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Example BOM Review

BEFORE THE MEDICAL BOARD OF CALIFORNIA

In the Matter of the Accusation Against:

NAME OF DOCTOR
Case No.


DECISION

As of [date]

As in every state, the Board of Medicine’s attorneys were the Attorney General of California, Supervising Deputy Attorney General, and Deputy Attorney General. This shows that the Board of Medicine is not a peer-lead governing body, but an extension of the State Judicial System.

The doctor was represented by [name of attorney]

He basically took a no contest choice, probably because of the cost and possible loss of license if decided not in his favor. But what he probably didn’t know is that a no contest at a medical board hearing is the same as pleading guilty.

CULPABILITY

  1. Respondent admits that he failed to keep adequate and accurate medical records, as more fully set forth in the Accusation, …and that he has thereby subjected his license to disciplinary action.

DISCIPLINARY ORDER

It is hereby ordered that Physician’s Certificate is revoked. However, the revocation is stayed and Respondent’s certificate is placed on 3 years probation on the following terms and conditions:

  1. Prescribing Practices Course. At respondent’s expense.
  2. Medical Record Keeping Course. At respondent’s expense.
  3. The Respondent shall notify hospitals where he has privilege and insurance companies of this decision.
  4. Respondent is prohibited from supervising physician assistants.
  5. Respondent shall obey all federal, state and local laws, all rules governing the practice of medicine in California and remain in full compliance with any court orders.
  6. Respondent shall submit quarterly declarations to board about compliance.
  7. Respondent’s place of residence, practice, license renewal, travel outside state shall be monitored and reported to Board if changed.
  8. Violation of Probation can result in loss of license.
  9. Respondent has to pay costs of probation monitoring.

JURISDICTION

This Accusation is brought before the Medical Board of California under the authority of the following laws.

  1. Section 2234 of the Code provides: “The Division of Medical Quality shall take action against any licensee who is charged with unprofessional conduct which includes:

b-c Various degrees of negligence.

  1. Section 2241.5 provides that a physician may prescribe for a person…dangerous drugs or prescription controlled substances for the treatment of pain.
  2. Section 2241.6 authorized the board to develop standards for review of cases concerning the management of a patient’s pain. The Guidelines for Prescribing Controlled Substances for pain include a history, appropriate examination, a treatment plan with objectives, informed consent, periodic review of the treatment, consultation where warranted and accurate and complete medical records.
  3. Section 2242 (a) provides:

“Prescribing dangerous drugs without an appropriate prior examination and a medical indication, constitutes unprofessional conduct.”

11.Section 2266 provides:

“The failure of a physician to maintain adequate and accurate records…constitutes unprofessional conduct.”

DRUGS

  1. The following dangerous drugs are relevant to the cause for disciplinary action:
  2. Oxycontin B. Percocet

FACTS

  1. August, 2003 Patient P.B, 60 y/o had a PE and medical history done. The board had no problem with the assessment or treatment. There was a break in treatment until 2006 as patient moved to Alaska. Then respondent took over again, examined patient Dec, 2005 and continued his regimen of Percocet. Prescriptions were continued Nov-Dec 2006 and Jan 2007 but there is no record of examination or billing for visit. June, 2007 does have a documented visit. The Board records that with changes in medication, there is no documented rational for the change. The Board basically nit-picks the respondent’s treatment and lack of documentation. The patient ends up being admitted to rehab by family for detox.

Based on this one patient and the respondent’s recordkeeping, the Board decided that the respondent was negligent and repeatedly negligent in his care and treatment of patient P.B. and failed to keep adequate records.

  1. Respondent’s billing ledger showed charges for multiple office visits for which there is no corresponding medical record.
  2. Responded prescribed for patient without documenting a treatment plan.
  3. Respondent failed to obtain or document informed consent to opioid therapy.
  4. Respondent failed to review the patient’s treatment at intervals.

My evaluation of these proceedings:

The doctor is young enough to know the importance of documentation from his medical training. But it would appear that he used a handwritten chart instead of a computer patient record. That makes it much more difficult to document all that is required. Decisions are made and acted upon with the internal understanding that all factors have been considered. But in today’s medicine, the absence of one little dot or crossed T can create a problem for the doctor. The action of the board to instruct the doctor on the appropriate recordkeeping and requiring him to have instruction in that is not a problem. However, the appearance of these “Prescribing Practices” for controlled drugs has become simply a way for the government to attack doctors criminally for actions that are not criminal.

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