0001
1 BEFORE THE NEVADA STATE BOARD OF MEDICAL
EXAMINERS
2 -oOo-
3
4
5 BOARD MEETING
6
7
8
9 SATURDAY, SEPTEMBER 8, 2001
10
11
12
13
14
15
State Medical Board Offices
1105 Terminal Way
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
0002
1 A P P E A R A N C E S
2
BOARD MEMBERS PRESENT
3
4 CHERYL A. HUG-ENGLISH, M.D., PRESIDENT
PAUL S.
STEWART, M.D.
5 JACQULINE C. JONES, Ed.D.
JOEL N.
LUBRITZ, M.D.
6 DONALD H. BAEPLER, Ph.D.
SOHAIL U.
ANJUM, M.D.
7 MARLENE J. KIRCH
STEPHEN K.
MONTOYA, M.D.
8
9
EXECUTIVE DIRECTOR
10
11 LARRY D.
LESSLY
12
DEPUTY EXECUTIVE DIRECTOR
13
14 MAUREEN E.
LYONS
15
GENERAL COUNSEL
16
17 RICHARD J.
LEGARZA
18
DEPUTY ATTORNEY GENERAL
19
20 CHARLOTTE
BIBLE
21
PHYSICAL ASSISTANT ADVISOR
22
23 NANCY E. MUNOZ
24
25
SIERRA NEVADA REPORTERS (775) 329-6560
0003
1 I N D E X
PAGE
2
1. CALL TO ORDER 1
3
3. ANNOUNCEMENT OF COMMITTEE APPOINTMENTS 2
4
4. CONSIDERATION OF AMENDMENT TO NEVADA
5 ADMINISTRATIVE CODE CHAPTER 630
6 11.
PERSONNEL 12
7 12.
CONSIDERATION OF REQUEST OF THOMAS J.
BRUMFIELD, M.D. FOR REMOVAL OF RESTRICTIONS
8 FROM HIS LICENSE NO. 2051 TO PRACTICE
MEDICINE
IN THE STATE OF NEVADA
13
9
13. CONSIDERATION OF PETITION OF RODNEY G.
10
HANDSFIELD, M.D. TO RESTORE HIS LICENSE
NO. 5354
TO PRACTICE MEDICINE IN THE
11 STATE OF
NEVADA
26
12 14. CONSIDERATION OF REQUEST FROM CARLOS E.
FONTE,
M.D. FOR APPROVAL OF MEDICAL
13 TRAINING
PER NRS 630.047(1)
35
14 15. PETITION FOR APPROVAL TO ALLOW
SIMULTANEOUS
COLLABORATION/SUPERVISION OF MORE THAN THREE
15 ADVANCED
PRACTITIONERS OF NURSING/PHYSICIAN
ASSISTANTS PER NAC 630.495(2) 47
16
16. CONSIDERATION OF REQUEST OF DAVID A.
17 ROSIN,
M.D., STATE MEDICAL DIRECTOR,
DIVISION OF MENTAL HEALTH AND
DEVELOPMENTAL
18 SERVICES,
TO WAIVE NEVADA STATE MEDICAL
LICENSURE
LAWS
50
19
17. ACCEPTANCE OF APPLICATIONS FOR LICENSURE 116
20
18. ACCEPTANCE OF APPLICATIONS FOR LICENSURE 50
21
19. RATIFICATION OF LICENSES ISSUED, AND
22
REINSTATEMENTS OF LICENSURE AND CHANGES
OF
LICENSURE STATUS APPROVED SINCE THE
23 JUNE 1
& 2, 2001 BOARD MEETING
116
24
25
SIERRA NEVADA REPORTERS (775) 329-6560
0004
1 I N D E X
(Continued)
2
PAGE
3 20.
REPORTS 118
Diversion
Program
118
4 Physician Assistant Advisory
Committee 124
Practitioner of Respiratory Care
5 Advisory Committee 129
Committee
to Study Post-Licensure
6 Continuing Competency Evaluation 135
Investigative Committee 139
7 Secretary-Treasurer 140
Colorado
Personalized Education for
8 Physicians Program 150
9 21.
LEGAL REPORTS 152
10 22. EXECUTIVE DIRECTOR'S REPORT 158
11 23. CONSIDERATION OF REQUEST BY NEVADA STATE
MEDICAL
ASSOCIATION FOR CHANGE TO NAC
12
630.230(l)AND NAC 630.230(m) 83
13 24. DISCUSSION AND CONSIDERATION OF
CORRESPONDENCE 183
14 25. MATTERS FOR FUTURE AGENDA 191
15 26. PUBLIC COMMENT 192
16
17
18
19
20
21
22
23
24
SIERRA NEVADA REPORTERS (775) 329-6560
25
0001
1 RENO, NEVADA, SATURDAY, SEPTEMBER 8,
2001, 8:50 A.M.
2 -o0o-
3
4 1.
Call to Order
5 PRESIDENT HUG-ENGLISH: I'll call the meeting
6 of the Nevada State Medical Board Examiners
to order of
7 September 8, 2001.
8 Welcome everybody this
morning. We do have
9 representatives here from PA Advisory
Committee and
10 Respiratory
Therapy Advisory Committee. Can you
state
11 your names for
the record?
12
MR. KESSINGER: Steve Kessinger,
respiratory
13 therapy.
14
MR. LANZILOTTA: John Lanzilotta,
physician
15 assistant.
16
MS. MUNOZ: Nancy Munoz, physician
assistant.
17
PRESIDENT HUG-ENGLISH: Again I want
to just
18 welcome our
new Board members, Dr. Anjum, Marlene Kirch,
19 Steve Montoya
to the Board.
20 I
need to let everybody know that this
21 morning we are
going to be jumping in and out of open to
22 closed
session. So it may be a little
disruptive for a
23 bit. The issues on the pain regulations, as well
as the
24 mental health
issues, will be dealt with after lunch about
25 one o'clock.
0002
1 3.
Announcement of Committee Appointments
2 PRESIDENT HUG-ENGLISH: The first item,
3 Agenda Item No. 3 this morning, I want to
deal with some
4 committee appointments. The first one is for the Internal
5 Affairs Committee. Jackie Jones is the chair of that
6 committee.
Dr. Lubritz also is on Internal Affairs
7 Committee, and Dr. Stewart is on it as well.
8 The second committee is one
that we need to
9 talk about a little bit. This is a committee to study
10 post licensure
continuing competency evaluation. As we
11 talked about a
little bit in past Board meetings, we had a
12 subcommittee,
Don Baepler has chaired that committee,
13 Arne
Rosencrantz has been on that as well, working with
14 the Federation
trying to come up with ideas as to what if
15 anything we
need to do to look at measuring competency for
16 physicians
that's different than what we're doing now.
17
So currently Don Baepler is chairing that,
18 Arne
Rosencrantz has indicated he would like to continue
19 to be on that
committee. Dr. Buchwald has an interest
in
20 continuing on
that committee. Dr. Stewart has agreed
to
21 be on the
committee.
22 I
would love to have at least one or two
23 different
Board physician members to be on that committee
24 to look at
this. I'm going to serve as ex-officio
member,
25 but I think it
is an important issue and one that I would
0003
1 welcome input. If anyone has interest.
2 Joel, would you like to be on that?
3 MEMBER LUBRITZ: Yes.
4 PRESIDENT HUG-ENGLISH: Anybody else?
5 MEMBER MONTOYA: I will.
6 PRESIDENT HUG-ENGLISH: Now that you have all
7 agreed to that, there is a meeting scheduled
October 24th
8 that will be in Reno with some folks from
the Federation
9 to talk about how we proceed from here. We can get you
10 that
information. But it is the 24th.
11 4. Consideration of Amendment to Nevada
Administrative
Code
Chapter 630
12
13
PRESIDENT HUG-ENGLISH: Moving on
to Agenda
14 Item No. 4,
Dick is going to tell us a little bit about a
15 change to
continuing medical education requirements that
16 we forgot to
deal with last time.
17
MR. LEGARZA: At the conference
call meeting
18 that you had
where you authorized me to go out in the
19 workshops to
conduct the workshops on respiratory therapy
20 stuff and the
rest of the changes in the regulations
21 adopting the
temporary regulation and the other stuff, as
22 you may
recall, the Investigative Committee met that day
23 here in Reno,
had a telephone conference call with folks
24 located in different
locations in Las Vegas, and a bunch
25 of people here
in the office and the IC met that day.
0004
1 They requested of me to request
of the Board
2 the time that we talk about the regulations,
which I
3 didn't do, I forgot to do, and when I forgot
to do it I
4 contacted the President before she left that
day and asked
5 her if I could include something in there
that I hadn't
6 sent you in the earlier packet. So there is a section 40
7 in the regulations that I have included in
the regulations
8 that you did not discuss earlier.
9 I have included it in there
because we were
10 in a hurry to
get the regulations going and the workshops
11 going on the
respiratory therapists. That is a
proposed
12 new paragraph
4 in addition to NAC 630.153.
13
We have sometimes a problem getting peer
14 reviews. The doctors are good about it, but a lot of
15 times it's
very difficult to get doctors to peer reviews,
16 and we try to
not pay them a lot of money and we don't pay
17 them a lot of
money. Most of them do it for nothing
when
18 they do it for
us.
19
The Investigative Committee felt that maybe
20 we should
consider, and that's why I have it in here, the
21 possibility of
giving doctors some CME credit for doing
22 peer review
for us. Our statute says you have to
have,
23 regulations
say you have to have category one CME and have
24 to get 40
hours in the biennium.
25
The committee proposed, and I have added it
0005
1 in here for your consideration and you can
say yes or no.
2 If you say no, it will come out of the
workshops. The
3 Board may issue continuing education hours
to any holder
4 of a license to practice medicine for the
performance of
5 any medical review for the Board. The hours issued by the
6 Board shall be proportionate to the medical
review
7 performed and may be applied to the total
hours required
8 for biennial registration.
9 I would suggest to you that
medical reviewers
10 that do
reviews for us, we always pick someone in the same
11
specialty. We always pick someone
from a different
12 geographical
area of the state. If we are looking at
a
13 physician from
the north, we pick a physician from the
14 south, and
visa versa. They tell us that they work
hard,
15 they have to
go to the books, they have to do a bunch of
16 things.
17
We talked about CME a little bit yesterday.
18 The committee
feels and IC felt and wanted to suggest that
19 you consider
giving our peer reviewers some CME credit for
20 that.
21
That is why it is in here, and that is why
22 it's on here
for your discussions. If you say yes,
we'll
23 proceed with
it at the workshops. If you say no, I'll
24 kill it in the
workshops.
25
MEMBER BAEPLER: I thought we
agreed we can't
0006
1 give CME per se but we would reduce the
requirements, like
2 from 40 to 37 or 35 because we have to have
those CME
3 credits accredited by somebody else.
4 MR. LEGARZA: No, I don't think we do. Our
5 regulation says it has to be category one
CME. This
6 proposed new regulation says that we may
give these in
7 lieu of that.
8 MEMBER BAEPLER: Well, what is the technical
9 difficulties of us giving CME credits? For the Federation
10 meetings they
do not give CME credits. They find a
11 sponsor that
examines the content of the meeting and
12 determines how
many credits it's worth. I just thought
13 that we would
for those individuals reduce their
14 requirement
from 40 to 35 or whatever it is.
15
MR. LESSLY: Don, that is because
to do that
16 they have to
be authorized to issue category one AMA
17 credit. What we're really saying in this, this
doesn't
18 have to be
category one AMA. You either have to
have
19 category one
AMA or credit from this Board for doing a
20 peer review.
21
MEMBER BAEPLER: Would these
credits have to
22 be used
anyplace other than for our requirement?
23
MR. LESSLY: No.
24
MEMBER BAEPLER: If they are
strictly
25 in-house, they
don't need it for a specialty?
0007
1 MR. LESSLY: You can take that credit from us
2 and go anywhere else. They couldn't get credit from the
3 AMA.
4 MEMBER BAEPLER: Essentially it is the same,
5 isn't it?
6 MR. LESSLY: Yes.
7 MEMBER ANJUM: Not use it for actual CME
8 hours anywhere else. What he is saying is correct, too,
9 you just give them three or four hours per
year which
10 amounts to the
same thing. If you want to give CME
hours,
11 it has to be
an educational.
12
MR. LEGARZA: Correct. We have a doctor that
13 does peer
review for us. He sends in a piece of
paper
14 that says he
did five hours in that peer review. When
it
15 comes time for
the biennial registration, he would only
16 have to send
us 35 hours of CME of category one because we
17 would have
given him credit for those five hours in lieu
18 of that
portion against the 40.
19
MEMBER STEWART: My question is,
the law says
20 40 hours of
category one CME, doesn't it?
21
MR. LEGARZA: The regulation says
--
22
MR. LESSLY: The legislature just
said you
23 will require
CME, but they left it up to us how to do it.
24 You can change
the reg and take out AMA.
25
MEMBER STEWART: I thought it was
a law law.
0008
1 MR. LEGARZA: We can change them to
2 noncategory one. It is all regulation.
3 PRESIDENT HUG-ENGLISH: Would it be simpler
4 to just say that -- I think where it gets
complicated is
5 that if someone is a family practice
physician and needs
6 category one CME, that this does not replace
that. I
7 think that's where the discussion is coming
up, that you
8 would not be able to use this, these hours
for that.
9 So read the wording again,
Dick.
10 MR. LEGARZA: The wording doesn't limit it
11 to -- we
require 20 hours in scope of practice, and 20
12 hours
generally. This language wouldn't limit
it to
13 nonscope of
practice. My representation to you would
be
14 that the peer
review stuff they are doing is in their
15 scope of
practice. I think the way it's worded
now, it
16 would qualify
in either one, either in the scope of
17 practice or
the other 20 hours. Probably wouldn't
qualify
18 for medical
ethics portion of it.
19
MR. LESSLY: You wouldn't be
asking the
20 person to do
it unless it was within their scope of
21 practice.
22
MR. LEGARZA: That is
correct. If we are
23 looking at a
family practitioner in the north, we're going
24 to get a
family practitioner in the south to look at that
25 person.
0009
1 PRESIDENT HUG-ENGLISH: I guess the issue is
2 it would meet our requirements for licensure
but would not
3 meet any specialty requirements for CME.
4 MR. LEGARZA: That is correct. We require 40
5 hours of CME in the biennium. This proposal says we'll
6 give you CME credit for doing peer reviews
for us up to
7 and including I suppose the 40 hours
depending on how many
8 they get.
9 MEMBER ANJUM: I think that is a better
10 wording. Credit for CME rather than giving CME.
11
MEMBER MONTOYA: How does it say
it in there?
12 The way you
read it, it isn't clear to me.
13
PRESIDENT HUG-ENGLISH: Why don't
you read it
14 again, Dick.
15
MR. LEGARZA: "The Board may
issue continuing
16 medical
education hours to any holder of a license to
17 practice medicine
for the performance of any medical
18 review for the
Board. The hours issued by the Board
shall
19 be
proportionate to the medical review performed."
20
MEMBER BAEPLER: Excuse me. Using hours
21 instead of
credits is important.
22
MR. LEGARZA: "Any hours
issued by the Board
23 for medical
review may be applied to the total hours
24 required for
biennial registration."
25
MEMBER ANJUM: Hours, not CMEs.
0010
1 MEMBER BAEPLER: Shall we have an upper limit
2 for the person that said they spent 20 hours
on the peer
3 review?
4 MR. LEGARZA: We could kill it, we can adopt
5 the concept, we can modify the concept with
an upper hours
6 thing.
Whatever is your pleasure. This
is a suggestion
7 of the Investigative Committee.
8 MEMBER LUBRITZ: I would think we should
9 probably limit it to 20 hours or 20 credits,
and if it
10 helps, it
helps. If it's not something that people
choose
11 to take in,
they don't have to.
12
MR. LEGARZA: That is
correct. Just like
13 they don't
have to charge us if they don't want to.
Many
14 of them don't.
15
MEMBER LUBRITZ: Are you looking
for a
16 motion?
17
PRESIDENT HUG-ENGLISH: Is
everybody feeling
18 okay about
this?
19
MEMBER ANJUM: 20 hour limit per
case, for
20 two years?
21
PRESIDENT HUG-ENGLISH: That
two-year period.
22 So you may
review five cases, or you may review 20 cases,
23 but the most
that you could submit would be 20 hours.
24
MEMBER LUBRITZ: It's a lot of
work when you
25 sit down and
review cases and whatever, and it certainly
0011
1 is in the specialty in which you practice.
