Board Hearings

In keeping with the trend for higher levels of resources to be allocated to examinations and disciplinary actions, across actions, across all professional areas, the most frequent percentage indicated an allocation of only 1 to 10 percent of resources to hearings. Approximately one-fifth of the pharmacy respondents, however, indicated allotments of 11 to 20 percent of resources to board hearings. By the same token, no pharmacy respondents indicated allocation of over 80 percent of resources. Nurses and veterinarians responded similarly but were significantly lower than pharmacists in the 11 to 20 percent range. (See Table 7.)

• Use of Board Resources in Legislative Efforts It is apparent from the data in the preceding tables, as well as the table below, that board allocation to the regulatory areas other than examinations and disciplinary actions is minimal. Perhaps the specific individual areas are considered as one by many boards and, as such, the responses to these series of questions all yield similar responses. Over 10 percent (78) of all respondents indicated allocation of only 1 to 10 percent of resources to legislative review. Again, pharmacists indicated a higher percentage of allocation, between 11 and 20 percent, of resources than the other professions. In no profession did more than 4 percent of respondents indicate that their board allocated more than 21 percent of resources to legislative efforts. (See Table 8.)

(4) Regulation of Licensees

Disciplinary actions and procedures represent one of the board's more important activities. Through these sanctions, the boards can regulate the licensees and protect the public against professional incompetence, unprofessional conduct, possible drug diversion, and leakages.

• License Violations, Regulations, and Disciplinary Actions Resulting in Revocation or Suspension

Disciplinary actions and licensure procedures represent one of the board's primary mechanisms for affecting practitioner and pharmacy activities as they relate to the prevention, control, and suppression of drug abuse. Through these mechanisms the boards can regulate the

licensees and protect the public against professional incompetence, unprofessional conduct, possible drug diversion and leakages. Again, all results derived from the questionnaire in this area were from a selected group of respondents with only one representative of each State regulatory board. Questions involving disciplinary actions resulting in suspension or revocation of a license had a high nonresponse rate, 31 percent (61). Of those States responding, 25 percent (5) of dentists, 33 percent of physicians D.O. (9), and 22 percent of veterinarians indicated that failure to register was common. Fortyeight percent of nurses (11) and 49 percent of physicians M.D. (18) were charged with drug addiction. Pharmacists, 57 percent (26), were cited most often for illegal sales of controlled substances. (See Table 10.)

(5) Field Survey Observations

The field surveys of Maryland, New York, and Virginia are presented in outline form in Table '11 and discussed below.

• Structure

New York has a central licensing bureau which performs all regulatory actions. In Maryland and Virginia, individual professional boards in the major health-related professions perform their own administrative and regulatory functions. Investigations

New York has an agency which conducts investigations for all professions. Maryland and Virginia do not have such investigative bodies. Investigations for the regulatory boards in Maryland and Virginia are conducted either by board members themselves, private investigators, State or local law enforcement agencies, or a compliance investigative unit which functions under the board of pharmacy.

• Drug Inspectors

The State boards of pharmacy in New York and Virginia directly maintain drug inspectors to monitor the activities of pharmacies and health professionals. By comparison, separate drug inspectors are maintained by the State departments of health in New York and Maryland.

7. RESULTS, FINDINGS,

AND IMPLICATIONS

The literature review, field survey, and questionnaire results addressed specific issues and possible problem areas confronting State regulatory licensing boards.

The review of available information yielded valuable insights and provided a definition of the boundaries for the study. Yet, when compared to other areas of study, the single most evident observation to result from this phase of the study was the apparent lack of published or unpublished research into the various aspects and ramifications of the diversion of drugs at the retail level.

The existing literature did, however, provide an indication of the two primary areas to be investigated:

Approximate measures of the extent of diversion of drugs at the retail (practitioner or pharmacist) level

• The existence of a number of discipline problems within the professions. These problems are closely related to the hybrid board-association structure which exists in the United States. This section makes recommendations to improve the licensing boards' operational capabilities. The study of State regulatory boards and professional associations was performed to obtain information to improve the effectiveness of State regulatory boards in fulfilling their responsibilities in controlling drug abuse and diversion. To do this, it was necessary to assess the boards' concern and interest in drug diversion and abuse. This effort focused upon the likely sources of controlled substances which are abused and diverted as well as the individual board's view of the relative seriousness of drug abuse and diversion within its profession and State. The findings in this section are organized around the relative seriousness of the problem as suggested by board member respondents. This section also provides a brief analysis of the implications of each of the suggested methods to ameliorate the identified drug problems.