Chancery Court Overturns Tennessee Board of Nursing Discipline

Chancellor Ellen Lyle of Davidson County Chancery Court reversed the disciplinary actions order by the Tennessee Board of Nursing against my client, a Tennessee registered nurse (referred to hereafter as “the RN”). Chancellor Lyle’s decision, which was issued July 24, 2015, overturned the Board of Nursing’s Amended Order, issued pursuant a hearing before the Board of Nursing last August 2014.

Chancellor Lyle’s decision, which can be found in its entirety here, reversed the Board of Nursing’s suspension of the RN’s license based on the Board’s finding that the RN was addicted to drugs or alcohol to the degree of interfering with nursing duties, and that she was unfit, incompetent, and/or unprofessional due to the use or removal of drugs from the hospital where she worked. In her reversal, Chancellor Lyle found that the only statutory violation supported by the record was that the RN was unprofessional for having in her office controlled substances that had not been documented for a patient. As such, the Chancellor reversed the suspension, but left in effect an assessment of costs of approximately $2,300 against the RN.

Chancellor Lyle found that the Board’s findings that the RN was addicted to drugs or alcohol and unfit/incompetent were unsupported by the evidence from the hearing before the Board of Nursing in August 2014. Specifically, the Board of Nursing found that the RN was unfit, incompetent, and addicted to drugs or alcohol in contradiction to the overwhelming evidence against these conclusions. This evidence included: a physician’s evaluation stating “there are no indications that [the RN] has or has had a Substance Use Disorder,” overwhelming testimony from co-workers that the RN was never impaired or intoxicated in or outside of work, and a lack of evidence that the RN ever removed narcotics without authorization from her employer. In conclusion, Chancellor Lyle succinctly stated:

“When all of the record is viewed as a whole, the outcome is that: (1) the evidence to support the Board’s decision amounts to suspicions and (2) these suspicions are rebutted and undercut by the other evidence of the record…Under these circumstances, the decision of the Board must be reversed.”

Chancellor Lyle’s decision marks a triumphant and tearful day for this RN, whose work ethic as a nurse for 35 years and nursing supervisor for over 18 years has been widely praised and sought after across the country. Her reputation was battered by the unfounded accusations against her, which escalated from a complaint by her former employer in 2012 to a full-blown hearing before the Tennessee Board of Nursing in 2014. The Board has a duty to protect the public, and ensure that unsafe nurses are not permitted to practice in Tennessee. This duty, however, does not permit the Board to discipline a licensee based on suspicions and conjectures.

It should come as a relief to this RN—and all nurses across the state of Tennessee—to know that if an unfounded complaint is levied against you, Chancellors like Chancellor Lyle are willing to stand up and ensure that the Board of Nursing does not discipline your license based on mere suspicions. Hopefully for other licensees across the state, it won’t take three years and an appeal to Chancery Court to ensure that justice occurs.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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Sex, Drugs, Alcohol & Prescription Medicine: When Can Your Personal Life Jeopardize Your License to Practice?

Alex Fisher and Erin Tolbert, the creator of MidlevelU, discuss personal and professional boundaries for health care professionals. The original article and video, published on MidlevelU, can be found here. Although Erin and Alex discuss personal and professional boundaries in the context of nurse practitioners, the same advice applies to other health care providers.

Romantic Involvement with Patients

The most important question to ask when considering romantic involvement with a patient is “Is this a former or current patient?”. Nurse practitioners and physician assistants should never date current patients. Should you find yourself interested in a patient, first and foremost transfer their medical care to another provider in the practice before proceeding. If you do proceed, do so with caution or you could find yourself charged with sexual misconduct. This blog post from MidlevelU outlines the ins and outs of what’s allowed when it comes to romantic involvement with a former patient.

