By: Louis M. Grossman

In September, the Department of Labor imposed significant fines against two Louisiana restaurants for violations of the Fair Labor Standards Act (“FLSA”). The iconic New Orleans Cajun-Creole restaurant Jacques-Imo’s paid more than $55,000 in fines for violating child labor laws under the FLSA; Superior Seafood paid out more than $230,000 in back wages and penalties.

Following an incident in which a 13 year old employee sustained third degree burns, the Department of Labor (“DOL”) audited Jacques-Imo’s restaurant and found it in violation of several Child Labor Law provisions.  First, the DOL found that the 13 year old employee sustained his injuries while cleaning a fryer when the oil temperature was in excess of 100 degrees.  Child Labor Laws prohibit minors from engaging in such dangerous work activities.  The DOL also found that the restaurant had allowed another minor to work hours beyond those permissible for children under the age of 16.

In the same month, news broke of another DOL audit of a local restaurant industry employer, Superior Seafood and Oyster Bar.  After an extensive audit of the company’s payroll practices and record-keeping, the DOL’s Wage and Hour Division concluded that the company had failed to pay overtime to more than 220 employees.  Specifically, DOL concluded that Superior Seafood had failed to combine hours worked by employees who held more than one position for purposes of determining overtime pay – i.e., that an employee who worked 40 hours as a bartender and 20 as a waiter was not paid overtime.  The DOL also found that the company had falsified records and failed to include incentive bonuses in calculating overtime payments.

These recent DOL audit findings serve as a stark reminder to Louisiana’s thriving hospitality industry of the importance of compliance with wage payment laws and maintaining appropriate payroll records. Proper training as well as back of the house postings can remind management not to assign minor employees to dangerous tasks and to ensure that the work schedules of minors comply with federal law.  Instructing restaurant management and payroll personnel/vendors  regarding the need to cumulate all hours worked by employees during a workweek for payroll purposes and including productivity compensation in employee overtime calculations is also essential for properly compensating employees for all time worked, including overtime.

Learn more about Kean Miller’s Labor and Employment Practice.

By: Michael J. deBarros

On October 22, 2019, the Louisiana Supreme Court issued its opinion in the Smith v. Citadel Insurance case.  Kean Miller’s Insurance Recovery Team assisted several amici in presenting arguments to the Court in the case.

In Smith, the Louisiana Supreme Court held that an insured’s bad faith claims against its insurer are governed by a ten-year prescriptive period, instead of a one-year prescriptive period.  In Louisiana, prescription (which is similar to the common law “statute of limitations”) is a mode of barring claims as a result of a failure to timely file a lawsuit on those claims.

The Smith decision is a big win for Louisiana insureds.  The ruling provides insureds sufficient time to discover their insurer’s bad faith acts or omissions and assert their rights, and it eliminates the often costly, complex, and fact-intensive litigation that previously ensued when some courts applied a one-year prescriptive period.

In ruling that an insured’s bad faith claims against its insurer are governed by a ten-year prescriptive period, the Smith Court relied heavily on Kelly v. State Farm (a case argued and briefed by Kean Miller’s Insurance Recovery Team) and reiterated that “in every case, the insurance company is held to a high fiduciary duty to discharge its policy obligations to its insured in good faith.”

By: Matt B. Smith and Maureen N. Harbourt

On September 30, 2019, the United States District Court for the Eastern District of Missouri, Eastern Division, issued an Opinion and Order setting forth the remedy required for Ameren Missouri’s violation of the Clean Air Act’s Prevention of Significant Deterioration (“PSD”) program. United States v. Ameren Missouri, No. 4:11-CV-77, Rec. Doc. 1122 (E.D. Mo. Sep. 30, 2019). Through the enforcement action, the EPA alleged that certain work done at Ameren’s Rush Island coal-fired power plant in 2007 and 2010 required a PSD permit and the installation of Best Available Control Technology (“BACT”) to control sulfur dioxide (“SO2”). The EPA further alleged that the failure of Ameren to apply for such a permit and install BACT resulted in substantial excess emissions from the Rush Island facility. The case had been bifurcated into separate liability and remedy phases, with the court finding that Ameren was liable for the alleged PSD violations on January 23, 2017. The most recent ruling focused on the remedy for such violations.

