1
1
2
3 NEVADA STATE BOARD OF MEDICAL
EXAMINERS
4 BOARD MEETING
5
6
7
8 * * * * * *
9
10
11
12
13
14
15
16 SATURDAY, DECEMBER 2, 2000 - 9 a.m.
17
18
19
EMBASSY SUITES LAS VEGAS
20 4315 SWENSON STREET
LAS VEGAS, NEVADA
89119
21
22
23
24
25
LISA JOHNSON & ASSOCIATES
(702) 369-5909 & (702) 596-6122
2
1 APPEARANCES:
2
3 ARNE D. ROSENCRANTZ
PRESIDENT
4
5 RICHARD J. LEGARZA, J.D.
GENERAL COUNSEL
6
7 PAUL A. STEWART, M.D.
SECRETARY-TREASURER
8
9 JOEL N. LUBRITZ, M.D.
10
ROBIN L. TITUS,
M.D.
11
12 MAUREEN E. LYONS
DEPUTY EXECUTIVE DIRECTOR
13
14 LARRY D. LESSLY, J.D.
EXECUTIVE
DIRECTOR
15 SPECIAL COUNSEL
16
DONALD H. BAEPLER, Ph.D., D.S.C.
17
18 JACULINE C. JONES, Ed.D.
19
DIPAK K. DESAI,
M.D.
20
21 SUSAN S. BUCHWALD, M.D.
22
JAN J. COHEN,
J.D.
23 ASSISTANT CHIEF DEPUTY ATTORNEY
GENERAL
24
ROBERT FRANTZ
25
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702)
596-6122
3
1 MR. ROSENCRANTZ: Now, we have been off for
2 four months and I guess what I'm saying is
I'm
3 probably now satisfied with Nevada
Broadcasters.
4 I think if we go back on
the air
5 and Larry met with them just the other day,
and I
6 happened to run into them. And Larry, I will let
7 you fill them in on what Bob said to you.
8 He said to me he really
wants our
9 account and wants us back on the air and he
said he
10 would do a good job for us.
11 That would be my
suggestion to go
12 back on the air I think for 5,000 a month
with them
13 to get the spot. This is going to -- by the way to
14 do a taped TV and a radio spot and that's
15 statewide.
16 MR. LESSLY: What we did last time is we did
17 the contract with them in three month
increments,
18 quarterly, so we can change our mind at any
time or
19
if we were dissatisfied with the quality or the
20 quantity.
21 So I would suggest if
you're going
22 to do it, that we tell them we'll do it
three months
23 subject to being renewed.
24 MR. ROSENCRANTZ: I think our thing was we were
25 approved -- if we can do it again I think
we were
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
4
1 approved to spend. I'll entertain a motion to
2 that.
3 Let me just tell you how
Nevada
4
Broadcasters works. They are a
nonprofit company
5 and they have about nine or ten nonprofits
that they
6 get money for and then take that money and
they run
7 their organization off of it. And they get three
8 spots from the media around the State
because they
9 are all members of the Nevada Broadcasters
10 Association.
11 So they do have control
how many
12 spots we can get or how many spots the
National
13 Guard can get. We need to press them a little bit.
14 In general, I think they do a real good
job.
15 I did want to comment too
they gave
16 us -- this summer they had an awards dinner
which I
17 was invited to go to and I received a very
nice
18 glass presentation from the Nevada
Broadcasters for
19 the Medical Board and they really do truly
20 appreciate our business and I think it's
more than
21 that.
I think it's really important that we be on
22 the air and let the public know that we're
open to
23 having all of our physicians aware that --
the
24 public aware that their physicians are open
to
25 whatever the public needs to know about
them.
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
5
1 And so that's where we're
at and I
2 guess unless there's any question.
3 DR. DESAI: How much is it costing?
4 MR. ROSENCRANTZ: Costing what?
The production
5 of the spot will cost $20,000 which we just
approved
6 and the advertising beginning on the air is
5,000 a
7 month.
8 DR. DESAI: How much does it come out to annual
9 budgets?
10 MR. LESSLY: Pretty close to diversion.
11 DR. DESAI: How much -- (inaudible).
12 MR. LESSLY: 150,000.
13 DR. BUCHWALD: This initially started with --
14 MR. ROSENCRANTZ: We have put it into our
15 budget and something that we planned to do
would
16 certainly be very disappointing to me
anyway if we
17 were to discontinue a service that is meant
to
18 service the public of the citizens of
Nevada. I
19 don't think that's the question.
20 I just came back. I think we're
21 approved to go ahead with this program
which is
22 basically I wanted to get approval for the
5,000 and
23 I think it is worth it to spend -- we'll
get a lot
24 of use out of that.
25 DR. LUBRITZ: Someone was telling us last board
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
6
1 meeting how much increased activity there
was on the
2 phone when we ran about physicians -- when
we ran
3 and did not run the ads. Can someone review that
4 for us again?
5 MR. ROSENCRANTZ: Maybe Maureen can.
6 MS. LYONS: There's survey that -- Dr. Stewart
7 and I requested a survey be done and it is
in agenda
8 under Item 7 -- results of the survey. We did it in
9 while the ad was running in June and then
we did it
10 again for two weeks same period of time in
September
11 when the ad was not running and I don't
know whether
12 the survey really reflects anything
significant.
13 DR. DESAI: (Inaudible).
14 MR. ROSENCRANTZ: First of all, it doesn't say
15 anything about complaints. We're not asking --
16 we're asking --
17 MR. LESSLY: We're specifically told to take
18 that out.
19 MR. ROSENCRANTZ: We don't ask for the public
20 to issue a complaint. We're asking if they want
21 information about their physicians. Really that is
22 not a fair question.
23 It's really more making
the public
24 aware that they can find out information
about their
25 physician, about their discipline, about
their
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
7
1 education.
2 It's a service that is
going along
3 everywhere and we're just at the forefront
of at
4 least being on television. But certainly physician
5 profiling which is something we're going to
talk
6 about later is not and --
7 DR. TITUS: I'm sorry, Arne. Did you say they
8 find out about physicians discipline? So they can
9 find how many actions --
10 MR. ROSENCRANTZ: Yes.
If a complaint has been
11 investigated and it comes to an action on
it, yes.
12 Not just a complaint.
13 DR. TITUS: Right, that's public knowledge
14 if --
15 DR. LUBRITZ: I guess I'd like to find out are
16 we going to make this a continuing
commitment from
17 now until the board at some point in the
future
18 decides that we're no longer going to spend
$60,000
19 or $80,000 which to me is a large sum of
money --
20 are we going to do that continuously
now? Is that
21 something that we have to budget; put into
our
22 budget?
23
MR. LESSLY: Yes, it is something
you have to
24 put into your budget. You no longer send a budget
25 to the executive branch any longer simply
do work
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
8
1 programs.
2 Each time we submit an
annual work
3 program, you'll determine what the line
item amounts
4 are and what the line item amounts --
what's the
5 appropriate --
6 DR. BAEPLER: It will come back to us each time
7 for renewal so we have an opportunity to
review it.
8 In other words, it's not built in in
perpetuity at
9 this point.
10 MR. LESSLY: No.
11 DR. LUBRITZ: But we can make the expenditure
12 if we feel it is something we want to make.
13 MR. LESSLY: Yes, as long as --
14 MR. ROSENCRANTZ: And we're committing for
15 three months at a time. Obviously we have to
16 hopefully go forward with it to -- with the
amount
17 of production money we put into it. I think we're
18 pretty well committed for the year.
19 My recollection we have
approval to
20 go
forward with this. We need a motion.
21 MR. LESSLY: Go ahead.
22 MR. ROSENCRANTZ: Spending $60,000.
23 DR. LUBRITZ: Should be reviewed if you'll
24 accept that as an --
25 MR. ROSENCRANTZ: I didn't make the motion.
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
9
1 DR. LUBRITZ: I would make a motion that we
2 move forward with the expenditure of
$60,000 per
3 year to be on an advertising for the Public
Service
4 Announcement with that being reviewed
quarterly.
5 DR. TITUS: Second.
6 MR. ROSENCRANTZ: Any further discussion? If
7 not, all in favor. Thank you very much.
8 I think that citizens of
Nevada
9 will serve -- if you look at the list and
see how
10 many people are calling on a monthly
basis. If
11 there's 50, 60, 100, that's a lot of people
to be
12 serving by the board. Think it's a service that is
13 really good.
14 Since we're on Agenda Item
Number
15 7, we'll continue on that, get this one
finished.
16 Do we have a committee
represented
17 for the Physicians Assistant Advisory? Not here
18 today.
19 MR. LESSLY: Not here.
20 MR. ROSENCRANTZ: The next item is Committee to
21 Study Post-Licensure Continuing Competency
22 Evaluations. Committee members, myself, Susan
23 Buchwald and Donald Baepler and this
committee went
24 to Dallas the 15th of November. The Federation
25 hosted us.
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
10
1 I think we had an
excellent meeting
2
and I'm first to report to you that I took specs and
3 got 90 percent on specs. That's pretty good. So I
4 assume almost any doctor could do that and
I must
5 admit I had a little bit of help from Dr.
Desai. We
6 shared a computer and he prompted me a
little bit so
7 we were able to get 90 on our scores so I
was very
8 proud of that.
9 DR. BAEPLER: It was also about 5 percent of
10 specs.
11 MR. ROSENCRANTZ: Anyway, I would like to have
12 the other committee members talk about what
we saw
13 and what we did maybe.
14 DR. BAEPLER: The visit did not solve our
15 problem nor answer our questions about what
we might
16 do regarding competency testing and I'd
like to find
17 a word different than competency. That's a horrible
18 red flag for any profession to use that
word. But
19 it gave us some concept as to what might be
20 available out there and I think it was a
very good
21 starting point for the committee and my
22 understanding is that the committee will
now meet
23 and really try to focus on the issue and
set up some
24 milestones and objectives and a time
schedule.
25 But it was very worthwhile
to find
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
11
1 out how these tests are constructed and how
updated
2 they are and what the options are of
manipulating
3 these tests and meet certain kinds of
situations
4 such as the one we're facing.
5 MR. ROSENCRANTZ: Susan, any comments?
6
DR. BUCHWALD: I don't have
anything to add
7 really.
8 MR. ROSENCRANTZ: Dee, you were there.
9 DR. DESAI: I was an observer.
10 MR. ROSENCRANTZ: I know but do you have any --
11 DR. DESAI: No.
12 DR. LUBRITZ: How much of that test do you
13 actually take?
14 MR. LESSLY: I took two and a half hours
15 worth.
16 DR. LUBRITZ: And you passed?
17 MR. LESSLY: I didn't have a tech rep like Arne
18 did.
19 DR. LUBRITZ: Didn't you say that you took it
20 at some point and passed?
21 MR. LESSLY: I took the same thing Robin took.
22 DR. LUBRITZ: My question is if a layperson, a
23 knowledgeable one through your association
with
24 medicine can pass an exam and my question
is what
25 benefit is it for us to have physicians
take it?
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
12
1 I'm not sure that there's a breakdown.
2 DR. BAEPLER: I think that the exam could be
3 restructured for the type of thing that we
want to
4 do and it would be my expectation that if
we ever
5 implemented such a program, that most, 99
percent or
6 so of the medical community would have no
problem
7 with it.
8 I think we're looking here
for
9
those that are really quite impaired.
The very high
10 risk person that we need to fair it out.
11 DR. LUBRITZ: Again, my point is if you're
12 going to pass 99 percent and if a layperson
can pass
13 the exam, to me it is even -- it would be
14 presumptuous on our part to say yes, we're
going to
15 let this position go out and practice
because he's
16 passed an exam that number one, an intelligent
17 layperson can pass and number two, perhaps
a third
18 or fourth year medical student can pass.
19 DR. BAEPLER: Let me say once again what I said
20 previously.
We did not find the answer to our
21 problem and this exam we are not committed
-- in
22 fact, it may not be the appropriate one at
all. And
23 pass is an arbitrary number. 70 -- 60, that's
24 totally arbitrary. We can massage that.
25 All I'm saying I know a
lot more
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
13
1 now about what is out there in terms of
2 possibilities because we discussed some
other
3 options as well. I don't think any member of this
4 committee would simply suppose that
everybody that
5 the specs exam -- it's a pretty general
exam.
6 DR. BUCHWALD: Joel, this is more of a
7 discovery process and it is so early in
infancy;
8 that there is absolutely no decision-making
or
9 discussion that has been ongoing that --
10 MR. ROSENCRANTZ: We're just in the learning
11 process.
Larry and particularly -- that's all they
12 presented to us and maybe some options to
--
13 MR. LEGARZA: It's a very professional
14 examination, specs is. I think there's years and
15 years and years of study and work that has
gone into
16 it.
I don't think if this committee decides -- I
17 took it, the 25 questions and --
18 DR. LUBRITZ: I don't want to ask you what you
19 got.
20 MR. LEGARZA: I had help but I missed four out
21 of 25.
But I had a little bit of help from
22 Dr. Buchwald.
23 There are people questions
on there
24 as well as medical questions. Frankly, I did pretty
25
good on the people questions. I
don't know if
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
14
1 doctors did as good. I think Larry would be the
2 exception rather than the rule. He has thirteen
3 years working with this board and a lot of
4 experience; knows about medications and has
heard
5 all these big, long words that these people
use.
6 There's no way that I can
pass the
7 two and a half hour exam. I don't know that it's
8 necessarily that easy of an exam.
9 DR. DESAI: How many physicians has taken specs
10 till now -- maybe less than one
percent. Nevada is
11 the only state which was more than 10
percent of the
12 total physician took the specs because
Nevada asked
13 them to take it.
14 So we are on the forefront
of
15 making sure that any physician who might
have
16 practiced or licensed ten years ago in some
state we
17 don't give them reciprocity. We want to make sure
18 they are competent and that's the reason of
the
19 specs.
20 DR. TITUS: Specs may be one that we can use
21 and maybe looking at in the future and
perhaps our
22 specialty boards but I think the specs is
certainly
23 an option and viable option that would be
there for
24 us in the future.
25 MR. ROSENCRANTZ: As Robin -- we talked about
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
15
1 the International Conference -- they're
using it in
2 Canada and they are also using it in
England and
3 Britain but they are using it maybe not so
4 proficient.
People are asking for it. The
public
5 is
asking for it from their physicians.
6 It's something that is
going to
7 come to the states in a big way and we are
going to
8 be aware of what is happening. Even just looking at
9 it,
it will probably be a long process.
