0002
1 BEFORE THE NEVADA STATE BOARD OF MEDICAL
EXAMINERS
2 -oOo-
3
4
5 BOARD MEETING
6
7
8
9 Saturday, March 3, 2001
10
11
12
13
14
15 OFFICES OF
NEVADA STATE BOARD OF MEDICAL EXAMINERS
1105 Terminal Way, Suite 301
16 Reno, Nevada
17
18
19
20
21 Reported
by: ERIC V. NELSON, CCR #57,
RPR, CM
22
23
24
SIERRA NEVADA REPORTERS (775) 329-6560
25
0003
1 A P P E A R A N C E S
2
BOARD MEMBERS PRESENT
3
4
ARNE D.
ROSENCRANTZ, Public Member, President
5 SUSAN S. BUCHWALD, M.D., Vice President
PAUL A.
STEWART, M.D., Secretary/Treasurer
6 DIPAK K. DESAI, M.D.
JACULINE C.
JONES, Ed.D., Public Member
7 JOEL N. LUBRITZ, M.D.
DONALD H.
BAEPLER, Ph.D., D.Sc., Public Member
8 ROBIN L. TITUS, M.D.
9
10
EXECUTIVE DIRECTORS
11
12 LARRY D.
LESSLY, Executive Director
MAUREEN E.
LYONS, Deputy Executive Director
13
14
BOARD COUNSEL
15
16
CHARLOTTE M.
BIBLE
17 Deputy
Attorney General
18
19
20
21
22
23
24
SIERRA NEVADA REPORTERS (775) 329-6560
25
0002
6 .
Reports
Diversion
Program......................... 25
Physician
Assistant Advisory Committee.... 36
Committee
to Study Post-Licensure
Continuing
Competency Evaluation.......... 43
Investigative Committee................... 43
Public
Service Announcement Committee..... 46
7 .
Legal Reports............................. 50
8 .
Executive Director's Report
Educational
Meetings...................... 57
Request for
Approval of 2000 Board Annual
Report.................................... 59
Consideration of Termination of Board
Annual
Audit.............................. 61
Change in
Physician Licensure Application. 63
Informational Items....................... 63
9 .
Legislation Report........................ 5
10 . Petition for Change of Status from
Restricted
County Licensure............... 74
11 . Petition for Restoration of Restricted
Licensure
to Full Unrestricted Licensure.. 74
12 . Acceptance of Applications for
Licensure.. 4
13 . Ratification of Licenses Issues, and
Reinstatements of Licensure............... 76
14 . Matters of Future
Agenda.................. 76
0001
1 RENO, NEVADA, SATURDAY, MARCH 3, 2001,
8:36 A.M.
2 -oOo-
3
4 PRESIDENT ROSENCRANTZ: Call the meeting to
5 order.
This is a continuation of our meeting that started
6 last night.
7 I meant to comment last evening
at the call
8 of order in regards to the reception that we
had for the
9 Federation of Medical Boards in Las Vegas
last week. A
10 lot of you
were there.
11
The feedback that I have received from the
12 Federation has
been really good. I think that they
were,
13 first of all,
they were really happy to think that we
14 would think
enough of them to do that, and they just had a
15 great time at
our reception, had a great time in Las Vegas
16 and
Nevada. They are extremely impressed
with our Board,
17 with our
staff, what we're doing. I'm
overwhelmed.
18
We have two speakers at the Federation
19 meeting in
Atlanta next month. I don't know that I
have
20 been to a
meeting, any of the meetings that I have been to
21 where they
have had two speakers from the same state.
22 Dr. Stewart
and Dr. Baepler will be speaking. And I
don't
23 know that we
have ever had a speaker. So this is
really
24 good.
25
We hopefully have good attendance at that
0002
1 meeting, and I'm just real pleased. I think we have a
2 good relationship with the Federation, and
they will
3 certainly be helpful to us and have been in
the past, and
4 we're looking forward to continuing that
relationship.
5 I wanted to thank you all for
coming, those
6 of you who did, and the support that we have
from the
7 Board in relationship to the
Federation. Thank you very
8 much.
Just a note -- yes. Maureen.
9 MS. LYONS: One thing.
I don't know if you
10 noted it on
your agenda, but I don't want to forget that
11 we didn't talk
about Item No. 4, Personnel. The other
12 item under
that in open session we didn't discuss.
13
PRESIDENT ROSENCRANTZ: Why don't
we go
14 through it
now.
15
MS. LYONS: Just so we wouldn't
forget.
16
PRESIDENT ROSENCRANTZ: We'll do
it right
17 now.
18 4. Personnel
19
MR. LEGARZA: To inform you that I
have been
20 informed that
Casey Miller, who is pregnant with her
21 second child,
is not going to come back to work after she
22 has the
baby. So I will have another change in
the
23 investigative
department. I haven't made up my mind
yet
24 whether or not
I'm going to ask Elizabeth Palakowski to
25 take over that
position as administrative assistant to me
0003
1 or move Elizabeth Palakowski back into the
investigation
2 position that she was in before. I think she's doing real
3 good, and I may put her back in there, and I
may hire
4 someone to take Casey Miller's position.
5 I need to put you on notice
that there will
6 be another new person in the investigative
department
7 probably -- Casey is going to try to work
through at least
8 the first week in July so that we can get
through the
9 registration period, because she has to help
me with all
10 of the
suspensions that Susan had signed and Arne has had
11 to sign of
about 400 some. So we will probably be
looking
12 at maybe
getting someone in a month, six weeks before that
13 perhaps. Whether it would be going out and getting an
14 investigator
and moving E-2 laterally or putting E-2 back
15 into the
investigative slot that we have and hiring
16 someone new
into the administrative assistant position.
17
With your permission, I would like to at
18 least be able
to have the latitude to decide which way I'm
19 going to go sometime
probably middle of May, first part of
20 June. So we're losing another one over there.
21
DR. BAEPLER: That requires Board
action.
22 I'll so move.
23
DR. BUCHWALD: Second.
24
PRESIDENT ROSENCRANTZ: Any one
opposed?
25 Those in favor
of the motion. Motion carries.
0004
1 (Whereupon, the motion was put
to a vote and
carried.)
2
3 PRESIDENT ROSENCRANTZ: We're going to -- my
4 comment was that due to family emergency,
I'm going to be
5 leaving about 11:00, 11:15. Susan will be taking over. I
6 thought I would be able to get through the
applications
7 for licensure, Agenda Item No. 12. Unless there is a
8 reason not to, we'll just take these in the
order that
9 they are in.
10
MR. LESSLY: Except for Cheryl has
11 Dr. Anthony,
the questions. They won't be here until
ten
12 or so.
13
PRESIDENT ROSENCRANTZ:
Correct. So we'll go
14 into Executive
Session and bring Dr. Harrison in.
15 12. Acceptance of Applications for Licensure
(Whereupon, the Board went into Executive
16
Session.)
17
18
19
20
21
22
23
24
25
0005
1 RENO, NEVADA, SATURDAY, MARCH 3, 2001,
1:12 P.M.
2 -oOo-
3
4 VICE PRESIDENT BUCHWALD: I'd like to call
5 the meeting back to order. We're going to jump around in
6 the agenda just a little bit. We'll start out with number
7 9, which is the legislation report, and as
you all know,
8 Mr. Barengo is our representative.
9 9.
Legislation Report
10
MR. BARENGO: There are a few
bills that
11 we're
concerned about. SB 52 which is the
Advanced
12 Practitioners
of Nursing to prescribe controlled
13
substances. That bill was heard
in the Senate and has
14 passed the
Senate, is now in the Assembly. And AB
78,
15 which is the
physicians assistance bill relating to
16 nurses, that
bill has passed the Assembly, is in the
17 Senate.
18
As physicians all of you know, I'm sure, but
19 you will
probably need to recollect that Nevada
20 Constitution
requires that each bill that is introduced go
21 through the
same process in each house. So it's
22 introduced and
it's read once when it is introduced, then
23 it goes to a
committee, the Constitution requires that a
24 bill be read
three times. It goes to a committee
where
25 they hear it,
they give it an up or down. If it is an
up
0006
1 they do pass, it is read on second reading
files, and that
2 is the time when they usually amend bills,
and then the
3 next time it comes back after it's been
amended -- if it
4 hasn't been amended, it comes back on the
next legislative
5 hearing, and that is the third reading. That is for final
6 passage.
7 VICE PRESIDENT BUCHWALD: Does it have to
8 follow sequentially one day after the next?
9 MR. BARENGO: The way the rotation is it goes
10 that way. If it is amended it may take a couple of days
11 because of the
amendment to get passed. So it may not
be
12 immediately
the next day. It may be the following
day.
13 That is a
technical problem. It is not how things
work.
14
And then on the third passage it is passed
15 and then it
has to go starting in the next house through
16 the same
process again. If there are any changes
on
17 either second
or third amendment, on third reading rather,
18 like on
amendments, the amendments then, once they are
19 adopted, they
don't do it until the bill has passed.
Once
20 the bill has
passed, then it has to go back to the house
21 of origin to
review the amendment, and for them to concur
22 in it. If they don't concur, then there is another
23 process that
they go through, and that is -- that is the
24 amendment
process, concur or not to concur. Well,
25 actually there
are several things that can be done at that
0007
1 point.
Let's say there is an amendment over here. It
2 goes back to the first house of origin. The first house
3 can concur in the amendment in which case
the bill
4 proceeds.
5 They do not concur, then it
goes back to the
6 house that amended it, and the house that
amended it,
7 their motion then is to recede from the
amendment or not
8 recede.
If they do not recede from the amendment, then
9 the bill goes to a conference
committee. And then they
10 have
conference committees, and they meet and they discuss
11 it. If they cannot meet within used to be two, I
think it
12 is now three,
if they cannot resolve the issue at the end
13 of two
conference committees, the bill dies.
All the
14 rules, the one
thing you have to know about the rules, all
15 the rules can
be done away with. No matter what the
rule
16 is, it can be
done away with.
17
What you really need to know in the
18 Legislature is
22, 12 and 1 can do anything. It is 22
19 votes in the
Assembly, 12 in the Senate, and the Governor.
20 That is the
only rule you really need to know.
21
Having said that, two of the bills we're
22 interested in
have gone from houses of origin to the other
23 house. Now we're waiting to see what happens in the
other
24 house.
25
Our bill, which is our revision bill, is SB
0008
1 91.
It is set for hearing eight o'clock Tuesday morning.
2 So far the story on this bill is that no
good action goes
3 unrewarded.
We were kind enough to agree with the
4 physical respiratory therapists to let them
put their bill
5 and their attempt to get a board into our
bill and have it
6 regulated by this body. This has caused nothing but
7 problems.
Nothing to do with our bill but everything to
8 do with what they want to do.
9 And it is a mess. The least of which is, to
10 quote Larry,
we put in an $800 amount to charge them for
11 the services
we perform, licensing, only because we love
12 the Legislature
but we don't want to go there every year
13 and get a
raise each time. We have had calls from
the
14 hospitals,
from everybody fuming about this. We
have to
15 explain to
them over and over again. The
respiratory
16 therapists
have formed a group that is now opposed to the
17 bill because
of that.
18
It is just -- I mean really we should have
19 never done
this for them. In any event, we'll see
what
20 happens on
Tuesday morning.
21
MR. LESSLY: We ought to tell you,
you need
22 to know this
unless you tell us contrary, in the event we
23 get to a point
Tuesday or whenever that this is really
24 going to
impede our bill, we may just dump them.
25
VICE PRESIDENT BUCHWALD: Can you
do that?
0009
1 MR. BARENGO: We have already spoken with the
2 chairman, Randolph Townsend. I said, Randolph, this is an
3 accommodation to these folks to try to help
them get
4 aboard and regulate them because they
couldn't do it by
5 themselves.
He understands that, and he will not let our
6 bill die because of their anger with them.
7 VICE PRESIDENT BUCHWALD: The whole problem
8 with the RP bill is money. This is the only problem they
9 have with the bill is money.
