How can consumers interact with state medical boards?

How can consumers interact with state medical boards?

Editor’s Note: When Dr. Thomas Kline tweeted last week that it’s time for chronic pain patients to “flood state medical boards with online complaints” about being cutoff w/ the CDC and “federal drug police invalid medical excuses, we asked Terri Lewis Ph.D. for an article that shows patients how they can do it and why it might be a good idea. We thank for her this submission to the National Pain Report.

Many patients do not know where to turn when they have concerns about the competency or conduct of a doctor. State medical boards are government agencies, usually housed in state Departments of Health, that are empowered to investigate complaints about doctors and, when warranted, take action against them. These entities are placed alongside other regulatory groups like Boards of Pharmacy, Licensure, and so forth. Members are usually nominated to these positions by the Governor for a specified term. Among their jobs is that of advising legislative bodies and monitoring the impact of regulation on licensed entities like hospitals, nursing homes, physician practices, and pharmacies.

Some of the most common standard-of care complaints include:

  • Prescribing the wrong medicine
  • Inappropriately prescribing controlled substances
  • Failure to diagnose a medical problem that is found later
  • Willfully or negligently violating the confidentiality between physician and patient except as required by law
  • Disruptive behavior and/or interaction with physicians, hospital personnel, patients, family members, or others that interferes with patient care
  • Failure to provide appropriate post-operative care
  • Failure to respond to a call from a hospital to help a patient in a traumatic situation

The Medical Practice Act defines unprofessional conduct in each state. Although laws vary from state to state, some examples of unprofessional conduct include the following:

  • Physician abuse of a patient
  • Inadequate record keeping
  • Failing to meet the standard of care
  • Prescribing drugs in excess or without legitimate reason
  • Failing to meet continuing medical education requirements
  • Dishonesty
  • Conviction of a felony
  • Delegating the practice of medicine to an unlicensed individual

Minor fee disagreements and poor customer service are not considered unprofessional conduct. Disagreements about changes to the patient treatment plan fall into a gray area of monitoring and oversight. A full 25% of survey respondents disclosed that they have lost their primary care physician as a result of changes to state and national laws. More than 30% of respondents report that their pain management physician has terminated their care relationship due to changes in the regulatory environment or disputes about the course of care in the current environment. While survey analysis continues this snapshot of 2884 of 4600 responses indicates that changes to prescribing plans are widespread. The role of patient protections is largely left to a negotiation between the prescribing physician and the patient.

Terri A Lewis, PHD

In a recent study state boards were queried about abrupt changes in controlled substances (CS) prescribing, to determine whether states have action plans in place to manage such situations, and were asked to describe the components of any such plans.

A total of 51 medical boards were contacted to determine states’ experiences with abrupt changes in CS prescribing, the extent of consumer complaints attributed to these events, and the types of plans in place to manage these situations. Forty-six executive directors of medical boards responded. Twenty boards (43.5%) confirmed that their state had experienced abrupt loss of CS providers and 11 (55%) of these executive directors indicated that the loss resulted in increased consumer complaints. The majority of executive directors (86%) had no corrective action plan. Six executive directors reported some type of action plan or process consisting of regulatory action, patient-provider connection, professional education, patient education, or public notice.

Most states do not have operational plans in place and the majority of state regulations are silent on abrupted care that includes step therapies, abandonment, or resulting harms. Further it is difficult to detect and confirm patient harm in the current system unless a patient files a report with their state medical board and requests an investigation. A few have key strategies that may be useful in addressing potential problems following abrupt loss of a prescriber. While state medical boards can play a significant role in the development of comprehensive preparedness plans to mitigate damage from the loss of CS prescribers in the community it is largely a function of insurance networks and local business practice. This makes for a very uneven delivery environment.

The majority of reports regarding physician misconduct remain unreported. There is concern that legitimate complaints to Boards are often inadequately investigated. In my own work, I have found that each state board operates differently with varying degrees of quality and accountability to the public. Some are politically oriented, while others are quite responsive to public concerns about safety and quality. There are no consistent operating practices from state to state.

