Month: May 2017

Physicians, pharmacists, and nurses: Are you stressed by license or renewal applications?

I have written on this topic before. Ten months ago I wrote about mandatory reporting requirements and the dreaded “yes questions.” Nineteen months ago I asked whether license applications or license renewals caused a sinking feeling in the pit of your stomach and wrote about that. Today I am revisiting this topic because it is part of my practice every week. Recently, I helped a new graduate make her first license application and a seasoned professional file his license renewal application. Both had alcohol-related incidents to report and explain. Last week I also helped three nurses and two physicians that were either “caught,” or otherwise had to self-report and explain alcohol or drug activity. It should come as no surprise then that the Oregon State Board of Nursing, the Oregon Board of Pharmacy, and the Oregon Medical Board are all well experienced with substance abuse issues and arrest records. The good news is that whether you are a nursing, pharmacy, or medical student, a recent graduate, or a licensed professional, if you have a substance abuse issue or arrest record, much can often be done to help you obtain or maintain your professional license.

Forward thinking medical students have time to act before applying for licenses

One forward thinking pharmacy student and another forward thinking medical student wanted to determine before starting their educations whether their arrest records involving drugs or alcohol would preclude them from obtaining a pharmacy or medical license upon graduation. The medical student would also need a DEA Registration. One nice thing about helping students at the beginning of their educations is the element of time. I can help a student anticipate what lies ahead, and understand what he or she can do ahead of time to improve the odds of being licensed upon graduation. Much can be done to help students prepare themselves well before it is time to apply for that first license.

Recent medical graduates likely have more to help their license applications than they know

If you are about to graduate as a nurse, pharmacist, or physician, and the thought of applying for your first license causes a sinking feeling in the pit of your stomach, there is reason to be hopeful. It is my experience that whatever drug, alcohol or arrest history is in your past, there will be many positive things to stress in your favor when applying for your first license. You are a new graduate after all, so you have done a number of things right; what are they? The key to this approach, however, is that whatever drug, alcohol or arrest history is truly in your past. If, for example, you have a drug history and you are arrested for a drug violation while your license application is pending, that new drug arrest presents a much more difficult obstacle to overcome.

Help for seasoned physicians, pharmacists, and nurses when renewing

Licensed professionals must report certain drug and alcohol related activity, convictions, and some arrests and often seek help with their license renewals. If you find yourself in this situation you are not alone, and the Oregon State Board of Nursing, the Oregon Board of Pharmacy, and the Oregon Medical Board are all well experienced with drug, alcohol, and arrest records.

Recently, I helped one licensed heath care professional complete his renewal application. He had an alcohol related incident since his last renewal but he had also done everything necessary to take care of his health and return to work. His renewal application made clear that insufficient explanations and/or documentation could delay his renewal. Fortunately, he did the hard work before I became involved and my role was limited to assisting his explanation and assembling the documents I knew his licensing board would expect to see to ensure he is healthy, competent, and safe to return to work. Despite his report of a significant alcohol related incident, his renewal went through without further effort.

Some time ago, I helped an out-of-state nurse obtain her Oregon nurse’s license. Her situation was not uncommon. When she was young, she incurred a relatively minor drug and arrest record about the same time she obtained her first nursing license, so her first nursing license issued with heavy restrictions and those restrictions that were never lifted. When she called upon me to help her apply for her Oregon nurse’s license, she was emotionally beaten by the restrictions that had haunted her practice for a decade. Once we started working together, I was impressed by all that she had accomplished personally and professionally since she was first licensed. Whatever happened a decade ago was old history, no longer relevant in gauging who she is today. All that we needed to do was organize and present her accomplishments in a way that could be understood and verified by the Oregon State Board of Nursing. Her unrestricted nursing license quickly issued, with no interview and no further questions. I was happy for her and impressed by the Oregon State Board of Nursing for processing her nursing license application so expediently.

A perfect storm is brewing for physicians prescribing narcotics

Defending physicians prescribing narcotics for chronic pain has never been easy and I have long criticized the the Drug enforcement Administration (DEA) for conflating the civil standard of care with the criminal conviction standard, thereby criminalizing the practice of medicine. Sixteen months ago I commented that the DEA unnecessarily extends its investigations to the detriment of physicians and patients (DEA investigations: How much is too much?), and 11 months ago I commented that a new standard of care has emerged for the treatment of chronic pain (The pendulum has swung: Treat chronic pain cautiously). Now Attorney General Jeff Sessions, who heads the DEA, has ordered his federal prosecutors to seek the maximum punishment for federal drug offenses. All tolled, a perfect storm is brewing for physicians prescribing narcotics to treat chronic pain.

Treating chronic pain > 90 days and 120 MED (morphine equivalent dose)

With a few exceptions (e.g., cancer pain or hospice care), if you treat chronic pain with narcotics in excess of 90 days and 120 MED (morphine equivalent dose) and your prescribing practices have not evolved over the past five to seven years consistent with the emerging standard of care, you have likely failed to “keep up” and you may be at risk of regulatory intervention. If you treat chronic pain with narcotics in excess of 90 days and 120 MED, and you are not a pain specialist, or you do not refer your patients to a pain specialist, and your patients are not on taper plans, your medical practice may be a ticking time bomb

Prescribing guidelines: The emerging standard of care

The following practice guidelines, offered by the Oregon Medical Board and Oregon Health & Science University (OHSU), reflect current standard of care expectations when prescribing narcotics to treat chronic pain:

If your practice is not in line with these recent guidelines, you may be risking sanctions by your state medical board or the DEA. If your practice comes to the attention of your state medical board, your medical license may be subject to quick restriction or threatened revocation. Similarly, if your practice comes to the attention of the DEA, your DEA Registration may be subject to restriction or revocation and, in a worst case scenario, you may be subject to a criminal investigation. This already serious problem has been exacerbated by a newly invigorated DEA that has been instructed United States Attorney General Jeff Sessions to pursue the maximum punishment available for federal drug law violations.