Tag: Oregon Board of Pharmacy

Defending a licensing Board complaint during the first few days

Posted on June 17, 2016 by - Licensure

You’re a physician, pharmacist, or nurse, and you just learned a complaint has been filed against you with the Oregon Medical Board, the Oregon Board of Pharmacy, or the Oregon State Board of Nursing. Now what?

Stop, collect your thoughts, establish the first deadline

If you just received word-of-mouth notice, or a letter from your licensing Board, time is momentarily on your side, so take advantage of it. Avoid knee jerk reactions. Whatever you do, do not call your licensing Board or the investigator that sent you a letter. You’re not ready. You’re too emotionally involved. Instead, establish the first deadline. Get time under control. Stop. Think.

Don’t assume you know the substance of the Board complaint

It is only natural to speculate about the nature of the complaint. The tendency is to speculate based upon what you know, and then rationalize why the Board complaint is unfounded. The problem with this approach is that your knowledge of the complaint is most often limited, and your conclusions may therefore be wrong. This is no way to plan your defense.

Retain a healthcare defense attorney with experience defending licenses for physicians, pharmacists, and nurses

The better approach is to have a healthcare defense attorney contact the investigator, to learn about the complaint and to further discover what most concerns the investigator. Be aware that this call to your investigator is not a call you can make well, because once the investigator explains the basis of the complaint, a reaction will expected of you. It’s only natural; this is the way conversation works. You, however, will not be prepared to answer. Yet there you are, on the phone with the investigator, your mind racing, wondering how to respond to fill the silence. This is no time to be experimenting with answers. Again, the better approach is to have an experienced healthcare defense attorney contact the investigator. Your attorney will then share this information with you in a private setting where the issues and concerns may be thoughtfully explored, without risk to you. Remember, your best answer to the complaint will take some time and work to marshal; it will not emerge extemporaneously during a first phone call with the investigator. Have your attorney make that first call instead.

Don’t blame others until you have explained your role

If others were involved in the circumstances setting up the Board complaint, do not blame them, at least not at first. For some, placing blame where it belongs is a strong personal instinct. If others were involved, they will be investigated or interviewed too. When it is your turn, the investigator wants to understand your role in the circumstances behind the complaint and, until your role is satisfactorily understood, blaming others will come off as evasive, uncooperative, and non-responsive. Don’t make this mistake. An experienced healthcare defense attorney will help you avoid this mistake. And remember, if your role in the complaint was truly small and non-contributing, it will not take long to explain, and a good explanation will reference the participation of others, from which the investigator will draw all appropriate conclusions. In the context of a medical Board investigation, blaming others requires a deft touch.

Two “red flags” when interviewing a licensing lawyer to defend your medical license

Posted on June 10, 2016 by - Licensure

Red flag #1: Blaming the licensing Board’s investigator

Earlier this year, a practitioner hired me as her second lawyer, and I took over the representation of her case.  Later, after much of our work had been completed, she expressed surprise at how helpful the investigator had been.  When I asked her why she was surprised, she explained that her first lawyer blamed the investigator, saying something like, “Oh, you have Jane Doe for an investigator, you’re in trouble.”  That was unfortunate.  I have worked with the same investigator and find her easy to work with. More importantly, I regularly represent nurses, pharmacists and physicians before the Oregon State Board of Nursing, the Oregon Board of Pharmacy, and the Oregon Medical Board, and there has never been a reason to blame the investigator.  It is my opinion that if a lawyer you interview blames the investigator, keep interviewing lawyers until you find one that works well with investigators.  Your interests will be better served in the short and long run.

Red flag #2: Utilizing a litigious approach with an investigator

Last year I had a chance to ask an investigator what she thought of the relatively small group of lawyers that routinely appear before her licensing Board.  I was surprised to learn that some used a tough approach, keeping communications short, and often implying that a contested case hearing (litigation) would be necessary when, in fact, they seldom are.  Needless to say, these lawyers, due to their uncooperative reputations, were not favored by the investigators.  As my record will demonstrate, I am willing to advance tough litigation in defense of physicians, pharmacists, and nurses, but litigation must be reserved for the right circumstances.

