Arkansas State Medical Board Riverfront Drive Little Rock, AR NEWSLETTER

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1 Arkansas State Medical Board Winter 2008 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. Bobbye H. Dennis Treasurer John E. Bell, M.D. Searcy, AR Mrs. Anne Britton Fayetteville, AR William F. Dudding, M.D. Fort Smith, AR David C. Jacks, M.D. Pine Bluff, AR Patty Pettway, D.O. Booneville, AR Douglas F. Smart, M.D. C. E. Tommey, M.D. El Dorado, AR John B. Weiss M.D. Fayetteville, AR Alonzo D. Williams, Sr., M.D. LEGAL COUNSEL William H. Trice, III 425 West Capitol Avenue Suite (501) PRESCRIBE, ADMINISTER OR DISPENSE By William H. Trice, III, Board Attorney 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 for a patient. 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 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 which the patient is to comply. A physician may also administer legend drugs and scheduled medication to a patient who is in his clinic setting. One administers medication when he applies a medicine or remedy or gives as a dose of something beneficial or suitable to the patient. The physician, at his direction, causes the person to take some legend drug or controlled substance into his or her system. A physician may also dispense medication to a patient, meaning that he or she will distribute the medication to the patient to take away from the clinic setting (Continued on page 2) DEA Rule on Issuance of Multiple Prescriptions for Schedule II Controlled Substances The Drug Enforcement Administration (DEA) has finalized a rule that amends its regulations to allow practitioners to provide individual patients with multiple prescriptions, to be filled sequentially, for the same schedule II controlled substance, with such multiple prescriptions having the combined effect of allowing a patient to receive over time up to a 90-day supply of that controlled substance. This rule became effective December 19, More information on this subject is available on the DEA website, under Federal Register Notices. INSIDE THIS ISSUE Prescribe, Administer DEA Rule Schedule II... 1 Telemedicine Fee Increase... 2 Board Actions & License... 3 Technology Reminder... 3 ASMB 2007 Annual Report ASMB Officers... 4 Methadone Hydrochloride... 5 PA Meeting Dates... 5 ASMB Meeting Dates... 5 Supervising Physicians... 5 Physician Assistant Updates... 5 Change of Address Form... 6

2 Page 2 (Continued from page 1) CCVS TELEMEDICINE PROFILE FEE INCREASE EFFECTIVE 2/11/2008! 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 permit from the Arkansas State Medical Board prior to dispensing the medication unless he or she was doing so within twelve (12) months prior to 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 him or her to be doing this dispensing. Usually this means that the drug is not available to the public through pharmacies in the area. 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. 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. As set forth in A.C.A , the physician must do the following, since he or she is now acting in the role of a pharmacist: 1. Personally dispense the legend drugs. 2. 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 a central registry. 3. The physician must 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 medication 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. The Arkansas State Medical Board defines a telemedicine physician (the practice of medicine by physicians located outside the state) as listed in AR Code This can be found in the Arkansas Medical Practices Act, Rules and Regulations available to download from the Board s website at by clicking on Information>Downloads. After review and vote by the CCVS Advisory Committee, the CCVS received approval at a public hearing held on December 6, 2007 to increase the CCVS profile fee to $225 per physician per profile on TELEMEDICINE physicians. The fee increase is to accommodate the additional verification fees charged the ASMB/CCVS, and to offset other out-of-pocket expenses necessary to meet increasing demands of credentialing telemedicine physicians. The fee increase will be effective February 11, The fee will be charged each organization s account at the time the telemedicine physician s profile is ordered. Due to the increasing number of verifications to be obtained, the increase will affect INI- TIAL telemedicine profile orders because Expedited, In-cycle and Out-of-cycle Recredential orders will not be possible on these types of physician profile orders. All orders will be ordered as initial orders. Orders will only be allowed if current Authorization and Releases (Organization and Board), Attestation and current CV is provided. The ASMB/CCVS maintains a list of all identified telemedicine physicians in the state. At the time the order is placed by the organization, an confirming the charge, organization name and physician name will be sent to the requesting organization. The organization will still have an opportunity to cancel the order via e- mail. It is becoming more expensive and difficult to obtain verifications in a timely manner, resulting in multiple attempts and requests, additional staff involvement as well as increasing verification fees charged the ASMB/CCVS by out-of-state hospitals. The out-of-state hospitals are struggling to meet the volume of requests coming in from all over the US and some countries. Arkansas has higher utilization because of the state mandated CCVS. Most of these verifications must be re-verified or repeated every 120 days if they are open or current in order to meet certification and accreditation organization requirements necessary for Arkansas hospitals and insurance products. In most instances the telemedicine physician has or will have licenses in every state and several countries and have multiple staff appointments in each, some totaling in excess of 500. The phenomenon of telemedicine physicians has exploded in both licensure and CCVS or credentialing in Arkansas and across the nation. While the need for utilization of telemedicine physicians is understood and necessary for those hospitals where access to on-site coverage is limited, the Medical Board does not feel that hospitals who do not utilize telemedicine physicians should be included in an across the board fee increase.

