• Alabama was successful in getting legislation passed to allow a grace period for license renewal with graduated late fees. This allows a licensee to continue to practice from October 1 through December 31 without a lapse in license. (Alabama previously lost it's grace period in it's sunset audit in 1996)
• In May 1999 the Board held a seminar with the largest professional trade organization in the state, to educate members of the profession on Alabama's laws and rules. The seminar was a tremendous success and was attended by almost 1/3 of the actively practicing doctors.
• The board created and implemented a Records Disposition Policy through the department of Archives and History allowing the proper archiving of historical records and disposal of records which are no longer necessary or useful.

• Being able to stop the unlicensed practice of chiropractic in a timely matter. Currently, the Board has to go through the District Attorney and file court injunctions to stop any unlicensed practice.

• The FCLB Power Polls have helped the Board get quick responses to questions several times this year.

• The State of Arizona, Board of Chiropractic Examiners continues to experience growth in the number of licensees, applications and regulatory investigations. Arizona contuinues to experience a considerable imigration of applicants for licensure from other states. In addition, the number of complaints received this year has surpassed previous years filings for this month in proceeding years , and the Board has taken disciplinary action against 14 licensees to date, with 8 hearings still pending.
• In addition to our regular duties of licensing and regulation, the Board has continued to work toward quality improvement and has been active in legislation this year. Some of the accomplishments are:
  • An upgrade to the Board database which has resulted in faster and more accurate processing of license renewals, expanded immediate access to public records and improved customer service.
  • The Development of a Policies and Procedures Manual to ensure consistance and quality in office operations.
  • Successful deflection of legislative "bullets" in the form of bill amendments which would have had either negative or unkown and consequences.

• The Board continues to face challanges in the regulation of clinics and businesses which provide for chiropractic services, but which are owned and operated by individuals who are not licensed in the State of Arziona.
• The newest challange before the Board involves attempts by the physical therapy profession to amend the laws governing the practice of chiropractic in the State of Arizona. We anticipate that this challange will be continued into the next legislative session.

• Regular Session, 1999 Act 1553 was signed into law by Governor Mike Huckabee on April 15, 1999. This Act amends various sections of the Arkansas Chiropractic Practices Act. New statute books have now been printed.
• The ASBCE conducted a public hearing on December 9, 1999, whereby the Board considered and approved an order to amend the Arkansas State Board of Chiropractic Examiners Rules & Regulations. The amendments were reviewed and approved by the Legislative Council on January 21, 2000.
• NEW TESTING FACILITY: The ASBCE is now conducting our licensure examinations at the new UAMS Clinical Skills Center located at the University of Arkansas for Medical Sciences Medical Center. This is the first clinical environment-testing site, which has been available to the Chiropractic Board to administer our licensure examination.

• Continued efforts to challenge attempts by physical therapists to expand their scope of practice to include spinal manipulation. This issue will be a main focus during the next 83rd General Assembly Regular Session, 2001.

• The FCLB has been instrumental assisting this board in preparation, information and updates regarding the National Practitioner Data Bank (HIPDB) entity registration verification, which now requires under Section 1921 of the Social Security Act that we report adverse actions taken against a chiropractors license to HIPDB. The FCLB is the Boards HIPDB designated authorized agent in reporting disciplinary information to HIP. As the Director of the ASBCE, I would personally like to thank Donna Liewer, Executive Director and staff for all the hard work that they have done in organizing this whole indefatigable process. THANKS!

• Plugging into and using CIN-BAD
• Re-establishing Pre-ceptorship - in the process
• Establishing point-persons to oversee specific board functions between meetings

• Regulating / Disciplining unlicensed / lapsed licensed D.C.'s

• CIN-BAD (and ALLDoCS) helping / will help to cut paperwork for new licensees and gain compliance for HIP database requirements

• Under legislation enacted in 1999, the Board’s statutorily required 3-month training program for new applicants for licensure was abolished.
• The Board was proud to have one of its consumer members, Ms. Jessie Kirkland, serve as Vice Chair.
• The Board undertook the requirements of Profiling and Credentialing as part of initial licensure and renewal. This required all applicants and licensees to undergo a criminal background check through the Florida Department of Law Enforcement and the Federal Bureau of Investigation. It also required licensees to publish on the Department of Health’s web-site their profile information. The Board, along with the Boards of Medicine, Podiatric Medicine and Osteopathic Medicine, is now on line with the statutorily mandated health care practitioner credentialing. This was a huge endeavor by the Department of Health in an effort to streamline the practitioner’s credentialing activities which have become costly and cumbersome. The name of the initiative is CORE STAT which came on line in early 2000. Visit the web-site at www.corestat.net.

