Review of the AMT Judiciary Function Kimberly A

Review of the AMT Judiciary Function Kimberly A. Cheuvront, Ph. D, MBA, MT(AMT) AMT Judiciary Councillor and Michael N. Mc. Carty, JD AMT Legal Counsel 2013 Annual Convention and Educational Conference Pittsburgh, PA

AMT Judiciary Committee • Created by Article IX, Section 3 of Bylaws • Consists of 3 voting and 1 non-voting member: – Judiciary Councillor (Chair) – appointed annually – Vice President – Additional active member, not a national Board member (usually an RMA) – appointed annually – Legal Counsel (ex officio – non-voting) 2

Judiciary Committee Duties (Art. IX, Sec. 3) “This Committee shall exercise all legal, punitive, and judiciary authority, receive and hear all complaints by and against the members, render interpretations of these Bylaws, receive, study, revise, and approve or disapprove all legislation sponsored directly or indirectly by this Registry or the societies thereof, draft and promulgate rules and regulations for the proper conduct of the functions of the Registry, and render opinions which are final unless an appeal to the Board of Directors is perfected. . . Also, the Judiciary Committee shall receive complaints of all members concerning Registry affairs, institute inquiries concerning such matters, and make reports to the individual members affected. ” 3

Legal Functions • Judiciary Councillor works closely with Legal Counsel and Executive Director – Corporate legal issues & Litigation (fortunately, very rare) – Interpret Bylaws – National and States’ – Review and approve proposed State Society bylaws and amendments (see State Officer’s Manual) – Consult on and approve Legislative positions • Federal legislation & regs – e. g. , CLIA; Medicare payment policies (competitive bidding, co-pays, CLFS adjustments); Meaningful Use • State legislation & regs – e. g. , lab personnel licensure; medical assisting practice scope issues; etc. – Besides Judiciary Committee, Judic. Councillor chairs Bylaws Committee; is member of Executive, Federal. Government Affairs, and State Legislative Committees 4

Disciplinary Function • Bylaws Article XI: “Any member found to have violated the AMT Standards of Practice, or to have committed acts or deeds constituting unethical professional practices or detrimental to the interests of the Registry, may be expelled from the Registry or receive such other sanctions as may be imposed. ” • AMT Standards of Practice, Art. VI: “The AMT professional shall respect the law and pledges to avoid dishonest, unethical or illegal practices, breaches of fiduciary duty, or abuses of the position of trust into which the professional has been placed as a certified healthcare professional. ” • NCCA Standards require accredited certification programs to have policies and procedures in place to address conduct that may be harmful to the public or inappropriate to the discipline (e. g. , incompetence, unethical behavior, or physical/mental impairment affecting performance). 5

GROUNDS FOR DISCIPLINE include, but not limited to: • Violations of the AMT Standards of Practice • Violation of AMT Bylaws • Conviction of a felony for job-related activities or for a crime involving moral turpitude. • Obtaining or attempting to obtain certification by fraud or deception • Knowingly assisting another individual to attain certification by fraud or deception. • Misstatement of material facts in gaining certification from AMT. • Unauthorized possession or distribution of AMT testing materials, including copying and reproducing examination questions. • Copying answers, permitting someone else to copy answers, or providing or receiving unauthorized assistance during the examination. 6

AMT Disciplinary Process (Summary – see full procedures on attached handout) • Any person may submit a complaint in writing to the AMT Office • Complaint is forwarded to Judiciary Committee for informal investigation/assessment • If Committee concludes there are grounds for disciplinary proceeding, Judiciary Councillor sends respondent letter outlining charges and giving him/her 60 days to respond – Letter usually discloses Committee’s proposed sanction, but may defer sanction pending further investigation • If Committee concludes there is insufficient basis to proceed, matter is terminated. No appeal is available to complainant from such a determination. 7

Disciplinary Process, cont’d • If case is initiated, JC’s initial letter will request that respondent supply any information, evidence, or arguments rebutting the charges – Letter also offers respondent opportunity to have impartial advisor appointed to help explain the process and prepare a defense (rarely requested) • If respondent fails to respond w/in 60 days, case proceeds to final sanction – Failure to respond also waives respondent’s right to appeal Committee sanction to Board of Directors 8

