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Illinois Professional License Defense AttorneyPatient-centric care is what our healthcare system has moved towards, but when is that too far? What happens when patients start to tell physicians how their treatment plan should look? As patients gain more and more access to information, they may become a more informed “customer”; this can be both good and bad. Patients can have a better understanding of what their issue is, but as the saying goes ‘your Google search does not replace a medical/osteopathic degree’.

Patients often use Google before they see their physician. Patients want to understand what is going on before they see a doctor or to determine whether they will even make an appointment to see one at all. There are several problems with this approach, the most important of which is a patient believing their symptoms fit a hundred different diseases. This belief can cause an overreaction, and entering a physician's office very anxious and stressed. When this happens, the patients may start to ask for unneeded tests, procedures, and medication. Physicians are then put into a difficult position: should they try to calm the patient and assure them or give in and run multiple tests to prove that WebMD did not actually diagnose them with the diseases. In some cases, the patient could actually be correct in their assumptions and not be overreacting, so physicians must use their judgment on the best course of action for that particular patient.

Sometimes poor medical judgment results when doctors are pressured by patients, and this can cause multiple issues including overprescribing opioids or running tests that aren’t needed. Any of these scenarios could cause the physician a problem with the Illinois Department of Financial and Professional Regulation, and their license. If a problem does arise, Williams & Nickl is here to help you get through that process and back on the right track. Our firm focuses on professional license defense to ensure the Medical Board does not violate your rights, and you have a chance to move on from your issue.

Chicago Defense Attorney for Doctors and NursesPatient-centric care is what our healthcare system has moved towards, but when is that too far? What happens when patients start to tell physicians how they want their treatment plan to look? As patients gain more and more access to information, they will be a more informed "customer"; this can be both good and bad. Patients can have a better understanding of what their issue is, but, as the common saying goes, your Google search does not replace a medical/osteopathic degree.

One way a patient can start to dictate how they are treated is by requesting specific medication. Pharmaceutical manufacturers plaster TV, print and internet sites with drug advertising with the urgent request “Ask your doctor about it!” Drug companies would argue that informative ads empower the consumer patient to obtain the medication they want, but physicians would counter that the consumer is not educated enough to make such a decision. Studies have shown that patients are more likely to get their medication of choice when they request it. This is true not only for the drug brand but also the drug type. Speculation occurs, as it is unclear whether the physician simply wants to pacify the inquisitive patient or if they truly believe the medication is the most appropriate treatment.

While listening to your patients and adhering to their requests can be harmless, patients dictating their medications can cause a lot of issues, including the overprescribing of opioids. This could ultimately cause a problem with the Illinois Department of Financial and Professional Regulation, and your license. Many have stated that the best practices are to work with your patient to make the decision together. Let your patient know how you came to your decision and do not be afraid to say NO, especially when it comes to controlled substances. If a problem does arise, Williams & Nickl is here to help you get through that process and back on the right track. Our firm focuses on professional license defense to ensure the Medical Board does not trample your rights, and you have a chance to move on from your past issue.

Illinois Healthcare Professional Defense LawyerAuthors and physicians Drs. Adam Cifu and Vinayak Prasad wrote a blockbuster book in 2015 that is making news lately. The abrupt change in medical gospel, sometimes being rewritten every week, is a true disaster for patients who try to keep up with the ‘latest and greatest’ in medicine. The authors use the term ‘medical reversal’ to describe sudden flip-flops in standards of care. Medical reversals cause angst among not just the patients, but the doctors that now must face the fact that their advice and practice was potentially harmful or maybe not even helpful in any way.

Examples of therapies and medical strategies that turned out to be wrong include estrogen-replacement therapy after menopause, use of coronary stents to open narrowed coronary arteries, lobotomy, Vioxx, vertebroplasty, arthroscopic knee surgery to repair degenerative meniscal tears, and more.

The authors try to find out why modern medicine reverses itself and to make suggestions on how to make it stop. State of the art health care can be harmful or unhelpful. Why do a surgical repair of the meniscus in a knee when physical therapy is just as effective? The causes are very common – an inadequate scientific study or a flawed study due to financial bias. And if the treatment makes a lot of common sense, it is more likely to be useless, which is very counter-intuitive.

