Doctor fights for her career after Idaho telemedicine sanction

Dr. Ann DeJong has had to sell her house in Wisconsin and is $200,000 in debt. Now her medical career is in jeopardy, all because she was sanctioned by Idaho for prescribing a common antibiotic over the phone. At the time, Idaho law required a face-to-face exam for a prescription. This year, lawmakers changed that to allow for consultations through telemedicine. DeJong was working for such a company, Consult-a-Doctor, when she prescribed the medication; it subsequently pulled out of Idaho. She says if Idaho doesn’t modify its order by October, she’ll lose her board certification in family practice, and thus her job and livelihood. “It would keep me from practicing anywhere,” said DeJong, who was licensed to practice medicine in eight states including Idaho when she took that call from an Idaho patient through Consult-a-Doctor in 2012. Idaho House Minority Leader John Rusche, D-Lewiston, a retired physician who sponsored this year’s telemedicine legislation, said, “I think the action on the part of the Board of Medicine is excessive. … It seems to me that this was a statement or an attempt by the members of the Board of Medicine to take on the whole issue of tele-health and telemedicine, and the vehicle that they had was this individual.” The sanctions issued against DeJong included requiring her to take an ethics course, to pay the board’s investigative costs and attorney fees, and to abide by all laws and rules. She has complied with all of those, said her Boise attorney, Joe McCollum. But the board also prohibited DeJong from providing “any type of medical/health care via telephone-email… to Idaho citizens.” Asked Rusche, “How do you take care of people if you can’t talk to them over the phone? How do you do that and be a family physician? In essence, they’ve said that she can’t practice.” That’s the sanction that triggered review of DeJong’s board certification in family practice, which is required for her job working as a fill-in doctor at Veterans Administration hospitals and rural hospital emergency rooms throughout the West. The sanction prompted reciprocal proceedings in every state in which DeJong was licensed, along with Nevada, where her medical license was pending. Five of those states reviewed the case and declined to impose any penalty on DeJong, including Nevada, which issued her an unrestricted license. But procedures still are pending against her in California, Arizona and Wisconsin, and California issued an initial decision to reprimand DeJong due to her Idaho sanction. Nancy Kerr, executive director of the Idaho Board of Medicine, said the board’s professional discipline committee has directed its lawyers to settle with DeJong. “We’ve changed our stance and yes, our board is working with Dr. DeJong through her attorney,” Kerr said. But time is running out. The American Board of Family Practice has delayed its consideration of revoking DeJong’s certification until its next meeting in October. And DeJong said the negotiations thus far haven’t been promising; a recent offer from the board’s attorney would have kept the telephone sanction, but added a four-year expiration date to it. “I am terrified, absolutely terrified,” she said. “I am just trying to stay hopeful.” Kerr said the board’s issue was more about the standard of care than telemedicine. “When you prescribe a medication for a patient, you want to make sure that the patient understands exactly what they should be doing,” she said. The patient had complained of severe cold symptoms, aches and pains and a slight fever. DeJong advised the patient to treat the symptoms, but also offered to call in a prescription for an antibiotic to take if the patient’s fever rose or her symptoms worsened, a move the patient welcomed. A pharmacist questioned the prescription, and it was never filled. DeJong severed all connections with Consult-a-Doctor after the incident. She trained in North Dakota and holds a Ph.D in pathology from the University of California-Davis in addition to her medical degree. Rusche said losing the ability to practice over the antibiotic prescription seems disproportionate; even doctors who’ve committed felonies often are able to continue to practice. A review of the board’s most recent final disciplinary orders against doctors shows four who were disciplined for excessive prescribing of controlled substances for pain; all were allowed to continue practicing, though one had his prescribing authority for controlled substances revoked. In another case, a doctor accused of having an inappropriate relationship with a female patient was allowed to continue practicing, but required to have a chaperone present when seeing any female patient. Kerr said the Board of Medicine recognizes that the rules have changed on telemedicine in Idaho. “Some of our providers on the board have practiced telemedicine and are aware of the issues,” she said. “It’s a work in progress, and we’re working with the Tele-Health Council … trying to make sure we give good access and make sure those patients are safe, that they’re getting the care they deserve.” That group, established by state legislation in 2014, is helping formulate rules for telemedicine in Idaho. Under this year’s legislation, the Idaho Telehealth Access Act, which passed both houses overwhelmingly and took effect July 1, doctors and patients may establish a doctor-patient relationship via “two-way audio and visual interaction.” The law requires that the same standards of care will apply to telemedicine as to in-person treatments, and retains a statement that treatment “based solely on an online questionnaire does not constitute an acceptable standard of care.” Rusche said DeJong’s case was among the reasons that Idaho’s legislation was passed and its council formed. “We want to be able to say what telemedicine is,” he said. “Some used it, frankly, as a way to assure that they could get control of competition from outside the state. So what we did is say, OK, it’s coming, tele-health is coming. What is appropriate to do?” Rusche said when he recently attended a meeting in New York, he saw health plans there offering the ability to call and talk to a primary-care physician over a cell phone as a benefit of the plan. “That’s part of what the market is,” he said. Had Idaho’s current laws been in effect when DeJong took that patient’s call in 2012, Rusche said, “Her employer would have come up with a system that was compliant, so I doubt that there would have been a problem at all.”