Arkansas State Medical Board Riverfront Drive Little Rock, AR NEWSLETTER

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1 Arkansas State Medical Board Fall 2009 NEWSLETTER Peggy Pryor Cryer Executive Secretary BOARD MEMBERS Trent P. Pierce, M.D. Chairman West Memphis, AR Joseph M. Beck, M.D. Vice-Chairman Bob E. Cogburn, M.D. Secretary Mountain Home, AR Mrs. Anne Britton Treasurer Omar T. Atiq, M.D. Pine Bluff, AR Harold B. Betton, M.D. Jim C. Citty, M.D. Searcy, AR William F. Dudding, M.D. Fort Smith, AR Roger Harmon, P.D. Jonesboro, AR John E. Hearnsberger, II, M.D. Nashville, AR Patty Pettway, D.O. Booneville, AR Sylvia D. Simon, M.D. Monticello, AR Douglas F. Smart, M.D. John B. Weiss, M.D. LEGAL COUNSEL William H. Trice, III 211 Spring Street (501) The State Medical Board occasionally receives inquiries about the proper usage of the compounding services offered by some pharmacies. The initial question involved compounding dosages of phentermine for weight loss in excess of the established guidelines and the Board s opinion was that this was not permissible. Medical Board Regulation 21 concerning anorexiant drugs is quite clear and a physician is considered exhibiting gross negligence or ignorant malpractice if this regulation is not followed carefully with the safety of patients being foremost. INSIDE THIS ISSUE Utilizing Compounding Pharmacy.. 1 Need A Dispensing Permit Board Actions... 2 NCQA Recertification... 3 PA Advisory Meeting Dates... 4 RC Meeting Dates... 4 Licensure/CCVS Workshops.. 4 Board Meeting Dates... 4 P r o f i l e J o h n H e a r n s b e r g e r M.D Evolution in CME..5 Utilizing the Compounding Pharmacy By Joseph M. Beck, M.D., Vice Chairman DO YOU NEED A DISPENSING PERMIT? By William H. Trice, III, Board Attorney A broader question involves compounding. The International Academy of Compounding Pharmacists feels that compounded pharmaceuticals fill a void left by mainstream manufacturers that produce drugs in limited dosage forms and strengths and in many cases the Board agrees. Many intravenous formulations of narcotics, minerals, and hyperalimentation are compounded by the hospital pharmacist for hospital use. Although in general it is illegal to compound the exact formulation and size of a drug that is commercially available, if a patient is intolerant to the excipients present in the pills, or allergic to a particular dye, etc., with an order from the physician these patients can be accommodated. In addition, pediatric dosages and formulations are often necessarily compounded to provide a more appropriate weight based medication, including transdermal substances. In the Board s opinion, these are entirely appropriate and helpful utilizations of the compounding process. State Boards of Pharmacy regulate compounding and the pharmacists who perform this needed service. The Board wishes only to remind physicians to utilize this service only when necessary and when legend drugs will not be in the best interest of the patient. Recently, the Board has received several complaints involving physicians who are dispensing various drugs and specifically the drug, Latisse, from their office. Latisse is a legend drug, and CANNOT be dispensed unless the physician has been granted a dispensing permit from the Board. A licensed physician in Arkansas may prescribe, administer or dispense with permission, legend drugs and scheduled medication to his or her patients. A physician must always establish a physician-patient relationship as set forth in Regulation 2.8 of the Rules and Regulations of the Arkansas State Medical Board, prior to prescribing, administering or dispensing any legend drugs. A physician prescribes medication for a patient when he directs, designates or orders the use of a particular remedy, therapy, medicine or drug for that patient. This usually is (Continued on page 3)

2 Page 2 BOARD ACTIONS & LICENSE ADJUSTMENTS Blue, Monte Dean, LRCP (RCP-1882) Alexander, AR - Emergency Order of Suspension, 8/21/2009 Carlson, Douglas Eugene, D.O. (E-4230) Alma, AR - Emergency Order of Suspension, 9/1/2009 Devlin, Michael Andrew, M.D. (E-3273) - Returned to Active, 8/26/2009 Greenwood, Denise Rochelle, M.D. (E-0176) - Revoked/Stayed, 8/20/2009 Harrison, Lonnie E., M.D. (C-7481) Maumelle, AR - Returned to Active, 8/11/2009 Johnson, Stacey March, M.D. (R-2724) Mountain Home, AR - Emergency Order of Suspension, 8/20/2009 Kauffman, Paul David, M.D. (C-5415) Salem, AR Morgan, Bobby Sturdivant, LRCP (RCP-3004) - Emergency Order of Suspension, 9/10/ Revoked/Stayed, 8/7/2009 Riley, Ray D., PA (PA-203) Mountain Home, AR - Returned to Active, 8/27/2009 Simpson, Todd Richard, D.O. (E-0141) - Revoked/Stayed, 10/2/ Emergency Order of Suspension, 9/10/2009 Vickers, Robin Michelle, LRCP (RCP-2373) Maumelle, AR - Emergency Order of Suspension, 9/17/2009 Wilson-Hitchcock, Christina, LRCP (RCP-2774) Mabelvale, AR - Returned to Active, 8/14/2009 Jones, Quitman Warde, Jr., M.D. (R-4318) Memphis, TN Watch our web site for a sneak peek and announcements with more details Our New Address

