BOARD OFFICE CONFERENCE ROOM

NEVADA STATE BOARD OF MEDICAL EXAMINERS

1105 TERMINAL WAY, SUITE 301 RENO, NEVADA 89502

 

Friday, March 29, 1996 and Saturday, March 30, 1996

 

PRESENT: Thomas J. Scully, M.D., President; Susan S. Buchwald, M.D., Vice President; M. Nafees Nagy, M.D., Secretary-Treasurer; Rex T. Baggett, M.D.; Dipak K. Desai, M.D.; Kathleen L. Ebner; Arne D. Rosencrantz; Paul A. Stewart, M.D.

ABSENT: Victor Scaramosino

STAFF PRESENT: Larry D. Lessly, Executive Director; Maureen E. Lyons, Administrative Assistant; Richard J. Legarza, General Counsel; Lana L. Millard, Receptionist/ License Specialist

ALSO PRESENT: Jan J. Cohen, Senior Deputy Attorney General

 

Friday, March 29, 1996

 

AGENDA ITEM 1

Call to Order - Thomas J. Scully, M.D., President

The meeting was called to order by the Board President, Thomas J. Scully, M.D., at 4:35 p.m. on Friday, March 29, 1996.

 

AGENDA ITEM 2

Approval of Minutes

- February 10, 1996 Board Meeting - Open/Executive Sessions

Mrs. Ebner indicated that the heading on the Executive Session minutes reads "Open Session" and should be corrected to read "Executive Session." Dr. Scully indicated that Dr. Roitman's first name as it appears in the Open Session minutes reads "Norman" and should be corrected to read "Norton."

Dr. Desai moved to accept the February 10, 1996 Board Meeting - Open/Executive Sessions with the corrections as indicated. Mrs. Ebner seconded the motion, and it passed unanimously.

 

AGENDA ITEM 5

Discussion of Proposed Changes to Nevada Administrative Code, Chapter 630 - Larry D. Lessly, Executive Director

Mr. Lessly referred members to the Proposed Permanent Amendments to Regulations as shown in the agenda book. He advised that hearings to receive comments from the public concerning the proposed amendments will be held in northern and southern Nevada in May, with a third hearing to take place at the Board's June meeting, at which time the Board will consider any further public comment and adoption of the finalized version of the proposed amendments. He added that once the Board adopts the amendments, they will be forwarded to the Legislative Counsel Bureau to be formatted for publication.

Mr. Lessly reviewed each proposed change to NAC Chapter 630 and received comments from members as follow:

1)         NAC 630.230 Prohibited professional conduct - no comments were made regarding the proposed changes to this regulation;

2) NAC 630.290 Application for certification - Dr. Nagy recommended the language "in the presence of a physician" be added, so that a physician assistant can only prescribe controlled substances in the presence of a physician;

3) NAC 630.330 Contents of certificate - no comments recommendations were made regarding the proposed change to this regulation;

4)         NAC 630.        Intractable pain defined - Dr. Buchwald directed that the word "intractable" be removed from the definition, as it is what is being defined;

5)         NAC 630.        Confidentiality of Diversion Program - no comments were made regarding this proposed new regulation;

6)         NAC 630.        Gross malpractice defined - no comments were made regarding this proposed new regulation;

7) NAC 630.    Malpractice defined - no comments were made regarding this proposed new regulation;

8)         NAC 630.        Gross medical negligence defined - no comments were made regarding this proposed new regulation; and

9) NAC 630. Appetite suppressants - no comments recommendations were made regarding this proposed new regulation.

Dr. Nagy moved to approve the proposed permanent amendments to regulations for public hearing per Nevada law. Dr. Desai seconded the motion, and it passed unanimously.

 

AGENDA ITEM 3 Personnel

- Ratification of Appointment of Bookkeeper

Mr. Lessly requested the Board's ratification of the hiring of Robert A. Frantz to begin employment on April 15, 1996 as the Board's bookkeeper, replacing Claire E. Mowrey who will be retiring on June 30, 1996.

Dr. Nagy moved to ratify the hiring of Mr. Frantz as bookkeeper effective April 15, 1996. Dr. Desai seconded the motion, and it passed unanimously.

Mr. Frantz appeared and gave a brief background of his employment history. He stated that he looks forward to working for the Board and providing members with innovative projections, budgets and investment opportunities, and with comprehensive bookkeeping using his extensive computer background.

 

AGENDA ITEM 6

Consideration of Request from the Federation of State Medical Boards for Support for Adoption of the Model Act. "An Act to Regulate the Practice of Medicine Across State Lines"

Dr. Scully advised that the Board must give some direction to Dr. Buchwald regarding its position concerning the Federation of State Medical Boards' proposed telemedicine model act, as she is the Board's voting delegate for the Federation's Annual Meeting and will be involved in discussion of the model act.

