- Associated Press - Sunday, April 27, 2014

SPOKANE, Wash. (AP) - Telemedicine - doctors treating patients over the phone, online or by videoconferencing - is a growing subset of the health care system.

But Idaho’s medical licensing board doesn’t approve and earlier this year punished a doctor for prescribing a common antibiotic over the phone. The sanctions against Dr. Ann DeJong are so severe that her board certification is threatened.

State lawmakers are more welcoming, seeing telemedicine as an option to bring health care to sparsely populated rural areas and address a severe doctor shortage in the state. The Idaho Legislature passed a bill nearly unanimously this year calling for stakeholders to set state standards for the practice of telemedicine.

In the meantime, the nation’s largest provider of telemedicine has pulled out of Idaho, citing regulatory issues.

“Frankly, telemedicine is a tool that we will have to use in Idaho to meet the manpower shortage, particularly in the rural areas,” said Rep. John Rusche, a Lewiston Democrat and doctor who co-sponsored the telemedicine bill. “If you’re in Challis and you want a dermatology or pulmonology consultation, it’s going to have to be done with telecommunications . or tell a patient to drive down to Idaho Falls in the middle of the winter.”

He added, “I think telemedicine will be an important part of how practice in Idaho is done, and we need some ability to do rational, consistent policies.”

The bill was co-sponsored by another physician-legislator, Rep. Fred Wood, R-Burley.

For her part, DeJong told The Spokesman-Review (http://bit.ly/1iruaqf ) that she feels like “a mouse in some sort of horrible maze.”

DeJong, a 38-year-old doctor, is licensed to practice medicine in nine states including Idaho, but the Idaho Board of Medicine sanction has triggered reviews of her licensing in all those other states and now threatens her board certification.

“When you’re not board certified and you have restrictions on your license, your credibility burns out and nobody wants to hire you,” she said.

DeJong, who trained in North Dakota and holds a doctorate in pathology from the University of California-Davis in addition to her medical degree, had built her career as a fill-in doctor in rural emergency rooms.

Concerned about how many patients she was seeing who couldn’t get in regularly to see a primary care doctor, she signed up in 2012 with a telemedicine company called Consult-a-Doctor. The company would refer calls to her for consultations in states in which she was licensed to practice.

On Feb. 9, 2012, she consulted by phone with a patient in the Boise area who had severe cold symptoms, aches and pains, and a slight fever. DeJong advised the patient to treat the symptoms but also offered to call in a prescription for an antibiotic to take if the patient’s fever rose or her symptoms worsened, a move the patient welcomed.

The pharmacist didn’t recognize DeJong’s name, however, and questioned the Eagle, Idaho, address shown on the prescription form, which was Consult-a-Doctor’s local address. After talking with DeJong, the pharmacist refused to fill the prescription, and DeJong said if it wasn’t legal he shouldn’t do so. However, Consult-a-Doctor later faxed the same prescription to another pharmacy without DeJong’s permission.

The Idaho Board of Medicine investigated and offered DeJong a settlement, which she declined, saying it included incorrect statements. The board held a full hearing and sanctioned her with the license restriction, which prevents her from consulting with patients by telephone or telecommunications, and ordered her to pay close to $10,000 in fines and costs and to take a medical ethics course.

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