10/22/10. Christopher Forest, MSHS, PA-C Rosslynn Byous, DPA, PA-C

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1 Christopher Forest, MSHS, PA-C Rosslynn Byous, DPA, PA-C 1. Explain the fundamental principles of ethical behavior 2. Categorize the elements of professionalism required for medical practice (ARC-PA: B2.16) 3. Demonstrate how unprofessional behavior can legally impact a PA s ability to practice 4. Convey how unprofessional behavior in their personal life can affect licensure 5. Summarize the PA s scope of authority, professional misconduct, gross negligence, competency, and standards of conduct 6. Identify personal steps to protect your license Professionalism requires the provider to serve the interests of the patient above his or her own self-interest o A commitment to the highest standards of excellence in practice of medicine and the generation and dissemination of knowledge o A commitment to sustain the interests and welfare of patients o A commitment to be responsive to the health needs of society Altruism act in best interest of the patient Accountability to provide good medical care Excellence effort to exceed expectations; commitment to life-long learning Honor&Integrity fair, truthful, refusal to violate personal and professional codes Respect for others patients, families, physicians, nurses, students - American Board of Internal Medicine Abuse of power Arrogance Greed Misrepresentation Impairment Lack of conscientiousness Conflict of interest Know the law Stay within the community standards of care Do not exceed your scope Documentation is critical Remember that what you do outside of work can impact your ability to practice - American Board of Internal Medicine 1

2 Physicians and physician assistants may not self-prescribe any controlled substance. This includes pharmaceutical samples The most common event that triggers a Medical Board investigation is a drunk driving conviction First conviction close the case for 5 years Second conviction extensive investigation Referred to Office of the Attorney General for consideration for disciplinary action TERM DEFINITION Accusation Charges filed against a licensee alleging violations of the Laws Accusation and Regulations Relating to Charges the Practice filed against of Physician a licensee Assistants. alleging violations of Laws and Regulations Relating to the Practice of Physician Default Decision Licensee Assistants. fails to respond to the Accusation by filing a Notice of Default Defense Decision or fails to appear at Licensee the administrative fails to respond hearing. to the Accusation by filing a Notice of Defense or fails to appear at the administrative hearing. Denied The application for licensure as a physician assistant is denied. Denied The application for licensure as a physician assistant is Decision The order of the Committee denied. in a disciplinary action. Decision The order of the Committee in a disciplinary action. Interim Suspension Order (ISO) An order issued upon petition by the Committee, Interim suspending Suspension a licensee Order from An all order a part issued of upon his or petition her physician by the Committee, assistant suspending practice. (ISO) a licensee from all or a part of his or her physician assistant Petition to Revoke Probation practice. Charges filed against a probationer seeking revocation of their license based upon violation(s) of probation. Petition to Revoke Probation Charges filed against a probationer seeking revocation of Probation Terms and their conditions license based placed upon on violation(s) a licensee of for probation. a specific period Probation of time as a result of disciplinary Terms action. and conditions placed on a licensee for a specific period of time as a result of disciplinary action. TERM DEFINITION Accusation Charges filed against a licensee alleging violations of the Laws Probationary and Regulations License Relating to A the conditional Practice license of Physician issued to Assistants. applicant with terms and conditions for a specific period of time. Public Default Reprimand Decision Licensee Licensee fails to was respond reprimanded to the Accusation for a minor violation(s). by filing a Notice of Defense or fails to appear at the administrative hearing. Revoked Licensee's right to practice is ended. Denied The application for licensure as a physician assistant is denied. Revoked, Stayed, Probation "Stayed" means the revocation is postponed. Professional Decision The order of the Committee practice may in continue a disciplinary so long action. as the licensee complies with the specific terms and conditions. Violation of probation Interim Suspension Order may (ISO) result An in order the revocation issued upon that was petition postponed. by the Committee, suspending a licensee from all or a part of his or her physician assistant practice. Statement of Issues Charges filed against an applicant to deny licensure. Petition to Revoke Probation Charges filed against a probationer seeking Stipulated revocation Decision of their license based A Settlement upon violation(s) agreed to in of lieu probation. of a formal hearing to resolve the accusation and impose discipline. Surrender Probation Terms and Licensee conditions stipulates placed to surrender on a licensee the license. for a The specific right to period of time as a result of disciplinary practice action. is ended. State: Licensure National: NCCPA Certification Professional: AAPA Membership 2