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Illinois Workplace Conduct LawyerDepending on where a physician works, there could be great relationships with nurses, or it could be very difficult. Although there is no blame or fault, some places have physicians and nurses working hand-in-hand and some experience stressful relationships between the providers. No matter, the vast majority of physicians and nurses want to have a strong working relationship with each other. In order to facilitate those relationships, there are some do’s and don’ts:

Communication is the first thing on which every provider can improve. You should let others know your expectations but also understanding the other side’s. Many times, a simple explanation can clear up what could have been a significant issue. Involving the nurses as much as possible and keeping them aware of what the physician is doing truly helps the relationship. Doing so will guide everyone to work together and limit the potential for antagonism and alienation.

The second goal is to improve one’s ability to understand. A common scenario is the one-upmanship game inherent in complaining/bragging as to who works the most hours or who has had the roughest shift. The easiest way to stop this is to practice ‘understanding.’ Knowing that both of practitioners have hard jobs and that sometimes working in the hospital of office isn’t fun for anyone can help calm relationships between the professions. Both positions have different roles in patient care, both are supposed to work as a team, and understanding these roles will help reduce tension.

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Chicago Cannabis Defense LawyerIn January of 2020, Illinois became the latest state to legalize recreational cannabis. The question for physicians is now ‘may I use cannabis without fear of being fired from my job?’ The quick answer is, of course, it depends. The longer answer is: it depends on where you work and when you’re using it.

First, employers can stop you from possessing and using cannabis at work. They still have the ability to discipline you for the possession of cannabis on company property and will be able to test you for the drug under reasonable suspicion. The problem is that cannabis can remain in your system for weeks, and there is no current test to determine if you are impaired.

Second, Illinois has a nondiscrimination law that bars employers from discriminating against employees for legal activities done outside of work hours. We assume that because cannabis is legal that employers cannot prevent you from using it outside of work, but if some is impaired when reporting to work, how would an employer test for it?

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Chicago Doctor and Nurse LawyerOn March 20, 2020 Governor Pritzker issued Executive Order 2020-10 (“Order”) which required all residents of Illinois to shelter in place. The Order was extended through April 30, 2020. The Order exempted all healthcare workers for the obvious reason that healthcare is a critical concern in the current global pandemic. The Illinois Department of Financial and Professional Regulation (“IDFPR”) has recently posted on its website bulletins related to the healthcare industry, a number of which are entitled “Guidance.” The bulletins concern the temporary relicensing of retired and out-of-state healthcare non-licensed practitioners. None of these bulletins deal with ethical issues in providing healthcare services in a COVID-19 environment.

Specifically, there does not seem to be real guidance for the #1 question Williams and Nickl receives from clients: Must a doctor, PA or nurse remain working in a hospital or clinical setting in which they objectively believe the practice environment is a danger to themselves or their families? The answer is NO!

Even though politicians and science experts resort more and more to the “war” analogy, an Illinois healthcare worker cannot be charged with desertion. As an Illinois healthcare licensee, you are not bound by the Uniform Code of Military Justice to sacrifice your life or the health of your family. But all healthcare professions have an affirmative duty to avoid patient abandonment. In short, no doctor, nurse or PA can quit on the spur of the moment. All healthcare practitioners are required to arrange, in one form or another, for the continuity of patient care. What constitutes reasonable notice and arrangement for continuity of care varies widely by individual circumstances.

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Chicago Pharmacist LawyerAs of March 30, 2020, the DEA will allow oral prescriptions of schedule II controlled substances when:

  • they are needed for the proper treatment of a patient;
  • there are no appropriate treatment options; and,
  • when submitting an electronic or paper prescription to the pharmacy prior to dispensing the substance is not possible.

Physicians and other prescribers can make the determination to phone in the emergency schedule II script after reviewing the circumstances for each patient, and that review must include the above criteria. Clearly, not every controlled II prescription will be prescribed by phone.

Pharmacists must be aware of qualifications that apply before you can dispense that phone script. First, oral prescriptions are limited to only the adequate amount the patient needs right away. Schedule II prescriptions that go past this period are still subject to the requirement for paper or electronic submission. Second, pharmacists must put the script into writing ASAP, and must cover all of the required fields besides the prescriber’s signature. 

