State Licensing Boards Research Articles

Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy.

One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public. To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States. Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions. A total of 2,400 cases were analyzed across 47 states and Washington, DC. None. Numerous complaint and respondent attribute variables were collected from final consent orders and database entries. Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes. Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

Item Response Theory Analysis of the Cultural Humility and Enactment Scale – Supervision

Objective This study aimed to validate the Cultural Humility and Enactment Scale - Supervision (CHES-S). Method The sample included a total of 201 post-masters counselors who were currently engaged in clinical supervision across 11 U.S. states, who were recruited from the state licensing board email lists. Analyses included confirmatory factor analysis (CFA) and item response theory (IRT) analysis based on a multidimensional adaptation of the partial credit model. Results We found evidence to support the three-factor structure of the CHES-S. We also found that the CHES-S can be used to distinguish participants scores from low to high CH, and that the thresholds of each item could capture participants responses in the expected order. Conclusion Evidencing reliability and validity with a sample of post-master’s practitioners engaged in supervision for licensure, the CHES-S can be effectively utilized as a tool to monitor supervisory process and outcome in clinical supervision.

The Steep Decline in Reporting to the National Practioner Data Bank, and a Look at Reporting Levels from “Plaintiff-Favorable” and “Defendant-Favorable” States

The establishment of the National Practitioner Data Bank (NPDB) was authorized in the Health Care Quality Improvement Act of 1986, and it mandated a federal database to collect information related to adverse actions initially against just physicians and dentists throughout the United States, including payments from malpractice lawsuits, restrictions on clinical privileges by hospitals, and medical licensure limitations and revocations by state licensing boards. The aggregate data reports made by this federal data bank began in 1991. The reporting level for the first ten years remained relatively stable in the nationwide range of 16,000 to 18,000 reports per year, but then a steady decline occurred over the second and third decades to under 8,000 reports per year by the year 2021. The researchers in this study explored a theory that might explain at least part of the drop in the states’ reporting levels. That is, states that could be called “Plaintiff-Favorable” (Arizona, Kentucky, New York, Pennsylvania, and Washington) would demonstrate a lesser rate of decline or even an increase in the reporting levels, and states that could be characterized as “Defendant-Favorable” (California, Michigan, Nevada, North Carolina, and Texas) would demonstrate a comparatively greater rate of decline in the reporting levels. The decline in reporting to the NPDB proved fairly consistent for both Plaintiff-Favorable and Defendant-Favorable states. The larger question as to why there occurred an overall negative trend in reporting to the NPDB across the United States during the second and third decades remains an intriguing area for future exploration.

Confronting Medical Diploma Mills: State Licensing Boards, Legislatures, and the Limits of Medical Authority in the 1920s.

In the standard story of the rise of professional authority in medicine in the 1920s, state medical licensing boards were partners in a coalition, led by the American Medical Association, to radically improve medical education. Boards obtained state laws that limited admission to licensing examinations to graduates of schools approved by the AMA, thus bringing about the rapid demise of low-quality schools by about 1925. The reality at the state level was quite different, however. Medical examining boards containing homeopaths, eclectics, and sometimes osteopaths could be far from reliable partners. Passing laws to benefit the medical profession was exceedingly difficult and dependent on local medical politics. Through the lens of a major medical diploma mill scandal revealed by a journalist in 1923, this paper examines reform efforts in three states greatly affected by the scandal: Missouri, where the scandal originated, Connecticut, and Massachusetts. In each of these states, graduates of low-quality schools as well as fake doctors from diploma mills were able to take a state examination and practice. This paper argues that the AMA, far from being the major player in the elimination of inadequate schools, could set standards but had to stay on the sidelines.

State Requirements for Non-Medical US Cannabis Retail Personnel.

