Analysis

TOPIC: Health; occupations; background checks for health professionals seeking reciprocal licensing in Michigan; revise procedure.
SPONSOR: Senator Conroy
COMMITTEE: Health Policy and Senior Citizens

POSITION: The Department of Consumer & Industry Services supports the bill.

PROBLEM/BACKGROUND: Section 16221(b)(x) of the Public Health Code provides that a final adverse administrative action by a licensure, registration, disciplinary or certification board of another state or territory of the Unites States is sufficient grounds for the Department to investigate and take disciplinary action. The Code does not currently allow disciplinary action to be taken based solely on final adverse action taken by the United States Government, the United States military, or another country, and investigation into the underlying facts of a case may be prohibitively costly.

DESCRIPTION OF BILL: SB 700 provides wording consistent with other sections of the Code relating to licensure or registration from another state, country, the US military or federal government; it provides for a signed release by a licensee or registrant licensed or registered in another country or state to enable the Department to obtain information regarding a disciplinary investigation conducted by a state, country, the government or the military; and strikes the requirement that sanctions imposed by another jurisdiction must still be in force for disciplinary action in Michigan to be implemented.

SUMMARY OF ARGUMENTS:
PRO: SB 700 would allow more efficient processing of formal actions taken by other jurisdictions and clarify that final actions taken by another country require only a certified copy of the disciplinary action as conclusive evidence of the final action. The bill will also broaden the ability of the Department to proceed in cases where the sanctions from another jurisdiction are no longer in place.

CON: The provision requiring a licensee to sign a waiver authorizing release of a disciplinary investigation involving the applicant or licensee may be of limited value in that many jurisdictions have statutes protecting investigatory action prior to, or if no formal administrative complaint is filed.

SUPPORTERS/OPPONENTS: No information is available at this time.

FISCAL INFORMATION: The total estimated cost for implementing the changes set forth in SB 700 is approximately $72,504.60. The breakdown is as follows:

To implement the waiver provision of the bill, new applications containing the waiver will need to be printed. Because virtually all colleges having health professional training programs, as well as various associations, have copies of licensing applications to distribute, it is anticipated that there will be a period of time where old applications, minus the waiver language will be received. A new application, including the waiver, will have to be returned to the applicant for signature.

Estimated cost of implementing a change on all application forms for all health professionals 18,000 applications received per year x 60% of applications to be returned for new application to be completed 10,800, each taking approximately 20 minutes to review, get new application, print envelope and letter of explanation, receive new application in mail, re-review application and refile.

Staff hourly rate of $14.86 X 3,600 hrs = $53,496
Postage = $3,456
TOTAL = $56,952

Revision of Application
Forms/Reprint application packets = $15,552.60
GRAND TOTAL = $72,504.60

ECONOMIC IMPACT: The cost of implementing the application changes may be offset by a reduction in cost to investigate allegations and potential disciplinary action.

ADMINISTRATIVE RULES IMPACT: None.

APPROVED:

During the past three years, the Office of Health Services has dealt with several physicians who have been licensed in Michigan, but who have been disciplined either by another country, or by the federal government. The absence of a provision allowing the department to utilize final adverse action by the government or military, or to utilize a final adverse action of another country has severely complicated pursuing disciplinary action against the licensee's Michigan license to practice medicine. The most prominent cases include the following.

Through the Army's Quality Assurance Committee, Dr A.'s staff privileges were limited following disciplinary proceedings at a military hospital in Italy. The final action was reported to the department and additional information was requested from the Army which originally indicated assistance would be provided to the department. Medical records were never provided, but on the basis of specific findings and conclusions of the peer review panel, an expert witness concluded that violations of the Public Health Code could be established. Ultimately, this physician's license was suspended, 22 months after the initial report was received. Had the department been able to proceed on the basis of the action taken by the Army, the case could have been closed much sooner.

Case 2

In April 1996, the department received information from the Department of Navy indicating that they had revoked Dr. B's clinical privileges due to impairment by alcohol abuse, lack of professional judgement and lack of current medical knowledge and expertise. The department did file an administrative complaint citing a final adverse action and a failure to report that action. When the department was unable to reach a settlement with the licensee, the file was transferred to the Department of Attorney General. At that time the Health Professionals Division informed the department that a US military action was not sufficient to establish a violation of the Code. Despite the concern, ultimately, disciplinary action was imposed on the licensee pursuant to a Consent Order and Stipulation.

Information was received by the department that a physician had been disciplined in Canada, although an appeal was pending. Due to the appeal, final documents were not available. We did however, have a copy of a court opinion and order from the Canadian judicial system referencing a suspension of hospital privileges. Based on that information, we reviewed the physician's application for licensure, determined that he had falsified his application by stating that he had never been censured, requested to withdraw from a health care facility staff or had privileges involuntarily modified. Disciplinary action was imposed based on the falsification of his application.

Case 4

Dr. D was licensed in Michigan, but in 1980, his license expired. The physician subsequently moved to Canada, and while there accrued several malpractice actions against him. The physician then moved to South Dakota, and then to Michigan where he again applied for licensure in 1993. In 1993, there was no disciplinary action yet pending against the physician and a Michigan license was issued. Following the issuance of a license in Michigan, Dr. D's Canadian license was disciplined. The physician had not lied on his application, the current provisions of the Code do not reference final action from another country, and the department was unable to obtain information from Canada, absent a signed release from the physician, which, although requested, was never received.