1. Florida Board of Medicine: Update and Overview
Jason J. Rosenberg, M.D., FACS
DATE

2. Overview Who is the Board of Medicine Licensure Statistics
Accessing Information
Committees, Councils & Meetings
Licensure Renewal
Practitioner Profiles
Expert Witnesses
Disciplinary Process & Implications
Board’s Activities
Pain-management Registration and Inspection Program
Office Surgery Registration and Inspection Program
Maintenance of Licensure
Wrong site surgery/person/procedure
Re-entry into practice

3. Who is the Board of Medicine?
Mission: To promote, protect and improve the health of all people in Florida.
Judge
Enforce legislation
Define quality
License
Communicate

4. Medical Board Structure
The Medical Board is a group of volunteers who are charged with upholding the Medical Practice Act for the State of Florida.
Twelve physician members
Three consumer members
All Members of the Board are appointed by the Governor.

5. Leadership

6. Licensure Statistics Profession # of licensees
Medical Physicians 67,455
Anesthesiologist
Assistants 60
Physician Assistants 5,108
Statistics taken from the MQA Annual Report July 1, 2010 – June 30,
2011
Stats include active, inactive, and delinquent licensees

7. Accessing Information
Board of Medicine web page
Board of Medicine Interested Parties List (Mailman)
Go to website above to sign up
Address, telephone, fax and
4052 Bald Cypress Way, Bin C03, Tallahassee, FL
(850)
(850)

8. Board Committees Major standing committees include:
Credentials Committee
Interviews license applicants whose prior history, including malpractice cases, raises questions of concern regarding the ability to practice with skill and safety, or questions about an applicant’s performance in medical school or prior practice in other jurisdictions
Rules/Legislative Committee
Develops recommendations for amendment of Board rules or creation of new rules, to clarify practice standards or to impose requirements to strengthen patient protection and quality of care. This committee also makes recommendations for Florida’s annual legislative session

9. Board Committees continued . . .
Probationers Committee
Monitors compliance of licensees who have been disciplined and placed under conditions or probation; reviews required reports of compliance and requires personal appearances from probationers as part of the ongoing monitoring, until such time as the conditions of probation are fulfilled
Surgical Care/Quality Assurance Committee
Determines necessary and appropriate revisions to the rule to strengthen patient safety and minimize the risk factors that contribute to adverse patient incidents; addresses issues related to quality of care and standards of practice; formulates policy recommendations for the full Board’s consideration, studies quality of care issues as they arise, and organizes and conducts symposia on special topics (e.g., treatment of obesity, disruptive physician).

10. Board Committees continued . . .
North and South Probable Cause Panels
Review investigations of complaints filed against licensees and determine whether the investigation materials reflect probable cause that the licensee violated regulatory requirements, including requirements relating to standards of care and misconduct. When probable cause is found, disciplinary action is initiated by the panels for final action by the full Board, after the licensee is afforded due process rights

11. Other Committees . Finance & Statistics Committee
Review the Board’s budgetary standing and to create/track statistics that assist the Board in making policy decisions
Expert Witness Committee
Approves expert witnesses to be used by investigators and probable cause panels in reviewing complaint investigations for a determination that standards of care were violated
Joint Anesthesiologist Assistant Committee (MD’s and DO’s share responsibilities)
Approve applicants for licensure as well as making recommendations for rule creation and/or changes relating to the regulation of this profession .

12. Other Committees Continued
Communication, Education and Information Committee
This committee is tasked with developing proactive communication strategies in an effort to educate and inform applicants, licensees and the public about the roles and activities of the Board of Medicine and the laws and rules and ethics regulating the practice of medicine

13. Councils under the Board Purview
Council on Physician Assistants
Council’s duties:
Certification of applicants for licensure
Development of rules regulating physician assistants
Making recommendations to the Board regarding all matters relating to physician assistants
Board’s duties:
Approve and adopt identical rule language recommended by the Council, or return the recommendation to the Council
Disciplinary actions against licensees

14. Councils under the Board Purview continued . . .
Dietetic-Nutrition Council
Council’s duties:
Certification of applicants for licensure
Development of rules regulating the practice of dietetics and nutrition counseling
Making recommendations to the Board regarding all matters relating to the practice of dietetics and nutrition counseling
Board’s duties:
Approval and adoption of administrative rules
Disciplinary action against licensees

15. Councils under the Board Purview continued . . .
Electrolysis Council
Council’s duties:
Certification of applicants for licensure
Development of rules regulating the practice of electrolysis
Making recommendations to the Board regarding all matters relating to the practice of electrolysis
Board’s duties:
Approval and adoption of administrative rules
Disciplinary action against licensees

16. Meetings
The Board of Medicine meets 6 times per year to handle hearings and Board business (February, April, June, August, October, December)
All meetings are open to the public and physicians may receive CME credit for attending one of the Board Meetings.
Physicians may receive 5 hours CME in the area of risk management/ethics by attending a full day of disciplinary hearings. Must arrive at 8:00 am and sign in with Board Staff at the meeting.

