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6 NEVADA STATE BOARD OF MEDICAL EXAMINERS
7 MEETING
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14 SATURDAY, AUGUST 26, 2000
15 RENO, NEVADA
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22 Reported by: SARAH FERGUSON, RPR
23 Computer-Aided Transcription
24
1
1 SATURDAY, AUGUST 26, 2000, 9:00
A.M.
2 ////////
3 MR. ROSENCRANTZ: We started this yesterday
4
afternoon, and just a couple of items for your attention
5 is that we have a time specific item at 10
o'clock with
6 our regulations. So we'll start that at 10 o'clock, and
7 at 2 o'clock we're going to hold the Board's
elections.
8 The reason we decided to do it time specific
is
9 Dr. Jones would like to participate in the
elections.
10 She's vacationing in Sun Valley, Idaho, and
I think we
11 better keep her happy. So we'll call her at 2 o'clock
12 for the elections when she is available.
13 Now, we're going to start with
Agenda Item
14 Number 12 which is about our public service
announcement
15 and
ask Quillin & Company to come to the table, if they
16 would.
17 As you know, over the past couple
years we've
18 been doing PSAs to make the public aware of
what we do
19 here in the Medical Board, that we regulate
and
20 discipline -- please sit down, Tim -- that
they can find
21 out information about their doctors, and
it's been a
22 very well-received program.
23 We've been on the air with a spot
from
24 Lieutenant Governor Laurie Hunt for about
six or seven
2
1 months.
I think the Board can consider the spot to be
2 getting a little old and that we ought to do
something
3 different.
4 So we've asked Quillin &
Company to do a
5 proposed spot for us. Larry Lessly, myself, and
6 Dr.
Lubritz met with them. I've met with
them several
7 times myself, and they've come up with an
idea. And
8 some of you were here when we had this
proposal last
9 time, and we'll certainly let Quillin tell
us what
10 they're going to do.
11 We have with us today Tim Quillin
from
12 Quillin & Company and Philip
Nobert. So, guys, you're
13 on.
14 MR. QUILLIN: Good morning.
I'm Tim, and
15 thank you for inviting us here. We're excited about
16 playing a part in getting this message out
before you.
17 We've had some fun in developing different
ideas. We've
18 presented about five ideas and whittled them
down slowly
19 to one that we feel communicates in the best
way the
20 important message that you do have to share
with the
21 people in this state.
22 And with that, I'd like to
introduce Philip
23 Nobert, who is our associate creative
director, and he
24 will walk you through our idea.
3
1 MR. NOBERT: Yes.
The idea here is generally
2 when we do television, as I'm sure you're
all aware, to
3 get to the message. You have to get people's attention
4 first, so a creative idea stands up and
says: Look at
5 me.
6 Once you suck in the viewer, you
have an
7 opportunity to tell the message, and that's
exactly what
8 we do.
It's a story of a person trying to find out more
9 about their doctor in a way that I guess you
can say is
10 maybe a bit extreme, and we turn that around
at the end
11 and give the idea of there is an easier way
to do it.
12 The name of the spot may seem a
little
13 familiar.
It's called Dr. Gate, and it opens up on sort
14 of a familiar visual of an office building
-- and I can
15 pass these around at some point -- at
nighttime, and
16 there is a couple of shadowy figures in
there. You see
17 some lights kind of moving around the office
building.
18 It's a glass office building, and we hear
whispering
19 conversation on walkie-talkies, and I'll
just dive right
20 in.
21 The names are sort of code names
because the
22 feel is it's like a mission.
23 First guy says on the
walkie-talkie: Number
24 2 to Number 1, we're in.
4
1 The guy says: Roger that.
Okay. We need
2 information on this guy, people -- he's
talking to a
3
group of people presumably -- school records, practice
4 history, everything. Now scatter.
5 At that point we see lights kind
of
6 scattering all over the place. We hear footsteps, file
7
cabinets, computer keys, computers turning on, they're
8 searching.
9 Suddenly a voice of reason steps
up and says:
10 Are you sure about this, sir? His name is Red Dog.
11 That's his code name.
12 He says: Red Dog, you know, he's my doctor.
13 This is my health we're talking about. You know, what
14 do you people all know about your doctors
anyway?
15 Everybody just sort of stops, you
know, for a
16 beat, and then the activity picks up again
as that
17 comment sits in. What do we really know?
18 The announcer comes in at that
point and says
19 very straightforwardly: There's an easier way to learn
20 about your doctor. Call the Nevada State Board of
21 Medical Examiners with questions. It's a free service.
22 At that point you see the graphic
coming up.
23 We only have it on the last frame, but
presumably it
24 will be up there for a while so you can
absorb it.
5
1 Nevada has the strictest
licensing
2 requirements in the country for
doctors. Make sure
3 yours measures up.
4 Again, the logo, the phone number
5 888-890-8210, and then we're back to -- just
a button
6 for humor's sake. Guy says:
Number 1, look. A
7 diploma.
He says: Bag it, Red Dog. And it fades to
8 black.
9 So, clearly, when competing on
television
10 with all the other things that are out
there, you do
11 need to stand up and be counted. And this one would be
12 something -- even if the sound was turned
off, you'd
13 wonder what is this shot that just sits
there for 30
14 seconds in this building with all these
flashlights and
15 what's going on in there.
16 And visually -- you know, even if
you didn't
17 hear what they were saying, at the end we
tie it back
18 with some sort of a logo treatment of what
it is, and
19 we'll talk to the media about it and receive
a spot
20 enough to really absorb the message.
21 So we also have a radio
spot. I will just
22 take it.
23 MR. ROSENCRANTZ: Go right ahead and do the
24 radio.
6
1 MR. NOBERT: For the radio, you don't have
2 the visual, obviously, at your disposal, so
you have to
3 create that feeling in the mind, so we have
the scene
4 created in our heads: Crickets chirping, police sirens
5 somewhere off in the distance sort of thing,
door
6 opening up, the walkie-talkie crackle, that
whole deal,
7 and the whisper talk. This time there is just one
8 dialogue.
9 Number 1 to Number 2, we're
in. Roger that,
10 Number 1.
It's go time. Okay, people. Grab anything
11 that will give us a clue about this guy,
school records,
12 practice history, anything, you name it.
13 So we hear the hurried footsteps
and papers
14 rustling, computer keyboards, file cabinets,
a little
15 chaotic in a sense. Somebody steps up and says: Yeah,
16 but this is a doctor's office.
17 He goes: You got a problem with that Red
18 Dog?
19 Somebody off in the distance
says: Hey, I
20 found something. Some people go towards that person.
21 What do you got, Cooper?
22 He goes: Well, uh, something's expired here.
23 The voice of reason pops up
again: Come on,
24 guys.
This is a subscription to People magazine.
7
1 He says: All right.
Fine. Keep looking.
2 He goes: Look, I really don't think we
3 should --
4
He goes: Hey. Then he comes to a stop. You
5 know, he is my doctor. This is my health. What do you
6 all know about your doctors? And sort of -- sort of a
7 murmur under their breath.
8 The announcer pops in: Want to know more
9 about your doctor? There is an easier way. Call the
10 Nevada State Board of Medical Examiners at
888-890-8210.
11 You can check education and practice
histories or bring
12 questions to the Board. It's a free service.
13 Nevada has the strictest
licensing
14 requirements in the country for
doctors. Make sure
15 yours measures up.
16 You hear a sound effect of
breaking glass or
17 something, and he says: Keep looking.
18 The announcer closes it one more
time:
19 Nevada State Board of Medical Examiners,
call
20
888-890-8210.
21 That's that.
22 MR. ROSENCRANTZ: Okay.
If you would, Phil,
23 could you pass the scripts around to the
Board members
24 so we could see them.
8
1 And my preface to our discussion
of this
2 would be that prior to Lieutenant Governor
Hunt's PSA,
3 we had a spot produced for us for our first
campaign,
4 and it was selectively liked by the Board
members. And
5 there was some feeling that it had a
negative
6 connotation to the credibility of the
physicians.
7 When Larry and Dr. Lubritz and I met,
we
8 tried to explain to Quillin & Company
that we didn't
9 want that.
And if you listen to the spot, it really
10 isn't.
There is no negative in it. At
least I don't
11 feel there is.
12 This is a real positive-type
spot. Sort of
13 talking about how the public can find out
about their
14 doctor's history. And I'd like to comment that you guys
15 can
read it, and you can visualize what it's going to
16 look like.
17 DR. HUG-ENGLISH: I think it's very clever,
18 but I do have some concerns. And I think one of the
19 concerns I have is that it gives the
impression that
20 we're trying to hide something or that
physicians are
21 trying to hide something about their records
or their
22 education, Dr. Gate.
23 I'm a little concerned about
that.
24 DR. BAEPLER: I'm a little concerned about
9
1 the final phrase: Make sure yours measures up. It's
2 put into context of Nevada has the toughest
licensing
3 requirements. Make sure yours measures up. They
4 certainly measure up to the licensing
department, or
5 they wouldn't be licensed. And beyond that, I'm not
6 sure what's inferred.
7 DR. STEWART: I had the same question. And I
8 think if you change the statement by saying
you can make
9 sure yours measures up, it delivers a
different message,
10 delivers a positive message.
11 DR. BAEPLER: Yeah.
12 MR. QUILLIN: That's a good point. I agree.
13 MR. ROSENCRANTZ: Any other feelings?
14 It's important that when you have
a message
15 go out on TV that it not just be something
that's
16 ordinary, or they're not going to listen to
it. Our
17 idea is that we want it to stand out. We want it to be
18 unusual.
19 I think this has -- in my own
opinion -- has
20 a good effect, and it will get your
attention both
21 watching and listening.
22 DR. TITUS: I agree with Cheryl in that it
23 comes across as if information on your
doctor is
24 secretive to begin with that these people
would have to
10
1 sneak into a doctor's office to look for a
diploma when
2 I don't know of a physician in a room that
doesn't
3 display their diploma on a wall, their
educational
4 background on the wall, and being proud of
it.
5 In no way is it a secretive
issue, at least
6 for me, and I'm not sure this is how --
under this
7 pretext of secrecy that we would want -- for
me, this
8 isn't something that I would want to see
aired
9 publically, that it's secret stuff to go --
even from
10 the get-go.
11 I agree it has to be in theory
catch an eye,
12 get people to listen to it. All those things that are
13 good for ads, but in this context, I don't
appreciate
14 it.
15 MR. ROSENCRANTZ: Any other comments?
16 DR. STEWART: Is there a way to punch up the
17 announcer's discussion in that these
18 mission-impossible-types are stupid because
the simple
19 way of doing this -- apparently, we're
focussing upon
20 the fact that everything is secretive. If we punched up
21 the idea from the announcer that it's
straightforward to
22 get any information that you would want or
need, call
23 the number.
I see that as your problem.
24 DR. TITUS: I think it's a bad idea, and you
11
1 ought to come up with a different
scenario. I just
2 don't think that scenario works for me. I mean
3 that's --
4 DR. HUG-ENGLISH: I'm concerned that it might
5 be perceived not only by physicians, but
also by the
6 public that:
Gosh, I better check because they're
7 hiding all this stuff, and what don't I
know.
8 Whereas, I don't think that's the
message
9 we're trying to get across. It's more if you have
10 questions or concerns, call us, and we'll
tell you.
11 But this sort of gives the
impression out
12 there that there is all this body of
information that's
13 been hidden before that you can now have
access to, and
14 that's what concerns me.
15 MR. ROSENCRANTZ: I want -- I think sometimes
16 we take ourselves to seriously, and I want
to make sure
17 that you're not. We can go back and do more. We
18 haven't produced the spot. It's not a problem.
19 I'm just saying that we've taken
the negative
20 out as far as the doctor looking
foolish. I think --
21 from my own perspective I think the public
does think
22 the information is secretive. I don't think that's a
23 secret.
I think they do. They don't know
where to get
24 the information. I don't know that the word is you want
12
1 to use for it. It's sort of a spoof on it.
2 DR. TITUS: It can be tongue-in-cheek, and it
3 can be -- the whole spot can be an
eye-catching kind of
4 spoof and all that type of thing. It doesn't have to be
5 a serious spot, but this information --
first of all,
6 what are we trying to accomplish? We have public
7 information, and for me, this way of
presenting it just
8 doesn't work.
9 There is all kinds of great ideas
that I'm
10 sure you have of doing it.
11 DR. LUBRITZ: Did we have one as a backup?
12 MR. ROSENCRANTZ: We have one other spot. We
13 don't have a story board, but we have
another spot.
14 Give us a run through on that one.
15 MR. NOBERT: Just to be clear on the Dr. Gate
16 idea, certainly the idea was never to imply
the idea of
17 hiding information. It was really more of a -- just
18 kind of a technique, tongue-in-cheek. We actually had
19 scripts with the same general concept that
were even a
20 little cheekier. It was obviously a spoof. It wasn't
21 supposed to be straightforward.
22 MS. MUNOZ: Can I say something?
23 MR. ROSENCRANTZ: Sure.
24 MS. MUNOZ: Your comment about taking
13
1 ourselves a little too seriously, when I was
listening
2 to this and thinking about it, I don't
really think the
3 public thinks about finding out about their
doctor that
4 much on the public level. I kind of perceived this more
5 as an information -- a service that they
didn't realize,
6 not that -- not that anybody ever tried to
hide
7 anything.
8 My perception when I was
listening to this
9 was:
Oh, yeah. This is going to inform
the public
10 about a service that they probably didn't
know that they
11 had available or that they could do
that. And
12 generally, I don't think the public really
thinks that
13 much about their doctor in that perspective.
14 I mean, they just assume and they
take for
15 granted that, you know, they've all
graduated. They've
16 got their diplomas and all of their
certificates and
17 everything.
