Title 10 — Subtitle 32. Board of Physicians

Certified by the:

Accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or its successor;

A postgraduate clinical medical education program that meets all of the following criteria:

A program conducted in the United States of America or Canada that is the equivalent of §B(3)(a), (b), or (c) of this regulation as determined by the Board of Physicians.

A member of ABMS;

An AOA certifying board;

The Royal College of Physicians and Surgeons of Canada; or

The College of Family Physicians of Canada.

The statutes and regulations governing the practice of medicine in Maryland;

Boundary issues; and

The role and functions of the Board.

12 months of accredited postgraduate training in one integrated program in which the:

A year of accredited postgraduate training which the applicant completed in a manner that satisfied the requirements of §B(20-1)(a)(i) and (ii) of this regulation but that did not satisfy the requirements of §B(20-1)(a)(iii) of this regulation, and which was followed by a year of training which the applicant completed in a manner that satisfied all of the requirements of §B(20-1)(a) of this regulation.

Achieve a passing score on all parts of the National Board of Medical Examiners examination as evidenced by an endorsement of certification issued by the National Board of Medical Examiners;

Achieve a score as follows:

Achieve a passing score, as evidenced by receipt of either a Diplomate Certification or a Certification of Completion issued by the National Board of Osteopathic Medical Examiners after January 1, 1971, on:

Achieve the recommended passing score on all levels of the Comprehensive Osteopathic Medical Licensing Exam of the National Board of Osteopathic Medical Examiners;

Achieve passing scores on any of the following examination combinations:

Achieve a passing score on all parts of the examination of any state board or the District of Columbia Board of Medicine in the United States;

Achieve a passing score on all steps of the United States Medical Licensing Examination (USMLE);

If completed before the year 2000, achieve passing scores on any of the following examination combinations:

Achieve a passing score on each part of the applicable qualifying examination of the Liceniate of the Medical Council of Canada.

Has successfully completed 2 or more years of a residency or fellowship accredited by the ACGME or the AOA;

Has met the following requirements:

Is Board-certified.

Last passed a medical licensing examination more than 15 years before this application;

Has never had specialty board certification or last passed a specialty board certification examination given by a member board of the ABMS or the AOA more than 10 years before this application;

Has not had a full, unrestricted medical license in at least one state of the United States or Canada within the 10-year period before this application; and

Has not actively practiced clinical medicine in the United States or Canada for at least 7 of the 10 years before this application.

All postgraduate training programs attended, regardless of whether the program was completed or not;

Each job held, regardless of whether the job was:

Any other activity engaged in, including all periods of unemployment;

An action, by a state licensing or disciplinary board, or a comparable body in the armed services, denying an application for licensure, reinstatement, or renewal;

An action taken against the physician's license, by a state licensing or disciplinary board, or a comparable body in the armed services, including but not limited to limitations of practice, required education, admonishment, reprimand, suspension, or revocation for an act that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

An investigation or charge brought against the physician by a licensing or disciplinary body or comparable body in the armed services;

A medical or health professional license for which the physician has applied if the application was withdrawn for reasons that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

An investigation or charge brought against the physician by a hospital, related institution, or alternative health care system that would be grounds for action under Health Occupations Article, §14-404, Annotated Code of Maryland;

Any limitation or loss in privileges by a hospital, related health care facility, or alternative health care system that would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for a criminal act;

A plea of guilty or nolo contendere, a conviction, or receipt of probation before judgment for an alcohol or controlled dangerous substance offense, including but not limited to driving while under the influence of alcohol or controlled dangerous substances;

An arrest which would provide a basis for investigation or charge which would be grounds for disciplinary action under Health Occupations Article, §14-404, Annotated Code of Maryland;

A physical or mental condition that currently impairs the physician's ability to practice medicine; and

The filing or settling of a medical malpractice action in which the physician is, or has been, named as a defendant within the past 5 years.

Copies of the complaints, pleadings, and judgments in all malpractice claims if the applicant has had 3 or more claims in the 5 years before the filing of the application for licensure;

Copies of all arrests, disciplinary actions, judgments, and final orders which occurred or were issued within the 7 years before submitting the application for licensure for driving while intoxicated, driving while under the influence of a chemical substance or medication, or any license probation, suspension, or revocation; and

All medical licensure, certification, and recertification examination results and the dates when these examinations were taken.

Verification of medical education;

Written and electronic statements from an authorized official of each of the applicant's accredited training programs which:

Documentation of successful completion of the examination requirements as described in Regulation .03G of this chapter, including submission of all applicant’s scores sent directly to the Board from the examination authority or authorities.

Hospitals, following training, at which the applicant has had privileges during the preceding 5 years; and

Disciplinary or adverse actions taken against the applicant by a:

All application and licensing fees as required in Regulation .12 of this chapter, payable to the Board at the time the application is submitted to the Board; and

The applicant's Social Security number which the Board shall use only for evaluation and identification of applicants and licensees, but may not disclose in any other context.

Medical malpractice judgments against the applicant;

Settlements made by the applicant in medical malpractice actions;

Actions taken against the applicant or the applicant's license by state disciplinary or licensing authorities; and

Actions taken against the applicant or the applicant's privileges by a hospital or hospital disciplinary authority which result in a loss, limitation, or suspension of privileges for a period greater than 30 days; and

A score of at least 26 on the “Speaking Section” of the Internet-Based TOEFL; or

A score of Advanced or higher on the OPI.