In September 2023, we examined requirements for budtenders working in nonmedical dispensaries in the 20 states with active non-medical cannabis markets. Two coders extracted data from each state's licensing board and/or governmental websites. The age requirement for budtenders was ≥21years old ( n =17) or ≥18 ( n =3). Most states ( n =16) required background checks; 10 specified felony convictions preventing employment, 5 allowed the Department to determine eligibility, and 2 allowed petitions upon denial. Twelve states required fingerprinting. There were application fees ($25-$300) in 13 states. Structured training was required in 7 states, while 5 states required employee training. Given the diverse budtender requirements, the evaluation of budtender standards is essential to assess the impacts of training on regulatory compliance and consumer education, and of application costs and conviction-based employment restrictions on social equity. This must inform the development of effective regulations and enforcement protocols, as well as and how to promote equity in cannabis regulations.

Provider-Perceived Impacts of Social Vulnerability on Patients’ Access to Care During the COVID-19 Pandemic

Objective: To study the provider-perceived impacts of social vulnerability on patients’ access to care during the COVID-19 Pandemic. Data Sources and Study Settings: Survey data was collected from healthcare providers in a medium-sized county within a south-eastern state in the U.S. during the COVID-19 pandemic. Study Design: A cross-sectional mixed-method survey design was utilized to collect qualitative and quantitative data from study participants. Data Collection: Healthcare providers were recruited from all major healthcare-related state licensure boards, including nurses, physicians, psychologists, social workers, and mental health counselors. The final study sample consisted of 141 licensed healthcare providers. Principal Findings: Healthcare providers in our study indicated that the social vulnerability factors impacted patients’ access to care. This study provides recommendations for improving access to care among socially vulnerable populations during pandemics as a means to reduce health disparities. The study also identifies areas for future research.

PA access to provider health programs.

This study assessed the availability of provider health programs (PHPs) for physician associates/assistants (PAs), as well as the accessibility of information about these resources through state licensing boards and PA constituent organizations. Data were collected through audits of the websites of the PA licensing board and state/district constituent group for each state and the District of Columbia from October to November 2022. Every state except Massachusetts has a PHP that serves PAs. Review of the 51 respective state licensing board websites revealed that 23 states (45.1%) list PHP information; only 9 states (17.6%) have PHP information listed on state PA constituent organization websites. The results of this study indicate that PHPs for PAs are widely available. Unfortunately, the broad availability of PHPs may be limited by the lack of accessible information about these programs in many states.

Professionalism in Physician Assistant Education as a Predictor of Future Licensing Board Disciplinary Actions.

The purpose of this study was to evaluate associations between postgraduate disciplinary actions (PGDA) by state licensing boards and physician assistant (PA) school documented professionalism violations (DPV) and academic probation. This was a retrospective cohort study comprising PA graduates from 2001 to 2011 at 3 institutions (n = 1364) who were evaluated for the main outcome of PGDA and independent variable of DPV and academic probation. Random-effects multiple logistic regression and accelerated failure time parametric survival analysis were used to investigate the association of PGDA with DPV and academic probation. Postgraduate disciplinary action was statistically significant and positively associated with DPV when unadjusted (odds ratio [OR] = 5.15; 95% CI: 1.62-16.31; P = .01) and when adjusting for age, sex, overall PA program GPA (GPA), and Physician Assistant National Certifying Exam Score (OR = 5.39; 95% CI: 1.54-18.85; P = .01) (fully adjusted). Academic probation increased odds to 8.43 times (95% CI: 2.85-24.92; P < .001) and 9.52 times (95% CI: 2.38-38.01; P < .001) when fully adjusted. Students with professionalism violation or academic probation while in the PA school had significant higher odds of receiving licensing board disciplinary action compared with those who did not. Academic probation had a greater magnitude of effect and could represent an intersection of professionalism and academic performance.

Protecting Your Professional Practice.

Lynn S. Muller, JD, BA-HCM, RN, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her bachelor of arts degree in health care management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the contributing editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the board of directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP Programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the third edition of Case Management: A Practical Guide for Education and Practice and third edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a certified facilitator for CCM CERTIFCATION 360, a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past President of the New Jersey Chapter of CMSA. Dr. Muller is the former director of social services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman, and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by email at: [email protected]. If you have an idea you would like to discuss, send your contact information by email and you will be contacted via your preferred method. The author reports no conflicts of interest.

