On March 12, 2018, Jonathan Reisman wrote an article for the Chicago Tribune called ‘Judgment calls: Who really needs a pain killer?’ Dr. Reisman is an emergency room physician at Schuylkill Medical Center in Pottsville, Pensilvania. Dr. Reisman explains how the presence of drug seekers has negatively impacted many physician’s practice.
Opioids have become quite the ‘hot’ topic in today’s society . When used properly they are a powerful blessing but when not properly used, they have an incredibly destructive potential. A popular question amongst doctors is whether or not to prescribe opioids. Patients have a tendency to exaggerate pain in order to receive painkillers. Some of the patients seek a buzz while others are trying to find a fix for opioid withdrawal, which is an painful and unpleasant condition. Due to this strong presence of drug-seekers, physicians have found prescribing opioids an incredibly difficult decision to make. This epidemic is spreading rapidly and tainting the way physician’s think and it is beginning to cast doubt over clinical instincts. Physicians enabled this epidemic and are now tasked with its salvation.
The Federal Drug Enforcement Administration brings physicians a great responsibility and minimal insight on discerning diseases from ‘drug-seekers’. The misuse of opioids is nuclear and brings about death and destruction. But, when used properly they have an unbridled power that almost immediately relieves patients of antagonizing pain. Opioids are a double edged sword that are extremely concerning and hard to ignore. Doctors are being faced with under treating pain or feeding an addictions; being pulled in opposite directions by a patient’s pain and a national crisis. In the 1990’s there was a horrifying under treatment of pain that angered the public. Physician’s have the power to alleviate pain but are withholding from it. In order to not re-live the past, a physician’s decision to prescribe or administer opioids tends to be influenced by this phenomenon that occurred in the 90’s. So, now what? Patient pain is a daily conundrum and the decision on whether or not to prescribe opioids has become an emotional tug for physicians.
The Medical Disciplinary Board’s purpose is to consider allegations of misconduct or malfeasance by members of the medical professions and to recommend appropriate discipline to the Secretary. The Board receives complaints through the investigative process, and through citizens who inform the Department of potential violations. The Board is composed of eleven members appointed by the Governor, seven of whom are physicians with representatives of the osteopathic and chiropractic branches included, and four of whom are members of the public. These are the Board Members listed as of January 30, 2018.
Sarita M. Massey M.D. | Chicago
Richard R. Fay D.C. | Wheaton
Ronald L. Johnson M.D. | Pittsfield
Grace Allen Newton JD, Public Member | Chicago
Frank J. Nicolosi M.D., J.D. | Rockford
Karen O’Mara D.O. | Chicago
Joseph W. Szokol J.D., M.D., MBA | Winnetka
Kenneth L. Schiffman M.D. | Oak Park
Henry C. Krasnow J.D., Public Member | Chicago
Garrick J. Hodge J.D., M.B.A., Public Member | Wadsworth
As set forth in the Illinois Medical Practice Act (“Act”), physicians are required to complete a report for the following: a. Adverse final action taken against you by any of the following:
another licensing jurisdiction (any other state or any territory of the United States or any foreign state or country),
peer review body,
health care institution,
professional society or association related to practice under the Act,
law enforcement agency,
court for acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act, or
state or federal agency that restricts or prohibits you from providing services to the agency’s participants.
Surrender of a license or authorization to practice as a medical doctor, a doctor of osteopathy, a doctor of osteopathic medicine, or doctor of chiropractic in another state or jurisdiction, or surrender of membership on any medical staff or in any medical or professional association or society, while under disciplinary investigation by any of those authorities or bodies, for acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act; or b. c.
2. Email complete signed forms to FPR.MedicalAdverse@Illinois.gov within 60 days. Adverse judgment, settlement, or award arising from a liability claim related to acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act.
The following is required:
Physician Name: Physician License No.: Physician Email: Physician Phone No.: Physician Address: (City, State, Zip Code) check if address changed PHYSICIAN ADVERSE ACTION INFORMATION Date of Occurrence: Description: Please use additional pages if needed and attach all relevant documentation (including, but not limited to a copy of an adverse final action taken against you).
Effective January 1, 2017, previously barred health care workers and first time applicants may become eligible for a license. Under the Department’s new process, a health care worker who was permanently revoked or denied due to a forcible felony may file a Petition for Review, which is currently available on the Department’s website. The review process does not apply to a forcible felony requiring registration under the Sex Offender Registration Act, involuntary sexual servitude of a minor, or a criminal battery against any patient in the course of patient care or treatment that is a forcible felony. Information about applying for licensure are available on the Department’s website.
The General Assembly recently passed legislation that will require all controlled substance license holders to register in Illinois Prescription Monitoring Program (PMP) by January 1, 2018.
The new law awaits the Governor’s signature but efforts to delay the start date of January 1 have not been successful. While the law does have an exception for emergency department prescribing, there is no exception for PMP registration (see details below).
ICEP urges all members, including residents, to begin the process for PMP registration now.
If you are licensed in the state of Illinois to prescribe controlled substances and are not already registered with the PMP, visit http://www.ilpmp.org to initiate your registration. If you experience programs registering, contact PMP at 217-524-1311, or via email to email@example.com.
Beginning January 1, the expected law will require prescribers to access patient information in the PMP before writing an initial prescription for a Schedule II narcotic, such as an opioid.
Exception for Emergency Department Prescribers
The requirement for documented access to PMP before prescribing a Schedule II narcotic is waived for EDs under the following circumstances:
7-day or less supply provided by a hospital emergency department when treating an acute, traumatic medical condition
ICEP will provide updates about the new law’s requirements as more information becomes available. At this time, penalties for noncompliance have not been announced.
Every Hospital in Arizona has medical staff bylaws, which are created and amended by the medical staff. The Medical Executive Committee (“MEC”) is the governing body of a Hospital’s medical staff. Arizona Law considers that medical staff bylaws to be a contract, and the disciplinary procedures in the bylaws must be followed if the medical staff (through the MEC) or the Hospital (though the Governing Board) wants to limit a doctors medical staff privileges. Doctors whose medical staff privileges are disciplined for more than 30 days, or doctors that leave in the middle of an investigation of their privileges to avoid discipline must be reported to the National Practitioner Data Bank. Therefore, doctors must demand that the medical staff bylaws (along with state and federal law) are adhered to.
The Illinois Department of Financial and Professional Regulation has recently been disciplining Illinois Nurses for issues related to the practice of Home Health Care. Many Nursing Agencies, that place nurses, have been auditing nursing records to verify that nurses are staying for as long as they say there are. Some Home Health Patients are even being interviewed. The Department also disciplines nurses for exceeding the scope of their licenses. Some nurses will change doctor’s orders, or even give care without consulting a doctor. Even though nurses can be overworked, they must check in with the medical director in charge of the patient before altering medical care to a Home Health patient.