Board of Medical Licensure and Discipline

Welcome to the Website of the Board of Medical Licensure and Discipline, a Division of the Rhode Island Department of Health. The purpose of this Website is to increase public access to crucial information about Rhode Island physicians, the Department of Health, and the process involved in protecting the public.

It also will inform physicians about how to apply for a Rhode Island Medical License, the requirements for Rhode Island Licensure, and information about the board meetings and subcommittee meetings.

Our goal is to provide information which furthers safe and healthy lives in safe and healthy communities.

Board Members and Staff

by Robert S. Crausman, MD MMS FACP FCCP

Introduction:

“The health and dignity of my patient will ever be my first concern. I will hold in confidence all that my patient relates to me. I will not permit consideration of race, gender, sexual preference, religion, nationality or social standing to come between me and my duty to anyone in need of my services. This pledge I make freely and upon my honor”

(Excerpt from the Physician’s Oath recited by graduating students of the Brown Medical School.)

* * *

Few professions involve the unique privileges and responsibilities that medicine and osteopathy requires of practitioners in modern American society. Upon entering the profession we all pledge to uphold a high standard of professional behavior that selflessly places our patients’ interests above our own. So extraordinary is this role and so necessary is this commitment, that every state operates a governmental agency to monitor and enforce the professional conduct of physicians. Little did I realize, when I recited the Physicians Oath after completing medical school at Brown that I would one day take on a key responsibility for this process in my home state of Rhode Island.

In September 2003 Governor Carcieri approved my appointment as Chief Administrator of the Rhode Island Medical Board of Licensure and Discipline (the Board) based on the recommendation of Dr. Patricia A. Nolan, RI Director of Health. I already knew a lot about the Board, of course, and frequently interacted with it in my capacity as residency program Director at the Memorial hospital (Pawtucket, RI) since 1995. During the summer, I began to prepare myself by attending several Board sessions and meeting individually with members. As the summer unfolded, I developed a more complete understanding of the Board, its role and vision—an understanding that I would like to share with my professional colleagues.

The Rhode Island Board of Medical Licensure and Discipline:

The Board is an agency of state government established, by law, to protect the public and to assure high practice and professional standards in the nearly 4000-member physician community. The Board discharges these responsibilities primarily through the licensing process, receiving and investigating complaints, and serving as a disciplinary body. It also assesses professional practices and develops remedial programs for specific physicians. Among other activities, the Board provides public information on physician licenses in Rhode Island; serves as a resource to government concerning the foreign-trained physician waiver program, assures the achievement of continuing medical education standards and educates the health care and lay community regarding the role of the Board and medical professionalism. These are daunting tasks, which not only require the efforts of a serious and dedicated Board, but also the support and participation of health care professionals, and the Rhode Island public. In the following paragraphs, I will briefly describe the legal basis, composition and activities of the Board.

The Statute:

Chapter 5-37 of the RI General Laws describes the Board's composition, the appointment of its members, its mandate, powers and functions.

Board Composition:

The Board includes both physicians and public members to provide broad representation of the medical and lay communities. The Governor appoints members with input from the appropriate medical or osteopathic societies. They include:

· Six licensed physicians, including:

   ·One full-time medical school faculty member
   ·Two osteopathic physicians

·Five public members, including:

   ·One attorney experienced as a plaintiffs counsel in medical malpractice
   ·One member of the general public who is at least 60 years of age
   ·Three public members not associated with the medical field

· One hospital administrator

The Director of the RI Department of Health (HEALTH) serves as chairperson. The Board’s Chief Administrator and Legal Counsel serve as ex officio, non-voting members. RI law protects members of the Board from civil or criminal legal action related to activities conducted in good faith.

Board Activities

Licensing:

A license to practice medicine in the State of Rhode Island is considered a privilege, not a right, granted to qualified physicians. The essential requirements for licensure include the following:

·Graduation from a school of medicine
·Successful completion of no less then one year of postgraduate training
·Three years of postgraduate training for ECFMG (Education Commission for Foreign Medical Graduates) certified international graduates
·Successful completion of the USMLE licensing examination
·Evidence of a high moral and ethical standard
·Payment of the application fee

The Board endeavors to render a decision on a complete license application within 90 days. However, the verification of all credentials, which requires information from multiple sources such as medical schools, graduate medical education programs, hospitals and professional references, often extends the processing time. For physicians previously licensed in Rhode Island, the Board mails out the annual application for renewal in March. The application is due on June 1; renewal takes effect on July 1. Soon, the Board will be implementing a two-year application cycle.