• The statutory requirement that an applicant’s national examination scores be within the past 10 years continues to present a problem for some applicants for licensure.

• The Board would like to thank the Federation for its assistance with compliance with the federal HIPDB requirements for reporting disciplinary actions. We are most pleased that we will be able to continue reporting directly to the Federation, which will in turn report to the HIPDB. The Federation’s staff is to be commended for its tireless efforts to assist member boards with this matter.

• The Honorable Cathy Cox, Georgia Secretary of State is pleased to announce the Georgia State Examining Boards Divisions move to Macon, Georgia in September, 1999. This move, from the Atlanta metro area makes the Georgia Board of Chiropractic Examiners office more centrally located in the State. With the move to Macon, Mollie L. Fleeman was named as Joint Secretary for the Examining Boards Division. Anita O. Martin joined the Board in December,1999, as the new Executive Director.

• The Georgia Board of Chiropractic Examiners still experiences challenges in getting the Healthcare Integrity and Protection Data Bank (HIPDB) operational to it’s fullest. With FCLB’s help as our reporting agency - we hope to have this challenge resolved this year.

• FCLB is of assistance to the Board with the information furnished by CINBAD.

• Adoption of rules defining areas of practice and better definition of ethics in advertising practices.
• Removal of prohibitions on advertising and profits from the sale of nutrition products in Iowa statute / law.
• Adoption of new rules pertaining to rulemaking, investigations and disciplinary procedures.

• Scope of practice - from physical therapy profession challenging advertising of physiotherapy (involves legal interpretations of statute and rules).

• CIN-BAD database used for approval of preceptors and as a resource for complaints / discipline purposes.

• Passage of Board rules which:
  • Adopt Part IV of N.B.C.E.
  • Ensure chiropractors have the right to use acupuncture in practice
  • Raise CEU requirements

• The most pressing challenge faced by our Board is in building relationships based on professionalism. The Board needs to accurately convey information to those people in state government who chose to follow their own agendas or half-truths. I personally would like the Board to build an outstanding reputation as advocates for patient choice, to become a model, and therefore a valuable resource for the Department with which we work.

• The FCLB has been an invaluable resource during one of the most challenging times of the Maine Board that I have witnessed in my 8 years of service. For instance, the power polls provided up to date, valuable information for decision making, and networking with other state boards brought varied perspectives, experiences and knowledge to the issues at hand. However, the most valuable assistance came from the FCLB's uncompromised commitment to public protection and professional standards. These high ethics served as a standard for our actions in public hearings and the numerous meetings it took to achieve our goals.

• Legislation:
  House Bill No. 343 was passed by the General Assembly and signed into law by Governor Mel Carnahan on July 13, 1999. Of significant importance to the Board are the provisions in the bill that amend Chapter 331: This bill allows the Board to move to a biennial renewal. The board has prepared revisions to the current rules and anticipates the change to take effect during the 2001 renewal period. This bill gave the Board injunctive authority. This is important to the Board because we will now have more enforcement ability to stop unlicensed practice activities. It can also be used to enjoin a chiropractor from practice if the Board believes the chiropractor presents a substantial probability of serious danger to the health, safety or welfare of any resident of this state or client or patient of the licensee. To actually stop a chiropractor from practicing in these situations, the Board will have to meet the burden of proof before filing an application with a court of general jurisdiction. It will be the courts and not the Board that actually issue the injunction, restraining order or other order as may be appropriate. House Bill No. 343 also contains several provisions changing the new acupuncture practice act. The Board considers most of the changes in this act as clean up measures from last year’s bill. It does, however, clarify that one member of the Acupuncturist Advisory Committee shall be a current member of the Missouri State Board of Chiropractic Examiners. The Board will have over-sight responsibility over the enforcement activities of this act. The Board will also license acupuncturists upon recommendation of the committee to those qualified under the statutes. The Board will be setting the fees upon the recommendation of the committee and will promulgate the rules necessary to carry out the provisions of the acupuncture practice act upon approval of the committee. It will be the Board, upon recommendation of the committee, who has the authority to deny licensure or discipline a licensee based upon the causes outlined in the bill, which are similar to those of most professional licensing agencies. This bill creates a new lien law for chiropractic physicians and other health care providers. Specifically, chiropractic physicians will have the same lien rights granted to hospitals.
  
