Board of Registration in Medicine Proposes Major Revisions in Regulations Governing the Practice of Medicine

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The regulations were first presented for public comment last Fall and rescinded in the face of significant public opposition.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

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