2 MEMBER BAEPLER: Oh, you learn.
3 MEMBER LUBRITZ: Seems reasonable.
4 MEMBER KIRCH: The general idea of this is to
5 have it at the workshops, for comment and
input. It would
6 come back for final adoption?
7 MR. LEGARZA: It is in the document that has
8 been circulated, the language that I read to
you. It is
9 in that document. That will be a subject to be discussed
10 at the
workshops as well as everything else that is in the
11 document.
12
Then we have to take the workshop record and
13 transcript,
and that all has to come back, that has to be
14 provided to
you people to read, to look at, so that you
15 can then make
your decision as to what you are going to do
16 in the
adoption or lack thereof of the regulations.
17
MEMBER KIRCH: So we could take
the public
18 input or anything
like that and make modifications. I
19 don't see a
problem letting it go out for comment
20 basically at
this point in time.
21
MR. LEGARZA: That's what it is.
22
MEMBER KIRCH: As long as we still
have the
23 opportunity to
modify it in a final form.
24
MR. LEGARZA: You do.
25
PRESIDENT HUG-ENGLISH: So I guess
I would
0012
1 need a motion that we would accept this
proposal to be
2 presented at the workshops.
3 MR. LEGARZA: With a 20-hour limit.
4 PRESIDENT HUG-ENGLISH: With the addition of
5 the 20-hour limit.
6 MEMBER BAEPLER: I would so move.
7 MEMBER LUBRITZ: Second.
8 MEMBER KIRCH: Second.
9 PRESIDENT HUG-ENGLISH: There is a motion and
10 the
second. All in favor? Opposed?
Chair votes in favor
11 of the
motion. The motion carries.
12
(Whereupon, the motion was put to a vote
and carried unanimously.)
13
PRESIDENT HUG-ENGLISH: What date
are those
14 workshops,
Dick?
15
MR. LEGARZA: The first workshop
is next
16 Wednesday in
Las Vegas at the Sawyer Office Building, room
17 4412,
beginning at 10:00 o'clock in the morning.
The
18 second
workshop is here on Thursday, the 13th, at 10:00
19 o'clock in the
morning.
20 11. Personnel
21
PRESIDENT HUG-ENGLISH: Number 11.
22 MR. LESSLY: Could I ask we have an executive
23 session for
that?
24
PRESIDENT HUG-ENGLISH: I need a
motion to go
25 into closed
session.
0013
1 DR. LUBRITZ: So move.
2 PRESIDENT HUG-ENGLISH: All in favor?
3 Opposed?
We are now in closed session.
4 (Closed session held at 9:04
a.m.)
5 (Open session resumed at 9:09
a.m.)
6 PRESIDENT HUG-ENGLISH: We are in open
7 session.
8 MEMBER STEWART: I make a motion that we
9 approve $2480 for calendar year retroactive
July 1st for
10 his good
efforts.
11
MEMBER KIRCH: Second.
12
PRESIDENT HUG-ENGLISH: There's
been a motion
13 and a
second. All in favor. Opposed?
Chair votes in
14 favor of the
motion and the motion carries.
15
(Whereupon, the motion was put to a vote
and carried unanimously.)
16
17 12. Consideration of Request of Thomas J.
Brumfield, M.D.
for
Removal of Restrictions from his License No. 2051
18 to
Practice Medicine in the State of Nevada
19
PRESIDENT HUG-ENGLISH: Our next
agenda item
20 is number 12
and consideration of Thomas Brumfield for
21 removal of
restrictions from his license to practice
22 medicine in
the State of Nevada.
23
MR. LEGARZA: Dr. Brumfield is
here?
24
MEMBER STEWART: He was on the
plane coming
25 up with us.
0014
1 PRESIDENT HUG-ENGLISH: Dr. Brumfield,
2 welcome to the State Board of Medical
Examiners. I'm
3 Cheryl Hug-English, President of the
Board. These are
4 other Board members, our attorneys and our
staff. I want
5 to welcome you today.
6 You're here today because you
are requesting
7 a change in your status of your Nevada
license from
8 inactive to active. I'm sorry.
You are here to lift the
9 restrictions that were put on that license.
10
DR. BRUMFIELD: Right.
11
PRESIDENT HUG-ENGLISH: The
restrictions were
12 that you
should not prescribe and dispense controlled
13 substances and
not obtain a DEA certificate. Do you
have
14 any comments
that you'd like to make?
15
DR. BRUMFIELD: Well, since I
suppose in the
16 past two, two
and-a-half years, chain drug stores have
17 increased in
the area of Las Vegas, and they require a DEA
18 number for all
patients with insurance forms, whether it's
19 controlled
substance or not, an increasing number of my
20 patients are
being denied that because I don't have any
21 DEA
number. So they are denied insurance for
their
22 prescriptions
that have nothing to do with controlled
23 substances.
24
PRESIDENT HUG-ENGLISH: So you are
basically
25 asking not
only, though, for a DEA number but lifting the
0015
1 restrictions placed on you to prescribe
controlled
2 substances; is that my understanding?
3 DR. BRUMFIELD: Well, in the past, it must
4 have been maybe 12 years ago, at that time I
was retiring,
5 selling my practice and retiring. And the Board mainly
6 had a complaint about class II controlled
substances. Now
7 I'm requesting to apply for only class III,
IV and V.
8 PRESIDENT HUG-ENGLISH: Do any of the Board
9 members have questions for Dr. Brumfield?
10
MEMBER JONES: I'm confused on the
DEA number
11 and the
insurance. I don't understand that part.
12
DR. BRUMFIELD: Well, they do that
for
13 billing
purposes. They use that number to bill
for the
14 insurance, and
why they do this, I don't know. But they
15 use a DEA
number to --
16
MEMBER JONES: If this is just in
regard to
17 their
prescription, the person who is prescribing
18 obviously has
a DEA number. So why wouldn't they use
that
19 number?
20 DR. BRUMFIELD: I don't know why they use it
21 but they
certainly do. Unless they have a DEA
number
22 there, they
will not process the insurance claim.
That's
23 Walgreens and
Longs and Sav-On and several others.
24
PRESIDENT HUG-ENGLISH: Larry.
25
MR. LESSLY: May I ask a
question. Are you
0016
1 saying, Doctor, that you can't write Dr.
Baepler a
2 prescription for penicillin unless you have
a DEA number
3 on record?
4 DR. BRUMFIELD:
I can write the prescription.
5 MR. LESSLY: They won't fill it?
6 DR. BRUMFIELD: They will fill it, but the
7 insurance, when they have insurance, the
patient has
8 insurance on prescriptions, they won't file
for a claim so
9 that they can collect money on their
insurance for the
10
prescription. They will fill the
prescription, but they
11 won't apply
for a claim.
12
MR. LESSLY: So it is a matter
between the
13 patient and
the insurer. Okay.
14
MEMBER LUBRITZ: Dr. Brumfield,
what specific
15 medications do
you feel that you would like to honor that
16 are controlled
in III, IV and V?
17
DR. BRUMFIELD: Well, mainly I
suppose like a
18 cough syrup or
a mild type of diazepam medication,
19 diazepam, one
of those type things.
20
PRESIDENT HUG-ENGLISH: Dr.
Brumfield, do you
21 understand
that the Board in looking at this, the
22 reasoning for
placing the restriction on your license
23 before was
because you had some real problems with
24 prescribing
controlled substances?
25
DR. BRUMFIELD: Yes, I understand
that.
0017
1 PRESIDENT HUG-ENGLISH: Can you explain to
2 the Board what's changed in that that would
make us want
3 to change that stipulation on your license
at this time?
4 DR. BRUMFIELD: Well, I think it's not a fair
5 situation when a DEA number is required for
people to get
6 a claim filed for their insurance, and also
DEA numbers
7 are required for certain -- if you want to
get a CME
8 credit that is on the Internet, you can't
register in the
9 Internet without a DEA number.
10 MR. LEGARZA: I beg your pardon? Would you
11 say that
again, sir?
12
DR. BRUMFIELD: There are certain
CME credits
13 that are
offered on the Internet, such as ethics, and
14 there's other
things, too, that are offered on the
15 Internet, and
they require when you register on the
16 Internet to
get that course and credits, that they require
17 a DEA number.
18
MR. LEGARZA: What does that have
to do with
19 prescribing
IIs, IIIs, IVs and Vs controlled substances,
20 sir?
21
DR. BRUMFIELD: It really has
nothing to do
22 with it.
23
MR. LEGARZA: There are a number
of
24 physicians in
this state that do not have DEA numbers that
25 prescribe.
0018
1 MEMBER STEWART: And they are with the nurse
2 practitioners before that, physician
assistants, and do
3 not need DEA numbers. Now I don't know. Can you get a
4 DEA number and not check any box?
5 DR. BRUMFIELD: DEA number and not what?
6 MEMBER STEWART: Check any box in regard to
7 whether you want II, II-A, III, IV, V?
8 DR. BRUMFIELD: Yes.
On a DEA application
9 you mark there what classifications that you
apply for,
10 whether it is
II, III, IV, V.
11
MEMBER STEWART: But my question
is the
12 opposite of
that. Can you apply for a DEA number and
opt
13 out of
checking any box?
14
DR. BRUMFIELD: Oh, I don't have
any idea.
15
PRESIDENT HUG-ENGLISH: My
understanding is
16 you have to
check the boxes, but you can limit the boxes
17 you
check. In other words, you can check all
of them, II,
18 III, IV, V, or
you can limit it, check III, IV, V or IV,
19 V. So you can sub limit what boxes you check,
but I don't
20 think they
would process it if you didn't check any boxes.
21 I think you
have to check something.
22
MEMBER BAEPLER: Are the pharmacists
aware of
23 that?
24
PRESIDENT HUG-ENGLISH: Yes.
25
MEMBER BAEPLER: They would look
up the
0019
1 category and see what's --
2 PRESIDENT HUG-ENGLISH: That's my
3 understanding, that if you limit the DEA
number to not
4 prescribing.
I mean certain physicians who have, for
5 example, research studies that involve other
drugs, that
6 would be listed, and that goes into the
pharmacies. But I
7 don't know how closely -- I mean I don't
know how closely
8 they check that on a routine basis.
9 MR. LESSLY: Is he asking for a DEA number
10 and continue
the restriction that he still can't prescribe
11 controlled
substances, or is he asking for a DEA number
12 and be able to
prescribe controlled substances?
13
MEMBER BAEPLER: He is asking for
III, IV, V.
14
MEMBER ANJUM: DEA number and III,
IV, V.
15 The concern is
how do pharmacists know what the
16 restrictions
are. You can write number I, II
prescription
17 and the
pharmacist will say the DEA number and fill it.
18 The pharmacy
has no control of really checking that.
19
MEMBER LUBRITZ: Dr. Brumfield, do
you have
20 anything
written from any of the insurance companies that
21 tell us that
they will not accept your prescriptions even
22 from
noncontrolled drugs if you don't have a DEA number?
23
DR. BRUMFIELD: I don't have
anything in
24 writing, but
on my prescription pad there is no DEA
25 number. So when a patient that has insurance takes
that
0020
1 to the pharmacy, the pharmacy calls me for a
DEA number,
2 and I have to tell them I don't have a DEA
number, and
3 then they say without that your patient
cannot be -- their
4 insurance company will not accept the
billing for the
5 insurance.
6 MEMBER ANJUM: So the patients are first.
7 MR. LESSLY: Why don't we simply refer this
8 to the Pharmacy Board and get it corrected
for him.
9 MEMBER LUBRITZ: I would think there would be
10 a way that we
could maybe help you, but without giving the
11 DEA number.
12
DR. BRUMFIELD: Without giving me
a DEA
13 number?
14
MEMBER LUBRITZ: Yes, sir. Like to see if
15 there is some
way -- we're going right now on what you
16 tell us, and
we're not refuting what you tell us, or I'm
17 not. But by the same token, there may be other
avenues
18 that we can
look at.
19
DR. BRUMFIELD: That would be
perfectly fine
20 with me as
long as I can get a DEA number so that my
21 patients are
not penalized by that. I don't really
care
22 whether I can
prescribe controlled substances or not.
23
PRESIDENT HUG-ENGLISH: Dr.
Brumfield,
24 perhaps it
would be a good idea for you to gather some
25 evidence, for
example, from insurance companies that won't
0021
1 fill prescriptions to bring back to the
Board.
2 DR. BRUMFIELD: I'm sorry.
But they don't
3 refuse to fill my prescriptions.
4 PRESIDENT HUG-ENGLISH: Refuse to pay
5 insurance.
That documentation would be helpful, as well
6 as I think it would be helpful for this
Board to get
7 information on whether or not we could limit
the DEA
8 number so that you can't prescribe
controlled substances
9 but still maintain a DEA number so that you
could -- but I
10 don't think we
have that information to rule on that
11 today.
12
MEMBER KIRCH: I have a question,
Doctor. Is
13 it the
pharmacies will not submit the claims to the
14 insurance
company or is it that the insurance companies
15 are refusing
to pay? It sounds like maybe Walgreens
or
16 something --
I'm confused there on which way that's
17 working, if
it's certain pharmacies are not submitting
18 maybe because
of their policies or if it's actual certain
19 insurers. I think it makes a difference, I would think.
20
DR. BRUMFIELD: Are you familiar
with like a
21 pin number for
Medicare?
22
MEMBER KIRCH: Right.
23
DR. BRUMFIELD: It works the same
way. If
24 that number
does not appear on the insurance claim, it's
25 returned and
it will not be processed. That DEA
number
0022
1 has to be on there or they will not, the
insurance company
2 will not process it.
3 MEMBER KIRCH: One of your comments was that
4 when the pharmacies call you asking for your
DEA number
5 and you tell them you do not have one, that
they can't
6 submit the claim. I'm just trying to clarify, is it the
7 pharmacies won't submit the claim or is it
the insurance
8 companies or a combination of both. I don't think that's
9 clear to any of us.
10
DR. BRUMFIELD: It's in the
processing of the
11 claim. I guess that would be with the insurance company.
12 If that number
is not on there, they just return it.
13
PRESIDENT HUG-ENGLISH: Nancy, do
you have a
14 comment?
15
MS. MUNOZ: It was only, it's only
been a
16 couple of
years since PA's, the legislation changed and
17 PA's have been
able to prescribe controlled substances,
18 and have been
able to apply for a DEA number. In all
19 those years
prior to that happening, I have never had a
20 situation
where an insurance company has refused to pay
21 for a
prescription written. I have never had
that happen.
22
And even today in practice I don't put my DEA
23 number on a
regular prescription. It's not printed
on
24 there and I
don't write it on there for any regular
25
prescriptions. So never had any
patients complained that
0023
1 they are not getting paid. Unless it's a nonformulary.
2 That is the only thing I have ever seen.
3 PRESIDENT HUG-ENGLISH: Thank you.
4 DR. BRUMFIELD: Well, I'm certainly having
5 that problem.
6 MEMBER LUBRITZ: May I make a motion that
7 Dr. Brumfield gather the information that we
would like to
8 get from him so that we can make a
determination as to
9 whether or not we can help him with this
request and bring
10 that to or
submit it back to the Board?
11
MEMBER JONES: I second it.
12
PRESIDENT HUG-ENGLISH: There is a
motion and
13 a second. Any discussion?
14
MEMBER MONTOYA: Dr. Brumfield,
you still
15 want to
prescribe some controlled substances, diazepam and
16 cough syrup
and stuff like that?
17
DR. BRUMFIELD: Is that what I'm
asking?
18 MEMBER MONTOYA: Yes.
19
DR. BRUMFIELD: Well, if I were to
prescribe
20 a controlled
substance, it wouldn't be any more than that.
21 I have yet to
prescribe for any of the class IIs, and I
22 certainly
would not prescribe class IIIs, unless it was
23 absolutely
necessary to the patient.
24
MEMBER LUBRITZ: Perhaps we should
make this
25 in two because
he is actually asking for two things.
0024
1 Number one, to get a DEA number so he can
have
2 prescriptions filled, and number two, from
what I can
3 understand, it was he never felt that he
should have the
4 ability to prescribe. So I think we have two issues. So
5 one would be for what I suggested, but that
would be how
6 we can help him fill his prescriptions. Number two I
7 guess would be I would not be in favor of
restoring his
8 controlled substance ability.
9 PRESIDENT HUG-ENGLISH: The motion that we
10 have, though,
is for him to go back out and gather more
11 information
for us as far as insurance companies'
12
nonpayment. I also think that in
addition to that but
13 maybe not part
of the motion, I'd like to find out, and
14 maybe our
wonderful attorneys can help us find out from
15 the DEA
whether or not you can get a limited DEA number
16 and how that
is monitored without controlled substances.