More importantly, consider the disadvantage you may suffer because of your lawyer’s “tough talk.”  For example, throughout the course of a licensing Board’s investigation, much information must be exchanged, and any alleged practice discrepancy prompting the complaint against you must be carefully evaluated.  Consider also that you will most likely be interviewed by the investigator, and much of the work of the interview can be accomplished between your lawyer and the investigator, sparing you much grief.  Whatever the cause of the complaint, solutions must be negotiated.  Ultimately, the investigator will write the summary of your case, including recommendations, that will become the basis of the Board’s decision against your medical license.  For all these reasons, it is my opinion that a cooperative and professional relationship between your lawyer and your licensing Board’s investigator will lead to the most efficient and complete exchange of information, and the best resolution of your case.  Along the way, you will be better informed too.

Do not dismiss the power of your licensing Board

Posted on June 8, 2016 by - Licensure

I have won significant federal court litigation defending health care providers, including physicians and pharmacists.  Knowing this, a health care provider growing weary of defending against his or her licensing Board will occasionally ask why I can’t do more in his or her case.  For example, one physician wanted me to sue the Oregon Board of Medicine in “a real court of law,” and one nurse asked whether I could obtain a Temporary Restraining Order (TRO) against the Oregon State Board of Nursing.  The answer is almost always “no.”  Let me explain why.

The 50 states regulate medical licensing and practice standards

In our State-Federal scheme of government, the power to regulate medical practice and licensing is reserved to the 50 states.  Admittedly, there is federal “overlay,” but still, when it comes to ensuring safe medical practice through the licensing of physicians, pharmacists, nurses, that role and power belongs to the states.

The 50 states exercise their “power” through state agencies

You may recall from civics classes that state and federal power is spread across three branches of government, the Legislative, the Judicial, and the Executive branches.  The Executive branch of state government is headed by the Governor, and the bulk of any state’s work is accomplished through a multitude of state agencies belonging to the executive branch.

Your licensing Board is a state agency

Whether you are a physician, pharmacist, or nurse, your licensing Board is a state agency, specifically empowered to ensure the safe practice of your profession (public safety) and the competency of each individual practitioner.

What you need to know: Respect your licensing Board

So, when the physician wanted me to sue the Oregon Board of Medicine in “a real court of law,” and the nurse asked whether I could obtain a TRO against the Oregon State Board of Nursing, you now know why the answer was “no.”  Even when the complaint against you is wrong, or the licensing Board is wrong, the licensing Board is nonetheless fulfilling its role as a state agency regulating your profession.  It is true that in some cases there may be an appeal to a state court (this happens occasionally) and, in the exceedingly rare case, an argument for a restraining order from a trial court (this has happened only once in my career), but this is not where you start.  You start with the agency – i.e., your state licensing Board – because your state licensing Board is not only empowered to regulate your profession, it has the most power to do so, and your interests will be best served by taking that power seriously.

More on how to “pass” (or fail) your licensing Board interview

Posted on May 30, 2016 by - Licensure

Whether you are being investigated by the Oregon State Board of Nursing (OSBN), the Oregon Medical Board (OMB), or the Drug Enforcement Administration (DEA), your success during your interview is key to the successful resolution of the investigation.  Today I will share with you the experience of three clients – a nurse, a physician, and a dentist – all of whom went to interview within a 14-day span this month.  Two “passed.”  One “failed.”  Let my tell you why.

The nurse and the Oregon State Board of Nursing (OSBN)

Earlier this year I undertook the representation of a well-qualified and experienced nurse under investigation by the Oregon State Board of Nursing (OSBN).  She went to interview this month.  At one hour and 45 minutes, her interview was long, and seemed even longer with four of us in a room that was too small and too hot.  The interview was led by the OSBN nurse investigator and assisted by an OSBN advanced practice nurse, with my client the focus of attention.