I think we
10 need to be commended for even looking at
it.
11 MR. LESSLY: We're the only state looking at it
12 at this point.
13 DR. BAEPLER:
The biggest dilemma we have and I
14 don't know how to resolve it is most of the
doctors
15 are specialists and the specialty boards
vary from
16 very difficult to automatic pass, and what
kind of
17 an exam do you come up with that is fair to
the
18 specialists or do you come up with a whole
number of
19 different exams. There's some fundamental problems
20 that this committee has to face.
21 MR. ROSENCRANTZ: Larry, do you have anything
22 to add?
23 MR. LESSLY: No.
24 MR. ROSENCRANTZ: I would ask if the committee
25 members if they would stay after this
meeting. We
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
16
1 can talk about how we can proceed. Maybe we'll do a
2 ten minute committee meeting after our
meeting
3 adjourns and talk about how to
proceed. I would
4 appreciate it if you would stay.
5 Next report is the IC.
6 Dr. Stewart.
7 DR. STEWART: I will pass around what we did.
8 We worked from 8:15 to 4:30 yesterday and
7:30 to
9 8:45 today.
We are current. This is a list of
the
10 closures.
We have a few people coming to visit us
11 in March.
We have three -- we have three complaints
12 that we authorized this morning.
13 MR. ROSENCRANTZ: Done the PSAs. Educational
14 Committee Meetings, the Fourth
International
15 Conference on Medical Regulation. I attended that
16 meeting in Oxford as well as Dr. Buchwald,
17 Dr. Titus, Dr. Stewart and Dr. Jones and if
any of
18 you have some comments, we'll hear them.
19 DR. BUCHWALD: Having gone to several
20 meetings -- maybe Dr. Jones can add to that
-- I
21 think the discussions held within the various
22 countries in regards to some uniformity of
23 credentialing has started to open up and
the
24 conversations are significantly less
guarded, and
25 people are a lot more willing to discuss their
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
17
1 problems and how they have resolved them as
this
2 issue that we're discussing, I think it's
becoming
3 more available.
4 MR. ROSENCRANTZ: I myself thought it was one
5 of the better conferences I've been
to. Very
6
interesting to meet regulators from different
7 countries.
8 As Susan said, they were
very open
9 to share their problems with us and we had
somebody
10 speak to us, then we went into a round
table
11 discussions, break up groups and it was
pretty well
12 done.
The setting was obviously spectacular.
But
13 it was a really worthwhile program. I think all of
14 us
that went got something out of it.
15 DR. JONES: And I think the one thing that was
16 interesting to me -- I don't remember his
name but
17 the world organization person talking about
how we
18
need to rethink our perspective on medicine
19 including going at it from a wellness
aspect, from a
20 societal aspect rather than zeroing
in. He
21 indicated that we're so specialized that we
forget,
22 we look at our own specialty and we forget
to look
23 at the whole picture and that we need to
focus on
24 becoming more aware of the world as a whole
instead
25 of just zeroing in on our own little
practice. I
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
18
1 think he gave a very interesting
presentation.
2 MR. ROSENCRANTZ: There was a lot to do in
3 Oxford and a lot to see and I have to tell
you that
4 I saw all of our members at all of the
meetings. I
5 think it was so interesting everybody just
enjoyed
6 it.
Really good attendance. I was
really proud of
7 the group.
We were very well represented there.
8 Our state certainly had
more than
9
other states, even more than some countries. I was
10 proud we were there participating.
11 DR. TITUS: As a take home though from that
12 meeting, I think -- I know it seems like a
very
13
broad meeting for us to attend but I will tell you
14 it really opened my eyes on the
recertification
15 issues and the competency issues and to
recognize
16 that Nevada may be the only state right now
that
17 would be -- we may be more advanced than
some states
18 on the question of recertification. I'm sure other
19 states are looking at the question.
20 But it is out there and
countries
21 are doing it and it's not just something in
the
22 future.
Something they are doing now and there's
23 incredibly extensive recertification
processes that
24 Canada goes through and different countries
are
25 doing and I certainly got some ideas on
what we
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
19
1 don't want to do and some ideas on what we
may do,
2 and it was very helpful for me on that note
to
3 something that we can take home here.
4 One other thing we were
going to
5 talk about from bringing up from that
meeting is
6 that in England they create these brochures
that we
7 all found pretty helpful, might be
something we can
8 look
at as a board doing at some point and I brought
9 some sample ones with me today that people
that
10 didn't see them might want to look at that
-- the
11 gentleman for England produces -- one is
ethical
12 considerations, good medical practice and
providing
13 information and those type of things.
14 And I think the issue that
we ran
15 into yesterday in the IC Committee was that
16 physicians didn't know necessarily the law
about
17 prescription and who you can prescribe for
and
18 instead of being in a unit like this that
we have
19 gotten which is a laws of medical practice,
this is
20 a very non-confrontive way of giving
information on
21 the laws of our state. We may want to look at
22 this.
And we're spending a lot of time on this
23 public service announcement. We may want to help
24 educate our physicians on good medical
practice and
25 not just give it in a legal binder. So I just
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
20
1 thought I would bring that up.
2 MR. ROSENCRANTZ: Maybe you'll pass those
3 around and leave them out at lunch. You guys will
4 look at them. They were very well done.
5 Bob, do you have anything
to say
6 about -- Bob Frantz.
7 MR. FRANTZ: Casey Miller, Kalkoski
8 (phonetics), and myself attended the CLEAR
9 Conference in Miami and I found it quite
informative
10 and helpful. I won't go through the little seminars
11 that we attended; however, we did attend
one the
12 last one of the entire conference was one
on
13 telemarketing and on-line pharmacies. And they had
14 a speaker from Washington D.C., from the
15 U.S. Department of Justice there, a trial
attorney,
16 and she was telling us how they trace
on-line
17 pharmacies for dispensing of drugs.
18 One of the examples she
used was an
19 on-line sale of Viagra and they traced it
back to
20 Australia where it was actually being
marketed out
21 of Australia. It is interesting the source that she
22 used to locate that and I thought, well,
it's a nice
23 source of information if we need to go back
and
24 utilize something like that.
25 And she utilized a -- I
don't know
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
21
1 how to say -- quite a, how to trace
something like
2 that and it was used by Sam Spade. I guess there's
3 a system out there called Sam Spade that
tracing it
4 back and it was interesting. But that was just one
5 of the conferences.
6 But I found it very nice,
very good
7 and enjoyed it very much. So for the three of us,
8 I'd like to thank all of you for allowing
us to
9 attend.
Thanks.
10 MR. ROSENCRANTZ: Don, Symposium on Medical
11 Licensure in the 21st Century.
12 DR. BAEPLER: This was a symposium held in
13 Washington in early September; I believe
September
14 6th and 7th.
15 It was attended by Larry
Lessly and
16 Maureen Lyons and Richard Legarza and
myself and we
17 went to all the meetings. That's the first input
18 and it was a very good conference.
19 It addressed directly the
question
20 we've been discussing of competency testing
with
21 some diversions. And I think the one thing that
22 came through loud and clear was that it is
a
23 national problem and it will be addressed
and that
24 is better for the various medical boards
around the
25 country to be proactive rather than
reactive that by
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122
22
1 doing nothing you won't avoid it. Nothing
2 imminent.
You got several years to be sure, a
3 decade perhaps that the public seems to be
demanding
4 it.
5 Some of the topics that
were
6 discussed were what the beginning M.D.
should really
7 know to enter the profession. That's the first
8 place
where you really want to test competency.
9 General competency for
physicians
10 was discussed. But that was a rather vague another
11 presentation. They discussed the continuing medical
12 education program as it currently exists
and
13 rightfully criticized it as in many areas
being
14 somewhat irrelevant to its fundamental
intent but
15 that it could be improved to help out with
the whole
16 question of competency.
17 They talked about
performance based
18 assessments of clinical skills and they
discussed at
19 length the
Canadian system for testing competency.
20 Particularly in the Province of Alberta
where it is
21 best worked out but cost prohibited with
the cost
22 per person is excessive. Canada may have to revise
23 downward their particular program because
they
24 simply can't afford it.
25 Even in a state like
Nevada where
LISA JOHNSON &
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1 you have a relatively small number of
M.D.'s
2 remembering that everyone would not be
tested at the
3 same time.
It's not like renewing your license
4 every two years. But there might be elements of
5 that Alberta system that one could
incorporate.
6 And then talked on the
human
7 genomic project and how this will affect
medicine
8 and the number two man of the federal
genomic
9 project delivered that address, and talked
about the
10 more 5.7 peritonuclear (phonetics) types
that have
11 been sequenced and that they really have
been able
12 to identify hundreds and hundreds of
sequences of
13 nuclear tides that relates to enzymes that
make a
14 person genetically disposed towards a
disease or
15 it's a genetically determined disease.
16 It's amazing how fast the
field is
17 moving.
They are saying that within perhaps a
18 shorter interval of five years, certainly
within a
19 decade, physician could have in his office
a
20 relatively inexpensive machine.
21 They have developed a chip
that has
22 sequences involving 10,000 different
enzymes,
23
peritonuclear types that relate to treating
24 ingredients in the enzymes. And that in a matter of
25 minutes with a drop of blood, you can
analyze 10,000
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1 different situations that could be
genetically
2 disposed or genetically determined.
3 It's tremendous diagnostic
tool
4 that would also eliminate certain
possibilities for
5 people as well as taking preventive steps
for people
6 that are disposed towards certain
situations.
7 Followed again much quicker than we think
by a new
8 type of medicine, practice of medicine that
would
9 actually alter the nuclear type sequence or
alter
10 the enzymes produced by existing nuclear
type
11 sequences to prevent genetically disposed
or
12 determined diseases.
13 Suggested that this might
be the
14 equivalent of the discovery of Penicillin
and the
15 advent of the many different antibiotics in
the
16 1940's.
This might change medicine as much as the
17 whole field of antibiotics changed medicine
in the
18 decade of the 40's.
19 Rather exciting
proposition. And
20 using relatively simple genetic technique,
one
21 caveat when is throughout you're taking
family
22 history of patients, be aware of the fact
that
23 10 percent of the people that you interview
don't
24 know who their father is and we're not
talking about
25 adopted children.
LISA JOHNSON &
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1 I might point out that in
the bird
2 species that are thought to be monogamous
and with
3 similar studies have been done, the rate of
fidelity
4 is a little bit better.
5 Very good meeting.
6 MR. ROSENCRANTZ: Dr. Jones, Federation of
7 State Medical Boards of the United States,
Inc.,
8 Medical Boards and Deceptive Health Care
Practices.
9 DR. JONES: I can't follow that.
10 I have copious notes
attached on to
11 the
front of my books and Bob carried it down here
12 for me and lost my notes. So I'm going on what I
13 remember and at my age my mind is going.
14 But Larry and Joel and
Richard went
15
down to Phoenix and actually the thing that I got
16 most I got out of the meeting was that
Nevada has
17 experienced and dealt with most of the
things that
18 people are now in other states are beginning
to
19 experience now. So I felt that we were way ahead of
20 the game.
21 However, there was one
presentation
22 that I felt several of the presenters
opened up
23
their presentations by saying alternative medicine
24 is not going to go away. So we need to work
25 together and one of them presented the
notes on
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1 Mandela stance (phonetics). Rather than dealing
2 with your enemies with fear and anger and
hate, to
3 love them and work with them, collaborate
with them
4 so that your patients can have the best of
both
5 worlds rather than fighting each
other. Find a
6 common ground that we can work together and
for the
7 benefit of our patient.
8 And I thought he gave a
very good
9 presentation. Lunch was very good, accommodations
10 were very nice and it was an enjoyable
trip; good
11 meeting.
12 MR. ROSENCRANTZ: Vicki Knopf is not here. She
13 went to a workshop. Do you know anything about
14 that; what she did? No.
Again we'll pass on that
15
one.
16 The Federation's Executive
Director
17 Management Seminar.
18 MR. LESSLY: I attended that seminar in Austin,
19 Texas, and the topic was exactly what we're
planning
20 on being involved in changing evaluation
instruments
21 for staff members. And I got some material on
22 up-to-date innovative measurement
instruments.
23 So I'm going to be asking
24 Dr. Buchwald to convene the Internal
Affairs
25 Committee, plus Dr. Baepler, and try to do
something
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1 with our evaluation instruments between now
and
2 June.
That was the primary topic at that particular
3 seminar.
4 Right after that seminar
the next
5 thing on the agenda is the Federations
Executive
6 Director Advisory Council Meeting. We had that
7 Advisory Council Meeting there in Austin right
after
8 that seminar. This Council kind of tells you what
9 the topics are out there that the
Federation is
10 addressing and brings you up to speed on
some things
11 that are happening.
12 There are two or three
things they
13 discussed at that conference. One being the
14 Federation Credential Verification
Service. That's
15 the central service where the Federation
operates
16 where the physician can apply through that
service
17 to have himself credentialed. And some states
18 actually require this, and then that
credentialing
19 service transmits to us a credentialing
package for
20 purposes of a licensure application.
21 They are now going to be
able to do
22 that electronically probably the 1st of the
year to
23 speed that process up. We use that process only
24 insofar as it meets our requirements. We have some
25 additional requirements that are not
included in
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1 that particular process that we also
require.
2 Another topic was the
PLAS. We're
3
talking about Post Licensure Competency Assessment,
4 PLAS presentation that Carol Fogert gave to
the
5 operation in Denver, Colorado. Personal assessment
6 operation that is up and running at a cost
of about
7 $7,000.
They are operating with five physicians per
8 month.
That is their capacity to evaluate.
That is
9 operating in apparently -- has been for
about the
10 last six months and 25 to 30 physicians do
it
11 already.
12 And the last thing is an
issue that
13 is more of an issue for other states than
it has
14 been for us, that's military licensure, military
15 physicians.
16 In Nevada we have a
statute that
17 says our licensing law does not apply to
military
18 physicians who perform their medical duties
as a
19 part
of their government job.
20 We took the position --
this board
21 took the position that a license is not
required for
22 a military position for instance to come
into the
23 hospital and any community in Nevada to
perform
24 medical services for a military medical
beneficiary
25 because that is in the performance of his
military
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1 duties.
2 That's probably an
enlightened
3 statute because apparently other states are
having
4 tremendous problems with this and are very
worried
5 about military doctors working in their
civilian
6 hospitals because the military is simply
phasing out
7 hospitals and tracking out medical care.
