know your state medical board

8/7/2019 Know Your State Medical Board

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KnowYourStates

MedicalBoard

AnIntegrativeMedicalPractitionersGuidetoUnderstandingtheLegalandRegulatory

Environmentsinthe50States


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TableofContents

SectionI:UnderstandingtheLaw.....................................................................................................1A.Introduction.........................................................................................................................................................................................1B.TheMedicalBoard ............................................................................................................................................................................2

1.TheBasics.............................................. ........................................ ........................................ ......................................... ........................ 22.ActivelyPracticingBoardMembers .................................. ......................................... ........................................ ........................ 33.ConflictsofInterest........................................ ......................................... ........................................ ........................................ ........... 3

C.TheComplaint..................................................................................................................................................................................... 31.StatuteofLimitations.. ........................................ ........................................ ........................................ ......................................... .... 32.AnonymousComplaints ...................................... ........................................ ......................................... ........................................ .... 33.SwornComplaints .................................... ........................................ ........................................ ........................................ .................. 44.Immunity&Malice......................................... ......................................... ........................................ ........................................ ........... 4

5.ResolvingtheDisputeDirectlywiththePractitioner ......................................... ........................................ ........................ 4D.Notice......................................................................................................................................................................................................41.NoticeisbyaReasonableServiceofProcessMethod........................... ........................................ ...................................... 42.CopyoftheComplaint....................................................... ......................................... ........................................ ............................... 43.TimetoAnswer........ ........................................ ......................................... ........................................ ........................................ ........... 54.NoticeinAdvanceofaHearing ..................................... ........................................ ........................................ ............................... 5

E.TheInvestigation...............................................................................................................................................................................51.PeerReview................................... ......................................... ........................................ ........................................ ............................... 52.IndependentExpertReview..................................... ........................................ ........................................ ...................................... 53.SharingExpertInformation.................................................. ........................................ ......................................... ........................ 5

F.TheHearing,Decision,&JudicialReview................................................................................................................................ 51.ClearandConvincingEvidence ..................................... ........................................ ........................................ ............................... 5

2.DemonstratingtheRiskofHarm........................................ ........................................ ......................................... ........................ 63.ConflictofInterestwiththePractitioner...................................... ........................................ ........................................ ........... 64.FindingtheStandardofCare:CMECredits ....................................... ......................................... ........................................ .... 65.ProportionalDiscipline....................................... ........................................ ......................................... ........................................ .... 66.TheAdministrativeJudgeorReviewPanelsRecommendedAction.................. ........................................ .................. 67.ExpungingDismissedActions....... ........................................ ........................................ ......................................... ........................ 78.MeaningfulJudicialReview...................................... ........................................ ........................................ ...................................... 7

G.IntegrativeMedicine........................................................................................................................................................................71.UnprofessionalConduct&IntegrativeMedicine.................................... ........................................ ...................................... 72.PermissiontoUseorIncorporateCAMTherapies ........................................ ........................................ ............................... 83.PatientChoiceinHealthCare ........................................ ........................................ ........................................ ............................... 84.InformedConsent ..................................... ........................................ ........................................ ........................................ .................. 8

H.Conclusion............................................................................................................................................................................................8

SectionII:RankingtheStatesforIntegrativeMedicalPractitioners.................................................. 9A.Introduction.........................................................................................................................................................................................9B.Methodology........................................................................................................................................................................................ 9C.StateRankings.................................................................................................................................................................................. 10

SectionIII:TheStateChecklists...................................................................................................... 11Alabama................................................................................................................................................................................................... 11Alaska ....................................................................................................................................................................................................... 12


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Arizona(MD)......................................................................................................................................................................................... 13Arizona(DO).......................................................................................................................................................................................... 14

Arkansas.................................................................................................................................................................................................. 15California(MD)..................................................................................................................................................................................... 16California(DO)...................................................................................................................................................................................... 17

Colorado .................................................................................................................................................................................................. 18Connecticut ............................................................................................................................................................................................ 19

Delaware ................................................................................................................................................................................................. 20DistrictofColumbia............................................................................................................................................................................ 21Florida(MD) .......................................................................................................................................................................................... 22Florida(DO)........................................................................................................................................................................................... 23Georgia ..................................................................................................................................................................................................... 24Hawaii....................................................................................................................................................................................................... 25Idaho ......................................................................................................................................................................................................... 26Illinois....................................................................................................................................................................................................... 27Indiana ..................................................................................................................................................................................................... 28Iowa........................................................................................................................................................................................................... 29Kansas....................................................................................................................................................................................................... 30Kentucky.................................................................................................................................................................................................. 31Louisiana................................................................................................................................................................................................. 32Maine(MD) ............................................................................................................................................................................................ 33Maine(DO)............................................................................................................................................................................................. 34Maryland ................................................................................................................................................................................................. 35Massachusetts....................................................................................................................................................................................... 36

Michigan(MD)...................................................................................................................................................................................... 37

Michigan(DO)....................................................................................................................................................................................... 38Minnesota ............................................................................................................................................................................................... 39Mississippi.............................................................................................................................................................................................. 40Missouri ................................................................................................................................................................................................... 41Montana................................................................................................................................................................................................... 42

Nebraska ................................................................................................................................................................................................. 43

Nevada(MD).......................................................................................................................................................................................... 44Nevada(DO) .......................................................................................................................................................................................... 45

NewHampshire.................................................................................................................................................................................... 46NewJersey.............................................................................................................................................................................................. 47

NewMexico(MD)................................................................................................................................................................................ 48NewMexico(DO)................................................................................................................................................................................. 49NewYork................................................................................................................................................................................................. 50NorthCarolina ...................................................................................................................................................................................... 51

NorthDakota......................................................................................................................................................................................... 52Ohio ........................................................................................................................................................................................................... 53

Oklahoma(MD).................................................................................................................................................................................... 54