Each state has its own response system found in the links attached here:

State Medical Boards snapshot (link)

http://www.fsmb.org/advocacy/state-boards-snapshot/

Summary of state laws

http://www.fsmb.org/siteassets/advocacy/opioids/pdfs/opioid-survey-charts.pdf

Issues by state (searchable filter)

http://www.fsmb.org/advocacy/key-issues/

Pain management regulations by state (links)

http://www.fsmb.org/siteassets/advocacy/key-issues/pain-management-by-state.pdf

Chronic care and use of opioids policy

http://www.fsmb.org/siteassets/advocacy/policies/opioid_guidelines_as_adopted_april-2017_final.pdf

PDMP Overview by state (links)

http://www.fsmb.org/siteassets/advocacy/key-issues/prescription-drug-monitoring-programs-by-state.pdf

Medical Cannabis overview by state (links)

http://www.fsmb.org/siteassets/advocacy/key-issues/medical-marijuana-requirements-by-state.pdf

Federation of state medical boards (FSMB.org). Search for information about your own state physician regulating board. To understand how physicians are regulated in the USA, explore this link-

http://www.fsmb.org/education/understanding-medical-regulation-in-the-united-states/

http://www.fsmb.org/consumer-faq/

To find out information about your state Medical Board, go to this link-

http://www.fsmb.org/contact-a-state-medical-board/

Find out about your physician’s training, licensing, and history of complaints,

http://www.docinfo.org/?&_ga=2.265355148.2077480378.1572160800-2106331410.1572160800#!/search/query

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Authored by: Terri A Lewis, PhD.

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Tom Cuddy

Several years ago I took my wife, a RSD/CRPS patient, to two Texas medical Board meetings. First year we came she was in a wheelchair due to the death of her pain specialist. During the long search for a new pain specialist who would take a patient well maintained on opioids we encountered all sorts of excuses not to take my wife as a patient. When the board denied they were creating a climate of fear if that is the case they need to communicate this with Texas MD’s because they all have received a very different message. The next year, after finding a specialist she walked in. they remembered her and were quite impressed by her walking and being obviously in much better shape. I think our appearances helped put a human face on.what to them may be mere statistics. It is worth it.

Jon Robertson

I’d love to have some support going up against Michigan’s medical board, who are part of the AG’s office, who has been harassing me for years, and keeping my case out of court with delay tactics. I lost my license and was thrown in jail last August, here over a year later, they are still asking for more time to prepare for trial. The trial date has come and gone. I can’t get my license back until after trial and the constitution guarantees the right to a speedy trial, but Michigan does not.

American

Thank you Terri for the links I reluctantly wrote my State Medical Board I’ll let you know if they respond.

Terri Lewis

If every person who reads this would send a letter to their state medical board asking for copies of their policies and procedures for assuring patient safety and quality care, and how to request an investigation regarding lack of care or abandonment, you would get at least 50 different responses. It would be quite illustrative.
Review the links I provided. Then lets have a conversation about how to make change in regulatory processes so that patients are accounted for.

None of us will ever be the same. Doctors and patients alike will never be the same and are forever effected by this tragedy. I do not believe there will ever be help for pain patients but I will keep fighting. It is even worse when a patient has had an unethical doctor who thinks only of himself and will do anything to protect himself. Lawyers will jump on the band wagon for all sorts of things but not for pain patients. If a doctor finds out you were ever treated with opiods no matter how long ago then you are not welcome. We are like lepers to most people today. I have been without pain medication for eight months and am just tired of trying to find help. I am to see if I am a candidate for an implantable nerve stimulater in the back for my abdominal pain but I just do not trust most docs anymore.I will see what happens.