3 Page 3 DO YOU NEED A DISPENSING PERMIT? By William H. Trice, III, Board Attorney (Continued from page 1) done in the form of a written prescription that the patient then takes to a licensed pharmacist who fills the prescription and puts the necessary instructions from the physician on the bottle of medication. A physician may also administer legend drugs and scheduled medication to a patient who is in his clinic setting. He administers medication when he applies a medicine or remedy or gives a dose to the patient. A physician may also dispense medication to a patient, meaning that the physician will distribute the medication to the patient to take away from the clinic setting for the patient to take at a later time under the instructions that are given to the patient. A physician may NOT dispense medication UNLESS he or she has obtained a dispensing permit from the Arkansas State Medical Board. Pursuant to A.C.A , the physician must obtain an application from the Arkansas State Medical Board and then inform the Board of the legend drugs and/or scheduled medication he or she desires to dispense to his or her patients, and the location of where he or she will be doing this dispensing. He or she must also demonstrate to the Board, prior to the Board approving the permit, that there is a need for the physician to be dispensing. Usually, this means that the drug is not available to the public through pharmacies in the area. Exemptions from a Permit: If a physician is dispensing medications that are not controlled substances, and they are in injectable form, the physician is exempt from having to obtain a permit. The physician also does not need a dispensing permit if he or she is only dispensing samples of drugs that are prepackaged and labeled and are given without cost to the patient; or The physician was dispensing legend drugs 12 months prior to (The Board office maintains this list) If a physician chooses to obtain a permit and has demonstrated a need for the permit, the physician must do the actual dispensing of the medication to the patient. Since the physician has been acting in the role of a pharmacist, dispensing cannot be delegated, it requires a physician to prepare and dispense the medications. The physician must do the following, pursuant to A.C.A : Personally dispense the legend drugs. Keep records of all receipts and distribution of the legend drugs. These records are subject to inspection by proper enforcement authority and shall readily be accessible for inspection and maintained in the central registry. Label the legend drugs with the following information: the patient s name and address, the prescribing physician s address and narcotic registry number issued by the Drug Enforcement Administration, the date of dispensing, and directions and cautionary statements for the taking of the medication by the patient. If you feel your practice has a need to dispense medications to patients that you cannot accomplish by prescribing for the patient or administering medication directly to the patient, you may contact the Board office for an application to receive a dispensing permit. NCQA RECERTIFICATION! The Arkansas State Medical Board s CCVS (Centralized Credentials Verification Service) recently completed an extensive audit process by the National Committee for Quality Assurance toward recertification in eight of the requested eight certification options (8 of 8). This process began in April 2009 with the submission of required quality improvement and policy and procedure documents to assure compliance with standards of the National Committee for Quality Assurance (NCQA) and culminated on August 24, 2009 with an on-site inspection of security and technology standards, policies and random file audits. The Arkansas State Medical Board received official notification on September 21, 2009 that the CCVS is certified, current and in good standing until September 2011 in the following requested certification elements: Certification in Application and Attestation Content Certification in Application and Attestation Processing Certification in DEA Certification in Education and Training Certification in Medical Board Sanctions Certification in Medicare/Medicaid Sanctions Certification in Verification of Licensure Certification in Work History