Drug and Alcohol Use

Use of substances like drugs and alcohol can carry consequences even if they don’t affect your job performance. Many employers prohibit drug use among employees, so even if use of certain substances is legal in your state and won’t affect your licensure status, it could leave you unemployed. Nurse practitioners and physician assistants working unconventional hours need to be careful when it comes to alcohol consumption. Avoid drinking before the night shift, even if you have an event to attend before clocking in.

Prescription Drug Use

Chronic use of medications that may impair performance is looked upon unfavorably by employers and licensing boards. The best way for healthcare providers to deal with issues like chronic pain is to pursue alternative treatment methods. If you are taking prescription medications, consistency is key. Make sure you are taking your medications as prescribed. Start new prescriptions that may have detrimental side effects when you have a few days off work so you know how they will affect you. Don’t show up impaired at work or you could lose your license, prescription or not.

 

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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How Little Does the Government Have to Prove to Revoke Your License?

Evidence picThis post, written by Alex Scarbrough Fisher, was originally published on midlevelu.com, and can be found here. It is republished with the permission of MidlevelU.com.

Just how little does the government have to prove to revoke your nurse practitioner license? This post looks at the legal standard required to prove facts in a contested case hearing in order to impose discipline on a nurse practitioner. Even though this delves into more technical legal concepts than in the norm on MidlevelU, it’s important to understand how much, or rather, how little, the Department of Health has to prove in a licensure action against an NP.

Burden of Proof

In a contested case hearing involving a discipline action brought against one’s advanced practice nursing license, the Department of Health carries the burden of proof. The burden of proof is the legal term used to describe the threshold a party seeking to prove a fact has to reach in order to have the fact legally established. In a criminal court case, the burden of proof the prosecutor has to reach to establish facts is that of beyond a reasonable doubt. In a civil action, generally, as well as in a contested case hearing involving licensure discipline before the Department of Health, the burden of proof required is preponderance of the evidence.

Preponderance of the Evidence: What Does That Mean?

Preponderance of the evidence requires demonstrating that a fact is more likely true than not. In practical terms, this means that the Department of Health has to convince the Board of Medical Examiners or Board of Nursing that the Department has at least 51% of the proof in their favor, while you, the nurse practitioner, have only 49% of the proof in your favor.

Proof can be established in a contested case hearing through the testimony of witnesses, the introduction of relevant, nonhearsay documents, or the introduction of affidavits, agreed to by both parties. One of the most important roles of a nurse practitioner’s attorney in preparing for a contested case hearing is to gather evidence to disprove the allegations that the Department has set forth in the formal notice of charges.

Why Does the Burden of Proof Matter?

The preponderance of the evidence standard is significant for a nurse practitioner preparing for a hearing before the Board of Medical Examiners or Board of Nursing because it conveys what level of proof the Department is required to reach in order to prove that the NP has violated a law or regulation and deserves punishment. Preponderance of the evidence is an important standard to consider when preparing one’s defense for a contested case hearing.

Finally, preponderance of the evidence is simply a low threshold requirement for the Department of Health to meet in order to revoke an individual’s license to practice medicine or nursing. A nurse practitioner going before the Board of Nursing needs to be aware of this low standard, and prepared to properly rebut it in a contested case hearing.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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Medical Records: What Needs to be Included from a Legal Standpoint?

Alex Fisher and Erin Tolbert, the creator of MidlevelU, discuss what needs to be included in medical records from a legal standpoint. The original article and video, published on MidlevelU, can be found here. Although Erin and Alex discuss medical record keeping in the context of nurse practitioners, the same advice applies to other health care providers, including physicians and physician assistants.

