Professional Regulation and Criminal Liability in Delaware
Lorna J. Granston
05/26/14
HCS 430
Dr. J. Kaplan

There are statutes that regulate health care professional on a federal level. It can be difficult to regulate professional on that level, therefore, there are also regulatory bodies on the State level. Regulatory statutes on the State level can offer specific policy and procedures for professional licensure, credentialing, certification and registration for those in health care. Each State in responsible for having specific regulation. Per the American Medical Association (AMA),” the process of obtaining a medical license--either initial licensure or a second or subsequent license in another state--can be a challenging process” (American Medical Association, 2014). The state statutes can be more complicated, but they ensure that professionals are properly prepared to perform health care services for a specific community. In Delaware there are state laws that are followed by state regulatory agency. The Registrar’s office which is part of Delaware’s General Assemble is responsible for the Administrative Code of Regulations and the Delaware On-line Statutory Code. This office is also the official repository of all regulations for the State of Delaware. Title 24 of this code of regulations is directed specifically to Professions and Occupations in the state of Delaware. Within Title 24, Chapter 17 is the Medical Practice Act. The Delaware agency that implements and oversees the regulation is the Division of Professional Regulation. Professional Regulation provides regulatory oversight for 34 boards/commissions, which are comprised of Governor - appointed public and professional members. The activities of this oversight include administrative, fiscal, and investigative support for 54 professions, trades and events. According the Delaware.gov, the key objectives of the agency are: * Provide assistance to applicants, seeking licensure, throughout the licensure process. * Issue and renew licenses for qualified professionals and business entities. * Maintain a licensing database to provide the public with vital licensure information, to notify licensees of renewal periods and continuing education requirements and to assist state and federal agencies in accomplishing their missions. * Respond to inquiries from the public, other state and national agencies and private organizations regarding Delaware licensed professionals. * Investigate complaints from the public who are the recipients of the professional services. * Partner with the Attorney General's Office to coordinate complaint disposition and disciplinary proceedings in accordance with the Administrative Procedures Act. * Oversee all board/commission activities to ensure that testing, licensing, disciplinary proceedings, rule-making and other regulatory activities are completed in an efficient manner and in compliance with the Delaware Code and applicable rules and regulations.
This agency is the authority for the two major regulatory boards in Delaware. The Board of Medical Licensure and Discipline and the Board of Nursing handle the licensure and certification of the majority of the health care professionals that practice in the State of Delaware. The Board has specific goals in order to meet is objectives: * Develops standards for professional competency * Promulgates rules and regulations * Adjudicates complaints against professionals and imposes disciplinary sanctions, when needed
These objectives are the guidelines used when supporting the health care professionals in Delaware. One of the most important function of the Board of Medical Licensure and Discipline is to set requirements for licensure in the state of Delaware. The Medical Act states that in order for a person to practice medicine in the State of Delaware the following must be met: * Has a certificate to practice medicine issued by the Board of Medical Licensure and Discipline; * Registers the certificate to practice medicine and renews it biennially; and * If required, has an occupational license pursuant to Part III of Title 30.
The Board issues physician (M.D. and D.O.) licenses and physician training licenses to residents, interns, fellows and house physicians. The Board also issues licenses these additional healthcare professions: physician assistants, respiratory care practitioners, acupuncture practitioners, acupuncture detoxification specialists, genetic counselors and polysomnographers (Delaware Department of State, 2014). In addition, a council for each of these healthcare professions advises and assists the Board on licensure and regulatory matters involving the specific professions. There different requirements set for each type of profession. For example there are specific requirements for physician licensure which are different from physician assistant licensure. All health care professionals are required to submit an application to start the process. The application process includes submitting information such and proof of your education, training and passing medical exam, as well as authorization for the board to perform a background check. The background check does include verifying standings with Delaware Child Protection Agency as well as any medical misconduct and/or criminal activity in other states where the applicant previously practiced. Submitting correct information to the Board in order to meet the Delaware State requirements is important. Of course there is some liability when depending on people to provide honest and truthful information in the application process. Even though there is a background check required, information such as medical misconduct can be omitted or overlooked if an applicant is not truthful about their previous work experience. The work performed to process the application by the Board is rigorous in order to ensure that all proper information is submitted by the applicant and there are no such liabilities in allow the applicant to practice in the State of Delaware. The Delaware Board of Nursing is similar to the Board of Medical Licensure and Discipline, but this board concentrates on the profession of Nursing. The Board issues licenses to registered nurses, practical nurses and advanced practice nurses. The objectives and function of this board falls in line with the same objectives and functions of the Board of Medical Licensure and Discipline. In order to practice nursing in the state of Delaware an application must be submitted, but there are some exceptions because there are some States recognize licensure from other States. These are “Compact States” where the applicant can apply for the multi-State licensure (State of Delaware, 2014). The requirements and process for Nurses and Advanced Practice Nurses is not as intense and vigorous as the process for Physicians. Both the Board of Medical Licensure and Discipline and the Board of Nursing are also responsible for maintenance and renewal of licensing. Delaware provides some convenience by allowing some information to be updated online. The renewal of licensure is also not as rigorous as the initial application as long as the applicant is renewing for the same State. In addition to managing the licensure and certification, the Division of Professional Regulation also addresses disciplinary and misconduct issues within the State of Delaware. The agency provides a mechanism for any state resident to initiate a complaint against any professional that provides services in the state. When it comes to professional misconduct and negligence, the individual facilities or organizations where the professional works should have risk and quality management policies. Quality management addresses processes and procedures and ensures that the best practices are in place. Risk management is to specifically reduce those areas that are deemed potential risk. Risk management also provides procedures to be followed in case of a risk event. Additionally the Delaware Medical Act indicates that there is a responsibility to report specific types of misconduct and negligence to the Division of Professional Regulation. This is called the Mandatory Duty to Report. For example a section of the Title 24, Chapter 17 of the Medical Act states:
”Every person to whom a certificate to practice medicine is issued and health care facility as defined in § 1740 of this title has a duty to report to the Board within 30 days:
a. Any partial or full removal of hospital privileges based on adverse events, unprofessional conduct or competency issues; and
b. Any disciplinary action taken by a medical society against that person; and
c. Any reasonably substantiated incidents involving violence, threat of violence, abuse, or neglect by a person toward any other person.”
Reporting to the State ensures that the proper disciplinary action is enforced. Recording of the misconduct and the consequential disciplinary action is important so that other States can be aware of previous issues or criminal liability. Not all cases result in criminal charges or having license revoked, maintaining the all the information maximizes regulation. Regulation of licensure and criminal liability is a complex process. On a National level, the AMA assists physicians with the process by providing State medical licensure requirements and statistics on a monthly basis. Having a licensure and certification process at the State level allows for concentrated attention to laws so the regulation is effective. Having effective regulation can ensure that the state and local community are receiving safe health care.

References

American Medical Association. (2014, May). Medical Licensure. Retrieved from AMA: http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure
Delaware Department of State. (2014, May 6). Board of Medical Licensure and Discipline. Retrieved from Delaware.gov: www.delaware.gov
State of Delaware. (2014, May). Board of Nursing. Retrieved from State of Delaware: http://dpr.delaware.gov/boards/nursing/
State of Delaware. (2014, May). Chapter 17. Medical Practice Act. Retrieved from Online Delaware Code: http://delcode.delaware.gov/title24/c017/sc04