Interstate Medical Licensure Compact Act — Pennsylvania’s Ill Drafted Version

Today our country’s geographically diverse population seeks competent medical care in their small outlying communities. This is prompting hospital administrators to investigate different ways to reach all of their potential constituents. The Affordable Care Act, by providing tax incentives and tax credits, is incentivizes businesses to create different modes of delivery of medical treatment to satiate the medical demands of communities where current medical care is sparse.

Increases in demand for medical care is coinciding with the 21st century’s growth in internet based communication capabilities and electronic medical record storage possibilities. This perfect equilibrium of expanding medical demands and new medical delivery capabilities is prompting many states to consider allowing out of state medical practitioners to receive expedited licensure through a national compact process.

The formal name of the law is the Interstate Medical Licensure Compact Act (the “Act”). With a stated purpose of strengthening avenues to health care through recent advances in the delivery of health care services, member states of the Act seek to develop a comprehensive process for expanding physician licensure from their one primary state to all states that participate in the Act. The Act seeks to adopt a prevailing standard for licensure that will allow medical boards of a participating state to retain jurisdiction to impose license discipline while promoting patient safety and expanding treatment options.

Pennsylvania has not yet enacted the Act. The Act has been introduced in the Pennsylvania General Assembly as House Bill 1619 of 2015. A similar bill has not been presented in the Pennsylvania Senate. The initial bill has been referred to the House Committee on Health as of October 14, 2015.

House Bill 1619 of 2015 requires the applying physician to designate a member state “as a state of principal license” for the purposes of registering for an expedited license. A state qualifies as a principle state if the physician possesses a full and unrestricted license to practice medicine in that state, is the location of the physician’s primary residence, and at least 25% of the physician’s medical practice is in that state.

A physician seeking multiple jurisdiction expedited licenses through the Act initially applies to their principle state medical board for “eligibility” of an expedited license. The principle state issues a letter of qualification verifying or denying eligibility, with a minor appeal process if there is a denial. Preconditions of principle state eligibility include standard competency and educational qualifications, a satisfactory criminal background check, and determination of suitability in accordance with 5 C.F.R. § 731.202.

Eligibility determinations are then delivered to an Interstate Licensure Commission, which will establish the registration process for licensure is member jurisdictions. The physician identifies in which states she is seeking licensure under the Act. Thereafter a member board shall issue the expedited license to the physician to practice medicine in the issuing state(s) upon payment of designated issuing state’s fees and costs. The practice of medicine in any issuing state will be consistent with the Medical Practices Act and laws and regulations of the both the principle state and member states.

An important part of the Act is the joint investigation and disciplinary process. House Bill 1619-2015 current form allows member boards of each state to participate in joint investigations by other member boards. Subpoenas issued by one member state shall be enforceable in another member state. Member boards may share investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under the Act. Any member state is authorized to investigate actual or alleged violations of statutes authorizing the practice of medicine in any other member state in which the physician holds a license to practice medicine. This sounds like a free for all, pile it on, rugby game.

Any disciplinary action taken by the physician’s principle licensing board (their home state) shall, under House Bill 1619 of 2015, be deemed unprofessional conduct subject to discipline by other member boards in addition to any violation of the Medical Practices Act or regulations of the principle state. Revocation, suspension, or surrender of a license in lieu of discipline or suspension shall cause the physician’s license to suffer similar status by each and every member board to which that physician is licensed.

Conversely, however, any reinstatement of the physician’s license by his principal state medical board shall not affect the encumbered status of that physician’s license in other member states unless and until each member state takes individual action to reinstate my license. This provision allows each member board to conduct the practice of their medical board license disciplinary action independent of the Act. This process is different the current due process rules that require each state’s discipline of a multiple state licensed professional to be independent of, and not link to, any prior state’s discipline.

Any discipline action taken by the physician by a member board, not the principal license board, may be used by other member boards as a conclusive disciplinary action warranting imposition of the same or less or sanction or a separate disciplinary action by other member boards. As well, any license investigation by a member board that becomes the subject revocation, surrender or relinquishment in lieu of discipline shall cause the physician’s license to suffer the same consequences without any further action in each other member board without the subject to any disciplinary investigation. The physician truly becomes hostage to the initiating state’s disciplinary process and must fight it to the death so as to avoid any automatic domino effect.

The Act seeks to balance the states’ citizens’ need for medical care, a nation’s policy interest in granting access to high quality medical care to all citizens, and a physician’s ability to provide competent medical service regardless of artificial state borders against patient safety and criminally active doctors. The primary concern of the Act is who will become the disciplinary supervisor of doctors practicing throughout the country under the Act. While this is a serious and weighty issue, the Act in its current form fails to safeguard the medical license of Pennsylvania’s many doctors who will choose it as their primary state of licensure.

Pennsylvania’s medical schools have produced thousands of doctors over the years. Many secure initial graduate school training licenses and stay in the Commonwealth after residency to care for Pennsylvania’s residents. Many choose Pennsylvania as a home. The Act as drafted in House 1619 of 2015 will discourage this.

Physicians who seek to practice medicine in multiple states through the Act will sacrifice a significant degree of due process if any disciplinary investigation is commenced or levied against them. While there is significant financial interest to provide internet-based face time oriented medical practice across state borders without driving distances, to save lives, the inevitable due process concerns are significant. Exploding populations are overrunning medical investigatory boards with rampant anonymous complaints that will warrant investigation.

Every day baseless complaints of Medicare Medicaid insurance fraud, pill mills, sexual assaults, or drug theft and diversion are generated from specious reporters who are either aggrieved patients, angry disgruntled business partners, jealous or angry co-employees, or scorned lovers. House Bill 1619 of 2015 exposes Pennsylvania’s principle-based medical practitioners to unilateral concurrent disciplinary process of member states without the ability to respond, investigate, or even defend oneself in a court of law. Member state’s unilateral actions will automatically trickle back to the physician’s primary licensure state, causing potentially automatic disciplinary action there. The Act as written is not in the interest of Pennsylvania medical community.

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