8 But they want their
military
9 physicians, a cost saving effort to perform
a lot of
10 the medical services for military
dependents and
11 active duty military.
12 So there is an agreement
that has
13 been cut between the Federation and the
Department
14 of Defense to require physicians coming
into any
15 state to notify the Medical Board even
though they
16 don't have to get a license, to notify the
Medical
17 Board and comply with certain basic
licensure
18 requirements. It just so happens they are our
19 requirements. Three years postgraduate training
20 right down the line.
21 So it would not have been
a problem
22 for us even if we had to address it this
way. We
23 don't have to address it this way. But that's
24 another step toward three year requirement
as far as
25 postgraduate training is concerned.
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1 That was about all I have
to report
2 from that Council meeting, sir.
3 MR. ROSENCRANTZ: Just a comment. How active
4 our board and staff has been. We're really proud of
5 all of us for committing the time and the
effort to
6 go to meetings and participate. I think that's what
7
we're empowered to do and asked by the state and the
8 public to listen to all the things that we
have done
9 and makes me feel that we do a good
job. I'm
10 pleased with that, pleased we're putting
out the
11 effort to do that.
12 Going to Agenda Item
Number 3.
13 MR. LESSLY: Arne, you skipped the
14 Secretary-Treasurer.
15 MR. ROSENCRANTZ: All right;
16 Secretary-Treasurer. Dr. Stewart.
17 DR. STEWART: Mr. Frantz.
18 MR. FRANTZ: Thank you, Dr. Stewart.
19 Take a quick look at it an
see if
20 you
have any questions. People were talking
about
21 the money necessary for running our ad
campaign.
22 If you go through the second page of that
bottom
23 line, 546, you can see what we have
allocated
24
budget-wise to the Public Service Announcements.
25 We have not spent any
money on that
LISA JOHNSON &
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1 account so far this fiscal year and we're
still in
2 very good financial shape.
3 This is the slowest time
of the
4
year for us during the fiscal year.
It is this
5 period of time probably beginning before
6 Thanksgiving through the end of the year
that we get
7 in again.
So what we normally see in revenues and
8 money coming in is really dab, dab. This is when we
9 tap into our savings at this time to carry
us
10 through this part of the year so --
11 MR. ROSENCRANTZ: Any questions for
12 Mr. Frantz?
Any questions for Dr. Stewart?
13 MR. FRANTZ: Thank you.
14 DR. LUBRITZ: Would it be possible to continue
15 so we can track on the Public Service thing
how
16 frequently we get calls?
17 MR. ROSENCRANTZ: As soon as we start --
18 MS. LYONS: The same survey --
19 DR. LUBRITZ: Someone calls, that's it; that's
20 a call?
21 MS. LYONS: So we'll start January 1st, and
22 I'll just do it until that board meeting.
23 MR. ROSENCRANTZ: I need an approval --
24 second.
Any discussion? All in favor?
25 Now, we'll try and see is anyone
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1 here
from the D.O. Board, Item Number 3?
Anyone
2 from the D.O. Boards? We'll pass on Agenda Item
3 Number 3.
4 We'll go to Agenda Item
Number 5.
5 Michael Garcia; is he here? There he is.
6 Michael is President of
the Nevada
7 Society for Respiratory Care, for Licensure
of
8 Respiratory Therapists by Nevada State
Board of
9 Medical Examiners.
10 MR. GARCIA: Good morning and thank you for
11 allowing us on your agenda today. I found your
12 comments regarding recertification a
physician
13 interesting and that our profession at a
national
14 level is struggling with the same
issue. Being that
15 our credentials come out of a national
credential
16 board, we can act on this for therapists
nationwide
17 and there will be recredentialed for
respiratory
18 therapists in the next few years. How it is going
19 to come about is subject to a huge debate.
20 DR. BAEPLER: You use the term recredentialing,
21 the word competency doesn't sneak in at
all.
22 MR. GARCIA: No, and I think the philosophy on
23 that is that competency is a subjective
assessment
24 typically from a -- from our perspective.
25 DR. BAEPLER: It's threatening too.
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1 MR. GARCIA:
Tends to turn the tide before you
2 open the door. So we're looking at recredentialing
3 and there are a variety of avenues being
addressed.
4 Continuing education is
going to
5 play a big role in that. There are those of us that
6 believe that the continuing education
requirements
7 are met and the need for testing competency
is at
8 least reduced.
9 MR. ROSENCRANTZ: It seems to me that the last
10 time you were here you came to this Board
11 representing therapists basically saying
that you'd
12 like us to represent you.
13 MR. GARCIA: That's correct.
14 MR. ROSENCRANTZ: I think we gave you some
15 guidelines as to how we can do that and now
you're
16 back before us. Can you tell us the purpose why
17 you're back.
18 MR. GARCIA: Well, I met with our constituency
19 within our society and our membership
through our
20 board and presented the information that we
received
21 here from your board. It became quite clear that
22 our membership, almost 100 percent, is
unified in
23 the fact that we believe we need to be
licensed in
24 the State of Nevada more importantly than
anything
25 else to protect the public safety. And I will
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1 reiterate, we're one of the last -- we're
one of six
2 states that remain yet to have formal
licensure in
3 this country for respiratory therapists.
4 It is our concern that
Nevada is,
5
has been and will continue to be somewhat of a
6 dumping ground for practitioners who lose
licenses
7 elsewhere.
And without going through all of the
8 reasons, we believe licensure is
appropriate. We
9 have certainly agreed that licensure under
the Board
10 of Medical Examiners is consistent with our
role in
11 health care, per se, and for a variety of
reasons is
12 a preferred approach.
13 What we do have in the
State of
14 Nevada right now is NRS 640b. It speaks to the
15 essential scope of practice in the
respiratory
16 therapists.
It says what a respiratory therapist
17 can do given a written or verbal order from
a
18 physician, nurse practitioner or a
physicians
19 assistant.
It goes on to indicate the respiratory
20 therapist must pass a national exam
administered by
21 the National Board of Respiratory
Care. Depending
22 on their level of education, they may end
up
23 retaining a credential or obtaining a
credential of
24 certification or registry.
25 The point is that prevents
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1 on-the-job training in this State which we
believe
2 is a good thing, that in itself elevated
the safety
3 for the public in this state but it has not
4 established continuing education
requirements. It
5 has not provided any mechanism for checking
6 reciprocity for therapists coming in from
other
7 states, background checks, licensure
checks; none of
8 that is going on.
9 So our goal is to be
licensed as
10 respiratory therapists under the BMOE. Now, did you
11 all get a copy of this?
12 When we last met, it was
our
13
impression that if we moved forward with this as a
14 part of a bill that I believe you intend to
present
15 to the legislature this year on other
matters, we
16 would tag on per se a statement that indicated
that
17 the BMOE will license and regulate
respiratory
18 practitioners. And you didn't want to get into
19 anymore verbiage than that.
20 Our members are very
concerned that
21 if that bill went through and passed, it
would
22 eliminate the safety net that we at least
have at
23 the moment under NRS 640b, there would be
24 immediately be no scope of practice, per se
for
25 respiratory practitioners, there will be no
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36
1 provision under law that requires that
practitioners
2 be credentialed, and there will be no
exclusions to
3 a variety of other care professionals that
might be
4 affected by your actions.
5 So I have forwarded this
language
6 in an effort to convince you all that if
you're
7 willing to move forward with licensing
respiratory
8 therapists, it is really in everyone's best
9 interest, not only respiratory therapists,
the
10 public of Nevada but the BMOE as well that
this
11 language be included in that bill. And basically it
12 states the purpose for the bill -- it does
define
13 our practice. It states the requirements in order
14 to be a respiratory therapist in this
State. And
15 though this language is not the exact
language that
16 is in the existing NRS 640b, it is
comparable and it
17 is the language that our national
association has
18 recommended that states seeking licensure
utilize.
19 And then we have taken the
20 applicability chapter that exists currently
in
21 NRS 640b and included it here as well
because
22 obviously, there are those that were
concerned when
23 this act went into place that it might affect
their
24 positions in this State either financially
or
25 professionally and agreements were made to
create
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1 this chapter to prevent obstructions of the
bill.
2 I would think that if the
BMOE is
3 willing to move forward with a bill to our
benefit,
4 these same folks would show up at the
doorstep and
5 this would have to be addressed again. So putting
6 it in up front might prevent any potential
obstacles
7 to
the passing of this legislation.
8 So today I'm asking you to
consider
9 this language and to agree to include it in
the
10 bill.
11 MR. LESSLY: You can't agree. I don't know how
12 many times we've gone over this. You can't agree to
13 include language in the bill.
14 What you have to do is
agree that
15 you're going to license these people and
then we'll
16 draft a bill that includes a scope of
practice. I
17 would assume that it would capture the
scope of
18 practice that already exists by statute,
but that
19 statute is going to be wiped out in the
process of
20 legislation.
21 We're not going to get
beyond
22 saying the Board of Medical Examiners is
empowered
23 to adopt regulations to govern the practice
of
24 respiratory therapy. We'll define the statute and
25 treat it exactly like we do a P.A.
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1 You have a long stack,
long list of
2 regulations to govern a P.A. so you can't approve
3 this language to put in your bill. We need to draft
4 a bill if you're going to do this.
5 MR. GARCIA: As I understand it, our research
6 indicates that when you did this with
physicians
7 assistants, this is exactly what you
did. It was in
8 your original --
9 MR. LESSLY: Your research is not correct.
10 MR. GARCIA: All right.
Then I have
11 misunderstood and misinformed. So maybe you'll have
12 to explain to me further.
13 MR. LESSLY: I just did.
14 MR. GARCIA: What I'm telling you is that I
15 don't understand. You're talking about two bills
16 then?
17 MR. LESSLY: We have a bill that has been
18 drafted.
Our bill draft requests will be amended to
19 include a provision that says the Board of
Medical
20 Examiners will license respiratory therapists. Here
21 is what a respiratory therapist is and
does. The
22 Board of Medical Examiners will adopt
regulations to
23 regulate respiratory therapists --
24 MR. GARCIA: You're saying here is what a
25 respiratory therapist is and does. That's what this
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1 is.
So then why are we in disagreement?
2 MR. LESSLY: We're not in disagreement. We're
3 not going to take your bill, your language
and say
4 that that's going to be the bill. It is going to
5 depend how the bill drafter puts it
together.
6 DR. BAEPLER: They are concerned if something
7 like that passes, then we're at liberty to
adopt any
8 standards and so on that we wish, and how can
we
9 give them assurances that the regulations
that this
10 Board will adopt in the future will in fact
reflect
11 what they now want in the bill.
12 MR. LESSLY: Because we go through a
13 legislative process and not a
regulations. If we
14 decide that it's appropriate to punish a
respiratory
15 therapist for a violation of the practice
act by
16
branding on the forehead, I assume we would have a
17 meeting and go through a regulation
adoption and
18 decide whether that was appropriate or not.
19 We cannot put in a bill on
20 respiratory therapy that deals in
minutiae. We have
21 to have a bill that says this is what a
respiratory
22 therapist is, this is how they practice,
they will
23 be regulated by the Board of Medical
Examiners, the
24 Board of Medical Examiners will do so by
25 regulation.
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1 DR. BAEPLER: It's an enabling bill.
2 MR. LESSLY: Yes; that's all it is. And going
3 beyond that then, I don't feel that we want
to do
4
that.
5 DR. BAEPLER: How many respiratory therapists
6 are there roughly?
7 MR. GARCIA: Close to 800.
8 DR. TITUS: What kind of fiscal (phonetics)
9 responsibility will we incur in costs?
10 MR. LESSLY: None.
They will have to pay for
11 it.
12 DR. TITUS: What fees are you paying now? Is
13 there a state --
14 MR. GARCIA:
There is no licensure in the
15 state; there are no fees paid.
16 MR. LESSLY: We would have to determine the
17 appropriate registration and application
fee. We're
18 not going to be able to do that right up
front.
19 We would have to have a
statute
20 that says you may set the fees. Just like our
21 statute says on all the rest of our
fees. Our
22 philosophy -- it's not a philosophy it's a
fact of
23 life, we charge P.A.'s what it costs to
regulate
24 them and we charge doctors what it costs to
25 credential them what it cost to regulate
them. We
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1 have to do the same thing with that
profession.
2 DR. TITUS: What kind of fees will be charged
3 to the P.A.'s?
4 MR. LESSLY: $400 application fee, $300
5 registration fee and --
6 DR. TITUS: How many P.A.'s are there
7 licensed?
8 MR. LESSLY: 150 or 60.
9 DR. BAEPLER: It's a biannual fee?
10 MR. LESSLY: Yes.
11 DR. TITUS: It's 160 and we end up charging 400
12 per ap?
13 MR. LESSLY: We have a bill in to raise the
14 limit on P.A.'s because we did not charge
the P.A.'s
15 enough right now.
16 DR. TITUS: Are your people aware in your group
17 that there's going to be a fee?
18 MR. GARCIA: We have made them aware that the
19 fee is not set in stone by any means but
that a
20 number we are familiar with is probably $400
for the
21 initial, based upon the information related
to the
22 P.A.'s, and it is our understanding that
subsequent
23 renewal fees would be pretty much based
upon the
24 ongoing costs versus income generated by
licensing
25 respiratory therapists, such that if cost
succeeded
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1 income at a biannual time, that we might
pay more.
2 Or if costs were less than income, we might
pay
3 less.
4 MR. LESSLY: We don't know what the
5 disciplinary rate would be. It is my impression
6 discussing with Dr. Stewart and Mike that
there are
7 a few disciplinary actions. That obviously brings
8 your costs up. So you might be charging them less
9 than you're charging the P.A., but we don't
know
10 that yet.
11 MR. GARCIA: We're certainly comfortable in
12 general with that uncertainty. What we are -- I
13
guess my point is when you speak to your enabling
14 bill and say this is what a respiratory
therapist
15 is, this is what we would like to see.
16 MR. LESSLY: We're going to use that. That's
17 already in your statutes.
18 MR. GARCIA: And I guess the next section that
19 requires that a therapist being
credentialed, that
20 would take a sentence in essence.
21 MR. LESSLY:
We're going to do that.
22 MR. GARCIA: Our constituency cannot face
23 losing the legal term respiratory therapist
is
24 registered or certified.
25 MR. LESSLY: We wouldn't want to take you
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1 without a requirement that you be certified
because
2 we don't want to go through a state
certification.