Oklahoma(DO)..................................................................................................................................................................................... 55Oregon...................................................................................................................................................................................................... 56Pennsylvania(MD) ............................................................................................................................................................................. 57Pennsylvania(DO).............................................................................................................................................................................. 58RhodeIsland.......................................................................................................................................................................................... 59SouthCarolina....................................................................................................................................................................................... 60

SouthDakota ......................................................................................................................................................................................... 61

Tennessee(MD)................................................................................................................................................................................... 62

Tennessee(DO).................................................................................................................................................................................... 63

Texas ......................................................................................................................................................................................................... 64


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Utah(MD) ............................................................................................................................................................................................... 65Utah(DO) ................................................................................................................................................................................................ 66Vermont(MD)....................................................................................................................................................................................... 67Vermont(DO)........................................................................................................................................................................................ 68Virginia..................................................................................................................................................................................................... 69Washington(MD)................................................................................................................................................................................ 70Washington(DO)................................................................................................................................................................................. 71

WestVirginia(MD)............................................................................................................................................................................. 72WestVirginia(DO).............................................................................................................................................................................. 73Wisconsin................................................................................................................................................................................................ 74Wyoming................................................................................................................................................................................................. 75

SectionIV:WheretoGoFromHere ............................................................................................... 76A.LearntheLawandGetInvolvedinYourState .................................................................................................................. 76B.ChangetheLawwiththeAllianceforNaturalHealthUSA........................................................................................... 76


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SectionI:UnderstandingtheLaw

A.Introduction

Acrossthenation,statelawsandregulationsarenotadequatelyprotectingpractitionersdueprocessrightsinmedicalboarddisciplinaryproceedings.Thispamphletandchecklistarecreatedspecifically

forlicensedmedicaldoctorsanddoctorsofosteopathypracticingintegrativemedicine,orthe

combinationofconventionalallopathicmedicinewithcomplementaryandalternative(CAM)

treatments.Wewillrefertothesetypesoflicensedphysiciansasintegrativemedicalpractitioners

(IMP).

StatemedicalboardswillusuallydisciplineIMPsinoneoftwoways:(1)unprofessionalconduct;or

(2)aproxyissue.Unprofessionalconductvariesfromstatetostate,butgenerallyincludessuch

offensesassexualmisconduct,convictionofafelony,andsubstanceabuse.Italsogenerallyincludes

afailuretopracticemedicineinanacceptablemanner.Becausesomeboardsmayviewconventional

medicineastheonlyacceptablemannerinwhichtopracticemedicine,IMPsareat-riskofdisciplinary

actions.Aproxyissuereferstoaviolationthatmaybeusedonlyasapremiseuponwhichto

disciplinetheIPforhisorherpracticeofintegrativemedicine.Proxyissuesmayincludepoorrecord

keepingorbillingdisputes.

Thepurposeofthispamphletandstatechecklistisonlytoprovideyouwithageneralsenseofthe

legalprotections,orlackthereof,inyourstate.Thispamphletdoesnotprovidelegaladviceand

shouldnotberelieduponwhenyouarelearningyourstateslaw.Laws,regulations,andpoliciesare

inconstantfluxandtheinformationcontainedheremaynotreflectthemostrecentlegalinformation

foryourstate.Ifyoushouldfindyourselfinanysituationdescribedinourcorrespondingpamphlet,

WhatEveryPractitionerNeedstoKnow,youshouldimmediatelyseektheadviceofcompetent,experiencedlegalcounselfamiliarwithdealingwithyourmedicalboardandotherstateregulatory

agencies.Dontmakeanystatementwhatsoevertoinvestigatorsorofficialswithoutthepresence

andapprovalofalawyer.Thisisthenumberonemistakeinnocentphysiciansmake.

Beforeexaminingthechecklists,itisnecessarythatyoureviewthefollowinginformation,which

explainseachtopiccoveredinthechecklistandwhyitisincluded.Althoughourchecklistisnot

exhaustiveandmoreofawishlistforIMPs,itwillprovideyouwithageneraloverviewofthelawin

yourstate.


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B.TheMedicalBoard

Asexplainedinourcorrespondingpamphlet,WhatEveryPractitionerNeedstoKnow,professional

licensingisanallegedefforttoensureprofessionalcompetenceandtoprotectthepublicfromharm,

fraud,anddeceit.Tothedetrimentoflicensedphysicians,however,thesegoalsareoftenlostinthe

ineffectivenessofthebureaucracy,theobviousbiastowardtraditionalWesternmedicine,andtheinherentself-servingandself-preservingnatureoftheboardsandagenciesinvolvedintheprocess.

Medicalboardsvaryfromstatetostate.Someboardsareindependentandsomepartofalarger

agency(liketheDepartmentofHealth).Someboardshearcases,whileothersrelyuponan

AdministrativeLawJudge.SomepurposefullyseektodisciplineIMPs,andsomedonot.Medical

boarddisciplineisthegreatestlegalriskforIMPs.WhetheramedicalboardisfriendlytoIMPs

dependslargelyuponthestateslawwithregardtoCAMtherapies,thephysician,andthetherapy

employed.Boardmembershipisacrucialcomponentaswell.Forexample,althoughTexashas

constitutionalandregulatoryprotectionsforhealthfreedomandthepracticeofcomplementaryand

alternativemedicine,certainmembersoftheTexasMedicalBoardhaveahistoryoftargetingand

punishingintegrativemedicalpractitioners.

EachstatehasitsownMedicalPracticeAct(MPA),whicharethelawsgoverningthepracticeof

medicine.Medicalboardswillalsodevelopregulationsforimplementingthevariousprovisionsof

thestatutes,inadditiontodevelopingitsownpolicies,statements,orguidelinesonspecificareasof

medicine.Nationalorganizations,suchastheFederationofStateMedicalBoards,generallyinfluence

theshapeanddirectionoftheregulatoryenvironment,butthedifferencesbetweenstatelaws

cannotbeunderstated.Again,itisyourresponsibilitytoknowthelawinyourstate.

