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October 2011
Volume 1, Issue 7 |
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About the Author
Lisa English Hinkle, Esq. is a Partner of McBrayer, McGinnis, Leslie & Kirkland, PLLC and Chair of the Health Care Law section. Ms. Hinkle has practiced law throughout Kentucky since her graduation from the University of Kentucky College of Law in 1982. She has been nominated and identified as U.S. News Best Lawyers in America in the field of health care law for two consecutive years, 2010 and 2011.
Ms. Hinkle has extensive experience in the health care law industry. She represents institutions such as hospitals and nursing homes as well as individual medical professionals, including doctors and nurses. She also represents small offices and large offices that are part of large networks. Some of the services she commonly provides are; Professional licensure defense ; Regulatory compliance; Certificate of need and licensing; Transactional health care; Physician contracts; Kentucky Board of Medical Licensure.
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WHO IS THE DOCTOR ANYWAY?
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Lisa English Hinkle
Attorney |
As more nurses, pharmacists, physical therapists, chiropractors and other allied health professionals obtain advanced degrees that confer the ability to use the title "doctor," physicians should be concerned that losing control over the term "doctor," a word that has identified physicians for centuries, will create confusion for consumers and lead to a loss of control over the practice of medicine. With a shortage of physicians nationally as well as in Kentucky, mid-level practitioners are becoming the gatekeepers for health care. Mid-level practitioners now make important medical decisions about diagnosis and access to care. In Kentucky, the Kentucky Board of Medical Licensure ("KBML") has taken an active role regulating the practice of certain allied health professions. Professions that have their own licensing authority, however, have the ability to broaden the scope of practice of their profession and determine what title may be used. The tensions between the professions may culminate in who gets to use the term "doctor."
The KBML has little control over Advanced Registered Nurse Practitioners ("ARNP"). ARNPs are regulated by the Kentucky Board of Nursing, which has the statutory authority to regulate the nursing profession. An ARNP's scope of practice is essentially defined by the specialty board certification earned by the nurse. Every ARNP is required to have a collaboration agreement with a physician for prescribing medication, but not to practice as an ARNP. The KBML has asserted control over ARNP's by issuing specific requirements for the physicians who serve as the collaborators. Detailed requirements for these agreements vary based upon whether the agreement covers controlled substances or non-scheduled legend drugs. Additionally, the KBML will only allow physicians to enter into two collaborative agreements and has issued a very detailed Board Opinion establishing the standards of prevailing practice for physicians collaborating with an ARNP. Other than the requirement for a collaborative agreement, an ARNP, however, may function independent of a physician and is entitled to bill patients for services. Twenty-three states allow nurse practitioners to practice without physician supervision or collaboration. While ARNPs are required to obtain a masters degree and pass a certification examination given by a specialty board that is recognized by the Kentucky Board of Nursing, ARNP's are not entitled to use the term "doctor." When an ARNP earns a doctorate, the ARNP will have a doctorate in nursing along with the authority to use the title "doctor of nursing." As a recent New York Times article reports, last year 153 nursing schools awarded doctor of nursing practice degrees to 7037 nurses and is projected to grow along with more nurses using the title doctor.
Physician Assistants ("PA"), on the other hand, are regulated by the KBML, which has issued very specific supervision requirements that are more detailed than the collaborative agreements for ARNPs. In 2010, the Kentucky Legislature enacted a statute authorizing licensure of PAs for the first time. PAs, however are regulated by the KBML, not by a profession specific board. The PA's licensure statute[1] limits not just a PA's scope of practice, but also a PA's ability to bill for his or her services independently of a physician. The statute specifically prohibits a PA from prescribing medications for a patient, requires a physician signature for medical records, and requires the active and continuous supervision of a physician. (READ FULL ARTICLE) |
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Copyright 2011 McBrayer, McGinnis, Leslie & Kirkland, PLLC. All Rights Reserved. |
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James H. Frazier, Managing Member of McBrayer, McGinnis, Leslie & Kirkland, PLLC, has been named by Best Lawyers as the "Lexington Best Lawyers Real Estate Law Lawyer of the Year" for 2012.
