Tenn. Comp. R. & Regs. 1155-02-.24 - MINIMUM DISCIPLINE FOR OPIOID PRESCRIBING
(1) If
the board or committee finds that its licensee has prescribed, dispensed, or
administered opioids in a manner that violates the board's or committee's
statutes or rules (for example, by prescribing in a manner that constitutes
gross healthcare liability or a pattern of continued or repeated health care
liability, ignorance, negligence or incompetence), the board or committee shall
make a finding that the licensee engaged in a significant deviation or pattern
of deviation from sound medical judgement. For purposes of such a finding,
sound medical judgment is the equivalent to the standard of care as defined in
T.C.A. §
63-1-122.
(2) Having made such a finding, the minimum
discipline that the board or committee assesses shall include the following:
(a) Reprimand;
(b) Successful completion of a board or
committee approved intensive continuing education course or program regarding
treatment with opioids;
(c) A
restriction against prescribing opioids for at least six (6) months, and until
successful completion of the required continuing education;
(d) One or more Type A civil
penalties;
(e) Proof to the
licensee's board or committee that they have notified any physicians,
podiatrists, advanced practice registered nurses, or physician assistants with
whom they collaborate of the discipline; and
(f) Where the licensee is a physician or
podiatrist, a restriction against collaborating with any advanced practice
registered nurses or physician assistants for issuing opioids during the period
in which the licensee is restricted from prescribing opioids.
(3) The prescribing boards and
committee recognize that a higher level of minimum discipline is required for
those licensees who have been disciplined for opioid-related prescribing
violations but continue to violate the standard of care. As set out in
paragraph (1) of this rule, the following findings are synonymous, though the
boards or committee may have used one or more sets of language to describe a
violation. If a licensee commits an order violation in which the prior order
contains one or more of the following findings, the licensee has committed an
opioid-related order violation for purposes of paragraph (5) of this rule:
(a) That the licensee had prescribed,
dispensed, or administered opioids in a manner that constituted gross
healthcare liability or a pattern of continued or repeated health care
liability, ignorance, negligence or incompetence;
(b) That the licensee engaged in a
significant deviation or pattern of deviation from sound medical judgement
related to the issuance of opioids;
(c) That the standard of care related to the
issuance of opioids was violated;
(d) That the licensee had dispensed,
prescribed or administered opioids not in the course of professional practice,
or not in good faith to relieve pain and suffering or not to cure an ailment,
physical infirmity or disease;
(e)
That the licensee was unfit or incompetent by reason of negligence, habits or
other cause related to the licensee's prescribing or issuance of opioids;
or
(f) That the licensee violated
the rules of the licensing entity with regard to prescribing or issuance of
opioids.
(4) If within
one (1) year from the date a licensee's opioid-prescribing privileges are
reinstated, having been restricted by an opioid-related order, that licensee's
board or committee finds that, during that year the licensee had prescribed,
dispensed, or administered opioids in a manner that violates the board's or
committee's statutes or rules (for example, by prescribing in a manner that
constitutes gross healthcare liability or a pattern of continued or repeated
health care liability, ignorance, negligence or incompetence), the board or
committee shall make a finding that the licensee re-engaged in a significant
deviation or pattern of deviation from sound medical judgement such that they
are a repeat offender. For purposes of such a finding, sound medical judgment
is the equivalent to the standard of care as defined in T.C.A. §
63-1-122.
(5) If the licensee commits an opioid-related
order violation within one year of the opioid-related order, or if the licensee
is found to be a repeat offender, the minimum discipline that the board or
committee assesses shall include the following:
(a) Probation;
(b) Successful completion of a practice
monitoring program which shall include at a minimum:
1. Board or committee approval of the monitor
or monitoring program;
2. Quarterly
reports to the board or committee which include the practice monitor's findings
with regard to the licensee's:
(i) Non-opioid
prescribing practices;
(ii) Medical
record keeping;
(iii) Pain
management;
(iv) Opioid treatment
practices-where the practice monitoring is longer than the restriction against
prescribing opioids; and
(v)
Compliance with the practice monitor's recommendations, including completion of
any additional education recommended by the practice monitor;
(c) A restriction
against prescribing opioids for twice the amount of time that was assessed in
the initial board or committee order, and for no less than one (1)
year;
(d) One or more Type A civil
penalties totaling at least twice the amount that was assessed in the initial
board or committee order;
(e) Proof
to the licensee's board or committee that they have notified any physicians,
podiatrists, advanced practice registered nurses, or physician assistants with
whom they collaborate of the discipline; and
(f) Where the licensee is a physician or
podiatrist, a restriction against collaborating with any advanced practice
registered nurses or physician assistants during the period in which the
licensee is restricted from prescribing opioids.
(6) Nothing in this rule shall prohibit the
board or committee from taking action in excess of the minimum disciplinary
action outlined herein. Each case shall be judged independently and may result
in additional discipline including other restrictions or a higher level of
discipline, including revocation, where appropriate. Further, nothing in this
rule shall prohibit the board or committee from taking disciplinary action
against a licensee based on a finding that the licensee violated the practice
act in manners additional to those outlined in paragraph (1) above, suggesting
a need for a higher level of discipline.
Notes
Authority: T.C.A. § 63-1-162.
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