1 BEFORE THE STATE BOARD OF MEDICAL EXAMINERS

2 FOR THE STATE OF NEVADA

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7 TRANSCRIPT OF PROCEEDINGS

8 Saturday, August 28, 1999

9 Reno, Nevada

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Reported by: REBECCA BRUCH, CSR #258, RPR, RMR, RDR

25 Computer-Aided Transcription

DISCOVERY REPORTING (702)329-3500

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1 APPEARANCES:

2 The Panel: Arne D. Rosencrantz - President

Dipak K. Desai, M.D.

3 Paul A. Stewart, M.D.

Joel N. Lubritz, M.D.

4 John Lanzillota, PA-C

Cheryl Hug-English, M.D.

5 Jaculine C. Jones, Ed.D.

Donald H. Baepler, Ph.D.

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7 For the Panel: LESLIE NIELSEN, ESQ.

Deputy Attorney General

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For the Board: RICHARD LEGARZA, ESQ.

9 General Counsel

1105 Terminal Way

10 Reno, Nevada

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13 I_N_D_E_X

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14 Matter of Nir Lorant, M.D. 3

15 Matter of Ronald Rosen, M.D. 9

16 Matter of Louis Emeterio, M.D. 19

17 Chapter 630 of Nevada Administrative Code 28

18 Acceptance of Applications for Licensure

Federico Gregorio, M.D. 31

19 Phillip Halvorsen, M.D. 35

William Harrison, M.D. 38

20 Paul Navar, M.D. 49

Carolyn Simmons, M.D. 53

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1 RENO, NEVADA; SATURDAY, AUGUST 28, 1999; 10:30 A.M.

--o0o--

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3 MR. ROSENCRANTZ: This is Agenda Item Number 9, the

4 adjudication in the matter of the Nevada State Board of Medical

5 Examiners versus Nir Lorant, M.D., Case Number 99-12175-1. I

6 think we need to take the roll of the adjudicating board

7 members: Myself, Arne Rosencrantz, president; Dr. Buchwald is

8 not here; Paul Stewart?

10:48A 9 DR. STEWART: Here.

10 MR. ROSENCRANTZ: Cheryl Hug-English?

11 DR. HUG-ENGLISH: Here.

12 MR. ROSENCRANTZ: Donald Baepler?

13 DR. BAEPLER: Here.

14 MR. ROSENCRANTZ: And Rex Baggett or replacement is

15 not here, but I do believe we have a quorum--

16 DR. LUBRITZ: Do I have to leave?

10:53A 17 MR. ROSENCRANTZ: I don't think so, Joel.

18 I assume that all the members of this adjudicating

19 committee have had the opportunity to read the record; is that

20 true?

21 It is.

22 And at this point we will identify the charges by

23 code. Violation of NRS 630.304, attempting to obtain a license

24 to practice medicine by fraud or misrepresentation or by false,

25 misleading, inaccurate or incomplete statements, a violation of

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1 NRS 630.304; and the second one, NRS 630.306(2)(a), that is

2 correspondent answered no on the application thereby engaging in

3 conduct intended to deceive, a violation of NRS 630.306(2)(a).

4 All of you having an opportunity to read the

5 material, we'll open this up now for discussion of the charges.

10:54A 6 DR. HUG-ENGLISH: In reading through it, it's very

7 clear to me that he had knowledge of the case in California

8 prior to his licensing in Nevada and that he still chose to

9 check that box on question 11 as no.

10:55A 10 MR. ROSENCRANTZ: Any further discussion? Anybody

11 else have anything they would like to add?

12 I agree with you, Dr. English, that it's seemingly

13 very apparent that he should have known and he still answered

14 no.

15 DR. STEWART: I think the question is easily

16 understandable in English, and I think that although the record

17 is replete with counsel's explanation of phone calls and didn't

18 understand what it meant, that it is a straightforward question,

19 he could have answered straightforwardly.

10:56A 20 MR. ROSENCRANTZ: We have two counts, Count 1 and

21 Count 2, and we need-- if there isn't any further discussion, we

22 need a motion individually on Count 1 and Count 2.

23 DR. HUG-ENGLISH: I would move that we find him

24 guilty in Count 1.

25 DR. BAEPLER: I'll second that.

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1 MR. ROSENCRANTZ: We have a motion and a second.

2 Any further discussion on it? If not, all in favor-- we'll do

3 this by roll call. Dr. Hug-English.

4 DR. HUG-ENGLISH: Yes, in favor.

5 MR. ROSENCRANTZ: Dr. Baepler.

6 DR. BAEPLER: Yes.

7 MR. ROSENCRANTZ: Paul Stewart, Dr. Stewart.

8 DR. STEWART: Yes.

10:25P 9 MR. ROSENCRANTZ: And myself votes yes as well.

10 Count 2.

11 DR. HUG-ENGLISH: I would move that we find him

12 guilty on Count 2.

13 DR. BAEPLER: I'll second that.

14 MR. ROSENCRANTZ: We have a motion and a second.

15 Any discussion?

16 All those in favor of that indicate by saying yes.

17 Dr. Hug-English.

18 DR. HUG-ENGLISH: Yes.

19 MR. ROSENCRANTZ: Dr. Stewart.

20 DR. STEWART: Yes.

21 MR. ROSENCRANTZ: Dr. Baepler.

22 DR. BAEPLER: Yes.

23 MR. ROSENCRANTZ: Chair votes in favor of yes, so

24 Count 1, Count 2, Dr. Lorant has been found guilty.

25 Now we move to the sanction phase of the

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1 adjudication, and attorney Mr. Legarza for the board has

2 suggested that we revoke Dr. Lorant's license to practice

3 medicine in the State of Nevada. There are other sanctions that

4 we can use. We can place the person on probation for a

5 specified period on any of the conditions specified; administer

6 to him a public reprimand; limit his practice or exclude one or

7 one or more specified branches of medicine from his practice;

8 suspend his license for a specified period or until further

9 order of the board; revoke his license to practice medicine;

10 require supervision of his practice, impose a fine not to exceed

11 $5,000; require him to perform public service without

12 compensation; require him to take a physical or mental

13 examination or an examination testing his competence; require

14 him to fulfill certain training or educational requirements; and

15 require him to pay all costs incurred by the board relating to

16 his disciplinary proceedings. If the board finds that a

17 physician has violated the provisions of NRS 439B.425, the board

18 shall suspend his license for a specified period or until

19 further order of the board.

10:59A 20 So we have those choices. And we can I assume

21 discuss the sanctions.

22 DR. HUG-ENGLISH: Personally, I have some real

23 concerns, and I do agree with the recommendation by our counsel

24 Dick Legarza to revoke his license in the state. I do think

25 that the charges are serious, I think that the charges in the

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1 action in California were serious enough that merited their

2 revocation and probation for five years. I think he knowingly

3 applied for a license knowing that he was under investigation,

4 and I think that that's a serious charge, and I would recommend

5 revocation.

6 DR. BAEPLER: Just a point of procedure here: If a

7 license is revoked, is it irrevocable, is there a stated time

8 interval? What's the custom here? Is a person ever eligible to

9 reapply?

10 MS. NIELSEN: They are eligible under 633.58, they

11 are eligible to reapply.

12 DR. BAEPLER: Was that in the form of a motion?

13 DR. HUG-ENGLISH: Yes, I'll make that motion, that

14 we revoke Dr. Lorant's license in the State of Nevada.

15 DR. BAEPLER: I will second that.

11:00A 16 MR. ROSENCRANTZ: We have a motion and a second.

17 And these-- this motion, Cheryl, applies to both counts?

18 DR. HUG-ENGLISH: That's correct.

11:01A 19 MR. ROSENCRANTZ: We have a motion and second. Any

20 discussion?

21 DR. STEWART: I would state on terms and

22 conditions, so I'll vote against the motion.

23 MR. ROSENCRANTZ: Why don't you tell us what your

24 feelings are, Paul.

25 DR. STEWART: I'd give him five years of probation

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1 with the costs, and community service. And the idea of him

2 being a monitored psychiatrist with a TV camera initially

3 appealed to me, but if I understand the allegations of the State

4 of California this may have occurred on off hours so I don't

5 know how the TV camera watching him with his patients helps.

6 MR. ROSENCRANTZ: Okay. We have a motion. Is

7 there any further discussion? We have a motion and second,

8 we'll take a roll-call vote. All those in favor of the motion

9 of revocation in the State of Nevada, Dr. Hug-English?

