Just Tell Me What You Want Me To Do: Conditions For License Reinstatement After Disciplinary Action

Do the right thing. Follow the rules. Straighten up and fly right. Do what you’re told. If the Illinois Department of Financial and Professional Regulation (IDFPR) has suspended your professional license or put you on probation, following or satisfying the probationary terms and conditions imposed by the department is a necessary prerequisite to reinstatement and resumption of your career. But it can be hard to comply with probationary terms if you don’t know what they are.

Unfortunately, the orders and consent decrees that impose sanctions and establish conditions for reinstatement are often so vague and ambiguous that it can be difficult, if not impossible, to know what you need to do to get your license back. And that ambiguity can lead to frustration, disappointment, and more months or years of sitting on the sidelines when the IDFPR denies your petition for restoration.

What Does Probation Mean For A Professional Licensee?

If the IDFPR determines that disciplinary action is warranted against a licensee, they have a range of sanctions they can impose, metaphorically ranging in severity from a slap on the wrist to a death sentence. The department can impose these sanctions in an order after a disciplinary hearing, or they can be part of a consent decree entered into between the licensee and IDFPR.

Probation is one of those sanctions. If the IDFPR places you on probation, you will be able to continue working or practicing subject to specific conditions and limitations established by the Department. As with probation in the criminal justice system, a violation of any of the imposed terms will create additional problems potentially involving further discipline. The probation term could be for a set period which will automatically expire providing the licensee complies with all conditions, or it could be for an indefinite time, requiring that the licensee petition the board to terminate the probation. 

But probationary terms can also be part of a license suspension. In that case, the licensee cannot obtain reinstatement of their license until they meet the conditions set forth in the order or consent decree.

Sometimes, probationary terms can be quite specific and usually relate to the nature of the acts or omissions that led to disciplinary action. Common probationary terms can include:

  • Undergoing physical or psychological exams
  • Seeing a therapist or undergoing psychotherapy
  • Completing a substance abuse program and attending ongoing counseling or support groups
  • Avoiding all criminal arrests/convictions during the probationary period
  • Complying fully with the applicable laws governing the licensed profession
  • Notifying an employer or employers about the probation
  • Fulfilling continuing education courses related to your violation

What If There Are No Specific Terms Contained In The Order Or Consent Decree?

When the terms and conditions for reinstatement are clear and specific, complying with them simply requires doing the work and staying out of trouble. But many license suspensions fail to delineate precisely what steps a licensee must take or complete to get their license back.

A licensee can spend their suspension or probationary term doing everything right – addressing the issues that got them in trouble, working on improving themselves personally and professionally, sobering up and undergoing therapy, etc. – and still not get their license reinstated. The power to give a licensee their career and livelihood back is entirely in the hands of the hearing officer who evaluates the petition for reinstatement.

That unfettered discretion can and does lead to unjust results. As noted, it can be hard to follow the rules if you don’t know what they are. Therefore, if a licensee is considering a consent decree to agree to probation or a license suspension, it is critical that the terms of probation be set forth as specifically as possible. This is yet another reason that licensees should never represent themselves before the IDFPR or enter into a consent decree without first consulting with an experienced Chicago professional license defense attorney.

Louis Fine: Chicago Professional License Defense Attorney

As a former Chief Prosecuting Attorney and administrative law judge for IDFPR, I have seen the serious consequences that an adverse enforcement decision can have on professionals who suddenly find their future in disarray. I understand how and why the Department decides to pursue investigations, how it handles negotiations, and how to approach formal proceedings in a way that gives my clients the best possible chance of a positive and expeditious outcome.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. Together, we will get you back to your clients and your career.

Proposed Legislation Would Remove Telemedicine Licensing Barriers

Well-before the world had heard of COVID-19, the use of telemedicine was increasingly seen as a way to expand patient access to care and address a growing shortage of physicians, particularly in rural and underserved areas. As noted by the authors of an article in the American Journal of Managed Care, “The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists.”

But the pandemic and the lockdowns that followed in its wake dramatically changed the telehealth landscape for doctors, patients, and insurers. Now, legislation recently introduced in Congress seeks to address licensing barriers that have stood in the way of leveraging this technology to improve patient care.

