COVID-19 Licensing and Information

Many licensees have contacted the Board with a variety of questions regarding COVID-19 as it relates to medical licensure, rules and regulations. Please submit other topics of interest as related to medical licensure during this time of declared emergency: email AHS.VDHMedicalBoard@vermont.gov

NEW GUIDANCE REGARDING OUTPATIENT CARE (05/04/2020)

On May 4, 2020, Governor Scott issued new guidance allowing the resumption of elective medical procedures. Information and guidelines for outpatient practices in general is available here:  https://governor.vermont.gov/press-release/governor-phil-scott-announces-some-elective-health-care-procedures-resume

The Standard of Care in Times of Emergency

(posted 03/23/32020)

The Board has received questions and expressions of concern about practicing medicine during the public health emergency brought about by COVID-19.   Healthcare professionals have been forced to adapt to rapidly changing circumstances and this is only the beginning.  The demand for services, constrained resources, the need to modify patient encounters to reduce risk of infection, and peers being unable to practice because of illness have impacted, or will impact, the way you treat patients. 

What does all this mean for you in terms of your personal liability, either regarding discipline for unprofessional conduct, or with regard to malpractice liability?

With respect to the Board of Medical Practice and the potential for discipline based on a failure to meet the standard of care, you can be assured that your actions will always be judged based on the circumstances.  That does not mean that anything goes in a crisis, but that due consideration will always be given to the circumstances in which you practice. 

The law that defines the different forms of unprofessional conduct requires the Board to consider the circumstances whenever deciding if the standard of care was met, as seen in 26 V.S.A. § 1354(a): 

22) in the course of practice, gross failure to use and exercise on a particular occasion or the failure to use and exercise on repeated occasions, that degree of care, skill, and proficiency that is commonly exercised by the ordinary skillful, careful, and prudent physician engaged in similar practice under the same or similar conditions, whether or not actual injury to a patient has occurred.

The Board does not play a role in malpractice lawsuits, and cannot give licensees legal advice, but we note that the statutory standard for malpractice liability includes comparable phrasing in the law that establishes what must be proved in a medical malpractice claim in Vermont, as seen in 12 V.S.A. § 1908:

In a malpractice action [ . . . ]  the plaintiff shall have the burden of proving:

(1) the degree of knowledge or skill possessed or the degree of care ordinarily exercised by a reasonably skillful, careful, and prudent health care professional engaged in a similar practice under the same or similar circumstances whether or not within the State of Vermont;

(2) that the defendant either lacked this degree of knowledge or skill or failed to exercise this degree of care; and

(3) that as a proximate result of this lack of knowledge or skill or the failure to exercise this degree of care the plaintiff suffered injuries that would not otherwise have been incurred.

Healthcare professionals may also want to consult the State of Vermont guidance on medical services in times of crisis.  The Vermont Department of Health has set forth a framework for operating in a public health emergency in a document known as the Crisis Standards of Care Plan.  A summary of the plan and the plan itself are available on the Health Department website.

Emergency and Deemed Licensure During COVID-19 (updated 04/06/2020)

Special provisions for the COVID-19 public health emergency have been passed to facilitate practice in Vermont by healthcare professionals who are not licensed in Vermont. This sets forth information for physicians (MD), physician assistants, and podiatrists. Other professions (including osteopathic physicians) are under authority of the Office of Professional Regulation. There is special guidance below regarding retirees, physician assistants, and residents or fellows who hold training licenses.   

There are two different paths available to be able to practice during the emergency. Both are expedited and free. Deemed licensure is faster, but not available to as many individuals depending on both the individual’s circumstances and the setting in which they will be practicing. Emergency licensure is available to many of those who cannot be “deemed.” 

Practice by “Deemed” Licensure

PLEASE NOTE:  The guidance here is for ONLY Board of Medical Practice professions (MD, PA, DPM). Other health care professions are licensed by the Vermont Office of Professional Regulation. That includes all types of nurses and osteopaths. Professionals not licensed by this Board need to go to the OPR site. 

Physicians, Physician Assistants, and Podiatrists who meet all the criteria below can be deemed to be licensed to practice in Vermont for practice in the following circumstances:

  1. Providing remote services by telemedicine (note that this refers to “telemedicine” in a generic sense, following the guidance in the emergency law and advisories issued by Vermont agencies and federal authorities). Telemedicine does not require the deemed form.
  2. As part of the staff of a licensed facility in Vermont.  Those practicing as part of the staff of a licensed facility must submit a small amount of information to identify themselves, provide contact information, and note where practicing.  That may be done by hospital staff on behalf of the licensee. A form for MDs, PAs and DPMs has been created for your convenience.

