NEWSLETTER. Propriety By Joseph M. Beck, II, M.D., Chairman

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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 Summer 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. Jonesboro, AR John E. Hearnsberger, II, M.D. Nashville, AR Veryl D. Hodges, D.O. Jonesboro, AR 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 From time to time the Board is tasked with dealing with a physician with a boundary problem. This is a broad term that covers a multitude of behaviors but the root cause, in my opinion, is the failure of the physician to be aware of propriety. This is defined as the quality of being proper; appropriateness and the usage and customs of a polite society. The public has certain expectations of physicians, some realistic and others not. I will deal with the realistic ones here. The public expects a physician to be clinical in the exam room. Not overly friendly, not distracted and certainly not sexual or suggestive in any way, shape or form, even in jest. The Board receives many complaints about doctors who have strayed beyond the bounds of propriety in this regard. Although society holds doctors in high regard and expects a benign interest in one s personal life, discussion of personal issues not germane to the problem at hand is improper and, if continued over time, can lead to trouble for the doctor. Although physicians have every right to expect just remuneration for their services, undue interest in money is another way the bounds of propriety may be breached. In general, bartering for services is frowned upon and may be looked upon as being inappropriately enriching for the doctor. The usage and customs of polite society dictate that a professional put the needs of the patient first and the collection of a fee second. Many complaints are received with the theme of the doctor putting money above his or her patient s best interest. Nothing will damage a physician s reputation more quickly or completely than the allegation of practicing medicine while impaired. The Board takes very seriously and Propriety By Joseph M. Beck, II, M.D., Chairman makes every effort to remove and rehabilitate such physicians for the safety of the public but in general doctors don t make the decision to practice under the influence all at once. Propriety dictates abstemiousness while in public, lest one be called or observed by a patient. Showing up at the ER after just one drink or tranquilizer and attempting to render care shows a disregard for the profession and for that particular patient one has sworn an oath to treat. Over time, the physician may push this particular proprietary boundary to the point that a true problem occurs. The practice of medicine is a richly rewarding way of life and a privilege of serving one s fellow man that is attained by few in our society. The Board would suggest that each doctor having a well-developed sense of propriety is the best inoculation against having an unpleasant interaction with the State Medical Board. Inside This Issue: Propriety 1 All Licensees Prepare for Mandatory Online Renewals in 2014 Meeting Dates 2 AR Prescription Monitoring Program 3 Governor Appoints New OT Examining Committee Member Board Actions & License Adjustments 3 Attention Physician Assistants: YOUR PROTOCOL PA Changes & Updates 4 DOT to Require Certification to Conduct DOT Physicals Acceptable & Unacceptable CEU s Occupational Therapists OTA's-Reminder to Notify the Board! 5 Free Opioid Prescribing Education From Boston University Change to Physician s CME