1.TheBasics

Thefirstthreelinesofthechecklistprovideyouwithageneraloverviewofyourstatemedicalboard.Itisimportanttobeawareofthesizeandcompositionofyourmedicalboard.Ifeverinvestigated,it

ishelpfultoknowhowmanypeoplesitontheboard,aswellasthecompositionofpractitionersand

publicmembers,asthesepeoplewillultimatelyjudgeyourfate.Itisalsohelpfultoknowwhich

healthcarepractitionersfallunderthejurisdictionofyourstatemedicalboard.Howoftentheboard

hasmeetingsprovidesinsightintoitsactivitylevel.

KeytoAbbreviations:

AT-athletictrainer;ACU-acupuncturist;ANA-anesthetistassistant;AUD-audiologist;BLD-biologicallab

director;CP-clinicalperfusionist;CT-cosmetictherapist;CHI-chiropractor;CIS-cardiovascularinvasive

specialist;CPM-certifiedprofessionalmidwife;CPP-clinicalpharmacistpractitioners;DO-osteopathic

physician;DEH-dentalhygienist;DEI-dietician;ELE-electrologist;EMT-emergencymedicaltechnician;GC-Geneticcounselors;HAD-hearingaiddispenser;HYP-hypnotherapist;ICU-mobileintensivecare

unit;LO-licensedorthotist;LP-licensedperfusionist;LPR-licensedprosthetist;LPED-licensed

pedorthist;MA-medicalassistant;MD-allopathicphysician;MDX-MDX-rayoperator;MP-medical

physicist;MR-medicalresident;MT-massagetherapist;MW-midwife;NA-nurseanesthetist;NAT-

naturopath;ND-nutritionist;NM-nursemidwife;NP-nursepractitioner;OT-occupationaltherapist;

OP-optometrist;OTA-occupationaltherapistassistant;ORT-orthotist;PA-physicianassistant;PER-

perfusionist;PT-physicaltherapist;PTA-physicaltherapistassistant;POD-podiatrist;POL-


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polysomnographpersonnel;POM-PractitionerOrientalMedicine;PRO-prosthetist;RA-radiology

assistant;RE-registeredelectrologist;RN-registerednurse;RAT-radiologicaltechnologist;RCP-

respitorycarepractitioner;RET-respiratorytherapist;RIT-residentintraining;RTL-radiological

technologistslimited;RPA-radiologypractitionerassistant;RRT-radiologicaltechnician;SA-surgical

assistant;SL-speechlanguagepathologist;SLA-speechlanguagepathologistassistant;SPA-Specialist

Assistant

2.ActivelyPracticingBoardMembers

Anotableconcernamongadvocatesofstatemedicalboardreformisthefactthatsomestatesdonot

requireboardmemberstoactivelypracticemedicine.Withoutthisqualificationformembership,

boardsmayeasilybecomposedofnon-practicingphysiciansacademics,professionalexperts,and

otherswhoaregenerallyunfamiliarwiththeday-in,day-outofseeingandtreatingpatients.Because

themedicalboardoverseesdisciplinaryproceedings,boardsshouldbecomposedofactively

practicingphysiciansfamiliarwithpatientcaretoensurefairnessintheevaluationoftheIMPs

treatment.

3.ConflictsofInterest

Byandlarge,statemedicalboardqualificationsdonotprohibitboardmembersfromhavinggeneral

conflictsofinterest.Qualificationsgenerallyfailtoaskwhetherthepotentialboardmemberhas

familymemberslicensedandunderthejurisdictionofthemedicalboard,orwhetherthepotential

memberhadafinancialinterestinanorganizationadversetolicensedphysicians,suchasinsurance

companies,regulatoryagencies,pharmaceuticalcompanies,ormalpracticeattorneys.Thisshouldbe

abasicrequirementtoensurefairnessintheproceedings.

C.TheComplaint

1.StatuteofLimitations

Forthemostpart,statemedicalpracticeactsdonothaveastatuteoflimitationsoncomplaints

againstphysicians.Fortheinvestigationtobethoroughandfairtoallparties,theboardshould

requirethecomplainantfilethecomplaintwithinsomanyyears(preferablyfouryears)ofthealleged

incident.Anyolderandmemoriesbegintofade,alongwithanyhopeoffairnessintheproceedings.

2.AnonymousComplaints

Farandawaythemostimportantissuefacingalllicensedphysiciansistheanonymouscomplaint.

Manystatespermitcomplainantstoremainanonymouswhensubmittingacomplaintagainsta

physician.Inaperfectexampleoftheabusethatmayresultfromsuchlaws,Dr.RobertaKalfut,formerpresidentoftheTexasStateMedicalBoard,hadherhusbandfileanonymouscomplaints

againstallofhercompetitors.Oncesummonedbeforeheratthemedicalboard,sheeffectively

eliminatedallcompetition.Insurancecompaniesmayfileanonymouscomplaintstoavoid

reimbursingaphysicianforaservice.Anonymouscomplaintsareagraveconcernandthreatto

licensedphysicians,especiallyIMPs.Inourchecklist,theboardispresumedtoallowanonymous

complaintsifitdoesnotspecificallyprohibittheminstatute,regulation,orpolicy.


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3.SwornComplaints

Thestatemedicalboardhasthepowertodisciplineaphysicianslicense,whichimpliestheboardhas

thepowertohurtaphysiciansverylivelihood.Forthesereasons,manymedicalboardreform

advocateswouldliketolimitcomplaintstothosesworntounderoath.Ifapersonswearstothe

truthofthestatementscontainedinthecomplaint,wearelesslikelytoseemalicious,biased,and

anti-competitivecomplaints.

4.Immunity&Malice

Iftheboardlaterlearnsthecomplainantfiledthecomplaintwithmalice,thelawshouldpermitthe

physiciantosuethatperson.Whilethereisimmunityforcomplaintsfiledingoodfaith,thereshould

benoimmunityforthosecomplaintsfiledwithmaliciousintent.