10 DR. HUG-ENGLISH: Yes.

11:02A 11 MR. ROSENCRANTZ: Did Stewart?

12 DR. STEWART: No.

13 MR. ROSENCRANTZ: Dr. Baepler?

14 DR. BAEPLER: Yes.

15 MR. ROSENCRANTZ: And the chair votes in favor of

16 the motion, so the motion carries.

17 So we will issue that order, correct?

18 MS. NIELSEN: Correct.

19 That ends the adjudication of Dr. Nir Lorant.

20 (Matter concluded at 11:00 a.m.)

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1 RENO, NEVADA; SATURDAY, AUGUST 28, 1999; 11:05 A.M.

--o0o--

2 MR. ROSENCRANTZ: We are on Number 10,

3 Consideration of Acceptance of Stipulation for Settlement in the

4 Matter of the Nevada State Board of Medical Examiners versus

5 Ronald C. Rosen, M.D., Case Number 99-11976. And we'll take a

6 roll call of the adjudicating members: Arne D. Rosencrantz is

7 present, that's myself. Dr. Stewart?

8 DR. STEWART: Here.

9 MR. ROSENCRANTZ: Cheryl Hug-English?

10 DR. HUG-ENGLISH: Here.

11 MR. ROSENCRANTZ: And Dr. Baepler?

12 DR. BAEPLER: Here.

13 MR. ROSENCRANTZ: And for the record, Susan

14 Buchwald, M.D. and Rex Baggett are not here.

15 We have a stipulation for settlement in the case of

16 Ronald C. Rosen.

17 MR. LEGARZA: You have the stipulation for

18 settlement in your packet; it has been approved by the

19 Investigative Committee. You also have the action that was

20 taken in California, as well as a copy-- I think you've got a

21 copy of our Complaint that you filed. You do.

22 This is an out-of-state action, we proceeded

23 against him primarily on the fact that there was an out-of-state

24 action placing limitation on his file. You see that in the

25 file, I will represent to you that's the same manner that other

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1 similar type of cases have been settled and taken care of in the

2 past. Whether or not you accept this stipulation, of course, is

3 something else again. So I'd recommend that you accept it.

4 DR. BAEPLER: I will so move.

5 DR. HUG-ENGLISH: Second.

11:05A 6 MR. ROSENCRANTZ: Motion and a second. Is there

7 any discussion?

8 Well, I have something.

9 This is an unusual case as I read it inasmuch as

10 the respondent was in the State of Nevada practicing here when

11 the case was filed, Complaint was filed. And there is a clause

12 in the disciplinary order from the State of California,

13 something I don't understand real well, but I'll have

14 Mr. Legarza explain it to us. It's called tolling for

15 out-of-state practice or in-state practice. And I think what it

16 means--if I'm wrong, Dick, please correct me--it means that

17 because he's not practicing in the State of Nevada, that none of

18 the disciplinary order is in effect, after five years he doesn't

19 have to fulfill not one thing, except maybe paying the fee. I

20 think there's one-- he had to pay the fee for the hearing. All

21 the other things, such as ethics courses, billing, monitoring,

22 community service, education courses, he doesn't have to

23 fulfill, he doesn't have to pay back the insurance company after

24 five years. I think it's an unusual situation where we have

25 somebody that was disciplined but isn't going to have to stand

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1 the consequences of discipline in California.

11:06A 2 MR. LEGARZA: You want me to comment on that?

3 MR. ROSENCRANTZ: Sure.

4 MR. LEGARZA: In the stipulation settlement and

5 disciplinary order beginning at page six and going over to page

6 seven, what the president is referring to is tolling for

7 out-of-state practice resident or in-state nonpractice. The

8 language that is in this particular paragraph is language that I

9 have seen since I have been here in every California stipulated

10 settlement with the exception of the language that the president

11 is pointing out, which says-- which is the last sentence. I

12 don't think that I've ever seen this sentence before. And maybe

13 Larry has, I don't know.

14 MR. LESSLY: I have not.

11:07A 15 MR. LEGARZA: During periods of temporary or

16 permanent residence or practice outside California or of

17 nonpractice within California as defined, respondent is not

18 required to comply with any terms or conditions of probation

19 other than the requirement for the payment of cost of recovery

20 as set forth in paragraph 12 below. Now, I have seen plenty of

21 them, and this board has proceeded formally against physicians,

22 many of them on California settlements or other states, but

23 California particularly, that say if you leave the State of

24 California and you are not practicing in the State of

25 California, as this one does say, your probationary period is

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1 tolled, and we're going to put you on probation for five years,

2 but if you go to Nevada next year and you come back to

3 California ten years from now, you've still got four years of

4 probation left. But this particular paragraph I have never

5 seen.

6 Comments: First of all, he was practicing in

7 Nevada at the time this was filed, he was practicing in Nevada

8 at the time it was settled. They got their cost money back from

9 him, as I see it they ordered him to pay back $25,000 to Aetna

10 Casualty and Life Insurance Company, but he doesn't have to do

11 that. I don't know if they just wanted him out of the State of

12 California and he agreed to this or what it is.

13 Mr. Rosencrantz is correct, it's different, he

14 hasn't been sanctioned in California, they have seen fit not to

15 do so except to recover their costs. I've never seen it before,

16 Mr. Rosencrantz. And Larry has indicated that he's never seen

17 that. I don't know what it means except maybe it means they had

18 a really weak case, or they wanted to make sure he stayed in

19 Nevada.

20 DR. STEWART: The description of the case for the

21 pediatric oncologist in their pleadings suggested that it is not

22 a weak case.

11:09A 23 MR. LEGARZA: And there's a lengthy-- several years

24 and several patients of billing for on-call when he's not there,

25 and they ordered him to pay $25,000 back to Aetna Casualty, but

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1 obviously he didn't have to do that, as well as nothing else in

2 there.

3 I will submit I'm not so sure that I agree that has

4 anything to do with what we do with him, but then-- we're not

5 punishing him for what California didn't punish him for.

11:10A 6 MR. ROSENCRANTZ: I guess my question, if this

7 board decided that they wanted the sanctions stronger than they

8 are on the stipulation for settlement that you have offered, if

9 we did not accept this and said, "Mr. Legarza, go back and

10 negotiate with the doctor and the attorney to get a stronger

11 settlement," if we came up with one, is that possible other than

12 going to hearing?

13 MR. LEGARZA: Well, I think that you either accept

14 or reject this settlement agreement. If you reject this

15 settlement agreement, I believe I would want to and would prefer

16 to go to hearing, that doesn't give me any heartburn. I don't

17 think-- I just don't think I want to hear about what I should or

18 should not do with respect to any further settlement. Either

19 accept the stipulation, if that's what you deem appropriate, or

20 reject the stipulation and I will contact the attorney and we

21 will try this case.

22 I mean, how long is it going to take me to try it?

23 Something you think isn't going to take very long and they take

24 forever. I don't know how much I have to fight the merits of

25 this particular case behind the scenes, and, obviously, I don't

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1 have the facts and circumstances surrounding that, but that is a

2 possible at least attempted defense to one of these things. I

3 mean, so it takes a day, so it takes two days, so what. It

4 doesn't give me any heartburn if you reject the settlement

5 agreement.

6 I will tell you the Investigative Committee has

7 approved it, as you well know; I couldn't bring it to you if

8 they didn't.

9 DR. BAEPLER: And you and Investigative Committee

10 were well aware of these stipulations that we just went over?

11:11A 11 MR. LEGARZA: Well, I wasn't aware of the

12 particular stipulation, the last portion of it that

13 Mr. Rosencrantz pointed out with respect to if you go away you

14 don't have to abide by this, but my reaction is so what, my

15 reaction to that is that can tell you a lot of things, that can

16 tell you they had a really weak case, I mean, why are they

17 ordering him to pay $25,000 back to Aetna Casualty and then

18 saying you don't have to pay it, what's going on here. Or they

19 just simply wanted to get rid of the guy but they didn't want to

20 revoke him and they settled the thing. I just don't know.

21 But I think, at least the way I feel about what

22 California did or did not do to him especially, I agree--

23 disagree with the president, what they didn't do to him I don't

24 think-- I don't think we should feel like we should have to make

25 up what may or may not have been their dereliction of duty.

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1 DR. HUG-ENGLISH: You commented just at the

2 beginning that this is consistent with what we have done as a

3 board for similar cases?

11:12A 4 MR. LEGARZA: It is.

