(We don't think so!)
With the rapid expansion of access to the internet in recent years, it is not too surprising that this wonderful tool brings a new set of issues to licensing authorities. Licensing boards across the country have been dealing with the practice of "telemedicine" and have taken positions about whether this type of practice will require full or limited licensure of physicians who utilize this technology. The issue each board has to decide is where the practice of medicine is occurring when the patient is in one state and the doctor is elsewhere in cyberspace. The Federation of State Medical Boards has taken the position that: "The practice of medicine occurs where the patient is." Thus, an out-of-state doctor using telemedicine to diagnose and treat a patient residing in Maryland would have to have a Maryland license or be acting as a consultant to a Maryland physician who has a bona fide doctor/patient relationship with the patient. Maryland physicians also should remember that if they practice medicine on patients elsewhere in cyberspace they are practicing in Maryland.
And now another issue has presented. Web sites have sprung up which advertise the availability of prescription medications on-line. No prescription? No problem. For a fee, an on-line consultation is available. The patient fills out a questionnaire which asks a number of health related questions. The questionnaire is submitted to the medical consultant and if the patient is approved, the patient is then assessed a fee for the consultation (generally $75) and the desired medication is subsequently provided by mail. All one needs is a credit card and the "right" answers, and medication is speeding on its way to his or her home in a "plain naked mailer."
The BPQA has serious concerns about this practice. Let's say the patient wants a drug like Viagra. Is an on-line questionnaire about the patient's past medical history really a medical consultation? Does a bona fide doctor/patient relationship exist when a person, previously unknown to the consultant, provides subjective answers to such questions as: "Do you have a heart disease?" Would a physician providing prescription medications to a patient based on a questionnaire be meeting the standard of care?
In February, the Federation of State Medical Boards (FSMB) participated in a meeting sponsored by the Food and Drug Administration to discuss on-line prescribing and sale of prescription medications. The FSMB attended to convey concern on behalf of state medical boards that engaging in Internet prescribing may be falling below acceptable standards of care, and may be endangering the health of individuals for whom they are prescribing.
The BPQA will be monitoring internet sites which advertise the availability of prescription medications after an on-line consultation. Any doctor providing the consultation or prescribing for a patient in Maryland who is not licensed in Maryland can be subject to up to a $50,000 fine for practicing medicine without a license. Doctors licensed in Maryland can expect their on-line prescribing to be subjected to peer review. Anyone with information about on-line consultation leading to prescription medications should contact the BPQA by phone at 1-800-492-6836, or by e-mail at BPQA@ EROLS.COM.
CLAYTON J. COWAN, M.D., License #: No License, Specialty: Anesthesiology (Tampa, FL) Application for licensure granted; probation for five (5) years subject to terms and conditions. The physician was disciplined by the Pennsylvania Board of Medicine based on its finding of the physician's inability to practice medicine and surgery because of illness and addiction to drugs and alcohol. The Pennsylvania discipline provided for a stayed suspension and probation subject to terms and conditions. Date of Action: 10/21/98.
ROBERT B. GOLDSTEIN, M.D., License #: D01275, Specialty: Urology (Baltimore, MD ) Surrender of License. The physician's surrender was prompted by his age, his plans for retirement, and an investigation of allegations that he engaged in inappropriate and unprofessional sexual comments while performing examinations of one female patient and two male patients in his office. Date of Action: 10/21/98.
PAULA A. MCKENZIE, M.D., License#: D35226, Specialty: OB/GYN (Bowie, MD) Reprimand; terms and conditions. The physician failed to meet standards of care in regard to three obstetrical patients. Date of Action 10/21/98.
JAMES R. RALPH, M.D., License #: D09679, Specialty: Psychiatry (Baltimore, MD) Violation of Consent Order of December 18, 1996. Suspension for 60 days, all but 2 weeks stayed; Probation for 3 years subject to terms and conditions. The physician continued to overbill although the Board's original consent order of December 18, 1996, advised him of billing irregularities and that he was being monitored for those irregularities. Date of Action: 10/21/98.
