Ohio Revised Code Chapter 4731 is the law governing the practice of medicine in Ohio. The Ohio Administrative Code is drafted by the Medical Board members and is reviewed and approved through a rule making process. Physicians in Ohio are required to know, understand and follow the guidelines established in these laws and rules.

These laws and rules can be found at the Medical Board’s website at: http://www.med.state.oh.us. You can also follow the following link to find these sections: http://codes.ohio.gov/orc/4731
or for the administrative rules go to: http://codes.ohio.gov/oac/4731

Pertinent sections of these laws and rules include:

Basis for disciplinary action can be found at R.C. 4731.22(B) which can be found at: http://codes.ohio.gov/orc/4731.22.

To learn more about licensing and continuing education go to: OAC 4731-10, which can be found at: http://codes.ohio.gov/oac/4731-10.

To learn more about prescribing of controlled substances go to: OAC 4731-11, which can be found at: http://codes.ohio.gov/oac/4731-11.

To learn more about the Medical Board’s hearing process go to: OAC 4731-13, which can be found at: http://codes.ohio.gov/oac/4731-13.

To learn more about the duty to report to the Medical Board go to: OAC 4731-15, which can be found at: http://codes.ohio.gov/oac/4731-15.

To learn more about what to do if you believe you suffer from  chemical dependency go to: OAC 4731-17, which can be found at:  http://codes.ohio.gov/oac/4731-17.

As practicing medical professionals in Ohio, you are required to know, understand and follow the laws  and rules in ORC 4731 and OAC 4731. Take the time to read the rules and, if you have questions, contact experienced legal counsel to assist you.

As always, if you have any questions about this post, please feel free to contact me at beth@collislaw.com.

Many people think that they are too busy to take a vacation or that if they leave for even a few days they will return to even more work than when they left. In some cases, Americans are afraid that if they do take a few days off their bosses will recognize that they are dispensable and may re-assign their work and their job to others. Despite whatever real or imaginary fears you might have about taking a break from work, the reality is that everyone needs to rest, relax and step back from the stress of their daily lives so that they have the energy to return to the workplace prepared to work. Physicians are no exception. Physicians deal with extremely stressful situations on a daily basis. Failure to take the appropriate breaks from your practice can lead to weight gain, depression, additional stress and poor decision-making.

As noted in previous posts, stress can lead physicians to make poor decisions related to patient care or can lead to them making poor personal decisions such as drinking and driving, committing a boundary violation with a patient, or seeking unacceptable ways to relieve stress such as sharing personal information with patients or “friending” patients on social media sites.  Ultimately, failure to implement appropriate stress management tools, including taking a vacation, can lead to future professional problems.

Whether you choose to stay home for a “staycation” or take that long-awaited trip, give yourself (and your practice) a break. It will do you a world of good.

As always, if you have any questions about the State Medical Board of Ohio or this post, please feel free to call me at (614) 486-3909 or email me at beth@collislaw.com.  My office will be closed from December 24, 2012 to January 3, 2013 to give everyone at CSC a much needed break.

I found it interesting that it has been reported that General Petraeus and Paula Broadwell allegedly wrote emails in “draft”, left the drafts in a draft email folder which they could both access and read, but did not send to each other, thereby attempting to avoid creating a trail of emails.

Engaging in social media creates a trail that can be used by employers, governmental agencies, criminal investigators, and State licensing boards as evidence of wrongdoing.  When a professional, like a physician, engages in email, texting, Facebook, Twitter, or other forms of social media with patients, they risk being determined to have committed a boundary violation with a patient.  A physician may not engage in a personal, sexual, or financial relationship with a patient.

In the past, these relationships were more difficult for employers or governmental agencies to prove because, in many instances, cases came down to a “he said – she said” situation.  However, in the digital age, impermissible relationships are documented in emails, texts, photos, videos, Facebook posts, and Tweets.

It is a violation of the State Medical Board of Ohio’s laws and rules to engage in a personal, sexual, intimate, or financial relationship with a patient.  Such relationships subject a physician to discipline by the Board.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to email me at beth@collislaw.com or call me at 614-486-3909.

