23664 Federal Register / Vol. 63, No. 83 /Thursday, April 30, 1998 /Rules and Regulations

Collection of Information

This rule contains no collection of

information requirements under the

Paperwork Reduction Act (44 U.S.C.

3501 et seq).

Federalism

The Coast Guard has analyzed this

regulation under the principles and

criteria contained in Executive Order

12612 and has determined that this

regulation does not have sufficient

federalism implications to warrant the

preparation of a Federalism Assessment.

Environmental Assessment

The Coast Guard has considered the

environmental impact of this regulation

and concluded that under section 2.B.2.

of Commandant Instruction M16475.1C

it will have no significant

environmental impact and it is

categorically excluded from further

environmental documentation. A

Categorical Exclusion Determination

and an Environmental Analysis

checklist is available for inspection and

copying in the docket to be maintained

at the address listed in ADDRESSES in the

preamble.

Unfunded Mandates

Under the Unfunded Mandates

Reform Act of 1995 (Pub. L. 104–4), the

Coast Guard must consider whether this

rule will result in an annual

expenditure by state, local, and tribal

governments, in the aggregate of $100

million (adjusted annually for inflation).

If so, the Act requires that a reasonable

number of regulatory alternatives be

considered, and that from those

alternatives, the least costly, most costeffective, or least burdensome

alternative that achieves the objective of

the rule be selected.

No state, local, or tribal government

entities will be effected by this rule, so

this rule will not result in annual or

aggregate costs of $100 million or more.

Therefore, the Coast Guard is exempt

from any further regulatory

requirements under the Unfunded

Mandates Act.

List of Subjects in 33 CFR Part 165

Harbors, Marine safety, Navigation

(water), Reporting and recordkeeping

requirements, Security measures,

Waterways.

Regulation

In consideration of the foregoing,

Subpart F of Part 165 of Title 33, Code

of Federal Regulations, is amended as

follows:

1. The authority citation for 33 CFR

Part 165 continues to read as follows:

Authority: 33 U.S.C. 1231; 50 U.S.C. 191;

33 CFR 1.05–1(g), 6.04–1, 6.04–6 and 160.5;

49 CFR 1.46.

2. A new § 165.T11–052 is added to

read as follows:

§ 165.T11–052 Safety Zone; Santa Barbara

Channel, CA.

(a) Location. The safety zone will

encompass a water area extending 500

yard in all directions from the center of

the Seacliff pier complex in the Santa

Barbara Channel, which is situated at

approximately 34°¥21.02′ N,

119°¥25.46′ W. All coordinates in this

paragraph use Datum: NAD 83.

(b) Effective Date. This section will be

in effect from 7 a.m. PDT on April 14,

1998 until 7 p.m. PST on January 3,

1999.

(c) Regulations. In accordance with

the general regulations in § 165.23 of

this Part, entry into, transit through, or

anchoring within this safety zone is

prohibited unless authorized by the

Captain of the Port.

Dated: April 13, 1998.

G.P. Wright,

Captain, U.S. Coast Guard, Captain of the

Port, Los Angeles-Long Beach, CA.

[FR Doc. 98–11229 Filed 4–29–98; 8:45 am]

BILLING CODE 4910–15–M

DEPARTMENT OF VETERANS

AFFAIRS

38 CFR Part 47

RIN 2900–AI78

Reporting Health Care Professionals to

State Licensing Boards

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

SUMMARY: It continues to be the policy

of the Department of Veterans Affairs

(VA) to report to State Licensing Boards

any separated physician, dentist, or

other licensed health care professional

whose clinical practice so significantly

failed to meet generally accepted

standards of clinical practice as to raise

reasonable concern for the safety of

patients. This document provides that,

in addition, VA will report to State

Licensing Boards any currently

employed physician, dentist, or other

licensed health care professional (one

who is on VA rolls) whose clinical

practice so significantly failed to meet

generally accepted standards of clinical

practice during VA employment as to

raise reasonable concern for the safety of

patients. Some health care professionals

who are VA employees also provide

health care outside VA’s jurisdiction.