5 DR. HUG-ENGLISH: And I think that in my mind needs

6 to be more of what we're concerned with as a board in settling

7 this than what California did in their discipline.

11:13A 8 MR. LEGARZA: One of the things that we do attempt

9 to do, and, of course, you've recently rejected a settlement in

10 a different case, which was a whole different story, but one of

11 the things we do attempt to do as an Investigative Committee,

12 and me working with the Investigative Committee, is we try to at

13 least recommend something to you that at least we believe has

14 historical basis for making that recommendation. You've just

15 adjudicated a case that there was no recommendation on. I don't

16 know what the results of that adjudication were, but I know what

17 the board has done other times, so there was no-- nothing there.

18 But this case, can we negotiate it, yes, we can;

19 are there parameters, yes, there are, so that's what you can do.

20 It is consistent with what the board has done in the past, but

21 by the same token, the board-- we've raised CME, for instance,

22 from 10 to 20 hours because of Dr. Buchwald's concern. That I

23 think was a couple of settlements back. So the IC has seen fit

24 to raise that. So maybe the past standard has been too low, I

25 mean, I don't know. If we adjudicate it, I mean-- what will the

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1 board do once you get the case proceeded to you after it's been

2 adjudicated may be something different. I don't know.

11:14A 3 MR. ROSENCRANTZ: In the California stipulation, by

4 the way, he did admit, he says, "Respondent admits that he

5 billed improperly in violation of Code Section 2334 and agreed

6 that he has thereby subjected his physicians and surgeons

7 certificate to disciplinary action."

8 I just have a problem with, you know the fact that

9 he's left California, really didn't pay his dues there in

10 regards to the disciplinary action, he's come here, he's

11 practicing in the State of Nevada, and there's no-- I mean,

12 we're taking an action against him, and maybe it is what the

13 State-- what we typically have done, but it just seems like he's

14 beat the system.

15 So we have a motion on the floor and we have a

16 second on the floor. Are there any more discussions? And the

17 motion is to accept the stipulation.

18 DR. HUG-ENGLISH: Before we do that, Arne, if I'm

19 hearing you in the discussion, what you would prefer is that we

20 take it back and deny the settlement and go to hearing?

11:15A 21 MR. ROSENCRANTZ: Well, my initial thoughts was I

22 don't know that we need to go to hearing. Mr. Legarza thinks we

23 need to, I think we just go back and ask for some more.

24 DR. HUG-ENGLISH: We just have to deny this or

25 accept--

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1 MR. ROSENCRANTZ: We can't do that, so we then have

2 to go to hearing, so, yes, I guess that's what I'm suggesting,

3 but I don't know that we'd get different results.

4 MR. LEGARZA: I think that if you don't take this

5 settlement, I can certainly do what perhaps I deem proper with

6 respect to possible settlement of the matter. If you don't

7 approve the settlement, I will go to hearing, I will tell you

8 that right now.

9 DR. STEWART: What would the hearing entail?

10 MR. LEGARZA: Not much--

11 DR. STEWART: That's not a stupid question, I mean

12 he admitted to the fact--

13 MR. LEGARZA: That doesn't make any difference, our

14 statute says if the license has been limited in another

15 jurisdiction, that is what he's charged with, he's charged with

16 NRS 633.013, provides suspension of a license to practice by

17 another jurisdiction constitutes grounds for initiating

18 disciplinary action in the State of Nevada. You had an action

19 against you in the State of California, your license was limited

20 in California. Here's a copy of it.

21 Now, what the defense may or may not do or may or

22 may not attempt to do is then attack the four corners of the

23 document itself in California. I think that's irrelevant and

24 immaterial. I have argued that in the past, I will argue that

25 in the future. It would depend on the attitude of the hearing

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1 officer, where the hearing officer may or may not be going with

2 respect to what he feels is fair or is not fair. It gives me no

3 heartburn to have to try the case.

4 DR. BAEPLER: But consistent with your attitude

5 towards what happened in California, it weakens to a degree your

6 concern about him avoiding penalties in California.

11:16A 7 MR. LEGARZA: We're not sentencing him for what

8 California didn't do to him.

9 DR. BAEPLER: I'm simply saying I agree with you,

10 but it should allay somewhat your concerns about him having

11 avoided penalties in California as a function of consistency.

11:17A 12 MR. ROSENCRANTZ: Well, right now we have a motion

13 on the floor and we have to take a vote on the question. All

14 those in favor of accepting the stipulation as written, say aye.

15 Dr. Hug-English.

16 DR. HUG-ENGLISH: Yes.

17 MR. ROSENCRANTZ: Dr. Stewart.

18 DR. STEWART: Yes.

19 MR. ROSENCRANTZ: Dr. Baepler.

20 DR. BAEPLER: Yes.

21 MR. ROSENCRANTZ: Chair votes against the motion.

22 Motion carries, stipulation is settled.

23 (Matter concluded at 11:16 a.m.)

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1 RENO, NEVADA; SATURDAY, AUGUST 28, 1999, 11:18 A.M.

2 --o0o--

3 MR. ROSENCRANTZ: Consideration of Motion for

4 Reconsideration of Order in the Matter of Nevada State Board of

5 Medical Examiners versus Louis C. Emeterio, M.D., Case Number

6 98-3853-1.

7 Take a roll of the adjudicating members present.

8 Arne Rosencrantz is present. Dr. Stewart?

9 DR. STEWART: Here.

11:18A 10 MR. ROSENCRANTZ: Joel-- Dr. Lubritz?

11 DR. LUBRITZ: Yes.

12 MR. ROSENCRANTZ: Dr. Baepler?

13 DR. BAEPLER: Yes.

14 MR. ROSENCRANTZ: Okay. That will be the

15 adjudicating board members.

16 I assume, Mr. Rosenberger--

17 MR. ROSENBERGER: Yes.

18 MR. ROSENCRANTZ: --I assume you're the attorney

19 for Dr. Emeterio?

20 MR. ROSENBERGER: Yes, James Rosenberger here on

21 behalf of Dr. Emeterio.

22 MR. ROSENCRANTZ: Mr. Rosenberger, is there

23 anything you would like to add to what you have submitted to the

24 board already?

25 MR. ROSENBERGER: Just very briefly, I know you

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1 don't like to hear from counsel, but just very briefly, I hope

2 the board remembers this particular case. This is a

3 circumstance of a very long-term physician in southern Nevada

4 who when it came to his attention that his prescribing practices

5 were probably not as up-to-date as one might hope, he was

6 brought before the board, he acknowledged that he needed to do

7 some things to change his prescribing practices.

8 Now, let's not be confused, this is not a case

9 where Dr. Emeterio was selling prescriptions or handing them out

10 in bars or anything like that. This was just solely a case

11 where Dr. Emeterio was overprescribing for certain pain

12 patients.

13 Rather than burden the board with an extended

14 hearing and experts, he acknowledged, "I need to do something to

15 change my practices," and that's what he's done. He was

16 originally revoked and given two years of probation. He was

17 given certain CME requirements. He has not only complied with

18 the CME requirements, he has gone beyond that. He signed a

19 contract with the Diversionary Committee to monitor his

20 prescription practices for a period of five years. So he is

21 being monitored by the Diversionary Committee group with regard

22 to his prescription practices.

23 He also is still counseling with a person who's

24 helping him with regard to how to deal with difficult patients,

25 that sort of thing. His record, what I'm saying, is spotless

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1 since this event. And I think his conduct in terms of

2 acknowledging his responsibility for this should be taken into

3 consideration at this point.

11:20A 4 Now, what we're basically asking for here, this is

5 a humanitarian request. The reality of medical practice today

6 in a small practice, if you don't have provider contracts you

7 shut your doors and you go to work at some big group if you

8 want. The problem is with the probation on his-- probationary

9 license at this point, he's been cut out of some contracts,

10 specifically with Sierra, that have really impacted his

11 practice. He's had to lay off at least one person in his

12 office, it looks like he'll have to shut the office if he

13 doesn't get provider contracts back.

14 And basically, this is, as I stated, a humanitarian

15 request that the board reconsider the revocation of

16 Dr. Emeterio's license, limit the probation to the period of

17 time already accrued, which would be 14 months, because he was--

18 actually almost 15 months, it will be 15 months in about a week,

19 and let him have his active license again so he can reapply for

20 these contracts. There have been indications from these

21 providers that if he did not have the probationary status on his

22 license, he would be returned to provider status with those

23 programs. That's Dr. Emeterio's request.