The number of virtual visits exploded as such appointments became seen more as a matter of health and safety rather than convenience. While it is estimated that only two percent of all patient appointments pre-pandemic were via telemedicine, a whopping 61 percent of visits have been conducted virtually since then. Even when, hopefully in the near future, COVID-19 recedes into memory, experts anticipate that telemedicine will remain an increasingly utilized option.

Scores of Separate Licenses Currently Needed For Telemedicine Across State Lines

But the inability of physicians to provide remote care to patients in other states where they are not licensed is holding back telemedicine’s potential and unnecessarily denying patients access to quality healthcare. This is particularly problematic in areas where the healthcare system is currently overwhelmed by COVID-19 cases.

The problem is that, as of November 2019, 49 state medical boards, plus the medical boards of the District of Columbia, Puerto Rico, and the Virgin Islands, require that physicians engaging in telemedicine have a license in the state in which the patient is located.

Equal Access To Care Act

However, a bill introduced in Congress in July – The Equal Access To Care Act (EACA) – seeks to remove this roadblock. If enacted, the act would allow licensed practitioners to provide services via telehealth in any state from any location for up to 180 days after the end of the current public health emergency period. On July 23, the federal government extended that period for another 90 days.

Specifically, the EACA provides that a physician, practitioner, or other healthcare provider who is licensed to provide health care services in their primary state, and who provides such health care services in interstate commerce through electronic information or telecommunication technologies to a patient in another state, does not need to obtain a comparable license from the state where the patient is located in order to provide such services.

It is expected that EACA will receive rare bipartisan support in both chambers. If it does pass, it raises the question of what happens to telehealth licensing requirements after the pandemic emergency ends. Given that almost all stakeholders have come around on the use of and payment for virtual visits, one would think that a permanent solution is more likely than not.

Expanded Medicare Coverage For Telemedicine Also On The Table

In addition to removing licensing burdens, Congress is also considering legislation to expand Medicare coverage for telehealth services. The Telehealth Modernization Act was introduced on July 30th. If it becomes law, the act would remove geographic and originating site restrictions from Medicare coverage of telehealth services, ensure that telehealth services at federally qualified health centers (FQHCs) and rural health clinics (RHCs) are covered by Medicare, and give the Health and Human Services Secretary the authority to permanently expand the types of telehealth services covered by Medicare, among other changes.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

What NOT To Do When Reopening Your Medical Practice in Illinois

We are now in Phase 3 of Gov. JB Pritzker’s five-phase Restore Illinois plan. For medical practices throughout the state, this means that many individuals who have delayed or deferred elective procedures, screenings, and other non-COVID-19 visits are now scheduling these visits. For physicians and staff at medical offices, returning to the routine care and treatment of patients will be anything but routine.

Healthcare providers across the country have been modifying their policies, practices, and procedures to comply with state and local requirements for the protection of both patients and staff. In Illinois, that means following safety guidance from the Illinois Department of Public Health. Additionally, the Centers for Disease Control & Prevention (CDC) has issued its “Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic” to help guide clinicians in their decision-making.

But on a more granular level, the modifications that practices must make to their clinical care and general operation can be quite extensive and require planning, thoughtfulness, and diligence in both formulation and execution. To help guide physicians in this regard. The American Medical Association (AMA) has compiled a reopening guide with actionable information, proposed best practices a checklist, and other resources to ensure that medical practices are ready to reopen.

Among the resources provided by the AMA is a list of mistakes that practices should avoid when reopening. Not only can such missteps put the health and safety of patients and staff at risk, but they can also draw the scrutiny of authorities who will not hesitate to intervene if a practice is not following required precautions.

