Dr. Thomas Trow, a doctor living in far eastern Oklahoma was disciplined Thursday for prescribing violations and perhaps for using Skype to treat patients. Among other issues, he was treating via a video platform without conducting an in-person assessment, according to NewOK, a regional publication citing records.
A Patient Died
NewOK further explained:
In March, a representative of the Oklahoma Health Care Authority alleged that Trow was “practicing telemedicine via Skype on SoonerCare members and prescribing (controlled dangerous drugs) without ever seeing the patients in person for an initial evaluation,” according to a June 14 complaint filed by a medical board investigator.
The investigator’s complaint also showed that one of Trow’s patients, identified only as R.C., was treated three times for drug overdoses in less than six months.
Trow was prescribing the patient Xanax and other powerful narcotic drugs at the time of the overdoses.
The patient known as R.C. died while under Trow’s care…
Responsibility for Patient Care Ultimately Rests with the Practitioner
Dr. Trow reportedly worked for Hartsell Psychological Services, a mental health service for residents of rural communities in southern Oklahoma. He apparently was having his traveling nurse meet with patients and having her present them to him via Skype. While we don’t know the specific details, the Oklahoma Medical Board site lists him as having two previous disciplinary actions for over prescribing and narcotics violation and record violations.
Readers of this blog may want to note that the reported disciplinary action was directed toward Dr. Trow for his actions. Regardless of Hartsell Psychological Services and their responsibilities, the disciplinary action taken by the Oklahoma Board was directed toward Dr. Trow.
The practitioner is always held responsible for the care delivered to clients and patients, regardless of employer or specific healthcare profession. As most of us have been taught in our basic ethics courses, it is our direct responsibility to know and understand all the laws related to our services, especially when we venture into new areas of practice.
Was Skype Involved, and If So, How?
Despite the bold title of the NewOK publication, Oklahoma doctor disciplined for using Skype to treat patients, the Oklahoma Medical Board website does not make reference to using Skype as part of the disciplinary action. The Oklahoma Medical Board’s meeting minutes for 9/12/2013 also do not mention Skype, but describe suspension of Dr. Trow’s license for nine months. Perhaps NewOK was privy to documents that haven’t yet surfaced on the web.
Proper Intake/Assessment Techniques
Again, while we are not privy to everything involved, the public record does state that Dr. Trow’s was disciplined for “failure to establish a physician/patient relationship” (see p.3 of the action).
If indeed Dr. Trow did not meet with his patients in-person, and his state board decided against such a practice, they will be in the majority. Most U.S. states require an in-person assessment when prescribing medication, and especially controlled substances.
A Little Training Can Go a Long Way
Telepractice is viable, but you have to be able to defend challenges with knowledge of the law, ethics and the scientific evidence to support your choices with each and every client or patient.
Fortunately, many responsible professionals have researched and published in the telehealth field. Intake, assessment and treatment have been successfully accomplished with over 1,000,000 patients via telemedical care.
Intake and a full range of problems can easily be avoided with focused training to help practitioners adopt a brick-and-mortar, in-person office to telepractice. As we announced in our blog posts, both the American Psychological Association and the American Telemedicine Association have released guidelines in 2013. Our posts announcing the release of these guidelines are Guidelines for the Practice of Telepsychology Now Available Online and the American Telemedicine Association (ATA) Announces Guidelines for Video-Based Online Mental Health Services.
Both point to the serious need for training before venturing into telepractice. Fortunately, structured CE and CME educational programs are now readily available, including through the Internet via test, audio and video.
Where to Find Evidence-Based Telepsychology and Evidence-BasedTelemental Health Training Online or at Conventions
The TeleMental Health Institute (TMHI) was launched in 2009 to help practitioners with both the challenges and opportunities brought by telepractice. We’ve developed webinars, 100% online coursework, master teleworkshops and a fully online Certificate program for practitioners who want to stay abreast of these issues and learn how to implement reasonable and practical risk management policies. The training is evidence-based and offered online 24/7 on this webpage in its many formats.