Iowa Admin. Code r. 653-13.7 - Standards of practice-interventional chronic pain management
This rule establishes standards of practice for the practice of interventional chronic pain management. The purpose of this rule is to assist physicians who consider interventional techniques to treat patients with chronic pain.
(1)
Definition. As used in this rule:
"Interventional chronic pain management" means diagnosing and treating pain-related disorders using interventional techniques for subacute, chronic, persistent, and intractable pain. These techniques include percutaneous needle placement for drug injection, nerve ablation, and certain surgeries. Common procedures involve injecting steroids, analgesic, and anesthetics into targeted areas such as the spine, joints, or nerves. This may include lumbar, thoracic, and cervical spine injections; nerve blocks; and processes like vertebroplasty. Fluoroscopy is used to assess chronic pain causes or aid in identifying anatomical landmarks during these techniques. Specific procedures include joint injections, nerve blocks, epidural injections, and nerve destruction.
(2)
Interventional chronic pain
management. The practice of interventional chronic pain management
shall include the following:
a. Comprehensive
assessment of the patient;
b.
Diagnosis of the cause of the patient's pain;
c. Evaluation of alternative treatment
options;
d. Selection of
appropriate treatment options;
e.
Termination of prescribed treatment options when appropriate;
f. Follow-up care; and
g. Collaboration with other health care
providers.
(3)
Practice of medicine. Interventional chronic pain management
is the practice of medicine.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Termination of the physician -patient relationship. A physician may choose whom to serve. Having undertaken the care of a patient, the physician may not neglect the patient. A physician shall provide a patient written notice of the termination of the physician -patient relationship. A physician shall ensure that emergency medical care is available to the patient during the 30-day period following notice of the termination of the physician -patient relationship.
(2) Patient referrals. A physician shall not pay or receive compensation for patient referrals.
(3) Confidentiality. A physician shall maintain the confidentiality of all patient information obtained in the practice of medicine. Information shall be divulged by the physician when authorized by law or the patient or when required for patient care.
(4) Sexual conduct. It is unprofessional and unethical conduct, and is grounds for disciplinary action, for a physician to engage in conduct which violates the following prohibitions:
a. In the course of providing medical care, a physician shall not engage in contact, touching, or comments of a sexual nature with a patient, or with the patient's parent or guardian if the patient is a minor.
b. A physician shall not engage in any sexual conduct with a patient when that conduct occurs concurrent with the physician -patient relationship, regardless of whether the patient consents to that conduct.
c. A physician shall not engage in any sexual conduct with a former patient unless the physician -patient relationship was completely terminated before the sexual conduct occurred. In considering whether that relationship was completely terminated, the board will consider the duration of the physician -patient relationship, the nature of the medical services provided, the lapse of time since the physician -patient relationship ended, the degree of dependence in the physician -patient relationship, and the extent to which the physician used or exploited the trust, knowledge, emotions, or influence derived from the physician -patient relationship.
d. A psychiatrist, or a physician who provides mental health counseling to a patient, shall never engage in any sexual conduct with a current or former patient, or with that patient's parent or guardian if the patient was a minor, regardless of whether the patient consents to that conduct.
(5) Disruptive behavior. A physician shall not engage in disruptive behavior. Disruptive behavior is defined as a pattern of contentious, threatening, or intractable behavior that interferes with, or has the potential to interfere with, patient care or the effective functioning of health care staff.
(6) Sexual harassment. A physician shall not engage in sexual harassment. Sexual harassment is defined as verbal or physical conduct of a sexual nature which interferes with another health care worker's performance or creates an intimidating, hostile or offensive work environment.
(7) Transfer of medical records. A physician must provide a copy of all medical records generated by the physician in a timely manner to the patient or another physician designated by the patient, upon written request when legally requested to do so by the subject patient or by a legally designated representative of the subject patient, except as otherwise required or permitted by law.
(8) Retention of medical records.
a. A physician shall retain all medical records, not appropriately transferred to another physician or entity, for at least seven years from the last date of service for each patient, except as otherwise required by law.
b. A physician must retain all medical records of minor patients, not appropriately transferred to another physician or entity, for a period consistent with that established by Iowa Code section 614.8.
c. Beginning July 1, 2023, a physician must appoint another Iowa-licensed physician , or other representative or entity that is held to the same standards of confidentiality as the physician , to ensure that all requirements of this subrule are met in the event of the physician 's death or incapacitation. Upon request by the board , the physician must be able to establish by sufficient proof the appointment of a representative pursuant to this paragraph.
d. Upon a physician 's death or retirement, the sale of a medical practice, or a physician 's departure from the physician 's medical practice:
(1) The physician or the physician 's representative must ensure that all medical records are transferred to another physician or entity that is held to the same standards of confidentiality and agrees to act as custodian of the records.
(2) The physician or the physician 's representative shall notify all active patients that their records will be transferred to another physician or entity that will retain custody of their records and that, at their written request, the records will be sent to the physician or entity of the patient's choice.