Disciplinary Process, cont’d • If respondent answers JC’s letter, Committee considers the rebuttal evidence/arguments and reaches a decision on final sanction – In extraordinary cases, committee may conduct a “hearing” in person or by phone – Care is taken to treat sensitive information with appropriate confidentiality • Sanctions may include exoneration/acquittal; reprimand or censure; probation with or without conditions; revocation or suspension of certification/membership; or other. • Respondent may appeal Committee’s sanction to BOD (unless appeal has been waived) • Complainant has no appeal from Committee’s decision • Final sanctions may be published in AMT Events 9

Effect of Revocation • Registrants whose certification is revoked or suspended are advised as follows: “. . . you are no longer entitled to represent yourself to the public (including employers or prospective employers) as a Registered Medical Assistant, or to use the initials “RMA, ” or to hold yourself out as a member of AMT. Any use of those designations by you would constitute a violation of AMT’s intellectual property rights, among other potential violations. ” • Registrants whose certifications are suspended for a specified minimum period must meet CCP and Reinstatement requirements to be readmitted. 10

Most Common Types of Disciplinary Cases 1. 2. 3. 4. 5. 6. 7. Prescription Fraud Felony Convictions Forgery of AMT Credentials Plagiarism Breach of Fiduciary Duty/theft Miscellaneous unethical conduct Breach of Security of AMT Examination Materials 11

Prescription Fraud • By far the most common disciplinary charge • Typically involves RMA writing or calling in unauthorized prescriptions for personal use and/or use by friends/relatives – Frequently for controlled drugs such as narcotic painkillers, amphetamines, sleep aids, or anti-anxiety meds • Usually – but not always – results in permanent revocation of certification & membership – Serious breach of Standards of Practice because it amounts to criminal activity and abuse of position as a professional medical assistant – Committee has shown leniency in form of minimum suspension period (e. g. , 1 to 5 years) with opportunity to reinstate in rare cases where respondent acknowledges problem, enrolls in and successfully completes rehab program. 12

Prescription Fraud - Examples • Jennifer Lyn Gray, RMA – Paducah, KY – Fraudulently called in prescriptions for controlled substances (Lortab, Phentermine, and Xanax) under her employer doctor’s name for herself and 2 friends – Rx’s had been called in several times a month in large quantities over a period of two years – Member sought leniency based on her admitted drug addiction, voluntarily having entered a Narcotics Anonymous program, and having stayed “clean” for several months – Committee nevertheless determined the nature, scope and severity of the violations was of such magnitude that leniency could not be justified. Certification was permanently revoked. 13

Prescription Fraud - Examples • Jennifer Florio, RMA – Vernon, NJ – Florio obtained multiple unauthorized prescriptions for narcotic meds using names of clinic pediatricians where she worked. – Scripts were for personal use and were phoned-in under her name and names of family members and co -workers – Respondent sought leniency (probation) and claimed she was a victim of co-worker’s drug dependency – JC followed-up with employer, who said there had been over 1, 000 scripts called in during past 2 years – Certification was permanently revoked. 14

Prescription Fraud - Examples • Debra Rink Todaro, RMA – Bordentown, NJ – RMA obtained unauthorized prescription for Percocet using name of her dermatologist employer – Committee proposed to revoke certification permanently – Todaro sought leniency, acknowledging the offense and stating her actions were due to an addiction to drugs and alcohol. She had entered an intensive rehab program. – Committee agreed to reduce proposed sanction; suspended certification for one year, w/ right to reinstate upon evidence of successful completion of rehab, no further violations of Standards of Practice, and compliance with CCP & reinstatement requirements. – JC determined Todaro was eligible for reinstatement in 2008 – a rehab success story! 15

Prescription Fraud – Additional Cases Resulting in Permanent Revocation • M. Segura, RMA (TX) – Attempted to order Vicodin for friend using name of clinic physician. RMA requested advisor per AMT Disciplinary Process (S. Hancock appointed); admitted guilt but sought probation in lieu of revocation because he was studying to be an RN. JC denied leniency and finalized permanent revocation. • J. Millirons, RMA (MO) – Called in and picked up unauthorized Rx’s for controlled drugs for self and boyfriend at 2 local pharmacies using names of 2 MDs at her clinic. RMA did not respond to the charges. • J. Harvin, RMA (NC) – Police arrested RMA and a second individual for picking up fraudulent prescriptions called in by RMA for a controlled substance, using the name of a physician at the family medicine clinic where she worked. Respondent’s request for leniency denied based on “a very serious case involving multiple incidences of prescription fraud, using multiple patient names and a number of different pharmacies to obtain a controlled substance in the course of employment as an RMA. ” 16

