ARTICLE I.
APPLICATION FOR LICENSURE,
RECIPROCITY, AND RENEWAL
1. Application
for Licensure
(A) Official application forms
are available on the Board's website. No application for licensure will be
considered unless fully and completely filled out on this form.
(B) An applicant must have official
documentation sent to the Secretary of the Board from the National Board of
Podiatric Medical Examiners that a passing score was achieved by the applicant
on the American Podiatric Medical Licensing Examination (APMLE) Part I and Part
II, or successor exam, of the National Board Examination.
(C) An applicant may take the state licensing
examination or submit official documentation from the National Board of
Podiatric Medical Examiners of a passing score on the Part III Examination (or
successor exam).
(D) No applicant
will be admitted to the state examination except on presentation of a valid
driver's license or other form of government-issued photo
identification.
(E) Applications
should be sent to the address provided on the Board's website.
(F) An application fee of $200 shall
accompany the application. The fee shall be sent in form of cashier's check,
personal check or money order.
(G)
The applicant will furnish with the application transcripts under seal of the
college or colleges of podiatric medicine attended.
(H) If an applicant wishes to take the state
examination, an application shall be completed and filed with the Board's
secretary-treasurer at least two months prior to the state Board examination,
unless otherwise provided by law.
(I) The application is subject to Arkansas
law at the time of consideration of the application by the Arkansas Board of
Podiatric Medicine.
(J) The state
examination shall be conducted in English.
(K) All state examinations shall be conducted
in the presence of at least one member of the Board.
(L) If an applicant fails to pass the state
examination, the applicant may appear before the Board for not more than two
examinations, both of which must be taken within a period of six months from
the date the applicant's license application is denied for failure to pass the
exam.
2. Reinstatement
An applicant who can demonstrate that he meets the following
criteria may have his license reinstated upon payment of the application
fee:
(A) Was previously licensed as a
podiatrist at any time in this state;
(B) Held his or her license in good standing
at the time of licensing;
(C) Did
not have his or her license revoked for:
(i)
An act of bad faith; or
(ii) A
violation of law, rule, or ethics;
(D) Is not holding a suspended or
probationary license in any state; and
(E) Furnish evidence of completion of the
number of hours of acceptable continuing medical education computed by
multiplying twenty (20) times the number of years the licensee has held an
inactive or invalid license, not to exceed 100 hours.
3. Reciprocity
(A) Required Qualifications. An applicant
applying for reciprocal licensure shall meet the following requirements:
(i) The applicant shall hold in good standing
a substantially similar license in another U.S. jurisdiction.
(a) A podiatric medical license from another
state is substantially similar to an Arkansas podiatric medical license if an
applicant has, or the other state's licensure qualifications require an
applicant to have:
(1) Graduated from a
legally incorporated, regularly established school of podiatric medicine
recognized by the Council on Podiatric Medical Education of the American
Podiatric Medical Association; and
(2) Completed the residency described in Ark.
Code Ann.
17-96-303(d)(2).
(b) The applicant shall not have had a
license revoked for:
(1) An act of bad faith;
or
(2) A violation of law, rule, or
ethics;
(c) The applicant
shall not hold a suspended or probationary license in a U.S. jurisdiction;
and
(ii) The applicant
shall be sufficiently competent in the field of podiatric
medicine.
(B) Required
documentation. An applicant shall submit a fully-executed application, the
required fee, and the documentation described below.
(i) As evidence that the applicant's
podiatric medical license from another jurisdiction is in good standing and is
substantially similar to an Arkansas podiatric medical license, the applicant
shall submit the following information:
(a)
Evidence of current licensure in good standing in that state. The Board may
verify this information online or by telephone; and
(b) A certificate of graduation from a
legally incorporated, regularly established school of podiatric medicine
recognized by the Council on Podiatric Medical Education of the American
Podiatric Medical Association; and
(c) A certificate issued by an accredited
podiatric residency program approved by the Council on Podiatric Medical
Education of the American Podiatric Medical Association as proof of the
satisfactory completion of the residency described in Ark. Code Ann.