3 Then you'll end up paying a fortune.
4 MR. ROSENCRANTZ: I think one of the things
5 that I see, Michael, is that your
constituents need
6 to understand they sort of give up control
--
7 MR. GARCIA: They understand that.
8 MR. ROSENCRANTZ: -- when they come to this
9 Board and yes, we can design something
hopefully
10 that will work and explain it to your
constituency,
11 but you're going -- they are going to have
to
12 understand that they are giving up control
and this
13 Board takes over and operates the same as
we do with
14 P.A.'s, which I've been here seven years
and seems
15 to really work well with the P.A.'s, and I
don't
16 know why it wouldn't work well with you.
17 I understand why we have
to do it
18 that way.
Do you need somebody from our Board to
19 explain to your group? I think Larry made it clear
20 this is the way it's got to be done and it's
getting
21 down to the wire. Now is the time for you to make a
22 decision because legislation is starting.
23 MR. GARCIA: We have with the exception that we
24 will not be remised in our responsibility
to protect
25 the public of Nevada.
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1 If there is not some sort
of
2 language that says the respiratory
therapists must
3 be credentialed and if it does not speak to
their
4 scope of practice, we certainly would not
want that
5 bill --
6 MR. LESSLY: There's no way this Board would
7 pass or that would even seek legislation
that didn't
8 include that.
9 What would we do; what
would be the
10 point; why would we want to regulate a
profession
11 that didn't have a definition, a scope of
practice
12 or a credentialing requirement.
13 MR. GARCIA: I misunderstood you completely. I
14 understood you to say that you were going
to put in
15 sentences that the BMOE will regulate and
license
16 respiratory --
17 MR. LESSLY: We are going to have that
18 sentence in there and we are going to wipe
out your
19 statutes --
20 DR. BAEPLER: But incorporate it here.
21 MR. LESSLY: And incorporate it in the --
22 sure.
You're aware of that.
23 MR. GARCIA: I'm aware of that.
24 MR. ROSENCRANTZ: And maybe change some of it.
25 MR. GARCIA: And they are aware of that.
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1 MR. LEGARZA: I think also we have a whole
2 bunch of language in our legislation that
we have
3 over there and this is just some ideas and
some
4 concepts maybe added to that language and
there's no
5 telling what the legislation may do to our
language,
6
your language.
7 It would be my guess if
the Board
8 approved this and your people wanted this
and we
9 went ahead to have the Nevada State Board
of Medical
10 Examiners regulate and license your people,
you and
11 whoever would be working closely with Bob
Morango
12 (phonetics), who is our legislative
consultant, in
13 getting this stuff through the legislature
and
14
making sure that we've got this enabling stuff so
15 that we can all sit down later, you, and me
and
16 Larry, and Bob Morango and promulgate
regulations to
17 propose to the Board to pass on the
discipline and
18 the stuff just like the P.A.'s.
19 I think what all Larry is
saying is
20 we need to enable it first and whatever
language we
21 think we need in there, you think we need,
we think
22 we can get in, the LCB says we can have
based upon
23 what they're going to do with your chapter
that --
24 there's no magic in those words as well as
there's
25 no magic in any other words that we have
there now
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1 because of these folks at the LCB.
2 MR. GARCIA: I think I have a clear
3 understanding.
4 MR. LESSLY: And Arne's point about you guys
5 and you understand once you do this, you're
6
relinquishing control.
7 You also have to
understand once we
8 take it, have it put into the appropriate
format and
9 take it to the legislature, we make you no
guarantee
10 that it's going to pass or it's going to
pass in the
11 form in which we submit it. Strange things can
12 happen in Nevada legislature. Someone can decide
13 that respiratory therapists should not be
allowed to
14 practice in Nevada, period, and change the
15 legislation. I mean, weird things happen.
16 DR. BAEPLER: It's a high risk operation.
17 MR. LESSLY: It's extremely high risk.
18 DR. BAEPLER: Can I try a motion? Move that we
19 approve this and that we proceed with
taking it to
20 the legislature subject to the approval of
the
21 respiratory therapists when they see what
is
22 actually going to be submitted, that they
should
23 have the opportunity to say no, don't
proceed.
24 DR. TITUS: I think we're past that.
25 MR. ROSENCRANTZ: No.
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1 DR. BAEPLER: I don't want this to appear that
2 we're trying to expand our scope. Rather we're
3 willing to accommodate them. That that will only
4 work if what we submit is satisfactory to
them. It
5 seems to be a little bit vague right now.
6 MR. LEGARZA: Second.
7 MR. ROSENCRANTZ: Motion to second. Any
8 discussion?
9 DR. BUCHWALD: I think it needs to be done
10 expeditiously.
11
DR. LUBRITZ: Don, I wonder if you
would accept
12 perhaps a slight change in your word, in an
attempt
13 to accommodate the respiratory
therapist. That even
14 puts it more out front. That we're not really
15 looking to expand. You have come to us and we're
16 happy to do it.
17 DR. BAEPLER: That explicitly meets my
18 objectives and I would like that inserted,
yes,
19 please.
20 MR. ROSENCRANTZ: Anymore discussion? Motion
21 to second?
All in favor? Opposed? Hearing none
22 opposed.
Motion carries and if --
23 MR. GARCIA: Thank you so much.
24 MR. ROSENCRANTZ: If you need help, I'm sure
25 that one of our staff members --
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1 MR. LESSLY: We are going to need your help.
2 MR. GARCIA: I do have one more question.
3 We met with Senators
Rawson and
4 Roggio (phonetics) on this and they
agreed. When we
5 did not know we would be moving forward
with the
6 BMOE to sponsor a --
7 MR. LESSLY: That has already been taken care
8
of.
9 DR. BAEPLER: We've already killed that.
10 MR. ROSENCRANTZ: You just think you got it.
11 Why don't we take a ten
minutes
12 break or so.
13
14 (BRIEF RECESS)
15 MR. ROSENCRANTZ: Agenda Item Number 6,
16 Consideration of Approval and Utilization
of Program
17 Director Reporting Form for Physicians
Licensed to
18 Participate in Postgraduate Training
Programs in
19 Nevada.
20 MR. LESSLY: We license postgraduate trainees.
21 We're one of the probably 15 to 20 states
that do
22 that and we have done that since 1985.
23 Unfortunately, I'm not so
certain
24 that we have done it appropriately. We do a
25 background investigation credentialing in
effect on
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1 an applicant to come into a postgraduate
training
2 program in Nevada and I'm not talking about
just the
3 University of Nevada Reno. There are other medical
4 schools that do some rotations through this
state
5 where we license those residents.
6 When we do it for the
initial year,
7 it's clean-cut. We have a form from the Program
8 Director saying Dr. John Doe has been
appointed to
9 the program. We do our investigation to make sure
10 he doesn't have a criminal background or
whatever;
11 had problems in some other country or
whatever, and
12 then we license the guy. He stays in the program.
13 The license is for one year. He stays in the
14 program and gets reappointed for say two or
three
15 more years.
We don't ever really do another
16 investigation or look back on that first
year to see
17 was there a problem. And it's our responsibility to
18 assure the public that this doctor in this
training
19 program is okay to treat.
20 So the Federation has an
attempt to
21 get states to even license residents has
come up
22 with this reporting form and I guess
there's nothing
23 sacred about it. I just thought it probably would
24 meet our needs if we started utilizing this
25 reporting form to require the Program
Director at
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1 the time we do a reappointment of the
second or
2 third year in a three year residency
program to tell
3 us if there was a problem with that
resident. If
4 there's not a problem, we are going to go
ahead and
5 issue that license. If there is a problem, we are
6 going to do like we have done with a couple
of
7 residents in the past; we're going to bring
them to
8 you and you're going to make a
determination whether
9 there's a competency issue.
10 So I'm suggesting that you
11 authorize the staff or direct the staff to
utilize
12 this reporting form -- obviously we'll
tailor it a
13 little bit to our situation and require the
Program
14 Director to give us that report on an
annual basis
15 when we re-license second, third, fourth
year
16 residents.
17
MR. ROSENCRANTZ: Larry, a couple
of years
18 ago -- (inaudible) we met with him. Was it not in
19 regards to even having some kind of
reporting at
20 that time --
21 MR. LESSLY: That was --
22 MR. ROSENCRANTZ: -- and they had some concern
23 about it and maybe you can express that to
the
24 Board.
25 MR. LESSLY: The concern was that medical
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1 schools ought to get to make the sole
determination
2
as to the appropriateness of their residents
3 continuing program, and I think that's an
archaic
4 way to look at it. If that's the situation, why
5 license.
And that's been the attitude in some
6 states where they are not licensed. They let the
7 medical school make that decision.
8 We made a determination
that a
9 resident is practicing medicine on Nevada
patients
10 just like any other doctor and requires
licensure.
11 And yes, at the time he did not want to see
us do
12 something extensive in the way of
credentialing and
13 licensure.
14 MR. ROSENCRANTZ: Have we had any discussion
15 with the new Dean?
16 MR. LESSLY: I don't know the new Dean; never
17 seen him.
18 DR. BUCHWALD: In the seven years that I've
19
been here the people that were medical students and
20 became residents and get in their first
year out in
21 private practice and retrospectively had a
track
22 record that we could not gain access to. And I
23 resent that.
24 I think if we are going to
allow
25 them the privilege of practicing medicine
in a
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1 supervisory or a nonsupervised settings and
we take
2 responsibility for having given them that
privilege,
3 we need to know more early on when there
are
4 potential issues. Almost like a diversion; if the
5 University can't deal with it because they
don't
6 have the power, potentially we can deal with
it
7 because we do have the power.
8 DR. DESAI: Say one physician who was not
9 finish the medical school in -- (Inaudible)
and
10 licensing board was criticized because we
gave him
11 the license to do the training license.
12 I think it's very
important that
13 medical school may not want us to know
which
14 resident they choose for that one
particular
15
program. But if we have to give
them a license in
16 training, it is responsibility --
(Inaudible).
17 Number two, that it is
very
18 important that not a single resident --
(Inaudible).
19 MR. LESSLY: That's all this does.
20 DR. DESAI: Third thing what happened many
21 years ago and the resident allowed to
moonlight in
22 the private clinic throughout the town in
Las Vegas
23 without any supervision of the faculty
members and
24 we stopped them because medical schools say
that all
25 residents -- (Inaudible). We allowed them to do
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1 twenty hours a month of moonlighting
outside.
2 When we found out they
would not
3 moonlighting in the UMC or any monitored
environment
4 by the faculty member on site, we say that
you
5 cannot do this anymore and -- so this
physician is
6 in training if you don't have --
(Inaudible) and I
7 think this form is excellent and I would
submit a
8 motion to support this issue and establish
this
9 mechanism.
10 DR. JONES: I will second.
11 MR. ROSENCRANTZ: Motion to second. Any
12 discussion?
13 Larry, a question. Is this sort of
14 like a legal licensure for a physician --
15 MR. LESSLY: Yes.
Except they do it on an
16 annual basis. We do it on an biannual basis.
17 We ask a lot of questions
of a
18 physician with an unrestricted medical
license. We
19 ask an awful lot of questions and do an
awful lot of
20 checking before we renew license every two
years.
21 With these people we've
just been
22 okay; here's your license; you're renewed.
23 MR. ROSENCRANTZ: Is there a fee for the
24 residency license yearly?
25 MR. LESSLY: Yes.
Yes.
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1 DR. STEWART: What do we do to make sure they
2 are all graduates of an approved medical
school?
3 MR. LESSLY: We do the same thing we do on any
4 other doctor coming to the State. We require direct
5 verification from the medical school. We look at
6 the practitioner data bank. We run them through the
7 Federation Bank. Obviously takes less time because
8 they don't have a practice history nine
times out of
9 ten.
But we do everything we do for a physician
10 that comes for a regular licensure.
11 DR. STEWART: Second question. Say the
12 department of X, Y and Z decides they do
not want to
13 sign the form?
14 MR. LESSLY: I'm not going to give him a
15 license.
16 MR. ROSENCRANTZ: Did you get any feedback from
17 Dr. (Inaudible) --
18 MR. LESSLY: I don't think this is a real
19 burden.
This is a, really the guy is okay or he's
20
not okay. We're not getting
involved in evaluating
21 it ourselves.
22 I think all it will do is
there may
23 be an instance where we want to talk to the
24 physician before I have you talk to the
physician
25 before we decide to extend that license.
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1 MR. ROSENCRANTZ: Any further discussion?
2 Motion in the second? All in favor?
Anyone
3 opposed?
Motion carries.
4 We have some waiting
doctors out
5 there.
We are going to skip to Agenda Item
6 Number 12.
7 Dr. Alberto Armas. Motion to
8 second?
All in favor?
9 Item Number 8.
10 MR. LEGARZA: We have a case that has been
11 filed against board members. Dr. Gilbert has filed
12 a lawsuit against Board members. The only board
13 member currently on the board that is named
in that
14 lawsuit, I have had the opportunity to
visit with
15 him about what the status of it is at this
time.
16 Basically tell you that
17 Dr. Gilbert's first lawyer petitioned the
Court to
18 be allowed to be removed as his lawyer
after Brian
19 Cusey (phonetics) and I filed a motion to
dismiss
20 and made noises about violations of Rule
11. He
21 filed a motion to be relieved. The Court denied
22 that motion.
23 He then filed a subsequent
motion
24 to be relieved and was allowed to be
relieved. And
25 Dr. Gilbert was -- represented
himself. Dr. Gilbert
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1 did get another lawyer and that lawyer did
file an
2 Amended Complaint that he thought he had a
right to
3 file as a matter of right in Federal Court
and he
4 didn't bother to read the records before he
filed it
5
in Federal Court. Without motion
by me, dismissed
6 it.
7 He filed a subsequent
Amended
8 Complaint and requested permission of the
Court
9 and/or stipulation by me. I refused to stipulate
10 and I have filed another motion to dismiss
the
11 amended -- Second Amended Complaint in that
case.
12 He has alleged a
conspiracy between
13 the board members and a witness for the
Board to go
14 after Dr. Gilbert's license to protect the
State of
15 Nevada; a witness for the board. It's bizarre.
16 Real bizarre.
17 That's the status of that
one with
18 respect to the Court orders, terms and
conditions
19 and probation status. Everyone is okay with all of
20 that.
21 And there's one Jed
(phonetics)
22 has -- is doing one of the appeals down
here so
23 lawyer talk about that. That's all I have.