    NOTE:  MD and DPM Residents are also eligible for this status. See note below about residents. Also see special announcement re emergency waiver of PA requirements for documentation of supervision.   

Professionals deemed licensed are not required to apply for an emergency license. There is no fee to be deemed licensed. Deemed licenses will be issued for the period while the declared emergency is in effect, but notice may be issued that a deemed license is no longer in effect.

To be deemed licensed to practice in one of the settings specified above, you must:

  1. Be licensed in at least one US jurisdiction and be in good standing in all jurisdictions where you are licensed.
  2. Not be subject to professional disciplinary proceedings in any other US jurisdiction (license is not suspended, revoked, or subject to limitations or conditions as a result of a disciplinary action, or formal charges issued. Notice only of an investigation is not disqualifying.
  3. Not be barred from practice in Vermont for reasons of fraud or abuse, patient care, or public safety.

Deemed License for Vermont Retirees – those who retired from practice within the last 3 years and let their Vermont license lapse are also eligible to practice under the “deemed” framework described above. That is limited to telemedicine or to practice with the staff of a licensed facility in Vermont. Your license must have been in good standing when you retired and not have subsequently been subject to discipline. You need only to submit the notice telling us who you are and providing contact information and where you will be practicing. 

Deemed licenses for Residents and Fellows who hold training licenses – residents and fellows who do not have a full license are eligible to be “deemed” to hold a Vermont training license, which we refer to as an LTL license. Those are not unlimited licenses but will allow you to practice as you may be assigned by your residency program. Examples of where this would apply are: Residents at DHMC who are assigned by their program to provide telehealth services are able to do so for patients in Vermont; DHMC residents who are assigned a new practice site in Vermont during the emergency. Some fellows hold full licenses – they fall under the general guidance that applies to holders of full licenses. 

Deemed licenses for PAs – PAs may qualify to be deemed licensed in Vermont as described above. The Board is issuing a limited waiver of documentation requirements for PA supervision during the public health emergency. Answers to most questions regarding supervision requirements can be found by reviewing the announcement.

Emergency Licenses

Those who do not qualify to be deemed licensed may apply for an emergency license. There is no fee for an emergency license and the process to apply involves much less than our normal licensing process. Emergency licenses will be valid for 90 days or the duration of the declared emergency, whichever is shorter, but may be reissued. The groups who would need to get an emergency license (because they cannot be deemed licensed) are:

  1. Holders of full licenses in other states who plan to practice in Vermont and who will not limit their practice exclusively to telemedicine or practice on the staff of a licensed facility. To be eligible for an emergency license all licenses held must be in good standing and you must not be subject to professional disciplinary proceedings in any other US jurisdiction (license is not suspended, revoked, or subject to limitations or conditions as result of a disciplinary action, or formal charges issued. Notice only of an investigation is not disqualifying.)
  2. Retirees who held a Vermont license that lapsed more than 3 years ago but less than 10 years ago. All Vermont retirees who fall into this group must obtain an emergency license in order to practice. Retired physicians who did not hold a Vermont license within the past 10 years are not eligible under the law. 

To apply for an emergency license please click here after you have reviewed all the steps below.

  • Create an account by choosing REGISTER. If you have already applied for licensure or have a lapsed Vermont license, please log into your existing account. DO NOT create another account. If you do not know your log in information, please use the password reset option. 
  • Once you have created an account or have logged in, from the ON-LINE SERVICES menu in the upper right-hand corner of the screen, choose "CREATE/CONTINUE APPLICATION" to start your application. You will choose the application for your profession: MD, PA or DPM. There is not a different application listed as “emergency” and do not fill out the Limited Temporary License Application as that is a training medical license for medical residents who are affiliated with a program.
  • Follow these instructions that are specifically for emergency licenses ONLY and supersede any instructions within the online application.
Board Waiver of Requirement for Documentation of New PA Practice Sites During Emergency

Deemed licenses for PAs – PAs may qualify to be deemed licensed in Vermont as described above. The Board is issuing a limited waiver of documentation requirements for PA supervision during the public health emergency. Answers to most questions regarding supervision requirements can be found by reviewing the announcement.

Prescribing (updated 03/25/2020)

Questions about prescribing requirements during the declared emergency?