Mr. Lessly gave a brief background surrounding the telemedicine issue, stating that Nevada is currently one of the states with the most stringent telemedicine laws. He summarized the Federation's model act, stating that it proposes that states issue "limited" licenses to physicians which would allow them to practice telemedicine from another state to the issuing state. He added that the model act proposes that eligibility for such licensure would be on a reciprocity basis, in which the applicant's "good standing" in a state where they hold full licensure would be the only criteria required for the issuance of a telemedicine license.

Mr. Lessly stated that the Board is required by statute to ensure that all applicants for licensure meet certain requirements and added his feeling that applicants for telemedicine licensure should be required to meet the same statutory requirements as applicants for full licensure. Dr. Nagy added that the Board's mandate is to protect the health, safety, and welfare of the citizens of Nevada, and he feels that holding two different standards for licensure eligibility would not fulfill this mandate. Dr. Scully expressed his agreement that the model act's proposal for telemedicine licensure based on reciprocity is too lenient.

Dr. Baggett made the suggestion that a condition for the practice of telemedicine be that a patient's local physician be required to be physically present during his or her patient's telemedicine consultation by a telemedicine licensee. Mr. Legarza expressed his support of Dr. Baggett's suggestion that each telemedicine licensee be required to have a fully licensed Nevada physician responsible for his or her practice of telemedicine to Nevada.

Dr. Scully directed Mr. Legarza to draft a letter from the Board to James R. Winn, M.D., Executive Vice President of the Federation of State Medical Boards, in anticipation of telemedicine discussion at the Federation's annual meeting, expressing the Board's position that:

1) The State of Nevada does not grant reciprocity for the practice of medicine and would be opposed to any licensing exception in the area of telemedicine by allowing reciprocity for the practice of telemedicine in Nevada; and

2) In telemedicine situations across state lines where the intent is to provide the patient with additional expertise, some consideration should be given to a requirement that the patient's physician in the recipient state - the patient's physical location - be present and participate in the treatment and care of the patient.

Dr. Scully directed Dr. Buchwald to express at the Federation's annual meeting the Board's position that telemedicine licensure in Nevada is necessary, however, Nevada will determine the requirements and parameters for the licensure.

 

AGENDA ITEM 7

Investigative Committee Report - M. Nafees Nagy, M.D., Chairman

Mrs. Lyons distributed for members' review copies of the 1995 Investigative Committee Statistical Report prepared by Kathy Shapland, Investigative Support Assistant.

 

AGENDA ITEM 12

Executive Director's Report - Larry D. Lessly

12 (g) Discussion of Federation of State Medical Boards' Annual Statistical Press Release

Mr. Lessly distributed copies of the Federation of State Medical Boards' 1995 Disciplinary Statistical Report and advised that the Nevada Medical Board ranked fourteenth in the nation for the most disciplinary actions taken during 1995.

 

AGENDA ITEM 7 (continued)

Investigative Committee Report - M. Nafees Nagy, M.D., Chairman

Dr. Nagy distributed the listing of recommended cases for closure from the March 29, 1996 Investigative Committee Meeting for members' review, and asked that a vote be taken to close the cases.

Mr. Rosencrantz moved to close the cases recommended for closure by the Investigative Committee. Dr. Buchwald seconded the motion, and it passed unanimously.

 

AGENDA ITEM 8

Secretary-Treasurer's Report - M. Nafees Nagy, M.D.

Mr. Lessly distributed copies of the Account Balances Report as of 3/31/96, and the Income/Expense and Budget Reports for 7/1/95 through 3/31/96. Dr. Nagy reviewed the reports with members and advised that the Board is currently under budget by $30,000 per month. He stated that Mr. Frantz, the Board's new bookkeeper, will be investigating new avenues for the investment of Board funds so as to improve Board income through savings investments.

Mr. Lessly reported that the $19, 000± under the computer category of the Board's budget will be spent on the approved new computer hardware and software for the Board offices by June 30, 1996. He added that the cabling for the Reno office computers has already been installed.

 

AGENDA ITEM 10

Setting of Additional Board Business Meeting in Mid-Summer 1996 - Thomas J. Scully, M.D., President

Dr. Scully stated that members should already be aware of the additional 1996 Board meeting scheduled for July 19, 1996, as Mrs. Lyons has already contacted members concerning the meeting. He advised that the new public and physician members should be appointed by that time, and will be attending the meeting. He stated that the following items will be on the agenda for the July meeting:

1)         Issues for the 1997 Legislative Session;

2)         Discussion of the Board's Diversion Program;

3)         Setting of the 1997-1999 Registration Fee; and

4)         Investigative/Legal Training Session.