24 MS. COHEN: Dr. Melbourne (phonetics) filed a
25 petition for judicial review which at this
point is
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1 just the records have been filed and the
brief of
2 Dr. Melbourne was due.
3 Dr. David Cohen has a
petition for
4 judicial review at the Supreme Court level
now and
5 it has been submitted on the briefs. Oral argument
6 has been denied by the Supreme Court. So they
7 haven't decided anything yet. They will decide.
8 And the motion for
reconsideration
9 on Dr. Harrison Bass has been denied so
that case is
10 concluded and I filed a motion to publish
which has
11 not been responded -- the Court has not
responded to
12 that yet.
That's the status of the Bass case.
13 MR. ROSENCRANTZ: All right.
Move on to Agenda
14 Item Number 10, Executive Session to
Discuss
15 Professional Competency of Casey N.
Jinks. Need a
16 motion to close. Motion to second? All in favor?
17
18 (EXECUTIVE SESSION)
19 (RECESS)
20
21 DR. BAEPLER: I move that we increase salary to
22 $19,500 as recommend by Maureen Lyons.
23 DR. TITUS: Second.
24 MR. ROSENCRANTZ: All those in favor?
25 Opposed?
Motion carries.
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1 Item Number 11, Petition
for
2 Approval to Allow Simultaneous
3 Collaboration/Supervision of More than Three
4 Advanced Practitioners of Nursing/Physician
5 Assistants per NAC 630.485(2), Tracey D.
Green,
6 M.D., Carson City Public Health Nursing.
7 I assume she's not
here. A letter
8 that she wrote to me and our response. Any
9 discussions?
10 DR. TITUS: Current statute is that they can
11 only do two unless approved by the Board.
12 DR. STEWART: Three.
13 DR. TITUS: They can do three or a combination.
14 DR. STEWART: Three P.A.'s, three APN's or a
15 combination of those two.
16 MR. LESSLY: At one time.
17
DR. STEWART: At one time.
18 DR. BUCHWALD: It seems to me that Tracey, the
19 well-respected practitioner in the North,
wrote an
20 explanatory letter saying that she
basically is --
21
would be collaborating with these four individuals
22 but -- less than a full-time employee and
clearly
23 some of these areas in these clinics
require
24 practitioners at the luxury, and I would be
in favor
25 of granting this request.
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1
MR. ROSENCRANTZ: Motion to
second. Any
2 discussion?
All those in favor? Opposed?
3 The motion carries.
4 Going to Item Number
13. These are
5 nonappearances. Acceptance for Applications for
6 Licensure.
Item number H, Carlos Letelier.
7 DR. TITUS: I think that in view of the fact
8 that this gentleman may have not had three
years of
9 formal residency but is GME (phonetics)
recognized,
10 this gentleman has had more than three
years of
11 postgraduate training in his field and I
move we
12 accept this application.
13 MR. ROSENCRANTZ: Second?
14 DR. BUCHWALD: I would like to discuss this.
15 MR. ROSENCRANTZ: Time for discussion.
16 DR. BUCHWALD: When I reviewed this, my concern
17 is that this individual has taken a very
superficial
18 plastics course and all of the cases that
--
19 virtually, every case that he presented as
20 documentation of his training in that
course are
21 well below the neck level and not in his
purview.
22 Perhaps that is an issue
for his
23 hospital where he is going to be doing
these
24 procedures, and we accept his license on
that basis
25 but I have some concerns in regards to what
he's
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1 going to do if he has his license.
2 DR. TITUS: I think he will be well received in
3 the location that he's going to practice.
4 DR. BUCHWALD: We're dealing with this
5
situation in the North with tragic results and I
6 think this is an opportunity again that we
may not
7 really have that I would like to have.
8 DR. TITUS: So your feeling is that his
9
cosmetic surgery training does not qualify him or
10 are you --
11 DR. BUCHWALD: He's using this year of cosmetic
12 surgery as one of his years. Is that not correct?
13 And this year of cosmetic surgery is
virtually
14 removal of lumps and bumps on fingers and
15 liposuction and taking out wires in fingers
and
16 stuff which somebody else put in. I don't feel that
17 this -- if the cases that he submitted
represents
18 everything that he did for that period of
time, it
19 is not -- I would not accept it as we do a
year of
20 formal training for any other individual.
21
DR. TITUS: I'm curious under the
cosmetic
22 surgery training, is there any ACGME
(phonetics)
23 recognized training in cosmetic surgery?
24 DR. BUCHWALD: I can't answer that.
25 MR. LESSLY: Sure.
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1 DR. BUCHWALD: There are many plastic surgery
2 residencies.
3 MR. LESSLY: The difficulty it raises on the
4 agenda is there is no ACGME approved
maxillofacial
5 surgery.
Maxillofacial surgery is not ACGME
6 approved and those programs, including this
one,
7 Harvard and one down in the South.
8 DR. DESAI: I think we have -- (inaudible).
9 DR. BUCHWALD: I don't have any problem with
10 his training through June of '96. I have no
11 problems with that, with his dental
training or his
12 two years of maxillofacial.
13 It is this third year of
cosmetic
14 surgery that I have a problem with.
15 DR. TITUS: That's the one that is certified
16 instead of the maxillofacial is not
certified?
17 MR. LESSLY: Maxillofacial surgery is not ACGME
18 approved.
There's nothing maxillofacial is
19 approved.
20 DR. LUBRITZ: This goes back to what we
21 discussed and that was that we don't limit
the
22 license.
We either give a license or we don't give
23 a license.
24 Here's a man that has an
M.D. in
25 1993, albeit that all of his training has
been
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1 dental, but there is a program where you go
through
2 dental school and then with an extra year
or
3 something you automatically can apply for
and get
4 your M.D.
Now he kind of snuck by.
5 Maxillofacial surgeries
are
6 extremely aggressive people in locality and
other
7 localities but the fact is I don't think
you can
8 treat him any different because if he wants
to come
9 do neurosurgery having done none and if he
can get
10 the privileges and open the office to do
it, he can
11 do it.
We just said we don't limit licenses.
12 MR. ROSENCRANTZ: I think the difference, and
13 Larry correct me if I am wrong, is he has
not
14 completed three years.
15 MR. LESSLY: No.
He's credited three years
16 postgraduate training.
17 MS. LYONS: But not well recognized.
18 MR. LESSLY: It's either ACGME approved or you
19
have to approve it and fellowships are either ACGME
20 approved or you have to approve it. I don't know of
21 any fellowships that are ACGME approved.
22 So you need to approve his
23 fellowship training, his fellowship year
'96 to '97,
24 you need to consider whether or not you're
going to
25 approve maxillofacial surgery for the other
two
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1 years.
You're approving all three.
2 DR. LUBRITZ: Suppose we -- so the question is
3 not specialty. The question is that for the last
4 year ACGME which he only completed two
years rather
5 than three years?
6 MR. LESSLY: He hasn't completed any ACGME.
7 DR. DESAI: Maybe '94 to '95 for Neurosurgery
8 in California maybe all year he did it but
in his
9 three years -- (Inaudible).
10 DR. BAEPLER: We also require three years of
11
progressive. So we have to keep
in mind --
12 MR. LESSLY: That's another statute.
13 DR. BAEPLER: Well, this is a new year. It has
14 to go through legislature.
15 DR. TITUS: Technically, we recognize that he
16 has had three years of progressive if we
accept it.
17 MR. LESSLY: Progressive is not the issue.
18 MR. ROSENCRANTZ: Whether we accept it.
19 MR. LESSLY: It's whether we accept it.
20 If you look at page two is
the
21 complete history on every other
maxillofacial
22 surgeon who has appeared in front of this
Board
23
seeking licensure and what you've done with them.
24 DR. BUCHWALD: I personally do not feel that he
25 has completed the intent of the law with --
by
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1 supplementing it with the fellowship
whether I
2 recognize it as an ACGME or not, from June
'96 to
3 '97, and I cannot endorse this
application.
4 MR. ROSENCRANTZ: We have a motion on the floor
5 to accept.
6 MS. LYONS: Yes, and it has been seconded.
7 MR. ROSENCRANTZ: Any further discussion? If
8 not, let's vote on the motion. All in favor of
9 accepting this motion?
10 DR. DESAI: I.
11 DR. LUBRITZ: I.
12 DR. BUCHWALD:
I.
13 MR. ROSENCRANTZ: All those opposed? You need
14 to get Dr. Stewart.
15 DR. BAEPLER: I voted affirmatively. It was a
16 soft voice.
17 MS. LYONS: Was your vote dimpled?
18 DR. BAEPLER: It was dimpled.
19 MR. ROSENCRANTZ: We need your vote,
20 Dr. Stewart.
21 Item I, John
Strobeck. We have a
22 motion in Dr. Strobeck's application.
23 DR. BAEPLER: I would move that we approve the
24 application for licensee.
25 MR. ROSENCRANTZ: Motion to second? Any
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1 discussion?
All those in favor? Anyone
opposed?
2 Motion carries.
3 Item Number 14,
Ratification of
4 Licenses Issued, and Reinstatements of
Licensure and
5 Changes of Licensure Status Approved Since
the
6 August 25 & 26, 2000 Board Meeting.
7 Agenda Item 14. A list of those
8 are in your report books.
9 DR. DESAI: I accept all the licensures.
10 MR. ROSENCRANTZ: Motion in the second? Any
11
discussion? Hearing none, all
those in favor?
12 Anyone opposed? The motion carries.
13 Item Number 15 is Matters
for
14 Future Agenda. We're not done there. Any other
15
matters? Why don't we go -- we
are going to skip --
16 We are going to go to Item
17 Number 9, the Executive Director's Report
and take a
18 few minutes.
19 MR. LESSLY: Let me start with the Requests for
20 Member and Staff Attendance at Educational
21 Meetings.
22 The Federation Conference
in April
23 is in Atlanta. We need to know those of you who
24 wish to go and I'm not going to be able to
go this
25 year.
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1 I would like authority to
designate
2 Maureen.
The Federation pays for two
3 representatives. They pay for the Executive
4 Director and the voting delegate. I would like the
5 authority to designate Maureen as the staff
exec who
6 would go to the meeting and have her way
paid by the
7 Federation and no cost to the Board. I need a
8 motion for that.
9 DR. TITUS: Second.
10 MR. ROSENCRANTZ: Motion to second? Any
11 discussion?
All those if favor? Opposed? Motion
12 carries.
13 DR. TITUS:
Need to know now who you want.
14 MR. LESSLY: No.
Just as soon as you can.
15 The Federation call for
Nominations
16 Resolutions and Awards is on the
agenda. I think we
17 sent that out to you beforehand and have
not gotten
18 a response.
So I assume that we are not going to
19 engage in that conduct this year. So I did put it
20 on here to let you have one more shot at
it.
21 DR. TITUS: You said you sent it out to us?
22 MR. LESSLY: Yes.
23 MS. LYONS: That was something else we sent
24 out.
It's in the agenda. It's in the
book. I
25 don't think we sent it out.
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1 MR. LESSLY:
So hearing no motion, I'll move
2 on.
3 MR. ROSENCRANTZ: Yes, sir.
4 MR. LESSLY: Legislation Update. Our bill has
5 been drafted by the Legislative Council
Bureau. It
6 looks like they have taken care of all the
issues we
7 have asked them to take care of. It will be
8 introduced through the Senate Congress
Committee and
9 I will take care of Monday of the change in
our bill
10 direct request to accommodate the
respiratory
11 therapist.
12 With respect to the
legislature, I
13 believe at the last meeting, Cheryl asked
that
14 everyone be notified in the event we have
some
15 necessity to appear in the legislature.
16 We need to designate
someone to
17 represent and I would assume you'll name
the
18
president as your official delegate and we'll pick
19 up anyone else we can in the event we have
an
20 emergency call which we get like be there
tomorrow
21 for a committee meeting or be there at 3 o'clock
22 this afternoon.
23 So I might assume that the
24 president is our official spokesman for the
25 legislature session this year.
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1 Informational Items you
have are
2 self-explanatory.
3 Let's go to the
organizational
4 operational charts, personnel policies and
job
5 description manual.
6 As you know, this is the
-- what
7 you have is -- I believe -- correct me if
I'm wrong,
8 Maureen, you have the complete reprint of
the
9 manual.
10 MS. LYONS: It's a complete reprint of the
11 manual and the changes. There are changes. The
12 changes are incorporated within the things
in
13 brackets are being omitted. Anything underlined
14 means it's new and you can tell what has
been
15 changed by looking at the date at the end
of the
16 item.
It will say today's date revised in
17 underlined in case --
18 MR. LESSLY: And I go through this quickly.
19 Maybe stop me if you have a question.
20 The operational and
organizational
21 charts remain the same. I don't believe there are
22 any changes to the policy statements. Those are all
23 personnel policy type statements.
24 On the job description,
you go to
25 president's job description. We have added points,
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1 panel members. We have utilized panels a couple of
2 times on disciplinary actions in the last
few
3 years.
We simply added that to his job
4 description.
5 No change to the vice
president.
6 Secretary-Treasurer's job description, Item
7 Number 7.
Approved the changes of license status of
8
qualified applicants. That needed
to be thrown in
9 there, all subject to Board approval at the
next
10 regularly scheduled board meeting. That's in
11 Mr. Legarza's description and mine and the
12
Secretary-Treasurer's.
13 Investigative Committee,
we have
14 added the oversight committee for the
Board's
15 program for impaired licensees. It's my
16 understanding that this was not to be a
permanent
17 situation.
So you need to tell me when you're ready
18 to pull that from the investigative
committee, or if
19 you even want it in at this point.
20 And then as far as the statistics
21 are concerned, the financial statistics are
22 concerned, and committee operations, we're
able to
23 do that stuff at each board meeting now and
in the
24
past it used to be quarterly. We
have changed
25 that.
Any problem with that one?
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1 On the Executive Director
Special
2 Council's job description, if you look down
at
3 number 12 and 13, you gave me the authority
to
4 administratively approve changes of
licensure
5 status.
And I specifically remember the charge I
6 was given with respect to the VISA waiver
candidates
7 who had made timely requests for renewal or
8 extension and the delay was not of their
making but
9 that of the Immigration and Naturalization
Service.
10 So those are the two changes there.
11 Up on Public Information,
supervise
12 public information, I added in news
media. Any
13 questions on that one?
14 The Deputy Executive
Director
15 proposing to change the title on that to
add
16 Information Systems Administrator. I would say that
17 Maureen spends half of her time, literally
half of
18 her time on this task now. That is a major
19 responsibility and frankly if --
20 MS. LYONS:
I could spend all my time on it
21 easily if I --
22 MR. LESSLY: If she weren't the Deputy
23 Director, we would have to have an
information
24 specialist under staff at this point in
order to be
25 able to function. So added that as a proposed
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1 change to her job title.