5.ResolvingtheDisputeDirectlywiththePractitioner

Afewstatesrequirethemedicalboardscomplaintformtoincludelarge,simplelanguage

encouragingthecomplainanttofirstattempttoresolvethedisputedirectlywiththephysicianbefore

filingthecomplaint.Manyphysiciansarebusinesspeopleandrespondquicklytopatientsfeedbackandconcerns.Byencouragingdirectresolutionfirst,theboardavoidsfrivolouscomplaintsthatwould

likelyaffectthephysiciansabilitytopracticemedicine.

D.Notice

Noticeisalegalconceptdescribingtherequirementthatapartybemadeawareofalegalproceeding

affectinghisorherrights.Here,theIMPmustbemadeawareofdisciplinaryinvestigationsand

hearingsthatwillaffecthisorherlicensetopracticemedicine.

1.NoticeisbyaReasonableServiceofProcessMethod

Serviceofprocessisthemannerinwhichapersonisservednotice.Thephysicianmustbeservedin

areasonablemanner,whetherthroughpersonaldeliveryormailtothelastaddressofrecordwith

theboard.Althoughthismayseemsimple,manystatelawsandregulationsfailtospecifyhowthe

boardshouldservethephysician.Thisisabasicproceduraldueprocessrightowedtoanyperson

beinginvestigatedorsummonedtoadisciplinaryhearing.Allmedicalboardsshouldaddressit.

2.CopyoftheComplaint

Noticeshouldincludeacopyofthecomplaintfiledwiththeboard.Toooften,physiciansareserved

noticewithoutanyideaofwhattheydidwrong.Somemedicalboardsrequiretheboardincludeastatementoftheallegationsinthecomplaint.However,anactualcopyofthecomplaint(freeof

redactions)willensurethephysicianisprovidedwithnoticeoftheincidentinquestion,thepatient,

andtherelevantfiles.Clearly,thisiswillhelpthephysicianbetterdefendhimorherselfagainstthe

charges.


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3.TimetoAnswer

Followingnoticeandareceiptofacopyofthecomplaint,theboardshouldprovidethephysician

withareasonableamountoftimetosubmitananswertothecomplaint.Allowinglittleornotimeto

answerharmsthephysiciansopportunitytodefendhimorherselfagainsttheallegations.Givingthe

physician15daystoanswerthecomplaintisareasonableamountoftimetoconsultanattorneyand

submitananswer.

4.NoticeinAdvanceofaHearing

Noticeshouldalsobeservedatleast30daysbeforethehearingdate.Anylaterandthephysician

doesnothaveadequatetimetoconsultwithanattorneyandprepareadefense.Thistooisabasic

rightthatthestatelawsorregulationsshouldaddress.

E.TheInvestigation

1.PeerReview

IMPsareconsiderablyconcernedaboutthepeerreviewprocessindisciplinaryinvestigationsandproceedings.Itisimperativeespeciallywithintegrativemedicalpractitionersthattheexperts

evaluatingwhetherthephysicianmetthestandardofcarepracticethesametherapiesasthe

physicianunderreview.MedicaldoctorsarenotoriouslybiasedtowardconventionalWestern

medicine.Ifgiventheopportunity,somemayfindtheuseorincorporationofanalternativetherapy

wasunprofessionalconduct,evenwhentherewaslittleriskofharmornoactualharm.Itis

imperativethatphysiciansemployingthesametherapiesreviewtheIMPsmedicalpractice.More

thananyothermeasurearguedforinthepamphlet,thiswoulddramaticallydecreasethelikelihood

ofIMPsbeingunjustlyprosecuted.2.IndependentExpertReviewAnecessarysafeguardinassessingthestandardofcareisensuringthereareproceduresfor

independentexpertreviewofthepractitionerstreatment.Independentreviewwilllessenthe

chancesofbias.Ifexpertsreachdifferentconclusions,anIMPwillhaveastrongerdefense.3.SharingExpertInformation

Finally,itisnecessarythatthemedicalboardshareitsexpertinformationwiththeIMPandhisorher

counsel.Althoughthisisnormallyrequiredinciviltrials,disciplinaryactionsbyregulatoryboardsare

adifferentmatter.Thisprovisionoughttobeincludedinthestatemedicalpracticeact,orstate

regulations.

F.TheHearing,Decision,&JudicialReview

1.ClearandConvincingEvidence

Ensuringtheburdenonthemedicalboardisclearandconvincingevidenceiscriticaltoprotecting

practitionersrights.Thelesserstandardofpreponderanceoftheevidencemeanstheboardmust

showthatitismorelikelythannotthatthepractitionerviolatedaprovisionofthestatesmedical

practiceact.Thisstandarddoesnotadequatelyprotectpractitioners,whoselivelihoodsand


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reputationsareatstake.Becausethemedicalboardcandestroyaprofessionalslivelihoodand

deprivepatientsofapractitioner,itisessentialthatthemedicalboarddemonstrateunprofessional

conductthroughclearandconvincingevidence.2.DemonstratingtheRiskofHarm

Wheneverthemedicalboardisseekingdisciplinaryactionagainstapractitionerslicense,itisessentialthattheboardshowthateitherthepatientwasactuallyharmed,orthattheriskofharm

outweighedrisksassociatedwiththeconventionaltreatment.Toooften,practitionerslicensesare

disciplinedevenwhentheboardhasnotdemonstratedactualharmorahigherriskofharmthanthe

conventionaltreatment.3.ConflictofInterestwiththePractitioner

Clearly,statelawandregulationsshouldprohibitaboardmemberfromparticipatinginahearingin

whichtheyhaveaconflictofinterestwiththepractitioner.ThisensurestheIMPisaffordedafair

andimpartialhearing.Unfortunately,notallstatesensurepractitionersareprovidedthisbasicright

indisciplinaryhearings.4.FindingtheStandardofCare:CMECredits

TheACCME(AccreditationCouncilforContinuingMedicalEducation)promotesstandardsofcare