2 Page 2 Prepare for Mandatory Online Renewals 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 receive an reminder to complete your renewal. The Board recommends that Licensees begin the online renewal process before their current license expires. Please carefully read and follow the instructions below to prevent unnecessary delays. 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. The Board takes the prevention of identity theft, fraud and cyber-attacks seriously. Similar to federal government online processes, you will be required to prove your identity through two separate steps before you can access your Online Licensee Account. Identity Verification Step 1: An Online Licensee Account instruction letter containing a Personal Identification Number (PIN) will be mailed to the Private Address. Identity Verification Step 2: Using information provided on the letter, the licensee will access a secure webpage. The PIN and other personal information will be entered. If the information is correct the licensee is allowed to create an Online Licensee Account. Account creation consists of choosing a password, security questions and activating the account via a link ed to the licensee s Private . To get started: 1. Ensure that the Board has your correct Private Address and Private address. 2. When your Online Licensee Account instruction letter arrives it will contain two key pieces of information: Your PIN and a link to the Online Services Registration web page. Enter the link into the Address Bar of your browser to insure you go to the correct page. BE- WARE OF IMPOSTERS! Do not use the Search Bar as you may wind up on a Private Licensing site with no affiliation to us. The correct web page will say Online Services Registration and a place to enter the PIN. 3. From the Online Services Registration page, fill in the requested information and click the I Attest button. You should continue to the Verification page where your Private address will be displayed. If it is not correct, STOP, and submit a Change of Address form with the corrected . If it is correct, click the Continue. Create your password and security questions and click Register. 4. Locate the Board s message sent to your Private from Support@armedicalboard.org with a subject line titled Action Required to Activate Account at Validate your account by clicking the link in the message. 5. Log into and access Online Renewal other services. REMEMBER: Registration for your Online Licensee Account is a one-time process that you may start at any time but don t delay. The deadline for mandatory online renewals is fast approaching. Register now and enjoy the benefits of all online services. If you have any questions, concerns or comments, you can contact us at or support@armedicalboard.org. Scheduled Board Meeting Dates for the Arkansas State Medical Board August 1-2, 2013 October 3-4, 2013 December 5-6, 2013 The agenda for each meeting will be posted online by 4:00pm the Wednesday of the week prior to each meeting. 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 Allied Healthcare Meetings Respiratory Care Examining Committee September 12, 2013 December 12, 2013 Occupational Therapy Examining Committee November 4, 2013 Physician Assistant Committee July 31, 2013 October 2, 2013 December 4, 2013 Dates and times of meetings are subject to change.

3 Page 3 Arkansas Prescription Monitoring Program Update Act 304 of 2011 established the Arkansas Prescription Monitoring Program (AR PMP) to be implemented under the direction of the Arkansas Department of Health in the spring of 2013 if funding was available. Currently, the program is operational through federal grants. The goals and benefits of a PMP are set forth in the legislation: To enhance patient care by providing prescription monitoring information that will ensure legitimate use of controlled substances in health care To help curtail the misuse and abuse of controlled substances To assist in combating illegal trade in and diversion of controlled substances To enable access to prescription information by practitioners, law enforcement agents and other authorized individuals and agencies Prescription drug abuse has become a major problem in the United States. Statistics for Arkansas alone are shocking. Arkansas ranked among the second highest group of states nationally in overall drug overdose deaths in 2008, with 5.1 per 100,000 deaths resulting from nonmedical use of opioid pain relievers. Arkansas ranked among the highest group nationally in the rate of kilograms of opioid pain relievers sold per 10,000 people in Abuse of prescription drugs has not eluded our youth. Nearly 20 percent of Arkansas teenagers have abused prescription drugs by the time they are seniors in high school. Prescription monitoring programs were created to assist healthcare practitioners in the battle against prescription drug abuse. The AR PMP collects Schedule II V prescription dispensing data. Pharmacies are now reporting this data to the AR PMP weekly for the previous Sunday through Saturday reporting period. Direct access to the database is now available to prescribers and pharmacists via the AR PMP website at Please direct technical issue questions to Health Information Designs at Questions about the program itself can be directed to Denise Robertson, P.D. at denise.robertson@arkansas.gov or Governor Appoints New Occupational Therapy Examining Committee Member Governor Mike Beebe recently appointed Ted Scallion to the Arkansas State Medical Board s Occupational Therapy Examining Committee. Mr. Scallion replaces Carolyn Loghry, the Consumer Member. Mr. Scallions current term expires March 1, Board Actions & License Adjustments 3/30/2013 through 7/18/2013 ALLEN, Teressia, OTA (OT-A389) Dardanelle, AR Reprimand, 6/25/2013 CLEMENTS, Todd Michael, M.D. (E-7236) Jonesboro, AR Consent Order, 7/17/2013 GREEN, Michael Dale, M.D. (C-7697) Springdale, AR Emergency Order of Suspension, 5/3/2013 JONES, Joseph Vernon, M.D. (N-5634) Blytheville, AR Surrendered, 4/5/2013 NAYLES, Lee Charles, M.D. (C-6342) Reprimand, 6/25/2013 PENNINGTON, Donald Harris, M.D. (C-4630) Clarksville, AR Consent Order, 5/24/2013 SCOTT, Little Joe, LRCP (RCP-2545) Magnolia, AR Returned to Active, 6/6/2013 Emergency Order of Suspension, 5/1/2013 SLOAN, Valerie Ann Turnbow, M.D. (E-4047) Bono, AR Surrendered, 6/7/2013 Emergency Order of Suspension, 5/1/2013 THOMPSON, Kelly Glenn, LRCP (RCP-3105) Returned to Active, 6/6/2013 Emergency Order of Suspension, 4/26/2013 WAWRZYNEK, Robert Francis, PA (PA-269) Crossett, AR Revoked, 6/25/2013 WHATCOTT, Brett David, D.O. (E-2230) Fort Smith, AR Emergency Order of Suspension, 5/1/2013 YOUNG, Karen Leslie, M.D. (C-7535) Consent Order, 5/24/2013