Licensed physician; and

Speech-language pathologist who is currently licensed to practice speech pathology in the United States.

This event was reported to the Board before a third examination; and

The Board determines that the medical/surgical event did indeed create the impairment.

Documentation from 3 licensed physicians that the applicant can communicate in a professionally competent manner with patients and health care providers; or

A hearing before the Board where the applicant is asked to describe the manner in which the applicant would obtain a history and physical examination from a typical patient.

The applicant is currently charged in another jurisdiction with conduct which would be grounds for discipline under the Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State;

The applicant is under investigation in another jurisdiction for an allegation concerning conduct that would be grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland, if the applicant were licensed in this State; or

The Board is investigating the applicant or application or has issued a notice of intent to deny licensure.

Issues of competence or conduct which caused the matter to be investigated;

Duty to protect the public in other jurisdictions from duplicative expenditures on investigation of licensure applications; and

Truthfulness of the applicant during the application process.

An inactive status shall be renewed every 2 years.

At the end of 2 years, a licensee with inactive status shall complete the renewal application, and pay the renewal fee, and any charges set by the Board.

If the licensee fails to renew their inactive license for any reason, the license will expire.

Practice medicine within Maryland;

Prescribe medication within Maryland; or

Conduct peer reviews of physicians within Maryland.

Has practiced medicine in Maryland for at least 10 years;

Has an active, unrestricted license to practice medicine in Maryland or is within 60 days of the expiration of an active, unrestricted license;

Has never been the subject of disciplinary action that has resulted in revocation or suspension of a medical license in any jurisdiction in which they have been licensed to practice medicine;

Is not under investigation by the Board; and

Is in good standing.

Practice, offer to practice, or attempt to practice medicine within Maryland;

Delegate medical acts within Maryland;

Prescribe medication within Maryland; or

Conduct peer review of physicians within Maryland.

Graduated from an LCME-accredited medical school or a foreign medical school that is listed in the World Directory of Medical Schools at the time of the applicant's graduation or, for doctors of osteopathy, meet the requirements of Health Occupations Article, §14-307(d)(2), Annotated Code of Maryland;

Satisfactorily completed a postgraduate training program which meets the following requirements:

Passed that specialty's certifying examination in either the country where specialty postgraduate training was obtained or where the applicant is practicing.

Be a member in good standing of the specialty board in the country from which the applicant is applying; and

Have functioned independently as both an academician and clinician for at least 3 years after the completion of postgraduate specialty training.

Letter from the chief of staff of any hospital where the applicant has practiced within the 5 years preceding the application for a postgraduate teaching license, detailing the applicant's competence to practice medicine;

Malpractice history;

Driving record including, but not limited to, convictions for driving while intoxicated or while under the influence of a chemical substance or medication;

Medical licensing examination results;

Physical or mental examinations, or both, by a physician or evaluation program for treatment of impaired physicians, or both, chosen by the Board.

Detailed evidence of the physician's qualifications and competence including the nature of the physician's proposed responsibilities, reasons for any limitations of those practice responsibilities, and the degree of supervision under which the physician will function, if any;

A copy of the relevant sections of the hospital bylaws which detail the requirements for, and mechanism of, supervising physicians; and

A copy of the relevant section of the hospital bylaws which detail the requirements for, and mechanism of, supervision of postgraduate physician teachers.

Only practice within the teaching institutions and programs specified within the application;

Practice medicine only in conjunction with the applicant's teaching responsibilities; and

Not practice medicine outside the applicant's teaching responsibilities.

The date on which the current license expires;

The date by which the renewal application shall be received by the Board for the renewal to be issued and mailed before the license expires;

The amount of the renewal fee and any additional charges set by the Board; and

“2-year period” means:

“Applicant” means:

Be accredited as Category I or II by the ACCME;

Be sponsored by an international, national, or state medical society, and meet the standards adopted by the ACCME;

Be an accredited training program and have been attended by the applicant within a 2-year period, on the basis of either of the following:

Is a service performed by a Board designee and involves medical record review for the Board and the service is performed without compensation and is credited up to a maximum of 10 credit hours for a 2-year period.

Currently holds an active time-limited certification issued by:

Provides proof of maintenance of a time-limited Board certification that is dated no longer than 5 years prior to the renewal date.

Contain at a minimum the:

Demonstrate that the CME activity fell within a 2-year period.

Program title;

ACGME accredited sponsor's name and location;

Physician's name;

Inclusive dates of the residency or fellowship;

Specialty area of residency or fellowship; and

Documented verification of completion by the sponsor.

At the time the applicant was licensed, had licensure requirements substantially equivalent to the Board’s current licensure requirements as set forth in Regulation .03 of this chapter; and

Offers a similar reciprocal licensure process to physicians licensed by the Board;

“Administrative reinstatement” means the reactivation of an inactive or expired license.

“Administrative reinstatement” does not include postdisciplinary reinstatement.

Health Occupations Article, §§14-5A—14-5F, Annotated Code of Maryland; or

Health Occupations Article, Title 15, Annotated Code of Maryland.

