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OREGON MEDICAL BOARD

 

DIVISION 65
HEALTH PROFESSIONALS' SERVICES PROGRAM

847-065-0005
Licensees with Mental Illness Treated in Hospital Exceeding 25 Consecutive Days
A licensee's participation in the Health Professionals’ Services Program (HPSP), to include inpatient evaluations or treatment in a treatment facility that exceeds 25 consecutive days, does not require an automatic suspension of a licensee, if the licensee is in compliance with their HPSP agreement and does not practice medicine during a period of impairment. If the HPSP makes a determination that the licensee has a mental illness that affects the ability of the licensee to safely practice medicine, the HPSP will ask the licensee to immediately withdraw from practice. If the licensee declines, the HPSP will immediately report to the Board that the licensee has a mental illness that affects the ability of the licensee to safely practice, and with this report provide a copy of the evaluation upon which this determination is based.
Stat. Auth.: ORS 677.265

Stats. Implemented: ORS 677.225, 677.645

Hist.: BME 20-2009, f. & cert. ef. 10-23-09; OMB 3-2011, f. & cert. ef. 2-11-11
847-065-0010
Purpose,
Intent and Scope
The Oregon Medical
Board recognizes that substance use disorders and/or mental disorders are potentially
progressive, chronic diseases. The Board believes that physicians, podiatric physicians,
physician assistants and acupuncturists who develop these diseases can, with appropriate
treatment, be assisted with recovery and return to the practice of medicine and
acupuncture. It is the intent of the Board that a licensee with a substance use
disorder and/or mental disorder may have the opportunity to enter the Health Professionals’
Services Program (HPSP). Participation in the HPSP does not shield a licensee from
possible disciplinary action.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0015
Definitions
The following definitions apply to OAR
chapter 847, division 065, except as otherwise stated in the definition:
(1) “Assessment or evaluation”
means the process an independent third-party evaluator uses to diagnose the licensee
and to recommend treatment options for the licensee.
(2) “Board” means
the Oregon Medical Board.
(3) “Business day”
means Monday through Friday, except legal holidays as defined in ORS 187.010 (or
ORS 187.020).
(4) “Contractor”
means the entity that has contracted with the Division to conduct the HPSP.
(5) “Diagnosis”
means the principal mental health or substance use diagnosis listed in the current
Diagnostic Statistical Manual (DSM). The diagnosis is determined through the assessment
and any examinations, tests or consultations suggested by the assessment.
(6) “Division” means
the Department of Human Services, Addictions and Mental Health Division.
(7) “DSM” means
the Diagnostic and Statistical Manual of Mental Disorders, published by the American
Psychiatric Association.
(8) “Federal regulations”
means:
(a) As used in ORS 676.185(5)(d),
a “positive toxicology test result as determined by federal regulations pertaining
to drug testing” means a test result that meets or exceeds the cutoff concentrations
shown in 49 CFR § 40.87 (2009); and
(b) As used in ORS 676.190(5)(g),
requiring a “licensee to submit to random drug or alcohol testing in accordance
with federal regulations” means licensees are selected for random testing
by a scientifically valid method, such as a random number table or a computer-based
random number generator that is matched with licensees’ unique identification
numbers or other comparable identifying numbers. Under the selection process used,
each covered licensee must have an equal chance of being tested each time selections
are made, as described in 40 CFR § 199.105(c)(5) (2009). Random drug tests
must be unannounced and the dates for administering random tests must be spread
reasonably throughout the calendar year, as described in 40 CFR § 199.105(c)(7)
(2009).
(9) “Fitness to practice
evaluation” means the process a qualified, independent third-party evaluator
uses to determine if the licensee can safely perform the essential functions of
the licensee’s health practice.
(10) “Final enrollment”
means a licensee has provided all documentation required by OAR 847-065-0035 and
has met all eligibility requirements to participate in the HPSP.
(11) “Independent third-party
evaluator” means an individual or center who is approved by the Board to evaluate,
diagnose, and offer treatment options for substance use disorders and/or mental
disorders.
(12) “Licensee”
means a licensed physician, podiatric physician, physician assistant or acupuncturist
who is licensed or certified by the Board.
(13) “Mental disorder”
means a clinically significant syndrome identified in the current DSM that is associated
with disability or with significantly increased risk of disability.
(14) “Monitoring agreement”
