State Board of Medical Examiners

Medical Psychology Supervision

Guidance for Medical PsychologistsDuring its 2014 session, the Louisiana Legislature established two (2) new categories of providers who are licensed and regulated by the Louisiana State Board of Examiners of Psychologists (LSBEP). As to each, the laws provide a supervisory relationship with a psychologist or medical psychologist (MP).  Specifically, Act 136 established licensed specialists in school psychology (LSSP); Act 137 created provisionally licensed psychologists (PLP).

A LSSP is defined as an individual:

[W]ho applies his knowledge of both psychology and education during consultation and collaboration with others and engages in specific services for students, such as direct and indirect interventions that focus on academic skills, learning, socialization, and mental health. La. R.S. 37:2352(4).

A LSSP who practices as such but is “working outside of the school system” is required to do so under the clinical supervision of a Louisiana licensed psychologist or MP, who is “administrative, clinically, and legally responsible for all professional activities of the licensed specialist in school psychology . . . and shall be required to sign any final reports. . ..” La. R.S. 37:2356.2.B(1)(b).

A PLP is defined as an individual who is:

[P]rovisionally licensed under this Chapter. La. R.S. 37:2352(7).

A PLP is required to maintain a relationship with a licensed psychologist or MP for purposes of clinical supervision. An MP who has entered into such a relationship “shall have legal functioning authority of the professional activities of the PLP.” La. R.S. 37:2356.2.D.

The LSBEP adopted emergency rules for PLP, which prescribe the supervisory obligations. (La. Reg. Vol. 40, No. 8, pp. 1474-1477 (Aug. 2014)). It is likely that rules prescribing obligations for supervisors of LSSP will be issued in due course.

While the LSBEP has no regulatory authority over MPs who do not maintain their license with the LSBEP, the supervisory requirements imposed upon LSSP and PLP by the law and any LSBEP regulations must be met in order for these individuals to lawfully practice their profession. With that in mind, the Board would consider it the professional obligation of any MP who undertakes the supervision of an LSSP or PLP to be aware of and comply with the obligations imposed on such supervisors by law and LSBEP rules. Failure to provide such supervision would work to the detriment of the LSSP or PLP (and clients), who could also be found to be engaged in an improper practice for lack of supervision.

In short, while there may little occasion for an MP to serve as a supervisor for a LSSP or a PLP, an MP who does so should comply with the supervisory obligations imposed by law and LSBEP regulations. To do otherwise may be viewed by the Board as unprofessional conduct or having a professional association with an improper practitioner, which could give rise to disciplinary investigation and/or action by the Board.  

 

CDC Guidance for Monitoring and Movement for Ebola Response

10/28/2014 12:07:28 PM

This is a message from the Louisiana Department of Health and Hospitals Emergency Operations Center (DHH EOC). To remain current on newly released information about the 2014 Ebola Epidemic, visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/vhf/ebola/index.html.

The situation in Louisiana has not changed. The Department of Health and Hospitals (DHH) continues to encourage preparedness for safe response to Ebola.

CDC has released new information for monitoring and movement for Ebola response. “Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola” is available http://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html and “Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure” is at http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html.

This updated guidance focuses on strengthening how we monitor people who may have been exposed to Ebola and how medical professionals will oversee their care and, when warranted to protect the public health or our communities, limit their movement or activities. Through these changes, CDC and state and local health departments seek to support people who may have been exposed to Ebola, while also continuing to stop Ebola at its source in West Africa through the valor of our health care workers who serve. These changes will help ensure their symptoms are monitored and a system is in place to quickly recognize when they need to be routed to care.
These actions will better protect potentially exposed individuals and the American public as a whole.

Key changes to the movement and monitoring guidance:
• New risk levels are given for people who may have been exposed to Ebola, as well as for those not at risk for the disease.
• The guidance recommends stricter actions for escalating level of risk based on the type of exposure.
• State and local public health authorities are advised to use active monitoring or direct active monitoring rather than having people monitor themselves.
• Specific guidance is given about monitoring health care workers who cared for patients with Ebola in a country with widespread transmission, and people who visited an Ebola Treatment Unit in one of those countries.
• Specific guidance is also given about monitoring health care workers who provided care of patients with Ebola in the United States

“Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure” lists the following factors as possible consequences for further international spread:

• the virulence (ability to cause serious disease or death) of the virus,
• the widespread transmission in communities and healthcare facilities in the currently affected countries, and
• the strained health systems in the currently affected and most at-risk countries.