The Board for initial licensure, for administrative expungement, or for administrative reinstatement; or

Disciplinary panel for postdisciplinary reinstatement.

“Complaint” means an allegation or report that:

“Complaint” includes, but is not limited to, the following:

Is composed of 11 Board members; and

Addresses:

The final written decision of the Board or disciplinary panel which results from a contested case proceeding or other formal proceeding and which contains findings of fact, conclusions of law, and a disposition which:

An order that denies postdisciplinary reinstatement of a license; or

An order to cease and desist from the practice of medicine.

“Investigation” means the gathering of the information necessary for the Board or a disciplinary panel to determine one or more of the following:

“Investigation” includes:

Treat the medical or surgical ailment, symptom, or problem in question; and

Would likely be familiar with the risks and benefits of treatments provided for that ailment, symptom, or problem.

The reactivation of a revoked or suspended license; or

The reactivation of a license surrendered while the licensee was under investigation or subject to disciplinary charges.

Given notice to answer allegations concerning violations of a statute over which the Board or a disciplinary panel has jurisdiction;

Notified as to a potential summary suspension pursuant to State Government Article, §10-226(c), Annotated Code of Maryland; or

Given notice to answer allegations concerning violations of a Board or disciplinary panel order.

Reprimands;

Places on probation;

Fines;

Suspends or revokes a license;

Disciplines by a consent order; or

Accepts a letter of surrender in lieu of charges or further investigation or prosecution.

Respond either in writing or by an appearance before the Board or a disciplinary panel; and

Present reasons and argument why a particular order should not be entered.

Shall review a complaint in light of the preliminary investigation; and

May direct further investigation, referral for peer review, closure without charges, or closure with an advisory letter.

Except as provided in §C(4)(b) of this regulation, upon the receipt of a timely written request from a psychiatrist who is the subject of a complaint concerning the quality of the psychiatric care provided by that psychiatrist, a quorum of a disciplinary panel shall review a subpoena for mental health records made or held by that psychiatrist before the subpoena is enforced.

Section C(4)(a) of this regulation does not apply to:

Section C(4)(b) of this regulation does not affect any rights which an individual may have under Health-General Article, Annotated Code of Maryland, to contest a subpoena in court.

Meet the standards of quality medical care; or

Keep adequate medical records.

Consider both the final peer review report and any written response submitted within the time period specified in §D(4) of this regulation; and

Determine whether there is reasonable cause to charge a respondent with failure to meet appropriate standards of quality care.

The day the complainant actually discovered the facts that form the basis of the complaint; or

The day when a reasonable person exercising due diligence should have discovered the facts that form the basis of the complaint.

Criminal convictions;

Sexual misconduct;

Other boundary violations;

Reciprocal actions under Health Occupations Article, §14-404(a)(21), Annotated Code of Maryland;

Ongoing substance abuse;

Fraudulent concealment of material information; or

Acts that occurred while a patient was a minor.

Close a complaint investigation without charges;

Take informal action by issuing a nonpublic advisory letter;

Request the respondent to enter into a disposition agreement with the disciplinary panel if the respondent suffers from substance abuse or a physical, mental, or emotional condition which may otherwise jeopardize medical care;

Except as provided in §E(1) of this regulation, vote to charge a respondent with a violation of a ground under Health Occupations Article, §14-404, Annotated Code of Maryland, or COMAR 10.32.07, or another statute which gives the Board or disciplinary panel authority;

Vote to deny administrative reinstatement; or

Accept a surrender on terms acceptable to the disciplinary panel.

In addition to charging, the disciplinary panel assigned to the complaint may vote to summarily suspend or vote an intent to summarily suspend the license of the respondent pursuant to State Government Article, §10-226(c), Annotated Code of Maryland.

A vote to summarily suspend the license of the respondent may be taken before the disciplinary panel charges the respondent.

After service of the charging document, the respondent and the complainant shall be offered a meeting with the disciplinary panel that was originally assigned the complaint and which sits as a DCCR. The meeting is a voluntary, informal settlement, proceeding to explore the possibility of a consent order or other resolution of the matter. The proceedings concerning a summary suspension are governed by Regulation .08 of this chapter and do not entail a meeting before a DCCR.

If the respondent and the administrative prosecutor each do not agree with the proposed settlement offered by the DCCR, the matter proceeds to a hearing before the Office of Administrative Hearings.

Except for the DCCRs consideration of a proposed resolution of a case achieved through the conference with the DCCR, the disciplinary panel, the parties, and the complainant may not make use of any commentary, admissions, facts revealed, or positions taken, including any disposition recommended by the DCCR, in the subsequent stages of the disciplinary proceedings unless the subject matter is available from other sources or is otherwise discovered. The respondent, administrative prosecutor, and complainant are prohibited from revealing this material.

The complainant and respondent may attend and participate as authorized by statute. The complainant may be accompanied by Board staff but not by any other person.

As soon as formal charges are issued; and

Until a disciplinary panel’s final decision is issued.

Proposed findings of fact;

Proposed findings of fact and proposed conclusions of law; or

Proposed findings of fact, proposed conclusions of law, and proposed disposition.

