Spring Newsletter 1999
BOARD OF PHYSICIAN
INTERNET PRESCRIBING DOES IT
MEET THE STANDARD OF CARE?
(We don't think
With the rapid expansion of access to the internet in recent years, it is not
too surprising that this wonderful tool brings a new set of issues to licensing
authorities. Licensing boards across the country have been dealing with the practice
of "telemedicine" and have taken positions about whether this type of practice
will require full or limited licensure of physicians who utilize this technology.
The issue each board has to decide is where the practice of medicine is occurring
when the patient is in one state and the doctor is elsewhere in cyberspace. The
Federation of State Medical Boards has taken the position that: "The practice
of medicine occurs where the patient is." Thus, an out-of-state doctor using telemedicine
to diagnose and treat a patient residing in Maryland would have to have a Maryland
license or be acting as a consultant to a Maryland physician who has a bona fide
doctor/patient relationship with the patient. Maryland physicians also should
remember that if they practice medicine on patients elsewhere in cyberspace they
are practicing in Maryland.
And now another issue has presented. Web sites have sprung up which advertise
the availability of prescription medications on-line. No prescription? No problem.
For a fee, an on-line consultation is available. The patient fills out a questionnaire
which asks a number of health related questions. The questionnaire is submitted
to the medical consultant and if the patient is approved, the patient is then
assessed a fee for the consultation (generally $75) and the desired medication
is subsequently provided by mail. All one needs is a credit card and the "right"
answers, and medication is speeding on its way to his or her home in a "plain
The BPQA has serious concerns about this practice. Let's say the patient wants
a drug like Viagra. Is an on-line questionnaire about the patient's past medical
history really a medical consultation? Does a bona fide doctor/patient relationship
exist when a person, previously unknown to the consultant, provides subjective
answers to such questions as: "Do you have a heart disease?" Would a physician
providing prescription medications to a patient based on a questionnaire be meeting
the standard of care?
In February, the Federation of State Medical Boards (FSMB) participated in a meeting
sponsored by the Food and Drug Administration to discuss on-line prescribing and
sale of prescription medications. The FSMB attended to convey concern on behalf
of state medical boards that engaging in Internet prescribing may be falling below
acceptable standards of care, and may be endangering the health of individuals
for whom they are prescribing.
The BPQA will be monitoring internet sites which advertise the availability of
prescription medications after an on-line consultation. Any doctor providing the
consultation or prescribing for a patient in Maryland who is not licensed in Maryland
can be subject to up to a $50,000 fine for practicing medicine without a license.
Doctors licensed in Maryland can expect their on-line prescribing to be subjected
to peer review. Anyone with information about on-line consultation leading to
prescription medications should contact the BPQA by phone at 1-800-492-6836, or
by e-mail at BPQA@ EROLS.COM.
BOARD DISCIPLINARY ACTIONS
OCTOBER - DECEMBER
CLAYTON J. COWAN, M.D., License #:
No License, Specialty: Anesthesiology (Tampa, FL) Application
for licensure granted; probation for five (5) years subject to terms and conditions.
The physician was disciplined by the Pennsylvania Board of Medicine based on its
finding of the physician's inability to practice medicine and surgery because
of illness and addiction to drugs and alcohol. The Pennsylvania discipline provided
for a stayed suspension and probation subject to terms and conditions. Date of
ROBERT B. GOLDSTEIN, M.D., License
#: D01275, Specialty: Urology (Baltimore, MD ) Surrender
of License. The physician's surrender was prompted by his age, his plans
for retirement, and an investigation of allegations that he engaged in inappropriate
and unprofessional sexual comments while performing examinations of one female
patient and two male patients in his office. Date of Action: 10/21/98.
PAULA A. MCKENZIE, M.D., License#:
D35226, Specialty: OB/GYN (Bowie, MD) Reprimand; terms
and conditions. The physician failed to meet standards of care in regard
to three obstetrical patients. Date of Action 10/21/98.
JAMES R. RALPH, M.D., License #: D09679,
Specialty: Psychiatry (Baltimore, MD) Violation of Consent
Order of December 18, 1996. Suspension for 60 days, all but 2 weeks stayed; Probation
for 3 years subject to terms and conditions. The physician continued
to overbill although the Board's original consent order of December 18, 1996,
advised him of billing irregularities and that he was being monitored for those
irregularities. Date of Action: 10/21/98.