In addition to various ancillary factual, procedural, and legal determinations, the court focused on evaluating BACT for SO2 emissions. The court applied the traditional five-step analysis to determine BACT,[1] “the maximum degree of reduction of [SO2]…which the permitting authority, on a case-by-case basis, taking into account energy, environmental, and economic impacts and other costs, determines is achievable for such facility.” Slip opinion, p. 28 (citing 42 U.S.C. § 7479(3)). Characterizing the BACT analysis as a “top-down” evaluation, the court determined that, if the option providing the highest level of control was “achievable” after considering the energy, environmental, and economic impacts related to that option, the analysis stops and that control is BACT. Id. at p. 30.

The court noted that there was no dispute concerning the first three steps of the analysis: identification of control options, elimination of technically infeasible options, and ranking of options by effectiveness.  The controversy concerned step 4 of the BACT process: evaluation of alternatives considering energy, environmental and economic factors. Ameren rejected wet Flue Gas Desulfurization (“FGD”) because it was not as cost effective as another control option. While the court noted that cost is a consideration in the process, the court’s interpretation of the process was that the BACT analysis “is not a search for the most cost-effective controls; nor is it a cost-benefit analysis.” Id. at p. 31. In reaching this interpretation, the court relied heavily on a statement in the EPA’s Draft NSR Workshop Manual that, for similar sources, it is presumed that cost and other impacts borne by one source may be borne by another. Id. Accordingly, the court found that an available technology is BACT unless it is rejected as being economically infeasible or is rejected due to adverse energy or environmental impacts. Id. at pp. 56-57, p.156,

Applying this approach, the court determined generally that some form of FGD scrubber (either wet or dry) is BACT for SO2 emissions based largely on the use of FGD scrubbers at other coal-fired power plants. Specific to the Rush Island facility, the court held that wet FGD scrubbers should have been installed as BACT for SO2 emissions. Id. at pp. 57 & 59-60. In so holding, the court rejected reliance on the incremental cost-effectiveness of two competing control technologies, a comparison of cost in dollars per ton of emission reductions of each technology, stating that incremental cost-effectiveness should only be considered when competing technologies have similar levels of effectiveness. Id. at pp. 41-42 & 44-45. Instead, the court focused on whether Ameren was capable of incurring the cost of the most effective control, wet FGD. Id. at pp. 55-56 & 62, ¶ 223 (“With respect to economic impacts, Ameren does not dispute that it can afford FGDs at Rush Island, and it presented no evidence that installing FGDs would otherwise impose an undue financial burden on the company.”) (see also pp. 109-13 analyzing Ameren’s financial resources and ability to obtain financing). Accordingly, the court ordered Ameren to apply for a PSD permit which proposes wet FGD as BACT for SO2 emissions.

The court further determined that Ameren’s failure to install scrubbers at Rush Island resulted in 162,000 tons of excess SO2 emissions through the end of 2016, continuing at a rate of approximately 16,000 tons per year until scrubbers are installed. Id. p. 58. To address these excess emissions, the court ordered Ameren to install a different control technology, dry sorbent injection (“DSI”), at a separate, nearby facility not subject to the lawsuit to reduce SO2 emissions from that facility. The court held that it had authority to reach beyond the Rush Island facility at issue because, under the CAA, it had the “authority to order a full and complete remedy for the harm caused by Ameren’s violations, and in doing so may go beyond what is necessary for compliance with the statute at Rush Island.” Id. at p. 149 (internal citations omitted). Because the installation of DSI at another facility in the same general area would benefit the impacted population by reducing SO2, the court found this remedy to be narrowly tailored to the harm suffered. Id. at p. 150. Further, the court found that this additional requirement was not an impermissible penalty because it required “emissions reductions up to, but not surpassing, the excess emissions from Rush Island.” Id. at p. 151.

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[1] The five steps applied by the court include (1) identifying all available control technologies for reducing the target pollutant; (2) eliminating those which are not technically feasible; (3) ranking the technically feasible technologies in order of effectiveness at reducing emissions; (4) evaluating the technologies based on energy, environmental, and economic impacts and other costs to determine the most effective technology that is achievable; and (5) selecting an emission limit based on how the technology has performed at other sources. Id. at pp. 29-30.