And I don't think the general public --
18 when they go into a physician's office, I
don't think
19 they really think about going to look for
those things
20 so that this actually puts a different
perspective on
21 it.
22 That's just how I perceived it,
and I
23 understand.
I totally respect what you're saying, and I
24 can see where from the professional level we
would think
14
1 of it along that line, but if this is to be
for the
2 public, then I kind of feel that it's going
to do the
3 job even though it's kind of spoofy. That's how I saw
4 it. I
think that was your intent.
5 MR. QUILLIN: We personalized it back down to
6 school records, practice history. You know, this is my
7 health, and I want to make sure that this
doctor knows
8 what he or she is doing.
9 We put forth a scenario so
ludicrous that no
10 one would ever seriously consider going and
breaking
11 into an office, and again, getting back to
that point of
12 saying:
Look, come on. There is a nice
easy way if
13 you're interested in finding out anything
about your
14 doctor.
15 MR. NOBERT: Did you know, by the way, that
16 this exists for you if you need it?
17 MR. ROSENCRANTZ: It reminds me of a tire
18 commercial.
I think it's Discount Tire that does a tire
19 commercial and talks about if you're ever
unhappy with
20 your tire, you can just bring it back, and
then they
21 take the tire and throw it through the
window.
22 And if you were a tire store,
would you
23 think:
We'll should I run that spot? But
the idea of
24 it is it's so memorable. That's why the spot gets --
15
1 MS. MUNOZ: Does the patient ever come in --
2 even a first-time patient and say: Okay.
I want to see
3 your credentials. No.
They just -- when they make an
4 appointment to see you, they just assume.
5 MR. LESSLY: Or they've already called us and
6 found out.
7 DR. BUCHWALD: I think the past experiences,
8 however, increase my sensitivity to any
innuendos that
9 imply even remotely that physicians are
secretive, that
10 we're doing things that potential we're not
trained to
11 do.
And the very first campaign we had, it wasn't the
12 public that was the major problem. The physicians were
13 totally insulted, and we didn't realize that
this was
14 going to be the case.
15 So I perhaps have an increased
sensitivity,
16 and I think the physicians are a little
tired of being
17 made the bad guys. And I think this would just kind of
18 perhaps reinforce the fact that we don't
tell everything
19 and/or it's not up front.
20 Knowing the people that I live
and work with
21 on a day-to-day basis, I understand it's a
spoof. We've
22 been through the spoof, and we've all
thought it was a
23 spoof and didn't take ourselves too
seriously, but we
24 found out that's not true. I -- maybe we don't have a
16
1 good sense of humor, but --
2 MR. ROSENCRANTZ: Susan, maybe the physicians
3 took it to seriously, but the public liked
it, and they
4 called, and we are there for the public.
5 It's not that we want to
downgrade physicians
6 by any means. Larry and I sat with these gentlemen and
7 talked about it and were sensitive to the
issue of what
8 happened in the past campaign.
9 If you don't want to do something
catchy,
10 then we'll go back to Governor Guinn and
just a straight
11 spot and see what kind of results we get.
12 DR. HUG-ENGLISH: If we were trying to sell a
13 product like a tire or something that we're
trying to
14 market that way, I could see doing a spoof
like this.
15 But my feeling is we're here to provide a
public service
16 announcement to tell them about the Board
and what
17 services are available to the public.
18 I think this does give the
impression, again,
19 that the physician's the bad guy, and I
think we've been
20 down that road before.
21 DR. BAEPLER: I like the slant however. I
22 think in one of the very early ones the
physicians had
23 some problem with was the wording that
almost invited
24 the public to call the Medical Board to
complain about
17
1 service, and that element is gone. You see, we're not
2 inviting complaints, and that's good.
3 MR. ROSENCRANTZ: Let's read the second one.
4 I don't remember how different it was.
5 MR. QUILLIN: It's a completely different
6 approach.
7 MR. NOBERT: It's called "Who's Examining
8 Who."
And this one, I guess, in some way, shape, and
9 form shows a doctor that's trying to
communicate to the
10 patient who has questions. I'll just kind of go through
11 it.
This is the television spot.
12 You open up on a doctor's
examining room, and
13 there is a Norman Rockwell illustration of a
guy sort of
14 looking at the diploma on the wall as his
robe sort of
15 starts to rise. So you've got that visual of that, and
16 the doctor comes in and enters.
17 I should have said that this is a
series of
18 cuts with a patient asking the doctor
questions, looks
19 like he's trying to get at something. So that's how it
20 starts.
21 The doctor comes in and catches
him, and he
22 just kind of turns around and assumes a
nonchalant
23 position.
Later on in the exam he's looking in his ear
24 or something, and he says -- the patient,
Mr. Simmons,
18
1 says:
So how long have you been in town, Doc?
2 Then we cut to another scene, and
he's doing
3 something else, tapping the knee. Then he goes:
So how
4 many patients do you have?
5 And then we cut to another scene,
and he
6 says:
Boy, I bet those boards weren't easy, huh?
7 Now we're cutting to the outside
of a men's
8 room.
There is a closed door, and the doctor is
9 standing there waiting outside for Mr.
Simmons inside.
10 He says:
Boy, med school must have been pretty rough,
11 huh, Doc?
12 Doctor close up smiles. He says:
I really
13 don't know, Mr. Simmons. I never went.
14 The glass breaks in the
restroom. We cut
15 back to the examination room, and you see
the Nevada
16 State Board of Medical Examiners, and the doctor
is
17 saying at the same time: Kidding, Mr. Simmons. I
18 attended med school at the University of
Nevada, Reno.
19 I graduated top of my class.
20 You know, there is an easier way
to find out
21 more about my background. Give the Nevada State Board
22 of Medical Examiners a call to find out
about education,
23 practice histories -- but, Mr. Simmons,
don't worry.
24 It's a free service.
19
1 And then we cut back to Mr.
Simmons as the
2 information sinks in. He says:
So how is your
3 handwriting, Doc?
4 It shows the patient who is not
feeling
5 really comfortable just coming out and
asking the
6 questions that he has.
7 The radio spot is really very
similar. We've
8 got that examining room ambiance, the
florescent
9 lighting, the scale, and back and forth
dialogue with
10 the doctor starting with: All right.
You can step off
11 the scale now, Mr. Simmons.
12 So, Doc, how long have you been
practicing?
13 Just about 16 years. Turn to your left.
14 Just about 16 years, huh? Nice.
15 If you could please keep still, Mr.
Simmons.
16 I saw on the news that there was
this guy who
17 worked as a doctor for years before somebody
found out
18 that he never actually went to medical
school. Yeah, I
19 think I heard something about that. Imagine that --
20 Turn to your right, Mr. Simmons.
21 -- never actually went to medical
school.
22 Mr. Simmons --
23 Med school was pretty rough, huh,
Doc?
24 Mr. Simmons, you know, I did
attend medical
20
1 school at the University of Nevada,
Reno. I graduated
2 at the top of my class.
3 You know, there is an easier way
to find out
4 more about my background. Just give the Nevada State
5 Board of Medical Examiners a call. Just by calling you
6 can find out about a doctor's education,
practice
7 histories --
8 Yeah, but --
9 Don't worry. It's a free service.
10 Then the announcer comes in: Nevada has the
11 strictest licensing requirements in the
country for
12 doctors.
You can make sure yours measures up.
Call the
13 Nevada State Board of Medical Examiners at
888-890-8210.
14 Say, Doc, how's that handwriting?
15 888-890-8210.
16 DR. DESAI: I like this one.
17 DR. HUG-ENGLISH: I like this one better too.
18 MR. QUILLIN: Visually, you could really have
19 some fun with it because you got a guy
trying to talk
20 with a tongue depressor in his mouth and is
still trying
21 to get across and is almost kind of looking
to control
22 the environment inside the examine
room. The doctor
23 knows exactly what he's up to the entire
time.
24 MR. ROSENCRANTZ: Do you have scripts on that
21
1 one?
Did you make copies of that? If
we could pass
2 them out just so we can look at them and see
if there is
3 any wording that we don't like.
4 Any discussion on this one while
he's getting
5 the script?
6 MS. LYONS: What is practice history? You
7 can find out about your doctor's practice
history. I
8 don't understand what that means. When people call in,
9 they're going to ask: I want to know about my doctor's
10 practice history. What is that?
11 DR. LUBRITZ: I had some question about that
12 too.
13 MS. LYONS: We don't have a history.
14 DR. LUBRITZ: Perhaps, where has he
15 practiced.
16 MS. LYONS: We really don't have that.
17 DR. DESAI: Or how long he has been
18 practicing?
19 MR. ROSENCRANTZ: We can certainly change
20 those words.
21 DR. DESAI: I still don't like: Make sure
22 yours measures up. If we can change that wording --
23 DR. BUCHWALD: Without having -- I think the
24 verbal things that I've heard -- I prefer
the verbiage
22
1 associated with the TV spot rather than the
radio spot.
2 DR. TITUS: I certainly like the overall
3 concept of this one better where the
physician is a
4 participant encouraging the patient to find
out more
5 information if they're interested, so the
overall gest
6 of this one --
7 DR. DESAI: Gives a feeling of proactive
8 rather than inactive.
9 DR. TITUS: Right.
Exactly.
10 MR. QUILLIN: That is true.
11 MR. ROSENCRANTZ: Tim, can you explain --
12 since we don't have a story board -- how you
would maybe
13 do this?
14 MR. NOBERT: We would shoot this in an
15 examining room, and we would just go through
a basic
16 examination.
And as the examination is happening this
17 guy is --
18 MR. QUILLIN: It starts out with him clearly
19 checking everything he can inside the room
to find out
20 about his doctor, and when the doctor walks
in he's
21 obviously startled and surprised and tries
to look
22 nonchalant.
Hear I am, just ready to be examined.
And
23 then a series of cuts.
24 MR. NOBERT: Basically, a series of cuts
23
1 where in each cut he asks a question
relative to what
2 he's trying to get at.
3 The doctor really from the get-go
-- you
4 know, you can shoot that in a way that he's
obviously on
5 to
him, and he's kind of going through the examination.
6 It gets to the point where he says: Look, Mr. Simmons,
7 here's what you need to do if you want to
find some
8 things out.
9 Pretty straightforward really. We just need
10 to find the actors who could pull it off,
and we know of
11 some people who would do that nicely.
12 MR. LESSLY: Nice.
13 MR. QUILLIN: We could have the doctor
14 saying:
Look, just relax. There is an
easy way to find
15 out about my practice history, whatever.
16 DR. BUCHWALD: It's probably nit-picking, but
17 I'm reading the one that says 30 on the top
of it, so
18 I'm assuming that's the radio --
19 MR. NOBERT: Television.
20 DR. BUCHWALD: TV, sorry.
21 For logical sequencing, I would
put the
22 request in regards to the medical school
prior to the
23 one on the boards, and then also I would say
something
24 in regards to Board Certification rather
than just
24
1 boards.
It's probably nit-picking to you, but I think
2 to the physician it means a totally
different thing.
3 MR. NOBERT: I think it's a matter of what
4 would somebody really ask. What would their questions
5 be in that situation? That's one of them. We have a
6 few questions to chose from -- what we can
agree would
7 be asked.
8 DR. BUCHWALD: I don't mean we have to use
9 the formal Board Certification, but some
kind of
10 licensing, some kind of paper.
11 MR. ROSENCRANTZ: After the medical school
12 you could say: I bet licensing wasn't easy?
13 DR. BUCHWALD: Something along those lines,
14 but the Board -- to have something in this
spot
15 regarding Board Certification I think would
appease a
16 lot of physicians and actually help with --
help with
17 the public.
18 MR. ROSENCRANTZ: Would you be concerned
19 about saying Board Certification?
20 MR. LESSLY: We don't give that out.
21 DR. BUCHWALD: But you verify whether or not
22 we have it.
23 MR. LESSLY: We don't have any way to verify
24 it other than what they tell us, and maybe
it's two
25
1 years old.
2 DR. HUG-ENGLISH: I don't think the public
3 is going to know what that means.
4 MR. ROSENCRANTZ: They think it's what we do
5 anyway.
6 MR. NOBERT: I just want to say that if the
7 only thing we accomplish with this spot is
that there is
8 a place you can go to find some things out
regardless of
9 whatever those things are that are important
to you to
10 find out, here's a phone number. Done.
That's what
11 we're trying to do.
12 DR. BUCHWALD: I definitely prefer this one
13 over the other.
14 DR. DESAI: Thank you.
15 MR. ROSENCRANTZ: Do we feel -- do I have a
16 consensus here that this would be the way
we'd want them
17 to go?
Maybe we'll have them work on this spot a little
18 bit.
Suggestions were given.
19 Possibly when they're done -- we
don't want
20 to produce a spot that alienates anybody --
we'll fax it
21 to everybody, and then go with this spot.
22 Do you like the idea of it? We thought it
23 would work.
They brought our committee about five or
24 six different spots. These are the two that we liked,
26
1 and I think Dr. Lubritz liked this one a
lot, if my
2 memory serves me right.
3 I'd like to have a fairly good
consensus that
4 this is the style we'll go at and do it?
5 DR. HUG-ENGLISH: I like it.
6 MR. ROSENCRANTZ: Some details -- so you know
7 we've given Quillin & Company a budget
of $15,000 to
8 produce it.
No more, maybe less, and we have that in
9 our budget.
We've been off the air for about three
10 months now.
This quarter we were off, and probably
11
maybe not go back on until November, so we have some
12 time.
13 I guess, I'd like a motion if we
can go ahead
14 and work on this spot?
15 (Whereupon, motions were made.)
16 MR. ROSENCRANTZ: Motion second. Any further
17 discussion on that? Okay.
All in favor?
18 THE BOARD: Aye.
19 MR. ROSENCRANTZ: Anyone opposed? Chair
20 votes in favor of the motion. Motion carries.
