License Revocation Research Articles

The Characteristics of Physicians Who are Re-Disciplined by Medical Boards: A Retrospective Cohort Study

Physician misconduct adversely affects patient safety and is therefore of societal importance. Little work has specifically examined re-disciplined physicians. A study was conducted to compare the characteristics of re-disciplined to first-time disciplined physicians. A retrospective review of Canadian physicians disciplined by medical boards between 2000 and 2015 was conducted. Physicians were divided into those disciplined once and those disciplined more than once. Differences in demographics, transgressions, and penalties were evaluated. There were 938 disciplinary events for 810 disciplined physicians with 1 in 8 (n = 101, 12.5%) being re-disciplined. Re-disciplined physicians had up to six disciplinary events in the study period and 4 (4.0%) had events in more than one jurisdiction. Among those re-disciplined, 94 (93.1%) were male, 34 (33.7%) were international medical graduates, and 88 (87.1%) practiced family medicine (n = 59, 58.4%), psychiatry (n = 11, 10.9%), surgery (n = 9, 8.9%), or obstetrics/gynecology (n = 9, 8.9%). The proportion of obstetrician/gynecologists was higher among re-disciplined physicians (8.9% vs. 4.2%, p = 0.048). Re-disciplined physicians had more mental illness (1.7% vs. 0.1%, p = 0.01), unlicensed activity (19.2% vs. 7.2%, p <0.01), and less sexual misconduct (20.1% vs. 27.9%, p = 0.02). License suspension occurred more frequently among those re-disciplined (56.8% vs. 48.0%, p = 0.02) as did license restriction (38.4% vs. 26.7%, p <0.01). License revocation was not different between cohorts (10.9% vs. 13.5%, p = 0.36). Re-discipline is not uncommon and underscores the need for better identification of at-risk individuals and optimization of remediation and penalties. The distribution of transgression argues for a national disciplinary database that could improve communication between jurisdictional medical boards.

A Comparison of International Drunk-Driving Policies and the Role of Drinking Patterns

Effective drunk-driving policies are not adopted consistently in many countries. To understand how drinking behaviors influence national drunk-driving policymaking, the associations between drunk-driving policies and country-level drinking volumes and patterns were examined. Data for 194 countries were obtained from the WHO 2012 Global Information System on Alcohol and Health. Country-level drinking behaviors were measured using average drinking volumes and patterns of drinking scores based on six attributes of risky drinking. Drunk-driving policies were categorized into preemptive measures (random breath testing, breath alcohol concentration limits for driving a vehicle, and sobriety checkpoints), penalties (community service, short- or long-term detention, fines, suspension or revocation of license, and vehicle impoundment), mandatory treatment, and ignition interlock. Data analysis was conducted in 2017. The percentages of each policy adoption were examined in countries with different drinking behaviors. The internal consistencies of preemptive measures were calculated using Cronbach's α. A structural equation model was established to examine the associations between drinking behaviors and drunk-driving policy categories, after adjusting for national income levels and general alcohol policies. Mandatory treatment and preemptive measures were less commonly adopted than penalties were. The adoption of preemptive measures had a low consistency level, and the consistency level decreased with drinking pattern riskiness. Risky drinking patterns were negatively associated with mandatory treatment policy. Drinking patterns are associated with national drunk-driving policymaking. Accessible medical treatment and comprehensive preemptive measures should be advocated in countries with risky drinking patterns.

Description and comparison of medication diversion in pharmacies by pharmacists, interns, and pharmacy technicians

Objectives1) To describe reported medication diversion within the practice of pharmacy; and 2) to compare diversion by employee type. DesignRetrospective study. SettingA sample of state board of pharmacy records was examined from 9 states. Disciplinary actions were obtained from the records for the time period of May 2008 to May 2013. ParticipantsPharmacy employees (pharmacist, technician, interns). InterventionNot applicable. Main outcome measuresWhen a diversion case was identified, the following items were obtained for each case of medication diversion: 1) category of pharmacy employee (pharmacist, technician, intern); 2) type of substance (control, noncontrol, both); 3) use of diverted substance (sale, personal use, both, undetermined); and 4) action taken by the board. ResultsA total of 811 medication diversion cases in 9 states were identified. Most cases involved a pharmacy technician (71.4%), controlled substances only (94.2%), and diversion for personal use (46.6%) and resulted in license or registration revocation or surrender (62.5%). When examining medication diversion use by purpose for diversion, there were significant differences by pharmacy employee type (sale use: P = 0.003; personal use: P = 0.032; unknown use: P < 0.001). ConclusionMedication diversion is a pressing problem. There were 811 cases examined by 9 state boards, and many cases may be unreported. Technicians represent nearly three-fourths of diversions. It is essential that the practice of pharmacy identifies and assesses strategies to reduce medication diversion.