4 Page 4 ALLIED HEALTH 2009 MEETING DATES RT Committee meeting will be Dec. 11, 2:00 pm here at the Board. The OT Committee will meet on Nov. 16, 2009 at 1:00 pm Contact Mikki Hughes mikkih@armedicalboard.org For RT - Any course approved by the AARC, NBRC or the ASRC is automatically approved for continuing education with the amount of CEU's they award. No pre-approval is necessary. New Appointment Darrell Benham, RRT, LRCP from Conway has recently been appointed by Gov. Mike Beebe to serve on the Respiratory Therapy Examining Committee for the term August 7, August 7, Mr. Benham replaces David Jordan who was awarded a plaque at the October Board meeting for his (22) years of service and in that capacity as Chairman. We welcome Darrell Benham. We thank David Jordan for his years of service, knowledge and dedication to the Committee, Board and Citizens of Arkansas. ARKANSAS STATE MEDICAL BOARD Meeting Dates December 3-4, 2009 February 4-5, 2010 April 8-9, 2010 June 3-4, 2010 August 5-6, 2010 October 7-8, 2010 December 2-3, 2010 *The Board will hold called meetings when necessary. Meetings will be held in the W. Ray Jouett, M.D. Conference Room at Little Rock, Arkansas Meeting dates are subject to change Be sure to notify the Board of any address change PHYSICIAN ASSISTANT ADVISORY COMMITTEE Meeting Dates December 2, 2009 February 3, 2010 April 7, 2010 June 2, 2010 August 4, 2010 October 6, 2010 December 1, 2010 Meeting dates are subject to change. Julia Feazell PA Licensing Coordinator Phone: (501) Fax: (501) jdf@armedicalboard.org ARKANSAS STATE MEDICAL BOARD and CENTRALIZED CREDENTIALS VERIFICATION SERVICE WORKSHOP Due to the heavy volume of requests for the ASMB and CCVS to provide workshops providing organizations with information on the medical licensure and CCVS processes, the first on-site workshop was scheduled for October 27, 2009 by the ASMB and CCVS. Information on each area was provided in two separate sessions that day, allowing organizations to sign up for either or both sessions. The first session included information on: applying for a medical license, the licensure processes, procedures, requirements, board appearances, different types of licenses, renewals and then rollover into the CCVS. The second session included: the Centralized Credentials Verification Service statute and organization participation, what happens after licensure is granted, follows the ASMB to CCVS rollover of information and how it is completed, what information may have to be reverified after licensure, how CCVS audits files for release, importance of the attestation and authorization and release, placing orders, who can access physician information, telemedicine orders, cancellations, free updates and much more. The first workshop filled up quickly so if you or your staff didn t get to attend this time, please watch the Medical Board s web site for the next workshop announcement. An announcement will be posted after January Get your reservations in quickly! Huge Success

5 Page 5 EVOLUTION IN CONTINUING MEDICAL EDUCATION IN ARKANSAS AND THE NEED TO SUPPORT ITS FUTURE Bob E. Cogburn, M.D., Board Member PROFILE OF A BOARD MEMBER John Hearnsberger, M.D. The roll of CME is more important to the practice of medicine than ever before. The Arkansas State Medical Board has joined efforts with the Office of Continuing Medical Education (OCME) at UAMS to determine the needs of Arkansas physicians and to promote Arkansas based CME. Be on alert for a statewide needs assessment survey and answer it promptly. The OCME remains the only accredited continuing medical education provider in the state of Arkansas. This appears to be a bit disturbing at first until you realize what has happened to continuing medical education, not only locally and statewide, but nationwide, as well. This is shocking because there is a continuing need for education, not only to maintain credentials and licensure, but also to maintain documented quality of care in the practice of medicine in our practices. Maintaining your Arkansas license to practice medicine requires twenty hours of continuing education each year. The cause of this apparent change in CME across our nation has several facets. First of all, with the changes in information technology, it has become rather easy to obtain CME via the Internet. This has become an important source of information for us, primarily because it is inexpensive and we do not have to travel and take time away from our practices. However, this method should never be allowed to completely