Licensing of Professionals Flashcards
State Licensing Laws
-Regulate entry into the profession & license renewal
-Regulate the services clinicians provide
-Prohibit provision of services for which clinicians aren’t licensed
-Provide for monitoring & discipline procedures
In Re Williams (Ohio Sup. Court)
Facts:
-Dr. Williams prescribed stimulants for weight loss before
they were prohibited in 1986.
-Later charged with prescribing them w/o “reasonable care” b/c majority view was against their use
-Deference to administrative agencies
-But OH S.Ct. determined board’s decision not supported by:
- Reliable,
- Probative &
- substantial evidence,
and they were not in accord w/ law.
-There was a differing majority and minority view in the medical community of when/how long to prescribe these stimulant drugs. Williams in minority, while majority disfavored the way Williams prescribed the stimulant meds
Issue:
- Is the state’s medical board required to present expert testimony in each misconduct hearing brought against a physician?
- Does the state medical board have authority to dismiss presented expert evidence that opposes its own majority views?
Holding:
-No, and no.
Hoover v. The Agency for Healthcare Administration (Florida)
Facts:
-Dr. Hoover treated chronic pain with opioids
-Regulating agency accuses H of violating FL law re: controlled substances
-Agency offered two experts (physicians) to testify that Hoover had prescribed possible lethal amounts of narcotics and had practiced below the standard of care.
-Neither had chronic pain expertise nor had examined any of Hoover’s patients or reviewed their medical records.
-The hearing officer found that the Agency had failed to meet its burden of proof on all charges relating to Hoover’s patients.
-Officer also noted in her findings that the only available federal guidelines relevant in this situation dealt with physicians using controlled substances to treat pain in cancer patients.
Issue:
May the Board of Medicine deny giving substantial weight to valid findings of the hearing officer charged with evaluating evidence and gauging the credibility of the witnesses’ testimony in an administrative hearing against a physician?
Holding:
-Nope. Board placed too much weight on the expert testimony.
-Hearing officer heard the testimony, evaluated the credibility of all witnesses and made a determination.
-Reasonable to give more weight to Hoover’s testimony than to Agency’s witnesses; they’d never examined Hoover’s patients nor were involved in chronic pain care and treatment.
“Chilling effect”
-Disciplinary actions by a state medical board against individual physicians have an effect on other physician’s practices
-Threat of legal action seems to lead doctors to avoid legitimate and effective treatments.
-Physician discipline by state licensing agencies usually addresses problems of character, not competence
Interstate Medical Licensure Compact
-Addresses issues brought up by critics of state by state licensing, and who say there should be a federal medical license
-However, because states usually regulate the practice of medicine, a fed licensing system less likely to be developed
-IMLC created a model interstate agreement (uniform system of state reciprocity)
National Practitioner Data Bank (NPDB)
-Partly created to help prevent doctors with disciplinary history in one state from moving to another and practicing until detected
-State licensing/disciplinary boards and hospitals required to report to this
Complementary and Alternative Medicine (CAM)
-medical products and practices that are not part of standard medical care
Complementary: used w/ standard therapy
Alternative: used instead of standard therapy
Homeopathy – uses natural substances (e.g. plants &
minerals)
Allopathic medicine: modern, mainstream medicine
In Re: Guess (North Carolina Sup. Court)
Facts:
-Board charged Dr. Guess w/ unprofessional conduct b/c he practiced
homeopathy
Issue:
May a medical board revoke a physician’s license for failure to conform to acceptable medical practice, even if there is no evidence of actual harm to patients?
Holding:
-Yes. A medical board may revoke a physician’s license for failure to conform to acceptable medical practice, even if there is no evidence of actual harm to patients.
-There was nothing arbitrary or capricious about the board’s decision.
-The fact that homeopathy is accepted elsewhere is irrelevant to the decisions of this state’s medical board
-S.Ct. reverses Ct. App
-NC later revises statute. Standard: safety risk > prevailing treatment or CAM ineffective
State Board of Nursing and State Board of Healing Arts v. Ruebke (Kansas Sup. Court)
Facts:
-Michelle Ruebke is practicing lay midwife
-In 1993, the State Board of Healing Arts (SBHA) (plaintiff) published a policy stating midwifery was practice of medicine, and would be classified as unlicensed practice of medicine and surgery
-Ruebke worked with supervising physicians; they gave consultation/assistance
-Ruebke never held herself out to be anything other than lay midwife
Issue:
-Statute does not cover midwives
-Pregnancy and childbirth are not diseases or abnormal conditions.
-Statute is not unconstitutionally vague
-A midwife is not free to engage in any activity whatsoever relating to pregnancy. There are boundaries.
Sermchief v. Gonzales (Missouri Sup. Court)
Facts:
-2 nurses & 5 drs. Want ct. to declare that
nurses’ practices are authorized under MO law.
-No allegation of harm
-Evolving role of nursing professionals
-
Advanced nurse practitioners (ANP)
Nurse midwives, nurse anesthetists, & others with specialized skills.
Physician assistants/associates (PA)
Physician delegates. Supervised by doctor.
