House Bill 487 is 1788 pages long. Its intended purpose is to “make operating and other appropriations and to provide authorization and conditions for the operation of state programs.” But there are a number of provisions that address somewhat different issues. As we continue to work through the Bill, we will provide additional client bulletins as appropriate. Today, however, we wanted to point out some major changes that will take effect on September 9, 2012.
Treatment of Chronic Pain
Ohio Revised Code (R.C.) §§4723.481 (advance practice nurses) and 4730.42 (physician assistants) now contain language specifically providing that a collaborating agreement and/or supervisory agreement may not permit the APN/PA’s authority to exceed that of the physician “including the physician’s authority to treat chronic pain with controlled substances and products containing tramadol.”
R.C. §4731.052 authorizes the Ohio State Medical Board (“OSMB”) to adopt rules and establish standards and procedures related to treatment for chronic pain. In addition, the following requirements have been added to existing provisions related to prescriptions of controlled substances or products containing tramadol for treatment of chronic pain i.e., a physician is:
- Required to obtain and review all available medical records or detailed written summaries of the patient’s treatment for chronic pain or the condition causing the pain.
- Encouraged to consult with a specialist.
Required to maintain a written record on the patient which documents: a.
- That other treatment modalities have been offered or attempted without success.
- Periodic assessment and documentation of the patient’s functional status; progress toward treatment objectives, and indicators of possible addiction, drug abuse, or diversion.
- Any adverse drug effects.
- Required to take into account the potential for abuse, dependency, diversion.
- Required to address with the patient the risks associated with protracted treatment.
This is clearly a very important issue to OSMB. Health care entities and physicians need to look at their current policies and procedures to see if the issue of chronic pain has been addressed in a manner that is compliant with the new requirements. If not, appropriate policies should be established.
Certificates of Conceded Eminence
A new Ohio Revised Code §4731.297 has been enacted that authorizes OSMB to issue a “certificate of conceded eminence” to international medical graduates who hold a medical degree from an educational instituted listed in the international medical education directory provided the individual meets a number of other very specific requirements. The certificate is available to an individual who has either (a) been appointed to serve as a full-time faculty member of a medical school; or (b) the individual has accepted an offer of employment with an academic medical center or affiliated physician group practice. If the individual will be with an academic medical center, the individual must also receive medical staff appointment and/or clinical privileges pursuant to the medical staff governing documents. The certificate is for a period of two (2) years (or duration of employment, whichever is shorter). The certificate may be renewed for additional two (2) year periods without limitation. Accordingly, if an academic medical center is interested in this type of individual, the center needs to check its medical staff governing documents to determine what changes need to be made to accommodate this type of practitioner.
Please note that this certificate is separate and distinct from a visiting medical faculty certificate (R.C. §4731.293) which requires a current unrestricted license to practice medicine in another state or country and which is only valid for a period of three (3) years (or duration of appointment, whichever is shorter) and which is not renewable.