Thursday, July 21, 2011

Traveling sick? WA beats MD beats MA.

As patients continue to move or travel in different states I have the opportunity to update my table of information on legality of practice of medicine across state lines.

Massachusetts gets an F

In two voice mail messages a representative of the Board of Registration in Medicine on June 30, 2011 explained, "If the patient is in Massachusetts, you would need a Massachusetts license." This applies not only to patients moving to the state, but also to patients traveling in the state. They even consider calling in a prescription to a pharmacy in MA to constitute practice of medicine, requiring a license to be legal.

Maryland gets a C

In a series of emails on July 18 and 19 a "Public Policy Analyst" at the Maryland Board of Physicians cited: Code of Maryland Regulations (COMAR) which specifically addresses "telemedicine" in stating that even a phone call with no fee would require a MD license, but she also pointed out that the Board would not likely know and that investigation might only occur after a complaint.

In a followup message, however, the Analyst told me that MD has a reciprocity agreement with DC, so physicians and patients located in or licensed in either jurisdiction might pretend it's just one state.

But there's more: In her final message she cited: §14–302.  Health Occupations Article, Annotated Code of Maryland:

"Subject to the rules, regulations, and orders of the Board, the
following individuals may practice medicine without a license:
(4)   A physician who resides in and is authorized to practice medicine
by any state adjoining this State and whose practice extends into this
State, if:
(i)   The physician does not have an office or other regularly
appointed place in this State to meet patients; and
(ii)   The same privileges are extended to licensed physicians of this
State by the adjoining state..."

As I read the map this covers: DC, VA, DE, PA, and WV. I know of no other state with such a rational statute. Every state should enact a similar law.

Washington gets an A+

I still have to pinch myself to make sure I'm not dreaming. Yesterday a representative of the WA Medical Quality Assurance Commission repeatedly assured me that WA considers the practice of medicine to take place where the physician -- not the patient -- is located. At least for purposes of patients traveling to other states I believe this is as it should be. I have a feeling this policy will not last, but until then, if you are sick, come to Washington! Or at least if your patient plans to travel, and you the physician want to retain your status as a non-criminal, encourage all your patients to choose WA as the place to vacation or travel on business.

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