3 Page 3 BOARD ACTIONS & LICENSE ADJUSTMENTS January 1, 2007 through December 31, 2007 Allen, William Lawson, Jr., M.D. (C-5028) Roland, AR - Suspended, 6/7/2007 Butler, Judith Arlene Basart, M.D. (E-2093) Blytheville, AR - Revoked, 4/24/ Returned to Active, 6/29/2007 Carino, Richard, M.D. (E-0916) Port Richey, FL - Emergency Order of Suspension, 4/30/ Surrendered, 6/7/2007 Carter, Donald E., Jr., LRCP (RCP-0883) Fort Smith, AR - Revoked/Stayed, 4/13/2007 Collie, William Richard, IV, M.D. (R-2220) Benton, AR - Returned to Active, 6/18/2007 Cone, John Baxter, M.D. (C-5181) - Returned to Active, 12/5/2007 Garcia, Raul, PA (PA-268) Lexington, KY - Emergency Order of Suspension, 10/15/2007 Gray, George Thompson, III, D.O. (R-3735) Conway, AR - Returned to Active, 2/1/2007 Henriksen, John Eric, M.D. (E-2924) Magnolia, AR - Emergency Order of Suspension, 3/7/ Returned to Active, 6/7/2007 Johnston, Julie Erin, LRCP (RCP-2762) Winter Haven, FL - Emergency Order of Suspension, 3/15/2007 Kauffman, Paul David, M.D. (C-5415) Salem, AR - Emergency Order of Suspension, 8/22/2007 Krannichfeld, Jon Michael, M.D. (C-4949) Eureka Springs, AR - Returned to Active, 4/4/2007 Lawson, John T., LRCP (RCP-1296) Gulfport, MS - Emergency Order of Suspension, 3/7/ Surrendered, 4/13/2007 Loop, Paul Jay, M.D. (E-1288) West Plains, MO - Emergency Order of Suspension, 12/21/2007 Mace, Shamea Marie, LRCP (RCP-0369) Dardanelle, AR - Revoked, 4/24/2007 Maes, Stephen Robert, M.D. (C-8283) Harrison, AR - Emergency Order of Suspension, 11/2/2007 Miller, James Lee, M.D. (C-4781) West Memphis, AR - Emergency Order of Suspension, 8/15/ Return to Active, 9/4/2007 Mitchell, Michelle D., M.D. (E-4190) Hot Springs, AR - Emergency Order of Suspension, 10/31/2007 Mohsen, Aly M., M.D. (E-3715) Harrison, AR - Surrendered, 2/6/2007 Nichol, Brian Thomas, M.D. (E-0476) North - Returned to Active, 2/2/2007 Odom, Max Kennon, II, M.D. (E-1461) Nashville, AR - Emergency Order of Suspension, 3/6/ Revoked/Stayed, 12/28/2007 Pope, Mark Joseph, M.D. (E-4109) Sheridan, AR - Returned to Active, 2/1/2007 Reifeiss, Jerry Scott, M.D. (C-7140) Morrilton, AR - Returned to Active, 8/3/2007 Rettinger, Dennis J., LRCP (RCP- 1054) Camden, AR - Revoked, 4/24/2007 Wawrzynek, Robert Francis, Jr., PA (PA-269) Dermott, AR - Returned to Active, 2/2/2007 Wilson-Hitchcock, Christina, LRCP (RCP-2774) Mabelvale, AR - Emergency Order of Suspension, 8/10/2007 Zeybel, Karen Louise, LRCP (RCP- 1378) North - Surrendered, 4/13/2007 TECHNOLOGY REMINDER ALL FILE ATTACHMENTS MUST BE IN ADOBE ACROBAT PDF FORMAT AND SENT DIRECTLY TO THE SUPPORT DEPARTMENT at support@armedicalboard.org for scanning. Please indicate who the recipient is on the subject line.