 

AGENDA ITEM 11

Legal Report - Richard J. Legarza, General Counsel

Jan J. Cohen, Senior Deputy Attorney General

11 (a) Consideration of Monitoring Fee Policy

Mr. Legarza advised the Board not to adopt a policy specifying probationary monitoring fee amounts to be imposed by the Board in its disciplinary actions. He stated that NRS Chapter 630 sets out the sanctions which can be imposed by the Board and the setting of monitoring fee amounts may take away from the Board's discretionary ability to impose those sanctions. After some discussion, it was decided by consensus to take Mr. Legarza's advice.

11 (b) Status of Petition for Judicial Review - Warren S. Gilbert, M. D.

Mr. Legarza reported that he has filed a Record on Appeal and Dr. Gilbert's attorney has twenty more days to file Points and Authorities in the matter.

11 (c) Status of Federal Court Complaint - McGelvey vs. Patricia R. Perry

Mr. Legarza briefed the Board concerning this matter which involves a lawsuit against Patricia R. Perry, former Executive Director of the Board, by a Nevada prison inmate which alleges that Mrs. Perry violated the law by not revoking the license of Kim A. Adamson, M.D. when he allegedly prescribed drugs during the period of his summary suspension of licensure. Mr. Legarza advised that Vicki L. Knopf, Board Investigator, investigated the matter and found the allegations to be false. He added that he has filed a Motion to Dismiss and a Motion for Summary Judgement in the matter.

 

RECESS

The meeting recessed at 6:30 p.m.

 

Saturday, March 30, 1996

The meeting was reconvened by the Board President, Thomas J. Scully, M.D., at 8:30 a.m.

PRESENT: Thomas J. Scully, M.D., President; Susan S. Buchwald, M.D., Vice President; M. Nafees Nagy, M.D., Secretary-Treasurer; Rex T. Baggett, M.D.; Dipak K. Desai, M.D.; Kathleen L. Ebner; Arne D. Rosencrantz; Paul A. Stewart, M.D.

ABSENT: Victor Scaramosino

STAFF PRESENT: Larry D. Lessly, Executive Director; Maureen E. Lyons, Administrative Assistant; Richard J. Legarza, General Counsel; Charles J. Romanolo, Diversion Program Compliance Specialist; Lana L. Millard, Receptionist/License Specialist

ALSO PRESENT: Jan J. Cohen, Senior Deputy Attorney General; C. Robert Vanselow, P.A.-C, Representative, Physician Assistant Advisory Committee to the Board

 

AGENDA ITEM 11   (continued)

Legal Report - Richard J. Legarza, General Counsel

Jan J. Cohen, Senior Deputy Attorney General

11 (d) Status of Petition for Judicial Review - Harriston Lee Bass. Jr. M. D.

Ms. Cohen advised that this matter has been adjudicated in favor of the Board. Mr. Lessly advised that Dr. Scully has signed the letter of reprimand to Dr. Bass, which will be published in the Board's newsletter.

11 (e) Status of Ninth Circuit Court Review - Alan J. Mishler, M.D.

Ms. Cohen advised that the current issue in this matter to be argued is whether Dr. Mishler was prohibited discovery during the hearing of the Board's Complaint against him as to the Board's alleged bias against him.

11 (f) Remand Hearing Update - Harriston Lee Bass Jr. M .D.

Ms. Cohen advised that she hopes to set a hearing date in this matter for sometime during the summer of 1996 - perhaps in August.

 

AGENDA ITEM 12

Executive Director's Report - Larry D. Lessly (continued)

12 (h) Review and Approval of Board Newsletter - April 1996_ Edition

Mr. Lessly stated that he had distributed copies of the April 1996 newsletter to members during a meeting break this morning and asked for any comments or suggested changes.

After some discussion, Dr. Nagy moved to approve the April 1996 newsletter for distribution. Mr. Rosencrantz seconded the motion, and it passed unanimously.

12 (i) Review of Federation of Sate Medical Boards' Ad Hoc Committee Report on Physician Impairment

Mr. Lessly stated that he placed this material in the agenda books for members' review and information, only.

 

AGENDA ITEM 4

Approval of Retention of Legal Counsel for Legislative Matters

Dr. Scully advised that the Board needs consider assistance for the 1997 Legislative Session as it begins in just nine months and added that Mr. Lessly has recommended the retention of Robert R. Barengo for such purpose.

Mr. Lessly introduced Mr. Barengo and advised that he invited him to the meeting to respond to any questions. He stated that Mr. Barengo has a history of representation of clients in the health care industry, and would actively protect the Board's best interest and keep the Board properly advised during the 1997 Legislative Session.