21 So, Mr. Quillin, your job will be
to fix this
22 up a little bit. Possibly -- maybe it's a good idea to
23 do some kind of a story board for our
committee, and
24 we'll send out scripts to the rest of the
Board before
27
1 we go any further and produce it.
2 But I think we're looking for
something done
3 right after -- in November sometime,
finished by
4 November.
So our time frame, I assume, is okay?
5 MR. QUILLIN: You have plenty of time. We're
6 very confident that both spots would be
excellent, and
7 this one that we've chosen, we can do some
nice things
8 with it.
9 MR. NOBERT: We'll make it fun.
10 MR. ROSENCRANTZ: Thank you very much for
11 coming.
12 MR. QUILLIN: Thank you.
13 MR. ROSENCRANTZ: Our next agenda item will
14 be Number 17, consideration of request for
Nevada
15 Society for Respiratory Care for licensure
of
16 respiratory therapists by Nevada State Board
of Medical
17 Examiners.
18 Do we have somebody from
Respiratory Care
19 here to speak?
20 Good morning.
21 MR. GARCIA: Mike Garcia, the president of
22 the Nevada Society for Respiratory Care.
23 PEGGY: Peggy (unknown last name), past
24 president.
28
1 MR. ROSENCRANTZ: Welcome.
Do you have a
2 presentation for us, or would you just like
to --
3 MR. GARCIA: It's not a presentation, and we
4 won't take up much of your time.
5 We have been working on a
strategic plan that
6 our governing Board approved late last year,
actually
7 initiated it the turn of this year, to take
the existing
8 Work Practice Act for respiratory
therapists, which is
9 NRS 640B, and elevate it to a licensure
status.
10 We have Senator Ray Rawson and
Senator
11
Raggio who agreed to sponsor our bill in the upcoming
12 legislature, and what we are currently
looking at are
13 options for how to establish the licensure
Board.
14 We believe that the probability
is high that
15 this piece of legislation will be enacted,
and looking
16 at the finances for the state, it is clear
to our
17 association that it makes most sense
physically to come
18 in under another existing Board in the
state.
19 From a professional standpoint,
respiratory
20 therapists as a whole in general consider
themselves to
21 be physician extenders, but we have had
informal
22 conversations with both the Board of
Pharmacy and the
23 Board that works with physical therapy,
occupational,
24 and speech language pathology.
29
1 Our first choice would be to
become a
2 subfunction of this Board, and that is what
we're here
3 to do today is just introduce that
concept. We have
4 provided your organization with a copy of
our strategic
5 plan that includes the existing Work
Practice Act and
6 the draft legislation -- our language that
we have
7 forwarded to a bill writer.
8 We expect some changes in that
language, but
9 I believe copies have been made available to
you all for
10 your review.
11 We'd like you to consider that
information
12 and consider giving us first an opportunity
to be
13 supported by your Board, and secondly, if it
comes to an
14 agreement, to include us in your Board.
15 MR. ROSENCRANTZ: Okay.
16 DR. STEWART: Mr. Lessly, would they be like
17 physician assistants, and we would take over
the
18 responsibility of licensing them like we
license
19 physician assistants?
20 MR. LESSLY: I'm not sure that's the concept
21 of their bill. I would say that from the standpoint of
22 how this Board operates, that's probably the
only way
23 that we would be able to do that.
24 And just so you guys understand,
what we do
30
1 with physician assistants is we have
legislative
2 authority to regulate physician
assistants. We don't
3 have a Board of Physician Assistants. We have a
4 physician assistant right next to you there
who sits
5 with this Board as an advisor on PA
matters. We have
6 legislative authority to totally regulate
physician
7 assistants by regulation, and that's how we
do that.
8 If you propose coming to this
Board to be
9 regulated by this Board, I would think that
that would
10 be the way the Board would want to do it --
assuming
11 they had an appetite for that -- would be to
say: Yes,
12 we would assume the legislative authority to
regulate
13 respiratory therapists. We would want the legislature
14 to grant us the further statutory authority
to do that
15 regulation by adopting our own regulations
or
16 administering that professional.
17 And just so you know, I mean, I
don't look
18 for any money from the legislature for
this. I don't
19 think that's going to happen. We're totally
20 self-funded, and we would have to make a
determination
21 of what the fee for licensure would be so
that that
22 aspect of regulation would be fully funded
from those
23 that are licensed.
24 MR. GARCIA: We've done research in that
31
1
area. The Community College of
Southern Nevada last
2 year completed a job survey of respiratory
therapists in
3 this state, and the results were just over
600
4 practitioners.
5 We're looking demographically
very similar to
6 the state of New Mexico. We know that respiratory
7 therapists there are paying $200 their first
year of
8 licensure and $100 each year thereafter.
9 We look at those funds in this state and
see
10 $120,000 the first year that would come to
this Board or
11 whatever Board that we end up with to handle
the initial
12 costs, which are the big costs, of getting
people
13 licensed.
14 We've looked at some of the other
states that
15 have had respiratory therapists under the
Board of
16 Medical Examiners to see what the incidents
of cost has
17
been ongoing after the initial start up, and what we've
18 seen are some pretty low figures.
19 The state of Maryland per se,
which was the
20 first state to license respiratory
therapists as a
21
function under the BOME, sees anywhere from four to 15
22 respiratory incidents or respiratory
occurrences at
23 their Board meetings in an -- in the last
eight-month
24 period.
32
1 Outside of getting them on Board,
the costs
2 do not seem to be profound.
3 MR. LESSLY: I would tell you that if you
4 have that many disciplinary actions, that
may be more
5 significant than what we have with
physicians as far as
6 formal actions are concerned.
7 MR. GARCIA: I find that interesting because
8 I noted that in the state of Maryland it is
-- it was
9 typically anywhere from 20 to 30 per month
for
10 physicians and physician assistants. It seemed like
11 such a small number in view of things in
proportion
12 considering the amount of respiratory
therapists versus
13 the amount of physicians.
14 Now, are you talking litigation?
15 MR. LESSLY: No.
I'm talking formal actions.
16 What, Mr. Legarza, 16 to 18 a year gleaned
from 600
17 complaints?
18 MR. LEGARZA: Yes.
19 MR. LESSLY: With a $2.2 million budget per
20 year to do that.
21 DR. STEWART: When you described four to 15
22 over eight months, is that complaints, or is
that --
23 MR. GARCIA: That's just them showing up at
24 the Board.
Actually, three were for complaints against
33
1 the practitioners for substance abuse
problems. One was
2 a reinstatement after a probationary period.
3 MR. LESSLY: How many disciplinary actions?
4 MR. GARCIA: Well, there were three that I
5 remember for sure, disciplinary actions.
6 MR. LESSLY: That is a different situation.
7 MR. ROSENCRANTZ: Do you understand what
8 Mr. Lessly is explaining to you?
9 MR. GARCIA: I believe so.
You're telling me
10 it costs money to go through and remove a
license or
11 bring to hearing removal of a license?
12 MR. LESSLY: It costs money to credential
13 through the licensing process. It costs money to
14 administratively investigate any type of complaint,
and
15 it costs money to do a formal action in the
form of
16 disciplinary action against a licensee. Those are the
17 three major areas that we deal with
financially.
18 MR. GARCIA: I understand that, and I know
19 that, once again, when we look at ourselves
in the state
20 of Nevada, we tend to look at Arizona, Utah,
New Mexico,
21 the states -- the southwestern states that
surround us.
22 The start-up costs for the state
of
23 New Mexico were $60,000 for the first two
years with the
24 same amount of practitioners. Now, I don't know what
34
1 they have cost them. They've been licensed now for
2 eight years, and I can certainly get the
data to see the
3 costs of that ongoing to the Board.
4 MR. LESSLY:
We would have to determine those
5 costs and be prepared to assess the
registration fee
6 based on those costs. You're talking about apples and
7 oranges here to a certain extent.
8 For instance, Utah is a state agency,
9 umbrella agency that administers health care
with
10 funding from the state.
11 We have no funding from any
source whatsoever
12 other than our licensees. So we have to make a
13 determination. We've done that with the PAs, sometimes
14 to their dislike. We've had to say the fees have got to
15 be raised in order to carry the financial
burden of
16
regulating you so that the doctors are not paying for
17 the PAs to be regulated.
18 What I'm saying is we really
wouldn't be able
19 to tell you what the start-up costs are
going to be
20 until we saw for certain what was going to
be involved,
21 and we would thereafter include in a
registration fee
22 for the biennium an appropriate fee that
would cover the
23 costs of administering that profession.
24 MR. GARCIA: That's makes sense.
35
1 DR. TITUS: What are the PA licensing fees?
2 MS. MUNOZ: I don't remember because usually
3 my employer pays it.
4 MS. HERUM: $200.
5 DR. TITUS: $200 to apply and then annually
6 or biannually --
7 MS. HERUM: Biannually.
8 MS. MUNOZ: We have 300 initially, 200
9 biannually.
10 MR. LESSLY: Our bill increases that limit
11 for PAs to 800 maximum. That doesn't mean that's what
12 the Board is using.
13 We've had discussions here
before. We talked
14 about fees.
It costs us as much to license a PA as it
15 does to license an MD because we do a very
thorough job
16
on PAs.
17 DR. BUCHWALD: How many PAs do we have
18 licensed in this state?
19 MS. MUNOZ: Between 180 and 200.
20 MR. GARCIA: It's a growing population. We
21 find very little argument in the need for
licensure in
22 the state in that all of the states
surrounding us --
23 all but six states in this nation --
currently regulate
24 respiratory therapist licensure.
36
1 We understand the general public
will support
2 us in this need as well. We're really looking for a
3 home.
We certainly aren't looking for a decision today.
4 What we're looking for is just
your due
5 consideration, put some thought into it, and
obviously,
6 pencil to the paper. We would, as health care
7 providers, like to come to this Board, but
obviously,
8 we're going to go where it makes financial
sense as
9 well.
10 MS. MUNOZ: Do you have a copy of your bill
11 draft?
12 MR. GARCIA: Yes. I
believe they were
13 provided.
I thought they were provided.
Each member
14 should have it.
15 MS. MUNOZ: -- physician extender in that
16 bill draft?
17 MR. GARCIA: Absolutely not.
18 When I use the term
"physician extender," I'm
19 using the academic term. There are a variety of
20 physician extenders in the health care up
and down the
21 continuum; certainly not the legal
term. We recognize
22 the physician assistant as the immediate
physician
23 extender in this state.
24 MR. ROSENCRANTZ: When I asked you if you
37
1 understood what Mr. Lessly said, you
explained that you
2 did about the fees, but I didn't get a
response to: Do
3
you understand the way this Board would want to
4 handle --
5 MR. GARCIA: Yes.
6 MR. ROSENCRANTZ: That's something that --
7 we've had proposals. We had some presentations by
8 respiratory therapists, and we have talked
about this.
9 And one of the things we feel probably
pretty strongly
10 about in my impression is we would want to
treat you
11 like the PAs and not -- for you not to have
your own
12 regulations on the Board, that we would do
those.
13 MR. GARCIA: And I guess my question would
14 be:
Does your physician assistant member have a vote on
15 this Board?
16 MR. ROSENCRANTZ: No.
17 MR. GARCIA: No.
And then that would
18 certainly -- I mean, I would have to
communicate that to
19 our constituency. Obviously, that would certainly have
20 an effect in them having us come to you.
21 MR. LESSLY: If you're talking about us
22 administratively running a Board of
Respiratory
23 Therapists to administer the respiratory
therapy
24 profession, you're talking about more money.
38
1 I would doubt that this Board
would -- what
2 would
be the point in that from the standpoint of this
3 Board?
4 And I think what I'm hearing here
is if this
5 Board did it, this Board would regulate
respiratory
6 therapists, and you would have someone here
to inform
7 the Board on matters that involve
respiratory therapists
8 as an advisor to the Board as Nancy sits
with us or
9 someone from the PAs sits with us at every
meeting.
10 MR. ROSENCRANTZ: Our rapport with the PAs
11 has been excellent, I think. I think we've really
12 gotten along well. We support them, and they support
13 us, and we have a good understanding. I don't know why
14 it couldn't be -- my impression is I would
kind of like
15 to do this, and I don't know how other
members of the
16 Board feel, but that's where I'm coming
from.
17 DR. TITUS: I think it's appropriate that the
18 respiratory therapists would be regulated
under this
19 Board.
I think it's appropriate and is the right home
20 for you as a profession. It's just working it out and
21 how -- again, having your own separate Board
-- a lot of
22 that logistically would have to be --
23 MR. GARCIA: The original language obviously
24 speaks to that model in that that model has
been
39
1 utilized in a variety of places
successfully. Our
2 national professional association, the
American
3 Association of Respiratory Care, has
prompted us to
4 start with that model, but it is clearly
just a working
5 model as we move forward with the
legislature.
6 DR. STEWART: How is this done in California?
7 MR. GARCIA: We've sworn that we won't -- in
8 California they have a free-standing
Respiratory Care
9 Board.
They have thousands and thousands of
10 practitioners that pay $600 a year for their
license,
11 and they have a seven-member Board that
oversees
12 respiratory care under one of the
departments of the
13 state legislature.
14 They are not attached to the
physicians at
15 all.
They are stand alone, and they are an entity unto
16 their own in this country. They operate very different
17 than almost any of the other Respiratory
Care Boards in
18 the nation.
19 We have seen most often where it
is a part of
20 the BOME, it is a committee of respiratory
-- four or
21 five respiratory therapists who recommend to
the BOME on
22 respiratory issues.
23 MR. LESSLY: Nancy is here as a
24 representative of that committee. We have a regulation
40
1 that requires them to do that.
2 MR. GARCIA: That's how we would foresee
3 folding the national model into the state of
Nevada.
