A performance audit of the Board of Medical Examiners complaint review process

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              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
OF THE
BOARD OF MEDICAL EXAMINERS
COMPLAINT REVIEW PROCESS
NOVEMBER 1982
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 82- 7
DOUGLAS R. NORTON. CPA
AUDITOR GENERAL
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
November 30, 1982
Members of the Arizona Legislature
The Honorable Bruce Babbitt, Governor
D r . M. David Ben- Asher, Chairman
Board of Medical Examiners
Transmitted herewith is a report of the Auditor General, A Performance
Audit of the Board of Medical Examiners, Complaint Review Process. This
report is i n response to Senate B i l l 1385 of t h e T h i r t y - f i f t h Legislature.
The blue pages present a summary of t h e r e p o r t ; a response from the Board
of Medical Examiners is found on the yellow pages.
My s t a f f and I w i l l be pleased to discuss or c l a r i f y items i n t h e r e p o r t .
Respectfully submitted,
~ o u ~ lR&. N orton
Auditor General
Staff: William Thomson
Peter N. Francis
Gloria Glover
Enclosure
1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 ( 602) 255- 4385
OFFICE OF THE AUDITOR GENERAL
A PERFORMANCE AUDIT OF THE
BOARD OF MEDICAL EXAMINERS,
COMPLAINT REVIEW PROCESS
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 82- 7
TABLE OF CONTENTS
SUblMARY
INTRODUCTION AND BACKGROUND
FINDING
Page
i
1
3
T h e B o a r d of M e d i c a l E x a m i n e r s has m a d e i m p r o v e m e n t s i n i t s
c o m p l a i n t r e v i e w process.
CONCLUSION
LIST OF TABLES
TABLE 1 - Review of Disciplinary Actions Involving Doctors
with Multiple Complaints
TABLE 2 - BOMEX Complaint Action Fiscal Years 1979- 80
through 1981- 82
The Office of the Auditor General has conducted a follow- up review of the
State of Arizona, Board of Medical Examiners ( BOMEX), complaint review
process as required by Senate Bill 1385 of the Thirty- fifth Legislature,
Second Regular Session. This review is based on findings contained in
performance audit report number 81- 11 prepared by the Office of the
Auditor General on the Board of Medical Examiners.
The Board of Medical Examiners, established in 1913, is responsible for
examining and licensing medical doctors in Arizona and protecting the
public from incompetent and harmful practitioners. The Board is comprised
of 12 members: 9 licensed physicians, 2 lay members and a licensed
professional nurse from the Arizona State Board of Nursing.
Results of this follow- up review show that BOMEX has improved its
complaint review process since Auditor General report number 81- 11 was
completed. BOMEX has improved its discipline of doctors with multiple
complaints. Discipline is more consistent with California guidelines and
statutory provisions in effect in Michigan that the Auditor General
previously utilized as a benchmark in measuring BOMEX actions. Also,
BOMEX has eliminated inappropriate Board member involvement in complaint
investigations by barring Board members from participating in the
investigative process. Previously, the Board was lenient in disciplining
doctors with multiple complaints and Board members were unnecessarily
involved in the actual complaint investigations.
Board communication with complainants and doctors has improved. A
pamphlet explaining the Board's complaint review process is now sent to
all complainants. In addition, a review of a sample of complaints
indicates the Board is now properly using the informal interview
procedure. Moreover, the number of formal hearings held has increased.
However, the Executive Director improperly closed three minor complaints
without full- Board review. We recommend that all opened investigations be
presented to the Board for final disposition.
F i n a l l y , while most of the recommendations s e t f o r t h i n t h e Auditor
General report of October 1981 appear t o have been followed by the Board,
the long- term e f f e c t s of these changes have yet t o be seen.
INTRODUCTION AND BACKGROUND
The Office of the Auditor General has conducted a follow- up review of the
Board of Medical Examiners ( BOMEX), complaint review process as required
by Senate B i l l 1385 enacted by the 35th L e g i s l a t u r e i n 1982. This review
is based on findings contained i n performance a u d i t report number 81- 11
prepared by the Office of the Auditor General on the Board of Medical
Examiners dated October 1981.
The Board of Medical Examiners, o r i g i n a l l y e s t a b l i s h e d by the L e g i s l a t u r e
i n 1913, is responsible f o r examining and l i c e n s i n g medical doctors i n
Arizona, renewing medical l i c e n s e s annually and p r o t e c t i n g the public from
incompetent and harmful p r a c t i t i o n e r s of medicine. The Board is comprised
of 12 members: 9 licensed physicians, 2 lay members and a licensed
p r o f e s s i o n a l nurse who is a member of the S t a t e Board of Nursing. All
members a r e appointed by the Governor, except the licensed nurse member
who is appointed by the Board of Nursing.
Audit Scope
The scope of t h i s a u d i t is limited t o a review of the Board's complaint
review process t o determine i f improvements have been made since the
i n i t i a l audit. Auditor General's report number 81- 11 s t a t e d t h a t t h e
Board had been l e n i e n t i n its d i s c i p l i n i n g of d o c t o r s w i t h m u l t i p l e
complaints and t h a t d e f i c i e n c i e s existed i n BOMEX complaint review
procedures. This a u d i t takes a second look a t these two areas.
Because t h i s review c l o s e l y follows the f i r s t a u d i t , the long- term e f f e c t s
of changes made by the Board have yet t o be seen. In a d d i t i o n , the Board
is now operating under new requirements and procedures a s a r e s u l t of
Senate B i l l 1385 enacted by t h e L e g i s l a t u r e i n 1982. Although
implementation had begun on some of i t s elements, the s t a t u t e was not i n
e f f e c t during the period of t h i s review.
The Auditor General and s t a f f express appreciation to the employees and
members of the Board for t h e i r cooperation and assistance during the
course of t h i s audit.
FINDING
THE BOARD OF MJ3DICAL EXAMINERS HAS MADE IMPROVEMENTS I N ITS COMPLAINT
REVIEW PROCESS.
The Board of Medical Examiners has made improvements i n i t s complaint
review process since Auditor General report number 81- 11 was completed.
BOMEX has 1) improved i t s d i s c i p l i n i n g of doctors with m u l t i p l e
complaints, 2) eliminated i n a p p r o p r i a t e Board member involvement i n
complaint i n v e s t i g a t i o n s , 3) improved Board contact with complainants and
doctors, and 4) used informal interviews a p p r o p r i a t e l y and held more
formal hearings. However, Board s t a f f improperly closed t h r e e complaints
without f u l 1- Board review.
Complaint Review Methodology
D i s c i p l i n a r y a c t i o n f o r s p e c i f i c d o c t o r s was reviewed f o r t h e period July
1981 through June 1982. I n i t i a l l y , a l i s t of 14 doctors with multiple
complaints was developed. Of these 14 d o c t o r s , 8 had a t l e a s t one
s u b s t a n t i a t e d complaint during t h e 1981- 82 review period. Following the
methodology employed i n the previous a u d i t , d i s c i p l i n a r y a c t i o n s taken i n
t h e s e c a s e s were analyzed by comparing Board a c t i o n s t o minimum a c t i o n s
suggested by d i s c i p l i n a r y g u i d e l i n e s used i n C a l i f o r n i a and requirements
i n Michigan s t a t u t e s .
Our follow- up complaint study a l s o consisted of reviewing a sample of
complaints randomly chosen from 304 complaints received by BOMEX between
July 1981 and June 1982. Of 60 complaints sampled, 41 had f i n a l a c t i o n
taken a t t h e time of our review.
D i s c i p l i n a r y Actions
BOMEX has improved its d i s c i p l i n i n g of d o c t o r s w i t h multiple complaints.
D i s c i p l i n e of these doctors by BObEX is more c o n s i s t e n t with suggested
d i s c i p l i n e i n C a l i f o r n i a and Michigan. Also, BOMEX i s c u r r e n t l y
developing d i s c i p l i n a r y guidelines f o r mandatory p e n a l t i e s f o r multiple
v i o l a t i o n s by a physician a s required by Senate B i l l 1385 enacted i n
1982. These improvements should be i n t e r p r e t e d with caution, however,
since t h e i r long- term e f f e c t s have yet t o be seen.
Recent d i s c i p l i n a r y a c t i o n s by BOMEX compare more favorably t o recommended
a c t i o n s of C a l i f o r n i a and Michigan. In our follow- up, 62.5 percent of the
a c t i o n s reviewed had d i s c i p l i n e equal t o or g r e a t e r than the minimum
d i s c i p l i n e required i n ~ a l i f o r n i a ' s d i s c i p l i n a r y guidelines or Michigan
s t a t u t e s ( s e e Table 1). Only 25 percent of the a c t i o n s reviewed were
found t o be l e n i e n t . This review shows an improvement from our p r i o r
report of 33 percent more a c t i o n s being equivalent t o those suggested by
the two other s t a t e s .
TABLE 1
REVIEW OF DISCIPLINARY ACTIONS
INVOLVING DOCTORS WITH MULTIPLE COMPLAINTS
Follow- up
I n i t i a l Audit Review
1981 1982
BOMEX d i s c i p l i n e equal t o o r g r e a t e r than
minimum required i n other s t a t e s 29.5%
BOMEX d i s c i p l i n e l e s s than minimum required
i n other s t a t e s 70.5 25.0
No minimum d i s c i p l i n e requirement found
i n other s t a t e s
BOPEX s t a t i s t i c a l r e p o r t s show t h a t the Board took more d i s c i p l i n a r y
a c t i o n and s t r i c t e r a c t i o n i n f i s c a l year 1981- 82 than i n p r i o r years.
Total a c t i o n s a g a i n s t d o c t o r s i n 1981- 82 increased s i g n i f i c a n t l y as shown
i n Table 2. In f i s c a l year 1981- 82, 32 t o t a l a c t i o n s were taken including
2 l i c e n s e suspensions and 5 revocations. In f i s c a l year 1980- 81, only 13
t o t a l a c t i o n s were taken and i n 1979- 80, only 14 a c t i o n s were taken. Only
one l i c e n s e was permanently suspended or revoked during the two- year
period 1979 through 1981.