Some “don’t’s” physicians should avoid when reopening, per the AMA, include:

  • Don’t jump the gun. Stay in line with the latest requirements and limitations issued by the governor, IDPH, and local authorities. These change frequently with events, so it is imperative that you keep continuously abreast of what is and isn’t permitted in terms of patient care and office safety.
  • Don’t assume your supply chain will return to normal. Assess your practice’s current inventory and future needs for personal protective equipment and order enough to have on hand when reopening.
  • Don’t allow non-patient visitors. Clearly post on your website and practice door your revised visitor policy. Reroute vendors, salespeople, educators, and service providers (other than caregivers) to phone or videoconference communication.
  • Don’t presume that your obligations as an employer are the same. In addition to new safety precautions and procedures for you and your staff, the pandemic has changed the rights of employees and the obligations of employers in several respects. From paid sick leave and family medical leave to ADA issues and more, practices should consult with experienced counsel to ensure that they avoid any exposure related to their employment practices.

Louis Fine: Chicago Professional License Defense Attorney

This is an unprecedented and challenging time for everyone, including and perhaps especially, for medical professionals. During this crisis, I remain committed to being a resource, counselor, and advocate for all Illinois licensees as they navigate the rapidly changing legal, regulatory, and practical landscape.

If you have questions or concerns about your professional license or COVID-19, please contact me immediately. Call (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Pritzker Indicates That IDFPR Will Take Action Against Professional Licensees Who Jump The Gun On Reopening

After over two months on personal and professional lockdown, we all want things to return to some semblance of “normal” at the earliest opportunity, while also remaining cognizant of the continuing public health risks posed by COVID-19. Business owners and service providers, including those who hold professional licenses, are desperate to get back to work and bring in income after sitting idle for what seems like forever.

But we are currently only in phase two of Gov. JB Pritzker’s administration five-phase “Restore Illinois” plan. This means that, depending on the course of the virus in the coming weeks, most businesses will continue to remain shuttered or extremely limited in operations for weeks to come, at minimum.

That’s not good enough for many professionals and business owners, especially in less hard-hit areas Downstate. From bars to salons to retail stores, many folks are defying public health orders and are opening their doors despite the prohibitions against doing so. But if you hold a professional license and start serving customers, clients, or patients in violation of the state’s current rules, you could be putting your professional license at risk.

In recent days, Pritzker has made it clear that he will turn up the heat on those businesses that open prematurely. This includes professional licensees.  At his May 14th daily COVID-19 briefing, Pritzker sternly issued the following warning:

“For the small minority of businesses that choose to ignore the medical doctors and the data and to ignore your legal obligations for the residents of your communities, there will be consequences. Businesses that ignore the executive orders, that ignore the law, will be held accountable by our department of Professional Regulation. There are enforcement mechanisms here that we will be using against them.”

“Practicing Beyond the Scope Permitted By Law”

The Illinois Department of Financial and Professional Regulation (IDFPR) has not as of yet issued any statements relating to the governor’s comments or provided any detail as to what actions they plan on taking, if any, against licensees who provide services to the public in violation of applicable laws and orders. However, it seems clear that they have the power to sanction licensees for such transgressions, including suspending their licenses.

All Illinois professional licensing acts enumerate scores of reasons a licensee can face disciplinary action, as do the administrative rules that apply to each act. Violating applicable laws or orders, or putting the health and safety of the public at risk, generally can constitute bases for sanctions against a licensee.

For example, the administrative rules that govern barbers, hairstylists, nail salons, and other cosmetologists provide that IDFPR “may suspend or revoke a license, refuse to issue or renew a license, or take other disciplinary action based upon its findings of dishonorable, unethical or unprofessional conduct… which is interpreted to include, but is not limited to, the following acts or practices:

  • Engaging in conduct likely to deceive, defraud or harm the public, or demonstrating a willful disregard for the health, welfare or safety of a client or student.  Actual injury need not be established;
  • Practicing or offering to practice beyond the scope permitted by law, or accepting and performing professional responsibilities that the licensee knows or has reason to know that he/she is not competent to perform;

Again, it remains unclear how aggressively IDFPR will pursue licensees who violate COVID-19 restrictions before they are lifted. Hopefully, it will be a moot point soon enough. But until then, licensees should be aware that they may be putting their business or career at long-term risk for short-term gain.

Louis Fine: Chicago Professional License Defense Attorney

This is an unprecedented and challenging time for everyone, including licensed professionals. During this crisis, I remain committed to being a resource, counselor, and advocate for all Illinois licensees as they navigate the rapidly changing legal, regulatory, and practical landscape.

