Board of Medical Licensure and Discipline

Rhode Island Board of Medical Licensure and Discipline Positions

In order to provide you with the most current information possible, this forum will be used to post various policies and positions held by the Board of Medical Licensure & Discipline.

12/12/2007 -  Physician or Advanced Practice Clinician Patient Visits in a Hospital Setting

In general, when caring for inpatients in an acute general medicine/surgical hospital, at least daily visits by either the attending physician, his/her physician cross-coverage, or advanced practice clinician should occur and be documented in the medical record.

"It is inappropriate to prescribe medications via the Internet or similar venue without an appropriate physician/patient relationship that would typically include: 1) patient history, 2) physical and/or mental health assessment, 3) legitimate records kept, 4) licensed and trained practitioners, 5) elements of informed consent wherever appropriate and reasonable, and 6) AMA/AOA code of ethics followed."

12/12/2007 -  Physician Self-Treatment or Treatment of Immediate Family Members

The Board endorses the AMA Statement E-8.19 located at:  http://www.ama-assn.org/ama/pub/category/8510.html.  Specifically, the Board emphasized that, "Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members."

08/09/2006 - E-Prescribing Statement

07/12/2006 - Independent Medical Examination Statement

04/12/2006 - Thermography Policy Statement

On the above date at the Board of Medical Licensure and Discipline Full Board meeting, on a motion made by Dr. Kessimian, seconded by Dr. Dinwoodie the Board voted to adopt the American Medical Association Policy Statement regarding Thermography.  The official statement may be obtained at http://www.ama-assn.org.

03/07/2005 - Reinsertion of endoscopically or surgically placed feeding tubes [e.g. G Tube] by the professional registered nurse

1. The nurse shall inform the physician prior to reinsertion, and before   resumption of feeding. The nurse must document the procedure in the medical record.
    
2. Within 30 days of initial placement [i.e., a “fresh” tube]: a nurse shall not reinsert the tube.
    
3. After 30 days from initial placement [i.e., a “mature” tube]: the tube may be reinserted by a nurse [RN] who has been deemed competent to perform the specific procedure by the facility or home care organization.  The nurse shall discontinue an attempted reinsertion if undue resistance is encountered.  The nurse shall confirm successful reinsertion by appropriate methods [e.g., pH testing of aspirated gastric contents, radiographic imaging] that are in concordance with written facility/agency policies and procedures.

Health care entities that treat patients with chronic G Tubes shall have a policy that stipulates the minimum training requirements, competency assessment of nurses for performing these procedures, and protocols for care of patients with endoscopically or surgically placed feeding tubes.

01/19/2004 - (Supersedes previous statement below) Board informational statement regarding Schedule II drug prescriptions:

In an interim policy statement issued by the US Drug Enforcement Administration in the November 16 issue of the Federal Register, DEA corrects misstatements made in its August 2004 FAQ entitled “Prescription Pain Medications: frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel”.  Pursuant to 21 USC 829(a) of the Controlled Substance Act, “No prescription for a controlled substance in Schedule II may be refilled.”  Guidance from DEA had previously permitted prescribers to prepare multiple prescriptions on the same date with instructions to fill on different dates.  However, DEA has reversed this guidance and now states that “…to prepare multiple prescriptions on the same day with instructions to fill on different dates in tantamount to writing a prescription authorizing refills”.  Therefore, this procedure is no longer compliant with current federal laws and regulations and is therefore prohibited.  DEA regulations setting forth the requirements for the issue of a controlled substance prescription are established in 21 CFR 1306.01-1306.27.

10/14/2004 - Board informational statement regarding Schedule II drug prescriptions:

From the Board of Medical Licensure and Discipline (BMLD) and Board of Pharmacy (BOP): The Uniform Controlled Substances Act allows for the prescription of up to a sixty [60] day supply of stimulants classified as schedule II drugs. Unfortunately, the prescription benefit associated with some health insurance plans do not allow for the dispensing more than a thirty [30] day supply. The BMLD and BOP jointly concludes that an appropriate practice for prescribing a sixty day supply of stimulants classified as schedule II drugs in accordance with UCSA is as follows: The authorized prescriber may write two separate prescriptions, each for a 30 day supply. Each prescription must be signed and dated on the date they were written. One prescription is intended for immediate dispensing. The second prescription must indicate the date for future dispensing, which must be no more than 30 days from the date written.

06/10/2004 - Board educational statement regarding nonmedical fetal ultrasound:

The Rhode Island Board of medical licensure and discipline cautions patients against the use of nonmedical diagnostic ultrasound for entertainment purposes. The FDA has warned that there is insufficient evidence to conclude that the use of fetal ultrasound in nonmedical settings is safe. Patients are advised to consult their treating physician for advice.

04/07/2004 - Statement regarding limited licenses:

At the Open Session of the Board of Medical Licensure and Discipline of 7 April 2004 the Board articulated the following statement regarding limited licenses. Of note, this does not represent a change from current practice, rather just a statement of what has been a longstanding practice.

Once a physician is granted a full license to practice medicine in the State of RI, the physician is no longer eligible for a limited license in RI [limited registration for training purposes]. Therefore, a physician may not place the full license on inactive status in order to resume or continue post-graduate training in RI. A physician with a full license is not required to have a limited registration if in post-graduate training.

A physician may request that the full license be placed on inactive status if post-graduate training is to occur in another State.

12/15/2003 - Policy statement on office based esthetic procedures:

It is the position of the Board that office based cosmetic or esthetic procedures that require the use of medical lasers, high-frequency radio waves, or injection of sclerosing chemicals or biologically active compounds [e.g. Botulinum toxin A, Botox] are medical procedures.

Therefore, prior to undergoing such procedures patients must receive a medical evaluation for appropriateness by a licensed and qualified physician or other practitioner acting within his/her scope of practice. Although these procedures may be performed by an appropriately trained nonphysician working under the supervision and direction of a physician or other practitioner acting within his/her scope of practice, it is the supervising physician's [or other practitioner acting within his/her scope of practice] responsibility to assure that procedures are conducted appropriately; with appropriate assessment, consent and follow-up; and upon appropriate patients; and that all patient records are maintained according to standards applicable for medical records; and that patient privacy is protected. The supervising physician or other practitioner acting within his/her scope of practice is responsible for any procedures carried out by nonphysicians under his/her direction.

Physicians [or other practitioner acting within his/her scope of practice] who perform and supervise such procedures must be able to demonstrate appropriate training and experience. Such training and experience may include, but is not limited to, residency or fellowship. The physician or other practitioner acting within his/her scope of practice is responsible to assure and document adequate training for individuals under his/her supervision.

Additionally, other cosmetic procedures such as dermabrasion or the application of potentially scarring chemical treatments [e.g. so-called chemical peels] should also meet this same standard.

10/21/2003 - Position on colonic irrigation by licensed and unlicensed health care practitioners:

"It is the position of the Board of Medical Licensure and Discipline, that colonic irrigation is the practice of medicine. Colonic irrigation has no known medical benefit."