CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements: A. The Respondent agrees to undergo monitoring by the Board until at least five years from the date on which the Board accepted this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period. B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s substance abuse history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice. C. The Respondent shall not prescribe any controlled substances to himself or any member of his family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirements. D. The Respondent has entered into a contract, dated March 12, 2014, and in a form acceptable to the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract. E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing. a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS. F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board. G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive. H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment with, or change the identity of the health care professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. as the healthcare professional who shall fulfill the monitoring requirements of this paragraph. I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent persons, approved in advance by the PHS. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its quarterly report to the Board. J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s licensing authority. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee. O. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control Program, and the state licensing boards of all states in which he has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for the duration of this Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken. P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in the practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training program. Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writing. R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement. S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals referenced in Paragraphs H, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring On or by the Board until at least five years from the date on which the Board accepted this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretionDecember 1, any periods during which 2017, the Respondent is not practicing medicineshall successfully implement all recommended changes to his practice, during which were made as part of the probationary period, may extend practice audit referenced in the probationary periodConsent Order in this matter.
B. The Respondent shall refrain from all consumption identify an evaluator to be approved by the Board, in advance, who will conduct a functional capacity evaluation focused on issues of alcohol, coordination and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed fine motor dexterity. Within one week of the RespondentBoard’s substance abuse historyapproval of said evaluator, for a legitimate medical purpose and in the usual course of Respondent must schedule the treating physician’s medical practicefunctional capacity evaluation.
C. The Respondent shall not prescribe any controlled substances have the entity which conducted the aforementioned audit (“audit entity”) return to himself or any member his office in April 2018 to review fifty (50) charts, randomly selected by the board-approved evaluator to determine whether the Respondent has made the corrections for the service dates during the period of his family; and agrees that this provision contained in this sentence will survive December 1, 2017 to April 1, 2018. Five (5) of the probationary period. Prescribing of controlled substances under this paragraph 50 charts must be in accordance charts of visits performed by physician extenders. The Respondent must arrange with all applicable state and federal controlled substance registration requirementsthe audit entity to submit the updated audit to the Board.
D. The Respondent has entered into a contract, dated March 12, 2014, and in a form acceptable agrees to accept any changes to this Agreement based on any supplemental reports issued by the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society. audit entity.
X. The Respondent agrees to abide fully by all terms that in ten (10) months following the adoption of this contract. This contract includes a provision that PHS Agreement and the Consent Order in this matter the audit entity will promptly inform the Board of any lapse or violation of its terms return to his office and review fifteen (15) charts, randomly selected by the Respondentboard-approved evaluator, and the contract provides for any necessary waivers five of privilege or confidentiality which will be charts showing visits performed by the Respondent. PHS shall submit quarterly reports physician extenders, to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that determine whether the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; successfully made changes suggested in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHSoriginal audit report.
F. The Respondent shall and the Board agree that “successfully made changes” means that at all times during least eighty (80) percent of his charts are deemed a “1” in the length audit entity’s scoring scale and twenty (20) percent or fewer of the probationary period charts are deemed a “2” in the audit entity’s scoring scale. Moreover, the Respondent and the Board agree that the Respondent will not have successfully made the changes suggested in the original audit report if any patient charts are deemed to be reasonably available to provide an immediate bodily fluid screen at higher than a “2” in the request of the Boardaudit entity’s scoring scale.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on bear all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant costs associated with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection complying with this Agreement. The Respondent may not terminate treatment with, or change the identity of the health care professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. as the healthcare professional who shall fulfill the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent persons, approved in advance by the PHS. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its quarterly report to the Board.
J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to appear before the Board, to the extent permitted by law. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s licensing authority. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. The Respondent shall appear before the Board or a committee of its members members, at such times as the Board may requestrequests, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such its committee.
O. J. The Respondent shall provide a complete copy of this Probation Agreementnotify and provide, with all exhibits and attachments within ten (10) days of acceptance of this Agreement by the Board, a complete copy of this Agreement with all exhibits and attachments by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; and any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department the Massachusetts Bureau of Public Health, Drug Control Program, Health Care Safety and Quality; and the state licensing boards of all states in which he has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for the duration of this Probation Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in the practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training program.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writing.
R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals referenced in Paragraphs H, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. Within ninety (90) days of approval of this Agreement, the Respondent shall complete five (5) continuing professional development credits in geriatric medicine, beyond those required for maintenance of licensure, and three (3) continuing professional development credits in prescribing opioids, beyond those required for maintenance of licensure.