10
MR. BARENGO: It is partially
money. It is
11 partially, as
I'm told, there is an elite group within the
12 respiratory
therapists who want the licensing. There
is a
13 regular group that doesn't care. And it's just all
14 wrapped up.
15
MR. LESSLY: What I intend to tell
the
16 committee on
Tuesday is that this Board has not set a fee.
17 Remember in
our bill we have $800 is the maximum you can
18 charge
physicians. We are not there. $800 is the maximum
19 you can charge
PA's. We're not there. We put $800 in as
20 the maximum we
can charge a respiratory therapist.
We're
21 not going to
be there.
22
But they made a representation to us they
23 thought there
were 400 respiratory therapists in Nevada.
24 Since that
time about a week ago or week and-a-half ago on
25 the phone they
said, well, we may have been wrong.
There
0010
1 is a survey done by the community college in
Southern
2 Nevada, and there may be 700 of them. My staff has done
3 some research, and there may a thousand or
1100 of them
4 based on some national office figures.
5 So I'm going to tell the
committee that don't
6 worry about this. I'm the person that will have to make
7 the recommendation to the Board about what
is the
8 appropriate fee to charge in order to
regulate that
9 profession from one biennium registration
period. If
10 there are 700
of them, I'm going to recommend to you that
11 they be
charged a hundred dollars application fee and a
12 hundred
dollars a year for the biennium. So it
would cost
13 $300 to be
licensed as a respiratory therapist for the
14 next two
years, including the application fee.
15
That generates $21,000 from the biennium. We
16 can certainly
regulate I think for that period of time
17 based on the
fact that we do not believe that their
18 disciplinary
rate is high. In other words, I don't
think
19 it's going to
require Mr. Legarza's staff additional time
20 or personnel
to handle the disciplinary actions and
21 complaints.
22
So that's what I intend to tell the session,
23 that I will
represent on the record that if there are 700
24 of them, that
will be my recommendation to you and that I
25 do not know
any reason why you would not follow that
0011
1 recommendation. What do you have to gain by charging them
2 $800 just for the pure hell of it.
3 DR. BAEPLER: Would you have to hire one more
4 staff member, do you think?
5 MR. LESSLY: Yes, we would have to hire
6 another licensing specialist.
7 DR. BAEPLER: I think a realistic question
8 for the legislators to ask, how would it
increase the
9 costs of your operation?
10
MR. LESSLY: My intention would be
another
11 licensing
specialist but not devoted to respiratory
12 therapists
alone. That would be stupid from a
management
13 standpoint.
14 I
would have a fourth licensing specialist
15 who would do
everything, and the other three would also
16 pick up respiratory
therapists. So all four handle all
17 three
professions we regulate. Unless they get
pregnant
18 as they tend
to do around here, we would have coverage.
19 So the minimum
that would occur is one more staffer.
That
20 doesn't talk
about administrative costs, Nor does it
21 address the
disciplinary actions.
22
MR. BARENGO: The rurals are
having a fit
23 about it, and
we tried to explain exactly what Larry has
24
explained. The other thing that
happened with this bill
25 is because
this is now opened up to some other chapters,
0012
1 why there is varying professions who want to
have little
2 things changed in it. So we'll have to see what they
3 want.
I don't know what they want.
4 DR. HUG-ENGLISH: Varying professions.
5 MR. BARENGO: Like the nursing wants
6 something changed.
7 DR. HUG-ENGLISH: In our bill?
8 MR. BARENGO: Yes.
They wanted to make
9 sure
-- I think they want to make sure that they can give
10 orders to
respiratory therapists.
11
DR. TITUS: We opened up a bill
turf battle.
12
MR. BARENGO: It becomes a
Christmas tree
13 everybody
wants to hang their ornament on.
14
MR. LESSLY: This is the time you
go to the
15 Legislature,
everybody is going to get on board.
16
VICE PRESIDENT BUCHWALD: Is
Tuesday the
17 first meeting
of our bill in the first house?
18
MR. BARENGO: Right.
19
MR. LESSLY: At that hearing --
20
MR. BARENGO: There is nobody
opposed to our
21 bill.
22
VICE PRESIDENT BUCHWALD: That you
know
23 about.
24 MR. BARENGO:
That we know about. I
25 shouldn't say
that. That is not exactly correct.
0013
1 Generally there is no one opposed to the
provisions of our
2 bill with the exception of those portions in
there, three
3 of them I believe, that have to do with new
causes wherein
4 a physician can be disciplined. We have had some
5 discussion, Larry and I at length, with
managed care
6 organizations about those three
sections. The one that
7 raised the most issue was the section that
talked about a
8 physician who does not appeal a decision of
managed care,
9 they solely for financial purposes can be
disciplined.
10
MR. LESSLY: That is my question
this
11 morning. Dr. Jones, Dr. Hug-English, Dr. Baepler and
12 Mr.
Rosencrantz, if he is available, will be going to that
13 hearing on
Tuesday. Dr. Titus has agreed that she
will be
14 present at the
Assembly hearing assuming we get to the
15 other side,
which happens to be chaired by a legislator
16 from rural
Nevada.
17
So I would encourage all of you, if any of
18 the rest of
you get an opportunity to come, do so.
If
19 not, I'll let
you know when the Assembly side is and give
20 you an opportunity
to go there if you want to.
21
We're not asking Board members to make any
22 presentation
unless you become infuriated by something
23 that occurs
and want to be heard.
24
DR. STEWART: Mr. Lessly, may I
ask: Is the
25 Christmas tree
going to affect our bill, in your opinion?
0014
1 MR. BARENGO: I have already discussed with
2 Senator Townsend, look, if this thing gets
to the point
3 where our bill gets hung up, take it all out
and make two
4 bills out of it by an amendment, which they
can easily do
5 and let our bill go and let's debate the
rest of it. The
6 problem with the debate on the physical
therapists, it is
7 not a rational debate, and it is not a
substantive debate.
8 So it's hard to get your arms around it.
9 MR. LESSLY: I intend to tell the Legislature
10 right off,
this Board is not there advocating for the
11 licensure of
respiratory therapists. That is a
12 legislative
decision that needs to be made by those people
13 that are
elected to do that; that we think if the
14 Legislature
decides it's appropriate to license them, we
15 think we are
the appropriate body to do that, and we have
16 the structure
and the capability and the experience to do
17 it. And are willing to do it.
18
DR. HUG-ENGLISH: So as I recall,
the
19 respiratory
therapists came to us asking us to do this.
20
MR. BARENGO: That's right. A group came to
21 us, to be
speaking for the profession. Now we're
finding
22 out that God
knows who these people are.
23
MR. LESSLY: I'm sure it will
become further
24 crystally
unclear to you Tuesday morning.
25
DR. STEWART: Do we need to
distance
0015
1 ourselves from this or do you need to play
it by ear?
2 MR. BARENGO: We don't know yet. Senator
3 Townsend understands. I have spent more time talking to
4 him about this than talking about the energy
crisis, which
5 is what he is really interested in. But he understands
6 fully what is going on about this, and as he
told me,
7 look, I know what's going on. I'll take care of it. That
8 is why I sit at the head of the table. I have every faith
9 that he will take care of us.
10
There are two other bills that are not
11 directly on
point that we need to discuss. One of
which
12 is Senate Bill
198 which comes up for a hearing on the 7th
13 at 2:00
p.m. Senator O'Connell, for those of
that know
14 her, this is a
subject matter that is near and dear to her
15 heart. She is of a Libertarian type less government
type.
16
The summary of it establishes a bill of
17 rights for
persons whose financial or other business
18 records are
subject to examination by regulatory
19 governmental
agencies. Under the definition as I read
it
20 we would fall
under that. And there is a section in
this
21 bill as the
records bill of rights, and it has a huge
22 amount of
rights that an individual should have when going
23 before a
regulatory body and having examination of
24 financial
records. We just need to be present to
make
25 sure we look
at it and understand the intention and to
0016
1 make sure that it would not overly burden us
and overly
2 add to the kind of work we would need to do.
3 VICE PRESIDENT BUCHWALD: Was that only
4 financial records or records in general?
5 MR. BARENGO: Financial records.
6 MR. LESSLY: We would look on those billing
7 for services not rendered.
8 MR. BARENGO: There is another bill that was
9 introduced by human resources committee in
the Senate,
10 Senate Bill
244, which I'm not sure where it comes from.
11 The name of
the individual was Clark, I believe that
12 talked to
Senator Rossman about this.
13 In
essence, what this does is sets up a
14 verification
organization to verify credentials of
15 providers of
health care. And then it says before
16 obtaining or
attempting to obtain the credentials of the
17 provider of
health care, the health care entity, the
18 hospital, or a
licensing board, this group, shall
19 determine
whether the credentials are available from the
20 verification
organization, which would have to go to a
21 private
business organization to see if the records are
22 there. And if they are available there, we got to
get
23 them from
there. And then or if they weren't, we
could
24 get whatever
else we needed from somewhere else.
Seeing
25 how we are a
body that is really the original body in this
0017
1 state for these things, we need to have this
corrected so
2 that it doesn't apply to us.
3 The theory, as I understand it,
is physicians
4 are harassed by the amount of credentialing
organizations
5 they
have to send their records to. It seems
to me I
6 don't understand that, but you guys know
better than I do.
7 If you have a file on it, you keep sending
the file to
8 everybody.
But I don't know. That's the
purpose of this.
9 VICE PRESIDENT BUCHWALD: That's interesting.
10 In Northern
Nevada we have been blessed by a very forward
11 looking
medical staff of the hospitals, and they have
12 developed a
universal application.
13
MR. BARENGO: They do down south.
14
VICE PRESIDENT BUCHWALD: So I'm
not certain.
15
MR. LESSLY: This would in reality
delegate
16 our
investigation of an applicant for a license to another
17 agency.
18
MR. BARENGO: For hospital
credentials,
19 delegate to
another agency.
20
VICE PRESIDENT BUCHWALD: The fact
that we go
21 to the primary
source or the originating source, that
22 would overlay
our --
23
MR. LESSLY: If this bill passed,
we don't
24 have a clue
where the credentialing agency -- whether they
25 used primary
source verification. I don't believe we
0018
1 would be forced to accept it. That's why we don't even
2 accept the federations of credentialing
activity unless it
3 happens to comply with what we need. We go beyond that
4 for additional verification
requirement. So we're going
5 to oppose this unless somebody wants to --
6 MR. BARENGO: We need to know what they
7 really want to do. And I don't know if it is a function
8 of this session, and I'm not picking on
these particular
9 bills I just read to you, but I have seen at
least five
10 bills this
session wherein the sponsor of the bill says,
11 gee, I didn't
know it would do that. I don't want to
do
12 that. Let's not hear it anymore.
13
So either they are not communicating to the
14 bill drafters
what they want to do or they were not
15 communicated
to and what the problem was so they could get
16 to the
problem. Whatever it is, there is -- and
the bill
17 drafters are
saying the same thing. They have never
seen
18 a session
where there are so many gaps in what the bill
19 was intended
to do and what the actual.
20
VICE PRESIDENT BUCHWALD: Are
there any
21 questions for
Mr. Barengo? Thank you very much. We
22 appreciate
that.
23
MR. LESSLY: Do you want to talk
about
24 podiatry
issues in case that pops up between now and the
25 next Board
meeting?
0019
1 VICE PRESIDENT BUCHWALD: Do I want to talk
2 about it?
Sure, do I? Of course we do.
3 MR. LESSLY: The podiatrists doing
4 amputations.
We understand there is legislation that
5 podiatry licensees would be expanding their
scope of
6 practice to do amputations. The question would be under
7 what conditions.
8 VICE PRESIDENT BUCHWALD: Is that a real
9 bill?
10
MR. BARENGO: There's been a draft
request on
11 this issue,
that is correct, and the podiatrist
12 association,
they either have retained or are looking to
13 retain some
lobbyists.
14
VICE PRESIDENT BUCHWALD:
Discussion?
15
DR. HUG-ENGLISH: I guess I would
feel
16 different if
it is a toe versus a foot or leg.
