Minimum Discipline For Opioid Prescribing

(1) If the Board finds that its licensee has prescribed, dispensed, or administered opioids in a manner that violates the Board’s statutes or rules (for example, by prescribing in a manner that constitutes gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence), the Board shall make a finding that the licensee engaged in a significant deviation or pattern of deviation from sound medical judgment. For purposes of such a finding, sound medical judgment is the equivalent to the standard of care as defined in T.C.A. § 63-1-122. (2) Having made such a finding, the minimum discipline that the Board assesses shall include the following: (a) Reprimand; (b) Successful completion of a Board approved intensive continuing education course or program regarding treatment with opioids; (c) A restriction against prescribing opioids for at least six (6) months, and until successful completion of the required continuing education; (d) One or more Type A civil penalties; (e) Proof to the licensee’s Board that they have notified any physicians, podiatrists, advanced practice registered nurses, or physician assistants with whom they collaborate of the discipline; and (f) Where the licensee is a physician or podiatrist, a restriction against collaborating with any advanced practice registered nurses or physician assistants for issuing opioids during the period in which the licensee is restricted from prescribing opioids. (3) The prescribing boards and committee recognize that a higher level of minimum discipline is required for those licensees who have been disciplined for opioid-related prescribing violations but continue to violate the standard of care. As set out in paragraph (1) of this rule, the following findings are synonymous, though the boards or committee may have used one or more sets of language to describe a violation. If a licensee commits an order violation in which the prior order contains one or more of the following findings, the licensee has committed an opioid-related order violation for purposes of paragraph (5) of this rule: ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 (a) That the licensee had prescribed, dispensed, or administered opioids in a manner that constituted gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence; (b) That the licensee engaged in a significant deviation or pattern of deviation from sound medical judgment related to the issuance of opioids; (c) That the standard of care related to the issuance of opioids was violated; (d) That the licensee had dispensed, prescribed or administered opioids not in the course of professional practice, or not in good faith to relieve pain and suffering or not to cure an ailment, physical infirmity or disease; (e) That the licensee was unfit or incompetent by reason of negligence, habits or other cause related to the licensee’s prescribing or issuance of opioids; or (f) That the licensee violated the rules of the licensing entity with regard to prescribing or issuance of opioids. (4) If within one (1) year from the date a licensee’s opioid-prescribing privileges are reinstated, having been restricted by an opioid-related order, that licensee’s board or committee finds that, during that year the licensee had prescribed, dispensed, or administered opioids in a manner that violates the Board’s statutes or rules (for example, by prescribing in a manner that constitutes gross healthcare liability or a pattern of continued or repeated health care liability, ignorance, negligence or incompetence), the Board shall make a finding that the licensee re-engaged in a significant deviation or pattern of deviation from sound medical judgment such that they are a repeat offender. For purposes of such a finding, sound medical judgment is the equivalent to the standard of care as defined in T.C.A. § 63-1-122. (5) If the licensee commits an opioid-related order violation within one year of the opioid-related order, or if the licensee is found to be a repeat offender, the minimum discipline that the Board assesses shall include the following: (a) Probation; (b) Successful completion of a practice monitoring program which shall include at a minimum: 1. Board approval of the monitor or monitoring program; 2. Quarterly reports to the Board which include the practice monitor’s findings with regard to the licensee’s: (i) Non-opioid prescribing practices; (ii) Medical recordkeeping; (iii) Pain management; (iv) Opioid treatment practices—where the practice monitoring is longer than the restriction against prescribing opioids; and (v) Compliance with the practice monitor’s recommendations, including completion of any additional education recommended by the practice monitor; ADVANCED PRACTICE REGISTERED NURSES CHAPTER 1000-04 (c) A restriction against prescribing opioids for twice the amount of time that was assessed in the initial Board order, and for no less than one (1) year; (d) One or more Type A civil penalties totaling at least twice the amount that was assessed in the initial Board order; (e) Proof to the licensee’s board or committee that they have notified any physicians, podiatrists, advanced practice registered nurses, or physician assistants with whom they collaborate of the discipline; and (f) Where the licensee is a physician or podiatrist, a restriction against collaborating with any advanced practice registered nurses or physician assistants during the period in which the licensee is restricted from prescribing opioids. (6) Nothing in this rule shall prohibit the Board from taking action in excess of the minimum disciplinary action outlined herein. Each case shall be judged independently and may result in additional discipline including other restrictions or a higher level of discipline, including revocation, where appropriate. Further, nothing in this rule shall prohibit the Board from taking disciplinary action against a licensee based on a finding that the licensee violated the practice act in manners additional to those outlined in paragraph (1) above, suggesting a need for a higher level of discipline.