- Answer - A physician may not perform or supervise a procedure that requires anesthesia in an office-based setting unless the office-based setting is accredited by an accreditation agency approved by the board.
- Because sedation is a continuum, it is not always possible to predict how a patient will respond. Physicians administering sedation must be able to rescue a patient whose level of sedation becomes deeper than initially intended. Physicians administering anesthesia, or supervising or directing the administration of anesthesia, must be knowledgeable about the risks and the interventions required for correcting any adverse physiological consequences that may occur.
- Answer -The following have been approved by the Board to offer this accreditation:
- (QuadASF) – American Association for Accreditation of Ambulatory Surgery Facilities, Inc.
- (TripleAHC) – Accreditation Association for Ambulatory Health Care, Inc.
- Joint Commission
- (HFAP) Health Facilities Accreditation Program
- Answer -Office based setting means any facility, clinic, center, office or other setting where procedures are performed that require anesthesia, which includes the following types: moderate sedation/analgesia, deep sedation/analgesia, general anesthesia or regional anesthesia. This term does NOT include a hospital operated by the federal government or a setting licensed under IC 16-21-2 as a hospital, ambulatory surgical center, abortion clinic or birthing center.
- Answer -If your office based setting described above is administering moderate sedation/analgesia, deep sedation/analgesia, general anesthesia, or regional anesthesia, you will need to be accredited. Accreditation is not required for the administration of local anesthesia, topical anesthesia, superficial nerve blocks, or minimal sedation/anxiolysis.
- Answers -
- “moderate sedation/analgesia" (also sometimes called "conscious sedation") means a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.
The following are conditions that a patient under moderate sedation/analgesia may experience:- No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate.
- Cardiovascular function is usually maintained.
- “deep sedation/analgesia" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. For purposes of this rule, reflex withdrawal from a painful stimulus is not considered a purposeful response.
The following are conditions that a patient under deep sedation/analgesia may experience:- The ability to independently maintain ventilatory function may be impaired.
- Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.
- Cardiovascular function is usually maintained.
- "general anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by pain stimulation.
The following are conditions that a patient under general anesthesia may experience:- The ability to independently maintain ventilatory function is often impaired.
- Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function.
- Cardiovascular function may be impaired.
- "regional anesthesia" means the administration of anesthetic agents to a patient to interrupt nerve impulses without the loss of consciousness and includes the following:
- Major conduction blocks, such as:
(A) epidural;
(B) spinal; and
(C) caudal; - Peripheral nerve blocks, such as:
(A) brachial;
(B) lumbar plexus;
(C) peribulbar; and
(D) retrobulbar; - Intravenous regional anesthesia, such as Bier blocks.
Notwithstanding section 2 of this rule, a superficial nerve block or application of a local anesthetic agent in which the total dosage administered exceeds the recommended maximum dosage per body weight described in the manufacturer's package insert shall be considered regional anesthesia for purposes of this rule.
- Major conduction blocks, such as:
- Answer - No, accreditation is not required. Those are defined as the following:
- "local anesthesia" means a transient and reversible loss of sensation in a circumscribed portion of the body produced by:
- a local anesthetic agent; or
- cooling a circumscribed area of the skin.
(The term includes subcutaneous infiltration of an agent.)
- “topical anesthesia" means a transient and reversible loss of sensation to a circumscribed area produced by an anesthetic agent applied directly or by spray to the skin or mucous membranes.
- "superficial nerve block" means an agent placed in the proximity of any nerve or group of nerves outside of the vertebral canal to produce a loss of sensation in an anatomic or circumscribed area. The term is limited to the following blocks:
- ankle;
- metacarpal;
- digit; and
- paracervical;
- "minimal sedation/anxiolysis" means a drug-induced state during which a patient responds normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are usually not affected.
- Answers -
- A physician who performs a procedure that requires anesthesia in an office-based setting, or who directs or supervises the administration of anesthesia in an office-based setting, must have:
- Admitting privileges at a nearby hospital;
- A transfer agreement with another practitioner who has admitting privileges at a nearby hospital;
- An emergency transfer agreement with a nearby hospital.
- Agreements with local emergency medical services (EMS) for the purposes of transfer of patients to the hospital in case of an emergency.
- Question - I am concerned that I may have a problem with alcohol/drug impairment or abuse. Where can I go to get help?
- Answers - You should contact the Indiana State Medical Association Physician Assistance Program, immediately at (317) 261-2060. For more information go to ISMA Website. Peer review laws allow for a physician to get assistance without the risk of license discipline as long as they are compliant with ISMA’s treatment recommendations.
- Answers - A practitioner who has personal knowledge based upon a reasonable belief that another practitioner holding the same licenses has engaged in illegal, unlawful, incompetent, or fraudulent conduct in the practice of medicine SHALL promptly report such conduct to either a peer assistance program, the Board or the Office of the Attorney General.