Accordingly, the reporting of currently

employed licensed health care

professionals who meet the standard for

reporting is necessary so that State

Licensing Boards can take action as

appropriate to protect the public.

Examples of actions that meet the

criteria for reporting are set forth in the

text portion of this rulemaking. Also,

nonsubstantive changes are made for

purposes of clarity.

DATES: Effective Date: June 1, 1998.

FOR FURTHER INFORMATION CONTACT:

Ruth-Ann Phelps, Ph.D., Veterans

Health Administration, Patient Care

Services (11B), Department of Veterans

Affairs, 810 Vermont Ave. NW,

Washington, DC 20420, at (202) 273–

8473 (this is not a toll-free number).

SUPPLEMENTARY INFORMATION: In a

document published in the Federal

Register on October 8, 1997 (62 FR

52519), we proposed to expand our

policy of reporting to State Licensing

Boards to include any currently

employed physician, dentist, or other

licensed health care professional (one

who is on VA rolls) whose clinical

practice so significantly failed to meet

generally accepted standards of clinical

practice during VA employment as to

raise reasonable concern for the safety of

patients. Previously, the regulations

only allowed the VA to report separated

employees. The comment period ended

on December 8, 1997. We received one

comment.

The regulations, among other things,

provide that VA will report individuals

to State Licensing Boards for ‘‘substance

abuse when it affects the individual’s

ability to perform appropriately as a

health care provider or in the patient

care environment.’’ The commenter

asserted that individuals should be

reported for any substance abuse that is

identified, and that any reporting

should include a recommendation that

the individual be required to obtain

assistance at a substance abuse

rehabilitation program.

No changes are made based on this

comment. The provisions of Section 204

of Public Law 99–166 set forth the basic

authority for reporting separated

individuals to State Licensing Boards.

This Statutory authority to report

separated individuals to State Licensing

Boards is limited to reporting based on

a finding concerning an individual’s

clinical competence. We believe the

policy for reporting should be the same

for separated and currently employed

individuals. Therefore, the final rule

provides for reporting only if the finding

of substance abuse reflects a finding that

the clinical practice of the individual so

significantly failed to meet generally
Federal Register / Vol. 63, No. 83 /Thursday, April 30, 1998 /Rules and Regulations 23665

accepted standards of clinical practice

during VA employment as to raise

reasonable concern for the safety of

patients. Even so, it would seem that in

almost every case in which substance

abuse is found, we would also be able

to determine that it affects the

individual’s ability to perform

appropriately as a health care provider

in the patient care environment.

Further, currently employed individuals

who are identified as substance abusers

are always encouraged by VA to obtain

rehabilitation assistance, and there is no

need to make a special recommendation

to State Licensing Boards since we are

aware that State Licensing Boards

routinely provide similar

encouragement.

Executive Order 12866

This rule has been reviewed by OMB

under Executive Order 12866.

Regulatory Flexibility Act

The Secretary hereby certifies that

this final rule will not have a significant

economic impact on a substantial

number of small entities as they are

defined in the Regulatory Flexibility

Act, 5 U.S.C. 601–612. The rule will

affect only individuals and will not

directly affect any small entities.

Therefore, pursuant to 5 U.S.C. 605(b),

this rule is exempt from the initial and

final regulatory flexibility analyses

requirements of §§ 603 and 604.

There are no applicable Catalog of

Federal Domestic Assistance program

numbers.

List of Subjects in 38 CFR Part 47

Health professions.

Approved: April 22, 1998.

Togo D. West, Jr.,

Acting Secretary.

For the reasons set forth in the

preamble, 38 CFR part 47 is amended as

follows:

PART 47—POLICY REGARDING

REPORTING HEALTH CARE

PROFESSIONALS TO STATE

LICENSING BOARDS

1. The authority citation for part 47

continues to read as follows:

Authority: Pub. L. 99–166, 99 Stat. 941; 38

U.S.C. 501.

2. The part heading for part 47 is

revised to read as shown above.

3. In part 47, both subpart A and

subpart B headings are removed.