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Chicago Pharmacist AttorneyDuring the COVID-19 pandemic, patients in rural areas face difficulties already present in obtaining care, including poverty, inconsistent virus information, and lack of transportation. Pharmacies serving these populations are working extra-hard to ensure the best care in their communities.

One way community pharmacies can help is with mobile clinic options. A mobile clinic can provide clinical and education services to those with transportation challenges. In addition to offering a telephone service to patients who cannot come to the pharmacy, mobile clinics can be at the disposal of area health agencies as the pandemic expands. While it may seem that patient outreach services can and will be affected by COVID-19 just as other non-health related business, pharmacies are able to adjust as more info about the virus comes online. Some pharmacies have adopted best practices including working with county health departments, senior centers, and school districts to assist the community with support, medication and needed supplies.

Requests for delivery have risen dramatically, for obvious reasons, and some pharmacies have developed a way to coordinate deliveries with patients that limits in-person contact. It is important to remember that pharmacists must be available for follow-up care to those patients. Some pharmacies are pushing state Medicaid programs to issue waiver requests for reimbursements on home delivery, which is critical due to the small margins that community pharmacies already endure.

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Chicago Pharmacist LawyerDuring the COVID-19 pandemic, pharmacists and pharmacy technicians have been included in legislation creating a tax holiday for health professionals and first responders who continue to serve. The “Helping Emergency Responders Overcome Emergency Situations” (HEROES) Act of 2020 did not originally include pharmacists as beneficiaries, but they have since been added.

The original bill only applied to physicians, nurses, physician assistants, nurse practitioners, hospital and medical facility support staff, emergency medical technicians, paramedics, firefighters, corrections officers, and law enforcement officers. The hope is that the legislation will be added to the next congressional COVID-19 legislative package so pharmacists have peace of mind.

What does the federal tax holiday mean? It would suspend federal tax withholding for four months and give the government the authority to extend withholding for an additional three months. It applies to all income up to $150,000 annually.

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Chicago Pharmacist LawyerPharmacists are on the front line of patient health during a pandemic like COVID-19, and one of the main reasons is that patients, prescribers, and pharmacies do not know how the virus will impact the future of the international supply chain and drug manufacturing. Some believed that allowing patients to ‘stockpile’ larger than usual quantities of their prescription medications could cause drug shortages. Now, the DEA is more concerned with making sure patients have access to medications during the shelter-in-place orders.

Although the Illinois Department of Financial and Professional Regulation, along with the Pharmacy Board, have not entered the fray, the Illinois Department of Healthcare and Family Services (Medicaid) provided for an override code for Refill Too Soon. This allows a 90-day supply for insulin and waives signature requirements for receipt of prescriptions. It remains to be seen if additional actions will occur by state government.

While the DEA is easing requirements, pharmacies should advocate for insurers to relax rules, too. CMS reminded Medicare Advantage Organizations and Part D sponsors of their inherent flexibility to remove prior authorizations requirements, waive prescription refill limits, and relax other restrictions. Pharmacists should recommend to patients (and possibly caregivers) to check prescription benefit coverages regarding early refills and supply limits.

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Chicago Primary Care Physician LawyerDo I have to disclose my criminal record to IDFPR? Can my criminal record impact my medical license?

The Illinois Department of Financial and Professional Regulation can and will find out about your criminal record, whether you are about to submit an application for physician licensure by endorsement or examination, or about to renew your existing medical license, or recently convicted and unsure of your next steps.

Will IDFPR and the Illinois Medical Licensing Board or the Illinois Medical Disciplinary Board revoke your license? Will you have any lesser impact of discipline on your license? The answers depend on what you were or are charged with, what the eventual charge to which you pleaded guilty was (or found guilty by a judge or jury), and what kind of sentence was imposed by the criminal court.

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Illinois Primary Care Physician LawyerSocial media has seeped its ways into every facet of our lives of the last decade, even our jobs. The question then becomes, how much, if any, should doctors be using their platforms? And if so, how? Some could make the argument that, especially for private practice, it helps grow their customer base. Others would argue that it is not something to be promoted, and the patient’s confidentiality is at risk.