17. Licensure Renewal
Florida physicians must renew their license every two years.
Renew ONLINE at
To renew a Florida license physicians are required to obtain a minimum of 40 hours of continuing medical education.
2 hours in prevention of medical errors
38 hours of general CME
Every third renewal: 2 hours Domestic Violence, 2 hours prevention of medical errors and 36 hours of general CME
Physicians practicing in Pain-management Clinics that are not Board certified as outlined in Rule 64B , FAC are required to have 15 hours CME in pain-management per year.
Recent reduction of renewal fee to $391 (includes background check fee and unlicensed activity fee)

18. Licensure Renewal
The Prevention of Medical Errors course has specific requirements
including a study of root cause analysis, error reduction, prevention
and patient safety, and the 5 most mis-diagnosed medical conditions in
Florida during the previous biennium and those conditions are:
1. Diagnosis of cancer
2. Diagnosis of surgical complications
3. Diagnosis of acute abdomen related conditions
4. Diagnosis of pregnancy related conditions
5. Diagnosis of neurological conditions
This list is subject to change every two years. Be sure to read Rule
64B , FAC for the most recent changes to the rule.
Be sure they get the right class so they get credit!

19. Renewal of Licensure continued . . .
Retired status – if you elect to place your license in a retired status, you are not permitted to practice medicine at all, including the writing of prescriptions
If audited, the physician will be required to produce the certificates at that time. Physicians may elect to upload their CME certificates into CE Broker which assists at audit time. Participation in CE Broker is not a requirement but can be accessed through out web page.

20. Practitioner Profiles
Must be updated within 15 days of any change [s , F.S.]
Mandatory fields:
Primary practice address
Secondary practice address
Staff privileges
Other state licensure
Year began practicing
Education and training
Other health related degrees
Professional and postgraduate training
Academic appointments
Specialty certification
Financial responsibility
Criminal Offenses
Final disciplinary action (multiple categories)
Actions on staff privileges
Liability claims
Some fields can be changed online, others have to be sent in for staff to update.

21. Practitioner Profiles continued . . .
View the Practitioner’s Guide to Completing and Updating the Profile at

22. Are you interested in serving as an Expert Witness?
The Department of Health is looking for certified physicians, in a wide range of specialty areas to serve as experts in a volunteer or paid status.
For more information, contact the Irene Lake at (850) extension 8212

23. Disciplinary Process Grounds for disciplinary action
S (1), Florida Statutes
S (1), Florida Statutes
Disciplinary guidelines
Rule 64B , Florida Administrative Code
This is where you find the statutes that outline the various types of violations and penalties.

24. DISCIPLINARY PROCESS = Confidential = Public Record
Mediation
Not Disputed
Final Order
= Confidential
= Public Record
Complaint
2d Citation
Issued
Agency
Consumer Services Unit
Closure/Referral to Other Agencies as
Non-Jurisdictional OR
Closure as Legally Non-sufficient
Investigation
Probable
Cause Panel
Selected by the
respective
professional board
from the
Department of Health
Prosecution
Attorney Review
Legal Services Section
Citation
Formal Hearing
Before DOAH
(Contests Charges)
Agency Director, If No formal
Probable Cause Panel Exists
This flow chart outlines the process a complaint goes through from when it’s filed until closed – either confidentially because no violation was found or closed through issuance of a citation or a Final Order issued by the Board.
07-08 Annual Report Stats
Informal Hearing
Before Respective Board
(No Dispute)
Final Board Action
and Disposition
Findings:
Case Disposition
Hearing Waived
Before Respective Board
(No Dispute)
Final Order
Imposing Discipline
Filed with Department
of Health
No Probable
Cause Found
Probable
Cause Found
Dismissal/
Closure
Administrative Complaint Filed
With Department
of Health
Election of Rights
By Licensee
Stipulation/Settlement
by Licensee to Respective
Board for Approval
Appeal Procedures
To District Court
of Appeals

25. Disciplinary Statistics
4,838 complaints filed
1,631 found legally sufficient
229 resolved through Final
Orders
200 resolved through citations
(1st citation is not discipline)
MQA Annual Report July 1, 2010 – June 30, 2011
This demonstrates our ability to sort through the complaints and only prosecute those that are found legally sufficient. The rest remain confidential.