Prescription Fraud – Additional Cases Resulting in Permanent Revocation • K. Holman, RMA (TX) – Phoned and picked up unauthorized Rx’s for a controlled drug using name of M. D. and a patient at community clinic where she was employed. – Did not respond to JC’s original letter; final revocation letter was returned as undeliverable w/ no forwarding address – Holman later complained to AMT Office about registrar’s telling prospective employer that her RMA cert. had been revoked, saying she never received the JC’s letter. JC gave her a final opportunity to appeal to BOD, but she failed to avail herself of the chance. – Recently requested reinstatement (May 2013). Denied. • Chad Mallory, RMA (FL) – Multiple forged prescriptions for Lortab (acetaminophen and hydrocodone), oxycodone, and alprazolam. – RMA forged sig. of his physician employer; scripts written for third parties who were not patients of the clinic. Employer tipped-off by Walgreen’s. – RMA did not respond to JC’s letter. • C. Salas, RMA (TX) – Charged w/ 13 counts of criminal Rx fraud. Called in Rx’s using the DEA and DPS numbers from physicians who were former employers. AMT notified by Denton police dept. No response received to JC’s proposed revocation letter. 17

Felony Convictions • Difference between handling of felonies at initial application stage vs. active member stage – AMT application forms require disclosure of prior felonies • Failure to disclose prior felony on application is automatic grounds for subsequent rescission of certification • Felonies disclosed on application are handled by AMT Executive Director on case-by-case basis. Decision whether to accept applicant is based on the recentness of the offense, the nature of the offense, the seriousness of the offense, and the relation of the nature of the offense to the delivery of healthcare services to patients. – Members have no clear obligation to disclose felony convictions after becoming certified • Dues renewal form does not require disclosure • If subsequent felony is brought to AMT’s attention, Judiciary Committee addresses on case-by-case basis – does the felony constitute a serious violation of AMT Standards of Practice? 18

Felony Convictions Case Examples • Howard Ollick, MT (FL) – AMT learned in 2002 that Ollick had been convicted in 1998 of three counts of perjury, for making false statements under oath in a Florida court as an alleged expert witness in the fields of forensic toxicology and psychopharmacology. – Falsely testified that he had earned a Ph. D. in organic chemistry, a Masters Degree in organic chemistry, and Bachelors Degree in chemistry. – Was sentenced to three years in prison, followed by five years of probation and assessed a $200 fine. – Florida Board of Clinical Laboratory Personnel revoked his CLT license in 2001. – Based on serious, job-related crimes, MT(AMT) certification was permanently revoked. (He did not respond to JC’s letter. ) 19

Felony Convictions Case Examples • Amber Lancaster, RMA (OH) – RMA certified in 1996 was convicted in 2005 of trafficking in drugs, a fourth-degree felony, for selling prescription pain medication (Percocet and Vicodin) on the streets of Adams County, OH. AMT was notified of conviction by probation officer. – Judiciary Committee felt trafficking of controlled substances reflected on fitness to practice as a medical assistant, since MAs frequently have access to controlled medication and their employers’ prescription pads; also may indicate a substance abuse problem. – Committee proposed permanent revocation; RMA did not respond. Certification permanently revoked in 2006. • Tengha Dai, RPT (OK) – On 2003 application for RPT certification, Dai failed to disclose prior felony conviction in Arkansas for possession of 100 “ecstasy” pills w/ intent to distribute. – Dai did not respond to Committee’s proposed sanction; RPT(AMT) certification permanently revoked in 2006. 20