The first hour of the interview was necessary to get at the core issues in this unusually complex case.  The OSBN’s investigator and advanced practice nurse were well prepared (aren’t they always?).  My client was also well prepared, however.

As we passed through the first hour of the interview, I was impressed by the depth of the discussion and by my client’s answers.  I privately marveled at how few members of the public will ever appreciate how carefully the practice of nursing is regulated in Oregon.  My client was subjected to questions for an hour and 45 minutes, by two investigators, and her interview had the tone of a thoughtful discussion.  She passed the test.  The case isn’t over, but my client did a stellar job, and representing her that day was professionally rewarding.

The dentist and the Drug Enforcement Administration (DEA)

I also prepared a dentist for an interview this month before the Drug Enforcement Administration (DEA). In this case, the dentist sought reinstatement of his DEA Registration, earlier surrendered.

In a December 7, 2015 post, I explained that in the right circumstances, reinstatement of a surrendered or revoked DEA Registration is possible.  These can be tough interviews, however, because in cases where a DEA Registration has been surrendered or revoked, there are usually a few “sensitive” issues.  Also, the interviews are conducted by DEA Drug Diversion Agents and, in my experience, there are always two of them.

This interview was nonetheless a success.  By the end of the interview, my client was advised he would have his DEA Registration back in four to six weeks, with a few temporary, common sense restrictions, but nothing that will interfere with his practice.  It doesn’t get much better than that!

The physician and the Oregon Medical Board (OMB)

In the same 14-day span this month, I was hired by a physician but, unfortunately, her interview occurred the week before I was hired, and she went alone, unprepared, and unrepresented.  She “failed.”  Let’s consider what my client was up against.  By the time of her interview at the Oregon Medical Board, the Board’s investigator, the Board’s Investigative Committee’s (IC), and the Board’s expert, had all finished their work.  Counting the Board’s investigator, the Board’s expert, and the four members of the Investigative Committee, six people were prepared to interview my client that day.  If you find yourself facing a Board interview, ask yourself the following questions:

  • What have you done to prepare?
  • Who has given you legal advice?
  • Who has prepared you?

If you cannot answer these simple questions in a reassuring manner (without rationalizations or excuses), you are not ready for your interview.  As I have said many times before, an interview with your licensing Board is no place to show up and see what happens.

The moral of the story

In this case, there is little doubt in my mind that this physician should have passed her interview, had she been ready.  But she wasn’t ready.  Don’t let this happen to you.  An experienced healthcare defense attorney will help you prepare for your interview.

How to “pass” (or fail) your licensing Board interview

Posted on May 21, 2016 by - Licensure

Whether your are a physician, pharmacist, or nurse defending against an investigation by the Oregon Medical Board, the Oregon Board of Pharmacy, or the Oregon State Board of Nursing, what I am about to share with you holds true.  At a minimum, you should expect your licensing Board to request (a) your written statement answering the complaint against you, and (b) your appearance at the Board’s office to sit for a recorded interview.  To help my client’s obtain a good interview, I keep the following points in mind while helping them prepare their written statements, and while preparing them for interview.

Know your case and accept responsibility where necessary

Although many Board complaints are full defensible, many others are not, and it is important to know which type of case you have.  While it is professionally rewarding to defend a licensee 100 percent, when a mistake was made, it is often preferable, if not necessary, to acknowledge the mistake, accept responsibility, provide mitigating context, and take corrective action to prevent a recurrence of the mistake.  Your licensing Board will respect either approach, so long as we have correctly identified which type of case you have.  An experienced healthcare defense attorney will help you accurately evaluate your case and develop a plan to defend your medical license.

Be well prepared for your licensing Board interview

If you do not know what the issues are, or what the likely questions will be, you are not prepared for your interview.  It is that simple.  Please know that an interview with your licensing Board is no place to show up and see what happens.  If this is your approach, you will fail.  In sharp contrast, an experienced healthcare defense attorney will identify the controlling legal issues and the questions you can expect to be asked during your recorded interview.  Please also know that your investigator will be well prepared to interview you and, by the time of your interview, your investigator will have drawn tentative conclusions about your case.  Some of the questions you will be asked will be well thought out in advance and, in those cases where your written statement was misleading, some of the questions will be pointed, and you will likely face a series of questions intended to expose your lack of candor.  Do not let this happen to you. An experienced healthcare defense attorney will help you avoid this trap.