17
MR. LUBRITZ: Below the ankle,
below the
18 ankle.
19
DR. TITUS: Do you know the
wording?
20
MR. BARENGO: I believe it is from
the ankle
21 down
amputation.
22
VICE PRESIDENT BUCHWALD: I would
even have
23 some concerns
regarding the ankle itself.
24
DR. BAEPLER: What kind of
training do they
25 generally
have?
0020
1 MR. LESSLY: Four years.
2 DR. BAEPLER: Four years after a
3 baccalaureate?
4 MR. LESSLY: Uh-huh.
5 MS. JONES: Is that part of the training?
6 MR. LESSLY: I can't answer that.
7 DR. HUG-ENGLISH: I think I'd want to know
8 that before we render an opinion as to how
we feel about
9 it.
I'd like to hear what the bill is suggesting. Does
10 that come up
soon?
11
MR. BARENGO: We haven't seen the
bill yet.
12 I just picked
up the intelligence on it.
13
DR. HUG-ENGLISH: Good antenna.
14
DR. TITUS: We don't have a rapport
with the
15 podiatry
board?
16
MR. BARENGO: I'm not sure if it
is podiatry
17 board bill or
podiatry association bill. I think it is
18 the
association.
19
MR. LESSLY: We'll act that way on
it.
20 Osteopathic Board, they have some bill draft
requests. I
21 guess it's not
in bill form yet, and they have
22 authorized --
remember, we said osteopaths, Mr. Barengo
23 will watch
your legislation. We were concerned, we
want
24 them to get
three years postgraduate education firmly into
25 place, and I
think they needed some help in the bill
0021
1 raising their fees, and Dr. Skully when he
was liaison
2 with them went to them and said, do what we
do and that is
3 set an upper limit so you don't have to go
down there
4 every year.
5 Now we're having to fight that
fight with the
6 respiratory therapists. But Mr. Barengo has been
7 authorized to advise the osteo board on
that. He has
8 correspondence from them saying that was
okay, and we're
9 obviously authorizing him to watch their
bills as a part
10 of his duties
with us.
11
Talk about yesterday? Yesterday
we were in
12 Carson City
for the morning, a part of the morning, and
13 testified on
-- it really wasn't a bill draft request.
14 There is a
bill draft request out there that has to do
15 with secret
meetings and private censorship, that sort of
16 thing, from
licensing boards. There was a discussion
held
17 by the
Assembly commerce and labor committee,
18 Mr. Barengo --
Senate commerce committee. Mr. Barengo
and
19 I went to
that, and I testified about how we do it and how
20 we do
everything open, above board and under the Open
21 Meeting Law
and that we have no authority to take any kind
22 of action in
any form other than public.
23
It became apparent at that meeting that
24 apparently the
Osteopathic Board is not like us, that they
25 have the
authority to take private disciplinary action
0022
1 against a physician licensed by that
Board. So we're
2 going to be in a little bit of conflict with
them about
3 that sort of thing unless they authorize Mr.
Barengo to do
4 something about it for them.
5 MR. BARENGO: Which they are thinking about
6 already.
7 MR. LESSLY: Anything else about yesterday?
8 MR. BARENGO: Senator Townsend prompted by
9 the Nevada Press Association really had a
bill draft
10 request made
extremely lengthy with every licensing board
11 there is and
every regulatory board, about having private
12 reprimands and
private meetings. Because of at least
one
13 incident that
took place locally where the psychiatric --
14
MR. LESSLY: Psychology.
15
MR. BARENGO: -- privately
reprimanded a
16 member of
their profession and did not release it to the
17 public, and
the newspapers are going nuts about it.
We
18 replied back
with a lengthy critique of it and met with
19 Senator
Townsend, said you have to look at how they do it,
20 what their
statutes say, and let us help you craft what
21 would be a
good process.
22 So when we came in front of the
committee
23 yesterday, we
put on the record how we do it, so people
24 can see it
would be a good, open, fair process for both
25 sides, the
individual being reprimanded and the Board's
0023
1 function itself. So that's where we are.
2 He is trying -- Senator
Townsend likes to
3 do -- likes to have discussions about
things, and as they
4 discuss, then he creates a bill. This is the beginning of
5 the process.
6 VICE PRESIDENT BUCHWALD: But it has to be
7 done by June; right?
8 MR. BARENGO: He's got to be done by the
9 first of April. Bills have to cross the houses. They
10 have to cross.
11 VICE
PRESIDENT BUCHWALD: By April?
12
MR. BARENGO: By April. Charlotte, did you
13 have something
to say?
14
MRS. BIBLE: No. I represent the Osteopaths
15 as well, and I
haven't done any informal reprimands, but
16 that would not
be my advice to do informal reprimands.
17
MR. BARENGO: They have in their
section that
18 says public or
private reprimand. And I did not know
that
19 either. I called Tray yesterday afternoon and said, you
20 know, have you
done these? No. Do you intend to do them?
21 No. Do you ever want to do them? No. I
suggest that you
22 call up the
LCB and in your BDR that hasn't come out and
23 you take them
out. He's getting the Board's agreement
24 with that.
25
MRS. BIBLE: Okay, good.
0024
1 VICE PRESIDENT BUCHWALD: Are there any
2 further questions or discussion on the
legislative? I'm
3 certain that Mr. Lessly will contact any and
all whenever
4 he wishes to bounce information or procure
investment of
5 time.
6 MRS. BIBLE: Can I ask one more? I
7 understood there was a bill to limit
discussions between
8 Board members of less than a quorum.
9 MR. LESSLY: That is the Reno City Council
10 bill amendment
to the Open Meeting Law to prohibit serial
11 discussions.
12
MR. BARENGO: That bill is moving
along.
13 Vivian
Freeman's bill. That bill is out there moving
14 along. It's part of the Open Meeting Law. I don't know
15 how far it's
going to go.
16
DR. LUBRITZ: I have one more
question. On
17 the nursing
bill to prescribe controlled substances, did
18 that just like
sail through or was there much discussion
19 about it?
20
MR. BARENGO: The medical society
was the
21 only opponent
to the bill, and there was a great deal of
22 discussion,
and it came down to the issue of discussion
23 that you would
suspect, came down to the word collaborate
24 or
supervise. The medical society through
Larry Mathias
25 suggested that
for controlled substances, the standard be
0025
1 supervision rather than collaboration, and
they had a
2 subcommittee meeting and they discussed it,
and they
3 looked at the regulations, and finally
somebody asked to
4 see what the Board of Medical Examiners did,
and I gave
5 them our three pages, and they then looked
at that, and
6 the committee recommended and the Senate
committee passed
7 the way it is.
8 DR. LUBRITZ: Thank you.
9 MR. BARENGO: I also told them that should it
10 pass the
house, that we would probably be looking at our
11 regulations and rewriting our regulations to
address the
12 issue.
13
DR. LUBRITZ: Thank you.
14
VICE PRESIDENT BUCHWALD: Any
further
15
discussion? Thank you again. Appreciate that.
16 6. Reports - Diversion Program
17
VICE PRESIDENT BUCHWALD: Let's go
back to
18 item number 6,
which is the reports. We'll start with
the
19 Diversion
Program. Carol.
20
MR. LESSLY: Paul is first.
21
VICE PRESIDENT BUCHWALD: I'm
sorry. Paul.
22
DR. STEWART: No reason to
apologize. Carol
23 was clearly
going to give the report of the diversion
24 program and
the Health Professionals Assistance
25
Foundation. I think that Carol
has been a superb addition
0026
1 and breath of fresh air to the Health
Professionals
2 Assistance Foundation. She has taken over and has managed
3 to get all of the things done that the Board
thought
4 should be done to make the foundation functioning
and
5 appropriate and capable of doing the things
that it needed
6 to do.
7 We had had an oversight
committee which was
8 in reality the investigation committee. I think that
9 there is no further need to the
investigative committee to
10 have oversight
of the foundation. They have done all
that
11 we have
asked. They are up and running. They are having
12 their
meetings. They are acting as a
foundation. They
13 are providing
the monitoring and the care.
14 I
know at least the people in the South
15 believe that
this is functioning well, and through
16 Mr. Lessly I
believe the people in the North believe that
17 it is
functioning well.
18
VICE PRESIDENT BUCHWALD: What is
our present
19 relationship
if this oversight committee no longer exists?
20
MR. LESSLY: She would be here
each meeting
21 like she is
today, but this is the first time she's been
22 here because her
previous reports have been reported to
23 Dr. Stewart's
committee.
24
VICE PRESIDENT BUCHWALD: Which is
a similar
25 system that we
have had in the past.
0027
1 MR. LESSLY: Right.
So if you eliminate the
2 oversight committee, she will be here each
Board meeting
3 to report to you as a Board.
4 DR. STEWART: Directly to the Board as
5 opposed to being filtered through the IC.
6 VICE PRESIDENT BUCHWALD: That's the
7 recommendation from the IC?
8 DR. STEWART: That's the recommendation from
9 the Secretary-Treasurer.
10
MR. LESSLY: And the Executive
Director.
11
VICE PRESIDENT BUCHWALD: Does
that need to
12 be --
13
MR. LESSLY: Yes.
14
VICE PRESIDENT BUCHWALD: -- a
motion?
15
DR. BAEPLER: I would so move.
16
DR. HUG-ENGLISH: Second.
17
VICE PRESIDENT BUCHWALD: Is there
any
18 discussion
about this? All in favor. Opposed?
19
(Whereupon, the motion was put to a vote
and carried.)
20
21
VICE PRESIDENT BUCHWALD: The
Chair votes in
22 favor of the motion. Any more, Paul?
23
DR. STEWART: No. Now I guess we should
24 hear from
Carol directly.
25
MS. BOWERS: Since the last Board
meeting on
0028
1 December 3rd, the number of participants in the
program
2 has not increased. I currently have five under
3 investigation, and those investigations
should be
4 completed by the end of March.
5 One bit of good news before I
get to the
6 Board meeting, I received a check from the
Hospital
7 Association for $31,702. And when I add in the two checks
8 I received from Carson City, the total
amount is $40,000.
9 So I was rather excited, to say the least.
10 I
spoke to -- oh, also I enclosed a list of
11 the hospitals
that were part of those contributions.
They
12 are: UMC, Saint Rose Dominican, Churchill
Community
13 Hospital,
William Dreary Hospital, Humboldt General
14 Hospital,
Carson City, Sunrise, Tahoe Pacific, and Washoe
15 Health
System. Those were the hospitals that
contributed.
16
When I spoke to Bill Welch, who is the
17 president of
the Hospital Association, he said that this
18 was just the
beginning, and they hoped to continue
19 supporting the
Health Foundation for at least the next
20 five
years. So I was very pleased.
21
And I have since spoken with Allen Stipe, who
22 was really a
big proponent of this movement, and he was
23 very pleased with
the results.
24
Also Les Soper was a big part of this.
25
We had our board meeting, the Foundation
0029
1 board meeting in Las Vegas on February
18th. It was a
2 long meeting. We made a lot of -- we did a lot of
3 business things. And we decided we're going to have a
4 workday where we get together and we change
-- we update
5 our contracts. We have taken a look at our mission
6 statement and our program outline and
updated those.
7 Fred Kirshner, who is on our
board, presented
8 a very thorough presentation on funding and
ways to get
9 grants, and so we're going to try to put
things together
10 and take a
look at a couple grants that he had in mind.
11 So that's
probably going to take a whole day.
12
We also decided, and I think I mentioned this
13 in December,
to increase the monitoring fees to each of
14 our
participants. And we discussed that at
the board
15 meeting, ways
to make that a little more palatable for the
16 participants
themselves because so many of them are
17 strapped
anyway.
18
So one of the suggestions that I had made
19 that seemed to
be pretty positive was that I facilitate a
20 small group in
Las Vegas at no charge to participants
21 which would
save them the increase on their monitoring
22 fees and since
I have had so much experience doing that, I
23 suggested
that, and it's being looked at and discussed
24 between the
committees, and I have talked to the members
25 of the
group. So it hasn't been resolved, but
it's a
0030
1 thought.