Deterrent effects of demerit points and license sanctions on drivers’ traffic law violations using a proportional hazard model

Current traffic law enforcement places an emphasis on reducing accident risk from human factors such as drunk driving and speeding. Among the various strategies implemented, demerit points and license sanction systems have been widely used as punitive and educational measures. Limitations, however, exist in previous studies in terms of estimating the interaction effects of demerit points and license sanctions. To overcome such limitations, this work focused on identifying the interaction effects of demerit points and license sanctions on driver traffic violation behavior. The interaction deterrent effects were assessed by using a Cox’s proportional hazard model to provide a more accurate and unbiased estimation. For this purpose, five years of driver conviction data was obtained from the Korea National Police Agency (KNPA). This data included personal characteristics, demerit point accumulation and license sanction status. The analysis showed that accumulated demerit points had specific deterrent effects. Additionally, license revocation showed consistent and significant deterrent effects, greater than those for suspension. Male drivers under their 30s holding a motorcycle license were identified as the most violation-prone driver group, suggesting that stricter testing for the acquisition of a motorcycle driver’s license is needed.

Methods of Combating the Legalization of Proceeds from Crime through Non-State Pension Funds

The crisis in the field of social security of the population occurred in the process of transformation of economic relations, and, first of all, in the pension system. A reform of the pension system has been implementing for a sufficient period of time, in order to overcome the negative phenomena. Non-state pension funds (further NPFs) have been severely criticized by the Ministry of Health and Social Development to address the mandatory pension insurance system. Private organizations ineffectively manage the pension savings of citizens, and there is also a place for - the legalization of criminal proceeds, the ministry believes, which can be confirmed by the data published by the Bank of Russia on the revocation of licenses from a number of NPFs[1].The legalization of criminal proceeds is by itself a very negative phenomenon, which adversely affects the individual organization, the economy as a whole and social life, exerting a detrimental effect on the economic and national security of society and the state. Operations, to some extent related to the legalization of criminal proceeds, significantly increase the risk of loss of reputation for non-state pension funds. As a result, these monetary resources fall into the global financial system, and acquire the ability to undermine the national currency and the economies of individual countries, thus creating a threat to both national and international security. Keywords: Legalization of criminal proceeds, private pension funds, risk-oriented approach, internal control.

Teacher License Revocation and Surrender in North Carolina due to Sexual Misconduct

The sexual misconduct of school employees has become a more common issue in the United States, and there has been very little empirical research conducted to provide context or understanding of the prevalence of this problem. Therefore, the purpose of this study was to investigate the reasons for license revocation and surrender in North Carolina with special attention to licenses lost due to sexual misconduct. Analysis indicated that 688 (91%) licenses were revoked and 67 licenses (9%) were voluntarily surrendered. The reasons listed for revocation or surrender were primarily sexual infractions with students ( n = 458; 61%). Employment information was located for 302 of the 458 school employees (66%) who lost their licenses due to sexual infractions. Of the 302 school employees found, 69 were coaches (23%) and 36 were music teachers (12%). Conclusions and implications for music teacher educators are discussed.

Blockchain Traffic Offence Demerit Points Smart Contracts: Proof of Work

In Malaysia, a new regulation of traffic offences demerit points has been over a debate. Therefore, a blockchain model is formulated to solve this issue. It serves a purpose to be a Proof of Work (PoW) of a blockchain system. This model contains application layer and blockchain layer with smart contract inside. The smart contracts act as a conditional filter which follows the regulation rules. It contains three contracts starting from the declaration of each offence’s demerit points and fines until the penalties when a certain amount of demerit points is collected, including revocation of driver license. The contracts will be automatically executed when such conditions are fulfilled. A transaction schema is also designed to match the schema of a traffic offence system. This model is deployed in online environment with two servers synced to each other to prove the decentralized characteristic of blockchain. It is developed using NodeJS while preserving JSON format for transaction between server and client. A user interface is also provided as a simulation media where a traffic officer can input offences and send it to blockchain server while public users or the driver itself can check the status of the driver license recorded on the blockchain. Government officer can monitor the records through a dashboard analytics provided which contains graphs and charts based on the records. This interface is used as media to do evaluation which produces satisfying results. The evaluation shows that the smart contracts are executed properly as compared to real regulations.

