In 1999, over 1800 physicians attended the Board of Physician Quality Assurance's (the "BPQA")New Licensee Orientation seminar. This 3-hour course became a requirement through regulations effective April 5, 1999. Physicians must attend prior to their first license renewal but physicians who have been licensed for more than two years are not affected by this requirement.
The new licensee seminars were started because of the BPQA's recognition that practicing medicine in Maryland is a highly regulated activity. Although ignorance of the law is not accepted as a defense, the BPQA wanted to do its part to educate its licensees and to help reduce the inadvertent breeches of Maryland laws caused by ignorance. Additionally, the course addresses two areas of great importance: appropriate boundaries between physicians and their patients and appropriate management of their patients' needs for pain relief without fear of sanction from the licensing board.
Response to the course has generally been positive. In April of 1999, the BPQA was awarded the "Best of the Boards" award by the Administrators in Medicine for developing the new licensee orientation program. Many physicians have expressed gratitude that the BPQA is conducting this out-reach activity and admitted that they "didn't know what they didn't know" until they were exposed to this course. Often physicians remained after the sessions to ask individual questions. Some physicians expressed the opinion that all licensees should attend and that the activity should be repeated every five years. Other physicians said they didn't want to come. A few physicians were angry about being made to attend and felt the course was a big waste of their time.
The BPQA doesn't have the luxury of knowing who "needs" education about the law. But there is some optimism that engaging in prevention will reduce the number of complaints against physicians. BPQA members are acutely aware of the career devastation that follows disciplinary actions. This seminar, targeting physicians early in their careers, is the BPQA's main outreach activity to try to keep doctors from "coming into our sights". Once the BPQA receives a complaint, the focus is on protecting the public, not the physician. But through the seminars, over 1800 physicians know that they can call the BPQA at 410-764-4777 for advice and assistance when they need guidance about the laws governing the practice of medicine in Maryland.
Physicians with names beginning A to L will renew their licenses next September. If you are a physician facing your first renewal, please don't wait until the last minute to attend this course. You could end up with late fees or no license come September 30, 2000. Any BPQA licensee is welcome to attend the seminars, even if it is not a renewal requirement for the individual.
Information about upcoming orientation session and registration can be found on page 4
of this issue of BPQA Newsletter.
Michael F. Mecinski, M.D., License #D44387, Specialty: None (Baltimore, MD). Suspension. The physician did not begin a residency program or an approved alternative program as required by his consent order dated February 24, 1999. Date of Action: July 1, 1999.
Ann Kathleen Cox-Teel, M.D., No License, Specialty: None (Dallas, TX). Application for licensure to be granted upon completion of condition; if granted then license reprimanded. The applicant was not able to provide proof of CMEs to the Texas Board, was investigated for this at the Texas Board, and did not report this to the Maryland Board. Date of Action: July 20, 1999.
Robert Michael Altman, M.D., License #D35189, Specialty: Psychiatry (Alexandria, VA). License reinstatement denied. The Board based its action on the Surrender of the Respondent's Virginia license because of the Virginia Board's investigation of sexual boundary crossing with a patient. July 28, 1999.
Edward P. Costlow, M.D., License #D19503, Specialty: None (Lutherville, MD). Reprimand; probation for one (1) year subject to conditions. The physician falsified his Maryland license to practice medicine and CDS registration, and his federal DEA registration, and practiced medicine with a non-renewed license. July 28, 1999.
Louis V. Gabaldoni, M.D., License #D25067, Specialty: OB/GYN (Philadelphia, PA). Reprimand; charges under §14-404(a)(3), (6), and (11) are dismissed. The physician failed to meet standards of care in the obstetric care provided to a patient. July 28, 1999.
Ronald A. Koval, M.D., License #D22349, Specialty: OB/GYN (Silver Spring, MD). Terms and conditions. The physician failed to cooperate with an investigation of the Board in that he did not monitor all correspondence to his address of record, respond to inquiries from the Board, and advise the Board of any change in his address of record. July 28, 1999.
Laurence T. Allen, M.D., License #D24293, Specialty: Psychiatry (Washington, DC) Reprimand; terms and conditions. The physician violated a term of his consent order of August 27, 1994, with regard to enrolling in and successfully completing a medical records course. Date of Action: August 25, 1999.
