healthlaw114notes.pdf LAW H 501
Columbia Law School
Popular in Fundamentals of Health Law
Popular in Law
This 6 page One Day of Notes was uploaded by Minyoung Choi on Wednesday November 5, 2014. The One Day of Notes belongs to LAW H 501 at Columbia Law School taught by Sallie Sanford in Fall. Since its upload, it has received 240 views. For similar materials see Fundamentals of Health Law in Law at Columbia Law School.
Reviews for healthlaw114notes.pdf
Eugh...this class is soo hard! I'm so glad that you'll be posting notes this semester.
Report this Material
What is Karma?
Karma is the currency of StudySoup.
You can buy or earn more Karma at anytime and redeem it for class notes, study guides, flashcards, and more!
Date Created: 11/05/14
Fundamentals of Health Law class notes 114 HEALTH CARE PROFESSIONAL LICENSING INSTITUTIONAL LICENSINGACCREDITATION Guest Speaker Cindy Jacobs HEALTH CARE PROFESSIONAL LICENSING AND SCOPE OF PRACTICE Title 18 RCW lists different health care business and professions Includes East Asian medicine recreation therapy animal massage practitioners athletic trainers body artpiercingtattooing and social workers What is the Practice of Medicine RCW 1871011 A person is practicing medicine if he does one or more of the following 1 Offers or undertakes to diagnose cure advise or prescribe for any human disease ailment injury infirmity deformity pain or other condition physical or mental real or imaginary by any means or instrumentality Including telemedicine 2 Administers or prescribes drugs or medicinal preparations to be used by any other person 3 Severs or penetrates the tissues of human beings Piercing the skin Would include acupuncture too which is probably included in East Asian medicine Statutory quotCarveouts License permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission Allows the licensee to perform prescribed health professional tasks and to use a particular title Certification may perform prescribed health professional tasks Registration formal notification submitted to a state agency prior to rendering services Exempt from MD licensing 0 Activities that may meet the definition of the practice of medicine performed by Good Samaritans rendering emergency medical assistance or by people caring for family members in the home 0 Activities that constitute the practice of medicine performed by medical students Must take place under the supervision and control of a physician licensed under the MD licensing laws Other exemptions eg GME TR license out ofstate MD very limited Similar although not identical exemptions for other types of licenses eg RN PA Hypotheticals MD teaches MA how to suture a simple laceration Can the MA now perform this procedure NO Suture piercing of skin practice of medicine PA supervises MD student who gives an injection to a patient is this okay NO Injection piercing of skin and administration of drug practice of medicine MD student must be supervised by a licensed physician ARNP Advanced Registered Nurse Practitioner supervises MD student who examines and assess patient is this okay Fundamentals of Health Law class notes 114 9 YES AS LONG AS ARNP makes it very clear to the patient and to the student that she is the one in charge and has the last say on the examination and assessment Examining and assessing is within the scope of ARNP practice MD supervises RN student is this okay 9 YES MD can supervise anyone of the same level or under MD practice encompasses RN practice 9 PA probably cannot supervise RN student RN Delegation Frequently misunderstood Can go up someone else RN or down RN someone else Downward delegation is very narrow and specific httpwwwdohwagovportals1Documents6000NurseDelegWSpdf httpwwwdohwagovPortals1Documents6000RegisteredNurseDelegationInSchoolS ettingspdf Upward delegation is simply the statutory carveout for RN licensure Nursing commission has a very helpful scope of practice decision tree httpwwwdohwagovPortals1DocumentsPubs609305pdf Trick Hypothetical A small group of physicians and nurses want to volunteer at a homeless shelter to provide foot care They would like to go to the drugstore and purchase some small sizes of OTC topical ointments etc to give to people as indicated is this okay What licensing laws are implicated 9 Constitutes practice of medicine even if OTC ointment 9 Rules on documentation of diagnoses and board of pharmacy regulations 9 Patient health information implications even if physicians and nurses keep documentation Patients must be registered at registered entities eg hospitals and clinics This is why many shelters will have health programs associated with hospitals and clinics 9 More a problem of risk than licensing 9 The group of physicians and nurses ended up just providing basic care eg clipping toenails and referrals Unauthorized practice of medicine is analogous to unauthorized practice of law A lawyer39s scope of practice encompasses a paralegal s scope of practice A lawyer can supervise a paralegal how to do legal work but there are some things only lawyers can do A doctor who owns his own clinic might think that he can make his nurses do his job but legally nurses can do things only within the scope of their practice Licensing Enforcement Governed by DOH BoardCommissions Specific licensing laws Uniform Disciplinary Act Fundamentals of Health Law class notes 114 Unauthorized practice UnprofessionaI conduct Competence standards of practice Sex drugs and rock and roll 0 Conduct standards 0 Impairment TELEMEDICINE AND OUT OF STATE LICENSING Largest hurdles to Telemedicine Reimbursement Licensure portability Local Regulatory Authority Several American colonies required medical licenses for local practice To protect the public from imposters eg fake doctors To protect the business interests of trained physicians don t want doctors from out of state to steal business State Regulatory Authority 10quot Amendment to the US Constitution The powers not delegated to the United States ie the federal government by the Constitution nor prohibited by it to the States are reserved to the States respectively or to the people gtgtgt Q Couldn39t Congress use the Commerce Clause to regulate telemedicine I guess they don39t want to mess with what was traditionally under state and local discretion Not like doctors are using USPS for teIemedicine Dent v West Virginia 129 US 114 123 1889 WV conviction for practicing medicine without a license is not in violation of the 14quot Amendment Due Process