4 Page 4 ARKANSAS STATE MEDICAL BOARD 2007 ANNUAL REPORT The 2007 members and officers of the Arkansas State Medical Board are as follows: Trent P. Pierce, M.D., Chairman; David C. Jacks, M.D., Vice- Chairman; Joseph M. Beck, II, M.D., Secretary; Mrs. Bobbye H. Dennis, Treasurer; John E. Bell, M.D.; Mrs. Anne Britton; Bob E. Cogburn, M.D.; William F. Dudding, M.D.; Patty K. Pettway, D.O.; Douglas F. Smart, M.D.; C. E. Tommey, M.D.; John B. Weiss, M.D. and Alonzo D. Williams, Sr., M.D. The Board met bimonthly and addressed complaints, hearings, and other pertinent business affecting health care in the State of Arkansas Licensing Statistics 2007 Statistics Medical Doctors and Doctors of Osteopathy Licensed 418 Medical Doctors and Doctors of Osteopathy (total) 8,411 Medical Doctors and Doctors of Osteopathy (in state) 5,680 Occupational Therapists Licensed 74 Occupational Therapists (total) 1,008 Occupational Therapy Assistants Licensed 34 Occupational Therapy Assistants (total) 183 Physician Assistants Licensed 32 Physician Assistants (total) 121 Respiratory Care Therapists Licensed 124 Respiratory Care Therapists (total) 1,775 Communication 4 Data Bank Report 1 Emergency Room Treatment 4 Ethics 43 Falsifying Information 3 Investigation 20 Malpractice 19 Miscellaneous 3 Medical Records 13 Negligence 66 Practicing/Allowing to Practice Without License 6 Over Charging 1 Over Prescribing 28 Actions taken by other states 18 Over Testing 1 Lack of physician response to patient 5 Quality of Care Issues 34 Staff Issues 6 Sexual Harassment 6 Terroristic Threatening 1 Unprofessional Conduct Board Actions Suspension 13 Revocation 3 Revocation (stayed) 2 Surrendered 4 Regulations Passed by the Board and/or Amended During 2007 Amendment to Regulation #18 Fee Schedule for Centralized Credentials Verification Service Summary of Board Proceedings for 2007 Section C. Fees for individual information requests: Individual Discussions and Issues (total) 460 Complaints (including investigations) 336 Issues 124 Credentialing or Recredentialing information $ concerning out of state physicians requiring a license pursuant to ACA Complaint Types (including investigations) Alcohol/Drugs 10 Advertising 1 Behavior/Attitude 18 Billing/Insurance Issues ASMB OFFICERS During the December 2007 meeting the Arkansas State Medical Board held the election of officers for Members voted into the officer positions are Trent P. Pierce, M.D., Chairman; Joseph M. Beck, II, M.D., Vice-Chairman; Bob E. Cogburn, M.D., Secretary and Mrs. Bobbye H. Dennis, Treasurer.

5 Page 5 Methadone Hydrochloride Tablets USP 40 mg (Dispersible) (Article received from the Little Rock DEA Office) As of January 1, 2008, manufacturers of methadone hydrochloride tablets 40 mg (dispersible) have voluntarily agreed to restrict distribution of this formulation to only those facilities authorized for detoxification and maintenance treatment of opioid addiction, and hospitals. Manufacturers will instruct their wholesale distributors to discontinue supplying this formulation to any facility not meeting the above criteria. Methadone is a long-lasting opioid medication used in the treatment of pain and narcotic addiction. The 5 mg and 10 mg formulations indicated for the treatment of pain will continue to be available to all authorized registrants, including retail pharmacies. The 40 mg methadone formulation is indicated for the detoxification and maintenance treatment of opioid addiction. The 40 mg strength is not FDA approved for use in the management of pain. Thus, the distribution and availability of the 40 mg formulation will be limited to registrants in only those settings using the 40 mg formulation for the appropriate indication. The DEA and pharmaceutical industry agree that the reported increase in methadone-related adverse events merits action and further agree to a united effort to assure that methadone is properly distributed, consistent with its approved uses. Industry and the federal entities involved commit to monitor the progress of this initiative. PHYSICIAN ASSISTANT ADVISORY COMMITTEE 2008 Meeting Dates February 6th, 2008 April 2nd, 2008 June 4th, 2008 August 6th, 2008 October 1st, 2008 December 3rd, 2008 Meeting dates are subject to change. ARKANSAS STATE MEDICAL BOARD Scheduled Meeting Dates 2008 February 7-8, 2008 April 3-4, 2008 June 5-6, 2008 August 7-8, 2008 October 2-3, 2008 December 4-5, 2008 *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. ATTENTION! SUPERVISING PHYSICIANS & PHYSICIAN ASSISTANTS! It is important that you notify the ASMB immediately when you disassociate your working relationship. You may do so by sending notification on letterhead with your signature by fax, letter or . Failure to do so could result in non-compliance with the Physician Assistant Advisory Committee, as your license is considered inactive when you do not have a Supervising Physician. Code (b) - A Physician Assistant shall notify the Board of any changes or additions in supervising physicians within ten (10) calendar days. ATTENTION! PHYSICIAN ASSISTANT UPDATES STAFF CHANGE: Effective November 9th, 2007, Julia Feazell assumed responsibility for the licensure of Physician Assistants. Phone Fax licensing@armedicalboard.org

6 Page 6 We re on the WEB!!! Arkansas State Medical Board 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 ATTENTION! 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. DIRECTORIES AVAILABLE ON CD ROM Printed directories are no longer available. Licensees may obtain a free CD directory by calling the Board and requesting one. All others may order via the website, at $25/CD, payment is via credit card only. 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