By: Jennifer J. Thomas

The U.S. Department of Health and Human Services, Office of Civil Rights (“OCR”), announced on October 2, 2019, that it had entered into a settlement with a private dental practice that had violated the HIPAA Privacy Rule by posting patient protected health information (“PHI”) on Yelp.  The OCR received a complaint in 2016 from a patient alleging that the dental practice had responded to the patient’s online Yelp review of the service the patient had received.  In response to the patient’s review, the dental practice disclosed on Yelp the patient’s PHI including:  last name, condition, details of the treatment plan, insurance, and cost information.  During OCR’s investigation, OCR discovered that the practice had also impermissibly disclosed PHI of other patients when responding to those patients’ reviews. OCR determined that the practice did not have a policy procedure regarding disclosures of protected health information related to social media or a notice of privacy practices that comply with the HIPAA Privacy Rule.

The settlement requires the dental practice to pay $10,000.00 and adopt a corrective action plan with two years of monitoring by OCR for HIPAA compliance.  Included in the corrective action plan is the development of policies and procedures that comply with federal standards governing the privacy and security of PHI, which must be approved by OCR.  The dental practice must distribute the policies and procedures to all employees and each employee must sign a certification that the employee has read, understands, and shall abide by the policies and procedures.  The policies and procedures must be updated at least annually and submitted for review by OCR. The dental practice must also submit reports to OCR summarizing the status of its implementation of the corrective action plan.

Like any business owner, a healthcare provider may think it’s necessary to respond to reviews posted on social media in order to protect the provider’s reputation.  However, as a covered entity, a healthcare provider is always bound to comply with HIPAA, as well as State confidentiality laws.  As suggested by OCR Director, Roger Severino, “doctors and dentists must think carefully about patient privacy before responding to online reviews.”

By: Elizabeth J. Wilson

The practice of medicine is changing almost daily, and a big contributor to the new landscape is technology. With the ever-growing list of apps and software platforms available, physicians and other health care providers are able to find and treat their patients in ways that were not possible in previous years.

Many of the same technologies that are being used in non-medical settings have proven useful in the healthcare world. One such area is call recording.  Certain software will allow physician groups, or other healthcare providers, to track whether a patient call originates from an online ad or website. Many times those same marketing companies that can track calls and analytics can also provide a platform to easily record and store calls coming into a healthcare provider’s office or call center.

The practice of recording phone calls is not uncommon. How often do you hear “your call may be recorded for quality assurance purposes” when you settle in for that long call with customer service? There are certainly benefits to having these patient calls recorded: customer service improvement, employee training, and tracking call sources, to name a few; but in the heavily regulated healthcare world, healthcare providers must consider other factors before making the decision to hit the record button.

From a HIPAA perspective, the provider must think about who or what is recording the calls, and where the audio recordings and any other information related to the audio recordings would be stored. Any entity a provider contracts with to record and store the patient telephone calls would need to sign a Business Associate Agreement, whereby the entity agrees to protect the patient information it receives in accordance with HIPAA. Failing to obtain a Business Associate Agreement in this instance would be a violation of HIPAA.

There is also the question of consent. Do you need to inform the patient the call is being recorded? One huge factor that goes to this consideration is, “Where is the patient located at the time of the call?” Louisiana is a one consent state, meaning at least one party to the conversation needs to know about the recording — and that one party can be the physicians’ practice making the recording. This means, as long as the medical provider is aware of the recording, a patient located in Louisiana does not have to be informed the call is being recorded. But what if the patient calls from a different state? Mississippi, Alabama, and Texas are also considered one consent states, but other states, including Florida, are “two-party consent” states, meaning you need the consent of both parties in order to make the recording. If a call is made from a patient located in Florida to a physician practice in Louisiana, the general legal consensus is that the physician practice must comply with the more stringent “two-party consent” requirements. Out of an abundance of caution, we would advise all of our healthcare provider clients to inform and request consent before recording any phone calls with patients. This way there is no question as to the legality of the recording, and you never run the risk of your patient being surprised when they learn of the existence of a stored call recording when they were never made aware they were being recorded.

Medical providers need to be cognizant that these audio records are likely considered health records. This means that recordings of patient telephone conversations with your nurse line or call center should be treated like any other medical record. Providers should retain the audio recordings for as long as all other records are retained, and ensure that those audio records are released along with the rest of the medical record when a valid authorization to release medical records is received.

Just as with traditional medical records, practices must consider security measures surrounding the creation and storage of these recordings. How are the recordings being stored? Will they be stored on cloud based servers? Will they be stored on your system? Will the audio files have to be sent or received at any point?  Will the files be encrypted? Who will be able to access the files? Do your privacy policies address call recording? All of these questions should be answered before determining 1) whether recording patient calls is appropriate for the provider, and 2) which recording system is the best choice.

The issue of malpractice liability should also be considered. A recorded conversation with a patient becomes discoverable evidence in the event of a claim, and this is a double edged sword. While a phone recording can be helpful in the event of a negative outcome (to prove what information was actually provided to the patient), it, just like any other documentation, can also be harmful (to prove what information was not provided to the patient). Thus, a provider should consider whether such recordings will be helpful or harmful if an issue were to arise. Also, it may be helpful for a provider to reach out to its malpractice carrier to see if there is any opinion on recording patient calls.

Finally, while not arising from health care regulations, one last consideration relates to whether a provider would be taking credit card payments over the phone during these recorded calls. Federal security standards set out compliance rules for practices relating to the processing of credit card payments over the phone and the storage of credit card information. When deciding to record patient phone calls, providers should be cognizant of these specific laws and standards for credit card processing, and insure that any call recording system selected will allow the health care provider to easily maintain compliance when it comes to patients’ credit card information.

Technology makes it very easy to hit record, but physicians and other providers should look hard at all of the relevant factors before implementing a policy to begin recording patient phone calls.

 

By Pam R. Mascari

Pipeline companies may not exercise their powers of eminent domain granted under the federal Natural Gas Act (NGA) in federal courts when seeking to acquire state-owned lands.   On September 10, 2019, in In re: PennEast Pipeline Company, LLC, the United States Court of Appeals for the Third Circuit ruled in favor of New Jersey finding that its sovereign immunity under the 11th Amendment prohibited PennEast Pipeline from condemning property owned by the State of New Jersey.

PennEast Pipeline Company, LLC obtained federal approval to construct a pipeline through Pennsylvania and New Jersey.    After PennEast obtained approval for the project, it sued in federal court to condemn and gain access to properties along the approved route.    Of  the 113 tracts sued upon, 42  are owned, at least in part, by the State of New Jersey.    The United States District Court for the District of New Jersey found that PennEast had met all conditions required under the NGA to exercise the right of eminent domain, rejected New Jersey’s argument that it was immune from suit by a private entity under the 11th Amendment, and granted PennEast orders of condemnation and immediate access to the properties.  New Jersey appealed to the United States Court of Appeals for the Third Circuit.

The Third Circuit opinion does not consider whether PennEast had met the requirements for exercising eminent domain under the Natural Gas Act.  Rather, the Third Circuit opinion is based completely the sovereign immunity created by the Eleventh Amendment to the United States Constitution which provides that:

The Judicial Power of the United States shall not be construed to extend to any suit in law or equity, commenced or prosecuted against one of the United States by Citizen of another State, or Citizen or Subjects of any Foreign State.

However, the Eleventh Amendment does not prevent the United States from suing a sovereign state government in federal court.

The Third Circuit pointed to the two competing powers at issue:  the federal government’s eminent domain power and the federal government’s exemption from Eleventh Amendment immunity.  PennEast argued that the NGA impliedly represents a delegation of the federal government’s power to sue a state government when exercising the power of eminent domain.  The Third Circuit rejected this notion finding no authority for a “delegation theory” of the waiver of sovereign immunity.  Further, the Third Circuit noted that Congress may only abrogate sovereign immunity by unequivocal statutory language. The court found no such unequivocal waiver of sovereign immunity in the NGA.

The obvious concerns of PennEast and the natural gas industry were recognized near the end of the opinion:

PennEast warns that our holding today will give State unconstrained veto power over interstate pipelines, causing the industry and interstate gas pipelines to grind to a halt – the precise outcome Congress sought to avoid in enacting the NGA.  We are not insensitive to those concerns and recognize that our holding may disrupt how the natural gas industry, which has used the NGA to construct interstate pipelines over State-owned land for the past eighty years, operates.

But our holding should not be misunderstood.  Interstate gas pipelines can still proceed.  New Jersey is in effect asking for an accountable federal official [rather than a private pipeline company] to file the necessary condemnation actions and then transfer the property to the natural gas company.

This precedential opinion was filed in Docket No. 19-1191 in the United States Court of Appeals for the Third Circuit on September 10, 2019. Due to the vast acreage of state owned water bottoms in Louisiana, this decision portends potentially significant changes in pipeline development within the state.