throughcontinuingmedicaleducation(CME)credits.IftheACCMEhasapprovedcreditfora

particulartherapy,likealternativemedicine,thenthattherapyshouldbeconsideredareasonable

standardofcare.5.ProportionalDiscipline

AsdiscussedintheIntroduction,medicalboardswillsometimestargetpractitionersforpracticingintegrativemedicine,butuseaproxyissuetodisciplinethem.Forexample,insteadofdisciplininga

practitionerforrecommendingthepatienttakecertainvitaminsandherbs,theboardwilldiscipline

himorherforpoorrecordkeeping.Insomecases,themedicalboardhaslevieddisproportional

disciplinaryactionforminoradministrativeviolations.Tocountersuchunethicalactionsbystate

medicalboards,thelawshouldrequirethedisciplinaryactionsoftheboardbeproportionaltothe

practitionersoffense.Apractitionerslicenseshouldneverberevokedforpoorrecordkeeping.6.TheAdministrativeJudgeorReviewPanelsRecommendedAction

Insomestates(notall),anadministrativejudgeorreviewpanelwillreviewtheevidence,makea

determination,andsubmitarecommendedactiontothemedicalboard.Insomestates,likeTexasforexample,themedicalboardhasbeenknowntoincreasethepunishmentbeyondwhatthereview

panelagreedupon.Unlessnewevidenceispresented,theboardshouldgivestrongconsideration

anddeferencetotherecommendedactionprovidedbytheadministrativejudgeorreviewpanel.In

allcases,theboardshouldnotincreasethepunishment.


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7.ExpungingDismissedActions

Toexpungeistoeraseordestroy.Dismissedcomplaintsshouldbecompletelyexpungedfroma

practitionersrecord.Unfortunately,somestateskeepdismissedactionsonfileforfuturereference.

Somestatesevenmaketheinformationpublicforanumberofyearsafterthedismissal.Adismissed

actiononapublicrecordstillhurtstheIMPsreputationinhisorhercommunity.Therefore,itis

imperativethatdismissedactionsarecompletelyexpungedfrompractitionersrecords.

8.MeaningfulJudicialReview

Althoughstatesallowpractitionerstoappealtheboardsdisciplinarydecision,thecourtsdonot

generallyhavethepowertoreversethatdecisionunlessitisfoundarbitraryandcapricious.Thisis

adifficultstandardofreviewtomeetinmostcases.Instead,thelawshouldprovideformeaningful

judicialreview,wherethefactsandthelawarerevieweddenovo,orasifcompletelynew.Such

judicialreviewwoulddetermedicalboardsfromunjustlydiscipliningpractitioners.

G.IntegrativeMedicine

1.UnprofessionalConduct&IntegrativeMedicine

Somestateshaveincludedaprovision,ineitherlaworregulation,declaringthattheunprofessional

conductcannotbebasedsolelyonthepractitionersuseorincorporationofCAM.Whilethissounds

great,itonlygoessofarinprotectingintegrativemedicalpractitioners.Themedicalboardmaystill

saytheuseorincorporationoftheCAMtherapywasadeviationfromthestandardofcare,or

outsidethelicenseesscopeofpractice.Furthermore,theymaystillgoafterthepractitionerfor

proxyissues,suchasrecordkeepingandbillingdisputes.Althoughthisisstillaverywelcomed

provisiontothelaw,itfallsshortofadequatelyprotectingIMPs.

Exampletextofthelaw:

Aphysicianandsurgeonshallnotbesubjecttodiscipline...solelyonthebasisthatthe

treatmentoradviceheorsherenderedtoapatientisalternativeorcomplementary

medicine...Cal.Bus.&Prof.Code2234.1(a)(2009).


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2.PermissiontoUseorIncorporateCAMTherapies

PermissiontouseorincorporateCAMtherapiesmaybefoundinastatute,regulation,orastatement

ofboardpolicy.Ittooishelpfulwhentheboardisfindingthestandardofcareinadisciplinary

investigationandhearing.Forexample,boththeArizonaMedicalBoardandtheKentuckyBoardof

MedicalLicensuredevelopedmodelguidelinesforlicensedphysiciansseekingtoincorporateoruse

CAMtherapies.

3.PatientChoiceinHealthCare

HereattheAllianceforNaturalHealthUSA,weworktoensureconsumersandpractitionershavea

righttochooseasustainableandpreventativeapproachtohealth,alongwithnutritionaland

integrativehealthcare.Weworktoprotectconsumersrighttoaccessintegrativehealthcare,and

practitionersrighttopracticeintegrativemedicine.Toaccomplishourgoals,thelegislaturemust

expressrespectforpatientchoicethatisconsistentwithprinciplesofinformedconsent.4.InformedConsentInformedconsentiscriticaltoallpracticingphysicians,regardlessofthetherapyemployed.

However,informedconsentisparticularlyimportantwhenpracticingintegrativemedicine.

Integrativemedicalpractitionersshouldinformpatientsoftherisksandbenefitsofbothconventional

andnon-conventionaltherapies.Ifthephysiciandocumentsevidenceofthepatientsunderstanding

ofthenatureoftherisksandbenefitsofthetherapy,aswellasthepatientsconsenttothe

integrativemedicaltherapy,unjustprosecutionislesslikely.

Exampletextofalaw:

La.Admin.Code,tit.46,pt.XLV,1707(A)(4)

InformedConsent.Aphysicianshallinformapatientorhisguardianofeachofthefollowing,

whichdiscussionsshallbenotedinsomeforminthepatient'srecord:

a.hiseducation,experience,andcredentialsregardinganyintegrativeor

complementarymedicinewhichisrecommended;and

b.therisksandbenefitsofbothconventionalmedicineandintegrativeor

complementarymedicineincorporatedwithineachtreatmentplan.

