One-Bite Reporting Exemption

In early 2018, the Ohio Academy of Family Physicians, in partnership with other physicians’ organizations and treatment providers, achieved a major legislative victory that at many times over the last four years seemed unlikely. Passage of House Bill (HB) 145 on January 24, 2018, marked a milestone on a long and arduous journey to ensure that physicians can seek confidential services to improve their health and well-being as a means to ensure patient care safety. A contentious stalemate with the State Medical Board of Ohio (SMBO) eventually gave way to collaboration that resulted in passage of legislation that maintains a physician’s ability to seek treatment for drug, alcohol, or other substance abuse if certain specified conditions are met.

Under provisions of the program commonly referred to as the “one-bite” exemption, a physician with drug or alcohol issues is not required to notify the SMBO if he or she meets the following conditions:
  • Examination at an approved treatment provider
  • If diagnosed with impairment, the individual completes treatment in accordance with SMBO requirements; and
  • The individual has not violated SMBO statutes or rules, other than those relating to impairment.

HB 145 clears up uncertainty about eligibility criteria for one-bite participation, without jeopardizing the confidentiality assured under the existing program. The legislation also specifies the criteria for operation of treatment facilities and for the organization assigned to monitor one-bite participants. In addition, the legislation requires the SMBO to contract with one organization to conduct the one-bite program and to perform the monitoring services related to the program. It is expected that the organization selected will be the Ohio Physicians Health Program (OPHP).

The OPHP is a nonprofit organization that offers confidential assistance to physicians and other health care professionals who may be affected by mental, emotional, and behavioral illness, substance-related, and addictive disorders. Their mission is to facilitate the health and wellness of health care professionals in order to enhance patient care and safety. For more than four decades, the OPHP has been confidentially helping impaired physicians regain the health and well-being needed to serve their patients.

HB 145 pertains only to substance abuse and addiction, and continues to leave open impairment because of mental or physical illness question. Nevertheless, due to the persistence of the OAFP and other physician organizations, the SMBO is now drafting proposed rules that, if adopted, would establish a confidential monitoring program that allows licensees with mental or physical illnesses, other than substance use disorders, to be monitored by the SMBO without being subjected to formal public disciplinary action. For those eligible physicians, non-disciplinary SMBO actions would not be reported to the National Practitioners Data Bank. The rule language does not go as far as the one-bite legislation in permitting the licensee to seek treatment confidentially (without involvement from the SMBO), but it is definitely another step in the right direction.

De-identified data from the non-disciplinary program will be evaluated once it is implemented. In addition, future decisions on disability discrimination rendered by the U.S. Department of Justice will be reviewed prior to deciding if additional legislative action is needed.

Although the OAFP has actively involved in writing these rules as well as the draft rules to implement HB 145, we were surprised to that significant changes were made to the most recent draft rules the SMBO circulated for comment. Comments have been submitted on the proposed changes and a meeting has been requested for the draft rules to be amended to honor the previously agreed on principles .

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