Lessons Learned From a Veteran's Perspective.

Lynn S. Muller, JD, RN, BA-HCM, CCM, began her career at Pace University as a registered professional nurse (RN), went onto earn her Bachelor of Arts degree in Health Care Management at St. Peter's University of New Jersey, and then her Juris Doctor from Quinnipiac University School of Law. She is currently a practicing attorney and the managing partner of Muller & Muller. Her practice includes defense of health care professionals before the state licensing boards, case management litigation, family law, wills, trusts, and estates, as well as consulting representation of medical practitioners, facilities, and health service corporations on such issues as regulatory compliance and day-to-day operations. Dr. Muller is a popular and sought-after keynote and session speaker at national and regional conferences. She is the Contributing Editor of Professional Case Management: The Official Journal of the Case Management Society of America (CMSA) and the Commission for Case Management Certification (CCMC), a former member of the Board of Directors of CMSA of New York City. She is an adjunct professor at Saint Peter's University School of Nursing in the MSN and DNP programs. Dr. Muller is the author of more than 80 articles in nursing and case management journals and listed on the NIH website. She is a contributor to the 2016 CMSA Standards of Practice and CMSA Career & Knowledge Pathways. Dr. Muller is the author of both legal chapters of the 3rd edition of Case Management: A Practical Guide for Education and Practice and 3rd edition of the CMSA Core Curriculum for Case Management. She is a former Commissioner for the Commission for Case Management Certification (CCMC), where she now serves on the Professional Development and Education Committee, is a Certified Facilitator for CCM CERTIFCATION 360 a Multi-day Immersion Program and other special projects. She is a contributor to the CCMC Case Management Body of Knowledge (CMBOK) and a past president of the New Jersey Chapter of CMSA. Dr. Muller is the former Director of Social Services for the Borough of Bergenfield, NJ, a community-based case management program she developed and initiated. Dr. Muller has also served her community as public defender, municipal court judge, and councilwoman and chaired the Borough's Barrier Free Committee. Address correspondence to Lynn S. Muller, JD, RN, BA-HCM, CCM, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). You are Invited to share your knowledge and experience. Do you have a question or issue you would like to see addressed here? Questions are always welcome. We encourage and invite all readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. If you have an idea, you would like to discuss, or are considering being a first-time author, send your contact information by email and you will be contacted via your preferred method. All inquiries and submissions are accepted by email at [email protected] Case Management Matters welcomes and invites you to submit articles, stories, practice tips, reflections, and revelations. We encourage new/first-time authors and will work with you. How has case management changed you and/or how have you affected the lives of others? All inquiries, questions, comments, and manuscripts should be submitted via email to [email protected] or by mail to Lynn S. Muller, P.O. Box 164, Bergenfield, NJ 07621-0164. If you have an idea for an article, but would like to discuss it, provide contact information in your email and you will be contacted by your preferred method. The author reports no conflicts. The author reports no conflicts of interest.

Veterans and Case Management Assessment.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent professional case manager, and managing partner of Muller & Muller. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and a board-certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Lynn is the author of more than 60 articles and the legal chapters of the fourth edition of Case Management: A Practical Guide for Education and Practice and the second and third editions of the CMSA Core Curriculum for Case Management. Lynn is a contributor to the CCM Body of Knowledge (CMBOK), CMSA Career & Knowledge Pathways Project, and CMSA Standards of Practice for Case Management (2016) and is the contributing editor of Professional Case Management. She is as a former commissioner for the Commission for Case Management Certification (CCMC), and now serves on the Professional Development and Education Committee and is a facilitator for CCMC's 360, the immersion study course. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by email at: [email protected]. If you have an idea you would like to discuss, send your contact information by email and you will be contacted via your preferred method. The author reports no conflicts of interest.