17-96-303(d)(2);
and
(ii) To demonstrate
that the applicant has not had a license revoked for bad faith or a violation
of law, rule, or ethics, as required by Article I., section 3.(A)(i)(b), and
that the applicant does not hold a license on suspended or probationary status,
as required by Article I., section 3.(A)(i)(c), the applicant shall provide the
Board with:
(a) The names of all states in
which the applicant is currently licensed or has been previously licensed;
and
(b) Letters of good standing or
other information from each state in which the applicant is currently or has
ever been licensed showing that the applicant's license has not been revoked
for the reasons listed in Article I., section 3.(A)(i)(b), and is not on
suspended or probationary status as described in Article I., section
3.(A)(i)(c). The Board may verify information online or by
telephone.
(iii) As
evidence that the applicant is sufficiently competent in podiatric medicine, an
applicant shall:
(a) Submit official
documentation from the National Board of Podiatric Medical Examiners of a
passing score on the American Podiatric Medical Licensing Examination (APMLE)
Part I and Part II (or successor exams); and either
(b) Pass the Arkansas state licensing
examination; or
(c) Submit official
documentation of a passing score on the PMLexis/ Part III Examination (or
successor exam).
ARTICLE II.
PROVISIONAL LICENSE
1. The Board shall issue a provisional
license immediately upon receipt of the required fee and the documentation
required under Article I., section 3.(B)(i) to show that the applicant has a
license from another jurisdiction that is in good standing and is substantially
similar to an Arkansas podiatric physician license.
2. An applicant shall submit a completed
application with all required remaining documentation in order to receive a
license.
3. The provisional license
shall be effective for 90 days or, if the complete application and remaining
documentation are submitted, until the Board makes a decision on the
application.
ARTICLE III.
COMPLAINTS AND DISCIPLINARY ACTION
1. In accordance with Ark. Code Ann.
§§
17-96-308
and
25-15-217,
the Board may revoke, suspend, refuse to renew, or otherwise penalize the
license of a podiatric physician after notice and hearing for any one or more
of the following causes:
(A) Is convicted of
a crime listed under Ark. Code Ann. § 17-3-102;
(B) Failure to display in the primary office
the current certificates of registration;
(C) Unprofessional and dishonest conduct,
including but not limited to:
(i) Aiding and
abetting an unlicensed person to practice Podiatric Medicine;
(ii) Violation of Ark. Code Ann. §§
17-96-101,
et seq; and
(iii) Violation of any
statute, rule, or order of the Arkansas Board of Podiatric
Medicine;
(D) Habitual,
intemperate, or excessive use of narcotics or any other habit-forming
drugs;
(E) Incompetent to practice
medicine to such an extent as to endanger the public;
(F) Insanity or mental disease if evidenced
by adjudication or by an involuntary commitment to an institution for treatment
of a mental disease or as determined by an examination conducted by three
impartial psychiatrists;
(G)
Submitting false, deceptive or unfounded claims, reports or opinions to any
patient or payor;
(H) Gross,
willful and continued overcharging for professional services;
(I) Failure to report to the Board any
disciplinary action, suspension or loss of privileges by a hospital, outpatient
treatment or surgical facility within 30 days of such action; and
(J) Failure to check the check the
information in the Prescription Drug Monitoring Program when prescribing
controlled substances, as required by the Prescription Drug Monitoring Program
Act, Ark. Code Ann. §§
20-7-601 et
seq.
2. Any person may
file a complaint with the Board against any licensed podiatric physician or
unlicensed person that charges said person with having violated the Board's
statutes or rules.
3. Complaints
must be submitted to the Board in written form.
4. The Board may designate an individual to
conduct investigations of written complaints.
5. Nothing in these rules shall prohibit
informal disposition of complaints or allegations by agreement of
parties
6. All hearings shall be
conducted in accordance with the Administrative Procedure Act, Ark. Code Ann.
§§
25-15-201 et
seq.
ARTICLE IV.
