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the veterinary hospital or clinic.”
The companion bill, SB 167, also introduced by Sen.
Schuitmaker February 15, 2017, amends sections 16221 and 16226 of the Public Health Code, which specifies and mandates sanctions that “shall” be brought by the Disci- plinary Subcommittee for various violations. It adds to section 16221 “violation of section 7303A(3)” as an infraction, and to section 16226 “suspension, revocation or permanent revocation” of a physician’s license as a penalty for that infraction.
It goes on to stipulate:
A DISCIPLINARY SUBCOMMITTEE THAT FINDS THAT A LICENSEE, A REGISTRANT, OR AN APPLICANT FOR LI- CENSURE OR REGISTRATION HAS VIOLATED SECTION 16221(V) SHALL, FOR A FIRST VIOLATION OF THAT SECTION, ORDER THE LICENSEE, REGISTRANT, OR APPLICANT TO COMPLETE A PROGRAM OF REMEDIAL CONTINUING EDUCATION FOCUSED ON PRESCRIPTION DRUG AND OPIOID ADDICTION, TO BE COMPLETED WITHIN 180 DAYS AFTER THE DEPARTMENT NOTIFIES HIM OR HER OF ITS ORDER UNDER THIS SUBSECTION. FOR A SECOND OR SUBSEQUENT VIOLATION OF SEC- TION 16221(V), OR A FAILURE TO COMPLETE THE PROGRAM DESCRIBED IN THIS SUBSECTION, THE DIS- CIPLINARY SUBCOMMITTEE SHALL IMPOSE 1 OR MORE OF THE SANCTIONS DESCRIBED IN SUBSECTION (1)
(Editorial comment: until a few years ago, the Board of Medicine and its Disciplinary Subcommittee had some discretion over the sanctions it might impose. The most recent revision of the Public Health Code stripped the subcommittee of discretion, requiring the sanctions to be imposed for many violations. That above is an example.) The House version of SB167, passed December 13, adds the requirement that:
BEGINNING MARCH 31, 2018, A LICENSED PRESCRIBER SHALL NOT PRESCRIBE A CONTROLLED SUBSTANCE LISTED IN SCHEDULES 2 TO 5 UNLESS THE PRESCRIBER IS IN A BONA FIDE PRESCRIBER-PATIENT RELATIONSHIP WITH THE PATIENT FOR WHOM THE CONTROLLED SUBSTANCE IS BEING PRESCRIBED. EXCEPT AS OTHER- WISE PROVIDED IN THIS SUBSECTION, IF A LICENSED PRESCRIBER PRESCRIBES A CONTROLLED SUBSTANCE UNDER THIS SUBSECTION, THE PRESCRIBER SHALL PROVIDE FOLLOW-UP CARE TO THE PATIENT TO MON- ITOR THE EFFICACY OF THE USE OF THE CONTROLLED SUBSTANCE AS A TREATMENT OF THE PATIENT’S MED- ICAL CONDITION. IF THE LICENSED PRESCRIBER IS UNABLE TO PROVIDE FOLLOW-UP CARE, HE OR SHE SHALL REFER THE PATIENT TO THE PATIENT’S PRIMARY CARE PROVIDER FOR FOLLOW-UP CARE OR, IF THE PATIENT DOES NOT HAVE A PRIMARY CARE PROVIDER, HE OR SHE SHALL REFER THE PATIENT TO ANOTHER LICENSED PRESCRIBER WHO IS GEOGRAPHICALLY AC- CESSIBLE TO THE PATIENT FOR FOLLOW-UP CARE.
“BONA FIDE PRESCRIBER-PATIENT RELATIONSHIP” MEANS A TREATMENT OR COUNSELING RELATIONSHIP BETWEEN A PRESCRIBER AND A PATIENT IN WHICH
BOTH OF THE FOLLOWING ARE PRESENT: (i) THE PRE- SCRIBER HAS REVIEWED THE PATIENT’S RELEVANT MEDICAL OR CLINICAL RECORDS AND COMPLETED A FULL ASSESSMENT OF THE PATIENT’S MEDICAL HIS- TORY AND CURRENT MEDICAL CONDITION, INCLUDING A RELEVANT MEDICAL EVALUATION OF THE PATIENT CONDUCTED IN PERSON OR VIA TELEHEALTH. (ii) THE PRESCRIBER HAS CREATED AND MAINTAINED RECORDS OF THE PATIENT’S CONDITION IN ACCORDANCE WITH MEDICALLY ACCEPTED STANDARDS.
(Editorial comment: Shortly after passage of the medical marijuana law, facing widespread abuse of the dispensing of medical need certificates, the legislature decided to put into law a definition of “bona-fide doctor-patient relation- ship” rather than allowing the Board of Medicine to define it, something it had already done. The amendment above extends this propensity and is for all intents and purposes legislating the practice of medicine.)
The House bill also adds a new section stating:
IF THE DEPARTMENT HAS A REASONABLE BASIS TO BELIEVE THAT A LICENSEE HAS VIOLATED SECTION 7303A(4) OR (5), THE DEPARTMENT IS NOT REQUIRED TO INVESTIGATE UNDER SECTION 16221 OR 16231 AND MAY ISSUE A LETTER TO THE LICENSEE NOTIFYING THE LICENSEE THAT HE OR SHE MAY BE IN VIOLATION OF SECTION 7303A(4) OR (5). A LETTER THAT IS ISSUED UNDER THIS SECTION IS NOT CONSIDERED DISCIPLINE.
7303A(4) is the new requirement to register with MAPS. 7373A(5) requires keeping of separate records for dispensing for 5 years and is not new. The wording of the amendment makes some sense administratively, because it allows the Department of Licensing and Regulatory Affairs to place a shot across the bow without having to deal with all the steps of a formal disciplinary action, such as opening a formal investigation and allowing for appeal to an administrative law judge.
The House version also adds to SB 167 verbatim the language from SB 166 and creates separate categories for violations of parts of SB 166 calling for “probation, limita- tion, denial, fine, suspension or permanent revocation.”
The Senate Concurred Bill, passed the same day, preserves the language about prescriber-patient relationship and the verbatim (redundant) additions of all of SB166, as well as the definition of bona-fide prescriber- patient relationship and the new violation categories on which the Disciplinary Subcommittee must act.
So there you have it, the legislative history of this new law that will substantially alter the way in which medicine is practiced. What we don’t have is all the negotiations, if any and with whom, that occurred between the February version and the June version, and the June version and the December version, which improved the legislation a little bit, but also encumbered it unnecessarily by once again getting into the legislative practice of medicine and including a number of basically unenforceable provisions.
Volume 70 • Number 2 Washtenaw County Medical Society BULLETIN 17


















































































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