Felony Disclosed on Application • If Executive Director denies application based on prior felony, applicant may appeal to BOD • Recent denial was successfully appealed to BOD: Ohio RPT Applicant – Pled guilty Jan. 2011 to prohibited sale of wildlife – Had operated butcher shop w/ husband; processed deer meat for hunters. Some “deadbeat” hunters never picked up their processed meat & sausage, so Rienschields tried to recoup costs by selling it to third parties. – Claimed they didn’t know it was illegal – Was 5 th degree felony (instead of misdemeanor) only because of the dollar amount involved (sold 1000+ lbs. over 3 years) – Forced to close butcher shop; then sought new career by attending Phlebotomy training program w/understanding felony wouldn’t preclude employment. Got straight A’s in program, did well w/clinicals • AMT Board unanimously granted appeal, finding crime did not reflect poor moral character 21

Forgery of AMT Credentials • Christy Phillips-Green, RMA (NC/MD) – Falsified letter of congratulations from AMT for passing certification exam by deleting “Registered Medical Assistant” and substituting “Licensed Practical Nurse” (see next slide), then used letter to obtain employment as LPN – a licensed profession. – In response to JC’s letter proposing revocation, respondent claimed she was hired and paid as a “Medical Assistant Floater” (did not deny altering AMT letter) – JC checked with employer, who confirmed respondent was hired as a LPN, not MA – RMA certification was permanently revoked 22

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More Forgeries. . • Heidi Lang (Algonac, MI) – Forged Pearson VUE score report and RMA(AMT) certificate. – AMT was tipped-off by Lang’s employer, who had been bugging her for verification of RMA certification – Lang finally supplied a certificate and score report, both of which appeared different from those of other AMT members employed by the clinic – Signatures of AMT Executive Director and President also appeared bogus (see next slide) – HR Director contacted AMT registrars; could find no record of Lang’s having applied for or received certification; Registration Number on certificate belonged to an AMT member in NY – Legal Counsel sent cease-and-desist letter, threatening criminal prosecution unless Lang confirmed she had destroyed all forged docs and agreed not to hold herself out as RMA or any other discipline certified by AMT. She responded as directed. 24

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More Forgeries. . • Daniel Smith (O’Fallon, MO) – Forged a letter from AMT stating he had passed the MT(AMT) exam. – Had provided falsified letter to DVA with job application – Had submitted application and qualified to sit for MT exam, but had not yet taken the exam – Dr. James Fidler (AMT Director of Testing & Competency Assurance) sent cease-and-desist letter. Candidate was barred from taking any future AMT exams. • Sylvia de la Fuente (Prescott, AZ) – Used falsified RMA certificate to obtain employment with Orthopedic practice. Employer became suspicious, contacted AMT, and AMT Office confirmed the forgery. – Legal counsel drafted cease-and-desist letter for Dr. Fidler. • Kymverlyne D. Shelly (Atlanta, GA) – Produced a falsified RMA certificate using a real RMA certificate issued in 2009 to a friend – Changed the name but not the ID # on the certificate. AMT office identified the real certificant, who listed Shelly as a Facebook “friend” – Legal counsel issued Shelly cease-and-desist letter and JC has proposed to revoke RMA’s certification for aiding and abetting the forgery 26

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Plagiarism Two cases in past several years where member submitted blatantly plagiarized articles to AMT Writing Awards Competition 1. Jason E. Merzlak, RMA, RPT (FL) – Copied article verbatim from another professional journal, Oncology Nurse Advisor. – – – Photocopied article directly from journal, whited-out real author’s name and typed-in his own (see next 2 slides). Committee disqualified writing entry and proposed 2 -year suspension of RMA and RPT certifications Member sought forgiveness stating he was “confused about the writing contest and what was involved with the process. ” Asked committee to consider that he’d “touched many patients’ lives” and had exceeded AMT’s CE standards. Committee denied leniency, finalized 2 -year suspension. Merzlak appealed to BOD; appeal denied. 30

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Plagiarism, cont’d 2. Name withheld – Member submitted article on Tourette’s Syndrome that had been copied nearly verbatim from a website, www. papers 4 you. com, that advertises: “We have over 60, 000 ready made Essays, Coursework, Assignments, Reports, Proposals, Dissertations and Theses available for sale! Buy your essay or dissertation today!” – Paper was posted on website as a sample of essays available for sale – AMT Publications Director, Diane Powell, discovered the plagiarism through a Google search – Committee issued a written reprimand to member, who is a current state society officer, noting: “Claiming another author’s scientific literature as your own work violates the AMT Standards of Practice and can be viewed as dishonest, unethical, and in some cases illegal. Submitting a plagiarized article for possible publication also puts AMT at risk for potential violations of copyright and intellectual property laws. ” 33

