State Board of Medical Examiners

Welcome to the Online Orientation for newly licensed medical practitioners. We are making this material available in this format so you don't have to schedule yourself to sit in a five hour orientation session, and can complete this at your convenience. You will need to devote approximately one hour to reviewing the material and one hour to answering the questions. You must complete the Questions Section and submit your answers in one sitting; if you can't, you will need to start over and answer the questions again. The Board office's licensee database will be updated once you complete the Orientation Questions, and you will also be able to print out a dated confirmation when you are finished. The material presented provides an overview of the New Jersey Board of Medical Examiners (BME), highlighting significant issues, laws and regulations. There are links provided so you may read relevant laws and regulations, or to provide you with access to more information on a topic. When you click on a link, don't close this window. Simply click on the link, and then close the link's window when you have finished viewing it. The BME's award winning website is also a great source for current information related to the practice of medicine in New Jersey, and contains all of the contact information you may need to communicate with BME staff. We encourage your questions and input, and look forward to hearing from you.

Introduction to the Board

New Jersey Board Of Medical Examiners Responsibilities

The paramount responsibility of the BME is the protection of the public's health, safety, and welfare. The Board meets its responsibility by licensing medical professionals, adopting regulations, determining standards of practice, investigating allegations of physician misconduct, and disciplining those who do not adhere to requirements - thereby assuring the public that the physicians are qualified, competent, and honest. In addition to physicians, the Board is responsible for the oversight of a number of allied health care providers.

History

Since the late 1800's, a license has been required to practice medicine in New Jersey. The Board, pursuant to the Medical Practice Act of 1894, was authorized to regulate the practice of medicine and surgery, including regulation of chiropractic. Today the State Board of Medical Examiners consists of 21 gubernatorial appointees: 12 physicians, at least two (2) of whom must be osteopathic physicians; three (3) public members; one (1) Commissioner of Health or his/her designee; one (1) executive department designee; one (1) podiatrist; one (1) physician assistant; one (1) bio-analytical laboratory director, who may or may not be an M.D.; and one (1) certified nurse midwife. (N.J.S.A. 45:9-1). Over the past 30 years, the role of the Board has been expanded to involve greater licensing responsibility for numerous and varied allied health care providers, and in some instances professions once subject to Board jurisdiction have been removed from the ambit of Board responsibility. At present, in addition to its responsibility to license and discipline physicians, the Medical Board is responsible for overseeing other allied health care providers as well. While the Board has the responsibility for oversight, administrative tasks relating to some license categories are presently being handled by staff in the Newark office (The BME and other Boards and Committees which oversee many professions and occupations in New Jersey fall under the oversight of the Division of Consumer Affairs, headquartered in Newark).

In recent years legislative emphasis has pointed to the recognition that only through more and better information will the public be appropriately safeguarded. A number of issues affecting public protection and discipline have appeared in legislative pronouncements. In 1983, legislation to improve reporting to the BME was passed. One law required health care facilities to notify the Board of any disciplinary proceeding or action resulting in suspension of privileges or removal or suspension from medical staff. Another encouraged voluntary reports of practitioner misconduct to the Board by providing immunity for good faith reports and assuring confidentiality of any information concerning physician conduct provided to the Board pending the results of an inquiry. Both provisions were strengthened in 1989, upon the passage of the Professional Medical Conduct Reform Act of 1989. In addition that legislation called for expanded identification of problem professionals, creation of a full time Medical Director, registration of medical residents in training and practicing in New Jersey prior to licensure, increased licensee information reporting at initial licensure and renewal, authority to require reeducation, and monitoring of probation and disciplinary restrictions. One of the most fundamental changes effected by the Act was in the area of malpractice and hospital adverse action reporting. The legislation created a new recommendatory body, denominated the Medical Practitioner Review Panel ("Panel"), intended to enhance the Board's ability to expeditiously react to reports of malpractice and adverse privilege actions taken by hospitals. The Panel consists of eight members appointed by the Governor - four physicians, three public members, one hospital administrator - and one of the members of the Board appointed by the BME President who is to serve in an ex officio capacity. (N.J.S.A. 45:9-19.8) The Panel receives notices of hospital or HMO discipline and notices of medical malpractice settlements or judgments.

