Healthcare Law and Business Library: The Definitive Online Source for Healthcare Data

Contributing Editor:

Gerard R. Goulet
Hinckley, Allen & Snyder LLP
Health Law Practice Group
Providence Office
1500 Fleet Center, Providence, RI 02903-3293
401 274-2000

I. Regulation of Practice of Medicine
A. Licensure.
1.	The Rhode Island Department of Health licenses physicians under Chapter 5-37 of the Rhode Island General Laws.
2.	The "practice of medicine" includes both allopathic and osteopathic medicine and is defined to include: (a) holding oneself out as being able to or professing to heal, offer or undertake, by any means or method, to diagnose, treat, operate or prescribe for any person ill or alleged to be ill with disease, pain, injury, deformity or abnormal physical or mental condition or (b) attaching the title M.D., physician, surgeon, D.O., osteopathic physician and surgeon or any other similar word or words or abbreviation to one's name indicating that one is engaged in the treatment or diagnosis of the diseases, injuries or conditions of persons.
3.	The Board of Medical Licensure and Discipline is established pursuant to Chapter 5-37-1.1 of the Rhode Island General Laws.
4.	The requirements for licensure are as follows:
	(a)	Graduates of medical schools located in the U.S.A. and Puerto Rico must:
		(i)		be of good moral character;
		(ii)		have graduated from a medical school accredited by the Liaison Committee for Medical Education ("LCME");
		(iii)		have satisfactorily completed two (2) years of post-graduate training in a program accredited by the Accreditation Council for Graduate Medical Education;
		(iv)		have satisfactorily passed an examination approved by the Board; and
		(v)		meet such other requirements as may be established by the Board.
	(b)	Graduates of Canadian schools must meet all of the same requirements except that the post-graduate training program must be accredited by the Accreditation Committee of the Federation of the Medical Licensing Authority of Canada or the Royal College of Physicians and Surgeons of Canada.
	(c)	Foreign Medical Graduates differ from their American and Canadian counterparts in the following ways. They must:
		(i)		have graduated from a medical school located outside of the United States which is recognized by the World Health Organization;
		(ii)		have received certification by the Education Commission for Foreign Medical Graduates ("ECFMG"); and
		(iii)		have satisfactorily completed three years internship or residency in a training program accredited by the Council for Graduate Medical Education.
	(d)	Fifth Pathway Foreign Medical Graduates must, in addition to the foregoing, have attained a score satisfactory to a medical school approved by the Liaison Committee on Medical Education on a qualifying examination acceptable to the State Board of Medicine.
	(e)	Osteopathic Physicians must:
		(i)		be of good moral character;
		(ii)		have graduated from an osteopathic medical school located in the United States that is accredited by the American Osteopathic Association;
		(iii)		have satisfactorily completed two (2) years of post-graduate training in a program approved by the American Osteopathic Association or the Accreditation Council for Graduate Medical Education;
		(iv)		have satisfactorily passed an examination approved by the Board; and
		(v)		have met such other requirements as may be established by the Board.
5.	Examinations approved by the Board include the following:
	(a)	the National Board of Allopathic Medical Examination ("NBME") or the National Board of Osteopathic Medical Examination ("NBOME"); or
	(b)	the Federation Licensing Examination ("FLEX"); or
	(c)	the United States Medical Licensing Examination; or
	(d)	the Licentiate Medical Council of Canada ("LMCC"), each section of which must be passed with a score of 75 or more.
	If an applicant fails to pass each section of the required examination on the fifth attempt, opportunity for re-examination will be subject to the applicant's completion of additional requirements as recommended by the Board on a case-by-case basis.
6.	Applications and instructions for applying may be viewed at and downloaded from www.docboard.org/ri/main.htm.
7.	Continuing Medical Education.
	All allopathic and osteopathic physicians must complete a prescribed program of continuing medical education established by the appropriate medical or osteopathic society and approved by the Board, two hours of which will relate to current information on universal precautions, infection control, modes of transmission, OSHA and other regulatory requirements. Licensees must apply for certification on a triennial basis, every third year after the 1999 registration.
B. Limited Registrations.
Limited registrations are available to (1) graduates of legally chartered medical schools or schools of osteopathic medicine who are appointed as interns, residents, fellows, or medical officers in hospitals or clinics maintained by the state or otherwise licensed by the state and (2) to outstanding physicians offered full time academic appointments by the dean of the medical school.
C. Unprofessional Conduct.
There are 31 categories of unprofessional conduct set forth at §5-37-5.1 of the Rhode Island General Laws. They are summarized as follows:
(1)	Fraudulent or deceptive procuring or use of a license or limited registration;
(2)	Deceptive advertising of medical business;
(3)	Conviction of (a) a crime involving moral turpitude; (b) a felony; (c) a crime arising out of the practice of medicine;
(4)	Abandoning a patient;
(5)	Dependence upon controlled substances, habitual drunkenness, or rendering professional services to a patient while intoxicated or incapacitated by the use of drugs;
(6)	Promotion of the sale of drugs, devices, appliances, or goods or services provided for a patient in a manner as to exploit the patient for financial gain;
(7)	Immoral conduct in the practice of medicine;
(8)	Willfully making and filing false reports or records in the practice of medicine;
(9)	Willfully omitting to file or record, or willfully impeding or obstructing a filing or recording, or inducing another person to omit to file or record, medical or other reports as required by law;
(10)	Failing to furnish details of a patient's medical record to succeeding physicians or other health care providers upon proper request pursuant to §5-37.3-4;
(11)	Soliciting professional patronage through agents or otherwise profiting from acts of those representing themselves to be agents;
(12)	Dividing fees or agreeing to split or divide the fees received for professional services for any person for bringing to or referring a patient;
(13)	Agreeing with clinical or bioanalytical laboratories to accept payments from these laboratories for individual tests or test series for patients;
(14)	Making willful misrepresentations in treatments;
(15)	Practicing medicine with an unlicensed physician except in an accredited preceptorship or residency training program, or aiding or abetting unlicensed persons in the practice of medicine;
(16)	Gross and willful overcharging for professional services; including filing of false statements for collection of fees for which services are not rendered, or willfully making or assisting in making a false claim or deceptive claim or misrepresenting a material fact for use in determining rights to health care or other benefits;
(17)	Offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment or medicine;
(18)	Professional or mental incompetency;
(19)	Incompetent, negligent, or willful misconduct in the practice of medicine which includes the rendering of medically unnecessary services, and any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing medical practice;
(20)	Failing to comply with the provisions of chapter 4.7 of title 23 relating to informed consent for abortion;
(21)	Surrender, revocation, suspension, limitation of privilege based on quality of care provided, or any other disciplinary action against a license or authorization to practice medicine in another state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating to a membership on any medical staff or in any medical or professional association or society while under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to unprofessional conduct as defined in Rhode Island;
(22)	Any adverse judgment, settlement or award arising from a medical liability claim related to unprofessional conduct as defined in Rhode Island;
(23)	Failing to furnish the board, its chief administrative officer, investigator or representatives, information legally requested by the board;
(24)	Violating any provision(s) of this chapter or the rules and regulations of the board or any rules or regulations promulgated by the director or of an action, stipulation, or agreement of the board;
(25)	Cheating on or attempting to subvert the licensing examination;
(26)	Violating any state or federal law or regulation relating to controlled substances;
(27)	Failing to maintain standards established by peer review boards, including, but not limited to, standards related to proper utilization of services, use of non-accepted procedure, and/or quality of care;
(28)	Medical malpractice;
(29)	Agreeing to treat a Medicare beneficiary and then charging or collecting from this beneficiary any amount in excess of the reasonable charge for that service as determined by the United States secretary of health and human services;
(30)	Sexual contact between a physician and patient during the existence of the physician/patient relationship; or
(31)	A physician providing services to a person who is making a claim as a result of a personal injury, who charges or collects from the person any amount in excess of the reimbursement to the physician by the insurer as a condition of providing or continuing to provide services or treatment.
D. Patient Disclosures .
Rhode Island requires its licensed physicians to make a number of disclosures to patients:
1.	(a)		Any physician who is not a participant in a medical insurance plan must post a notice, in a conspicuous place in his or her medical offices where it can be read by his or her patients, which reads, in substance, as follows: "To my patients: I do not participate in a medical insurance plan. You should know that you will be responsible for the payment of my medical fees."
	(b)		Any physician who fails to post this notice is not entitled to charge his or her patients any amount for medical fees in excess of that allowed had the physician participated in a medical insurance plan.
(2)	Every physician must disclose to patients eligible for Medicare, in advance of treatment, whether the physician accepts assignment under Medicare reimbursement as payment in full for medical services and/or treatment in the physician's office. This disclosure is given by posting in each physician's office, in a conspicuous place, a summary of the physician's Medicare reimbursement policy. Any physician who fails to make the disclosure as required in this section is not allowed to charge the patient in excess of the Medicare assignment amount for the medical procedure performed.
3.	When a patient requests, in writing, that his or her medical records be transferred to another physician, the original physician must promptly honor the request. The physician is reimbursed for reasonable expenses incurred in connection with copying the medical records.
