled Substances The DEA has a closed system of distribution in that every entity that handles pharmaceutical controlled substances is required to register with the DEA; importers, exporters, manufacturers, distributors, pharmacies and practitioners must adhere to special recordkeeping and security requirements pertaining to controlled substances. Once the drug is dispensed to the individual patient, the recordkeeping and security requirements cease. For the purposes of this dialog, how physicians obtain, administer and dispense CSs will be discussed. To stay in that closed system of distribution, a physician obtains CSs from a wholesaler or a local pharmacy, and the transfer from the wholesaler to the physician is via an invoice or a specialized order form, a DEA-222 in the case of Schedule II controlled substances. Not only do physicians have to account for all the controlled substances that come into their practice but how they go out as well. This is typically done by either documenting the dispensation and/or administration in a logbook or patient file. Another example is if the drug is dropped on the floor and is not usable, then it needs to be documented in such a way to show the drug going out of the inventory. It s really nothing more than balancing a checkbook. When a physician prescribes a drug to a patient, it is usually the pharmacist that fulfills the request. Once given to the patient, the pharmacist s recordkeeping requirement ceases. The DEA Little Rock District Office has become aware of some physicians mandating their patients bring back unused portions of their controlled substances and give it to the physician prior to them prescribing additional medication. (This is typically seen where there may be an issue where a drug is not strong enough, too strong or one that causes an allergic reaction.) However, when a physician requires the patient to turn over the drug (allegedly for destruction) due to the circumstances as described above, that activity is illegal for a few reasons. The drug belongs to the patient and is their property. The physician can suggest ways for the patient to dispose of the unused/unwanted drug, but the physician cannot take possession of another s property. Also, a patient is not a DEA registrant and cannot legally give/ transfer the drug to the physician. If the physician is in possession of another person s drugs, he can be arrested for Illegal Possession of a Controlled Substance (a felony) as he did not obtain it through the original closed system of distribution. The only way for a physician to legally dispose of controlled substances is by reporting the destruction on a DEA -41 form and having it destroyed by an authorized entity. The Department of Health provides this service to DEA registrants in Arkansas. If the physician takes in a drug from a patient, a non-registrant, the physician cannot properly account for the drugs as it is not a proper transfer from one DEA registrant to another, and it cannot be reported on a DEA-41 form because the patient is not a registrant. Therefore, not only can the physician be charged criminally for Illegal Possession, but can also face a civil fine of up to $10,000 for recordkeeping violations. SUMMARY: A physician can only obtain controlled substances from another DEA registrant. Title 21 Code of Federal Regulations (CFR) (a) A physician can only dispose of a controlled substance through another DEA registrant via a DEA-41 form; Title 21 CFR Every registrant is required to maintain on a current basis a complete and accurate record of each (controlled) substance manufactured, imported, received, sold, delivered, exported, or otherwise disposed of by him/her; Title 21 CFR (a). It shall be unlawful for any person to refuse or negligently fail to make, keep or furnish any record, report, notification, declaration, order or order form, statement, invoice or information required to be kept under this subchapter; Title 21 United States Code (USC) 842(a)(5). In case of a violation of paragraph (5) of this section, the civil penalty shall not exceed $10,000; Title 21 USC 842(c)(1)(B). For questions, contact Lisa Barnhill, DEA Diversion Group Supervisor, License Applicants Designated Contacts During the licensure process, the designated contact is normally the person who is assisting the applicant with the licensure process. It is not the person who speaks for the applicant. The applicant is the person requesting a license and is the person responsible for any entries on the application or in answering questions pertaining to the license application process. This includes responding to the communications posted to the applicant s online checklist. Only one designated contact is allowed so applicants should have their designated contacts notify any other interested parties of their status. If the applicant wishes to change their designated contact, the required form must be downloaded from the Board s website, completed and faxed to or ed to the Board as a.pdf attachment to support@armedicalboard.org and the new contact will replace the old one in the system.