Other legislative changes included a shift from voluntary reporting of licensee incompetence or impairment presenting imminent danger to the public to mandatory reporting by colleagues. Failure to report was made subject to disciplinary action. Existing confidentiality protections were strengthened to provide that information resulting in no action remains confidential. In addition, a full time Medical Director was authorized to review medical malpractice reports and complaints of impairment or incompetence and to assist the Panel. Immunity was provided for good faith actions taken by the BME or Panel. The law required the Board to provide for registration and permits, and for the scope of practice of practitioners in training. It also required the Board to notify all licensed facilities and associated licensees of formal disciplinary actions taken.

Through other legislative initiatives, since 1990, the BME has been required to notify pharmacists of physicians who are not permitted to prescribe controlled substances. (P.L. 1991, c. 304, N.J.S.A. 45:9-16) In the mid 1990's, the Board was given responsibility to enforce two additional mandates. It must ensure that physicians carry mandatory malpractice insurance, (P.L. 1997, c. 365, N.J.S.A. 45:9-19.7) and report out-of-state actions against their medical licenses. (P.L. 1995, c. 69, N.J.S.A. 45:9-19.16) In 2002, the Legislature increased required medical training from one year of post-graduate training to two, called for future hiring to provide for an Education Director to serve as liaison to focused reeducation programs, required continuing medical education, and authorized the Panel and the BME to refer practitioners to focused reeducation. (P.L. 2 001, c. 307). In 2003, the Board was charged (P.L. 2003, c. 96, N.J.S.A. 45:9-22.21) with the duty to implement the Web-based New Jersey Health Care Profile. You've probably already received notification about updating your Profile. If you haven't done so already, please go to the site as soon as you can. Many consumers use the site to check out their physicians and locate specialists in one or another field of medicine.

Each reform has served a laudatory purpose and better enabled the Board to achieve its paramount role of protecting the public. They enable the public's expectations of quality medical care in New Jersey. And they arm the Board in their responsibility for investigating and taking action against those who fail to maintain New Jersey's high standards of medical care delivery, or those who break laws and ignore regulations governing licensure.

Board And Board Committee Meetings

The full New Jersey Board of Medical Examiners has monthly meetings, which are scheduled a year in advance, with the dates posted on our meetings page.

Board meetings are held in two parts. One is open to the public, and includes:

Closed sessions, attended by Board members only, are held when matters need to be discussed privately, such as:

• Closed disciplinary actions (sister-state-actions)
• Closed committee minutes

Additionally, there are multiple committee meetings scheduled each month, as follows:

• Credentials Committee (monthly)
  • Reviews credentials and qualifications of license and permit applicants
  • Questions applicants under oath as necessary to clarify qualifications
  • Makes licensing recommendations to full NJBME
    


• Executive (monthly)
  • Policy, regulations, legislation
    


• Screening (3 meetings per month)
  • Reviews incoming complaints
    


• Priority Review Committee (monthly)
  • Review and prioritize investigations
    


• Preliminary Evaluation Committee (4 meetings per month)
  • Investigate in confidential session
  • Hear testimony under oath as necessary
  • Make recommendations to NJBME regarding disposition of matters heard. Recommendations may range from "No cause for action" to "Disciplinary action recommended"
    


• Impairment Review Committee(Consists of 2 BME Members,  2 PHP Representatives,  1 Member designated by the Commissioner of the NJ Department of Health and Senior Services (NJDHSS),  Executive Director and Medical Director of the BME participate but have no vote.)
  • Evaluates cases and issues related to licensee impairment such as drug/alcohol dependency, psychiatric or physical disability
  • Makes recommendations to full NJBME on impaired licensee eligibility for Alternative Resolution Program (ARP)
    