It is important to keep in mind what role you play as a physician. If you have a doctor-patient relationship with a person, you should not employ that person in your practice, loan them money, enter into financial arrangements with them, agree to pick medications up for them at the pharmacy, agree to treat them privately for “free off the books” because they do not have insurance or for any other reason. You need to treat all persons to whom you provide medical care to the same. While you may have sympathy for a patient who does not have insurance or may not be able to get an appointment with their “regular treating doctor”, if you elect to treat someone as a patient, you must follow the accepted standards of care for such treatment.

There is no prohibition from a physician treating an employee of their practice. However, the employee needs to be treated exactly like every other patient in the practice. They need to be physically examined and a patient chart needs to be maintained for any treatment or prescribing that is done for the patient. They need to be referred out for consultation or sent for followup tests or evaluations. Their chart should also include the same history, physical and background information that you would include for any patient.

When treating friends or employees, physicians will often fail to maintain a patient record or fail to accurately record the examination and treatment that they provided to the patient. Any written record is better than no written record, however, you should prepare a written medical record for this friend/patient as you would for any other patient in your practice.

Too often, physicians allow themselves to be ”cornered” by a neighbor to call them in a prescription over the weekend and then they fail to take the appropriate steps to examine the patient and document their treatment.  I have also seen physicians who have agreed to treat a patient for free and then not maintain any medical record for the patient. They have told me ”I wasn’t billing insurance, so I did not create a record”. This is inappropriate. You may subject yourself to disciplinary action by the State Medical Board of Ohio if you do not maintain medical records when you treat a patient. It doesn’t matter if you are not billing insurance for your service. If you provide medical care to a patient, you need to have a medical record showing what treatment you provided.

Know what hat you are wearing. It is never a good idea to have multiple relationships with patients. However, if you choose to treat a friend or an employee, you still need to practice above the standard of care, which dictates that you record a history and physical and document the treatment you provided to the patient.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, feel free check out my website at www.collislaw.com  or email me at beth@collislaw.com or call me at (614) 486-3909.

In Ohio, under Ohio Revised Code Chapter 119, decisions of the State Medical Board can be appealed to the Franklin County Courts. The Court will then determine if the decision of the Board was based on reliable, probative and substantial evidence and is in accordance with law. Pons v. Ohio St. Med. Bd., 66 Ohio St.3rd 619, 621. However, case-law exists in Ohio that the Courts will not reverse a decision of the Medical Board purely on the belief that the sanction is too harsh. Henry’s Cafe, Inc. v. Bd. of Liquor Control, (1950), 170 Ohio St.233. Even if the evidence is clear that the Ohio Medical Board imposed a sanction that was different or harsher than was imposed in other similarly situated cases, the Courts still not reverse a Medical Board decision.

The only way to obtain relief from a Medical Board decision by the Courts is to show that the Board based its decision on evidence that was contrary to law or was not reliable, probative or substantial. While it is not unheard of to have a Medical Board decision reversed by the Court, it is certainly an uphill battle.

It is the intent of Ohio administrative procedure law that state agencies be given the authority to regulate others in their profession. Arlen v. State Med. Bd (1980), 61 Ohio St.2d 168. Therefore, if a physician is issued a Notice of Opportunity for Hearing (citation letter), it is important to put your best case forward at the administrative hearing before the Medical Board.  The Court will rarely disturb the final decision of the Medical Board.  Unlike Illinois, Ohio courts will not reverse a Medical Board decision because the Court thinks the sanction is too harsh.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to email me at beth@collislaw.com or call me at (614) 486-3909 or see our firm website at www.collislaw.com.

You may wonder what this has to do with physicians and the medical profession? We are now in a world where virtually everyone is carrying a camera/video camera on their phones with the ability to take and upload photos and videos to the internet and to the world in moments.  Behaviour that professionals may have engaged in that they thought was private may now be published to the world.

I have not seen a case yet where the Ohio Medical Board uses video footage of a physician ”acting badly” as evidence of impairment or inability to practice medicine, however, in my opinion it is just a matter of time. Physicians need to be aware that the Medical Board can take an action against a physician for their conduct, even if it is not related to the practice of medicine. You do not need to be “falling down drunk” at work to be disciplined by the Medical Board. A photo or video of you clearly impaired at a bar taken at 2am when you are scheduled for surgery at 7am could serve as the basis for discipline.

Social media can also be evidence of a boundary violation with a patient. Do you “friend” patients on Facebook? Do you have photos of yourself and a patient taken in social settings? These could all constitute boundary violations with patients.

