within one year the professional bound- aries course offered by the University of California San Diego Physician Assess- ment and Clinical Education (PACE) program; to complete within one year 12 hours of CME, including four hours in ethics and eight hours in medical record-keeping; to pass within one year the Medical Jurisprudence Examination within three attempts; to refrain from treating her immediate family; and to pay an administrative penalty of $5,000 within 60 days. Ms. Robinson says penalties for these violations vary depending on their se- verity. The board may require physi- cians to retake and pass the Medical Jurisprudence Examination, complete continuing medical education in medi- cal record-keeping, pay fines of $500 to $5,000 per incident, complete the professional boundaries course offered by the University of California San Di- ego PACE program, and/or refrain from treating immediate family. In the most egregious cases, the
board can suspend and even revoke a physician’s license. The Texas Medical Liability Trust sug- gests physicians consider the following before making the decision to treat fam- ily members, employees, or friends:
• Would treating family, friends, and staff conflict with your professional standards of care? Examples would be treating without completing a physical examination or without di- agnostic testing.
• Can you be objective when treating this person as a patient?
• Does your family, friend, or employee need specialized medical care that you cannot provide?
• The Health Insurance Portability and Accountability Act (HIPAA) privacy is- sues and protection of your medical records.
Austin attorney Michael Sharp, JD, specializes in administrative and health law and serves on TMB’s Disciplinary Stakeholder Group, which reviews and provides feedback to the board as it de- velops and revises disciplinary rules and policies. He says physicians must adhere
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to TMB medical records rules for all pa- tients, including family members and employees.
He encourages physicians to review
TMB’s rules regarding contents of medi- cal records. Chapter 165.1 says adequate medical records should document each patient encounter and include:
• The reason for the encounter and rel- evant history, physical examination findings, and prior diagnostic test results;
• An assessment, clinical impression, or diagnosis;
• A plan for care (including discharge plan if appropriate); and
• The date and legible identity of the observer.
Should physicians decide to treat em- ployees, friends, and family members, Mr. Sharp advises they outline the policy in the practice’s employee handbook.
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“Physicians can stipulate in the policy and procedure guide whether they’ll treat acute or chronic health problems for employees and family members, as well as guidelines for confidentiality of medical records,” he said.
Ethical considerations A number of medical organizations have examined the matter of physician treat- ment of family members, friends, and employees.
The TMA Board of Councilors opin- ion includes a note informing physicians that the legal requirements for treat- ment of family members and friends and for keeping medical records exceed the Board of Councilors’ ethics opinion. Physicians should consult TMB rule 190.8(1)(M),
http://bit.ly/r1WnuE, for more information. They also should talk to their attorney for legal advice on the matter.
Jesse Moss Jr., MD, chair of the Board
For more information, contact The Schlameus Team at Colliers International. (713) 222-2111 or
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October 2011 TEXAS MEDICINE 35 6/9/11 1:29 PM
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