Included in this video are some suggestions for best practices that health care providers should use when prescribing controlled substances to back up their decision making and protect themselves from disciplinary action. These recommendations include:

  1. Document a complete social history including a history of drug and alcohol abuse.
  2. Get a pain management contract in place and maintain this as part of the patient’s medical record for individuals who are prescribed these types of medications on a long-term basis.
  3. Consider drug testing patients who are prescribed controlled substances. Make sure your practice has a protocol in place regarding next steps when drug test results are inconsistent with the patient’s prescribed medication regime.
  4. Discuss (and document!) pain management alternatives before prescribing narcotic medications. Regulatory boards like to see that patients have explored options aside from long term pain management with prescription drugs.
  5. Make use of state controlled substance medication prescribing databases before prescribing controlled substances. In some states this is required by law. Document that you have checked this record.
  6. Don’t prescribe without documentation. Even if you aren’t charging a patient for a visit where controlled substances are prescribed, medical documentation is required.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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What Nurse Practitioners Need to Know Before Agreeing to License Restrictions

Attorney Alex Fisher recently had the opportunity to visit with Erin Tolbert, the creator of MidlevelU, an online resource for health care providers such as nurse practitioners and physician assistants, and discuss how nurse practitioners are regulated as a profession. The original article and video, published on MidlevelU, can be found here. Although Erin and Alex discuss restrictions in the context of nurse practitioners, the same advice applies to other health care providers, including physicians and physician assistants.

If you’ve been notified of pending disciplinary action against you as a nurse practitioner, agreeing to a simple restriction on your license rather than a more formal disciplinary hearing may seem like the obvious best choice to diffuse the situation. Perhaps the Board of Nursing puts an agreement on the table that allows you to practice provided that your charts are simply reviewed by a physician. Not too shabby given the alternative, right?

A restriction on your license to practice is a stipulation, usually given as a result of disciplinary action, that limits your scope of practice. A restriction may be a prescribing restriction or an oversight mandate, for example. What many nurse practitioners don’t know is that even the smallest restriction placed on your NP license can send your career into a tailspin.

There are times when agreeing to restrictions on your license as part of disciplinary action is going to be your best bet. But, agreeing to restrictions on your license should never be taken lightly or done without legal counsel as it can have some serious implications.

Restrictions placed on your license could, and often do, trigger administrative action from other organizations such as the DEA. As a result, your DEA license may be revoked. Restrictions may also result in decertification essentially making you ineligible to practice. As a result of changes to your certification and prescribing status, you may lose hospital privileges and ultimately your job.

Restrictions placed on your nurse practitioner license can ruin your ability to practice. Always seek legal council if you face disciplinary action, regardless of the offer put on the table by your board of oversight. You may be able to get a better deal or approach the matter in a way that allows you to keep your career.

 The following clip provides insight on the positives and negatives of agreeing to restrictions on your license.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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A Delicate Balancing Act: The Supervision of Nurse Practitioners by Physicians

balancing rocksThis post, written by Alex Scarbrough Fisher, was originally published on midlevelu.com, and can be found here. It is republished with the permission of MidlevelU.com.

The supervision of nurse practitioners by physicians, in states that require such supervision, is often a delicate balancing act between responsibility on both the supervising MD and the NP. In order to fully illustrate this delicate balance, I will look at the specific requirements for  nurse practitioners and physicians in Tennessee.

If you live in a state that requires you as a nurse practitioner to have a supervising physician, I highly recommend reviewing the rules that govern you, as well as the rules and regulations that govern your supervising physician. Understanding what is required of each party will lead to clarity for both individuals, and hopefully a more enjoyable work environment, as well as a safer environment for your patients.

Requirements of Nurse Practitioners

In Tennessee, for example, nurse practitioners are required to keep a record of their current supervising physician with the Board of Nursing at all times. This record is commonly referred to as a “Notice and Formulary”, and must be filed within 30 days of any changes in supervising physician. This document includes notice to the Board of Nursing of who your supervising physician is, as well as a copy of the formulary describing what legend drugs you, the nurse practitioner, has permission to prescribe.