The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact on allegations which are disputed;

The disciplinary panel may rescind the delegation if:

If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(2)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue conclusions of law and a disposition based on the undisputed material facts, after giving the parties a reasonable opportunity for written and oral argument.

The delegation to the Office of Administrative Hearings is limited to making proposed findings of fact and conclusions of law on allegations which are disputed; and

The disciplinary panel may rescind the delegation if:

If a delegation to the Office of Administrative Hearings has been rescinded pursuant to §B(3)(b) of this regulation, the disciplinary panel shall set the case on the disciplinary panel docket for the disciplinary panel to issue a disposition based on the undisputed material facts and conclusions of law, after giving the parties a reasonable opportunity for written and oral argument.

The parties execute a proposed consent order settling all aspects of the case; and

The disciplinary panel initially assigned the complaint agrees to that proposed consent order.

A list of witnesses to be called; and

Copies of documents intended to be produced at the hearing.

The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of any statement made to the respondent by the patient which was not recorded in the respondent’s medical record of the patient, and which affected the patient’s course of treatment, including but not limited to:

The respondent shall notify the administrative prosecutor not later than 45 days after the issuance of charges of:

The notices required by §C(2)(a) and (b) of this regulation shall be in writing and shall state:

Unless the respondent has provided the notice required by §C(2) of this regulation, the administrative law judge shall exclude from the hearing any evidence described in §C(2)(a) or (b) of this regulation.

Each party shall provide to the other party not later than 15 days prior to the prehearing conference or 45 days prior to the scheduled hearing, whichever is earlier:

If the administrative law judge finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the administrative law judge shall exclude from the hearing:

The administrative law judge shall consider and decide arguments concerning the sufficiency of the report at the prehearing conference and may require that the report be timely amended, if insufficient, to allow the opposing party ample opportunity to prepare for hearing.

If an expert adopts the written report of the disciplinary panel’s peer reviewer or reviewers, or adopts a sufficiently specific charging document as the expert’s report, that adoption is considered to satisfy the requirements set forth in §C(3) of this regulation.

The prehearing conference, if scheduled; or

If no prehearing conference is scheduled, 15 days prior to the hearing.

In hearings conducted by an administrative law judge of the Office of Administrative Hearings, §C of this regulation shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01.

In the event of a conflict between §C of this regulation and COMAR 28.02.01, §C of this regulation shall apply.

Any party may file with the disciplinary panel, that delegated the case to an administrative law judge, exceptions to a proposed decision of an administrative law judge within 15 days of its issuance. A party may file a response to any exceptions within 15 days of the date the exceptions are filed. The disciplinary panel may extend the period for filing exceptions and responses. The disciplinary panel may grant a party filing exceptions the opportunity to file a reply to a response within a stated period of time as determined by the disciplinary panel in any specific case. No further exceptions or responses of any kind may be accepted.

Format.

Exceptions, responses, and replies may refer to the record by citing the exhibit number or the transcript page.

The disciplinary panel chair or the disciplinary panel chair’s designee may in each case rule on specific procedural issues with respect to written exceptions.

The disciplinary panel may not accept additional evidence through the written exceptions process.

If either party files exceptions, the disciplinary panel shall schedule a hearing, ordinarily 30 days after the receipt of responses to the exceptions, after which the disciplinary panel shall issue an order containing the disciplinary panel’s findings of fact, conclusions of law, and disposition.

The presiding disciplinary panel member, usually the disciplinary panel chair, shall:

The party who filed the first exceptions shall ordinarily proceed first.

Both parties consent to the admission of additional documentary evidence and the disciplinary panel determines that acceptance of the additional evidence would promote the just and efficient completion of the process; or

The disciplinary panel determines that either:

An exceptions hearing; or

Other formal disciplinary panel proceedings.

When a time period is not stated in an order for revocation, the disciplinary panel may not entertain an application for postdisciplinary reinstatement until at least 3 years after the date of the order.

A revocation of a license may not be for less than 1 year and may be permanent.

The disciplinary panel may not entertain an application for postdisciplinary reinstatement after an order of revocation unless:

The disciplinary panel that issued the final order revoking or suspending the respondent shall entertain applications for reinstatement pursuant to the procedures and standards of Regulation .06B of this chapter.

Except as a disciplinary panel order directs otherwise in a specific case, if a licensee subject to probation or suspension fails to renew a license:

Section C(3)(a) of this regulation does not:

A written application for reinstatement on a form prescribed by the Board;

The appropriate fee;

Written responses to any questions the disciplinary panel may propose concerning the reasons the license was revoked or surrendered and the petitioner’s current fitness to practice; and

Evidence of the completion of continuing medical education credits to the same extent as if the petitioner had been continuously licensed;

If the letter of surrender indicates that the surrender or the revocation order is for a certain length of time, the time period has expired; or

If the letter of surrender or revocation order does not indicate a time certain, 3 years have passed since the date of the order; and

If the letter of surrender makes reinstatement contingent on certain conditions, those conditions have occurred;

May conduct an informal inquiry which shall include, if requested, an opportunity for the petitioner to have a personal interview with the panel;

May consider the petitioner’s history; and

May consider presentations from both the petitioner and the administrative prosecutor’s office.