B. No later than three months following the adoption of this Agreement, the Respondent shall undergo an audit of twenty-five (25) of her medical records, randomly selected, by a Board-approved entity. The Respondent agrees to undergo monitoring incorporate all recommendations to remediate deficiencies made by the Board until at least five years from the date on which the Board accepted Board-approved entity into this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s substance abuse history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practiceAgreement.
C. The Respondent This Agreement shall not prescribe any controlled substances to himself or any member remain in effect for five (5) years following the date of his family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirementsadoption.
D. The Respondent has entered into must document her remediation of any deficiencies identified by the audit through quarterly monitoring reports filed by a contract, dated March 12, 2014, and in a form acceptable to the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society-approved monitor. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides submit for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS.
F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to approval the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment with, or change the identity name of the health care professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. as the healthcare professional who shall fulfill the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent persons, approved in advance by the PHS. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its quarterly report to the Board.
J. The Respondent shall file, monitor within thirty (30) days of completion of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. audit.
E. The Respondent shall submit to bear all costs, including the Board copies of all correspondence and application materials submitted to another state’s licensing authority. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction cost of any period of the Respondent's probationary licensureaudit, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. associated with complying with this Agreement.
H. The Respondent shall appear before the Board Board, or a committee of its members members, at such times as the Board may requestrequests, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such its committee.
O. I. The Respondent shall provide a complete copy of this Probation Agreementnotify and provide, with all exhibits and attachments within ten (10) days of acceptance of this Agreement by the Board, a complete copy of this Agreement with all exhibits and attachments by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he she practices medicine; any in- or out-of-state health maintenance organization with whom he she has privileges or any other kind of association; any state agency, in- or out-of-state, with which he she has a provider contract; and any in- or out-of-state medical employer, whether or not he she practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department the Massachusetts Bureau of Public Health, Drug Control Program, Health Care Safety and Quality; and the state licensing boards of all states in which he she has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he she becomes associated for the duration of this Probation Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he she has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in the practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training program.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writing.
R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals referenced in Paragraphs H, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring by the Board until for at least five years from the date on which of the Board accepted Board’s acceptance of this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, medicine during the probationary period, may extend the probationary period. Under no circumstances will early termination of this Agreement be allowed.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s substance abuse history, for a legitimate medical purpose and may engage in the usual course practice of medicine under conditions that the treating physician’s medical practiceBoard may impose. The Respondent is not currently practicing medicine and shall not practice medicine until, upon his petition, the Board approves a practice plan and worksite monitor.
C. The Respondent shall not prescribe agrees to propose a worksite monitor as part of any controlled substances to himself practice plan required by Paragraph B above. Any monitor, or any member of his family; and agrees that this provision contained change in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph monitor, must be approved in accordance with all applicable state and federal controlled substance registration requirementsadvance by the Board.
D. The Respondent has entered into agrees to complete a contract, dated March 12, 2014, and in a form acceptable to the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board assessment within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS.
F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreementapproval of the Consent Order and to comply with all recommendations made by PHS, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreementas reported by PHS Director Xx. Xxxxxx Xxxxxxx.
X. The Respondent may not terminate treatment with, or change the identity of the health care agrees to complete twenty Board-approved continuing professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. as the healthcare professional who shall fulfill the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly development (CPD) credits in medical ethics (with a group-counseling program for chemically dependent persons, approved focus on patient abandonment and a physician’s responsibility to ensure continuity in advance by the PHS. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its quarterly report to the Board.
J. The Respondent shall file, patient care) within thirty (30) sixty days of the execution approval of the Consent Order.
F. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent’s compliance with this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. .
G. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation this Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. §§ 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. .
H. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s licensing authority. .
I. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. .
J. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee.
O. K. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control Program, Health Bureau of Health Care Safety and Quality; and the state licensing boards of all states in which he has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for the duration of this Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in the practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training program.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writing.
R. L. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. M. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Pursuant to paragraph A, above, early termination of this Agreement will not be allowed. Except for requests for modifications related to the identity of the health care professionals worksite monitor(s) referenced in Paragraphs H, Paragraph C and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring by the Board until at least remain in this Agreement for five years from the date on which it is adopted by the Board. The Respondent may file a petition to terminate the Probation Agreement after three-years of documented proof that he complied with Section IV, Paragraph B, (a) through (h). The Respondent acknowledges that said petition to terminate after three years of compliance would be in the discretion of the Board accepted to allow. The Respondent further agrees to comply with all other requirements of this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary periodAgreement.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed agrees to the following:
(a) complete an office audit within ninety (90) days of the Respondent’s substance abuse history, for a legitimate medical purpose approval of this Agreement and in the usual course implement all of the treating physician’s medical practice.
