The proposed new Rule 64B15-6.0112, F.A.C., is intended to address standard terms which the Board utilizes in its orders. The proposed new Rule 64B15-6.0113, F.A.C., is intended to address the variables which are utilized in the event a physician ...

DEPARTMENT OF HEALTH
Board of Osteopathic Medicine

RULE NO: RULE TITLE
64B15-6.0112: Standard Terms Applicable to Orders
64B15-6.0113: Probation Variables
PURPOSE AND EFFECT: The proposed new Rule 64B15-6.0112, F.A.C., is intended to address standard terms which the Board utilizes in its orders. The proposed new Rule 64B15-6.0113, F.A.C., is intended to address the variables which are utilized in the event a physician assistant is placed on probation by the Board.
SUMMARY: The proposed new Rule 64B15-6.0112, F.A.C., addresses standard terms for disciplinary orders which apply to physician assistants. The proposed new Rule 64B15-6.0113, F.A.C., sets forth the various probation variables which apply to physician assistants who are placed on probation by the Board.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC AUTHORITY: 456.072(2), 459.005(1), 459.015(5) FS.
LAW IMPLEMENTED: 456.072(2), 459.015(5) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Pamela King, Executive Director, Board of Osteopathic Medicine/MQA, 4052 Bald Cypress Way, Bin #C06, Tallahassee, Florida 32399-3256

THE FULL TEXT OF THE PROPOSED RULE IS:

64B15-6.0112 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) PAYMENT OF FINES AND COSTS. All fines and costs shall be paid by check or money order made payable to the Board and sent to DOH/Client Services, P. O. Box 6320, Tallahassee, Florida 32314-6320, within 30 days of the filing of the Order.

(2) ADDRESSES. Respondent must keep current residence and practice addresses on file with the Board. Respondent shall notify the Compliance Office, in writing, within 10 days of any changes of those addresses. Furthermore, if the Respondent's license is on probation, the Respondent shall notify the Compliance Office within 10 days in the event that Respondent leaves the active practice of medicine in Florida.

(3) COMPLIANCE ADDRESS. All reports, correspondence and inquiries shall be sent to: DOH, Client Services Unit, 4052 Bald Cypress Way, Bin #C01, Tallahassee, Florida 32399-3251, Attn: Medical Compliance Officer.

(4) CONTINUITY OF PRACTICE.

(a) TOLLING PROVISIONS. In the event the Respondent leaves the State of Florida for a period of 30 days or more or otherwise does not or may not engage in the active practice of medicine in the State of Florida, then certain provisions of the requirements in the Board's Order shall be tolled and shall remain in a tolled status until Respondent returns to the active practice of medicine in the State of Florida. Respondent shall notify the Compliance Officer 10 days prior to his/her return to practice in the State of Florida. The following requirements shall be tolled until the Respondent returns to active practice:

1. The time period of probation shall be tolled.

2. The provisions regarding direct supervision and required reports from the supervisor shall be tolled.

3. The requirement for quality assurance review of Respondent’s practice shall be tolled.

4. Any provisions regarding community service shall be tolled.

5. Any requirements regarding lectures.

(b) ACTIVE PRACTICE. In the event that Respondent leaves the active practice of medicine for a period of one year or more, the Respondent may be required to appear before the Board and demonstrate the ability to practice medicine with reasonable skill and safety to patients prior to resuming the practice of medicine in the State of Florida.

(5) COMMUNITY SERVICE AND CONTINUING EDUCATION UNITS. All community service requirements, continuing education units/courses must be completed, and documentation of such completion submitted to DOH/Client Services, at the address set forth in subsection (3) above.

(a) DEFINITION OF COMMUNITY SERVICE. “Community service” shall be defined as the delivery of volunteer services to an entity which is exempt from federal taxation under 26 U.S.C. s. 501(c)(3), without fee or cost to the patient or the entity, for the good of the people of the State of Florida. Community service shall be performed outside the physician assistant’s regular practice setting. Community service plans must be pre-approved by the Board.

(b) CONTINUING EDUCATION. Continuing education imposed by Board Order shall be in addition to those hours required for biennial renewal of licensure. Said continuing education courses must be pre-approved by the Board and shall consist of a formal live lecture format.

(6) PROBATION TERMS. If probation was imposed by Board Order, the following provisions are applicable:

(a) DEFINITIONS: DIRECT SUPERVISION – is supervision by a supervising physician (supervisor), as set forth in the Order. Direct supervision requires that the supervisor and Respondent work on the same premises. The supervisor shall be board-certified in the Respondent's specialty area.

(b) REQUIRED SUPERVISION:

1. If the terms of the Order direct supervision of the licensee’s practice (supervision), the Respondent shall not practice medicine without an approved supervisor, as specified by the Final Order.