TABLE 2
BOMEX COMPLAINT ACTION
FISCAL YEARS 1979- 80 THROUGH 1981- 82
Complaints received - 1. J- 304
L e t t e r s of Concern** 88 128
D i s c i p l i n a r y a c t i o n :
Censures
Probation NEW
S t i p u l a t i o n NEW
Summary suspension
Suspension
Kevocat ion
Total
Source: BOMEX s t a t i s t i c a l summary
* Data on complaints received p r i o r t o f i s c a l year 1981- 82 a r e a v a i l a b l e
by c a l e n d a r y e a r only. Complaints received by c a l e n d a r y e a r a r e a s
follows: 1979- 224; 1980- 319; 1981- 314.
** L e t t e r s of Concern a r e not considered an o f f i c i a l d i s c i p l i n a r y a c t i o n
by the Board.
BOMEX is c u r r e n t l y developing guidelines i n compliance with l e g i s l a t i o n
passed i n 1982 which requires the Board provide t h e l e g i s l a t u r e with
recommended mandatory p e n a l t i e s f o r multiple v i o l a t i o n s by a physician.
The deadline f o r providing t h i s information is January 1, 1983. These
guidelines are designed t o f u r t h e r improve t h e d i s c i p l i n a r y process by
p r e s c r i b i n g appropriate actions i n cases involving repeat v i o l a t i o n s .
Board Member Involvement
Inappropriate and unnecessary Board member involvement in complaint
investigations has been eliminated. Board members currently review
investigative reports but are barred from actively participating in
investigations of complaints.
Auditor General report number 81- 11 stated that Board members were
unnecessarily involved in the investigative process and overburdened with
assignments. Board members participated in investigational interviews and
acted directly on Board dispositions resulting in an appearance of
partiality in some cases.
Board members currently review investigative reports but are not allowed
to participate directly in the investigative process. A staff physician
at BOMEX prepares a report on the complaint, listing his findings and
recommendations. This report is reviewed by a Board member who makes a
second recommendation for disposition. At the Board meeting, the staff
physician presents the complaint to the Board. The reviewing Board member
is provided an opportunity to give his comments but is barred from making
motions or voting on matters related to the complaint.
Board Contact
Board contact and communication with complainants and doctors has also
improved. complainants are contacted by the Board and currently are
provided a pamphlet explaining Board investigative procedures. Also,
doctors are properly notified of the complaint filed against them.
The Board contacts all patient/ consumer complainants through routine
correspondence. Patient/ consumer complaints receive acknowledgment
letters and letters of disposition. Also, in April 1982 the Board
prepared a pamphlet describing the complaint investigation process at
BOMEX which is enclosed with letters of acknowledgment. The pamphlet
includes information on complaint processing procedures and a list of
possible disciplinary actions which can be taken by the Board.
It appears a l l doctors receive n o t i f i c a t i o n of complaints within s t a t u t o r y
time l i m i t s . A l l complaints i n our sample acted upon by the Board had a
l e t t e r sent apprising the doctor of the complaint.
Board Procedures
Our follow- up review revealed no inappropriate use of informal interviews
by the Board. In addition, the number of formal hearings held by the
Board has increased.
Auditor General report number 81- 11 stated t h a t t h e Board held informal
interviews rather than formal hearings even when case circumstances
warranted a formal hearing. Informal interviews are not appropriate i n
very serious cases or when the doctor involved is uncooperative. During
the 18- month period of January 1979 through June 1980, only 4 formal
hearings were held compared to 49 informal interviews.
Our follow- up review found no cases i n which informal interviews were
inappropriately used by the Board. In f i v e cases sampled, the Board held
an informal interview with the doctor involved i n the complaint. The
f a c t s i n these f i v e cases did not indicate that formal hearings would have
been more appropriate.
Moreover, the number of formal hearings held by the Board has increased.
Seven doctors were involved i n formal hearings during the 12- month period
reviewed compared to four doctors during the p r i o r 18- month review
period. This amount represents an increase i n the percentage of hearings
t o complaints received from 1.1 percent during January 1979 through June
1980 to 2.3 percent during f i s c a l year 1981- 82. The Board a t t r i b u t e s t h i s
increase to the 1981 s t a t u t o r y authorization t o u t i l i z e hearing o f f i c e r s
i n l i e u of convening the Board for formal hearings.
Unauthorized Complaint Closures
Board s t a f f closed complaints without proper Board a u t h o r i z a t i o n or
approval. F i l e s had been closed a f t e r i n v e s t i g a t i o n s had begun but before
the Board o r any of i t s members reviewed the complaint. Neither BOMEX
s t a t u t e s nor a Board r e s o l u t i o n on t h e d u t i e s of the Executive Director
allows the closing of complaint matters by s t a f f .
Our sample of complaints during f i s c a l year 1981- 82 included t h r e e minor
complaints t h a t had been a d m i n i s t r a t i v e l y closed by the Executive Director
a f t e r i n v e s t i g a t i o n s were begun but before the Board or a Board member
reviewed the case. Usually, a w r i t t e n i n v e s t i g a t i v e report would be
prepared by a s t a f f physician, then a Board member would be assigned by
the Executive Director t o review the report and make a recommendation on
d i s p o s i t i o n of the case.
Neither BOMEX s t a t u t e s nor Board a u t h o r i z a t i o n s allow the closing of
complaint matters by BOMEX s t a f f . I n June 1982, the Board passed a
r e s o l u t i o n s e t t i n g out a d m i n i s t r a t i v e d u t i e s of the Executive Director.
These d u t i e s included the i n i t i a t i o n of i n v e s t i g a t i o n s but n o t c l o s u r e of
i n v e s t i g a t i o n s . When Auditor General s t a f f questioned one case, the
Executive Director reopened the f i l e and requested Board d i r e c t ion on the
matter.
CONCLUSION
Since the Auditor General report on BOMEX dated October 1981, BOMEX has
improved its complaint review process. However, the long- term e f f e c t s of
these changes have yet t o be seen.
RECOMMENDATION
A l l complaints received and i n v e s t i g a t i o n s opened should be presented t o
the Board f o r f i n a l d i s p o s i t i o n .
Governor
Bruce Babbitt
C/ luirt? lutl
M. David Ben- Asher. M. D
V i c ~ Cl ltrirtnut~
James E. Brady. Jr., M. D.
Secrertrr~,
Steven S. Spencer, M. D
Erec. lrtii~ e Dirri, ror
Douglas N. Cerf
Assoc. E. uecuti~. e Dirrt lor
9 Michael C. Smith
Telephonr
( 602) 255- 375 1
THE ARIZONA BOARD OF MEDICAL EXAMINERS
5060 north 19th avenue, suite 300 . phoenix, arizona 85015
November 23, 1982
The Board of Medical Examiners would l i k e t o f o r m a l l y i n d i c a t e
its a p p r e c i a t i o n t o t h e Auditor G e n e r a l ' s s t a f f f o r developing a
r e p o r t which r e c o g n i z e s t h e p o s i t i v e e f f o r t s t h a t have been
made by t h e Board t o c a r r y out its s t a t u t o r y mandate t o p r o t e c t
t h e p u b l i c through l i c e n s u r e , r e g u l a t i o n , r e h a b i l i t a t i o n and
d i s c i p l i n e of the S t a t e ' s a l l o p a t h i c p h y s i c i a n s . T h i s is par-t
i c u l a r l y g r a t i f y i n g s i n c e t h e A u d i t o r G e n e r a l is not noted f o r
its r e c o g n i t i o n of any p o s i t i v e e f f o r t s by s t a t e a g e n c i e s . The
Board is aware t h a t t h e r e a l i t i e s o f S u n s e t Review r e q u i r e t h e
A u d i t o r G e n e r a l t o f i n d f a u l t , but t h e z e a l with which t h e Audi-t
o r General undertook t h e o r i g i n a l review of t h e Board l e f t a
s u b s t a n t i a l l y " skewed" impression of how e f f e c t i v e l y t h i s Board
was c a r r y i n g o u t its s t a t u t o r y r e s p o n s i b i l i t i e s .
The Board was pleased t o s e e t h a t t h e A u d i t o r G e n e r a l f e l t t h e
Board was more c o n s i s t e n t with C a l i f o r n i a ' s d i s c i p l i n a r y guide-l
i n e s and Michigan's s t a t u t o r y p e n a l t i e s . However, t h e Board
f i n d s t h e use of t h e s e " benchmarksff a n e c d o t a l , s i n c e n e i t h e r
C a l i f o r n i a nor Michigan rank as high i n d i s c i p l i n a r y a c t i o n per
thousand p h y s i c i a n s a s does Arizona. The f o l l o w i n g t a b l e , which
r e f l e c t s t h e 1980 annual s t a t i s t i c s a s prepared and published by
P u l i t z e r p r i z e winning r e p o r t e r , J o e l B r i n k l e y , i n t h e
L o u i s v i l l e , Kentucky Courier J o u r n a l newspaper, well i l l u s t r a t e s
t h e p o i n t .