  The Board is now focusing its attention to finding ways to shorten the time span in the issuance of a license to practice. The Board has introduced legislation that would allow the board the ability to issue a temporary license. If passed, the Board could grant a temporary license to practice chiropractic to a person who holds a current, valid, unrestricted license in a state other than Missouri. The temporary license could be issued for a maximum of ninety days and could be renewed once.



• Complaints and Discipline:
  Complaints involving inappropriate conduct or sexual misconduct decreased in fiscal year 1999 by 33%. Last year, complaints involving inappropriate conduct or sexual misconduct declined by 20%. The Board contributes this two-year decline in the number of sexual misconduct complaints to a new rule that was implemented in 1998, requiring all chiropractic physicians to earn at least four (4) hours of continuing education in either boundary training or emergency procedures. We have not yet measured the number of licensees who chose to earn the additional four-hour continuing education requirement in boundary training. However, the Board believes that the statistics prove that it has been beneficial, if for no other reason than to make licensees more aware of the problem.



• New Licensing System:
  On September 23, 1999, the Board went “live” with a new licensing system, commonly referred to as PROMO (Professional Registration of Missouri). This new system not only makes the Board Y2K compliant but also offers many standard and enhanced features that were previously not available. As with any new program, the Board is experiencing normal transition issues but looks forward to the improved communications and services that PROMO will provide to our customers.



• Renewal Fee Increase:
  By law, the Missouri State Board of Chiropractic Examiners is required to be totally self-supporting. All the salaries and expenses for the operation of the Board must be appropriated and paid from the “State Board of Chiropractic Examiners Fund”. Although the Board instituted numerous measures to cut costs, the Board’s operational expenses continued to exceed the revenue collected annually over the past three years. In order to cover the Board’s operational costs, the Board estimated that it needs to generate approximately $32,500 in additional revenue each year. Therefore, effective December 1, 1999, the annual renewal fee increased by $25.00. The new renewal fee is $150.00. The Board believes that the cost savings with the new continuing education rules will more than offset the $25.00 renewal fee increase as these rules will allow a licensee to earn 12 of the 24 hour requirement through “other continuing education experiences”.



• Licensing of Massage Therapists:
  In accordance with House Bill No. 343, the Missouri Division of Professional Registration has been assigned the State Board of Therapeutic Massage to license and regulate massage therapists and businesses. This Board is comprised of seven members, including one public member and one nonvoting member of the massage education community. This Board had its first meeting on July 22, 1999 and has completed writing the rules and regulations. The Board must promulgated rules regarding 1) procedures for filing an application; 2) the content, conduct and administration of the licensing examination; 3) the educational requirements for licensure; 4) the standards and methods to be used in assessing competency: 5) the applicable fees; etc. Upon expiration of the grandfathering period (December 31, 2000), an applicant for licensure as a massage therapist must complete 500 hours of instruction and subsequently pass an examination. The new law specifically exempts from licensure those practitioners who act under a Missouri State license and perform soft tissue manipulation within their own scope of practice. The Board anticipates that they will begin processing applications for licensure in October 2000.

• Continuing Education continues to be a challenge. The Board would like to see a central clearing house to list approved courses and to maintain instructor credentials. A national approval program would ease the burden on the licensing boards and provide licensees with a choice of location and topics as needed for their particular practice.



• The Board is currently seeking review and revision of the State Department of Revenue’s guidelines that disallow physical examinations by chiropractors for applicants seeking a school bus operator’s permit. Since the Federal Highway Administration amended its rule in 1992 to permit health care professionals other than doctors of medicine or osteopathy to perform physical examinations of commercial motor vehicle drivers, it is the Board’s position that it applies to school bus operators as well.

• The FCLB provided invaluable assistance to the Board in complying with the federal requirements for reporting to the National Practitioner Data Bank and the Healthcare Integrity and Protection Data Bank. By becoming the authorized agent and using the information submitted for CIN-BAD, the board was able to comply with the new laws expeditiously. Without the assistance of the FCLB many staff hours and resources would have been expended by the board to comply.