4 MR. LESSLY: I'm hearing that's the concept
5 if this Board wanted to take this on. Then they need to
6 come back to us and tell us whether or not
that's a
7 concept they can live with before we're
willing to
8 discuss this any further.
9 PEGGY: We're also prepared with the
10
licensure fees after hearing California with their $600
11 fee and New Mexico with --
12 MR. GARCIA: 200 and 100 a year which --
13 MR. ROSENCRANTZ: Do they have time to wait
14 to come back to us in December?
15 MR. GARCIA: The bill writers have agreed to
16 write the bill leaving one blank. Up to the final 11th
17 hour, they can leave where our Board will
be, and it
18
will take a little bit of revision as to how it would
19 operate based on this Board because they
recognize that
20 that is the biggest -- that's our serious
obstacle at
21 the moment.
22 MR. LESSLY:
I think any bill that this Board
23 will support would be very, very simple, and
it's going
24 to be respiratory therapists are regulated
by the Nevada
41
1 State Board of Medical Examiners who will
conduct that
2 regulations adopted by the Board, and you're
hereby
3 empowered to do that. That's the bill.
4 PEGGY:
Actually, we're looking to just
5 addendum the existing --
6 MR. GARCIA: The Work Practice Act, 640B, is
7 in existence now, so that would not preclude
it as I
8 understand it.
9 MR. LESSLY: That would probably wipe that
10 out.
That might be the guideline for the adoption of
11 regulations.
12 MR. GARCIA: That is an important point. I
13 sure appreciate you educating me there
because obviously
14 I have to make my constituency aware of
that.
15 This simple association has spent
15 years
16 getting to the point where they got the
legislation to
17 recognize that respiratory care is something
that goes
18 on in medicine. It has some boundaries and guidelines.
19 Those are well established by law in this
state, and I
20 doubt any respiratory therapist in this
state would risk
21 losing that in order to be in this Board.
22 DR. LUBRITZ: Would -- is it your impression
23 if you had a Board to choose to associate
with, you
24 would like it to be this one?
42
1 MR. GARCIA: Yes.
2 DR. LUBRITZ: We might want to see -- would
3 we like them with us? I personally would, so perhaps we
4 could make their job easier by saying: Here's what we
5 would expect. If you can live with this, let's get this
6 done, as Mr. Lessly suggested, and here's
what it will
7 take.
8 And let's make it easy rather
than you go try
9 something.
It doesn't work, and you bring it back and
10 bring it back. Perhaps we could say: If you'll do A,
11 B, C, D, and E in this order, then it will
make things
12 easy for us to incorporate you into our
agency.
13 MR. GARCIA: That makes sense to me, sir.
14 MS. MUNOZ: In this draft, as I understand
15 it, your definition for Board means a State
Board for
16 Respiratory Care, so this would be -- this
is not what
17 you really want to do.
18 MR. GARCIA: That would be changed. This was
19 a starting point for the bill writer based
upon
20 legislation that has been prompted
elsewhere, obviously.
21 MS. MUNOZ: This is actually creating a
22 Board.
You're really going to have to change the
23 language of this considerably.
24 MR. GARCIA: Our first thought was we have a
43
1 Work Practice Act. We need to create a Board. Along
2 the trail of where is your Board going to
be, we came
3 into the financial realities and recognized
that we
4 probably need to be with an existing
Board. So we
5
recognize that obviously changing language for something
6 like that won't take much work.
7 MR. ROSENCRANTZ: All right.
Would you like
8 to propose a motion?
9 DR. LUBRITZ: If we can put it in its proper
10 context that the State Board of -- Nevada
State Board of
11 Medical Examiners makes suggestions to the
--
12 MR. GARCIA: Nevada Society for Respiratory
13 Care?
14 DR. LUBRITZ: -- Nevada Society for
15 Respiratory Care on how they might expedite
Nevada State
16 Board of Medical Examiners accepting them as
members to
17 be regulated as our physician
assistants. Does that
18 make sense?
19 MR. GARCIA: Licensed and --
20 MR. ROSENCRANTZ: Do we have a motion? Is
21 there a second?
22 (Whereupon, motions were made.)
23 MR. ROSENCRANTZ: Any further discussion?
24 Hearing no discussion, all those in favor?
44
1 THE BOARD: Aye.
2 MR. ROSENCRANTZ: Any opposed?
Chair votes
3 in fair of the motion. Motion carries.
4 You sort of have a direction
hopefully.
5 MR. GARCIA: Ladies and gentlemen, thank you
6 very much.
7 DR. DESAI: Mr. Lessly is your contact
8 person.
9 MR. GARCIA: We will be in touch.
10 MR. ROSENCRANTZ: It's five minutes to 10.
11 We'll take a five-minute recess.
12 (Whereupon, a recess was taken.)
13 MR. ROSENCRANTZ: The purpose of this hearing
14 is to receive comments from all interested
persons
15 regarding the adoption, amendment, or repeal
of
16 regulations pertaining to Chapter 630 of the
Nevada
17 Administrative Code, an adoption of proposed
18 regulations, Legislative Counsel Bureau File
Number
19 R121-00.
20 For the information of all in
attendance, the
21 Board conducted a workshop as is required by
the
22 Administrative Procedures Act of the State
of Nevada on
23 July 27th, 2000 in Las Vegas, Nevada, and on
July 28th,
24 2000 in Reno, Nevada.
45
1 The testimony and comments taken
at those two
2 workshops together with all written comments
that have
3 been provided to the Board to date have been
read and
4 reviewed by each member of the Board.
5 If there are persons present
today who did
6 not have an opportunity to testify at a
workshop on
7 these regulations or did not submit written
comments,
8 I'm going to provide time for such persons
to speak
9
should they so desire.
10 I should point out again, though,
that if you
11 testified at a workshop or provided written
comments to
12 the Board, we have reviewed that testimony
and those
13 comments, and there is little purpose in
repeating them
14 today.
15 It is my understanding that Dr.
Baepler, a
16 public member of the Board, after reviewing
all of the
17 workshop testimony and written comments has
requested
18 staff to prepare for him an amended version
of the
19 regulations.
All of the Board members have been
20 provided with a copy of that amended version
and have
21 reviewed it.
22 Copies of the regulation and
amendments to
23 the regulations are available on the table
in the back
24 of the room.
46
1 Procedurally, if there is a
motion -- if
2 there is a motion by a member of the Board
to take any
3 action on these regulations, I will take
discussions
4 from Board members with respect to that
action followed
5 by testimony from those in attendance who
wish to be
6 heard.
7 I am allocating three to five
minutes per
8 speaker for such testimony, and we will
conclude
9 testimony no later than 12 noon.
10 I will start with those wishing
to testify in
11 favor of the regulations followed by those
wishing to
12 testify against adoption of the regulations.
13 I will now entertain a motion
with respect to
14 the regulations LCB File Number R121-00.
15 DR. BAEPLER: Mr. President, before I offer
16 the motion, there is a few comments that I
would like to
17 make for the record.
18 As you indicated, this Board
proposed certain
19 additions and amendments to Chapter 630 of
the Nevada
20 Administrative Code, and duly noticed public
hearings or
21 workshops were held, and the public was
invited to
22 submit written testimony which we received
in some
23 abundance and continue to receive it even as
recently as
24 this week, I believe.
47
1 There was little or no comment on
the
2 amendments to Sections 2, 3, and 4, but
there was an
3
abundance of comments on Section 1.
Section 2, 3, and
4 4, by the way, are by way of amendments, and
Section 1
5 constitutes a new provision which as
originally stated
6 and noticed in these meetings Section 1, the
new
7 section, is necessary to regulate the
practice of
8 integrative or complementary medicine in the
state.
9 So my comments will really be
addressing
10 Section 1; although, the motion will include
the
11 adoption of Sections 2, 3, and 4 because
they seem to be
12 noncontroversial. And people could certainly comment on
13 them if they wish, but it appears to be
satisfactory as
14 written.
15 I think there is a couple of
points that need
16 to be made, and I'm now referencing Section
1 only.
17 Number 1, new Section 1, was
largely
18 misconstrued and misinterpreted by many
members of the
19 public as it was originally worded, and we
must really
20 emphasize that Section 1 does not in any way
expand the
21 authority of the State Board of Medical
Examiners.
22 Certainly, as you read through
the various
23 comments from the public, the inference is
that we are,
24 in essence, trying to invade turf of other
licensed
48
1 groups.
In fact, we are not. It does not
in any way
2 change the scope of coverage or the
authority defined in
3 statute for this particular Board.
4 The second inference that you can read
5 through many of the public comments is that
it would
6 expand the scope of practice by MDs. And again, I
7 submit it does not. The definition of the scope of
8
practice of the MDs is broad and perfectly acceptable to
9 this Board, and we are not expanding or
changing in any
10 way the types of medicine that the MD,
licensed MD, in
11 this state can perform.
12
A common objection to the original proposed
13 Section 1 revolved around language. A number of terms
14 such as integrative medicine and
complementary medicine
15 and several others, which are words that
mean different
16 things to different people, seem to really
confuse the
17 issue.
18 And so the first thing that the
amended
19 version of Section 1 accomplishes is
removing all of
20
those terms from what is the new proposed Section 1.
21 The second point that must be
made is that
22 the changes in the amendment that we are
proposing
23 today -- the amendment is to the old language
of Section
24 1, which is a new section -- is a process of
deletion,
49
1 not of addition. There are no substantive changes that
2 add any new concepts.
3 A rough analogy would be that we
propose to
4 adopt the Ten Commandments as our guiding
principle, and
5 as a function of public input, the public
objects to
6 Commandments 1, 2, and 3. So we are now amending our
7 proposal to adopt 4 through 10 and leaving
out three, in
8 other words, leaving 4 through 10 unchanged.
9 I think it's very critical because
had we
10 added any substantive new material, then it
would be
11 necessary, I believe, to go back and to hold
additional
12 public meetings and duly notice them and get
public
13 input into new material. Since we added nothing new but
14 rather simply deleted, it does not appear
necessary to
15 notice and repeat public workshops and
public hearings.
16 It also, by the way, makes
Section 1 much
17
shorter and, I believe, clears up any of the ambiguities
18 that were found in the original text.
19 Very briefly, if we look at the
objections, I
20 already mentioned the terminology which has
been cleaned
21 up.
The chiropractors, in essence, took a letter that
22 Drs. Fuller, Royal, and the Chiropractor
Kevin Jenkins,
23 who I believe is also an advanced
practitioner of
24 homeopathy, sent out to the chiropractors,
and we
50
1 received many letters from these
chiropractors all
2 identical without changing a word. And so it's very
3 easy to grasp the collective input from the
4 chiropractors by reading one letter.
5 And they seem to infer that they
would be
6 concerned that the Board of Medical
Examiners is moving
7 towards an attempt to regulate the
chiropractors, and I
8 don't know how they get the inference out of
the
9 proposed new Section 1, but clearly that is
not the
10 case.
11 As I indicated previously, there is no
12 expansion of functions of authority for this
Board in
13 the proposed regulations either in the
original wording
14 or in the amended form.
15 Private citizens seem to
misunderstand
16 various provisions. A typical example of that would be
17 an individual who thought that if the
regulations were
18 adopted, you would now have to get a
prescription from a
19
medical doctor to buy vitamins.
Again, how they get
20 that inference out of the regs, I don't
know. But it's,
21 again, an example of the general
misunderstanding that
22 people get which suggests confusion in the
language of
23 the original document itself.
24 The Medicine Board was concerned
about the
51
1 medical doctors performing acupuncture,
which they can
2 do under the statute as currently
construed. UCLA, for
3 example, the medical school, offers a
graduate course in
4 acupuncture to graduate MDs and comes within
the purview
5 of this Board as the legislation is
currently written.
6 So again, it is not adding anything if the
doctor
7 wishing to perform this is properly trained.
8 The reflexologists objected
verbally, not in
9 writing, to the amendment thinking that we
would be
10 invading their turf to their financial
detriment. Well,
11 we don't intend to invade their turf, but
financial
12 considerations obviously are not paramount
in our minds
13 when we consider the legitimate functions
and
14 regulations of the medical community.
15 The American College for the
Advancement of
16 Medicine objected principally to the
language in the
17 original version, and the amended version,
which is
18 before you today, effectively removes the
whole core of
19 their objections.
20 Dr. Royal and Mr. Edwards, who
are members of
21 the Homeopathic Board of Medical Examiners,
wrote
22 extensive letters to us as well as to other
people
23 urging them to contact us. Again, a misunderstanding to
24
a degree with respect to Dr. Royal.
52
1 One of his principal concerns was
the
2 language, which has now been removed, but
his letters to
3 us contained more than a modicum of
hyperbole. He kind
4 of -- the kinds of statements such as: As individuals
5 on this Board, if we vote to adopt the new
regulations,
6 we would be in violation of one or more of
the criminal
7 statutes thereby inferring that we would be
creating or
8 performing a criminal act if we voted.
9 Now, this type of hyperbole
reduces this
10
gentleman's credibility in my mind and lessens to a
11 degree the impact of the constructive
objections that he
12 raised.
13 One final point is that if you
adopt the
14 amended version, which is before you, I
think would be a
15 very, very good example of how a public
Board holds
16 public workshops and hearings and actually
responds to
17 the public by incorporating into the
document the
18
principal objections that the public had.
19 Very often boards are not
responsive. The
20 public workshops and hearings are
perfunctory, and the
21 input from the public is largely
ignored. And I think
22 it would be very commendable for this Board
to actually
23 set an example here by showing that we take
public input
24 seriously.
53
1 With that, I would move that this
Board adopt
2 the changes to Chapter 630 of the Nevada
Administrative
3 Code as handed to you yesterday and
available to the
4 public since early this morning which in the
instance of
5 Sections 2, 3, and 4 shows no changes from
our original
6 manuscript.