1980
Ranking S t a t e
Medical Medical Bd Actions
Doctors D i s c i p l i n a r y per 1,000
i n 1980 Actions Doctors
1 Oregon 5,232 82 15.7
2 New J e r s e y 10,567 124 11.7
3 Wyoming 61 0 6 9.8
4 Arizona 5,859 42 7.2
5 Alabama 5,229 30 5.7
6 V i r g i n i a 10,476 47 4.5
7 New Mexico 2,292 10 4.4
8 Michigan 15; 571 56 3.6
9 Washington 8,450 29 3.4
10 Missouri 8,508 29 3.4
11 M i s s i s s i p p i 3,015
12 Maryland 13,282
PLEASE ADDRESS ALL COMMUNICATIONS TO THE EXECUTIVE DIRECTOR FOR THE BOARD
November 23, 1982
A u d i t o r G e n e r a l
Page 2
Georgia 8,549
F l o r i d a 21,131
s o u t h C a r o l i n a 4,607
Texas 24,058
Nevada 1,233
Oklahoma 4,194
Kansas 4,043
C a l i f o r n i a 60,752
North C a r o l i n a 9 , 742
Colorado 6,391
Rhode I s l a n d 2,163
A l a s k a 627
Iowa 3,917
Minnesota 8,297
Utah 2 , 570
Louisiana 6,997
Tennessee 7,686
Ohio 18,781
Wisconsin 8,005
Delaware 1,047
Idaho 1,134
Pennsylvania 23,742
Massachusetts 16,661
New Hampshire 1,701
Kentucky 5,212
Maine 1,927
I l l i n o i s 22,228
New York 49,978
Connecticut 8,322
Ind iana 7,527
South Dakota 884
North Dakota 956
Montana 1,153
Vermont 1,215
Hawaii 2,265
Nebraska 2,509
West V i r g i n i a 2,857
Arkansas 3,070
D i s t . of Columbia 4,164
Perhaps the A u d i t o r G e n e r a l would not have u t i l i z e d the guide-l
i n e s of C a l i f o r n i a and t h e s t a t u t o r y p e n a l t i e s of Michigan a s
benchmarks i f it had f i r s t e v a l u a t e d t h e s e s t a t i s t i c s . Add it ion- 4
a l l y , t h e A u d i t o r G e n e r a l f a i l e d t o r e c o g n i z e t h a t i n 12.5% of
November 23, 1982
A u d i t o r G e n e r a l
Page 3
t h e c a s e s included i n its s u r v e y , t h e Arizona Board of Medical
Examiners took d i s c i p l i n a r y a c t i o n where Michigan and C a l i f o r n i a
would not. ( See Table 1 page 1)
In view of t h e f o r e g o i n g , t h e Board w i l l c o n t i n u e t o d e l i b e r a t e
with c a u t i o n , a c t with d e c i s i v e n e s s and oppose incompetence and
u n p r o f e s s i o n a l conduct with f i r m n e s s , while at the same time
e v a l u a t i n g t h e c i r c u m s t a n c e s o f each case and a s s u r i n g t h a t t h e
p u b l i c is not placed i n jeopardy.
With regard t o t h e Auditor G e n e r a l ' s f i n d i n g t h a t t h e Executive
D i r e c t o r i n a p p r o p r i a t e l y closed 3 complaints before t h e Board
reviewed t h e c a s e s , t h e f o l l o w i n g d e t a i l s of t h e s e c a s e s w i l l
r e f l e c t t h e a p p r o p r i a t e n e s s of t h e a c t i o n . However, s i n c e t h e
A u d i t o r ' s s t a f f h a s e x p r e s s e d c o n c e r n s a b o u t t h e s e a c t i o n s , t h e
Board w i l l c o n s i d e r a t its December 1982 meeting t h e f e a s i b i l i t y
of a l l o w i n g t h e Executive D i r e c t o r t h e a u t h o r i t y t o f i l e matters
f o r information where t h e i n v e s t i g a t i o n was i n s t i t u t e d by t h e
Board's s t a f f and showed no v i o l a t i o n of t h e Medical P r a c t i c e
Act. The above would not i n c l u d e t h e a u t h o r i t y t o f i l e m a t t e r s
f o r i n f o r m a t i o n which were r e c e i v e d a s a r e s u l t of w r i t t e n com-p
l a i n t s or m a l p r a c t i c e c l a i m s ,
Case 1
Physician A had been on p r o b a t i o n , f o r s u b s t a n c e abuse, u n t i l
September 1979. In October 1981, t h e Drug Enforcement Admini-s
t r a t i o n ( DEA) advised t h e Board's s t a f f t h a t t h e doctor had
o r d e r e d 1 oz of pharmaceutical cocaine f o r o f f i c e use.
The Executive D i r e c t o r questioned the p h y s i c i a n ' s u s e o f cocaine
i n l i g h t of h i s s p e c i a l t y and p a s t h i s t o r y of s u b s t a n c e abuse
and, t h e r e f o r e , d i r e c t e d t h e Board's i n v e s t i g a t i v e s t a f f t o
proceed t o t h e d o c t o r ' s o f f i c e , t o g e t h e r with DEA a g e n t s i f
n e c e s s a r y , t o 1 ) o b t a i n a log of p a t i e n t s who r e c e i v e d the co-c
a i n e , a s well a s t h e i r medical r e c o r d s , 2) check a l l n a r c o t i c s
maintained i n the o f f i c e , and 3) o b t a i n a b i o l o g i c a l f l u i d sam-p
l e .
A s t h e i n v e s t i g a t o r s e n t e r e d t h e b u i l d i n g t o c a r r y out t h i s d i -
r e c t i v e , t h e pharmacist i n Doctor A ' s b u i l d i n g i n q u i r e d a s t o
what was happening. The pharmacist was asked if he had s u p p l i e d
any more cocaine t o Doctor A b e s i d e s t h e 1 o z , which was e a r l i e r
r e p o r t e d to BOMEX. The pharmacist r e p o r t e d t h a t the doctor had
only ordered t h e 1 oz of c o c a i n e , which was s t o r e d i n the phar-
November 23, 1982
Auditor General
Page 4
macy s a f e . The drug was being u t i l i z e d i n p r e p a r i n g a 60cc
s o l u t i o n , a p p l i e d t o p i c a l l y i n t r e a t i n g o f f i c e p a t i e n t s and
d i s p e n s e d o n l y i n small amounts. The s o l u t i o n contained
only a minute amount of c o c a i n e .
The Board i n v e s t i g a t o r s s i g h t e d t h e 1 oz b o t t l e o f c o c a i n e taken
from t h e s a f e and found t h a t an a p p r o p r i a t e amount was m i s s i n g ,
which c o i n c i d e d w i t h the p h a r m a c i s t ' s r e p o r t i n which he s t a t e d
t h a t he had prepared t h e t o p i c a l s o l u t i o n once.
Recognizing a t t h i s point t h a t t h e q u e s t i o n which i n i t i a t e d t h e
d i r e c t i v e , namely, t h a t Doctor A was p e r s o n a l l y u s i n g c o c a i n e ,
was i l l - f o u n d e d , t h e i n v e s t i g a t o r c a l l e d the Executive D i r e c t o r
f o r i n s t r u c t i o n s on how t o proceed i n t h i s m a t t e r . The Execu-t
i v e D i r e c t o r determined t o t e r m i n a t e the i n v e s t i g a t i o n . Ac-c
o r d i n g l y , t h i s m a t t e r was not p r e s e n t e d t o t h e Board. Indeed,
t h e r e was nothing t o p r e s e n t .
Case 2
In October 1980, while conducting an u n r e l a t e d pharmacy s u r v e y ,
a Board i n v e s t i g a t o r found t h a t Doctor B was p r e s c r i b i n g
P r e l u d i n 75mg f o r weight c o n t r o l . This information was pro-vided
t o t h e Executive D i r e c t o r , who d i r e c t e d t h a t an in- depth
survey be conducted i n t o Doctor B 1 s p r e s c r i p t i o n - w r i t i n g h a b i t s ,
as h i s p r e s c r i p t i o n p r a c t i c e s had been c r i t i c i z e d by BOMEX on a
p r e v i o u s occasion.
A pharmacy survey of 34 pharmacies revealed 43 p r e s c r i p t i o n s f o r
39 p a t i e n t s . 36 p a t i e n t s r e c e i v e d p r e s c r i p t i o n s f o r 30 P r e l u d i n
i n compliance with the Board ' s Amphetamine R e g u l a t i o n . However,
one p a t i e n t r e c e i v e d 2 p r e s c r i p t i o n s f o r 30 P r e l u d i n . The
o t h e r p r e s c r i p t i o n s were w i t h i n accepted l i m i t s .
The doctor was n o t i f i e d i n w r i t i n g ( s e e a t t a c h e d October 27,
1981 l e t t e r ) of t h e Board's r e g u l a t i o n l i m i t i n g amphetamine pre-s
c r i p t i o n s t o 30 days f o r t h e t r e a t m e n t of exogenous o b e s i t y .
The Doctor r e p l i e d on October 28, 1981 t h a t he would d i s c o n t i n u e
a l l p r e s c r i p t i o n s of amphetamines f o r weight c o n t r o l . The
Executive D i r e c t o r , a t t h i s p o i n t , a d m i n i s t r a t i v e l y closed the
f i l e .
On September 17, 1982 t h e Auditor G e n e r a l ' s s t a f f pointed o u t t o
t h e Executive D i r e c t o r t h a t he had no a u t h o r i t y t o r e s o l v e t h i s
m a t t e r . Recognizing the Auditor G e n e r a l ' s d i f f i c u l t y i n e v a l u a t -
November 23, 1982
Auditor General
Page 5
ing a c t i o n s taken based on common s e n s e , the Executive D i r e c t o r
reopened t h e case and immediately r e f e r r e d t h e m a t t e r t o t h e
Board f o r its c o n s i d e r a t i o n . Also a pharmacy survey was c a r r i e d
out which i n d i c a t e d i n t h e seven- month period from A p r i l
through October 1982, the doctor had w r i t t e n no p r e s c r i p t i o n s
f o r Schedule I1 drugs.
Case 3
On June 1 , 1982, an a i d e t o a n Arizona congressman r e q u e s t e d t h e
Board's a s s i s t a n c e i n " ~ e r s u a d i n- g " t wo d o c t o r s t o r e l e a s e cer-t
a i n medical information f o r use i n e s t a b l i s h i n g t h e d i s a b i l i t y
claim of a c o n s t i t u e n t f o r S o c i a l S e c u r i t y A d m i n i s t r a t i o n bene-f
i t s .
Upon i n q u i r y by the Board, it was found t h a t one of t h e physi-c
i a n s , who had r e t i r e d from t h e p r a c t i c e 6 months e a r l i e r , had
a l r e a d y n o t i f i e d t h e a i d e t h a t he c o u l d n o t f i n d t h e c o n s u l t a -
t i o n r e p o r t which h e p r e p a r e d f o r an i n s u r a n c e company, but i f
she c o n t a c t e d the i n s u r a n c e company, t h e r e p o r t could e a s i l y be
o b t a i n e d . The a t t a c h e d June 18, 1982 l e t t e r a p p r o p r i a t e l y re-f
l e c t s the substance of t h i s m a t t e r .
Likewise, t h e second p h y s i c i a n had r e l e a s e d r e c o r d s t o t h e pa-t
i e n t and h i s a t t o r n e y p r i o r t o t h e a i d e ' s r e q u e s t . The physi-c
i a n ' s o f f i c e t o l d t h e a i d e of t h e above s i t u a t i o n a s well a s
the f a c t t h a t s h e c o u l d get t h e record from t h e p a t i e n t or from
h i s a t t o r n e y . Yet a s a r e s u l t of t h e Board's i n q u i r y i n t o t h i s
m a t t e r , t h e doctor s e n t a d d i t i o n a l copies of t h e s o u g h t - a f t e r
medical r e c o r d s t o t h e a i d e , once t h e a p p r o p r i a t e r e l e a s e of
r e c o r d s was submitted.