replace live interactions. Internet CME is the most difficult to monitor and is even more difficult to document how the CME activity has influenced your practice of medicine. Secondly, physicians are used to CME being free however, the economy has taken care of that. It simply is not free any longer and we are going to have to pay for our own rather than having it provided by the pharmaceutical industry. According to the ACCME, CME activities arise from identified needs in our practice. There are many ways that needs can be identified. Specifically, physicians might feel that they need specific skills or to learn new material. They can also be identified through quality assurance activities at our local hospitals. Once a need or gap in learning is identified, an activity planner can prepare a program following the ACCME guidelines and eventually present this learning activity to the physician. The next step is to analyze how this learning activity has modified your practice. In other words, was it worthwhile and how do you know that it was or not? Thus, the OCME has a dynamic continuum of identification of needs, gathering resources, presenting and activity, and evaluation of results. Watch for the needs assessment survey In the very near future, you will receive the statewide needs assessment survey sent from the University. The purpose of this survey is to find out what you need as a practicing physician in the way of continuing medical education. It is urgently important for you to answer this survey. It is anticipated that in the future, the number of required hours of CME credits will increase to keep up with our surrounding states and specialty societies. Be diligent in responding to the survey, this is an excellent way of getting your voice heard in the decision making process as to how we practice our profession in Arkansas. Dr. John Hearnsberger grew up in Fordyce, always wanting to be a doctor. After graduation he enrolled at Baylor University on a track scholarship, but decided to transfer to the University of Arkansas where he completed his BA in Zoology in He went on to medical school at UAMS, graduating in Growing up in a small town, general practitioners were the only doctors he knew and thus, he went to medical school, planning to be a general practitioner. However, he fell in love with surgery during his junior year and became a general surgery resident in After five years of surgical training, he became board certified and left Little Rock for Nashville, Arkansas, where he established the first full-time general surgery practice at Howard Memorial Hospital. He practiced there and at Hempstead County Hospital until He served on the Board of Directors of Howard County Hospital, for a time serving as chairman. Then he went through his midlife crisis and jumped out of the frying pan into the fire. He returned to UAMS as a thoracic surgery resident July 1, 1990, probably the oldest thoracic resident in the country. He then joined Cardiovascular and Thoracic Surgery Associates July 1, 1992, completed his thoracic surgery boards and practiced there for thirteen years performing heart surgery, including heart transplants. He retired from CVTS July 31, 2003, having been in active surgical practice twenty-five years to the day. However, he decided it was time to get back into the pan and returned to Nashville in January 2004 where he and his partner are engaged in a busy, rural, general surgery practice. Dr. Hearnsberger was appointed to the Arkansas State Medical Board in July 2009 by Governor Mike Beebe.

6 Page 6 We re on the WEB!!! Main Phone: (501) Regulatory Fax: (501) CCVS Fax: (501) Accounting/Personnel Fax: (501) Licensing Fax: (501) License Renewals Fax: (501) QA/CS Fax: (501) 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. WEB INFORMATION CENTER MEDICAL PRACTICES ACT BOOKLETS $15 PER COPY or free from the web site at COPIES OF ALL BOARD REGULATIONS ARE INCLUDED IN THE MEDICAL PRACTICES ACT BOOKLET. It is the physician s responsibility to read and comply with these rules. Online Directory Printed CD-ROM directories are no longer available All actively licensed Arkansas Physicians, Respiratory Therapists, Occupational Therapists, Physician Assistants and Radiology Practitioner Assistants may be queried in the Online Directory. To purchase data files of these practitioners, please visit our Data Portal. Payment is via secured online order form with Visa, Mastercard only. ATTENTION! Change of Address Form is now available on the ASMB Web Site: Please FAX: (501) (Licensing@armedicalboard.org) or Mail to: Arkansas State Medical Board Little Rock AR