3 Page 3 Board Actions & License Adjustments 7/19/2013 through 11/5/2013 BALL, Charles William, M.D. (C-5265) Hot Springs, AR Revoked/Stayed, 8/21/13 BERTRAM, Ronald Jon, M.D., (E-3360) Bentonville, AR Consent Order, 9/20/13 CARTER, Frances Brannan, LRCP (RCP-2706) North Emergency Order of Suspension, 10/30/2013 CLEMENTS, Todd Michael, M.D. (E-7236) Emergency Order of Suspension, 9/5/13 DESANTIS, James Michael, M.D. (E-6765) Marietta, GA Emergency Order of Suspension, 7/31/13 FLETCHER, Kelly Renee, M.D. (E-7240) Ashdown, AR Emergency Order of Suspension, 8/29/13 Revoked/Stayed, 10/3/2013 FORTE, Kevin Francis, M.D. (C-7691) Emergency Order of Suspension, 9/4/13 Consent Order, 10/11/2013 GILLIAM, Linda Harris, M.D. (E-4919) Emergency Order of Suspension, 10/29/2013 GOMEZ, Henry Luis, M.D. (E-1534) El Dorado, AR Emergency Order of Suspension, 8/30/13 GRANT, Alissa Michelle, M.D. (E-7744) West Memphis, AR Consent Order, 9/13/13 GREEN, Michael Dale, M.D. (C-7697) Springdale, AR Revoked/Stayed, 8/21/13 MCDONALD, Candace Ray, LRCP (RCP-1973) Stamps, AR Revoked/Stayed, 8/6/13 NIETO, Arthur, M.D. (E-4397) Helena, AR Surrendered, 8/5/13 PETTY, Corwin Durant, M.D. (E-2717) Lowell, AR Emergency Order of Suspension, 8/29/13 Revoked/Stayed, 10/3/2013 ROWE, Thomas Eugene, OTA (OT-A090) Emergency Order of Suspension, 8/29/13 Reprimand, 10/18/2013 SIMPSON, Todd Richard, D.O. (E-0141) Fayetteville, AR Emergency Order of Suspension, 10/22/2013 STREETT, David Julian, M.D. (E-1489) Emergency Order of Suspension, 8/20/13 SUMMERHILL, Jeffrey Allen, D.O. (E-3568) Arkadelphia, AR Emergency Order of Suspension, 8/30/13 Returned to Active, 10/4/2013 WARREN, William Sidney, Jr., M.D. (C-6145) Returned to Active, 10/4/2013 WHATCOTT, Brett David, D.O. (E-2230) Fort Smith, AR Revoked/Stayed, 8/21/13 Proposed Regulation Governing Office Based Surgery Act 587 of 2013 addresses the criteria required of facilities when performing surgery in a physician s office. The Act mandates the Medical Board to establish a regulation outlining the rules to which physicians must adhere. Watch the Board s website for a draft of said regulation and the date for the upcoming public hearing. New License Applicants If your license application originally indicated that you do not need a temporary permit and your work situation changed to require a permit, a letter and fee of $50.00 must be submitted to implement that request. Your request will be submitted to the Board Chairman when your file is complete and waiting for the Board to approve your license, it will not be submitted while your application is in process.