Do not attempt to mislead your licensing Board

You are taking a huge risk if you attempt to mislead your licensing Board, either in your written statement, or while answering questions during your recorded interview.  Your licensing Board has resources, and it will conduct a background check.  One or more investigators will investigate your background, and the investigators are very skilled at what they do.  If, for example, you had a bad experience in another state, especially one involving a similar issue giving rise to your current licensing Board investigation, you should expect the out-of-state incident to be discovered and investigated by your licensing Board.  Please know that any effort to mislead your licensing Board about the prior out-of-state incident will almost certainly be exposed and, when this happens, you will have lost your credibility with your licensing Board.  Do not let this happen to you.  The better approach is to know when to acknowledge the mistake, accept responsibility, provide mitigating context, and take corrective action to prevent a recurrence of the mistake.  This is delicate work, requiring the assistance of an experienced health care defense attorney, to ensure you are adequately defended.

Conclusion

In sum, to ensure a good interview, you need to accurately evaluate your case, you need to be well prepared, and you need to be candid when answering questions, all the while defending yourself and protecting your license.  This is difficult work, and it requires the assistance of an experienced healthcare defense attorney to do it well.

The Oregon pharmacist’s role in preventing prescription drug diversion

Posted on January 16, 2016 by - Licensure

The “corresponding responsibility” imposed on Oregon pharmacists

It is a crime is to “knowingly or intentionally” distribute or dispense a controlled substance unless “authorized” by the Controlled Substances Act (CSA). See, 21 U.S.C. § 841(a). Authorization is obtained by “registering” with the Attorney General. See, 21 U.S.C. § 822(a)(2). Persons registered with the Attorney General are authorized to possess, manufacture, distribute, or dispense controlled substances to the extent authorized by their registration. See, 21 U.S.C. § 822 (b). Physicians licensed by a state and registered with the Attorney General are “practitioners” and, as such, they are authorized to prescribe and dispense controlled substances (see, 21 U.S.C. § 829(a)&(b)) in “the course of [their] professional practice.” See, 21 U.S.C. § 802(21); see also, United States v. Moore, 423 U.S. 122, 140 (1975). Similarly, pharmacists licensed by a state and practicing in a pharmacy registered with the Attorney General, are authorized to dispense controlled substances. Giving effect to this federal statutory scheme, the Drug Enforcement Administration (DEA) promulgated a regulation that broadly requires all prescriptions to be issued for a “legitimate medical purpose” and imposes “a corresponding responsibility [on] the pharmacist who fills the prescription.” See 21 CFR § 1306.04(a). A pharmacist’s failure to observe whether a prescription is issued for a legitimate medical purpose can lead to administrative and criminal sanctions.

The difficult task faced by Oregon pharmacists

Compared to the prescribing physician or nurse, a pharmacist’s exposure to a patient is but a brief encounter. For most patients, a visit to a pharmacy is more akin to a sales transaction that a health care event and, should something seem amiss to the dispensing pharmacist, neither the patient nor the patient’s prescribing physician will have much tolerance for questions. Nonetheless, it is in this environment that the Oregon pharmacist is expected to ensure that all prescriptions are issued for a legitimate medical purpose.

