Alabama Board of Medical Examiners and Medical …

1 Alabama State Board of Medical Examiners Newsletter and Report Volume 21, Number 1. Inside: Using mid-level Medical practitioners Prescription Drug in your Medical practice Monitoring Program The State of Alabama allows physi- provided is acceptable. Physicians found not to be cians to extend their practices by collab- A CRNP or PA who is hired by and in compliance with the Pre- orating with a Certified Registered Nurse paid by a clinical or corporate entity scription Drug Monitoring Program may incur a Practitioner (CRNP) or by having a may not perform clinical duties with- penalty. Physician Assistant (PA) registered to out the benefit of a collaborative page 2 them. These mid-level practitioners may agreement (CRNP) with a physician see patients for and with the physician in or being registered (PA) to a physi- Professionalism in the accordance with the cian.

2 The physi- applicable statutes and The physician has the responsibility cian's license is Practice of Medicine to ensure, inasmuch as possible, that What is professionalism rules. In Alabama , when vulnerable, even mid-level practitioners the quality of care administered by the if the physician and why must physicians examine and treat collaborating CRNP or PA registered does not hire or aspire to high standards of practice? patients, they do so to his license is equivalent to the care pay the mid- page 6 under the physician's that would have been given had the level practition- Medical license. Even physician performed the treatment er's salary. Ensuring Quality in the federally qualified rural personally. The rules for Collaborative Practice health facilities and clinics must adhere collaborating with a CRNP are some- A CME course is available to these rules.

3 Agencies such as the what different from those for a PA. in 2006 to teach the Veteran's Administration, Public Health, registration. Physicians should care- responsibilities of and Acute Care Hospitals and Licensed fully study the specific rules for each resources for physicians Skilled Facilities have specific and limit- mid-level practitioner category and and nurse practitioners in a collaborative practice ed exceptions. The physician has the review them periodically to verify agreement. responsibility to ensure, inasmuch as that they, as well as the CRNP or PA, page 8 possible, that the quality of care adminis- are in compliance. New laws and tered by the collaborating CRNP or PA rules are posted at the Board 's web- Public Action Reports registered to his license is equivalent to site in addition to articles published of the Medical Licen- the care that would have been given had in the Board 's newsletter.

4 The physician performed the treatment The rules and requirements for a sure Commission and personally. covering physician are different Board of Medical Because the physician's license is from those for a collaborating Examiners directly affected by the actions of the physician or those for a physician Public Actions for the time period November 2005. CRNP or PA, the physician should who has a PA registered to them. always be comfortable with and The physician who collaborates with through January 2006. page 9 knowledgeable of the capabilities of a CRNP or who registers a PA must the mid-level practitioner. have a current, unrestricted license to Physicians must continually monitor practice medicine in the state of Upcoming CME. Opportunities the practice patterns of the CRNP or Alabama .

5 If the physician is certified Make a note of these PA and the specific care and treat- by or eligible for Board certification opportunities to earn CME. ment that they give to ensure that the by a specialty Board approved by the page 12 quality and standard of care that is (continued on page 3). Alabama BME Newsletter and Report Alabama A Message from the Executive Director Board of Medical Prescription Drug Monitoring Examiners Program Board Rules Craig H. Christopher, MD, by Larry Dixon Chairman At its Feb. 15, 2006, meeting, the Alabama Birmingham Board of Medical Examiners approved an emer- Jorge Alsip, MD, Vice Chairman gency rule requiring Dispensing Physicians* to Mobile report to the Prescription Drug Monitoring Program established by law and administered by Kenneth Aldridge, MD the Alabama Department of Public Health all dis- Tuscaloosa pensed controlled substances, Schedules II-V, in James G.

6 Chambers, III, MD the manner and within the time frame required Huntsville by state law and the Health Department's rules. All Dispensing Physicians have been required Edward C. Facundus, MD for some time to register with the Alabama Board Huntsville of Medical Examiners ; however, there has never Larry Dixon Richard M. Freeman, MD been a penalty provision for failure to do so. The Auburn state law establishing the Controlled Substances Prescription Database requires each licensing agency to ensure that its licensees provide the infor- Steven P. Furr, MD mation required by the Prescription Drug Monitoring Program. The Alabama Jackson Board of Medical Examiners has determined that the only way to assure com- Allan Goldstein, MD pliance is to have a penalty provision for physicians who are found not to be Birmingham in compliance.

7 Therefore, the emer- gency rule approved at the Feb. 15, David P. Herrick, MD. Montgomery The state law 2006, Board meeting authorizes the Board to assess administrative Alcus Ray Hudson, MD establishing the fines, up to $10,000 per violation, Jasper against any physician who acts as a Controlled Substances dispensing physician, but who has Juan Johnson, MD. Birmingham Prescription Database not registered as such with the Board and against any physician Ross Bob Mullins, Jr., MD requires each licensing who does not report to the Valley Controlled Substances Prescription agency to ensure that Database as required by state law. Marsha D. Raulerson, MD. Brewton its licensees provide Through a mailing to every physician in Alabama holding an George C.

8 Smith, Jr., MD the information Alabama Controlled Substances Ashville Certificate and articles at the required by the Board 's web site and in this Pamela D. Varner, MD. Birmingham Prescription Drug newsletter, the Board has defined the meaning of Dispensing Monitoring Program. Physician and informed licensed Larry Dixon, Executive Director physicians of the importance of registering with the Board as dis- Patricia Shaner, General Counsel pensing physicians, if applicable, and of complying with the laws governing the Controlled Substances Prescription Database. [For more information con- cerning dispensing Physicians, see the Newsletter Links section of ]. *A Dispensing Physician is one who distributes to a patient any controlled substance, except pre-packaged samples or starter packs, which have been purchased by the physician.

9 2 Issue 1 2006. Alabama BME Newsletter and Report When the collaborative practice with a CRNP or the Using mid-level Medical practitioners in registered practice with a PA is terminated for any your Medical practice reason, the Board of Nursing must be notified continued from page 1 promptly about the CRNP and the Board of Medical American Medical Association or the American Examiners about the PA and physician. Osteopathic Association, the physician must have practiced medicine for at least one year to be eligi- Below are summaries of the requirements for collabo- ble for collaboration or registration. ration with a CRNP or registration with a PA. If the physician is not Board certified or eligible for certification, the requirement is at least three years Certified Registered Nurse Practitioners of active Medical practice.

10 The Board of Nursing of the State of Alabama (ABN). Because a Retired Senior Volunteer Program licenses and oversees the activities of nurses in the state. (RSVP) license is a restricted license, an RSVP Registered Nurses who have taken additional training physician may not serve as a collabo- and a certification exami- rating physician for a CRNP or in a nation may perform exam- registration with a PA. A retired physi- inations and treatments cian may serve as a covering physician A Certified beyond those permitted by for either type of mid-level practitioner Registered Nurses. To if she/he is registered with the Board . Registered Nurse function in this manner, Each covering physician for a mid- the CRNP must collabo- level practitioner must be listed indi- Practitioner or a rate with a physician.