Social media can be a wonderful tool to reconnect with old friends and to share photos with family members and friends. But, it can also lead to trouble for professionals if not used wisely. As physicians, your conduct needs to be professional 24/7.

As always, if you have any questions about this post or about the State Medical Board in general, please feel to contact me at 614-486-3909 or email me at beth@collislaw.com.

In my practice, I represent physicians who are being investigated by the State Medical Board.  I also regularly represent residents who face discipline in their residency program or who are seeking licensure for the first time.  For most of my clients, an investigation in their practice by the State Medical Board may be the first time they have ever been questioned by a person in authority or “called on the carpet” for their actions.   Based on this new experience, it is interesting how they react.

A Board investigation is an incredibly stressful time for the physician. Their entire professional livelihood is on the line and any discipline that is imposed by the Board will have significant ramifications to their job, hospital credentialing status, third-party payor status, board certifications and may affect other state licenses.

Investigations by the State Medical Board do not have a statute of limitations and, once the Board starts an investigation, it is not limited to just the scope of the complaint.  The Board may review all aspects of the physician’s practice. In addition, while conducting an investigation, the Board can order the physician to undergo a chemical dependency evaluation or a mental or medical evaluation to determine if they have a condition that may affect their ability to practice medicine.

In order to get through a Medical Board investigation, the physician needs to be patient, cooperative and still maintain the same level of professionalism in their practice while seeing patients. This calls for resiliency on the part of the physician.

Physicians hold patients’ lives in their hands. They need the intelligence, executive function skills, and downright grit to maintain their composure in an ever-changing medical field. So, before entering medicine or if you are a practicing physician, I think it is important to consider .. are you resilient enough to be a physician?

As always, if you have any questions about this post or the State Medical Board of Ohio, please feel free to contact me at (614) 486-3909 or email me at beth@collislaw.com.

1) Go to the following link:http://med.ohio.gov/pdf/OnLineChangeOfAddress.pdf

2) Contacting the CME/Records section of the Medical Board at 614-644-1464 and providing the Board with your change of address; or

3) Go on-line to www.license.ohio.gov and choose the “change address” option to change your address on-line.

Once you change your address, check back to the Board website after about 72 hours to verify that your change of address was properly recorded.

Why is it so important to make sure the Medical Board has your most up to date contact information? If the Board has any questions or concerns that need to be addressed by you, it will send the information to your “address of record”. If you are the subject of an investigation or if you are subjected to a random CME audit, the letters of inquiry will be sent to your address of record.

It is important to note, you are generally provided with a short period of time (generally 30 days) to respond to Board inquiries. Failure to respond may result in an adverse action against your license. For example, in a disciplinary proceeding, if you are notified by mail that the Board proposes to take a disciplinary action against your license for an alleged violation of the Medical Practice Act, under Ohio Revised Code Chapter 119, you have thirty (30) day from the date the notice was MAILED to you to request a hearing. If you fail to request a hearing in a timely manner, the Medical Board will take a disciplinary action (including possibly a suspension or revocation of your license) without considering your side of the story.

In addition, if the Medical Board takes a disciplinary action against a licensee and the Board is unable to provide the licensee with a copy of the final Adjudication Order (ie. if the Board does not have your current address) then the Board is required to PUBLISH the disciplinary action in your local newspaper.

It only takes a minute. You should check with the Board at www.license.ohio.gov to verify that the Board has your current address. If it doesn’t, please follow the prompts listed above to update your address with the Board.

As always, if you have any questions about this post or about the State Medical Board in general, please feel free to contact me at (614) 486-3909 or email me at beth@collislaw.com.

In the past, as long as a physician on probation did not have a positive alcohol screen, i.e. illegal substance or prescription medication without  a valid prescription, the Board generally did not always require perfect compliance with all other probationary terms. Again, generally,if a physician failed to submit a quarterly declarations of compliance or failed to attend all required AA meetings, the Board would customarily  address the issue at their quarterly meeting or would send the physician a “friendly” letter advising them that they were not in compliance and requesting that steps be taken to ensure compliance.

Under the direction of former Board Member, Mr. Albert, the Board rarely charged a probationer with failure to comply with the terms of their Consent Agreement, unless they tested positive for drugs or alcohol.  Most recently, however, the Board has taken a much stricter position on probationers who are not 100% in compliance with ALL the terms in their Board Orders or Consent Agreements.