4 Page 4 Incomplete Profiles The Centralized Credentials Verification Service (CCVS) originally allowed requests for incomplete profiles to assist organizations during the time the mandate initially came into effect, January Organizations were utilizing them as they adjusted to the CCVS turn-around-time for processing their physician credentialing profiles. The volume of orders flooded the CCVS causing a backlog in processing and the incomplete profiles were utilized by facilities to assist in their credentialing just during that time period. This was never meant to be a long term process. It is important for organizations to note that the information on the incomplete profile is not protected by the ASMB/CCVS guarantee since the file has not yet completed the quality assurance audit process. The CCVS staff may not have completed data entry of verification updates, which may have been received. The definition of an incomplete profile, in reference to the Centralized Credential Verification Service (CCVS) credentialing system, is that the customer has requested the profile be released to them before the scheduled due date and before the file has been reviewed for current, complete and accurate information or gone through the quality audit process. For this reason, it has never been recommended that Incomplete profiles be utilized for credentialing purposes. The CCVS is allowed a certain amount of time by law to process each type of order (Initial, Recredential, Expedited) to obtain missing verifications, to update and review each file. Although that may not happen the day an organization places the order, it will be completed on or before that order s scheduled due date. Organizations and physicians should always plan with that due date in mind. When an organization requests incomplete profiles, they are not allowing reasonable time for completion of that process. While it is recognized that organizations do have emergencies - such as last minute changes in meeting agendas; accelerated credentialing requests by the administrator, medical director or physician; orders not placed with the scheduled due date in mind; status updates, etc, the ASMB/ CCVS does provide the ability for organizations to expedite their orders in these types of emergencies. Utilizing incompletes to check file status or avoid expedited fees will not provide organizations with an accurate picture of current or accurate status, as verifications may be received but since the staff has to work them in the order they are received, may not have reached that order yet. The incomplete order cannot be utilized as an excuse to obtain the missing information because it is not on that profile. When an incomplete request is received, the CCVS must still perform minimal processes and cursory reviews to be sure that certain required NCQA standards have been met before the incomplete profile can be provided. The file is NCQA Recertification! not released in the system so this involves two staff to be working the file at the same time. Once the profile is completed, it must then be released in the system and then faxed again within 30 days so the customer can complete their credentialing files. Since the file is in an automatic electronic working queue, incomplete requests must be done manually and out-of-order. Obtaining an incomplete request has been utilized by a few organizations as a method to check status on an order. All of this must also be manually documented and tracked. The ASMB s CCVS does not have the additional staff to process these manual requests. Organizations should utilize the order system with appropriate turn-around-times already in place in order to avoid delays in turn-around-times and releases. Organizations that continually request multiple incompletes at the last minute cannot be accommodated because of the need to have staff available to work on the manual processes that incompletes require. Although the CCVS staff will try to assist an organization with an incomplete request by the date needed, it is unlikely this will be possible with the volume of work. The management staff s primary consideration has to always focus on completing existing orders, volume requirements, productivity goals and scheduled due dates. Organizations that find themselves continually dependent on incomplete profiles are advised to establish a better system internally for meeting their credentialing committee time frames and their organization s needs, or plan to order the profiles with the scheduled due date in mind or order Expedited profiles and allow the process to be completed. This will allow for a fair and consistent completion and release of all profiles by the scheduled due date and within the guidelines of the state mandate. The Arkansas State Medical Board s Centralized Credentials Verification Service (CCVS) recently underwent an extensive audit process toward recertification in eight of the requested eight elements (8 of 8). This process begins even before the start of the survey in order to meet the look-back period. The staff is required to begin submitting/uploading documentation in early July 2013 for quality improvement and policy and procedure information to assure compliance with standards of the National Committee for Quality Assurance. It culminated with an on-site inspection on August 19, 2013 that included security standards, policies and random file audits by the NCQA surveyor. The Arkansas State Medical Board received official notification on September 16, 2013 that the CCVS is current and in good standing, meeting all requested certification elements with the next survey scheduled Continue on page 5