means an individualized agreement between a licensee and the contractor that meets
the requirements for a diversion agreement set by ORS 676.190.
(15) “Positive toxicology
test result” means a test result that meets or exceeds the cutoff concentrations
shown in 49 CFR 40.87 (2009), a test result that shows other drugs or alcohol, or
a test result that fails to show the appropriate presence of a currently prescribed
drug that is part of a treatment program related to a condition being monitored
by HPSP.
(16) “Provisional enrollment”
means temporary enrollment, pending verification that a licensee meets all program
eligibility criteria.
(17) “Self-referred licensee”
means a licensee who seeks to participate in the program without a referral from
the Board.
(18) “Substance abuse”
means a disorder related to the taking of a drug of abuse (including alcohol); to
the side effects of a medication; and to a toxin exposure, including: substance
use disorders (substance dependence and substance abuse) and substance-induced disorders
(including but not limited to substance intoxication, withdrawal, delirium, and
dementia, as well as substance induced psychotic disorders and mood disorders),
as defined in DSM criteria.
(19) “Substantial non-compliance”
means that a licensee is in violation of the terms of his or her monitoring agreement
in a way that gives rise to concerns about the licensee’s ability or willingness
to participate in the HPSP. Substantial non-compliance and non-compliance include,
but are not limited to, the factors listed in ORS 676.185(5). Conduct that occurred
before a licensee entered into a monitoring agreement does not violate the terms
of that monitoring agreement.
(20) “Toxicology testing”
means urine testing or alternative chemical monitoring including blood, saliva,
breath or hair as conducted by a laboratory certified, accredited or licensed and
approved for toxicology testing.
(21) “Treatment”
means the planned, specific, individualized health and behavioral-health procedures,
activities, services and supports that a treatment provider uses to remediate symptoms
of a substance use disorder and/or mental disorder.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0020
Participation
in Health Professionals Services Program
Effective July 1,
2010, the Board must participate in the Health Professionals’ Services Program
and may refer eligible licensees to the contractor in lieu of or in addition to
discipline. Only licensees who meet the eligibility criteria may be referred by
the Board to the contractor.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0025
Eligibility for Participation in
Health Professionals Services Program
(1) Licensee must be evaluated by an independent
third-party evaluator.
(2) The evaluation must include
a diagnosis of a substance use disorder and/or mental disorder with the appropriate
diagnostic code from the DSM, and treatment options.
(3) Licensee must provide a
written statement agreeing to enter the HPSP and agreeing to abide by all rules
established by the Board.
(4) Licensee must enter into
the “HPSP Monitoring Agreement.”
(5) The Board will determine
whether a Board-referred licensee’s practice has presented or presents a danger
to the public. The contractor will determine whether a self-referred licensee’s
practice has presented or presents a danger to the public.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0030
Procedure
for Board Referrals
(1) When the Board
receives information involving a licensee who may have substance abuse and/or a
mental disorder, the Board staff will investigate and complete a report to be presented
at a Board meeting.
(2) If licensee
meets eligibility criteria and the Board approves entry into the HPSP, the Board
will provide a written referral. The referral must include:
(a) A copy
of the report from the independent third-party evaluator who diagnosed the licensee;
(b) The treatment
options developed by the independent third-party evaluator;
(c) A statement
that the Board has investigated the licensee’s professional practice and conduct;
(d) A description
of any restrictions or requirements imposed by the Board or recommended by the Board
on the licensee’s professional practice;
(e) A written
statement from the licensee agreeing to enter the HPSP and agreeing to abide by
all terms and conditions established by the contractor; and
(f) A statement
that the licensee has agreed to report any arrest for or conviction of a misdemeanor
or felony crime to the Board within three business days after the licensee is arrested
or convicted.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0035
Procedure
for Self- Referred Licensees
Board licensees may self-refer to the HPSP.
(1) Provisional Enrollment:
To be provisionally enrolled in the program, a self-referred licensee must:
(a) Sign a written consent allowing
disclosure and exchange of information among the contractor, the licensee’s