The benefits of posting on social media are evident in some respect. Doctors, physicians, and osteopaths, especially those who are paid on the amount they bill, can use social media to gain patients. A surgeon might consider whether they can post a surgery they did that day to promote themselves or even to provide teaching opportunities for young doctors. Doing so is dangerous – patient confidentiality laws go very deep, and Illinois law also prohibits the use of a person’s image without consent for commercial purposes. Know also that some health care professionals have been called before IDFPR professional boards to answer for their posting of x-rays and other imaging on social media, when the intent was only to show how ‘not to do’ a procedure.

Some physicians, especially those in residency, have been known to use their social media platform to vent. This can help with some of the problems that have been known to cause physician burnout. But the same rules apply, don’t post anything about your patients, with the caveat that your residency program may take issue with specific types of ‘venting.’

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Illinois Primary Care Physician AttorneyPrimary Care Physicians are becoming increasingly hard to find, and the wait time to see them is getting longer and longer (30% longer between 2014 and 2017, according to Merritt Hawkins). Wait times are up to around 24 days per visit. Even worse, in rural areas primary care physicians are almost becoming non-existent.

The question becomes, is it because fewer medical and osteopathic school students want to go into the profession? And if so, why? The demand for these doctors is increasing every day, but there is still a need. One of the most speculated reasons for this is the pay. Primary Care Physicians are among the lowest-paid physicians in the United States, and with mounting school debt, students find themselves more interested in the higher paid positions.

The Washington Post noted in 2019 that “the Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032.” It goes on to state “studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one.”

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Illinois Prescription Monitoring ProgramYou may have heard that as of January 1, 2018, Illinois veterinarians were required to register with the Illinois Prescription Monitoring Program (PMP). The obligation to register is mandatory and you can expect your professional license to practice veterinary medicine to be publicly disciplined if you fail to do so. In addition to registering, the law now requires a veterinarian to also consult the PMP “to assess patient access to controlled substances” whenever an initial script is written for any Schedule II narcotic.

You should know that this law does not apply to narcotic prescriptions for cancer treatment, palliative care, or a seven day or less supply provided by a hospital emergency department when treating an acute, traumatic medical condition.

Accordingly, you are required to check the controlled substance patient record in the PMP. You are probably also required to check the controlled substance record of the owner as well, but there is not yet any clear authority on which to rely. Although veterinarians have no clinical training in assessment or diagnosis of human addiction, you would be expected to exercise clinical judgement as to whether it is appropriate to write a Schedule II prescription.

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Illinois Professional License Defense LawyerCan a professional licensed in Illinois be subject to discipline only because the license holder was disciplined in another state?

Most likely no, but the Illinois Department of Financial and Professional Regulation won’t let that stop them. While the Medical Practice Act authorizes discipline of doctors based on sanctions imposed in another state, that discipline requires analysis beyond the fact that one was disciplined elsewhere. That is, the Illinois statute may authorize discipline based on out-of-state sanctions, but that does not mean that discipline is reasonable in every case.

In the case of Dr. Cadogan vs Division Of Professional Regulation of the Illinois Department of Financial and Professional Regulation (2013 IL App (1st) 122160-U), the court determined that the Illinois’ discipline was unreasonable based on the relationship between the out-of-state violation, the statutory intent, and the state's justification for punishing the license holder. The court determined that the statutory authorization to discipline a license holder does not, in and of itself, justify the imposition of punishment.

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Illinois Medical License Defense AttorneysAbsolutely not. An IDFPR investigator is a civilian investigator who possesses no police powers. Even if it was a local police officer who demanded that you immediately stop your clinic or office activities and submit to an interview, you are not required to submit. In the police officer scenario, you have an absolute constitutional right to not speak to any police official. The same is true for an IDFPR investigator. A civilian investigator may try to intimidate you into answering questions, but our strong advice is to not answer.

The best practice is to be polite and courteous to the IDFPR investigator. Inform them that you would be happy to answer their questions and will do so as soon as you have a chance to contact your attorney. Then terminate the conversation. It is trickier if the investigator demands to do an impromptu inspection of the premises – you have to determine whether they are authorized to perform a controlled substances inspection. The best practice is to let them inspect what they want. Note that the word inspect means inspect only. It does not mean they can make copies of documents or take documents with them. You or a trusted staff member should accompany the investigator at all times in your office.

As in all enforcement encounters, the best practice is to first copy their IDFPR credentials. Do not speak with anyone – ever – about your practice and never allow them into the employee-only area of the clinic or office unless you are completely confident of their identity. Next, politely ask them to explain the nature of the inquiry. It would help your case to write down all of the answers that you receive. There is no doubt that this action will unnerve the investigator and may convince them to terminate the encounter sooner than expected.

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Illinois Veterinarian License Defense AttorneysWe tell all young professionals just starting out that eventually, they should incorporate. However, the Illinois Veterinary Medicine and Surgery Practice Act of 2004 (“Vet Act”) specifically permits a veterinarian to practice as an individual (the IRS calls this a sole proprietorship). Because there is no registration requirement for a sole proprietor with the Secretary of State and accordingly no registration fees, as well as streamlined tax reporting to the IRS, it might be tempting to see this route as the easiest when one start’s a professional career. But it is not the path that most corporate lawyers or tax accountants would recommend.

As your practice grows, you will undoubtedly start to enter into a variety of standard business relationships: leasing your practice space and equipment, contracts for the purchase of equipment and supplies, and employment relationships with relief vets, veterinary technicians, and other employees. Although the law permits you to conduct your practice as a sole proprietor, one is strongly cautioned against doing so. For example, when practicing as an LLC (a hybrid between a partnership and a corporation), your liability for the debts of the LLC is limited to your investment in the LLC. As a sole proprietor, you are personally liable for all the debts incurred by the practice. A creditor could go after your home, your personal checking and savings accounts, and your car to satisfy a debt obligation. There can also be significant tax savings if an LLC or a corporation is structured properly.

Our strongest advice to any professional contemplating the start-up of a private practice is to seek out a corporate lawyer and a tax accountant with whom you are comfortable. Obtaining advice and assistance upfront can save you time, frustration and money over the course of your career.

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Chicago Veterinarian License Defense AttorneysThe quick answer is yes, but you must follow strict guidelines as set forth in your Act and Rules. We take no position on whether veterinarians should allow chiropractors, physical therapists, medical orthopedic or plastic surgeons to “crossover” into veterinary medicine. Instead, veterinarians should be aware of the risks and responsibilities of asking a healthcare provider, who is licensed to treat only human ailments, for assistance in a veterinary medical case.

There are six sections of the Veterinary Medicine and Surgery Practice Act of 2004 (“Act”) and the Rules for Administration of the Act (“Rules”) that must be read together. When looked at as a whole, they  determine the regulations governing the “complementary, alternative or integrative therapies” in veterinary medicine. Section 4 of the Act exempts a medical or chiropractic physician or a physical therapist (and others) from prosecution for practicing veterinary medicine without a license providing you follow these requirements:

1.       The responsible vet must make a written request for assistance to the non-vet;

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Chicago IDFPR License Defense AttorneysAfter spending 20 years in school and countless hours studying, who doesn’t want to go straight into a job working 60-80 hours a week? Most doctors don’t go into medicine for the money, they go into it because they have a passion for helping people, but at what point is it too much? Depending on your specialty, you could be working these long weeks for 7+ years after receiving your medical or osteopathic degree and even further into an attending position; so how do doctors avoid burnout? According to the New England Journal of Medicine and the American Medical Association, the two main areas to focus on are your relationships and your physical health. If you don’t curb burnout, you will cause serious issues down the line with your medical license and your career that you spent so long building.

Relationships:

One of the main factors that leads to physician burnout is the feeling of seclusion. This feeling could be because you are new to the area and don’t know anyone, or because you don’t recognize everyone is going through the same thing. Taking the time to make friends inside and outside of your program can help. Talking to fellow residents will help you find ways to make your days easier and gives you the ability to vent your frustrations. Don’t forget to keep in contact with your friends and family who may not live close can help as well. Your family may not understand all your problems at work, but they will give you the ability to talk about something outside of the hospital. A support network is critical for both young and experienced physicians.

Physical Health:

Ensuring you are eating correctly and exercising and sleeping enough is extremely important to avoiding burnout. Since you are likely a physician and reading this, you already know this but maybe don’t always act on it. Taking small steps to ensure that you go to the gym, eat a few healthy meals, and try to get an extra 30 minutes of sleep a night can go a long way. You are busy, you don’t always have time to focus on your physical health but taking small steps can drastically decrease your likelihood of burnout.

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