Licensing Investigations: Suggestions from Social Workers Who Received Sanctions

Abstract When clients have concerns about licensed social workers, they may file complaints with their state licensing boards. Although prior research has explored the types of complaints made against social workers, there has been little research on the experiences of social workers who are being investigated. This phenomenological study is based on in-depth interviews designed to gain a better understanding of the lived experiences of 13 licensed social workers who participated in licensing investigations and received sanctions by a state licensing board for violating state laws, rules, or ethical standards. The researchers used an interpretive approach to analyze the interviews and identify common themes surrounding participant suggestions for improvement for licensing boards when investigating complaints and issuing sanctions. Research participants suggested that being investigated for licensing violations can cause significant levels of anxiety, stress, and embarrassment. Although some participants felt that the investigation process was fair, others expressed deep concerns about how they were treated. The participants’ suggestions for improving the investigation process centered around five primary themes: ensuring the process is fair, treating licensees with kindness and respect, using a collaborative approach, using a corrective approach, and hiring professional social workers as investigators.

Having the Talk: Meaningful Use of Legal Documents.

Lynn S. Muller, JD, BA-HCM, RN, CCM, is a nurse attorney, independent professional case manager, and managing partner of Muller & Muller. She is an adjunct professor in the MSN and DNP programs at Saint Peter's University of New Jersey. Lynn is a registered nurse and a board-certified case manager with extensive nursing and case management experience. Her law practice includes defense of health care professionals before the state-licensing boards, consultant on such issues as regulatory compliance and accreditation, civil litigation, Wills, Trusts and Estates, and Family law. Lynn is the author of more than 60 articles and the legal chapters of the fourth edition of Case Management: A Practical Guide for Education and Practice and the second and third editions of the CMSA Core Curriculum for Case Management. Lynn is a contributor to the CCM Body of Knowledge® (CMBOK), CMSA Career and Knowledge Pathways Project, and CMSA Standards of Practice for Case Management, and is the contributing editor of Professional Case Management. She is a former commissioner for the Commission for Case Manager Certification (CCMC), serves on the Professional Development and Education Committee, and is a facilitator for CCMC's 360®, the immersion study course. Address correspondence to Lynn S. Muller, JD, BA-HCM, RN, CCM, Muller & Muller, P.O. Box 164, Bergenfield, NJ 07621 ([email protected]). Disclaimer: The information contained in this department is for educational purposes only. It is not legal advice, which can be given only by an attorney admitted to practice in the jurisdiction/state(s) in which you practice. Do you have a question or issue you would like addressed here? Questions are always welcome. We encourage ALL readers to submit questions and/or manuscripts, as well as topics you would like to see addressed in this department. Questions and other inquiries are accepted by email at: [email protected]. If you have an idea you would like to discuss, send your contact information by email and you will be contacted via your preferred method. The author reports no conflicts of interest.

How Should State Licensing and Credentialing Boards Respond When Government Clinicians Spread False or Misleading Health Information?

The spread of health misinformation by health care professionals who also hold government positions represents a long-standing problem that intensified during the COVID-19 pandemic. This article describes this problem and considers legal and other response strategies. State licensing and credentialing boards must use their authorities to discipline clinicians who spread misinformation and to reinforce the nature and scope of professional and ethical obligations of government and nongovernment clinicians. Individual clinicians must also play an important role by actively and vigorously correcting misinformation disseminated by other clinicians.

Understanding Medical Malpractice Lawsuits.

Understanding Medical Malpractice Lawsuits.

Family violence content in baccalaureate and master's level social work programs

Summary Scholars continue to call for social work students to be better prepared in the areas of family violence. In this study, we gathered information on the inclusion of intimate partner violence (IPV), child maltreatment, and elder abuse content in accredited baccalaureate and master's level social work programs across the United States. A survey invitation was sent to 538 baccalaureate and 306 master's level social work program directors in the summer of 2020. The final sample consisted of program directors representing 177 baccalaureate and 79 master's level social work programs. Survey data were analyzed using descriptive statistics. Findings Data revealed that 12.43% of baccalaureate social work programs had a course on elder abuse, 25.42% had a course specific to IPV, and 60.45% had a course focused on child maltreatment; however, few programs required these courses. Master's program directors reported that 6.33% of their programs had a course on elder abuse, 34.18% on IPV, and 46.84% on child maltreatment; yet only three programs required a course on child maltreatment and none required courses on IPV or elder abuse. Applications Social workers will likely work with client systems who experience family violence and it is critical that social work programs look for ways to improve the quantity and quality of family violence content into their curricula. It is also important for state licensing boards to require content on family violence at the initial and renewal stages. These educational efforts will enhance the knowledge and abilities of the social work workforce.