3 Complaint filed Complaint reviewed (5-7 days) Determination phase o Further Investigation o Expert witness review o Closed if no validity o Accusation if valid To the Attorney General Stipulation To the Physician Assistant Committee for agreement 1. Field office review 2. AG in the field office 3. Violation no accusation o Citation - publicly cited o Departure one time o Remediative actions for the violation o Fine o "Get their attention State of California Physician Assistant Committee State of California Physician Assistant Committee 4. Accusation o Served o Public record o They have an opportunity to respond o Attorneys meet o Proposed decision after the attorneys (Board) meet o Hearing with the ALJ days to respond Activity Year Ending June 2009 License Applications Received 596 New Licenses Issued 565 Renewals Issued 3310 Total Current Licenses 7,260 Complaints Received 205 Complaints Closed 188 Investigations Opened 52 Citations Issued 6 Accusations Filed 14 Probation 10 (46 active) Revocation 2 Voluntary Surrender 4 State of California Physician Assistant Committee Data from the State of California Physician Assistant Committee Activity Year Ending June 2009 Incompetence/Negligence 80 Unprofessional Conduct 35 Criminal 27 Non-jurisdictional 24 Drug-related 9 Unlicensed 8 Fraud 7 Discipline by another state 4 Substance Abuse 4 Sexual Misconduct 0 (5 previous yr) Other 7 State license revoked as the result of a final adjudicated disciplinary action for violation of professional practice statutes or regulations AAPA membership is automatically revoked Exception: incident that does not impair the capability to provide medical care (i.e. lapse in payment of licensure fees) AAPA publishes these names in AAPA News and on the public pages of the AAPA Web site Data from the State of California Physician Assistant Committee 3

4 Certified PAs may incur disciplinary review for: o Irregular behavior o Fraudulent credentials o Legal, regulatory, and credentialing actions Code of Conduct outlines principles Case Origination o Self report during maintenance of adverse licensure, crimes, or adjudication of mental incompetence o Reports on state board actions o Individual complaints (cheating, fraud, credentials) 1. Staff review: with medical consultant 2. Review Panel: 1 st level of appeal 3. Executive Committee review: restricted to cases in which the PA alleges that a procedural error may have occurred and/or the review panel s decision was arbitrary and capricious 600 cases 53 cases 14 cases 2009 Take No Action Issue a Letter of Concern not reportable Issue a Letter of Censure reportable Revocation of Certification Revocation of Eligibility Other CME, exempt exams, fines, etc. Ac#on taken by Licensing Agency: # of Cases Cer#fica#on Revoca#on Le;er of Revoca#on of Eligibility Censure Revoca.on License/Privileges Surrender License/Privileges Suspension License/Privileges License Denial, Condi.ons, Reprimands, Censure, Other Le;er of Concern No Ac#on License Restricted 3 3 License Issued under Proba.on Disciplinary Ac.ons Taken by Dept of the Army 2 2 Disciplinary Ac.ons Taken by Dept of the Air Force YTD Total

5 Medical Board of California Newsletter Quarterly 5

6 6

7 7

8 8

9 Know the law Stay within the community standards of care Do not exceed your scope Documentation is critical Remember that what you do outside of work can impact your ability to practice 1. Do NOT prescribe for individuals who are not patients of your practice N-E-V-E-R. 2. Maintain clear and complete medical records on all your patients. 3. If it is important, do it yourself (e.g. file licensure/ certification paperwork). 4. Maintain professional relationships with your patients at all times; if you wish to pursue a personal relationship, then terminate the professional relationship first and then wait. 5. Remember that regulators/commissioners are happy to evaluate your story but are unlikely to forget you lied. 6. Know the law as well as you know clinical medicine; it is just as important. 7. Comply with both the spirit and the letter of the law. 8. Don t let novelty or greed cloud your judgment. 9. A license and certification are more important than a job. 10. In summary, live and practice with Integrity. 9

10 2010 PAEA Annual Education Forum, Friday, October 22, 2010 (Session 1032) 101 Ways to Lose Your License Using Published Legal Actions to Teach Principles of Professionalism and Ethical Behavior to PA Students Christopher Forest, MSHS, PA- C Rosslynn Byous, DPA, PA- C DISCIPLINARY LANGUAGE TERM Accusation Default Decision Denied Decision Interim Suspension Order (ISO) Petition to Revoke Probation Probation Probationary License Public Reprimand Revoked Revoked, Stayed, Probation Statement of Issues Stipulated Decision Surrender DEFINITION Charges filed against a licensee alleging violations of Laws and Regulations Relating to the Practice of Physician Assistants. Licensee fails to respond to the Accusation by filing a Notice of Defense or fails to appear at the administrative hearing. The application for licensure as a physician assistant is denied. The order of the Committee in a disciplinary action. An order issued upon petition by the Committee, suspending a licensee from all or a part of his or her physician assistant practice. Charges filed against a probationer seeking revocation of their license based upon violation(s) of probation. Terms and conditions placed on a licensee for a specific period of time as a result of disciplinary action. A conditional license issued to an applicant with terms and conditions for a specific period of time. Licensee was reprimanded for a minor violation(s). Licensee's right to practice is ended. "Stayed" means the revocation is postponed. Professional practice may continue so long as the licensee complies with the specific terms and conditions. Violation of probation may result in the revocation that was postponed. Charges filed against an applicant to deny licensure. A Settlement agreed to in lieu of a formal hearing to resolve the accusation and impose discipline. Licensee stipulates to surrender the license. The right to practice is ended.

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