17 Because I
don't know the answer to that.
18
MR. LEGARZA: We can find that
out.
19 PRESIDENT HUG-ENGLISH: There is a motion and
20 second. Any further discussion? All in favor?
Opposed?
21 The chair
votes in favor of the motion. Motion
carries.
22
(Whereupon, the motion was put to a vote
and carried unanimously.)
23
24
PRESIDENT HUG-ENGLISH: What that
means,
25 Dr. Brumfield,
we will have you back and reconsider this,
0025
1 but we do want to have more information
provided from you
2 as well as information that we will gather
about the DEA
3 number and whether there is some limitation
that we can
4 place on that.
5 DR. BRUMFIELD: You want me to supply
6 information on whether I can have a DEA
number without
7 checking any of the categories? Is that one of the
8 things?
9 PRESIDENT HUG-ENGLISH: No.
Whether or
10 not -- we want
to know whether or not it is possible to
11 get a DEA
number that would limit controlled substances,
12 and your
ability to prescribe them. That's one
issue.
13
The second issue is that we'd like for you to
14 provide
documentation to the Board whether or not
15 insurance
companies really are refusing to pay based on
16 the fact you don't have a DEA number. So that's what we
17 need for you
to provide.
18
DR. BRUMFIELD: As far as the DEA
number now
19 in the
application for that, whether I can get a DEA
20 number without
any category of controlled substance being
21 checked?
22
PRESIDENT HUG-ENGLISH: That's
correct.
23
MEMBER ANJUM: So with some
categories.
24
PRESIDENT HUG-ENGLISH: Right.
25
MEMBER ANJUM: We're going to get
that
0026
1 ourselves.
2 PRESIDENT HUG-ENGLISH: We're going to get
3 that information through the Board. When you come back --
4 can we put him on the agenda for next
meeting? You will
5 come back to our December Board
meeting. If you can have
6 that information back to us by December,
we'll review this
7 again at that time.
8 DR. BRUMFIELD: All right.
9 13.
Consideration of Petition of Rodney G. Handsfield,
M.D. to
restore his License No. 5354 to Practice
10 Medicine
in the State of Nevada
11
PRESIDENT HUG-ENGLISH: Thank
you. The next
12 is 13,
application of Rodney Handsfield to restore his
13 license to
practice medicine in the State of Nevada.
14
Is Dr. Handsfield here today?
15
MR. LEGARZA: Yes, he is.
16
PRESIDENT HUG-ENGLISH: Dr.
Handsfield,
17 welcome to the
State Board of Medical Examiners. These
18 are other Board
members, our attorneys and staff. You
are
19 here today
because you would like us to consider restoring
20 your license.
21
Would you like to make a few comments to the
22 Board?
23
DR. HANDSFIELD: I'd just like to
request
24 that the Board
consider reinstatement of my medical
25 license.
0027
1 PRESIDENT HUG-ENGLISH: Do you want to tell
2 us why?
3 DR. HANDSFIELD: I'm a drug addict and an
4 alcoholic, and have been for many
years. My actions over
5 the years have caused myself and other
people many
6 problems.
I entered treatment in Atlanta at the St. Jude
7 Recovery Center on June 29th, 1999, and
spent 14 months
8 both at Talbot and in their halfway house in
downtown
9 Atlanta known as St. Jude Recovery
Center. It took me a
10 long time and
losing a lot for me to get honest with
11 myself and
realize what my actions have done.
12
On the 21st of September I will have been
13 free of drugs
and alcohol for two years, and am currently
14 participating
in the recovery physician programs in Las
15 Vegas.
16
PRESIDENT HUG-ENGLISH: Thank
you. Dick, did
17 you want to
make some comments?
18
MR. LEGARZA: I'd like to if I
could.
19 Dr. Handsfield
has a lawyer by the name of Steve Bennett
20 who I have
been working with for the last two years.
I
21 have
represented to Mr. Bennett that I would at least
22 recommend to
the Board that Dr. Handsfield's license be
23 restored. Also represented to him that I don't restore
24 the license,
the Board does that, but I would make that
25
recommendation.
0028
1 For your information, Dr.
Handsfield was a
2 problem for quite some period of time. Early on in the
3 diversion program Dr. Jim Tracy and Dr. Vic
Rueckl
4 attempted as best they could to get his
attention. They
5 visited with him. They tried to get him to go off to get
6 help.
He threw the top of an oxygen bottle at Dr. Tracy.
7 We had him in front of the Investigative
Committee, and
8 when he left the Investigative Committee he
threw a rock
9 at Dr. Rueckl.
10 I went to Las Vegas and tracked him down at
11 his house and
personally served him with an order from the
12 Board, and we
were able to get his attention with the
13 cooperation of
the diversion program, the Investigative
14 Committee, and
he never was any kind of other problem
15 other than
disruptive, substance abuse, and we were able
16 to get his
attention.
17
He went to Talbot for a considerable period
18 of time, and
he went to St. Judes, which for those of you
19 information
who don't know, it is when you run out of
20 money, you
can't stay at Talbot Marshall, and you go to
21 St. Judes, and
you work your way through recovery program.
22 I
have taken the time myself to personally
23 talk with Dr.
Rueckl. I have taken the time myself to
24 personally
call Dr. Tracy, who is no longer associated
25 with the
diversion program. They are both well
aware of
0029
1 his recovery, state of recovery, what he has
done, and
2 they are both 100 percent supportive of him
and of him
3 getting his license.
4 I think that he is an example
of the success
5 of the Nevada State Board of Medical
Examiners's diversion
6 program.
So on behalf of myself as being involved with
7 that and on behalf of the diversion program,
I guess
8 especially Dr. Rueckl and Dr. Tracy, it
would be my
9 recommendation to the Board that you
favorably consider
10 his
application for relicensure.
11
MEMBER BAEPLER: Doctor, if your
license were
12 restored would
you continue participation in the diversion
13 program?
14
DR. HANDSFIELD: Yes.
15
MEMBER STEWART: Rodney, it's been
two years
16 since you
practiced medicine. I know you have done
State
17 of Nevada
CMEs. How do you see yourself getting
back into
18 the practice
of medicine? Are you going to do office
19 urology for a
while and then move on? Are you going to
20 try and do
office and surgical urology? What are
your
21 plans for
yourself?
22
DR. HANDSFIELD: My plans are to
do office
23 urology only
for the foreseeable future.
24
MEMBER LUBRITZ: What would that
entail
25 specifically?
0030
1 DR. HANDSFIELD: It would entail of course
2 evaluation and treatment of patients in a
nonsurgical
3 fashion.
Whether I would do invasive examinations using
4 cystoscope or not, I haven't really thought
about that.
5 My hospital privileges have all
lapsed. I
6 haven't practiced actually in three
years. So they have
7 all lapsed.
So I would have to reapply for hospital
8 privileges and take it from that point.
9 MEMBER STEWART: Do you have a sponsoring
10 urologist or
somebody that would bring you into his
11 office? Are you planning to open your own office
again?
12
DR. HANDSFIELD: I have spoken
with two
13 urologists who
are considering it. I'm not planning to
14 open my own
office for any foreseeable future.
15
MEMBER LUBRITZ: How about any
office
16 surgeries?
17
DR. HANDSFIELD: Pardon me? Office
18 surgeries?
19
MEMBER LUBRITZ: Any office
surgeries?
20
DR. HANDSFIELD: Perhaps
vasectomies.
21 Perhaps
venereal warts. But I do not think that
I would
22 enter into a
hospital practice for some time.
23 MEMBER
ANJUM: There are some free-standing
24 medical
facilities also. Would you consider this
a
25 hospital
practice if you use those or a surgery practice?
0031
1 DR. HANDSFIELD: Would I consider a
2 free-standing surgery center to be in the
realm of office
3 surgery?
4 MEMBER ANJUM: Yes.
5 DR. HANDSFIELD: No.
6 PRESIDENT HUG-ENGLISH: Any other questions?
7 MEMBER STEWART: Could we go into closed
8 session for a few minutes?
9 MR. LEGARZA: I don't think so.
10
MEMBER LUBRITZ: We cannot?
11
MR. LEGARZA: No.
12
MEMBER ANJUM: I think when you go
back into
13 hospital
practice, you have to reapply for the privileges;
14 right?
15
DR. HANDSFIELD: Yes.
16
MEMBER ANJUM: You have to go
through the
17 process of
monitoring. There is a setup already for
that.
18
MEMBER MONTOYA: Therein lies the
problem.
19 Most of the
problems are going to be outcome based
20
monitorship. They watch you over
a year, and if nothing
21 falls out they
will say okay, you are done. Most of the
22 monitorships
are two years on the surgical side.
That's a
23 concern that I
do have.
24
MR. LEGARZA: If we get his favor
we can go
25 into closed
session.
0032
1 MR. LESSLY: If he waives 21 days notice.
2 Doctor, we have to give you a specific 21
days notice
3 before we can go into a closed session to
discuss the
4 situation with you. There's been a request that we be
5 allowed to go into closed session. Your lawyer isn't
6 here, obviously. Would you waive the 21 days notice to
7 allow the Board to go into closed session to
discuss this
8 matter?
9 DR. HANDSFIELD: Yes.
10
MR. LEGARZA: Would you?
11
DR. HANDSFIELD: Yes.
12
MR. LESSLY: And the AG's office
buys that?
13
MS. BIBLE: Yes. You understood you had a
14 right to that
notice and that you are waiving that so they
15 can consider
this?
16
DR. HANDSFIELD: Yes.
17
MR. LEGARZA: Is that okay with
you, Doctor?
18
DR. HANDSFIELD: Yes.
19
MR. LEGARZA: Do you think your
lawyer would
20 approve of
that?
21
DR. HANDSFIELD: I don't know, but
I approve
22 of it.
23 PRESIDENT HUG-ENGLISH: We will ask you to
24 step out for a
few minutes.
25
MR. LEGARZA: You have to have a
motion.
0033
1 PRESIDENT HUG-ENGLISH: Motion to move into
2 closed session.
3 MEMBER ANJUM: I move.
4 PRESIDENT HUG-ENGLISH: We'll ask you back in
5 just a few minutes.
6 (Closed session at 9:40 a.m.)
7 (Resumed open session at 9:53
a.m.)
8 PRESIDENT HUG-ENGLISH: We're now back in
9 open session.
10
Dr. Handsfield, thank you for giving us that
11 opportunity to
discuss your case. I think the Board is
12 very impressed
by the fact of the efforts that you have
13 put into
recovery, the fact that you have been so honest
14 and forthright
about your problems and the steps that you
15 have taken to
get into recovery and sustain your recovery.
16 You have also
done and documented all of your CME hours,
17 and that's
appreciated as well.
18 I
would request a motion from the Board.
19
MEMBER STEWART: I make a motion,
20 Dr.
Handsfield, based on the comments that the President
21 has made, with
the knowledge that you appear to be in good
22 recovery,
we're all delighted about that, I would make a
23 motion that we
grant you a restricted license to practice
24 medicine in
the state of Nevada from the time frame of now
25 until our
March meeting, at which time the Board will
0034
1 review how you have done over those six
months and define
2 if the restriction from your license can be
removed.
3 The restriction will be for
office practice
4 only with the ability to perform removal of
venereal
5 worts, vasectomies and diagnostic
cystocolostomies and
6 anything else that might be approved by the
7 secretary-treasurer and the Investigative
Committee.
8 As an aside, we're choosing six
months to
9 allow you to get back into practice and show
us that you
10 can do more so
that we can remove the restriction from
11 your
license. Don't assume that this is a
restriction
12 forever. It's to get you started.
13
DR. HANDSFIELD: Thank you.
14
MEMBER KIRCH: I would second that
motion.
15
PRESIDENT HUG-ENGLISH: There is a
motion and
16 a second. All in favor.
Opposed? Chair votes in favor
17 of the
motion. The motion carries.
18 (Whereupon, the motion was put to
a vote
and carried unanimously.)
19
20
PRESIDENT HUG-ENGLISH: Dr.
Handsfield, if
21 you want to
contact the office this week and you will have
22 your restricted
license until the March meeting.
23
DR. HANDSFIELD: Thank you all
very much.
24
MR. LEGARZA: I already have Dr.
Handsfield's
25 money, I
think.
0035
1 DR. HANDSFIELD: What's left of it. Thank
2 you very much. Special thanks to Mr. Legarza.
3 14.
Consideration of Request from Carlos E. Fonte, M.D.
for
Approval of Medical Training per NRS 630.047(1).
4
5 PRESIDENT HUG-ENGLISH: Moving on to Agenda
6 Item
No. 14, and this is something that we tabled from our
7 last conference call meeting August 17th,
consideration of
8 request from Carlos Fonte for approval of
medical
9 training.
Is Dr. Fonte here?
10
MR. FRANTZ: It doesn't appear,
but I'll go
11 down to check.
12
He is not here.
13
PRESIDENT HUG-ENGLISH: Okay. Well, just in
14 review, this
was the issue we brought up on our telephone
15 conference
call that Dr. Fonte was requesting his vascular
16 training
course be approved. You all have the
letter
17 that's
written.
18
The Board had questioned last time about
19 whether or not
the patients would be informed of the fact
20 that they would
have someone there in training. He has
21 provided that
documentation and enclosed that consent
22 form, as well
as a lot of other documentation about the
23 program.
24
Does anybody have any comments?
25 MEMBER
ANJUM: I didn't understand last time
0036
1 we were talking. Are we supposed to consider that are we
2 giving temporary license to people who are
training or
3 getting on-hand training, or are we
approving this course
4 in itself?
5 MR. LESSLY: You are only approving this
6 course.
7 PRESIDENT HUG-ENGLISH: You are only
8 approving the course.
9 MEMBER ANJUM: Is it part of our jurisdiction
10 and duty to
monitor that and anybody who wants to conduct
11 a course, are
we supposed to do that?
12
MR. LESSLY: Medical Practice Act
does not
13 apply in
situations where physicians come into this state
14 for training
that is approved by the Board. So they
can
15 come in for
that training without having to get a license
16 to practice
medicine in the state of Nevada, if you
17 approve the
training. So that's why it's on the
agenda.
18
MEMBER KIRCH: Is there such a
thing as
19 referenced as
educational Nevada state license to
20 participate?
21
MR. LESSLY: No.
22
MEMBER KIRCH: So they can
participate
23 without any
special license?
24
MR. LESSLY: Yes, NRS 630.047
which says,
25 "This
chapter," meaning the Nevada Practice Act, "does not
0037
1 apply to physicians who are legally
qualified to practice
2 in the state where they reside and come into
this state on
3 an irregular basis to: Obtain medical training approved
4 by the Board from a physician who is
licensed in this
5 state."
6 MEMBER ANJUM: So we have to approve the
7 training.
8 MR. LESSLY: Right.
9 PRESIDENT HUG-ENGLISH: It seems to me that
10 he's done a
nice job of providing, answering the questions
11 that we had
last time, both about the consent form as well
12 as what his
complication rate has been, and it seems to me
13 that it looks like
a course that's well monitored, and I
14 think this is
the way that physicians do learn new skills
15 throughout the
country in every specialty; when new things
16 come up, they
do go to training courses like this. And
17 I'm inclined
to want to approve it.
18
Joel, you had a comment.
19
MEMBER LUBRITZ: There were a
couple things.
20 I think he
certainly did attempt to answer what we asked
21 of him. In looking through the course, it says -- this
is
22 on one of his
peripheral interventions course
23 curriculum --
it says approximately three quarters of
24 curriculum
consists of hands-on procedural training in the
25 cardiac
catheterization lab. Now, is that on
models, is
0038
1 that on patients?
2 Because if you look at the
informed consent,
3 my questions were, we're not in a residence
program, and
4 they do note that someone else -- do they
really know --
5 there is a difference between I'm going to
have someone
6 there with me and do the patients actually
know that that
7 someone else may actually be doing the
procedure and not
8 observing the procedure. I didn't see that in there.
9 There's a big difference.
10 In other words, I think that we
would not be
11 informing the
public of the fact that there is a
12 difference in
someone coming in to watch and we're going
13 to take this
on as an educational program and there will
14 be someone
participating with me. But I think if
someone
15 is going to be
doing that procedure, it should be spelled
16 out that they
could actually be doing the procedure with
17 me, your
doctor, guiding them. Big difference, I
think.
18 MEMBER ANJUM: Hands-on training is a big
19
difference. I have a
concern. I don't know.
