After reports of discipline given to an Oklahoma-based psychiatrist by the Oklahoma Medical Board for using Skype, along with other infractions, many professionals in the telehealth world were confused about the facts of this case. See Oklahoma Doctor Disciplined For Using Skype To Treat Patients? for early details of the controversy. The issues included not only the unsuitability of Skype for healthcare, but also the differences between states as they struggle to define other requirements for telehealth, such as the need for conducting in-person assessments when prescribing medication via telephone and telehealth equipment.
In a September 12, 2013 filing by the Oklahoma State Board of Medical Licensure and Supervision, Thomas Edward Trow, MD, pled guilty to the allegations in the Complaint and Citation filed on June 14, 2013. Dr. Trow is a 65-year-old physician, licensed in 1974. In a document outlining the hearing and disciplinary action in the State of Oklahoma’s Board of Medical Licensure and Supervision vs. Thomas Edward Trow, MD, the Board clearly stated their decision that, “Skype is not an approved method of providing Telemedicine.”
Documents from the disciplinary action show that Dr. Trow was seeing patients by Skype, and often did not see them in person prior to prescribing medication. The death certificate of the patient who died as a result of his contact with Dr. Trow through Skype showed that he “died of natural causes (HBP and COPD) and no toxicology report was ordered.”
Documents from the disciplinary action highlighted the following:
Upon completion of a thorough and comprehensive investigation process, it has been determined that no patient deaths are attributable to Dr. Trow. (p. 2)
According to the hearing documents, Dr. Trow apparently admitted to violating the Telemedicine guidelines under his employer, the Oklahoma Health Care Authority (OHCA), which is the primary entity in the state of Oklahoma charged with controlling costs of state-purchased health care. Dr. Trow apparently did not obtain proper contracts and did not use approved telehealth equipment. More specifically, OHCA wrote a Letter of Concern to Dr. Trow on 8-17-2012 informing him that he was in violation of their rules and regulations as follows:
a) no approved contract with OHCA, using unapproved equipment and no patient consent forms authorizing telemedicine.
The document referenced above stated that Dr. Trow reported that he thought these obligations were the responsibility of his employer and that they had gotten it approved. He admitted that he did not see all of his telepsychiatry patients via Skype, but rather, some were “nurse only” visits.
This landmark case illustrates several key points:
1. Informed consent for working in telehealth is required by some states.
2. In-person assessments are required by some states prior to telehealth services, thereby rending telehealth as appropriate primarily for follow-up care.
3. Telehealth equipment needs to be HIPAA compliant, and Skype does not meet HIPAA standards.
4. When operating as a licensed professional, it is unwise to assume that other parties will handle one’s duties related to state law.
In its document, the Board further delineated relevant aspects of its considerations regarding telemedicine.
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