2 On the supervisory
responsibility,
3 she supervises the administrative staff
except she
4 does not supervise the administrative
assistant to
5 the General Counsel. That person works directly for
6 Dick.
So we put that provision in.
7 The rest of the stuff you
can see
8 she simply does the administrative
approvals on
9 licensure changes in my absence, and she
has that
10 authority that you gave her a couple of
board
11 meetings ago.
12 And the other is act as
Web master
13 for the Board's website. Any questions on her?
14 Second page, the annual
reports.
15 This is just an update to cover all the
things she
16 does on information management.
17 Financial manager, we have
taken
18 out the computer list and labels upon
request. Bob
19 no longer does that. That is handled otherwise in
20 the office now. Questions on his?
21 General Counsel, he talks
to the
22 news media also and he does the same review
on
23 credentials that I did along with the
secretary.
24 The administrative
assistant to the
25 General Counsel is simply an update to
indicate
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1 exactly what she does. This job description was
2 well in need of revision.
3 DR. BUCHWALD: At this moment, who holds this
4 job?
5 MR. LESSLY: Casey.
6 DR. STEWART: Can I ask for an interpretation
7 of number one? It is going to come up in the other
8 thing; Administrative Assistant to the
General
9 Counsel.
Open to lead complaint and add
10 investigative file.
11 MR. LESSLY: We open all files now. That's
12 your direction that if we get something in,
we open
13 a file on it.
14 DR. STEWART: What are we going to call those
15 files?
Investigative files?
16 MR. LESSLY: It's an investigative committee.
17 That's what they are.
18 DR. STEWART: Dr. Desai spoke eloquently before
19 about the fact that they were complaint
files. I
20 don't care what you call them, Larry. I Just need
21 to know how to fill in the application.
22 MR. LESSLY: I'm waiting for you to say.
23 DR. DESAI: I think they are complaints in
24 which full investigation -- any complaints
-- I
25 added everything is for initial complaint
and then
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1 when the Board decides to proceed with the
full
2 investigation, then -- (Inaudible).
3 MR. LEGARZA: That's when it's a complaint. I
4 understand what you're trying to say and
what you're
5 saying, but the complaint is after the
thing has
6 been filed.
7 DR. BUCHWALD: I have a problem and I
8 understand what you're saying too and
potentially we
9 are going to have to address that gray area
and
10 decide when the assessment of a complaint turns
into
11 an investigation.
12 And you know, these
assessment of
13 complaints that we do that either are not
in our
14 purview to deal with, are clearly in our
purview but
15 not something that needs further
investigation.
16 How are we going to
designate those
17 from the ones that -- do we ask for more
18 investigation even before we consider
filing a
19 complaint even though we may not file a
complaint?
20 And there's a big difference between those
two
21 entities so --
22 MR. LEGARZA: You can call it violation
23 allegations.
24 MR. LESSLY: What are you going to call your
25 investigators, complaint reviewers now?
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1 DR. STEWART: Violation of allegation
2 reviewers.
Please understand where I'm coming from,
3 Mr. Lessly.
We're going to approve an application
4 form for relicensure. And if anytime there has been
5 a written whatever to the Board and the
Board
6 forwards it to Mr. Legarza to open a file,
if we
7 call that file an investigation file, then
I guess
8 every physician in the State of Nevada is
going to
9 have to check yes, has he ever been
investigated.
10 MR. LESSLY: If he knows.
11 DR. STEWART: We send out letters to the
12 physician asking him for his side of the
story which
13 would put the physician on notice that he's
being
14 for one of the better word, quote, quote
15 investigated, quote, quote.
16 DR. BAEPLER: Take a specific instance. We get
17 a complaint from the pharmacy group that is
certain
18 a doctor might be over-prescribing. Now, do we
19 automatically notify that doctor or do we
first of
20 all look into the record a little bit to
see if
21 there's anything there? I suspect we don't always
22 just notify the doctor if we don't find
anything at
23 all.
24 DR. STEWART: We had one of those this time and
25 there was a Dr. Leonard (phonetics) that
was
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1 associated with us so I assume that we
notified the
2 doctor.
3 DR. BAEPLER: I don't recall the Dr. Leonard.
4
MR. LEGARZA: If we look at the
license
5 application that we have, the renewal
application,
6 we're looking at question number 11. It's on -- if
7 it -- this could help solve the problem.
8 We don't really care about
I don't
9 think about the answer to question 11 so
long as it
10 is one of our existing licensees. And we're talking
11 about renewal applications. We already know that
12 information; those of our licensees that we
have
13 investigated. Fair statement?
14 DR. BAEPLER: No.
What if you answered eleven
15 incorrectly?
16 MR. LEGARZA: We're talking about the concern
17 of our licensees being able to answer this
question
18 honestly.
19 DR. BAEPLER: Right.
20 MR. LEGARZA: And the question is if their name
21 is on this list the way the question is
phrased
22 termed now, they are going to have to
answer yes if
23 they are on this list. I agree with Dr. Stewart.
24 I think that we're
interested about
25 what happens to someone when they are
somewhere else
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1 and what has happened to them by way of an
2 investigation when they are coming here for
3 licensure.
I think we are. Maybe we aren't,
but I
4 think that we are.
5 I think that we are also
probably
6 interested in whether or not any of our
licensees
7 have been investigated by any other
licensing entity
8 or agency in the United States of America,
if any of
9 our licensees are licensed in other states.
10 If we changed this
questionnaire to
11 be, have you ever been, A, notified that
you're
12 investigated before; B, investigated before
or
13 charged with or be convicted with any
violation or
14 regulation -- by any other medical
licensing board,
15 hospital, medical society or any other
agency, I
16 think we have --
17 MS. LYONS: Any other than Nevada.
18 MR. LEGARZA: Because we don't care and we
19 don't -- because we know about our folks
and we know
20 the investigation --
21 DR. STEWART: But question eleven --
22 MR. LEGARZA: You got to answer it yes. Yes,
23 sir, I agree with you 100 percent.
24 MR. LESSLY: If it's happened to you in the
25
last two years.
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1 MR. LEGARZA: If it's happened to you in the
2 last two years.
3 DR. STEWART: Well, I misstated on the last
4 application.
5 MR. LEGARZA: I'm sure everybody does and I
6 agree. We don't care about your experience with the
7 Nevada State Board of Medical
Examiners. We already
8 know about it. But we might care about your
9 experience with the State of Illinois.
10 DR. STEWART: I would not disagree with that.
11 MR. LEGARZA: So we can change the language
12 there to say has anyone else been after you
by way
13 of investigating you, then that takes care
of the
14 problem there.
15 DR. STEWART: Now, Dr. Lubritz would like to
16 reup at Sunrise Hospital. How does he answer the
17 exact same question?
18 MR. LEGARZA: You know, I'll tell you what.
19 I'm not in the business of giving Dr.
Lubritz legal
20 advice and --
21 DR. BAEPLER: There's a different concept
22 here.
The doctor that makes a mistake writes their
23 own prescription is something that a
complaint is
24 now issued to us and we investigate
it. Does that
25 kind of mistake mean that he has been
investigated
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1 for a violation of the statute? No.
Rule or
2 regulation governing the practice of
medicine. No.
3 He can answer no to this particular
question even
4 though we're investigating what might be a
medical
5 error because he's not being investigated
for what
6 you asked for here.
7 DR. LUBRITZ: Let me add another scenario. We
8 sometimes get complaints this doctor was
rude, this
9 doctor was too rough on his
examination. Number
10 three, this doctor overcharged or charged
me for
11 something that he didn't really perform the
services
12 for.
13 DR. BAEPLER: Doesn't violate a single thing
14 here.
15 MR. LEGARZA: Well, the last example, Doctor,
16 could be a violation of medical practice
act. It's
17 a violation of medical practice act;
services not
18 rendered.
19 DR. LUBRITZ: You look at the situation and
20 then all of us on the committee say you
know what, I
21 don't think -- let's take the person was
rude --
22 didn't really charge me, the patient made a
mistake
23 on understanding of the bill or really did
get the
24 services; whatever. Those are the ones we say, hey,
25 and --
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1 DR. DESAI: Is that not the truth everybody --
2 you send me a letter Dr. Desai -- Mr. Smith
send you
3 my explanation documentation. Everything I may hear
4 from you depending on -- (Inaudible) -- I
never
5 considered it an investigation. You wrote me a
6 letter.
I sign the letter. Now, what
should I
7 think about it? Am I investigated because someone
8 say something I did wrong or should I
consider that
9 I got investigated and they found something
that I
10 did wrong?
Very logical question and we need to sit
11 back, think about it. President wants to appoint a
12 doctor to maybe do something but there's no
reason
13 to argue something which I still don't
understand.
14 MR. LEGARZA: We can take out have you ever
15 been investigated for.
16 MR. LESSLY: Would be the only state in the
17 union that doesn't ask that question.
18 DR. BAEPLER: No; I think we have a problem
19 with semantics here and I don't think we
have any
20 problem with the general intent. But you don't want
21 to adopt some kind of a rule that means 90
percent
22 of Nevada physicians have to say, yes, they
have
23
been investigated.
24 MR. ROSENCRANTZ: Why can't we use the
25 terminology therein formally investigated.
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1 MR. LESSLY: I don't know what that means in
2 Texas or --
3 MR. ROSENCRANTZ: We say we can have twenty
4 complaints on Dr. Desai -- sorry to pick on
him --
5 that hasn't been formally and we'll say,
no, we
6 don't have any complaints because it's not
a
7 formal -- we've taken no disciplinary action
against
8 the doctor.
9 MR. LESSLY: Have you taken disciplinary action
10 against a doctor is what we tell them.
11 MR. LEGARZA: Have you ever been charged with
12 or convicted of any violation of any
statutes, rule
13 or regulation governing the practice of
medicine.
14 DR. BAEPLER: That makes sense; absolutely.
15 MR. LESSLY: Say it again, please.
16
DR. STEWART: Have you ever been
charged with
17 or convicted of any violation of any
statute, rule
18 or regulation governing the practice of
medicine.
19 I started doing this, asking
for a
20 definition of what the Investigative
Committee does
21 and you returned to me that the
Investigative
22 Committee investigates.
23 MR. LESSLY: I don't think there's any question
24 about that.
I think that's exactly what the
25 Investigative Committee does. I think
that's exactly
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1 what I do about 80 percent of my time and
exactly
2 what Vicki and Elizabeth and now Casey do.
3 If we get a complaint on a
4 physician, we make a determination first as
to
5 whether or not we have jurisdiction. If there's not
6 jurisdiction, we won't even open the case.
7 If we believe there is a
8 possibility that there has been a violation
of the
9 medical practice act, we open a case and we
10 investigate it. We don't just ask the physician for
11 a response.
We do that but we also will conduct our
12 own independent investigation. We will talk to
13 witnesses.
We will talk to patients. We'll
do a
14 multitude of things depending on where the
case is
15 going.
16 And the investigation in
my opinion
17 is completed really almost from an
investigative
18 standpoint by the time your presentation is
made to
19 the Investigative Committee on a request
for a
20 formal complaint, period.
21 DR. STEWART: I will not disagree with one word
22 you said.
Therefore, we investigated 300 physicians
23 in the last four months.
24 MR. LESSLY: Yes, sir and they need to say yes
25 to this.
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1 MR. LEGARZA: To this question, yes, sir.
2 Technically, you bet, they should say yes.
3 DR. STEWART: I will tell you that If you ask
4 4,000 physicians that have been through
that, none
5 of them know and I don't want to be in the
position
6 of selectively saying you lied because you
went
7 through the Investigative Committee and you
got a
8 clean bill of health, but you were
investigated.
9 MR. LESSLY: I don't have any problem with
10 that.
11 DR. BAEPLER: Since we know what the intent is
12 and our's later, can you come back with
some
13 recommended language at the next meeting as
a
14 substitute for this question?
15 DR. JONES: Why can't we do just what he said?
16 MR. LESSLY: You can change the re-registration
17 one right now; take out A and B. We have to have an
18 approved registration form in order to be
able to
19 commence registration.
20 DR. BAEPLER: You got a time.
21 MR. LESSLY: And the content of that
22 registration form is going to have a direct
bearing
23 on the next issue that we are going to talk
about
24 which is profiling what's going to go
on-line. Can't
25 get the information unless you ask the
right
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1 questions on the registration form.
2 MR. ROSENCRANTZ: I agree with Dr. Stewart.
3 They have to answer the question yes at
this point
4 in time and I also will tell you that we
don't care
5 about our licensees as to whether or not
they answer
6 to that yes, because we already know about
them.
7 We might care and we
should care
8 about our licensees that are actively
licensed in
9 the State of Nevada because almost half of
those are
10 not practicing in this State. They are practicing
11 somewhere else. Even those that are practicing in
12 this State, if they are practicing
somewhere else,
13 we want to know. I think legitimately, we have a
14 legitimate interest in knowing as to
whether or not
15 someone else is investigating them. We know whether
16 we're doing that.
17 So if you leave it the way
it is,
18 have you ever been A, notified that you're
under an
19 investigation by an Investigative Board or
charged
20 with or convicted of a violation, da, da, da
by any
21 other state or licensing entity, or by this
State.
22 MS. LYONS: You can actually break a question
23 down with, have you ever been. Then you can say
24 Investigated Board, line yes or no, filed
on, yes or
25 no.
You can break the question and have them
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1 separate it.
2 MR. LEGARZA: If you look at this new form we
3 have done the A, B, C, D to try to break
those
4 things out.
Our licensees it also says during
5 the last two years 30 percent of them tell
us
6 about every malpractice case they have ever
had.
7 25 percent of our licensees don't even read
the
8
application. 35 percent of our
licensees have
9 someone else fill it out for them. And about
10 40 percent of the applications we get we
have to
11 send back to get them done right.
12 DR. STEWART: Have you ever been in states
13 other than Nevada.
14 MR. LEGARZA: We can put that language in to
15 get the intent out.
16 DR. JONES: Aren't there other agencies in
17 Nevada that if --
18 MR. LEGARZA: We ask the criminal stuff and --
19 MS. LYONS: You're saying Nevada Board of
20 Medical Examiners. You have to say in the State of
21 Nevada.
22 MR. LEGARZA: Have you ever been notified
23 you've been investigated before by anyone
other
24 than Nevada State Board of Medical
Examiners.
25 DR. BAEPLER: You're adding the word notified
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1 by, which I like. Right?
2 MR. LEGARZA: Yes, sir.
3 DR. BAEPLER: You're adding that word.
4 MR. LEGARZA: We have changed it have you ever
5 been notified.
6 DR. BAEPLER: I like that.
7 MR. LEGARZA: Investigated or charged with or
8 convicted of violation of any --
9 DR. STEWART: I think if you guys on Monday can
10 massage the wordage, I would be happy that
the words
11 were massaged.
12 MR. LEGARZA: We can do that.
13 MR. ROSENCRANTZ: Why don't we have a
14 conference call on Monday or Tuesday,
Larry, with
15 Dr. Stewart, myself and Dr. Buchwald; see
if we can
16 do the words. We can spend a lot of time.
17 MR. LEGARZA: You're right and you know, we
18 don't care because --
19 MR. LESSLY: Can I go ahead with the
20 administrative assistant job description if
there
21 are changes. Anyone concerned about that one?
22 DR. STEWART: Can we, until that happens leave
23 one on Administrative Counsel to the
General
24 Counsel --
25 MR. LESSLY: They are his investigative files.
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1 That's what we call them in the
office. That has no
2 bearing whatsoever.
3 Chief Investigator, no
changes.
4 Administrative Investigator, no changes. In fact, I
5 think on the Senior License specialist in
paragraph
6 one and two, you can see the change has
been made to
7 address the change in Rebecca Richard's job
8 description.
9 License Specialist remain
the
10 same.
Receptionist, there's a change in paragraph
11 five addressees and computer licensing
system --
12 Administrative Assistant job
13 description, Maureen has that person now
doing
14 advice on the telephone of licensure
requirements
15 and doing the initial determination of
eligibility
16 to license.
You know, we don't send anyone who
17 calls and says, I'd like an application to
practice
18 in Nevada, we might ask them if they have
three
19 years postgraduate training so we cannot
waste our
20 time and their's if they don't. She does that sort
21 of thing.
22 The other job description,
23 Conversion Compliance Specialist, that's
the old job
24 description. That was utilized when we had Charlie
25 on the staff.
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1 Medical Review is Dr.
Barnett's job
2 description. We added down in paragraph 8, perform
3 special duties as assigned. He does the, other than
4 strictly reviewing the complaints with the
5 investigative process, he assists us
sometimes with
6 licensing issues also. So we just stuck that in
7 there to kind of get a catch all to that
function
8 also.
9 Those are all the changes
to the
10 policy manual for this year that we propose
and I
11 guess I need a motion to either approve or
12 disapprove.
13 DR. DESAI:
Motion to accept.
14 MR. ROSENCRANTZ: Motion to second.
15 Any discussion?
16 DR. BAEPLER: Yes. I
would like to really
17 commend him for updating this and bringing
this
18 together.
This is not an easy thing to compile.
19 There's an awful lot of offices in the
State that
20 are not this defined and organized. So it's really
21 nice to have this.
22 MS. LYONS: Thank you.
23 MR. ROSENCRANTZ: Agree with you. Thank you,
24 staff.
All those in favor? Opposed? Motion
25 carries.
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1 MR. LESSLY: Next we need to go to the issue of
2 on-site use of our website for profiling
and Maureen
3 will handle that.
4 MS. LYONS: I'm distributing a proposal from
5 our software people to set up a profiling
of our
6 licensees on our website.
7 This proposal reflects the
standard
8 information that they would put on the
website. We
9 can look at that information -- we can --
there may
10 be some on there that you would not want
people to
11 have access to; the general public. And there may
12 be items that aren't on here that you would
want to
13 add.
14 This is the basic charge
for doing
15
this. If we were to want to add
items, that charge
16 could go up to another $10,000. Probably not much
17 more than that depending on what kind of
information
18 you would want the public to have.
19 On page one it lists the
items that
20 anybody could access who has -- who is on
the
21 Internet.
They can find out licensing name,
22 profession which would be their specialty
of scope
23 of practice, license type, license status,
their
24 education which would be their medical
school
25 education.
It would be their postgraduate training
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1 if we wanted that on there as well --
although I
2 would want to discuss that first and
disciplinary
3 action which would be a brief description
of the
4 disciplinary action and the date of the
action.
5 Then for verification of
licensure,
6 right now if an entity wants verification
of
7 licensure they request a letter of
verification from
8 us.
The cost for that letter is $25.
9 So if you look on page
two, you'll
10 see a $5,000 fee to create a duplicate
database that
11 can be accessed through the website and
that
12 database would add license number, issue
date and
13 expiration date whereas the regular general
public
14 information doesn't include that. However, this
15 duplicate database would only be able to be
accessed
16 by persons that have an account with us, an
ID and
17 password that they would enter and they can
access
18 this additional information which is the
basic
19 verification information that anyone
needing
20 official verification of licensure needs to
have.
21 And we can then charge them per hit, per
person that
22 they look at.
23 DR. BUCHWALD: I have this skepticism and I
24 need reassurance. I realize this is a very limited
25 input to the computer, this information is
a very
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1 small amount and obviously public knowledge. I
2 mean, you hear about people who can get
into
3 websites anywhere.
4 MS. LYONS: That's right;
that's hacking. The
5 way the website would work with that fear
would be
6 like if we were to -- if that could happen
would be
7 that they would access our website. By accessing
8 our website, they would go right to our
files that
9 are in the office and they would pull up
this
10 information. But somebody who knew something about
11 computers can hack behind that and they can
get
12 whatever they want.
13 So the way that it's going
to work
14 with system automation is that on a daily
basis we
15 would FTP information which is you take
information
16 and you send it through the Internet. So on a daily
17 basis the particular information that the
Board
18 wants the public to see, only that
information would
19 be -- there would be a backup done for that
day; any
20 changes that occurred during the day. Everyday the
21 staff is making changes. Only if those bits of
22 information would be downloaded and FTP'd
to a file
23 server at system automation in Maryland.
24 So when people access our
website
25 and
they would click on this link to check on
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1 profiling, they wouldn't even be going to
our file
2 server.
They would be going to this isolated bits
3 of information that are in the file server
in
4 Maryland.
5 DR. BUCHWALD: But that's not my concern. I
6 understood the protection that it was going
to a
7 different system.
8 MS. LYONS: Okay.
9 DR. BUCHWALD: My concern is that we're saying
10 that we take responsibility for that
information,
11 that that information is correct.
12 And so my concern is
people going
13 from the outside into New Jersey computer
bank and
14 altering the information of a license
number or an
15 issue date so that when someone goes to get
that
16 information, they are getting incorrect
17 information. See what I'm saying?
18 My concern is that we cannot
verify
19 that they have in fact received correct
20 information. It's not safe information because we
21 have lost control of it.
22 MS. LYONS: You think that you feel they could
23 go to the backup information that is FTP'd
to
24 Maryland and change it?
25 DR. BUCHWALD: Yes.
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1 MS. LYONS: They can hack into our information
2 that is FTP'd to them and alter it?
3
DR. BUCHWALD: If they call you
and you fax it
4 to them, we're saying that as of this date,
this
5 information is correct. This is their license
6 number and the issue date and people are
depending
7 on that information to be correct.
8 So my concern is that once
you send
9 it out and I don't want it in-house either
-- I'm
10 not saying that it should be here -- but once
you
11 have sent it someplace elsewhere, people
have access
12 to it, unlimited access to it, people who
are very
13 smart, sometimes they are very stupid; can
get in
14 there and change that information.
15 That's my concern that we
aren't
16 maintaining our level of expertise and
verification
17 that we have up to this point.
18 I mean, when we send something
out,
19 people know that it's right.
20 DR. LUBRITZ: My skepticism goes far beyond
21 that.
If someone wants to call up and say where did
22 I graduate high school. They can ask me, I have my
23 diplomas displayed. Did you do a residency; yes;
24 whatever.
That's different than having things on
25 the website.
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1 There are some instances
of people
2 who why don't you give them your Social
Security
3 number on there and your VISA. Everything else is
4 on there.
5 People just have nothing
to do all
6 day now but sit there and roam on the
web. I don't
7 do it.
I don't know how to turn one on but I hear
8 who people that do and I just assume have
that
9 information not on the website.
10 I just assume have not
information
11 where they call up and say Nevada State
Board, can
12 you tell me about doctor so and so; yes, I
would be
13 happy to fax you that information on what
it is and
14 I think we should probably keep a log on
who we fax
15 information to.
16 MS. LYONS: We don't really fax it. We do send
17 out form of licensure.
18 DR. LUBRITZ: I would hate to see all of the
19 information that we have on a website that
somebody
20 that could tap in. I would hate to have that
21 information out there free to the world.
22 DR. BUCHWALD: All of the information that
23 you're talking about is actually in-house.
24 DR. TITUS: Have we given permission to go
25 forward?
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1 DR. BUCHWALD: We have a website. It's the law
2 of the land.
3 DR. TITUS: And we're looking at expanding.
4 MS. LYONS: We have a website with a bunch of
5 information. Newsletters are on there, agendas.
6 This is something -- Arne
was one
7 that has been suggesting this and the
public is
8 demanding it.
9 I have the general E-mail
address
10 for the Board so I kind of sift through
what comes
11 through in the general E-mail on a daily
basis. I
12 get at least one person if not more
E-mailing me
13 saying can't I find out about my doctor on
the web.
14 DR. LUBRITZ: That's 365 people per year that
15 to me -- and the public.
16 MS. LYONS: Then on the phone people call in.
17 DR. STEWART: You're getting an average of 300
18 hits a day.
19 MR. ROSENCRANTZ: Larry.
20 MR. LESSLY: Couple of issues. We're not
21 opposed to developing information basis that
the
22 public can access regarding Nevada
physicians. But
23 in fact, you're now presenting to the
public and
24 specifically another meeting for it. I would point
25 out that no state board of medical
examiners has
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1 proceeded to an expansive physician
profiling
2 project without legislation direct
Maryland,
3 Massachusetts, Rhode Island. The other states that
4 are being used for that that's the case.
5 The issues that you talk
about in
6 the beginning, there would be no problem
with you
7 making that available through the
website. The more
8 expansive information that would be a
problem,
9 should be discussed I think before you
proceed.
10 The most significant
problem right
11 now the State of California with health
care fraud
12 is physician identification and that has
been
13 according to the California Medicaid
Department
14 Division has been overwhelmingly because
the lack of
15 security of the California Licensing Board
of
16 information regarding physician licensing
numbers
17 and other information.
18 So I think as we proceed
19 step-by-step, some states have had
significant
20 experience now in developing these
information
21 access resources like Massachusetts,
obviously the
22 primary one and has done so
successfully. After
23 building in a number of safeguards and
those
24 safeguards included making sure that there
was
25 sufficient public discussion in the
development of
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1 protocols, development of the security
arrangement
2 in ascertaining exactly what the public,
small p,
3 large P -- many of the so called public who
are
4 identified turned out to be a commercial
interest
5 that are seeking information for purposes
that have
6 nothing to do with determining whether or
not
7 physicians or is not the physician of
record or is
8 not someone capable of providing
information.
9 There are a lot of
motivation for
10 undefined publics who would like
information that
11 they may or may not have a good reason for
having.
12 It may be good for them.
13 So we certainly support
improving
14 the access, Nevada patients, their
families,
15 relevant information about their
physicians. That
16 information should be timely, should be
valid and
17 should be updated.
18 We would be happy to work
with you
19 in the development of the protocols for
that but I
20
think it is something to proceed step-by-step and
21 with a caution that this is not altogether
simply
22 let's put it -- put the information out
there and
23 it's good for the public to have it as with
the
24 national practitioner database --
(Inaudible) --
25 general accounting office the congressional
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1 nonpartisan group that analyzes government
programs
2 slapped the MPB for inaccuracy for problems
with the
3 database and once again recommended before
any of
4 that to be made public, it needs to be
looked at
5 with a great deal of skepticism. (Inaudible).
6 There's nothing wrong with
the
7 track you're on but caution and some
concern that
8 protections are built in. It's very important and
9 this is a matter I'm sure at this point
while
10 certainly with Nevada State Medical
Association
11 physicians I have indicated that you're
proceeding
12 towards releasing on your website
information which
13 is currently available to the public who
calls the
14 Board. I think if there's any intention of
expanding
15 beyond that or expanding to other
resources, that
16 that's something that really should be
proceeded
17 with more caution.
18 Those are my only comments
at this
19 point.
20 MR. ROSENCRANTZ: Maureen, we can buy this
21 piecemeal rather than the whole package.
22 MS. LYONS: This is what they would standardly
23 offer at that rate. If we wanted to add more items
24 that they can find, then I can't guarantee
that
25 price would remain as it is here.
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1 MR. ROSENCRANTZ: At least the information we
2 have on the first page is maybe -- table
this in the
3 next meeting. Let's look at it and talk about it
4 again at our next meeting. We are going -- not
5 going to let it go.
6 MS. LYONS: Would be better a committee the
7 board members rather than trying to do it
with the
8 whole board.
9 DR. LUBRITZ: I'd like the whole board.
10 MS. LYONS: To clear it up more.
11 MR. ROSENCRANTZ: We'll put it on the next
12 agenda. In the meantime, the board members will
13 have this.
If you have any questions, call Maureen
14 and discuss it with her and we'll handle
it.
15 DR. BAEPLER: I understand fully what the first
16
item is. I don't personally what
is involved with
17 the next two.
18 MS. LYONS: Well, at that site, the information
19 on the next page would also be FTP but
there would
20 be like a duplicate database. One database anyone
21 can access and the duplicate database would
include
22 those three items and those three items are
required
23 by verification, people verifying licensure
need
24
those three items. So they would
have an account
25 and a --
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1 DR. BAEPLER: I can see having number one on
2 the website really might reduce the volume
of calls
3 coming into your office. I don't know how many
4 calls you get.
5 MS. LYONS: We get a tremendous amount of
6 verification calls.
7 MR. ROSENCRANTZ: Maybe there isn't any problem
8 with the first page putting that on to our
website.
9 DR. LUBRITZ: I think there is.
10 MR. ROSENCRANTZ: We are going to stay with the
11 motion.
12 MR. LESSLY: Can we go to the last items in our
13 report registration forms. Turning to those. Let
14 me tell you briefly what the changes are on
this
15 other than obviously the dates. Reorganization in
16 the way the questions appear.
17 On page one, item number
five needs
18 the name and location, medical school which
I
19 graduated.
That is a computer driven request this
20 time.
We think that we're not real sure that all
21 that information is correct because of the
number of
22 hands that have been involved in this over
the last
23 twenty years. So we would like to be able, when we
24 do the input and update computer system as
a result
25 of registration, to address that issue and
clean it
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1 up and know that it's correct.
2 One thing if you look on
page two,
3 specialty codes, those are all renumbered
updated.
4 Nonconventional medicine. If you eliminate the term
5 alternative medicine and used the catch all
term
6 nonconventional medicine to cover that
previously
7 alternative medicine category. We put that in
8 there.
There's one thing missing on this form and
9 what is missing is your postgraduate
education. We
10 took that off because -- and we need to
discuss
11 whether or not it is going to go on. Not
12 postgraduate; the certification.
13 We're telling people when
they call
14 in that Dr. Buchwald is certified by the
Surgery
15 Board.
We really don't know whether Dr. Buchwald is
16 or not.
Because Dr. Buchwald might have lost her
17 certification or let it expire or lying to
us when
18 they filled out her application. It's difficult for
19 us to guarantee that information.
20 MS. LYONS: No, it's impossible.
21 MR. LESSLY: It's impossible and it -- tell you
22 quite truthfully, I don't think the public
cares
23 about postgraduate education. They do care about
24 whether or not you're board certified. They know
25 what board certification means.
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1 So we have a real serious
2 question.
All intertwines what you do on a website
3 issue.
It is something the public wants to know not
4 something that we can guarantee. We're in a
5 quandary.
6 MS. LYONS: Currently we do give out board
7 certification information. I would not
8 personally -- I would feel very uncomfortable
9 guaranteeing that that information is
correct. I
10 know for a fact that board certification
information
11 about many of our licensees is
incorrect. Because
12 we don't know whether it's current as of
the date
13 that we are giving that information on the
14 telephone.
15 When they fill out this
form every
16 two years, the licensee indicates I'm board
17
certified. We put here it's board
certification by
18 the American Board of American
Specialties. Many
19 times they'll say yes and you may find out
it's the
20 academy of something. So we take that for the God
21 truth and put it in our computer and give
it out to
22 people and it's not correct.
23 MR. LESSLY: It's been happening for years.
24 MS. LYONS: There's a toll free phone number to
25 the American Board of Medical
Specialties. Anyone
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1 can call and say is doctor so and so board
certified
2 and they'll say yes or no current as of
today.
3 Whatever.
I feel much more comfortable when
4 people call and ask that question. We just say we
5 cannot -- that's not information generated
by our
6 office; therefore, we'll give you a toll
free number
7 and you can call them and find out.
8 DR. DESAI: How many phone calls you get per
9 week asking for whether the physician --
10 MR. LESSLY: We give that information to every
11 call asking for -- we have a standard
litany.
12 MS. LYONS: This is one piece of information.
13 MR. LESSLY: I'm uncomfortable with that.
14 DR. DESAI: We're not in the business to tell
15 people he's a good or bad doctor depending
on --
16
MR. LESSLY: I think that's what
some members
17 of the public think it implies it is simply
18 certification.
19 DR. STEWART: In your profiling program, when
20 you -- what is the goal, your goal two
years down
21 the road on having on the website Dr.
Stewart, yes,
22 he's licensed. Thank you very much, or Dr. Stewart
23 born here, went to school here, certified
here,
24 here,
here and here, office address, phone number,
25 hospital affiliation --
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1 MS. LYONS: That would be up to you.
2 MR. LESSLY: I have absolutely no goal.
3 MS. LYONS: That's up to you to decide.
4 DR. STEWART: When the hospital calls you, they
5 just want to know that we have a license;
right?
6 MR. LESSLY: No.
7 DR. STEWART: What does the hospital ask you?
8 MR. LESSLY: Credentials.
Number of that
9 license and the expiration and the issue
date.
10 MS. LYONS: Three items that you see on the
11 second page.
12 DR. STEWART: When the central verification
13
people call you, do they want to know the same
14 questions?
15 DR. DESAI: That the license is current or
16 not.
17 MS. LYONS: Status of licensure and --
18 DR. STEWART: Would you, Mr. Lessly, plan to
19 say that I went to school at X and I have
my
20 residency at Y and my fellowship at Z?
21 MR. LESSLY: I don't have any plan. I was
22 asked to put that program together and see
what you
23 guys --
24 DR. STEWART: What does Massachusetts do?
25 MR. LESSLY: We have it right here.
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1 DR. STEWART: If you're planning to do that --
2 MR. LESSLY: I'm not planning.
3 DR. STEWART: Massachusetts will give you --
4 criminal convictions, hospital discipline
and board
5 discipline.
6 MS. LYONS: The only one more thorough than
7 that is Florida.
8 DR. BUCHWALD: Do they guarantee that
9 information to be accurate?
10 MR. LESSLY: Everyone puts disclaimers.
11 MS. LYONS: No; disclaimers.
12 MR. LESSLY: Everyone puts disclaimers. When
13 you do the double website situation we're
talking
14 about and you give the issue date, the
expiration
15 date, the license number, we have to
guarantee
16 that.
That's why we charge for it.
17 Remember years ago when we
said we
18 don't really want to give by phone
credentialing
19 information to credentialing entities --
we're not
20 just trying to make money on this but when
the
21 computer program is run and it gives that
22 information and I sign that and the board
seal goes
23 on, that we're responsible for that.
24 DR. BUCHWALD: That's what was concerning me
25 before.
Regardless, any information that we have to
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1 guarantee that we want to guarantee, I
don't know
2 how we can do it on the web.
3 MR. LESSLY: Well, people do it all kinds of
4 ways.
They say the physician reports that she is
5 board certified by the American Board of
Surgery.
6 We can do it that way. We can do it if you want to
7 verify here is the 800 number to the
American Board
8 of Medical Specialties. They'll tell you whether or
9 not this person is currently.
10 The physician reports that
she has
11 hospital privileges at Washoe St. Mary's,
etcetera.
12 We don't know if you lost -- we're supposed
to
13 know -- but we don't always know that you
lost your
14 privileges yesterday or that they were
suspended
15 because you didn't do your charts or
something.
16 Every one of these
websites has
17 major, major, major disclaimers at the
beginning,
18 but then they also change the language as
they go
19 through are you board certified, is what I
said.
20 The physician reports that she's board
certified.
21 DR. DESAI: How many verification request you
22 get per month?
23 MS. LYONS: Written letters of verification?
24 Bob would know.
25 MR. FRANTZ: There's a lot of them; a 100.
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1 DR. DESAI: If you justify the cost now --
2 MR. LESSLY: $100,000 a year.
3 DR. DESAI: (Inaudible).
4 MR. LESSLY: You have to listen to the
5 proposal.
The proposal is that they come under the
6 website on another screen. That screen, for lack of
7 a better description, gives you the
information that
8 you need to credential. It gives you the initial
9 issue and state, determination date,
expiration
10 date, the license number of the
physicians's name.
11 In order to do that, if
you're
12 running a credentialing agency, you're
going to have
13 to call Mr. Frantz and you're going to get
a code to
14 be able to access that information on the
web and
15 it's going to number the hits that you make
with
16 your code on that site each month and he's
going to
17 send you a bill for $25 a hit.
18 So no, we cannot afford to
reduce
19 our income by $100,000 a year by doing away
by
20 written verifications having that to be
able to be
21 done on the Internet. I mean, it will go from
22 $100,000 to zero overnight.
23 DR. DESAI: How many people require to do this
24 job, part-time, full-time?
25 MR. LESSLY: None.
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1 MS. LYONS: Our receptionist; that's her job.
2 MR. LESSLY: Our receptionist does it. She
3 verifies it. She brings the forms in, runs the
4 computer program, puts a seal on it and I
sign it.
5 DR. DESAI: How much FTP comes out; 1/8, 1/16,
6 1/2?
7 MR. LESSLY: If you count the phone calls that
8 she gets, the phone verifications from
credentialing
9 entities and from members from the public,
it is the
10 substantial portion of her job.
11 MS. LYONS: 80 percent.
12 MR. ROSENCRANTZ: I don't want to see you
13 confuse the fact we're talking about
putting
14 something on-line for the public compared
to making
15 something maybe a little more convenient
for
16 credentialing agencies or for us. You're talking
17 about two different things. . What we're talking
18 about on the second and third page is
something
19 additional.
20 MR. LESSLY: It's part of the total package.
21 And the reason we're saying if you're going
to do
22 it, you need to look at that as you may be
able to
23 cut that employee's job down drastically at
no
24 additional cost.
25
DR. DESAI: That's what I'm trying
to figure it
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1 out how -- because we may have to massage
certain
2 pages certain different ways, but for
verification
3 it makes a lot of sense to make the money
and it is
4 the cost.
5 DR. LUBRITZ:
With that having been said, I
6 don't want to exclude myself from the
public and
7 this person of the public feels that it's
being done
8 well now.
9 We have certain
expenses. We just
10 talked about budgeted expenses. I don't think this
11 is a money-making organization that we have
to
12 have.
13 So I think we need to
consider what
14 is it that our goal is in putting this on,
how big
15 is that quote, public. So maybe we should start
16 keeping some information to see do they
really want
17 it.
18 MR. ROSENCRANTZ: Joel, in Massachusetts I
19 don't know how many hits -- we're talking
about
20 state hits.
Hundreds of thousands of requests from
21 the public about --
22 DR. LUBRITZ: Then why don't we adopt
23 everything that --
24 MR. ROSENCRANTZ: I'm not saying we give them
25 everything Massachusetts does. We're just trying to
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1 get some baby steps. We'll tell you next meeting --
2 yes --
3 MS. LYONS: The only question remaining on this
4 registration form is do you want us to
continue
5 asking the licensees to indicate whether or
not they
6 are board certified? We omitted it because of the
7
feelings we have. In fact, we
would like to stop
8 giving that information over the phone and
instead
9 say we cannot guarantee information is not
in-house
10 generated; please call 800 la, la, la.
11 MR. ROSENCRANTZ: You don't think as a board
12 the staff has any need for that
information?
13 MR. LESSLY: It's not part of our licensee
14 process.
15 DR. DESAI: A lot of family can't understand.
16 Someone might have signed that and a month
later it
17 might have expired.
18 MR. LESSLY: Do we have a motion to approve the
19 forms?
20 DR. STEWART: I hate to do this. Can I ask a
21 question about number five? Have you been a
22 defendant in a legal action. Is the medical legal
23 screening panel a legal action?
24 MR. LESSLY: No.
25 DR. STEWART: How do people answer that
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1 question?
2 You can go through the
medical
3 legal screening panel, get an okay and then
they
4 file suit in which case the answer is yes.
5 Just because you're the
medical
6 screening legal panel the answer is no
until
7 somebody files a suit or until you pay.
8 MR. ROSENCRANTZ: It is not a legal action.
9
The minute the lawsuit is filed, it is a legal
10 action.
Can we have a motion?
11 We have a motion to
second. Any
12 discussion on that? All in favor?
Opposed? Motion
13 is approved.
14 And we want to go ahead
and have a
15 motion on our application with the office
talking to
16 the committee in regards to terminology --
17 MR. LEGARZA: Let me just -- before you do, let
18 me just -- look at number 11 in front of
you and I
19 want to read some language, see if this is a good
20 starting over point.
21 Have you ever been A,
notified that
22 you were under investigation or B,
investigated for,
23 C, charged with or D, convicted of any
violation of
24 statute, rule or regulation governing your
practice
25 as a physician, as a physician assistant or
by any
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1
medical licensing board other than the Nevada State
2 Board of Medical Examiners, any hospital,
medical
3 society, governmental entity, or other
agency.
4 Pretty clear?
5 DR. BAEPLER: That solves my biggest problem
6 with it.
7 MR. LEGARZA: And that would be both on the
8 P.A. as well as the M.D. --
9 DR. DESAI: I would be happy with that. I make
10
a motion we accept.
11 DR. LUBRITZ: Second.
12 MR. LESSLY: We're not going to have a
13 conference call.
14 MR. ROSENCRANTZ: We're not going to have a
15 conference call then.
16 DR. STEWART: I just don't want somebody coming
17 down the road and saying 300 doctors didn't
answer
18 the question correctly.
19 MR. ROSENCRANTZ: We have a motion and a
20 second.
Any discussion? All in
favor? Anyone
21 opposed?
Motion carries.
22 Matters for Future Agenda,
Item
23 Number 15.
We'll be a little more prepared to talk
24 to you Dr. Lubritz about that.
25 DR. DESAI: Can you send us copies?
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1 MR. ROSENCRANTZ: Again, Item Number 16, Public
2 Comment required by NRS 241.020(2)(c)(3) of
Nevada's
3 open meeting under this Item, the members
of the
4 general public may bring matters not
appearing on
5 this agenda to the attention of the
board. The
6 board may discuss the matters, but may not
act on
7 the matters at this meeting. If the Board desires,
8 the matters may be placed on a future
agenda for
9 action, comment on any topic is to be
limited to not
10 more than two minutes in order to
accommodate the
11 Boards's schedule and other speakers. Please
12 address your comments to the chair and not
to the
13 individual board members.
14 Do we have any public
comment?
15 Hearing no public comment, we adjourn the
meeting.
16 Thank you very much.
17
18
19
20 (THE MEETING WAS ADJOURNED)
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1 REPORTER'S CERTIFICATE
2
3 STATE OF NEVADA)
: SS
4 COUNTY OF CLARK)
5
6
7 I, LISA J. JOHNSON, CERTIFIED COURT
REPORTER,
8 HEREBY CERTIFY THAT I TOOK DOWN IN
STENOTYPE ALL OF
9 THE PROCEEDINGS HAD IN THE BEFORE-ENTITLED
MATTER AT
10 THE TIME AND PLACE INDICATED, AND THAT
THEREAFTER
11 SAID STENOTYPE NOTES WERE TRANSCRIBED INTO
12 TYPEWRITING AT AND UNDER MY SUPERVISION.
13 THAT THE FOREGOING TRANSCRIPT
CONSTITUTES A
14 FULL, TRUE AND ACCURATE RECORD OF THE
PROCEEDINGS
15 HAD.
16 IN WITNESS WHEREOF, I HEREUNTO
SUBSCRIBE MY
17 NAME AT LAS VEGAS, NEVADA.
18
19
20
21 LISA J. JOHNSON, COURT
REPORTER
22
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25
LISA JOHNSON &
ASSOCIATES
(702) 369-5909 & (702) 596-6122