The proposed rule amendments are intended to address a third level of physician supervision for those physicians who are placed on probation and to clarify supervision requirements.

 

DEPARTMENT OF HEALTH

Board of Medicine

RULE NOS.:RULE TITLES:

64B8-8.0011Standard Terms Applicable to Orders

64B8-8.0012Probation Variables and Practice Restrictions

64B8-8.0021Provisions Governing All Supervisors or Monitoring Physicians.

PURPOSE AND EFFECT: The proposed rule amendments are intended to address a third level of physician supervision for those physicians who are placed on probation and to clarify supervision requirements.

SUMMARY: The proposed rule amendments add a third level of supervision to the Board’s probationary rules to be entitled “immediate” supervision and to require the supervisor to be physically located in the same room as the physician who is being supervised. The rule amendments also clarify the probation variables with regard to the new language regarding supervision and clarify requirements for supervising physicians.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: During discussion of the economic impact of this rule at its Board meeting, the Board concluded that this rule change will not have any impact on licensees and their businesses or the businesses that employ them. The rule will not increase any fees, business costs, personnel costs, will not decrease profit opportunities, and will not require any specialized knowledge to comply. This change will not increase any direct or indirect regulatory costs. Hence, the Board determined that a Statement of Estimated Regulatory Costs (SERC) was not necessary and that the rule will not require ratification by the Legislature. No person or interested party submitted additional information regarding the economic impact at that time.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 456.072(2), 458.309, 458.331(5), FS.

LAW IMPLEMENTED: 456.072(2), 458.331, FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Claudia Kemp, J.D., Executive Director, Board of Medicine/MQA, 4052 Bald Cypress Way, Bin # C03, Tallahassee, Florida 32399-3253.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64B8-8.0011 Standard Terms Applicable to Orders. Unless otherwise approved by the Board or its designee, or addressed by the Final Order, the following are the terms applicable to all Final Orders rendered by the Board in disciplinary proceedings.

(1) through (6) No change.

(7) Probation Terms. If probation was imposed by Board Order, the following provisions are applicable:

(a) Definitions.

1. Indirect Supervision is supervision by a supervising monitoring physician (monitor), as set forth in the Board’s Order. Indirect supervision does not require that the supervisor monitor practice on the same premises as the Respondent. However, the supervisor monitor shall practice within a reasonable geographic proximity to Respondent, which shall be within 20 miles and shall be readily available for consultation. The supervisor monitor shall be board-certified in the Respondent’s specialty area.

2. Direct Supervision is supervision by a supervising physician (supervisor), as set forth in the Order. Direct supervision requires that the supervisor be physically located on the same premises where the Respondent practices medicine and Respondent work in the same office. The supervisor shall be board-certified in the Respondent’s specialty area.

3. Immediate Supervision is supervision by a supervising physician (supervisor), as set forth in the Board’s order. Immediate Supervision requires that the supervisor be physically located in the same room when supervising the Respondent. The supervisor shall be board-certified in the Respondent’s specialty area.

4.3. Probation Committee or “Committee” are members of the Board of Medicine designated by the Chair of the Board to serve as the Probation Committee.

(b) through (h) No change.

(8) through (11) No change.

Rulemaking Authority 458.309(1), 458.331(5) FS. Law Implemented 458.331(5) FS. History–New 8-1-06, Amended 6-23-10, 7-3-17,            .

 

64B8-8.0012 Probation Variables and Practice Restrictions.  In instances where a Respondent is placed on probation or where practice restrictions are imposed by the Board, the Board shall determine the terms and conditions of Respondent’s probation or practice restrictions. The following terms of probation are utilized by the Board to ensure that Respondents are safely practicing medicine. Possible terms of probation and restrictions on practice include, but are not limited to:

(1) through (3) No change.

(4) Immediate Supervision Required. If immediate supervision is required by the Board, Respondent shall not perform designated procedures unless under the immediate supervision of a board-certified physician fully licensed under Chapter 458, F.S., who has been approved by the Probationer’s Committee.

(a) The supervisory physician shall be physically located in the same room with the Respondent where the designated procedure is performed.

