opsc 2015 annual convention syllabus · opsc’ 54 a onven a p a 42 wednesday 4 2015: 4:00pm -...
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2015 OPSC Annual Convention
syllabus
February 4-8, 2015 Hyatt Regency Mission BaySan Diego, California
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm
Professionalism: The Relationship with State Medical Boards and Their Disciplinary FunctionPresented by Joseph Zammuto, DO
OPSC’s 54th Annual Convention and Exposition Syllabus 35
PRESENTATIONLearning Objectives andSelf ASSESSMENT questions
LEARNING OBJECTIVES SELF ASSESSMENT QUESTIONS1. Describe the composition and responsibility of the board
2. Describe the licensing and disciplinary process
3. Identify ways to avoid attention from the board
4. Provide resources for additional information on future changes
1. What is the OMBC composition? a. 10 DOs and 10 Public b. 4 DOs and 2 Public c. 5 DOs and 4 Public
2. How was the OMBC established? a. Statute b. Lottery c. Initiative
3. What year was the OMBC established? a. 1921 b. 1922 c. 1923
4. Who does the OMBC protect? a. Nurses b. Doctors c. Patients
5. Which is not a Physician Competency? a. Patient Care b. Medical Knowledge c. Practice-based learning and improvement d. Interpersonal and communication skills e. Professionalism f. Systems-based practice g. ICD-10
6. Which is not unprofessional conduct? a. Professional misconduct b. Substandard care c. Inappropriate prescribing
d. False advertising e. Discharging a patient from your practice
7. What is the greatest source of complaints? a. Anonymous b. Family member c. Patient d. Malpractice e. Other
OPSC’s 54th Annual Convention and Exposition Syllabus 36
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Professionalism: The relationship with state medical boards and
their disciplinary function
The Osteopathic Medical Board of California
Current and New activities for the Future.
OPSC’s 54th Annual Convention and Exposition Syllabus 37
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Goals/Objectives
• Describe composition and responsibility of the board
• Describe the licensing and disciplinary processes
• Identify ways to avoid attention from the board
• Provide resources for additional information
OPSC’s 54th Annual Convention and Exposition Syllabus 38
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
• Board composition– Nine members– Three Year Length of term– OSTEOPATHIC PHYSICIANS regulated by
the board– FIVE Physicians/FOUR Public members– Gubernatorial appointment
OPSC’s 54th Annual Convention and Exposition Syllabus 39
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
• The Board was not established by statute, rather by an Initiative Act.
• Established by Osteopathic Initiative Act of 1922
• * Amended by the State electorate in 1962• Mission of the board is to protect the
public.• Duties & responsibilities of the board
OPSC’s 54th Annual Convention and Exposition Syllabus 40
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Teaching on medical licensure and regulation
Source: 2007 LCME Annual Medical School Questionnaire
126 LCME-accredited medical schools
Number of US Medical Schools Teaching on Medical licensure/regulation
Included in required course Included in elective course
70 19
Good News: 71% of medical schools report teaching on the topic of medical licensure and regulation
OPSC’s 54th Annual Convention and Exposition Syllabus 41
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Teaching on medical licensure and regulation
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 11; 12,512 respondents
Do you believe that the time devoted to your instruction in the following area was inadequate, appropriate or excessive?
Medical licensure/regulation
Inadequate Appropriate Excessive
61.4% 38.3% 0.3%
Bad News: Most medical students feel inadequately informed on issues relative to medical licensure and regulation
OPSC’s 54th Annual Convention and Exposition Syllabus 42
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Licensure Evaluate applicants’ fitness to practice
— Medical education and training— Examination of cognitive and clinical skills necessary for the independent
practice of medicine— Character— Prior disciplinary action
Regulation Establish standards for physician licensure and practice
Discipline Take appropriate action against individual physicians’ licenses for
unprofessional, incompetent or unlawful practice of medicine
State Medical Boardsa triad of functions for public protection
OPSC’s 54th Annual Convention and Exposition Syllabus 43
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Professionalism
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 16: Indicate whether you agree or disagree with the following statement about your preparedness for beginning a residency training program; 12,524 respondents
“I understand the ethical and professional values that are expected of the profession.”
Strongly Agree Agree No Opinion Disagree Strongly Disagree 56.2% 41.1% 2.4% 0.2% 0.1%
Graduating medical students are confident in their understanding of the tenets of the medical profession
OPSC’s 54th Annual Convention and Exposition Syllabus 44
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Physician Competencies(Source: ACGME/ABMS)
1. Patient Care2. Medical Knowledge3. Practice-based learning and improvement4. Interpersonal and communication skills5. Professionalism6. System-based practice
OPSC’s 54th Annual Convention and Exposition Syllabus 45
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Definitions
• Medical practice (defined)• Unprofessional conduct (defined)
– Professional misconduct– Substandard care– Inappropriate prescribing– False advertising– Etc.