And we have talked with the people up North, and
2 that may be a little more difficult finding
somebody up
3 North to do that.
4 We also talked, we have a
diversion committee
5 in the North, we have a diversion committee
in the South.
6 We get together once a month in both
areas. I facilitate
7 those and we talk about changing the
composition of those
8 committees to make them more an evaluation
type committee.
9 And we have added in the South, we have
added Les Soper
10 and George
Kaiser and Vic Rueckl to the committee in the
11 South. We haven't made any additions in the North
because
12 it is already
a pretty stable committee.
13
Dr. Rueckl and I spoke at the medical school
14 in Reno this
past month, and we do that every year. I
15 also attend
the student assistance meeting in Reno.
16 Dr. Rueckl and
I are speaking at the VA Hospital in Reno
17 on March 6th.
18 I
spoke last night and Thursday morning to
19 Sunrise
Hospital, their nursing staff about -- well,
20 Thursday it
was called conflict resolution, and last night
21 it was called
empowerment. They were both the
same. So I
22 don't know
where they got the different names. So
it was
23 kind of
interesting, and they hoped to make that kind of
24 an ongoing
thing.
25
The disruptive group in Las Vegas will end
0031
1 its first year in April. Dr. Babinski thinks it's been a
2 very good success. We have only had one of the physicians
3 have repeat incidences since it's been in
the group.
4 VICE PRESIDENT BUCHWALD: Out of how many?
5 MS. BOWERS: Out of six.
And we're right now
6 dealing with him. It's kind of a mess. But anyway, it
7 seems the group has helped some people. In fact, we have
8 seen some things that we have talked about
writing because
9 I'm not sure there is anybody else that does
disruptive as
10 we do down in
Las Vegas.
11
What he also wants to do is end that group
12 and meet each
one of them on a follow-up basis
13
individually. He thinks the
group, a year-length group
14 for them is
more than adequate. And I'm certainly
not
15 opposed to
that. We're going to bring it up in the
16 diversion
committee meeting in Las Vegas sometime in
17 March. I can't remember.
18
I'm going to be sending letters of
19 appreciation
to all the hospitals, including the Hospital
20 Association,
including the hospitals that didn't
21
contribute. We want everybody to
know who did. I'm going
22 to be doing
that.
23
DR. BAEPLER: One question
there. Is there
24 any evidence
that this might be a continuing contribution?
25
MS. BOWERS: According to Bill
Welch, it is.
0032
1 But there's no --
2 DR. BAEPLER: There is no guarantee. It just
3 depends on how you approach them.
4 MS. BOWERS: Right.
I was very excited that
5 we had what we did. We're having some trouble -- I
6 finally got the financial statement from the
bookkeeper,
7 and it appears to be okay, and I try and
meet with him on
8 a regular basis. But he's been making some mistakes that
9 I'm not comfortable with. So I'm going to be looking for
10 a different
bookkeeper.
11
I'm also going to be taking a course in Quick
12 Books myself
so I can at least -- not that I'm going to do
13 the books, but
I want to be able to read them and know,
14 besides what I
can pick out, I want to know what's going
15 on
completely. So I'm going to do
that.
16
DR. LUBRITZ: You are dealing with
a
17 bookkeeper or
accountant?
18
MS. BOWERS: Due to finances, that
we had a
19 bookkeeper was
the best choice at the time. So I'm
going
20 to look into
both and see which is better.
21
VICE PRESIDENT BUCHWALD: I have
one question
22 when you gave
your statistics. When it says five
23 currently
under investigation, does that mean that some of
24 those five are
elsewhere, being evaluated elsewhere?
25
MS. BOWERS: No, no, no. It means there may
0033
1 have been a call to me from whoever, and I'm
still -- in
2 fact, two of them are from the board, and
I'm still in the
3 process --
4 VICE PRESIDENT BUCHWALD: Two of the board?
5 MS. BOWERS: Not board members. A call came
6 from the board to me about a physician
licensed in the
7 state of Nevada.
8 VICE PRESIDENT BUCHWALD: Thank you for
9 clearing that up.
10
MS. BOWERS: I will be meeting
with them next
11 week or the
week after.
12
VICE PRESIDENT BUCHWALD: So if
someone is
13 sent away or
agrees to go away --
14
MS. BOWERS: That is not counted
in there.
15
VICE PRESIDENT BUCHWALD: Are they
counted in
16 any of the
participants?
17
MS. BOWERS: They are counted as
18 participants,
and they are licensed as being in treatment
19 or evaluation
on the bottom. Right now we have two,
one
20 at Farley and
one at Talbot. The one at Farley is a
21 relapse from a
physician monitoring.
22
VICE PRESIDENT BUCHWALD: Where is
Farley?
23
MS. BOWERS: In Virginia.
24
VICE PRESIDENT BUCHWALD: Are
there any
25 questions for
Carol?
0034
1 DR. STEWART: There is a suit against the
2 Foundation?
3 MS. BOWERS: There is.
4 DR. STEWART: Is it important we know what it
5 is about or does it make any difference to
us?
6 MS. BOWERS: Yes. I
forgot about that. It
7 is a suit filed by a dentist against the
Dental Board, the
8 Nevada Health Foundation, Jim Tracy and
Spring Brook
9 Institute.
Our insurance company has said that they will
10 not represent
us because the suit does not fall under the
11 realm of what
we are insured for.
12
Our lawyers, Lionel, Sawyer & Collins, we're
13 looking at two
different ways to handle this. We're
14 looking at --
one is a pro bono to us and deal with the
15 insurance
company at a later date.
16 However, the way the lawsuit is
written, it
17 was dismissed
-- there was a court date last Tuesday, and
18 it was
dismissed against two of those entities, and I
19 don't remember
who they were. And the judge asked them
to
20 rewrite it.
21
So our lawyer, who is Cam Fehrenbach, is
22 going to speak
to the insurance company and say it is
23 going to be
rewritten so it will encompass what they were
24 insured
for. So there's really no settlement to
the
25 issue. It's kind of a silly lawsuit. But then I was
0035
1 involved in those, and it didn't turn out so
silly.
2 VICE PRESIDENT BUCHWALD: And the essence of
3 the lawsuit is?
4 MS. BOWERS: Those people that are being sued
5 took money from him for a profit and then he
ended up
6 losing his license. I mean we don't even deal with
7 dentists.
We certainly don't take any money from anybody.
8 MR. BAEPLER: You do have one dentist in your
9 program.
10
MS. BOWERS: Because he has asked
to be
11
monitored. But we have no written
policies or anything.
12 My guess is
that Jim Tracy did this as a favor to the
13 Dental
Board. That's where that stands. There is no
14 resolution.
15
VICE PRESIDENT BUCHWALD: Thank
you. Are
16 there any
other -- I'm sorry, Larry.
17
MR. LESSLY: One other thing we
ought to talk
18 about I guess
occurred yesterday. The Senate committee
19 that I
testified in front of was very concerned about how
20 matters that
go into diversion programs, how physicians or
21 licensees who
go into diversion program are handled from
22 the standpoint
of confidentiality, whether the public has
23 a right to
know who the physician is in a diversion
24 program or do
we handle it publicly.
25 I
told them how we handle it. I think that
0036
1 it was okay.
But I would tell you that I think that the
2 issue is certainly up for discussion before
the
3 Legislature again.
4 VICE PRESIDENT BUCHWALD: It's dangerous.
5 Any further questions? Thank you, Carol. I appreciate
6 that.
John.
7 Physician Assistant Advisory Committee
8 MR. LANZILOTTA: Bob talked about our bill,
9 and pretty much I'm here to thank the Board
for its
10 support and
advice. Senate Bill 78 will be read and
then
11 heard again
and pass the labor and commerce committee
12 authorizing an
RN to possess and administer medications at
13 the direction
of a PA. It has the efficiency and
14 continuity of
health care to patients in Nevada and by
15 health care
delivered by PA's in both rural, urban clinics
16 and hospitals,
and this legislation will be beneficial to
17 PA's whose
practice is always conducted within the
18 framework and
context of a physician's supervision, and
19 help us
realize our full potential in delivering care in
20 Nevada.
21
Again, as a group or we as a group appreciate
22 the Board's
advice, support, and also their mandates,
23 strict
mandates for professional licensure standards,
24 which really
have brought us to credibility in our
25 profession
here to get to this point. I want to
thank you
0037
1 for your support, and so far I think it
looks good. But
2 again, thanks.
3 The other -- I read in the
American
4 Association of Physician Assistants
legislative newsletter
5 that the Federation of State Medical Boards
will be
6 accepting data on disciplinary actions taken
by all PA
7 regulatory authorities, and just didn't know
how that was
8 coming down.
I talked to Maureen about that, and on their
9 side I really can't find any information
other than you
10 can do a run
on a PA or an MD or DO if you send 9.95 on
11 your credit
card, you can get the disciplinary actions.
12 But I couldn't
find any other information about that.
13
MS. LYONS: It wasn't really a
federation.
14 It was a link.
15
MR. LANZILOTTA: Their banner is
right on
16 top. And also they are nearly ready to begin
credentials
17 verifications
for PA's. I was just wondering how that
18 would work
through our Board, the same as with physicians
19 as far as the
reporting?
20
MR. LESSLY: It depends on what
they have in
21 the
verification credentials service. That
is a big money
22 maker for
them. That is why they are doing
it. Some
23 states have
required that any applicant for a medical
24 license, and I
will assume they would do it for a PA
25 license, too,
use the Federation credentials service.
0038
1 Ohio; does some big states.
2 We decided we would accept it,
but we might
3 request that the applicant augment the
application to
4 cover those things that we were concerned
about that were
5 not absolutely verified by the
Federation. I guess we
6 would probably recommend to you that you do
the same thing
7 with respect to PA's.
8 One of the things that the
Federation does is
9 we say we have primary source verification
and you went to
10 Moscow
University Medical School in Moscow, Russia.
We
11 want something
from Moscow, Russia, the medical school
12 that we
translate and determine that you did in fact have
13 a medical
education. And we force the physician,
we keep
14 the pressure
on them, yeah, we have gotten from that
15 school in the
past and you will write and try to get it.
16
The Federation will say, well, we didn't get
17 it, so this is
an exception to the process, and they click
18 it that
way. And so we're sending you his
credentials,
19 but we never
did verify primary source.
20
Well, we don't do that because our licensed
21 people will be
able to look at an application from a
22 physician, no
matter where he went to medical school in
23 this world,
and I would bet you ninety-nine times out of a
24 hundred
without any research they can tell me whether or
25 not we can get
primary source verification from that
0039
1 location.
2 So there's a -- I'm not in
favor of using it
3 because I don't think it's that accurate or
that thorough.
4 Some states do. My recommendation would probably be, and
5 I'd have to see what the package looks like,
that we treat
6 it the same way as we do a license for an
MD.
7 DR. LUBRITZ: How long has the Federation
8 been doing this?
9 MR. LESSLY: Credentials services, three
10 years
maybe. They talked about it for a long
time. Maybe
11 it's been on
line for three years.
12
DR. LUBRITZ: Why would they be
doing that?
13
VICE PRESIDENT BUCHWALD: Money.
14
MR. LESSLY: It is particularly
beneficial
15 for some
reason for foreign medical graduates.
You come
16 to the United
States and you need to shotgun applications
17 around to look
for residencies, get a license whatever.
18 You go to
them. You pay them 200 bucks I think to
apply,
19 to file your
application with them, and then there is a
20 fee for each
medical board to which that application is
21 sent.
22
But there is a bigger issue here, and we saw
23 this in Las
Vegas at our reception for the Federation of
24 State Medical
Board board of directors. They
approached
25 Rebecca and,
oh, we would really like Nevada to require
0040
1 that all applicants use our service. They didn't approach
2 me on that because they know what my answer
is going to be
3 to it.
But it's a money maker for them.
4 DR. LUBRITZ: Personally I have a problem
5 with that.