Complaints and discipline:

The Board serves as a clearinghouse for written complaints regarding unprofessional conduct. Complaints may come from individuals, institutions, public officers, other physicians, healthcare professionals or anyone else who has contact with medical professionals—including the Board itself. All complaints and investigations remain confidential prior to final Board action.

The Board reviews all complaints and refers those meriting further investigation to a three-member subcommittee. The subcommittee—including at least one physician and one layperson—investigates and makes a recommendation to the full Board. The Board may issue subpoenas to compel the production of documents, records or testimony. Failure to comply with a subpoena may result in punishment for civil contempt by the RI Superior Court.

Written Board decisions include findings of fact and law. A majority of Board members must concur in order for an individual to be found guilty of unprofessional conduct. A variety of sanctions may be administered including: a reprimand; a suspension, limitation or restriction to practice medicine; probation subject to conditions and requirements; indefinite revocation of the medical license; mandatory participation in a remedial continuing medical education program; compelled submission to care, counseling or treatment; and assessment of fees to cover the administrative costs of proceedings. Appeals receive judicial review by the RI Superior Court.

In cases of egregious misconduct constituting an immediate danger to the public, the Director of Health may immediately suspend the individual’s license.

Unprofessional conduct:

In addition to technical and intellectual proficiency, the public expects physicians to maintain a high standard of medical professionalism. Medicine’s ethical creed places the patient's interests above one’s own. Unfortunately, professionalism is a difficult concept to capture succinctly. The statute itself speaks in terms of negative examples, i.e. behaviors or activities that constitute “unprofessional conduct”. Examples include:

·Conviction of a crime arising from the practice of medicine
·Patient abandonment
·Medical practice while under the influence of alcohol or illicit drugs
·Volitional falsification or misrepresentation of medical reports, records or treatments
·Failure to provide the medical records or reports appropriately requested in the course of patient care
·Fee splitting, willful overcharging for professional services, deceptive billing practices or collection of fees for services not rendered
·Malpractice or incompetent, negligent or willful misconduct in the practice of medicine
·Sexual contact in the context of a physician/patient relationship
·Failure to comply with requests from the Board or its agents.

No single list or source can offer practicing physicians guidance in every conceivable circumstance. However, the Board relies upon the American Medical Association (AMA) code of ethics as the legal standard. (Go to www.ama-assn.org/ama/pub/category/2498.html )

Physician profiles:

Information about physicians can help consumers make better choices about the health care they receive. RI law guarantees the public access to physician data including information about medical school attendance, graduate medical education, Board certification, years of practice, hospital and medical school affiliations, and publications. In addition the Board must provide a description of any final disciplinary actions within the most recent 10 years, any restriction or revocation of hospital privileges, and all the medical malpractice judgments, arbitration awards and settlements. The Board asks physicians to review their professional profiles periodically to assure accuracy.

Impaired Physicians:

According to the US Comorbidity Survey (1990-92), 52 million people (29.5%) age 15 to 54 had some type of alcohol, drug abuse or mental health (ADM) disorder within the past year. The professional literature suggests that physicians may experience ADM with at least the same rates as a general population--possibly higher. Easy access to controlled substances and stressful work conditions for physicians may actually increase prevalence[1,2].

The Board assumes two responsibilities with regard to the behavioral health of practicing physicians: protecting patients from harm that may arise from impaired practice and facilitating appropriate treatment and a safe return to medical practice whenever feasible. Addressing these two objectives requires close coordination between the governmental and the private professional sides of medical practice.

The Board works with the Physician’s Health Committee of the RI Medical Society to provide treatment and rehabilitation for impaired physicians. The committee offers assessment services for physicians with behavioral health problems, including sexual boundary violation, gambling, sexual and Internet addictions, and disruptive behaviors. It oversees treatment and readiness for a safe return to practice. Physician’s referrals may be self-initiated or based on the signed, written referral by others in the health-care community. Legal statute protects anyone who makes a good-faith referral from liability. For more information, interested parties may contact the committee at (401) 331-3207.

