CONDITIONS OF PROBATION. During the probationary period, which shall be effective on the date 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 in which the Board approves the Probation Agreement and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. 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 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 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 20, 2013, 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, 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. 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 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 shall immediately notify the Board by telephone whenever, in 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 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 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 ▇▇▇▇▇▇ (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 shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, 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 ▇▇▇▇ ▇▇▇▇▇, 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 persons with substance use disorders, 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. 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 (▇▇▇▇) 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 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 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, 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 pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, Massachusetts. Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on for a minimum of five years from the date 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 in which the he entered into this agreement with this Board approves the Probation Agreement and for such further period thereafter as the Board shall determine for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. 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 chemical dependency 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 20September 17, 20132015, 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, this . 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. 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 professional 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 professional 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 professional 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 professional notifies healthcare professional(s) 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 professional healthcare professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his 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 ▇▇. ▇▇▇▇▇▇▇▇ ▇▇▇▇▇, M.D. ▇ 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 persons individuals with substance use disordersmisuse 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.
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 (▇▇▇▇) 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 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 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, Bureau of Health Care Safety and QualityDrug 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 pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, Massachusettsplan.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇a Board approved worksite monitor. Said monitor, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ successor(s), shall submit quarterly reportsevaluations of the Respondent to the Board. The Respondent’s 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on for five years from the date 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 in which the Board approves the Probation Agreement of approval of this Agreement, and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. At the Board’s discretion, any Any periods during which the Respondent is not practicing medicine, during the probationary probation period, may will extend the probationary period. The Respondent may petition to terminate this Agreement after practicing medicine for three years.
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 chemical dependency 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 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 20November 24, 20132015, 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, this . 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. 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 she 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.
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 Board-approved and licensed or certified health care professional 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 professional 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 professional 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 professional notifies healthcare professional(s) 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 ▇▇▇▇▇▇ (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 professional healthcare professional(s) shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, his 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 ▇▇▇▇ ▇▇▇▇▇, 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 persons individuals with substance use disordersmisuse 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.
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 (▇▇▇▇) 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 her status with this Board. The Respondent shall submit to the Board copies of all correspondence and application materials submitted to another 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, Bureau of Health Care Safety and QualityDrug Control Program, 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 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. The Respondent is not currently practicing medicine and shall engage not practice medicine until, upon her petition, the Board approves a practice plan and worksite monitor. Said practice plan shall include a transitional practice plan. The Respondent agrees to propose a worksite monitor as part of any practice plan required by Paragraph P above. Any monitor, or change in the practice of medicine only pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program monitor, must be approved in Brighton, Massachusetts.
Q. Until advance by the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on the date 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 three years from the date in which the Board approves the Probation Agreement of approval of this Agreement, and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. At the Board’s discretion, any periods during which the Respondent is not practicing 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, alcohol and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s chemical dependency historyhistory of substance use, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. 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.
D. 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. E. The Respondent has entered into a contractSubstance Use Monitoring Contract with a Behavioral Health Addendum, dated March 20effective April 25, 20132017, 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. F. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, this 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. 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 G. During the length of the probationary period period, the Respondent shall be reasonably available available, at all times, 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 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 shall immediately notify the Board by telephone whenever, in 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 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 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 ▇▇▇▇▇▇ (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 shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, 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 ▇▇▇▇ ▇▇▇▇▇, 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 persons with substance use disorders, 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.
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 (▇▇▇▇) 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 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 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, 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 pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, Massachusetts.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on the date 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 in which the Board approves the Probation Agreement of approval of this Agreement, and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. At the Board’s discretion, any periods during which the Respondent is not practicing 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, alcohol and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s chemical dependency historyhistory of substance use, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. 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.
D. 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. E. The Respondent has entered into a substance use monitoring contract, dated March 20November 11, 20132012, 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. F. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, this 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. 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. G. 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 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 shall immediately notify the Board by telephone whenever, in 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 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 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 ▇▇▇▇▇▇ (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 shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, 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 ▇▇▇▇ ▇▇▇▇▇, 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 persons with substance use disorders, 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.
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 (▇▇▇▇) 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 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 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, 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 pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, Massachusetts.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on the date 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 December 3, 2020 (five years from the date in which of the Board approves the Probation Agreement Board’s acceptance of this Agreement) and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. 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 chemical dependency history, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice. The treating physician shall have been informed of the Respondent’s substance abuse history before issuing any such prescription. 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.
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 shall survive the probationary period. Prescribing The 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 substance use/behavioral monitoring contract, dated March 20April 4, 2013, and in a form acceptable to the Board, with Physician Health Services Services, Inc. (“PHS”) of the Massachusetts Medical Society. The Respondent agrees to abide fully by all terms of this contractcontract for the duration of this probationary period. 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 ’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, this 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. In addition to the random drug testing identified in paragraphs D and E, above, the Respondent shall undergo twelve random sevoflurane metabolite tests per year. These tests will be administered under the direction of PHS and subject to the same requirements set forth in Paragraphs E1 through E5.
