Update on Regulations

Recommendation to Board of Medicine from MSV

In the fall issue of the newsletter we shared with you that the MSV ( Medical Society of Virginia) had agreed to support and present to the Virginia Board of Medicine a series of regulations to curb practitioners from carrying out techniques and practices which are not in the best interest of their patients.

MSV Suggested Board Amendments to BOM RECOMMENDATIONS:

A. 18VAC85-20-320 A.1 and 2 should be modified so that administration of over 300mg of lidocaine (or equivalent doses of other local anesthetics) will be subject to the requirements for office-based anesthesia.

B. 18VAC85-20-340 should be reviewed for consideration of adding evidence-based guidelines or limits regarding the appropriate dosage of lidocaine in an office-based setting with respect to liposuction. In addition, the Board should consider the inclusion of evidence-based limits on the amount of supernatant fat to be removed during liposuction, both when done as a single procedure and as part of a combined procedure.

C. 18VAC85-20-340A.2 should be modified with the additional requirement that the maximum planned duration of all surgical procedures combined must not exceed eight hours.

D. 18VAC85-20-370.B should be modified so that “reasonable proximity” is defined as within 30 minute transport time.

E. Surgical consent forms for patients who undergo surgery covered by office-based anesthesia regulations (18VAC85-20-310, etc.) should be required to have one of two statements:

The physician performing the surgery is certified by [list a board or boards recognized by the ABMS]; or  The physician performing the surgery is not board certified.

In addition, the surgical consent for office-based surgery should contain the wording:  The physician and this office comply with the Virginia regulations for office-based anesthesia.

Even though a decision has been made to present these regulations for approval, it has not been presented yet. The energies of the MSV are occupied with dealing with the Legislative session. Multiple bills are being “dropped” regarding issues related to Medicaid funding, limitations on abuses in the Malpractice litigation, and opposition to a fee schedule for Workmen’s Compensation Reimbursement.

Once the legislative session ends in the spring we plan to push these regulations forward for approval. If we are successful it will serve as a first step in a process aimed at improving the quality of surgical procedures performed in Virginia.