• There has been a strong push by a splinter educational organization in Nebraska to replace current Board Members, with my position being challenged strongly, requiring repeated appearances before the Board of Health in hearing, and finally procuring the re-appointment through dialoguing and communication with the second group.



• Rewriting the Rules and Regs, which included clarification on advertising, defining the duties of non-licensed personnel and rewriting the continuing education as an update with mandated hours.



• Seeing a continual diminishment in investigations through repeated Board appearances at state association meetings, mailings and publications by the Department.

• The implementation of the proposed Rules and Regs after the first hearing and working for a compromise with all doctors in the state to see the changes implemented.

• Sinbad has been extremely important for us on licensure for individuals who have requested licensure and have had either a misdemeanor or felony. The information we have received from Sinbad has been more than beneficial to allow us to make an informed decision on these doctors.

• In response to the Governor's initiatives for auto insurance and personal injury reform, the New Jersey Board adopted comprehensive regulations governing the performance of diagnostic and electro-diagnostic testing. The regulations impose a heightened level of record-keeping to insure that such tests are clinically supported. It also identifies those tests which have not been reliably demonstrated to identify conditions amenable to chiropractic care beyond the information attainable from the taking of a complete patient history and the performance of a thorough clinical examination, or those which fail to yield data of sufficient clinical value in the development and implementation of a plan of treatment, such as spinal diagnostic ultrasound, current perception threshold tests, iridology, reflexology or surrogate arm mentoring.



• The Board has spent considerable time developing proposed regulations on patient record reviews to insure that practitioners conduct a review of a complete patient record and requiring the reviewer to cite specific deviations from Board regulations when commenting that a patient record is insufficient. Further, the rule requires that care may not be terminated solely on the basis of a patient record review. An examination be conducted in order to terminate care.



• The Board is developing new regulations to cope with the issue of utilization review by defining the term and including it in the Board's "Scope of Practice" regulations. Thus, an individual performing such a function must hold a valid New Jersey license. The licensee may not conduct a utilization review without at least two years of post-graduate clinical experience.

• Keeping up with the significant volume and complexity of complaints involving fraud.

• Power poll results on the regulatory issues named in # 2 and #3 have been very helpful in gaining perspective on complex issues. Just knowing that you don't have to reinvent the wheel saves time, effort and expense!

• The Board advised the umbrella agency leadership and attorneys, who accepted the advice, that it is within the lawful scope of practice for chiropractors to treat primary peripheral sports injuries so long as the care addresses "removal of nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column" as defined in the authorizing statute. This legal interpretation essentially asserts that an injury does not have to be caused by a chiropractic condition, so long as the healing can be enhanced by chiropractic care through removal of nerve interference. This opinion recognizes that the statutory reference to "nerve interference" can be motor or sensory in nature, thereby removing the long held misinterpretation that an injury or condition had to originate in the vertebral column. The opinion further asserts that as a chiropractic approach, the spine must be addressed in some manner or the practitioner may be found negligent.



• The Board successfully recommended acceptance for licensure by endorsement the limited and diminishing number of applicants who passed National Board exams administered by a state rather than the NBCE so long as they meet all other licensure requirements and have practiced for at least seven out of ten years without misconduct.



• New York State Board Members continue to provide leadership and support for the NBCE Part IV exam in the Northeast, and in other parts of the country as needed. The population is growing at the two New York sites with the addition of new states accepting or requiring the exam. Aside from assuring continuity of exam administration standards, the Board Members have assisted the NBCE to identify actual and potential problem areas, and to address them effectively before they compromise the integrity or quality of the exam.

• Professional Misconduct -- Multidisciplinary practice, especially involving chiropractors employed by medical practitioners and professional corporations fraudulently or deceptively constituted to maximize revenues at patients' expense.



• Policy Development -- Interstate and multi-state practice, including telepractice and insurance review procedures that require licensed professionals to make determinations based on clinical expertise that affect patient outcomes.



• Regulatory Partnerships -- Efforts to facilitate and encourage rival state chiropractic organizations to either unify or conduct business, especially legislative initiatives, in a collegial, cooperative manner in the interest of the public and the profession.

• Committee on Minority Issues -- One of the most important initiatives the FCLB has undertaken is the focus on minority issues as they relate to regulation of the chiropractic profession. The Committee on Minority Issues has completed a Power Poll, which indicates an alarming passivity across the nation regarding efforts to involve racial and ethnic minority groups in the chiropractic profession.
  
