The Iowa Board is aware of situation
here are minutes from last meeting
The Iowa Board of Medicine (IBM) met in public session on Wednesday, September 12, 2007. Board members in attendance included physician members Carol Frier, DO, Blaine Houmes, MD, Yasyn Lee, MD, Dana Shaffer, DO, Siroos Shirazi, MD, Rod Zeitler, MD, and public members Tom Drew, JD, Sally Schroeder, and Janece Valentine, JD. Absent was Asha Rijhsinghani, MD, the most recent IBM appointee.
In attendance for the Iowa Medical Society (IMS) were Jeanine Freeman, JD, Senior Vice President of Legal Affairs; Heidi Goodman, JD, RN, Manager of Public and Regulatory Affairs; and Eric Nemmers, JD, MHA, Manager of Legislative Policy.
Pain Management Rules
The IBM is proposing to amend its existing rules on chronic nonmalignant pain management to broaden its regulatory outreach to all pain care situations, including treatment of acute pain. Particularly the IBM seeks to emphasize that undertreatment is as much of a problem in care as overtreatment. IMS commented on the IBM's initial draft and raised several concerns particularly related to the broad field of acute pain management. Further changes are being considered and a final draft will be presented to the IBM for its approval in November.
Joint Pain Statement
The IBM, the Iowa Board of Nursing, the Iowa Board of Pharmacy, and the Iowa Board of Physician Assistants are working on a draft policy statement regarding pain treatment and management. The draft developed by these boards relied upon pain management statements from the boards of medicine from New Mexico and Oregon. The IBM will re-examine the joint statement for adoption purposes in November.
Interventional Pain Procedures
The 2007 IMS House of Delegates adopted Resolution 07-15 directing IMS to seek a statement of policy from the IBM stating that interventional pain medicine procedures performed with fluoroscopically guided needle placement (to the spine, paraspinal tissue, and other vital structures of the body) constitute the practice of medicine and, further, that interventional pain medicine procedures shall be performed by qualified MD or DO physicians licensed in the state of Iowa. IMS worked with interested member physicians in developing a letter of request which was submitted to the IBM in late July. The IBM asked for further information from IMS about the nature of this request and why it has come up. IMS explained that increasingly allied health professionals, particularly CRNAs, are seeking greater independence in the field of pain management. For example, CRNAs have proposed to the Iowa Department of Public Health that they be recognized as able to supervise fluoroscopically guided needle placement procedures for pain management purposes. The Iowa Board of Nursing believes the CRNAs have such authority and training; IMS does not. The Department has delayed further discussion. IMS believes that an articulated policy statement from the IBM is important to establish that pain management is the practice of medicine; this does not preclude physicians from delegating certain tasks and functions to properly trained allied health practitioners. IMS argued that the IBM, on the one hand, seeks to impose disciplinary standards upon physicians in managing pain so, on the other hand, the IBM should be similarly prepared to state that pain management is the practice of medicine. Roles for allied health practitioners in pain management must be grounded from this base. The IBM asked IMS to review its request and provide clarifications consistent with the day's discussion.