Recently, the Medical Board issued a Notice of Opportunity for Hearing to a physician who had been on probation with the Board since 2005.  Despite the fact that all of the physician’s urine screens were negative, the Board proposed to discipline the physician for allegedly failing to comply with the following terms of the physician’s Consent Agreement: failure to submit quarterly reports to the Board in a timely manner; failure to submit AA logs to the Board; failure to seek Board approval for required courses and for a monitoring physician. Despite no evidence of relapse, the Board voted at its June meeting to revoke this physician’s medical license for failure to be 100% in compliance with the Board’s Order or Consent Agreement.

If you are under probation, please beware. The terms and conditions of Board Orders or Consent Agreements are mandatory. Failure to strictly comply with all terms and conditions of the Board Order or Consent Agreement can serve as the basis for further Board disciplinary action.

As always, if you have any questions regarding this post or the State Medical Board in general, please feel free to contact me at 614-486-3909 or email me at beth@collislaw.com.

I have tried to figure out the whole, scrubs as casual wear issue. It makes sense to see medical professionals around the hospital or on the hospital grounds in their scrubs. I don’t find it unusual to see health care professionals grabbing a quick-lunch in their scrubs. However, the wearing of scrubs has gone way beyond that.   Is the rationale for wearing the scrubs that “I could be called to the hospital at any minute, so I need to be prepared?” This might be it. However, yesterday, I saw someone cutting their grass in their scrubs! I hope they don’t wear that same outfit into the hospital if they are immediately called in for an emergency.

My father was a practicing anesthesiologist for over forty years. He left the house before 6am in a suit and tie and returned late each evening in a suit and tie. I can’t say that I ever saw him in scrubs. He certainly never went to dinner or cut the grass in scrubs.

Now, some may ask, “who cares what medical professionals wear”?  While I agree that we live in a much more casual society than even 20 years ago, I do believe that it decreases the level of professionalism and respect for the profession when medical professionals are constantly wearing their “hospital uniform” outside of the work setting. Just something to consider.

(Wearing scrubs out of the hospital, even to cut your grass will NOT lead to discipline by the State Medical Board of Ohio.)

As always, if you have any questions about this post or about the State Medical Board in general, please feel free to contact me at 614-486-3909 or email me at beth@collislaw.com.

In the past, I have written about the three main areas where the State Medical Board in Ohio takes disciplinary actions against physicians: (1) for submitting false information to the Board, (2) for violating a professional boundary with a patient and (3) for issues related to drugs or alcohol (see previous post entitled, “What the Medical Board Really Cares About – Sex, Drugs and Lies”).  Recently, I looked at many of the cases before the Medical Board to determine if there are similar warning signs or red flags that may have been present before a complaint is filed with the Board. What I found is that in many instances the physician had been living a life that is out of balance.

Physicians are trained to look for signs of health (or disease) in their patients, however, too often they do not look for those warning signs in themselves. I often see that the complaint with the Medical Board is just the “final straw” in a year (or years) of a physician living an unbalanced life.  I find that, in many cases, physicians are overworked, overweight, stressed out, and living meaningless and angst filled lives. Many are taking medications to help them sleep and then other medications to help them get through their work days. Many eat out too often, haven’t seen the inside of a gym in ages (or ever), and are living meaningless, spiritless lives.

In terms of boundary violations, they rarely happen  to physicians who are in loving, supportive marriages or relationships. Many times, a physician will find themselves immersed in a Medical Board investigation when they are also in the middle of an ugly divorce or professional partnership that has taken a turn for the worst.

As physicians, you worked hard in school to put yourself in a position where you would have choices. Choices about where you work and what type of work you would like to engage in on a daily basis. Now is the time to exercise those choices and put yourself in a work environment that you find interesting, fulfilling and enjoyable.

I recently read that in tough financial times many people start to step back from their jobs (or job searches) and consider what they can do to make their overall lives better. Many have found that by spending more time with family and friends, exercising more often, and taking “control” of their lives they have found the energy and spirit to be more successful in work or in their job searches. Despite the tough economy, gym memberships were up in 2011 and many more people participated in Weight Watchers and other programs to improve the overall quality of their lives.

Doctors … look at your lives. Are you healthy, happy and fulfilled? If not, now if the time to reclaim your life and the direction of your professional career.

