Little Rock, AR NEWSLETTER

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1 Arkansas State Medical Board NEWSLETTER Fall 2010 Peggy Pryor Cryer Executive Secretary Board Members: Trent P. Pierce, M.D. Chairman West Memphis, AR Joeseph M. Beck, II, M.D. Vice-Chairman Bob E. Cogburn, M.D. Secretary Mountain Home, AR Sylvia D. Simon, M.D. Treasurer Monticello, AR Omar T. Atiq, M.D. Pine Bluff, AR Harold B. Betton, M.D. Jim C. Citty, M.D. Searcy, AR Ms. Rose Crane William F. Dudding, M.D. Roger Harmon, P.D. Jonesboro, AR John E. Hearnsberger, II, M.D. Nashville, AR Patty K. Pettway, D.O. Booneville, AR Douglas F. Smart, M.D. John B. Weiss, M.D. Fayetteville, AR Legal Counsel: William H. Trice, III 211 Spring Street In 2008 the Arkansas State Medical Board outlined a physician s responsibility upon entering into a Collaborative Agreement with an advanced practice nurse by passing a regulation that was approved by both the Arkansas Medical Society and the Arkansas Osteopathic Association. This regulation was never implemented upon the recommendation of the joint House and Senate Legislative Review Committee. Although the regulation was not implemented and physicians cannot be sanctioned for not following its recommendations, the Board believes it contains sound and practical advice that physicians could utilize in crafting collaborative practice agreements with Advanced Practice Nurses. After continuing to address complaints involving physicians and their lack of knowledge regarding their responsibility after signing a collaborative agreement with an APN, the Board requested at the August 2010 meeting that a situation that came before the Board be communicated to physicians to show the complexity of the problem. A licensed physician in general family practice entered into a collaborative agreement with an advanced practice nurse so that she would be granted a certificate of prescriptive authority from the Arkansas State Board of Nursing to prescribe scheduled medications. The physician and the advanced practice nurse worked together for many years within the clinic setting of the physician. The advanced practice nurse, unbeknownst to the physician, obtained a second job working in an emergency room in a local hospital. While rendering care to patients in the emergency room setting, she committed malpractice, a claim was made against her, and she settled the claim for $250,000, all unknown to the physician. Situations similar to this may be of concern to licensed physicians who are asked to enter into a collaborative agreement with an advanced practice nurse. The following are statutes that the Board feels are important and some guidelines that the physician may wish to follow when considering such a relationship. REGULATION 30 - COLLABORATIVE PRACTICE REGULATION This regulation has not been implemented at this time What You Need to Know About Your Collaborative Agreement ACA (2) states that a collaborative practice agreement means a written plan that identifies a physician who agrees to collaborate with an advanced practice nurse in the joint management of the health care of the advanced practice nurse s patients, and outlines procedures for consultation with or referral to the collaborating physician or other health care professionals as indicated by a patient s health care needs; ACA (a)(2) provides that: An advanced practice nurse may obtain a certificate of prescriptive authority from the Arkansas State Board of Nursing if the advanced practice nurse has a collaborative practice agreement with a physician who is licensed under the Arkansas Medical Practices Act, and who has a practice comparable in scope, specialty, or expertise to that of the advanced practice nurse on file with the Arkansas State Board of Nursing. ACA (c) states: A collaborative practice agreement shall include, but not be limited to, provisions addressing: (1) The availability of the collaborating physician for consultation or referral, or both; (2) Methods of management of the collaborative practice, which shall include protocols for prescriptive authority; Continue over on page 5 Inside This Issue: Your Collaborative Agreement 1,5 Board Passes Regulation 34 2 ASMB/CCVS Next Workshop 2 Scheduled Board Meeting 3 Allied Healthcare Meetings 3 Change to CME Regulation 3 Board Actions & License Adjustments 3 Death of Past Board Member 3 Just Licensed, Why Wait on CCVS? 4 Profile Status Checks 4 Getting Information to the CCVS 4 Authorization and Releases 4 Credentialing/Reappointment Apps 5

2 Page 2 Board Passes Regulation 34 Regarding Requirements of Physicians in Completing Death Certificates At the August 2010 meeting, the Arkansas State Medical Board adopted Regulation 34 regarding the requirements of licensed physicians in completing death certificates. This regulation became effective October 1, The regulation follows: ACA requires physicians in the State of Arkansas to comply with the requirements when completing death certificates. ACA (a)(2)(p) provides that the Arkansas State Medical Board may revoke or suspend a license of physicians, or impose other sanctions as provided by law, if a licensed physician violates a rule of the Board. I. A licensed Physician who has been in charge of a patient's care for the illness or condition that resulted in the death of the patient shall complete, sign and return to the funeral director the medical certification on the death certificate within two (2) business days after receipt of the death certificate, except when an inquiry is required by law pursuant to ACA as set forth herein: 