C. The Respondent shall not prescribe any controlled substances to himself or any member of his family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirements.
D. The Respondent has entered into a contract, dated March 12, 2014, and in a form acceptable to the Board, with Physician Health Services (“PHS”) recommendations of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.audit;
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses submit proof to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS.
F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses implemented all audit recommendations;
(c) agrees to attend a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, compliance conference with the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to at the end of six months from the date of said notification from in which the health care provider concerning Board adopts the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(sAgreement;
(d) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in agrees that all audit provisions will be automatically incorporated into this Agreement;
(e) complete at least twenty hours of continuing professional development credits in a Board-approved intensive, and shall notify in-person course on prescribing controlled substances;
(f) agrees to signing mutual releases allowing the Board if and auditor to share information;
(g) a Board-approved worksite monitor who will review 10 randomly selected charts per month and also confirm that the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment with, or change is using the identity of the health care professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. as the healthcare professional who shall fulfill the monitoring requirements of this paragraph.Prescription Monitoring Program; and
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent persons, approved in advance by the PHS. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its (h) quarterly report to the Board.
J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. All agreements whereby third parties are to provide written reports, releases, records or any other information reporting to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. approved worksite monitor.
C. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s states licensing authority. .
D. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. .
E. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee.
O. F. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments attachments, within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control Program, and the state licensing boards of all states in which he has any kind of license to practice medicinelicense; the Drug Enforcement Administration – Boston Diversion Group; and the Massachusetts Department of Public Health Drug Control Program. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for during the duration of this Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. .
G. The Board expressly reserves Respondent, and not the authority to independently notifyBoard, at any time, any of shall be responsible for the entities designated above, or any other affected entity, payment of any action it has takenfee or charge occasioned by the Respondent’s compliance with this Agreement.
P. X. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in the practice of medicine only through the at Heywood Family Medicine, 000 Xxxx Israel Deaconess Medical Center radiology training programXxxxxx, Xxxxxxx, Xxxxxxxxxxxxx.
Q. I. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency programDoctor Xxxxxxxxx, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writingBoard.
R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals referenced in Paragraphs H, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring by the Board until at least five years from the date on in which the Board accepted this approves the Probation Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s substance abuse chemical dependency history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. The Respondent shall not prescribe any controlled substances to himself herself or any member of his her family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirements.
D. The Respondent has entered into a contract, dated March 12September 23, 20142013, and in a form acceptable to the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which this requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, weekly on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS.
F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) professional experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) professional shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) professional shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) professional notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety xxxxxx (90) days prior to the date of said notification from the health care provider concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) professional shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment with, or change the identity of the health care professional without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxx Xxxxxxx, M.D. and Xxxxxx Xxxx-Xxxxxxxx, M.D. LICSW as the healthcare professional professionals who shall fulfill the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent personspersons with substance use disorders, approved in advance by the PHS. The Respondent shall keep a diary of his her attendance at such meetings. The Respondent shall submit this diary to PHS for periodic verification and PHS shall submit current copies of the diary in its quarterly report to the Board.
J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. .
K. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. .
L. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s states' licensing authority. .
M. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. .
N. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee.
O. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he she practices medicine; any in- or out-of-state health maintenance organization with whom he she has privileges or any other kind of association; any state agency, in- or out-of-state, with which he she has a provider contract; any in- or out-of-state medical employer, whether or not he she practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control ProgramBureau of Health Care Safety and Quality, and the state licensing boards of all states in which he she has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he she becomes associated for the duration of this Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he she has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. .
Q. The Respondent shall engage be monitored in the practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training program.
Q. Until the by a Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board -approved successor, shall submit quarterly evaluations of the Respondent to the Boardmonitor. The Respondent’s monitor worksite monitor(s) shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writingBoard.
R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals referenced in Paragraphs H, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective for a minimum of five years from the date on in which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring by the Board until at least five years from the date on which the he entered into this agreement with this Board accepted this Agreement and for such further period thereafter as the Board shall determine for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s substance abuse history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. The Respondent shall not prescribe any controlled substances to himself or any member of his family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirements.
