COVID-19 Update: Prescriptions, elective care, and other guidance

Board of Healing Arts COVID-19 guidance
The Kansas Board of Healing Arts (the Board) has posted guidance for physicians and other licensees on issues related to COVID-19. Among the issues covered are statements on the prescribing of hydroxychloroquine and the performance of non-urgent surgical and other procedures during the COVID-19 public health emergency. In response to inquiries from several members, KMS recently asked the Board to clarify if a physician could be disciplined for “off-label” prescribing of hydroxychloroquine, or for performing non-urgent or elective surgical or other procedures during this pandemic.

The Board responded to the KMS inquiry by emphasizing that the Board’s guidance is not intended to replace physician judgment in prescribing and other clinical decisions but instead urges consideration of the many complex and somewhat unique factors at work during the pandemic that should be taken into account and may help inform the exercise of the clinician’s professional judgment.

The Board’s document includes references to prescribing and dispensing guidance from the Kansas Board of Pharmacy but confirmed that there is no prohibition on legal “off label” prescribing, nor did the Board intend to imply any such prohibition. The Board’s statements were intended to be informational and to encourage physicians to ensure that they are complying with the standards of care and professional conduct in regard to any prescription order for “off-label” uses of drugs that may be in limited supply during this pandemic. 

The Board’s document also cites guidelines from the American College of Surgeons (ACS) on non-emergent surgical procedures. Again, the Board notes that it neither adopts nor rejects the ACS guidelines, but provided them only as information and a credible reference source that may inform physician judgment.

In summary, the Board noted that it considers each case that comes before it according to the unique facts and circumstances relevant to the case. Further, it will continue to separate good faith clinical decisions that are in line with the requirements of professional responsibilities described in the healing arts act from decisions that rise to the level of unprofessional conduct warranting discipline.

CMS guidance on elective/non-emergent care
In collaboration with medical societies and associations, CMS this week released recommendations regarding postponing non-essential surgeries and other procedures. The document provides recommendations to limit those medical services that could be deferred, such as non-emergent, elective treatment, and preventive medical services for patients of all ages. Decisions remain the responsibility of local health care delivery systems, including state and local health officials, and those clinicians who have direct responsibility for their patients. However, in analyzing the risk and benefit of any medical treatment or service, the clinical situation must be assessed to ensure conservation of resources, including these key considerations:

  • Current and projected COVID-19 cases in the community and region.
  • Ability to implement telehealth, virtual check-ins, and/or remote monitoring.
  • Supply of personal protective equipment available at the practice location and in the region.
  • Staffing availability.
  • Medical office/ambulatory service location capacity.
  • Testing capability in the local community.
  • Health and age of each individual patient and their risk for severe disease.
  • Urgency of the treatment or service.

See full 2-page CMS document for more detail.
Liability surrounding KU medical student early graduates
As we shared in the last KMS update, more than 50 senior students from the University of Kansas School of Medicine will graduate early to participate in the Kansas Pandemic Volunteer Health Care Workforce, a program that will deploy them throughout Kansas as part of the state's response to the COVID-19 pandemic. We received questions regarding the liability of these students.
In short, the supervising physician assumes liability for the student. For complete information, see KSA 65-2811a regarding special permits allowed for KU medical school graduates who have not yet begun a post graduate program. Among other things, the statute says: “The special permit, when issued, shall authorize the person to whom the special permit is issued to practice medicine and surgery under the supervision of the person licensed to practice medicine and surgery who has agreed to sponsor and accept responsibility for the services rendered by such special permit holder. … A person who practices under a special permit issued herein shall not be deemed to be rendering professional service as a health care provider in this state for purposes of KSA 40-3402, and amendments thereto.”
State and federal pharmacy guidance
As always, physicians have sole prescriptive authority for their patients, whether related to COVID-19 and non-COVID-19 care.  
The Kansas Board of Pharmacy has issued guidance regarding emergency refills. The Board will not pursue disciplinary action against licenses or registrants through May 31, 2020, who dispense emergency refills to patients in accordance with KSA 65-1637(k)(2), for up to 30 days at the pharmacist’s discretion. Total dispensing per prescription should not exceed a 30-day supply. The Board recommends documenting the authorization agent as “COVID-19 emergency” in the patient record.
The U.S. Drug Enforcement Administration (DEA) has issued guidance to DEA-registered physicians providing new flexibility for physicians managing patients with opioid-use disorder. The guidance permits physicians and other health professionals with a waiver allowing them to prescribe buprenorphine for the treatment of opioid use disorder to issue these prescriptions to new and existing patients based on an evaluation via telephone. The new policy is effective March 31 for the duration of the COVID-19 emergency. Details about this guidance, released on March 31, can be found here.
Updated guidance released March 27, from the DEA on Schedule II controlled substances grants practitioners 15 days within which to provide a written prescription to the pharmacy. This exception is limited to emergency oral prescriptions only. This exception is granted from March 16, 2020, through the duration of the Public Health Emergency (unless modified or withdrawn by DEA).
Children’s Mercy to accept patients statewide up to age 26
Children’s Mercy Kansas City announced Wednesday that it is offering to receive pediatric patients from across the state to allow hospitals to free up bed space during COVID-19. Children’s Mercy is also expanding the age range to accept patients up to age 26. Hospitals seeking to transfer patients should contact Children’s Mercy at 1-800-GO-MERCY.

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If you have questions about this update or other matters, please contact KMS Executive Director Rachelle Colombo: This email address is being protected from spambots. You need JavaScript enabled to view it..