G. 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 participate at least weekly in a group-counseling program for persons with substance use disorders, approved in advance by the Board 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 writing any time that any treating physician writes a prescription for its quarterly report to the Respondent for a controlled substance in Schedules II through IV, inclusiveBoard.
H. I. The Respondent shall be under the care of a licensed or certified health care professional experienced in the treatment of substance use disorders chemical dependency 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 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 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 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 ▇▇▇▇▇▇ (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 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 ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇, M.D. M.D., as the his healthcare professional who shall fulfill the monitoring requirements of this paragraphprovider.
I. The Respondent shall participate at least weekly in a group-counseling program for persons with substance use disorders, approved in advance by the PHS▇. The Respondent shall keep a diary may engage in the practice of his attendance at medicine under such meetingsconditions as the Board may impose. The Respondent is not currently practicing medicine and shall submit this diary to PHS for periodic verification not practice medicine until such time as the Board approves a practice plan and PHS a work site monitor. The Respondent understands and agrees that any such practice plan shall submit current copies include specific provisions regarding the Respondent’s access to, use and disposition of the diary in its quarterly report medications, as well as working hours and level of supervision that are satisfactory to the Board.
J. K. 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 (▇▇▇▇) 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 states' state’s 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. P. 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.
Q. 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 professional referenced in Paragraph I, 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.
R. 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, Bureau of Health Care Safety and QualityDrug 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 pursuant to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, Massachusetts.
Q. Until the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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
Sources: Probation Agreement
CONDITIONS OF PROBATION. During the probationary period, which shall be effective on the date 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 in which the Board approves the Probation Agreement of approval of this Agreement, and for such further period thereafter as the Board shall for reasonable cause order. The Respondent understands that issuance of subsequent limited licenses, a full license or renewals of either may be conditioned upon an extension of this Agreement. At the Board’s discretion, any periods during which the Respondent is not practicing medicine, during the probationary period, may extend the probationary period. The Respondent agrees that he will not petition the Board for early termination of this Agreement.
B. The Respondent shall refrain from all consumption of alcohol, alcohol and use of all controlled substances, unless specifically prescribed by a treating physician who has been informed of the Respondent’s chemical dependency historyhistory of substance use, for a legitimate medical purpose and in the usual course of the treating physician’s medical practice.
C. 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.
D. 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. E. The Respondent has entered into a substance use monitoring contract, dated March 20August 8, 20132016, 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. The Respondent shall authorize PHS to report immediately any missed tests or positive tests.
E. F. The Respondent shall undergo random bodily fluid screenings as required by PHS or as may be required by the Board, this 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. 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. G. 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 experienced in the treatment of substance use disorders chemical dependency 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 Respondent shall continue individual psychiatric treatment and attend all required meetings. The health care professional referenced in this paragraph shall immediately notify the Board by telephone whenever, in her his or his or 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 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 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 ▇▇▇▇▇▇ (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 shall confirm in writing, within ten (10) days of the Board’s accepting this agreement, her his or 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 ▇▇▇▇ ▇▇▇▇▇, M.D. as agrees to submit the name of a healthcare professional who provider to the Board for its approval. The healthcare provider shall fulfill submit quarterly reports regarding the monitoring requirements of this paragraphRespondent’s fitness to practice and overall health to the Board.
I. The Respondent shall participate at least weekly in a group-counseling program for persons individuals with substance use disorders, 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.
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 (▇▇▇▇) 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 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 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, Bureau of Health Care Safety and QualityDrug 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 is not currently practicing medicine and shall engage in not practice medicine until, upon his petition, the Board approves a practice of medicine only pursuant plan and worksite monitor. The Respondent agrees to submit a transitional practice plan to the St. ▇▇▇▇▇▇▇▇▇ Medical Center’s Surgical Residency Program in Brighton, MassachusettsBoard for its approval.
Q. Until The Respondent agrees to propose a worksite monitor as part of any practice plan required by Paragraph P above. Any monitor, or change in monitor, must be approved in advance by the Board, upon petition of the Respondent, orders otherwise, the Respondent shall be monitored by ▇▇▇▇▇ ▇▇▇▇▇▇▇, M.D. and ▇▇▇▇ ▇▇▇▇▇▇▇▇, M.D. and any Board approved successor. ▇▇. ▇▇▇▇▇▇▇▇ shall submit reports once per month for the first twelve months that the Respondent returns to the practice of medicine. ▇▇. ▇▇▇▇▇▇▇ shall submit quarterly reports. The Respondent’s monitors 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. Pursuant to paragraph A, above, the Respondent agrees not to petition for early termination of this Agreement. Except for requests for modifications related to the identity of the health care professionals professional, worksite monitor and worksite referenced in Paragraphs paragraphs H, P and Q, 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
Sources: Probation Agreement