OFFICERS OF THE ARKANSAS BOARD OF PODIATRIC MEDICINE AND
THEIR DUTIES
1. The officers of
the Arkansas Board of Podiatric Medicine shall consist of a President and a
Secretary-Treasurer. They shall be elected annually by the members of the Board
and shall serve a term of one year, or until their successors are elected and
qualified.
2.
President. The president shall be the chief executive officer of
the Board and shall preside at all of its meetings. The president shall sign
all licenses and perform such other duties as may pertain to the office. The
president shall approve all requests for the expenditure of funds of the Board,
and shall have power to vote on all questions coming before the
Board.
3.
Secretary-Treasurer. The following described duties of the
Secretary Treasurer may be delegated to Board staff. The Secretary-Treasurer
shall be in charge of the books, records, property
, and money of
the Arkansas Board of Podiatric Medicine. The Secretary-Treasurer shall conduct
the Board's correspondence, keep a complete and accurate record of the business
transactions at all meetings and of all fees received and expenses paid under
these rules and shall report the same to the Arkansas Board of Podiatric
Medicine annually. The Secretary-Treasurer shall also have the following duties
and responsibilities:
(A) The
Secretary-Treasurer shall keep a complete record listing the names and
addresses of all persons to whom licenses have been granted with the number,
and the date of issuance of each license.
(B) The Secretary-Treasurer shall collect all
fees and renewals, and deposit to the account of the Arkansas Board of
Podiatric Medicine all money received not later than the first day of the
calendar month following receipt of the money.
(C) The Secretary-Treasurer shall keep a full
and complete record of all forfeited, revoked and expired licenses, and shall
countersign all newly issued licenses.
(D) The Secretary-Treasurer shall receive and
submit to the Board for approval all applications for licensure and shall
further be required to keep a full and complete record thereof.
(E) The Secretary-Treasurer shall notify the
members of the Board of the dates and places of all regular and special
meetings of said Board, and shall notify applicants for licensure of the date
and place of examination.
(F)
Before taking possession of office, the Secretary-Treasurer shall file with the
president of the Board such surety bond as may be required by the Board, the
expense of which shall be paid by the Board. At the expiration of the term of
office the Secretary-Treasurer shall deliver to the successor all books,
records, property, and money of the Board.
(G) The Secretary-Treasurer shall receive and
submit to the Board for approval all applications for license and any
complaints regarding podiatric physicians that appear to be violations of these
rules.
(H) The Secretary-Treasurer
shall not issue any duplicate license number or reassign any number that may
become vacant.
4. Other
members of the Board may countersign, license, preside over meetings when
necessary, and aid in conducting examinations of
applicants.
ARTICLE V.
MEETINGS OF THE ARKANSAS BOARD OF PODIATRIC
MEDICINE
1. The Board shall
hold an annual business meeting. Special meetings of the Board may be called by
the President, or in the absence or inability of the President to act, by the
members of said Board, for the proper and efficient discharge of their duties
as required by law.
2. At all
meetings of the Board, three members shall be necessary for the
transaction of business, and all motions must have two favorable votes in order
for them to carry. At examinations only one member need be present to supervise
the examination and render such service as may be needed.
ARTICLE VI.
PODIATRIC PHYSICIAN DELEGATION
1. Act 472 of the 87th General Assembly of
the State of Arkansas, as of the year 2009, authorized Podiatric Physicians to
delegate the performance of certain medical practices or tasks to qualified and
properly trained employees (commonly referred to as medical assistants), who
are not licensed or otherwise specifically authorized by Arkansas law to
perform the practice or task. This rule will set forth standards to be met and
the procedures to be followed by the Podiatric Physician when delegating to
employees.
2. Definitions for
Purposes of this Article VI.:
(A) "Podiatrist"
means an individual licensed by the Arkansas Board of Podiatric Medicine as a
Podiatric Physician.
(B) "Medical
Practice" means those tasks or functions that are delegated to a qualified and
properly trained employee, including the administration of drugs, pursuant to
Act 472 of 2009 and this rule.
(C)
"Delegate" means to authorize a qualified and properly trained employee to
perform a medical practice that does not conflict with a provision of the
Arkansas Code that specifically authorizes an individual to perform a
particular practice.