D. The Respondent has entered into a contract, dated March 12September 17, 20142015, and in a form acceptable to the Board, with Physician Physicians’ Health Services (“PHS”) of the Massachusetts Medical SocietyServices. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS Physicians’ Health Services will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS Physicians’ Health Services shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS Physicians’ Health Services or as may be required by the Board, which . This requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection shall be observed by PHS or its designee. An officer of PHS or representative from the Physicians’ Health Services shall file reports of the screening evaluations completed during the previous three months with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS Physicians’ Health Services to notify the Board immediately by telephone and in writing.:
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS the Physicians’ Health Services has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS the Physicians’ Health Services in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS Physicians’ Health Services contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHSPhysicians’ Health Services. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHSPhysicians’ Health Services.
F. The Respondent shall shall, at all times during the length of the probationary period period, be reasonably available to provide an immediate bodily fluid screen at the request of the Board. The Respondent shall immediately notify the Board if he misses a toxicology screen, if he tests positive for any substance, or if he relapses.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care healthcare professional(s) experienced in the treatment of substance use disorders abuse who shall submit written reports, including reports on all missed sessions, to the Board or its designee Physicians’ Health Services as often as the Board deems necessary necessary, but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS Physicians’ Health Services submits to the Board. The health care healthcare professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care healthcare professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, is hospitalized, or is non-compliant with the treatment plan. In the event that the health care healthcare professional(s) notifies notify the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider healthcare professional(s) concerning the Respondent. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care healthcare professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or and her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment with, or change the identity of the health care professional healthcare professionals without prior Board approval. The Respondent has chosen Xxxxxxx Xxxxxxxx, M.D. Xx. Xxxxxxxx Xxxxx as the healthcare professional professional(s) who shall fulfill the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent personsindividuals with substance misuse issues, approved in advance by the PHSBoard. The Respondent shall keep a diary of his attendance at such meetings. The Respondent shall submit this diary to PHS the Physicians’ Health Services for periodic verification and PHS the Physicians’ Health Services shall submit current copies of the diary in its quarterly report to the Board.
J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS Physicians’ Health Services may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s states' licensing authority. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee.
O. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control Program, and the state licensing boards of all states in which he has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for the duration of this Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. The Respondent may engage in the practice of medicine under such conditions as the Board may impose. The Respondent shall engage in is not currently practicing medicine and is prohibited from doing so until such time as the Board approves a practice of medicine only through the Xxxx Israel Deaconess Medical Center radiology training programplan.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice Respondent shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xxa Board approved worksite monitor. Xxxxx’x radiology residency programSaid monitor, and any Board approved successorsuccessor(s), shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor monitors shall immediately (within twenty-four hours) report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board Board. The Respondent also agrees to provide authorizations permitting any Board-approved monitor to communicate with Physicians’ Health Services and the healthcare professionals listed in writingParagraph H of this Agreement.
R. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity of the health care professionals healthcare professional referenced in Paragraphs Paragraph H, and the Respondent's ’s employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective five years from on the date on which the Board accepts this Agreement, the Respondent shall comply with each of the following requirements:
A. The Respondent agrees to undergo monitoring by the Board until for at least five years from the date on which of the Board accepted Board’s acceptance of this Agreement and for such further period thereafter as the Board shall for reasonable cause order. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period.
B. The Respondent shall refrain from all consumption of alcohol, and use of all controlled substances, unless specifically prescribed undergo annual assessments for fitness to practice medicine by a treating physician who has been informed Board-approved psychiatrist. The results of the Respondent’s substance abuse history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. The Respondent shall not prescribe any controlled substances to himself or any member of his family; and agrees that this provision contained in this sentence will survive the probationary period. Prescribing of controlled substances under this paragraph must be in accordance with all applicable state and federal controlled substance registration requirements.
D. The Respondent has entered into a contract, dated March 12, 2014, and in a form acceptable to the Board, with Physician Health Services (“PHS”) of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contract. This contract includes a provision that PHS will promptly inform the Board of any lapse or violation of its terms by the Respondent, and the contract provides for any necessary waivers of privilege or confidentiality by the Respondent. PHS shall submit quarterly reports to the Board which detail the Respondent's compliance with this contract.
E. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, which requirement may be reasonably modified from time to time consistent with scientific or practical advances in the field of alcohol and drug detection. The Respondent shall submit random samples at least weekly, on average, or at such other frequency as the Board or PHS may require. Sample collection assessments shall be observed by PHS or its designee. An officer of PHS shall file reports of the screening evaluations completed during the previous three months filed with the Board within thirty (30) days as part of their quarterly report. Said reports shall specify the dates on which samples were taken and shall specify the results of the analysis of such samples and shall be signed by the person in charge. In addition, the Respondent shall obtain the written agreement of PHS to notify the Board immediately by telephone and in writing.
a) in the event that Respondent’s sample is found to contain any evidence of alcohol or any controlled substance in violation of this Probation Agreement; or
b) in the event that PHS has other reliable evidence that the Respondent has used alcohol or any controlled substance in violation of this Probation Agreement; in the event that the Respondent misses any random bodily fluid test, excluding an administrative or laboratory mistake beyond the Respondent’s control; in the event that the Respondent refuses to cooperate with PHS in monitoring bodily fluids in any manner; or in the event that the Respondent withdraws any waiver filed in connection with this Probation Agreement; or in the event that the PHS contract is terminated for any reason other than successful completion of the contract, as determined by the Director of PHS. The Respondent agrees to waive any privileges he may have concerning such reports and disclosures to the Board by PHS.
F. The Respondent shall at all times during the length of the probationary period be reasonably available to provide an immediate bodily fluid screen at the request of the Board.
G. The Respondent shall immediately notify the Board in writing any time that any treating physician writes a prescription for the Respondent for a controlled substance in Schedules II through IV, inclusive.
H. The Respondent shall be under the care of a licensed or certified health care professional(s) experienced in the treatment of substance use disorders who shall submit written reports, including reports on all missed sessions, to the Board or its designee as often as the Board deems necessary but in any event at least once every three months. Copies of these attendance reports shall be part of the quarterly report that PHS submits to the Board. The health care professional(s) shall immediately notify the Board by telephone whenever, in his or her professional judgment, the Respondent poses a potential danger to the health, safety and welfare of the Respondent’s patients. In addition, the health care professional(s) shall immediately notify the Board by telephone and in writing in the event that the Respondent terminates treatment, or is non-compliant with the treatment plan. In the event that the health care professional(s) notifies the Board that the Respondent poses a danger to the health, safety or welfare of the Respondent’s patients, or terminates treatment, the Board may obtain any and all information, reports and records for a period not to exceed ninety (90) days prior to the date of said notification from the health care provider concerning the Respondentannually. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The health care professional(s) Board-approved psychiatrist shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent may not terminate treatment withhas chosen Xxxxxx Xxxxxxxxxx, or M.D. as the psychiatrist who shall complete the annual assessments. The Respondent must petition the Board for approval of any change in the identity Board-approved psychiatrist.
C. The Respondent shall undergo annual assessments for fitness to practice medicine by a Board-approved cognitive therapist. The results of the health care professional without prior assessments shall be filed with the Board approvalannually. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The Board-approved cognitive therapist shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent has chosen Xxxxxxx XxxxxxxxXxxxx Xxxxxx, Ph.D. as the cognitive therapist who shall complete the annual assessments. The Respondent must petition the Board for approval of any change in the Board-approved cognitive therapist.
D. The Respondent shall undergo annual assessments for fitness to practice medicine by a Board-approved sleep disorder specialist. The results of the assessments shall be filed with the Board annually. The Respondent hereby waives any privileges concerning such information, reports, records and disclosures to the Board. The Board-approved sleep disorder specialist shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his or her agreement and undertaking with respect to the obligations set forth in this Agreement, and shall notify the Board if the Respondent withdraws any waiver filed in connection with this Agreement. The Respondent has chosen Xxxxx Xxxxxxx, M.D. as the healthcare professional sleep disorder specialist who shall fulfill complete the monitoring requirements of this paragraph.
I. The Respondent shall participate at least weekly in a group-counseling program for chemically dependent persons, approved in advance by the PHSannual assessments. The Respondent shall keep a diary must petition the Board for approval of his attendance at such meetings. any change in the Board-approved sleep disorder specialist.
X. The Respondent shall submit this diary agrees to PHS for periodic verification and PHS shall submit current copies comply with any recommendations made as part of any of the diary in its quarterly report annual assessments, required by Paragraphs B-D above, and any other recommendations made by his healthcare providers, including, but not limited to the Boardcognitive home exercises.