The current practice standard: screening for “red flags”

I can assure you from my work defending physicians and pharmacists that screening for red flags is expected of all practitioners. For the pharmacist, however, screening for red flags may be one of the better tools available to detect prescription drug diversion, to ensure that all prescriptions are issued for a legitimate medical purpose. Agreeable or not, screening for red flags is also important because whether a pharmacist screened for red flags will be a consideration for the Oregon Board of Pharmacy and DEA drug diversion investigators whenever there is a suspicion of drug diversion and one or more red flags were present. The Oregon Board of Pharmacy addresses screening for red flags on its website at: http://www.oregon.gov/Pharmacy/pages/index.aspx), and further links to an YouTube educational video: https://www.youtube.com/watch?v=WY9BDgcdxaM&feature=youtu.be:

While screening for red flags to prevent drug diversion has its limits (and its critics, which include patients, prescribing and dispensing practitioners, and pain control advocates who may feel pitted against one another), it is nonetheless the current practice standard against which a pharmacist’s conduct will be measured, and it is therefore important to incorporate this type of scrutiny into the Oregon pharmacist’s day-to-day practice.

 

Settling a dispute with your licensing Board

Posted on November 28, 2015 by - Licensure

Is settlement possible?

The answer to this question is emphatically “yes.” In fact, most cases that proceed beyond an investigation, to the issuance of a Notice of Proposed Disciplinary Action, are settled. This is true whether you are a nurse, pharmacist, or physician licensed by the Oregon State Board of Nursing, the Oregon Board of Pharmacy, or the Oregon Medical Board. Such settlements are known by a different name – a “consent order,” or a “stipulated order,” to name two examples – but these are settlements nonetheless.

How to settle your case

Unlike most settlements,you don’t pay money to settle a disciplinary matter. Instead, you agree to accept “discipline” by your licensing Board. In a case involving a “minor” violation or discrepancy, the settlement may be an agreement to accept a “reprimand.” A reprimand is on the low end of the disciplinary continuum, typically the starting place for discipline, although a reprimand should not be dismissed lightly, a point I stressed in a prior post on September 25, 2015. If a reprimand is not enough, perhaps a fine or short suspension will be necessary to reach settlement. In a more difficult case, you may need to negotiate probation, and perhaps the imposition of practice mentors and monitors. In the worst case, you are left to negotiate surrender of your licensure, and, hopefully a fw key terms of future reinstatement

A smart settlement requires an experienced lawyer and an experienced investigator (the investigator with your licensing Board is most likely experienced, but if not, rest assured, someone else with experience will negotiate on behalf of the Board). The trick to a smart settlement is that both negotiators must be experienced in order to recognize the most likely outcome, whether your case is litigated or settled. The goal of a smart settlement is to get to the “bottom line” quickly sparing cost and grief. Unreasonable expectations on either side with thwart a smart settlement.

Is settlement necessary?

A settlement is never necessary, because a licensee always has a right to a hearing to defend his or her license, unless or until you waive that right, usually as part of your settlement. Even if settlement is not necessary, settlement should always be considered. I had two cases this year in which settlement was earnestly discussed, but ultimately rejected. The investigator proposed settling offering to stipulate to a reprimand in each case. In the end, however, I recommended against a reprimand-settlement after determining that neither of my clients violated any law or practice standard. My clients accepted my recommendation and, in the end, the Board closed both cases without discipline. The two examples show why experience is helpful, if not necessary.

In a more serious case, especially one where you are exposed to revocation of your license, settlement may be your best option, and perhaps the only way to manage risks and control expenses. In the worst of cases, where your licensing Board is pursuing nothing short of revocation, settlement may be your only option if you want to manage risks and ensure that you keep your license.

How to proceed

An experienced licensure lawyer will be necessary, otherwise your decision to settle, to stand firm, or to proceed to hearing, will be more akin to a gamble that an informed decision. An experienced lawyer will be able to evaluate your specific circumstances and make reasoned recommendations. In some cases, an experienced lawyer can strongly recommend when to stand firm, or when to settle. In other cases – the close-call cases – an experienced lawyer can make recommendations in the alternative, enumerating the pros and cons for each recommendation, enabling you to make the best decision in your unique circumstance. In the worst of cases, where your hearing will certainly result in a loss, an experienced lawyer will recognize that inevitability and tell you as much, i.e., that anything gained through settlement will be more than will be gained by taking that case to hearing. An experienced lawyer will guide you through this process.