H.Conclusion

Wehopethisinformationishelpfultoyouandyourintegrativemedicalpracticeasyoucontinueto

learnaboutyourstatesmedicalboardandthelawsandregulationsgoverningthepracticeof

medicineinyourstate.Thisinformationshouldnotberelieduponaslegaladvice,butonlyasabrief

introductiontoyourstate.Ifyoushouldfindyourselfunderinvestigationbyyourstatesmedical

board,pleasecontactacompetentandknowledgeableattorneyfamiliarwithhandlingregulatory

agenciesinyourstate.TheAllianceforNaturalHealthUSAcanhelppointyouintherightdirection.


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SectionII:RankingtheStatesforIntegrativeMedicalPractitioners

A.Introduction

Nostatehastheperfectmedicalpracticeactortheperfectstatemedicalboardforintegrativemedicalpractitioners.Lawsarecreatedbylegislatures,whicharefullofimperfectpeople.Boardsare

alsofullofimperfectpeoplesometimeswithabiasforconventionalWesternmedicine.Board

membership,forexample,playsasignificantroleinwhetherornottheboardisfriendlyto

integrativemedicalpractitioners.Ifthemedicalboardiscomposedofmembershostiletointegrative

medicine,thenthosememberswillfindreasonstodisciplineanIMPslicense,evenwhenthereseem

tobeprotectionsinthelawforcomplementaryandalternativemedicine.Ifmedicalboardmembers

arefriendlytointegrativemedicine,thentheboardwilllikelynottakeadvantageoflegalgapsor

loopholestodisciplineanIMPslicense.Therefore,arankingslistmayeasilyfluctuateasnew

memberscomeandgoandaslawschange.Withthesetruthsinmind,takethefollowingrankings

withagrainofsalt.

B.Methodology

Torankall50states,includingtheDistrictofColumbia,wefirsttalliedeachstatescheckmarks.The

totalpossiblecheckmarksastatecouldtallyinallsixcategoriesis26.Thedatawassortedfirst

accordingtothetotalnumberofcheckmarks.Ifstatesweretied,theywerethensub-sorted

accordingtohighesttallyintheIntegrativeMedicine&HealthFreedomcategoryandiftheytied

again,theywerefinallysub-sortedaccordingtothehighesttallyfromtheindividualaveragesofthe

otherfivecategories.Thetotalnumberofcheckmarksisclearlythemostimportantnumber,asit

indicateshowclosethestatecomestoourlegalwishlistforthestates.TheIntegrativeMedicine

&HealthFreedomcategoryisimportantbecauseitrevealswhetherornotthatstatehasaddressedthepracticeofintegrativemedicineorcomplementaryandalternativetherapies.Statesaddressing

andacknowledgingintegrativemedicineandCAMtherapiesaremorelikelytohavefavorablelaws,

regulations,orpoliciesforitspractice.Finally,withoutwantingtodiscounttheimportanceofthe

othercategories,weaveragedthesecategoriesindividuallyandnotedthetotalvalue.Thestate

rankingslist(below)istheresultofthisanalysis.


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C.StateRankings*

1. NorthCarolina2. Florida(MDandDO)3. Kentucky4. Oklahoma(MD)5. Louisiana6. Colorado7. Mississippi8. California(MDandDO)9. Arizona(MD)10.Utah11.Georgia12.Maryland13.Illinois14.Alabama15.Nevada(MD)16.Oregon17.Wyoming18.Massachusetts19.Washington(MD)20.Delaware21.Texas22.Ohio23.Nebraska24.Michigan(DO)25.Maine(MDandDO)26.Washington(DO)27.Arizona(DO)andRhodeIsland28.NewYork

29.WestVirginia(MD)30.NorthDakota31.Nevada(DO)32.Oklahoma(DO)33.SouthCarolina34.Michigan(MD)35.Wisconsin36.Indiana37.Virginia38.Pennsylvania(MDandDO)39.Tennessee(MDandDO)40.IowaandKansas41.Missouri42.NewJersey43.Vermont(MD)44.Minnesota45.Arkansas46.Idaho47.NewMexico(MDandDO)48.DistrictofColumbia**49.Hawaii50.Alaska51.NewHampshire52.Connecticut53.Vermont(DO)54.Montana55.WestVirginia(DO)56.SouthDakota

Disclaimer:Theserankingsaresubjecttochangewithmodifications,additions,andrepealstostate

laws,regulations,andpolicies.Theserankingsshouldnotberelieduponaslegaladviceorasa

completepictureoftheregulatoryenvironmentinyourstate.

*Therankingsforstateswithseparatemedicalandosteopathicboardswerecalculatedseparately.

Manystatesmedicalandosteopathicboardstiedintherankingsandthisisindicatedinparenthesis.

However,thosestatesthathaddifferentrankingsfortheirboardsappeartwiceonthelist.

**NotethatalthoughtheDistrictofColumbiaranksnearthebottomofourlist,theboardhasbeen

foundinpracticetodismisscomplaintsagainstmultipleIMPsuponsubmissionofdetailedwritten

requestsbytheirlegalcounsel.


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SectionIII:TheStateChecklists

AlabamaAlabamaBoardofMedicalExaminers&theMedicalLicensureCommission,POBox946,Montgomery,AL36101,www.albme.org

THEMEDICALBOARD

BoardSize/Composition Board: 15 / 15 MD; Commission: 8 / 7 MD, 1 Public

BoardMeetingFrequency Monthly

ProfessionsRegulatedbytheBoard MD,DO,PA,AA

Practitionermembersoftheboardmustbeactivelypracticingpractitioners

Boardmemberqualificationsprohibitanyconflictsofinterest(family,financial,etc.)

