May 2015

PLEASE READ THIS IMPORTANT MESSAGE FROM THE OKLAHOMA MEDICAL BOARDAND COMPLETE THE ONLINE PRESENTATION BY NOVEMBER, 2015

Oklahoma Health Care Providers’ Responsibilities and Rights Under Certain Medical Treatment Laws

In Accordance with Oklahoma State law (Title 63, Okla. Stat. Ann, Section 3162), the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) is required to prepare an Online Presentation regarding medical treatment laws that must be viewed at least once during each consecutive two calendar-year period by all health care providers and other defined officials associated with an inpatient health care services entity.

As of Thursday, March 12, 2015, the online presentation was made available on our website. You may access the presentation on our website on the “Education” section https://secure.okmedicalboard.org/cme/

You will have to create a new login and password for this site. Your existing login for the online renewal website does not work on the CME site. If you have a License issued by OSBMLS, such as an MD or PA license, you can use the “Professional” registration. Most people receiving an email directly from the Medical Board will use the “Professional” registration. All other licensees and non-licensees required to view the material should use the “Public” registration. There is no difference in the course material. Instructions for creating a login to view the course material are in the document at the link below: http://www.okmedicalboard.org/download/742/MEDICAL_TREATMENT_LAW_HB2603_ONLINE_PRESENTATION_GUIDE.pdf

Or use this: The Guide to create login & use the online presentation can be downloaded at: The Guide to MTLA

The course will take approximately one hour to complete. If you wish, you may pause and resume at the section where you left off at a later time using the login information you created. After you successfully log in and complete the course “Oklahoma Health Care Providers’ Responsibilities and Rights Under Certain Medical Treatment Laws,” you will be given the opportunity to print a certificate of completion. Retain this certificate for your personal and/or your employer’s records. Do not send the certificate to the Medical Board. We will be notifying all providers we license (MDs and PAs) individually by the e-mail address we have on file. Other providers will be notified by their licensing boards, Hospital Association, Health Department, et al. This will complete the medical board’s responsibilities under HB2603. Please assist us in spreading the word to each and every healthcare provider and others in your facility that are required to comply with this law. Thank you. Oklahoma Medical Board Phone: 800-381-4519 Website: http://www.okmedicalboard.org

Full Requirements of the law: Pursuant to state law (Title 63, Okla. Stat. Ann, Section 3162), inpatient health care services entities (1) shall ensure that all health care providers and other defined officials (2) associated with the inpatient health care services entity are provided with a copy of this brochure and sign a certification that they have read the brochure found here and are familiar with their responsibilities and rights as set forth therein within fourteen (14) days of beginning employment with, beginning service on the board of directors of, or beginning to provide services to patients at the entity; and at least once during each calendar year. http://www.okmedicalboard.org/download/738/HEALTH+CARE+PROVIDERS+BROCHURE+NOV+2014+FINAL508.pdf

In addition to the requirements relating to this brochure, at least once during each consecutive two calendar-year period all health care providers and other defined officials associated with an inpatient health care services entity shall observe an online presentation prepared by the State Board of Medical Licensure and Supervision regarding medical treatment laws information. The time required for observation of this presentation shall count as part of, rather than being in addition to, continuing education otherwise required for licensed health care providers.

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President’s Letter Imagine the thrill of buying your tickets, confirming your hotel reservations, and finally getting to see the results of all your hard work together. Will he like it? Did I speak too soon? How long will this relationship last?

Driving towards the event that is likely to have a significant impact on your next 20 years, you struggle with suppressing the anxiety of a new role, and not being too complacent with the status quo. You’ve gone down this road in Oklahoma enough times to become familiar with the terrain from many different angles. No GPS for you! Of course, I’m speaking of the Oklahoma State Medical Association (OSMA) annual meeting held April 17th & 18th at the OSMA headquarters in Oklahoma City. Now, before you rush to stone me for giving you a false pretense to read this newsletter, let me give you a behind the scenes look at what really goes on amongst the doctors of the OSMA!

I arrived at my destination at 8 am to find a very organized and friendly registration. Not long lines, mind you, but a hot piping breakfast to make us all smile from the very beginning. While waiting for our caucus to begin, I realized just how congenial and warm our fellow doctors from Oklahoma really are. I’m truly grateful that despite our “silos” and competing health care systems, it’s nice to be appreciated for who you really are…another doctor! But you can only eat for so long, and the show must go on.

On a personal note, I was a bit skeptical of how we as 10-12 Tulsa county doctors would produce something meaningful for the rest of the OSMA general session. To my delight, I came away with the following:

1. The Speaker (Dr. George Monks) and Vice-Speaker (Dr. Mary Clarke) of the House of Delegates made us feel right at home by answering our questions about procedures, but most importantly, came by our caucus to welcome us to the meeting. They kept things moving throughout the general session and ran the delegate elections with an equal voice for all of the candidates.

2. We had the privilege of hearing from Dr. Brockman on what really happened during his year as OSMA president! In all seriousness, he enlightened us on his advocacy trip to Washington DC, and made it quite clear that there are always two sides to every story and legislative issue. I appreciate his willingness to stand in the gap for the benefit of Oklahoma doctors. Now that your term as OSMA president is over, you might even have some extra time for those long runs!