1. The county coroner, prosecuting attorney, and either the county sheriff or the chief of police of the municipality in which the death of a human being occurs shall be promptly notified by any physician, law enforcement officer, undertaker or embalmer, jailer, or coroner or by any other person present with knowledge of the death if: A. The death appears to be caused by violence or appears to be the result of a homicide or a suicide or to be accidental; B. The death appears to be the result of the presence of drugs or poisons in the body; C. The death appears to be the result of a motor vehicle accident, or the body was found in or near a roadway or railroad; D. The death appears to be the result of a motor vehicle accident and there is no obvious trauma to the body; E. The death occurs while the person is in a state mental institution or hospital and there is no previous medical history to explain the death, or while the person is in police custody or jail other than a jail operated by the Department of Correction; F. The death appears to be the result of a fire or an explosion; G. The death of a minor child appears to indicate child abuse prior to death; H. Human skeletal remains are recovered or an unidentified deceased person is discovered; I. Postmortem decomposition exists to the extent that an external examination of the corpse cannot rule out injury, or in which the circumstances of death cannot rule out the commission of a crime; J. The death appears to be the result of drowning; K. The death is of an infant or a minor child under eighteen (18) years of age; L. The manner of death appears to be other than natural; M. The death is sudden and unexplained; N. The death occurs at a work site; O. The death is due to a criminal abortion; P. The death is of a person where a physician was not in attendance within thirty-six (36) hours preceding death, or, in prediagnosed terminal or bedfast cases, within thirty (30) days; Q. A person is admitted to a hospital emergency room unconscious and is unresponsive, with cardiopulmonary resuscitative measures being performed, and dies within twenty-four (24) hours of admission without regaining consciousness or responsiveness, unless a physician was in attendance within thirty-six (36) hours preceding presentation to the hospital, or, in cases in which the decedent had a prediagnosed terminal or bedfast condition, unless a physician was in attendance within thirty (30) days preceding presentation to the hospital; R. The death occurs in the home; or S. The death poses a potential threat to public health or safety. T. Upon receiving notice of a death that poses a potential threat to public health or safety, the county coroner shall immediately notify the Department of Health. 2. Nothing in this section shall be construed to require an investigation, autopsy, or inquest in any case in which death occurred without medical attendance solely because the deceased was under treatment by prayer or spiritual means in accordance with the tenets and practices of a well-recognized church or religious denomination. With regard to any death in a correctional facility, the county coroner and the State Medical Examiner shall be notified, and when previous medical history does not exist to explain the death, the Department of Arkansas State Police shall be notified. Or pursuant to ACA ; or pursuant to ACA et seq as set forth herein: When a death is reported to a coroner, he shall conduct an investigation concerning the circumstances surrounding the death of an individual and gather and review background information, including, but not limited to, medical information and any other information which may be helpful in determining the cause and manner of death. II. In the absence of the physician or with his or her approval, the certificate may be completed and signed by his or her associate physician, by the chief medical officer of the institution in which death occurred, by the pathologist who performed an autopsy upon the decedent, or by a registered nurse as provided in this subsection c, if the individual has access to the medical history of the case and has reviewed the coroner's report if required and if the death is due to natural causes. The individual completing the cause-of-death section of the certificate shall attest to its accuracy either by a signature or by approved electronic process. III. A registered nurse referred to in Section B above is a registered nurse who is employed by the attending hospice and may complete and sign the medical certification of death and pronounce death for a patient who is terminally ill, whose death is anticipated, who is receiving services from a hospice program certified under ACA and who dies in a hospice inpatient program or as a hospice patient in a nursing home. ASMB/CCVS Next Workshop The next workshop provided by the Arkansas State Medical Board and Centralized Credential Verification Service (CCVS) will be in early Spring of This will cover the processes in each organization, as well as any new developments in both websites. Please send your office managers, credentialing staff or any other person wanting to know more about these organizations, how they work and the step-by-step process to getting physicians licensed and then credentialed through the CCVS in this state. You may request prior notification or watch for the WORKSHOP REGISTRATION notifications to appear on both the Board s website at and the CCVS s website at