Criminal Records and Licensure in Five Allied Health Professions: Is There Evidence of a Disparate Impact on Historically Marginalized Groups?

In health care, licensing is pervasive. Restrictions on applicants with criminal records may have a disparate impact on historically marginalized groups. There is bipartisan interest in evaluating whether occupational licensing requirements are too strict. The authors analyze how 12 representative states (California, Colorado, Connecticut, Delaware, Florida, Illinois, Missouri, New York, Ohio, Pennsylvania, South Dakota, and Texas) respond when people with criminal records apply for a license for five entry-level allied health professions (dental hygienist, occupational therapy assistant, physical therapy assistant, radiologic technologist, and respiratory therapist). With one exception for one allied health profession, all states require their licensing boards to consider past serious criminal convictions. A majority of states require the conviction to be substantially related to the scope of professional duties for it to provide a basis for disqualification. Most states make it difficult for applicants with criminal records to determine whether they may obtain a license. State licensing boards have considerable discretion in handling applicants with a criminal record. The trend is toward fewer restrictions, but more could be done to increase the transparency of state licensing board guidelines, practices, and procedures-particularly in the states that still rely on a "good moral character" test.

Physicians and Cognitive Decline: A Challenge for State Medical Boards

ABSTRACT Older physicians benefit from their many years of experience and the skills they have developed over decades of practice. At the same time, they may be at risk of cognitive decline, which raises concerns about job performance deficits. The question that this article addresses is whether state medical boards have a role to play in identifying clinicians with cognitive decline. It discusses what state medical boards currently do in this regard and analyzes whether they should do more. It also discusses relevant legal constraints and ethical obligations. The article ultimately concludes that state medical boards would be wise to adopt late career screening programs that are carefully designed to balance the interest of clinicians and patient safety. Such programs could be implemented only after experts determine which preliminary tests and more comprehensive follow-up tests can best identify job-related cognitive impairment and at what age the testing program should commence. Any testing program would have to include due process protections, efforts to provide reasonable accommodations to facilitate job performance, and a public relations campaign to build support among clinicians and professional organizations. Although the article focuses on state medical boards, its analysis and recommendation are relevant to all state licensing boards that oversee health care providers.

“Don’t Shame Me; Walk with Me”

Although prior research has explored the types of sanctions imposed by regulatory boards on social workers for licensing violations, empirical investigations surrounding the impact of sanctions on social workers is limited. This qualitative study explored the lived experiences of 13 licensed social workers who participated in licensing investigations and received sanctions by a state licensing board for violating state laws, rules, or ethical standards. The researchers used a phenomenological approach to analyze the interviews and identify common themes. Participants described the impact of the investigation process and sanctions on their emotional well-being, reputation, finances, and careers. They also expressed concerns about the potential impact on their clients. Participants’ recommendations for licensing boards include greater use of corrective actions rather than relying on punitive measures, avoiding suspensions, and a more strategic use of supervision and consultation.

Resources for Ethical Decision-Making

Purpose: This article is written from the perspective of a former American Speech-Language-Hearing Association (ASHA) Board of Ethics (BOE) member and focuses on Step 3 of the ethical decision-making process: consulting resources. The ASHA Code of Ethics, the Assistants Code of Conduct, and general procedures of the BOE are summarized. Given that many of the complaints reviewed and settled by the ASHA BOE arise from disciplinary actions imposed by state licensing boards and state or federal courts, the “intersection” of the ASHA BOE and other regulatory agencies is considered. Several ethics resources available on the ASHA website are highlighted. Common themes of ethics complaints are presented, and suggestions to avoid being the subject of an ethics complaint are offered. Conclusion: Familiarity with available ethics resources can serve as an important buffer for ethical dilemmas that may occur in everyday professional practice.