And in the instance of Section 1, it shows
7 some rather significant changes by deletion rather
than
8 by anything that is additive.
9 MR. ROSENCRANTZ: Do we have a motion?
10 (Whereupon, motions were made.)
11 MR. ROSENCRANTZ: Any discussion?
12 DR. HUG-ENGLISH: Before we vote I just
13 wanted for the record to make a comment, a
brief one,
14 about some of the testimony that was given
in the
15 hearings.
16 Both Drs. Fuller, Royal, and Dr.
Edwards made
17 comments referencing the fact that there is
little or no
18 education in traditional medical schools
with respect to
19 alternative or complementary medicine.
20 I serve as a faculty member at the
University
21 of Nevada School of Medicine, and let me
just speak
22 first to that particular school.
23 In the first two years of our
program, we
24 incorporate the biopsychosocial model which
incorporates
54
1 both mind and body in treating the whole
patient. In
2 addition, in the clinical years there is an
alternative
3 or complementary medicine elective available
to
4 students.
We also have a diversity week at which time
5 guest lecturers in alternative medicine are
invited to
6 come and speak to students.
7 And finally, we have a faculty
member in the
8 Department of Family Medicine who is trained
in
9 acupuncture and who incorporates medical
acupuncture as
10 part of her practice who also has students
doing
11 electives as well.
12 As far as on the national level,
I have data
13 from the National Center for Complementary
Alternative
14 Medicine that states that 75 out of 117
medical schools,
15 or 64 percent of them, actually offer
courses in
16 complementary and alternative medicine.
17 So the point that I want to make
is that
18 clearly traditional medical schools are
providing
19 training and exposure to complementary,
integrative, or
20 alternative medicine to be included in their
curriculum.
21 MR. ROSENCRANTZ: Thank you.
Any other
22 discussion from Board members?
23 I want to comment that I want to
thank staff
24 for holding these workshops and getting this
public
55
1 input and getting it out to us, and I really
want to
2 thank Dr. Baepler who worked really hard on
these
3 amended regulations last week and getting
them out to
4 us. I
think they're excellent, and I'm really happy
5 with them.
6 For purpose of expediency, I will
now take
7 testimony from those wishing to speak in
favor of the
8 adoption of the regulations and Dr.
Baepler's proposed
9 amendment to the regulations.
10 I have the regulation sign-in
sheets. I have
11 them now, and I'm going to start with Dr.
Christi Bonds.
12 Dr. Bonds, you have the floor.
13 DR. BONDS: Thank you.
I see some familiar
14 faces here, but for those of you who do not
know me,
15 I'll review who I am and what I do.
16 My name is Dr. Christi Bonds. I'm a
17 Board-Certified family practitioner, a
graduate of this
18 University of Nevada School of Medicine and
residency
19 training right here in Reno. At present I serve as an
20 assistant clinical professor in the
Department of
21 Community and Family Medicine at the School
of Medicine.
22 And finally, I am a 1994 graduate
of the UCLA
23 medical acupuncture postgraduate training
for physicians
24
which is sponsored by the American Academy of Medical
56
1 Acupuncture.
I also have a homeopathic license.
2 I am here to speak in support of
a proposed
3 regulation of the Board of Medical Examiners
which
4 defines the necessary limitations and scope
of practice
5 for a medical doctor who chooses to
incorporate
6 nonconventional therapies. The original draft of this
7 proposed regulation defined alternative
therapies as
8 validated, nonvalidated, and invalidated,
and the
9 revised regulation proposal has eliminated
these
10 definitions.
11 I was somewhat disappointed to
see that
12 deletion because I feel they are relevant,
and so I am
13 going to go ahead and briefly discuss these
concepts
14 today.
15 This regulation is entirely
appropriate. It
16 describes my integrated approach to medicine
in private
17 practice here in Reno. After ascertaining that a
18 patient has received conventional medical
assessment and
19 treatment, I am willing to use alternative
therapies
20 such as medical acupuncture. I asked this Board several
21 years ago whether medical acupuncture did
come under the
22
scope of a medical license, and you affirmed that it
23 did.
This was in 1997.
24 This regulation supports the
concept of
57
1 integrated medical practice which uses the
best of many
2 medical models. It is entirely compatible with a
3 physician's responsibility to safeguard the
health and
4 welfare of the public who seek our medical
care.
5 It does not limit the use of
alternative
6 therapies, but instead places their use
within a safe
7 and rational context, and it assures the
physician that
8 you will not be subject to disciplinary
actions simply
9 for using unconventional therapies as long
as they are
10 practiced in a safe manner.
11 The field of alternative
therapies is rapidly
12 growing, and knowledge about how different
therapies
13 work is still very much in its infancy. Many of these
14 fields are old, such as the use of herbs for
symptom
15 relief, and they have generally been
considered safe.
16 But in today's complex
environment, we are
17 finding that these substances must be looked
at in
18 conjunction with other factors. For instance, in 1992
19 the highly respected Commission E of Germany
published
20 its report that a standardized extract of
St. John's
21 Wort was as effective as Prozac for mild
depression, and
22 no side effects or toxicity were noted.
23 However, many of you probably
know that a few
24 months ago the British journal Lancet
published several
58
1 reports of toxicity with the use of St.
John's Wart. It
2 turns out that this herb has a now known
metabolic
3 pathway through the liver's cytochrome P450
isoenzyme
4 system, CYP3A4, which also metabolizes more
than 73
5 different medications.
6 St. John's Wart has been shown to
decrease
7 the effectiveness of protease inhibitors
taken for the
8 treatment of AIDS. It decreased the effectiveness of
9 cyclosporine taken to help patients not
reject their
10 heart transplants. It also has been shown to reduce the
11 levels of estrogen in birth control pills
and thus may
12 also reduce their effectiveness.
13 The point is six months ago we thought
14 St. John's Wort was essentially safe, and
now we know
15 that much care must be taken when
recommending the use
16 of St. John's Wart, particularly when
patients are
17 taking prescription medications.
18 This evidence-based approach to
the use of
19 alternative therapies proposed by this
regulation is
20 clearly within the scope of licensed medical
doctors.
21 We practice in an atmosphere of contemporary
peer-based
22 review to maintain the highest standards of
care, and it
23 is the nature of our medicine to be ever
changing.
24 Physicians are constantly adding to our
knowledge by
59
1 participating in scientific research
designed to answer
2 questions of efficacy, mechanism of action, safety,
and
3 risks of various medical therapies. As new evidence and
4 information emerges, we modify our practice
of medicine
5 accordingly.
6 The initial proposed regulation
outlined the
7 categories into which alternative therapies
can be
8 placed.
They are validated therapies, nonvalidated
9 therapies, and invalidated therapies. These are, in
10 fact, the very same categories into which
physicians
11 place all potential medical treatments,
whether they're
12 pharmacological drugs, surgical procedures,
13 psychological interventions, or new methods
of physical
14 therapies.
15 Validated therapies are clearly
the first
16 choice of therapy for patient. Nonvalidated therapies
17 are generally medical treatments which are
thought to
18 have a logical use in treatment, but have
not been
19 researched enough to make definite
conclusions. When
20 prescription medications are used for
non-FDA-approved
21 complaints, a physician is using a
nonvalidated therapy.
22 Many alternative therapies fall
into this
23 category at this time because of the
relatively new use
24 of alternative therapies within the context
of
60
1 conventional medicine.
2 Now, invalidated treatments are
entirely
3 different.
To be defined as an invalidated therapy
4 means that a drug, herb, or other therapy
has been
5 clearly shown to not be effective by
multiple studies
6 involving many patients in well-designed
clinical
7 trials.
There are few alternative therapies that have
8 been studied to this extent so far, so our
work lies
9 before us to answer the many questions that
alternative
10 therapies create.
11 And as Dr. Hug mentioned, the
Center for
12 Complementary and Alternative Medicine, a division
of
13 the National Institutes of Health, is
actively pursuing
14 these issues. No doubt our Medical Board will consider
15 creating a knowledgeable panel to stay
abreast of this
16 research and these issues.
17 In the remainder of my testimony,
I would
18 like to speak directly to the Board about
three
19 principal points in regard to the proposed
regulations.
20 Briefly, first, the primary care
physician,
21 i.e. gatekeeper, provides the most secure
role to
22 integrate various medical therapies. All over this
23 country large medical centers are creating
models for
24 safely and effectively integrating
alternative therapies
61
1 into a wholistic delivery of medicine for
the total
2 well-being of the patient.
3 The primary care physician in
these centers
4 coordinates the total care of these
patients. He or she
5 assesses and diagnoses the patient, then
refers the
6 patient for an integrated treatment that may
7 concurrently include acupuncture,
chemotherapy,
8 nutritional approaches, and more.
9 Second, I really urge you to look
toward the
10 goal that doctors receive the appropriate
training in
11 medical school and residency to incorporate
12 alternatives. Again, as Dr. Hug mentioned to us, this
13 is already happening. This is the best way to come to
14 terms with nonvalidated therapies. We see this training
15 already being provided in the majority of
medical
16 schools, and residency programs are not far
behind.
17 Maybe they are even a little ahead.
18 Major medical malpractice
carriers now
19 include alternative therapies such as
medical
20 acupuncture in their coverage. Having primary care
21 physicians trained through residency in
emerging new
22 therapies is surely the best way to protect
the public
23 interest.
24 Finally, the unique Nevada
phenomenon of a
62
1
separate state Board regulating homeopathic physicians,
2 who often are not licensed to practice
conventional
3 medicine in the state of Nevada and freely
perform
4 invalidated or nonvalidated therapies with more
risk
5 than benefit, will surely confuse this issue
and the
6 public.
7 MR. ROSENCRANTZ: Thank you very much.
8 Next, we'll hear from Dr.
Diamond. And I
9 said at the beginning we were going to limit
it to three
10 to five minutes, but since we only have a
few requests
11 to speak, you may have the floor with my
privilege of
12 gavel.
13 DR. DIAMOND: Good morning.
I would like to
14 introduce myself first, and my wife says I
have to type
15 it out because I go on forever, so I have.
16 My name is John Diamond, and I'm
a
17 Board-Certified pathologist trained at the
Albert
18 Einstein College of Medicine in the Bronx,
New York, the
19 Clinical Center of the National Institutes
of Health in
20 Bethesda, Maryland, and The State University
of New York
21 Upstate Medical Center in Syracuse. I'm a 22-year
22 licensee of this Medical Board.
23 From 1978 to 1988 I was at
various times
24 associate professor of pathology and
clinical pathology
63
1 in Syracuse, New York, and associate
professor in the
2 Department of Pathology at the University of
Nevada,
3 Reno, School of Medicine.
4 I was an attending pathologist at
5 Saint Mary's Medical Center, the Washoe
Medical Center,
6 and the rural hospitals of Incline Village,
Portola,
7 Fallon, Lovelock, and Yerington. From 1984 to 1986 I
8 was a medical director of Sierra Nevada
Labs, now known
9 as Labcor.
10 Thank you for allowing me to
speak today
11 because I wish to speak on behalf of the
regulations
12 concerning alternative and complementary
medicine and
13 their integration and adoption by the State
of Nevada
14 Board of Medical Examiners.
15 Let me first explain why I believe
that
16 adoption of these regulations are important
for both
17 physicians and for the public of Nevada at
large. I
18 will become a little bit personal here
because you must
19 understand where this is all coming from.
20 In 1979 I had a personal medical
experience,
21 which I can only describe as a total-body
collapse,
22 where I spent two weeks in intensive care
and three
23 weeks in a step-down unit with my heart,
lungs, and
24 kidneys showing evidence of impending
failure.
64
1 At the type of discharge, I had
been given no
2 diagnosis, no prognosis, no treatment, and
no cause for
3 the etiology of my problem. I knew instinctively that
4 the cause of my problem was a whole
mind-body problem
5 that had overwhelmed me and caused my body
to
6 progressively shut down.
7 I was therefore forced to look
elsewhere for
8 the roots of my medical presentation and did
so by
9 looking for philosophies of medicine that
looked at the
10 whole body instead of just the organ systems
that had
11 just failed me.
12 In order to accomplish this end,
I studied
13 and was trained in medical acupuncture at
UCLA in
14 1988 -- and I was in the second class of
their
15 program -- for three years in homeopathy at
the Pacific
16 Academy in Berkeley, and two years in the
Chinese
17 herbology by the master herbalogist,
Anastacia White,
18 also in Berkeley, California.
19 In 1988 I left the practice of
pathology and
20 started a practice offering integrated
medicine to the
21 people of Northern Nevada -- the best of all
treatments
22 in a logical, patient-centered and not
disease-centered
23 approach.
24 It has taken almost 13 years for
the Medical
65
1 Board to embrace these concepts, and I
welcome these
2 regulations as a recognition of the value
that these
3 modalities will bring to patients throughout
the state,
4 to our patients.
5 These regulations will protect
both the
6 citizens and the physicians of this state
that wish to
7 have and to practice a full complement of
medicine under
8 the
safe jurisdiction of a single Medical Board.
9 These regulations will open up
the practice
10 of alternative and complementary medicine to
all
11 physicians who can now expand their practice
to help
12 their patients that are sensitive to drugs
and who have
13 not been helped by conventional therapy, as
was in my
14 personal case.
15 There was only one medicine, that
is
16 integrated medicine, the blending of
conventional and
17 alternative and complementary medicine, and
it is best
18 governed by a single Medical Board who can
assure its
19 credibility, safety, and practice.
20 Thank you.
21 MR. ROSENCRANTZ: Thank you very much.
22 Next Dr. Gary Holt?
23 DR. HOLT: My name is Gary Holt, and I don't
24 have a speech, but I have a few things I
want to say.