employer, independent third-party evaluators and treatment providers;
(b) Sign a written consent allowing
disclosure and exchange of information among the contractor, the Board, the licensee’s
employer, independent third-party evaluators and treatment providers in the event
the contractor determines the licensee to be in substantial non-compliance with
his or her monitoring agreement as defined in OAR 847-065-0065;
(c) Attest that the licensee
is not, to the best of the licensee’s knowledge, under investigation by the
Board; and
(d) Agree to and sign a monitoring
agreement.
(2) Final Enrollment: To move
from provisional enrollment to final enrollment in the program, a self-referred
licensee must:
(a) Obtain at the licensee’s
own expense and provide to the contractor, an independent third-party evaluator’s
written evaluation containing a DSM diagnosis and diagnostic code and treatment
recommendations;
(b) Agree to cooperate with
the contractor’s investigation to determine whether the licensee’s practice
while impaired presents or has presented a danger to the public; and
(c) Enter into an amended monitoring
agreement, if required by the contractor.
(3) Once a self-referred licensee
seeks enrollment in the HPSP, failure to complete final enrollment may constitute
substantial non-compliance and may be reported to the Board.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0040
Disqualification
Criteria
Licensees, either
Board-referred or self-referred, may be disqualified from entering the HPSP for
factors including, but not limited to:
(1) Licensee’s
disciplinary history;
(2) Severity
and duration of the licensee’s impairment;
(3) Extent
to which licensee’s practice can be limited or managed to eliminate danger
to the public;
(4) If licensee’s
impairment cannot be managed with treatment and monitoring;
(5) Evidence
of criminal history that involves injury or endangerment to others;
(6) Evidence
of sexual misconduct;
(7) Evidence
of non-compliance with a monitoring program from another state;
(8) Pending
investigations with the Board or boards from other states;
(9) Previous
Board investigations with findings of substantiated abuse or dependence; and
(10) Prior
enrollment in, but failure to successfully complete, the Oregon Medical Board Health
Professionals Program or HPSP.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0045
Approval
of Independent Third-Party Evaluators
(1) To be approved
by the Board as an independent third-party evaluator, an evaluator must be:
(a) Licensed
as required by the jurisdiction in which the evaluator works;
(b) Able
to provide a comprehensive assessment of and written report describing a licensee’s
diagnosis, degree of impairment, and treatment options; and
(c) Able
to facilitate a urinalysis of the licensee at intake.
(2) The Board
reserves the right to not approve an independent third-party evaluator for any reason.
(3) The Board
or contractor will not accept an evaluator as independent in a particular case if,
in the Board’s or contractor’s judgment, the evaluator’s judgment
is likely to be influenced by a personal or professional relationship with a licensee.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0050
Approval
of Treatment Providers
(1) To be approved
by the Board as a treatment provider, a provider must be:
(a) Licensed
as required by the jurisdiction in which the provider works;
(b) Able
to provide appropriate treatment considering licensee’s diagnosis, degree
of impairment, and treatment options proposed by the independent third-party evaluator;
and
(c) Able
to facilitate a urinalysis of the licensee at intake.
(2) A treatment
provider may not have a personal or professional relationship with a licensee.
(3) The Board
will maintain a list of treatment providers available to licensees upon request.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: BME
15-2010(Temp), f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert.
ef. 10-25-10; OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. &
cert. ef. 7-31-12 thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12
847-065-0055
Licensee
Responsibilities
All licensees must:
(1) Agree to report any arrest
for or conviction of a misdemeanor or felony crime to the contractor within three
business days after the licensee is arrested or convicted of the crime;
(2) Comply continuously with
his or her monitoring agreement, including any restrictions on his or her practice,
for at least two years or longer, as specified in the monitoring agreement;
(3) Abstain from mind-altering
or intoxicating substances or potentially addictive drugs, unless the drug is approved
by the contractor and prescribed for a documented medical condition by a person
authorized by law to prescribe the drug to the licensee;
(4) Report use of mind-altering
or intoxicating substances or potentially addictive drugs within 24 hours to contractor;
(5) Participate in a treatment