Tess

thank u so much for this..i know my hubby whole 18yr relationship with his doctor has changed..its terrifying because this doctor like so many others have complete power over my husband function and our whole lives..since the guidelines it’s been like night and day..we can’t report any mistreatment and they know it!! and it makes them feel incredibly powerful.i have never seen treatment on this level my whole life. it has scared even my grown children are afraid all doctors will act like this..i have to remind them they are not yet an inatractable pain patient yet..i pray everyday they will never be

Ann Sable

OH MY WORD! We have read deeply into this and every article before that…over and over again. And, as usual, we have voiced, sent every imaginable letter and so on to all the idiots above us…to death. They all know because they all caused this seemingly (dare I say…) ‘genocide’. It’s a living hell for all of us and the only ones that aren’t suffering, are the ones that are sadly no longer here. Terri, do you really believe that the ones at the top are listening and reading every single piece that is sent to them one way or another. Not a chance in hell. They’re laughing away, all the while, they are importing the very thing that is killing people on the streets. And they care for us, deeply…pfft! I know that you are trying, I truly do…as with many others as well. But, you MUST also listen to all these people down below, they are absolutely CORRECT.

But, thank you for your service in this matter.

Chereese

Thank you very much Dr. Lewis for the wealth of information.
It will definitely be utilized.
Thank you, NPR.

Terri Lewis

If you read a little more deeply, I was asked to comment on lodging complaints to state medical boards. I provided current links to information of importance to folks on their site. I also reflected that state medical boards are silent on our issues primarily because they lack actionable direction from their state legislators and inaction is protected by blame shifting and silent regulations.
Before you grouse about your frustration with letter writing campaigns, consider where you might put your energy so that it does some good. Medicine is regulated by the states. If you want something to change, the take the time to inform yourselves and put some effort into determining exactly who in your state is accountable for the lack of action and responsiveness you can readily observe at the state level.
Corrupted practices persist because we tolerate them.

American

So we are supposed to complain to the very same government that knowingly did this to all of us in the first place I know we’re supposed to keep our enemies close but I just can’t bring myself to do it. Hitler had the decency to euthanize the disabled in 1939 but 80 years later history repeats itself and this is an entirely different beast I now prefer to have as little or no involved with for the rest of my miserable needlessly suffering life with maybe the exception of voting for them all out of office each time! My retainer fee is still burning a hole in my pocket if an attorney wants to stand up and follow more money. Ps. 👆 The facial expression on the picture of the doctor above reminds me of the expression on my doctor’s face now and most of society when I asked for ongoing pain relief. Thank you for the information though.

Margret drumheiser

Excuse me you stated that it’s difficult to detect hoe about asking the 50 million or more debilitating pain pts. We are the ones suffering and being torchered. Living out lives in hell. Not because fof many we have Dr care but are inadequately or ineffectively be treated for our debilitating intractable chronic pain which is an illness that humanely needs to be treated . Because yes I believe it is neglect and failure to do what a Dr was educated and licensed and ethically should be doing. It’s not the fact many of us don’t have Dr but the Dr are being put in an ethical position by our government, the DEA AND DOJ. Their made to decide ethically do do I effectively treat my debilitating intractable chronic pain pt and risk loosing my license, my livelihood and risk prosecution and go to jail for life or do I say this is all I’m able to give knowing that the pt is suffering but their hands are tied. At least the pts are getting something and are not completely without any pain med or Dr even though you know it’s not effectively treating their pt and pt is loosing their quality of life. How is this meeting the standard of care how is knowingly allowing a pt to suffer and be torchered?? Just because of the ethically delema. Why are these Dr and the ama not standing up , standing with pts and fighting these injustices. Fighting to get government and DEA out of our Dr offices and PDMP RECORDS. THIS IS how their continuing their witchunt against Dr, us and pharmaceutical companies. Using these PDMP records for personal use to monitor Dr, keep record of which Dr prescribe opioid pain meds, to who, how much . Their compairing one Dr to another which is ridiculous. Their not taking into account why the Dr wrote these meds , how many Dr in the, practice, or of its single, Dr is he pain specialist vs general practitioner. Of course pain specialist gonna write a lot more pain meds for Christ sakes. Something needs to change. Before more cpp suffer and comitt suicide .

Collins Larry Mahlon

This article is a waste of time. I have personally written medical boards, President of US, Congress, Secretary of Health and Human Services, and many more. Not only did none of these people or agencies respond to my inquiries, our government has done nothing to correct what the CDC has done to chronic pain sufferers. I am so tired of just hearing about small talk and no action from those in charge of healthcare. Until a legal firm or lawyer gets legally involved and is willing to help us, this travesty upon chronic pain sufferers will continue. Sorry, but you wasted your time writing this article.

