Arkansas Administrative Code › Agency 060 - STATE MEDICAL BOARD › Rule 060.00.18-002 - Amendment to Regulation 2.4

Current through Register Vol. 49, No. 6, June, 2024
REGULATION NO. 2
The Arkansas Medical Practices Act authorizes the Arkansas State
			 Medical Board to revoke or suspend the license issued by the Board to practice
			 medicine if the holder thereof has been found guilty of grossly negligent or
			 ignorant malpractice.
"Malpractice" includes any professional misconduct, unreasonable
			 lack of skill or fidelity in professional duties, evil practice, or illegal or
			 immoral conduct in the practice of medicine and surgery.
It shall include, among other things, but not limited to:
1. Violation of laws, regulations, and
		  procedures governing payment to physicians for medical services for eligible
		  public assistance recipients and/or other third party payment
		  programs.
2. Participation in any
		  plan, agreement, or arrangement which compromises the quality or extent of
		  professional medical services or facilities at the expense of the public
		  health, safety, and welfare.
3.
		  Practicing fraud, deceit, or misrepresentation in the practice of
		  medicine.
4. The prescribing of
		  excessive amounts of controlled substances to a patient including the writing
		  of an excessive number of prescriptions for an addicting or potentially harmful
		  drug to a patient "Excessive" is defined as the writing of any prescription in
		  any amount without a detailed medical justification for the prescription
		  documented in the patient record.
A. Chronic
		  Pain: If there is documented medical justification, "excessive" is defined,
		  pursuant to the Centers for Disease Control fCDQ guideline for prescribing
		  opioids for chronic pain.as prescribing opioids at a level that exceeds >=
		  50 Morphine Milligram Equivalents (MME) per day, unless the physician/physician
		  assistant documents each of the following:
a.
		  Objective findings, which include, but are not limited to. imaging studies, lab
		  testing and results, nerve conduct ion testing, biopsy, and any other test that
		  would establish pain generating pathology.
b. Specific reasons for the need to prescribe
		  >= 50 MED per day.
c. Documented
		  alternative treatment plans as well as alternative therapies triaied and failed
		  prior to considering chronic opioid therapy.
d. Documented risk factor assessment
		  detailing that the patient was informed of the risk and the addictive nature of
		  the prescribed drug.
e. Documented
		  assessment of the potential for abuse and/or diversion of the prescribed
		  drug.
f. That the Prescription Drug
		  Monitoring Program had been checked prior to issuing the
		  prescription.
g. A detailed
		  clinical rationale for the prescribing and the patient must be seen in an
		  in-person examination every three (3) months or every 90 days.
h. The definition of "excessive" as contained
		  in this Regulation shall not apply to prescriptions written for a patient in
		  hospice care, in active cancer treatment, palliative care, end-of-life care,
		  nursing home, assisted living or a patient while in an inpatient setting or in
		  an emergency situation.
i. Regular
		  urine drug screens should be performed on patients to insure the patient is
		  taking prescribed medications and is not participating or suspected of
		  participating in diversion or abuse of non-prescribed medications. The
		  treatment of chronic pain shall be consistent with the CDC guidelines as they
		  relate to baseline drug testing, and at least annual follow up testing as
		  warranted for treatment.
j. A pain
		  treatment agreement must be signed and reviewed by the patient when initiating
		  chronic opioid therapy. This agreement should discuss the following: informed
		  risk and addictive nature of prescribed medications, outline the specific
		  expectations between patient and physician, informed consent for periodic urine
		  drug screenings and random pill counts with urine screening as well as the
		  provisions for termination of opioid therapy.