• Medical Practitioner Review Panel (one meeting per month)


• Panel Screening (monthly)

Housekeeping

The BME has approximately 50 full time employees, and is located in the State Capital, Trenton. Legal support services are provided by the Division of Law under the Attorney General. Funding for Board activities comes from license fees, fines and penalties. The BME website has all of the mailing and telephone contact information you might need. The Board's Document Management Unit processes about 50,000 pieces of mail and scans close to 300,000 license and discipline related documents each year. The Call Center handles approximately 65,000 callers each year, sharing their information and knowledge with consumers and licensees alike. Permit and License application reviewers prepare and review credentials for nearly 2500 applicants each year, issuing close to 1700 plenary licenses and 800 training permits.

There are different statuses for plenary licenses: Active, Reduced-fee Active, Inactive, and Retired. Reduced-fee Active licensees must be at least 65 years of age and hold no HMO or hospital affiliations, but may actively practice medicine and prescribe. Inactive and Retired licensees pay no renewal fee and cannot practice medicine or prescribe.

Licenses are renewed every two years, on odd years. It's very important that you notify the Board office via the website, or by fax when you change your mailing address as renewal notifications are not forwarded by the Post Office. The notification will give you information about renewing your license on line, paying with a credit card, or the process to follow if you would rather renew with a paper form. The notification is mailed 3-4 months before your license expires. You may renew for thirty days after your license expires and pay a "late" fee of $100. Thirty one days after your license expires it will be automatically placed in Suspended status without further notice to you. If you don't intend to practice in New Jersey, you should renew via the license renewal website to Inactive status. Otherwise, once your license is placed in Suspended status, you will have to reinstate your license to Active status, even if you intend to place it in Inactive status. This is a more expensive and lengthier process than reinstating from Inactive status. (To reinstate from Expired status, licensees pay the $175 reinstatement fee, $100 late fee, and full renewal fees for all renewal cycles in which your license was in Expired status. To reinstate from Inactive status you will pay the $175 reinstatement fee and the full renewal fee for the current renewal cycle.)

If you have completed an accredited graduate medical education program within 12 months prior to licensure, you are exempt from CME requirements for the initial biennial renewal cycle except that within 24 months of initial licensure you must take this Orientation course. After the first renewal cycle though, in order to renew your license, you must attest to having earned the CME credits required each renewal cycle. 100 hours are required every two years, 40 of which must be in Category I, and 60 in Category I or II. You may carry 25 hours and apply them to the next renewal cycle. American Medical Association Physician Recognition Award CME definitions are used to determine whether credits earned are acceptable, as well as those of the American Osteopathic Association and the Council on Podiatric Medicine. Random audits are used to evaluate compliance with CME regulations once the renewal is complete. You will be asked to provide transcripts and certificates as evidence of participation. You are responsible for maintaining verifiable evidence of participation for six years following completion of CME activities. Unverified CME Tracker services are not accepted as documentation - verified Transcripts and Certificates of Participation are accepted. Descriptions of Category I and Category II eligible activities can be found in the AMA Physician Recognition Award (PRA) Information Booklet.

Waivers or extensions may be granted for hardship reasons, and require supporting documentation. You must apply within 60 days of the end of the renewal cycle by certified mail. If a waiver or extension is granted, it applies only to the renewal cycle for which it was granted; you must reapply each cycle.

Cultural Competency training is also required for licensees who graduated medical school prior to 2009. Audits are performed to insure compliance.

Once granted certification to perform in-office sedation, and dependent upon the type of certification issued, you will be required to earn CME specific to the type of certification. For Office based general anesthesia, 60 hours of Category I CME in anesthesia every three years are required. For office based conscious sedation and regional anesthesia, 8 hours of Category I CME in anesthesia must be earned every three years.

Avoiding the Attention of the Board and the Possibility of Disciplinary Action

Remember why you became a physician? A high IQ, medical education or advanced degrees aren't an inoculation against greed, foolish behavior or impairment. Avoid arrogance and you may avoid trouble.