ANTONIO A.M. BERTUMEN, M.D., License #: D21651, Specialty: OB/GYN (Baltimore, MD) Reprimand; terms and conditions. The physician failed to meet standards of care with regard to a patient in his practice of obstetrics and gynecology. Date of Action: 10/28/98.
ANTONINO H. CALON, M.D., License #: D20655, Specialty: Internal Medicine (Havre de Grace, MD) Revocation. Violation of the Board's consent order of April 11, 1995, that is, failing to practice competently and within the standard of care for ten (10) patients as determined by peer review conducted during his probationary period. Date of Action: 10/28/98.
ROBERT MILLMAN, M.D., License #: D13977, Specialty: Family Practice (Rockville, MD) Suspension for thirty (30) months; stayed; probation for thirty (30) months subject to terms and conditions. The physician failed to meet appropriate standards of care in his practice of family medicine. Date of Action: 10/28/98.
KI N. LEE, M.D., License #: D23473, Specialty: Anesthesiology (Potomac, MD) Suspension for three (3) months; effective November 2, 1998; upon reinstatement, probation for three (3) years subject to terms and conditions, one of which is having his practice restricted to outpatient pain management. The physician failed to meet appropriate standards of care in cases in which the Respondent provided anesthesia care for two patients. Date of Action: 10/28/98.
CARL R. SHOWALTER, M.D., License #: D11537, Specialty: Psychiatry (Harrisonburg, MD) Revocation. The physician was disciplined by the Virginia Board for unprofessional conduct based on his representation to seven patients that masturbation therapy is a legitimate treatment for various disorders; the physician had patients engage in this activity during therapy, did this to patients, and took nude pictures during therapy sessions. Date of Action: 10/28/98.
ALBERT H. DUDLEY, III, M.D., License #: D22935, Specialty: Orthopedic Surgery (Owings Mills, MD) Suspension for six months with all but six weeks stayed; effective November 20, 1998; probation for three years subject to terms and conditions; fine of $10,000. The Board found that the physician was guilty of unprofessional conduct in the practice of medicine; that the physician failed to meet standards of care; and that the physician prescribed drugs which were not medically necessary to one patient. Date of Action 11/4/98.
MARTIN J. SHUMAN, M.D., License #: D08334, Specialty: Opthalmology (Glen Burnie, MD) Limitation on practice as follows: the physician will perform no surgery, including but not limited to the YAG procedure, and will practice in an office setting only. Date of Action: 11/4/98.
JOSEPH K. SARFO, M.D., License #: Nonrenewed 1987, Specialty: Pediatrics (Talihina, OK) Application for reinstatement denied. The Maryland action is based on the action of New York: (1) by the medicaid program to exclude the physician's participation for five years, (2) by a New York hospital to terminate temporary privileges and to deny his application for privileges for furnishing the hospital false information about his Medicaid exclusion, and (3) by the New York Medical Board to put the physician on probation when the physician returns to the state. Date of Action: 11/10/98.
STANLEY Z. FELSENBERG, M.D., License #: D01085, Specialty: None (Baltimore, MD) Suspension. In accordance with the mandate of the Court of Appeals of Maryland the suspension order of May 22, 1996, is affirmed and thereby reinstated. Date of Action: 11/10/98.
John K. Aziz, M.D., (formerly John D. Tolliver, M.D.) License #: D36868, Specialty: None (Baltimore, MD) Reinstatement order (license to be reinstated upon filing and processing of licensure forms); probation for five (5) years subject to terms and conditions. The physician has met the requirements for reinstatement. Date of Action: 11/18/98.
BARBARA N. VAN HORN, M.D., License #: D28796, Specialty: None (Washington, DC) Reprimand. The physician was in breach of a federal service requirement as a result of federal loans granted to finance her medical school education. Date of Action: 11/18/98.