The committee demonstrates an excellent success rate,with over 90% of referred physicians returning to practice. The Board, generally, only monitors the progress of physicians working with the committee, but will intervene if necessary.

The Conrad State 30 program:

The Board also administers the J1 visa waiver program for the state of Rhode Island. Foreign medical graduates undergoing post-graduate residency training in the US under the J1 visa program must return to their homeland for two years before applying for immigration to the United States. The Conrad State 30 program, under the US Immigration and Naturalization Service, permits each state to exempt up to 30 physicians from this requirement-- provided they practice in a medically underserved area. Official health professions shortage areas (HPSA), federally qualified health centers, Veterans Administration, state or county hospitals usually qualify. Each year, the Board, in concert with the Department of Health determines how to implement this program to meet the state’s changing health-care needs.

Continuing medical education:

As a condition of licensure, every physician in Rhode Island must complete an approved course of continuing medical education in the preceding three years. Currently this requires 60 hours of category one CME credits of which at least two must relate to blood-borne pathogens.

Looking forward:

As I reflect upon the functions of the Board, I am struck by both the scope of its current responsibilities and the challenges that it will surely face in the coming years. Changes in information and therapeutic technology, confidentiality regulations, new therapeutic drugs, economic and reimbursement policies, an aging population, emerging infectious diseases, malpractice litigation and many other factors will affect the profession and provide a constantly change background for its core values. Although no one can predict how this will all unfold, there are several more practical objectives that the Board may set for short term.

Customer service plays an important role in successful government as well as successful business programs. The Board can continue to benefit from improved customer service innovations. Streamlining the licensing process, so important to assure a high minimum standard for the privilege of practicing medicine, may facilitate more rapid introduction of new physicians into the state. Those who are anticipating completion of their GME (Graduate Medical Education; Residency or Fellowship) could apply earlier than is currently allowed (i.e. the month prior to graduation). Further, the disparity of requirements between graduates of US versus international medical schools warrants review.

Second, the Board should re-emphasize its proactive roles with respect to assuring high standards of medical practice and professionalism. Of course, the receipt, investigation and adjudication of complaints will continue. But the Board could play a more active role in preventing the conditions in which unprofessional conduct may occur. Some options include sponsoring education programs emphasizing the meaning and importance of professionalism in local medical societies, medical schools and academic medical centers. Initiating studies that focus upon practice behaviors that reduce medical errors would be timely and appropriate. Developing new linkages for gathering and analyzing data in conjunction with third-party payors and hospitals may also offer useful insight. Finally the Board should continue to work with the Physicians Health Committee to emphasize the early identification and prevention of behavioral disorders that undermine quality practice in addition to providing treatment and rehabilitation when they occur. JCAHO now requires an annual education presentation related to physician health. This requirement offers an excellent opportunity for the Board, the Physicians Health Committee, teaching hospitals and others to increase awareness and promote early assessment and referral of physicians.

These are only a few of the ideas that may help take the Board of Medical Licensure and Discipline into the future. I look forward to the challenge and welcome your suggestions, insights and feedback in the days ahead.

References:

1. Early, P. Substance abuse related disorders. In problem physicians: a national perspective. A report to the Georgia composite state Board of medical examiners. Talbott G. and Crosby L. editors. 1995: 7-10.

2. Femino J, Nirenberg, T. Treatment outcome studies con physician impairment: a review of the literature. Rhode Island medicine and health. 1994. 77(10):345-350

Board Members and Staff

Board Members

Staff Members

Robert S. Crausman, MD, MMS, FACP, FCCP
Chief Administrative Officer, Board of Medical Licensure & Discipline
Associate Professor of Medicine, Brown Medical School

Charles Alexandre MS, RN - Chief, Health Professionals Regulation

Bruce W. McIntyre, Esquire - Legal Counsel

Lauren Dixon - Full License and Training License Coordinator

Mary Salerno - Administrative Officer

Linda Julian - Board Investigator