FETAL ALCOHOL EDUCATION RULE
On August 1, 1997, Minnesota Statute, section 214.12 subd.3. became law and required the Minnesota Board of Medical Practice to enact a rule requiring physicians who treat pregnant women and children with fetal alcohol syndrome and fetal alcohol effects to receive education on fetal alcohol syndrome/effects. The law reads as follows:
Subd. 3. FETAL ALCOHOL SYNDROME. The board of medical practice and the board of nursing shall require by rule that family practitioners, pediatricians, obstetricians, and gynecologists, and other licensees who have primary responsibility for diagnosing and treating fetal alcohol syndrome in pregnant women or children receive education on the subject of fetal alcohol syndrome and fetal alcohol effects, including how to (1) screen pregnant women for alcohol abuse; (2) identify affected children; and (3) provide referral information on the needed services.
This law is part of a major legislative effort to raise public awareness of the problems associated with fetal alcohol syndrome and to mobilize resources and people to make positive changes regarding this preventable condition. About $5 million was appropriated to develop programs directed at reducing fetal alcohol syndrome and provide better care to affected children. For more information about this legislative effort, contact the Minnesota Department of Health for a copy of the Governor's Task Force on Fetal Alcohol Syndrome Report, Suffer The Children: The Preventable Tragedy of Fetal Alcohol Syndrome, or go to www.governor.state.mn.us/new/firstlad/fasinfo.htm for a copy of the report and other fetal alcohol information links.
One of the findings of the Task Force was that key professionals have insufficient information regarding fetal alcohol syndrome and fetal alcohol effects and that physicians were reluctant to diagnose a child because of the difficulty of the diagnosis and uncertainty of effective treatment options. Also, physicians did not routinely screen women for alcohol use during pregnancy.
Recognizing the importance of effective education, the Minnesota Board of Medical Practice worked in collaboration with officials of the Minnesota Department of Health and Minnesota Medical Association to develop a proposed rule on fetal alcohol syndrome education. The purpose of the rule is to provide practical information to physicians, help them network with specialists in the field, and create mechanisms for educating the public. An example of this goal is the development of a statewide diagnostic clinic that would assist practitioners, clinics and other programs in offering services regarding fetal alcohol syndrome and its prevention.
The proposed rule on Fetal Alcohol Education reads as follows:
5600.2600 Fetal Alcohol Education
Subpart 1. Announcement and request form. On July 1, 1999, the board shall mail to all current licensees an announcement regarding Minnesota Statute, section 214.12 subd. 3. The announcement must indicate that the board will provide, at no cost, educational materials on fetal alcohol syndrome and fetal alcohol effects and its prevention to licensees who have primary responsibility for:
- patient care which involves identifying and treating children with fetal alcohol syndrome and fetal alcohol effects;
- patient care of pregnant women that involves prevention or treatment of patient behavior which may create a risk that the child or children born to the patient will have fetal alcohol syndrome or fetal alcohol effects;
- both items (A.) and (B).
A request form for the materials must be included with the announcement mailing. The affected licensees shall complete and return the request form within 60 days of the date of receipt of the announcement mailing.
Subpart 2. Educational materials. Licensees who return the request form described in subpart 1. shall be sent educational materials by the board which contain the following information:
- methods for screening pregnant women for alcohol use and abuse;
- referral and treatment options involving a pregnant woman who is abusing alcohol;
- methods for identifying children with fetal alcohol syndrome and fetal alcohol effects and referral and treatment options available for affected children; and
- a listing of resources, referral organizations, and persons available to assist in the prevention, identification, and treatment of fetal alcohol syndrome and fetal alcohol effects and with the prevention, assessment, and treatment of alcohol abuse by pregnant women.
Subpart 3. Applicants. Persons applying for licensure between July 1, 1999 and June 30, 2002, shall be asked during their licensure interview if their future practice will involve caring for pregnant women or children with fetal alcohol syndrome or fetal alcohol effects. If the applicant responds affirmatively to the question, a copy of the educational materials described in subpart 2. shall be provided to them.
Subpart 4. Expiration.This part expires on July 1, 2002.
The rule is straightforward in its approach. All physicians will receive a mailing in July 1999, explaining the fetal alcohol rule and law. Any physician who assumes to provide patient care to a pregnant woman or a child found to have fetal alcohol syndrome or fetal alcohol effects is required to return a request form asking that a fetal alcohol education information package be sent to them from the Board. Licensees will have 60 days in which to return the request form.
The educational information is designed to be practical providing guidance about screening pregnant women for alcohol abuse and identifying children who may have fetal alcohol syndrome/effects. The information will also include a listing of persons and organizations that will act as resources available to assist physicians in caring for patients either to prevent or treat fetal alcohol syndrome/effects. With this information in the hands of practitioners, the goal is to have knowledgeable practitioners working in a coordinated effort to prevent alcohol abuse with pregnant women and offer better care to children who have fetal alcohol syndrome/effects. The $5 million appropriation approved by the legislature will be available to help practitioners and organizations create long term programs for the future.
The rule will be in place for three years to allow to allow new physicians to receive the educational information, while the new programs are being put in place.
The Board must complete a rulemaking process for the fetal alcohol rule to take effect. This process officially started in December 1997. From January 1998 to May 1998, Board staff and members of the Minnesota Medical Association, Minnesota Department of Health, and other interested parties met and worked out proposed rule language. The Board also wrote a document titled the Statement of Need and Reasonableness that explains the need for the rule and why the rule is reasonable.
The next step will be the mailing of the Notice of Intent to Adopt the Fetal Alcohol Education Rule without a hearing to all physicians and other interested parties, followed by publication of the Notice in the State Register on August 3, 1998. This will begin the 30 day comment period for public comment on the proposed rule. Interested persons can provide oral and written comments on the rule. If a person wants to propose a change in the rule language or wishes to request a hearing on the proposed rule, they must submit the change or request in writing within the 30 day comment period.
After the 30 day comment period, the Board reviews the comments and approves the rule or approves the rule with modifications. The rule information is then sent to the Office of Administrative Hearings for legal review and approval. It is expected the rule will be submitted to the Office of Administrative Hearings in late mid-September 1998. The rule would take effect a week after publication in the State Register, this being about early October 1998.
There were 15 comments received regarding the proposed rules. With no hearing required, the rules were submitted to the Office of Administrative Hearing for legal review.
The Office of Administrative Hearing approved the rule on November 4, 1998. The rule will take effect on November 30, 1998, and implementation will occur starting July 1, 1998 with the mailing to all physicians notifying them about the rule and providing the request form for education materials on fetal alcohol issues.
Please watch for more information in the Spring 1999 Board Newsletter or at this Website.
For more information regarding the proposed Fetal Alcohol Education Rule or rulemaking process, please call William Marczewski, at 612-617-2152, or write to the Board:
Minnesota Board of Medical Practice,
335 Randolph Ave. Suite 140
St. Paul, MN 55102