11:23A 24 MR. ROSENCRANTZ: Mr. Legarza, do you have a

25 position?

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1 MR. LEGARZA: I didn't file any response,

2 opposition to or agreement with the petition, simply because he

3 has completed everything that he has been requested to do, he

4 has completed everything that were terms and conditions of his

5 probation. My only position is the board saw fit to place him

6 on two years of probation. I'm not aware of the board ever

7 having done this in the past, with one exception as I understand

8 it. I think it's totally discretionary with the board as to

9 whether or not the board wants to do this.

10 MR. LESSLY: Mr. Rosencrantz?

11 MR. ROSENCRANTZ: Yes.

12 MR. LESSLY: Counsel, did you say you're asking the

13 board to reconsider the revocation of his license or are you

14 asking the board to terminate the probationary--

11:24A 15 MR. ROSENBERGER: Terminate the probationary

16 period, I'm sorry if I misstated myself.

17 MR. ROSENCRANTZ: Dr. Stewart.

18 DR. STEWART: May I ask what agreement he has with

19 the diversionary program?

20 DR. TRACY: Excuse me?

21 DR. STEWART: What agreement he has?

22 DR. TRACY: He has an abstinence agreement, that we

23 do random urine tests on him, he has to see a therapist that

24 deals with some of his difficult-patient issues. And as far as

25 I'm concerned, Dr. Emeterio has been completely compliant with

23

1 everything that we've asked him to do. He's been pretty

2 exemplary, actually. He even, with his continuing education we

3 recommended he go to a more extensive course at Case Western, he

4 did that, went to a week course instead of a couple smaller ones

5 to I feel help bring him up to speed.

6 And the issue, as I see it, I think the board, if

7 he's out of compliance, Mr. Legarza is going to get a call from

8 me right away. But the truth is that people who do have

9 probationary status on their license, it does impact their

10 ability to earn a living with the managed care contracts.

11 That's the only difference it would be, I don't see anything

12 changing except for the fact he may not be so strongly impacted

13 by the insurance companies.

11:25A 14 MR. ROSENCRANTZ: Question for you, Dr. Tracy: He

15 wasn't impaired at the time, was he? Did we find him impaired?

16 MR. LEGARZA: You did not.

17 DR. LUBRITZ: We found he had difficulty with

18 dealing with difficult patients, he couldn't essentially tell

19 them no.

20 DR. BAEPLER: Why the urine test and that kind of

21 thing? It doesn't seem to relate.

22 DR. TRACY: Well, he did test positive for

23 something on a urine test, and we sent him for evaluation and

24 came back he was not dependent, but part of the agreement was he

25 remain abstinent, that's how that happened. When we meet with

24

1 someone, we urine test.

11:26A 2 MR. ROSENBERGER: It was prescription medication.

3 DR. BAEPLER: It's an agreement with you?

4 MR. ROSENCRANTZ: The question is why diversion is

5 even involved in this discussion.

6 MR. ROSENBERGER: I could probably answer that,

7 because when we were here before this board with regard to the

8 proceedings in Dr. Emeterio's case, Dr. Rueckl was here and

9 approached me after the meeting and said, "Listen, call me, I

10 think maybe we can help Lou deal with some of these problems

11 with these patients." And that's how diversionary became

12 involved in the first place. And Dr. Emeterio agreed, he's

13 there to get any help that he can get.

14 MR. ROSENCRANTZ: Well, we have a request. I guess

15 what we'd look for is probably a motion to fulfill that request.

16 DR. LUBRITZ: I make that motion.

17 MR. ROSENCRANTZ: Dr. Lubritz makes the motion.

18 DR. LUBRITZ: With the stipulation that he stay

19 with diversion.

20 MR. ROSENCRANTZ: We have a motion.

21 DR. LUBRITZ: How long?

11:27A 22 DR. TRACY: Five years.

23 MS. NIELSEN: I don't think you can do that,

24 because you're going to continue with a restriction on his

25 license. That doesn't solve his problem. If you make removing

25

1 him from probation conditioned upon remaining in the diversion

2 program, then you have restricted his license.

3 DR. LUBRITZ: I would withdraw that.

4 DR. TRACY: He's already signed a contract with us.

5 MR. ROSENBERGER: He has a contract, and if for

6 some reason he doesn't fulfill the terms of the contract, the

7 committee will refer him to Mr. Legarza.

8 MR. LEGARZA: Well, they may refer him to me, that

9 doesn't mean the Investigative Committee would necessarily do

10 anything simply because he hasn't abided by terms and conditions

11 of his contract. There would have to be evidence that he's

12 either practicing impaired or something like that.

13 He's voluntarily entering into a contract with

14 them. This board did not order it, and it's something that he

15 has decided to do voluntarily. And if there's no jurisdiction

16 agreement, which there wouldn't be, I'm not so sure necessarily

17 there is, because he's on probation either with respect to

18 diversion, but whether or not he remains with diversion does not

19 necessarily mean that any investigative committee of this board

20 is going to file some sort of formal complaint against him

21 because he's quit doing that. But then again, it wasn't a term

22 and condition of his probation at any rate, so whether or not

23 you let him off probation for the remainder of his probation I

24 don't think has any relevance or bearing on whether or not he

25 remains a signatory with the diversion program.

26

1 DR. LUBRITZ: I would delete that stipulation and

2 suggest that we let him off the remaining portion of his

3 probationary period.

11:28A 4 MR. ROSENCRANTZ: We have a motion.

5 DR. STEWART: I'll second the motion.

6 MR. ROSENCRANTZ: We have a motion and a second.

7 Discussion?

11:29A 8 I've got to just-- I thought when we did

9 Dr. Emeterio that we were pretty lenient, my own personal

10 opinion, I thought a two-year probation, we had 40 some odd

11 counts against him, no telling how many cases there really were,

12 and I am-- I thought it was a pretty lenient penalty, and I

13 probably am not in favor of the motion.

14 Any other discussion? If not, we'll call for the

15 question.

16 DR. STEWART: Well, Arne, I tend to agree with you,

17 Mr. Rosencrantz-- I think you're correct, there was 48 or 49

18 counts of excessive prescribing. I'm somewhat confused,

19 although I've read all of this material, we revoked, we stayed

20 the revocation, we placed him on a two-year probation, we asked

21 him to get education which he has done. Whether or not the

22 diversion program is helpful here, when I hear that I think of

23 something, I'm then told that they're helping him deal with

24 difficult patients, not helping him deal with his difficulties.

25 I guess my only question to myself is did we attempt to put him

27

1 out of business and because of other business practices are we

2 now asked to put him back in business, I guess that's what

3 you're asking.

4 DR. BAEPLER: I was not here when this original

5 case came forward, but it occurs to me, if I remember correctly,

6 he not only overprescribed for people that were in excessive

7 pain, but he prescribed and overprescribed for people he hadn't

8 even examined. And I believe he admits to that allegation.

11:31A 9 MR. ROSENCRANTZ: Any further discussion? Call for

10 the question. Tough one.

11 Dr. Stewart.

12 DR. STEWART: I vote against the motion.

13 MR. ROSENCRANTZ: Dr. Lubritz.

14 DR. LUBRITZ: I vote for the motion.

15 MR. ROSENCRANTZ: Dr. Baepler.

16 DR. BAEPLER: I vote against the motion.

17 MR. ROSENCRANTZ: And the chair votes against the

18 motion. The motion does not carry.

19 (Matter concluded at 11:50 a.m.)

20

21 * * * * * * * * * * * * * * * * * *

22

23

24

25

28

1 RENO, NEVADA; SATURDAY, AUGUST 28, 1999; 11:52 A.M.

--o0o--

2 MR. LEGARZA: You have in your packets the

3 Legislative Council Bureau language and format that they

4 utilized in adopting our proposed regulations, both sets, the

5 set adopted in March in Carson City, and the set adopted in June

6 here in Reno.

7 What I am handing you now is a modified version of

8 what you have in your books. But it's not-- it's not-- it is

9 not a substantially modified version. I received these

10 Legislative Council Bureau proposed regulations-- I think they

11 were faxed to me the day before Maureen-- maybe it was the day

12 Maureen was putting the board book together, and I started

13 working on them, and I have probably three full days working in

14 them, because they're completely changed from where we were, to

15 try to make a comparison with what we proposed and what they in

16 fact did do.