Be reminded that coordinated public health actions are essential to stop and reverse the spread of Ebola. Health care workers who take care of patients with Ebola are not only helping the nations facing the Ebola outbreak but also protecting people in the United States by helping to fight the outbreak at its source. The risk in this country will only be fully addressed when the current outbreak in Africa is over, and the participation of U.S. and other health care workers from outside of the countries with widespread transmission is essential to control the disease.

For general discussion about Ebola, email the Louisiana Department of Health and Hospitals at Ebola@la.gov. Immediately notify the Louisiana Office of Public Health at 504-568-8313 or after hours at 800-256-2748 to discuss a possible exposure, report a suspected case and arrange for laboratory testing.

 

Emergency Temporary Permits

The Board has received inquiries regarding the procedure for issuance of an emergency temporary permit in the event of a public health emergency, as declared by DHH. Click here.

 

CHANGES IN PRESCRIBING HYDROCODONE COMBINATION DRUGS

The Board continues to receive questions from authorized prescribers concerning the impact of the changes to the CDS classification of Hydrocodone combination products, effective October 1, 2014.  Click HERE to view an advisory, prepared by LAMMICO, that should provide the explanation for how these changes will affect your prescribing practices.

 

Physician Collaboration with Advanced Practice Registered Nurses

A public hearing will be held on Wednesday, September 24, 2014, at 10 a.m. at the office of the Louisiana State Board of Medical Examiners, 630 Camp Street, New Orleans, LA 70130 on the proposed rules Physician Collaboration with Advanced Practice Registered Nurses.

 

DEA to Publish Final Rule Rescheduling Hydrocodone Combination Products

For immediate release

On Friday the U. S. Drug Enforcement Administration (DEA) will publish in the Federal Register the Final Rule moving hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II, as recommended by the Assistant Secretary for Health of the U.S. Department of Health and Human Services (HHS) and as supported by the DEA’s own evaluation of relevant data.  The Federal Register has made the Final Rule available for preview on its website today at http://go.usa.gov/mc8d.  


This Final Rule imposes the regulatory controls and sanctions applicable to Schedule II substances on those who handle or propose to handle HCPs.  It goes into effect in 45 days (October 14, 2014).


The Controlled Substances Act (CSA) places substances with accepted medical uses into one of four schedules, with the substances with the highest potential for harm and abuse being placed in Schedule II, and substances with progressively less potential for harm and abuse being placed in Schedules III through V.  (Schedule I is reserved for those controlled substances with no currently accepted medical use and lack of accepted safety for use.)  HCPs are drugs that contain both hydrocodone, which by itself is a Schedule II drug, and specified amounts of other substances, such as acetaminophen or aspirin. “Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents,” said DEA Administrator Michele Leonhart, “Today’s action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available.”

 

When Congress passed the CSA in 1970, it placed HCPs in Schedule III even though it had placed hydrocodone itself in Schedule II.  The current analysis of HCPs by HHS and the DEA shows they have a high potential for abuse, and abuse may lead to severe psychological or physical dependence.  Adding nonnarcotic substances like acetaminophen to hydrocodone does not diminish its abuse potential.  The many findings by the DEA and HHS and the data that support these findings are presented in detail in the Final Rule on the website.  Data and surveys from multiple federal and non-federal agencies show the extent of abuse of HCPs.  For example, Monitoring the Future surveys of 8th, 10th, and 12th graders from 2002 to 2011 found that twice as many high school seniors used Vicodin®, an HCP, nonmedically as used OxyContin®, a Schedule II substance, which is more tightly controlled.
In general, substances placed under the control of the CSA since it was passed by Congress in 1970 are scheduled or rescheduled by the DEA, as required by the CSA and its implementing regulations, found in Title 21 of the Code of Federal Regulations.  Scheduling or rescheduling of a substance can be initiated by the DEA, by the HHS Assistant Secretary of Health, or on the petition of any interested party.  (Detailed information on the scheduling and rescheduling process can be found beginning on page 8 of Drugs of Abuse on the DEA’s website at http://www.justice.gov/dea/pr/multimedia-library/publications/drug_of_abuse.pdf.)

 

Supervising Physician’s New Requirement for Approval of Permit

Effective October 1st, all physicians submitting applications for the one-time supervising physician (SP) credential must successfully complete a short online course on the subject of Physician Assistant Supervision to demonstrate their knowledge of the rules and regulations.  The course is entitled “Supervising Physician Assistants” and can be accessed via the Online Education section on the Board’s homepage. 

 

Clarification to Comments re PA's

Louisiana State Board of Medical Examiners provides clarification to comments concerning regulations for physician assistans. See here.

 

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