The D i r e c t o r believed t h a t t h e r e was no v i o l a t i o n t o r e p o r t t o
t h e Board a s t h i s m a t t e r had been r e s o l v e d p r i o r t o t h e Board's
involvement.
Hopefully, with t h e above d e t a i l s , a more v a l i d assessment of
t h e A u d i t o r ' s concerns can be made.
In c o n c l u s i o n , t h e Board is w i l l i n g t o place its r e c e n t record
a g a i n s t any o t h e r s t a t e medical board a s well as a g a i n s t any
o t h e r h e a l t h r e g u l a t o r y agency i n Arizona. The Board's adminis-t
r a t i v e , i n v e s t i g a t i v e , and l i c e n s u r e p r o c e d u r e s , r e c o r d manage-
November 23, 1982
Auditor General
Page 6
ment and s t a t u t e s a r e a model f o r o t h e r a g e n c i e s . The Board
b e l i e v e s t h e Auditor G e n e r a l ' s r e p o r t , t o a l a r g e degree, recog-n
i z e s t h e s u p e r i o r i t y of its o p e r a t i o n s .
w~ sp/& L yy
M. David ' Ben- Asher, M. D.
Chairman
~ x e c u t i v e D i r e c t o r
(;,# I ,, rtjor
Ilracc i h b b ~ r t
C / : ; I , ~ ~ I I , I ~ I
I1!: t! iip 2. S: iba. % l. l>.
0 I ,( v ~ ~ ~ I , J I ~ , ~ I , J I ~
11 1). 1\ 1d Ih. n-,\\ l~~. r. i1 . l).
. sI, r,~. r o* r,~. O c t o b e r 2 7 , 1981
. l, it:: cb 1:. l\:: idy. l r . . \!. I).
b. 2 , '
THE ARiZONA BOARD OF MEDICAL EXAFY'IINE'RS
5060 north 19th avenue, s t ~ ~ t3e00 phoenrx, artzona 85315
Re: ~ IinphctaniineI < c g ~ l l ai ot n
Dcar Doctor
The A r i z o n a Board o f b l c d i c a l I ~ s n r i ~ i r l e riss i n r e c e i p t
o f t h e e n c l o s e d copy of a sum! liclry o f your p r e s c r i p t i o n s
s i n c e J u n e 1981.
A t t h i s p o i n t i n t i m e , t h e Bu:~ rd would l i k e t o rcrnirld
you o f t h e Alnphctaniine R e g u l a t i o n which c o v e r s t h e
drug P r e l u d i n , and r e a d s a s f o l l o w s :
R4- 1G- 10 Amphetalnine R e g u l a t i o n
A. The A r i z o n a Board o f Medical Examiners a f t e r
r e v i e w i n g a v a i l a b l e d a t a and i n f o r m a t i o n , f i n d s t h a t
t h e u s e of amphetamines and s i m i l a r sympathomimetic
d r u g s h a s a h i g h p o t e n t i a l f o r a b u s e and dependence.
13. O r a l Arnphetamincs - T l ~ c 13oard f i n d s tllc \\ sc of
o r a l amphetamines and s i m i l a r sympathomirnctic d r u g s i n
t h e t r e a t m e n t of exogenous o b e s i t y s h o u l d be r e s t r i c t e d
t o s h o r t term ( l e s s t h a n one month) a d j u n c t i v e t h e r a p y
i n p a t i e n t s whose o b e s i t y h a s proven r e f r a c t o r y t o o t h e r
Illec2SUTCS. - --
C. I n j e c t a b l e ilmphctamines - The Doard f i n d s t h e r e
a r e no t h e r a p e u t i c i n d i c a t i o n s f o r t h e use of i n j e c t a b l e
alnphetaluincs o r s i m i l a r sympathornimetic d r u g s .
D. I t is t l l e r e f o r e , t h e o p i n i o n of t h i s Ronrd
t h a t t h e prescription of or- nl arnphctamincs beyond t h e s e
l i r ~ i i t a t i o n s , o r any use of i n j c c t a b l e a r n p h e t n ~ n i n c s , i s
3 c o n d u c t o r p r a c t i c c \ chic11 docs o r might c o n s t i t u t e
a d z n g c r t o t h e h e a l t h , w e l f a r e o r s a f e t y of t h e p a t i e n t
o r t h e p u b l i c , and t l i u s c o n s t i t u t e s u n p r - o C c s s i o ~ \ a l
conduct ancl is a v i o 1 : i t i o n of A . R . S . 5 3 2 - 3 2 - 1 . ! 0 1 . 1 0 ( t )
n s n~ ncnclcd.
The Eoard has n o t i f i e d you i n t h e p a s t of t h i s
r e g u l a t i o n , and your compliance w i t h it will climi-n
a t e t h e need f o r Board monitoring o r your p n r t i c i -
p a t i o n i n an i n v c s t i g n t i o n a l i n t e r v i e w .
Though t h e summary appears t o i n d i c a t e t h a t you a r c
c u r r e n t l y only w r i t i n g f o r a t h i r t y ( 3 0 ) day S~ ipply
of t h e P r e l u d i n , o n e p a t i e n t , llowevcr, r e c e i v e d two
p r e s c r i p t i o n s f o r t h i r t y ( 3 0 ) s i n g l e u n i t dosages of
I'rcludin or1 J u l y 16, 1381 and August 2 4 , 1981. The
Hoard a d v i s e s t h a t you r e v i e w y o u r r e c o r d s and i f you
Elre p r o v i d i n g p r c s c r i p t i o r l s f o r wcight c o n t r o l , t h a t -
you r c c v n l u a t c t i ~ e s cp rescriptions, as you may be i n
v i o l a t i o n of t h e c u r r c n t amphetamine r e g u l r l t i o n .
Your compliance w i t h t h e 130ard1s c u r r e n t r u l e s and
r e g u l a t i o n s would bc urged and g r e a t l y a p p r c c i a t c d .
I f you have any q u e s t i o n s regarding t h i s m a t t e r , p l c a s e
do not h e s i t a t e t o c o n t a c t me d i r e c t l y , c i t h c r by
l e t t e r o r phone.
S i n c e r e l y ,
BOARD OF JIEDI CAL ESAJIIXERS
STATE OF ARIZONA
Douglas N . Cerf
Executive D i r c c t o r
October 28, 1981
The Arizona Board of Medical Examiners
- - 5060 N. 13th Avenue S u i t e 300
Phoenix, Arizona 85015
Rc: October 27, 19S1 l e t t e r
Dear S i r s ,
I would l i k e t o inform you t h a t s i n c e Septenber 15, 1981, I have
discontinued w r i t i n g p r e s c r i p t i o n s f o r amphetamines for weight c o n t r o l .
However, I would l i k e to thank the Board f o r reciinding me of t h e
anpheteminc r e g u l a t i o n a t t h i s point.
S i n c e r e l y ,
June 18, 1982
Mr. Douglas C e r f , Executive D i r e c t o r
Arizona Board of Fledical Examiners
5060 North Nineteenth Avenue, S u i t e 300
Phoenix, Arizona 85015
Dear M r . Cerf :
- This i s i n r e f e r e n c e t o t h e claim which has been lodged a g a i n s t me
by t h e o f f i c e of
S t r a n g e l y enough, a f t e r f o r t y - s i x and a h a l f y e a r s of medical p r a c t i c e ,
I have t o w a i t u n t i l e i g h t months a f t e r my r e t i r e m e n t b e f o r e someone
lodges the f i r s t complaint t h a t h a s e v e r been made about my p r o f e s s i o n a l
conduct.
I h a r d l y know how t o answer t h i s . Obviously, who lodged
t h e complaint, read my r e p o r t i n which I t o l d h e r t h a t I remember
examining t h i s p a r t i c u l a r p a t i e n t f o r an i n s u r a n c e company but was
completely unable t o f i n d a copy of my r e p o r t t o him. This happens
r a r e l y , take my word f o r it, but I am s u r e you w i l l a p p r e c i a t e t h e
f a c t t h a t it can happen. I f u r t h e r suggested t o h e r , i n an e f f o r t
t o be as c o o p e r a t i v e a s I could, t h a t i f she o b t a i n e d t h e name of
the insurance company from t h e p a t i e n t , and I am s u r e he would have
it, a l l she had t o do was w r i t e t o them and ask them f o r the o r i g i n a l
r e p o r t t h a t I s e n t t o them. I n s t e a d of doing t h a t , she w r i t e s you a
l e t t e r which w i l l g e t h e r a b s o l u t e l y nowhere a t a l l .
1- am impressed- by h e r use of t h e term " r e l e a s e of i n f o r m a t i o n t o a
Congressional o f f i c e " . I n t h i s p a r t i c u l a r c a s e , i f i n s t e a d of a
Congressional o f f i c e , t h i s r e q u e s t was made by t h e P r e s i d e n t oE the
United S t a t e s , the Prime M i n i s t e r of Great B r i t a i n , t h e Prime k l i n i s t e r
of West Germany, t h e P r e s i d e n t of F r a n c e , a n d , f o r good measure, the
P r e s i d e n t of t h e Soviet S t a t e , it s t i l l wouldn't g e t them anywhere.
I c a n ' t f u r n i s h i n f o r m a t i o n t h a t I simply c a n ' t f i n d .
I cannot t h i n k , i n l i n e with t h e r e q u e s t , of any a p p r o p r i a t e a c t i o n
which could be takcn by' your agency t o persuade ( and she d o e s n ' t even
s p e l l t h i s c o r r e c t l y ) me t o r e l e a s e i n f o r m a t i o n t h a t I am unable t o
put my hands on.

Description

Rating
TITLE	A performance audit of the Board of Medical Examiners complaint review process
CREATOR	Arizona. Office of the Auditor General.
SUBJECT	Arizona Board of Medical Examiners; Medicine--Practice--Arizona;
Browse Topic	Government and politics
DESCRIPTION	25 pages (PDF version). File size: 662.839 KB. A report to the Arizona State Legislature November 1982, Report No. 82-7.