4 Page 4 Attention Physician Assistants: Your Protocol By Charles Pillow, PA-C, Member ASMB Physician Assistant Advisory Committee I have had the privilege of serving on the PA Advisory Committee to the Arkansas State Medical Board for the past year. One function of the committee is to review and approve PA applications for licensure and the change of supervising physicians. Prior to the meeting I review a huge stack of these applications. The portion of the application on which I spend most of my time is the Physician Assistant Protocol and Delegation of Services Agreement. This is also the area of your application that generates the most questions and discussion from members of the advisory committee. I hope this article will help Arkansas physician assistants prepare a more thoughtful and useful protocol and make your committee appearance easier. My first recommendation, and in my opinion, the most urgent, is to take possession of your protocol. Too many times, I see protocols that appear as if office personnel printed off the protocol example from the Arkansas State Medical Board website and had the PA and physician sign it. These protocols appear as if no thought or discussion about the PA and Supervising Physician relationship has occurred generating questions from committee members. Your protocol should describe the type of practice and how you will assist the physician in the practice. This process obviously has to start with a discussion between you and your prospective supervising physician prior to your scheduled appearance before the Committee. The clinic managers can and should be involved in these discussions, but you and the supervising physician should review and approve every word of your protocol. These discussions will not only help you create a better protocol and working relationship with your supervising physician but will prepare you and your supervising physician for your committee appearance. The section of the protocol that seems to raise most of the committee questions is the procedures section. You and your supervising physician should discuss and decide what procedures you can and will currently perform and what you plan to do in the future. Do not include procedures you will not do in the practice, even if you are capable of doing them. For example, it is very unlikely an orthopedic practice will do pap smears. This type of procedure request always raises questions from the committee. Include only procedures your supervising physician has observed you doing and he/she is confident in your skills to perform. I personally like to see a statement about procedures you and your supervising physician plan to do in the future, which indicates thought and planning about your PA/Supervising Physician relationship. Once your supervising physician has trained and observed you doing these procedures, he/she can send a letter to the medical board asking that this procedure be added to your protocol. There is no set number of procedures the supervising physician must observe; however, he/she must observe enough to be confident in your ability to perform the procedure. You are not required to appear before the committee again to add procedures to your protocol. Your written protocol is a very important document describing and defining your relationship with your supervising physician and it helps the PA Advisory Committee decide if this relationship is appropriate. Developing a working relationship with your supervising physician by paying close attention to the procedures you are requesting to do and taking possession of your protocol are two recommendations I have for developing a better protocol and making your committee appearance easier and less stressful. Physician Assistant Changes & Updates Regulation 24: Rules Governing Physician Assistants of the Medical Practice Act states that any change in protocol must be submitted to the Board and approved by the Board prior to any change in the protocol being enacted by the physician assistant. The protocol shall include, but not be limited to, the following: the location of practice; the name of the supervising physician; the name of the back-up supervising physician(s) and a description of when the backup supervising physician will be utilized. In essence, any time you make a change, whether it be to add another backup supervising physician or adding another work location, etc., the proper paperwork must be submitted and approved by the Physician Assistant Advisory Committee prior to that change taking place. Department of Transportation (DOT) to Require Certification to Conduct DOT Physicals The National Registry for Certified Medical Examiners is a new Federal Motor Carrier Safety Administration program. As of 5/21/14, only examiners who have completed training endorsed by the DOT will be allowed to do physicals on commercial motor vehicle drivers to determine their fitness to be able to safely operate a motor vehicle. Visit nationalregistry.fmcsa.dot.gov for more information about how to become certified. This information was provided by Gary Moffitt, M.D. For questions, he can be reached at (479)