OPSC’s 54th Annual Convention and Exposition Syllabus 46
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Statistical Data
• Licensees: 15,000• Number of complaints: 700• 4.6%
OPSC’s 54th Annual Convention and Exposition Syllabus 47
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Disciplinary Process
Complaint
Investigate CloseContinue Investigation
Warning
Resolve by ConsentSummary Suspension
Investigation Committee
Consent Parameters
Decision
Hearing
Optional Appeal: Administrative Review Board
OPSC’s 54th Annual Convention and Exposition Syllabus 48
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Disciplinary Process
Complaint received
Investigation/review
Dismissal Charges filed/Formal complaint process
Dismissal Board action
OPSC’s 54th Annual Convention and Exposition Syllabus 49
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Complaint Process
• Outline of the Board’s complaint process
OPSC’s 54th Annual Convention and Exposition Syllabus 50
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
History of Complaints
10000
12000
14000
16000
18000
20000
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
0
100
200
300
400
500
600
700
800
900
1000
Licensees
Complaints
OPSC’s 54th Annual Convention and Exposition Syllabus 51
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Sources of Complaints
24, 3%108, 13%
339, 41%101, 12%
257, 31% AnonymousFamily MemberPatientMalpracticeOther
OPSC’s 54th Annual Convention and Exposition Syllabus 52
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Complaint categories
Other jurisdiction 39 1.8%Incomp. / Unethical 706 33.3Unprofessional 700 33.0Illness 56 2.6Non-jurisdictional 20 0.9Medical records 99 5.0Addiction 34 1.6Prescribing 287 13.5Sexual misconduct 35 1 6
OPSC’s 54th Annual Convention and Exposition Syllabus 53
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Case Studies
OPSC’s 54th Annual Convention and Exposition Syllabus 54
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Impaired Physicians Program (IPP)
• Contracted Vendor: Maximus, Inc.(800) 522 9198 Phone• Osteopathic Medical Board, Diversion
Evaluation Committee(3) three licensed D.O.’s
• California Code of Regulation; Title 16, Division 16, Article 12.5, Sections 1660,1660.2,1660.4,,1661,1661.2,1661.4,1662
OPSC’s 54th Annual Convention and Exposition Syllabus 55
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Medical board goal
“Rehabilitate, when possible, persons who are impaired or who practice medicine unethically or below minimal standards of care, and prohibit persons who have not been rehabilitated from practicing medicine.”
Source: State Medical Board of Ohio
OPSC’s 54th Annual Convention and Exposition Syllabus 56
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
0
5
10
15
20
25
30
35
40
45
50
2002 2003 2004 2005 2006 2007
Impairment Actions
Impairment Action
OPSC’s 54th Annual Convention and Exposition Syllabus 57
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
0
5
10
15
20
25
30
35
Negligence /IncompetenceFraud
Impairment
Other
InappropriateprescribingSexual misconduct
Records
Violation of P/O
Final Disciplinary Actions by Type of Misconduct in 2007
Source: State medical board of ___.
As
% o
f all
final
dis
cipl
inar
y ac
tions
OPSC’s 54th Annual Convention and Exposition Syllabus 58
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Compliance Monitoring
• Over 40 licensees currently monitored by the Board (On Probation)
• Currently 16 Participants in Diversion program. Primarily impairment cases
• Usually monitored for a minimum of 5 years for diversion participants.
OPSC’s 54th Annual Convention and Exposition Syllabus 59
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Reporting Requirements
• Reference Business and Professions Code 800 for Reporting Requirements.
• http://leginfo.legislature.ca.gov/faces/codesdisplayText.xhtml?lawCode=BPC&division=2.&title=&part=&chapter=1.&article=11.
OPSC’s 54th Annual Convention and Exposition Syllabus 60
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Serious Misconduct
• Negligence/Incompetence• Impairment• Sexual abuse• Fraud• Inappropriate prescribing
OPSC’s 54th Annual Convention and Exposition Syllabus 61
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
The Investigation
• Medical Records– Medical Coordinator review
• Interview• Background Checks• Expert Opinions• Closed• Investigation Committee
OPSC’s 54th Annual Convention and Exposition Syllabus 62
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Investigation Committee
Possible recommendations1. Closure2. Further investigation3. Administrative warning4. Impairment review5. Hearing6. Summary suspensionConsent Parameters
OPSC’s 54th Annual Convention and Exposition Syllabus 63
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Board Hearings• Hearing committee of 9• Administrative law judge• Court reporter• Attorneys• Parties• Witnesses/evidence
• Not bound by strict evidentiary rules
• Standard of proof:– Identify preponderance, clear
and convincing or other
ACTORS
PROCESS
OPSC’s 54th Annual Convention and Exposition Syllabus 64
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Board Decisions
• Censure and reprimand• Suspension (actual/stayed)• Probation (monitoring)• Limitation of license• Revocation• Monetary fine• Education/Training • Community Services• Dismissal
OPSC’s 54th Annual Convention and Exposition Syllabus 65
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Administrative Review Board
• Established by…• Review board composition Board has
medical Consultant who reviews complaints. If further review necessary, case sent to specialty expert.