J. The Respondent shall file, within thirty (30) days of the execution of this Probation Agreement, written releases and authorizations sufficiently broad in scope so as to allow the Board to obtain any and all medical and laboratory reports, treating physicians’ reports and records concerning the Respondent’s treatment during the probationary period. PHS may retain as confidential the identity of informants who have disclosed suspected or known substance misuse to those programs under the promise of confidentiality. F. All agreements whereby third parties are to provide written reports, releases, records or any other information to the Board under this Probation Agreement shall be submitted to the Board for approval within thirty (30) days after the Probation Agreement is approved by the Board. All such releases and agreements must, in addition to waiving any relevant state law privileges or immunities, provide the Board with access to all material covered by 42 CFR, Part 2, and the Criminal Offender Records Information (XXXX) Act, so-called, M.G.L. c. 6, ss. §§ 167-178; all such releases and agreements must provide that the released party shall notify the Board if any waiver is withdrawn. In the event that any such releases or waivers are not sufficient to obtain access to any information which the Board in its discretion considers relevant, the Respondent agrees to obtain personally such information and furnish it to the Board, to the extent permitted by law. .
G. In the event that the Respondent seeks licensure to practice medicine in another state, the Respondent shall notify the Board of such fact and shall disclose to the licensing authority in such state his probationary status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another state’s states' licensing authority. .
X. In the event the Respondent should leave Massachusetts to reside or practice out of the state, the Respondent shall promptly notify the Board in writing of the new location as well as the dates of departure and return. Periods of residency or practice outside Massachusetts will not apply to the reduction of any period of the Respondent's probationary licensure, unless the Respondent enters into a monitoring agreement, approved by the Board, in the new location. .
I. The Respondent shall appear before the Board or a committee of its members at such times as the Board may request, upon reasonable advance notice, commensurate with the gravity or urgency of the need for such meeting as determined by the Board or such committee.
O. J. The Respondent shall provide a complete copy of this Probation Agreement, with all exhibits and attachments within ten (10) days by certified mail, return receipt requested, or by hand delivery to the following designated entities: any in- or out-of-state hospital, nursing home, clinic, other licensed facility, or municipal, state, or federal facility at which he practices medicine; any in- or out-of-state health maintenance organization with whom he has privileges or any other kind of association; any state agency, in- or out-of-state, with which he has a provider contract; any in- or out-of-state medical employer, whether or not he practices medicine there; the Drug Enforcement Agency, Boston Diversion Group; Department of Public Health, Drug Control Program, Health Bureau of Health Care Safety and Quality; and the state licensing boards of all states in which he has any kind of license to practice medicine. The Respondent shall also provide this notification to any such designated entities with which he becomes associated for the duration of this Probation Agreement. The Respondent is further directed to certify to the Board within ten (10) days that he has complied with this directive. The Board expressly reserves the authority to independently notify, at any time, any of the entities designated above, or any other affected entity, of any action it has taken.
P. K. The Respondent may engage in the practice of medicine under such conditions as that the Board may impose. The Respondent is not currently engaged in the practice of medicine and shall not engage in the practice of medicine only through until such time as the Xxxx Israel Deaconess Medical Center radiology training programBoard approves a practice plan. Any practice plan must be consistent with the recommendations made by the University of San Diego Physician Assessment and Clinical Education Program. Any practice plan must also be consistent with any recommendation made by the healthcare professionals referenced in Paragraphs B-D above. At the time of any petition for approval of a practice plan, the Respondent will submit the name of a worksite monitor for each practice location. Once approved, the monitor(s) will submit quarterly reports with the Board.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent’s clinical practice shall be monitored by Xxxxxx Xxxxxxxxx, MD, Associate Program Director of Xx. Xxxxx’x radiology residency program, and any Board approved successor, shall submit quarterly evaluations of the Respondent to the Board. The Respondent’s monitor shall immediately report any concerns about potential violations of this Probation Agreement by telephone, and in writing, directly to the Board in writing.
R. L. The Respondent, and not the Board, shall be responsible for the payment of any fee or charge occasioned by the Respondent's compliance with this Probation Agreement.
S. M. The Respondent may request that the Board modify any of the conditions set forth above. The Board may, in its discretion, grant such modification. Except for requests for modifications related to the identity identities of the health care professionals referenced in Paragraphs HB-D and the monitor referenced in Paragraph K, and the Respondent's employment, the Respondent may make such a request not more than once in any one year period, nor any sooner than one year from the date of this Probation Agreement.
Appears in 1 contract
Samples: Probation Agreement