Clause Due consideration therefore for the protection of the society may well induce the State to exclude from practice those who have not such a license or who are found upon examination not to be fully qualified States generally agree that physicians treating patients through telemedicine are practicing medicine in the location of the patient States do not agree when Iicensure is required and when it is exempt What s the Big Deal Criminal Prosecution unlicensed practice of medicine is a crime in most states Licensure unlicensed practice is professional misconduct in the state of the patient Once that state takes action WA can reciprocate Medical Malpractice in ID the burden shifts to an unlicensed physician defendant to prove her services were within the standard of care if licensed burden on plaintiff Fundamentals of Health Law class notes 114 WA Law Broad Definition of Practice of Medicine RCW 18710111 A person is practicing medicine if he or she h offers or undertakes to diagnose cure advise or prescribe for any human disease ailment injury infirmity deformity pain or other condition physical or mental real or imaginary by any means or instrumentality Licensure Required RCW 1871021 No person may practice or represent himself or herself as practicing medicine without first having a valid license to do so Express Exemption to Licensure RCW 18710306 The practice of medicine by any practitioner licensed by another state or territory in which he or she resides provided that such practitioner shall not open an office or appoint a place of meeting patients or receiving calls within this state M AC Medical ualit Assurance Commission Construes Exem tion Narrowl Rules of statutory construction require exemptions to be narrowly construed MQAC construction is very narrow The licensure exemption in RCW 18710306 does not apply to Telemedicine practice MQAC Telemedicine Policy Effective 1 04201 4 Appears not to apply to pro bono consultations Practice of medicine occurs at location of patient Except when treated patient in WA and conducting a brief follow up through Telemedicine to patient in other state State Law Generally License required in state of patient location Some states have telemedicine licenses Some states have limited consultation exemption 0 Same specialty Does it make a difference if eg a PCP asks a specialist 0 Frequency Does it matter how often the consultation happens 0 Payment Does it make a difference if it was a paid consultation AK Telemedicine License required Except free curbside consult with AK located licensed MD Can t prescribe controlled substance without performing physical exam Can be done by licensed healthcare provider with patient 2012 guideline 92014 statutory safe harbor from licensure action without personally conducted physical exam if Exam conducted by a licensee with patient 4 Fundamentals of Health Law class notes 114 Physician or her group practice is available for follow up Patient consents to and actually sends records to patient s PCP privacy concerns Tele psychiatry in AK AK HHS seeking clarification of AK Board39s position applied to tee psychiatry where Standard of care is almost never to physically examine patient Patients have to choose between prescription and privacy consent to disclose to PCP Big problem because there are not that many psychiatrists in AK Federal Portability Attempts HR 2001 Veteran s E Heath amp Telemedicine Support Act VETS Act of 2013 Would allow any licensed health care professional employed or contracted in the Veterans Affairs system to practice in any location in any state through the use of telemedicine regardless of state of licensure Probably will survive because Veterans Affairs HR 3077 Telemedicine for Medicare Act T ee Med Act of 2013 Would allow for a Medicare provider licensed in one state to treat any Medicare beneficiary in any other state via telemedicine without requiring licensure where the patient is located Most likely will die in Congress Even if miraculously passed states will challenge and win Interstate Medical Licensure Compact WA Expected to significantly reduce barriers to the process of gaining licensure in multiple states helping facilitate licensure portability and telemedicine while expanding access to health care by physicians particularly in underserved areas of the nation Authorized by Article 1 10 Clause 3 of the US Constitution Contains elements of both contract and statutory law MQAC asked governor lnslee to request its adoption Several medical boards from other states have expressed written or verbal support Compact Core Principles Participation is strictly voluntary for both physicians and state boards Participation creates another pathway for licensure but does not otherwise change a state39s existing Medical Practice Act Requires the physician be licensed by and under the jurisdiction of the laws and board of the state where the patient is located Regulatory authority will remain with the participating state medical boards not national compact staff State boards participating in an interstate compact are required to share complaint investigative information with each other Hypotheticals gtgtgt Sorgg I don t have notes for this T T 5 Fundamentals of Health Law class notes 114 A MT patient travels to WA to see a particular surgeon and the surgery takes place in WA Can the surgeon continue to advise the patient over the phone after the patient returns home to MT What about a video visit 9 Would be allowed under WA law but here MT law applies because the patient is in MT MT law doesn t seem to be as detailed A WA radiologist reviews CT scan and MRI images for a prospective patient from CA The images are transmitted electronically from an imaging facility in CA Licensing issues 9 Reading CT scan MRI images practice of medicine 9 Probably okay A panel of WA physician experts on hepatitis C conducts live video sessions for primary care physicians in outlying areas who care for hep C patients The PCPs present their patient cases without the patient present and receive advice on how to manage the care Licensing issues A WA pathologist provides a diagnosis to an ID physician on a specimen from an ID patient Does the pathologist need to be licensed in ID
Are you sure you want to buy this material for
You're already Subscribed!
Looks like you've already subscribed to StudySoup, you won't need to purchase another subscription to get this material. To access this material simply click 'View Full Document'