Innovations In Clinical Neuroscience

JAN-FEB 2017

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

Issue link:

Contents of this Issue


Page 60 of 63

[ 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 ] Innovations in CLINICAL NEUROSCIENCE 61 R I S K M A N A G E M E N T s hould confirm directly with appropriate licensing bodies whether a particular license will be required for the assignment. Obviously, this includes a license to practice medicine if you accept an out-of-state assignment. As one physician found out, relying solely on an employer to determine legal requirements can be a costly mistake. An Ohio physician permanently lost her medical license for issuing prescriptions to patients without an in-person examination. She had been assured by her employer's CEO that the manner of prescribing was legal. Additionally, an attorney for a national telemedicine organization assured her that the manner of prescribing was proper and legal. When the Ohio appellate court upheld the medical board's revocation of her license, the court noted that she "did not consult with any other attorney, nor did she contact anyone with the board to determine whether prescribing medications over the internet was permissible in Ohio." 1 2. Comply with United States Drug Enforcement Agency (DEA) and state registration. Federal DEA registration is required in each state where controlled substances are prescribed. (Federal DEA registration covers multiple prescribing locations within one state, but it does not cover multiple states.) Additionally, states can require their own registration for controlled substance as well as for legend drugs. Under the federal Controlled Substances Act, no controlled substance may be prescribed without at least one in-person evaluation of the patient. Many states adopt this in-person evaluation requirement for legend drugs. 3. Understand each facility's definition of "close observation." A remarkable number of claims and lawsuits against psychiatrists following inpatient suicides involve psychiatrists working at more than one facility and c onfusing levels of observation. For example, "Level 1" at one facility may call for constant observation while at another facility "Level 1" means 15- minute checks. When the psychiatrist confuses his or her facility with another facility's observation levels, patients may inadvertently be given window of opportunity in which to hurt themselves. 4. Know what your signature means. Psychiatrists often are asked to sign various forms related to patient services whether the psychiatrist performed the services or not. A psychiatrist's signature may be needed on insurance forms to attest that the patient received the billed-for treatment or on treatment plans to signify that a psychiatrist has reviewed the plan and agrees with it. A psychiatrist should review the wording of the form he or she is signing. If there is no wording to indicate what the psychiatrist's signature means, the psychiatrist should annotate his or her signature so that the services that are actually rendered are clear. 2 A psychiatrist's signature for peer review or quality assurance purposes, for example, should include an annotation describing what was reviewed. Signing forms without annotating the signature could be used to infer that the psychiatrist provided services he or she did not provide. An unannotated signature can be proffered to mean anything anyone—including plaintiff attorneys—wants it to mean. 5. Comply with states' and facilities' requirements. In addition to requiring their own controlled substance registration, states can impose other requirements on licensees or registrants. If a locum tenens assignment means practicing in another state (in-person or via telemedicine), psychiatrists may be required to register with that state's prescription monitoring program, obtain continuing medical education credits, prescribe electronically, or other r equirements. Some states require checking that state's prescription monitoring program before issuing a prescription for a controlled substance. (Even if checking the prescription monitoring program database is not required before prescribing, the risk management advice is to check the database anyway. It's a valuable safety tool.) Facilities also may require privileging or credentialing prior to working there. 6. Clarify your responsibilities. The locum tenens company should clarify psychiatrists' responsibilities before arrival at assignments. Vague terms, such as "psychiatric services," should be fleshed out. Will psychiatrists be expected to see patients outside of their subspecialty? What on-call responsibilities come with the assignment? 7. Make sure medical malpractice coverage is in place. Locum tenens companies typically provide medical malpractice insurance coverage for psychiatrists. Psychiatrists should obtain proof of coverage. Psychiatrists should also clarify whether coverage includes all incidents and activities or is limited to the assignment location. 8. Understand the statutory and regulatory requirements for supervision. Locum tenens assignments sometimes include supervisory duties for nurse practitioners and/or other providers. The scope of the nurse practitioner's or other provider's practice, including any prescribing authority, is defined by each state, either by the legislature and/or nursing or other licensing board regulations. States vary in the extent to which a nurse or other provider's practice is regulated and in the degree of supervision required. Additionally, the specific activities that

Articles in this issue

Archives of this issue

view archives of Innovations In Clinical Neuroscience - JAN-FEB 2017