As always, if you have any questions about this post or about the State Medical Board of Ohio in general, please feel free to email me at beth@collislaw.com or call me at 614-486-3909.

In one case, the Medical Board suspended the license of a physician for 180 days after a hearing based on the finding that the physician had engaged in a sexual relationship with an indigent patient after providing the patient with “free” medical care and “free” medicine. From the physician’s perspective, she honestly believed that she was providing a medical service to the patient that he could not otherwise afford and that she should not then be “punished” for providing this care.   The physician did not comprehend that having a personal (read: sexual) relationship with the patient violated the physician/patient relationship.  Regardless of the fact that the medical care provided to the patient without charge, a physician-patient relationship was created.  The Board suspended the physician’s license for 180 days for the boundary violation.

In the second case, the State’s attorney offered for Board approval a Consent Agreement  for a physician who had engaged in a sexual relationship with a patient, which proposed to impose no active suspension on the physician’s license. The rationale given by the State’s attorney for no suspension was the fact that the patient was also the corporate attorney for the medical practice and therefore the legal staff did not believe that there was the same imbalance of power between the physician and the patient that usually leads to physician discipline. The state’s attorney argued that the physician and attorney/patient were on a more even footing.  The state’s attorney argued there was no imbalance of power and consequently no suspension should be imposed on the physician’s license.

The Board members did not agree with this argument. In a rarely seen move by the Board, the proposed Consent Agreement, was rejected by the Board.  While this is a very unusual fact pattern, it clearly shows the Board believes strongly about the inherent imbalance of power in a physician-patient relationship.

As always, if you have any questions about this post or about the medical board in general, please feel free to call me at 614-486-3909 or email me at beth@collislaw.com.

The first question I am always asked by physicians is “What will get me in trouble with the Medical Board”.  While the Medical Board can discipline a licensee for a wide range of things, there are three areas that seem to be of their highest concern: Sex, Drugs and Lies.

Sex. The Board typically takes disciplinary action against a licensee who has sex with a patient. However, the Board is also concerned with boundary violations with patients. Have you employed a patient in your office or loaned money to a patient or signed a car note or credit card application for a client? The line in the sand between a doctor and a patient should be clear. There should be no overlapping of a doctor/patient relationship and a personal relationship.

Drugs. Nearly half of all disciplinary actions handled by the Medical Board each year involve impaired physicians. Physicians who have been diagnosed with drug or alcohol problems. The Medical Board is also very concerned about the prescribing habits of physicians. Has the physician prescribed to the mother of a patient as opposed to the patient because only the mother has insurance? Has the physician prescribed a controlled substance to a family member?  Has the physician prescribed a drug to a patient for other than legitimate medical purposes?

Lies. The Medical Board does not like to be lied to. If you complete an application and fail to give clear, concise and accurate information to the Board, you will likely face a disciplinary action. Similarly, if you are the subject of discipline by another state and fail to tell the Ohio Board, you will likely be subject to discipline in Ohio not just for the “sister state discipline” but also for failing to disclose the action to the Ohio Board.

At the Board meeting today, the Board will consider final discipline in four cases. One involves practicing below the standard of care in the prescribing of medications to four patients that also resulted in felony and misdemeanor convictions; two cases relate to alcohol abuse or addiction and relapse and one involves an inappropriate sexual relationship with a patient. http://www.med.ohio.gov/pdf/Agenda/Agenda%20-2012/03-12agenda.pdf

Off to the meeting….

As always, if you have any questions about this post or about the State Medical Board of Ohio, feel free to email me at beth@collislaw.com or call me at 614-486-3909. I look forward to your questions.

Physicians who believe they may need treatment should seek an assessment immediately. Your health is the most important consideration.   However, in seeking an assessment for suspected chemical dependency or substance abuse, it is important to submit to an evaluation at one of the State Medical Board of Ohio approved facilities. A list of the facilities approved by the Medical Board can be found at: http://www.med.ohio.gov/pdf/treatment_compliance/TREATMNT.pdf

It is imperative that you seek an evaluation and follow the treatment recommendation of the Medical Board approved treatment facility. Seeking an assessment or treatment at a non-Medical Board approved facility will NOT be accepted by the Medical Board and you will be required to repeat the treatment.  However, if you voluntarily seek treatment and follow the recommendations of an approved treatment facility, you may be able to avail yourself to the Medical Board’s ONE BITE policy.