17 Everything that we have proposed with the exception

18 of about maybe 60 or 70 words is somewhere in these regulations

19 where I think that it's supposed to be. Larry reviewed them, I

20 gave them to him when I got them in a place where you could

21 follow them and we both came up with about four proposed changes

22 that I then requested of the Legislative Council Bureau to make

23 on the first set that they sent us, which are in your book.

24 They accepted all those recommendations and made

25 all of those changes in these regulations. So what we have

29

1 proposed and what we have adopted as temporary regulations both

2 in March and in June, what have been reviewed by me, and Larry

3 was kind enough to also review them, I believe that the

4 Legislative Council Bureau has done a good job of putting them

5 in language that takes care of our intent, takes care of what we

6 want to do.

7 They, of course, are going to have to be amended

8 immediately with respect to the presentation that Mrs. Rebecca

9 Gaul gave you with respect to the testing, but my recommendation

10 is that you adopt these so that I can notify the Legislative

11 Council Bureau, so they can put them in the final format and

12 into our regulations, so they can go on the internet, and then

13 we can begin making the changes. Everything is there with the

14 exception of some kind of lead-in language, but everything that

15 Larry and I requested that they add back in has in fact been

16 done.

17 DR. HUG-ENGLISH: I would move that we accept the

18 revised proposed regulations as drafted and just submitted to

19 us.

20 DR. DESAI: Second.

11:51A 21 MR. ROSENCRANTZ: We have a motion. Do we have a

22 second?

23 DR. HUG-ENGLISH: I move we adopt--

24 DR. DESAI: I second.

25 MR. LANZILLOTA: I just have a question, but it

30

1 says physician's assistant, and I know that that's been probably

2 the proper term now, but the proper term in the last few years

3 has been that by the American Academy of Physicians Assistants,

4 so I don't know how difficult that would be to--

5 MR. LEGARZA: You're talking about the apostrophe?

6 MR.LANZILLOTTA: Yes.

7 MR. LEGARZA: That's a fight that you lose with me.

11:52A 8 MR. ROSENCRANTZ: We have-- any further discussion?

9 Call for the question. All those in favor.

10 (Ayes so indicate.)

11 MR. ROSENCRANTZ: Anyone opposed?

12 (None indicated.)

13 MR. ROSENCRANTZ: Chair votes in favor of the

14 motion. The motion carries.

11:53A 15 (Matter concluded at 11:53 a.m.)

16

17 * * * * * * * * * * * * * * *

18

19

20

21

22

23

24

25

31

1 RENO, NEVADA; SATURDAY, AUGUST 28, 1999; 1:35 P.M.

2 --o0o--

3

1:35P 4 MR. ROSENCRANTZ: All right. Start with the first

5 one.

6 We start out in executive session.

7 DR. STEWART: Motion for executive session.

8 DR. JONES: Second.

9 MR. ROSENCRANTZ: Second. All in favor.

10 (Ayes so indicated.)

1:36P 11 MR. ROSENCRANTZ: Good afternoon, Dr. Gregorio.

12 I'm Arne Rosencrantz, president of the board; these are other

13 board members and staff. And we're here to discuss your

14 licensure. And I believe Dr. Lubritz will be--

15 DR. LUBRITZ: Hi, how are you?

16 DR. GREGORIO: I'm okay.

17 DR. LUBRITZ: Dr. Gregorio graduated from the

18 University of the Philippines in Manila, did his internship and

19 residency, one was in Philadelphia, his internship, and in

20 Darby, Pennsylvania, did a residency from 1972 to '76 in general

21 surgery. He passed his specs with a score of 80 in 1991. He's

22 certified by the American Board of Surgery in 1980, recertified

23 in 1990, and will sit for examination again in October of 1999.

24 The reason for his appearance is that he answered

25 affirmatively to number 12, that is, have you been a defendant

32

1 in a legal action involving professional liability, and number

2 two, the second was number 31, have you ever been investigated

3 for a charge or convicted with any violation of a statute.

4 One of the cases appears to have been sealed, one

5 was more recent. These occurred in 1983, 1989 and 1995. And

6 one was under a hundred thousand dollars, and that most recently

7 was settled for $40,000.

8 If you could quickly tell us about claim number

9 one, and then number two which was sealed, if you could give us

10 that information.

1:38P 11 DR. GREGORIO: Okay. Case number one occurred--

12 DR. LUBRITZ: 1983.

1:39P 13 DR. GREGORIO: '83.

14 DR. GREGORIO: It resulted in a permanent

15 neurologic damage to a second twin that we had delivered by

16 emergency Cesarean section. I believe it was fetal distress

17 caused by prolapsed cord and necessitated quick Cesarean

18 section. Unfortunately, it was a little late for the baby;

19 first twin was however born spontaneously and was okay.

20 DR. LUBRITZ: And that settlement was I think for a

21 total amount of $800,000, and I think $200,000 paid on your

22 account?

23 DR. GREGORIO: Yes, that's right.

24 DR. LUBRITZ: The second?

25 DR. GREGORIO: The second case, it resulted in a

33

1 postoperative complication.

2 DR. LUBRITZ: Might I just add, so that you will

3 know, although an amount of $300,000 was paid, Dr. Gregorio, as

4 I recall, was not cited for any malpractice; is that correct?

1:40P 5 DR. GREGORIO: Correct.

6 And in conjunction with that, the Illinois State

7 Board of Regulation automatically reviews cases of this nature

8 and that is related to my affirmative response to the other

9 question as to if I were investigated, and that itself was

10 closed with no prejudice on my part.

11 DR. LUBRITZ: Would you tell us about that?

12 DR. GREGORIO: Okay. This lady was 57 years old

13 and she presented to the emergency room with severe massive

14 rectal bleeding. And I was asked to see the patient because I

15 was the surgeon, the only surgeon in the town. I treated her

16 initially with resuscitation and fluids, and in spite of I would

17 say more than eight units of blood over the next 24 hours, she

18 had not quit bleeding.

19 I then sent her to the nearby hospital to get some

20 diagnostics done, specifically a scan, CT scan, and they

21 informed me that it was indeed coming from the sigmoid colon,

22 sent the patient back to me. And at that point, having failed

23 with the conservative approach, I decided to go ahead and remove

24 the portion of the bowel that was presumably bleeding, and

25 massively at that time, which I accomplished with segmental

34

1 resection of the colon and exteriorized colostomy. Together

2 with closure of the rectal stump. She didn't stop bleeding,

3 however. Her postop course had become prolonged and complicated

4 with illius, it was rather prolonged, and at that point I

5 couldn't decide if this was a result of malfunctioning colostomy

6 or if she had developed enterocolitis from the massive

7 antibiotic that I had been using.

8 I started her on DPN, as well, and tried to support

9 as best I can, hoping the illius might resolve and that would be

10 it. However, she continued not to progress well, and before I

11 could decide to reoperate she aspirated and couldn't revive her

12 at that point. And that is how I lost the patient.

1:43P 13 MR. ROSENCRANTZ: Any other questions?

14 DR. DESAI: Make a motion to go into open session.

15 MR. ROSENCRANTZ: We have a motion. Second?

16 DR. HUG-ENGLISH: Second.

17 MR. ROSENCRANTZ: All in favor, say aye.

18 (Ayes so indicated.)

19 DR. DESAI: Motion to accept Dr. Gregorio's

20 application.

21 DR. HUG-ENGLISH: Second.

22 MR. ROSENCRANTZ: We have a motion and second.

23 Discussion?

24 Call for the question. All in favor?

25 (Ayes so indicated.)

35

1 MR. ROSENCRANTZ: Opposed?

2 (None indicated.)

3 MR. ROSENCRANTZ: There being no one opposed, chair

4 votes in favor of the motion.

5 Dr. Gregorio, you'll be hearing from the office.

6 DR. GREGORIO: Thank you very much.

7 DR. DESAI: Make a motion to go again into closed

8 session.

9 DR. HUG-ENGLISH: Second.

10 Made and seconded. All in favor?

11 (Ayes so indicated.)

12 MR. ROSENCRANTZ: Opposed?

13 (None indicated.)

14 MR. ROSENCRANTZ: We're in executive session.

1:44P 15 Dr. Halvorsen, I'm Arne Rosencrantz, president of

16 the board; these are other board members and staff. And we have

17 some questions to you in regards to your licensure.

18 DR. HALVORSEN: Okay.

19 MR. ROSENCRANTZ: Dr. Stewart.

20 DR. STEWART: Hello, sir.

21 Dr. Halvorsen is trained in Louisville and then in

22 Cleveland, and is board certified in both OB-GYN and maternal

23 fetal medicine. He is here because of a interesting malpractice

24 case.