2. The supervisor must be licensed under Chapter 459, F.S., in good standing, in active status, without restriction or limitation on his/her license, must be qualified by training and experience, and must not have any conflicts of interest that would prohibit him or her from impartially performing his or her duties as a monitor. Specific grounds for rejecting a proposed supervisor by the Board or its designee shall include but are not limited to the following:

a. The proposed supervisor has previously been subject to disciplinary action against his/her medical license in this or any other jurisdiction;

b. The proposed supervisor is currently under investigation, or is the subject of a pending disciplinary action;

c. The proposed supervisor is not actively engaged in the same or similar specialty area;

d. The proposed supervisor is not practicing on the same premises as the Respondent;

e. The proposed supervisor is a relative or employee of the Respondent.

(c) TEMPORARY APPROVAL. The Board confers authority on the Chair of the Board to temporarily approve Respondent’s supervisor. To obtain this temporary approval, Respondent shall submit to the Compliance Officer the name and curriculum vitae of the proposed supervisor. This information shall be furnished to the Chair of the Board by way of the Compliance Officer. This information may be faxed to the Compliance Officer at [phone], or may be sent by overnight mail to the Compliance address as set forth in subsection (3) above. Should Respondent's supervising physician be temporarily approved, said approval shall only remain in effect until the next meeting of the Board. Absent said approval, Respondent shall not practice medicine until a supervising physician is approved. Temporary approval shall only remain in effect until the next meeting of the Board.

(d) FORMAL APPROVAL. If Respondent is placed under the direct supervision of a physician, Respondent shall have the supervisor with him/her at the first probation appearance before the Board. Prior to consideration of the monitor/supervisor by the Board, the Respondent shall provide the supervisor a copy of the Administrative Complaint and the Board’s Order in this case. Respondent shall submit a current curriculum vitae, a description of current practice, and a letter agreeing to serve from the proposed supervisor to the Compliance Officer no later than 21 days before the Respondent’s first scheduled probation appearance. Respondent’s supervisor shall also appear before the Board at such times as directed by the Board. It shall be the Respondent’s responsibility to ensure the appearance of his/her supervisor as directed. Failure of the supervisor to appear as directed shall constitute a violation of the terms of the Board’s Order and shall render the Respondent subject to additional disciplinary action.

(e) CHANGE IN SUPERVISOR. In the event that Respondent’s supervisor is unable or unwilling to fulfill his/her responsibilities as a supervisor as described above, the Respondent shall advise the Compliance Office of this fact within 24 hours of becoming aware of the situation. Respondent shall submit to the Compliance Office the name of a temporary supervisor for consideration. Respondent shall not practice pending approval of this temporary supervisor by the Chair of the Board. Furthermore, Respondent shall make arrangements with his/her temporary supervisor to appear before the Board at its next regularly scheduled meeting for consideration of the supervisor by the Board. Respondent shall only practice under the supervision of the temporary supervisor (approved by the Chair) until the next regularly scheduled meeting of the Board whereat the issue of the Board Chair’s approval of the Respondent's new supervisor shall be addressed.

(f) REPORTS. If directed by Board Order, probation reports, in affidavit form, shall be submitted by the Respondent and shall contain the following:

1. Brief statement of why physician assistant is on probation.

2. Practice location.

3. Describe current practice (type and composition).

4. Brief statement of compliance with probationary terms.

5. Describe relationship with supervising physician.

6. Advise Compliance Officer of any problems including office incident reports filed; loss or restriction of hospital staff privileges; or any Medicare/Medicaid program exclusions, restrictions or limitations.

(g) SUPERVISOR REPORTS. If directed by Board Order, supervisor reports, in affidavit form shall include the following:

1. Brief statement of why physician assistant is on probation.

2. Description of probationer’s practice.

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

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

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

(h) INVESTIGATIVE REPORTS. Respondent understands that during the period of probation, at a minimum, semi-annual investigative reports will be compiled with the Department of Health concerning compliance with the terms and conditions of probation and the rules and statutes regulating the practice of medicine.

(7) COSTS OF COMPLIANCE. Respondent shall pay all costs necessary to comply with the terms of the Board’s Order. Such costs include, but are not limited to, the costs of preparation of the investigative reports detailing compliance with the terms of the Order, the cost of analysis of any blood or urine specimens submitted pursuant to the Order, and administrative costs directly associated with Respondent’s probation. See Section 459.015(2), F.S.

(8) SUSPENSION. In the event that a Respondent’s license expires during the period that the license is suspended, this action shall not relieve the Respondent of the responsibility to renew the license at the end of each licensure period. If the Respondent fails to renew the license at the end of any licensure period, all normal conditions and consequences imposed by statute or rule of the Board for failure to timely and properly renew a license shall apply. Renewal of a suspended license during the period of suspension shall not affect the suspension of the license and the suspension shall continue until all requirements for reinstatement have been met.