Language	English
Publisher	Arizona. Office of the Auditor General.
TYPE	Text
Material Collection	State Documents House Received Reports
Acquisition Note	Publication or link to publication sent to reports@lib.az.us
RIGHTS MANAGEMENT	Copyright to this resource is held by the creating agency and is provided here for educational purposes only. It may not be downloaded, reproduced or distributed in any format without written permission of the creating agency. Any attempt to circumvent the access controls placed on this file is a violation of United States and international copyright laws, and is subject to criminal prosecution.
DATE ORIGINAL	1982-11-30
Time Period	1980s (1980-1989)
ORIGINAL FORMAT	Paper
Source Identifier	LG 6.2:M 32/2
Location	17408365
DIGITAL IDENTIFIER	82-7.pdf
DIGITAL FORMAT	PDF (Portable Document Format)
DIGITIZATION SPECIFICATIONS	Digitized into PDF form through scanning at the Records Management Division, Arizona State Library.
REPOSITORY	Arizona State Library. Archives and Public Records--Law and Research Library.
File Size	662.839 KB
Full Text	STATE OF ARIZONA OFFICE OF THE AUDITOR GENERAL A PERFORMANCE AUDIT OF THE BOARD OF MEDICAL EXAMINERS COMPLAINT REVIEW PROCESS NOVEMBER 1982 A REPORT TO THE ARIZONA STATE LEGISLATURE REPORT 82- 7 DOUGLAS R. NORTON. CPA AUDITOR GENERAL STATE OF ARIZONA OFFICE OF THE AUDITOR GENERAL November 30, 1982 Members of the Arizona Legislature The Honorable Bruce Babbitt, Governor D r . M. David Ben- Asher, Chairman Board of Medical Examiners Transmitted herewith is a report of the Auditor General, A Performance Audit of the Board of Medical Examiners, Complaint Review Process. This report is i n response to Senate B i l l 1385 of t h e T h i r t y - f i f t h Legislature. The blue pages present a summary of t h e r e p o r t ; a response from the Board of Medical Examiners is found on the yellow pages. My s t a f f and I w i l l be pleased to discuss or c l a r i f y items i n t h e r e p o r t . Respectfully submitted, ~ o u ~ lR&. N orton Auditor General Staff: William Thomson Peter N. Francis Gloria Glover Enclosure 1 1 1 WEST MONROE SUITE 600 PHOENIX. ARIZONA 85003 ( 602) 255- 4385 OFFICE OF THE AUDITOR GENERAL A PERFORMANCE AUDIT OF THE BOARD OF MEDICAL EXAMINERS, COMPLAINT REVIEW PROCESS A REPORT TO THE ARIZONA STATE LEGISLATURE REPORT 82- 7 TABLE OF CONTENTS SUblMARY INTRODUCTION AND BACKGROUND FINDING Page i 1 3 T h e B o a r d of M e d i c a l E x a m i n e r s has m a d e i m p r o v e m e n t s i n i t s c o m p l a i n t r e v i e w process. CONCLUSION LIST OF TABLES TABLE 1 - Review of Disciplinary Actions Involving Doctors with Multiple Complaints TABLE 2 - BOMEX Complaint Action Fiscal Years 1979- 80 through 1981- 82 The Office of the Auditor General has conducted a follow- up review of the State of Arizona, Board of Medical Examiners ( BOMEX), complaint review process as required by Senate Bill 1385 of the Thirty- fifth Legislature, Second Regular Session. This review is based on findings contained in performance audit report number 81- 11 prepared by the Office of the Auditor General on the Board of Medical Examiners. The Board of Medical Examiners, established in 1913, is responsible for examining and licensing medical doctors in Arizona and protecting the public from incompetent and harmful practitioners. The Board is comprised of 12 members: 9 licensed physicians, 2 lay members and a licensed professional nurse from the Arizona State Board of Nursing. Results of this follow- up review show that BOMEX has improved its complaint review process since Auditor General report number 81- 11 was completed. BOMEX has improved its discipline of doctors with multiple complaints. Discipline is more consistent with California guidelines and statutory provisions in effect in Michigan that the Auditor General previously utilized as a benchmark in measuring BOMEX actions. Also, BOMEX has eliminated inappropriate Board member involvement in complaint investigations by barring Board members from participating in the investigative process. Previously, the Board was lenient in disciplining doctors with multiple complaints and Board members were unnecessarily involved in the actual complaint investigations. Board communication with complainants and doctors has improved. A pamphlet explaining the Board's complaint review process is now sent to all complainants. In addition, a review of a sample of complaints indicates the Board is now properly using the informal interview procedure. Moreover, the number of formal hearings held has increased. However, the Executive Director improperly closed three minor complaints without full- Board review. We recommend that all opened investigations be presented to the Board for final disposition. F i n a l l y , while most of the recommendations s e t f o r t h i n t h e Auditor General report of October 1981 appear t o have been followed by the Board, the long- term e f f e c t s of these changes have yet t o be seen. INTRODUCTION AND BACKGROUND The Office of the Auditor General has conducted a follow- up review of the Board of Medical Examiners ( BOMEX), complaint review process as required by Senate B i l l 1385 enacted by the 35th L e g i s l a t u r e i n 1982. This review is based on findings contained i n performance a u d i t report number 81- 11 prepared by the Office of the Auditor General on the Board of Medical Examiners dated October 1981. The Board of Medical Examiners, o r i g i n a l l y e s t a b l i s h e d by the L e g i s l a t u r e i n 1913, is responsible f o r examining and l i c e n s i n g medical doctors i n Arizona, renewing medical l i c e n s e s annually and p r o t e c t i n g the public from incompetent and harmful p r a c t i t i o n e r s of medicine. The Board is comprised of 12 members: 9 licensed physicians, 2 lay members and a licensed p r o f e s s i o n a l nurse who is a member of the S t a t e Board of Nursing. All members a r e appointed by the Governor, except the licensed nurse member who is appointed by the Board of Nursing. Audit Scope The scope of t h i s a u d i t is limited t o a review of the Board's complaint review process t o determine i f improvements have been made since the i n i t i a l audit. Auditor General's report number 81- 11 s t a t e d t h a t t h e Board had been l e n i e n t i n its d i s c i p l i n i n g of d o c t o r s w i t h m u l t i p l e complaints and t h a t d e f i c i e n c i e s existed i n BOMEX complaint review procedures. This a u d i t takes a second look a t these two areas. Because t h i s review c l o s e l y follows the f i r s t a u d i t , the long- term e f f e c t s of changes made by the Board have yet t o be seen. In a d d i t i o n , the Board is now operating under new requirements and procedures a s a r e s u l t of Senate B i l l 1385 enacted by t h e L e g i s l a t u r e i n 1982. Although implementation had begun on some of i t s elements, the s t a t u t e was not i n e f f e c t during the period of t h i s review. The Auditor General and s t a f f express appreciation to the employees and members of the Board for t h e i r cooperation and assistance during the course of t h i s audit. FINDING THE BOARD OF MJ3DICAL EXAMINERS HAS MADE IMPROVEMENTS I N ITS COMPLAINT REVIEW PROCESS. The Board of Medical Examiners has made improvements i n i t s complaint review process since Auditor General report number 81- 11 was completed. BOMEX has 1) improved i t s d i s c i p l i n i n g of doctors with m u l t i p l e complaints, 2) eliminated i n a p p r o p r i a t e Board member involvement i n complaint i n v e s t i g a t i o n s , 3) improved Board contact with complainants and doctors, and 4) used informal interviews a p p r o p r i a t e l y and held more formal hearings. However, Board s t a f f improperly closed t h r e e complaints without f u l 1- Board review. Complaint Review Methodology D i s c i p l i n a r y a c t i o n f o r s p e c i f i c d o c t o r s was reviewed f o r t h e period July 1981 through June 1982. I n i t i a l l y , a l i s t of 14 doctors with multiple complaints was developed. Of these 14 d o c t o r s , 8 had a t l e a s t one s u b s t a n t i a t e d complaint during t h e 1981- 82 review period. Following the methodology employed i n the previous a u d i t , d i s c i p l i n a r y a c t i o n s taken i n t h e s e c a s e s were analyzed by comparing Board a c t i o n s t o minimum a c t i o n s suggested by d i s c i p l i n a r y g u i d e l i n e s used i n C a l i f o r n i a and requirements i n Michigan s t a t u t e s . Our follow- up complaint study a l s o consisted of reviewing a sample of complaints randomly chosen from 304 complaints received by BOMEX between July 1981 and June 1982. Of 60 complaints sampled, 41 had f i n a l a c t i o n taken a t t h e time of our review. D i s c i p l i n a r y Actions BOMEX has improved its d i s c i p l i n i n g of d o c t o r s w i t h multiple complaints. D i s c i p l i n e of these doctors by BObEX is more c o n s i s t e n t with suggested d i s c i p l i n e i n C a l i f o r n i a and Michigan. Also, BOMEX i s c u r r e n t l y developing d i s c i p l i n a r y guidelines f o r mandatory p e n a l t i e s f o r multiple v i o l a t i o n s by a physician a s required by Senate B i l l 1385 enacted i n 1982. These improvements should be i n t e r p r e t e d with caution, however, since t h e i r long- term e f f e c t s have yet t o be seen. Recent d i s c i p l i n a r y a c t i o n s by BOMEX compare more favorably t o