66
1 First I'll introduce myself. It's sort of
2 uncomfortable talking about yourself, but
just to
3 identify with the more traditional members
of the Board,
4 I will.
5 I finished in the top third of my
class at
6 Tulane Medical School. I trained at Walter Reed in the
7 Army
in radiology and had the opportunity to finish at
8 the University of California, San Francisco,
in
9 radiology where I did a cardiac-radiology
fellowship as
10 an instructor.
11 I then went on to private
practice, did that
12 for a number of years in rural California,
to return to
13 the University of California in 1988-89 to
complete a
14 fellowship in musculoskeletal radiology and
MRI.
15
After that I taught at the University of
16 California, Davis, as assistant professor
for a couple
17 years before coming to Reno in 1991. I have a number of
18 publications in the medical literature
including
19 first-author articles in Radiology and other
top
20 journals.
21 I think I can best be summed up
by what
22 Dr. Blakey said about me when I started this
kind of
23 medicine, alternative kind of stuff. He said:
That
24 Gary Holt's the best radiologist in town,
but now he's
67
1 doing that flaky stuff.
2 And so I'd like to go on about
the flaky
3 stuff and point out to the Board that
actually some of
4 the things that were flaky four years ago
are now
5 appearing in journals today like
Gastroenterology.
6 There is no place to go to learn
this new
7 medicine that's developing, so I started the
8 old-fashioned way as physicians in this
country did many
9 years ago, and I apprenticed myself to a
person I found
10 to be moral, well-intentioned, highly
intelligent,
11 capable person, the gentleman who just
spoke.
12 I took my time off from
radiology, and I
13 spent afternoons with him seeing what he was
doing which
14 became a formal apprenticeship. His patients would come
15 up to me and grab my white coat and say:
16 Dr. Holt, Dr. Holt, Dr. Diamond
took my kid
17 off of Prednisone and inhalers, and now he's
fine, and
18 all he needs is his rescue inhaler. You got to go into
19 this kind of medicine. We need you.
20 And I saw that enough that I
said: There's
21 something here, and I must admit that some
of the things
22 I saw him do and some of the things I've
learned
23 myself -- my first impression was uh-huh.
24 And let me say that everything's
not a
68
1 hundred percent, but I have learned some
things that
2 really helped me. And I have fixed a lot of patients in
3 this town that conventional medicine
couldn't fix.
4 And it's egotistical in a way,
but in another
5 way it's such a feeling of reward to help a
patient that
6 sits before you crying after two or three
years of
7 workup, and nobody knows what the hell is
wrong with
8 them.
You give them some probiotics.
You give them
9 some Chinese herbs. You give them some lifestyle
10 changes, and they're cured. There is a tremendous sense
11 of satisfaction, and there is a cost
savings.
12 So I did some other stuff. I studied under
13 Anastacia White, some herbs. I went to the Pacific
14 Academy of Homeopathy, which is a good
place, for two
15 and a half years. I also graduated from the UCLA School
16 of Medicine's course in medical
acupuncture. There are
17 thousands of us now.
18 Both Dr. Diamond and I have passed
the
19 qualifying examination for this Board to be
developed.
20 We are in the process of developing a
regular Medical
21 Speciality Board that confirms to all the
requirements
22 of the other boards such as general
practice,
23 neurosurgery, et cetera. We have taken our so-called
24 unconventional treatment to a limit that we
can at this
69
1 point.
2 My interests are slightly
different here, and
3 I'm interested in a field called functional
medicine,
4 which means intervening early in patients'
problems with
5 nutritional supplements or lifestyle changes
to affect
6 early recovery of function, minimal
morbidity.
7 And everything in -- this is a
society now.
8 There are about 600 of us that go to these
international
9 meetings all for the medical
literature: The Top Stuff,
10 Journal of Nutrition, Lancet, New England
Journal of
11 Medicine.
Those are the principles I'm bringing into my
12 practice.
13 And the exciting thing is that I
went onto
14 the internet this morning just to see what
was new, and
15 there was an article in Gastroenterology
about using
16 probiotics, which are friendly bacteria like
17 lactobacillus, et cetera, to recolonize the
bowel and
18 reestablish a healthy bowel milieu to treat
pouchitis,
19 and it showed that the recidivism rate was
much less
20 just giving probiotics.
21 There is some powerful
information coming
22 out.
It's legitimate medicine, and my concern is
23 that -- my coordination is my concern. My concern is
24 when you say "nonconventional,"
hey, I'm doing some good
70
1 stuff.
2 And I think as things change what
is
3 conventional and nonconventional will
change, and that's
4 why I think it's important that one Board
regulate
5 medicine.
When people ask me: What kind of
medicine do
6 you practice? I say:
I try to practice good medicine.
7 In my mind a person with
sciatica, typical
8 sciatica, should have acupuncture, possibly
Chinese
9 herbs, and homeopathy because I can fix
probably 80
10 percent of them, and I can keep them off of
drugs that
11 may be potentially damaging like
nonsteroidal
12 anti-inflammatories which is part of the
conventional
13 treatment which is the Number 1 cause for
admission to
14 the hospital for gastrointestinal
bleeding. So what's
15 nonconventional about that?
16 I think this is where the Board
needs to
17 look, and this is a wonderful first step
you're taking
18 to establish your authority and credibility
which I
19 think was latent before, but unfortunately,
a few years
20 ago you guys were asleep when the homeopaths
passed that
21 Section 2 which defines homeopathy.
22 I'm also a licensed
homeopath. I took their
23 examination while I was in my third month of
school, and
24 I trained with Dr. Diamond. They were amazed at how
71
1 well I did.
I didn't know shit. I've learned
a lot
2 since then.
I've learned a bit more since then, but the
3 important thing is I have to pay them $500 a
month. I
4 have to go to their meetings, and they even
try to make
5 me belong to their society.
6 I'm a doctor. Okay?
I'm a physician. I'm
7 an MD.
I want to be regulated by this Board.
I want to
8 practice medicine. The Board says I can do neurosurgery
9 if I'm trained. Why the hell can't I use an acupuncture
10 needle or give essentially benign energetic
input to a
11 person's body in the form of homeopathy?
12 I really support what you're
doing, and this
13 is for what I think is the best interest of
medicine as
14 it develops because I understand that this
Board is here
15 to provide protection for the public health,
for the
16 people, and to make sure that people that do
what they
17 do are qualified.
18 But there is no one to promote
the best
19 development of medicine. I don't think the AMA
20 completely has that in grips, and I think a
lot of us
21 physicians have the wrong idea when we think
of the
22 Board of Medicine as setting standards and
all that.
23 They're just like saying: If you're bad, we're going to
24 kick you out.
72
1 So there is an opportunity for
the Board to
2 perhaps sleaze passed their
legislature-given authority
3 and help mold medicine and allow medicine to
develop. I
4 was told in medical school: Medicine never changes
5 until the current generation of physicians
die. Right?
6 And I can tell you as a person who is out on
the
7 fringes, there is a lot of truth in it.
8 I think times are changing. I think
9 conventional physicians are open to the
medical
10 literature, and the medical literature shows
that things
11 are changing. So I do -- I support these regulations
12 completely.
I just hope that my documentation
13 requirements are no greater than the family
14 practitioners and the specialists whose
notes I get from
15 time to time, and there are a couple other
things I want
16 to say.
17 Well, I think the thing to
summarize -- this
18 is my philosophy and the reason I feel
worthy to take up
19 your time is because I'm doing it. Dr. Diamond and I
20 both have busy practices. In four years my practice is
21
outgrowing my ability to serve it, and I think we
22 practice good medicine. And I think there is not one
23 physician on this Board or in this state
that could come
24 and watch what we do and say that we don't
take good
73
1 care of our patients.
2 I send patients to Dr. Buchwald
if I think
3 they have an appendicitis or even if I don't
know. By
4 being an MD, by being under this Board, I'm
able to
5 refer and maintain my credibility with my
colleagues.
6 So what I ask for is that this
Medical Board
7
wake up and take charge of what it was given the right
8 to by the legislature, and that's the
practice of
9 medicine by any means or instrumentality.
10 Thank you for your time.
11 MR. ROSENCRANTZ: Thank you, Dr. Holt. Larry
12 Matheis?
13 MR. MATHEIS: Larry Matheis, executive
14 director of the Nevada State Hospital
Association. Very
15 briefly because you have revised these, we
do support
16 the revised Section 1. We stood in support of the
17 original Section 1 as well.
18 It's clear that what you are
doing is simply
19 restating because the issues of
complementary medicine
20 have emerged in the public dialogue. You're restating
21 the basic principles that have been held by
this Board
22 for at least 20 years and probably beyond
that, and that
23 is that you're holding Nevada licensed MDs
to the
24 highest possible professional standard; that
a physician
74
1 may choose any modality they wish, but they
have to be
2 prepared to defend their judgment.
3 The public really can't ask that
a
4 professional be held at any higher standard
than that,
5 and that's what this does. So I think that that's
6 appropriate.
I think those boards which view their role
7 more as trade associations to protect
behavior
8 regardless of the consequences to patients
need to
9 justify that attitude, and you don't have a
problem with
10 that.
That has been something that we've raised in
11 concert with you when some boards have
chosen to seek to
12 expand their authority largely to assure that
anything
13 unproven or undefendable can be done in the
name of
14 commerce, and that's not a good enough
justification for
15 any state organization.
16 We do also have no objections on
the
17 technical and logistical issues addressed in
Sections 2
18 through 4.
19 Thank you.
20 MR. ROSENCRANTZ: Thank you, Mr. Matheis.
21 We will now take testimony from
those persons
22 wishing to speak against adoption of the
regulations.
23 Let me remind you that if we've heard your
views or seen
24 a written presentation in the workshop, we
don't need to
75
1 hear them.
So if there is anyone else who is here who
2 would like to speak against the regulations
or
3 Dr. Baepler's amended regulations, we'll
take that
4 testimony now.
5 MS. BERKLEY: I'm Paula Berkley, and I'm the
6 lobbyist for the Chiropractic Board here in
Nevada, and
7 I'm not testifying on your regulations really
at all.
8 I'm sure you're relieved because I'm
obviously not a
9 doctor or an attorney, so I wouldn't
presume.
10 We did send the Board here a
letter
11 requesting a clarification on the
regulations, and let
12 me give you a little background about why we
did that.
13 I think it was two years ago the
Chiropractic
14 Board did a fairly extensively rewrite of
its
15 regulations and came up with something like
70 or 80
16 pages of regulation changes, and it was, you
know, not a
17 fun thing, so I empathize with your process
here.
18 But in that time we did not
receive one
19
letter from one chiropractor in objection or comment
20 either for or against our regulations. So when we
21 started getting phone calls, a plethora of
them,
22 regarding the Medical Board regulations, we
were a
23 little concerned and wanted to be somewhat
responsive to
24 their concerns.
76
1 I think this Board has received
somewhere
2 between 60 and 70 letters, and so what we
had asked for
3 in our written request for the workshop was
maybe a
4 paragraph on a piece of paper that basically
would make
5 them feel a little bit more like parade
rest, that these
6 regulations do not affect Chapter 634 of the
7 chiropractic regulations.
8 As you well know, the perception
sometimes,
9 you know, guides people rather than
understanding really
10 what the regulations say, and chiropractors
aren't
11 attorneys, and they're not MDs.
12 So what our Board is basically
offering is
13 that if you would send that letter to us, we
would send
14 it to our 450 chiropractors and maybe put
the issue to
15 rest.
16 And so I would repeat that
request, and if
17 you could do that, that would be great. That's all I
18 have to say unless you have any questions.
19 MR. LEGARZA: I can speak to this issue just
20 briefly, if I may. We have met as well as the lady has
21 appeared at one of the workshops, and the
position of --
22 that she has requested is the Chiropractic
Board has
23 requested that we give them something in
writing that
24 these regulations aren't applicable to the
Chiropractic
77
1 Board.
2 And I have told her that it is my
opinion as
3 the lawyer for the Nevada State Board of
Medical
4
Examiners, but nevertheless, it is my opinion that the
5 chiropractors have misunderstood the
regulations. As
6 Dr. Baepler has said, the law of the state
of Nevada
7 does not allow us to regulate chiropractors.
8 A letter from us, in my opinion,
would be an
9 exercise in futility. We should not be in the position
10 of writing to the Chiropractic Board, to the
Medical
11 Acupuncture Board, to the Engineering Board,
or to the
12 Board that takes care of lawyers or
architects or anyone
13 else that our regulations aren't applicable
to them.
14 They simply do not apply to
chiropractors.
15
Our regulations have nothing to do with chiropractors.
16 The law specifically states that we only
regulate our
17 licensees.
That has never been the intent of this Board
18 so far as I know to attempt to regulate the
19 chiropractors. I have represented that to the lady
20 publicly.
I do so again now.
21 It is my legal opinion that if
the Nevada
22 State Board of Medical Examiners attempted
to regulate
23 the chiropractors, it would be stopped by
any court in
24 this state.
78
1 But to be asked to write a letter
of
2 explanation to that effect or they may
object to our
3 regulations, I find just -- I have a little
trouble with
4 us sending a letter to every licensing Board
in the
5 state of Nevada every time we impose a
regulation. I've
6 addressed that before, and I think we
understand each
7 other.
8 DR. BAEPLER: Would it be appropriate for you
9 to write your members saying you attended
this meeting,
10 and you can reflect the opinion of the
gentleman which
11 is a matter of record?
12 MS. BERKLEY: We haven't had a Board meeting
13 on this issue yet. It's scheduled in September, and
14 certainly, we can do that. I think sometimes when one
15 Board is making comments on other people's
regulations,
16 there is a little less credibility, quite
frankly.
17 I think you guys are the ones
that are doing
18 the regulations, so it would be more
effective, I think,
19 again, if it came from you.
20 We kind of view this -- you know,
and this is
21 definitely just a -- we've talked, and you
know, he has
22 his opinion, and I have mine. We kind of view this as
23 we're the public like you had requested, and
when you
24 get 70 letters from your public that has
some concern
79
1 about it, I don't see any harm in putting
that in
2 writing.