What is One-Bite?   The One Bite rule allows impaired licensees who seek and complete treatment and aftercare at a Medical Board approved treatment provider to remain in the private sector for monitoring, as long as their acts did not result in a criminal conviction or put patients or others at risk of harm:

Within One Bite:

• Alcohol only
• Illegal drug use
• Taking drugs from sources that did not involve patients
• Issuing prescriptions for one’s own use in one’s own name

Outside of One Bite:

• Criminal conviction related to use or abuse of a controlled substance at or near the time the Board is determining if they meet the requirements for One Bite
• Treatment in lieu
• Relapse
• Failure to complete appropriate treatment and aftercare with a Board approved provider
• Criminal acts that involve the use of another’s name or involve patient’s name
• Compromised patient care
• Out of state action

If the Board becomes involved by investigator contact with the licensee or the Board orders the licensee for an assessment the individual no longer qualifies for One Bite.  One Bite is basically ONE chance to voluntarily seek treatment for substance abuse without having to submit to monitoring by the Medical Board.

Are hospitals and colleagues required to report the suspected impaired physician to the Medical Board? Under Ohio R.C. 4731.224 (http://codes.ohio.gov/orc/4731.224) and O.A.C. 4731-15-01 (http://codes.ohio.gov/oac/4731-15-01) licensees and health care facilities are relieved of the obligation to report the impaired physician to the Medical Board IF the individual has sought treatment at a Medical Board approved facility.

As always, if you have further questions, feel free contact me at beth@collislaw.com or at 614-486-3909.

Fights about money are rarely about money. There are intergenerational scripts about money and often people bring opposing narratives about money from their respective families of origin. Such polarized views may be the source of conflict. For example, I see a couple wherein the man is the penny pincher and the woman is a spendthrift. Both partners claim that they were more moderate in their respective relationships with money before marrying one another. The couple essentially are in reaction to one another and become increasingly extreme in their reactivity as they watch their spouse be more extreme in theirs. They co-create their problematic dynamic around money. Thus, underlying emotional issues may underlie money battles. And though Howard Markman, Ph.D. and director of the Center for Marital and Family Studies at the University of Denver, states that “Money is the number one thing that couples fight about in America,” what is surprising is that for many couples, money fights are not a function of much money you have or don’t have. I have a very wealthy couple in my practice, for example, that fight about money day in and day out. They have more money than they or their children can possibly spend. Yet they argue about money daily.

Money problems encountered in the Great Recession of the early Twenty First Century may, nevertheless, reflect a lowered divorce rate. People may not be able to afford two households. They may put off divorce. One couple in my practice (http://www.Cunninghamtherapy.com) came in for counseling to help them deal with this situation. They wanted to divorce, could not afford it, and were forced to live together till more money came in. In their work with me, they developed a new-found pride in their ability to compromise and make co-habitation work. They are renewing their wedding vows next month.

In other situations, people who become unemployed may find themselves at home together more often. In this increased togetherness, they may experience stress at the change. The delicate balance has been disturbed…a small change can tip the balance and topple stability within a couple’s dynamic.

In my practice at http://www.Cunninghamtherapy.com, I have seen the increased economic stress resulting from joblessness lead to an increase in alcohol and drug abuse. Some of my colleagues are also reporting an increase in cases of domestic violence alongside unemployment rates. Unemployment undoubtedly causes stress, leads to depression and can lead to explosive situations.

Interestingly, newly unemployed partners may move away from traditional gender roles. Research shows that marriages with more egalitarian rather than traditional gender roles fare better. It is useful for couples to take the emotion out of the busy-ness and draw up an agreed-upon list dividing the household and parenting duties in an equitable manner.

In terms of recession and economic stress to a marriage or relationship, the more relevant question to ask is whether or not the marriage is made up of two emotionally mature individuals who do not resort to blame and recrimination in the face of stressors, but rather can unite around finding creative solutions to economic problems. For example, a return to school to increase one’s skills while unemployed may be one example of such a solution. Dr. Cunningham believes that therapy can increase productivity and one’s ability to generate solutions as less energy/anxiety is bound up in the relationship system. Visit her web site at http://www.Cunninghamtherapy.com to explore whether or not her model of practice may be right for you and your spouse. For those who cannot afford therapy, there are not-for-profit agencies that offer very low-fee services with clinical interns.