6 MR. LESSLY: I do, too.
7 DR. LUBRITZ: Then are we going to stay
8 silent on it?
9 MR. LESSLY: About them doing it? No, we
10 will not
require it. This Board has not said we
will
11 require it.
12
We have said if you want to use it, doctor,
13 if you want to
use the Federation credentialing service
14 and have them
send that to us, that's fine. Whatever
they
15 have done
right, we'll take. What they have not
done to
16 the depth that
we do, the initial investigation on your
17 application,
we're going to require that we go beyond
18 that.
19
DR. LUBRITZ: Let's go a little
beyond it.
20 More and more
states do it.
21
MR. LESSLY: Yes.
22
DR. LUBRITZ: And then will it
become you
23 will do it now?
24
MR. LESSLY: They don't have any
right to say
25 that because
that's our decision.
0041
1 DR. LUBRITZ: Right.
2 MR. LESSLY: That's what they would like to
3 see is every state require that then they
are running the
4 credentialing service.
5 DR. LUBRITZ: Of course.
6 MS. LYONS: Essentially it leads to national
7 licensure.
8 DR. LUBRITZ: I don't think that we should
9 personally let it go by without
anything. I would stand
10 up and say,
hey, we elect to have a Federation of states.
11 Don't tread on
me. Hey, that's our job. Don't be taking
12 it away from
us. Don't make it a money making project
for
13 you. Otherwise if you acquiesce to that, you know
where
14 it is going
right now. So my thought is we shouldn't
let
15 them just go
by.
16
Maybe people aren't as forward thinking as we
17 are.
18
MR. LESSLY: I don't think we can
stop them
19 from doing
what they are doing. But we have not
20 acquiesced to
it. We have said up front that your
service
21 does not meet
our standards.
22
DR. LUBRITZ: I think it should be
brought up
23 at the
Federation meeting. Say, why are you
doing this?
24 Are you not
satisfied with what the states are doing?
Are
25 you doing this
to make money?
0042
1 MR. LESSLY: I would say that -- I guess I
2 would defend the Federation's concept to a
very limited
3 extent.
There are probably some boards out there that by
4 using the Federation credentialing
verification services,
5 they are really upgrading their
standards. We're not. We
6 would be downgrading ours.
7 So it probably is of some
service to some
8 smaller boards or boards with limited
financial resources
9 or with limited staff. I just don't think it meets our
10 criteria by
any stretch of the imagination. They
know our
11 opinion on it.
12
DR. LUBRITZ: Is everyone saying,
oh, gee,
13 this is the
Federation and maybe we just shouldn't say
14 anything?
15
MR. LESSLY: I don't see
that. I don't think
16 there are that
many states utilizing it yet. I don't
see
17 that everybody
is buying off just because it is an easy
18 way out. For some it probably is an easy way out.
19
But the type of states using it vary widely.
20 Some of the
bigger states are going to it. One of
the
21 reasons some
of the bigger states go to it is they have a
22 tremendous
influx of foreign medical grads who utilize
23 that
service. Some of the bigger states have
gone to it
24 because their
requirements for initial licensure are
25 not -- for
investigation on initial licensure are not as
0043
1 strong as ours. It is sort of all over the spectrum.
2 VICE PRESIDENT BUCHWALD: Any further
3 discussion?
4 The Committee to Study Post
Licensure.
5 MS. LYONS: Are you done, John?
6 MR. LANZILOTTA: Yes.
7 MR. LESSLY: If she is talking, he is.
8 Committee to Study Post-Licensure Continuing
Competency
Evaluation
9
10
VICE PRESIDENT BUCHWALD: The
committee
11 meeting had to
be cancelled, and there is nothing to relay
12 to the Board
at this time. Were you really done?
13
MR. LANZILOTTA: Yes.
14
VICE PRESIDENT BUCHWALD: Dr.
Stewart, do you
15 want to give
us the IC report?
16 Investigative
Committee
17
DR. STEWART: Yesterday and early
this
18 morning we
finished the March 2nd-3rd investigative
19
committee. I'll pass around the
cases that are closed.
20
We interviewed eight physicians.
We have
21 left some
things open for further peer review that do not
22 appear here
since we haven't made a determination. The
23 investigative
committee managed to get through everything
24 that we needed
to get through.
25
In regard to the Secretary Treasurer's
0044
1 report, that's really Mr. Frantz.
2 VICE PRESIDENT BUCHWALD: Bob.
3 DR. BAEPLER: Do we need action on IC?
4 DR. STEWART: I was going to let it go around
5 the table first.
6 MR. FRANTZ: It is pretty much of a
7 straightforward report. There isn't anything unusual
8 except for the dinner last night hasn't been
added into
9 the expense category yet, which will change
our figures
10 dramatically.
11
Everything seems to be going along fine with
12 us as far as
income and expenses. We're still under
13 budget for
everything, still under budget for the income
14 figures. That is due to the fact that the last
15 Legislature
changed our figures and created a problem for
16 us. We are utilizing them to accommodate the
state. They
17 overprojected
our income and overprojected our expenses.
18 But most of
the figures that I have in here as far as
19 budget amounts
except for the income side and the expense
20 side is
accurate as we submitted them.
21
An example would be like in the expense of
22 personnel
unallocated, you will see 451 sitting in the
23
unallocated. That is where I
moved the figures to kind of
24 keep
everything else in line so I could watch it closely.
25 At the same
time, you go down to the operating expense, we
0045
1 have $335,000 sitting in legal. That is what we have in
2 that particular case. So otherwise we're pretty much in
3 line with what we projected here. We're doing fine.
4 DR. STEWART: On June 30th, what do you
5 expect the reserves of the Board to be
before you add in
6 the July 1st?
7 MR. FRANTZ: It's difficult to project that
8 right now because we're coming into renewal
time. And
9 those expenses will be involved. I'll have a better idea
10 probably at
the June meeting.
11
But we will be -- I don't even want to make a
12 guess. It is hard to make a guess right now. I would
13 like to see as
much as I possibly can, but to tell you
14 exactly what
it will be, I can't.
15
Any questions in regards to it?
This is as
16 of yesterday
morning about 11:15.
17
VICE PRESIDENT BUCHWALD: We'll
accept this
18 report as is
then.
19
DR. STEWART: Can we move to
accept the
20 report of the
Investigative Committee?
21
DR. DESAI: I make a motion to
motion to
22 accept the IC
report as presented.
23 DR. LUBRITZ: Second.
24
THE COURT: All those in
favor. Opposed,
25 Chair votes in
favor of the motion.
0046
1 (Whereupon, the motion was put
to a vote
and carried.)
2
3 Public Service Announcement Committee
4 VICE PRESIDENT BUCHWALD: I believe in your
5 booklet you have the results of the phone
survey. Do you
6 want to go over that, Maureen?
7 MS. LYONS: Dr. Stewart had asked me to do
8 the survey again, and obviously, they get
more phone calls
9 than are reflected on here. The phone is just real busy,
10 the front desk
coverage, Casey and Misty, either they are
11 there many
times when the phone rings. So they did
not
12 ask every
person who called in about a doctor, how they
13 heard about
it.
14
This is a random sampling of that time period
15 of January 2nd
through February 21st. Obviously, there
16 were more
phone calls that came in during that time.
17
So from the results I think it is sort of an
18 even spread
between the PSA resulting calls versus, say,
19 medical
society, county society referrals.
20
DR. LUBRITZ: As I look at it,
there was a
21 dramatic
increase on the second page, whatever time limit
22 that was. So my question is: What happened at that time
23 when we
started seeing all the Xs in TV as opposed to the
24 radio, which
was all on the first page?
25
MS. LYONS: Our public service
announcements
0047
1 ran during that entire period of time. So I don't know
2 why that would happen. It's not like they began in the
3 middle of that time frame.
4 DR. TITUS: Maybe they changed the timing of
5 the ads.
6 DR. LUBRITZ: It seems very obvious, bang,
7 there is a cluster.
8 VICE PRESIDENT BUCHWALD: I really don't have
9 any information about continuation of the
contract.
10
MR. LESSLY: If we are going to
continue, we
11 need a motion
to do that. We do that on a quarterly
12 basis.
13
VICE PRESIDENT BUCHWALD: We renew
it
14 quarterly?
15
MR. LESSLY: Yes. This is the last meeting
16 we have until
March. So I need some authority to
continue
17 with it on
March the 1st, if you want to continue with it.
18
DR. TITUS: Can you review the
cost again?
19 MR.
LESSLY: $5,000 a month.
20
DR. TITUS: You budgeted
that?
21
DR. DESAI: Make a motion to give
Mr. Lessly
22 authority to
continue the contract for public service
23 announcements
for next three months.
24 DR. LUBRITZ: Second.
25
VICE PRESIDENT BUCHWALD: Any
discussion?
0048
1 All in favor. Opposed?
Okay.
2 (Whereupon, the motion was put
to a vote
and carried.)
3
4 MR. LESSLY: Would you like to see the ad
5 played?
6 VICE PRESIDENT BUCHWALD: Sure.
7 DR. BAEPLER: Now that we voted.
8 (The announcement was played.)
9 MR. LESSLY: That's it.
10
VICE PRESIDENT BUCHWALD: Any more
discussion
11 on this?
12
DR. BAEPLER: My comments I can't
make.
13
DR. STEWART: There was a phone
number and
14 there was a
website at the bottom?
15
VICE PRESIDENT BUCHWALD: I didn't
see a
16 website.
17
MR. LESSLY: Let's see it again.
18
DR. STEWART: I saw a phone
number, but I
19 didn't see a
website. It took them 10 hours to get
that.
20
VICE PRESIDENT BUCHWALD: You're
kidding.
21
DR. STEWART: No, serious. Ten hours.
They
22 were in the
office for 10 hours. They used my
office, 10
23 hours.
24
VICE PRESIDENT BUCHWALD: Did you
charge
25 them?
0049
1 DR. STEWART: No.
2 VICE PRESIDENT BUCHWALD: Given the
3 discussion that we had yesterday,
potentially I don't
4 think it costs anything to put that on.
5 MR. LESSLY: You don't?
6 VICE PRESIDENT BUCHWALD: To imprint the
7 overprints?
8 MR. LESSLY: I don't know.
9 DR. DESAI: We don't have all the information
10 on the
website, do we?
11 MR. LESSLY: No.
12
DR. HUG-ENGLISH: Probably should
wait until
13 we get it
done.
14
MS. JONES: Maybe have that number
on there.
15 By the time
they say this is the number, it's over.
16 DR. HUG-ENGLISH: You can't read it that
17 fast.
18
MS. JONES: If somebody needed to
get a paper
19 and write it
down. Next quarter or whenever they do
it
20 again.
21
DR. TITUS: When we have the website,
they
22 can leave the
number in there longer.
23
DR. HUG-ENGLISH: I like it. I think it is
24 clever.
25
VICE PRESIDENT BUCHWALD: I can't
wait until
0050
1 I hear what somebody doesn't like about it.
2 MR. LESSLY: I'm sure you will hear.
3 DR. TITUS: It's been playing already, hasn't
4 it?
5 DR. HUG-ENGLISH: Since January 1st.
6 MS. BOWERS: I have seen it. I like it.
7 VICE PRESIDENT BUCHWALD: I haven't seen it
8 in the North. Of course, I don't watch much TV.
9 MR. LESSLY: We have a January report that
10 Arne left if
anyone wants to look at that on where our
11 things have
been playing during the month of January, and
12 I didn't get a
chance to look at it because he just left
13 it with us and
said it was okay, not particularly great
14 but it was
okay.
15
VICE PRESIDENT BUCHWALD: We'll
pass that
16 around, and
everybody can peruse that.
17
Lets move on to legal reports.
We'll start
18 with Mr.
Legarza.