Probation;

Requirements for supervision;

Further review of competence or performance;

Limitations on practice; or

Other conditions that the disciplinary panel considers necessary; or

For a conviction, at least:

For a plea of guilty, including an Alford plea, or a plea of nolo contendere, at least one of the following:

Lack of conviction or plea;

Whether the crime is one involving moral turpitude;

Misidentity of the respondent with the defendant in the criminal matter; and

Other relevant issues, if any, other than mitigation.

Proposed order for summary suspension; and

Show cause notice letter providing an opportunity to the respondent to show cause why the order should not be issued.

The statutory authority upon which the order is based;

Notification that the respondent may request a full hearing to appeal the summary suspension, if executed by the disciplinary panel; and

Statements of investigatory information which serve as a basis for the order.

The disciplinary panel shall serve the respondent:

The disciplinary panel may choose to serve the respondent personally.

The disciplinary panel determines that the health, welfare, and safety of the public or the physician imperatively requires immediate suspension;

Notice and opportunity to be heard before the action is not feasible; and

The respondent is provided with a postdeprivation opportunity to be heard within 15 days by the disciplinary panel, that voted to summarily suspend the license.

Shall allow for consideration of oral presentations and documents considered by the presiding disciplinary panel member to be relevant and material to the proceeding and not unduly repetitious; and

May not admit oral testimony or witnesses.

For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe:

A stayed suspension in which the stay is conditioned on the completion of certain requirements is ranked as probation.

A stayed suspension not meeting the criteria for §A(3)(b) of this regulation is ranked as a reprimand.

A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction.

The addition of a fine does not change the ranking of the severity of the sanction.

The sanction with the highest severity ranking should be used to determine which ground will be used in developing a sanction; and

The disciplinary panel may impose concurrent sanctions based on other grounds violated.

The absence of a prior disciplinary record;

The offender self-reported the incident;

The offender voluntarily admitted the misconduct, made full disclosure to the disciplinary panel and was cooperative during the disciplinary panel proceedings;

The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct;

The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct;

The offender has been rehabilitated or exhibits rehabilitative potential;

The misconduct was not premeditated;

There was no potential harm to patients or the public or other adverse impact; or

The incident was isolated and is not likely to recur.

The offender has a previous criminal or administrative disciplinary history;

The offense was committed deliberately or with gross negligence or recklessness;

The offense had the potential for or actually did cause patient harm;

The offense was part of a pattern of detrimental conduct;

The offender committed a combination of factually discrete offenses adjudicated in a single action;

The offender pursued his or her financial gain over the patient’s welfare;

The patient was especially vulnerable;

The offender attempted to hide the error or misconduct from patients or others;

The offender concealed, falsified or destroyed evidence, or presented false testimony or evidence;

The offender did not cooperate with the investigation; or

Previous attempts to rehabilitate the offender were unsuccessful.

Practicing medicine without a license in violation of Health Occupations Article, §14-601, Annotated Code of Maryland; or

A violation of an order of cease and desist from practicing medicine without a license.

The extent to which the respondent derived any financial benefit from the improper conduct;

The willfulness of the improper conduct;

The extent of actual or potential public harm caused by the improper conduct; and

The deterrent effect of the fine.

Except as specified in §C(3)(b) of this regulation, the Board may impose fines as follows:

If the conduct resulted in harm to any patient, the Board may consider each patient seen to be a separate violation when imposing a fine listed in §C(3)(a) of this regulation.

Except as provided in §E(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the disciplinary panel may impose a civil fine under Health Occupations Article, §14-316(d)(5), 14-5A-13(d)(2), 14-5B-12(d)(2), 14-5D-12(g), or 15-307(f), Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §14-404, 14-5A-17, 14-5B-14, 14-5D-14, or 15-314, Annotated Code of Maryland.

Section E(1)(a) of this regulation does not limit the Board’s or disciplinary panel’s authority to require completion of the missing continuing medical education credits.

If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate:

Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines.

If a licensee has been previously fined or otherwise disciplined under §E(1) or (2) of this regulation, the disciplinary panel may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate:

Upon a finding of a violation, the disciplinary panel may impose any discipline authorized under Health Occupations Article, §14-404(a), 14-405.1, 14-5A-17, 14-5B-17, 14-5C-17, 14-5D-14, 14-5E-16, 14-5F-18, 15-314, or 15-316, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense.

The disciplinary panel may not apply the sanction described in §E(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits.

Issue a license; or

Deny the application.

Failing to meet the minimal qualifications or requirements of licensure;

Committing an act or an omission constituting grounds for discipline under Health Occupations Article, §14-404, Annotated Code of Maryland;

Failing to complete the application or failing to provide additional information requested by the Board in connection with the application;

Submitting false or misleading information in connection with the application; or

Failing to cooperate with the Board’s investigation of the application.

The Administrative Procedure Act;

COMAR 28.02.01; and

COMAR 10.32.02.04C, which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01.

The Administrative Procedure Act;

COMAR 28.02.01; and

COMAR 10.32.02.04C which shall, whenever possible, be construed as supplementing and in harmony with COMAR 28.02.01.

Is a public document; and

Is effective immediately unless the order states otherwise.

A respondent may challenge the factual or legal basis of the initial order by filing a written opposition within 30 days of its issuance, and may include a request for a hearing.