5 Page 5 NCQA Recertification! Continued from pg. 4 before September 21, Certification by NCQA is required by the state of Arkansas and the staff maintains continuous status from one survey to the next in the following elements: Application Processing Education and Training DEA Certification License to Practice Medicare/Medicaid Sanctions Medical Board Sanctions Work History CVO Application and Attestation Content? License Renewal Questions? The medical board staff is continually asked to help licensees complete their license renewals, particularly those questions that involve notification to the Board. They are uncertain if they should report events that they reported already. The answer, of course, is that it is not correct to report events already reported to the Board. Your answer should revolve around events that happened since your license was last renewed. For newly licensed physicians, this will revolve around events that happen after you were initially licensed. Licensees that are compelled to see an attorney s advice with answering questions should be aware that an attorney s incorrect recommendation is not a safeguard against possible disciplinary action. Examples of some contradictory advice might be not reporting an action that was pled down, expunged or closed. The Arkansas State Medical Board requires the reporting of these actions but an attorney might inform the licensee there is no need to report. Remember, only answer Yes if it happened since your last license renewal. Otherwise, the answer is No. Yes answers generate a new event or they are perceived as a new negative event and can be avoided by remembering your reporting date range. IMPORTANT MESSAGE Scheduled Board Meeting Dates for the Arkansas State Medical Board December 5-6, 2013 February 6-7, 2014 April 3-4, 2014 June 5-6, 2014 August 7-8, 2014 October 2-3, 2014 December 4-5, 2014 The agenda for each meeting will be posted online 1 week prior to each meeting on Wednesday by 4:00 pm. The Board will hold called meetings when necessary. Meetings will be held in the Board Room at 1401 West Capitol Avenue, Suite 340 Little Rock, Arkansas Scheduled Allied Healthcare Meetings Respiratory Care Examining Committee December 19, 2013 Physician Assistant Committee December 4, 2013 Pain Management Review Committee March 20, 2014 July 24, 2014 December 18, 2014 Dates and times of meetings are subject to change. Online Renewals Required for All Licensees in 2014 The Arkansas State Medical Board implemented an online renewal process to save time and money and increase efficiency. Beginning with the 2014 license renewal cycle, all renewals must be completed online. Your license will expire on the last day of your birth month. If you have never created an Online Licensee Account, an online renewal instruction letter will be mailed to your Private Address two months before your license expires. If you have an Online Licensee Account you will only receive an reminder to complete your renewal. ATTENTION: Before creating an Online Licensee Account you must provide the Board with a valid Private Address and Private address. If either of these requirements are missing or incorrect, your registration will be delayed until a Change of Address form is submitted. If you are not certain of the addresses the Board has in your file, fill out the entire Change of Address form and fax it to The form can be found on our web site in the Forms & Publications section.

6 Page 6 Mission of the Arkansas State Medical Board Protecting the health, safety, and welfare of the people of the State of Arkansas with the goal that all citizens be provided with the highest quality health care. Arkansas State Medical Board 1401 West Capitol Avenue, Suite Contact us! Juli Carlson-Regulatory (501) Susan Wyles -Regulatory/Licensing PA/RA (501) Brenda Engelhoven-Regulatory/Malpractice (501) Kim Cormier-Licensing Coordinator Laurel Mills-Licensing Coordinator Heather Owen-Licensing Coordinator Kay Zuber-Licensing Coordinator Mandi Roberge-Licensing LRCP/OT (501) Eugenia Stone-Renewal Coordinator (501) Karen Boling-Renewal Support Specialist (501) Angie Meehleder-Quality Assurance/ Customer Service Manager (501) Support/Help Center (501) Main Phone Regulatory Fax: (501) CCVS Fax: (501) Accounting/Personnel Fax: (501) Licensing Fax: (501) License Renewals Fax: (501) QI/CS Fax: (501) Online Directory All actively licensed Arkansas Physicians, Respiratory Therapists, Occupational Therapists, Occupational Therapists Assistants, Physician Assistants and Radiology Practitioner Assistants may be queried in the Online Directory. To purchase data files of these practitioners, please visit our website. Payment is via a secured online order form with Visa or MasterCard only. ATTENTION! Change of Address Form is now available on the ASMB Web Site: Please FAX: (501) (support@armedicalboard.org) in.pdf only or Mail to: Arkansas State Medical Board 1401 West Capitol Avenue, Suite Change of Address may be completed online with a licensee account.