THECOMPLAINT

Statuteoflimitationsoncomplaints

Anonymouscomplaintsareprohibited

Complaintsmustbesworntounderoath

Thereisnoimmunityforcomplaintsfiledwithmalice

Complainantisencouragedtoattempttoresolvethedisputedirectlywiththepractitioner

NOTICETOPRACTITIONER

Noticeisbyareasonableserviceofprocessmethod

Noticeincludesacopyofthecomplaint

Practitionerhasatleast15daysafterserviceofprocesstoanswerthecomplaint

Noticeforaformalhearingisnotlessthan30daysafterthedateofservice

THEINVESTIGATION

Peerreviewisconductedbypractitionersemployingthesametherapiesasthepractitioner

Thereareproceduresforindependentexpertreviewofthecomplainantsallegations

Theidentity,qualifications,statements,andreportsofeachexpertaremadeavailabletothepractitioner

THEHEARING,DECISION,&JUDICIALREVIEW

Standardofprooffordisciplinaryactionagainstalicenseeisclearandconvincing

Theboardmustshowactualharm,orahighriskofharmcomparedtotheconventionalmodality

Boardmembersmaynotparticipateiftheyhaveaconflictofinterestwiththepractitioner

Infindingthestandardofcare,theboardconsidersCMEcreditsasareasonablestandardofcare

Disciplinaryactionsmustbeproportionaltothepractitionersoffense

Theboardmuststronglyconsiderthedisciplinerecommendedbytheadministrativelawjudgeorpanel

Dismissedactionsareexpungedfromthepractitionerspublicrecord

Judicialreviewismeaningfulthecourtreviewsthefactsandlawdenovo

INTEGRATIVEMEDICINE&HEALTHFREEDOM

UnprofessionalconductcannotbebasedsolelyonthepractitionersuseorincorporationofCAM

PractitionersmayuseorincorporateCAM

Statutoryorregulatorylanguageexpressingrespectforpatientchoiceinhealthcare

InformedconsentisconsideredbytheboardwhenapractitionerusesorincorporatesaCAMtherapy


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AlaskaAlaskaStateMedicalBoard,550W.7

thAve.,Ste1500,Anchorage,AK99501,www.commerce.state.ak.us/occ/pmed.htm

THEMEDICALBOARD

BoardSize/Composition 8/5MD,1PA-C,2PublicMembers

BoardMeetingFrequency 4timesperyear

ProfessionsRegulatedbytheBoard MD,DO,DPM,PA-C,MICP



THECOMPLAINT











THEINVESTIGATION



















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Arizona(MD)ArizonaMedicalBoard,9545E.DoubletreeRanchRd.,Scottsdale,AZ85258,www.azmd.gov

THEMEDICALBOARD

BoardSize/Composition 12/8MD,4Public

BoardMeetingFrequency Everyothermonth

ProfessionsRegulatedbytheBoard MD

Practitionermembersoftheboardmustbeactivelypracticingpractitioners Boardmemberqualificationsprohibitanyconflictsofinterest(family,financial,etc.)

THECOMPLAINT











THEINVESTIGATION













INTEGRATIVEMEDICINE&HEALTHFREEDOM*





*PractitionersmayalsoreferpatientstoaCAMprovider.SeeArizonaMedicalBoard.TheArizonaMedicalBoardsGuidelinesfor

PhysiciansWhoIncorporateorUseComplementaryorAlternativeMedicineinTheirPractice.

Theuseofchelationtherapyfortreatmentotherthanheavymetalpoisoningisconsideredunprofessionalconductunlessthelicensee

obtainsinformedconsentandconformstoexperimentalprocedures.Ariz.Rev.Stat.32-1854(40)(2010).


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Arizona(DO)ArizonaBoardofOsteopathicExaminersinMedicine&Surgery,9535E.DoubletreeRanchRd.,Scottsdale,AZ85258,www.azdo.gov

THEMEDICALBOARD

BoardSize/Composition 7/5DO,2PublicMembers

BoardMeetingFrequency Bimonthly

ProfessionsRegulatedbytheBoard DO


THECOMPLAINT











THEINVESTIGATION














UnprofessionalconductcannotbebasedsolelyonthepractitionersuseorincorporationofCAM PractitionersmayuseorincorporateCAM




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ArkansasArkansasStateMedicalBoard,2100RiverfrontDrive,LittleRock,AR72202,www.armedicalboard.org

THEMEDICALBOARD

BoardSize/Composition 14/11MD,1DO,2ConsumerMembers

BoardMeetingFrequency Bimonthly

ProfessionsRegulatedbytheBoard MD,DO,PA,RT,OT,RPA,RA



THECOMPLAINT











THEINVESTIGATION



















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California(MD)MedicalBoardofCalifornia,2005EvergreenSt.,Ste1200,Sacramento,CA95815,www.mbc.ca.gov

THEMEDICALBOARD

BoardSize/Composition 15/8MD,7Public

BoardMeetingFrequency Quarterly

ProfessionsRegulatedbytheBoard MD



THECOMPLAINT











THEINVESTIGATION













INTEGRATIVEMEDICINE&HEALTHFREEDOM*





*Californiastatesitisonlyprudenttopermitalternativeandcomplementarytreatmentsbecauseitcantakeupto17yearsforthe

scientificcommunitytorecognizeanewbestpracticeinthetreatmentofdiseases.Cal.Bus.&Prof.Code2234.1(c)(West

2010).


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California(DO)OsteopathicMedicalBoardofCalifornia,1300NationalDr.,Ste150,Sacramento,CA95834,www.ombc.ca.gov

THEMEDICALBOARD

BoardSize/Composition 9/5DO,2PublicMembers,2ND

BoardMeetingFrequency 3-4timesperyear

ProfessionsRegulatedbytheBoard DO


THECOMPLAINT











THEINVESTIGATION



















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ColoradoColoradoMedicalBoard,1560Broadway,Ste.1300,Denver,CO80202,www.dora.state.co.us/medical

THEMEDICALBOARD

BoardSize/Composition 16/8MD,3DO,1PA,4PublicMembers


ProfessionsRegulatedbytheBoard MD,DO,PA



THECOMPLAINT











THEINVESTIGATION


















*Coloradostrictlyprohibitslicenseesfromdeviatingfromthestatesdefinedscopeofpracticeforeachprofession.Colo.Rev.Stat.

