Category Archives: Professional Licensing Cases

On September 19, 2018, our former California Governor Brown approved Senate Bill No. 1448 into law. It is effective July 1, 2019.

Under the current laws, the Medical Board of California issues licenses to, as well as regulates and imposes discipline upon physicians and surgeons. Similarly, there is the Osteopathic Medical Board of California, State Board of Chiropractic Examiners,  Naturopathic Medicine Committee, Acupuncture Board, and the State Board of Chiropractic Examiners that also perform the same functions for their respective applicants and licensees.

Beginning July 1, 2019, and pursuant to Business and Professions Code Section 2228.1 et sec., each of the above professional licensees are required to disclose to each patient, their guardian or health care surrogate, before their first visit if they have been placed on probation on or after July 1, 2019, involving four(4) categories of misconduct, as follows:  criminal conviction involving harm to patients; sexual abuse, misconduct, or relations with a patient; drug or alcohol abuse causing harm to a patient or when such use impairs the ability to practice safely; and inappropriate prescribing that results in patient harm and having been placed on probation for five or more years

The disclosure must set forth the following: (1) the licensee’s probation status; (2) the length of time of the probation; (3) the end date of the probation; (4) all of the practice restrictions or limitations placed on the licensee by the State Agency;  (5) the Agency’s telephone number; and, set forth (6) how the patient can find further information regarding the probation on the Internet Web site

In addition, the respective licensees must obtain from each of their patients, or the patient’s guardian or health care surrogate, a separate and signed copy of the disclosure.

There are some exceptions, such as a situation in which a patient was not known to the doctor until immediately prior to the start of the visit, their guardian or health care surrogate, is unavailable, unconscious or unable to comprehend and sign the disclosure; the visit is unscheduled; occurs in an emergency room; an urgent care facility; and includes consultations in inpatient facilities.

This landmark new law commonly referred to the “Patient’s Right to Know Act” is the first in the nation to require doctors to tell their patients if they are on probation. It provides an additional means by which a patient can learn of their physician’s disciplinary record, if any.

Effective January 1, 2019, Business and Professions Code Section 740 became new California law (Assembly Bill  2760 was signed by then Governor Brown on September 10, 2018) requiring those who prescribe medication to be more vigilant of patients who have an increased risk of substance abuse.

A prescriber is now required to provide education to a patient for overdose prevention, as well as the use of Naloxone Hydrochloride (commonly referred to as Narcan, which is available in generic form, is an opioid antagonist used for the reversal of opioid overdose, including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose) or a comparable drug approved by the United States Food and Drug Administration [FDA].

Business & Professions Code section 740 specifies the applicable criteria as the following:

1. the prescription dosage for a patient is 90 or more morphine milligram equivalents of an opioid medication per day; and/or
2. an opioid medication is prescribed concurrently with a prescription for benzodiazepine; and/or
3. a patient has the indications of an increased risk for overdose.

Section 741(a)(1)(C) offers the following examples that indicate an” increased risk of overdose,” including but not limited to:

1. a patient with a history of overdose;
2. a patient with a history of substance use disorder; or
3. a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant

Business & Professions Code section 742 states that a prescriber who fails to abide by the prescription or education requirements shall be referred to the appropriate state licensing board for the disciplinary action. Notably, the focus of Spital and Associates is on representing those who have a professional license in California, whether in the investigative stage or written and published Accusation, such as one filed by the Medical Board of California.

All opiates come from the poppy plant. Opioids have a similar effect to an opiate, but are often synthetic or partially synthetic. Both opiates and opioids are classified by the U.S. Drug Enforcement Agency as Schedule II drugs, which are considered acceptable for certain medical purposes, such as for relief of pain, but are deemed highly addictive, including Dilaudid (hydromorphone), Demerol (meperidine), Dolophine (methadone), Duragesic or Sublimaze (fentanyl), morphine, opium, OxyContin and Percocet (oxycodone), Vicodin and other medications with hydrocodone, and various drugs with Codeine. On the other hand, Heroin, LSD, marijuana (cannabis) and Ecstasy are Schedule I drugs, and these are considered the most dangerous and have no acceptable medical or safe use.

There is no question but that acute and chronic pain are debilitating medical conditions. Approximately two (2) million individuals in the United States suffer from SUBSTANCE USE disorders related to prescription opioid pain relievers. It is noteworthy that prescription drugs are the “second” most commonly abused substances, alcohol being number one. The number of deaths from opioid pain relievers that have been prescribed by physicians represent more than the number of overdose deaths involving heroin or cocaine.

Some individuals are predisposed to develop problems as a result of using drugs because they have lower levels of self-control. Notwithstanding the above, there are others who become addicted because of one or more set of personality behaviors when utilizing certain narcotics, even though lawfully prescribed by a physician.  It is hoped the mandate set forth above and a new law in California will result in a substantial decline in deaths and, of course, it will increase the nature and scope of effective and alternative modalities for pain management.