25 Can you explain to us how a baby delivered a

36

1 hundred miles away is your responsibility?

2 DR. HALVORSEN: Well, the honest answer to that is

3 I wish I could. This was a patient who was an insulin-dependent

4 diabetic who we were providing care for, and had an episode of

5 possible preterm labor and was flown to our hospital. This is

6 around 36 or 37 weeks at that point. She was this for probably

7 a week or so.

8 And then at that point her blood-sugars were in

9 adequate control, she was not in labor, and the surveillance of

10 the fetus at that point was totally reassuring. We had no more

11 reason to maintain her in the hospital, and she was discharged.

12 That evening she went into labor. We requested and

13 suggested to her that she stay in Spokane. She elected not to

14 do this and went home. She went into labor that evening and

15 probably went into ketoacidosis. The extent to which this was

16 recognized and dealt with appropriately was perhaps not the

17 same-- perhaps not dealt with in the same fashion as we might

18 have done, and the baby was born and developed cerebral palsy.

19 We were sued because the-- we were accused of

20 discharging her inappropriately, despite the fact that her

21 blood-sugars were normal, controlled, despite the fact that she

22 was not in labor, despite the fact that she was at that point at

23 the time that she was discharged was, in fact, not by definition

24 preterm labor-- she was 37 weeks, not 36, she was 37 by the time

25 discharged, by the time she wasn't in preterm labor, even if she

37

1 had been, but she wasn't. Sugar was fine, baby was fine. But

2 we were sued because it was alleged that we inappropriately

3 discharged her. We were also sued because the accusation was

4 that we should have adopted a hands-on approach to her

5 management in a hospital 70 miles away. Is that--

1:48P 6 DR. STEWART: I have no other questions.

7 MR. ROSENCRANTZ: Anyone else have any questions

8 for Dr. Halvorsen?

9 DR. DESAI: Make a motion to go into open session.

10 DR. STEWART: Second.

11 MR. ROSENCRANTZ: Motion made and seconded to go

12 into open session. All in favor, say aye.

13 (Ayes so indicate.)

14 MR. ROSENCRANTZ: Opposed?

15 (None indicated.)

16 DR. DESAI: Make a motion to accept Dr. Halvorsen's

17 application.

18 DR. STEWART: Second.

19 MR. ROSENCRANTZ: Motion and second. Discussion?

20 All those in favor.

21 (Ayes so indicated.)

22 MR. ROSENCRANTZ: Anyone opposed?

23 (None indicated.)

24 (Off the record.)

1:49P 25 MR. ROSENCRANTZ: We have accepted your

38

1 application, Dr. Halvorsen.

2 DR. HALVORSEN: Thank you. Appreciate that.

3 (Off the record.)

4 DR. DESAI: Make a motion to go into executive

5 session, please.

6 MR. ROSENCRANTZ: Second?

7 DR. HUG-ENGLISH: Second.

8 MR. ROSENCRANTZ: All those in favor, say aye.

9 (Ayes so indicate.)

10 MR. ROSENCRANTZ: Opposed?

11 (None indicated.)

12 MR. ROSENCRANTZ: We're in executive session.

1:50P 13 MR. ROSENCRANTZ: Good afternoon, Dr. Harrison, I'm

14 Arne Rosencrantz, president of the board; these are other board

15 members and staff.

16 And we have Dr. Baepler who will conduct the

17 questioning.

18 DR. BAEPLER: Dr. Harrison, at the present time you

19 have voluntarily surrendered your license in the State of

20 Nevada; is that correct?

1:51P 21 DR. HARRISON: That is correct.

22 DR. BAEPLER: So essentially you are applying for a

23 license--

24 DR. HARRISON: Completely new license, yes.

25 DR. BAEPLER: Completely new license. And prior to

39

1 being licensed in the State of Nevada you had certain

2 difficulties in-- was it the State of California, it was your

3 Navy experience?

4 DR. HARRISON: That's correct again.

5 DR. BAEPLER: And that resulted in 1988 in a court

6 martial which apparently involved your obtaining funds

7 inappropriately in conjunction with research programs?

8 DR. HARRISON: No, sir, that's not exactly correct.

9 Would you like me to expound on that?

10 DR. BAEPLER: Yeah.

11 DR. HARRISON: Fine. I was the Director of

12 Clinical Research at Naval Hospital in San Diego, and in 1975 we

13 began to be-- it began to be a problem throughout southeast Asia

14 with penicillin-resistant gonorrhea, and since I had been

15 working with sexual diseases, the Surgeon General directed me to

16 find a cure for penicillin-resistant gonorrhea, which my

17 resident fellows and I proceeded to do.

18 Unfortunately, the Navy wasn't able to provide us

19 with any funds for doing that research, and so with my academic

20 connections through the Uniformed Services Medical School and

21 University of Washington, I obtained research grants from

22 several pharmaceutical industries to fund the research. What I

23 wasn't aware of was that between the time I had been a research

24 fellow at the University of Washington and the time that this

25 event occurred, a new Navy regulation had gone into effect which

40

1 prohibited Naval officers from establishing contracts with

2 defense contractors, and, of course, all the big pharmaceutical

3 firms are defense contractors. And so I was technically in

4 violation of that Navy regulation, even though I wasn't aware

5 that it existed, it was a regulation that required absolute--

6 there's a particular term for it which I can't remember, but I

7 was obligated to follow that regulation.

8 We went to a general court martial on conflict of

9 interest, and the judge at the trial, military judge dismissed

10 the charges on two separate occasions. The prosecuting JAG

11 officer appealed the dismissal of charges, the Court of Military

12 Appeals upheld some of the charges, dismissed others, and the

13 bottom line was after a period of three years my defense counsel

14 directed me to enter a plea bargain just to end the court

15 martial, which I did. And that was one count of conflict of

16 interest.

17 DR. BAEPLER: And that resulted in loss of

18 seniority points, a 10,000-dollar fine?

1:54P 19 DR. HARRISON: I was taken off the promotion list

20 to Admiral and fined $10,000.

21 DR. BAEPLER: And then the IRS came into the scene

22 and you were fined $5,000 and given what, three years probation?

23 DR. HARRISON: That's correct.

24 DR. BAEPLER: As a function of that episode?

25 DR. HARRISON: Prosecutor in the Navy case turned

41

1 the records that he had over to the IRS, and they found that

2 there had been some inadequate recordkeeping, and even though

3 the amount of income tax was less than $2,000, with fines and

4 penalties and so forth, the amount came to more than that. And

5 so again we had the fine and the probation for a-- a misdemeanor

6 violation of the tax code.

1:55P 7 DR. BAEPLER: Now, you were licensed in the State

8 of Nevada in June of 1994?

9 DR. HARRISON: Yes, sir.

10 DR. BAEPLER: And sometime from there you became

11 involved in the selling of prescriptions, first of all involving

12 a pharmacist; is that correct?

13 DR. HARRISON: Yes, sir.

14 DR. BAEPLER: To provide prescriptions for a fee, I

15 believe 100 or 200 dollars, depending on the nature of the

16 prescription, or some amount thereof, you using patients' names

17 who were, of course, unaware of your selling these prescriptions

18 so that the pharmacist could cover his inventory; is that

19 correct?

20 DR. HARRISON: That's basically what happened, yes,

21 sir.

22 DR. BAEPLER: You at the same time were practicing

23 with Bechtel at Mercury in North Las Vegas?

1:57P 24 DR. HARRISON: Yes, sir, I was medical director for

25 Bechtel.

42

1 DR. BAEPLER: Does that require a Q clearance?

2 DR. HARRISON: Yes, it does.

3 DR. BAEPLER: You're aware of the jeopardy you put

4 the Bechtel people in who some also have clearance by using

5 their names in a narcotics related type of episode?

6 DR. HARRISON: I am completely aware of that,

7 that's one of the more shameful aspects of this whole episode.

8 DR. BAEPLER: And you also were a physician

9 visiting patients in hotels?

10 DR. HARRISON: Yes, sir.

11 DR. BAEPLER: So that you had really at this point

12 in your career three sources of income, one from the Bechtel

13 relationship, one from the hotel relationship, and you have

14 what, a Captain's retirement from the Navy?

15 DR. HARRISON: Yes, sir.

16 DR. BAEPLER: Twenty-year retirement?

17 DR. HARRISON: Yes, sir.

18 DR. BAEPLER: And then you sold undercover agents,

19 or at least one, prescriptions?