The notice and formulary is viewed as a contract between the nurse practitioner and the supervising physician authorizing what the nurse practitioner is permitted to prescribe, and who is supervising that prescribing. The Board of Nursing views the filing of the Notice and Formulary as the NP’s responsibility. As such, the Board won’t accept “I gave the notice and formulary to my supervising physician and he must have forgotten to mail it in” as an acceptable excuse to not having one on file. I recommend that all nurse practitioners ensure that they have a current notice and formulary on file by mailing in the notice themselves rather than relying on a staff member or their supervising physician to do so. The full Rules for Nurse Practitioners in Tennessee can be found here.

Requirements of Supervising Physicians

Supervising physicians in Tennessee are required to develop joint protocols between the supervising MD and the NP outlining the acceptable standard of care for patients to be treated and which drugs are appropriate to prescribe. These joint protocols should be dated and signed by the MD and NP, and should be maintained at their practice site. The supervising physicians is responsible for ensuring compliance with these joint protocols.

Supervising physicians in Tennessee are also responsible for reviewing 20% of all the nurse practitioner’s patient charts, and 100% of the NP’s charts when a controlled drug has been prescribed. This review should take place at a minimum of every 30 days. The full Rules for Supervision of a Nurse Practitioner in Tennessee can be found here.

Developing joint protocols with your supervising physician, and having him or her review 20% of your patient charts and 100% of charts where a controlled substance is prescribed allows for an extra level of protection for both NPs and patients. This provides a second set of eyes on a patient chart for an NP who may be unsure regarding their diagnosis, or who might even get audited by the Department of Health at some point during his or her career.

Joint protocols provide clarity for the NP and supervising MD as to standard of care and the appropriate way to handle patients in different situations. Although developing joint protocols and reviewing patient charts is the responsibility of the supervising MD, it benefits the NP to make current and future supervising physicians aware of these requirements if they are not already. For those nurse practitioners outside of Tennessee, reviewing your state’s applicable rules for you as a nurse practitioner is highly recommended to ensure success in your next supervising physician relationship.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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Regulation of Nurse Practitioners

Attorney Alex Fisher recently had another opportunity to sit down with Erin Tolbert, the creator of MidlevelU, an online resource for health care providers such as nurse practitioners and physician assistants, and discuss how nurse practitioners are regulated as a profession. The original article and video, published on MidlevelU, can be found here.

Erin and Alex discuss:

Who is in Charge of Nurse Practitioners?

In some states nurse practitioners are regulated by the Board of Medical Examiners, while in other states nurse practitioners are regulated by the Board of Nursing. The American Association of Nurse Practitioners has a helpful breakdown of the regulation of nurse practitioners in each state that can be found here.

How Does the Way You are Regulated Affect Your Practice?

In theory, the Board that regulates you should not matter if the regulations are fairly consistent from state to state, but in reality, the Board that regulates a nurse practitioner can have a significant impact on their practice. For example, if a provider is in a state like Tennessee where nurse practitioners are regulated by the Board of Nursing, and if the provider is brought before the Board on a complaint related to prescribing, some of the Board members who will be determining whether that individual is disciplined or not will likely be registered nurses who have never written a prescription before or dealt with prescribing in their own practice.

Who is Responsible?

It’s often difficult to determine who is responsible, or ‘where the buck stops’ when a complaint is made about a nurse practitioner’s actions when the supervising physician is regulated by the Board of Medical Examiners and the nurse practitioner is regulated by the Board of Nursing. The bottom line is that a nurse practitioner is responsible for his or her own actions, particularly when it comes to prescribing. Writing a prescription is like signing a contract–which is why it is so important that nurse practitioners document each time a prescription is written.

How Can Nurse Practitioners Improve Relationships with their Supervising Physicians?

I recommend that nurse practitioners develop written protocol with their supervising physicians. Having protocol in writing will clarify expectations for all parties.