How do you view your patients? As people in need of your help, or as a way to make money, a partner in an unlawful plot, or an object of desire?

What do you do when no one is watching? The Board can't police your every activity, but if you get in the habit of cutting ethical corners because you think no one is watching, your bad acts may compound until you are caught. Nobody became a physician to obtain drugs, sexual partners or simply to make money. Keep in mind the reasons you became a physician and the temptation to misuse your license will be diminished.

Many consumer complaints about physicians are based on poor communication. When a patient feels that he/she is not important to their physician, the patient begins to question the quality of care they are receiving. When patients perceive that their doctor is uncaring and thus giving inadequate care, they are more likely to complain to the Board. Some of the complaints the Board receives involve physicians who are rushed, annoyed, allow staff to behave rudely towards patients, keep patients with appointments waiting too long, complain to their patients, exhibit a lack of self awareness regarding personal biases, don't speak in a language the patient understands, aren't truthful about fees, don't return phone calls, and don't follow up on test results, to name a few. To avoid having to respond to these types of complaints, practice your best communication skills with every patient. Exhibit a respectful, caring attitude, listen actively, obtain the services of an interpreter if necessary. Follow up promptly on test results and consultations, especially after your patient is discharged from the hospital. Be clear about fees, charges for missed appointments, interest on late payments, and collection policies. And make sure your office staff know what you expect of them, and how you would like your patients treated by them. In return you will likely see better compliance and outcomes from your patients. They will trust you, make fewer complaints to the Board and you'll have a decreased risk of lawsuits - a win-win for all.

Activities Which Will Generate an Invitation to attend a Board Committee Meeting

Licensees are required to cooperate in BME investigations and to obey BME orders. The following are examples of situations which may be deemed professional misconduct and provide grounds for discipline.

Failure to timely respond, answer questions, provide information or documents, attend proceedings or provide access to premises. For example, in WC v. Robins and the New Jersey State Board of Medical Examiners - It was found that a licensee who fails to cooperate during an investigation by preventing an inspection of her medical office may be disciplined, even if she was acting on the erroneous advice of her attorney.

A licensee has a duty to cooperate with the BME and can not avoid that duty by claiming a physician/patient or psychologist/ patient confidentiality privilege, or HIPAA privacy provisions.

A licensee must also cooperate with the Boards' Investigative Powers - Investigative powers of the Board of Medical Examiners, the Attorney General and the Director of the Division of Consumer Affairs (N.J.S.A. 45:1-18) include:

• Inspection of premise from which a practice is conducted.
• Review of records, books or documents prepared or maintained in the course of practice.
• Review of goods or items used to practice.
• Issuance of administrative subpoenas to compel attendance at investigative hearings or production of records.
• Demands for statements in writing under oath as to facts and circumstances concerning rendering of professional services.
• Impoundment of evidence pursuant to a court order.
• Compelling skills assessment to determine if licensees can practice with reasonable skill and safety.

Grounds For Discipline Of Licensees Under N.J.S.A. 45:1-21

• Obtaining a license through fraud, deception, or misrepresentation.
• Failure to notify the Board of an action against your license in another state.
• Omission of a criminal conviction on an application form.
• Failure to renew your license in a timely manner can result in the suspension of your license without a hearing.
• Failure to maintain malpractice insurance in the minimum amount of $1,000,000 per occurrence and $3,000,000 per policy year.
• Use or employment of dishonesty, fraud, deception, misrepresentation, false promise or false pretense.
• Gross negligence, gross malpractice or gross incompetence which damaged or endangered the life, health, welfare, safety or property of another person.
• Repeated acts of simple negligence, malpractice, or incompetence.
• Alteration of medical records, including late additions without proper identification and dating.
• Professional or occupational misconduct as may be determined by the Board.
• Conviction of, or engaging in, acts constituting crimes of moral turpitude or crimes relating adversely to the practice of medicine.
• Disciplinary action against a license issued by another state, agency or authority.
• Failure to comply with any act or regulation administered by the board.
• Incapability of discharging the functions of a licensee consistent with the public health, safety or welfare.
• Failure to submit applications and comply with regulations of the Department of Environmental Protection (DEP) and/or the Department of Health and Senior Services (DHSS). It is the physician's responsibility to insure that the practice of medicine is conducted in a safe and sanitary fashion. DHSS performs overt and covert inspections, and licenses certain practice sites in NJ. Infection Control measures are regulated by DEP, as are some types of medical equipment. They also enforce OSHA requirements and hazardous waste disposal.
• Violation of the Insurance Fraud Prevention Act as found in a civil or administrative proceeding.
• Presently engaged in drug or alcohol use likely to impair the ability to practice with reasonable skill and safety. (Presently means "at this time" or any time within the previous 365 days).
• Indiscriminate prescribing or dispensing of controlled dangerous substances.
• Aiding, abetting or permitting unlicensed practice.
• Fraudulent advertising.

Statutes and Regulations Related to the
Practice of Medicine in the State of New Jersey

The New Jersey State Board of Medical Examiners regulates its licensees through enforcement of statutes enacted by the legislature and regulations. The statutes and regulations governing medical practice in New Jersey are located on the Medical Board website

Statutes regarding Professions and Occupations which apply to a variety of professional boards including Medicine and Podiatry are found at N.J.S.A. 45:1-1 et. seq. Statutes pertaining to Medicine and Surgery are at N.J.S.A. 45:9-1 et. seq.

Regulations are promulgated by the BME (rulemaking) and govern a variety of areas including training of physicians, licensing standards, exemptions from licensure requirements, surgery, anesthesia and special procedure services in an office setting, eye examinations, dispensing of drugs, and general rules of practice. The latter category of rules governs such diverse areas as sexual misconduct, excessive fees, pronouncement of death, patient records, advertising, termination of patient relationships, professional practice structure, prohibition of kickbacks and professional fees and investments. These regulations can be found at N.J.A.C. 13:35-1.1 et. seq.

Licensees and other members of the public may petition the BME for rulemaking.

Confidentiality of Investigations- Investigations of the Board of Medical Examiners are confidential with certain limited exceptions N.J.S.A. 45:1-36.

Colleague Reporting -
A NJ licensee is required to report another practitioner who demonstrates an impairment or activities of a colleague that pose a clear and imminent danger to public health and welfare (N.J.S.A. 45:1-37). Examples of the type of misconduct which you are required to report are gross negligence, indiscriminate prescribing, actions which pose an imminent danger to the public health safety and welfare.

• Under N.J.A.C. 13:35-4A.5, you are required to report an office surgery/special procedure/anesthesia resulting in death/transport to a hospital for observation or treatment within 24 hours or other complications.
• The reporting physician is not liable for damages unless he "knowingly reported false information". Failure to make a report may subject you to disciplinary action and civil penalties.

You Also Have A Personal Duty To Report -
There is a 10-30 day reporting window, after which failure to report may be deemed professional misconduct. Arrests and convictions, action by health care facilities against your privileges, disciplinary actions by other State licensing authorities, adverse actions taken by the NJ Department of Health and Senior Services, or any Federal health or insurance program, medical malpractice changes, or actions taken by a malpractice insurance carrier, a change in office location or mailing address, financial or other interest in a health care facility are some of the reportable issues. You must also report any newly developed medical conditions, including the use of chemical substances which impair or limit your ability to practice with reasonable skill and safety, including hospitalizations, supervised rehabilitation, a leave of absence from hospital or health care organizations relating to such medical conditions (the information will be confidentially maintained by the NJ BME).

Report To Patient -
You have a duty to report abnormal findings suggesting a potentially serious medical condition determined during a physical exam for employment or insurance where contractually the results of the exam would not be ordinarily shared with the patient.