Robert D. Skipworth, M.D., License #D28906, Specialty: Family Practice. (Laurel, MD) Revocation. The physician was found guilty of prescribing controlled dangerous substances in violation of the Md. Ann. Code, Article 27, Section 288, and was thereby subject to statute which requires revocation of his license. Date of Action: August 10, 1999.
Nicholas G. Scotto, M.D., License #D43246, Specialty: Psychiatry (Salisbury, MD) Reprimand; terms and conditions for four (4) years. The physician wrote prescriptions for Controlled Dangerous Substances for himself in the names of others and issued undated CDS for patients. Date of Action: August 25, 1999.
Sylvanus Achu, M.D., Registration #P13158, Specialty: Internal Medicine (Baltimore, MD). Surrender of Registration. The physician's decision to surrender his registration was prompted by his suspension from a hospital residency program, his later resignation from the program, and the Board's investigation into a complaint about his prescribing a Controlled Dangerous Substance to a patient with whom he had a personal relationship. Date of Action: August 26, 1999.
Bruce I. Lobar, M.D., License #D35586, Specialty: Neurology (Berlin, MD). License subject to terms and conditions. In his application for license renewal the physician failed to advise the Board that his application for privileges at a hospital had been denied, and in his application for hospital privileges in 1989 and 1996 the physician failed to accurately disclose his residency history. Date of Action: August 27, 1999.
Raul Ruiz-Camauer, M.D., License #D21583, Specialty: Anesthesiology (Buenos Aires, Argentina). Surrender. The physician's decision to surrender was prompted by the fact that he now resides in Argentina and an investigation of his licensure and a peer review report that concluded that he breached the standard of care in the administration of an epidural regional anesthetic to a patient and by failing to adequately monitor the patient's ventilatory function after general anesthesia was induced. Date of Action: September 8, 1999.
Joseph O. Boggi, D.O., License #H36807 Specialty: Internal Medicine (Silver Spring, MD). Suspension for one (1) year and thereafter until compliance with conditions. The Board found that the physician was incompetent to practice medicine, committed unprofessional conduct in the practice of medicine, and failed to cooperate with a Board investigation. Date of Action: September 22, 1999.
Roland Imperial, M.D., License #: D05276, Specialty: Nuclear Medicine and Anatomic Pathology (Bethesda, MD). Summary suspension. The Board concluded that the physician was guilty of unprofessional conduct, failed to meet standards of care, failed to comply with CDC guidelines on universal precautions, failed to cooperate with a Board investigation, and failed to keep adequate medical records. Date of Action: September 22, 1999.
Raman K. Sood, M.D., License #D33298, Specialty: Internal Medicine and Medical Oncology (BelAir, MD). Reprimand; probation for three (3) years subject to conditions. The Board found the physician guilty of unprofessional conduct and failure to meet standards of care in the physician relationship with a patient. Date of Action: September 22, 1999.
Imran U. Khan, M.D., License #D38932, Specialty: Neurology (Pueblo, CO). Reinstatement of licensure is denied. The physician was disciplined by the licensing authority of Colorado (revocation of license) for acts that would be grounds for discipline in Maryland, that is, violation of standards of care, overutilization of tests, studies, and treatment, and failing to make essential entries on patient records. Date of Action: September 29, 1999.
Since June 1, 1999 when HB 674 became effective, the Board and its staff have been busy with the tasks associated with the new law. HB 674 "Health Occupations - Physician Assistants Prescriptive Authority" replaces the former "Job Descriptions" with "Delegation Agreements" and authorizes physicians to delegate to physician assistants the authority to write medication orders and/or exercise prescriptive authority. All physician assistants must transfer from job descriptions to delegation agreements.
Previous job descriptions listed all medical acts to be delegated to the physician assistant. While the new agreements require a description of medical acts delegated by the supervising physician to the physician assistant, they do not require a detailed list of medical acts to be delegated. The new law gives broad latitude to the physician to delegate responsibilities and procedures to the PA with whom the agreement is signed. Under the new law the Board may not authorize a physician to delegate medical acts under a delegation agreement to more than 2 physician assistants in a non-hospital setting.