If you have questions or concerns about your professional license or COVID-19, please contact me immediately. Call (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Flying Blind: When Your Professional License Comes Under Attack, Will You Even Know Why?

Under the Fifth Amendment to the U.S. Constitution, no person shall be “deprived of life, liberty, or property, without due process of law.” While the Fifth Amendment only applies to the federal government, the Fourteenth Amendment provides identical protections from unfair deprivation of those things by a state.

The Illinois Department of Financial and Professional Regulation (IDFPR) is a body of the state of Illinois. And your professional license is your property, likely one of your most valuable possessions insofar as your livelihood depends on it. This means that when the IDFPR initiates formal proceedings that could result in the denial, suspension, or revocation of your license, you are entitled to due process of law before they take such actions.

But due process in the context of administrative hearings like those before the IDFPR may not mean what you think it means. In fact, there is a good chance that you won’t receive the same due process protections that are your rights in a criminal prosecution or even in a civil lawsuit. This includes being fully informed of the allegations against you.

Due process involves many substantive and procedural aspects depending on the nature of the proceedings. One such element of due process is the right to know exactly why you are in the crosshairs of prosecutors, a plaintiff, or an administrative body. After all, you can’t properly mount a defense if you don’t know what you are defending yourself against.

In criminal cases, the Sixth Amendment gives defendants the right “to be informed of the nature and cause of the allegation” they face. The Federal Rules of Civil Procedure, as well as Illinois’ rules of civil procedure, contain similar requirements that a plaintiff’s complaint must provide sufficient detail to apprise the defendant of the claim for which they are being sued.  

When a complaint fails to contain enough information to either support a claim or afford the defendant an ability to respond, the defendant can move to dismiss the complaint on that basis.

Licensees facing formal IDFPR disciplinary action also have the right to be adequately advised of the allegations against them and can move to dismiss a complaint if the Department falls short in this regard.

The problem is that the standards that apply in administrative proceedings are much more forgiving to those making the accusations, allowing them to pursue catastrophic sanctions against licensees with minimal detail as to why they are doing so.

Under the Illinois Administrative Procedure Act (APA), agencies like the IDFPR only need to provide the following in their formal complaints regarding the claims against a licensee:

  • A statement of the legal authority and jurisdiction under which  the proceeding is to be held;
  • A reference to the particular sections of the substantive and procedural statutes and rules involved;
  • Except where a more detailed statement is required by law, a short and plain statement of the matters asserted;

Courts have held that the charges filed before an administrative agency like IDFPR “need not be drawn with the precision required of pleadings in judicial actions. They only must be drawn sufficiently so that the alleged wrongdoer is reasonably apprised of the case against him to intelligently prepare his defense.” Siddiqui v. Department of Professional Regulation.

“In determining whether the respondent has adequate notice, a court may consider the discovery and other materials available to the respondent.” Secrest v. Department of Corrections. But this just leads to another due process problem inherent in IDFPR proceedings.

Limited Discovery Rights

The process of investigating, obtaining evidence, and eliciting testimony relevant to a case – whether it be a civil, criminal, or administrative proceeding like IDFPR disciplinary hearings – is known as “discovery.” It’s how the parties find out the facts, whether they help or hurt their respective cases. It is a fundamental aspect of fairness, and if a party is not permitted to fully develop the evidence necessary to support their case or challenge the evidence obtained by the other side, it is an inherently unfair process.

In formal IDFPR disciplinary proceedings, the licensee’s ability to pursue the discovery necessary to defend themselves is extremely limited. In fact, the extent of allowable discovery is determined by the very people who are prosecuting the case. Once the Department provides names of witnesses, including the name of any individual whose complaint may be at the heart of the proceedings, a respondent cannot take their depositions unless the Department’s attorney agrees. If the Department nixes a deposition request, that means the respondent will not be able to confront that witness, learn what his testimony will be, or attack the veracity of his testimony until the actual hearing. That is manifestly unjust and leaves a respondent and their attorney fighting with one arm tied behind their back.