• Expert Reviewers under contract with Board.
• Process: Refer to Osteopathic Medical Board’s Complaint Process.
OPSC’s 54th Annual Convention and Exposition Syllabus 66
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Physician Participation
• Board chair, board staff (if applicable)• Board members• Adjudicatory committees• Medical coordinators• Expert consultants• Administrative warning• Physician monitoring/supervision
OPSC’s 54th Annual Convention and Exposition Syllabus 67
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Specialties at Risk
• Internal Medicine• Family / General Practice• Psychiatry• OB / GYN
Source: ___ board. Based upon disciplinary sanctions taken for sexual violations, 1997-2007
OPSC’s 54th Annual Convention and Exposition Syllabus 68
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Communications
Graduating medical students are confident in their ability to communicate effectively
Source: 2007 AAMC Medical School Graduation Questionnaire
Question# 16: Indicate the degree of preparedness for entering a residency training program. 12,527 respondents
“I have the communication skills necessary to interact with patients and health professionals.”
Strongly Agree Agree No Opinion Disagree Strongly Disagree
60.6% 36.6% 2.3% 0.3% 0.1%
OPSC’s 54th Annual Convention and Exposition Syllabus 69
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
National Data: Board Actions by Type, 1991-2006
336 39
9 626
584
584
611 73
975
373
166
764
7 706
640 76
379
170
9
3767
3838
3944
4015 41
69 4590
5502
5344
4867
280
4 2
971
308
1 3
571
381
3 3
821
372
8
0
1000
2000
3000
4000
5000
6000
7000
1991
: 3,14
0
1992
: 3,37
0
1993
: 3,70
7
1994
: 4,15
5
1995
: 4,39
7
1996
: 4,43
2
1997
: 4,46
7
1998
: 4,52
0
1999
: 4,56
9
2000
: 4,61
1
2001
: 4,66
2
2002
: 487
5
2003
: 523
0
2004
: 626
5
2005
: 613
5
2006
: 557
6
Non-Prejudicial Prejudicial
Total Actions
Source: Federation of State Medical Boards
OPSC’s 54th Annual Convention and Exposition Syllabus 70
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
1024.7974.2
929.1
697.5
514.1
316.4236.1
25
125
225
325
425
525
625
725
825
925
1025
Unprofessional Conduct NegligenceSubstance Abuse Controlled Substance ViolationsFraud Sexual MisconductFailure to Maintain Adequate Medical Records
National Data: Basis for Board Actions against Physicians, 1997-2006
Neg
ligen
ce
Unp
rofe
ssio
nal C
ondu
ct
Subs
tanc
e Abu
se
Con
trol
led
Subs
tanc
e V
iola
tions
Frau
d
Sexu
al
Mis
cond
uct
Failu
re to
Mai
ntai
n A
dequ
ate
med
ical
Rec
ords
Source: Federation of State Medical Boards
OPSC’s 54th Annual Convention and Exposition Syllabus 71
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
How Often Do Physicians Get Disciplined by State Licensing Boards?
~750,000 licensed physicians in the U.S.
2,250 physicians disciplined annually (0.3%) – over a ten year period
OPSC’s 54th Annual Convention and Exposition Syllabus 72
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Grounds for Discipline
Grounds for action, including…• Standard of care violations• Inappropriate prescribing• Breaching professional ethics
Source: Identify relevant statute/code
OPSC’s 54th Annual Convention and Exposition Syllabus 73
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
Source: Teherani A, Hodgson C, Banach M, Papadakis M. “Domains of Unprofessional Behavior During Medical School Associated with Future Disciplinary Action by a State Medical Board.” Academic Medicine 2005; 80(10):S17-S20
Behavioral domains associated with subsequent discipline by a state medical broad
• Poor reliability and responsibility
• Lack of self-improvement and adaptability
• Poor initiative and motivation
OPSC’s 54th Annual Convention and Exposition Syllabus 74
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
For further information
• Board website: www.ombc.ca.gov• Board phone numbers:
phone 916 928 8390; fax 916 928 8392• Email contact: [email protected]• Board’s physical address: 1300 National Drive, Suite 150 Sacramento, CA 95834-1991
OPSC’s 54th Annual Convention and Exposition Syllabus 75
WEDNESDAY, FEBRUARY 4, 2015: 4:00pm - 5:00pm ................ Professionalism: The Relationship with State Medical Boards and Their Disciplinary Function | Presented by Joseph Zammuto, DO
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