The Board shall consider that opposition and shall provide a hearing if requested.

After considering the written opposition and the presentation at the hearing, if any, the Board may issue a final order to rescind, modify, or affirm the cease and desist order.

The Board shall serve the final order by hand delivery, certified mail, or first-class mail to the last known address of the respondent.

The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act.

The Board may impose a fine as provided in Regulation .09C of this chapter on any individual who violates a cease and desist order.

Before imposition of a fine for violation of a cease and desist order, the Board shall give notice of the alleged violation, and an opportunity for a hearing.

The hearing may not concern issues:

The only issues to be considered at the hearing are:

The Board shall issue a final order stating whether a violation occurred and if so, the amount of the fine.

The respondent may seek judicial review of the Board’s final order as provided in the Administrative Procedure Act.

The application is submitted more than 3 years after the imposition of an administrative action by the Board or after administrative reinstatement or termination of suspension of the license, whichever is later;

The licensee had no incidents of a public sanction since the administrative action identified in the application occurred; and

The licensee is not currently under probation or investigation by the Board.

Failure to pay taxes or unemployment insurance contributions under Health Occupations Article, §1-213(b), Annotated Code of Maryland;

Failure to complete continuing medical education requirements under Health Occupations Article, §14-316(d), Annotated Code of Maryland;

Failure to renew a license on time under Health Occupations Article, §14-606(a)(5), Annotated Code of Maryland; or

Failure to notify the Board in writing of change of name or address within the time required under Health Occupations Article, §14-316(f).

Accredited by:

Certified to participate in the Medicare Program, as enacted by Title XVIII of the Social Security Act.

“Collaboration” means the communication and decision-making process among health care providers who are members of a patient care team related to the treatment of a patient which includes the degree of cooperation necessary to provide treatment and care to the patient.

“Collaboration” includes:

“Collaboration” does not require constant, physical presence of a collaborating physician on-site in the practice setting provided that the collaborating physician is accessible by electronic means.

That offers a degree after graduation from high school;

That is in the United States, its territories and possessions, or the British Commonwealth; and

Where all academic and clinical courses are taught in English.

A hospital;

An ambulatory surgical facility;

A federally qualified health center as defined in Health-General Article, §24-1301(b), Annotated Code of Maryland; or

Any other practice setting listed on a hospital delineation of privileges document.

A hospital as defined under Health-General Article, §19-301(g), Annotated Code of Maryland;

A comprehensive care facility that:

An emergency room that is physically connected to a hospital or a freestanding medical facility that is licensed under Health-General Article, Title 19, Subtitle 3A, Annotated Code of Maryland.

Prescribe and administer:

Give verbal, written, or electronic orders for medications; and

Dispense starter dosages or drug samples.

Of short duration of 72 hours or less; or

Before obtaining a larger quantity of the drug to complete therapy.

Receives after initial licensure as a physician assistant; and

Requires to perform advanced duties.

Failure to attend two successive committee meetings without adequate reason;

Failure to attend Board mandated training; or

Failure to complete necessary ethics filing requirements;

Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment;

Graduation from a recognized English-speaking professional school; or

Receiving a grade of:

Have graduated from a physician assistant program accredited by The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), its predecessor, or its successor; and

Have passed the physician assistant national certifying examination administered by the National Commission on Certification of Physician Assistants (NCCPA) or its successor.

A bachelor’s degree; or

At least 120 credit hours of education at the college or university level.

Each patient care team physician’s name and Maryland license number;

A description of each patient care team physician’s qualifications to collaborate with a physician assistant;

The practice specialty of each listed patient care team physician;

The physician assistant’s name and Maryland license number;

The primary location and settings where the physician assistant will practice;

The employer of the physician assistant;

A description of the settings where the physician assistant will practice;

Any delegation of prescriptive authority and, if applicable, dispensing according to Regulation .08 of this chapter; and

Any other information deemed necessary by the Board to carry out the provisions of Health Occupations Article, Title 15, Annotated Code of Maryland.

Detail the practice of the physician assistant;

Limit the physician assistant's scope of practice; or

Specify office procedures.

Appropriate to the education, training, and experience of the physician assistant;

Customary to the practice of a patient care team physician listed on the collaboration agreement; and

Performed in a manner consistent with the collaboration agreement; and

The patient care team physician listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment;

The physician assistant listed on the collaboration agreement has been credentialed by the exempt facility as a condition of employment; and

The advanced duty to be delegated by the patient care team physician to the physician assistant is reviewed and approved in a process approved by the exempt facility before the physician assistant performs the advanced duty.

Principles of radiography;

Image acquisition;

Principles of exposure;

Image evaluation;

Radiation safety;

Equipment overview; and

Documentation; and

Include anterior-posterior and lateral radiographic studies of extremities, not including the head, on at least 20 separate patients; and

Be under the direct supervision of the delegating physician or radiologist.

Shall review the collaboration agreement;

May conduct a personal interview of the physician assistant and patient care team physicians; or

May recommend to the Board that the collaboration agreement be modified to ensure conformance with the requirements of Health Occupations Article, §§15–302 and 15–302.1, Annotated Code of Maryland.

