Holding a medical license in several states can lead to some unforeseen and unfortunate consequences. Even a conscientious practitioner can inadvertently run afoul of a state's practice act or regulations, which differ from state to state, and the consequences of that single misstep can be exponentially problematic. Any resulting disciplinary action likely must be reported to every other jurisdiction in which the practitioner is licensed, and those jurisdictions in turn can be expected to impose their own disciplinary action. Furthermore, state disciplinary actions are reported to the National Practitioner Data Bank (NPDB), which state licensing authorities are obligated to query on licensure applications and renewals. Containing the ripple effect of these disciplinary actions can take years.
Take for example the case of Dr. Mariana Quinn, who has been licensed for more than 30 years to practice medicine in New York, where she maintains a small practice.* Dr. Quinn also served as the Chief Medical Officer of a health care company with clinics in 20 states around the country, in each of which she held medical licenses. She enjoyed an excellent, professional reputation as a practitioner and had never been disciplined or the subject of a medical board complaint or medical malpractice claim.
In September 2014, Dr. Quinn entered into a consent order with the New Jersey Medical Board, which had suspended her license for three months to be followed by a one-year probationary period. She also was required to take continuing medical education courses and a Juris Prudence Examination. The New Jersey Medical Board alleged that Dr. Quinn (i) failed to obtain a Registration Certificate issued by the U.S. Drug Enforcement Administration (DEA) for New Jersey prior to placement of orders of controlled substances for the purpose of prescribing, administering or dispensing of controlled substances; (ii) delegated the authority to dispense controlled substances by virtue of her medical license; (iii) administered, dispensed or prescribed a narcotic drug or other drug having addiction-forming or addiction-sustaining liability other than in the course of legitimate professional practice; and (iv) these actions resulted in unprofessional conduct including dishonorable or unethical conduct likely to deceive, defraud or harm the public.
The factual bases for the allegations stem from the fact that Dr. Quinn, using her name and New York DEA registration, caused Tramadol to be sent to one of her company's clinics in New Jersey. At the time of the shipment, Tramadol was not a scheduled drug under federal law. The drug was to be available when the clinic opened and a local practitioner was to sign for the responsibility of the drug before it was dispensed. Tramadol was added to New Jersey's list of controlled substances in July 2011, but no Medical Board, Nursing Board, or Pharmacy Board issued notice regarding Tramadol's addition to New Jersey's list of controlled substances. Several states had issued notices regarding Tramadol, however. Because company policy did not permit clinics to carry, dispense, or prescribe narcotics, Dr. Quinn decided, upon learning of the notices regarding Tramadol, to remove the drug from every company clinic's formulary and notified them to stop distributing the drug.
However, for a period of time before the company became aware that New Jersey had reclassified Tramadol as a controlled substance, a state-certified, advanced practice registered nurse (APRN) with prescriptive authority dispensed Tramadol on at least one occasion at the New Jersey clinic. No question was raised about the propriety of this practice, as New Jersey Board of Nursing rules expressly grant such prescriptive authority based on a collaborative relationship with a physician – in this case, Dr. Quinn. When the practice came to the attention of the New Jersey Medical Board, however, the Medical Board notified physicians that such prescriptive authority was non-delegable. Dr. Quinn was caught in this crossfire.
Given the choice of agreeing to a relatively brief suspension of her license or running the risk of a licensure revocation following a contested case hearing before the New Jersey Medical Board, Dr. Quinn opted to enter into a consent order. The suspension of her license in New Jersey was only the beginning of a host of problems. Nearly every jurisdiction in which Dr. Quinn was licensed required her to report her suspension; a failure to timely do so would be an added count of discipline and subject the doctor to additional fines.
In addition to reporting the disciplinary action against Dr. Quinn's license to the NPDB, the New Jersey Medical Board reported it to each state in which she was licensed, thereby triggering the filing of disciplinary complaints against her in all 20 states. Many state boards customarily seek "reciprocal discipline"; that is, to mirror the discipline issued by the New Jersey Medical Board. Fortunately, most of those state boards, after reviewing Dr. Quinn's response to the New Jersey Medical Board's consent order, declined to pursue reciprocal discipline and either dismissed the complaints outright or simply placed Dr. Quinn's license on probation until such time as the discipline in New Jersey was lifted. However, five medical boards chose to mirror the suspension of her license, to be followed by probation, fines, and prescribing courses. In New York, where her private practice was at risk, Dr. Quinn decided to have her case heard on the merits. The New York Medical Board dismissed all charges against her after hearing her case.
Dr. Quinn's challenges were not limited to state licensure, however. She had to respond to inquiries from government payors, such as Medicaid, Medicare, and TRICARE, as well as private health insurance companies. In addition, Dr. Quinn faced inquiries from the Drug Enforcement Agency, the hospitals where she held privileges; and credentialing boards, such as the American Board of Family Medicine, where she held a certification. Fortunately, no adverse action was taken against her by any of those bodies.
This conscientious and dedicated doctor spent a substantial amount of time over the course of three years responding to the disciplinary proceedings and the resulting inquiries, and traveling to states where in-person attendance was required for medical board meetings or hearings, taking time away from her office and part-time practice.
One can see how easily even a conscientious practitioner can run afoul of a state's practice act or regulations, considering the differences from one state to another. Physicians who are similarly licensed in multiple states would do well to take heed of Dr. Quinn's experience and maintain a heightened awareness of the myriad of rules and regulations that apply to their practice in those states.
*This article is based on a true account of discipline against a physician's license. The name of the practitioner and the actual medical boards involved have been changed. We are grateful to "Dr. Quinn" for graciously agreeing to share her story in the hope that other physicians can avoid the problems she faced.