  In addition to the equity aspect of such inclusion, there is a very pragmatic consequence of engaging in outreach to minority populations: the assurance of the survival of chiropractic in a changing world. The FCLB has recognized that chiropractic care has hardly reached the racial and ethnic minority populations in this country. That measure can be inferred simply by looking at the lack of diversity on our state boards and their FCLB Delegates. There appears to be little evidence of inclusion efforts in states with or without large proportions of racial and ethnic minorities.
  
  Not only are these under-represented groups suffering the consequences of not receiving needed health care, but the profession is suffering from not receiving the considerable political clout wielded by this burgeoning population. Lack of awareness of the profession, lack of understanding, lack of role models, lack of career opportunities, lack of investment in and from the profession all combine to constrict chiropractic to a relatively homogeneous profile, whether it be practitioners, chiropractic students or patients. That is a formula for the eventual demise of the chiropractic profession.
  
  A failure to engage the rich, new blood of diverse populations is a failure to adhere to the chiropractic profession's vitalistic foundation, which relies on the continuous renewal of the innate health and strength of the human organism. Exclusion of any part of that organism throws the whole into imbalance and a state of compromised function. The same principle holds true for the societal organism. The FCLB knows that, and has responded. Now the whole body of FCLB Delegates must follow that lead and engage in state-by-state efforts to include all people in the benefits and opportunities associated with this wonderful profession -- chiropractic.

• HB 506: In November 1999, Representative J. Kirk Schuring (R-Jackson Twp.) introduced House Bill 506, which is the first comprehensive revision of the Chiropractic Practice Act since the creation of the State Chiropractic Board in 1975 pursuant to Senate Bill 75. The legislation is the same in content as House Bill 812, which Rep. Schuring introduced in August 1998 at the request of the State Chiropractic Board. For over three years, the State Board has worked with the leaders in the chiropractic profession to prepare legislation that will do the following:
  • Give chiropractors a statutory doctor/patient privilege that currently does not exist;
  • Provides for a “special limited license” for traveling doctors, preceptors and residencies; The Board will also allow established doctors who meet certain criteria to be licensed if they have practiced in another state (restoring interstate mobility through reciprocity);
  • Increases the penalty for unlicensed chiropractic practice to a felony, as it is in medicine;
  • Creates an “impaired physicians program” to assist doctors with chemical dependency problems;
  • Creates a “Quality Intervention Program” to assist doctors with clinical and patient care issues, outside of the disciplinary process;
  • Permits the Board to appoint advisory committees from amongst the profession to advise it on various issues - those appointed may be reimbursed for expenses and represented by the Attorney General’s office in case of litigation;
  • Eliminates the state board exams in favor of the more objective and standardized Part IV examination on the NBCE, permitting doctors interstate mobility to over 35 states;
  • Provides the Board with the ability to regulate in-person and telephone solicitation, thereby protecting the public and leveling the playing field for ethical practitioners;
  • Expands the types of penalties the Board may impose. Currently, the Board may only “suspend” or “revoke” a doctor’s license for a violation. The new language permits reprimands and fines, which may be more appropriate for minor violations;
  • Provides protection to doctors who report the unethical activities of certain other doctors;
  • Adopts in statute the term “chiropractic physician” as a legally permissible title, codifying what is already an administrative rule;
  • Permits the Board to reform the Continuing Education process - it is the Board’s intent to liberalize how CE is earned through the rule making process (i.e. online education, out of state seminars, journal articles, etc.);
  • Substantially lowers the fees the Board charges for a roster of licensees or a replacement license;
  • Suspends the license automatically of doctors convicted of serious felonies, (i.e. aggravated murder, murder, rape, robbery, etc.);
  • Permits the Board to handle minor violations without disciplining a doctor by using a warning, rather than formal discipline. Informal disciplinary action may not be used by a third party payor to take adverse action against a doctor.

  The intent of the legislation is to modernize the Board’s practice act to be consistent with the other regulated professions in Ohio and to follow “best practices” in professional regulation nationally. Furthermore, the Board needs the ability to regulate the chiropractic profession into the next century. The Board wants chiropractic to grow and prosper and this bill should allow the Board and chiropractic to do so. A strong Board is able to protect the interests of chiropractic and the patient public!
  
  Since the legislation is voluminous, this summary is not all-inclusive. The Board office would be happy to provide you with a copy of the bill or you can go online at http://www.legislature.state.oh.us/laws.cfm to view the legislation.
  