recommended a c t i o n s of C a l i f o r n i a and Michigan. In our follow- up, 62.5 percent of the a c t i o n s reviewed had d i s c i p l i n e equal t o or g r e a t e r than the minimum d i s c i p l i n e required i n ~ a l i f o r n i a ' s d i s c i p l i n a r y guidelines or Michigan s t a t u t e s ( s e e Table 1). Only 25 percent of the a c t i o n s reviewed were found t o be l e n i e n t . This review shows an improvement from our p r i o r report of 33 percent more a c t i o n s being equivalent t o those suggested by the two other s t a t e s . TABLE 1 REVIEW OF DISCIPLINARY ACTIONS INVOLVING DOCTORS WITH MULTIPLE COMPLAINTS Follow- up I n i t i a l Audit Review 1981 1982 BOMEX d i s c i p l i n e equal t o o r g r e a t e r than minimum required i n other s t a t e s 29.5% BOMEX d i s c i p l i n e l e s s than minimum required i n other s t a t e s 70.5 25.0 No minimum d i s c i p l i n e requirement found i n other s t a t e s BOPEX s t a t i s t i c a l r e p o r t s show t h a t the Board took more d i s c i p l i n a r y a c t i o n and s t r i c t e r a c t i o n i n f i s c a l year 1981- 82 than i n p r i o r years. Total a c t i o n s a g a i n s t d o c t o r s i n 1981- 82 increased s i g n i f i c a n t l y as shown i n Table 2. In f i s c a l year 1981- 82, 32 t o t a l a c t i o n s were taken including 2 l i c e n s e suspensions and 5 revocations. In f i s c a l year 1980- 81, only 13 t o t a l a c t i o n s were taken and i n 1979- 80, only 14 a c t i o n s were taken. Only one l i c e n s e was permanently suspended or revoked during the two- year period 1979 through 1981. TABLE 2 BOMEX COMPLAINT ACTION FISCAL YEARS 1979- 80 THROUGH 1981- 82 Complaints received - 1. J- 304 L e t t e r s of Concern** 88 128 D i s c i p l i n a r y a c t i o n : Censures Probation NEW S t i p u l a t i o n NEW Summary suspension Suspension Kevocat ion Total Source: BOMEX s t a t i s t i c a l summary * Data on complaints received p r i o r t o f i s c a l year 1981- 82 a r e a v a i l a b l e by c a l e n d a r y e a r only. Complaints received by c a l e n d a r y e a r a r e a s follows: 1979- 224; 1980- 319; 1981- 314. ** L e t t e r s of Concern a r e not considered an o f f i c i a l d i s c i p l i n a r y a c t i o n by the Board. BOMEX is c u r r e n t l y developing guidelines i n compliance with l e g i s l a t i o n passed i n 1982 which requires the Board provide t h e l e g i s l a t u r e with recommended mandatory p e n a l t i e s f o r multiple v i o l a t i o n s by a physician. The deadline f o r providing t h i s information is January 1, 1983. These guidelines are designed t o f u r t h e r improve t h e d i s c i p l i n a r y process by p r e s c r i b i n g appropriate actions i n cases involving repeat v i o l a t i o n s . Board Member Involvement Inappropriate and unnecessary Board member involvement in complaint investigations has been eliminated. Board members currently review investigative reports but are barred from actively participating in investigations of complaints. Auditor General report number 81- 11 stated that Board members were unnecessarily involved in the investigative process and overburdened with assignments. Board members participated in investigational interviews and acted directly on Board dispositions resulting in an appearance of partiality in some cases. Board members currently review investigative reports but are not allowed to participate directly in the investigative process. A staff physician at BOMEX prepares a report on the complaint, listing his findings and recommendations. This report is reviewed by a Board member who makes a second recommendation for disposition. At the Board meeting, the staff physician presents the complaint to the Board. The reviewing Board member is provided an opportunity to give his comments but is barred from making motions or voting on matters related to the complaint. Board Contact Board contact and communication with complainants and doctors has also improved. complainants are contacted by the Board and currently are provided a pamphlet explaining Board investigative procedures. Also, doctors are properly notified of the complaint filed against them. The Board contacts all patient/ consumer complainants through routine correspondence. Patient/ consumer complaints receive acknowledgment letters and letters of disposition. Also, in April 1982 the Board prepared a pamphlet describing the complaint investigation process at BOMEX which is enclosed with letters of acknowledgment. The pamphlet includes information on complaint processing procedures and a list of possible disciplinary actions which can be taken by the Board. It appears a l l doctors receive n o t i f i c a t i o n of complaints within s t a t u t o r y time l i m i t s . A l l complaints i n our sample acted upon by the Board had a l e t t e r sent apprising the doctor of the complaint. Board Procedures Our follow- up review revealed no inappropriate use of informal interviews by the Board. In addition, the number of formal hearings held by the Board has increased. Auditor General report number 81- 11 stated t h a t t h e Board held informal interviews rather than formal hearings even when case circumstances warranted a formal hearing. Informal interviews are not appropriate i n very serious cases or when the doctor involved is uncooperative. During the 18- month period of January 1979 through June 1980, only 4 formal hearings were held compared to 49 informal interviews. Our follow- up review found no cases i n which informal interviews were inappropriately used by the Board. In f i v e cases sampled, the Board held an informal interview with the doctor involved i n the complaint. The f a c t s i n these f i v e cases did not indicate that formal hearings would have been more appropriate. Moreover, the number of formal hearings held by the Board has increased. Seven doctors were involved i n formal hearings during the 12- month period reviewed compared to four doctors during the p r i o r 18- month review period. This amount represents an increase i n the percentage of hearings t o complaints received from 1.1 percent during January 1979 through June 1980 to 2.3 percent during f i s c a l year 1981- 82. The Board a t t r i b u t e s t h i s increase to the 1981 s t a t u t o r y authorization t o u t i l i z e hearing o f f i c e r s i n l i e u of convening the Board for formal hearings. Unauthorized Complaint Closures Board s t a f f closed complaints without proper Board a u t h o r i z a t i o n or approval. F i l e s had been closed a f t e r i n v e s t i g a t i o n s had begun but before the Board o r any of i t s members reviewed the complaint. Neither BOMEX s t a t u t e s nor a Board r e s o l u t i o n on t h e d u t i e s of the Executive Director allows the closing of complaint matters by s t a f f . Our sample of complaints during f i s c a l year 1981- 82 included t h r e e minor complaints t h a t had been a d m i n i s t r a t i v e l y closed by the Executive Director a f t e r i n v e s t i g a t i o n s were begun but before the Board or a Board member reviewed the case. Usually, a w r i t t e n i n v e s t i g a t i v e report would be prepared by a s t a f f physician, then a Board member would be assigned by the Executive Director t o review the report and make a recommendation on d i s p o s i t i o n of the case. Neither BOMEX s t a t u t e s nor Board a u t h o r i z a t i o n s allow the closing of complaint matters by BOMEX s t a f f . I n June 1982, the Board passed a r e s o l u t i o n s e t t i n g out a d m i n i s t r a t i v e d u t i e s of the Executive Director. These d u t i e s included the i n i t i a t i o n of i n v e s t i g a t i o n s but n o t c l o s u r e of i n v e s t i g a t i o n s . When Auditor General s t a f f questioned one case, the Executive Director reopened the f i l e and requested Board d i r e c t ion on the matter. CONCLUSION Since the Auditor General report on BOMEX dated October 1981, BOMEX has improved its complaint review process. However, the long- term e f f e c t s of these changes have yet t o be seen. RECOMMENDATION A l l complaints received and i n v e s t i g a t i o n s opened should be presented t o the Board f o r f i n a l d i s p o s i t i o n . Governor Bruce Babbitt C/ luirt? lutl M. David Ben- Asher. M. D V i c ~ Cl ltrirtnut~ James E. Brady. Jr., M. D. Secrertrr~, Steven S. Spencer, M. D Erec. lrtii~ e Dirri, ror Douglas N. Cerf Assoc. E. uecuti~. e Dirrt lor 9 Michael C. Smith Telephonr ( 602) 255- 375 1 THE ARIZONA BOARD OF MEDICAL EXAMINERS 5060 north 19th avenue, suite 300 . phoenix, arizona 85015 November 23, 1982 The Board of Medical Examiners would l i k e t o f o r m a l l y i n d i c a t e its a p p r e c i a t i o n t o t h e Auditor G e n e r a l ' s s t a f f f o r developing a r e p o r t which r e c o g n i z e s t h e p o s i t i v e e f f o r t s t h a t have been made by t h e Board t o c a r r y out its s t a t u t o r y mandate t o p r o t e c t t h e p u b l i c through l i c e n s u r e , r e g u l a t i o n , r e h a b i l i t a t i o n and d i s c i p l i n e of the S t a t e ' s a l l o p a t h i c p h y s i c i a n s . T h i s is par-t i c u l a r l y g r a t i f y i n g s i n c e t h e A u d i t o r G e n e r a l is not noted f o r its r e c o g n i t i o n of any p o s i t i v e e f f o r t s by s t a t e a g e n c i e s . The Board is aware t h a t t h e r e a l i t i e s o f S u n s e t Review r e q u i r e t h e A u d i t o r G e n e r a l t o f i n d f a u l t , but t h e z e a l with which t h e Audi-t o r General undertook t h e o r i g i n a l review of t h e Board l e f t a s u b s t a n t i a l l y " skewed" impression of how e f f e c t i v e l y t h i s Board was c a r r y i n g o u t its s t a t u t o r y r e s p o n s i b i l i t i e s . The Board was pleased t o s e e t h a t t h e A u d i t o r G e n e r a l f e l t t h e Board was more c o n s i s t e n t with C a l i f o r n i a ' s d i s c i p l i n a r y guide-l i n e s and Michigan's s t a t u t o r y p e n a l t i e s . However, t h e Board f i n d s t h e use of t h e s e " benchmarksff a n e c d o t a l , s i n c e n e i t h e r C a l i f o r n i a nor Michigan rank as high i n d i s c i p l i n a r y a c t i o n per thousand p h y s i c i a n s a s does Arizona. The f o l l o w i n g t a b l e , which r e f l e c t s t h e 1980 annual s t a t i s t i c s a s prepared and published by P u l i t z e r p r i z e winning r e p o r t e r , J o e l B r i n k l e y , i n t h e L o u i s v i l l e , Kentucky Courier J o u r n a l newspaper, well i l l u s t r a t e s t h e p o i n t . 