CASES INVOLVING ALLEGATIONS OF Miscellaneous Unethical Conduct Patient Identity Theft – S. Golden, RMA (IL) • RMA used credit card info of patients at Northwestern Memorial Hospital lab to pay her own utility bills and other expenses • Police found Social Security and credit card numbers and birth dates of more than 50 lab patients when they searched her home • RMA was charged with Aggravated Identity Theft -story reported in Chicago Tribune, USA Today, CBS, etc. • JC proposed permanent revocation of RMA certification; no response received to JC’s letter. 34

CASES INVOLVING ALLEGATIONS OF Miscellaneous Unethical Conduct • Arkansas RMA (name w/held) – Physician complained that RMA “abandoned patients” when she resigned abruptly from employment midday; and that she had slandered the physician in the presence of patients and pharmaceutical company reps – JC sent letter requesting explanation for RMA’s actions – RMA responded forcefully that during her two weeks’ employment, she had been repeatedly harassed sexually by the office manager (physician’s husband) and subjected to other unprofessional behavior. • Office Mgr. greeted her on second day of work with, “Hello Mrs. Sexy Black, how are you today? ” • A few days later Office Mgr. offered her $200 to perform oral sex; made several other improper comments • RMA provided letter of commendation from new employer – Committee decided no sanction was warranted in view of oppressive employment conditions and the fact that no patient was actually abandoned by RMA’s lunch-hour departure => Case DISMISSED 35

CASES INVOLVING ALLEGATIONS OF Miscellaneous Unethical Conduct • Ashley B. Baumann, RMA (TX) – Original complaint alleged unsavory pattern of conduct unrelated to job performance – nasty divorce; child support arrearages; contempt of court citation; lost custody of her kids; boyfriend with a long rap sheet; mother convicted of marijuana possession – but nothing amounting to a clear violation of Standards of Practice – However, Google search 1 -1/2 years later revealed she’d been arrested in California w/ boyfriend while spray-painting a pickup truck in a Wal-Mart lot, and extradited to Texas on charges of forgery and conspiracy to commit organized crime. – Pled guilty in 2009 to a felony of engaging in organized crime, was sentenced to one year of confinement in the county jail (boyfriend also pled guilty and got 3 -year sentence). – JC issued proposed revocation based on felony conviction involving moral turpitude. No response; revocation final. 36

CASES INVOLVING ALLEGATIONS OF Miscellaneous Unethical Conduct • A. Mata, RMA (TX) – Altered pt. progress notes & submitted fraudulent health ins. claims; certification revoked (no resp. by RMA) • J. Tetrick, RMA (MO) – “Identity thief” - used name and personal info of M. D. employer to apply for credit; JC proposed permanent revocation; RMA did not respond – sanction finalized. • N. Ward, RMA (TX) – Multiple instances of unprofessional, erratic & unstable behavior in presence of patients. – Case complicated by fact that complaining M. D. had been disciplined twice in past year by TSBME for altering medical records and prescribing numerous meds to herself and at least one other pt. without medical records. – JC nevertheless suspended RMA’s certification for a minimum period of six months, and until she submitted evidence of having satisfactorily completed a counseling program with a mental health professional. RMA did not respond to charges. 37

CASES INVOLVING ALLEGATIONS OF Miscellaneous Unethical Conduct • Missouri MT (name w/held) – Supervisor at Missouri hospital lab complained that MT had intentionally discarded a pt. specimen because she was upset at supervisor for reprimanding her about out-of-range QCs – MT answered w/ aid of attorney, via sworn affidavit. Admitted tossing the sample, but did so 4 days after supervisor (complainant) had run the wrong test on the specimen (electrolytes instead of lipid panel ordered). Specimen was probably spoiled by the time it was discarded. – MT portrayed matter as latest in a series of efforts by supervisor to coverup her own errors. Said there had been frequent spats between supervisor and other Filipino techs. – JC determined there were no credible grounds for finding MT had violated Standards of Practice or otherwise engaged in unlawful or unethical activities that would warrant a disciplinary sanction. => Case Dismissed. 38