The US Drug Enforcement Agency has an informative webpage that is updated regularly. It addresses topics including whether requirements for in-person contact with patients for controlled substance prescribing are in effect.

Updated March 25th, 2020:
One of the important announcements issued by DEA is a relaxation of the requirement for prescribers of controlled substances to have a separate DEA registration for each state in which they prescribe or dispense controlled substances. Click here to read the announcement or visit the DEA website.    

New York Governor Andrew Cuomo Requesting Assitance (03/27/2020)

New York Governor Andrew Cuomo is requesting additional health professionals to assist with surge capacity in New York. 

Vermont Healthcare Professionals Serving Patients in Other States Using Telemedicine

(posted 03/31/2020)

The Board of Medical Practice has received many inquiries from licensees asking about whether they may use telemedicine to serve their patients who reside in other states and who are remaining in their homes. Normally a medical professional must be licensed in the state where a patient is located in order to legally practice. The Board of Medical Practice does not have control over whether our licensees may practice in other states, but we are sharing information about guidance that has been issued by our neighbors in New York, New Hampshire, and Massachusetts.  

New York

New York Governor Andrew Cuomo issued Executive Order 202.5 on March 18, 2020. The relevant portion copied below provides that from the date of the order through April 17, 2020, physicians and physician assistants who are licensed in good standing in another state but not licensed or registered in New York may practice in New York without civil or criminal penalty related to lack of license or registration. 

NOW, THEREFORE, I, Andrew M. Cuomo, Governor of the State of New York, by virtue of the authority vested in me by Section 29-a of Article 2-B of the Executive Law to temporarily suspend or modify any statute, local law, ordinance, order, rule, or regulation, or parts thereof, of any agency during a State disaster emergency, if compliance with such statute, local law, ordinance, order, rule, or regulation would prevent, hinder, or delay action necessary to cope with the disaster emergency or if necessary to assist or aid in coping with such disaster, I hereby temporarily suspend or modify, for the period from the date of this Executive Order through April 17, 2020 the following: 

  • Sections 6512 through 6516, and 6524 of the Education Law and Part 60 of Title 8 of the NYCRR, to the extent necessary to allow physicians licensed and in current good standing in any state in the United States to practice medicine in New York State without civil or criminal penalty related to lack of licensure;
  • Section 6502 of the Education Law and Part 59.8 of Title 8 of the NYCRR, to the extent necessary to allow physicians licensed and in current good standing in New York State but not registered in New York State to practice in New York State without civil or criminal penalty related to lack of registration; 
  • Sections 6512 through 6516, and 6541 of the Education Law and Part 60.8 of Title 8 of the NYCRR 8 NYCRR, to the extent necessary to allow physician assistants licensed and in current good standing in any state in the United States to practice in New York State without civil or criminal penalty related to lack of licensure;
     

New Hampshire

New Hampshire has issued an Emergency Order authorizing practice under an emergency license. The Emergency Order states that in order to obtain an emergency license you need to present evidence of being licensed in good standing in another state. Use this form to apply.

Visit the New Hampshire Board’s page for more information about licensure for the COVID-19 emergency in New Hampshire.   

To provide evidence of your license status in Vermont:

  1. Go to the Vermont Look Up a License and click the button on the left that says DETAIL to look yourself up.If you have had different licenses in the past, be sure to pick the license that is "Active."
  2. Click the button at the bottom for PRINTABLE VIEW
  3. At that point, use your preferred method to get an image of the screen, such as a screen shot or printing and scanning. 
  4. You can submit the form and your license information via email to: oplclicensing@oplc.nh.gov

Massachusetts

The Massachusetts Board of Registration in Medicine has posted a very short application for emergency licensure that asks for only the most basic identifying information, contact information, medical school, and primary state of practice. The email address for submitting the application is on the form itself. 

OPR Order Regarding Certain Drugs Being Prescribed for COVID-19 (04/14/2020)

(Posted 04/14/2020)

The Office of Professional Regulation has issued an order calling on pharmacists to apply “enhanced drug utilization review” to newly-established outpatient prescriptions for drugs that are known or believed to be under investigation for COVID-19 indications.  The eleven drugs listed in the order include chloroquine, hydroxychloroquine, and remdesivir.  The enhanced drug utilization review requires scrutiny of:  the documented diagnosis stated on the prescription; plausibility of the diagnosis and drug being within the prescriber’s practice; whether the drug is reasonably indicated; and, the quantity prescribed.