3. Resolutions to the OSMA annual meeting are designed to express the consensus of practicing doctors in the state of Oklahoma. Some resolutions, if passed, will move on to the AMA annual meeting in Chicago this summer for debate by the entire AMA delegation. It became quite apparent from several of the resolutions passed that physicians aren’t willing to give up (and we shouldn’t) how we determine what constitutes the quality of medical practice. For example, Tulsa County (Dr. Siegler was the author) presented a successful resolution that called into question the traditional role of “board certification” to determine hospital privileges and insurance reimbursements. If governments and hospitals alike are in favor of “evidence based medicine”, then quality of care for our patients should be determined by scientific data, not age old traditions that become burdensome to maintain.

4. Candidates to the AMA delegation (including alternates) from the state of Oklahoma are elected at the OSMA annual meeting. I’m not used to listening to doctors on the campaign trail, but there’s a time for everything! Tulsa County was fortunate to have Dr. Scott Dunitz (PLICO Board) and Dr. Pete Aran (AMA Alternate Delegate) elected to represent our interests in their upcoming terms. Don’t forget to congratulate them on that accomplishment.

5. Finally, what would the afternoon session be like without a report from our OSMA lobbyists, Jim Dunlap, Pat Hall and OSMA Legislative Director, Wes Glinsmann on legislative issues this session? This might surprise you, but the most controversial issue this session was hunting rights on feral hogs! The trio we have hired to lobby for the practice of medicine are truly an outstanding asset to us as Oklahoma doctors. I would be remiss not to mention the PMP bill which has now been signed into law and will soon be implemented in each of our medical offices. We have included some of the most frequently asked questions about the PMP bill in this newsletter for your information.

So is getting involved in leadership medicine worth the effort? You may be discouraged about what medicine will look like in 20 years, but without the dedicated leadership from our state, I can guarantee it would look much worse. Attending the OSMA annual meeting opened my eyes to the benevolence of practicing doctors who are willing to take a risk and stand up for the practice of medicine. Make sure you thank them every chance you get.

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Inpatient health care services entities shall ensure that all health care providers & other defined officials associated with the inpatient health care services entity provide the entity with a copy of each dated certification by the Board verifying that the provider or official observed the online presentation described in subsection A of this section in compliance with this requirement & shall maintain such copies on file for a minimum of four (4) calendar years following the calendar year to which they apply. The files of such copies shall be subject to inspection under subsection B of Section 1-705, & Sections 1-829 and 1-1911 of Title 63 of the Oklahoma Statutes.

1. Inpatient health care services entities are those hospitals defined in paragraphs 2, 3 and 5 of Section 1-701 of Title 63 of the Oklahoma Statutes, a nursing facility as defined in paragraph 10 of Section 1-1902 of Title 63 of the Oklahoma Statutes, a specialized facility as defined in paragraph 11 of Section 1-1902 of Title 63 of the Oklahoma Statutes, and those long-term care facilities described in subparagraphs E and F of paragraph 1 of Section 1-1945 of Title 63 of the Oklahoma Statutes. 2. Other defined officials means with regard to a particular health care services entity, to the extent such officials exist, the members of the board of directors, the administrator or chief executive officer, and the general counsel, by whatever titles those serving these functions may be called.

IN MEMORIAM

John H. Smith, Jr., M.D.March 30, 2015

HISTORY OF MEDICINE IN TULSA COUNTY

The Tulsa County Medical Society is sponsoring the publishing of a comprehensive history of the practice of medicine in Tulsa County. Beginning with the first known practitioners in the area and continuing to the present, this book will recognize the medical pioneers and events that have shaped our medical community and provide an opportunity for our members, both past and present, who have built upon that legacy to include their own career histories. This will be a hardcover, fully illustrated piece that members will want to keep and share with family members, friends and patients for years to come. Our history will be published by Legacy Publishing Co. of Birmingham, Alabama and is scheduled for a winter, 2016 publishing date. Publisher John Compton has published histories of numerous other medical communities including Nashville, Memphis, and Raleigh, North Carolina. He has most recently worked with the Oklahoma County Medical Society and will be publishing the history of Oklahoma County’s medical community later this year. Please let us know if you have photos you think would be of interest or information that you would like to see included.

On March 31, 2015 Governor Mary Fallin signed HB 1948, which will require physicians to check the state’s prescription monitoring program (PMP) database before prescribing opioids and other powerful drugs. Below are some of the most frequently asked questions about HB 1948:Q: When will the law take effect? A: November 1, 2015.

Q: What drugs will I be required to check? A: Opiates, benzodiazepines & carisoprodol.

Q: How often will I have to check the PMP? A: You must check on the initial prescription of any of the drugs listed above. For a patient who is on one of these drugs long-term, you must re-check at least every 180 days.

Q: Can my staff check the PMP for me? A: Yes. The new law will allow staff members to have their own log-in credentials and check the PMP on behalf of the prescribing physician. This is different from the current law, which prohibits prescribers from allowing staff to access the PMP, subject to a $2,000 fine per violation.

