Vermont Board of Medical Practice Investigation Procedures
Last year, in response to concerns raised by licensees about the process used by the Vermont Board of
Medical Practice in investigations, a bill was introduced that did three things. H. 350 required the Board
of Medical Practice to remove information about charges and investigations from the VBMS website and
from the public registry when cases were dismissed by the Board or by the court. This was an issue
raised by licensees whose cases were dismissed, but found that information about the dismissed
charges was still available through internet searches on the VBMP’s website. The bill also required the
Board’s investigators to meet law enforcement standards and obtain certification from a nationally
recognized entity regarding the investigation of licensing cases. Finally, the bill required the VBMP to
conduct a review of its policies and procedures for investigating unprofessional conduct cases; to accept
recommendations from stakeholders regarding this issue; and to report to the legislature on changes
the Board makes regarding those investigations.
To provide input to the Board, the Vermont Medical Society gathered recommendations and concerns
from members about the investigation process over the spring and summer of 2014, and submitted
preliminary recommendations to the Board prior to its annual Board retreat in September, where the
investigative process was discussed at length by the Board. Subsequently the Board prepared proposed
rules that address several of VMS’ concerns. The rules specify the process and standards that the Board
will use in cases that are Board-initiated, as opposed to cases initiated by patient or public complaints.
The rules also include requirements for notice to licensees who are being investigated and sets a
standard for delaying notice. The rule states that visits to licensees’ practices will ordinarily be
scheduled in advance in the normal course of business and includes examples of the types of cases
when an unannounced visit may occur.
The rule did not address several of VMS’ concerns. For example, it did not include a standard to be used
when patient records are subpoenaed. VMS had proposed adoption of the standard used to obtain
records in cases investigating attorneys. The proposed rule did not authorize licensees to have access all
information in the case relied on by the Board. The Board informed VMS that it did, however, provide
all information to licensees once formal charges are filed.
VMS prepared a comparison of the VMS proposals and the VBMP proposed rule and distributed it to
VMS members along with the proposed rule.
After reviewing the proposed rule, VMS members made several additional suggestions. They
recommended including a requirement that the notice to a licensee specify which of the 39 listed
unprofessional conduct provisions a licensee is being investigated for and recommending that the Board
adopt standard operating procedures for investigations to ensure quality and professionalism or the
investigation.
David Herlihy, the Executive Director of the Board plans to attend the VMS Council meeting to discuss
this issue with VMS members. The meeting will be held at the Doubletree Hotel in South Burlington
on Saturday, February 21, from 9 to 11 am. Any VMS member is welcome to attend.
Background information:
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VMS Recommendations – August 2014
VBMP Proposed Rules – January 2015
VMS comparison chart – January 2015
Please contact VMS with any thoughts or suggestions about the VBMP investigation process.
Mental Health: Two Issues for the VMS Council
In mid-December, VMS met with the Commissioner of Mental Health to discuss the patients waiting in
Emergency Departments for Level 1 Involuntary Psychiatric Placements. Although the Vermont
Psychiatric Care Hospital opened July 1, 2014, this continues to be a problem, with some patients
waiting several weeks for admission. Notes and recommendations from that meeting are ….
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Last year VMS adopted a policy that recommended that all patients be placed within 24
hours. VAHHS position is that patients in the Emergency Department should be
admitted or discharged within 6 hours, which is the emergency department standard for
patients with other types of illnesses. The VMS Council may wish to amend VMS policy
to reduce the time for admission from 24 hours to 6 hours.
The Commissioner of Mental Health is requesting funding for a permanent 14 –bed
involuntary Secure Residential Facility to be located in Middlesex that would replace a
temporary 7-bed secure residential facility in Middlesex. This facility is designed for
patients who do not need the acute medical services available at a hospital, and may
serve some of the patients who are admitted from the criminal justice system who stay
for long periods of time. VAHHS is supporting this proposal, and the VMS Council may
wish to weigh in as well.
Governor’s Budget Proposes Elimination of State Funding for Educational Loan Repayment -$700,000
cut.
The Educational Loan Repayment (ELR) program has been administered by the University of Vermont
College of Medicine Area Health Education Centers (AHEC) Program for many years. It is one of the most
important recruiting tools and workforce incentives to encourage physicians to practice in Vermont.
The goal of the loan repayment program is to ensure a stable and adequate supply of primary care
practitioners, dentists, nurses and nurse educators to meet the health care needs of Vermonters. State
loan repayment funding provided grants to 130 health professionals last year.
In 2014 there were 57 grants to primary care practitioners, including family physicians, general
internists, pediatricians, obstetrician/gynecologists, psychiatrists, nurse practitioners and physician
assistants. The average primary care award last year was $7946, although the average debt of
applicants was $131,155 and there were 119 applicants who did not receive awards at all. ELR grants
were also awarded to 17 dentists, 52 nurses and 4 nurse educators/faculty. All grant recipients agree to
practice in Vermont in underserved areas last year.
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This funding is particularly important this year since Medicaid reimbursement for primary care will be
reduced about 20% in calendar year 2015 due to a federal grant that was not continued or replaced with
state funds. Even in 2014, when the federal funds were available, fewer family practice, internal
medicine and psychiatric practices were accepting new Medicaid patients than were accepting any new
patients.
This proposed cut is being reviewed by the House Appropriations Committee, which is the first stop on
its way. It will also be reviewed on the House floor and then again by the Senate Appropriations
Committee and by the full Senate, so there will be multiple opportunities for input on this important
issue.
Background information:
AHEC Data about Loan Repayment
Department of Health – Health Care Professional Data
Please contact VMS to let us know how the reduction in loan repayment will affect your practice’s
ability to recruit physicians or how it will affect your ability to practice in Vermont.
You can also send your concerns directly to the members of the House Appropriations Committee.
(Insert link to committee contact information here.)
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