20 Traditionally
any training program has been sort of the
21 domain of a
teaching institution where there is a teaching
22 program,
somebody expert in the field, and that's what
23 they do in and
out and they conduct different training
24 programs. Even in Las Vegas, someone in the hospital
came
25 to me about
four years ago, they didn't have an open heart
0039
1 program. Has a hands-on training program compared to
some
2 other places, better places where we live in
Las Vegas,
3 Nevada.
4 I have nothing against it, but
I have always
5 heard of all hands-on training programs at
least conducted
6 by high class teaching institutions. The person who is
7 there, he does nothing else but does that
particular
8 procedure day in day out. Rather than me who do one test
9 maybe three times a week, you know. I don't know.
How
10 does everybody
else feel about it?
11
Even if you talk to the people -- I mean,
12 doing
endoplasties and one or two corneals.
Personally
13 there are a
variety of peripheral arteries that you have
14 to know the
number of catheters and techniques and
15 complications
on not one particular aspect, many aspects
16 of it. If you go to the radiology section and
discuss
17 with them,
they will say that there are many courses,
18 which he has
mentioned this course too, those many courses
19 go from weeks
to a month, not a weekend course.
20
On hands-on training, there is no weekend
21 course. I talked to some of the radiologists, some
very
22 credible and
respected, they couldn't think of any
23 hands-on
training programs unless it's a month or a
24 two-month or
six-month course.
25 I
don't know. I'm not against it. I'm very
0040
1 much in favor of starting those things in
Las Vegas. But
2 does anyone have an open heart program that
is there for
3 two and-a-half and three years? It's a combined cardiac
4 peripheral lab. Training program should at least be
5 offered by a designated peripheral lab who
does a number
6 of procedures.
7 MEMBER BAEPLER: Do we have one in Las Vegas?
8 MEMBER ANJUM: Designated?
Radiologists have
9 designated labs, yes. But in cardiology department, at
10 Sunrise
Hospital there is a designated lab that just
11 started. They are working on it. UMC, I don't know much
12 about it. This is a combined lab combined program. How
13 many cases do
we do there? Sunrise Hospital which has
14 four labs does
four times more cases than Summerlin which
15 has a much
larger patient population and patient selection
16 to go for.
17
UMC which has a teaching program and the
18 program
director, a medical director available, too.
I
19 think we need
to consider all those things. He's done
a
20 wonderful job
in putting together the package. It is
very
21 good. But I had all these questions I want to throw
out
22 to see how
people feel about it.
23
MEMBER MONTOYA: Is Summerlin
developing a
24 vascular
program?
25
MEMBER ANJUM: I'm so far away
from the
0041
1 hospital that I don't know.
2 MEMBER MONTOYA: I'm with you.
It sounds
3 like there is a certain dedication hospital
to support
4 this kind of thing, and I'm wondering if
they are not
5 trying to get a dedicated peripheral
vascular lab to get
6 more cardiac procedures out there. And which he may be
7 just by starting this thing to see what
problems there
8 are.
9 MEMBER LUBRITZ: Cheryl, if I could. It
10 says, when Dr.
Fonte is describing his employment, it says
11 the informed
consent will include the risks, the benefit
12 and options as
well as identifying the primary operator
13 and any
assistant or slash associate physicians who may
14 participate in
the procedure. That's not doing the
15 procedure, and
I think that from what I'm getting, when
16 you are
getting hands-on you are --
17
PRESIDENT HUG-ENGLISH: Well, I
would tend to
18 disagree. I think if he's training people, that they
are
19 sort of
functioning as an assistant in the procedure.
I
20 don't think
they are going to give a lecture and then say
21 go in and do
this procedure and I'm going to stand and
22 watch
you. I think that they will be
participating and
23 learning how
to do it. But I don't think it's unlike
24 going to learn
how to do endoscopic procedures or having
25 you have an
assistant or resident that is working with you
0042
1 on a case.
I don't see this as that different.
2 I guess it seems to me that he
is saying he
3 is identifying not only who is going to be
the primary
4 operator but also identifying anybody else
that's going to
5 participate.
Now I like that word participate in the
6 procedure because it doesn't say it is going
to be there
7 observing.
It is participating.
8 MEMBER LUBRITZ: But does it mean as the
9 primary surgeon?
10
MEMBER MONTOYA: Joel, when I'm
working with
11 a resident,
I'm the primary surgeon despite how much I let
12 he or she
do. I am still the surgeon. So I am still a
13 primary
surgeon.
14 MEMBER
LUBRITZ: You are in a residence
15 program. I think there is a certain specter about
16 residence
program and a weekend course. Not the
same.
17 Not the same.
18
MEMBER MONTOYA: It is still
training as I
19 perceive
it. Still training to advance yourself
in a
20 certain field
over a certain area.
21
MEMBER LUBRITZ: I will not argue
with you.
22 I'm just
giving you anecdotally what I feel is
23 appropriate.
24
PRESIDENT HUG-ENGLISH: I think
the reality
25 of medicine
today, though, is that quite frankly, people
0043
1 who have finished their residencies and
completed
2 training, new procedures come out every
year, and in order
3 for physicians to keep up their own
training, they don't
4 go back to a residence program to get those
skills. They
5 usually go to some sort of course.
6 I think this is a limited
course. Obviously,
7 what they are going to be able to see and do
is limited in
8 a weekend.
So I think this is a very beginning basic kind
9 of training for this type of procedure. But I have a hard
10 time saying
that the Board would not support something
11 like this
because what we do want is people to become
12 trained and
maintain their competency, and I see this as
13 the way that
he's trying to attempt to do that.
14
MEMBER LUBRITZ: Dr. Anjum, you do
these
15 procedures?
16
MEMBER ANJUM: I do.
17
MEMBER LUBRITZ: I come to you and
I say,
18 Dr. Anjum, are
you going to be the one performing this?
19 Yes, and I'll
have an assistant. But no, are you going
to
20 do it, Dr.
Anjum, because I know you and I don't know some
21 student who is
going to come in? Are you going to do
this
22 a hundred
percent for me?
23
MEMBER ANJUM: Well, special cases
are made,
24 but there are
other ways, too. In a training program
you
25 always say I have
residents with me, but I'll be watching
0044
1 mostly, and I'll make sure everything is
taken care of. I
2 think that will be my answer to that.
3 MS. BIBLE: Doctor, part of your concern and
4 the language that is in the consent
agreement that is not
5 as specific as you like it to be to inform
people that
6 they are part of a training program, even
though it says
7 it may be physician and associates,
students, technical
8 assistants.
It appears to me they would have to list
9 those in that following lines. Maybe you want it to be
10 more explicit
that you are going to be having the surgery
11 under the
training circumstance.
12
MEMBER LUBRITZ: Yes. That's why I would
13 like to have
Dr. Anjum here so I can say what are you
14 really going
to let someone do. That perhaps would
have
15 satisfied my
questions. But yes, I would want it to
be
16 very specific
in the informed consent.
17 MS. BIBLE:
Dr. Montoya, is this the same
18 consent form
you use to have residents assist you?
19
MEMBER MONTOYA: It is essentially
the same,
20 not exactly
the same. We do have both at UMC and
Sunrise,
21 and I can
speak to the Sunrise form where it says
22 assistants and
students assist me in surgery. Every
once
23 in a while I
get a patient that says, I don't want the
24 resident, I
only want you to help me, and I'll say, may
25 the resident
hold the retractor. He says yes. In that
0045
1 case I say I'll do everything, and I honor
those wishes.
2 The patients do know that they are going to
have students
3 assisting.
4 MS. BIBLE: If you want more explicit
5 language.
6 PRESIDENT HUG-ENGLISH: One thing we could do
7 --
8 MEMBER LUBRITZ: I would be satisfied with
9 that.
10
PRESIDENT HUG-ENGLISH: -- is we
can approve
11 it with a
stipulation. I mean we can come up with
some
12 language right
here and send it back saying approval with
13 you revising
your consent form to say X, Y and Z.
Would
14 you be okay
with that?
15
MEMBER LUBRITZ: Sure.
16
MEMBER MONTOYA: In that case I
make a motion
17 that we
approve the course of Dr. Fonte for vascular
18 intervention
with the stipulation that he lists the
19 surgeon and
the assistants. How would you like to
say
20 that, Joel?
21 PRESIDENT
HUG-ENGLISH: And it is part of the
22 training
program.
23
MEMBER MONTOYA: It is part of the
training
24 program.
25
MEMBER LUBRITZ: And that someone
other than
0046
1 him may actually be doing the procedure with
him
2 observing.
That's really what we're talking about.
I
3 think if you say something other than that,
you are duping
4 the public.
5 Let's take your mom. Let's make it your mom,
6 your wife, your sister, your daughter. Sure, it's okay.
7 Well, are you going to be doing it or are
you just going
8 to be watching? That's how I tend to look at it. I just
9 want to inform them.
10
PRESIDENT HUG-ENGLISH: So there
is a motion
11 to approve the
program with a modification in the consent
12 form. Is there a second?
13
MEMBER KIRCH: Second.
14
PRESIDENT HUG-ENGLISH: Any
further
15
discussion? All in favor? Opposed?
Chair votes in favor
16 of the motion
and the motion passes.
17
(Whereupon, the motion was put to a vote
and carried unanimously.)
18
19
PRESIDENT HUG-ENGLISH: We'll
notify
20 Dr. Fonte that
he needs to modify his consent form. Do
we
21 want to have
him send back the copy of that to the Board?
22
MEMBER LUBRITZ: Please.
23
PRESIDENT HUG-ENGLISH: Okay. People need a
24 break? Take a break.
25 (Recess taken at 10:14 a.m.)
0047
1 RENO, NEVADA, SATURDAY, SEPTEMBER 8,
2001, 10:27 A.M.
2 -oOo-
3
4 PRESIDENT HUG-ENGLISH: We will reconvene.
5 15.
Petition for Approval to Allow Simultaneous
Collaboration/Supervision of More Than Three Advanced
6 Practitioners of Nursing/Physician
Assistants per NAC
630.495(2).
7
8 PRESIDENT HUG-ENGLISH: Item No. 15, as I
9 understand, Dr. Wrightson is not going to
come today.
10 This was again
a tabled item from August 17th conference
11 call. It's a petition for approval to allow
simultaneous
12 collaboration
of more than three APN's, and you received
13 last time his
initial letter. As you recall in our
14 conference
call, the Board wanted more information as to
15 why he needed
to supervise more than three and what the
16 circumstances
were going to be. I think did everybody
17 just receive
the letter that Maureen passed out?
18
MEMBER BAEPLER: He is asking for
an interim
19 waiver.
20
PRESIDENT HUG-ENGLISH: That is
correct.
21
MEMBER STEWART: He is also asking
us to be
22 part of a
solution to care of indigent records.
23
MEMBER MONTOYA: I would like to
say I will
24 abstain from
voting on this particular issue simply
25 because of a
conflict of interest.
0048
1 PRESIDENT HUG-ENGLISH: Okay.
Appreciate it.
2 Thank you.
3 Any comments about this? Has everybody had
4 an opportunity to read this letter we just
got?
5 MEMBER BAEPLER: He is really requesting to
6 supervise three and-a-half on an interim basis.
7 MEMBER ANJUM: Who will supervise?
8 MEMBER BAEPLER: Another physician, assigned
9 to another physician. 50 percent of her time with another
10 physician, on
page 1 at the top.
11
Interim can last a decade. It's a
little bit
12 open-ended;
isn't it? What's a reasonable interim
period
13 for recruiting
another physician, one year?
14 I
would move that we accept this interim
15 exception to
our policy if interim is defined as a
16 one-year
interim.
17
PRESIDENT HUG-ENGLISH: There's
been a
18 motion. Is there a second?
19
MEMBER ANJUM: I second.
20
PRESIDENT HUG-ENGLISH: There is a
motion and
21 a second to approve more than three for the
interim period
22 of a
year. Any further discussion?
23
MEMBER LUBRITZ: Yes. What have we done in
24 the past for
others that have asked for more than three?
25
MR. LEGARZA: I don't think you
have ever
0049
1 denied.
I think they have all been approved.
I think you
2 have had maybe five.
3 MEMBER STEWART: But they were all for
4 governmental reasons, family planning
clinics, rural
5 health.
They have all been associated with government.
6 MEMBER LUBRITZ: Do you consider this the
7 same?
8 MEMBER STEWART: Yes.
Joel, were you
9 indicating you wanted to modify the motion
to not make it
10 for an interim
period, or are you okay with the year
11 period?
12
MEMBER LUBRITZ: No, I just needed
some
13 information.
14
PRESIDENT HUG-ENGLISH: The motion
again is
15 to allow more
than three for the interim period of a year.
16 That was
seconded. Any further discussion?
17
MEMBER BAEPLER: Could I modify
that
18 specifically
to say four? More than three, he could
have
19 ten of them.
20
PRESIDENT HUG-ENGLISH: That's
correct.
21 That's what
he's asked us for specifically is four.
All
22 in favor. Opposed?
Chair votes in favor of the motion.
23 Carries.
24
(Whereupon, the motion was put to a vote
and carried unanimously.)
25
0050
1 18.
Acceptance of Applications for Licensure.
2 PRESIDENT HUG-ENGLISH: We're going to move
3 now to Agenda Item No. 18. These will be applications for
4 acceptance for licensure. The first one is Shalheen Ali,
5 and Board members were assigned to
question. I think,
6 Dr. Baepler, you are assigned to this
one. We need -- may
7 I have a motion to go into closed session?
8 MEMBER BAEPLER: So move.
9 PRESIDENT HUG-ENGLISH: All in favor.
We're
10 in closed
session.
11
(Closed session at 10:32 a.m.)
12
(Open session at 1:46 p.m.)
13 16. Consideration of Request of David A. Rosin,
M.D.,
State Medical Director, Division of Mental
Health and
14
Developmental Services, to Waive Nevada State Medical
Licensure
Laws
15
16
PRESIDENT HUG-ENGLISH: We'll call
the
17 meeting back
to order. Our next agenda item is number
16,
18 that is
consideration of the request of David Rosin, M.D.,
19 State Medical
Director of the Division of Medical Health
20 and
Developmental Services, to waive the Nevada State
21 Medical
Licensure laws. Is Dr. Rosin here?
22
MS. PYZEL: Yes.
23
PRESIDENT HUG-ENGLISH: If you
want to state
24 your names for
the record, and then we'll be happy to hear
25 your comments.
0051
1 MS. PYZEL: Thank you.
My name is Cynthia
2 Pyzel.
I'm Chief Deputy Attorney General for now the
3 Department of Human Resources. But for 12 years I have
4 been the counsel also for the Division of
Mental Health
5 and Developmental Service. With me is Dr. David Rosin,
6 who is the medical director for the Division
of Mental
7 Health and Developmental Services.
8 What has brought us here is a
conundrum
9 that we seek the Board's help with. The Legislature this
10 past session
passed your SB 91 which heightened the
11 provisions
having to do with licensure and specifically
12 temporary
licensure of doctors. What the Division
has
13 through time
depended upon is the provision of services
14 from locum
tenens doctors while we're in the process of
15 recruiting
other physicians who will be permanent
16 physicians for
us, and that is something that we have used
17 as a matter of
history, unfortunately, because it's
18 difficult to
get people recruited and hired.
19
With the changes that have been made in the
20 law most
recently and the effective date coming in as it
21 did, it puts
us in a position as the Division of not being
22 able to
provide adequate services for the population that
23 we serve which
by definition is the indigent, chronic
24 mentally ill,
a very described population that the agency
25 provides
services to which have been the context and
0052
1 confines of the agency. Southern Nevada Adult Mental
2 Health Services is the specific agency that
this affects,
3 which is a HCFA accredited agency that is
also going by
4 state laws, Division rules and overseen by
the state
5 medical director and the agency facility
director.
6 I have got Dr. Rosin here to
talk about the
7 specifics that we have, but we're here to
help do some
8 brainstorming. We're seeking some help in that respect,
9 because I know that law is the law and you
can't get a
10 waiver from
the law. I know that regs are regs and
there
11 can be some
waivers from those. What we need is some
type
12 of creative
problem solving, frankly, and some help from
13 you in being
able to continue to provide the services in
14 the south to
chronically mentally ill who are indigent.
15
Dr. Rosin just got back from vacation in
16 North
Carolina, flew into Las Vegas and up here for this.
17 I have had him
put together a list for your education to
18 know that
we're not sluggards with respect to attempting
19 to hire
full-time permanent staff and our need for this is
20 a stopgap
measure.
21
DR. ROSIN: Thank you. I appreciate the
22 opportunity to
address this group.