Similarly, if there are witnesses that the licensee wishes to subpoena for testimony, those subpoenas have to be authorized and approved by the Department. Again, the very people seeking to deprive someone of their professional license can also deprive them of their ability to defend themselves.

With the deck so stacked against licensees, it is crucial that you retain an experienced IDFPR defense attorney to protect your rights, your license, and your livelihood if you find yourself in the Department’s sights.

Louis Fine: Chicago Professional License Defense Attorney

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will get you back to your clients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Pritzker Executive Order Gives Hospitals and Healthcare Workers Immunity From Civil Liability During COVID-19 Crisis

With Illinois hospitals and healthcare workers overwhelmed on the front lines of the COVID-19 pandemic, and with freshly minted doctors and retired healthcare professionals being called into the fight, Gov. JB Pritzker signed an Executive Order providing them with immunity from civil liability for “rendering assistance” during the crisis.

Executive Order 2020-19, issued on April 1, 2020, directs “all Health Care Facilities, Health Care Professionals, and Health Care Volunteers, as defined in Section 1 of the order, to render assistance in support of the State’s response to” the COVID-19 disaster proclamation. It provides that all such facilities, professionals, and volunteers:

“shall be immune from civil liability for any injury or death alleged to have been caused by any act or omission… which injury or death occurred at a time when [the hospital, professional, or volunteer] was engaged in the course of rendering assistance to the State by providing health care services in response to the COVID-19 outbreak, unless it is established that such injury or death was caused by gross negligence or willful misconduct”

As defined in the order, “health care facilities” include “any government-operated site providing health care services established for the purpose of responding to the COVID-19 outbreak,” such as the field hospital recently established at McCormick Place. The order also covers hospitals, skilled and intermediate care nursing facilities, skilled and intermediate facilities under the ID/DD Community Care Act, skilled mental health rehabilitation facilities, kidney disease treatment centers, emergency medical service providers, outpatient surgery centers, and institutions that provide major medical diagnostic equipment, among others.

Health care professionals for purposes of the order include “all licensed or certified health care or emergency medical services workers” providing services at a health care facility in response to the COVID-19 outbreak or “are working under the direction of the Illinois Emergency Management Agency or the Department of Public Health in response to the Gubernatorial Disaster Proclamations.”

Health care volunteers are defined as volunteers or unlicensed medical or nursing students who are working under IEMA or DPH in response to the governor’s disaster proclamation.

The order cites several statutory bases for the grant of immunity, including the Illinois Emergency Management Agency Act, the Good Samaritan Act, and the Emergency Medical Services Systems Act.

The immunity provided through the governor’s order is just one of several steps that Illinois has taken to make it easier for desperately needed physicians and health care workers to participate in the COVID-19 battle, including expedited healthcare license reinstatement and streamlined out-of-state licensing.

Louis Fine: Chicago Professional License Defense Attorney

This is an unprecedented and challenging time for everyone, including licensed professionals. During this crisis, I remain committed to being a resource, counselor, and advocate for all Illinois licensees as they navigate the rapidly changing legal, regulatory, and practical landscape.

If you have questions or concerns about your professional license or how these variances and other COVID-19 changes affect you, please contact me immediately. Call (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

URGENT COVID-19 Professional Licensing Update

Pritzker Paves Way for Expedited Healthcare License Reinstatement

IDFPR Issues Emergency Variances and Extensions

With the vast majority of Illinois residents working from home – or not working at all – because of the COVID-19 pandemic, the Illinois Department of Financial and Professional Regulation (IDFPR) has announced several variances and extensions that impact all 1.3 million Illinoisans with professional licenses. It is likely that these first five variances, issued on March 18th, 2020, will not be the last.

Healthcare Workers: Expedited Reinstatement and Streamlined Out-of-State Licensing

In fact, at his Saturday, March 21st daily coronavirus press conference, Gov. JB Pritzker issued a plea to retired healthcare workers to join the fight against the virus, indicating that the state would expedite licensing and waive fees for any healthcare professionals seeking reinstatement. “Applications will be processed on an expedited basis, and we’ll be coordinating with hospitals and health care sites throughout the state to deploy these re-enlisted medical professionals to the frontlines,” Pritzker said.