(9) RETURN OF LICENSE. Any Order which suspends a license, revokes a license, or accepts a Respondent’s offer to voluntarily relinquish his/her license shall require the Respondent to return the license to the Department within 30 days from the date the Final Order is filed. This shall not apply to instances where the Board or a court has granted the Respondent a stay of the suspension.

Specific Authority 459.005(1), 459.015(5) FS. Law Implemented 459.015(5) FS. History–New________.

 

64B15-6.0113 Probation Variables.

In instances where a Respondent is placed on probation by the Board, the Board shall determine the terms and conditions of Respondent’s probation. 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) APPEARANCES REQUIRED. Respondent shall appear before the Board at the first meeting after said probation commences, at the last meeting of the Board preceding termination of probation and either quarterly, semiannually, or annually as set forth in the final order. Respondent shall be noticed by Board staff of the date, time and place of the Board meeting whereat Respondent’s appearance is required. Failure of the Respondent to appear as requested or directed shall be considered a violation of the terms of probation, and shall subject the Respondent to disciplinary action.

(2) DIRECT SUPERVISION REQUIRED. If direct supervision is required by the Board, Respondent shall not practice except under the direct supervision of a board-certified physician fully licensed under Chapter 459, F.S., who has been approved by the Board.

(a) The supervising physician shall work on the same premises as the Respondent.

(b) Absent provision for and compliance with the terms regarding temporary approval of a supervising physician set forth in paragraph 64B15-6.0112(6)(c), F.A.C. Respondent shall cease practice and not practice until the Board approves a supervising physician.

(c) Respondent shall have the supervising physician appear at the first probation appearance before the Board.

1. Prior to approval of the supervising physician by the Board, 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 meeting shall constitute a violation of the Board’s Order.

3. Prior to the approval of the supervising physician by the Board, Respondent shall submit to the Board 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 assistant 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 459, F.S., and the rules promulgated pursuant thereto.

(3) ALTERNATE SUPERVISOR. In view of the need for ongoing and continuous supervision, Respondent shall also be required to submit the curriculum vitae and name of an alternate supervising board-certified osteopathic physician who shall be approved by Board. Such physician shall be licensed pursuant to Chapter 459, F.S., and shall have the same duties and responsibilities as specified for Respondent's supervising physician during those periods of time which Respondent’s supervising physician is temporarily unable to provide supervision. Prior to practicing under the direct supervision of the alternate supervising physician, Respondent shall so advise the Board in writing. Respondent shall further advise the Board in writing of the period of time during which Respondent shall practice under the supervision of the alternate supervising physician. Respondent shall not practice unless Respondent is under the supervision of either the approved supervising physician or the approved alternate.

(4) CONTINUING MEDICAL EDUCATION. Should the Board determine that continuing medical education (CME) is appropriate during the probationary period, the Board shall determine the number of hours and subject area of the required CME. The CME shall be Category I Continuing Medical Education. Respondent shall submit a written plan to the Chairperson of the Board for approval prior to the completion of said courses. The Board confers authority on the Chairperson of the Board to approve or disapprove said continuing education courses. In addition, Respondent shall submit documentation of completion of these continuing medical education courses in each report. These hours shall be in addition to those hours required for biennial renewal of licensure. Said continuing education courses shall consist of a formal live lecture format.

(5) PRN REQUIRED. Should the Board determine that a contract by the Professionals Resource Network (PRN) is appropriate, Respondent shall participate and comply with the PRN contract.

(a) Respondent shall enter into an after care contract with PRN, shall comply with all its terms, and shall be responsible for assuring that the medical director of PRN send the Board a copy of said contract.

(b) Respondent shall execute a release that authorizes PRN to release information and medical records (including psychiatric records and records relating to treatment for drug dependence and alcoholism) to the Board of Osteopathic Medicine as needed to monitor the progress of Respondent in the PRN program.

(c) Respondent shall authorize the director of PRN to report to the Board of Medicine any problems that may occur with Respondent and any violations of Chapter 456 or 459, F.S. Such a report shall be made within 30 days of the occurrence of any problems, or violations of Chapter 456 or 459, F.S.

(6) PRESCRIBING PROHIBITION OR RESTRICTION. If Respondent is licensed as a prescribing physician assistant and should the Board determine that it is appropriate to require a restriction of Respondent's prescribing privileges, the Board shall set forth the length of said restriction and determine which substances shall be affected.

(7) RESTRICTION ON TREATING PATIENTS OF THE OPPOSITE GENDER. Should the Board determine there should be a restriction on treating patients of the opposite gender, Respondent shall not examine or treat any patients of the opposite gender without an employee who is of the same patient gender and who is a health care practitioner licensed by the Department of Health present in the room.

Specific Authority 456.072(2) FS. Law Implemented 456.072(2) FS. History–New________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Council on Physician Assistants
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Board of Osteopathic Medicine
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 10, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: November 17, 2006