20 DR. HARRISON: I did that.

21 DR. BAEPLER: From a car in a parking lot at the

22 Rio?

23 DR. HARRISON: On one occasion that happened, yes,

24 sir.

1:58P 25 DR. BAEPLER: And when you were finally arrested

43

1 they had a search warrant and searched your home and found a

2 controlled substance; is that correct?

3 DR. HARRISON: Yes, sir.

4 DR. BAEPLER: Do you mind telling us what that was?

5 DR. HARRISON: I had a number of controlled

6 substances in my traveling bag that we used to make house calls

7 at the hotel. If memory serves, I had Demerol and diazepam,

8 possibly some Phenergan and Compazine.

9 DR. BAEPLER: If I am correct, the investigation

10 established and you did not deny numerous sales of prescriptions

11 on an illegal basis, and you plea bargained a single count of

12 possession? Am I overstating that, is that the way it turned

13 out?

14 DR. HARRISON: That's the way it turned out, yes.

1:59P 15 DR. BAEPLER: And that was a very recent event,

16 that was just this last March, in 1999?

17 DR. HARRISON: That's correct. I was in

18 residential treatment for four months, and the hearing and the

19 trial were postponed while I was in treatment.

20 DR. BAEPLER: And in July of 1999, California

21 revoked your license this last month?

22 DR. HARRISON: Yes, they did.

23 DR. BAEPLER: I notice that you were in treatment

24 for alcoholism, and do you make a connection between the alcohol

25 problem and your activities with respect to the prescriptions?

44

1 DR. HARRISON: Yes, sir, I think there's a very

2 clear connection there.

3 DR. BAEPLER: There was no mention of it, I was

4 surprised to see, the alcohol-related problem, there was no hint

5 of it during the various items I read, and no evidence that you

6 were impaired apparently while you were negotiating sales with

7 the undercover agents or anything like that?

2:00P 8 DR. HARRISON: I'm sorry, I don't--

9 DR. BAEPLER: It did not appear from the

10 transcripts that I was reading that when you were actively

11 selling illegal prescriptions, that you were in any way impaired

12 as a function of having consumed alcohol?

13 DR. HARRISON: That's probably because I didn't

14 drink when I was out seeing patients making house calls and so

15 forth. And my drinking was a very solitary affair that took

16 place in the late evenings and on weekends when I wasn't going

17 out in public.

18 DR. BAEPLER: I don't question that, but I'm just

19 trying to see how you in applying for a license now, I think you

20 would like to connect the problem that-- your alcohol problem

21 appears to be under control, and I would infer from that that

22 you would no longer be selling illegal prescriptions, and I

23 cannot connect the two, the alcohol problem and selling of

24 illegal prescriptions?

2:01P 25 DR. HARRISON: I see. Would you like me to expound

45

1 on that a bit?

2 DR. BAEPLER: If you could.

3 DR. HARRISON: I'll try. I really appreciate the

4 opportunity to come before the board and say my peace. This is

5 probably the most painful experience in my life having to do

6 this, and I am extremely ashamed and remorseful about my

7 behavior. I don't-- I'm not trying to say that I didn't know

8 what I was doing selling the prescriptions because I was

9 drinking, but I think the fact that I had not used alcohol at

10 all in 40 some years and began drinking when I came to Las Vegas

11 and became involved in the relationship that I was involved in

12 with a woman, the alcohol clouded my judgment, it gave me the

13 ability to rationalize the fact that what I was doing was not

14 really that wrong, and that I was only breaking the law a little

15 bit and not really committing some heinous crime. So I think

16 the alcohol, if you will, lubricated my mind to the point that I

17 was able to overcome my previous morals and ethics and

18 standards, if you will, to do what I clearly knew was wrong.

2:02P 19 DR. BAEPLER: It would appear you were in full

20 possession of your faculties when you were explaining to the

21 undercover agent that you could not write the prescriptions too

22 close together because it would trigger a possible investigation

23 and disclosure of the problem, it seemed to be a rather lucid

24 explanation of the illegal process while you were negotiating

25 with the agent.

46

2:03P 1 DR. HARRISON: Yes, sir.

2 DR. BAEPLER: I have no other questions.

3 MR. ROSENCRANTZ: Does anyone else have any other

4 questions?

5 DR. HUG-ENGLISH: Dr. Harrison, has anybody advised

6 you that if your petition or for license is denied, that that's

7 reportable?

8 DR. HARRISON: Yes, they have.

9 DR. HUG-ENGLISH: And that if you were to withdraw

10 your application at this time, it would not be reportable?

11 DR. HARRISON: I've been so advised, yes.

12 DR. DESAI: I make a motion to go into open

13 session.

14 DR. LUBRITZ: Second.

15 MR. ROSENCRANTZ: Motion and a second. Any

16 discussion?

17 All in favor?

18 (Ayes so indicate.)

19 MR. ROSENCRANTZ: Anyone opposed?

20 (None indicated.)

21 MR. ROSENCRANTZ: We're in open session.

22 DR. DESAI: Make a motion to deny Dr. Harrison the

23 petition.

24 DR. BAEPLER: I will second.

25 MR. ROSENCRANTZ: We have a motion and a second.

47

1 Any discussion?

2 No discussion. Call for the question. All those

3 in favor, say aye.

4 (Ayes so indicated.)

5 MR. ROSENCRANTZ: Anyone opposed?

6 (None indicated.)

7 MR. ROSENCRANTZ: Chair votes in favor of the

8 motion.

9 Dr. Harrison, your motion is denied.

2:04P 10 DR. HARRISON: Thank you.

11 DR. HUG-ENGLISH: Can I ask a question, and maybe

12 Vic could answer: Why in the world would he come before us at

13 this point?

14 DR. RUECKL: It wasn't 1999, it was 1998.

15 DR. BAEPLER: What?

16 DR. RUECKL: When he was actually arrested, it was

17 a year and a half ago.

18 DR. BAEPLER: But California just revoked.

19 MR. LESSLY: He was revoked in California.

20 DR. RUECKL: I understand, I'm just saying the

21 incident itself was 1998.

22 DR. DESAI: What would you have recommended,

23 Dr. Rueckl?

24 DR. RUECKL: Well, you know, I understand where

25 you're voting, and, you know, why you are where you are, I

48

1 certainly do. I also, you know, know Dr. Harrison for the last

2 year and know what he's been doing and approve of what he's been

3 doing very much so. He's probably the most compliant person we

4 have. You know, from my standpoint I'd like him at some point

5 to be able to obtain a license, he's going to work in the AIDS

6 clinic with Jerry Cade, I'd like to see him on probation for

7 whatever. I received ten years myself. And I think if he met--

8 you know, he does anything wrong, he's gone. He's obviously

9 demonstrated that he has done this repeatedly.

10 DR. BAEPLER: This gentleman had three legitimate

11 sources of income, a full Captain's retirement after 20 years,

12 two other revenue streams from his activities as an M.D., and he

13 had to sell prescriptions for a hundred dollars here and two

14 hundred dollars there, I mean, you'd have a pretty lucrative

15 combined income from three positions. I still can't connect up

16 the alcohol problem or the sexual problem that he had.

17 DR. RUECKL: Basically, he supported several

18 prostitutes that basically worked for him, and he did-- that's

19 where his money went.

20 (Off the record.)

21 DR. DESAI: Make a motion to go into executive

22 session.

23 MR. ROSENCRANTZ: Second.

24 DR. HUG-ENGLISH: Second.

2:07P 25 MR. ROSENCRANTZ: We're in executive session.

49

1 Good afternoon, Dr. Navar, I'm Arne Rosencrantz,

2 president of the board; these are other board members and staff

3 and attorney. And we're here to talk to you about your

4 licensure. And Dr. Desai.

5 DR. DESAI: Dr. Navar graduated in 1982 from

6 University of Texas, residency in general surgery between 1985,

7 board certified in emergency medicine in '90. The reason we ask

8 him to come here, because Dr. Navar has answered affirmatively

9 on question number 12 in reference to allegation of malpractice

10 in a 34-year-old female patient, and he had two malpractice.

2:08P 11 DR. NAVAR: That's correct.

12 DR. DESAI: Will you please explain the first one

13 to the board, what happened and how your involvement, what was

14 your involvement in the case?