Judith Jermark

Terri James, you are exactly right. State medical boards are not going to do anything for a legitimate chronic pain patient. If a prescribing healthcare provider is part of a healthcare corporation, there isn’t any need to complain to the corporation either. They welcomed the CDC guidelines on prescription pain medication and accepted them as gospel, because the guidelines enhanced the corporations’ own agendas.

Unfortunately, this has all been about money. Pharmaceutical companies paying physicians to prescribe opioids, as well as paying members of Congress, pharmacies and healthcare insurance companies. Then when the real “drug addicts” started overdosing and dying, it was about money again going to the same people. The DEA wasn’t about to stop illicit drugs from killing people because it is just too much work, so they got lists of prescribing physicians who prescribed opioids to their patients and helped doctors punish the patients by stopping, tapering, weaning from, whatever they call it, necessary pain meds for functioning. Then doctors abandoned their patients and left them to die, commit suicide, or go to the streets for illicit meds for pain. State medical boards? I don’t think so.

Bruce

What’s the deal with the person on Twitter who has the Terrify Lewis, PhD account with Terri’s picture and things drawn on it? I read their account and profile and only seems to be mildly goofy. I’ve seen Terri on here numerous times and she seems helpful, at least as much as she can be. Bruce

Rosalind Rivera

How is this supposed to help? It’s not the doctors that need to be investigated, it’s the DEA!!! Is our government deaf, dumb and blind?? The DEA, HHS ETC are the problem. Doctors are running scared, shutting down, cutting doses and eliminating care altogether because of the insane statues and unfair and cruel power wielded by the DEA and other agencies and we, the chronic pain community and the entire nation know who they are. We’ve filled out surveys and added our names to numerous lists and complained and all for what? To have the abuse continue and escalate! It seems that there is nothing that we can do will ever stop these death squads except perhaps develop a good working relationship with our local drug dealers!

Thank you Dr. Lewis 4 taking your time & collecting this infor & sharing it. This is a top-notch article. I had all but 2 of standard of care / Medical Practice Acts happened to me. I am dealing w/ MPA issues since surgery. Here’s another excellent article
Psychologytoday.com
” it’s time for psychology to lead not follow” Oct 27, 2019
Must read article. It states that billions of taxpayer dollars 4 mental health, that NIMH admits to wasting taxpayers money / not reducing suicides. There’s no new or better treatments. That it proves CCP r forced to do Psychotherapy to receive pain meds. Policymakers & Healthcare Pros don’t understand what good therapy means. New clinical practice guidelines issued by American psychology Association which evaluates / recommend psychotherapist based on Institute of medicine criteria, are a tragic mistake. The criteria designed to evaluate biological interventions like medication Psychotherapy is not like medication.

David Hickle

[edit] the entire health care system and the USA system

Kris Aaron

Many physicians want to keep prescribing opioids to their pain patients but are forbidden to by their employers. We have nowhere to turn when the “head office” won’t let our doctors continue treating us based on their sound medical judgement.
Between threats from the DEA, bureaucratic obstinance and investor greed (when profits are down due to increases in malpractice insurance costs for doctors who dare to prescribe opioids), it’s no wonder many physicians say to hell with it and retire early.
We’re left to “treat” our pain with useless, expensive therapies our insurance companies won’t cover, illegal drugs that may be lethal or a visit to the “Drs. Smith & Wesson Pain Clinic.” This is why the most terrifying words ever spoken are “I’m from the government and I’m here to help you!”

Cindy too

A few years ago I moved from MA to FL.
MA devotes a lot of resources to consumer protection. FL doesn’t.
Some of this is for political reasons; Dem vs GOP govt.
But some is $$.
FL has super low taxes.
You get what you pay for.

Also, FL docs operate very differently than MA docs.
Of my many FL docs, only one office returns all calls.
A nurse confirmed that FL docs often dont’ call back.
In MA, every doc’s office returned calls, promptly.