3 The Engineering Board and the
archaeologists
4 or whatever are not writing you, so you
definitely -- it
5 would be futile, I would agree in that case,
to write
6 them.
7 DR. BAEPLER: It appears a single
8 chiropractor wrote us --
9 MS. BERKLEY: Well, if they put their
10 signature on it, you know, then they have a
concern
11 about it.
12 I'm not trying to argue with
you. I'm trying
13
to be responsive to our public and just, you know, get
14 the issue away. I just as soon have the clarification.
15 If you don't want to do that, that's
fine. Our Board
16 asked me to come in on my Saturday just to
ask.
17 MS. COHEN: I'd like to say that this is a
18 jurisdictional issue. A Board only has jurisdiction
19 over its own licensees, and I mean, that's a
matter of
20 law and so --
21 MS. BERKLEY: I understand that.
22 MS. COHEN: -- this Board doesn't really need
23 to do -- what you're really asking is an
advisory
24 opinion more or less from them that they really
can't
80
1 give another Board.
2 MS. BERKLEY: I don't think you're asking
3 them to give it to another Board --
4 MS. COHEN: Your own Board could easily
5 handle this issue by assuring its licensees
that it has
6 jurisdiction over them, and this Board does
not. It
7 could be handled that way.
8 MS. BERKLEY: Yes, it can be handled that
9 way, but the issue will remain. It's okay.
If you
10 don't want to do it -- I can't prevent them
-- I felt
11 like this might just make the thing go away.
12 I don't know whether the
homeopaths and the
13 chiropractors' concern about this will then
go to the
14 legislative commission and, you know, it
goes on
15 forever.
I was kind of hoping to keep the chiropractors
16 out of it.
That's what I was trying to do.
17 MR. ROSENCRANTZ: Thank you for your
18 testimony.
19 MS. BERKLEY: Thank you.
20 MR. ROSENCRANTZ: We have a motion and a
21 second.
We'll take a vote on this regulation and the
22 amended regulation. Okay.
All those in favor?
23 THE BOARD: Aye.
24 MR. ROSENCRANTZ: Chair votes in favor of the
81
1 motion.
Anyone opposed? Motion carries.
2 Pretty exciting really, and I'm
actually even
3 more excited after listening to the doctors
that
4 practice this kind of medicine, and I
appreciate you
5 coming in and speaking in favor of it. It's helpful to
6 me to understand, not being a medical
doctor, what you
7 do and the benefits to the public by having
the ability
8 of the physicians in this state to be able
to practice
9 that kind of medicine. So I appreciate your comments.
10 DR. STEWART: Could I ask a question?
11 MR. ROSENCRANTZ: Where is the appropriate
12 place to go to solve the problems that the
lady
13 requested?
Is it the Chiropractic Board asking the
14 Attorney General's opinion?
15 MS. COHEN: Its own Board would be the place.
16 DR. STEWART: Is it appropriate that the
17 Board, that the Chiropractic Board, ask the
Attorney
18 General for an opinion?
19 MS. COHEN: It could do that, yes.
20 DR. STEWART: Because it is not appropriate
21 that we as allopathic physicians tell the
Chiropractic
22 Board what we think. It's appropriate that the Attorney
23 General define the law.
24 MS. COHEN: Interpret the law, yes.
82
1 DR. STEWART: Thank you.
2 MR. ROSENCRANTZ: We'll take a 10-minute
3 recess.
4 (Whereupon, a recess was taken.)
5 MR. ROSENCRANTZ: I call this meeting back to
6 order.
We're back on the agenda on Item Number 11.
7 MS. BOWERS: I think the diversion program is
8 going well both in Las Vegas and in
Reno. I have some
9 concerns about the number of participants
and our lack
10 of getting new participants; although, I
have five under
11 investigation at the moment.
12 The funding proposal that I
presented to Alan
13 Stype was presented at the hospital
association with
14 very positive feedback, and money is
supposedly
15 forthcoming.
I have received foundation money.
16 I have the services of a
bookkeeper who I
17
have been working with since the last Medical Board
18 meeting, so the finances are coming
together, and a
19 report was given yesterday regarding those
finances.
20 And I've learned more about accounting
than I
21 ever really wanted to know or thought I
could know. So
22 I think all in all the program is doing well
since I
23 have been there.
24 MR. ROSENCRANTZ: Thank you.
83
1 MR. LEGARZA: Just one little comment.
2 Everything that staff -- my people have
referred to
3 Carol to look at, she has looked at, and she
has
4 responded in writing. It's wonderful.
5 MR. ROSENCRANTZ: And the report that we got
6 from Dr. Stewart was also very good. I appreciate your
7 work.
Thank you.
8 Actually, what we wanted to go
to,
9 Dr. Stewart, is Item Number 14, the AIC
committee
10 report.
11 DR. STEWART: We have passed around a list of
12 cases for closure that we went through
yesterday
13 morning, yesterday afternoon, and again this
morning.
14 We have asked five or six
individuals from
15 the current crop of review to come and visit
us in Las
16 Vegas in December. So I would move that you would
17 accept the closure of the cases as listed on
the five
18 pages that have been passed around.
19 (Whereupon, motions were made.)
20 MR. ROSENCRANTZ: Motion to second. Any
21 discussion?
All those in favor?
22 THE BOARD: Aye.
23 MR. ROSENCRANTZ: Anyone opposed? Chair
24 votes in favor of the motion. Motion carries.
84
1 Thank you, Dr. Stewart. I appreciate the
2 hard work.
3 MS. HUG: Mr. President, I think we also
4 forgot Number 11, the physician assistant
from
5 yesterday.
6 MR. ROSENCRANTZ: We can do that. We'll move
7 to Number 11. Nancy?
8 MS. MUNOZ: Short and sweet. No real news
9 except we are still working on our bill
draft
10 regulation, the proposed legislation, to add
physician
11 assistant to the Nurse Practice Act, and
that's moving
12
along very well.
13 DR. LUBRITZ: Tell me what is the Nurse
14 Practice Act that you would like to be
associated with?
15 MS. MUNOZ: It's just that there is that
16 regulation in the Nurse Practice Act that
states who the
17 nurses will take orders from. It does not include
18 physician assistant, and we just want that
added.
19 DR. LUBRITZ: Great.
20 MR. ROSENCRANTZ: Okay.
Thank you. We'll
21 move to Item Number 18, consideration of
request by
22 Nevada Academy of Physician Assistants for
Board support
23 of the Academy's proposed legislature.
24 MS. HERUM: Hi, I am Meg Herum. I'm
85
1 president for Nevada Academy of Physician
Assistants,
2 and I'm spearheading our getting the
physician assistant
3 added to the Nurse Practice Act which was a
wonderful
4 question.
Thank you.
5 There is a list -- I believe it's
physicians,
6 chiropractors, advanced practitioners of
nursing, and
7 dentists -- no. I'm sorry.
Take away chiropractors --
8 dentists and podiatrists that a nurse can
take an order
9 from.
10 Back in 1987 when they added the
advanced
11 practitioners of nursing, the Nursing Board
wanted to
12 add physician assistants with that. And one way or
13 another we got -- there was an objection to
that, and we
14 got removed.
There is a long discussion about that, but
15 that's for some other time.
16 So we've now -- I've run into a
lot of
17 physician assistants in the state calling me
saying:
18 I'm about to lose my job because the
physician is saying
19 if a nurse can't take your order, you're no
good to me.
20 Or such as at UMC in Las Vegas,
they have put
21 a freeze on hiring physician assistants for
that same
22 reason:
A nurse can't take your orders.
You're no good
23 to me.
24 There has been a lot of
discussion about
86
1
interpretation of that law that obviously if it says you
2 can accept an order from a physician, that
implies you
3 should be able to accept that order from a
physician
4 assistant.
5 A lot of places now are functioning that way,
6 and that's fine. But there are nurses that are saying:
7 I will lose my license if I take your order
because
8 you're not listed as a provider that I can
accept that
9 order from.
10 So our goal -- then I went -- I
sat down with
11 Cathy Apple, who was here at the last
meeting, and we
12 discussed this whole issue and what's the
best way to go
13
about it. And we're going to go
to legislation to get
14 our names added to that list basically is
the bottom
15 line.
16 So the Nursing Board has been in
favor of
17 that which, again, Cathy Apple had mentioned
that. I've
18 also discussed it with Mr. Matheis, and
they're in favor
19 of that, the hospital association, of
course.
20 I just met with Nevada Nurses
Association, a
21
small subgroup -- if you're not familiar with them, a
22 small subgroup of the Board, their Board --
and they --
23 I have a survey that Cathy Apple had done
across the
24 country on that such issue, nurses taking
orders from
87
1 physician assistants, and all the other
states are
2 dealing with that. I have that in a little packet, and
3 I will be happy to pass that out to
everyone.
4 There were -- out of 60
jurisdictions, there
5 were 20 responses, and 17 of them said: Yes, we do take
6 orders from physician assistants. The only one who said
7 no was Mississippi who at the time did not
employ or
8 allow physician assistants to work in that
state which
9 has just recently been changed.
10 So the Nevada Nurses Association
said they
11 want to take their own survey. They asked me to put an
12 article in their journal. They're going to take a
13 survey of all 16,000 nurses in the state of
Nevada, ask
14 them -- majority rules. If they feel they should take
15 an order from a physician assistant, then
the NNA will
16 support us.
If not, then they either will not, or they
17 will abstain.
18 So that article was written by
Cynthia Bunch,
19 the one on top. I have an article in there as well that
20 I wrote.
I just came out. It went into
their -- it's
21 called Our Information, a news journal that
goes out to
22 all nurses in the state just for having a
license. I
23 believe it's written by the NNA, but it's
not -- it goes
24 to every nurse in the state with a license.
88
1 And I tried to explain in there
that which I
2 have come up against at the Board meeting
which was that
3 nurses were not really enlightened or
understood exactly
4 what the training of a physician assistant
was. So that
5 was my goal to educate and to help them
understand why
6 this would be an important thing for them to
accept our
7 orders.
8
So I provided in there some background on our
9 education and data and Cathy Apple's survey
and that
10 sort of thing. That just came out August 4th. All
11 nurses in the state have received it by now,
and the
12 comment card that's on there they're
encouraged to send
13 back and respond to. So that is just one organization
14 that I'm waiting for their response.
15 When I met with their Practice
Board actually
16 for the NNA, they thought that it seemed
very
17 reasonable.
They didn't see this should be a large
18 issue, but anyway, we'll have to wait and
see. Their
19 Board meeting is going to be in September,
October, to
20 get the collection responses on that.
21 I also spoke with a gentleman
with the Nevada
22 State Medical Society, and he's also in
favor of our
23 proposal.
So I'm coming to the Board asking for your
24 support.
We would like to have a letter of written
89
1 testimony from the Board if they were going
to support
2 our issue of going to legislation. That's why I'm here
3 today.
4 DR. LUBRITZ: Looking for a motion? I make a
5 motion that we support their -- what are you
calling it?
6 MS. HERUM: Addition of physician assistant
7 to the Nevada Nurse Practice Act.
8 DR. LUBRITZ: -- addition of physician
9 assistant to the Nevada Nurse Practice Act.
10 DR. BUCHWALD: Second.
11 MR. ROSENCRANTZ: Any discussion, yes?
12 DR. TITUS: This is essentially affecting
13 where I work in a rural area whether or not
-- this has
14 been an ongoing battle for years in my small
town, and
15 Nancy can testify because I was her
sponsoring physician
16 on whether or not our nurses can take orders
from
17 physician assistants when the doctor's not
around, those
18 sorts of issues, whether they can work the
ER, and what
19 their level of function is. And I would be a strong
20 advocate in support of this.
21 MS. MUNOZ: Thank you, Doctor.
22 DR. STEWART: Is this something that
23 Mr. Berango could help them with?
24 MR. LESSLY: Yes, sir.
90
1 MR. ROSENCRANTZ: That's a good idea. I
2 would suggest that you contact --
3 MR. LEGARZA: I'll contact him for you.
4 MS. HERUM: Please.
5 MR. ROSENCRANTZ: Any other discussion? If
6 not, we'll call for question. All those in favor?
7 THE BOARD: Aye.
8 MR. ROSENCRANTZ: Opposed?
Chair votes in
9 favor of the motion. Motion carries. Thank you.
10 The next item of business is
Agenda Item 19,
11 request by the University of Nevada School
of Medicine
12 for support of establishment of a pharmacy degree
13 program.
14 MR. LESSLY: Mr. President, Kim Buckstein was
15 going to be here this morning. I don't think that he is
16 here.
He did send me a letter on August 7th -- that was
17
after the agenda was sent to you, so you have that as a
18 handout here this morning -- asking for
support from
19 this Board to establish a School of Pharmacy
here in the
20 state of Nevada.
21 DR. BAEPLER: I wish he were here. I would
22 like to know where it currently stands in
the Regents'
23 priority list. Are we into the typical north-south
24 battle as to which university is going to
get it? I'm
91
1 just not informed about this at all, and
obviously, it's
2 up to the Board of Regents to make that
determination on
3 its way to the legislation, but do you have
any
4 background on this at all?
5 MR. LESSLY: The only thing I know is what
6 I've read in the papers, and it's my
understanding that
7
there would be basic science-type training in Reno and
8 that the balance of the school would go to
Las Vegas.
9 And that's the only thing that I've --
10 DR. BAEPLER: The timing is awkward because
11 the budget for biennium has long since been
submitted,
12 and if it's not in that budget, the request
from the
13 Regents, it's not on the priority list, and
14 consequently, nothing could be done for another
two
15 years.
So I don't quite have a sense of where this is.