- Answers - The use of a laser is included in the definition of the practice of medicine, which is below. Therefore, only a licensed physician may perform or designate to “an agent” any procedure with a laser, unless provided for in the exclusions section of the statute.
IC25-22-5-1-1.1 Definitions Sec. 1.1 as used in this article:- (a) “practice of medicine or osteopathic medicine” means any one (1) or a combination of the following:
- (1) Holding oneself out to the public as being engaged in:
- (C) the performing of any kind of surgical operation upon a human being, including tattooing, except for tattooing (as defined in IC 35-42-2-7), in which human tissue is cut, burned or vaporized by the use of any mechanical means, laser, or ionizing radiation, or the penetration of the skin or body orifice by any means, for the intended palliation, relief or cure;”
- Answers - Refer to Pharmacy law IC 25-26-13-16
- (a) A pharmacist shall exercise his professional judgment in the best interest of the patient’s health when engaging in the practice of pharmacy.
- (b) A pharmacist has a duty to honor all prescriptions from a practitioner or from a physician, podiatrist, dentist, or veterinarian licensed under the laws of another state. Before honoring a prescription, the pharmacist shall take reasonable steps to determine whether the prescription has been issued in compliance with the laws of the state where it originated. The pharmacist is immune from criminal prosecution or civil liability if he, in good faith, refuses to honor a prescription because, in his professional judgment, the honoring of the prescription would:
1. Be contrary to law;
2. Be against the best interest of the patient;
3. Aid or abet an addiction or habit; or
4. Be contrary to health and safety of the patient
- Answers - Prescribing for yourself and your family is never a good idea; however the law does not prohibit it. If you choose to do so, you need to be sure you are complying with practice standards and keep appropriate records. Physicians have been disciplined by the Board for not keeping records of family members they have treated.
- Answers - See 844 IAC 5-2-16 which includes in part the following:
- (a) A practitioner, upon his/her retirement, or upon discontinuation of the practice of medicine or osteopathic medicine, or upon leaving or moving from a community, shall notify all of his/her active patients in writing, or by publication once a week for three (3) consecutive weeks in a newspaper of general circulation in the community, that he/she intends to discontinue his/her practice of medicine or osteopathic medicine in the community, and shall encourage his/her patients to seek the services of another practitioner, provided, however, that this section shall not apply to practitioners solely engaged in internship, residency, preceptorship, fellowship, teaching, or other postgraduate medical education or training programs. The practitioner discontinuing his/her practice shall make reasonable arrangements with his/her active patients for the transfer of his/her records, or copies thereof, to the succeeding practitioner, or to a program conducted by a medical society or association approved by the medical licensing board.
- You may also contact the Indiana State Medical Association as they have written information explaining what steps a physician needs to take to retire/close a practice. You can contact ISMA at (317) 261-2060
- Answers - Please review IC 25-22.5-1-1.1
- “Practice of medicine or osteopathic medicine” means any one or a combination of the following:
(4) Providing diagnostic or treatment services to a person in Indiana when the diagnostic or treatment services:
(a) are transmitted through electronic communications; and
(b) are on a regular, routine, and non-episodic basis or under an oral or written agreement to regularly provide medical services……etc. - If you meet 4a & b above you would need a license in Indiana before proceeding. If you are unsure you should consult your own counsel.
- Answers - All malpractice settlements and/or judgments must be reported on the renewal following the settlement/judgment. You do not need to report it prior to that.
Licensed practitioners that have a specific question or questions about the scope of practice of their licensed profession may request a "practice ruling" from the Indiana Professional Licensing Agency (PLA) and the Medical Licensing Board of Indiana (the Board). The PLA and the Board may provide a formal determination/interpretation based on the practitioner's factual situations/circumstances. Licensed practitioners may submit a "Request for Practice Ruling" through the web-based form provided on the PLA's "Request for Practice Ruling" web page. Additional information and instructions for submitting a "Request for Practice Ruling " are provided on the web page. All requests will be reviewed by the PLA's legal team, and PLA's legal team will draft a ruling for the Board's consideration and potential adoption. All rulings adopted by the Board will be posted to the Indiana Register as well as the comprehensive list provided on the the PLA's "Request for Practice Ruling" web page.
I Want To
- Renew my license.
- Digitally certify my license.
- Change my address on my license.
- Verify a license.
- Find the disciplinary information on a license that has or has had action taken against his/her license.
- “Practice of medicine or osteopathic medicine” means any one or a combination of the following:
- (1) Holding oneself out to the public as being engaged in:
- (a) “practice of medicine or osteopathic medicine” means any one (1) or a combination of the following:
- "local anesthesia" means a transient and reversible loss of sensation in a circumscribed portion of the body produced by:
- “moderate sedation/analgesia" (also sometimes called "conscious sedation") means a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation.