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clinic because it fit into one of the exemptions, did not have to take action to comply with the pain-clinic legislation. The facility could determine on its own whether it was required to register. If the facility erroneously chose not to register, any physician who practiced medicine therein would be in violation of section 458.3265 or section 459.0137, Florida Statutes, and would be subject to discipline by his or her medical board. HB 21 changes this arrangement by requiring that the clinics exempt from having to register must apply to the DOH for a certificate of exemption. Thus, if a facility advertises in any medium for any type of pain-management service or prescribes in any month the above mentioned medications to a majority of the facility’s patients for the treatment of chronic nonmalignant pain, but fits within one of the eight exceptions, that facility has to apply for a certificate of exemption. The DOH will have to adopt a form for the application, and will have to approve or deny the certificate within 30 days after receipt of the application. The FMA will notify members as soon as the application form is approved and available. HB 21 requires each person registered with the DEA and authorized to prescribe controlled substances to take a board-approved two-hour continuing education course on prescribing controlled substances. The course must be taken from a “statewide professional association of physicians in this state that is accredited to provide educational activities designated for the AMA PRA Category 1 credit™ or the American Osteopathic Category 1-A continuing medical education credit as part of biennial license renewal.”The course must be taken by allopathic physicians, osteopathic physicians, podiatrists, dentists and optometrists who are registered with the DEA. Advanced registered nurse practitioners and physician assistants already have to take a three-hour course on controlled substance prescribing.The Board of Medicine and the Board of Osteopathic Medicine have approved a joint FMA/FOMA course, which is available at www.FLmedical.inreache.com. EACH PHYSICIAN REQUIRED TO TAKE THE COURSE MUST DO SO INITIALLY BY JAN. 31, 2019, AND THEN PRIOR TO EACH SUBSEQUENT LICENSURE RENEWAL. It should be noted that the standards of practice regarding the treatment of chronic, nonmalignant pain are unchanged. The 3-7 day limit on prescribing Schedule II opioids only applies to acute pain – not chronic nonmalinant pain. The requirement for checking the PDMP database, however, applies for the prescription of almost any controlled substance, for any reason. It does not matter if the prescription is for acute pain or chronic nonmalignant pain. If you are an FMA member who has questions about how HB 21 affects your practice, please contact FMA General Counsel Jeff Scott, Esq., at jscott@flmedical.org Florida Risk Management/Patient Safety Act Medical Errors Medical errors are a common occurrence in the healthcare industry. According to the landmark Institute of Medicine (IOM) report in 1999, To Err is Human: Building a Safer Health System, there are 44,000 to 98,000 deaths each year in the United States, or at least 120 deaths per day, because of human error related to the delivery of healthcare. It is estimated that there are 7,000 deaths each year from medication errors alone and that medication errors occur in 1 of every 5 doses given in hospitals. According to the IOM report, more people in this country die each year from preventable medical errors than from motor vehicle accidents, breast cancer, or AIDS. After the IOM report, much attention was focused on the epidemic of medical errors. What could be done to reduce and ultimately rid the American healthcare system of these errors? Wachter and Shojania (2004) in their book Internal Bleeding, say “the problem is relatively straightforward and could be solved if all errors were reported to newspapers and to regulators, bad-apple physicians and nurses were purged, and sleep-deprived residents and interns were allowed to get a little shut-eye.” They contend that most errors are made by “good but fallible people” who are working within flawed systems, and that the systems need to be fixed. “It’s as if we spent the last