12-36-106(4)(2010).InColorado,thereistheopportunitytoobtaintruepeerreviewthroughtheestablishmentofProfessionalReview

Committees.Colo.Rev.Stat.12-36.5-104(2010).Coloradosintegrativepractitionersshouldconsiderformingsuchacommittee.


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ConnecticutConnecticutMedicalExaminingBoard,POBox340308,Hartford,CT06134,www.dph.state.ct.us

THEMEDICALBOARD

BoardSize/Composition 15/8MD,1DO,1PA,5PublicMembers


ProfessionsRegulatedbytheBoard MD,DO,PA

Practitionermembersoftheboardmustbeactivelypracticingpractitioners Boardmemberqualificationsprohibitanyconflictsofinterest(family,financial,etc.)*

THECOMPLAINT









Practitionerhasatleast15daysafterserviceofprocesstoanswerthecomplaint**


THEINVESTIGATION

















*Boardmembersmaynotbeelectedorprofessionalmembersofaprofessionalsocietyorassociationrelatedtomedicine.

**Physicianshave14daystoansweracomplaint.


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DelawareDelawareBoardofMedicine,POBox1401,Dover,DE19903,www.dpr.delaware.gov

THEMEDICALBOARD

BoardSize/Composition 16/11MD,5PublicMembers

BoardMeetingFrequency 10Annually

ProfessionsRegulatedbytheBoard MD,PA,Resp.Care,AC,Paramedics


THECOMPLAINT











THEINVESTIGATION


















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DistrictofColumbiaDistrictofColumbiaBoardofMedicine,71714

thSt.NW,Ste1600,Washington,DC20005,www.hpla.doh.dc.gov/bomed

THEMEDICALBOARD

BoardSize/Composition 11/7MD,3ConsumerMembers,1DirectorofDept.ofHealth


ProfessionsRegulatedbytheBoard MD,DO,AA,SA,PA,AC,NATPractitionermembersoftheboardmustbeactivelypracticingpractitioners


THECOMPLAINT










Noticeforaformalhearingisnotlessthan30daysafterthedateofservice*

THEINVESTIGATION


















*Noticeforahearingmustbegivenatleast15daysinadvanceofthehearingdate.


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Florida(MD)FloridaBoardofMedicine,4052BaldCypressWay,BINC03,Tallahassee,FL32399,www.doh.state.fl.us

THEMEDICALBOARD

BoardSize/Composition 15/12MD,3PublicMembers

BoardMeetingFrequency 7meetingsperyear

ProfessionsRegulatedbytheBoard MD,PA,ANA,DEI,ND,ELE


THECOMPLAINT











THEINVESTIGATION












Judicialreviewismeaningfulthecourtreviewsthefactsandlawdenovo*






*Itmaybepermissibletoreviewalicenserevocationorderdenovo.Stateexrel.DeGaetaniv.Driskell,139Fla.49(1939).


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Florida(DO)FloridaBoardofOsteopathicMedicine,4052BaldCypressWay,BINC06,Tallahassee,FL32399,www.doh.state.fl.us/mga/osteopath/index..html

THEMEDICALBOARD

BoardSize/Composition 7/5DO,2PublicMembers

BoardMeetingFrequency Approx.4timesperyear

ProfessionsRegulatedbytheBoard DO,PA,AA



THECOMPLAINT











THEINVESTIGATION












Judicialreviewismeaningfulthecourtreviewsthefactsandlawdenovo*






*Itmaybepermissibletoreviewalicenserevocationorderdenovo.Stateexrel.DeGaetaniv.Driskell,139Fla.49(1939).


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GeorgiaGeorgiaCompositeMedicalBoard,2PeachtreeSt.NW,36

thFl.,Atlanta,GA30303,www.medicalboard.georgia.gov

THEMEDICALBOARD

BoardSize/Composition 15/11MD,2DO,2PublicMembers


ProfessionsRegulatedbytheBoard MD,DO,Resp.Care,PER,ACU,ORT



THECOMPLAINT











THEINVESTIGATION



















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HawaiiHawaiiMedicalBoard,POBox3469,Honolulu,HI96813,www.hawaii.gov/dcca/pvl

THEMEDICALBOARD

BoardSize/Composition 11/7MD,2DO,2PublicMembers


ProfessionsRegulatedbytheBoard MD,DO,PA,EMT-B,EMT-P



THECOMPLAINT











THEINVESTIGATION



















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IdahoIdahoStateBoardofMedicine,1755WestgateDr,Ste140,Boise,ID83704,www.bom.state.id.us

THEMEDICALBOARD

BoardSize/Composition 10/6MD,1DO,2Public,1DirectorofIdahoStatePolice

BoardMeetingFrequency Quarterly

ProfessionsRegulatedbytheBoard MD,DO,PA,AT,DEI,POL,RET



THECOMPLAINT











THEINVESTIGATION



















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IllinoisIllinoisStateMedicalDisciplinaryBoard,100W.RandolphSt.,Ste9-300,ThompsonCtr,Chicago,IL60601,www.idfpr.com

THEMEDICALBOARD

BoardSize/Composition 18/10MD,2DO,4PublicMembers,2DC

BoardMeetingFrequency DisciplinaryBoard:Biweekly

ProfessionsRegulatedbytheBoard MD,DO,PA,CHI



THECOMPLAINT











THEINVESTIGATION



















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IndianaMedicalLicensingBoardofIndiana,400W.WashingtonSt.,RmW072,Indianapolis,IN46204,www.in.gov/pla/medical.htm

Note:ComplaintsinIndianaarehandledbytheConsumerProtectionDivisionoftheOfficeoftheAttorneyGeneral.

THEMEDICALBOARD

BoardSize/Composition 7/5MD,1DO,1ConsumerRepresentative

BoardMeetingFrequency 11timesperyear

ProfessionsRegulatedbytheBoard MD,DO,ACU,PT,PA,RT,OT,HAD,HYP



THECOMPLAINT











THEINVESTIGATION






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