23
As Cindy Pyzel has said, we have been
24 dependent over
the years on -- although I have only been
25 back in the
state for seven months now working as the
0053
1 medical director, my experience with the
Division goes
2 back to 1995 when I came and I was stationed
up here in
3 Reno.
4 In the five years, last five
years that the
5 Division has been required to provide
on-level services,
6 we have used an average of 22 locum tenens
psychiatrists
7 in the state in the Division north and south
per year.
8 This last year the Division used 25 locum
tenens
9 psychiatrists. We do this as we try to recruit
10 psychiatrists
in the face of national shortage. In
some
11 areas of California where they pay more than
we pay there
12 is a 23
percent rate of vacancy. So we compete
against a
13 sister state
that has ability to fund their positions.
14
As Miss Pyzel mentioned, we operate under,
15 our physicians
operate only in our state in facilities
16 providing
inpatient care, providing services to the
17 outpatient
care, various programs for the elderly and
18 seriously
mental ill forensic populations, people being
19 released from
prison systems. All these programs we
20 operate north
and south are dependent upon psychiatric
21 inputs. They have other people, a team of major
medical
22 people on
their team.
23
All of the people whether they are locum
24 tenens
physicians that we're seeking some help with or
25 whether they
are staff psychiatrists or consultant
0054
1 psychiatrists, they all operate under the
protocol of the
2 Division policies and procedures of the
Division of Mental
3 Health.
In addition, each agency has its own policies and
4 procedures, and these physicians have to
operate under
5 those strict policies and procedures as well
as staff
6 rules and regulations all under HCFA,
supervision from the
7 federal level.
8 In addition, we have ongoing
CQI, quality
9 improvement which means that physicians that
we do employ
10 are under
ongoing scrutiny.
11
Since I have been back in the state we have
12 tried to intensify for this ruling in
July. We tried to
13 begin in the
last six months to intensify our efforts to
14 recruit
psychiatrists in the south. We have 18
positions
15 in the
south. Currently because of illness on
three of my
16 active
psychiatrists I'm trying to provide services to our
17 operation in
the south.
18
We have done a lot of recruiting both
19 nationally and
locally beginning with the convention in
20 New
Orleans. Dr. John Connolly, who is
licensed in this
21 state and has
worked here, will be joining us sometime in
22 the very near
future. Dr. Houlick will be presenting
23 himself before
this Medical Board I think at your November
24 meeting. She has accepted a position which will be
based
25 on her
presentation and your decision here.
0055
1 Dr. Larry Montgomery, who I
worked with in
2 South Carolina, has agreed to come and is
going to start
3 with us towards the end of the month. Dr. Sarasanto, a
4 psychiatrist from New York, has been
successfully
5 recruited.
He expected to take the exam, will take his
6 spec exam.
He will join us based on his passing of the
7 spec exam.
8 We have extended an offer to
Dr. Rosario,
9 also from the East Coast. We're waiting a response and
10 hope that it
is going to be positive.
11
Just in the last week of August we
12 interviewed
Dr. Roband from Chapel Hill, Raleigh, North
13 Carolina, and
he is making a decision as to whether to
14 proceed with
application.
15
Out of all of these, we only had one
16 physician who
chose to take a physician. Dr. Sail was
17 interviewed
from Georgia, and he is accepting a position
18 in the state
of Washington because of family.
19
We have one additional psychiatrist who we
20 will be seeing
next week, Dr. Anum. He won't be
eligible
21 to come to the
state until he finishes his residence.
22 We're trying
to reach into residence programs as well.
23
The issue of recruitment has not just been a
24 southern
issue. In the north we have successfully
in the
25 last three
months recruited psychiatrists, three
0056
1 psychiatrists, and they will join the staff
here.
2 Unfortunately, in the south they recruit the
same people
3 as the people in the north, and they have to
make a
4 decision as to whether to practice in Reno
or in Las
5 Vegas.
And two of the folks that are on board coming on
6 board this month here in the north we
attempted to recruit
7 in the south.
8 In addition, they recruited a
contract
9 psychiatrist in the north. We had a medical director in
10 the north
recruited but he could not break a contract.
He
11 was to have
started in June.
12
So you can see in terms of getting full-time
13 staff
positions, we have had a lot of activity.
However,
14 building the
staff and filling vacancies is something that
15 does not
happen overnight. It is an ongoing
process which
16 will continue.
17
In October I'll be going to Florida to the
18 APA fall
meetings, and I'll be recruiting at that meeting
19 as well.
20
In addition to those efforts, we also have
21 been trying to
recruit contract psychiatrists out of the
22
community. We're looking for all
sources. We recruited
23 Dr. Learsha
who came out of retirement. He used to
work
24 for us. Dr. John Minution who worked for us and
working
25 with the
sister agency and is now contracting with us.
0057
1 Dr. Connolly who will be joining us
permanently on a
2 contract basis. And Dr. Teenhouse, who is the chairman of
3 the department of psychiatry, has agreed to
be a contract
4 psychiatrist with us in the south for
limited hours
5 running a clinic.
6 I would like to just talk about
some of the
7 additional efforts we're putting into this
effort to try
8 to become fully staffed with people that are
fully
9 licensed in the state, because we as an
agency and as a
10 Division do
agree that we want licensed, fully licensed
11 people and we
have no disagreement with the Board on that
12 issue, and we
agree that people should be fully licensed
13 in this state.
14 I
have been working with another sister state
15 agency to have
Clark County declared a physician shortage
16 area so they
will be eligible for J-1 physicians.
This
17 cannot be done
on a population basis as can rural Nevada.
18 However,
because of the underserved on economic basis,
19 there is an
underserving of the mentally ill population
20 that is quite
significant. We believe that we're going
to
21 be successful
and we'll know in October.
22
Part of that work has been to poll all the
23 physicians in
that area in terms of the number of Medicaid
24 patients that
are senile. So we can demonstrate the
25 population
that we see is part of an underserved
0058
1 population.
If we are able to have the Clark County
2 designated as a HCFA, we will be able to try
to get J-1
3 physicians to help us.
4 We advertized nationally in the
APA
5 newspaper, on the website in Psychiatric
Times. In
6 addition, we have attempted something in the
south which
7 we were successful in the north using an
advanced practice
8 of nursing in the north as a physician
extender. In the
9 south we are attempting to look at
psychiatric nurses and
10 psychiatric
physician assistants. There are a few
that
11 are well
qualified, and we have been successful in getting
12 a fast tract
on contract basis to try to use these
13 physicians
extenders.
14
MS. PYZEL: What we did with that
was to go
15 to the State
Board of Examiners and ask for permission to
16 have a form
contract that is otherwise tracked in terms of
17 financial data
so that we can just sign people up right
18 away without
the three-month contracting process that the
19 State normally
requires. That is an expedited process
20 that we have
done both of the hiring of psychiatrists in
21 this state and
now with the advanced practitioners and the
22 nurse
practitioners as well. So in attempt to
get these
23 people on
board and serving quickly.
24
I'm sorry, go ahead.
25
DR. ROSIN: No problem. I would just like to
0059
1 take a moment to tell you the problem we
face. I said
2 earlier we have 18 full-time positions
available.
3 Currently we have nine full-time
psychiatrists employed.
4 However, I have indicated only six
and-a-half of those are
5 available now for work. Plus we have people out on sick
6 leave for indeterminate period of time. We have nine
7 centrally full-time vacancies.
8 We have three locum tenens that
are with us
9 from before July 1st. Two of those will be leaving in
10
September. We have one locum
tenens that will be joining
11 us that was
able to pass the requirements for licensure.
12 So we will be
going from six full time plus two, three
13 locums to six
plus one locum. The third locum will be
14 leaving in
October. We're attempting to work with a
head
15 hunter, but we
have to go out to bid on that, and we have
16 a process of
doing competitive bidding with the head
17 hunters to see
if we can't hire psychiatrists that way.
18
In addition, we're trying to work with the
19 military and
work with the psychiatric community by making
20 flex hours in
our clinics so that we can hire people at
21 night to serve
our populations.
22
We have had some losses to our staff which
23 has made this
worse. Dr. Frank Masters retired in
July.
24 One of our
fine university physicians Dr. Marris is on
25 extended leave
having had a baby. Dr. Minution also
left
0060
1 to work at a sister agency, although he is
back with us on
2 a contract basis. Dr. Sahaney, one of our full-time
3 doctors, is planning a potential move to the
Veterans
4 Hospital in Las Vegas. Dr. Rick Horton, who is one of our
5 full-time physicians, will be leaving us
within the next
6 month or two to become the residence
director for the
7 university psychiatric program in Las
Vegas. So we're
8 potentially going to lose two more.
9 One of the issues that we face
as do all
10 other state
run institutions throughout the country is
11 that people
come into these jobs with relatively small
12 training, and
they use the experience that they get with
13 us and then
they move on. So recruitment has to be
an
14 ongoing active
process. The issue -- we are working
hard
15 to get out and
find one now, but this issue of finding
16 people is a
constant process.
17 MS. PYZEL:
And the reason that I asked
18 Dr. Rosin to
have that information available is to assure
19 the Board that
it's not a simple matter of just relying on
20 a contract
with a locum tenens provider to fill slots and
21 provide bodies
to provide the services, that we are
22 committed to
the ongoing philosophy of trying to get
23 dedicated
doctors to do this type of work, but that
24 frankly, the
state agencies have not been able to achieve
25 that on a
full-time basis. We are very happy that
0061
1 Dr. Rosin came back from his stint in South
Carolina to
2 assume the responsibilities as statewide
medical
3 coordinator because he has been dedicating
his efforts
4 toward the recruitment of full-time
permanent staff.
5 However, in the meantime, we
have been having
6 to rely on locum tenens because we have
people lining up
7 for medication clinics, and we need to be
able to provide
8 that service for people. We have been using locum tenens,
9 which I think provides significant success
in terms of our
10 service
delivery system in the past. Not a lot
of adverse
11
incidents. I can think of one
that made it before the
12 medical legal
screening panel, and that was using a
13 locums.
14
So help us. That's why we're
here.
15
PRESIDENT HUG-ENGLISH: Thank you
for the
16 information,
to both of you, and Mr. Lessly, I believe you
17 have some
comments.
18 MR. LESSLY: Yes.
Thank you. Back in 1985,
19 when the
Medical Practice Act was completely redrafted,
20 reenacted, we
included temporary licenses. To make
21 something
clear, there has never been a locum tenens
22 license issued
to a mental health official. What they
23 have are
temporary licenses. The purpose of that
statute
24 in 1985 was to
accommodate rural Nevada communities who
25 for some
reason lost a physician and were told by the
0062
1 Board to have inadequate medical care.
2 The statute's always read since
1985 that a
3 temporary license can be issued for a
specified period if
4 the physician is licensed and in good
standing in another
5 state and the Board determination in order
to provide
6 medical services for a community without
adequate medical
7 care.
A temporary license issued pursuant to the
8 provisions of this paragraph is not
renewable. At least
9 three executive directors before me have as
I have done,
10 put extreme
stretch marks on this statute. The
purpose of
11 the statute
was to take care of rural Nevada communities,
12 not a state
agency.
13
We have done some very constructive
14 interpretation
of this statute to call mental health a
15
community. And the Board has made
a determination that it
16 was without
adequate medical care. That allowed the
17 executive
director to issue these temporary licenses.
18
At one time the Board gave instructions that
19 a license was
not to be issued for more than 90 days.
20 That's pretty
much the policy we have followed unless we
21 are given a
date by anyone seeking a temporary license,
22 not just
mental health.
23
The paragraph says that the temporary license
24 is not
renewable. So there's been some
constructive
25 interpretation
of that statute by at least three previous
0063
1 executive directors prior to me, and we have
not renewed
2 those licenses. We have extended them.
3 We have issued 44 of those
since 1987 to the
4 Mental Health Division. Of those 14 have gone on to get
5 permanent licensure. We have gone out of our way for many
6 many years to accommodate this situation.
7 This is not something that we
have caused.
8 You all have in front of you a letter from
Fran Brown who
9 is the executive director I believe of the
Commission on
10 Mental Health
and Developmental Services which is dated
11 September the
4th addressed to me telling us that we have
12 created this
problem, with copies to the Governor and
13 everyone
else. Unfortunately, I had to find out
about the
14 existence of
those accusations from the press the day
15 before I
received the letter. The press already
had the
16 letter.
17
We need to be abundantly clear as to what the
18 procedure was
that resulted in any kind of change in
19 licensure
requirements. Over a year prior to the
20 enactment of
this statute SB 91 or the bill SB 91, the
21 Board made a
determination that all physicians who
22 practice in
the state of Nevada ought to have the same
23 qualifications
for licensure. The statutes require that
24 if you come
here for permanent licensure, you have to take
25 the specs
examination if in fact you have not yet or
0064
1 another major exam within ten years.
2 So the change that was produced
by SB 91 was
3 to require that temporary licenses and locum
tenens
4 license, and again locum tenens are not in
issue here,
5 would be subject to the same requirements.
6 For a number of years mental
health would
7 hire people on temporary licenses with the
hope of getting
8 them fully licensed and getting permanent
licensure for
9 them, and they would go take the specs
examination during
10 that period of
time. We bent over backward during that
11 period of time
to accommodate that situation.
12
We extended one license three times for a
13 physician who
continually failed the specs examination
14 until the
Board finally said, enough. We have had
15 applications
from potential psychiatrists in mental health
16 who come to us
with out-of-state disciplinary actions
17 which
precludes us from giving a temporary license because
18 they have got
to meet the full Board in order that the
19 Board can make
a determination whether they wish them to
20 have any kind
of a license in the State of Nevada.
21
It's not a situation that has been created by
22 SB 91. In times prior to about two years ago, the
specs
23 examination
was only given several times a year. It
was
24 an examination
that you had to register for and specified
25 location and
specified date. That's no longer the
case.
0065
1 The specs examination is fully
computerized.
2 You register for that examination with the
Federation of
3 State Medical Boards. You go to Sylvan Learning Center.
4 There are 200 sites around the country that
you can go to
5 and take that examination. The results are readily
6 available.
7 And the examination is nothing
more than an
8 exam, and Dr. Stewart is somewhat familiar
with this,
9 weeds out purely the incompetent
physician. You would
10 have to be
really incompetent to fail this examination.
11 Some of our
Board members have taken a sample examination,
12 I have taken
the sample examination. It's not
something
13 that is an
onerous burden.
14
Anyone who wants to come to the state of
15 Nevada to get
a license simply has to take that
16
examination. That is the law in
the State of Nevada as of
17 July 1. The only exception in the past has been locum
18 tenens.
19
The Board made a determination, a policy
20 decision as it
has the right to do by statute that all
21 physicians
ought to have the same qualifications. I
22 appreciate the
fact that mental health deals with
23 indigent. I would only point to you, your decision with
24 respect to the
other bill that was passed in the session
25 of the
Legislature that you supported to create a
0066
1 volunteer license to allow physicians to
come to Nevada
2 and get a license without any fee if they
were going to
3 solely treat indigent patients. But you didn't waive the
4 requirement that they take the specs
examination or for
5 even that kind of license.
6 Unfortunately, the publicity
that has been
7 created by this issue has caused a lot of
interest from
8 other physicians. I have had multiple phone calls from
9 physicians who are employed in Southern
Nevada in mental
10 health who
said we don't think that the newspaper article
11 that's been
running in Las Vegas is very fair. It is
an
12 attempt to make
it look as if the Board of Medical
13 Examiners is
responsible for the recruiting problem that
14 mental health
has, and that is not so. It is an
internal
15 administrative
problem.
16
Any physician who has a locum tenens license
17 is going to
have to take the specs exam. If a
recruiting
18 agency
recruits someone to come here, they need to send
19 that physician
down to a computer center and take the
20 exam. If the physician passes the exam, the
physician is
21 going to get a
license. It's not a burden.
22
It is an expense. You have to pay
to take
23 the
examination. The policy has been adopted
by this
24 Board. The Legislature passed that bill
unanimously. The
25 Governor
signed it. It's the law.
0067
1 Now I need to point out one
other thing about
2 this letter from the Commission on Mental
Health and
3 Developmental Services. That our interpretation of that
4 law is somehow different from an
interpretation made by
5 the Senior Deputy Attorney General for the
Department of
6 Human Resources. I have not seen any Attorney General's
7 opinion to the contrary.
8 Miss Pyzel has indicated that
the statute is
9 a statute and you have no authority to waive
that statute.
10 I also asked
for a legal opinion. Mr. Legarza spent
some
11 hours in the
law library and gave me a legal opinion to
12 the effect
that you can't do it. Our Deputy Attorney
13 General agrees
with that decision.