Mr. Barengo responded to several questions from members, and advised that he does not feel that his past and present work experience would cause any conflicts with his working for the Board.

Dr. Nagy moved to retain Mr. Barengo as legislative counsel beginning in January 1997 for not more than $3,000 per month, plus any additional fees for any singular specific assignments from the Board such as assistance with the drafting of proposed legislation which assistance is required as soon as possible. Dr. Baggett seconded the motion, and it passed unanimously.

 

AGENDA ITEM 9

Diversion Program Report - Charles J. Romanolo, Diversion Program Compliance Specialist

Mr. Romanolo referred members to his Diversion Program Statistical Report for August 1995 through March 29, 1996. He advised that since this report, he has had one additional physician relapse and has referred another physician to the Investigative Committee, which Committee filed a Complaint against the physician and recommended to the Board summary suspension of licensure pending hearing. The Board subsequently suspended this physician's license pending hearing set for May 22, 1996.

Mr. Romanolo reviewed statistics for members and responded to questions. He advised that he will be sending a "reminder (collections) letter" with his invoices this quarter to those program participants who are in arrears in paying their monitoring fees.

Dr. Scully asked whether the task of urine collections is becoming overwhelming for Mr. Romanolo. Mr. Romanolo responded that this task takes much of his time, especially since many of the aftercare programs require urines to be taken twice each month. He advised that he may require help with this task on a case-by-case basis in the near future.

 

AGENDA ITEM 13

Adjudication

- BME vs. Karl William Meisenheimer, M.D., Case No. 95-5131-2

A Court Reporter was in attendance to record this Agenda Item.

Adjudicating members, Dr. Scully, Chairman, Dr. Buchwald, Dr. Desai and Mr. Rosencrantz, found Dr. Meisenheimer guilty of both counts one and two of the Complaint in case no. 95­5131-2. Dr. Desai moved to suspend Dr. Meisenheimer's license for a period of thirty days, fine him $2,000, charge him $2,000 to cover administrative and investigative costs in bringing the Complaint against him, issue him a public written reprimand, and order him to perform forty hours of community service, which service to be designated by the Investigative Committee of the Board.

(Please refer to the Court Reporter's transcript for further detail.)

 

AGENDA ITEM 17

Ratification of Licenses Issued. Status Changes & Reinstatements

Mrs. Ebner moved to ratify the licenses issued, and the license status changes and reinstatements made since the February 1996 Board meeting. Dr. Desai seconded the motion, and it passed unanimously.

 

AGENDA ITEM 18

Matters for Future Agendas

Mr. Lessly asked members to consider for discussion at the July Board meeting the following recommendations for possible proposed legislation for the 1997 Legislative Session:

Sec. 1

NRS 630.110 is hereby amended to read as follows:

630.110 Compensation of members and employees; deposit of money received by board.

1. Out of the money coming into the possession of the board, each member and advisory member of the board is entitled to receive;

(a) A salary of not more than $80 per day, as fixed by the board, while engaged in the business of the board; and

(b) A per diem allowance and travel expenses at a rate fixed by the board, while engaged in the business of the board. The rate must not exceed the rate provided for state officers and employees generally.

2. While engaged in the business of the board, each employee of the board is entitled to receive a per diem allowance and travel expenses at a rate fixed by the board. The rate must not exceed the rate provided for state officers and employees generally.

3. Expenses of the board and the expenses and salaries of its members and employees must be paid from the fees received by the board pursuant to the provisions of this chapter, and no part of the salaries or expenses of the board may be paid out of the state general fund or from the penalties imposed by the board pursuant to this chapter.

4. All money received by the board from:

(a) Fees must be deposited in financial institutions in this state which are federally insured, invested in United States treasury bills or notes. or deposited in institutions in this state whose business is the making of investments.

(b) Penalties must be deposited with the state treasurer for credit to the state general fund.

Sec. 2

NRS 630.160 is hereby amended to read as follows:

630.160 Requirements for license to practice medicine.

1. Every person desiring to practice medicine must, before beginning to practice, procure from the board a license authorizing him to practice.