3 Page 3 Scheduled Board Meeting Dates for the Arkansas State Medical Board December 2-3, 2010 February 3-4, 2011 April 7-8, 2011 June 9-10, 2011 August 4-5, 2011 October 6-7, 2011 December 1-2, 2011 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 and times are subject to change. Allied Healthcare Meetings Board Actions & License Adjustments June 25, 2010 through September 24, 2010 Brown, Melanie J., LRCP (RCP-0951) - Emergency Order of Suspension, 8/23/2010 Gilliam, Linda Harris, M.D. (E-4919) Jonesboro, AR - Emergency Order of Suspension, 8/19/2010 Goldsby, Ricky, LRCP (RCP-0992) Sherwood, AR - Emergency Order of Suspension, 7/15/2010 Karlsson, Finnbogi Oddur, M.D. (E-4172) Peel, AR - Emergency Order of Suspension, 7/21/2010 Respiratory Therapist Advisory Committee Dec. 10, 2010 (Beginning at 2:00 PM) Occupational Therapy Committee November 8, 2010 (Beginning at 1:00 PM) Physician Assistant Advisory Committee December 1, 2010 (Beginning at 2:00 PM) Radiologist Assistants Committee December 1, 2010 (Beginning at 5:00 PM) Dates and Times are subject to change Change to CME Regulation At the August 2010 meeting the Arkansas State Medical Board conducted a public hearing and voted to amend Regulation 17 governing The change removed the continuing medical education requirements. The change removed ability for retired physicians to be exempt from the ability for retired physicians to be exempt from the CME requirement. Maintenance of a medical the CME requirement. license in this state requires twenty hours of continuing education each year at the time of license renewal. The types of qualifying material for CME are outlined in the regulation. Should a physician choose not to renew his/her medical license, please be reminded that an active license is required to write prescriptions for medications. Visit our website at and go to Forms and Publications or contact the Medical Board office for a copy of Regulation 17. Kradel, Joseph Charles, M.D. (E-1183) - Consent Order, 9/10/2010 McBay, Billy Reid, M.D. (C-7950) Conway, AR - Reprimand, 8/17/2010 Murphy, Fred Yocum, M.D. (C-6451) Magnolia, AR - Consent Order, 9/10/2010 Rodgers, Charles David, LRCP (RCP-0472) Bryant, AR - Emergency Order of Suspension, 8/23/2010 Silver, Danny, M.D. (E-0321) - Consent Order, 9/10/2010 Tomlinson, Robert J., M.D. (E-0329) Fayetteville, AR - Surrendered, 8/6/2010 Death of Past Board Member Mr. Ted J. Feimster, a past Consumer Representative Board member, died September 5, Mr. Feimster was appointed by then-governor Jim Guy Tucker and served on the Arkansas State Medical Board from 1993 to The Board appreciates Mr. Feimster s dedication to protecting the citizens of Arkansas and expresses their sympathy to the family for their loss.

4 Page 4 Just Licensed, Why Wait on CCVS? Getting Information to the CCVS Physicians that just completed the Arkansas State Medical Board licensure process may wonder why it is that their credentialing is delayed while the hospital where they wish to practice waits on the CCVS to process their order. The explanation regarding this is enclosed in the licensure application packet but is sometimes not fully understood. The licensure process captures information that is necessary for the full Board to make their decision. Once a license is issued, certain items of core information automatically roll over into the CCVS. It is not available to CCVS until then. The CCVS is a separate organization located in the Board and receiving oversight by the Board, mandated by state law and with regulations specified by that law. The CCVS staff objectives are to comply not only with these laws but certification agency requirements as well. State law determines the amount of time the CCVS can take to complete their updates, audits and corrections, cost of these updates and other policies. State law also dictates that no file will be moved ahead of another file, except by the payment of an expedited fee for special handling. The files must be worked in the order they are received. Organizations determine when they wish to place their orders and the type of orders they wish to place via a secured Internet ordering capability. A physician cannot call to order for them nor access this site. Anything that might have been overlooked, waived or not obtained at licensure must be corrected, verified, attempted or obtained prior to CCVS release to the organization. While the Board may waive a requirement at licensure, the CCVS must show documented attempts to obtain it. If there is a specific CCVS process a physician or the office staff would like clarification about, please contact and it will be provided. Authorization and Releases Organizations and physicians should be aware that there are two distinct authorization and releases (A&R) utilized by the ASMB and CCVS. One is utilized by the ASMB/CCVS to obtain verifications in order to update the physician s credentialing information and one is utilized by the CCVS only to meet requirements that the physician must give his/her permission for a specific organization to retrieve their credentialing information. The ASMB/CCVS authorization and release is exactly the same as the one utilized at initial licensure application. It s lengthy and requires a physician s social security number to obtain specific documentation like staff appointment information, employment and education verifications for the ASMB/CCVS. It only authorizes the Board to obtain it, not any organization. The CCVS authorization and release is quite brief, contains two sentences above the physician s printed name and signature block. Most significant is the fact that the name of the organization should be listed in the