Report to the Department Of Health And Senior Services -

• Communicable Diseases and HIV
• Patient with infectious venereal disease who fails to cooperate with treatment
  Communicable Disease Service - (609) 826-4894
  

The HIV/AIDS regulations below can be found online. LexisNexis provides free public access to the New Jersey Administrative Code and the New Jersey Register at http://lexisnexis.com/. Up-to-date information on all DHSS proposed and adopted rules, orders, notices and extensions is available on that Department's Rules page.

• N.J.A.C. 8:61 - School attendance by persons with HIV; AIDS Drug Distribution Program; Counseling and Testing of Pregnant Women for HIV; Disclosure of Children's HIV/AIDS Status.
• N.J.A.C.8:44-3 - State Sanitary Code, Limited Purpose Laboratory -- Rapid HIV testing at Department-funded counseling and testing sites.
• N.J.A.C. 8:57-2 - Reporting Requirements for HIV/AIDS
  

Report To Adult Protective Services (APS) -
You are required to report suspected abuse, exploitation, or neglect of a vulnerable adult living in the community to your County APS provider. You may report abuse to (800)792-8820 or call 211 to find the contact information for your county APS provider. For more information call Adult Protective Services, DHSS at 609-341-5467

Report Animal Bites -
to the local health department where the bite victim resides within 24 hours of identifying the bite. If the patient residence is unknown, bites shall be reported to the local health where the health care provider is located.

A directory of local New Jersey Health Departments is posted on the New Jersey Office of Local Public Health Licensure, Compliance, and Enforcement Program website (http://www.state.nj.us/health/lh/community/index.shtml#1).

If the bite victim does not live in New Jersey, the case shall be reported to the New Jersey Department of Health by calling (609) 826-5964 or 4872.

Report Cerebral Palsy Cases -
The New Jersey Birth Defects and Autism Reporting System is also known as the Special Child Health Services Registry. Information on electronic registration is available at (609)292-5676

• The form (SCH-0) to be used for reporting is available here.

Reporting Hearing Impaired Or Deaf Child Under 21 Years Of Age -
NOTE 1: Newborn Hearing is reportable THROUGH 21 years of age.
From Newborn Hearing RULES (N.J.A.C.8:19-1):

• 8:19-1.11 Documenting and reporting a diagnosed hearing loss
  (a) When a permanent hearing loss is confirmed, the forms identified in 1 and 2 below shall be completed and submitted to the Department as soon as possible after diagnosis:
  1. For children from birth to 36 months of age, a Newborn Hearing Follow-up Report form and a Special Child Health Services Registration form shall be completed and submitted to the Department as soon as possible after diagnosis. The Special Child Health Services Registration form shall include specification, in the "diagnosis" section of the form, of the type and degree of hearing loss, the affected ear(s), and, if applicable and known, the syndrome related to the child's hearing loss.
  2. For children from birth through 21 years of age, a Special Child Health Services Registration form shall be completed and submitted to the Department as soon as possible after diagnosis, which shall include specification, in the "diagnosis" section of the form, of the type and degree of hearing loss, the affected ear(s), and, if applicable and known, the syndrome related to the child's hearing loss.
     
• forms (SCH-0, SCH-2, SCHS-3) are available here.
  - For initial reporting and hearing screening follow-up reporting through the New Jersey Immunization Information System, call (609) 292-5676

Report to the Director, Motor Vehicle Commission-
Within 24 hours of determination, any person 16 years of age or older who despite medical treatments exhibits persistent or recurrent convulsive seizures, recurrent periods of unconsciousness, impairment or loss of motor coordination due to conditions such as, but not limited to, epilepsy in any of its forms.

Report to the Department Of Children And Families -
In New Jersey, any person having reasonable cause to believe that a child has been subjected to abuse or acts of abuse should immediately report this information to the State Central Registry (SCR). If the child is in immediate danger, call 911 as well as 1-877 NJ ABUSE. A concerned caller does not need proof to report an allegation of child abuse and can make the report anonymously. Any person who, in good faith, makes a report of child abuse or neglect or testifies in a child abuse hearing resulting from such a report is immune from any criminal or civil liability as a result of such action. Calls can be placed to the hotline anonymously.