(D)
"Supervision" means the act by a Podiatric Physician in directing and
overseeing an employee who performs a delegated medical practice.
(E) "Medical Assistant" means an employee of
a Podiatric Physician who has been delegated medical practices or tasks, and
who has not been licensed by or specifically authorized to perform the practice
or task pursuant to other provisions of Arkansas law.
3. General Provisions
(A) The delegating Podiatric Physician
remains responsible for the acts of the employee performing the delegated
medical practice;
(B) The employee
performing the delegated medical practice shall not be represented to the
public as a licensed Podiatric Physician licensed nurse, licensed physician's
assistant, or other licensed healthcare provider; and
(C) Medical practices delegated pursuant to
this statute and rule shall be performed under the Podiatric Physician's
supervision.
4.
Procedures for Delegating a Medical Practice
Prior to delegating a medical practice or task, the Podiatric
Physician shall determine the following:
(A) That the medical practice or task is
within that Podiatric Physician's authority to perform;
(B) That the medical practice or task is
indicated for the patient;
(C) The
appropriate level of supervision for the Podiatric Physician to exercise while
the medical practice or task is being performed;
(D) That the person to whom the medical
practice or task is being delegated is qualified and properly trained to
perform the medical practice or task; and
(E) That the medical practice is one that can
be appropriately delegated when considering the following factors:
i. That the medical practice can be performed
without requiring the exercise of judgment based on medical
knowledge;
ii. That the results of
the medical practice are reasonably predictable;
iii. That the medical practice can be safely
performed according to exact, unchanging directions;
iv. That the medical practice can be
performed without the need for complex observations or critical decisions;
and
v. That the medical practice
can be performed without repeated medical assessments.
5. Additional Requirements for
Delegating the Administration of Drugs
(A) A
Podiatric Physician may only delegate the administration of drugs that do not
require substantial, specialized judgment and skill based on knowledge and
application of the principles of biological, physical, and social
sciences.
(B) Administration of
drugs, delegated pursuant to this rule, shall only be permissible within the
physical boundaries of the delegating Podiatric Physician's offices.
(C) The Podiatric Physician shall evaluate
the acuity of the patient and make a determination that delegation is
appropriate.
(D) The Podiatric
Physician shall determine the competency of the person to whom the
administration of drugs is being delegated through training and experience,
including the physician's personal observation.
6. Prohibitions
(A) A Podiatric Physician shall not transfer
his or her responsibility for supervising an unlicensed person in the
performance of a delegated medical practice, except to another Podiatric
Physician who has knowingly accepted that responsibility;
(B) A Podiatric Physician shall not authorize
or permit an unlicensed person to whom a medical practice is delegated to
delegate the performance of that practice to another person;
(C) A Podiatric Physician shall not delegate
to an unlicensed person the administration of anesthesia;
(D) A Podiatric Physician shall not delegate
a medical practice that is not within the authority of that physician or is
beyond the Podiatric Physician's training, expertise, or normal course of
practice; and
(E) A Podiatric
Physician shall not delegate a medical practice to an unlicensed person if the
practice is beyond that person's competence.
ARTICLE VII.
Licensure for Active Duty Service Members, Returning
Military Veterans, and Spouses
1.
(A) As
used in this rule, "returning military veteran" means a former member of the
United States Armed Forces who was discharged from active duty under
circumstances other than dishonorable.
(B) "Automatic licensure" means the granting
of occupational licensure without an individual's having met occupational
licensure requirements provided under Title 17 of the Arkansas Code or by this
Rule.
2. The Board shall
grant automatic licensure to an individual who holds a substantially equivalent
license in another U.S. jurisdiction and is:
(A) An active duty military service member
stationed in the State of Arkansas;
(B) A returning military veteran applying for
licensure within one (1) year of his or discharge from active duty;
or
(C) The spouse of a person under
Article VII., section 2.(A) or (B).
3. The Board shall grant such automatic
licensure upon receipt of all of the below:
(A) Payment of the initial licensure
fee;
(B) Evidence that the
individual holds a substantially equivalent license in another state;
and
(C) Evidence that the applicant
is a qualified applicant under Article VII., section 2.(A), (B), or
(C).