4.	Every physician must, upon written request of any patient who has received health care services from the physician, at the option of the physician, either permit the patient to examine and copy the patient's confidential health care information, or provide the patient a summary of that information. If the physician decides to provide a summary and the patient is not satisfied with a summary, then the patient may request, and the physician must provide, a copy of the entire record. At the time of the examination, copying or provision of summary information, the physician is reimbursed for reasonable expenses in connection with copying this information. If, in the professional judgment of the physician, it would be injurious to the mental or physical health of the patient to disclose certain confidential health care information to the patient, the physician is not required to disclose or provide a summary of that information to the patient, but must upon written request of the patient disclose that information to another physician designated by the patient.
5.	Every physician who has ownership interest in health facilities, laboratories, residential care/assisted living facilities, adult day care programs, or equipment not on the physician's premises, must, in writing, make full disclosure of his or her ownership interest in the facility or therapy prior to utilization by the patient. The written notice must state that the patient has free choice either to use the physician's proprietary facility or therapy or to seek the needed medical services elsewhere.
E. Complaints .
1.	Complaints specifying the grounds therefor may be filed in writing by any person or the board, on its own initiative, may determine that an investigation is warranted. Complaints are investigated by a three-person investigating committee, one member of which is a member of the public and one member of which is a licensee of the same type, allopathic or osteopathic, as the physician to whom the complaint relates. If the investigating committee determines that probable cause exists for a finding of unprofessional conduct, the accused may request a hearing before a separately constituted three-person hearing committee, one member of which will be a representative to the public and one member of which will be a physician. The accused is entitled to: (a) a specification of charges; (b) notice of the date, time and place of hearing; and (c) the following rights:
	(i)		to respond to the charges in writing within 20 days of service of the notice;
	(ii)		to appear personally and have counsel present;
	(iii)		to produce witnesses and evidence;
	(iv)		to cross-examine witnesses;
	(v)		to examine any documentary evidence produced against him or her; and
	(vi)		to have subpoenas issued by the hearing committee of the board.
	The board's subpoena power is enforceable in Superior Court. The hearing committee can only find a physician guilty of unprofessional conduct by majority vote. If it does so, it prepares a written report of its findings of fact, conclusions of law, and disciplinary order for transmission to the Director of Health.
F. Sanctions .
Sanctions which may be imposed on an accused found guilty of unprofessional conduct are as follows:
(1)	Administer a reprimand;
(2)	Suspend or limit or restrict the license or limited registration to practice medicine;
(3)	Require the physician to serve a period of probation subject to certain conditions and requirements including, where appropriate, sanctions or restitution;
(4)	Revoke indefinitely the license or limited registration to practice medicine;
(5)	Require the physician to submit to the care, counseling, or treatment of a physician or program acceptable to the board;
(6)	Require the physician to participate in a program of continuing medical education in the area judged deficient;
(7)	Require the physician to practice under the direction of a physician in a public institution, public or private health care program, or private practice for a period of time specified by the board;
(8)	Assess against the physician the administrative costs of the proceedings instituted against the physician up to ten thousand dollars ($10,000);
(9)	Any other condition(s) or restrictions deemed appropriate under the circumstances.
G. Appeals .
Any person aggrieved by a decision of the board and director may file a notice of appeal with a complaint in accordance with the Rules of Civil Procedure in Superior Court within 30 days after the director's decision. Appeals have precedence on the calendar, are considered emergency matters and should be heard within 30 days of the date of appeal. Stays of sanctions are not permitted unless the court determines it cannot place the matter on its docket within the 30-day period specified.
H. Summary Suspension .
Where the director possesses evidence indicating that a physician's continuation in practice would constitute an immediate danger to the public, the director may temporarily (and summarily) suspend the physician's license, but a hearing must be conducted by the board within 10 days of the suspension action.
I. Medical Records .
In addition to the foregoing, the licensing statute regulates medical record completion, patient access and retention at §5-37-22. This is also set forth in the medical record link from the board's website at www.docboard.org/ri/main.htm. The most significant aspect of the statute is the limit on physician charges for copying medical records (not more than 25 cents per page for the first 100 pages and not more than 10 cents per page for pages 101 and after, plus a maximum retrieval fee of $15 and a maximum quick retrieval fee of $10 for 48-hour service). In addition, physicians may not charge for: (1) immunization records required for school admission; (2) records for applicants or claims for Social Security benefits, Medical Assistance, RiteCare, Temporary Disability Insurance, and unemployment compensation; (3) records of civil court certification applicants; or (4) records of worker's compensation claimants.