Reinstatement after surrender or revocation of your state medical license

Posted on November 26, 2015 by - Licensure

There is a second chance

This week have I worked with a pharmacist and a nurse, both of whom are taking steps toward reinstatement of their licenses to practice pharmacy and nursing. In the nurse’s case, she surrendered her license just over a year ago. At that time, we negotiated a few key terms of reinstatement as part of a larger settlement.Today her application for reinstatement is pending. In the pharmacist’s case, his revocation was the recent result of taking his case to hearing, and losing. He retained me afterward. Despite his recent revocation, there was an extenuating fact or two and, only months after his revocation, he is taking the first steps necessary toward reinstatement.

Reinstatement after revocation or surrender is possible

Both the nurse and the pharmacist have reason to be hopeful about reinstatement. These are not pie-in-the-sky dreams in either case. In both cases, reinstatement is a very real possibility. On behalf of the nurse, I am working directly with the investigator at the Oregon State Board of nursing that accepted the nurse’s surrender of licensure just over one year ago. Similarly, on behalf of the pharmacist, I am working directly with the individual at the Oregon Board of Pharmacy most closely connected to the pharmacist’s revocation of licensure. These are very real and genuine discussions, with the representatives of each licensing Board being helpful and encouraging.

What you need to know

If you have surrendered your license, or lost your license to revocation, and you want to practice again, there is hope. In the two cases I mention above, the path to reinstatement will require approximately 18 months of earnest work. There are no tricks, and there is no magic, and whatever the circumstances that led to the surrender or revocation of your licensure, those circumstances will need to be fully addressed. Trust with your licensing Board will need to be fully reestablished.

How to get started

After surrender or revocation, your position is too weak and you are too emotionally involved to do this on your own. In the right circumstances, I can approach the licensing Board on your behalf, negotiate a potential reinstatement process, and then guide and represent you throughout that process. Nothing is guaranteed, however, and honest hard work will be required. If either one of us falters in this regard, your chances of reinstatement will be reduced.

Pharmacists: Protect yourself by spreading responsibility

Posted on November 20, 2015 by - Licensure

The responsibilities of an Oregon pharmacist are extensive

A pharmacist licensed to practice pharmacy by the Oregon Board of Pharmacy has the duty to use that degree of care, skill, diligence and professional judgment that is exercised by an ordinarily careful pharmacist in the same or similar circumstances. See OAR 855-019-0200. The general responsibilities of a pharmacist are extensive, and there are many opportunities to make a mistake. See, e.g., OAR 855-019-0200(1)-(7) (listing some responsibilities). Moreover, a retail or institutional pharmacy may only only be operated when a pharmacist is physically present in the pharmacy to supervise the pharmacy. See OAR 855-041-1015(1). It should come as no surprise then, that most mistakes or problems will be assigned to the pharmacist on duty when the mistake is made or the problem arises in some damaging way.

Be wary, share the problem, and implement corrections

Although a practicing pharmacist will always be responsible for meeting professional standards, be wary of accepting responsibility for institutional problems, or the problems of others. If workload is too high to avoid medication or dispensing errors, or if technicians or cashiers are exceeding the lawful scope of their respective roles, or whatever the problem may be, expose and share the problem. Be proactive. Find and implement solutions. Otherwise, you may be assuming sole responsibility for problems and mistakes that will no doubt occur under your supervision.

Do not become isolated; report upstream; seek help

If problems are not easily corrected, do not sit of the problem. Do not become isolated with the problem. Instead, report the problem upstream. A friendly email spotting a potential problem and asking for help is a good place to start. Proposing a solution is even better. The worst thing you can do, however, is to become isolated and do nothing, all the while being responsible for an unsafe practice that will eventually result in a problem that is reported to the Oregon Board of Pharmacy. When that happens, blaming the pace of workplace, or the staff, or the corporate management, will not get you very far if you failed to address the problem you spotted on your watch, while you were supervising the pharmacy.