KUM HAI LEE, M.D., License #: D24844, Specialty: None (Rockville, MD) Fine of $1,000. The physician practiced medicine with an expired license. Date of Action: 11/16/98
DARRELL M. GRAY, M.D., License #: D21711, Specialty: Internal Medicine (Baltimore MD ) Reprimand and fine of $1,000. The physician failed to provide documentation of 50 hours of category I continuing medical education credits and failed to respond to letters requesting the documentation verifying the 50 hours of CME credits. Date of Action: 11/18/98.
CHONG MIN PARK, M.D., License #: D28699, Specialty: Orthopedic Surgery (Westminster, MD) Fine of $1,000. The physician failed to correctly answer the question on his licensure renewal regarding continuing medical education. Date of Action: 12/16/98.
The Physician Palliative Care Hotline has been established as a toll-free number: 1-800-492-3805. It is available to physicians who wish to obtain immediate free consultation on pain management in palliative care. The initial call will be handled through the Emergency Medical Resource Center answering services.
The physician calling the hotline should request the "pain hotline." The dispatcher will take the calling physician's name and phone number and will indicate that a pain management physician will call back within 15 minutes. The on-call physician will be paged immediately. All on-call physicians are board-certified in hospice and palliative care medicine.
NOTE: As with any consultation, ultimate responsibility rests with the treating physician.
The Board of Physician Quality Assurance endorses the ethical guidelines of the American Medical Association, the American Osteopathic Association and the American Psychiatric Association. These organizations provide thoughtful and widely accepted guidelines for ethical conduct for the medical profession. In June of 1998, the AMA adopted the Council on Ethical and Judicial Affairs report entitled "Sexual or Romantic Relations Between Physicians and Key Third Parties." The position adopted by the AMA defines sexual contact with key third parties that occurs concurrent with the patient\physician relationship as unethical and therefore constitutes sexual misconduct. Because this is an issue of considerable importance to physicians, the AMA recommendations are reproduced below:
1). Patients are often accompanied by third parties who play an integral role in what has usually been seen as a dyadic patient-physician relationship. The physician interacts and communicates with these individuals about the patient's condition and is in the position to offer them information, advice, and emotional support. The more deeply involved the individual is in the medical decision-making and clinical encounter, the more troubling is any sexual or romantic contact with the physician. This is especially true for the individuals whose decisions directly impact on the health and welfare of the patient. Such key individuals may include, but are not limited to: spouses or partners, parents, guardians, surrogates, and proxies designated by durable power of attorney.
2) The risk of exploitation can vary with the intensity and emotional nature of treatment. Several things contribute to the vulnerability of the patient and key third party: the nature of the patient's medical problem; the length of the professional relationship; the degree of emotional dependence the third party has on the physician; and the importance of the clinical encounter to the surrogate and patient.
3) Physicians should refrain from sexual or romantic interactions with these key third parties. Sexual contact with these individuals that occurs concurrent with the patient-physician relationship is unethical and constitutes sexual misconduct.
(References pertaining to this report are available from the AMA Office of Ethics Standards.)
For the last two years the BPQA Newsletter has provided licensees with the ballot to vote on the candidates nominated to fill openings on Board. This year, MedChi has again asked BPQA to distribute the ballot. MedChi has also established some new ground rules. In order to be a nominee, an individual must be placed in nomination by a physicians organization of at least 25 members or be supported by 25 Maryland licensed physicians. Ballots will be distributed to all Maryland licensed physicians. Results of the election will then be forwarded to Governor Glendenning who will select the replacements for retiring Board members. This year BPQA will lose Dr. Charles Hobelmann and Dr. Suresh C. Gupta who have served the maximum of two terms and who are not eligible for reappointment. Dr. Mary M. Newman whose term also expires this year is eligible for reappointment to a full four-year term. Dr. Newman's name will be submitted to the Governor by MedChi for reappointment in accordance with the Annotated Code of Maryland, Health Occupations 14-202 (d).
Certification for all Medical Radiation Technologists and Nuclear Medical Technologists will expire on April 30, 1999. Renewal packets were be mailed out the first week of March. If you have moved since the 1997 renewal, you must notify the Board, in writing, of your new address. If this is your first renewal, you are exempt from the 24 hours of continuing education. All other technologists are required to have 24 hours of continuing education which must be accrued between May 1, 1997 and April 30, 1999.