By: Brian R. Carnie

The wait is over for better or worse – the Trump Administration has released the Department of Labor’s final rule concerning changes to the salary requirements to be exempt from the overtime pay requirement under the Fair Labor Standards Act (FLSA).

Under the final rule, the DOL has increased the minimum salary threshold that must be paid in order for most executive, administrative or professional employees to qualify for exemption from $455 per week ($23,660 annually) to $684 per week ($35,568 annually).  This new salary threshold does not apply to teachers, doctors, lawyers, or certain other exempt professionals who are not currently subject to the salary basis or salary level tests.  While the new salary threshold is $11,908 less per year than what was originally proposed in 2016, it still presents headaches for many employers who have exempt employees who are paid well below this new salary level.

The final rule also raises the amount paid to an employee to qualify for the highly-compensated employee exemption (from $100,000/yr to $107,432/yr), a much lower increase than what the DOL proposed earlier this year.  As expected, the final rule makes no changes to the duties requirements that these administrative, executive or professional employees must also meet in order to qualify for exemption.

Covered employers have until January 1, 2020 to make necessary changes (which is when the final rule is effective), after which employers could be held liable for overtime pay violations in subsequent workweeks for up to 3 years after each violation (plus liquidated damages and attorneys’ fees).  This final rule will likely be the subject of various court challenges over the course of the next few months but employers are cautioned not to solely rely on the court system in the event courts refuse to enjoin the final rule.

What Employers Can Do

For affected exempt employees who are not paid enough to qualify under the increased salary basis test, consider the following:

  1. Compute what their current weekly salary would be under a 40 hour workweek and then figure how much overtime s/he would have to work before hitting the new minimum salary level (this will determine whether and how much of a change will be needed).

2. For employees whose hours significantly vary week to week and who meet the applicable requirements, consider adopting the fluctuating workweek method which permits employers to pay non-exempt employees a fixed weekly salary regardless of the number of hours worked.  If you implement this properly, employers only have to pay one-half (.5) the regular rate of pay for all hours that exceed 40 per workweek instead of the typical one and one-half (1.5) overtime rate.

You may also consider setting a maximum hour cap beyond which they cannot work without prior management approval.  However, should one or more non-exempt employees exceed this cap in a particular workweek, you must pay them the required overtime for that workweek but you may discipline them for violating the cap.

3. For employees whose hours are fairly consistent, consider translating their current weekly salary to an hourly rate where they would continue to receive approximately the same amount of compensation even if they are re-classified as non-exempt and are paid overtime.

4. Take steps to manage off the clock work by employees who were previously treated as exempt, especially if they use electronic devices such as smartphones or laptops outside of the workplace (or outside of normal work hours) for work purposes.

5. Implement a “safe harbor” policy that details your timekeeping requirements and prohibits off the clock work.  Such a policy may provide a good faith defense to liquidated damages stemming from FLSA OT violations, and may also preserve an employee’s exempt status in the event impermissible deductions are made.

By Jennifer Jones Thomas

On September 10, 2019, the Centers for Medicare and Medicaid Services (“CMS”) published a Final Rule in the Federal Register which will require Medicare, Medicaid, and Children’s Health Insurance Program (“CHIP”) providers and suppliers to disclose current and previous affiliations with other providers and suppliers who CMS identifies as posing an undue risk of fraud, waste, or abuse.  The effective date of the Final Rule is November 4, 2019.  The Final Rule will require providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that: 1) Has uncollected debt; 2) Has been or is subject to a payment suspension under a federal healthcare program; 3) Has been or is excluded by the Office of Inspector General (“OIG”) for Medicare, Medicaid, or CHIP or; 4) Has had its Medicare, Medicaid, or CHIP billing privileges denied or revoked.  “Affiliation” is defined as:

  • A five percent (5%) or greater direct or indirect ownership interest that an individual or entity has in another organization.
  • A general or limited partnership interest (regardless of the percentage) that an individual or entity has in another organization.
  • An interest in which an individual or entity exercises operation of managerial control over, or directly or indirectly conducts, the day-to-day operations of another organization either under contract or other arrangement, regardless of whether or not the managing individual or entity is a W-2 employee of the organization.
  • An interest in which an individual is acting as an officer or director of a corporation.
  • Any reassignment relationship.