26. Implications of Disciplinary Action
If you have licenses in multiple states and have had action on a license in one state, you should report that action to the other states.
Disciplinary action is reportable to the Healthcare Integrity Protection Databank, Federation of State Medical Boards, Drug Enforcement Agency and the American Medical Association.
Disciplinary action may have an effect on medical malpractice insurance, HMO coverage, staff privileges and other state licensure.

27. Tips to avoid discipline
Update profile [s , F.S.]
Notify Board before you move or close your practice [s , , , Rule 64B ]
Do not pre-sign prescriptions [s (1)(aa]
Maintain medical records on friends, family and employees [s (1)(r), (1)(m)]
Patient boundaries [s , (1)(j)]

28. Tips to avoid discipline
Do not Internet prescribe [s (1)(t), Rule 64B ]
Pre-approve any advertisement of your services – disclaimer required [s , Rule 64B8-11]
Know the fees you can charge for copies of medical records [Rule 64B ]
Know the legible prescription laws [s , s. 668 and Rule 64B ]
Know the controlled substance prescribing laws [s , and Rule 64B ]
Notify patients of adverse incidents [s , , ]

29. Help for impaired & rehabilitation for disable physicians
The Board has an excellent evaluation and rehabilitation program that is a phone call away: Professional Resource Network (800)
For most practitioners, this is and remains a confidential process that offers help
Program recently expanded to include medical students

30. What’s on the Board’s Radar?
Pain Management
Office Surgery Regulation
Maintenance of Licensure
Wrong site/person/procedures
Re-Entry into Practice
Communication, Education and Information

31. Pain Management
In 2007, 8,620 drug related deaths (approx 5% of all deaths in Florida) 2007 Medical Examiners Commission Drug Report
The Board continues to support the prescription drug monitoring program [eForcse].
The Board has met several times with the Boards of Osteopathic Medicine, Pharmacy and Nursing along with other stakeholders to address issues involving patient deaths related to prescription medications
The Board, in conjunction with the Federation of State Medical Boards (FSMB), is attempting to obtain funding to send FSMB’s publication “Responsible Opioid Prescribing, A Physician’s Guide” to all physicians licensed in our state.

32. Office Surgery Registration Program
Every licensed physician who holds an active Florida license and performs Level II surgical procedures in Florida with a maximum planned duration of more than five (5) minutes or any Level III office surgery, as fully defined in Rule 64B , F.A.C., shall register the office with the Department of Health.

33. Office Surgery Registration Program
Total number of facilities registered = 411
Total number of physicians registered = 641
From Board of Medicine Annual Report for Fiscal Year

34. Wrong site surgery/procedure/person statistics
The Board of Medicine recently held a Wrong site surgery/procedure/person (WSS) workshop. Results indicate that most of the cases result from a breakdown of the process of communication between doctor, patient and staff as related to the time out procedure and do not necessarily reflect any lack of skill or judgment on the part of the operating surgeon. We will continue to explore better ways to educate physicians and staff on more effective ways to perform the time out and pause prior to beginning the procedure in order to help eliminate this recurring but preventable problem.
During fiscal year , 4,838 complaints were filed.
Of those complaints, 1,631 complaints were found to be legally sufficient
Of those, the Board took 229 disciplinary actions against physicians.
Of the 229 disciplinary actions taken, 19 were based on wrong site/procedure/person violations
The Board is currently reviewing the Pause Rule [Rule 64B , FAC] to continue addressing Wrong Site cases.