5 Page 5 Guidelines for Acceptable & Unacceptable CEU s Occupational Therapists The Occupational Therapy Examining Committee has worked diligently to provide Arkansas licensees a list of guidelines of generally accepted and unaccepted continuing education. Occupational Therapists can now obtain continuing education units for volunteering for an organization that adds to the overall development of one s practice roles, mentoring an OT or OTA colleague, and participating in a professional occupational therapy study/online group, to name a few. The guidelines for acceptable and unacceptable CEU s are located on our website, From our homepage, select your credentials under For the Professional tab. On the right-hand side of the page, in the Forms and Publications box, you will see a link for the guidelines. We also suggest you review Regulation 6, the continuing education section, in the Medical Practice Act. It is the goal of the Committee that you will find the improvements beneficial. If you have questions with regards to CEU s, please contact Mandi Roberge, Occupational/ Respiratory Therapy Licensing Coordinator, directly at or adr@armedicalboard.org. OTA's-Reminder to Notify the Board! Occupational Therapy Assistants working in Arkansas are required by the following Regulation to notify the Board when adding/removing a supervising OT/L. Regulation 6, Section 6.2: (E) Before an occupational therapy assistant can assist in the practice of occupational therapy, he must file with the Board a signed, current statement of supervision of the licensed occupational therapist(s) who will supervise the occupational therapy assistant. Change in supervision shall require a new status report to be filed with the Board. (F) In extenuating circumstances, when the occupational therapy assistant is without supervision, the occupational therapy assistant may carry out established programs for up to thirty calendar days while appropriate occupational therapy supervision is sought. It shall be the responsibility of the occupational therapy assistant to notify the Board of these circumstances. (G) Failure to comply with the above will be considered unprofessional conduct and may result in punishment by the Board. Free Opioid Prescribing Education From Boston University The Federation of State Medical Boards has reported that Boston University School of Medicine is offering a free online continuing medical education (CME) course entitled Safe and Competent Opioid Prescribing Education (SCOPE) of Pain. The program addresses many key elements of the physician component of the Obama Administration s prescription drug abuse prevention plan on prescriber education released in This is a free education program that has been accredited for a maximum of 3.0 AMA PRA Category 1 Credits. It is comprised of three educational modules that must be completed in order for the learner to earn their online certificate of credit. The program is available at For questions or assistance, contact Kelly Alfred, Director of Education Services, at kalfred@fsmb.org, or Ilana Hardesty, SCOPE Program Manager at hardesty@bu.edu. Reminder - Change to Physician s CME Requirements In February 2012 the Arkansas State Medical Board passed an amendment to Regulation 17 regarding continuing medical education (CME). The amendment to the regulation requires physicians to obtain 50% of the 20 hours of annual CME to be in their primary area of practice and designated as Category 1 as defined in the regulation. Primary area of practice is defined as the area in which you are currently practicing. Example: If you trained as a general surgeon and are now volunteering in a free clinic, your primary area of practice would be general medicine rather than surgery. Physicians are to be compliant with this change effective with the 2013 license renewals. To review Regulation 17 in its entirety, go to Create an online account to renew your license! Read how on pages 2. The OTA Supervision form is located on our website under Forms and Publications, forms.aspx. The form may be submitted by fax or mail.

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 (501) Laurel Mills-Licensing Coordinator (501) Kay Zuber-Licensing Coordinator (501) Mandi Roberge-Licensing LRCP/OT (501) Carolyn Blenden-Renewal Coordinator (501) Karen Boling-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 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 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.

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