2. Except as otherwise provided in NRS 630.161 or 630.164, a license may be issued to any person who:

(a) Is a citizen of the United States or is lawfully entitled to remain and work in the United States;

(b) Has received the degree of Doctor of Medicine from a medical school;

(1) Approved by the Liaison Committee for Medical Education of the American Medical Association and American Association of Medical Colleges; or

(2) Which provides a course of professional instruction equivalent to that provided in medical schools in the United States approved by the Liaison Committee for Medical Education[which he attended for a total of 2 years immediately preceding the granting of the degree];

(c) Has passed;

(1) All parts of the examination given by the National Board of Medical Examiners;

(2) All parts of the Federation Licensing Examination;

(3) All parts of the United States Medical Licensing Examination;

(4) All parts of a licensing examination given by any state or territory of the United Sates, if the applicant is certified by a specialty board of the American Board of Medical Specialties;

(5) All parts of the Licentiate of the Medical Council of Canada examination; or

(6) Any combination of the examinations specified in subparagraphs (1), (2) and (3) that the board determined to be sufficient;

(d) Has completed 3 years of:

(1) Graduate education as a resident in the United States or Canada in a program approved by the board, the Accreditation Council for Graduate Medical Education of the American Medical Association or the Coordinating Council of Medical Education of the Canadian Medical Association; or

(2) Fellowship training in the United States or Canada approved by the board or the Accreditation Council for Graduate Medical Education; and

(e) (Appears personally before the board and) satisfactorily passes a written or oral examination, or both, as to his qualifications to practice medicine and provides the board with a description of the clinical program completed demonstrating that the applicant's clinical training met the requirements of paragraph (b) of this subsection.

Sec. 3

NRS 630.165 is hereby amended to read as follows:

630.165 Application and affidavit for license; additional requirements; burden of proof; appearance for examinations.

1. Any applicant for a license to practice medicine shall submit to the board, on a form provided by the board, an application in writing, accompanied by an affidavit stating that:

(a) The applicant is the person named in the proof of graduation and that it was obtained without fraud or misrepresentation or any mistake of which the applicant is aware; and

(b) The information contained in the application and any accompanying material are complete and correct.

2. In addition to the other requirements for licensure, the board may require further evidence of the mental, physical, medical or other qualifications of the applicant it considers necessary.

3. The applicant bears the burden of proving and documenting his qualifications for licensure.

[4. If an applicant does not appear for two consecutive examinations after receiving notification by the board that his application is complete, the board shall reject the application.]

Sec. 4

NRS 630.255 is hereby amended to read as follows:

630.255 Inactive licensees: Leaving state; ceasing or failing to practice; reinstatement.

1. Any licensee who changes the location of his practice of medicine from this state to another state or country, has never engaged in the practice of medicine in this state after licensure or has ceased to engage in the practice of medicine in this state for 12 consecutive months [must] may be placed on inactive status by order of the board.

2. Before resuming the practice of medicine in this state, the inactive registrant shall:

(a) Notify the board of his intent to resume the practice of medicine in this state;

(b) File an affidavit with the board describing his activities during the period of his inactive status;

(c) Complete the form for registration for active status;

(d) Pay the applicable fee for biennial registration; and

(e) Satisfy the board of his competence to practice medicine.

3. If the board determines that the conduct or competence of the registrant during the period of inactive status would have warranted denial of an application for a license to practice medicine in this state, the board may refuse to place the registrant on active status.

Sec. 5

NRS 630.273 is hereby amended to read as follows:

630.273 Physician's assistant: Issuance and conditions of certificate.

1. The board may issue a certificate to an applicant who is qualified under the regulations of the board to perform medical services under the supervision of a supervising physician. The application for a certificate as a physician's assistant must be cosigned by the supervising physician.[, and the certificate is valid only so long as that supervising physician employs and supervises the physician's assistant].

2. A supervising physician shall not cosign for, employ or supervise more than one physician's assistant at the same time, except that in a township whose population is less than 16,000, he may supervise two physician's assistants at the same time.

Sec. 6

NRS 630.301 is hereby amended to read as follows:

630.301 Grounds for initiating disciplinary action or denying licensure: Criminal offenses; suspension or other modification of previous license; surrender of previous license while under investigation; gross or repeated malpractice. The following acts, among other, constitute grounds for initiating disciplinary action or denying licensure:

1. Conviction of a felony, any offense involving moral turpitude or any offense relating to the practice of medicine or the ability to practice medicine. A plea of nolo contendere is a conviction for the purposes of this subsection.

2. Conviction of violating any of the provisions of NRS 616.630, 616.635, 616.640 or 616.675 to 616.700, inclusive.

3. The suspension, modification or limitation of the license to practice any type of medicine by any other jurisdiction or the surrender of the license or discontinuing the practice of medicine while under investigation by any licensing authority, a medical facility, a branch of the armed services of the United States, an insurance company, an agency of the Federal Government or an employer.

4. Gross [or repeated] malpractice or malpractice, which may be evidenced by claims [of malpractice] settled against a practitioner.

Sec. 7

NRS 630.352 is hereby amended to read as follows:

630.352 Notification of disposition of charges; board may provide physician with copy of complaint; disciplinary actions available to board.