Q: Can I put a copy of the PMP check in the patient’s record? A: Yes, you can note that you checked the PMP and/or print out a copy of the PMP report and keep it in the patient’s medical chart. This differs from the current law, which prohibits any notation of a PMP check in the patient’s record. The new law does not require documentation in the chart, it is left to the discretion of the physician.

Q: Are there any exemptions? A: Yes, prescriptions provided to patients in nursing homes or end-of-life care are exempt.

Q: I’m a surgeon and my patients are going to be in pain. Won’t this law slow down their post-operative pain treatment? A: In most cases, it shouldn’t. The law does not require the PMP to be checked at the time of prescription, just prior to the prescription being written for a patient of record. In other words, the PMP can be accessed as soon as a patient has an appointment or during the pre-operative period so that the prescription can be ready as soon as it is needed.

Q: Who will be responsible for enforcement of this law? A: The various licensure boards will be responsible enforcing the law on their respective licensees. Violations will be treated & investigated just like any other complaint. Previously, enforcement was done by the Bureau of Narcotics with fines of up to $2,000 per violation.

Q: Will this be the law permanently? A: No, the bill contains a five-year sunset provision, meaning the Legislature would have to act to reauthorize it at that time. We are confident that advances in eprescribing along with education regarding the PMP and opioid prescribing will make a permanent mandate unnecessary.

Q: How do I or a member of my staff get registered to access the PMP? A: Contact the OK Bureau of Narcotics at 1-877-627-2674 or pmphelpdesk@obn.state.ok.us.

Tulsa County Medical Society5315 South Lewis AvenueTulsa OK 74105-6539

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Many parents and grandparents are reluctant to discuss their estate plans—particularly their plans for leaving behind an inheritance—with younger generations of the family. They may feel uneasy revealing too many specifics about their plans, fearing that their children or grandchildren will feel entitled and not become productive members of society.

However, failure to have conversations about the family’s wealth and educate younger members on financial management can lead to long-term problems, says Jeff Sanders, Managing Director and Market Executive of The Private Bank at Bank of Oklahoma. It can lead to poor documentation and organization as well as financial mismanagement by adult children who were never taught to manage or value money. It can also cause a lack of participation among family members in the wealth-transfer process.

“I think there is a fear that once the future heirs know the size of the estate that they potentially will become less motivated to become a success themselves,” Sanders adds. “But what families need to realize is that avoiding conversations about the family’s wealth creates many problems of its own.”

Sanders says older generations can take some steps to improve communication and, in the process, ensure that younger family members are prepared to take the reins in the future.

Create a values statement. Before talking with younger generations about money, senior family members should thoroughly understand—and write down—the financial values and lessons they wish to impart. A values statement can be anywhere from one page to many pages, but the idea is to clarify your values around money and relay those values to younger family members who may feel disconnected from the family history and wealth-building process. The written values statement should be seen as a living document that can be built upon and adapted in the future; it lays out fundamental information to help younger family members better understand the importance of preserving the family’s wealth. “The values statement might

explain, for example, how the family’s wealth was first created and stress the importance of hard work, saving and investing,” Sanders says. “It might outline key principles about building and managing wealth.”

Engrain financial values through active involvement. One common issue among high-net-worth families is that younger generations never learn the skills and financial values they need to preserve the family’s wealth plans and legacy. As a result, they may end up investing money recklessly or, worse, spending it all. But there are key ways to teach younger generations to value the family’s wealth and learn to preserve it, Sanders says. For example, parents should involve their adult children in annual reviews with the family’s financial advisor. This will give the children strong knowledge of how the family’s assets are invested and ensure they know where to turn for wealth-management questions or concerns in the future. Parents can encourage their children to take an even more hands-on role by asking them to research and report back on various types of investments, whether real-estate investment trusts (REITs), exchange-traded funds (ETFs), or master limited partnerships (MLPs). This process helps educate them about the workings of various investment types and provides them with a better understanding of the investing process, Sanders adds. Some families with philanthropic goals set up charitable foundations and appoint their children to the governing boards. This gives the children an active role in helping the family determine how it selects and donates to various causes.

Explain and organize the estate-planning documents. Many people’s estate plans include various legal documents, including a will, a health-care directive, power of attorney and trusts. Younger family members may eventually be responsible for seeing that those legal arrangements are followed and enforced. It’s important that they are familiar with these documents and where they can find them, if need be. Keeping copies of the documents in a safe place—and explaining to the younger generation how they can be accessed—can help improve communication regarding your estate plans and ensure a smoother wealth transfer, Sanders says.

Prepared by WSJ Custom Studios, December 23, 2014. The opinions expressed herein reflect the judgment of the author at this date and are subject to change without notice and are not a complete analysis of any sector, industry or security. The content in this document is for informational and educational purposes only and does not constitute legal, tax or investment advice. Always consult with a qualified financial professional, accountant or lawyer for legal, tax and investment advice.

Greg Lee | 918.293.7579 | greg.lee@bokf.com www.bankofoklahoma.com

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Greg Lee | 918.293.7579 | greg.lee@bokf.com www.bankofoklahoma.com