The Board of Physician Quality Assurance is responsible for protecting the public and for approval of the delegation agreements. Physicians are reminded that when duties and responsibilities are delegated, the physician is responsible for the care rendered by the physician assistant. The Board considers the PA an agent of the physician in the performance of all practice related activities. A physician assistant is required to wear an identification tag or badge which identifies the individual as a physician assistant and must identify himself/herself as a physician assistant.
Physicians and physician assistants should carefully read the laws and regulations that will apply to entering into delegation agreements. Ignorance of the law or regulations will not be an excuse for violations. The statute and regulations can be found at the Board's website (http:\www.docboard.org). Look for the link under "Hot Topics."
The Board's Physician Assistant Advisory Committee meets regularly on the second Wednesday of each month at 4201 Patterson Ave., Baltimore. This meeting is open to the public. Call 410-764-4768 to confirm date, time and room as meeting places and dates are subject to change.
The Board of Physician Quality Assurance continues to conduct its free orientation programs for newly licensed physicians in Maryland. These three-hour sessions provide physicians with information about the laws governing the practice of medicine in Maryland, and information about the Board's position on issues including standards of care, inappropriate/sexual behavior, fraudulent billing, substance abuse, prescribing pain medications and many others. The participants review case studies to develop an understanding of the Board's authority and responsibility. The sessions are held across Maryland in various locations. For information about the orientation sessions, please contact Rod Clark, Education and Training Director, at 410-764-2492, or 1-800 492-6836, ext. 2492. All programs will begin at 6:00 p.m. and will end by 9:00 p.m. unless otherwise noted.
Please notify BPQA with your first and second program preferences, from the schedule below and notify BPQA by mail or fax of your preference information. Also include your name, address, and telephone number where you can be reached during normal business hours. You will be notified of your registration and receive directions and a course outline once you have been scheduled by BPQA for this program. Physicians may earn 3-hours Category I Continuing Medical Education Credits toward licensure renewal. Fax your registration information to 410-358-2252.
December 6, 1999 Civista Hospital (LaPlata. MD)
December 9, 1999 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
January 12, 2000 Cumberland Memorial Hospital Center (Cumberland, MD)
January 13, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
January 20, 2000 Montgomery County Medical Society (Rockville, MD)
February 10, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
February 19, 2000 BPQA Office 4201 Patterson Ave (Baltimore, MD) 10:00 A.M. - 1:00 P.M.
March 1, 2000 Southern Area (Civista Hospital LaPlata, MD) 5:00 P.M. - 8:00 P.M.
March 7, 2000 Memorial Hospital (Easton, MD)
March 9, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
March 15, 2000 Montgomery County Medical Society (Rockville, MD)
April 3, 2000 Sacred Heart Hospital (Cumberland, MD)
April 13, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
April 15, 2000 BPQA Office 4201 Patterson Ave (Baltimore, MD) 10:00 A.m. - 1:00 P.M.
May 1, 2000 Peninsula Regional Medical Center (Salisbury, MD) 5:00 P.M. - 8:00 P.M.
May 11, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
May 17, 2000 Montgomery County Medical Society (Rockville, MD)
June 5, 2000 Civista Hospital (LaPlata MD) 5:00 P.M. - 8:00 P.M.
June 8, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
June 14, 2000 Montgomery County Medical Society (Rockville, MD)
July 6, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
July 12, 2000 Montgomery County Medical Society (Rockville, MD)
August 10, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
August 19, 2000 BPQA Office 4201 Patterson Ave. (Baltimore, MD) 10:00 A.m. - 1:00 P.M.
September 14, 2000 MedChi Offices 1211 Cathedral Street (Baltimore, MD)
September 21, 2000 Montgomery County Medical Society (Rockville, MD)
September 23, 2000 BPQA Office 4201 Patterson Ave. (Baltimore, MD) 10:00 A.M. - 1:00 P.M.
City: ______________________________________ State: ____ Zip Code ___________________
Telephone :_______________Fax : ______________ E-Mail Address: ______________________
1st Preference:_________________ 2nd Preference: _________________
Please Indicate your first and second program preference.
You will receive a confirmation of your registration and directions once you have been scheduled by BPQA for this program.
The BPQA is guided by the ethical guidelines of the American Medical Association (AMA), the American Osteopathic Association, and the American Psychiatric Association. The following is excerpted from the AMA guidelines dealing with sale of "health related products" from doctors' offices:
In-office sale of health-related products by physicians presents a financial conflict of interest, risks placing undue pressure on the patient, and threatens to erode patient trust and the primary obligation of physicians to serve the interest of their patients before their own. When these items offer some health-related benefits the physician's influence over the sale is amplified and makes it even more necessary to place limits on such activities.