19 7. Legal Reports
20
MR. LEGARZA: Our contract with
the Nevada
21 Physicians
Assistance Foundation, I turned it into the
22 Board of
Examiners on December the 8th, and last week,
23 week before,
Larry came in and says, where is our
24 contract? I said, I don't know. So I got to checking,
25 and guess
what. They never got it on the Board of
0051
1 Examiners agenda.
2 So luckily, I had a
file-stamped copy that I
3 made them file stamp. So the time had expired to get it
4 on to the March one. But Casey took it over, and
5 supposedly it's going to be on the March
15th agenda. So
6 we don't have any permission yet to pay you,
Carol.
7 MS. BOWERS: How nice.
8 MR. LEGARZA: I don't think there is any
9 problem.
But the budget people who we pay how much to,
10 Bob?
11
MR. FRANZ: I did about 13,000 a
year, but we
12 haven't had to
pay them this year yet.
13
MR. LEGARZA: We're thinking about
not paying
14 them anything
unless they sue us. We might not pay
them
15 then.
16
Dr. Larant, who had a petition for judicial
17 review, I
filed a motion to dismiss that petition for
18 judicial
review. It was going on in two different
parts
19 in District
Court here in Washoe County. They both
20 granted that
motion to dismiss. The time has expired
for
21 him to appeal
it to the Supreme Court. So we may after
22 three years
now be finished with Dr. Larant.
23
Dr. Gilbert who sued Mr. Lessly and the
24 adjudicating
members of his case, which nobody here --
25
DR. DESAI: I was.
0052
1 MR. LEGARZA: You were on it?
2 DR. STEWART: It was Rex and I and someone
3 else.
Haven't been shot yet.
4 MR. LEGARZA: Right.
Anyway, the Federal
5 District Court has dismissed that. I don't think it's
6 going to go anywhere. Larry hasn't jumped me yet to go in
7 on sanctions and fees, but I'm sure he will
do that now
8 that I mentioned it.
9 Dr. Concha, you disciplined him
two meetings
10 ago. There has been a petition for judicial review
filed
11 on his
behalf. I have filed a motion to dismiss
that.
12 They waited a
minimum of 78 days, maximum of 105 days
13 before they
filed it. The statute under 233B is
clear you
14 have 30
days. It's jurisdictional.
15 I
expect to win that. But I haven't heard
16 anything yet
from the court. I have not received a
17 response yet
from the people who have filed the petition.
18
DR. LUBRITZ: What was that case
again?
19
MR. LEGARZA: Dr. Concha was a
doctor from
20 California
that had an action taken against him in
21 California. It was one of the out-of-state action
cases.
22 It was
filed. We had a hearing. He came in and
23 represented
himself. The hearing officer spent a lot
of
24 time talking
to him about you probably shouldn't be doing
25 this yourself.
0053
1 The Board found him in
violation of Medical
2 Practice Act, a simple thing. You didn't revoke him.
3 Placed him on probation and made him pay the
fees, and he
4 decided that he didn't like that. He hired a lawyer down
5 in Las Vegas who wrote a letter saying, gee,
we want you
6 to reconsider this. That lawyer was retained in time to
7 file a petition for judicial review and
didn't. I think
8 that lawyer has got a problem.
9 Then he hired another lawyer who filed a
10 petition for
judicial review and came up with a phony
11 argument for
jurisdiction, nobody is in violation of any
12 of the Board
ordered terms and conditions of probation.
13 And you all have
read and I assume reread the redo, if you
14 will, of the
advisory opinion that has been requested and
15 argued a
motion and action on that. Arne has
already
16 signed it in
anticipation that you would approve it.
So I
17 would like a
motion to be allowed to --
18
DR. DESAI: I so move.
19
DR. HUG-ENGLISH: Second.
20
DR. STEWART: Could we have some
discussion?
21
VICE PRESIDENT BUCHWALD:
Discussion?
22 DR.
STEWART: I'm just a little confused why
23 he -- I am not
confused, but I'm confused why we gave him
24 an opinion.
25
MR. LEGARZA: Every licensee has a
right to
0054
1 request an advisory opinion of the
Board. Our regulations
2 say that it has to be in so many days prior
to a meeting
3 and that we have to then address it at the
next regularly
4 scheduled meeting, which is what this is
doing. This is
5 only the I think fourth one that I have
written since I
6 have been general counsel of the Board.
7 This guy called up, and he had
a question of
8 me, and I tried to answer his question as
best I could,
9 and I don't know what -- he is either being
asked to do
10 some of this
work or whether he's interested in this from
11 his own
standpoint, I don't know. But they have
a right
12 to ask for it.
13
Once they do that, then we give them the
14 opinion. So I don't know why he asked for it. I know
15 that's not
your question. But every licensee has a
right
16 for an
advisory opinion. And we're required to
give it to
17 them.
18
DR. STEWART: I understand.
19
VICE PRESIDENT BUCHWALD: Who is
Dr. Osgood?
20
DR. STEWART: Dr. Osgood was a
former medical
21 director for
FHP, the medical director of United.
United
22 is leaving
this state. Dr. Osgood is starting a
company
23 which will go
into physicians's offices and do compliance
24 work so that
the feds will not sanction the offices.
25
VICE PRESIDENT BUCHWALD: In
relation to some
0055
1 of the new regulations that the federal
government has put
2 out?
3 DR. STEWART: In regard to fraudulent
4 billing, overbilling, errors in billing.
5 MR. LEGARZA: Inadvertent billing.
6 DR. STEWART: Inadvertent billing.
7 MR. LEGARZA: His question was, does the
8 Nevada Medical Board of Examiners have the
right to
9 investigate.
The answer is certainly. Can it
result in
10
discipline? It depends on whether
or not they file a
11 formal
complaint. It's my fourth opinion, and
it's my
12 fourth
nonopinion opinion since I have been here.
13
DR. STEWART: I assume Dr. Osgood
will use
14 this in his
arsenal to tell physicians' offices why they
15 should have a
compliance program.
16
MR. LEGARZA: I'm sure he
requested it for
17 his own
reasons, and obviously, you have confirmed that.
18
DR. DESAI: I think also Dr.
Osgood is a
19 director of
United Health Care. He has a lot of
20 information
about physicians, which he can use it with
21 this letter
that you have been sanctioned before, have you
22 had some
problems before. And this is the opinion
of the
23 licensing
board. Now you really need my services.
24
VICE PRESIDENT BUCHWALD: We have
a motion on
25 the
floor. Is there any further
discussion? All in
0056
1 favor.
Any opposed?
(Whereupon, the motion was put to a vote
2 and carried.)
3
4 MR. LEGARZA: That's all I have.
5 VICE PRESIDENT BUCHWALD: Good.
Mrs. Bible,
6 do you have any report?
7 MRS. BIBLE: Yes, I do.
I just have one
8 matter regarding Dr. Bass.
9 VICE PRESIDENT BUCHWALD: Oh, no.
10 MRS. BIBLE:
He and his counsel filed a
11 petition for
writ of certiorari in the U.S. Supreme Court.
12
VICE PRESIDENT BUCHWALD: What
does that
13 mean?
14
MR. LEGARZA: They filed the type
of document
15 to get a U.S.
Supreme Court review of their case and their
16 issues that
arose out of their disciplinary action before
17 this Board,
the due process claims, and we waived the
18 opportunity to
file a response. If the Court entertains
19 the petition,
grants the petition for a writ, it will
20 order us to do
a brief.
21
But in talking with other attorneys in my
22 office, and we
have an attorney who is a fellow that is
23 into learning
about Supreme Court advocacy, this case does
24 not have the
type of appeal that the Supreme Court would
25 take. It's too narrowly related to his particular
0057
1 circumstances before the Board. So I really doubt that
2 there will be anything to come of it.
3 MS. LYONS: What is it called, writ of?
4 MRS. BIBLE: Certiorari.
5 VICE PRESIDENT BUCHWALD: Thank you.
Does
6 anybody have any questions for Mrs. Bible?
7 Thank you. Welcome to our Board.
8 MRS. BIBLE: Thank you.
9 VICE PRESIDENT BUCHWALD: I think that takes
10 care of the
legal reports. The Executive Director's
11 report.
12 8. Executive Director's Report
Educational Meetings
13
14
MR. LESSLY: Thank you. First item is the
15 meeting of the
Federation in Atlanta, Georgia. We have
16 previously
come to you with some requests for people to
17 attend. I just make it real simple. We ought to have
18 approval for
everybody who we know is going. If I
don't
19 have your name
on here and you want to go, tell me.
20 I
had previously asked for Elizabeth Sarube
21 who is a
licensing specialist to go. We think
that
22 Mr. Raderbrice
should go. You have previously approved
23 Maureen to go
in the Executive Director's slot for this.
24 Mr. Legarza to
go. Dr. Titus, Dr. Jones, Dr. Desai,
25 Dr. Lubritz
wants to go, and Dr. Stewart and Dr. Baepler
0058
1 would be going as speakers, which means that
their costs
2 are paid by the Federation.
3 Miss Lyons's costs will be paid
by the
4 Federation.
And Arne was going as the delegate, and his
5 costs would be paid by the Federation. So we have from
6 this list eleven people who wish to go. Of those 11, four
7 of those will be paid by the
Federation. So we would be
8 sending seven people out of our budget, and
we obviously
9 have adequate money to do that. So I think --
10
MS. LYONS: I also have a
request. Carol
11 Bowers had
requested an interest to go to the meeting, and
12 I would like
to see if she could go as well, approval for
13 her to go.
14 MR. LESSLY: So we would need a motion for
15 final
approval, and once that's done, Maureen will in fact
16 spend the
money to register all of you.
17
DR. DESAI: I make a motion to
approve all
18 eight people's
expenditures to be paid for this meeting.
19
MR. LESSLY: Including Carol?
20
DR. DESAI: Yes, that makes
eight.
21
FROM THE FLOOR: Second.
22
VICE PRESIDENT BUCHWALD: There is
a second.
23 Any further
discussion? All in favor. Opposed?
Anybody
24 here that
doesn't want to go?
25
MR. LESSLY: I should point out
that not
0059
1 knowing when our bill, assuming it gets
through the
2 Senate, will get to the Assembly, my best
guess is it will
3 happen the week that all of you are gone to
Georgia and
4 that I am up in Oregon. Dr. Buchwald has agreed to be
5 available that week so that I can get on an
airplane and
6 fly back down here to go with Mr. Barengo to
the hearing
7 on that bill in the event that it happens in
that week,
8 and I'll bet you that it does.
9 VICE PRESIDENT BUCHWALD: Probably.
10 Request for
Approval of 2000 Board Annual Report
11 MR. LESSLY: Second item is the request for
12 approval of
2000 Board annual report. Maureen can
tell
13 you about
that.
14
MS. LYONS: It is in the agenda
books. I'm
15 sure you all
had a chance to look at it. It's basically
16 the same
information that we have been providing over the
17 past few
years.
18
The only page that is missing is the page
19 containing our
disciplinary action statistics as tallied
20 by the
Federation of State Medical Boards. The
reason
21 that page is
not in there yet is because we have not
22 received the
final tally of the statistics as categorized
23 by the
Federation. So that's not in there yet.
24 I
guess I would request approval of it
25 pending
receipt of that page, and that page is something
0060
1 they generate. So really it is -- I guess I'm asking for
2 approval in advance of what they provide.
3 VICE PRESIDENT BUCHWALD: Now would you
4 update the professional staff list?
5 MS. LYONS: Well, this is for the year 2000,
6 and Bryce did not start until 2001.
7 VICE PRESIDENT BUCHWALD: Got you.
Thank
8 you.
9 DR. TITUS: That was my question, too,
10 because I'm no
longer the chief of staff, but I guess I
11 was at the
time.
12
MS. LYONS: Next time we'll change
it.
13
VICE PRESIDENT BUCHWALD: Are
there any
14 questions
about the validity or any concerns about the
15 information in
the annual report? Do I have a
motion?
16 May I have a
motion?
17
DR. DESAI: I make a motion. Move that we
18 accept the
2000 annual report as presented.
19 DR. LUBRITZ: Second.
20
VICE PRESIDENT BUCHWALD: Somebody
pass the
21 cookies
around, please.
22
DR. DESAI: Someone second?