Breaches of AMT Exam Security • King Abdulaziz Univ. Hospital, Riyadh, Saudi Arabia – Massive scandal in 2002 -03 that seriously compromised AMT’s MT/MLT exam data bank – Exam forms were stolen on two separate occasions from proctor’s locker in hospital and copied, then distributed to exam candidates in Saudi Arabia and Philippines – AMT was alerted by extraordinarily high scores on exam administrations – all of which were ultimately canceled – JC was able to pinpoint the primary culprits after much research – Resulted in revocation of principal culprit’s certification, 2 -year suspension of proctor’s certification, and numerous score cancellations • Individuals who were found to have possessed copies of exam were required to submit affidavit attesting to having destroyed all copies – Scandal was a nightmare for Dr. Fidler & EQS Committee – many test questions had to be retired from item pool & replaced. • All MT, MLT & CMLA exams now administered only by computer 39

Breach of Patient Privacy • N. Leonard, RMA (MO) – Complaint alleged that while employed at St. Louis hospital, RMA impermissibly accessed PHI of complainant (ex-boyfriend) and his children – Hospital audit of the complainant’s medical records confirmed RMA had improperly accessed PHI – RMA’s employment was terminated for the breach – Due to serious nature of violation of HIPAA and state privacy laws, JC proposed permanent revocation of RMA certification. RMA did not respond to charges; certification permanently revoked. 40

Breach of Fiduciary Duty • Three cases in past four years in which a State officer has misappropriated state society treasury funds: 1. 2. 3. State Treasurer withdrew over $8, 700 from ATMs using state society debit card. Treasurer died shortly after misappropriation, leaving no estate. Insurance claim filed & paid. State President facing difficult domestic situation withdrew $2, 480 from state bank acct. to assist in move to another state. Promptly self-reported situation and apologized to District Councillor. JC placed member on probation pending repayment of debt over 12 month schedule. State Treasurer made at least 31 separate charges unrelated to legitimate society business on the AMT-issued credit card. Unauthorized transactions totaled $5, 458. JC suspended membership & certifications for min. of 2 yrs; required debt repayment over 12 mos. ; permanently barred from holding state or national office. 41

Examples of No-Action Cases 1. Single acts of negligence – JC declined to initiate disciplinary proceedings involving isolated negligent acts, e. g. , where: a. b. 2. RMA who had been instructed to administer a Tetanus Toxoid vaccine, instead injected pt. w/ Tuberculin Purified Protein Derivative MT cross-matched blood to the wrong pt. , failing to follow a prescribed 3 -step process. Patient was unharmed because the blood was compatible, but it was registered as a “sentinel event” triggering a report to AMT. General allegations of inappropriate workplace behavior – JC refused to intervene in complaint by ex-girlfriend (non-member) that male MT had solicited her to visit him during MT’s night shift at hospital lab to engage in sexual activities, “including taking pictures. ” – While raising possible questions about MT’s character, alleged behavior did not rise to level of violating Standards of Practice, and complaint is more appropriately directed to hospital HR department. 42

Interventions • Legal counsel will become involved in particularly important cases of discrimination against AMT credentials – U. S. Army; U. S. Air Force; U. S. State Department – State Licensure matters – legislative and regulatory • Judiciary Committee will intervene in issues or disputes at the state society level, as necessary – Disputed election procedures; issues of candidate eligibility for state elections; disputes involving delegate selection to annual mtg. ; etc. – Most such disputes should be referred to Council initially • Legal counsel is occasionally consulted by Dr. Fidler on matters of suspect exam results or suspected cheating 43

Mock Disciplinary Case Presentation • Speakers will present factual scenario involving alleged member misconduct • Members of audience will interactively discuss how they would handle the case • YOU be the judge 44

Lessons Learned. . . • “Just Say ‘No’ to Prescription Fraud!” • Disciplinary process generally works well and provides a fair forum for complainants and respondents to present their cases • Be careful whom you accuse. . . – Case brought in 1996 by Ron Reese, MT, backfired on him completely, ending up in permanent revocation of Reese’s AMT membership and certification. – Reese filed complaint accusing another member of slandering him by stating he had been convicted of a recent crime; the alleged ‘slander’ turned out to be absolutely true – in 1994 Reese had pled “no contest” to a felony charge of theft of $8, 893. 43 from his former employer. – The tables turned, the accuser became the accused …. . 45