(b) Absent provision for and compliance with the terms regarding temporary approval of a supervising physician set forth in paragraph 64B8-8.011(7)(c), F.A.C., Respondent shall cease performing the designated procedure[s] until the Probationer’s Committee approves a supervising physician.

(c) Respondent shall have the supervising physician appear at the first probation appearance before the Probationer’s Committee.

1. Prior to approval of the supervising physician by the committee, the Respondent shall provide to the supervising physician a copy of the Administrative Complaint and the Board’s Order filed in the case.

2. A failure of the Respondent or the supervising physician to appear at the scheduled probation meeting shall constitute a violation of the Board’s Order.

3. Prior to the approval of the supervising physician by the committee, Respondent shall submit to the committee a current curriculum vitae and description of the current practice of the proposed supervising physician. Said materials shall be received in the Board office no later than 21 days before the Respondent’s first scheduled probation appearance.

(d) The responsibilities of a supervising physician shall include:

1. Submit quarterly reports, in affidavit form, which shall include:

a. Brief statement of why physician is on probation.

b. Description of probationer’s practice.

c. Brief statement of probationer’s compliance with terms of probation.

d. Brief description of probationer’s relationship with supervising physician.

e. Detail any problems which may have arisen with probationer.

2. Should the Board determine that Respondent’s medical records need to be reviewed, the Board shall set forth the percentage of the records and type of records to be reviewed by the supervising physician. The patient records shall be selected by the supervising physician on a random basis at least once every month.

3. Report to the Board any violation by the probationer of Chapters 456 and 458, F.S., and the rules promulgated pursuant thereto.

(4) through (10) re-numbered (5) through (11) No change.

Rulemaking Authority 456.072(2), 458.331(5) FS. Law Implemented 456.072(2) FS. History–New 8-1-06, Amended 5-1-17,_____.

 

64B8-8.0021 Provisions Governing All Supervising Supervisors or Monitoring Physicians.

(1) The supervisor/monitor shall be furnished with copies of the Administrative Complaint, Final Order, Stipulation (if applicable), and other relevant orders.

(2) The Respondent shall not practice or perform designated procedures without a supervisor/monitor unless otherwise ordered by the Board. The Respondent shall appear at the next meeting of the Board’s Probation Committee with his proposed supervisor or monitor unless otherwise ordered.

(3) After the next meeting of the Probation Committee, Respondent shall only practice or perform designated procedures under the supervision of the supervisor or monitor. If for any reason the approved supervisor/monitor is unwilling or unable to serve, Respondent and the supervisor/monitor shall immediately notify the Board of Medicine Compliance Officer and Respondent shall cease practice or cease performing designated procedures until a temporary supervisor/monitor is approved. The Chairman of the Probation Committee may approve a temporary supervisor/monitor who may serve in that capacity until the next meeting of the Probation Committee at which time the Committee shall accept or reject a new proposed supervisor/monitor. If the Probation Committee or the Board reject the proposed supervisor/monitor, Respondent shall cease practice or cease performing designated procedures until a new supervisor/monitor is approved by the Probation Committee and the Board.

(4) The supervisor/monitor must be a licensee under Chapter 458, F.S., in good standing, without restriction or limitation on his license. In addition, the Board may reject any proposed supervisor/monitor on the basis that he or she has previously been subject to any disciplinary action against his or her license to practice medicine in this or any other jurisdiction. The supervisor/monitor must be actively engaged in the same or similar specialty area unless otherwise provided by the Board. The Probation Committee or the Board may also reject any proposed supervisor/monitor for good cause shown.

(5) Supervisors/monitors must serve as volunteers without compensation but in instances where a licensee is unable to find a volunteer supervisor/monitor, the licensee, with the approval of the Board, may contract with a third party entity that provides supervisors/monitors for a fee.

Rulemaking Authority 458.309 FS. Law Implemented 458.331 FS. History–New 1-23-06, Amended 11-16-09,                          .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Rules/Legislative Committee, Board of Medicine

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Board of Medicine

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 2, 2018

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 16, 2018