first sentence, which states that the physician authorizes the ASMB to provide credentialing information to [insert name of organization] Physicians should never sign a blank authorization and release because if the name is not listed exactly as that organization signed its account under with the ASMB/CCVS, the authorization and release will be rejected and the process will begin again. If an organization or a physician is trying to send something to the CCVS, there are some hints that might be of some assistance. A fax verification only verifies you sent it on that date/time to that number. It does not verify that it was received at that number. Keep in mind that faxed documents go awry all the time from any fax machine. If you continuously get a BUSY signal on the fax number you are dialing, try sending your fax from a different fax machine in your organization and if that works, it could be your fax machine. There are several rollover faxes that will accept the faxes from the (CCVS) fax. If none of that works, the CCVS at ccvs@armedicalboard.org and someone will assist you. When sending attachments to the CCVS, they must be sent as Adobe.pdf attachments and they must be sent to support@armedicalboard.org and not the standard CCVS address. Your with attachments will not be received by the CCVS otherwise; it will be stripped at the firewall due to our strict security policies to protect the confidential physician information on file. All other s without attachments should be sent to the standard address of ccvs@armedicalboard.org so someone can promptly assist you. When organizations are sending Authorization and Releases for posting, please try to send at least 24 hours before needing it posted to allow for any problems receiving, and for CCVS review. If it is still not posted, send an to ccvs@armedicalboard.org asking for the status of the A&R and stating when it was faxed. Someone will contact you immediately to assist you. Please do not call and leave messages with any staff. All of these issues have to be tracked and assistance promptly provided. Profile Status Checks Please do not contact the ASMB or the CCVS to check on the status of your credentialing file ordered by the organization with whom you are waiting to be privileged. This will slow your process completion down. Organizations always know when to expect your credentialing profile. Release time is established and guaranteed by state law. The CCVS has specific requirements that must be met prior to release to that organization and calling will not shorten the turn-around-time. The major goal of the CCVS is to get the credentialing information to the organization as quickly and accurately as possible. Be aware that if a CCVS staff person calls you to ask for clarification or information, they cannot tell you when the file will be completed. They may not even be the person working the file; they may be just preworking the file ahead of assignment to a credentialing specialist. Files must go through a specific process with someone else reviewing and releasing the file after it is updated. If that audit process indicates further follow-up or verification is needed, it will go back into process. The CCVS averages approximately 1500 files a month and it is critical that the staff are not interrupted in their processing of all CCVS profile orders in order to make these numbers. Physicians should never allow someone to sign for him/her. This is not acceptable and will delay their credentialing if the signature audit picks this up at any time.

5 Page 5 What You Need to Know About Your Collaborative Agreement Continued from page 1 (3) Coverage of the health care needs of a patient in the emergency absence of the advanced practice nurse or physician; and (4) Quality assurance. ACA (d) provides that: If a collaborative practice results in complaints of violations of the Arkansas Medical Practices Act, the Arkansas State Medical Board may review the role of the physician in the collaborative practice to determine if the physician is unable to manage his or her responsibilities under the agreement without an adverse effect on the quality of care of the patient. To better delineate and explain the requirements on a physician who desires to enter into a collaborative practice agreement with an advanced practice nurse, the Arkansas State Medical Board states affirmatively that the licensed physician must comply with Arkansas law as stated hereinabove, as well as the following: I. The collaborating physician must be licensed to practice in the state of Arkansas, and be in the active clinical practice of medicine located within the state of Arkansas, or in a state which borders Arkansas and in a county in such state contiguous to the state of Arkansas. II. The collaborating physician must be easily in contact with the APN by radio, telephone, electronic or other telecommunication device. III. The collaborating physician must be engaged in the active practice of medicine and have a practice comparable in scope, specialty, or expertise to that of the Advanced Practice Nurse with whom he or she has entered into a collaborative practice agreement. IV. The collaborating physician must provide notification of the following information to the ASMB, in a manner and form established by the Board: 1. The names and professional titles of anyone with whom they are collaborating; 2. When a material change has occurred in the collaborative agreement or practice; 3. Termination of any collaborative practice agreement. 4. List the scope, specialty and expertise of practice in which the physician is engaged. 