23
DR. LUBRITZ: Second.
24
VICE PRESIDENT BUCHWALD: Any
further
25
discussion? All in favor. Opposed?
0061
1 (Whereupon, the motion was put
to a vote
and carried.)
2
3 Consideration of Termination of Board Annual
Audit of
Supervising/Collaborating Physicians of Physician
4 Assistants and Advanced Practitioners of
Nursing
5 MR. LESSLY: Next item I have is my
6 suggestion to you that you terminate the
Board annual
7 audit of supervising/collaborating
physicians of physician
8 assistants and advanced practitioners of
nursing. You
9 remember we started this program off several
years ago by
10 going out and
looking at every PA to see that they were in
11 compliance
with all the regulations on practice of a PA.
12 We never had
any problems.
13
So then last time we went to -- they
14 literally put
the names of all the people in the hat, and
15 I drew out ten
percent and they went out, ten percent plus
16 all the Board
members, and they went out and did an audit
17 on them,
supervising/collaborating physicians and PA's and
18 AP's. We didn't find any problems. The wheel is not
19 broken, let's
don't fix it.
20
DR. DESAI: It is the same thing
we did in
21 1995, we
stopped the oral exam.
22
MR. LESSLY: Exactly. We gave 1100
23 examinations
over a period of time and we had one failure.
24
DR. DESAI: One failure.
25
MR. LESSLY: We said why are we
doing the
0062
1 exam.
My suggestion to you is if we thought -- if we
2 started hearing of problems, we would come
back to you.
3 But it's an awful expenditure of time,
travel, money and a
4 lot of staff time that I don't think is
accomplishing
5 anything right now.
6 DR. DESAI: I make a motion to terminate
7 Board annual audit of supervising and
collaborating
8 physicians of PA's and AP's.
9 DR. HUG-ENGLISH: Second.
10
VICE PRESIDENT BUCHWALD: I'd like
to say
11 that I don't
have a problem with the removal of the audit.
12 But I
certainly wouldn't want to take away the potential
13 for surprise
visits.
14
MR. LESSLY: It's always a
possibility.
15
DR. DESAI: If we got a complete
through IC,
16 we can always
send someone.
17
MR. LESSLY: Or if we start
getting a rash of
18 complaints
with PA's about something that concerned us, we
19 can always do
something at that point.
20
VICE PRESIDENT BUCHWALD:
Sometimes you don't
21 want to wait
until the complaints come in.
22
MR. LANZILOTTA: And I think if I
can say
23 something,
that it would be the responsibility of the PA
24 Board adviser
to keep the word out there that the
25 potential
exists, to keep people educated and reminded
0063
1 that it's in the NAC that that's a
regulation and should
2 be followed.
This is me speaking myself now.
But I would
3 still keep the word out, the selected charts
and the 10
4 percent that I spread around at the
meetings. That's my
5 own number.
I think that's safe and keeps good --
6 DR. BAEPLER: Don't let them know you lulled
7 us into complacence.
8 VICE PRESIDENT BUCHWALD: Any further
9 discussion?
All in favor. Opposed?
10
(Whereupon, the motion was put to a vote
and carried.)
11
Change in Physician Licensure Application
Process re:
12 Acquisition of
AMA Physician Profile
13 Informational
Items
14
MR. LESSLY: The other things are
strictly
15
informational. We have had a
change here within the
16 office on the
application process on requiring the AMA
17 physician
profile, which is one of the profiles that we
18 look at before
we license a physician. In the past we
19 have had the
physician get that profile. He has to
pay
20 for that. It has to be mailed to us.
21
We're now able to access the AMA data bank
22 and get that
profile on our own from the office. So
we
23 have started
doing that. That obviously speeds the
24 process
up. It's just as accurate. It's more accurate
25 because you
get it immediately.
0064
1 And it's no cost to take a
disposition. So
2 it cuts down the licensure cost to the
physician, and it
3 makes a much quicker process. That is strictly an
4 informational item.
5 VICE PRESIDENT BUCHWALD: Does it cost us?
6 MR. LESSLY: No, it does not cost us.
7 I was approached at the
reception for the
8 Federation officers at Las Vegas to inquire
if any of you
9 Board members would wish to serve on
committees of the
10 Federation
next year. Dr. Wynn made the error in
asking
11 Dr. Baepler if
he would be interested in serving on a
12 committee, and
he said, well, if you put me on a committee
13 that does
something, but otherwise I'm not interested in
14 serving on
it. He said, well, all your Board
members are
15 that way. I would like to ask all of them because that
is
16 the people we
want on committees.
17 So any of you want to serve on a
Federation
18 committee, he
suggests that a letter go from you to George
19 Drokoman over
in Salt Lake City, who is the incoming
20 president of
the Federation, on serving on whatever they
21 need you to
serve on or trying to pick a committee.
22
If any of you want to do that, if you will
23 let me know, I
have a fairly standard letter that we can
24 use for
that. Dr. Baepler. Anyone else?
25
DR. TITUS: I would be interested.
0065
1 MR. LESSLY: I'll get something to both of
2 you next week.
3 VICE PRESIDENT BUCHWALD: Paul.
4 MR. LESSLY: Paul.
Anyone else?
5 The next item I have to tell
you about is
6 something that's occurring in the
building. Jack Neil
7 asked me, who was moving out
downstairs. I don't know
8 because this thing is in a big transition
here.
9 The Regional Transportation Commission
has
10 purchased this
building. They are our landlord. They
11 have a
long-range plan to do a lot of things in this
12 building, one
of which is to when you get off the elevator
13 and walk into
our office to the left, the hallway that
14 runs all the
way down, and our licensing office is down
15 that hallway,
they have a plan to put in I suppose some
16 type of glass
door at that point and rip everything out
17 all the way
down to the end of the building and completely
18 open that
space up with a stairway downstairs to their
19 other offices
on the second floor. There is obviously
an
20 impediment to
us that is our space down there that is
21 leased to us.
22
They also have a plan that would
23 incorporate --
you have all been in this back storeroom
24 that we have,
the large office suite that has a door at
25 both ends, one
of them locked up where our file cabinets
0066
1 are all stored, all of our records and investigative
2 records.
They would like that space.
3 They came to us last week and
said we'd like
4 to talk to you about this, because I had
approached them
5 about what their long-range plan was. I wanted to know if
6 they were going to kick us out of this
building in three
7 years when our lease expires so we can at
least start
8 thinking about that.
9 Bob and I approached them about
it. Within
10 five minutes
from talking to the person who handles leases
11 here, we had
representatives from the Street and Highway
12 Commission
coming up here to talk to us. They want
our
13 space.
14
So we said, well, we'll accommodate you if we
15 can. So what we have got as a proposal is directly
below
16 us there is
another large office, I think it's bigger than
17 this office a
little bit, that is completely gutted.
We
18 would, if we
did this and you approved this, we would move
19 the licensing
specialists office to the room directly
20 below us. The stairway is right here for access. And we
21 can utilize
the furniture that we purchased, the new
22 furniture
that's been purchased for that space.
There is
23 a way to put
it in there and make it work. We would
set
24 that office up
with four work stations in it because if we
25 in fact do get
the respiratory therapists, there would be
0067
1 a fourth person down there.
2 Eventually some day I do see
that that will
3 expand to the point that we would need
another licensing
4 specialist.
So it would take care of any growth in the
5 licensing department.
6 In the meantime, they would
store all of our
7 file cabinets from the back room across the
hall in this
8 empty conference room area until the two
offices between
9 us and the investigative office become
available, at which
10 time they will
move our file cabinets into that area
11 between us and
the investigators's office for storage.
We
12 would lease
that from them, with the idea that even longer
13 range if we
need additional office space, and there isn't
14 going to be
any more available ever to us in this office
15 after this
move, we would then take our file cabinets out
16 there and
either move them to another building or off site
17 and be able to
expand into that office space long range.
18
This is an additional square footage of about
19 345 feet, 385
square feet. Our lease has three years
to
20 run. I said I'd like to have something in return
for
21 this. How about an extension of the lease? We have two
22 years
approved. I said I want three.
23 I
believe that Monday morning they will come
24 up and tell me
that they are willing to give us three.
25 And we
discussed a four percent per annum increase during
0068
1 those three years.
2 You will recall that this
building was in
3 bankruptcy or about to go into bankruptcy
with the
4 previous owner at a time a couple years ago,
and I decided
5 to renegotiate the lease or get an extension
to the lease.
6 And so I was able to get I think the
three-year period
7 that we're coming into with absolutely no
increase over
8 what we're paying this year.
9 So we have an extremely good
situation. I
10 believe that
if we don't do this, we will be gone at the
11 end of our
lease, and if we want to stay here, we need to
12 do this in
order to have the only possibility for future
13 expansion by
temporary storing next door.
14
DR. BAEPLER: If this worked out,
you would
15 have at least
six years?
16 MR. LESSLY:
Yes, sir. We would have six
17 years from
next July, we would have six years from next
18 June. They pay for the move. That's one of the other
19
conditions. The only thing we
would pay for would be
20 dropping the
computer lines, the phone lines, through a
21 hole in
Maureen's office back here, I suppose, and taking
22 care of the
security system with arming the door
23
downstairs. So I don't think it's
a substantial expense
24 to us.
25 I do not believe that the additional expense
0069
1 for the additional 385 square feet is that
significant,
2 and it takes care of our planning for at
least six years.
3 So I would like to negotiate that with them
on Monday, try
4 to get a proposed lease put together with
the general
5 terms that I have talked to you about and
ask for a
6 conference call Board meeting to approve
that so -- they
7 are anxious to start the move now, and they
have also said
8 that we can pick the carpeting, and the
ladies would like
9 to pick the appropriate carpeting and wall
colors
10 downstairs.
11
So I think it is an advantageous situation
12 for us, and I
would -- you tell me -- unless someone tells
13 me not to do
this, I'm going to go get a proposed lease
14 and ask for a
telephone conference call to approve it.
15
VICE PRESIDENT BUCHWALD: My only
concern is
16 the security
of those records if they are not contained
17 within the
office.
18
MR. LESSLY: You mean if we went
off-site?
19
VICE PRESIDENT BUCHWALD: No,
no. If they
20 are in a
storage closet.
21
MR. LESSLY: Those?
22
VICE PRESIDENT BUCHWALD: They are
within the
23 confines of
the office.
24
MR. LESSLY: There will be a
security system.
25
MS. LYONS: The same alarm system.
0070
1 MR. LEGARZA: I don't think they are going to
2 be over there that long because these guys
are already on
3 their way out.
4 MR. LUBRITZ: Larry, could you go and tell
5 them, assuming that this is a good place,
get a good rent,
6 whatever, that the Board would like to see a
five year
7 extension?
8 MR. LESSLY: I could try that.
9 DR. LUBRITZ: I mean if this is a good place
10 and good rent
and it is a good place.
11
MR. LESSLY: I don't believe they
will get
12 that to us,
Joel. I'll tell you why. I do believe they
13 have an
eventual game plan to occupy this entire building.
14 I think the
only reason I'm getting this extension is they
15 need our space
now for this space of development.
16
But I'll ask them for a ten year extension.
17 I want to get
all I can get, because you obviously make
18 money doing
that ahead of time. So sure, I will go
to
19 them and say
the Board would like a five year extension.
20 What can we
do? Maybe we can get four. Okay?
21
We will be starting --
22
VICE PRESIDENT BUCHWALD: Is there
any
23 further
discussion? Any recommendation?
24
MR. LESSLY: We will be starting registration
25 in two weeks
for the next biennium, so there will be a
0071
1 tremendous amount of mailing going out. We do this the
2 beginning of March and then later on as the
progress -- as
3 the registration progresses. We won't send out a second
4 mailing, but our game plan is to send out
the first
5 mailing by the first of March to hopefully
have it done by
6 the 15th of March. It's a process of awaiting returns and
7 processing them. That will be happening in two weeks.