14 I
want to make it abundantly clear that in my
15 view, this is
not a problem created by the passage of SB
16 91. It is a problem that has been ongoing for
some time.
17 It's my understanding from the calls I
18 received from
physicians on staff in Clark County Mental
19 Health that
nine physicians have quit their full-time
20 positions over
the last two years. There's obviously
some
21 type of
problem in recruiting there. I do not
think it is
22 a problem
created by a simple requirement that a physician
23 take the specs
examination like any other physician and
24 prove basic
competency to come into the state of Nevada
25 and practice medicine.
0068
1 How can you philosophically
adopt an approach
2 that would cause this agency to treat
indigent patients
3 that the physicians treating those indigent
patients
4 should somehow be less competent or not be required
to
5 prove competency as opposed to other
physicians treating
6 other patients here in the state of
Nevada? I'll be happy
7 to answer any questions about the history of
the
8 Legislation.
9 DR. LUBRITZ: I was going to ask you another
10 question. How many doctors quit?
11
MR. LESSLY: Nine.
12
MEMBER LUBRITZ: In what period of
time?
13
MR. LESSLY: Two years.
14
MEMBER LUBRITZ: Can you address
that for us?
15
DR. ROSIN: I have indicated the
physicians
16 that have left
since I have been there, and I started on
17 the last day
of January. We have lost one to
retirement
18 and one other
physician, half-time physician left when I
19 got
there. I think he had been planning to
leave.
20
In the medical leadership there have been
21 acting medical
directors for several years, four or five
22 years in the
south, and I don't know that there has been
23 any ongoing
medical leadership consistently at that
24 particular
agency. Though it's not just an issue in
the
25 south. It is an issue in the north as well. It is just
0069
1 that we have been successful in recruiting
physicians
2 there.
I don't have history prior to January 1 to speak
3 about the other people that left.
4 MEMBER STEWART: Mr. Lessly, you say we have
5 been given 44 licenses.
6 MR. LESSLY: Since 1987.
7 MEMBER STEWART: Over 14 years.
8 MR. LESSLY: Yes, sir.
9 MEMBER STEWART: So this is a tremendously
10 chronic
problem.
11
MR. LESSLY: Yes.
12
MEMBER STEWART: It is not related
to the
13 fact that
specs is now required for the last 60 days.
14
MR. LESSLY: No, I would indicate
to you that
15 Dr. Rosin's
letter indicates there is nine positions to be
16 filled. That seems to coincide with the figure I have
17 been given as
to vacancies over the last couple of years.
18
No, I don't think it is a problem that's been
19 created by the
requirement to take specs. SB 91
requires
20 some other
things, too. It requires three years of
21 progressive
post-graduate education. These
physicians
22 meet those
requirements. The only change is the
23 requirement to
take the special purpose examination.
24
PRESIDENT HUG-ENGLISH: Dr. Rosin,
I'm
25 curious, and I
appreciate the information that you brought
0070
1 with you today. It's helpful in telling us the
2 recruitment efforts. But as I was writing them down, it
3 appears to me that there is about seven or
eight people
4 that you have listed that you have already
recruited to
5 join your staff.
6 DR. ROSIN: I'm actively recruiting, that is
7 correct.
8 PRESIDENT HUG-ENGLISH: So it would appear to
9 me that in part, the problem is being
resolved in those
10 recruitment
efforts in the listing of the names that you
11 have to join
your staff.
12 I
also was glad to hear because one of my
13 suggestions
would be that you try to use more ancillary
14 health care
providers, such as PA's, nurse practitioners,
15 that can help
your staffing, particularly in these times
16 of shortage,
that certainly could work under your current
17 psychiatrists
and in collaboration with them. So I
would
18 think that
would be one way to work around this.
19 I
think that the Board is faced with a tough
20 issue here in
that basically we're faced with a situation
21 where a
statute has been passed that requires temporary
22 licensees to meet the same licensure
requirements as all
23 licensed
physicians in the state of Nevada. And I
don't
24 see that we
really have any discretion, and we have been
25 given two
legal opinions that we don't have discretion to
0071
1 change that.
That is law.
2 So I think we're really left
with a situation
3 of looking at other options for you in your
recruitment
4 efforts, which it appears to me by what you
have listed
5 you have already begun to do.
6 DR. ROSIN: We have a crisis coming in this
7 coming month with two locums leaving and
only one
8 replacement yet to be fully licensed and
with the other
9 two physicians going to the university,
which they are
10 university
physicians now working with us, that the
11 vacancies I
have now, I will, unless there is some way
12 that we could
get assistance, I will be shutting down
13 services.
14 I
have to run an acute care hospital which I
15 must staff
24-seven. And the only way I'm going to
be
16 able to staff
that now without some relief in the short
17 haul is to
begin shutting down my clinics in Las Vegas.
18
MEMBER LUBRITZ: Dr. Rosin, have
you given
19 consideration
to other specialties who could come in and
20 help? For instance, internists, general
practitioners,
21 certainly can
at least be of assistance under the
22 direction of
the psychiatrists on. I know that there
are
23 an awful lot of general physicians,
internists, family
24 practitioners
who treat a lot of psychiatric problems.
25 Perhaps not on
the level that you treat, but certainly in
0072
1 that group of indigents there might be a
certain group of
2 those that you could designate by diagnoses,
hey, they can
3 be taken care of by other contract
physicians that you
4 could bring in in other specialties.
5 DR. ROSIN: Sir, we have not explored that
6 particular option, and I'm open to look at
any option
7 quite frankly at this point.
8 MEMBER LUBRITZ: If you need help, there is a
9 whole army out there.
10
DR. ROSIN: The issue that we're
dealing with
11 here is these are
the sickest of the sick, the severely
12 mentally ill
clients. And whether or not I can be
13 successful, if
there is adequate training in that
14 subspecialty,
I have not explored this.
15
MEMBER BAEPLER: Given the fact that
we
16 cannot
obviously amend the statute, can you think of
17 anything that
this Board can do to help you?
18
MS. PYZEL: That's what we thought
we'd put
19 on the table
here today. I don't know if there is
some
20 way that
people could practice under the overall
21 supervision of
a licensed practitioner, licensed
22
practitioners. We can do that
type of thing.
23
Mr. Lessly was referencing NRS 630.261 which
24 references
locum tenens special restricted and temporary
25 licenses, and
it looked as though there was some
0073
1 flexibility within that statutory scheme to
talk about
2 some additional abilities for restricted
licenses for
3 specific periods of time, because I do
believe this is a
4 short-term issue, that Dr. Rosin's overall
efforts for
5 recruiting are going to be -- those efforts
are going to
6 be resolving the issue in a long haul.
7 But I think in the next quarter
perhaps
8 that's where we need some assistance trying
to find a way
9 to bridge that gap. That's why I was pleased, because
10 Mr. Lessly
obviously has more history with this Board than
11 I do, to
understand that there is a long history of this
12 Board working
with our Division to provide the kind of
13 assistance
that everybody needs to make sure that these
14 people get the
best services that we can possibly provide
15 to them. I was looking for something within that realm
of
16 the restricted
license or the temporary license to do.
17
My understanding, this whole thing did sort
18 of come to a
head with the passage of the bill, and the
19 sending out of
the letter. The restricted licenses are
20 going to be quite a bit more restricted in the
future;
21 that there was
an issue with the 36 months of consecutive
22 timing with
some of these people. I don't know if
that's
23 the case.
24
But what we were attempting to do -- because
25 I didn't see a
bright line answer coming out of here
0074
1 either.
Like I said, I know the law is the law.
I know
2 that the Board still retains the ability to
do temporary
3 licenses, to deal with locum tenens, to do restricted
and
4 special licenses, and to seek some
assistance in creative
5 talent hopefully in finding a way to bridge
that temporary
6 gap.
7 MEMBER BAEPLER: Are you suggesting that
8 temporary people are readily available?
9 DR. ROSIN: On July 6th, I had seven
10 locums --
pardon me. On the last day of August, I
had
11 seven locums
on line to come in and assist us while we
12 went through
this recruiting. That dropped to
one. The
13 one locum is
joining us this September.
14
PRESIDENT HUG-ENGLISH: Is the
reason that
15 that dropped
to one that they were unwilling to take the
16 specs exam, or
were there some other issues?
17
DR. ROSIN: No. We go out with contract
18 bids, and we
have three locum tenens companies that we are
19 successfully
bidding as of July 1. So we're
restricted in
20 our use of
locums to those three companies.
21
The issue that we have is that those
22 companies are
national companies, and people come here
23 from all over
that practice all over. Matter of fact,
24 some practiced
for me when I was in South Carolina.
25
The issue is there are other states.
I took
0075
1 the specs exam myself when I came here for a
temporary
2 license while I got my permanent license and
passed it.
3 I'm familiar with the specs exam. These locum tenens,
4 that is their livelihood and go from state
to state. We
5 are one of the few states that require
specs. They just
6 go elsewhere.
7 There is a psychiatric
shortage, especially
8 when you look at state agencies, and if you
put up what
9 they consider as a hill to climb, they just
go elsewhere.
10 There are all
kinds of jobs everywhere.
11
MR. LESSLY: 13 states require
specs, and I'm
12 not sure that
figure is entirely accurate. Because
there
13 are bills in a
number of other state legislatures in these
14 states to
require specs, and I'm not sure of the results
15 of that.
16
PRESIDENT HUG-ENGLISH: I'm
curious why your
17 efforts are
focused on locum tenens.
18
DR. ROSIN: They are welcome. The locum
19 tenens agency
we use to see if we can get somebody to fill
20 the
vacancies. What I told you, the list of
things that I
21 have been
through have nothing to do with locum tenens.
22 That is all
our agency effort to recruit psychiatrists
23 into this
state and Division efforts. Because I'm
also
24 trying to
bring in psychiatrists to the north.
25
MEMBER LUBRITZ: Are you
advertising in the
0076
1 American Psychiatric Association journals,
et cetera?
2 DR. ROSIN: Yes.
3 MEMBER LUBRITZ: For full times?
4 DR. ROSIN: Yes.
We are running month after
5 month.
That started I think in April, we started running.
6 We have been on the website, the APA
website, which is the
7 national website, been to one national
meeting, I'm going
8 to another.
So we have been since in March, early April
9 -- it took me a little of bit of time to
sort of assess
10 when I got
here -- but we have been heavily recruiting and
11 continue to do
that as we speak.
12
MEMBER LUBRITZ: You need to ask
the Governor
13 for more money
to get more doctors in here.
14
DR. ROSIN: There was a
substantial increase
15 in salary, and
money has not been the issue on one doctor
16 that was
interested from Washington. It wasn't
dollars.
17 He couldn't
get out of the C. The other doctor went
to
18 Washington
because of his family. So in fact the
19 Legislature
and the Governor have been fairly generous.
20
PRESIDENT HUG-ENGLISH: Dr. Rosin,
do you
21 ever work with
residents?
22
DR. ROSIN: Residents are a major
part of our
23 program here
in the north. The psychiatric residence
has
24 been based
here in Reno. Dr. Teenhouse, the
chairman of
25 the
department, moved as of July 1st or June 1st, I guess
0077
1 down to Las Vegas.
2 We are currently, even though
we're stressed
3 on our doctors, we're preparing to become
joint commission
4 accredited here in the south like we are in
the north.
5 Our plans are to be joint accredited, and
when the
6 residence program begins in the south we
plan to be active
7 in that and look forward to that.
8 Residents provide a lot of
assistance in the
9 north, and we certainly look forward to that
relationship,
10 continuing
relationship with the university and be a part
11 of a teaching
program.
12
MS. PYZEL: We try to hire them,
too, when
13 they become
ready for that.
14
PRESIDENT HUG-ENGLISH: That was
my thought
15 is that's also
a good way I think to meet your recruit.
16
DR. ROSIN: The first class came
through in
17 my first year
here, and we recruited several folks in the
18 north. That is where they have had their training
19
experience. We will do that in
the south also.
20
MS. PYZEL: I'm glad we have had
the
21 opportunity to
appear before you, because I think if the
22 perception was
that facilities and the agencies were using
23 locums as a
recruiting source, that that is clearly not
24 the case. I think it is very important for you to hear
25 that. That we understand the need to have long-term
0078
1 dedicated doctors who understand the
program, who can
2 provide the continuity of care for these
clients that they
3 need so desperately. That's something that we're looking
4 for all the time to try to do.
5 But the reality is that in
order to keep
6 things going in addition, the locums have
been something
7 that the agencies have had to fall back on
the use of for
8 the short-term interim basis.
9 MEMBER STEWART: What is the average age of
10 the locums
physicians?
11
DR. ROSIN: I think they are
either -- I
12 think it's a
bimodal piece. They are either in their
13 probably 40's,
late 30's, early 40's, or they are doctors
14 at the end of
their career. However, some of the
doctors
15 at the end of
their career are actual doctors.
16
That has been a concern I have heard people
17 talk about in
terms of people who are old and unable to
18 provide
service. And I have asked locums to
leave. In my
19 tenure up here
in the north when people were not providing
20 care as to
what I felt was adequate level, I have asked
21 them to leave.
22
MEMBER STEWART: Gentlemen and
ladies in
23 their late
30's, if they left a psychiatric residence and
24 took the
psychiatric board --
25
MR. LESSLY: Are they USLE from
medical
0079
1 school?
2 MS. PYZEL: We don't need more lawyers in the
3 practice of psychiatry.
4 MEMBER STEWART: -- they would have passed a
5 certifying exam within the last ten years,
and they would
6 easily be licensed. So I'm confused.
7 DR. ROSIN: I wish I could answer that
8 confusion for you. My impression is they are bimodal. I
9 don't have figures on that, sir. I mean, I can get those
10 figures. I ran figures as to what our dependency is,
but
11 I don't have
those figures.
12
MEMBER LUBRITZ: What he was
saying was they
13 don't have to
really take anything.
14
DR. ROSIN: In our recruitment
there are
15 people that we
are recruiting, one of the physicians we
16 recruited, his
boards are over 10 years old. Not all of
17 the physicians
we are recruiting are going to take specs.
18 Some of them
do, some of them don't.
19
MEMBER BAEPLER: Neither would the
20 temporaries.
21
DR. ROSIN: Except that we can't
find them.
22
MEMBER BAEPLER: If they are out
there.
23
DR. ROSIN: We're not getting
them. Like I
24 say, we looked
at three national recruiting companies for
25 locums, and we
have been unable to get them, to be able to
0080
1 find people who are qualified for the
licensure here. And
2 we're dependent on them for this temporary
fix.
3 MR. LEGARZA: You are dependent on the locums
4 agencies to get you temporary licensees;
correct?
5 DR. ROSIN: Yes.
That was my comment. We
6 are also looking at contract physicians and
trying to get
7 other people to fill in the gaps because
we're trying to
8 stretch as much as we can. But our ability to attract
9 locums is through the locum agencies.
10
PRESIDENT HUG-ENGLISH: Dr. Rosin,
I think
11 this Board
appreciates the situation that you're in, and I
12 also think
that, unfortunately, there's not going to be
13 much we're
able to offer as far as a solution. I
think
14 that our hands
are pretty tied by the fact that this is
15 state law now,
and we can't waive that statute to change
16 the
requirements for this specific group.
17 I
think that the only thing that we can offer
18 is to increase
perhaps your reliance on some of the other
19 health care
professionals in the area, such as PA's, nurse
20 practitioners,
other physicians in other specialties for a
21 two- to
three-month period until you can get some of these
22 folks, the
seven that you listed that have already agreed
23 to come on
board. But I don't really see that there
is
24 really
anything else this Board is going to be able to
25 offer you as
far as a solution.
0081
1 I guess we need to do an
official motion to
2 vote on the consideration. We do as a Board -- I do need
3 a motion to vote on the consideration of Dr.
Rosin's
4 request.
5 MEMBER BAEPLER: Let me add one thing, if I
6 could.
Work on the angles that you were talking about,
7 and work with Mr. Lessly and staff to see if
there is any
8 wiggle room there. There probably isn't but at least give
9 it an effort. We would certainly cooperate with you to
10 that degree.
11
MS. PYZEL: Thank you.
12
PRESIDENT HUG-ENGLISH: I'd be
willing to
13 hear a motion.
14
MEMBER BAEPLER: I'll so move.
15
PRESIDENT HUG-ENGLISH: I need a
motion to
16 move
what? I need a motion on action on
considering the
17 request to
waive Nevada state medical licensure.
18
MEMBER BAEPLER: The obvious motion
has to be
19 that we cannot
grant this.