DR. CUNNINGHAM’S 8 TIPS TO DEAL WITH THE IMPACT OF THE RECESSION ON YOUR RELATIONSHIP:

1. Do not judge each other’s spending choices too harshly. Do not treat your spouse like a child by telling him/her that his purchase is not necessary or is foolish. This will never resolve spending dilemmas and will only increase resentment and conflict. Instead, strive to respect each other’s adulthood and individuality. Each partner comes from a family that may have a different culture of spending.

2. Listen carefully to your partner’s concerns and ideas about possible solutions. Remain open-minded. Be open to a new re-evaluation of priorities. Learn to negotiate with each other about money issues.

3. Remember that in unity, there is strength. But also remember that respecting difference makes for a stronger sense of unity. Harsh storms weathered together can strengthen a relationship. Successful compromise breeds increased pride in accomplishment.

4. Now may be the perfect time to introduce children to the importance of cooperation, viewing themselves as family team members. Instead of responding with an “automatic” kneejerk response to one another in a stressful economic situation, children can observe the adults managing themselves by talking to one another in a respectful manner and agreeing upon viable solutions.

5. Be aware that our relationship to money may be merely mirroring our parents’ relationship with money or, conversely, we may be reacting to our parents’ relationship with money in a manner that is outside our awareness.

6. Start having open talks about money with each other. Be curious about how your experiences in childhood informed your ideas about money. Let go of “right” and “wrong.” The important goal is to respect your partner’s differences. Look deeper.

7. Share equally the responsibilities of budgeting, investing and saving money. Divide up the tasks. Meet weekly. Don’t fight. Share information. Make collaborative decisions.

8. Each partner should save some autonomy by maintaining a small personal account for their own spending.

At http://www.Cunninghamtherapy.com, couples get practice in respecting difference and still staying connected. Call 619 9906203 for a complimentary consultation. ]]> http://brockdp.wordpress.com/2009/11/04/california-repeals-821-5/ Wed, 04 Nov 2009 01:13:40 +0000 Brock D. Phillips http://brockdp.wordpress.com/2009/11/04/california-repeals-821-5/ Recently my partner Greg Abrams was reviewing legislation just enacted in California and noticed a bill that repealed California Business and Professions Code §821.5. That section required peer review bodies, primarily medical staffs, to send a report when the staff initiated an investigation or intervention concerning a physician, who by reason of a perceived disabling physical or mental condition, might not be able to safely provide patient care. Under the statute as written, the reports were to go to the diversion program run by the Medical Board. Historically that program would use these reports to follow, and as appropriate, provide assistance, where the physician’s problem was related to substance abuse. The dilemma leading to its repeal is that the legislature shut down California’s diversion program over a year ago, rendering the statute somewhat moot. Some entities were continuing to make reports that were just going to the Medical Board, instead of the diversion program. The Board was trying to figure out what it should do with these reports but it’s not clear that any rational system had been put in place, so they simply repealed the statute requiring the reports.

This series of steps further demonstrates how California is drifting on the issue of physicians with substance abuse problems. Since shutting down the diversion program, California has not come up with any coherent way of dealing with impaired physicians. My own experience, and I believe the experience of the old diversion program is that many impaired physicians, if given the proper assistance and structure, and if appropriately motivated, can achieve long lasting sobriety and resume safe and effective medical practice, to everyone’s benefit. The current absence of an appropriate program for impaired physicians in California creates a gaping hole in the State’s handling of this problem. Efforts to enact new legislation that would create a newer [better?] version of diversion have been talked about but no substantive action has taken place to date. This seems another expression of the dysfunction of our state government.

Background:
The War on Drugs, War on Doctors, and the Pain Crisis in America; DeLuca; 2004.

In a 1953 Yale Law Journal article, Rufus King wrote:

“Our grievous error was in allowing the narcotics addict to be pushed out of society and relegated to the criminal community. He isn’t a criminal. He never has been. And nobody looked on him as such until the furious blitzkrieg launched around 1918 in connection with the enforcement of the Harrison Act…

“Narcotics-users were ‘sufferers’ or ‘patients’ in those days; they could and did get relief from any reputable medical practitioner, and there is not the slightest suggestion that Congress intended to change this-beyond cutting off the disreputable “pushers” who were thriving outside the medical profession and along its peripheries.”
[The Narcotics Bureau And The Harrison Act: Jailing The Healers And The Sick; Rufus B. King; 26 Yale Law Journal, 784-787; 1953.]