8 The last thing I have for an
informational
9 item for you is at the next Board meeting in
June,
10 one-third of
our Board will be departing. We have a
11 reservation
for a dinner that night for Dr. Buchwald,
12 Mr.
Rosencrantz and Dr. Desai over at Bricks restaurant.
13 So the
schedule will be for June that we would have the
14 investigative
committee on Friday, with the intention of
15 going to
Bricks probably at 7:00 o'clock on Friday night
16 for that
departure dinner, and then the Board meeting on
17 Saturday. So you would all need to plan to be here
again
18 on that
Friday. Questions about that?
19 I
have no knowledge as to -- I have some
20 knowledge but
I have no definite knowledge as to interest
21 or who
potential replacements would be. I have
made it
22 known that it
would be advantageous to the Board from the
23 standpoint of
disciplinary actions to have those
24 appointments
made ahead of time if we could so that those
25 people could
get climatized. Any questions about
that?
0072
1 DR. HUG-ENGLISH: The dates on that again,
2 Larry, June 2nd?
3 MR. LESSLY: The dinner would be the 1st
4 and the Board meting on the 2nd. So it would be Friday
5 night and Saturday.
6 VICE PRESIDENT BUCHWALD: You don't
7 anticipate having a couple of hours of
meetings on Friday
8 then like we established at this point in
time?
9 MR. LESSLY: Sure.
10
VICE PRESIDENT BUCHWALD:
Okay. I was just
11 making that --
12
MR. LESSLY: I would hope we would
do a 4:30
13 meeting and go
to dinner and probably schedule full boards
14 again for the
morning like we did today. Does
everybody
15 think that is
the better way to do it instead of starting
16 them after
lunch when you are tired? We use
basically the
17 same schedule
we did for this meeting. And that is all
I
18 have to
discuss, Madam President.
19
VICE PRESIDENT BUCHWALD: Vice
president.
20 Any further
questions?
21
DR. LUBRITZ: If you wanted to get
the six
22 doctors who
were here for their applications, you could
23 save the mail
on six doctors.
24
MR. LESSLY: I hope that the six
doctors who
25 were here
would be -- you mean just to get it to you?
0073
1 DR. LUBRITZ: Sure.
2 MR. LESSLY: So you can get it to your front
3 office to fill it out for you. I'll be delighted to give
4 you a copy today.
5 VICE PRESIDENT BUCHWALD: That brings up the
6 question.
Are we going to make it absolutely clear once
7 again because we have set a precedent now,
that there is
8 going to be absolutely no grace period?
9 MR. LESSLY: It is on the form. We have
10 another Board
newsletter that will go out sometime in the
11 month of
April, which we will do like we have done in the
12 past, send to
you ahead of time for approval, and we don't
13 get objections
to it from the Board members, then we go
14 ahead and
print it and publicly send it out. We
will also
15 put an article
in that newsletter that goes to all of our
16 licensees
about there is no grace period.
17
VICE PRESIDENT BUCHWALD: In bold
print.
18
MR. LEGARZA: We're absolutely
positive that
19 every licensee
certainly has their current address with
20 us. We won't have any problems with that.
21
MR. LESSLY: We're sure a number
of those
22 will come
back.
23
VICE PRESIDENT BUCHWALD: None of
those 600
24 scheduled not
to be deliverable will be coming back.
25
0074
1 10.
Petition for Change of Status from Restricted County
Licensure Per
NRS 630.164 to Unrestricted Active Licensure
2
3 VICE PRESIDENT BUCHWALD: If there is no
4 further issues, let's move on to number 10,
which is the
5 petition for change of status from
restricted county
6 licensure per NRS 630.164 to unrestricted
active
7 licensure.
This is regarding Dr. Gregory Nielsen under
8 tab 10.
I'll open it for discussion.
9 DR. DESAI: Make a motion to change the
10 status of Dr.
Gregory's license from restricted to
11 unrestricted.
12
DR. HUG-ENGLISH: Second.
13
VICE PRESIDENT BUCHWALD: Any
discussion?
14 All in
favor? All opposed? Chair votes in favor of the
15 motion.
16
(Whereupon, the motion was put to a vote
and carried.)
17
11. Petition for Restoration of Restricted
Licensure to
18 Full
Unrestricted Licensure
19
VICE PRESIDENT BUCHWALD: Number
11 is the
20 petition for
restoration of restricted licensure to
21 full --
unrestricted licensure. This is on Dr.
Rodney
22 Handsfield stating
that this request has been withdrawn.
23
MR. LEGARZA: The request hasn't
been
24
withdrawn. The petition hasn't
been withdrawn, but
25 Dr.
Handsfield's attorney has indicated a couple of weeks
0075
1 ago that he couldn't be here, and I sent him
back the
2 schedule as to when the Board meets, and I
have got
3 correspondence yesterday that he wants to
put it on the
4 September agenda.
5 VICE PRESIDENT BUCHWALD: Good.
That is a
6 good month.
7 DR. LUBRITZ: I don't know if that is a good
8 month because that will be when new members
are here and
9 they won't have previous background.
10
DR. TITUS: I won't be here in
September.
11 I'll be on a
river.
12
DR. HUG-ENGLISH: I don't think we
can -- I
13 mean, if
that's when they want to put it on, I don't think
14 we can really
control that, can we?
15
MR. LEGARZA: The lawyer said that
Saturday,
16 March the 3rd,
was inconvenient for him and wanted me to
17 call him so we
could set up a mutual date for the Board to
18 hear the
petition. I wrote him back a letter,
said the
19 Board meets on
the following three Saturdays, June,
20 September and
December. I told him you can pick
whatever
21 you want. He picked September.
22
DR. BAEPLER: Those new members
can be
23 brought up to
speed on an item like this.
24
MR. LESSLY: Besides that, the old
members
25 may still be
here. Who knows.
0076
1 13.
Ratification of Licenses Issued, and Reinstatements
of Licensure
and Changes of Licensure Status Approved
2 Since the December 1 & 2, 2000 Board
Meeting
3 VICE PRESIDENT BUCHWALD: Under tab 13 is a
4 listing of the new licenses issued,
reinstatement of
5 licenses.
6 DR. DESAI: Make a motion to accept it.
7 DR. HUG-ENGLISH: Second.
8 VICE PRESIDENT BUCHWALD: Any discussion?
9 Okay.
All in favor. Opposed?
10
(Whereupon, the motion was put to a vote
and carried.)
11
12 14. Matters for Future Agenda
13
VICE PRESIDENT BUCHWALD: Matters for
future
14 agenda. Joel.
15
DR. LUBRITZ: The letter that we
got from
16 Mr. Lessly
about the incorrect information that was given
17 by Larry
Mathias in the Gazette I think needs some
18 correction,
and I'd like to be able to discuss that.
19
VICE PRESIDENT BUCHWALD: Can we
put it on
20 the agenda?
21
MR. LESSLY: You can put it -- it
is not
22 really an
action item, but if you want to do something by
23 consensus, you
can talk about your concern.
24
DR. LUBRITZ: My concern is that
information
25 isn't
accurate, and I think that it needs to be accurate.
0077
1 MR. LESSLY: The information in the letter is
2 accurate, but Mathias' information isn't
accurate.
3 DR. LUBRITZ: Exactly.
4 MR. LESSLY: Does everyone know what we're
5 talking about?
6 VICE PRESIDENT BUCHWALD: I'm lost.
7 MR. LESSLY: Mr. Mathias ran an article in
8 the local newspaper here as a part of the
Medical
9 Association's anniversary or something, and
Dr. Lubritz
10 has a copy of
it if any of you want to see it. And he
11 said that the
greatest thing, one that I recall, greatest
12
accomplishments of which they were very pleased was their
13 getting the
bill through the Legislature to require three
14 years
postgraduate education in Nevada and that we were
15 now the
standard, and I had sent a memo to you indicating
16 I don't
remember seeing that in there, and neither does
17 Tom Skully,
and we were the two people who presented the
18 bill in 1985.
19
DR. BAEPLER: You hired an expert.
20
MR. LESSLY: We had an expert from
Washington
21 D.C. I asked Dr. Skully what he remembered. His memory
22 parallels
mine.
23
VICE PRESIDENT BUCHWALD: What's
to be
24 gained?
25
DR. LUBRITZ: Just setting the
record
0078
1 straight.
My same thought is what's to be gained with all
2 the hassle that we get from the Medical
Association?
3 DR. STEWART: I would like to see the hassle
4 we get from the Medical Association to go
away, but I
5 don't necessarily know how to get that
on. So therefore,
6 I see nothing to be lost in setting the
record straight.
7 DR. BAEPLER: The letter had a semihumorous
8 tone to it, the type of thing where he
should have been
9 copied at least, really. I would not at all mind
10 conveying to
him the message Larry conveyed to us in this
11 letter in the
style that you conveyed to see how he
12 responds.
13
MR. LESSLY: One of the other
things that
14 could occur, I
suppose, if I wrote him a letter and it
15 indicate it
was my feeling that this Board felt that he
16 ought to make
that correction, and I would offer him the
17 services and
medium of our newsletter in the month of
18 April, which
goes to all of our licensees, not just the
19 half that
belong to the Medical Association, I would give
20 him an
opportunity to put an article -- I'm the editor of
21 that
newsletter -- I would give him an opportunity to use
22 our newsletter
free of charge to correct the error he's
23 made.
24
DR. DESAI: Ignore him.
25
DR. HUG-ENGLISH: Yeah, I think
that I'm not
0079
1 sure that it wouldn't just further the sort
of animosity
2 or antagonism that seems to exist if we do
this. I'm not
3 sure that -- I have no problem in pointing
out to him that
4 he shouldn't have done it in a letter or
having Larry
5 write a letter saying I think this
information was
6 incorrect and the Board had some concerns
about it. But
7 I'm not sure that -- I don't think he's
going to print a
8 retraction in the newsletter.
9 DR. LUBRITZ: He doesn't have to. We can.
10 See, my
thought is if you let people continue to do the
11 things that
they do, that you feel are incorrect, you're
12 inviting
more. And that's just my opinion.
13
So my thought is set him straight on those
14 matters that
you can set him straight on. This is
just a
15 small thing,
and I agree with you, I don't think it's
16 going to --
Paul said it's not going to make things go
17 away, and it
is certainly not going to make things any
18 worse because
I'm not sure that they can get any worse.
19 DR. TITUS: One of the highest forms of
20 compliments is
to mimic somebody else's behavior, and if,
21 Larry, in this
article he said one of the Nevada State
22 Medical
Associations's lasting legacies to sponsor
23 legislation is
that that is what we're referring to,
24 obviously,
they were quite against it at the time, the
25 Board, and I
wasn't a member of it, put that through but
0080
1 now they have embraced it. I think a letter to him with a
2 copy to the current president, that we are
happy that you
3 have embraced this legislation after these
many years but
4 just a general reminder.
5 MR. LESSLY: But they didn't sponsor it.
6 DR. TITUS: Just a general reminder of who
7 sponsored the legislation. You read it and caught it, and
8 we're now glad they want it to be theirs.
9 MR. LESSLY: If I prepared a letter and the
10 president sign
such a letter.
11
VICE PRESIDENT BUCHWALD: The one
is not
12 here.
13
MR. LESSLY: This is what you get
when you
14 leave the
meeting. I suppose none of this Board
would be
15 upset? Okay.
16
DR. TITUS: Would that help?
17 VICE PRESIDENT BUCHWALD: Any matters for
18 future
agenda? Take under advisement that I
just read
19 this NRS
241.2020 for public comment. This
meeting is
20 adjourned.
21
(Meeting adjourned at 2:57 p.m.)
22
23
24
25
0081
3 , 2001, and thereafter took stenotype notes
of the
0082
1 proceedings, and thereafter transcribed the
same into
2 typewriting as herein appears;
3 That the foregoing transcript
is a full, true
4 and correct transcription of my stenotype
notes of said
5 proceedings.
6 Dated at Reno, Nevada, this
26th day of
7 March, 2001.
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12 ERIC V.
NELSON, CCR #57
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SIERRA NEVADA REPORTERS (775) 329-6560
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