Notify the delegating patient care team physician listed in the collaboration agreement and the physician assistant in writing of the particular elements of the advanced duty approval request that were the cause for the modification or denial;

Set forth the specific reasons for the modification or denial; and

Give the applicant an opportunity to submit an amendment to the advanced duty or request a hearing before the Board.

Fails to complete the application;

Fails to provide additional information requested by the Board in connection with the application; or

Submits false or misleading information to the Board in connection with the application.

Give written notice to the applicant; and

Set forth the specific reasons for the ineligibility.

Prescribing of:

Giving verbal, written, or electronic orders for medications;

Dispensing starter dosages or drug samples;

Passed the physician assistant national certification exam administered by the National Commission on the Certification of Physician Assistants, Inc. within the previous 2 years; or

Completed 8 Category I hours of pharmacology education within the previous 2 years; and

A bachelor's degree or its equivalent; or

2 years of work experience as a physician assistant.

Package is labeled as required by Health Occupations Article, §12-505, Annotated Code of Maryland; and

No charge is made for the drug sample or starter dosage.

Completing an application on a form approved by the Board;

Paying the required renewal fee as defined in Regulation .16 of this chapter;

Attesting to completion of continuing education activities as specified in §D of this regulation; and

Meeting any additional requirements set by the Board for renewal of a license.

At least 8 hours of Category 1 education on pharmacology topics earned during the 2-year period preceding:

In addition to the continuing education hours specified in §D(1)(a) of this regulation, at least 42 hours of Category I continuing education earned during the 2-year period preceding:

Shall earn at least 8 hours of Category 1 education on pharmacology topics prior to the expiration of the physician assistant license; and

Is not required to complete any other hours of Category I continuing education prior to the expiration of the physician assistant license.

A physician assistant shall obtain documentation of attendance at Category I continuing education and retain the documentation for 6 years.

The documentation shall contain, at a minimum, the following information:

Proof of maintenance of certification by the National Commission on Certification of Physician Assistants may be used to document compliance with the continuing education requirement.

Are customary to the practice of a listed patient care team physician; and

Are suitable to be performed by the physician assistant, taking into account the physician assistant’s:

Name and license number of the patient care team physician and physician assistant; and

Reason for termination, including a description of conduct or incident that resulted in the termination.

Immoral conduct in the practice of medicine; or

Unprofessional conduct in the practice of medicine;

While under the influence of alcohol; or

While using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, §5-101, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication;

The name of the laboratory;

The amount paid to the laboratory for the test or test series; and

The amount of procurement or processing charge of the licensed physician, if any, for each specimen taken;

Surrendered the license issued by the state or country to the state or country; or

Allowed the license issued by the state or country to expire or lapse;

Associates with a pharmacist as a partner or co-owner of a pharmacy for the purpose of operating a pharmacy;

Employs a pharmacist for the purpose of operating a pharmacy; or

Contracts with a pharmacist for the purpose of operating a pharmacy;

In an alcohol or drug treatment program that is accredited by the Joint Commission or is certified by the Maryland Department of Health; or

Under the care of a health care practitioner who is competent and capable of dealing with alcoholism and drug abuse;

Prima facie evidence that the physician assistant cannot perform delegated medical acts; and

Cause for denial of an application or suspension of a license.

For the purpose of an audit to verify general compliance with the Maryland Physician Assistants Act; or

To investigate an allegation with respect to a physician assistant.

The compliance section of the Board; or

An outside agency that has jurisdiction over a facility.

For the purposes of this regulation, the severity of sanctions is ranked as follows, from the least severe to the most severe:

A fine listed in the sanctioning guidelines may be imposed in addition to but not as a substitute for a sanction.

The addition of a fine does not change the ranking of the severity of the sanction.

The sanction with the highest severity ranking shall be used to determine which ground will be used in developing a sanction; and

The Board may impose concurrent sanctions based on other grounds violated.

The absence of a prior disciplinary record;

The offender self-reported the incident;

The offender voluntarily admitted the misconduct, made full disclosure to the Board, and was cooperative during the Board proceedings;

The offender implemented remedial measures to correct or mitigate the harm arising from the misconduct;

The offender made good faith efforts to make restitution or to rectify the consequences of the misconduct;

The offender has been rehabilitated or exhibits rehabilitative potential;

The misconduct was not premeditated;

There was no potential harm to patients or the public or other adverse impact; or

The incident was isolated and is not likely to recur.

The offender has a previous criminal or administrative disciplinary history;

The offense was committed deliberately or with gross negligence or recklessness;

The offense had the potential for or actually did cause patient harm;

The offense was part of a pattern of detrimental conduct;

The offender committed a combination of factually discrete offenses adjudicated in a single action;

The offender pursued his or her financial gain over the patient’s welfare;

The patient was especially vulnerable;

The offender attempted to hide the error or misconduct from patients or others;

The offender concealed, falsified, or destroyed evidence or presented false testimony or evidence;

The offender did not cooperate with the investigation; or

Previous attempts to rehabilitate the offender were unsuccessful.

The extent to which the respondent derived any financial benefit from the improper conduct;

The willfulness of the improper conduct;

The extent of actual or potential public harm caused by the improper conduct; and

The deterrent effect of the fine.

