Two weeks after a doctor in eastern Oklahoma who used Skype to treat mental health patients was placed on probation for two years, the state medical board adopted a policy meant to clarify guidelines of the relatively new practice of telemedicine.
During the meeting, the board adopted a position statement on the definition of a face-to-face encounter “by telemedicine,” which can include sessions with approved audio and video devices.
Board members expressed concerns about doctors prescribing potentially dangerous drugs using only telemedicine, but most agreed that some patients — under particular circumstances — can benefit from the relatively new method of health care delivery.
Lyle Kelsey, executive director of the medical board, said a public forum will be held Nov. 7 during the board's regular meeting to further discuss telemedicine and its growing demand in Oklahoma.
Kelsey said the position statement crafted by the board and unveiled Wednesday is meant “to help direct physician medical care currently going on.”
“After the public hearing, the rule will proceed through the legislature and governor's office for approval,” Kelsey said. “This will take some time and likely won't become effective until May or later of 2014.”
The board adopted the policy statement during a special meeting held Wednesday evening at its Oklahoma City headquarters.
Skype usage discussed
The action taken Wednesday by the medical board comes on the heels of the sanctioning of Dr. Thomas Trow, of Park Hill, a small community in far eastern Oklahoma.
Trow was disciplined by the medical board Sept. 12 after he was found to be in violation of numerous state laws dealing with medical doctors, including prescribing controlled drugs “without sufficient examination and the establishment of a valid physician-patient relationship,” an order filed against Trow shows.
In a complaint filed by a medical board investigator, it was revealed that Trow used Skype to see patients as far back as early 2011.
Trow drew the attention of board investigators in March 2012 after they received a complaint from the Oklahoma Health Care Authority, who alleged that Trow was “practicing telemedicine via Skype on SoonerCare members and prescribing CDS (controlled dangerous substances) without ever seeing the patients in person for (an) initial evaluation.”
It wasn't the only Skype-related complaint filed against Trow, records show.
“The Oklahoma Health Care Authority filed an additional and related complaint stating they have been billed for telemedicine visits via Skype by Hartsell Psychiatric Clinic, who contracts (Trow) for their medical services,” an order filed Sept. 12 states.
“However, neither the clinic nor (Trow) has a contract with OHCA to provide such services and Skype is not an approved method of providing telemedicine.”
Board documents show that one of Trow's patients overdosed three times between April and November of 2011.
The patient died four days after the most recent overdose, although board investigators noted that the patient died of natural causes. Two of Trow's other patients during this time died, as well, but their deaths were also ruled natural, records show.
It was also determined through the board's investigation that Trow was seeing pain management patients via Skype. Such patients are typically prescribed large amounts of potentially dangerous painkillers and other drugs, a major concern for board member Dr. J. Andy Sullivan, an orthopedic surgeon.
When interviewed by investigators, Trow said he began using Skype to see patients when his health went on the decline. He said patients would go to one of several clinics owned by his employer and that a nurse “presented the patients to him via Skype.”
“He stated that he did not think he had to see patients in person since they were psychiatric patients,” a board investigator wrote about Trow.
Telemedicine in use
Dr. Paul Preslar, of Midwest City, said he uses telemedicine to treat patients in Oklahoma's rural areas.
Preslar, who described himself as a family doctor, said there are many cases where telemedicine is appropriate, even demonstrating the website he uses to see patients over the Internet.
The doctor said he doesn't prescribe narcotics when practicing telemedicine and that the website displays a disclaimer to let patients know what to expect.
Presler said he treated a patient for a spider bite using telemedicine in recent weeks. He said things like poison ivy and minor colds are treatable using only telemedicine but acknowledged that many diagnoses must be made with a face-to-face, in-person visit.
As for Oklahoma doctors using Skype to treat patients in the future, it appears the practice is still not allowed.
An official with the University of Oklahoma Health Sciences Center described Skype as being “consumer-grade.” She said those “heavily involved” in telemedicine in Oklahoma use equipment that is “medical- or professional-grade.”