Innovations In Clinical Neuroscience

JAN-FEB 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 1 – 2 , J A N U A R Y – F E B R U A R Y 2 0 1 7 ] 62 R I S K M A N A G E M E N T c onstitute supervision vary from state to state. Psychiatrists should have a very clear understanding of what is required by the state's nursing or other licensing board as well as the psychiatrist's own licensing board. Psychiatrists should know what is expected of them before accepting assignment or agreeing to be a supervisor and before signing-off on a form as a supervisor. Other organizations that may be involved, such as health insurance companies, hospitals and other facilities, and Medicare/Medicaid, may have their own requirements for supervision. 9. Know how to get patients admitted to a local hospital. Psychiatrists should know the procedure for getting patients admitted to a local hospital. In some cases, involuntary admission may be required. Psychiatrists should know how to initiate an involuntary admission if needed. 10. Have a contact at the locum tenens company. Having an easy-to-reach contact at the locum tenens company can go a long way to reducing psychiatrists' potential professional liability risks and other problems. The locum tenens company representative can clarify psychiatrists' duties and help solve disputes that arise during the assignment. If psychiatrists accept locum tenens assignments that involve telemedicine, those psychiatrists should consider these additional, special concerns. 11. Confirm representations about licensure made by the locum tenens company. If the locum tenens assignment involves telemedicine, remember that the practice of medicine occurs where the patient is located. Services to out-of- state patients typically require an additional medical license. 1 2. Comply with DEA and state registration. If the locum tenens assignment includes telemedicine activities involving out-of-state patients, remember that under the federal Controlled Substances Act, no controlled substance may be prescribed without at least one in-person evaluation of the patient. There is a telemedicine exception to the one in- person evaluation requirement, but only for telemedicine as strictly defined by the Controlled Substances Act. Under most circumstances (greatly simplified here), to prescribe without an in-person examination, even via telemedicine, the patient either needs to be in facility with its own DEA registration or the patient needs to be in the physical presence of another provider with his or her own DEA registration. (There are other exceptions that are extremely limited.) For a more in-depth analysis of this issue, please see my colleague's commentary "Telemedicine—Still So Many Unknowns." 3 13. Comply with states' and facilities' requirements. States vary in the degree to which they regulate the practice of telemedicine; some regulate extensively, others less so. The field is also changing. States frequently enact new regulations, so psychiatrists practicing via telemedicine must keep up-to-date. Some states require an in-person evaluation for prescribing controlled substances as well as for legend drugs; some states outright prohibit the prescribing of any medication via telemedicine. Psychiatrists who fail to investigate state requirements may place themselves in peril. An Idaho doctor who prescribed an antibiotic without an in- person examination faced disciplinary proceedings by the state medical board as well as had her board certification threatened. 4 She also had to defend herself before multiple state medical boards when those boards acted on the I daho Board's sanction. She was licensed in nine states. (State medical board sanctions from one state trigger reviews by every other state where a physician is licensed.) SUMMARY While taking locum tenens assignments, in and of itself, poses no special professional liability risks, such an endeavor does require planning and preparation—just as accepting any job does. Understanding and complying with federal, local, and facility requirements and providing good care and treatment are, as always, the best ways for psychiatrists who are taking locum tenens assignments to avoid potential professional liability risks as well as other problems. REFERENCES 1. Holzhauser v. State Medical Board of Ohio, 2007 WL 2773472 (Ohio App.) 2. Council on Psychiatric Services. Guidelines regarding psychiatrists' signatures. Am J Psychiatry. 146(10):1390. 3. Vanderpool D. Telemedicine—still so many unknowns. August 23, 2016. Linked In [website]. www.linkedin.com/pulse/telemedicine-still-so- many-unknowns-donna-vanderpool-mba-jd. Accessed February 2017. 4. Russell BZ. Doctor who prescribed antibiotic by phone could lose certification. April 27, 2014. The Spokesman-Review [website]. www.spokesman.com/stories/2014/apr/27/doctor -who-prescribed-antibiotic-by-phone-could/. Accessed February 2017. AUTHOR AFFILIATION Mr. Cash is Assistant Vice President of Risk Management at PRMS, Inc., Arlington, Virginia. ADDRESS FOR CORRESPONDENCE Donna Vanderpool, MBA, JD, Vice President, Professional Risk Management Services, Inc., 1401 Wilson Blvd., Suite 700, Arlington, VA 22209; E-mail: vanderpool@prms.com

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