Except as provided in §F(2) or (3) of this regulation, if a licensee has submitted an application claiming the completion of continuing medical education credits and the licensee fails to document the completion of such continuing medical education credits when audited by the Board, the Board may impose a civil fine under Health Occupations Article, §15-307(f), Annotated Code of Maryland, of up to $100 per missing continuing medical education credit in lieu of a sanction under Health Occupations Article, §15-314, Annotated Code of Maryland.

Section F(1)(a) of this regulation does not limit the Board's authority to require completion of the missing continuing medical education credits.

If a licensee has willfully falsified an application with respect to continuing medical education credits, the licensee may be charged under one or more of the following, as appropriate:

Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §15-314 or 15-316, Annotated Code of Maryland, and the sanctioning guidelines.

If a licensee has been previously fined or otherwise disciplined under §F(1) or (2) of this regulation, the Board may, for a subsequent offense relating to continuing medical education credits, charge a licensee under one or more of the following, as appropriate:

Upon a finding of a violation, the Board may impose any discipline authorized under Health Occupations Article, §15-314 or 15-316, Annotated Code of Maryland, and the sanctioning guidelines for a subsequent offense.

The Board may not apply the sanction described in §F(1) of this regulation in determining a sanction for a licensee previously fined or disciplined for an offense related to continuing medical education credits.

Hospital;

Nursing home;

Health maintenance organization;

Community health center;

Public health clinic;

Similar institution; or

Medical office of more than one psychiatrist.

A complete list and description of the duties to be assigned to the psychiatrist's assistant.

A detailed description of the supervisory relationship between the psychiatrist and the psychiatrist's assistant or the psychiatrists in a facility and the psychiatrist's assistant. The description of the supervisory relationship shall include a schedule of patient reviews.

The name of a principal psychiatrist who will be responsible for the assigned duties and supervision of all psychiatrist's assistants;

The total number of psychiatrist's assistants to be employed.

Under the influence of alcohol, or

Using any narcotic or controlled dangerous substance, as defined in Criminal Law Article, Annotated Code of Maryland, or other drug that is in excess of therapeutic amounts or without valid medical indication;

“Telehealth” means a mode of delivering health care services through the use of telecommunications technologies by a health care practitioner to a patient at a different physical location than the telehealth practitioner.

“Telehealth” includes synchronous and asynchronous interactions.

“Telehealth” does not include the provision of health care services solely through:

Government issued photograph identification;

Insurance, Medicaid, or Medicare card; or

Documentation of the patient’s:

Monitoring and recording physiologic data during sleep, including sleep-related respiratory disturbances, under the supervision of a licensed physician; and

Using the data collected under §B(17)(a) of this regulation for the purposes of assisting a licensed physician in the diagnosis and treatment of sleep and wake disorders.

Enrolled in an accredited educational program in order to qualify for a license as a polysomnographic technologist; and

Performing polysomnography services within the accredited program under the supervision of a licensed physician and without compensation.

Before October 1, 2009, are registered polysomnographic technologists; and

On or after October 1, 2009, are both registered polysomnographic technologists and licensed polysomnographic technologists;

One in psychiatry or internal medicine;

One in pulmonary medicine; and

One in neurology; and

May not be or ever has been:

May not:

Documentation of graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment;

Documentation of graduation from a recognized English-speaking professional school; or

Documentation of receiving a grade of at least:

Graduation from a respiratory care educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs; and

Completion of the Committee on Accreditation for Respiratory Care’s curriculum for a polysomnography certificate that is accredited by the Commission on Accreditation of Allied Health Education Programs;

Graduation from an electroneurodiagnostic technology educational program that is accredited by the Commission on Accreditation of Allied Health Education Programs; and

Completion of an add-on track in polysomnography for electroneurodiagnostic technologists that is accredited by the Commission on Accreditation of Allied Health Education Programs; or

A student enrolled in a sleep technologist educational program supervised at a sleep laboratory accredited by the American Academy of Sleep Medicine or The Joint Commission by:

A sleep technologist with a current, active, unrestricted license in another state or is otherwise recognized and has practiced as a sleep technologist in another state who has:

Continuous positive airway pressure, bi-level positive airway pressure titration, or adaptive servo-ventilation on spontaneously breathing patients;

Supplemental low flow oxygen therapy during polysomnogram;

Capnography during polysomnogram;

Cardiopulmonary resuscitation;

Pulse oximetry;

PH probe placement and monitoring;

Esophageal pressure;

Sleep staging, including surface electroencephalography, surface electrooculography, and surface submental electromyography;

Surface electromyography of arms and legs;

Electrocardiography;

Respiratory effort, including thoracic and abdominal;

Plethysmography blood flow;

Snore monitoring;

Audio or video monitoring;

Implementation of a written or verbal order from a licensed physician that requires the practice of polysomnography;

Monitoring the effects a nasal device used to treat sleep apnea has on sleep patterns provided that the device does not extend into the trachea; and

Monitoring the effects an oral device used to treat sleep apnea has on sleep patterns provided that:

Submitting a renewal application on a form supplied by the Board;

Paying the required renewal fee set by the Board in Regulation .09 of this chapter;

Attesting to the completion of at least 20 hours of approved continuing education, earned during the 2-year period preceding the expiration of the license, as specified in Regulation .08 of this chapter; and

Meeting any other requirement set by the Board.