Download the proposed regulations.
On April 25, the Board of Registration in Medicine will hold the
final hearing on its proposed new regulations at its Boston
headquarters. It is unclear when the Board will vote to adopt or
amend its proposal but it is anticipated that this will occur
shortly thereafter.
The regulations were first presented for public comment last
Fall and rescinded in the face of significant public opposition.
The currently proposed regulations were revised in some areas,
unchanged in others and some new additions were made.
The initial proposals to which the MMS objected in the Fall
remain fundamentally unchanged in the new draft. Unless there is
significant public testimony, we anticipate the regulations will be
adopted as drafted.
Error Reporting by Physician Offices and Hospitals
The Board proposes to create a new "Division" at the Board
housing two new committees, the Patient Care Oversight Committee
and the Quality Improvement Committee. Under the strict language of
the regulations, all physician practices with two or more
physicians could be required to meet similar administrative burdens
to hospitals concerning bylaws, mandated reports, board approved
plans and assigning personnel to be trained in error reporting by
the Board.
There is some language that would allow physicians with hospital
affiliations the opportunity to report specific errors in their
practices through a hospital PCA program. However, this provision
may not require hospitals to participate in such reports, and does
not serve as an exemption from broader requirements. While the
thinking of the members of the Board remains unclear, the Board
chair and Board staff have expressed an intention to extend PCA
reporting into physician offices to some degree.
There are no provisions in the proposed regulations
detailing how error reports will be processed at the Board to
ensure review by qualified physicians; nor do
they state how the Board will be staffed to provide the significant
infrastructure necessary to translate thousands of reports into
meaningful advisories and standards of care.
In remarks to the Coalition for the Prevention of Medical
Errors, Board Chair Martin Crane, MD, said the new Quality
Improvement Committee will look at specific incident and error
reports. He stated that no member of the Board would serve on the
QIC, and asserted that concerns about leaking of information on
errors to those making decisions on licensing and disciplinary
actions are unfounded. It is not clear from the proposed
regulations who will review reports.
Disciplinary Standards
The phrase "in its sole discretion" occurs several times in the
regulations. The Board's listing of disciplinary offenses includes
failure to meet the standard of care and engaging in conduct that
demonstrates a lack of good moral character or engaging in
disruptive behavior that affects or has the potential to affect the
delivery of professional medical services.
The MMS remains concerned that physicians are not given clear
and reasonable standards of behavior. The MMS strongly supports
ethical behavior at all times by physicians but believes that
regulations should clearly outline what behavior is prohibited and
not grant absolute discretion to the Board and its staff to
determine on a case by case basis what behavior will result in
disciplinary action.
Due Process
The Board would take on the power to issue and approve
subpoenas, to issue fines to hospitals and physicians and to recoup
the cost of its investigations from the subject of the
investigation. The Board gives no clear statement in its
regulations of how its disciplinary processes would work, nor does
it outline the procedural rights physicians have to timely and fair
decisions.
Licensing
The Board proposes complex new rules on renewals of licenses,
including the ability of the Board to demand competency testing of
physicians and to set practice restrictions. How such standards
would be applied is vague and would be at the discretion of the
Board. Dr. Crane has stated that competency testing would be
applied to those physicians seeking to return to practice after a
significant absence. The regulations appear broader and allow the
discretion to the Board to chose whom to test and what tests to
administer.
Next Steps
The members of the Board are volunteers who are uncompensated
for their work and who are sincerely dedicated to serving the
public and the medical community. They have the final determination
on approval of the regulations which have been prepared by the
Board staff. The Board is a very large agency with revenues and
appropriations which may reach 7.1 million dollars for the next
fiscal year. The regulations are over 90 pages long and are
extremely complex.
The MMS urges physicians to take the time to review the proposed
regulations, to watch this space and other MMS communications for
further information and to contact the MMS Department of Government
Relations with any specific questions. We urge those of you who
know members of the Board to contact them directly for their
perspective on these proposals.
The members of the Board are:
Asha Wallace (serves until April 30)
Peter Paige, MD (starts serving May 1)
Martin Crane, MD Chairman
Roscoe Trimmier, Jr. JD Vice Chair
Randy Wertheimer, MD
E. George Daher (former Chief Justice of the Housing Court)
Guy Fish, MD
John Herman, MD
The MMS will present formal testimony on the proposal on the 25.
Copies of that testimony may be circulated in the medical community
prior to the hearing. We urge the involvement of hospital medical
staffs, specialty societies and all forums where the future of
medicine is discussed, to review these regulations carefully and
consider submitting comments to Board members.
-- MMS Department of Government
Relations