• Any person who knowingly fails to report suspected abuse or neglect according to the law or to comply with the provisions of the law is a disorderly person and subject to a fine of up to $1000 or up to six months imprisonment, or both.

Report to the Director of the Division Of Consumer Affairs  -
any toy related death or injury

Surgery, Special Procedures and Anesthesia in an Office Setting

There are minimum standards for Office based surgical and anesthesia services, including specific anesthesia CME every three years for office based anesthesia services. You must be credentialed for surgical/special procedure and anesthetic administration by a hospital or may apply to the BME for Alternative Privilege credentialing.

Minor Surgery: Safely and comfortably performed with local or topical anesthesia, minimal pre-op medication or intra-operative tranquilization and where likelihood of complications requiring hospitalization is remote. (E.g. excision moles, warts, cysts, repair simple lacerations, I & D, arthrocenteses, proctoscopies, paracenteses, non-invasive laser with topical anesthesia.)

Surgery: Manual or operative procedure performed upon the body for preserving health, diagnosing or treating disease, repairing injury, correcting deformity, defects, prolonging life or relieving suffering. Includes but not limited to, incision or curettage of tissue or organ, suture or other repair of tissue or organ, closed or open reduction of a fracture or extraction of tissue from uterus.

Minimum standards listed in the New Jersey Statutes for Office based surgical and anesthesia services lists equipment, training, CME, ACLS certification, etc. Please refer to the following for specifics:

• (N.J.A.C. 13:35-4A.6) MD, DO DPM performing surgery and special procedures in an office; Pre-procedure counseling, records, recovery and discharge.
• (N.J.A.C. 13:35-4A.7) MD,DO, DPM administering or supervising administration of office anesthesia; Pre-anesthesia counseling, monitoring, recovery records and discharge. Specific Anesthesia CME every 3 years for office based anesthetic services: General - 60 Category I, Regional - 8 Category I, Conscious Sedation - 8 Category I or II.

BME Alternative Privilege Credentialing

• Recommendations are required attesting to competence, including personal knowledge of your practice in the 2 years prior to application for alternative privileges
• If training for anesthesia or surgical/special procedures was in residency, an application for alternative privileges will be considered within 2 years of graduating from your residency program, using residency training letters of recommendation and case lists
• 2 years of redacted patient log information must be submitted with application - including complications log
• alternative privileging is renewable every 2 years

Medications:

Prescriptions must be on New Jersey Prescription Blanks (NJPBs) and include full identification of the practitioner, including National Provider Identifier number if you're required to have one. Prescription blanks must also be sequentially numbered. Adequate notice must be given, by a sign in the office or a pamphlet, advising each patient that they may request a generic substitution for any brand name drug prescribed. For Schedule II CDS, the number of doses indicated by written word must be followed by the written numeral. Each CDS must be written on a separate NJPB.

Examination of a patient's condition is required prior to dispensing drugs or issuing a prescription except in the following situations when based upon sound medical judgement:

• Admission orders for newly hospitalized patient
• If on-call for established patient of another physician
• Continuation of meds, short term, for new patient prior to first visit
• For an established patient believed not to require an exam before a new prescription
• For a collaborative practice partner
• Treatment of emergency medical condition requiring urgent treatment to avoid serious dysfunction or impairment

Under N.J.A.C. 13:35-7et.seq. significant regulations apply to the following special situations:

• In office dispensing
• Controlled Dangerous Substances
• Pain Management
• CDS for Detoxification
• Amphetamines and sympathomimetic amines
• Anabolic Steroids
• Treatment of obesity

Responsibility for the Care and Treatment Environment (N.J.A.C. 13:35)

You are responsible to insure that the practice of medicine is conducted in a safe and sanitary fashion, that equipment on site is adequate for it's use and is maintained, that infection control measures are followed, OSHA requirements are met, and proper hazardous waste disposal procedures are followed. Overt and covert inspections are conducted. In certain situations, site licensing by the Department of Health and Senior Services is required.