The Attorney General of Pennsylvania has recently taken to charging health professionals, alleged to have substance abuse problems, as if they were drug criminals. Pennsylvanians need to understand is that AG Tom Corbett is mis-informing them and playing them for fools in a venal and socially destructive game that at once creates, and then plays off of, Americans’ trumped-up fears of a ‘prescription drug crisis’ for which there is very little scientific evidence.

It is bizarre and unnecessary and a complete waste of taxpayer money for an Attorney General to attack as ‘dangerous drug criminals’ people who are at worst allegedly substance misusing physicians posing close to zero public threat.

Unbelievable. In New York cases like that of Dr. Zampogna discussed here yesterday [AG Corbett Bags Another Dangerous Doc], would be referred to the Committee for the Physicians Health (CPH) which works closely with the Office of Professional Medical Conduct (OPMC) which is our state Medical Board.

Physicians in NY, if determined to be suffering from a Substance Misuse Disorder on expert Addiction Medicine evaluation, would be treated as “impaired physicians,” and they would be compelled by the CPH / OPMC, under threat, usually, of licensure revocation, to enter a more or less intensive, depending on the individual case, monitored treatment program.

I used to treat such ‘impaired physicians’ who were being monitored by CPH routinely from 1990-2000 in my positions as medical director and later chief of Smithers Addiction Treatment and Research Center in NYC (which now has a new name, due in no small part to yours’ truly – it’s an old, long, ultimately senseless story).

Docs recover at a phenomenal rate, their success due in part to consistent and ongoing, usually expert, individualized treatment. That sort of approach, encouraged by New York’s CPH, treats ill physicians up to the medical standard of care, and keeps them working if that can safely be accomplished. Alternatively, Corbett’s approach criminalizes them at great social expense.

There is no medical justification for treating substance misusing physicians as criminals (cleave them from Medicine into the hands of Law), nor is there any compelling public health reason for doing so. Physicians are one of the few groups of addiction patients who overwhelmingly have excellent outcomes with standard-of-care medically-directed therapy. But don’t wait for the academic medical community to stand up against drug warriors like Tom Corbett who are grossly distorting the norms and ethics of Medicine, nor should you expect state medical boards weigh in on the advisability of treating sick people as criminals as a matter of State policy. And, of course, the American Society of Addiction Medicine (ASAM) is MIA.

This is all as it ever was. The AMA, various pain societies and addiction medicine societies, and the honorable and ethical segment of the legal and law enforcement profession, historically ALWAYS CAVE before the policeman’s wrath. I have mused, a little, on the reasons for this elsewhere. [The Solution... Is NOT More Negotiation with Law Enforcement; DeLuca; 2004]

Dermatologists? Self-prescribing doctors are socially significant dangerous drug criminals? Jeez, get a grip! I’d like to think these were humorous aberrations, but I’m starting to get the sickening feeling that there is a method to this madness.

Here is what I fear is behind Corbett’s criminal indictments of what are, allegedly, physicians with Substance Misuse Disorders (yes, that is the correct terminology), based on the Dr. Zampogna case and similar actions:

I fear we are witnessing the evolution of a new war on doctors tactic – demonize physicians directly. Cast suspicion on ALL physicians, if possible, but certainly imply that any physician who ever handles or prescribes any controlled substances for any reason is a presumptive criminal sleaze. That’s the default perception drug warriors like Tom Corbett seek to firmly establish in the public mind, and in the minds of judges, and juries.

Having succeeded in creating the public perception that all pain patients are defacto “addicts” (= criminals) and all clinicians justified, if not legally obligated, in treating them all as potential criminals first and as patients second, it is only a small, logical, very do-able next step to work the exact same magic on the providers themselves. Here comes the media blitz; doctors with drug problems! (gasp!)… wait for it.

Corbett is just another self-serving drug warrior panderer. He is truly a Jailer of the Healers and the Sick. The good people of Pennsylvania ought put a stop to his destructive and selfish little pogrom against easy prey physicians. I cannot believe PA is so rich, or it’s voters so self-righteous and mean-spirited, that they would pay for and put up with the likes of Tom Corbett. Your AG is off the rails, Pennsylvania; do something about it!

Sickeningly fascinating.

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