My FL PM is great. While he imposed a forced taper last year due to the CDC Guidelines, it could have been much worse than it was, & last spring after the CDC author stmt etc, I begged for relief & he increased my dose to near the original.
BUT, one day I called for an Rx due to a terrible migraine — very unusual for me to call mid-appt and my pain problem is not head-related — and I never got a call back. Plus, when I told him about it at my next appt, he just shrugged his shoulders.

I’ve been “fired” by 2 docs down here for bizarre, unfounded stated reasons. I’ve always been a high medical utilizer & have had tons of docs, and good relationships with all of them. I’d often brought gifts. This was beyond bizarre.

I called the FL medical bd when my first FL PM fired me. They said she could fire any patient she wanted.

They acted only on her 2 clearly illegal acts. They ordered her: (1) to send me a letter that she was terminating me, which she’d never done (I only found out when I called to make my next appt & was told I “was no longer a patient”.; & (2) to release my records to my new PM, which she’d repeatedly refused to do.

But they did nothing for ethics problems.

In MA, I’m sure I would have received more help when she fired a long time patient due to a tox screen that showed alcohol even though I’d had NONE. She refused to discuss or to consider lab error & much more. Her office was always horribly run, & I’d wanted to leave, but on my own terms.

Sue Lewis

Best of luck with this. I am a physician who used to treat many chronic pain patients. When the clinic I was working for (hospital based) decided that we all needed to abruptly decrease or stop pain medications in our chronic pain patients I quit. I did not agree with this approach. Subsequently I was reported to the state medical board by that clinic and I spent 4 years going through all kinds of requirements placed by the medical board. I had my license restricted and I was required to go through an evaluation of competency and a psych eval! I finally completed all of the requirements of the board and now have my full license back. I will NEVER prescribe chronic pain medications again in my career. The previous clinic tried to destroy me financially, professionally and personally. Until the government is overwhelmed with patient complaints, I believe nothing will change. No wonder doctors are terrified! I should add that I have been seeing patients for over 25 years and I am board certified in my specialty.

vicky swift

terri, I’m with you. Links to more govt garbage do not serve us well. No one is listening. Blue Cross now dictates how many pain pills I get. Yes, i’ve been cut by half where i was just a few months ago. Walgreens denies any role in this, they are just the innocent bystanders. Yeah right. the doctor has no say in the matter much anymore. Count me in as another casualty of the fake opiod war being waged against chronic pain patients. I was told by someone from Blue Cross that the plan is to eventually take away ALL pain medication. I havent been functional since my long acting meds were removed 8 months ago, now spending much of my day in bed in pain. why dont we get organized and file a class action suit against the govt? that is something i could get behind.

Pardon me but when your main health issue is chronic pain, it seems one can’t interact with anyone that can help them and furthermore what good would it do to interact with one’s State Medical Board? I’m not trying be a smart-aleck, I truly would like an answer. If one is fortunate enough to keep one’s physician, they are now required to send you to a pain clinic for an evaluation (of course this is after they ALREADY KNOW what’s wrong with you to begin with) then are required by the government to do what said pain clinic states to do. With the exception of losing one’s physician all together, being completely abandoned with no pain medication, or for the fortunate ones to be kept by one’s physician or pain clinic doctor only to be cut down to 1/4 of what one was taking several years back has anyone experienced differently? That’s what all this is about. How do we make a difference? Lord knows we’ve tried just about everything except for hiring attorneys to fight the government and we just can’t seem to find anyone at the moment willing to tackle that particular job. You can speak to your physician till the cows come home and they are not going to put you back on the amount of pain medication you were previously allowed to take so that you can live your life with some sort of normalcy because they are terrified of what might happen to them. That’s why they did what they did to begin with. Contacting government offices and officials; that really has gotten us far now hasn’t it? No offence but we can have all of the links there is to everything listed above and we already know the answers. Surveys, pain management, drug monitoring, medical regulations and key issues. We’ve filled out multiple surveys, we know all too well about pain management or shall I say non pain management, drug monitoring, the NEW medical regulations and most definitely the key issues at hand. Please correct me if I’m wrong.

Cindy R

Thank you, I’ve been looking for some of this information and hadn’t had much success. This is exactly what I needed!