If you are certified as both a Medical Radiation Technologist and a Nuclear Medical Technologist, you will not be required to have 48 hours of continuing education. You may satisfy the continuing education requirement by documenting 24 hours from programs which are relevant to either designation.
On or about April 1, 1999, new regulations will go into effect requiring physicians who are applying for the first renewal of a Maryland Medical License to attend the Board of Physician Quality Assurance New Physician Orientation Program. This means that if you received your initial medical license within the last two years, and your license expires in 1999 (your last name begins with the letters M-Z), you must attend this orientation program as a requirement for the renewal of your license. If you have already attended an orientation, you should have received a certificate indicating your attendance. The BPQA may defer this requirement for license renewal for physicians who are not practicing medicine in Maryland. These deferments will be handled on an individual basis. THE ORIENTATION IS DIVIDED INTO THREE SEGMENTS
1. The Board of Physician Quality Assurance
Attendees will learn the essential elements of the Maryland Medical Practice Act and regulations affecting their practice of medicine in Maryland, the role and function of BPQA, and the essentials of the "peer review" process, and the physician's responsibility in the process. State agencies a physician must contact for permits, forms, and information essential in the practice of medicine are enumerated and many of the forms are supplied at the orientation.
2. Boundary Issues
Participants are guided through the BPQA disciplinary process and examine actual sanitized cases to understand the decision making process the Board employs. This segment demonstrates the situations which could become potential problems and should stimulate physicians to begin thinking about the danger signals of boundary violations. In addition, BPQA Board members address topics including the balance of power in a physician/patient relationship, the patient who makes unethical requests, as well as appropriate office atmosphere.
3. Prescribing CDS
The video, A Sense of Balance presents the position of the Maryland Board of Physician Quality Assurance as well as that of the Federation of State Medical Boards on prescribing to patients with pain. Participants examine cases brought before the Board which deal with pain treatment to develop an understanding of the Board's position on prescribing controlled drugs.

March 8, 1999 Memorial Hospital Easton, MD May 19, 1999 Montgomery County Medical Society March 11, 1999 MedChi Offices 1211 Cathedral Street June 7, 1999 Southern Area - Civista HospitalMarch 18, 1999 Montgomery County Medical Society June 10, 1999 MedChi Offices 1211 Cathedral StreetApril 5, 1999 Western Area June 16, 1999 Montgomery County Medical SocietyMay 3, 1999 Penninsula Gen Hospital Salisbury, MD July 8, 1999 MedChi Offices 1211 Cathedral StreetMay 13, 1999 MedChi Offices 1211 Cathedral Street July 14, 1999 Montgomery County Medical Society
This program can also be approved for Category I CME (3-Hours).
These programs are free. However, everyone must register to attend. If you are applying for CME, please make reservations at least three weeks in advance of the orientation. The program begins at 6:00 p.m. and ends at 9:00 p.m. A light dinner is provided.
For more information about these programs or to register for one of these programs, call Education and Training Unit of BPQA at 410-764-5972.
The renewal applications for physicians whose last names begin with the letters M-Z will be mailed in late June to the last address the physician supplied to the Board. Please notify the Board if you have not received your renewal application by the middle of July. Earning 50 Category I CME's is a requirement for renewal. If you are unsure of what constitutes Category I CME's, contact the Board and request a copy of the CME regulations. Please also pay close attention to when your CME's should have been earned and how long you should keep the documentation. Additional requirements apply for first time renewal. (See article on page 5.)
Physicians whose renewal applications are not postmarked by September 30, 1999, are no longer licensed to practice in Maryland. In the two month period following expiration of licensure, the Board will accept the renewal form with the renewal application fees and a $50 late fee. Until their licenses are renewed, physicians who file late applications are not authorized to practice medicine. Any physician who does not renew the license by the end of the two month period will have to apply to reinstate the license.
There will not be an increase in the licensure fee for this renewal. The last fee increase occurred in 1991.