As a young nurse practitioner, ask questions and seek mentorship as you are developing your own medical judgment. You as an nurse practitioner are responsible for your own actions, so make sure you have a good support system in place to ensure that you are providing the best possible care to your patients.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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The Nurse Practitioner Disciplinary Process: How It Works

Attorney Alex Fisher recently had an opportunity to sit down with Erin Tolbert, the creator of MidlevelU, an online resource for health care providers such as nurse practitioners and physician assistants, and discuss how the nurse practitioner disciplinary process works in Tennessee. The original article and video, published on MidlevelU can be found here.

Erin and Alex discuss:

The Difference Between Disciplinary Action and Medical Malpractice

Medical malpractice occurs when a health care provider is sued by an individual, usually a patient or family member of a patient, in civil court. In such a case, the health care provider is being sued for money. By contract, disciplinary action is initiated by the Department of Health, typically once a complaint has been filed against a health care provider, regarding that provider’s professionalism. In such a case, what is at stake is the health care provider’s professional licensure.

What happens when a complaint is filed against your license?

When a valid complaint is made against a health care provider, the complaint is assigned to an investigator with the Department of Health to investigate. Once the investigation has concluded, the investigator hands over the case to an attorney in the Department of Health. If the attorney thinks discipline is appropriate, the health care provider will then receive a letter in the mail from the Department of Health. This letter is referred to as a 4-5-320(c) letter, and is discussed in further detail here.

What happens if you receive discipline from the Department of Health?

Discipline on one’s nurse practitioner license can range from a letter of concern to a reprimand to probation or suspension all the way up to revocation. Depending on the alleged conduct of the provider, a wide range of outcomes are possible.

What should you do once you find out a complaint has been filed against you?

I recommend hiring an attorney to represent you prior to accepting an interview with a Department of Health investigator or responding to any correspondence from the Department of Health. Having a complaint filed against one’s professional license is an emotional situation, and a health care provider really needs a third party who is neutral and removed from the situation who can best advocate for him or her.

 

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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Avoiding Disciplinary Action as a Nurse Practitioner

Attorney Alex Fisher recently had the fantastic opportunity to sit down with Erin Tolbert, the creator of MidlevelU, an online resource for midlevel providers such as nurse practitioners and physician assistants, and discuss common pitfalls for nurse practitioners that may lead to licensure discipline. The original article and video, published on MidlevelU can be found here.

Erin and Alex discuss:

The main reasons nurse practitioners are usually brought before the Board of Nursing, which include prescribing without documentation, ethical concerns, and criminal convictions.

Attorney Alex Fisher explains how investigation by the Department of Health in Tennessee is a complaint driven process, which means complaints are initiated by members of the public, such as patients, co-workers, supervisors or employers, and general members of the public.

Prescribing Without Documentation

Prescribing issues that result in discipline generally concern prescribing narcotics without documenting the rational for prescribing and documenting that the individual is the nurse practitioner’s patient.

Falsification of Documentation

Documentation issues that result in discipline generally result from falsification of documentation, such as false documentation of checking vitals, taking a test, or any other documentation in a patient’s chart that does not accurately reflect the nurse practitioner’s interventions.

Criminal Convictions

Criminal convictions that result in severe discipline are generally more serious in nature, such as violent crimes. It is less likely that someone will receive harsh discipline for a lesser misdemeanor, such a DUI conviction. Regarding criminal convictions, the requirements for self-reporting vary from state to state. Even if your state does not require self-reporting, when a nurse practitioner renews her license, she should be sure to reanswer any questions on her practitioner profile accurately to reflect the criminal conviction.

 

 

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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Licensing, Regulations, and Hearings Before the DEA

DR writing RXAlex Fisher was contacted by the Albany Law Review to provide a review of the article published in their 78th volume, “Drug Diversion, Administrative Revocation, and Application hearing for Medical and Pharmacy Practitioners: A Primer for Navigating Murky, Drug-Infested Waters.” This article, written by Drug Enforcement Administration (“DEA”) Chief Administrative Law Judge John Mulrooney and DEA law clerk, Andrew Hull, which can be found here, and provides an excellent summary of the administrative process surrounding DEA licenses.