Alcohol gas sensors capable of wireless detection using In2O3/Pt nanoparticles and Ag nanowires

An unconventional method is developed to fabricate flexible and transparent sensors for real-time, wireless sensing of alcohol vapors using hybrid nanostructures of indium oxide and Pt nanoparticles (as an active channel) with random networks of metal nanowires (as electrodes and antennas). The hybrid structures of indium oxide and Pt nanoparticles present high response and selectivity for ethanol vapor sensing with detecting the blood alcohol concentration range corresponding to the license suspension or revocation in the Road Traffic Act of many countries (blood alcohol concentration 200 ppm). The integration of a Bluetooth system or an inductive antenna enables wireless operations of the alcohol sensor using smartphones for applications as wearable and hands-free devices with flexible, transparent film geometries. Furthermore, these sensor systems exhibit outstanding thermal reliabilities for their stable operations over wide temperature ranges between −40 °C and 125 °C, which can extend their practical use for automobile electronics. Such devices can be transferable onto diverse nonplanar surfaces including steering wheels and curved glasses of phones, which suggests substantial promise for their applications in next-generation automobile or wearable electronics.

Nurses With Substance Use Disorders: Where We Are and What Needs To Be Done.

Nurses have the same rate of substance use disorders (SUDs) as the general public. Management of nurses with SUDs is moving from being punitive, including public license suspension or revocation, to alternative-to-discipline (ATD) programs that focus on early intervention and non-punitive, confidential help, which often involve continued employment. These programs have good retention rates, and nurses who complete them have fewer criminal convictions and are able to retain their nursing licenses and maintain successful careers in nursing. Barriers to nurses receiving care for SUDs include wide variability in ATD programs, inconsistent funding for treatment, and lack of policies and support for nursing students. Recommendations include changes to nurse practice acts to make ATD programs more uniform, provide adequate funding for all nurses and nursing students, and allow nurses to seek and obtain care without disclosing directly to Boards of Nurses. Colleges of nursing should implement policies to encourage early identification and treatment in nursing students, including ATD and dismissal programs. [Journal of Psychosocial Nursing and Mental Health Services, 55(12), 11-14.].

Bank Otkritie and Binbank: Was There an Option Other Than Bailout

Some of Russia’s big private banks were faced with the risk of banking license revocation in August–September 2017. The financial resolution of Bank Otkritie and of Binbank was implemented using a new mechanism – The Fund for Banking Sector Consolidation.

Effects of a penalty point system on traffic violations

We analysed data from the Norwegian driver’s licence penalty point register over a three-year period, in order to investigate whether the number of incurred penalty points in a given time period can predict the probability of incurring additional points in the subsequent period. Data for all category B drivers without penalty points at the start of the study period were included in the analyses. Norway’s penalty point system implies that speeding and various other traffic violations result in two or three penalty points for full-license drivers and four or six points for probationary-license drivers. Eight points within a three-year period results in a six-month disqualification. Two hypotheses were formulated: 1) A “driving style effect” implying that drivers with previous penalty points have a higher probability of incurring new points than drivers without previous points; and 2) a “deterrence effect” implying that drivers with more than four points have a reduced probability of incurring new points, due to impending risk of license revocation. Results showed an inverted U-shaped relationship between number of penalty points incurred during a one-year period and the number of additional penalty points incurred in the subsequent year, with the highest number for drivers with four previous points. Thus, both hypotheses were clearly supported, and it is concluded that the penalty point system has a significant deterring effect for drivers who are at high risk of losing their license at the next infraction.

Offshore schemes and tax evasion: The role of banks

We use mandatory Russian banks’ reports to the Central Bank to construct a novel measure of offshore-banking. Individual bank involvement in offshore operations is calculated as a fraction of total transactions with foreign countries that go through offshore financial centers. We find that offshore-active banks perform less financial intermediation and focus more on international wire transfers. We show a positive relation between banks’ offshore activities and tax evasion of companies doing business through these banks. Finally, we show that the Central Bank eventually responds to this behavior: offshore-active banks have higher likelihood of license revocation and criminal investigation against top-management.

Bank of Russia Updates Bank Resolution Mechanism To Increase its Control

The resolution of Bank Otkrytie FC will be the first case of applying a recently introduced new mechanism for the resolution of commercial banks. The mechanism enables the Bank of Russia to control more efficiently bank resolution costs and can tilt the balance between banking license revocation and solvency recovery in favour of the latter.

Subsidiary Imprisonment in Criminal and Misdemeanor Law of Serbia // Supletorni zatvor u krivičnom i prekršajnom pravu Srbije

In a criminal (criminal and misdemeanor) law the right to deprivation of liberty of movement of another person - a perpetrator of a criminal offense - based on a decision of the court for a specified period of time is a type of criminal sanction of institutional character (whether it is punishment, security measure or educational measure). However, criminal law knows the so-called special forms of law-based deprivations of liberty, which do not represent the type and measure of criminal sanctions. These are, in fact, forms of deprivation of liberty that represent the substitute for the other previously imposed, entirely or partly, unpaid penalties - fine, driving license revocation or work in the public interest. This Paper deals with the concept, type and characteristics of the subsidiary imprisonment in positive criminal law of the Republic of Serbia.

PERLINDUNGAN HUKUM BAGI NASABAH BAITUL MAAL WA TAMWIL (BMT) YANG DILIKUIDASI DI INDONESIA

Baitul Maal wa Tamwil (BMT) is one type of micro finance institution that uses sharia principles. The BMT contributes to a real small economic by providing financing and channeling of funds. But the problem arises when liquidation occurs on the BMT, which rules should be used as a rule to solve it. This paper discusses the legal protection for BMT customers who are liquidated in Indonesia. The aim is to explain how legal protection forms for customers and why this legal protection is necessary for customers. The analysis used is statute approach and a conceptual approach. The legal basis of protection for BMT customers is Law no. 1 of 2013 on Microfinance Institutions (LKM), particularly articles 24 and 25, which regulate the prevention of disputes or revocation of licenses. Article 26 states that the Financial Services Authority (OJK) provides a deposit service if it makes them lose. But if BMT incorporated in the form of cooperative (koperasi) the law that use as basis is Law No. 25 of 1992, especially article 54 on the settlement. Differences in this rule become one of the factors slow the settlement of the problem of BMT customers that liquidated. The government should provide clear rules regarding the institutional status of BMT, so that the settlement of client's legal protection becomes clear

Informed trading by foreign institutional investors as a constraint on tunneling: Evidence from China

AbstractManuscript TypeEmpiricalResearch Question/IssueThis paper investigates how the trading activities of foreign institutional investors (FIIs) affect the tunneling activities of controlling shareholders in an emerging economy (China).Research Findings/InsightsWe use an unbalanced panel dataset of 167 FIIs with investments in Chinese real estate firms during the period 2003 to 2011, which gives us 1006 firm‐year observations in total. We find strong support for our hypothesis of an inverted U‐shaped relationship between FII trading turnover and the extent of tunneling by controlling shareholders.Theoretical/Academic ImplicationsIn many emerging economies, the institutional environment for investor protection is weak. Powerful controlling shareholders may take the opportunity to extract private benefits via tunneling activities to the detriment of minority shareholders, and informed minority investors may also take advantage of less well‐informed investors. There are thus multiple principal–principal agency conflicts. FIIs are a particularly important group of informed investors. On the one hand, large‐scale aggressive trading by FIIs should drive stock prices to fundamentals, provide market discipline to management, and thus limit tunneling. On the other hand, FIIs may opt to exploit their private knowledge to gain trading profits at the expense of uninformed investors, and implicitly support tunneling. We highlight these potential effects, and demonstrate empirically an inverted U‐shaped relationship between FII trading turnover and the extent of tunneling.Practitioner/Policy ImplicationsTunneling is a serious issue, particularly in emerging economies where the institutional arrangements for minority investor protection are often weak. FII involvement may enhance market discipline, but may also exacerbate the problem, so policymakers need to guard against potential adverse effects. An ownership cap on FII shareholdings is unlikely to be effective, but policymakers might strengthen QFII license revocation policies and issue more licenses to promote competition among FIIs.