  

• State of Ohio Chiropractic Job Classification: The Board held its annual planning retreat at the Ohio Veteran’s Home (OVA) in Sandusky, Ohio on March 29-30, 2000. At this retreat the Board met with the Director of the OVA who requested the Board’s assistance in creating a state job classification for a chiropractor in order to employ a chiropractic physician at the OVH. The Board is working to create this classification, position description and pay range. The state of Ohio currently has several classifications for health care professionals and the Board is eager to include chiropractic.

• On-Line License Verification: The Board just completed developing its on-line license verification. Chiropractic physicians may be looked up by license number, first or last name, city, state, zip code or county of practice. This system will enable consumers as well as managed care organizations to verify the status of an Ohio licensee via the Web.

What difficult challenges does your board currently face?

• Prosecuting the unlicensed practice of chiropractic.
• Budgetary constraints.
• Developing meaningful relationships with other health care regulatory boards.

• The FCLB is an invaluable resource of information and updates pertaining to the National Practitioner Data Bank (HIPDB) and is a great resource and facilitator of information obtained from Power Polls, etc.

• We successfully resolved several major sexual misconduct cases. In doing so, we have refined our investigative process to routinely involve a psychological evaluation of the doctor involved to help us determine the continued risk to patients and their potential for rehabilitation.
• We were able to stop of unlicensed practice of chiropractic by two people ( one a California DC and the other a formerly licensed DC) by obtaining a restraining order and issuing notices of $10,000 civil penalties.
• The OBCE had a retreat in September of 1999 during which we reviewed our strategic plan and the results of a survey sent to the field docs and a group of patients and insurance people. The majority of respondents were very positive in their view of the work of the OBCE and it was also clear to us that we needed to improve our communication to all of our stakeholders. We have begun a process of meetings around the state to open up dialogue with the field doctors.

• See number 3 above. Communication is a challenge! We also found from our survey that many people have the role of the OBCE confused with that of a state association. It is a great source of frustration to some that we do not "actively support the chiropractic profession" and a source of frustration to us that they do not understand that that is not our role. We are working to correct that misconception with our face to face meetings with doctors.
• We continue to work on our Guidelines process. This topic could easily be included under one of our achievements as well as here as a challenge. We have made much progress and there is a lot of work to go. The challenges include keeping many people involved and the continuing need for resources to support the process.
• Our Guideline process is beginning to dig into the meat of the question of minimal competence and we are also beginning the process of defining continued competence. Both of these issues present great challenges to us.

• The FCLB has been instrumental in assisting our board in preparation, information and updates regarding the National Practitioner Data Bank (HIPDB) entity registration verification. We have supported the FCLB in this effort and the result is a one-stop process for reporting our disciplinary actions to CIN-BAD and HIPDB. Thanks to the FCLB for their persistence in working through the many challenges involved in this.

• The agency acquired a new Xerox Document Centre 332 ST machine on a lease/purchase agreement. The Document Centre can copy, fax, scan, print and image. We also purchased a compatible document imaging software package that enables every employee in the office to use the machine from his or her computer. The agency now prints all licenses and facility registration forms in-house on the Document Centre.
• The application deadline for Continuing Education Course approval was changed from the previous calendar year of no later than November 15 to 100 days prior to the date the course will be offered. After the application is reviewed and approved, each C.E. course is posted on the TBCE Web Page. All agency applications and annual renewal forms have been or are in the process of being updated and revised so they will be more user friendly.

• Licensee and facility numbers are increasing rapidly in our State and the workload on a limited staff is becoming a significant problem. Additional Staff members are needed now in Enforcement and Licensing but the Legislature is reluctant to authorize any additional F.T.E. for the agency. Implementing and administering the recently adopted Administrative Fines and Penalties is moderately complex. The process is further complicated when the Respondent refuses to sign the proposed Agreed Order from the Enforcement Committee. Moving forward with the case through the Contested Hearing process requires another level of additional work by the Director of Enforcement, the Executive Director and the Assistant Attorney General.

• The FCLB was extremely helpful to our Board in complying with the new federal law requiring regulatory health profession agencies to report disciplinary actions to the Healthcare Integrity and Protection Data Bank. In fact, the TBCE has designated the FCLB as their Authorized Agent of Record for reporting adverse licensure actions to the federal government.