Basis for DEA Discipline

After receiving discipline at the state level on their medical, nurse practitioner, or physician assistant license, many of my clients are often contacted by the DEA regarding agreed-to restrictions on their DEA license, or even the agreed surrender of that license.

The DEA has the authority to suspend, revoke, or otherwise sanction a healthcare provider’s DEA license on the following five bases:

  • material falsification in registration application
  • conviction relating to a violation of state or federal controlled substance law
  • state action against state controlled substance privilege
  • exclusion from participation in a federal health care program, and
  • the commission of an action that would “render enjoyment of the registration inconsistent with public interest.”

Id. at p. 104-105.

The fifth basis on which the DEA may discipline a healthcare provider’s DEA license, the commission of an action that would “render enjoyment of the registration inconsistent with public interest,” is substantially similar to a common state catchall provision found within the regulations for each profession.

For instance, here in Tennessee, discipline of a licensee by the Board of Medical Examiners is permitted on the grounds of “unprofessional, dishonorable, or unethical conduct.” The DEA’s “inconsistent with public interest” provision also encompasses the discipline of a healthcare provider by their state licensing board, such as the Board of Medical Examiners or Board of Nursing as a legal basis for discipline of a provider’s DEA license. Id. at 111.

In addition to a healthcare provider’s discipline by their professional board, the DEA also considers a criminal conviction relating to manufacturing, distributing, or dispensing of controlled substances as an appropriate basis for the discipline of a provider’s DEA license. Id. at 120.

The DEA also considers “self-abuse of controlled substances and alcohol” and “failure to take steps to prevent against diversion of controlled substances” as potential “public interest” concerns that could lead to the limitation or revocation of a health care provider’s DEA license. Id. at 131. Specifically, the DEA considers “self-abuse of controlled substances and alcohol” and “failure to take steps to prevent against diversion of controlled substances” as potential “public interest” concerns that could lead to the limitation or revocation of a health care provider’s DEA license. Id. at 131.

DEA Administrative Hearing

Within the article, Judge Mulrooney explains in detail the process of an administrative hearing before the DEA. As in most administrative hearings, the burden is on the government to prove that an applicant or licencee has violated a provision of the DEA and that their license should be revoked, disciplined, refused. Id. at 135. Additionally DEA hearings usually take place at one central location—the DEA Hearing Facility in Arlington, Virginia. Id. at 141-42.

As with administrative hearing at the state level, a party appearing before a DEA administrative proceeding may retain an attorney or represent him or herself. Id. at 153. Uniquely, the DEA administrative proceeding also allows a party to be represented by an employee of the party, which contemplates that pharmacies and manufacturers, as the entities themselves, are often the respondent before a DEA administrative proceeding. Id.

At the actual hearing, similar also to state administrative proceedings under the Uniform Administrative Procedures Act in Tennessee, hearsay evidence may be admissible if relevant. Id. at 156.

Conclusion

In concluding, Judge Mulrooney makes an excellent point:

“An unprepared or unschooled counsel can unwittingly choose a tactic or make a concession that can result in the loss of a medical or pharmaceutical practitioner’s livelihood” Id. at 162.

As in any specialized field, but even more so when a practitioner’s ability to prescribe is on the line, it is important for a provider who is facing discipline by the DEA to be represented by counsel who is familiar with and has an intimate knowledge of the process and proceeding before the DEA.

Just as a patient wouldn’t choose a cardiology to perform brain surgery, a healthcare provider should not retain counsel to represent them before the DEA or in any administrative proceeding who is not experienced and specialized in this unique area.

Alex Scarbrough Fisher

Alex Scarbrough Fisher is an associate attorney at Thompson Burton PLLC. Her practice area focuses on litigation and administrative law. Alex’s administrative law practice’s emphasis is in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing.

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