1. Any member of the board, except for an advisory member serving on a panel of the board hearing charges, may participate in the final order of the board. If the board, after a formal hearing, determines from clear and convincing evidence that a violation of the provisions of this chapter or of the regulations of the board has occurred, it shall issue and serve on the physician charged an order, in writing, containing its findings and any sanctions.

2. If the board determines that no violation has occurred, it shall dismiss the charges, in writing, and notify the physician that the charges have been dismissed. If the disciplinary proceedings were instituted against the physician as a result of a complaint filed against him, the board may provide the physician with a copy of the complaint, including the name of the person, if any, who filed the complaint.

3. Except as otherwise provided in subsection 4, if the board finds that a violation has occurred, it may by order:

(a) Place the person on probation for a specified period on any of the conditions specified in the order;

(b) Administer to him a public reprimand;

(c) Limit his practice or exclude one or more specified branches of medicine from his practice;

(d) Suspend his license for a specified period or until further order of the board;

(e) Revoke his license to practice medicine;

(f) Require him to participate in a program to correct alcohol or drug dependence or any other impairment;

(g) Require supervision of his practice;

(h) Impose a fine not to exceed $5,000;

(i) Require him to perform public service without compensation;

(j) Require him to take a physical or mental examination or an examination testing his competence; [and]

(k) Require him to fulfill certain training or education requirements: and

(1) Require him to pay all costs incurred by the board relating to the discipline of the person.

4. If the board finds that the physician has violated the provisions of NRS 439B.425, the board shall suspend his license for a specified period or until further order of the board.

Sec. 8

Chapter 630 of NRS is hereby amended by adding thereto a new section to read as follows:

630. Contempt. If any person in proceedings before the board disobeys or resists any lawful order or refuses to respond to a subpoena. or refuses to take the oath or affirmation as a witness or thereafter refuses to be examined, or is guilty of misconduct during a hearing or so near the place thereof as to obstruct the proceeding. the board shall certify the facts to the district court of the county where the proceeding is being conducted. The court shall thereupon issue an order directing the person to appear before the court and show cause why he should not be punished as for contempt. The order and a copy of the certified statement shall be served on the person. Thereafter the court shall have jurisdiction of the matter. The same proceedings shall be had, the same penalties may be imposed and the person charged may purge himself of the contempt in the same way. as in the case of a person who has committed a contempt in the trial of a civil action.

Dr. Scully directed that these proposals be detailed in the minutes of this meeting so that members can review them in preparation for the July meeting's legislative discussion.

 

AGENDA ITEM 14

Consideration of Request for Temporary Licensure

- Neil Robertson Mackenzie Buist, M.D.

Rebecca A. Gaul, License Specialist, appeared for this agenda item.

Mr. Lessly advised that Dr. Buist had initially applied for licensure in October 1994, to work for the State of Nevada Health Division to provide consultation services to Nevada children with metabolic disorders. At that time, he was informed by Board staff that he would be required to take and pass SPEX to be eligible for permanent licensure. At the request of the Health Division, the Board issued a temporary license to Dr. Buist on January 23, 1995, to practice medicine in the medically underserved area of Pediatric Metabolism and Medical Genetics, with the understanding that during the term of his temporary license he would sit for the SPEX. The term of Dr. Buist's temporary license was the longest term of any temporary license ever issued by the Board and expired on February 9, 1996. Dr. Buist has not taken the SPEX and is requesting the Board's consideration of issuing him another temporary license so that he may return to his work for the Health Division.

Dr. Buist appeared with Judith Wright of the Health Division and stated that he is present at the request of the Health Division. Dr. Nagy asked Dr. Buist why he did not take the SPEX. Dr. Buist stated that it is not to his advantage to take the SPEX and the examination has nothing to do with his specialty. Dr. Scully advised Dr. Buist that Nevada does not license by specialty. Dr. Buist stated that since it is Nevada which needs him and not vice versa, he feels he should not have to put himself out by taking the SPEX. Dr. Nagy stated his feeling that Dr. Buist is willfully refusing to take the SPEX and is, therefore, shunning Nevada law. Mr. Lessly asked Dr. Buist whether he would consider taking the SPEX if the Board offered to issue him a temporary license for a specified term in which for him to do so. Dr. Buist stated that he would think about it and thanked the Board for its time.

Mr. Legarza advised that per statute, temporary licenses are not renewable and Dr. Buist is ineligible for any type of licensure unless he takes and passes the SPEX or any American Board of Medical Specialties certification examination. Mr. Lessly stated that Mrs. Gaul has put together a listing of 24 metabolic specialists in California. Dr. Nagy directed that the Health Division be provided that list. Dr. Baggett stated his feeling that at this point the Board has exhausted all possible avenues by which it could assist the Health Division.