35. Some risk factors and/or causes
Breakdown in communication
Surgical site not marked or not marked properly
Patient records, X-rays or other diagnostic studies not available in OR for verification
Incomplete pre-op assessment
Staffing issues and/or other distractions
Emergency cases
Unusual time pressures
Multiple patient surgeries scheduled on same day with a cancellation
Multiple procedures on same patient
X-rays reversed
Pause is performed and surgeon subsequently leaves the room

36. Areas of improvement: Pause Rule 3 R’s Poster Campaign
Executive Director and Board Members presents information about preventing wrong site surgery at training programs, hospitals, universities, medical organization and other entities throughout Florida
Meeting with parties who have a goal to improve patient safety
Patient Safety Corporation
Florida Medical Association
Board of Nursing
Board of Osteopathic Medicine

37. 64B8-9.007 Standards of Practice – The Pause Rule.
The Board of Medicine interprets the standard of care requirement of Section (1)(t), F.S., and the delegation of duties restrictions of Section (1)(w), F.S., with regard to surgery as follows:
(1) The ultimate responsibility for diagnosing and treating medical and surgical problems is that of the licensed doctor of medicine or osteopathy who is to perform the procedure. In addition, it is the responsibility of the treating physician or an equivalently trained doctor of medicine or osteopathy or a physician practicing within a Board approved postgraduate training program to explain the procedure to and obtain the informed consent of the patient. It is not necessary, however, that the treating physician obtain or witness the signature of the patient on the written form evidencing informed consent.

38. (2) This rule is intended to prevent wrong site, wrong side, wrong patient and wrong surgeries/procedures by requiring the team to pause prior to the initiation of the surgery/procedure to confirm the side, site, patient identity, and surgery/procedure.
(a) Definition of Surgery/Procedure. As used herein, “surgery/procedure” means the incision or curettage of tissue or an organ, insertion of natural or artificial implants, electro-convulsive therapy, endoscopic procedure or other procedure requiring the administration of anesthesia or an anesthetic agent. Minor surgeries/procedures such as excision of skin lesions, moles, warts, cysts, lipomas and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of consciousness other than minimal pre-operative tranquilization of the patient are exempt from the following requirements.

39. (b) Except in life-threatening emergencies requiring immediate resuscitative measures, once the patient has been prepared for the elective surgery/procedure and the team has been gathered and immediately prior to the initiation of any procedure, the team will pause and the physician(s) performing the procedure will verbally confirm the patient’s identification, the intended procedure and the correct surgical/procedure site. The operating physician shall not make any incision or perform any surgery or procedure prior to performing this required confirmation. The medical record shall specifically reflect when this confirmation procedure was completed and which personnel on the team confirmed each item. This requirement for confirmation applies to physicians performing procedures either in office settings or facilities licensed pursuant to Chapter 395, F.S., and shall be in addition to any other requirements that may be required by the office or facility.
(c) The provisions of paragraph (b) shall be applicable to anesthesia providers prior to administering anesthesia or anesthetic agents, or performing regional blocks at any time both within or outside a surgery setting.

40. (3) Management of postsurgical care is the responsibility of the operating surgeon.
(4) The operating surgeon can delegate discretionary postoperative activities to equivalently trained licensed doctors of medicine or osteopathy or to physicians practicing within Board approved postgraduate training programs. Delegation to any health care practitioner is permitted only if the other practitioner is supervised by the operating surgeon or an equivalently trained licensed doctor of medicine or osteopathy or a physician practicing within a Board approved postgraduate training program.
Specific Authority FS. Law Implemented (1)(t), (v), (w) FS. History–New , Formerly 21M , 21M , 61F , 59R-9.007, Amended , , ,

41. What can you do to avoid this?
Pause to ensure you have the right procedure, site and patient.

42. JCAHO recommendations:
Visit patient in the pre-op area
Mark the surgical site with the patient
Verify the records (patient chart, X-rays, diagnostic studies, etc) and have these available in the OR
Obtain oral verification in the OR by reading the consent
Take a time-out to verify 3 R’s and document
Monitor compliance with these steps

43. Making the incision on correct site of correct patient
The Board accepts no excuse for wrong site surgery
If you make the mistake, document it or the Board will increase the penalty
If you make the mistake, advise the patient and/or the patient’s representative or the Board will increase the penalty

44. Although wrong site/procedure/patient surgery incidents are a very, very small percentage of surgical encounters, most if not all wrong site surgery is preventable. The cause of a wrong site surgery is a breakdown of communication in the preparatory process prior to performing the procedure. Careful use of the “Pause or Time-Out” prior to each step in the preparatory process can and will prevent wrong site surgery.

45. Re-entry into practice
The Board is concerned about the competency of physicians who do not practice for a period of time for one reason or another and then return to practice. For this reason, the Board will be conducting workshops regarding re-entry into practice requirements to ensure the safety of patients in our state.
Stay tuned to our web page for additional information and dates for the workshops.

46. QUESTIONS?