[Federal Register Volume 63, Number 83 (Thursday, April 30, 1998)]
[Rules and Regulations]
[Pages 23664-23665]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-11466]
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DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 47
RIN 2900-AI78
Reporting Health Care Professionals to State Licensing Boards
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
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SUMMARY: It continues to be the policy of the Department of Veterans
Affairs (VA) to report to State Licensing Boards any separated
physician, dentist, or other licensed health care professional whose
clinical practice so significantly failed to meet generally accepted
standards of clinical practice as to raise reasonable concern for the
safety of patients. This document provides that, in addition, VA will
report to State Licensing Boards any currently employed physician,
dentist, or other licensed health care professional (one who is on VA
rolls) whose clinical practice so significantly failed to meet
generally accepted standards of clinical practice during VA employment
as to raise reasonable concern for the safety of patients. Some health
care professionals who are VA employees also provide health care
outside VA's jurisdiction. Accordingly, the reporting of currently
employed licensed health care professionals who meet the standard for
reporting is necessary so that State Licensing Boards can take action
as appropriate to protect the public. Examples of actions that meet the
criteria for reporting are set forth in the text portion of this
rulemaking. Also, nonsubstantive changes are made for purposes of
clarity.
DATES: Effective Date: June 1, 1998.
FOR FURTHER INFORMATION CONTACT: Ruth-Ann Phelps, Ph.D., Veterans
Health Administration, Patient Care Services (11B), Department of
Veterans Affairs, 810 Vermont Ave. NW, Washington, DC 20420, at (202)
273-8473 (this is not a toll-free number).
SUPPLEMENTARY INFORMATION: In a document published in the Federal
Register on October 8, 1997 (62 FR 52519), we proposed to expand our
policy of reporting to State Licensing Boards to include any currently
employed physician, dentist, or other licensed health care professional
(one who is on VA rolls) whose clinical practice so significantly
failed to meet generally accepted standards of clinical practice during
VA employment as to raise reasonable concern for the safety of
patients. Previously, the regulations only allowed the VA to report
separated employees. The comment period ended on December 8, 1997. We
received one comment.
The regulations, among other things, provide that VA will report
individuals to State Licensing Boards for ``substance abuse when it
affects the individual's ability to perform appropriately as a health
care provider or in the patient care environment.'' The commenter
asserted that individuals should be reported for any substance abuse
that is identified, and that any reporting should include a
recommendation that the individual be required to obtain assistance at
a substance abuse rehabilitation program.
No changes are made based on this comment. The provisions of
Section 204 of Public Law 99-166 set forth the basic authority for
reporting separated individuals to State Licensing Boards. This
Statutory authority to report separated individuals to State Licensing
Boards is limited to reporting based on a finding concerning an
individual's clinical competence. We believe the policy for reporting
should be the same for separated and currently employed individuals.
Therefore, the final rule provides for reporting only if the finding of
substance abuse reflects a finding that the clinical practice of the
individual so significantly failed to meet generally
[[Page 23665]]
accepted standards of clinical practice during VA employment as to
raise reasonable concern for the safety of patients. Even so, it would
seem that in almost every case in which substance abuse is found, we
would also be able to determine that it affects the individual's
ability to perform appropriately as a health care provider in the
patient care environment. Further, currently employed individuals who
are identified as substance abusers are always encouraged by VA to
obtain rehabilitation assistance, and there is no need to make a
special recommendation to State Licensing Boards since we are aware
that State Licensing Boards routinely provide similar encouragement.
Executive Order 12866
This rule has been reviewed by OMB under Executive Order 12866.
Regulatory Flexibility Act
The Secretary hereby certifies that this final rule will not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601-
612. The rule will affect only individuals and will not directly affect
any small entities. Therefore, pursuant to 5 U.S.C. 605(b), this rule
is exempt from the initial and final regulatory flexibility analyses
requirements of Secs. 603 and 604.
There are no applicable Catalog of Federal Domestic Assistance
program numbers.
List of Subjects in 38 CFR Part 47
Health professions.
Approved: April 22, 1998.
Togo D. West, Jr.,
Acting Secretary.
For the reasons set forth in the preamble, 38 CFR part 47 is
amended as follows:
PART 47--POLICY REGARDING REPORTING HEALTH CARE PROFESSIONALS TO
STATE LICENSING BOARDS
1. The authority citation for part 47 continues to read as follows:
Authority: Pub. L. 99-166, 99 Stat. 941; 38 U.S.C. 501.
2. The part heading for part 47 is revised to read as shown above.
3. In part 47, both subpart A and subpart B headings are removed.
4. In Sec. 47.1, paragraph (a) is removed; paragraphs (b) through
(h) are redesignated as paragraphs (a) through (g), respectively; new
paragraphs (h) and (i) are added, and the authority citation is
revised, to read as follows:
Sec. 47.1 Definitions.
* * * * *
(h) Currently employed licensed health care professional means a
licensed health care professional who is on VA rolls.
(i) On VA rolls means on VA rolls, regardless of the status of the
professional, such as full-time, part-time, contract service, fee-
basis, or without compensation.
(Authority: 38 U.S.C. 501, 7401-7405; Section 204(b) of Pub. L. 99-
166, 99 Stat. 952-953; Pub. L. 99-660, 100 Stat. 3743.)
Sec. 47.2 [Removed]
5. Section 47.2 is removed.
Sec. 47.3 [Redesignated as Sec. 47.2]
6. Section 47.3 is redesignated as Sec. 47.2.
7. The newly redesignated Sec. 47.2 is revised to read as follows:
Sec. 47.2 Reporting to State Licensing Boards.
It is the policy of VA to report to State Licensing Boards any
currently employed licensed health care professional or separated
licensed health care professional whose clinical practice during VA
employment so significantly failed to meet generally accepted standards
of clinical practice as to raise reasonable concern for the safety of
patients. The following are examples of actions that meet the criteria
for reporting:
(a) Significant deficiencies in clinical practice such as lack of
diagnostic or treatment capability; errors in transcribing,
administering or documenting medication; inability to perform clinical
procedures considered basic to the performance of one's occupation;
performing procedures not included in one's clinical privileges in
other than emergency situations;
(b) Patient neglect or abandonment;
(c) Mental health impairment sufficient to cause the individual to
behave inappropriately in the patient care environment;
(d) Physical health impairment sufficient to cause the individual
to provide unsafe patient care;
(e) Substance abuse when it affects the individual's ability to
perform appropriately as a health care provider or in the patient care
environment;
(f) Falsification of credentials;
(g) Falsification of medical records or prescriptions;
(h) Theft of drugs;
(i) Inappropriate dispensing of drugs;
(j) Unethical behavior or moral turpitude;
(k) Mental, physical, sexual, or verbal abuse of a patient
(examples of patient abuse include intentional omission of care,
willful violation of a patient's privacy, willful physical injury,
intimidation, harassment, or ridicule); and
(l) Violation of research ethics.
(Authority: 38 U.S.C. 501; 7401-7405; Section 204(b) of Pub. L.
99-166, 99 Stat. 952-953; Pub. L. 99-660, 100 Stat. 3743.)
[FR Doc. 98-11466 Filed 4-29-98; 8:45 am]
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