4. In § 47.1, paragraph (a) is removed;

paragraphs (b) through (h) are

redesignated as paragraphs (a) through

(g), respectively; new paragraphs (h) and

(i) are added, and the authority citation

is revised, to read as follows:

§ 47.1 Definitions.

* * * * *

(h) Currently employed licensed

health care professional means a

licensed health care professional who is

on VA rolls.

(i) On VA rolls means on VA rolls,

regardless of the status of the

professional, such as full-time, parttime, contract service, fee-basis, or

without compensation.

(Authority: 38 U.S.C. 501, 7401–7405;

Section 204(b) of Pub. L. 99–166, 99 Stat.

952–953; Pub. L. 99–660, 100 Stat. 3743.)

§ 47.2 [Removed]

5. Section 47.2 is removed.

§ 47.3 [Redesignated as § 47.2]

6. Section 47.3 is redesignated as

§ 47.2.

7. The newly redesignated § 47.2 is

revised to read as follows:

§ 47.2 Reporting to State Licensing

Boards.

It is the policy of VA to report to State

Licensing Boards any currently

employed licensed health care

professional or separated licensed

health care professional whose clinical

practice during VA employment so

significantly failed to meet generally

accepted standards of clinical practice

as to raise reasonable concern for the

safety of patients. The following are

examples of actions that meet the

criteria for reporting:

(a) Significant deficiencies in clinical

practice such as lack of diagnostic or

treatment capability; errors in

transcribing, administering or

documenting medication; inability to

perform clinical procedures considered

basic to the performance of one’s

occupation; performing procedures not

included in one’s clinical privileges in

other than emergency situations;

(b) Patient neglect or abandonment;

(c) Mental health impairment

sufficient to cause the individual to

behave inappropriately in the patient

care environment;

(d) Physical health impairment

sufficient to cause the individual to

provide unsafe patient care;

(e) Substance abuse when it affects

the individual’s ability to perform

appropriately as a health care provider

or in the patient care environment;

(f) Falsification of credentials;

(g) Falsification of medical records or

prescriptions;

(h) Theft of drugs;

(i) Inappropriate dispensing of drugs;

(j) Unethical behavior or moral

turpitude;

(k) Mental, physical, sexual, or verbal

abuse of a patient (examples of patient

abuse include intentional omission of

care, willful violation of a patient’s

privacy, willful physical injury,

intimidation, harassment, or ridicule);

and

(l) Violation of research ethics.

(Authority: 38 U.S.C. 501; 7401–7405;

Section 204(b) of Pub. L. 99–166, 99 Stat.

952–953; Pub. L. 99–660, 100 Stat. 3743.)

[FR Doc. 98–11466 Filed 4–29–98; 8:45 am]

BILLING CODE 8320–01–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[Region II Docket No. NY25–2–173b, FRL–

5995–4]

Approval and Promulgation of

Implementation Plans; New York State

Implementation Plan Revision

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Direct final rule.

SUMMARY: The Environmental Protection

Agency (EPA) is approving a revision to

the New York State Implementation

Plan (SIP) for ozone concerning the

control of volatile organic compounds.

The SIP revision consists of

amendments to the New York Code of

Rules and Regulations. This revision

was submitted to comply with the

gasoline vapor recovery provisions for

gasoline service stations in the Clean

Air Act (the Act). The intended effect of

this action is to approve a program

required by the Act which will result in

emission reductions that will help

achieve attainment of the national

ambient air quality standard (NAAQS)

for ozone.

DATES: This rule is effective on June 29,

1998 unless relevant adverse comments

are received by June 1, 1998. If EPA

receives relevant adverse comments, a

timely withdrawal will be published in

the Federal Register.

ADDRESSES: All comments should be

addressed to: Ronald J. Borsellino,

Chief, Air Programs Branch,

Environmental Protection Agency,

Region 2 Office, 290 Broadway, 25th

Floor, New York, New York 10007–

1866.

Copies of the state submittal are

available at the following addresses for

inspection during normal business

hours:

Environmental Protection Agency,

Region II Office, Air Programs Branch,

290 Broadway, 25th Floor, New York,

New York 10007–1866