plan approved by a third-party evaluator or treatment provider;
(6) Limit practice as required
by the contractor or the Board;
(7) Cooperate with supervised
monitoring of practice;
(8) Participate in a follow-up
evaluation, when necessary, of licensee’s fitness to practice;
(9) Submit to random drug or
alcohol testing, unless the licensee is diagnosed with solely a mental health disorder
and the Board does not otherwise require the licensee to submit to random drug and
alcohol testing;
(10) Report at least weekly
to the contractor regarding the licensee’s compliance with the monitoring
agreement;
(11) Report applications for
licensure in other states, changes in employment and changes in practice setting
to the contractor;
(12) Agree to be responsible
for the cost of evaluations, toxicology testing, treatment and monitoring;
(13) Report to the contractor
any investigations or disciplinary action by any state, or state or federal agency,
including Oregon;
(14) Participate in required
meetings according to the treatment plan; and
(15) Maintain current license
status and/or report any changes in license status.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0060
Completion
Requirements
(1) The time spent participating in a monitored
program before transferring from the Health Professionals Program to the Health
Professionals’ Services Program effective July 1, 2010, will be counted toward
the required term of monitored practice.
(2) The licensee will remain
enrolled in the program for a minimum of two consecutive years.
(3) The Board-referred licensee
must have complied with the licensee’s monitoring agreement to the satisfaction
of the Board. The self-referred licensee must have complied with the licensee’s
monitoring agreement to the satisfaction of the contractor.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0065
Substantial Non-Compliance Criteria
(1) The contractor will report substantial
non-compliance with a diversion agreement to the Board within one business day after
the contractor learns of the substantial non-compliance, including but not limited
to information that a licensee:
(a) Engaged in criminal behavior;
(b) Engaged in conduct that
caused injury, death or harm to the public, including engaging in sexual impropriety
with a patient;
(c) Was impaired in a health
care setting in the course of the licensee’s employment;
(d) Received a positive toxicology
test result;
(e) Violated a restriction on
the license’s practice imposed by the contractor or the Board;
(f) Was civilly committed for
mental illness;
(g) Entered into a diversion
agreement, but failed to participate in the HPSP;
(h) Was referred to the HPSP,
but failed to enroll in the HPSP;
(i) Forged, tampered with, or
modified a prescription;
(j) Violated any rules of prescriptive
authority;
(k) Violated any provisions
of OAR 847-065-0055;
(L) Violated any terms of the
diversion agreement; or
(m) Failed to complete the monitored
practice requirements as stated in OAR 847-065-0060.
(2) The Board will review reports
from the program. The Board may request the contractor to provide the licensee’s
complete record, and the contractor must send these records to the Board as long
as a valid release of information is in place.
(3) If the Board finds that
a licensee is substantially noncompliant with a diversion agreement, the Board may
investigate and determine the appropriate sanction.
Stat. Auth.: ORS 676.185 - 676.200 &
677.265
Stats. Implemented: ORS 676.185
- 676.200 & 677.265
Hist.: BME 15-2010(Temp),
f. & cert. ef. 8-3-10 thru 1-18-11; BME 20-2010, f. & cert. ef. 10-25-10;
OMB 9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12; OMB 22-2013(Temp), f. 8-2-13,
cert. ef. 8-3-13 thru 1-30-14; OMB 38-2013, f. & cert. ef. 10-15-13
847-065-0070
Licensees
with Primary Residence or Work Site Outside of Oregon
If a licensee’s
primary residence or work site is located outside the State of Oregon, the licensee
must enroll in the HPSP, in accordance with OAR 847-065-0025 and 847-065-0030 for
Board-referred or 847-065-0035 for self-referred licensees, and may choose to be
monitored by the out-of-state’s health professional program if the following
conditions are met:
(1) The other
state’s health professional program is substantially similar with the relevant
Oregon statutes. It is the duty of the contractor to verify this information and
notify the Board of any discrepancies;
(2) The other
state’s health professional program sends quarterly reports on the licensee
to the contractor; and
(3) The other
state’s health professional program will promptly report any substantial non-compliance
with the licensee’s diversion agreement to the contractor.
Stat. Auth.: ORS
676.185–676.200 & 677.265

Stats. Implemented:
ORS 676.185–676.200 & 677.265

Hist.: OMB
9-2011, f. & cert. ef. 4-25-11; OMB 17-2012(Temp), f. & cert. ef. 7-31-12
thru 1-15-13; OMB 33-2012, f. & cert. ef. 10-22-12

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