16 MR. LEGARZA: I can give you a little bit
17 because I was down at the legislature when
the -- I
18 can't remember who it was that was making
the
19 presentation on behalf of the university
system, if you
20 will, and it was a joint logo. It was a joint
21 north-south logo.
22 The appearance was that there was
no dispute
23 over who was going to do what or the other,
and the
24 feeling I got from the legislators was: Don't forget we
92
1
just got talked to about dental school not too long ago,
2 and we got told that that wasn't going to
cost any
3 money.
And now you're telling us a pharmacy school
4 isn't going to cost any money. Go back to the drawing
5 board and come back here and tell us the
truth. I heard
6 that that day.
7 DR. BAEPLER: I'm not aware of any
8 controversy, nor do I think that anybody
denies the
9
need. I'm just not clear on where
it stands.
10 DR. BUCHWALD: I would just say from a need
11 point of view I would be very supportive of
this College
12 of Pharmacy.
13 MR. ROSENCRANTZ: If you read the letter,
14 that's sort of what they want from us is
just some
15 support.
16 DR. LUBRITZ: I would be certainly --
17 DR. DESAI: They're looking for support
18 basically.
19 MR. ROSENCRANTZ: Do you want to do that in a
20 form of a motion?
21 DR. DESAI: I make a motion that the State
22 Board of Medical Examiners supports the idea
of having
23 the community -- the University School of
Medicine start
24 the process of evaluation for a Pharmacy
School.
93
1 DR. HUG-ENGLISH: Second.
2 MR. ROSENCRANTZ: Motion seconded. Any
3 further discussion? All those in favor?
4 THE BOARD: Aye.
5 MR. ROSENCRANTZ: Anyone opposed? Chair
6 votes in favor of the motion. The motion carries.
7 MR. LESSLY: Prepare an appropriate letter,
8 and the president will sign it?
9 MR. ROSENCRANTZ: Yeah.
10 MR. LESSLY: I think we're ready to go to
11 Item Number 21, Mr. President. We have -- Dr. Block is
12 present.
13 MR. ROSENCRANTZ: Okay.
Call for Dr. Block.
14 Do we need a motion to go into
closed
15 session?
16 (Whereupon, motions were made.)
17 MR. ROSENCRANTZ: Any discussion? All those
18 in favor?
19 THE BOARD: Aye.
20 MR. ROSENCRANTZ: Opposed?
Chair votes in
21 favor of the motion. Motion carries.
22 (Whereupon, a closed session was
had.)
23 MR. ROSENCRANTZ: Why don't we start and do
24 Number 22.
94
1 (Whereupon, motions were made.)
2 MR. ROSENCRANTZ: Any discussion? Hearing no
3 discussion, call for the question. All those in favor?
4 THE BOARD: Aye.
5 MR. ROSENCRANTZ: Anyone opposed?
6 DR. DESAI: I have a question, now. New
7 licensees are going down or going up in
number, or what
8 is the real status?
9 MS. GAUL-RICHARD: At this time last year we
10 had issued just in your average unrestricted
license
11 276.
As of Friday, we have already issued 302, and we
12 still have a couple hundred pending. I think we're
13 going to be up this year.
14 DR. DESAI: I'm looking for the income.
15 MR. ROSENCRANTZ: I think when we figured
16 that budget, we sort of planned that we
wouldn't have
17 that many.
18 MR. LESSLY: You can never guess.
19 MS. GAUL-RICHARD: The last couple of weeks
20 we've been getting in sometimes each two or
three a day,
21 not every day, but it's been staying busy.
22 DR. DESAI: The state is growing.
23 MR. ROSENCRANTZ: I went back to the
24 licensing department yesterday afternoon,
and they were
95
1 very busy back there.
2 MR. LEGARZA: They don't work in the
3 afternoons, I thought.
4 MR. ROSENCRANTZ: They were working.
5 DR. BUCHWALD: It seems like there used to be
6 a seasonal swing to it, but there doesn't
seem to be.
7 MR. LESSLY: The transitory nature of
8 medicine.
9 MS. GAUL-RICHARD: It used to quiet down
10 between October and December and into January,
and that
11 doesn't happen anymore.
12 DR. TITUS: I think physicians are more
13 transient.
They move more than they did traditionally.
14 You used to get on your residency or
training program
15 and go to a community and stay there for
your entire
16 life, and now they move.
17 DR. BUCHWALD: But if you move more than
18 once, we start looking at you --
19 MR. LESSLY:
Particularly if you cross state
20 lines.
21 MS. GAUL-RICHARD: We look at that when we're
22 looking at the applications. If they've moved three or
23 four times either within that state or
across state
24 lines, we sometimes wonder why are they
moving around so
96
1 much.
We take a look at that.
2 MR. ROSENCRANTZ: Is there any matters for
3 future agenda? We could talk about that.
4 MR. LESSLY: I handed out the Citizens
5 Advocacy Center Brochure. It's not on the agenda simply
6 because we just got it after the agenda had
gone out.
7 They're asking if we'd like to participate
in a pilot
8 project to establish a better working
relationship with
9 hospitals on reporting; whereby, we would
report to
10 hospitals everything we're doing with anyone
11 disciplinary-wise, and they would report to
us.
12 I'm not advocating that you
participate in
13 this.
We have the statutory requirement that hospitals
14 report to us, and we have some
confidentiality issues
15 about what we can or should give to a
hospital at what
16 stage of an investigation.
17 I think bottom line is I don't
think that our
18 situation as far as relationship with
hospitals and
19 information is so bad that we even need to
really
20 consider this. I wanted to give it to you.
21 If someone feels that we ought to
give
22 serious thought to this, let me know, and
I'll let the
23 president know, and we'll try to address
this in
24 September.
97
1 DR. LUBRITZ: Who are these people?
2 MR. LESSLY: This is an organization
3 designed -- this is Ralph Nadar's group that
does the
4 Cindy Wolf statistics. Now you know who these people
5 are.
6 DR. TITUS: I vote that we do it only if
7 Ralph Nadar becomes president.
8 MR. LESSLY: If someone has questions on it
9 or feels strongly that we ought to consider
it, give me
10 a call.
That's the only thing I have.
11 MR. ROSENCRANTZ: I'd like to make a
12 suggestion because we talked about it
earlier, and
13 that's profiling. Could we have some information to
14 give to this Board about profiling at our
next meeting?
15 MR. LESSLY: Maureen's working on it, and
16 we'll share that with the Board.
17 MR. ROSENCRANTZ: I think it's time for
18 elections.
It's 2 o'clock, and I have Dr. Jones' phone
19 number.
Ms. Maureen, if you could make that phone call
20 for us and let her participate.
21 (Whereupon, the phone call is
initiated, and
22 Dr. Jones is on speaker phone.)
23 MR. ROSENCRANTZ: We're so happy that you're
24 in Sun Valley and that you're having a wonderful
time,
98
1 I'm assuming.
2 DR. JONES: I am.
3 MR. ROSENCRANTZ: You are vacationing?
4 DR. JONES: Yes, I am.
5 MR. ROSENCRANTZ: And now for almost the most
6 important action of the day we have you
involved,
7 election of officers, so we thank you for
your
8
participation.
9 DR. JONES: You're certainly welcome.
10 MR. ROSENCRANTZ: I think we'll start with
11 the office of president, and we're looking
for a
12 nomination.
13 DR. DESAI: I wish to nominate Arne
14 Rosencrantz.
15 (Whereupon, motions were made.)
16 MR. ROSENCRANTZ: A motion and then a second
17 for Mr. Rosencrantz. Any discussion?
18 DR. BUCHWALD: I would move that we close
19 nominations.
20 (Whereupon, motions were made.)
21 MR. ROSENCRANTZ: All in favor of that
22 motion?
23 THE BOARD: Aye.
24 MR. ROSENCRANTZ: Let's call for the
99
1 question.
All in favor?
2 THE BOARD: Aye.
3 MR. ROSENCRANTZ: Thank you.
Mr. Rosencrantz
4 has been re-elected. Did we get an aye from you Jackie?
5 DR. JONES: Yes.
6 MR. ROSENCRANTZ: I just want to make sure
7 who my friends are. The office of vice-president?
8 DR. DESAI: I make a motion of Susan.
9 (Whereupon, motions were made.)
10 MR. ROSENCRANTZ: A motion and a second. Any
11 discussion?
12 DR. STEWART: I move to close nominations.
13 (Whereupon, motions were made.)
14 MR. ROSENCRANTZ: A motion and a second to
15 close nominations. All those in favor?
16 THE BOARD: Aye.
17 MR. ROSENCRANTZ: Call for question. All
18 those in favor?
19 THE BOARD: Aye.
20 MR. ROSENCRANTZ: Anyone opposed? Chair
21 votes in favor of the motion. Susan is the
22 vice-president. The next office would be
23 secretary-treasurer.
24 DR. BAEPLER: I'm going to nominate Paul
100
1 Stewart.
2 (Whereupon, motions were made.)
3 MR. ROSENCRANTZ: A motion and a second. Any
4 discussion?
5 DR. DESAI: Motion to close the nomination.
6 (Whereupon, motions were made.)
7 MR. ROSENCRANTZ: All in favor of that?
8 THE BOARD: Aye.
9 MR. ROSENCRANTZ: All in favor of Dr. Stewart
10 for secretary-treasurer?
11 THE BOARD: Aye.
12 MR. ROSENCRANTZ: Jackie?
13 DR. JONES: Yes.
14 MR. ROSENCRANTZ: Thank you very much. I
15 hope we didn't overburden you today, but
Susan does want
16 to talk to you.
17 I'd like to make a comment. I thank you very
18 much for re-electing me president. It's very meaningful
19 to me.
I appreciate it very much. I hope
that I'm
20 doing a good job. I haven't gotten in too much trouble
21
except for the one issue with the Clark County Medical
22 Society, I guess, but another than that
we've been going
23 along pretty well.
24 DR. STEWART: You should view that as a badge
101
1 of courage not being in trouble.
2 MR. ROSENCRANTZ: I think it's a real team
3 effort, though, and I want to thank every
one of the
4 members of the Board for their help and
their
5 participation. It really is a team effort, and I feel
6 that this Board -- I'm really proud of
it. When I go
7 and sit in a legislative committee meeting
or council
8 meeting, I'm really proud of what we
do. I'm proud of
9 the work we do and proud of the effort we
do. I think
10 everybody here takes it seriously, and it's
really a
11 pleasure to be on this Board.
12 I've been on a lot of boards, and
I've been
13 president of a lot of different boards, and
by far this
14 is absolutely the best Board that I've ever
sat on. So
15
I appreciate that.
16 And to go along with the Board
members, it
17 wouldn't happen without staff, the executive
staff,
18 Mr. Lessly, Maureen, and everyone involved,
licensing
19 and investigative. We just have terrific employees. I
20 think the rest of us feel that way, and I
want to go on
21 record and say that we're very
fortunate. I think all
22 of us on the Board thank the staff for the
great job in
23 helping us look good, bringing new ideas to
us, and
24 really protecting the people of Nevada,
which is what we
102
1
are here to do. I just can't -- I
don't say it enough,
2 but I'm really proud of what we do. So thank you very
3 much.
4 And every time we get a new Board
member,
5 somebody we don't know like a Robin Titus or
6 Dr. Baepler, they just pick right up and
join in and do
7 such a terrific job. It's really exciting, so thank you
8 very much, and I appreciate that.
9 I need to make some appointments
to the
10 investigative committee, and Dr. Stewart,
obviously you
11 will be continuing on as chairman of that
committee.
12 And Robin, we're throwing you into the fire
here.
13
Dr. Titus, we'd like to put you in the investigative
14 committee along with Dr. Baepler as a public
member.
15 We'll give Jackie Jones a chance to rest for
another
16 year.
She did that for about four years straight.
17 I think you'll find that some
people lobbied
18 for that position. I spoke to them, and it is a real
19 integral part of being on the Board, and I
think you'll
20 enjoy its work. But I think you'll really enjoy it, and
21 I think it will bring you farther along and
advance your
22 career on the Board.
23 And for our internal affairs
committee which
24 Susan would chair as vice-president, I would
ask
103
1 Dr. Lubritz, who hasn't sat on that
committee yet, to be
2 on that committee along with Jackie Jones. So those
3 will be our committees for next year. I'll appreciate
4 all your corporation and good work in the
future.
5 MS. LYONS: When do their terms start then?
6 MR. LESSLY: Today.
7 MS. LYONS: Today.
8 MR. ROSENCRANTZ: We're finished with our
9 agenda.
Is there anything else that anyone has to say?
10 Anybody have anything else?
11 A comment required by NRS
2410202C3 of the
12 Nevada Open Meeting Law, under this item
members of the
13 general public may bring matters not
appearing on this
14 agenda to the attention of the Board. The Board may
15 discuss the matters, but may not act on the
matters at
16 this meeting. If the Board desires, the matters may be
17 placed on the future agenda for action.
18 Comment on any topic is to be
limited to not
19 more than an hour and 15 minutes in order to
accommodate
20 the board's schedule and the speakers. Please address
21 your comments to the chair instead of the
individual
22 Board members.
23 Since the only member of the
public we have
24 is the stenographer, if she wants to say
anything --
104
1 THE COURT REPORTER: No.
2 MR. ROSENCRANTZ: Otherwise, the meeting is
3 adjourned.
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1 - C E R T I F I C A T E -
2
3 STATE OF NEVADA )
)
ss.
4 COUNTY OF WASHOE )
5 I, Sarah Ferguson, a registered
professional
6 reporter, do hereby certify that I served as
the Court
7 Reporter for the within cause on the date
aforesaid and
8 that the within transcript is a true and
correct
9 extension of my stenotype notes taken at the
aforesaid
10 time and place and reduced to writing by
means of
11 computer-aided transcription.
12 Dated this 5th day of September,
2000.
13
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15
SARAH FERGUSON, RPR
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