ANTONIO A.M. BERTUMEN, M.D., License
#: D21651, Specialty: OB/GYN (Baltimore, MD) Reprimand;
terms and conditions. The physician failed to meet standards of care
with regard to a patient in his practice of obstetrics and gynecology. Date of
ANTONINO H. CALON, M.D., License #:
D20655, Specialty: Internal Medicine (Havre de Grace, MD)
Revocation. Violation of the Board's consent order of April 11, 1995,
that is, failing to practice competently and within the standard of care for ten
(10) patients as determined by peer review conducted during his probationary period.
Date of Action: 10/28/98.
ROBERT MILLMAN, M.D., License #: D13977,
Specialty: Family Practice (Rockville, MD) Suspension
for thirty (30) months; stayed; probation for thirty (30) months subject to terms
and conditions. The physician failed to meet appropriate standards of
care in his practice of family medicine. Date of Action: 10/28/98.
KI N. LEE, M.D., License #: D23473,
Specialty: Anesthesiology (Potomac, MD) Suspension for
three (3) months; effective November 2, 1998; upon reinstatement, probation for
three (3) years subject to terms and conditions, one of which is having his practice
restricted to outpatient pain management. The physician failed to meet
appropriate standards of care in cases in which the Respondent provided anesthesia
care for two patients. Date of Action: 10/28/98.
CARL R. SHOWALTER, M.D., License #:
D11537, Specialty: Psychiatry (Harrisonburg, MD) Revocation.
The physician was disciplined by the Virginia Board for unprofessional conduct
based on his representation to seven patients that masturbation therapy is a legitimate
treatment for various disorders; the physician had patients engage in this activity
during therapy, did this to patients, and took nude pictures during therapy sessions.
Date of Action: 10/28/98.
ALBERT H. DUDLEY, III, M.D., License
#: D22935, Specialty: Orthopedic Surgery (Owings Mills, MD)
Suspension for six months with all but six weeks stayed; effective November 20,
1998; probation for three years subject to terms and conditions; fine of $10,000.
The Board found that the physician was guilty of unprofessional conduct in the
practice of medicine; that the physician failed to meet standards of care; and
that the physician prescribed drugs which were not medically necessary to one
patient. Date of Action 11/4/98.
MARTIN J. SHUMAN, M.D., License #:
D08334, Specialty: Opthalmology (Glen Burnie, MD) Limitation
on practice as follows: the physician will perform no surgery, including but not
limited to the YAG procedure, and will practice in an office setting only.
Date of Action: 11/4/98.
JOSEPH K. SARFO, M.D., License #:
Nonrenewed 1987, Specialty: Pediatrics (Talihina, OK)
Application for reinstatement denied. The Maryland action is based on
the action of New York: (1) by the medicaid program to exclude the physician's
participation for five years, (2) by a New York hospital to terminate temporary
privileges and to deny his application for privileges for furnishing the hospital
false information about his Medicaid exclusion, and (3) by the New York Medical
Board to put the physician on probation when the physician returns to the state.
Date of Action: 11/10/98.
STANLEY Z. FELSENBERG, M.D., License
#: D01085, Specialty: None (Baltimore, MD) Suspension.
In accordance with the mandate of the Court of Appeals of Maryland the suspension
order of May 22, 1996, is affirmed and thereby reinstated. Date of Action: 11/10/98.
John K. Aziz, M.D., (formerly John
D. Tolliver, M.D.) License #: D36868, Specialty: None (Baltimore, MD)
Reinstatement order (license to be reinstated upon filing and processing of licensure
forms); probation for five (5) years subject to terms and conditions.
The physician has met the requirements for reinstatement. Date of Action: 11/18/98.
BARBARA N. VAN HORN, M.D., License
#: D28796, Specialty: None (Washington, DC) Reprimand.
The physician was in breach of a federal service requirement as a result of federal
loans granted to finance her medical school education. Date of Action: 11/18/98.
KUM HAI LEE, M.D., License #: D24844,
Specialty: None (Rockville, MD) Fine of $1,000.
The physician practiced medicine with an expired license. Date of Action: 11/16/98
DARRELL M. GRAY, M.D., License #:
D21711, Specialty: Internal Medicine (Baltimore MD ) Reprimand
and fine of $1,000. The physician failed to provide documentation of
50 hours of category I continuing medical education credits and failed to respond
to letters requesting the documentation verifying the 50 hours of CME credits.
Date of Action: 11/18/98.