20
MEMBER LUBRITZ: Second.
21
PRESIDENT HUG-ENGLISH: Okay. There is a
22 motion to deny
consideration to waive the Nevada state
23 medical
licensure Law. It was seconded. Is there any
24 further
discussion?
25
MEMBER LUBRITZ: Perhaps that
could be
0082
1 modified so we can say why, two legal
opinions which
2 advise that we cannot under statute allow
that.
3 MEMBER BAEPLER: We can't waive the statute.
4 That's the reason why the motion. We don't have the
5 option of accommodating the request.
6 MEMBER LUBRITZ: Would you accept that?
7 MEMBER BAEPLER: Certainly.
8 PRESIDENT HUG-ENGLISH: Is that an amendment
9 to the motion?
10
MEMBER LUBRITZ: Yes.
11
PRESIDENT HUG-ENGLISH: Is there a
second to
12 that
amendment?
13
MEMBER STEWART: Yes.
14 PRESIDENT HUG-ENGLISH: The amended motion
15 then is that
we deny consideration to waive the Nevada
16 state medical
licensure laws due to the fact that it is
17 now state law
and we cannot waive a statute. All in
18 favor? Opposed?
Chair votes in favor of the motion.
The
19 motion
carries.
20
(Whereupon, the motion was put to a vote
and carried unanimously.)
21
22
PRESIDENT HUG-ENGLISH: Thank you for
coming.
23
MS. PYZEL: Thank you for your
consideration.
24
PRESIDENT HUG-ENGLISH: Is there a
time issue
25 on Agenda Item
No. 23?
0083
1 MR. LEGARZA: Yes, one o'clock.
2 23.
Consideration of Request by Nevada State Medical
Association for Change to NAC 630.230(l) and NAC
3 630.230(m).
4 PRESIDENT HUG-ENGLISH: I think in light of
5 that we'll skip the next agenda items and
move to number
6 23, which is consideration of request by
Nevada State
7 Medical Association for a change in NAC
630.230(l) and NAC
8 630.230(m).
Is Marjorie Uhalde here?
9 DR. COPPOLA: No, she is not here
10
unfortunately. I'm Ralph Coppola. I'm a practicing
11
otolaryngologist here in Reno.
12
PRESIDENT HUG-ENGLISH: Please
have a seat.
13 Be
comfortable.
14
DR. COPPOLA: I'll fall
asleep.
15 Unfortunately,
she could not be here.
16 The reason we're asking for this request
is
17 fairly
simplistic, and I won't take much time doing it.
18 But as an
example, I'm on call right now, and if one of my
19 partners'
patients called in for pain medication, I would
20 have to do one
of several things. One is refuse to take
21 care of the
patient and give them the pain medication,
22 which is not
good patient management; or two, take one of
23 the more
expensive options, which is either to keep my
24 office open,
ask the patient to come to my office and be
25 seen there,
complete history and physical being done, and
0084
1 then prescribe according to the medical
necessity; or the
2 third, which unfortunately which is being
done on the
3 majority of patients at the present time, is
that they are
4 being sent to the emergency room, where
again you have an
5 inordinate charge, have delay in treatment,
a patient who
6 is in pain has to go to the emergency room,
and take the
7 extra time.
8 So what we're asking is
consideration by this
9 Board that they would consider the
elimination of that
10 requirement
that complete history and physical be done.
11
PRESIDENT HUG-ENGLISH: Thank you.
12 Dr. Stewart.
13
MEMBER STEWART: I'm a little
confused by
14 your
comments. As I understand what the Board
has done in
15 the past was
to come up with a statement of model
16 guidelines for
the use of controlled substances for the
17 treatment of
pain, and adopted by incorporating the
18 Federation's
guidelines for doing that. I think I
19 understand
what we did. Let me tell you what I
think we
20 did, and then
ask you why you would make that comment.
21
In the introduction of the law, and I know
22 that you can
read, but let me read for you, "Through his
23 continued
commitment to assist state medical boards in
24 protecting the
public and improving the quality of health
25 care in the
United States, the Federation undertook an
0085
1 initiative to develop model guidelines for
state medical
2 boards and other health care regulatory
agencies for use
3 in regulating the prescribing of controlled
substances in
4 the management of chronic cancer and
noncancer pain."
5 They did this to focus and encourage the
medical
6 community, that's all of us, including the
medical
7 society, to adopt consistent standards
promoting the
8 public health by facilitating the provision
of adequate
9 and effective pain control and educating the
medical
10 community on
treating chronic pain, underline chronic,
11 within the
bounds of the professional practice.
12
Under the preamble, it says that we recognize
13 that
principles of quality medical practice dictate that
14 the people of
Nevada have access to appropriate and
15 effective pain
relief. The Board encourages physicians
to
16 do effective
pain management as part of a quality medical
17 practice for
all patients with pain, whether acute or
18 chronic, and
it's especially important for patients who
19 experience
pain as a result of terminal illness.
The
20 Board
recognizes that controlled substances may be
21 essential in
treatment of acute pain due to trauma or
22 surgery and
chronic pain whether due to cancer or
23 noncancer
origins.
24
Physicians are referred to the U.S. Agency
25 for Health
Care and Research Clinical Practice guidelines
0086
1 for a sound approach to the management of
acute and cancer
2 related pain. And then we go on and adopt pain control
3 legislation dealing with chronic pain.
4 I do not know how the medical
society and
5 physicians in general have made the leap of
logic that
6 acute pain related to an ankle fracture or a
nitidus media
7 for a broken arm or a broken leg is the
treatment of
8 chronic ongoing pain for which the regulations
were
9 promulgated.
10
Can you explain to me how this has gotten so
11 confused?
12
DR. COPPOLA: I cannot, sir. All I do know
13 is that I sit
on several boards, I'm on the Washoe County
14 Board of
Directors, I'm on the Executive Committee of the
15 State Medical
Association, the AMA delegate to the House
16 of Delegates,
I'm a practicing physician here in Reno.
17 And I can say
truthfully that all of these four levels of
18 people,
physicians, who can also read, have somehow or
19 other taken
that leap and come to the interpretation of
20 what I just
spoke to.
21
MEMBER STEWART: Well, let's talk
about the
22 leap of
logic. It says chronic pain. It says pain
23 control.
24
DR. COPPOLA: I agree.
25
MEMBER STEWART: It does not say
acute pain.
0087
1 DR. COPPOLA: If Dr. Primmer who I'm taking
2 call for right now, my partner, has a
patient, and he does
3 a lot of head and neck cancer work, they
call me this
4 afternoon and need pain medication, can I
legally with a
5 safe harbor prescribe pain medication to
this patient
6 today within the next half hour?
7 MEMBER STEWART: Let me ask you a few
8 questions.
Has another doctor seen the patient, has
9 another doctor done a history and physical,
do you have
10 access to the
history and physical? Are you his
covering
11 physician?
12 DR. COPPOLA: I'm his covering physician.
13 That is the
only thing I can answer in the affirmative to.
14
MEMBER STEWART: If you are the
covering
15 physician for
another physician, patient presents with
16 acute pain, I
believe that you can treat that patient's
17 pain, and some
people would suggest that if you didn't
18 treat that
pain, that somebody would yell, scream or rant
19 and rave at
you.
20
DR. COPPOLA: I realize the other
21 regulations,
sir, which is putting us in a bind.
22
MEMBER STEWART: I'm not sure that
it is
23 putting -- I
think you are not hearing what I'm saying,
24 which Mr.
Lessly and Mr. Legarza and the President of the
25 Board also
agree to. These are chronic pain
regulations.
0088
1 DR. COPPOLA: If the majority of the
2 physicians in the state of Nevada -- and we
have another
3 person here from the southern part of the
state, believe
4 that this is the case -- there appears to be
a problem.
5 And I don't know. I'm not a member of the Board. I'm
6 just a practicing physician. If a majority of practicing
7 physicians in the state of Nevada believe
what I just
8 said, then maybe there's something wrong in
the language
9 or maybe this Board should somehow or
another --
10
MEMBER STEWART: I do not want to
insult you.
11 Have you read
this personally yourself?
12
DR. COPPOLA: Yes.
13
MEMBER STEWART: Did you
understand that it
14 was on the
basis of chronic pain?
15
DR. COPPOLA: Correct.
16
MEMBER STEWART: Then why would
you explain
17 about a
patient in need of acute pain relief?
18
DR. COPPOLA: I was just using the
simple
19 example, sir.
20
PRESIDENT HUG-ENGLISH: I think
the issue is
21 that obviously
there is a lot of confusion on these
22 regulations,
and that's why we're here to discuss it.
23 That's why it
was put on the agenda.
24 I
think that the Board's attempt is to help
25 clarify that,
to say that in management of acute pain,
0089
1 these regulations really don't apply, that
it would be
2 okay for you as a covering physician,
knowing that your
3 partner has worked that patient up, for you
to prescribe
4 pain medication to that patient.
5 If other issues that have come
up as far as
6 hospice care and those kinds of things,
there certainly
7 can be a good cause shown for treating those
patients
8 knowing that an evaluation has been done and
that they
9 have been under a physician's care.
10
In the section 1 where it says that the Board
11 will not take
disciplinary action against a physician for
12 failing to
adhere strictly to the provisions of these
13 guidelines if
good cause is shown for such deviation.
I
14 think you
raised one issue. I think hospice raises
15 another issue
that there are exceptions to that
16
requirement. And certainly that
requirement is designed,
17 and I think
that the guidelines state it, that it is
18 dealing in
chronic pain.
19
And really, it's amazing because the
20 regulations
were put -- these guidelines were put forward
21 really to make
it easier for a physician to treat people
22 with chronic
pain and to set some guidelines in place so
23 that it makes
it easier to do that. But I think there
has
24 been some
resulting confusion that it crosses over to a
25 management of
an acute one-time dose of a controlled
0090
1 substance.
2 DR. COPPOLA: Well, you have a chronic
3 patient with acute onset, it doesn't make
any difference.
4 You have a patient that is unknown to me
that may have a
5 chronic problem and I personally have never
seen, I do not
6 have records available sitting in my back
pocket right
7 now.
What do I do?
8 MEMBER STEWART: Let me read you two
9 paragraphs.
If this doesn't explain it --
10
DR. COPPOLA: Excuse me, Dr.
Stewart, for a
11 second. And it's become the norm both in the north
and
12 the south now,
unfortunately, by a multiplicity of
13 physicians to
refer that patient, either not treat, which
14 is bad, or
send the patient to the emergency room, which
15 is obviously
an increase in expense.
16 I
think if it is indeed a problem with the
17 language or
interpretation with us as practicing
18 physicians,
then I think a simple explanation to us
19 somehow or
another by letter or referencing to your annual
20 journal or
monthly journal or something, would certainly
21 be helpful.
22
But right now there are a number of us who
23 are afraid to
treat.
24
MEMBER STEWART: I'm sorry that
that's true
25 because let me
read.
0091
1 "Physicians should not
fear disciplinary
2 action from the Board or other state
regulatory or
3 enforcement agency for prescribing,
dispensing or
4 administering controlled substance
including opiate,
5 analgesics for legitimate medical purpose
in the
6 usual course of professional
practice. The Board
7 will consider prescribing, ordering,
administering
8 and dispensing controlled substance for
pain to be a
9 legitimate medical purpose if based on scientific
10 knowledge
of the treatment of pain or based on sound
11 clinical
grounds. Prescribing must be based on
clear
12
documentation of unrelieved pain, when we're talking
13 about
chronic pain and in compliance with applicable
14 state and
federal law. Each case of prescribing
for
15 pain
would be evaluated on an individual basis.
The
16 Board
will not take disciplinary action against a
17 physician
for failing to adhere strictly to the
18
provisions of these guidelines if good cause is shown
19 for the
deviation. Physician's conduct is
evaluated
20 to a
great extent by outcome of the patient taking
21 into
account whether the drug is used medically
22 and/or
pharmacologically recognized to be appropriate
23 for the
diagnosis of the individual patient's needs
24 and
recognizing that sometimes a pain cannot be
25
completely relieved."
0092
1 So in the IRS comment, we have guided
2 physicians and given them a safe harbor and
given them
3 wide-ranging ability to prescribe pain
medicine to
4 patients who are in pain. And we have even said that if
5 you evaluate and treat and give informed
consent to the
6 patient and review the patient's records
periodically, you
7 have an absolute safe harbor.
8 Some of us here do not
understand how such
9 clear language with the pain control people
having input,
10 with this
being revisited at least four times that I'm
11 aware of in
the last two years, that the interpretation is
12 in some way
the Board requires a complete history and
13 physical
before a dying patient can receive medication or
14 somebody with
an acute orthopedic surgical injury can
15 receive
medicine. That was not the intent of
this.
16
And by my reading aloud for the record, which
17 I hope will be
disseminated to all members of the State
18 Medical
Society, we didn't do this for that reason.
19
PRESIDENT HUG-ENGLISH: Dr.
Baepler.
20
MEMBER BAEPLER: I think we have a
rather
21 unusual
situation here. We have identical goals
and
22 philosophies,
we being the Board and the medical
23
community. That it's impossible
to have conflict
24 resolution
here because there isn't any conflict on what
25 we want to
do. It is a bit curious that these
guidelines
0093
1 and the identical language have been adopted
in other
2 states without this issue arising, you see.
3 DR. COPPOLA: I come as the messenger today.
4 I was recruited at the last minute. But I do hear a lot
5 of the scuttlebutt that's going on.
6 I have obviously read the
stuff, and I think
7 this letter by the Board of July 17th,
unfortunately,
8 addition of NAC 630.230 may have resulted in
confusion
9 regarding the Board's intent and may well
unwind the
10 desired
outcome. So we're agreeing.
11
Instead of encouraging physicians do use the
12 guidelines, it
creates a disincentive to treat patients
13 with chronic
pain because the language could be read to
14 permit no
physician judgment as to the appropriate use of
15 the
guidelines. That's where the confusion
is.
16
MEMBER BAEPLER: That appears he
has not read
17 the guidelines
because if he read the part read to you
18 today, that is
clearly not the case.
19
MR. LEGARZA: Can I ask the doctor
a couple
20 of questions?
21
Doctor, you know, do you not, that the Nevada
22 State Medical
Association petitioned the Nevada State
23 Board of
Medical Examiners to adopt the Federation
24
guidelines? You are aware of
that, are you?
25
DR. COPPOLA: Uh-huh.
0094
1 MR. LEGARZA: Do you have a problem with the
2 Federation guidelines?
3 DR. COPPOLA: No, sir.
4 MR. LEGARZA: Sir?
5 DR. COPPOLA: I have not in the past.
6 MR. LEGARZA: You don't have a problem with
7 the Federation guidelines. But your problem is with the
8 law that says if you deviate from the
Federation
9 guidelines, it's grounds for disciplinary
action; is that
10 correct?
11
DR. COPPOLA: It seems
appropriate.
12
MR. LEGARZA: What should we do
with the
13 guidelines,
just throw them away and not have them?
14
DR. COPPOLA: No.
15
MR. LEGARZA: What would be the
purpose to
16 adopt the
guidelines if there isn't going to be a sanction
17 for not
following the guidelines?
18
MEMBER BAEPLER: Let me also add
it was
19 almost
redundant to add that. When we adopt
other
20 guidelines and
regulations, we don't add a phrase that
21 says this time
we mean it. Clearly, if we had not put
22 that phrase in
and a person is a deviant from the
23 guidelines, we
have the authority to take action. So it
24 was a
meaningless and philosophically redundant article to
25 incorporate
into this. It doesn't add anything to
it.
0095
1 MR. LEGARZA: But you say you can live with
2 the guidelines. And they are okay.
3 DR. COPPOLA: They have been around for a
4 while.
5 MR. LEGARZA: Well, they have been around for
6 about six months now. But you can live with them. They
7 are okay.
There's nothing wrong with the guidelines.
8 DR. COPPOLA: What I am saying, sir, is it's
9 a misunderstanding of the practicing
physician as to what
10 has happened.
11
MR. LEGARZA: Where is the
misunderstanding?
12
DR. COPPOLA: I don't know where
it is.
13
MR. LEGARZA: In the guidelines or
in the
14 disciplinary
portion?
15
DR. COPPOLA: In the disciplinary
portions in
16 the
inflexibility, as I understand it. What
I have been
17 told is that
the majority of practicing physicians in the
18 state of
Nevada, it's their understanding that unless some
19 of the things
in what was just read, and I'm on call, I do
20 not have
access to the records, I have not seen the
21 patient, I do
not know the patient --
22
MR. LEGARZA: I don't mean to
interrupt you,
23 but you are
saying you can't live with the guidelines.