Mr. Lessly was directed to draft a letter to the Health Division concerning the circumstances surrounding Dr. Buist's ineligibility for Nevada permanent and temporary licensure and his failure to take the SPEX, and to enclose with the letter a copy of Mrs. Gaul's listing of metabolic specialists.

 

RECESS

The meeting recessed for lunch at 12:00 p.m.

The meeting reconvened at 12:45 p.m.

 

AGENDA ITEM 15

Review of Controlled Substance Prescribing by Physician Assistants as Authorized by 1995 Legislature

Dr. Scully confirmed with members that they had reviewed the minutes from the 1995 Legislative session, distributed earlier in the meeting, pertaining to the adoption of the law allowing controlled substance prescribing by physician assistants. He introduced Keith Macdonald, Executive Secretary for the Nevada State Board of Pharmacy, Dr. Paul Dieringer, incoming President of the Nevada State Medical Association, and Larry Matheis, Executive Director of the Nevada State Medical Association.

Mr. Macdonald briefly explained the Pharmacy Board's schedules of drugs, and defined various narcotics and amphetamines. He advised that physician assistants who prescribe any type of medication are required to be licensed by the DEA and by the Nevada State Board of Pharmacy and may only do so under the supervision of a physician per NRS Chapter 630. He added that a physician assistant is limited to prescribing those drugs which his supervising physician is limited to prescribe.

Mr. Vanselow described the physician assistant/ supervising physician relationship as a "living dynamic process" and gave a history of physician assistant prescribing to date, stating that he was responsible for drafting the language for the legislation which eventually passed allowing controlled substance prescribing by physician assistants.

Dr. Dieringer stated that it is his and the Nevada State Medical Association's opinion that the new law allowing controlled substance prescribing by physician assistants is not an attempt on the part of physician assistants to begin practicing independently of their supervising physicians.

Mr. Matheis stated that he feels that there is a false "perception" being created by this new law concerning controlled substance prescribing by physician assistants. He explained that he feels the new law creates the perception that physician assistants are now able to act independently of their supervising physicians. He stated that he feels some sort of enforcement procedure to ensure that physician assistants are not acting independently needs to be implemented to alleviate this perception.

After some discussion, Dr. Scully directed that the Board's "Application for Approval as Supervising Physician" form be re-drafted by Mr. Legarza in a manner which more strongly defines and reinforces a supervising physician's responsibility to the Board and for his physician assistant, and that letters be drafted and sent to all physician assistants and supervising physicians specifically advising them of the laws concerning controlled substance prescribing by physician assistants.

 

AGENDA ITEM 16

Acceptance of Applications for Licensure - Appearances

open session

16(o) Attila Somosheavi-Szokol. M.D.

Attila Somoshegyi-Szokol, M.D. appeared before the Board with Mr. Romanolo and Dr. F. Victor Rueckl, consultant to the Board's Diversion Program. Dr. Scully stated that after expiration of Dr. Szokol's temporary license in January 1995, he entered the Talbot-Marsh Treatment Program in Georgia due to his relapse of alcohol abuse in Nevada. He advised that Dr. Szokol transferred to St. Jude's Recovery Center in Atlanta, in February 1995 and readmitted to Talbot-Marsh in June 1995, where he successfully completed his treatment and was discharged in July 1995. Dr. Scully added that since his discharge from Talbot-Marsh, Dr. Szokol has been participating in a recovery program and living in California. He advised that Dr. Szokol is appearing before the Board for consideration of his application for licensure as he has been offered a position at the Northern Nevada Correctional Center in Carson City.

Dr. Rueckl stated that he feels that Dr. Szokol truly wants to remain in recovery at this time and understands that if he ever again abuses any substance he is through with medicine in Nevada. He added that he supports Dr. Szokol's request for restricted licensure to work under Michael P. Fitting, D.O. at the Northern Nevada Correctional Center in Carson City.

Dr. Szokol stated that he is in recovery, attends daily AA meetings with his sponsor, participates twice weekly in intensive aftercare in Oakland, California and meets with his psychologist once each week. He advised that he last treated a patient in January 1995 during the term of his temporary Nevada licensure, while working at the Northern Nevada Correctional Center in Carson City. He stated that he understands that this is his last chance for a medical career and requested the Board's consideration to grant him licensure.

After some discussion, Dr. Nagy moved to grant Attila Somoshegyi-Szokol, M.D. a restricted license to practice medicine in Nevada under the following terms and conditions:

1) ...that he work only at the Northern Nevada Correctional Centers in Carson City and Lovelock under the supervision of Michael P. Fitting, D.O.;

2) ...that he work only eight hours per day, Monday through Friday;

3) ...that he not work on Saturday or Sunday;

4) ...that he not work any night shifts;

5) ...that he reside in Reno and commute home to Reno each day following his work shift; and

6) ...that he comply with all of the terms of his agreement/contract with the Board's Diversion Program.