CHONG MIN PARK, M.D., License #: D28699,
Specialty: Orthopedic Surgery (Westminster, MD) Fine of
$1,000. The physician failed to correctly answer the question on his
licensure renewal regarding continuing medical education. Date of Action: 12/16/98.
THE BOARD'S DISCIPLINARY ACTIONS ARE A MATTER
OF PUBLIC RECORD. A COMPLETE COPY OF ANY FINAL ORDER MAY BE OBTAINED BY CALLING
410-764-2475. THERE IS A SMALL FEE TO COVER THE COST OF COPYING THE DOCUMENT.The
BPQA Web-Site at www.docboard.org lists all licensees and whether or not there
has been a disciplinary action.
PHYSICIANS' PALLIATIVE CARE PAIN
HOTLINE UPDATE 1-800-492-3805
The Physician Palliative Care Hotline has been established as a toll-free number:
1-800-492-3805. It is available to physicians who wish to obtain immediate free
consultation on pain management in palliative care. The initial call will be handled
through the Emergency Medical Resource Center answering services.
The physician calling the hotline should request the "pain hotline." The dispatcher
will take the calling physician's name and phone number and will indicate that
a pain management physician will call back within 15 minutes. The on-call physician
will be paged immediately. All on-call physicians are board-certified in hospice
and palliative care medicine.
NOTE: As with any consultation, ultimate responsibility rests with the treating
RELATED TO PATIENT SURROGATES
The Board of Physician Quality Assurance endorses the ethical guidelines of the
American Medical Association, the American Osteopathic Association and the American
Psychiatric Association. These organizations provide thoughtful and widely accepted
guidelines for ethical conduct for the medical profession. In June of 1998, the
AMA adopted the Council on Ethical and Judicial Affairs report entitled "Sexual
or Romantic Relations Between Physicians and Key Third Parties." The position
adopted by the AMA defines sexual contact with key third parties that occurs concurrent
with the patient\physician relationship as unethical and therefore constitutes
sexual misconduct. Because this is an issue of considerable importance to physicians,
the AMA recommendations are reproduced below:
1). Patients are often accompanied by third parties who play an integral role
in what has usually been seen as a dyadic patient-physician relationship. The
physician interacts and communicates with these individuals about the patient's
condition and is in the position to offer them information, advice, and emotional
support. The more deeply involved the individual is in the medical decision-making
and clinical encounter, the more troubling is any sexual or romantic contact with
the physician. This is especially true for the individuals whose decisions directly
impact on the health and welfare of the patient. Such key individuals may include,
but are not limited to: spouses or partners, parents, guardians, surrogates, and
proxies designated by durable power of attorney.
2) The risk of exploitation can vary with the intensity and emotional nature of
treatment. Several things contribute to the vulnerability of the patient and key
third party: the nature of the patient's medical problem; the length of the professional
relationship; the degree of emotional dependence the third party has on the physician;
and the importance of the clinical encounter to the surrogate and patient.
3) Physicians should refrain from sexual or romantic interactions with these key
third parties. Sexual contact with these individuals that occurs concurrent with
the patient-physician relationship is unethical and constitutes sexual misconduct.
(References pertaining to this report are available from the AMA Office of Ethics
NEW PHYSICIAN MEMBERS SOUGHT FOR
For the last two years the BPQA Newsletter has provided licensees with the ballot
to vote on the candidates nominated to fill openings on Board. This year, MedChi
has again asked BPQA to distribute the ballot. MedChi has also established some
new ground rules. In order to be a nominee, an individual must be placed in nomination
by a physicians organization of at least 25 members or be supported by 25 Maryland
licensed physicians. Ballots will be distributed to all Maryland licensed physicians.
Results of the election will then be forwarded to Governor Glendenning who will
select the replacements for retiring Board members. This year BPQA will lose Dr.
Charles Hobelmann and Dr. Suresh C. Gupta who have served the maximum of two terms
and who are not eligible for reappointment. Dr. Mary M. Newman whose term also
expires this year is eligible for reappointment to a full four-year term. Dr.
Newman's name will be submitted to the Governor by MedChi for reappointment in
accordance with the Annotated Code of Maryland, Health Occupations § 14-202 (d).
MEDICAL RADIATION TECHNOLOGISTS
ANDNUCLEAR MEDICAL TECHNOLOGISTS
Certification for all Medical Radiation Technologists and Nuclear Medical Technologists
will expire on April 30, 1999. Renewal packets were be mailed out the first week
of March. If you have moved since the 1997 renewal, you must notify the Board,
in writing, of your new address. If this is your first renewal, you are exempt
from the 24 hours of continuing education. All other technologists are required
to have 24 hours of continuing education which must be accrued between May 1,
1997 and April 30, 1999.