Administrative license suspension: Does length of suspension matter?

ABSTRACTObjective: Administrative license revocation (ALR) laws, which provide that the license of a driver with a blood alcohol concentration at or over the illegal limit is subject to an immediate suspension by the state department of motor vehicles, are an example of a traffic law in which the sanction rapidly follows the offense. The power of ALR laws has been attributed to how swiftly the sanction is applied, but does the length of suspension matter? Our objectives were to (a) determine the relationship of the ALR suspension length to the prevalence of drinking drivers relative to sober drivers in fatal crashes and (b) estimate the extent to which the relationship is associated to the general deterrent effect compared to the specific deterrent effect of the law.Methods: Data comparing the impact of ALR law implementation and ALR law suspension periods were analyzed using structural equation modeling techniques on the ratio of drinking drivers to nondrinking drivers in fatal crashes from the Fatality Analysis Reporting System (FARS).Results: States with an ALR law with a short suspension period (1–30 days) had a significantly lower drinking driver ratio than states with no ALR law. States with a suspension period of 91–180 days had significantly lower ratios than states with shorter suspension periods, while the three states with suspension lengths of 181 days or longer had significantly lower ratios than states with shorter suspension periods.Discussion: The implementation of any ALR law was associated with a 13.1% decrease in the drinking/nondrinking driver fatal crash ratio but only a 1.8% decrease in the intoxicated/nonintoxicated fatal crash ratio. The ALR laws and suspension lengths had a significant general deterrent effect, but no specific deterrent effect.Practical Implications: States might want to keep (or adopt) ALR laws for their general deterrent effects and pursue alternatives for specific deterrent effects. States with short ALR suspension periods should consider lengthening them to 91 days or longer.

Commentaries on health services research

Commentaries on health services research

Validation of prescriber risk indicators obtained from prescription drug monitoring program data

BackgroundPrescription opioids are commonly overprescribed. However, validated measures of inappropriate controlled substance prescribing are lacking. This study examined associations between prescriber risk indicators developed as part of a public health surveillance project and medical board disciplinary actions against prescribers. MethodsWe compiled 12 prescriber risk indicators using data from the Maine prescription drug monitoring program (PDMP) for 2010. We used logistic regression models to assess the relative likelihood of the top 1%, 2%, 5%, and 10% of prescribers on each risk indicator having been subject to medical board disciplinary actions, those citing inappropriate prescribing, or those involving license suspension or revocation, during 2010–2014, controlling for prescriber medical specialty and gender. ResultsThe top 1% of prescribers for number of patients, opioid prescriptions per day, and opioid dosage prescribed per day had a greater likelihood of medical board disciplinary actions citing inappropriate prescribing, relative to a matched sample of other (non-top 1%) prescribers. Of the 56 prescribers in the top 1% for opioid prescriptions per day, nine (16.1%) were sanctioned for inappropriate prescribing, compared with 11 of 224 (0.5%) in the comparison group. The top 2% of prescribers for opioid dosage per day, and average distance patients travel to prescriber, had a greater likelihood of actions involving license suspension, revocation, or denial for renewal. ConclusionsMeasures derived from PDMP data may be useful in assessing levels of inappropriate prescribing of controlled substances in a population of prescribers, and in evaluating changes associated with efforts to influence prescriber behavior.

An International Comparative Study on Driving Regulations on People with Dementia

Over 40% of people with dementia drive, with a two to five times greater accident risk than controls. This has fueled public concerns about the risk of traffic accidents by drivers with dementia (DWD). We compared driving regulations on seniors and DWD between ten European and Asia-Pacific countries to identify key implications for national strategies. Moderate to severe dementia was a reason for driver's license revocation in all countries. However, regulations on mild dementia varied considerably, with most basing their decisions on severity, rather than simply the presence of dementia. Most used validated assessments, but responsibility for triggering the administrative process fell on drivers in some countries and on physicians in others. Administrations should consider the following when developing driving policies: 1) ideal regulations on DWD should ensure that restrictions are implemented only when needed; 2) fitness to drive should be assessed using validated instruments; 3) the use of processes that automatically initiate driving competency examinations following a diagnosis of dementia should be explored; and 4) restrictions should be delicately tailored to a range of driving competence levels, and assistive incentives compensating for lost driving privileges should be provided.