ARTICLE
VIII.
CONTINUING MEDICAL EDUCATION
1. As part of the application for annual
license renewal, licensees must submit to the Board proof that they completed
twenty hours of approved continuing medical education within the year prior to
the license renewal date.
2. A
continuing medical education hour shall be considered "approved" if:
(A) The hour has been approved by the Council
on Podiatric Medical Education of the American Podiatric Medical
Association;
(B) The hour was
obtained when attending official meetings presented by any State Podiatric
Medical Association;
(C) The hour
was obtained from meetings approved by the Council on Medical Education of the
American Medical Association or approved by the Council on Osteopathic Medical
Education of the American Osteopathic Association as long as the hours pertain
to the practice of Podiatric Medicine and
(D) The hour was obtained from hospital
lectures, as long as the hour pertains to the practice of Podiatric
Medicine.
3. The Board
will accept any "approved" hours, as that term is defined in Article VIII.,
section 2 above, regardless of whether those hours are from meetings, the
internet, or periodicals.
4. In
addition to the methods of approval for continuing medical education hours
provided in Article VIII., section 2 of this Rule, the Board may consider prior
approval of meetings. Such prior approval shall be obtained from the Secretary
of the Board or, if the Secretary is unavailable to consider hours for
approval, a designee of the Board appointed by the President of the
Board.
ARTICLE IX.
PRESCRIBING AND DISPENSING SCHEDULE II NARCOTICS
1. Unless otherwise stated in this Article
IX., terms used shall be defined in accordance with the Prescription Drug
Monitoring Program Act, A.C.A. §§ 20-7601 et seq.
2. Dispensing Schedule II Narcotics.
A podiatric physician shall not dispense Schedule II
narcotics.
3. Prescribing
Schedule II Narcotics.
(A) The prescribing of
excessive amounts of controlled substances to a patient including the writing
of an excessive number of prescriptions for an addicting or potentially harmful
drug to a patient. "Excessive" is defined as the writing of any prescription in
any amount without a detailed medical justification for the prescription
documented in the patient record.
(i) Chronic
Pain: If there is documented medical justification, "excessive" is defined,
pursuant to the Centers for Disease Control (CDC) guideline for prescribing
opioids for chronic pain, as prescribing opioids at a level that exceeds
[GREATER THAN EQUAL TO] 50 Morphine Milligram Equivalents (MME)per day, unless
the physician/physician assistant documents each of the following:
(a) Objective findings, which include, but
are not limited to, imaging studies, lab testing and results, nerve conduction
testing, biopsy, and any other test that would establish pain generating
pathology.
(b) Specific reasons for
the need to prescribe [GREATER THAN EQUAL TO] 50 MED per day.
(c) Documented alternative treatment plans as
well as alternative therapies trialed and failed prior to considering chronic
opioid therapy.
(d) Documented risk
factor assessment detailing that the patient was informed of the risk and the
addictive nature of the prescribed drug.
(e) Documented assessment of the potential
for abuse and/or diversion of the prescribed drug.
(f) That the Prescription Drug Monitoring
Program had been checked prior to issuing the prescription.
(g) A detailed clinical rationale for the
prescribing and the patient must be seen in an in-person examination every
three (3) months or every 90 days.
(h) The definition of "excessive" as
contained in this rule shall not apply to prescriptions written for a patient
in hospice care, in active cancer treatment, palliative care, end-of-life care,
nursing home, assisted living or a patient while in an inpatient setting or in
an emergency situation.
(i) Regular
urine drug screens should be performed on patients to insure the patient is
taking prescribed medications and is not participating or suspected in
participating in diversion or abuse of non-prescribed medications. The
treatment of chronic pain shall be consistent with the CDC guidelines as they
relate to baseline drug testing, and at least annual follow up testing as
warranted for treatment.
