Alabama Administrative Code › Title 545 - MEDICAL LICENSURE COMMISSION OF ALABAMA › Chapter 545-X-1 - ORGANIZATION AND ADMINISTRATION › Section 545-X-1-.11 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) These rules
			 incorporate by reference those definitions contained in
Code of
			 Ala. 1975
, §§
								20-2-2,
			 41-22-3,
			 unless the context clearly indicates otherwise. For the purposes of these
			 rules, the following words and phrases shall have the respective meanings
			 ascribed by this section:
(a) Licensee shall
			 mean a physician licensed to practice medicine in the State of
			 Alabama.
(b) Commission shall mean
			 the Medical Licensure Commission of the State of Alabama.
(c) Certificate shall mean a certificate of
			 qualification duly issued by the Alabama State Board of Medical
			 Examiners.
(d) Board shall mean the
			 Alabama State Board of Medical Examiners.
(e) Complainant shall mean the party that is
			 responsible for preparing and prosecuting complaints in contested cases before
			 the Medical Licensure Commission.
(f) Respondent shall mean the licensee whose
			 license to practice medicine is the subject of the complaint filed before the
			 Commission.
(g) Legal Counsel shall
			 mean an individual designated as a legal counsel by the Medical Licensure
			 Commission of Alabama and appointed pursuant to these rules.
(h) Parties shall mean the complainant, the
			 respondent, and any person permitted to intervene in a contested
			 case.
(i) Legitimate medical
			 purpose shall mean a therapeutic treatment regimen or program generally
			 recognized and accepted in the field of medical science as being safe and
			 effective in the diagnosis, treatment, correction or alleviation of a specific
			 medical condition of the patient, under all relevant circumstances.
(j) Practicing medicine in such a manner as
			 to endanger the health of the patient of the practitioner shall mean to expose
			 the health of the patient to unreasonable risks of harm which are not medically
			 justified by the expected benefits to the patient, under all the circumstances
			 evident in the diagnosis and treatment of the medical condition of the
			 patient.
(k) Performance of
			 unnecessary diagnostic tests or medical or surgical services shall mean to
			 administer medical tests or medical or surgical services which are not
			 reasonably indicated or which are not reasonably required in order to ensure
			 the well being of the patient of the practitioner, after considering all of the
			 circumstances.
(l) Malpractice as
			 used in these rules shall mean negligence. Gross malpractice shall mean gross
			 negligence. Negligence shall mean the failure to do that which a reasonably
			 prudent physician would have done under the same or similar circumstances, or
			 the doing of that which a reasonably prudent physician would not have done
			 under the same or similar circumstances. Gross negligence is the conscious
			 doing of an act or the omission of some duty to act with a conscious disregard
			 of known conditions of danger or with careless and reckless indifference to the
			 consequences of such act or omission. For the purposes of this rule the
			 existence of negligence or gross negligence may be established without proof of
			 actual injury or harm to the patient, provided that the act or omission
			 complained of created a substantial risk of harm to the health and wellbeing of
			 the patient which risk was known or should have been known to a reasonably
			 prudent practitioner and which was not medically justified by the expected
			 benefits to the patient from the act or omission.
(m) In considering whether a fee for medical
			 services is grossly excessive, as this term is used in these rules, the
			 Commission may consider the following factors:
1. The difficulty and/or uniqueness of the
			 service performed as well as the time, skill and/or experience
			 required;
2. The fee customarily
			 charged in the locality for similar physician services;
3. The amount of the charges
			 involved;
4. The nature and length
			 of the professional relationship with the patient;
5. The experience, reputation and ability of
			 the physician in performing the kind of services involved;
6. The costs to the physician of devices or
			 appliances or other special items (excessive of reasonable overhead expenses)
			 furnished in connection with the service; and
7. The facts relating to the opportunity of
			 the patient and physician to discuss the amount of fees in question prior to
			 the initiation of the medical services.
(n) Licensed practitioners specializing in
			 the treatment of depression shall mean a psychiatrist licensed to practice
			 medicine in the State of Alabama or a physician licensed to practice medicine
			 in the State of Alabama who devotes a substantial portion of his practice to
			 the specialized treatment of mental or emotional illness.
(o) Physician shall mean either a doctor of
			 medicine or a doctor of osteopathy.
(p) The practice of medicine shall mean and
			 include both the practice of medicine and the practice of osteopathy.
(q) Licensed to practice medicine shall mean
			 either the practice of medicine by a doctor of medicine or the practice of
			 osteopathy by a doctor of osteopathy.
(r) Doctor shall mean either a doctor of
			 medicine or a doctor of osteopathy.
(s) False or fraudulent claims for medical
			 services shall mean any claim or claims requesting payment for any medical
			 services which contain any misrepresentation of any material fact, or any
			 suppression of any material fact, regarding any services for which the claim or
			 claims is made if such misrepresentation or suppression is made with knowledge
			 that such fact is being misrepresented or suppressed or if such
			 misrepresentation or suppression is made recklessly without
			 knowledge.
(t) Minimum standards
			 for medical records shall mean medical records maintained as to each patient in
			 each physician's office which shall be documented legibly in the English
			 language and which shall include, at a minimum, a record of:
1. the patient's complaint or
			 complaints;
2. the history and
			 physical examination;
3. the
			 treatment given or recommended; and,
4. all follow up recommendations.
(u) Hearing officer shall mean an
			 individual designated as a hearing officer by the Medical Licensure Commission
			 of Alabama and appointed pursuant to these rules.