Today, March 23rd, IDFPR announced several actions to implement this directive. Specifically:

  • Physicians whose licenses are expired or inactive for less than three years can temporarily restore their license, for no fee or continuing education requirement, to work under the direction of Illinois Emergency Management Agency (“IEMA”) and the Illinois Department of Public Health (“IDPH”) or in a long-term care facility, hospital, or federally qualified health center (“FQHC”). Application for physician reinstatement can be found here.
  • Physician Assistants whose licenses are inactive or in non-renewed status for less than three years can also temporarily restore their license, for no fee or continuing education requirement, to work under the direction of IEMA and IDPH or in a long-term care facility, hospital, or FQHC. Applications for reinstatement can be found here.
  • Licensed practical nurses, registered professional nurses, advanced practice registered nurses, and respiratory care therapists whose licenses are inactive or in nonrenewed status for less than five years can also temporarily restore their license, for no fee or continuing education requirement, to work under the direction of IEMA and IDPH or in a long-term care facility, hospital, or FQHC. Applications for reinstatement can be found here.
  • Out-of-State physicians, nurses, physician assistants, pharmacists, and respiratory care therapists may practice in Illinois if they are licensed in another state and are in good standing. These licensees must be operating under the authority of IEMA/IDPH or at a long-term care facility, hospital or FQHC, and must meet the standards of care mandated by the respective health care acts. They must provide contact information and dates of arrival and departure on forms provided by IDFPR. This temporary practice approval expires on September 30, 2020. Applications for an Out-of-State Temporary Practice Permit can be found here.

In addition to these healthcare-focused changes, other COVID-19 variances issued by IDFPR include:

Upcoming License Renewal Extensions

Any professional licenses issued by the Department that have renewal dates between March 1st, 2020 through and including July 31st, 2020 are granted an automatic extension to renew to September 30th, 2020.

Continuing Education Obligations

All current licensees whose license renewal deadlines fall between March 1st, 2020 and July 31st, 2020 shall have up to, and including, September 30th, 2020 to complete their continuing education coursework.

The Department is also allowing licensees to complete their continuing education coursework remotely without requiring live attendance. The variance allows for interactive webinars and online distance education courses in addition to currently permitted methods.

Louis Fine: Chicago Professional License Defense Attorney

This is an unprecedented and challenging time for everyone, including licensed professionals. During this crisis, I remain committed to being a resource, counselor, and advocate for all Illinois licensees as they navigate the rapidly changing legal, regulatory, and practical landscape.

If you have questions or concerns about your professional license or how these variances and other COVID-19 changes affect you, please contact me immediately. Call (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Cognitive Decline Among Older Physicians Leading to Increased Screening

For every accomplished physician who dreams of retiring early, there is one who can’t imagine giving up the work that brings them so much personal and professional satisfaction and financial security. Every year, 20,000 American doctors turn 65, but only half of them retire by then. Thousands of physicians continue to practice well past their 70th, even 80th, birthdays. It is estimated that one in every eight practicing doctors in the U.S. is over 65, overseeing 50-70 million office visits and 11 million to 20 million hospitalizations each year.

One In Eight Doctors Over 70 Found to Have Significant Cognitive Deficits

With so many patients receiving care from physicians 65 and up, many hospitals and healthcare systems are also increasing their scrutiny of the cognitive abilities and faculties of these senior clinicians. Major institutions such as Scripps Health Care, Intermountain Healthcare, Stanford Hospitals and Clinics, and Penn Medicine have implemented mandatory cognitive screens for older practitioners.

At Yale New Haven Hospital, for example, all applicants 70 or older who seek reappointment to the medical staff are required to have an objective evaluation of cognitive function as part of the two-year reappointment process. What a recent round of that testing revealed was that one in eight doctors who participated in the screening had cognitive deficits that were likely to impair their ability to practice medicine independently.

Testing or No Testing, Cognitive Issues Raise Professional Licensing Concerns

The wisdom and efficacy of such testing programs is subject to debate, with many arguing that age-based screening is empirically unjustified or inherently discriminatory. Whether subject to required testing or not, however, all older physicians who continue to treat patients later in life will at some point face difficult questions about their abilities and the prudence of continuing to practice.