The Secretary will have the authority to deny provider enrollment based on an affiliation the Secretary determines poses an undue risk of fraud waste or abuse.  CMS believes that this rule will help “make certain that entities and individuals who pose risks to the Medicare and Medicaid programs and CHIP are removed from and kept out of these programs.”  Specifically, the Final Rule will allow the Secretary:

  • To revoke or deny a provider’s or supplier’s Medicare if they are currently revoked under a different name, numerical identifier, or business identity.
  • To revoke a provider’s or supplier’s Medicare enrollment, including all practice locations, regardless of whether they are part of the same enrollment, if the provider or supplier billed for services performed at, or items furnished from, a location that it knew or should reasonably have known did not comply with the Medicare enrollment requirements.
  • To revoke a physician’s or other eligible professional’s Medicare enrollment if he or she has a pattern of practice of ordering, certifying, referring, or prescribing Medicare services, items or drugs that is abusive, represents a threat to the health and safety of Medicare beneficiaries, or otherwise fails to meet Medicare requirements.
  • To revoke a provider’s Medicare enrollment if he or she has an existing debt that CMS refers to the U.S. Department of Treasury.
  • To deny a provider’s Medicare enrollment application if the provider is currently terminated or suspended from participation in a state Medicaid program or any other federal healthcare program or the provider’s license is currently revoked or suspended in a state other than that in which the provider is enrolling.

The Final Rule also increases the maximum re-enrollment bar from the current three years to ten years.  If a provider submits false or misleading information on the enrollment application, the Secretary can bar enrollment for three years.

CMS reports that the new revocation authority will lead to approximately 2,600 new revocations per year with a projected savings over a ten year period at $4.16 billion.  The new reenrollment and reapplication bar provisions will apply to 400 of CMS’ revocations resulting in an additional savings of $1.79 billion over 10 years.

By Eric Lockridge and Wade Iverstine

Lenders who finance farm operations, including those who provide equipment, seed, fertilizer, and other farming-related products on credit, should be aware that the Family Farmer Relief Act of 2019 has been signed into law. This new law allows a “family farmer” with up to $10,000,000.00 in debt to restructure and to reduce debts under Chapter 12 of the Bankruptcy Code.  The provisions in Chapter 12 are more farmer friendly than the alternatives the law available under Chapter 7 (liquidation) or Chapter 11 (debt reorganization or asset sale).  When Congress first established Chapter 12 of the Bankruptcy Code in 1986, it was available only to family farmers whose debt was $1,500,000.00 or less.  In 2019, farming is a much more high-tech and capital-intensive endeavor than it was 30+ years ago.  Even part-time farmers are likely to have more than $1.5 million in debt today once one adds up the often-financed cost of acquiring land, necessary equipment, seed, fertilizer, and other necessities.

Under the new law, a family farmer, or the family farmer and spouse, can qualify to file for bankruptcy relief under Chapter 12 so long as their total debt is no more than $10,000,000.00 (non-contingent and liquidated), and at least fifty (50%) percent of the debt arises out of farming operations (e.g., not personal credit card spending), among a few other requirements.

Agricultural lenders and vendors should be aware of this change in the law. Many more farmers are eligible for a Chapter 12 bankruptcy today than were eligible a few weeks ago.

By Jennifer Jones Thomas

In December of 2018, the Louisiana State Board of Medical Examiners (“The Board”), approved adoption of an amendment to the rules governing the practice of telemedicine.  The Board published a Notice of Intent for the amendment in April of 2019 in the Louisiana register with the amended Rule becoming final on August 20, 2019.  Prior to the amendment, the Board’s Rule permitted physicians using telemedicine to be at any location at the time the services are provided; however the patient receiving the telemedicine services must be “in any location in this state at the time that the services are received.”   LAC 46:XLV.7505C.  The Board’s amendment to the rule deletes the words “in this state.”   The intent of the amendment is to “not inadvertently prevent physicians from prescribing medication or other health care services to their patients who may be vacationing or temporarily outside of Louisiana.”  This amendment answers a common question of what a physician can do to help an established patient who is temporarily out of state and becomes ill.  With this amendment, a Louisiana-licensed physician would not be prevented under Louisiana law from assisting the patient by prescribing medication.  However, the Board cautions that engaging in such activity may or may not be lawful or permitted by the medical licensing authority in the state in which the patient is located.  Therefore, before prescribing medication or providing other medical services to a patient on vacation in a state other than Louisiana, a physician would be wise to check the telemedicine rules established by the state where the patient is located.