Nurses ages 55 to 64 increased 142% and RNs over age 65 increased 158% in number from FY 2000 until FY 2009. The number of RNs ages 25 to 34 only increased 26%. The smallest increase from 2000 to 2009 among RNs was nurses under age 25. Among LVNs, two age groups decreased in number from FY 2004 to FY 2009. The number of LVNs under age 25 decreased 7% and LVNs ages 45 to 54 decreased 2%. LVNs ages 25 to 34 increased 13%, LVNs ages 35 to 44 increased 18%, LVNs ages 55 to 64 increased 25% and LVNs over 65  increased 32% from FY 2004 to FY 2009. Industry analysts express concerns that this shift in age will cause a decrease in the supply of nurses as licensees reach retirement age.”

This is very concerning because unless there is a shift towards getting more new, younger nurses there will a huge shortage as the general population becomes older.  This is also in relation to the decreased size of the younger generation and that it is projected there will not be enough to support the older generation with Social Security.  But the effect on one’s health care in older years is just as worrisome.

What is the TMB doing with rehab cases that either have not yet had an ISC or do not have an Order which will be ready by the November meeting? There must be several of these.

Currently, the plan is review each case individually as the investigation is resolved. Then determine if there are any criminal concerns, diversion of narcotics or harm to patients as a result of the addiction. If the answer is no, they will likely be referred to the PHP once it is operational. If the answer is yes to those questions, those investigations will be sent to an ISC for a disciplinary hearing. If the ISC Panel agrees there is one or more of those problems, then those individuals will be subject to a public disciplinary order by the Board. Of course, as the PHP is still in its development stages and the Board still is not fully sure how it is all going to work, all of this is subject to change.

Being a friend, employer, good colleague, or even a family member, you want to make that person happy. You do not want to appear unwelcoming or unable to help this person. The reason physicians choose this demeaning profession is to help people, but at the same time, protocols were established both to help the patient and the physician.

In engaging in a hallway consultation, one arguable establishes a physician-patient relationship. A physician-patient relationship is created a patient consults with a physician or receives medical care, and the patient reasonably believes that a consultation, examination, diagnosis or treatment took place. Therefore, whether a relationship was established is depended on what the patient thought, not what the physician thought or even if money was changed hands.

Providing a diagnosis, recommending treatment, or providing a prescription opens the genii’s bottle on what could occur. If someone walked into one’s office, and make a complaint, a reasonable physician would not provide a diagnosis, treatment or prescribe medications without a history and physical, and not making a record of this treatment. However, by providing a diagnosis, treatment or prescribe medications to someone in an informal setting, that is what you are doing. Without the proper information, one would provide incorrect diagnosis, treatment or prescribe the wrong medication.

Unlike most states, prescribing for yourself or family members is not against the law in Texas. The fact that there is not a law against it does not mean it is advisable. In fact recently, the Texas State Board of Medical Examiners instituted a rule (22 TEXAS ADMINISTRATIVE CODE §190.1(c)(1)(L)(M)) on prescribing habits that are not in violation to the Medical Practice Act.
Generally, the Board requires that one must first establish a proper professional relationship with the patient prior to prescribing either dangerous drugs and/or controlled substances. A proper professional relationship requires the following:
a. establishing that the person requesting the medication is in fact who the person claims to be;
b. establishing a diagnosis through the use of acceptable medical practices such as patient history, mental status examination, physical examination, and appropriate diagnostic and laboratory testing. An online or telephonic evaluation by questionnaire is inadequate;
c. discussing with the patient the diagnosis and the evidence for it, the risks and benefits of various treatment options; and
d. ensuring the availability of the physician or coverage of the patient for appropriate follow-up care.
If the person in question is oneself, a family member, or a “close personal relationship,” requires:
a. prescribing or administering dangerous drugs or controlled substances without taking an adequate history, performing a proper physical examination, and creating and maintaining adequate records; and
b. prescribing controlled substances in the absence of immediate need. “Immediate need” shall be considered no more than 72 hours.
Failure to follow these guidelines may lead to disciplinary action by the Board. It could lead to malpractice suit. Notably, some malpractice carriers will not cover negligent acts that took place outside the traditional practice setting.
The wise thing to do is to refuse to do any hallway consultations. Rather, you can ask the individual to come to your office and formally make them a patient of yours. You are not required to charge the person, but you should treatment them as a new patient. The person should complete a history, should undergo a physical, appropriate diagnostic testing, and documenting all that took place.

As we learn more, we will have more positing on this exciting change.