Disciplinary Actions Common complaints / discipline Reporting: formal and public Standard of Care (SOC) Expert Witnesses 2016 AIM Executive Academy (AEA) Kathleen Selzler Lippert, Kansas ED, JD, CMBE 201April 23, 2014

Complaint Investigation Board Action Whether you have been an Executive Director for a medical board for a short or long time, the perennial question of ‘now what’ will hit your radar. Examples of ‘now what’ moments may include: Complaint caller is extremely agitated, demanding that you require his physician to prescribe some medication they deem life saving or necessary for pain relief or they will end their life …. Right now. Complaint caller is extremely agitated and believes your agency and staff to be co-conspirators with physician who is poisoning them and threatens harm against your staff, sends staff Facebook requests, or other stalking type behavior, law enforcement is challenged to locate them because they are homeless and call from track phones. Complaints provide strong indication of practice violation but licensee employs attorney and all possible stall tactics to delay investigation including objecting to subpoenas, seeking court injunctions to block or limit subpoenas, and issue counter attack subpoenas. Media calls, sets forth proposition that as a state agency there is a duty to be transparent and as a regulator your mission is public protection, so why is anything redacted from any agency document. Media calls, notes that board discipline for boundary violation of intimate relationship between provider and patient was less than revocation, asks for explanation of how this order fulfills mission of public protection. Media calls, notes that % of hospitals took privilege action against providers in your state and your board failed to identify providers on your web page that lost their hospital privileges and it appears there was no adverse license action for such mis-conduct. Then there are the calls from legislators, the Governor’s office, and others that present a host of other questions about your agency disciplinary actions and reporting of such actions.

‘Some people from the medical board Some complaints, investigations, and board actions are more visible – or targets for a segment of NBC News episode of Dateline. Sex Drugs Rock n’ roll Are prime targets for additional scrutiny. ‘Some people from the medical board are here to see you.’

Disciplinary Process Complaint Received Initial Investigation/ Review Investigative Committee Complaint Closed Investigative Interview Each board has a unique process and people who make decisions. AND …. Just like ice cream, boards and board members come in different “flavors”. They have different voices and make different choices, and even the same board changes (their stance on an issue or discipline) over time. Discuss: Expert Witnesses: Where do you get them? What do they cost? Testifying expert v. in-house staff medical reviewer Standard of Care: Best practice v. minimum standard Further Investigation/ Outside Review Final Board Action

Disciplinary Action Common Causes Prescribing Violations Impairment Behavioral Issues Boundary Issues Criminal Convictions Violations of Board Orders Failure to update Physician Profile Failure to timely renew license Failure to obtain Board approval for supervision of PA prior to the PA beginning work Substandard practice (Standard of Care SOC)

Board Actions / Orders Non- Public (if statutory authorization): Letter of Concern (LOC) Professional Development Plan (PDP) Advisory Letters Public: Censure / fine / costs Education / training Reprimand Impairment monitoring Limitation / Restriction / Probation / Conditions relating to practice Suspension Revocation Not everything the Board does is disciplinary. Examples: Physician who left practice to raise kids and wants to return to practice after being out of practice for 5 years. They have not done anything wrong. There is no clear evidence they are not competent to practice. There is cause for concern that they may be behind in their clinical competency but they may not be; it may depend on their area of specialty. A board order that provides for a proctor or mentor is not to discipline the person but to ensure public safety. A physician who has a DUI but there is no evidence that substance use has manifested or impacted patient care. Board may want to ensure patient safety with a monitoring plan or abstinence plan to ensure patient safety but not to punish or discipline the provider but to ensure patient safety.

Reporting Board Orders Who NPDB FSMB Website Newsletter Media What Guide Book Rules Public info only? Non-public info?

Reporting Board Orders NPDB NPDB Guidebook Help line: 800-767-6732 help@npdb.hrsa.gov Regional Representative

FSMB Reporting Is there a process to notify other state medical boards if a practitioner’s license is suspended? Or report any board action … FEDERATION OF STATE MEDICAL BOARDS The Disciplinary Alert Report is compiled and published by the Federation of State Medical Boards of the United States, Inc., as a reference source for its member boards. The Disciplinary Alert Report or any of its data, listings, or other constituent elements may not be republished, sold, or duplicated, in whole or in part, for commercial or any other purposes, or for purposes of compiling lists or files without the express written permission of the Federation's Executive Vice President as authorized by the Board of Directors. The use of this Disciplinary Alert Report to establish independent data files or compendiums of information is strictly prohibited.

Information to Consumers How do you let the public know about board orders? Board’s website (copy of board orders) Newsletter by medical board Verification of medical license (different search engines, copies of board orders) Minutes for board meetings Media – Call from Dateline or Reporters

Transparency … Isn’t always clear Doesn’t always make it safe

Transparency … Isn’t always clear Transparency is a buzz word used by media, consumers, providers, stakeholders Transparency is not always clear Transparency does not always make it safe Inherent conflict between transparency and confidentiality My media box points (handouts)

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Questions? Kathleen Selzler Lippert, JD, CMBE Kansas State Board of Healing Arts Executive Director 800 SW Jackson Lower Level – Suite A Topeka, Kansas 66612 Klippert@ksbha.ks.gov 785-296-3680 Questions? 14