5. List the scope, specialty and expertise of practice in which the Advanced Practice Nurse is engaged. 6. Provide a copy of the Collaborative Agreement exclusive of specific protocols. 7. Provide a copy of the quality assurance plan that is utilized by the physician and the advanced practice nurse that have entered into a collaborative agreement. The physician should inform the Board when there are changes to the information that is to be provided to the Board by the physician as stated in this paragraph. A copy of the collaborative agreement must be maintained by the collaborating physician and made available to the Arkansas State Medical Board upon request and must include, at a minimum, provisions addressing: 1. The availability of the collaborating physician for consultation or referral or both; 2. Methods of management of the collaborative practice, which shall include protocols for prescriptive authority; 3. Coverage of the health care needs of the patient in the emergency absence of the APN or the physician; 4. Quality Assurance Plan VI. The collaborating physician shall be responsible for ensuring that each patient receives written documentation as to who the collaborating physician is and how he or she may be reached and/or contacted. The failure of a physician to comply with this Regulation will be considered a violation of the Medical Practices Act and (a)(2) (P), and subject the physician to the possibility of a disciplinary hearing and the imposition of sanctions against his or her license pursuant to Arkansas law and the Administrative Procedure Act. Adopted: August 8, 2008 The implementation date of this regulation has been delayed until further notice. Credentialing/Reappointment Applications What do physicians need to provide to organizations when applying for initial privileges or when going through the reappointment process? Here are some general tips to remember for both organizations and physicians: 1. Physicians do not need to provide, nor can credentialing organizations ask for, copies of certificates (except Continuing Medical Education certificates) for education, specialty board certification, Federal or state DEA or CDS, other state licenses and malpractice insurance coverage. This only applies if they are credentialing physicians for Arkansas and does not apply if they are credentialing physicians for any other state or country. The ASMB will not provide CCVS profiles to other states, CAQH or the FSMB for any purpose. 2. The application can request a copy of ACLS, CPR, Malpractice Claims documents, CME certificates, call or admit coverage information, handicap accessibility, volume statistics, CCVS attestation, detail information on any arrests or convictions or health issues identified on any attestation and the specific organization s CCVS Authorization and Release and peer recommendations. If the application is for any state other than Arkansas, the physician must complete it and provide the requested information if he/she plans to practice there, or currently is practicing there. 3. If the organization s application contains a statement or requirement that you are to provide copies of any of the items provided by the CCVS, simply write in that space, Must obtain from the state mandated CCVS. Contact for questions. 4. Insurance organizations will usually use a generic application that is good for all states and is not specific to Arkansas so these questions may be included. If you receive a letter stating that you will be dropped or cannot be processed because you did not provide these, please call The staff will follow up with the organization to get this cleared as quickly as possible but will need some information before contacting the organization. 5. It is important to note that even if an organization credentialing or reappointing a physician for Arkansas contracts with an outside application service organization such as CAQH, the organization(s) utilizing that application is still responsible for complying with the applicable Arkansas state law regarding the CCVS. They cannot reject a physician s application based on compliance with the law and must inform the application service or their internal staff about this law. Address Changes Have you changed your office or home address? Please remember to download the ASMB s Change of Address form on the Board s website at and fax the completed form to the Board at OR sign up for our new online services using this link ( and change your address/contact information so both the Directory and CCVS can be updated by your new online licensee account.

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 Contact us! Juli Carlson-Regulatory (501) Julia Feazell -Regulatory/Licensing PA/RA (501) Brenda Engelhoven-Regulatory/Malpractice (501) Pat Fisher-Licensing Coordinator - (A-H) (501) Laurel Mills-Licensing Coordinator - (I-Q) (501) Kay Zuber-Licensing Coordinator - (R-Z) (501) Mandi Roberge-Licensing LRCP/OT (501) Carolyn Blenden-Renewal Coordinator (501) Jenny Dollar-Renewal Support Specialist (501) Angie Meehleder-Quality Assurance/ Customer Service Manager (501) Support/Help Center (501) Main Phone (501) Regulatory Fax: (501) CCVS Fax: (501) Accounting/Personnel Fax: (501) Licensing Fax: (501) License Renewals Fax: (501) QI/CS Fax: (501) Online Directory 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. 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. MEDICAL PRACTICES ACT BOOKLETS $15 PER COPY or free from the web site at 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