1. Physicians who do sell health related products from their offices should not sell any health-related good whose claims of benefit lack scientific validity. Physicians should rely on peer-reviewed literature and other unbiased scientific sources that review evidence in a sound, systematic fashion when judging the efficaciousness of the product.
2. Physicians who sell health-related products from their offices should follow these guidelines to limit their conflicts of interest minimize the risk of brand endorsement, and ensure a focus on benefits to patients.
a). Physicians may distribute health-related products to their patients free of charge or at cost, in order to make useful products readily available to their patients. When health-related products are offered free or at cost, it removes the elements of personal gain and financial conflicts of interest that may interfere, or appear to interfere, with the physician's independent medical judgment.
b). Except under certain circumstances, such as those described in Opinion 8.032, "Conflict of Interest: Physician Ownership of Medical Facilities," physicians should not sell a health-related good when patients can obtain a product that offers the same medical benefit at a local pharmacy or health-products store.
c). Physicians must disclose fully the nature of their financial arrangement with a manufacturer or supplier to sell health-related products. Disclosure includes informing patients of financial interests as well as about the availability of the product or other equivalent products elsewhere. Disclosure can be accomplished through face-to-face communication or by posting an easily understood written notification in a prominent location that is accessible by all patients in the office. In addition, physicians should, upon request, provide patients with understandable literature that relies on scientific standards in addressing the validity of the health-related good.
3. Physicians should not participate in exclusive distributorships of health-related products, in which the products are available only through physicians' offices and for which product there is no comparable alternative available at a local pharmacy or health-products store. Physicians should encourage manufacturers to make their products more widely accessible to patients.
CEJA Report 1-A-99- page 5
Attention physicians who last names begin with M-Z: New Maryland law requires that BPQA make certain information available to the public. Look for your physician profile in the mail within the next several weeks. Do not discard this mail from the Board. Please carefully review your initial profile, correct any factual errors and mail the correct profile to Board within the specified amount of time. For further information, check out "Hot Topics" at our website at www.docboard.org.
Three physicians and one public member were appointed to the BPQA by Governor Parris Glendenning. Our new public member is Willie Lena Austin, Ph.D., who obtained her doctorate in Mycology from Atlanta University. Dr. Austin teaches microbiology at Howard University in Washington, D.C. and has worked as an international consultant on health care problems pertinent to pathological fungal infections. Dr. Austin lives in Capital Heights, Maryland.
Carol Bender, M.D. is in private practice in Rockville, Maryland. A graduate of State University of New York Upstate Medical Center, she also trained at the Washington Hospital Center in Washington, D.C., and is board eligible in internal medicine. Dr. Bender obtained a Masters of Science in Business from The Johns Hopkins University in 1996.
Elizabeth Serrin Gantt, M.D. practices gastroenterology in Rockville, Maryland. Dr. Gantt graduated from The Johns Hopkins School of Medicine and did further training both at Hopkins and Yale University in New Haven, Connecticut. She is board certified in both internal medicine and gastroenterology.
Baltasar Velez, M.D. practices general surgery in Baltimore, Maryland. Dr. Velez obtained his medical degree from the University of Havana in Havana, Cuba. He did his post graduate training at St. Joseph Hospital in Mishawaka, Indiana, and at St. Joseph Hospital in Baltimore, Maryland.
With the addition of these new members, two thirds of the BPQA board has less than two years of service on the BPQA. Sidney Seidman, M.D. assumed the chairmanship of the Board in July and has been working hard to educate our new members about Board process. Our new members have shown enthusiasm and energy. They have demonstrated that they are eager to contribute their skills to fulfilling the charge of the Board to protect the public and maintain a high standard of medical practice among Maryland physicians.
Attention physicians who last names begin with M-Z: New Maryland law requires that BPQA make certain information avaiable to the public. Look for your physician profile in the mail within the next several weeks. Do not discard this mail from the Board. Please carefully review your initial profile, correct any factual errors and mail the correct profile to Board within the specified amount of time. For further information, check out "Hot Topics" at our website at www.docboard.org.