Dr. Desai seconded the motion, and it passed unanimously.

Dr. Nagy moved to go into Executive Session to discuss the character and professional competence of applicants for licensure. The motion was seconded by Dr. Buchwald, and passed unanimously.

Executive session

16 (j) Ernest Sullivent. M.D.

Upon returning to Open Session, Dr. Desai moved to accept Ernest Sullivent, M.D.'s two months non-ACGME approved postgraduate training in Aeromedicine along with his 35 months ACGME approved postgraduate training as meeting the three-year postgraduate training requirements for licensure and to accept his application for licensure contingent upon his entering into a formal contract with the Board's Diversion Program. Dr. Nagy seconded the motion, and it passed unanimously.

Dr. Desai moved to return to Executive Session. Dr. Buchwald seconded the motion, and it passed unanimously.

16 (k) Ronald Gemberlina, M.D.

Upon returning to Open Session, Dr. Buchwald moved to accept the application for licensure of Ronald Gemberling, M.D. Dr. Desai seconded the motion, and it passed unanimously.

Dr. Stewart moved to return to Executive Session. Dr. Nagy seconded the motion, and it passed unanimously.

16 (1) Willifred Campbell, M.D.

Upon returning to Open Session, Dr. Nagy moved to accept the application for licensure of Willifred Campbell, M.D. Dr. Desai seconded the motion, and it passed unanimously.

Dr. Baggett moved to return to Executive Session. Dr. Desai seconded the motion, and it passed unanimously.

16 (m) Candice Lane M.D.

Upon returning to Open Session, Dr. Nagy moved to accept the application for licensure of Candice Lane, M.D. Dr. Buchwald seconded the motion, and it passed unanimously.

open session

16 (n) Brian Rees. M.D.

Brian Rees, M.D. appeared before the Board due to his affirmative response to question #16 on his application for licensure indicating that he was a defendant in a malpractice suit.

Dr. Rees explained the circumstances surrounding the malpractice suit in which he was named a defendant. He advised that he is currently living in Los Angeles, California and may be moving to Nevada to consult in natural preventive medicine. He explained that he has received training in herbal medicines in India and Iowa, and has begun introducing East Indian herbal medicine into his allopathic practice. Upon questioning from Dr. Nagy, Dr. Rees confirmed that he is not planning to open a clinic in Las Vegas for homeopathic purposes, but will be acting as a consultant to transcendental meditation centers there.

Dr. Buchwald moved to accept the application for licensure of Brian Rees, M.D. Mrs. Ebner seconded the motion, and it passed unanimously.

16 (p) Bradley Thomas. M.D.

Bradley Thomas, M.D. appeared before the Board due to his affirmative response to question #16 on his application for licensure indicating that he was a defendant in a malpractice suit.

Dr. Thomas explained the circumstances surrounding the malpractice suit in which he was named a defendant. He advised that he is currently employed at Truckee Hospital and would like to begin working at its affiliate hospital in Incline Village, which necessitates his obtaining Nevada licensure.

Dr. Nagy moved to accept the application for licensure of Bradley Thomas, M.D. Dr. Desai seconded the motion, and it passed unanimously.

16 (q) Frederick Goll. III. M.D.

Frederick Goll, III, M.D. appeared before the Board due to his affirmative response to question #18 on his application for licensure indicating that he was arrested for a motor vehicle violation in October 1994.

Dr. Goll explained the circumstances surrounding his arrest, stating that he was speeding in a 35 MPH zone and crossed the center line. He stated that he was originally charged with OWI (operating a motor vehicle while intoxicated), but the charge was later reduced to reckless operation of a motor vehicle. He advised that he plead guilty to the charge of reckless operation and paid a $500 fine plus court costs.

Dr. Goll advised that he has never received any disciplinary action against any medical or residency license he has ever held in any state. He added that he does not abuse alcohol.

Dr. Nagy asked Dr. Goll whether he would be willing to enter into a contract with the Board's Diversion Program, should such a contract be found necessary after an evaluation by the program. Dr. Goll stated that he would be willing to undergo an evaluation and enter into such a contract if necessary.

Dr. Nagy moved to accept Dr. Frederick Goll's application for licensure under the conditions as discussed. Dr. Desai seconded the motion, and it passed unanimously.

Dr. Scully advised Dr. Goll that Mr. Romanolo would be in contact with him once he has located himself in Nevada.

 

ADJOURNMENT

Dr. Desai moved to adjourn the meeting. Mr. Rosencrantz seconded the motion, and it passed unanimously.

The meeting adjourned at 3:25 p.m.