1980 Ranking S t a t e Medical Medical Bd Actions Doctors D i s c i p l i n a r y per 1,000 i n 1980 Actions Doctors 1 Oregon 5,232 82 15.7 2 New J e r s e y 10,567 124 11.7 3 Wyoming 61 0 6 9.8 4 Arizona 5,859 42 7.2 5 Alabama 5,229 30 5.7 6 V i r g i n i a 10,476 47 4.5 7 New Mexico 2,292 10 4.4 8 Michigan 15; 571 56 3.6 9 Washington 8,450 29 3.4 10 Missouri 8,508 29 3.4 11 M i s s i s s i p p i 3,015 12 Maryland 13,282 PLEASE ADDRESS ALL COMMUNICATIONS TO THE EXECUTIVE DIRECTOR FOR THE BOARD November 23, 1982 A u d i t o r G e n e r a l Page 2 Georgia 8,549 F l o r i d a 21,131 s o u t h C a r o l i n a 4,607 Texas 24,058 Nevada 1,233 Oklahoma 4,194 Kansas 4,043 C a l i f o r n i a 60,752 North C a r o l i n a 9 , 742 Colorado 6,391 Rhode I s l a n d 2,163 A l a s k a 627 Iowa 3,917 Minnesota 8,297 Utah 2 , 570 Louisiana 6,997 Tennessee 7,686 Ohio 18,781 Wisconsin 8,005 Delaware 1,047 Idaho 1,134 Pennsylvania 23,742 Massachusetts 16,661 New Hampshire 1,701 Kentucky 5,212 Maine 1,927 I l l i n o i s 22,228 New York 49,978 Connecticut 8,322 Ind iana 7,527 South Dakota 884 North Dakota 956 Montana 1,153 Vermont 1,215 Hawaii 2,265 Nebraska 2,509 West V i r g i n i a 2,857 Arkansas 3,070 D i s t . of Columbia 4,164 Perhaps the A u d i t o r G e n e r a l would not have u t i l i z e d the guide-l i n e s of C a l i f o r n i a and t h e s t a t u t o r y p e n a l t i e s of Michigan a s benchmarks i f it had f i r s t e v a l u a t e d t h e s e s t a t i s t i c s . Add it ion- 4 a l l y , t h e A u d i t o r G e n e r a l f a i l e d t o r e c o g n i z e t h a t i n 12.5% of November 23, 1982 A u d i t o r G e n e r a l Page 3 t h e c a s e s included i n its s u r v e y , t h e Arizona Board of Medical Examiners took d i s c i p l i n a r y a c t i o n where Michigan and C a l i f o r n i a would not. ( See Table 1 page 1) In view of t h e f o r e g o i n g , t h e Board w i l l c o n t i n u e t o d e l i b e r a t e with c a u t i o n , a c t with d e c i s i v e n e s s and oppose incompetence and u n p r o f e s s i o n a l conduct with f i r m n e s s , while at the same time e v a l u a t i n g t h e c i r c u m s t a n c e s o f each case and a s s u r i n g t h a t t h e p u b l i c is not placed i n jeopardy. With regard t o t h e Auditor G e n e r a l ' s f i n d i n g t h a t t h e Executive D i r e c t o r i n a p p r o p r i a t e l y closed 3 complaints before t h e Board reviewed t h e c a s e s , t h e f o l l o w i n g d e t a i l s of t h e s e c a s e s w i l l r e f l e c t t h e a p p r o p r i a t e n e s s of t h e a c t i o n . However, s i n c e t h e A u d i t o r ' s s t a f f h a s e x p r e s s e d c o n c e r n s a b o u t t h e s e a c t i o n s , t h e Board w i l l c o n s i d e r a t its December 1982 meeting t h e f e a s i b i l i t y of a l l o w i n g t h e Executive D i r e c t o r t h e a u t h o r i t y t o f i l e matters f o r information where t h e i n v e s t i g a t i o n was i n s t i t u t e d by t h e Board's s t a f f and showed no v i o l a t i o n of t h e Medical P r a c t i c e Act. The above would not i n c l u d e t h e a u t h o r i t y t o f i l e m a t t e r s f o r i n f o r m a t i o n which were r e c e i v e d a s a r e s u l t of w r i t t e n com-p l a i n t s or m a l p r a c t i c e c l a i m s , Case 1 Physician A had been on p r o b a t i o n , f o r s u b s t a n c e abuse, u n t i l September 1979. In October 1981, t h e Drug Enforcement Admini-s t r a t i o n ( DEA) advised t h e Board's s t a f f t h a t t h e doctor had o r d e r e d 1 oz of pharmaceutical cocaine f o r o f f i c e use. The Executive D i r e c t o r questioned the p h y s i c i a n ' s u s e o f cocaine i n l i g h t of h i s s p e c i a l t y and p a s t h i s t o r y of s u b s t a n c e abuse and, t h e r e f o r e , d i r e c t e d t h e Board's i n v e s t i g a t i v e s t a f f t o proceed t o t h e d o c t o r ' s o f f i c e , t o g e t h e r with DEA a g e n t s i f n e c e s s a r y , t o 1 ) o b t a i n a log of p a t i e n t s who r e c e i v e d the co-c a i n e , a s well a s t h e i r medical r e c o r d s , 2) check a l l n a r c o t i c s maintained i n the o f f i c e , and 3) o b t a i n a b i o l o g i c a l f l u i d sam-p l e . A s t h e i n v e s t i g a t o r s e n t e r e d t h e b u i l d i n g t o c a r r y out t h i s d i - r e c t i v e , t h e pharmacist i n Doctor A ' s b u i l d i n g i n q u i r e d a s t o what was happening. The pharmacist was asked if he had s u p p l i e d any more cocaine t o Doctor A b e s i d e s t h e 1 o z , which was e a r l i e r r e p o r t e d to BOMEX. The pharmacist r e p o r t e d t h a t the doctor had only ordered t h e 1 oz of c o c a i n e , which was s t o r e d i n the phar- November 23, 1982 Auditor General Page 4 macy s a f e . The drug was being u t i l i z e d i n p r e p a r i n g a 60cc s o l u t i o n , a p p l i e d t o p i c a l l y i n t r e a t i n g o f f i c e p a t i e n t s and d i s p e n s e d o n l y i n small amounts. The s o l u t i o n contained only a minute amount of c o c a i n e . The Board i n v e s t i g a t o r s s i g h t e d t h e 1 oz b o t t l e o f c o c a i n e taken from t h e s a f e and found t h a t an a p p r o p r i a t e amount was m i s s i n g , which c o i n c i d e d w i t h the p h a r m a c i s t ' s r e p o r t i n which he s t a t e d t h a t he had prepared t h e t o p i c a l s o l u t i o n once. Recognizing a t t h i s point t h a t t h e q u e s t i o n which i n i t i a t e d t h e d i r e c t i v e , namely, t h a t Doctor A was p e r s o n a l l y u s i n g c o c a i n e , was i l l - f o u n d e d , t h e i n v e s t i g a t o r c a l l e d the Executive D i r e c t o r f o r i n s t r u c t i o n s on how t o proceed i n t h i s m a t t e r . The Execu-t i v e D i r e c t o r determined t o t e r m i n a t e the i n v e s t i g a t i o n . Ac-c o r d i n g l y , t h i s m a t t e r was not p r e s e n t e d t o t h e Board. Indeed, t h e r e was nothing t o p r e s e n t . Case 2 In October 1980, while conducting an u n r e l a t e d pharmacy s u r v e y , a Board i n v e s t i g a t o r found t h a t Doctor B was p r e s c r i b i n g P r e l u d i n 75mg f o r weight c o n t r o l . This information was pro-vided t o t h e Executive D i r e c t o r , who d i r e c t e d t h a t an in- depth survey be conducted i n t o Doctor B 1 s p r e s c r i p t i o n - w r i t i n g h a b i t s , as h i s p r e s c r i p t i o n p r a c t i c e s had been c r i t i c i z e d by BOMEX on a p r e v i o u s occasion. A pharmacy survey of 34 pharmacies revealed 43 p r e s c r i p t i o n s f o r 39 p a t i e n t s . 36 p a t i e n t s r e c e i v e d p r e s c r i p t i o n s f o r 30 P r e l u d i n i n compliance with the Board ' s Amphetamine R e g u l a t i o n . However, one p a t i e n t r e c e i v e d 2 p r e s c r i p t i o n s f o r 30 P r e l u d i n . The o t h e r p r e s c r i p t i o n s were w i t h i n accepted l i m i t s . The doctor was n o t i f i e d i n w r i t i n g ( s e e a t t a c h e d October 27, 1981 l e t t e r ) of t h e Board's r e g u l a t i o n l i m i t i n g amphetamine pre-s c r i p t i o n s t o 30 days f o r t h e t r e a t m e n t of exogenous o b e s i t y . The Doctor r e p l i e d on October 28, 1981 t h a t he would d i s c o n t i n u e a l l p r e s c r i p t i o n s of amphetamines f o r weight c o n t r o l . The Executive D i r e c t o r , a t t h i s p o i n t , a d m i n i s t r a t i v e l y closed the f i l e . On September 17, 1982 t h e Auditor G e n e r a l ' s s t a f f pointed o u t t o t h e Executive D i r e c t o r t h a t he had no a u t h o r i t y t o r e s o l v e t h i s m a t t e r . Recognizing the Auditor G e n e r a l ' s d i f f i c u l t y i n e v a l u a t - November 23, 1982 Auditor General Page 5 ing a c t i o n s taken based on common s e n s e , the Executive D i r e c t o r reopened t h e case and immediately r e f e r r e d t h e m a t t e r t o t h e Board f o r its c o n s i d e r a t i o n . Also a pharmacy survey was c a r r i e d out which i n d i c a t e d i n t h e seven- month period from A p r i l through October 1982, the doctor had w r i t t e n no p r e s c r i p t i o n s f o r Schedule I1 drugs. Case 3 On June 1 , 1982, an a i d e t o a n Arizona congressman r e q u e s t e d t h e Board's a s s i s t a n c e i n " ~ e