Confronting issues of cognitive decline, if not impairment, is no easy task, personally and professionally. But recognizing any such concerns is also an ethical imperative. Continuing to practice while suffering from cognitive impairment significant enough to raise concerns about patient safety can subject a physician of any age to disciplinary action and the loss of their license.

The Illinois Medical Practice Act (the “Act”), for example, makes it a basis for suspension or revocation of a license for a physician to practice if they have a:
• Mental illness or disability which results in the inability to practice under this Act with reasonable judgment, skill or safety.
• Physical illness, including, but not limited to, deterioration through the aging process… which results in a physician’s inability to practice under this Act with reasonable judgment, skill, and safety.

The Act also imposes reporting requirements on certain health care executives regarding “impaired” physicians, defined as those who lack the ability “to practice medicine with reasonable skill and safety due to physical or mental disabilities as evidenced by a written determination or written consent based on clinical evidence including deterioration through the aging process or loss of motor skill… of sufficient degree to diminish a person’s ability to deliver competent patient care.”

Doctors, for all their talents, are as vulnerable as anyone else to the inevitable effects of time and aging. While debate may continue as to the best way to identify and remediate instances of age-related cognitive or physical impairment, doctors who practice well into their golden years need to combine their clinical judgment with self-awareness when evaluating the wisdom of continuing to treat patients. Failing to do so puts both patients and professional licenses at risk.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Task Force Recommends More Breaks, Shorter Shifts, and Fewer Responsibilities for Illinois Pharmacists

Pharmacists are highly trained and knowledgeable professionals. They handle and dispense powerful drugs to vulnerable patients who rely on them for guidance and for their careful filling and dispensing of prescriptions.

But pharmacists are also human. Their jobs come with business pressures, policies, and priorities that may impede their ability to fulfill their duties as they should. These pressures can have tragic consequences when pharmacists feel like they can’t spend the time needed to properly advise patients about their prescription. Overwhelmed and overworked pharmacists may also make any number of critical errors between the time they receive a prescription from a patient or their physician and the time they dispense the prescribed medication.

These problems manifested themselves in a 2016 Chicago Tribune investigation which found that pharmacists at 52% of 255 Chicagoland pharmacies failed to adequately warn customers about drug interactions that could result in adverse health consequences or death.

As a result of this shocking report, the state of Illinois formed a task force to examine and make recommendations on “how to further advance the practice of pharmacy in a manner that recognizes the needs of the healthcare system, patients, pharmacies, pharmacists, and pharmacy technicians.” 

On October 11, 2019, the Illinois Collaborative Pharmaceutical Task Force released its final Report and Recommendations.

An Assembly-Line Process

The report found that pharmacists felt overwhelmed by an assembly-line process at busy pharmacies where they are expected to fill hundreds of prescriptions in a single shift. In turn, pharmacists routinely skipped breaks and meals and became easily distracted due to competing priorities and too many responsibilities relating to the management and operation of pharmacy practices.

 In the report, the task force made the following recommendations:

  • Increasing whistleblower protections for pharmacists and pharmacy technicians who report violations of the Pharmacy Practice Act (the “Act”);
  • Adding new grounds for discipline of licensed pharmacists under the Act, including:
    • Failing to provide “adequate time for a pharmacist to complete professional duties and responsibilities”;
    • Failing to provide “sufficient personnel to prevent fatigue, distraction or other conditions that interfere with a pharmacist’s ability to practice with competency and safety or creates an environment that jeopardizes patient care”;
    • Failing to provide “appropriate opportunities for uninterrupted rest periods and meal breaks”;
  • Adding a new section to the Act entitled “Pharmacy Work Conditions,” which states that:
    • Employers “shall keep and maintain a complete and accurate record of the daily break periods of its pharmacists”;
    • Employers “shall not require a pharmacist, student pharmacist, or pharmacy technician to work longer than twelve (12) continuous hours per day, inclusive of the breaks”;
    • A pharmacist working longer than six continuous hours per day shall be allowed to take a 30-minute uninterrupted meal break and one 15-minute break, as well as one additional break if working 12 hours per day.
    • No pharmacist shall work longer than five hours per day without the opportunity to take an uninterrupted meal break.