15 DR. NAVAR: First one was in 1991, it was a case of

16 a female about 40 years of age who presented to the emergency

17 department with ammonia. The patient had pretty severe

18 pneumococcal pneumonia. I saw her initially, basically worked

19 her up, including blood gases, sputum culture, blood cultures

20 started to treat her. I called the internal medicine doctor on

21 call for us at the time and he came in and admitted her to the

22 hospital. Patient had an extremely rocky hospital course, was

23 in the hospital for about six months, almost died several times,

24 was left with a significant neurologic deficit from a stroke

25 that she suffered about two weeks after she was initially

50

1 hospitalized.

2 She alleged that she was mistreated in the

3 emergency department as well as throughout the hospitalization,

4 and I was one of about four or five doctors that was sued in the

5 case, as well as the hospital. Unfortunately, the hospital and

6 my insurance company thought it best to try to settle the case.

7 The case was settled for a very large amount. My contribution

8 to the settlement from my insurance company was about four

9 percent of the total award.

2:09P 10 DR. DESAI: Okay.

11 DR. NAVAR: I to this date don't think I did

12 anything wrong in this particular case.

13 DR. DESAI: Who ended up paying the maximum?

14 DR. NAVAR: The internal medicine physician and the

15 hospital.

16 DR. DESAI: Tell us about the second case.

17 Thirty-four-year-old female, 37 weeks--

2:10P 18 DR. NAVAR: That was a case where a female

19 presented herself in the emergency department, I think that was

20 '93-- '92 or '93 in the latter stages of pregnancy with some

21 abdominal pain, took a look at her, put her on the monitor, on

22 the fetal monitor, didn't see any signs of labor at this time,

23 she was not bleeding vaginally, and we discharged her. She had

24 had prenatal care at another clinic.

25 About six hours later she went into labor, went to

51

1 another hospital and ended up having a placental abruption. In

2 this particular case I think I probably missed the abruption on

3 the first visit. But I guess what misled me in the first visit

4 is I didn't note-- there was no vaginal bleeding on the initial

5 examination. But in that particular case, the woman delivered a

6 stillborn and the case was settled.

2:11P 7 DR. DESAI: I have no more questions.

8 Are you still practicing as an emergency room

9 physician?

10 DR. NAVAR: Yes, sir.

11 DR. HUG-ENGLISH: I move we approve--

12 DR. BAEPLER: Move we go into open session.

13 DR. JONES: Second.

14 DR. LUBRITZ: You want discussion first?

15 MR. ROSENCRANTZ: Sure. Is there any discussion?

16 DR. LUBRITZ: Dr. Navar, you were-- you did a

17 residency in general surgery and then board certified by the

18 American Board of Emergency Medicine in 1990. Did you ever

19 practice general surgery?

20 DR. NAVAR: No, sir.

21 DR. LUBRITZ: How did you go from one to the other?

22 DR. NAVAR: Actually, I didn't complete the general

23 surgery residency, I did three years of a six-year residency at

24 the University of Utah affiliated hospitals. In the middle of

25 my second and third year I just decided I really didn't want to

52

1 be a general surgeon. I had been moonlighting at the time,

2 emergency medicine started to attract me. Back in the early

3 '80s when emergency medicine was kind of in its infancy you

4 could become board certified through practice by accumulating

5 five years and a certain number of hours of practice, and that's

6 how I became board certified in emergency medicine.

2:12P 7 MR. ROSENCRANTZ: We need a motion.

8 DR. HUG-ENGLISH: I now move that we accept

9 Dr. Navar's application for licensure.

10 DR. DESAI: Second.

11 MR. ROSENCRANTZ: We have a motion and second. Any

12 further discussion?

13 If not, call for the question. All those in favor?

14 (Ayes so indicate.)

15 MR. ROSENCRANTZ: Anyone opposed?

16 (None indicated.)

17 MR. ROSENCRANTZ: Chair votes in favor of the

18 motion.

19 Dr. Navar, your application has been accepted.

20 DR. NAVAR: Thank you very much.

21 MR. ROSENCRANTZ: Do we have a motion to go into

22 executive session?

23 DR. DESAI: Make a motion to go into executive

24 session.

25 DR. HUG-ENGLISH: Second.

53

2:13P 1 MR. ROSENCRANTZ: Second. We're in executive

2 session.

3 Bring in Dr. Simmons.

4 All those in favor of going into executive session,

5 say aye.

6 (Ayes so indicate.)

7 MR. ROSENCRANTZ: Opposed?

2:14P 8 (None indicated.)

9 MR. ROSENCRANTZ: Welcome, Dr. Simmons.

10 DR. SIMMONS: Um-hum.

11 MR. ROSENCRANTZ: I'm Arne Rosencrantz, president

12 of the board; these are members of the board and staff. And

13 we're going to talk to you today about your application for

14 licensure.

15 Dr. Hug-English?

16 DR. HUG-ENGLISH: Hi, Dr. Simmons. You were asked

17 to appear before us today with respect to the relinquishment of

18 your hospital privileges in Sierra View District Hospital in

19 California.

20 DR. SIMMONS: Um-hum.

21 DR. HUG-ENGLISH: Tell us a little bit about that.

22 DR. SIMMONS: It was a voluntary relinquishing of

23 my privileges to do C-sections following an episode that

24 resulted in a stale birth back in February. The circumstances

25 surrounding it are still somewhat under dispute, and I've

54

1 requested a hearing, and I've also requested and am obtaining

2 legal counsel in terms of what happened, how it happened, and

3 the ad hoc-- the calling of the ad hoc committee that was done

4 by the OB department and also the medical executive committee's

5 response as to what happened. So it's still all somewhat in

6 dispute.

2:16P 7 DR. HUG-ENGLISH: Is there-- has there been a case

8 filed against this, as well, a malpractice case?

9 DR. SIMMONS: No.

10 DR. HUG-ENGLISH: Are you primarily practicing

11 family practice or OB-GYN?

12 DR. SIMMONS: I am a board-certified family

13 practice physician with a fellowship in OB-GYN, and so there I

14 was allowed to do Cesarean sections, limited amounts of GYN--

15 office GYN and OB.

16 DR. HUG-ENGLISH: I'm curious, on your AMA profile

17 you list primary specialty as OB-GYN--

18 DR. SIMMONS: It's a mistake.

19 DR. HUG-ENGLISH: --secondary, family practice?

20 DR. SIMMONS: No.

21 DR. HUG-ENGLISH: I just wanted to clarify that,

22 because it seemed to me by the rest of your record that you were

23 primarily family practice.

24 DR. SIMMONS: Yes.

25 DR. HUG-ENGLISH: Okay. Are you planning to

55

1 continue to do OB-GYN?

2:17P 2 DR. SIMMONS: I was thinking about all of this, it

3 happened really as-- I began thinking about coming to Reno and

4 setting up practice here basically before all of this happened.

5 I was thinking possibly about doing some OB, but the people that

6 I'll probably be working for, High Sierra Medical Group right

7 now they're not supporting a family practitioner doing OB, so

8 it's something that I really won't mind giving up because

9 getting up at three o'clock in the morning is kind of rough.

10 And I've been doing it for four years.

11 DR. HUG-ENGLISH: Okay. I don't have any further

12 questions.

13 MR. ROSENCRANTZ: Anyone else have any questions of

14 Dr. Simmons?

15 DR. DESAI: Make a motion to go into open session.

16 DR. LUBRITZ: Second.

17 MR. ROSENCRANTZ: We have a motion and second. All

18 those in favor?

19 (Ayes so indicated.)

20 MR. ROSENCRANTZ: Opposed?

21 (None indicated.)

22 DR. DESAI: Make a motion to accept Dr. Simmons'

23 application.

24 DR. LUBRITZ: Second.

25 MR. ROSENCRANTZ: We have a motion and second. Any

56

1 discussion?

2 Hearing no discussion, call for the question. All

3 those in favor?

4 (Ayes so indicated.)

5 MR. ROSENCRANTZ: Anyone opposed?

6 (None indicated.)

7 MR. ROSENCRANTZ: Chair votes in favor of the

8 motion.

9 Your licensure application has been accepted,

10 doctor. Thank you very much.

2:18P 11 DR. SIMMONS: Thank you.

12 (Matter concluded at 2:20 p.m.)

13

14

15

16

17

18 I hereby certify that the foregoing is a true and accurate

transcript from the above-entitled proceedings to the best of my

19 knowledge, skill and ability.

20

_______________________________ ____________________________

21 REBECCA BRUCH, CCR #258 Date

22 23

24 25