(j) A pain
treatment agreement must be signed and reviewed by the patient when initiating
chronic opioid therapy. This agreement should discuss the following: informed
risk and addictive nature of prescribed medications, outline the specific
expectations between patient and physician, informed consent for periodic urine
drug screenings and random pill counts with urine screening as well as the
provisions for termination of opioid therapy.
(B) Acute Pain: For treatment of acute pain,
"excessive" is further defined as an initial prescription written for more than
seven (7) days, without detailed, documented medical justification in the
medical record. If the patient requires further prescriptions, they must be
evaluated in regular increments with documented medical justification for
continued treatment in medical record.
(C) When opioids are started, clinicians
should prescribe the lowest effective dosage. Clinicians should use caution
when prescribing opioids at any dosage, should carefully reassess evidence of
individual benefits and risks when considering increasing dosage to > 50
morphine milligram equivalents (MME)/day, and should avoid increasing dosage to
> 90 MME/day or carefully justify a decision to tritrate dosage to > 90
MME/day.
ARTICLE
X.
PRESCRIPTION DRUG MONITORING PROGRAM
1. A Podiatric Physician shall check the
information in the Prescription Drug Monitoring Program when prescribing:
(A) An opioid from Schedule II or Schedule
III for every time prescribing the medication to a patient; and
(B) A benzodiazepine medication for the first
time prescribing the medication to a patient.
2. This Article X. does not apply to the
following:
(A) A licensee administering a
controlled substance:
(i) Immediately before
or during surgery;
(ii) During
recovery from a surgery while in a healthcare facility;
(iii) In a healthcare facility; or
(iv) Necessary to treat a patient in an
emergency situation at the scene of an emergency, in a licensed ground
ambulance or air ambulance, or in the intensive care unit of a licensed
hospital;
(B) A
healthcare provider prescribing or administering a controlled substance to:
(i) A palliative care or hospice patient;
or
(ii) A resident in a licensed
nursing home facility; or
(iii)
Situations in which the Prescription Drug Monitoring Program is not accessible
due to technological or electrical failure.
3. A licensee must document in the patient
record that the Prescription Drug Monitoring Program was checked.
ARTICLE XI.
FEES
The Board shall impose the following fees:
Initial License Fee - $200
Annual Renewal Fee - $75
ARTICLE XII.
CRIMINAL HISTORY
1. Pre-Licensure Criminal Background Check
(A) Pursuant to Act 990 of 2019, an
individual may petition for a prelicensure determination of whether the
individual's criminal record will disqualify the individual from licensure and
whether a waiver may be obtained.
(B) The individual must obtain the
pre-licensure criminal background check petition form from the Board.
(C) The Board or the Board's designee will
respond with a decision in writing to a completed petition within a reasonable
time.
(D) The Board's response will
state the reasons for the decision.
(E) All decisions of the Board in response to
the petition will be determined by the information provided by the
individual.
(F) Any decision made
by the Board in response to a pre-licensure criminal background check petition
is not subject to appeal.
(G) The
Board will retain a copy of the petition and response and it will be reviewed
during the formal application process.
2. Waiver Request
(A) If an individual has been convicted of an
offense listed in A.C.A. § 17-3-102(a), except those permanently
disqualifying offenses found in subsection (e), the Board may waive
disqualification of a potential applicant or revocation of a license based on
the conviction if a request for a waiver is made by:
i. An affected applicant for a license;
or
ii. An individual holding a
license subject to revocation.
(B) The Board may grant a waiver upon
consideration of the following, without limitation:
i. The age at which the offense was
committed;
ii. The circumstances
surrounding the offense;
iii. The
length of time since the offense was committed;
iv. Subsequent work history since the offense
was committed;
v. Employment
references since the offense was committed;
vi. Character references since the offense
was committed;
vii. Relevance of
the offense to the occupational license; and
viii. Other evidence demonstrating that
licensure of the applicant does not pose a threat to the health or safety of
the public.
(C) A request
for a waiver, if made by an applicant, must be in writing and accompany the
completed application and fees.
(D)
The Board will respond with a decision in writing and will state the reasons
for the decision.
(E) An appeal of
a determination under this section will be subject to the Administrative
Procedures Act §
25-15-201
et seq.