J. Reports to the Board .
The following reports are required to be filed with the board:
1.	Malpractice insurers must file reports of civil actions filed and settlements and final judgments in any causes of actions for death or personal injury caused by a physician's negligence or rendering of unauthorized professional services.
2.	All hospitals and licensed health care facilities must report all actions, disciplinary or otherwise, that limit, suspend, or revoke a physician's privilege to practice or acquire supervision of a physician, even if voluntarily agreed to by the physician.
3.	Courts must report convictions of crimes.
K. Reports from the Board .
The board reports changes of privilege related to quality of patient care of which it becomes aware to the board of trustees of all hospitals and licensed health care facilities in Rhode Island. All disciplinary actions are reported by the board to the Federation of State Medical Boards ("FSMB"), the National Practitioner Data Bank ("NPDB") and/or the Health Care Integrity and Protection Data Bank ("HIPDB").
L. Confidential File .
The board maintains a confidential file to assist it with its investigations. This file is also made available to licensed health care facilities in connection with their privileging processes. The file includes:
(1)	all malpractice claims against a physician and their disposition;
(2)	all reports of hospital or medical society disciplinary action, including resignations and withdrawals of applications for privileges relating to unprofessional conduct;
(3)	reports by state or federal courts of felony convictions;
(4)	reports of sanctions imposed by peer review organizations and health insurers;
(5)	annual reports by hospitals and health maintenance organizations of current appointments to their medical staffs;
(6)	information supplied by the Federation of State Medical Boards and the American Medical Association.
M. Physician Profile .
Each licensed physician must provide the following information to the Board to be included in an individual profile to be made available to the public in accordance with Section 5-37-9.2 of the Rhode Island General Laws (where appropriate, the information usually covers the physician's 10 most recent years):
(1)	names of medical schools and dates of graduation;
(2)	graduate medical education;
(3)	final disciplinary actions by licensing boards in other states;
(4)	criminal convictions for felonies;
(5)	revocation or restrictions of hospital privileges for reasons related to competence or quality of care or resignation from or non-renewal of medical staff membership or restriction of hospital privileges during the course of an investigation;
(6)	all medical malpractice judgments, arbitration awards and settlements where payment was made to a complaining party;
(7)	specialty board certification;
(8)	number of years in practice in each state;
(9)	names of hospitals where the physician had privileges in any state;
(10)	location of the physician's primary practice setting;
(11)	appointments to medical school faculties;
(12)	publications in peer reviewed medical literature;
(13)	professional or community service awards.
N. Generic Substitution .
Unless the professional judgment of the physician otherwise dictates, physicians must authorize a less expensive generic equivalent drug when prescribing a drug by brand name.
O. Impaired Physicians .
Physicians who exhibit certain types of problems (e.g., substance abuse, psychiatric or medical illness, disruptive behavior or sexual boundary violations) may be self-referred or may be referred by health care facilities, practice partners, family members, patients, friends, or the Board of Medical Licensure and Discipline to the Physicians' Health Committee. This is a medical peer review committee that has been maintained voluntarily by the Rhode Island Medical Society since 1978. A current list of committee members is available at www.rimed.org (click on "Governance," then on "Committees"). The process is consensual and cooperative. Typically, a referral for a confidential evaluation and treatment is made by one of the sources outlined above. The recovering physician is then monitored and supported through a long-term aftercare contract with the committee. Assuming the physician is successful in addressing the presenting problem, the committee serves as an active advocate before the Board and credentialing entities, such as health care facilities and insurers. For more information or to make a referral, Rosemary Maher, ACSW, LICSW, CEAP should be contacted at 401-331-3207.
P. Further Information .
The board's website at www.docboard.org/ri/main.htm provides links to:
(1)	the state DOCFINDER;
(2)	the AIM DOCFINDER maintained by the Association of State Medical Board Executive Directors;
(3)	information about how to file a complaint;
(4)	information about disciplinary actions of the board;
(5)	the licensing law - Chapter 5-37 of the General Laws and the Uniform Controlled Substances Act - Chapter 21-28 of the General Laws;
(6)	regulations relating to:
	(a)		pain assessment;
	(b)		licensure and disciplining of physicians;
	(c)		limited medical registration;
	(d)		distributors of controlled substances in Rhode Island; and
	(e)		practices and procedures before the department of health and access to public records;
(7)	information about J-1 visa waivers;
(8)	information about medical records;
(9)	the ABMS certification codes list;
(10)	the Educational Commission for Foreign Medical Graduates;
(11)	the NBME, USMLE, and LMCC with respect to the examinations they offer.