r s u a d i n- g " t wo d o c t o r s t o r e l e a s e cer-t a i n medical information f o r use i n e s t a b l i s h i n g t h e d i s a b i l i t y claim of a c o n s t i t u e n t f o r S o c i a l S e c u r i t y A d m i n i s t r a t i o n bene-f i t s . Upon i n q u i r y by the Board, it was found t h a t one of t h e physi-c i a n s , who had r e t i r e d from t h e p r a c t i c e 6 months e a r l i e r , had a l r e a d y n o t i f i e d t h e a i d e t h a t he c o u l d n o t f i n d t h e c o n s u l t a - t i o n r e p o r t which h e p r e p a r e d f o r an i n s u r a n c e company, but i f she c o n t a c t e d the i n s u r a n c e company, t h e r e p o r t could e a s i l y be o b t a i n e d . The a t t a c h e d June 18, 1982 l e t t e r a p p r o p r i a t e l y re-f l e c t s the substance of t h i s m a t t e r . Likewise, t h e second p h y s i c i a n had r e l e a s e d r e c o r d s t o t h e pa-t i e n t and h i s a t t o r n e y p r i o r t o t h e a i d e ' s r e q u e s t . The physi-c i a n ' s o f f i c e t o l d t h e a i d e of t h e above s i t u a t i o n a s well a s the f a c t t h a t s h e c o u l d get t h e record from t h e p a t i e n t or from h i s a t t o r n e y . Yet a s a r e s u l t of t h e Board's i n q u i r y i n t o t h i s m a t t e r , t h e doctor s e n t a d d i t i o n a l copies of t h e s o u g h t - a f t e r medical r e c o r d s t o t h e a i d e , once t h e a p p r o p r i a t e r e l e a s e of r e c o r d s was submitted. The D i r e c t o r believed t h a t t h e r e was no v i o l a t i o n t o r e p o r t t o t h e Board a s t h i s m a t t e r had been r e s o l v e d p r i o r t o t h e Board's involvement. Hopefully, with t h e above d e t a i l s , a more v a l i d assessment of t h e A u d i t o r ' s concerns can be made. In c o n c l u s i o n , t h e Board is w i l l i n g t o place its r e c e n t record a g a i n s t any o t h e r s t a t e medical board a s well as a g a i n s t any o t h e r h e a l t h r e g u l a t o r y agency i n Arizona. The Board's adminis-t r a t i v e , i n v e s t i g a t i v e , and l i c e n s u r e p r o c e d u r e s , r e c o r d manage- November 23, 1982 Auditor General Page 6 ment and s t a t u t e s a r e a model f o r o t h e r a g e n c i e s . The Board b e l i e v e s t h e Auditor G e n e r a l ' s r e p o r t , t o a l a r g e degree, recog-n i z e s t h e s u p e r i o r i t y of its o p e r a t i o n s . w~ sp/& L yy M. David ' Ben- Asher, M. D. Chairman ~ x e c u t i v e D i r e c t o r (;,# I ,, rtjor Ilracc i h b b ~ r t C / : ; I , ~ ~ I I , I ~ I I1!: t! iip 2. S: iba. % l. l>. 0 I ,( v ~ ~ ~ I , J I ~ , ~ I , J I ~ 11 1). 1\ 1d Ih. n-,\\ l~~. r. i1 . l). . sI, r,~. r o* r,~. O c t o b e r 2 7 , 1981 . l, it:: cb 1:. l\:: idy. l r . . \!. I). b. 2 , ' THE ARiZONA BOARD OF MEDICAL EXAFY'IINE'RS 5060 north 19th avenue, s t ~ ~ t3e00 phoenrx, artzona 85315 Re: ~ IinphctaniineI < c g ~ l l ai ot n Dcar Doctor The A r i z o n a Board o f b l c d i c a l I ~ s n r i ~ i r l e riss i n r e c e i p t o f t h e e n c l o s e d copy of a sum! liclry o f your p r e s c r i p t i o n s s i n c e J u n e 1981. A t t h i s p o i n t i n t i m e , t h e Bu:~ rd would l i k e t o rcrnirld you o f t h e Alnphctaniine R e g u l a t i o n which c o v e r s t h e drug P r e l u d i n , and r e a d s a s f o l l o w s : R4- 1G- 10 Amphetalnine R e g u l a t i o n A. The A r i z o n a Board o f Medical Examiners a f t e r r e v i e w i n g a v a i l a b l e d a t a and i n f o r m a t i o n , f i n d s t h a t t h e u s e of amphetamines and s i m i l a r sympathomimetic d r u g s h a s a h i g h p o t e n t i a l f o r a b u s e and dependence. 13. O r a l Arnphetamincs - T l ~ c 13oard f i n d s tllc \\ sc of o r a l amphetamines and s i m i l a r sympathomirnctic d r u g s i n t h e t r e a t m e n t of exogenous o b e s i t y s h o u l d be r e s t r i c t e d t o s h o r t term ( l e s s t h a n one month) a d j u n c t i v e t h e r a p y i n p a t i e n t s whose o b e s i t y h a s proven r e f r a c t o r y t o o t h e r Illec2SUTCS. - -- C. I n j e c t a b l e ilmphctamines - The Doard f i n d s t h e r e a r e no t h e r a p e u t i c i n d i c a t i o n s f o r t h e use of i n j e c t a b l e alnphetaluincs o r s i m i l a r sympathornimetic d r u g s . D. I t is t l l e r e f o r e , t h e o p i n i o n of t h i s Ronrd t h a t t h e prescription of or- nl arnphctamincs beyond t h e s e l i r ~ i i t a t i o n s , o r any use of i n j c c t a b l e a r n p h e t n ~ n i n c s , i s 3 c o n d u c t o r p r a c t i c c \ chic11 docs o r might c o n s t i t u t e a d z n g c r t o t h e h e a l t h , w e l f a r e o r s a f e t y of t h e p a t i e n t o r t h e p u b l i c , and t l i u s c o n s t i t u t e s u n p r - o C c s s i o ~ \ a l conduct ancl is a v i o 1 : i t i o n of A . R . S . 5 3 2 - 3 2 - 1 . ! 0 1 . 1 0 ( t ) n s n~ ncnclcd. The Eoard has n o t i f i e d you i n t h e p a s t of t h i s r e g u l a t i o n , and your compliance w i t h it will climi-n a t e t h e need f o r Board monitoring o r your p n r t i c i - p a t i o n i n an i n v c s t i g n t i o n a l i n t e r v i e w . Though t h e summary appears t o i n d i c a t e t h a t you a r c c u r r e n t l y only w r i t i n g f o r a t h i r t y ( 3 0 ) day S~ ipply of t h e P r e l u d i n , o n e p a t i e n t , llowevcr, r e c e i v e d two p r e s c r i p t i o n s f o r t h i r t y ( 3 0 ) s i n g l e u n i t dosages of I'rcludin or1 J u l y 16, 1381 and August 2 4 , 1981. The Hoard a d v i s e s t h a t you r e v i e w y o u r r e c o r d s and i f you Elre p r o v i d i n g p r c s c r i p t i o r l s f o r wcight c o n t r o l , t h a t - you r c c v n l u a t c t i ~ e s cp rescriptions, as you may be i n v i o l a t i o n of t h e c u r r c n t amphetamine r e g u l r l t i o n . Your compliance w i t h t h e 130ard1s c u r r e n t r u l e s and r e g u l a t i o n s would bc urged and g r e a t l y a p p r c c i a t c d . I f you have any q u e s t i o n s regarding t h i s m a t t e r , p l c a s e do not h e s i t a t e t o c o n t a c t me d i r e c t l y , c i t h c r by l e t t e r o r phone. S i n c e r e l y , BOARD OF JIEDI CAL ESAJIIXERS STATE OF ARIZONA Douglas N . Cerf Executive D i r c c t o r October 28, 1981 The Arizona Board of Medical Examiners - - 5060 N. 13th Avenue S u i t e 300 Phoenix, Arizona 85015 Rc: October 27, 19S1 l e t t e r Dear S i r s , I would l i k e t o inform you t h a t s i n c e Septenber 15, 1981, I have discontinued w r i t i n g p r e s c r i p t i o n s f o r amphetamines for weight c o n t r o l . However, I would l i k e to thank the Board f o r reciinding me of t h e anpheteminc r e g u l a t i o n a t t h i s point. S i n c e r e l y , June 18, 1982 Mr. Douglas C e r f , Executive D i r e c t o r Arizona Board of Fledical Examiners 5060 North Nineteenth Avenue, S u i t e 300 Phoenix, Arizona 85015 Dear M r . Cerf : - This i s i n r e f e r e n c e t o t h e claim which has been lodged a g a i n s t me by t h e o f f i c e of S t r a n g e l y enough, a f t e r f o r t y - s i x and a h a l f y e a r s of medical p r a c t i c e , I have t o w a i t u n t i l e i g h t months a f t e r my r e t i r e m e n t b e f o r e someone lodges the f i r s t complaint t h a t h a s e v e r been made about my p r o f e s s i o n a l conduct. I h a r d l y know how t o answer t h i s . Obviously, who lodged t h e complaint, read my r e p o r t i n which I t o l d h e r t h a t I remember examining t h i s p a r t i c u l a r p a t i e n t f o r an i n s u r a n c e company but was completely unable t o f i n d a copy of my r e p o r t t o him. This happens r a r e l y , take my word f o r it, but I am s u r e you w i l l a p p r e c i a t e t h e f a c t t h a t it can happen. I f u r t h e r suggested t o h e r , i n an e f f o r t t o be as c o o p e r a t i v e a s I could, t h a t i f she o b t a i n e d t h e name of the insurance company from t h e p a t i e n t , and I am s u r e he would have it, a l l she had t o do was w r i t e t o them and ask them f o r the o r i g i n a l r e p o r t t h a t I s e n t t o them. I n s t e a d of doing t h a t , she w r i t e s you a l e t t e r which w i l l g e t h e r a b s o l u t e l y nowhere a t a l l . 1- am impressed- by h e r use of t h e term " r e l e a s e of i n f o r m a t i o n t o a Congressional o f f i c e " . I n t h i s p a r t i c u l a r c a s e , i f i n s t e a d of a Congressional o f f i c e , t h i s r e q u e s t was made by t h e P r e s i d e n t oE the United S t a t e s , the Prime M i n i s t e r of Great B r i t a i n , t h e Prime k l i n i s t e r of West Germany, t h e P r e s i d e n t of F r a n c e , a n d , f o r good measure, the P r e s i d e n t of t h e Soviet S t a t e , it s t i l l wouldn't g e t them anywhere. I c a n ' t f u r n i s h i n f o r m a t i o n t h a t I simply c a n ' t f i n d . I cannot t h i n k , i n l i n e with t h e r e q u e s t , of any a p p r o p r i a t e a c t i o n which could be takcn by' your agency t o persuade ( and she d o e s n ' t even s p e l l t h i s c o r r e c t l y ) me t o r e l e a s e i n f o r m a t i o n t h a t I am unable t o put my hands on.

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Home A performance audit of the Board of Medical Examiners complaint review process

A performance audit of the Board of Medical Examiners complaint review process

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