Good Samaritan Act (N.J.S.A. 2A:62A-1)

Immunized from civil liability - Any Good Samaritan rendering care (in good faith and without thought of consideration) at the scene of an accident or emergency or while transporting the victim for further treatment; in a health care facility if your actual duty, including on call duty, doesn't require a response to a patient emergency situation. Immunity is granted from liability for failure to inform when emergent situation necessitates action in absence of the ability to properly inform the patient or an authorized representative. Not immune from liability are acts or omissions by you in such situations which are determined to involve gross negligence, recklessness or willful misconduct.

The Complaint And Discipline Process

The Board receives approximately 75-100 complaints per month from sources like: consumers, other governmental agencies, law enforcement agencies, court officials, insurance fraud investigators. They also receive adverse action reports from agencies with a mandate to report such actions like medical malpractice insurers and health care facilities.

Each and every one is investigated.

The nature of the allegations dictates the type and the depth of the investigation. Consumer complaints run the gamut from "Doctor kept me waiting too long", to "he overdosed my father", to "she removed the wrong lung".

In most cases the Board asks for the Doctor's response to the complaint to be considered in the investigation. Please provide a timely response - your reply and explanation must reach the Board office within 21 days. Failure to respond in a timely fashion may result in you being directed to appear before a Committee of the Board for Failure to Cooperate.

When the Board determines that a complaint has merit, the Formal Discipline process begins. New Jersey's Attorney General is the sole legal representative of the Board, and the Attorney General's Office prosecutes formal complaints against licensees, and those found to be practicing medicine while unlicensed. Licensees have a right to counsel at disciplinary proceedings before the BME. When a matter is heard, an Administrative Law Judge (ALJ) issues an Initial Decision which is reviewed by the Board. The Board can either adopt, reject or modify the findings of fact and conclusion of law, and the penalties recommended by the ALJ. The final decision is made by the Board. Licensees have the right to appeal a final decision of the Board to the Appellate Division of the New Jersey Superior Court.

Additionally, the Board has the authority to take the interim measure of temporarily suspending a license if there is a palpable demonstration of imminent danger to the public. When a license is revoked or suspended, or clinical practice is barred by another state or licensing authority, and the Board finds that either the continued practice endangers or poses a risk to public health and safety, or gross or repeated negligence, fraud or professional misconduct adversely affecting public health and safety is involved, the Board is authorized to impose an immediate suspension.

Possible disciplinary sanctions and other dispositions of Formal Complaints may include:

• Revocation of license
• Suspension of license
• Reprimand
• Probation, limitations on license
• Penalties
• Costs of investigation and prosecution
• Remedial education, supervision
• Community service and other measures

Under N.J.S.A. 45:1-25, monetary penalties may be assessed as follows:

• A maximum of $10,000 for the first violation.
• A maximum of $20,000 for the second and subsequent violations (more than one violation may be found in a single proceeding and assessed as a second violation).

In the event that the Board finds no basis for formal disciplinary action, a private resolution of a complaint may include:

• letter of admonishment, or
• private letter agreement

Either of which may require your submission of urine/blood samples and/or participation in the Physician Assistance Program (PAP).

The Board may institute formal discipline following a licensee's failure to comply with a letter agreement, or upon the finding of a positive urine or blood test and/or demonstration of a relapse. Deceptive behavior, such as attempting to invalidate a drug screen, presenting a fraudulent attendance record, and substituting specimens can also cause a private discipline to be sent to the Board for formal action. And any change in status while under the Board's scrutiny as the result of a private letter, such as an action against your license or privileges, an arrest, or your lack of participation in the PAP, will certainly heighten the Board's interest in your activities and may lead to further, more formal disciplinary action.