If you are certified as both a Medical Radiation Technologist and a Nuclear Medical
Technologist, you will not be required to have 48 hours of continuing education.
You may satisfy the continuing education requirement by documenting 24 hours from
programs which are relevant to either designation.
NEW PHYSICIAN ORIENTATION-EDUCATIONAL PROGRAMREQUIRED
FOR FIRST TIME RENEWAL
On or about April 1, 1999, new regulations will go into effect requiring physicians
who are applying for the first renewal of a Maryland Medical License to attend
the Board of Physician Quality Assurance New Physician Orientation Program. This
means that if you received your initial medical license within the last two years,
and your license expires in 1999 (your last name begins with the letters M-Z),
you must attend this orientation program as a requirement for the renewal of your
license. If you have already attended an orientation, you should have received
a certificate indicating your attendance. The BPQA may defer this requirement
for license renewal for physicians who are not practicing medicine in Maryland.
These deferments will be handled on an individual basis. THE ORIENTATION IS DIVIDED
INTO THREE SEGMENTS
1. The Board of Physician Quality Assurance
Attendees will learn the essential elements of the Maryland Medical Practice Act
and regulations affecting their practice of medicine in Maryland, the role and
function of BPQA, and the essentials of the "peer review" process, and the physician's
responsibility in the process. State agencies a physician must contact for permits,
forms, and information essential in the practice of medicine are enumerated and
many of the forms are supplied at the orientation.
2. Boundary Issues
Participants are guided through the BPQA disciplinary process and examine actual
sanitized cases to understand the decision making process the Board employs. This
segment demonstrates the situations which could become potential problems and
should stimulate physicians to begin thinking about the danger signals of boundary
violations. In addition, BPQA Board members address topics including the balance
of power in a physician/patient relationship, the patient who makes unethical
requests, as well as appropriate office atmosphere.
3. Prescribing CDS
The video, A Sense of Balance presents the position of the Maryland Board of Physician
Quality Assurance as well as that of the Federation of State Medical Boards on
prescribing to patients with pain. Participants examine cases brought before the
Board which deal with pain treatment to develop an understanding of the Board's
position on prescribing controlled drugs.
THESE ORIENTATIONS ARE SCHEDULED AS FOLLOWS:
March 8, 1999 Memorial Hospital Easton, MD May 19, 1999 Montgomery
County Medical Society March 11, 1999 MedChi Offices 1211
Cathedral Street June 7, 1999 Southern Area - Civista HospitalMarch
18, 1999 Montgomery County Medical Society June 10, 1999 MedChi Offices 1211 Cathedral
StreetApril 5, 1999 Western Area June 16, 1999 Montgomery
County Medical SocietyMay 3, 1999 Penninsula Gen Hospital
Salisbury, MD July 8, 1999 MedChi Offices 1211 Cathedral StreetMay
13, 1999 MedChi Offices 1211 Cathedral Street July 14, 1999 Montgomery County
This program can also be approved for Category I CME (3-Hours).
These programs are free. However, everyone must register to attend. If you are
applying for CME, please make reservations at least three weeks in advance of
the orientation. The program begins at 6:00 p.m. and ends at 9:00 p.m. A light
dinner is provided.
For more information about these programs or to register for one of these programs,
call Education and Training Unit of BPQA at 410-764-5972.
PHYSICIAN LICENSURE RENEWAL TIME
The renewal applications for physicians whose last names begin with the letters
M-Z will be mailed in late June to the last address the physician supplied to
the Board. Please notify the Board if you have not received your renewal application
by the middle of July. Earning 50 Category I CME's is a requirement for renewal.
If you are unsure of what constitutes Category I CME's, contact the Board and
request a copy of the CME regulations. Please also pay close attention to when
your CME's should have been earned and how long you should keep the documentation.
Additional requirements apply for first time renewal. (See article on page 5.)
Physicians whose renewal applications are not postmarked by September 30, 1999,
are no longer licensed to practice in Maryland. In the two month period following
expiration of licensure, the Board will accept the renewal form with the renewal
application fees and a $50 late fee. Until their licenses are renewed, physicians
who file late applications are not authorized to practice medicine. Any physician
who does not renew the license by the end of the two month period will have to
apply to reinstate the license.
There will not be an increase in the licensure fee for this renewal. The last
fee increase occurred in 1991.