After more than a quarter of a century in publication, Best Lawyers is designating "Lawyers of the Year" in high-profile legal specialties in large legal communities. Only a single lawyer in each specialty in each community is being honored as the "Lawyer of the Year."
Best Lawyers compiles its lists of outstanding attorneys by conducting exhaustive peer-review surveys in which thousands of leading lawyers confidentially evaluate their professional peers. The current, 18th edition of The Best Lawyers in America (2012) is based on more than 3.9 million detailed evaluations of lawyers by other lawyers.
The lawyers being honored as "Lawyers of the Year" have received particularly high ratings in the Best Lawyers' surveys by earning a high level of respect among their peers for their abilities, professionalism, and integrity.
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McBrayer, McGinnis, Leslie & Kirkland, PLLC would like to announce that Terry McBrayer has been selected for induction into Junior Achievement's Bluegrass Business Hall of Fame.
Since 1989, Junior Achievement's Bluegrass Business Hall of Fame has annually recognized the esteemed leaders of the Central Kentucky business community. To be considered as a Hall of Fame member, an individual's record of business achievement must demonstrate courageous thinking and actions, vision and innovation, business excellence, inspiring leadership, and community mindedness.
In addition, nominees must serve as a role model for those who follow. Stated more simply, Bluegrass Business Hall of Fame members are individuals whose work has moved the Central Kentucky community in a better, stronger direction.
Junior Achievement of the Bluegrass, Inc. uses hands-on experiences to help young people understand the business of life. In partnership with business leaders and educators, Junior Achievement brings the real world to students, opening their minds to their potential and preparing them for the world of work.
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Robert E. Maclin, Partner in our Lexington office, receives a AV Martindale-Hubbell� Peer Review RatingTM.
The Martindale-Hubbell Peer Review Ratings help buyers of legal services identify, evaluate and select the most appropriate lawyer for a specific task at hand. Lawyer Ratings serve as an objective indicator that a lawyer has the highest ethical standards and professional ability and are used by buyers of legal services to justify their hiring decisions. Combined with the Martindale-Hubbell� Client Review Ratings, self-reported professional credentials and other fact-based performance data, the peer review ratings contribute to the comprehensive view of a lawyer.
Martindale-Hubbell conducts secure online Martindale-Hubbell Peer Review Rating surveys of lawyers across multiple jurisdictions and geographic locations, in similar areas of practice as the lawyer being rated. Reviewers are instructed to assess their colleagues' general ethical standards and legal ability in a specific area of practice.
After a lawyer's General Ethical Standards and Legal Ability Ratings are confirmed, his/her ratings are aggregated to create an overall numeric rating for each rated area of practice. The numeric rating determines the peer review rating, which includes a rating term and certification mark. An AV� PreeminentTM (4.5-5.0) certification mark is a significant rating accomplishment - a testament to the fact that a lawyer's peers rank him or her at the highest level of professional excellence.
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T. Bruce Simpson, Jr. and Ryan C. Daugherty, attorneys in our Lexington office, recently received a published Court of Appeals Decision: Birchwood Conservancy v. United Brotherhood of Carpenters.
This is a case where our clients the Birchwood Conservancy in Scott County sued the United Brotherhood of Carpenters for breach of contract when the Union failed to rebuild a barn it tore down in connection with a PBS documentary that was being filmed at the time about Birchwood Conservancy. Birchwood is a non-profit organization which cares for more than 100 different species of rare and exotic animals. Because the barn was not rebuilt as agreed, the animals did not have shelter from the cold weather and many of them died.
The Union defended the law suit on the basis that it could not be sued because Kentucky law barred a union from suit since it was an unincorporated association. However, the Union never raised this defense until after 2 � years of litigation involving numerous depositions, other discovery and motions for summary judgment. The defense of lack of capacity to be sued was not raised until Birchwood moved for a trial date. The Scott Circuit Court agreed with the Union and dismissed the case. However, in an opinion issued recently and ordered to be published the Kentucky Court of Appeals unanimously reversed the Scott Circuit Court and remanded the case for trial.
Mr. Simpson and Ms. Daugherty worked on the Appellate Court brief and Mr. Simpson did the oral argument before the Court of Appeals. |
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