A bill currently pending in the Illinois legislature would incorporate the task force’s recommendations into the Pharmacy Practice Act. The bill also includes new provisions for disciplinary action, including written warnings or fines against the pharmacy, pharmacist, and pharmacist-in-charge that would be posted online and could not be expunged, as well as possible license revocation for repeat violations. The bill is expected to become law during the current legislative session.

Louis R. Fine: Chicago Pharmacist License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of pharmacists and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois pharmacist’s license and get you back to your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.

Telemedicine and Physician Licensing: How the 19th Century is Holding Back the 21st

teleAdvancements in technology almost always outpace efforts by legislators and regulators to address the new realities, issues, and concerns that arise from such innovations. Laws that made sense even a short ten years ago can quickly become anachronistic, if not counterproductive.

Such is the dilemma facing physicians and healthcare providers who see telemedicine as a key way to address a growing physician shortage, especially in rural and other underserved areas. That shortage is expected to grow to 120,000 doctors by 2030, according to a 2018 report by the Association of American Medical Colleges.

51 Different Licenses

The problem is that while the internet knows no borders, medical licenses do. Increasingly, the inability of physicians to provide remote care to patients in other states where they are not licensed is holding back telemedicine’s potential and unnecessarily denying patients access to quality healthcare.

Physicians must be licensed in each state where their current and future patients are located, so a doctor wanting to counsel patients through telemedicine would need to obtain and stay compliant with licensing requirements in up to 51 jurisdictions governed by 51 different medical boards imposing 51 different standards, conditions, and rules.

The current state-based medical licensing regime traces its roots back to the 19th Century, and the system is clearly showing its age. While effective and robust licensing is still essential in ensuring quality of care, the lack of license reciprocity and portability between states is now more of a hindrance to providing such care than a help.

That is why already active efforts to change medical licensing to facilitate telemedicine continue to gain steam. The most successful of these efforts to date has been the Federation of State Medical Licensing Board’s (FSMB) work establishing the Interstate Medical Licensure Compact. Physicians in good standing can freely practice in any of the states participating in the compact so long as they possess a “full and unrestricted” license in their state of principal license (SPL). To date, only 24 states, including Illinois, have joined the compact.

A Uniform, Nationwide System

This still leaves too many doctors and too many patients locked out of telemedicine. As noted by the authors of a recent article in the American Journal of Managed Care, “The impact of restricting telemedicine falls hardest on poor patients, the uninsured, and those who rely on state Medicaid programs, many of whom lack access to reliable transportation and cannot travel across state lines to see specialists.”

That is why the FSMB and other telemedicine advocates have advanced several proposals to enhance license portability and reduce regulatory barriers to telemedicine. They all are based around a mutual recognition scheme whereby states honor each other’s medical licenses based on models that have been successfully used in Europe and Australia and by the Veterans Health Administration, US military, and US Public Health Service.

Adoption of a nationwide licensing scheme would be facilitated by establishing consistent standards for using and regulating telemedicine services, the sharing of malpractice, medical error, and license cancellation or suspension information between states, and other federal and state-level reforms.

Any efforts that would streamline the physician licensing process while at the same time increasing access to healthcare for those who need it most should be encouraged.

Louis R. Fine: Chicago Physician License Defense Attorney

Throughout my career, I have been protecting the livelihoods and professional futures of physicians and other health care providers before the IDFPR, combining insight and experience with zealous and strategic advocacy.

The moment you are contacted by IDFPR or learn that you are under investigation is the moment that you should contact me. I will immediately begin communicating with IDFPR prosecutors and work with you to develop the strategy best suited to achieving the goal of an efficient, cost-effective outcome that avoids any adverse action. Together, we will protect your Illinois physician’s license and get you back to your patients and your career.

Please give me a call at (312) 236-2433 or fill out my online form to arrange for your free initial consultation. I look forward to meeting with you.