Report the problem to others licensed by Oregon Board of Pharmacy

Each pharmacy must have one pharmacist-in-charge employed on a regular basis at each location who shall be responsible for the daily operation of the pharmacy. See OAR 855-041-1010(1). Share the problem with your pharmacist-in-charge. If you are the pharmacist-in-charge, report up to management and ownership. Remember, the pharmacy is also licensed by the Oregon Board of Pharmacy, and the pharmacy must ensure that it is in compliance with all state and federal laws and rules governing the practice of pharmacy and that all controlled substance records and inventories are maintained in conformance with the keeping and inventory requirements of federal law and board rules. See OAR 855-041-1010(2). If you instead choose to “sit” on a problem until it results in a complaint to the Oregon Board of Pharmacy – because your believe you lack the authority to correct the problem, or your believe that management “won’t do anything” – then the problem will be your problem alone, when the Oregon Board of Pharmacy becomes involved. Don’t let this happen to you.

When all else fails

If you genuinely believe you have no one to report to that will help you, then the problem is truly yours to resolve. At this point, you will be best served to consult a pharmacy inspector, or an experienced attorney, for guidance. An experienced licensure attorney can contact the Board of Pharmacy looking for solutions, without disclosing your name. In the rare event that you are left with no other alternative than to report your pharmacy to the Oregon Board of Pharmacy, an experienced licensure attorney can make the report for you, in the most constructive fashion. The alternative is to sit on a ticking time bomb. Don’t do it.

When facing serious discipline, do not assume your license in another state is safe

Posted on November 17, 2015 by - Licensure

In a prior post on August 30, 2015, I cautioned against applying for a new license in a second state before an investigation in your home state is concluded. The reason was simple. Once you are disciplined by one state licensing Board, the licensing Boards in the other states in which you are licensed will likely follow suit by opening a second investigation, often imposing some form of discipline, or even mirror-image discipline, sometimes called “reciprocal discipline.” Knowing this, it is almost always a mistake to apply for a new license in another state while a current investigation and potential for discipline is pending against you in your home state. It just leads to another investigation in a state you have never practiced. Don’t risk it, unless there are extenuating circumstances and the consequences are fully understood. This practical advice applies whether you are licensed as a physician, pharmacist, or nurse, facing discipline by the Oregon Medical Board, the Oregon Board of Pharmacy, or the Oregon State Board of Nursing.

Today’s warning

Today I have a different warning: If you are facing serious discipline by your home state licensing Board, do not simply assume that your license in another state is safe. Here’s why: Once you are disciplined by your home state, you will likely have an obligation to report that discipline to all other licensing Boards in all other states in which you are licensed. Even if you fail to self-report your discipline to the other state licensing Boards, your discipline may be reported to a national data bank, and the other state licensing Boards will learn of your discipline through the national data bank. So, I repeat myself: If you are facing serious discipline by your home state licensing Board, do not simply assume that your license in another state is safe, and this practical advice applies whether you are licensed as a pharmacist, physician, or nurse, facing discipline by the Oregon Board of Pharmacy, the Oregon Medical Board, or the Oregon State Board of Nursing.

Work for the best result, but plan for the worst result

As I write this, I can think of one individual who lost his license in a revocation proceeding all the while thinking he could move to a nearby state in which he was licensed. It is, unfortunately, never that simple when a health care provider’s medical license is revoked or surrendered. And never forget that some serious offenses, the type of offenses that may lead to the surrender or revocation of your license to practice medicine, pharmacy or nursing, may result in your being excluded – i.e., federal exclusion by the Office of the Inspector General, or “OIG” – from participation in any employment that receives federal subsidies, reimbursement, or payment, which is most of the employments available to you as a physician, pharmacist, or nurse.

Be conservative to avoid surprises

This is important: Whenever you consent to discipline in one state, analyze the impact of that discipline on licenses you hold in other states. Always assume that similar discipline will follow in all other states in which you are licensed until you know otherwise. Be smart, make decisions and plan accordingly. And do not forget to consider the risk of federal exclusion by the OIG. In sum, you may be able to practice in another state after surrendering or being revoked elsewhere, but do the hard work first, and do not rely upon assumptions. An experienced licensing Board attorney can guide you through the analysis.