24 There's a big difference. Can you live with the
25 guidelines or
can you not live with the guidelines?
0096
1 DR. COPPOLA: Yes, I can live with those.
2 MR. LEGARZA: Okay.
Then what's wrong with
3 living with the guidelines?
4 DR. COPPOLA: Misinterpretation, sir, for
5 some reason the physicians of the State of
Nevada think
6 that they can't -- that somehow or another
this NRS has
7 deviated from that, and it's put a hole in
the guidelines,
8 as I understand it. But again, I'm here at the last
9 minute.
So I may not be -- Dr. Havins, can you help me on
10 this?
11
DR. HAVINS: If I'm permitted to
speak.
12
MEMBER STEWART: Certainly.
13 PRESIDENT HUG-ENGLISH: You certainly can,
14 briefly.
15
DR. HAVINS: Let me just read NAC
630.230,
16 prohibited
professional conduct. Number 1, "A
person who
17 is licensed as
a physician or physician's assistant shall
18 not (m) engage
in the practice of writing prescriptions
19 for controlled
substances to treat acute pain or chronic
20 pain in a
manner that deviates from the guidelines set
21 forth in the
model guidelines for the use of controlled
22 substances for
the treatment of pain."
23
If you look at the guidelines, within the
24 guidelines,
number 1 says -- because it's section 2 of the
25 model
guidelines -- "that a physician when evaluating a
0097
1 patient for the treatment of pain with
controlled
2 substances must" is the language used,
"must complete a
3 history and physical and record it in the
patient's chart.
4 MR. LEGARZA: What is wrong with that, Doc?
5 DR. HAVINS:
Thank you. The thing wrong with
6 that is that it's impractical.
7 MEMBER BAEPLER: It also allows for
8 exceptions to that.
9 DR. HAVINS: If this was removed, then the
10 model
guidelines would be adopted, which means the
11 preamble would
relieve those situations where there's
12 reasonable
exceptions.
13
MR. LESSLY: Preamble is already
adopted.
14
MR. LEGARZA: The whole thing is
adopted.
15 DR. HAVINS: If that's the case, then there's
16 no necessity
for 1(m).
17
MR. LESSLY: Oh, no, no, no.
18
DR. HAVINS: The 1(m) says you
will not
19 deviate from
the guidelines within the guidelines.
20 MEMBER BAEPLER: But the guidelines allow for
21 exceptions.
22
DR. HAVINS: Then there is a
23
misinterpretation of what the guidelines within the
24 guidelines say
because section 2 says guidelines. Does
25 that not mean
the guidelines?
0098
1 MEMBER STEWART: Could you read what we think
2 the law says?
3 MEMBER BAEPLER: I know the section he is
4 referring to, and there is a problem there
that existed in
5 my
mind, too, because it seemed to be contradictory, and I
6 felt much better when I read the paragraph
that you quoted
7 that, first of all, it focuses on chronic,
not acute pain,
8 as a general guiding principle; and
secondly, exceptions,
9 a doctor will not be disciplined for
deviating, that is
10 part of the
guideline, if he is following good medical
11 practice and
can explain what he is doing. The whole
12 purpose was to
give --
13
MR. LEGARZA: "will be
evaluated on an
14 individual
basis. The Board will not take
disciplinary
15 action against
a physician for failing to adhere strictly
16 to the
provisions of these guidelines if good cause is
17 shown for such
deviation. Physician's conduct will be
18 evaluated to a
great extent by the treatment outcome
19 taking into
account the drug used medically," et cetera.
20
The doctor points out his hypothetical is he
21 is covering
for his partner. And he gets a call from
Pete
22 Smith saying I
need medications. The doctor says I have
23 either got to
give him the medications or not give him the
24 medications.
25
Why doesn't the doctor go down to his office,
0099
1 check Pete Jones's medical record and see
whether or not
2 Pete is in fact getting those medications,
and if he is,
3 when was the last refill he had. He has a medical record
4 that is there. It exists.
He fills the prescription.
5 DR. HAVINS: From a lawyer's point of view, I
6 can understand that 100 percent, but it's
impractical in
7 the clinical practice of medicine. But I understand how
8 you look at it.
9 DR. COPPOLA: I may not have access to my
10 partner's
office.
11
MR. LEGARZA: We're now taking
exceptions to
12 the guidelines
as well.
13
MR. LESSLY: Let's take a step
back. I think
14 there is
confusion. The preamble as part of these
model
15 guidelines is
part of what we adopted. In that
preamble
16 it says that
it will be evaluated on an individual basis
17 and that we
will not take disciplinary action for failing
18 to adhere
strictly to the provisions of these guidelines
19 if just cause
is shown for such deviation.
20 I
think this situations that you both have
21 brought up
when you are covering on call for a partner
22 that you know
through your practice has had a medical
23 evaluation,
that is a just exception. The
practicality
24 is, and I
think every physician in here would agree, that
25 every
prescription, it is not feasible to go to look up
0100
1 medical records because you may be covering
for a partner
2 that is in a different office and you don't
have access to
3 those.
4 So that in itself is
impractical. I think we
5 all recognize that. I don't see that what these
6 guidelines say that is an issue. I think you can do that
7 without risk of having discipline.
8 I also think the hospice people
for a dying
9 patient, the same situation applies. They have had a
10 medical
evaluation. That person that is on call
or that
11 is asked to
prescribe that controlled substance over the
12 weekend is not
under obligation to go down and do another
13 full
evaluation of that patient. That's not
what these
14 guidelines
say. And that's not what the intention
of this
15 Board is.
16 And so I think that really we are all
on the
17 same
page. I think that there is confusion
about it, and
18 perhaps maybe
it could be addressed by a letter or our
19 next
newsletter to address this, but I don't think there
20 is any
difference in what the Board is promulgating with
21 these
guidelines to what you all are saying you want.
I
22 don't think
there is. Yes.
23
DR. HAVINS: When the motion was
made by
24 Dr. Baepler to
accept the -- to adopt by reference the
25 model
guidelines, there was no mention of anything else in
0101
1 addition to that. There is an addition.
2 MEMBER BAEPLER: What is the addition?
3 DR. HAVINS: The addition is .230, 630.230(1)
4 (m).
5 MR. LEGARZA: Don, that is not correct. That
6 was in the workshops all the time.
7 DR. HAVINS: I didn't say they were not. I
8 said when he made the motion, he made the
motion to adopt
9 by reference.
10
MR. LEGARZA: It's all in the same
workshop
11 document. It's ultimately the same intent
document. It
12 was there from
the beginning, Don. The sanction for not
13 prescribing
properly, for engaging in the practice of
14 writing
prescriptions for controlled substance and writing
15 prescriptions
without an appropriate examination which
16 confirms the
medical necessity for controlled substances
17 has existed in
the regulations of the Nevada State Board
18 of Medical
Examiners since I'm aware of their existence.
19 That is always
been there.
20
When we adopted the first batch of pain
21 regulations
that we sent to the LCB and the LCB changed
22 around and
caused the "difugalty" to begin with on the
23 regulations,
there was still this same prohibition in
24 there with
respect to a disciplinary ground, you
25 prescribing
medications in certain ways, this is how you
0102
1 do it in that thing, and if you didn't
follow that, then
2 you stood the chance of having some
discipline against
3 you.
4 DR. HAVINS: That's correct.
5 MR. LEGARZA: In the hearings, Don, that we
6 had, I specifically told everyone when we
were trying to
7 decide whether or not we could adopt the
Federation
8 guidelines by reference -- you were there --
I said are we
9 going to adopt Don Havins's first petition,
his second
10 petition, or
the one he participated in with the Nevada
11 State Medical
Association criticizing his own, and I said
12 if we go back
to nothing, we're going to go back to the
13 old
disciplinary stuff. And no matter what
we do, we're
14 still going --
we still have to have, if we say you're
15 supposed to do
A, B, C and D, we always have something on
16 the other side
that says, well, if you don't do A, B, C
17 and D, you may
be subject to disciplinary action.
18
Physicians are overreacting to this entire
19 thing, and I
think you are. The Nevada State Board of
20 Medical
Examiners doesn't pick on physicians.
Evidently
21 you people
think that they do.
22
Cases are presented to the Investigative
23
Committee. The Investigative
Committee reviews those.
24 These
guidelines say that you won't just go out and file a
25 complaint
against a physician. The Investigative
0103
1 Committee of the Nevada State Board of
Medical Examiners
2 doesn't have to file a complaint against a
physician.
3 They are not required to by the law.
4 Those people work hard and
long hours and
5 meet with physicians, and to say that
somehow this is
6 causing physicians to not prescribe is a
tempest in a
7 teapot.
It is baloney.
8 DR. COPPOLA: Mr. Legarza, my request would
9 be we need to be unconfused. Maybe in addition, in your
10 next
newsletter what Dr. Stewart read, something very
11 simply is they
are saying some of the erroneous things
12 that have come
out are wrong, however the other you want
13 to do it would
help us.
14
MR. LESSLY: We're going to do a
newsletter
15 next
month. We'll be happy to do it.
16 MR. LEGARZA: This Board has bent over
17 backwards
trying to accommodate the practicing physicians
18 with respect
to pain control with respect to proper pain
19 control. I mean, for anybody to consider that there's
bad
20 intent here to
go after doctors is way out of line, way
21 out of line.
22
PRESIDENT HUG-ENGLISH: I think
that to put
23 it into
perspective, really the only time that this Board
24 has filed
against physicians has been when they have been
25 selling
medications.
0104
1 DR. COPPOLA: We're aware of that.
2 PRESIDENT HUG-ENGLISH: I really do think
3 that it's more confusion than substance on
this issue.
4 And I think that the guidelines are what
this Board is
5 looking at.
I do think that there is a misperception.
6 For the record, I would like to state Mr.
Legarza did not
7 change these guidelines and did not make an
additional
8 thing that made it more difficult to follow.
9 It is simply the regulation
that says if
10 these aren't
followed, you could be subject to discipline
11 which has been
in place for a long time. There have
been
12 no changes to
these guidelines. We adopted the
Federation
13 guidelines for
controlled substances, and that has not
14 changed.
15
So I think that really this can maybe be
16 resolved in
our newsletter and clarifying some of the
17 issues that
have been confusing to physicians, and I think
18 we can put
this to rest. Joel.
19
MEMBER LUBRITZ: Well, I would
like to answer
20 I think Dr.
Coppola's question. I'm an
otolaryngologist
21 also. I think to answer your question, where did
the
22 confusion come
from?
23 I
think some of the confusion came from, and
24 I'm not
pointing fingers but I'm just going to answer a
25 question, I
think part of it was on Dr. Havins's
0105
1 misconception of what it was, and that was
disseminated
2 through the Clark County Medical Society,
and it was
3 disseminated to Nevada State Board of
Medical Examiners.
4 Am I right, Doc?
5 DR. HAVINS: I'm just reading the language --
6 if it means -- first of all, it says acute
or chronic.
7 Here it says acute and chronic. Number two, if it is
8 meant to just be the guidelines in general,
why does it
9 say from the guidelines found in the
guidelines?
10
MR. LESSLY: It doesn't say that.
11
DR. HAVINS: Yes, it does.
12
MR. LESSLY: It says from the
guidelines.
13
DR. HAVINS: In a manner that
deviates from
14 the guidelines
set forth in the model guidelines.
15 MR. LESSLY: Here are the guidelines.
16
DR. HAVINS: There is not a
problem with the
17
guidelines. The problem is with
.230(1)(m), anything
18 negative about
removing .230(1)(m). If there is -- if
the
19 Board doesn't
want to do that, can you at least remove
20 where it says
deviates from the guidelines set forth in
21 the model
guideline. That is confusing when you
look in
22 the model
guidelines, the guidelines that are in section
23 2. If you remove that phrase, it will at least
say the
24 model
guidelines.
25
MEMBER LUBRITZ: If I may, I think
the
0106
1 confusion, Don, has been in your head. I think that you
2 have transferred that confusion in your head
to the heads
3 of all of these other people because you
have sat here
4 before, never said a word to the Board, but
go back and
5 talk to and rattle up people. You created this
6 discussion.
I'm not talking out of school. I
called you
7 a
nitpicker. Well, I called you a
nitpicker because of
8 this kind of stuff.
9 I can also tell you that
someone called me
10 after a two
hour ethics course that you gave, they called
11 me up and said
what's the problem with the Board, this
12 Board, and Dr.
Havins? I said I didn't know there was
13 one. And he said, well, there obviously is. He says
14 because Dr.
Havins -- we were sitting around and talking
15 that the Board
is run by an attorney.
16 Well, the Board was run by as
president Arne
17
Rosencrantz. He's not an
attorney. These guys right here
18 are
attorneys. But I can tell you we act
here as a Board.
19 We ask their
advice. We solicit their advice just
like
20 Clark County
asks for your advice in whatever.
21
But I think to sit out there and stir up the
22 pot rather
than come to us and cause all this statewide
23 confusion that
Dr. Coppola is talking about I think is
24 ludicrous. I think that if you have a problem, just like
25 any other
doctor, you probably need to discuss it with us
0107
1 rather than starting a statewide confusion,
according to
2 Dr. Coppola.
3 And the attorney doesn't run this
thing. We
4 all sit around here, and there are things
that sometimes
5 the attorneys feel is correct that we think
are incorrect.
6 There are sometimes that vice versa.
7 But I think that we're trying
to get along
8 with Clark County Medical Society. I think we're trying
9 to get along with the State Medical
Society. We'd like
10 nothing better
than to not have these confusions running
11 around.
12 I
think the way that we can do that is to do
13 things out in
the open and don't do them behind doors so
14 that we get
this kind of rancor in a thing where we have a
15 lot more
important things to do than take care of problems
16 that are not
really problems except in someone's head.
17
MEMBER BAEPLER: Just in addition
to that. I
18 think we can
clarify this matter in a newsletter. I
would
19 like to
clarify one other issue already if it's
20 appropriate.
21
The letter from Dr. Havins which was very
22 widely
circulated would give the distinct impression that
23 the Board
adopted guidelines and subsequently to that the
24 staff added a
significant element that in essence
25 corrupted the
motion of the Board. I state
emphatically
0108
1 that this did not happen.
2 MEMBER LUBRITZ: There is something else,
3 too.
The OBGYN Society, they sent a letter around to
4 everybody.
Now that language in there seemed very
5 reminiscent of the same language that we
have here.
6 I mean, I do a frontal attack,
Don. I don't
7 go around the side and do whatever. If I say something is
8 right, it's right; if I say something is
wrong, I'm going
9 to tell you about it, and I have already
told you that.
10
So I'm merely making these people aware of
11 the discussion
that you and I had. I think that we
really
12 want to get
along with all other societies. We're
all
13 doctors.
14
And I'm going to tell you about we're not
15 after
doctors. We just closed 53 cases in the
16 Investigative
Committee. Do you know how many
complaints
17 we have
against those doctors? Zero. Have you any idea
18 how many
complaints we get per year?
19
DR. HAVINS: I don't. I think the Board does
20 a great
job. My concern --
21
MEMBER LUBRITZ: Evidently not
everybody.
22
DR. HAVINS: Your newsletter will
straighten
23 us out.
24
MEMBER LUBRITZ: What I'm talking
about is we
25 get about 800
complaints a year, and how many doctors do
0109
1 we file on?
2 MR. LEGARZA: This year we filed on 13 so
3 far, I think.
4 MEMBER LUBRITZ: Out of 800?
5 MR. LEGARZA: One of them has been a
6 controlled substances prescribing case.
7 MEMBER LUBRITZ: How many have been for other
8 reasons?
9 MR. LEGARZA: Majority have been for lying to
10 us on
applications, we have had two or three malpractice
11 cases. 13 to 15 we have had so far, I think you
12 adjudicated
six yesterday. The Investigative
Committee
13 closed
53. You close anywhere from sometimes
200.
14 Physicians are
invited in that you talk to.
15
MEMBER LUBRITZ: Dr. Coppola, I'm
telling you
16 and I'm
telling Dr. Havins, we don't go after doctors.
I
17 think that if
you look at any of the complaints where they
18 have been
significant problems that we have found, you'd
19 say you know
what, you have been too easy on them.
And
20 I'd like to
drop it at that.
21
PRESIDENT HUG-ENGLISH: I think --
go ahead.
22 DR. COPPOLA: I was just going to say for
23 whatever
reason this is pertaining to this subject but
24 maybe an
aside, is that whatever the reason, the
25 practicing
physicians in the state of Nevada, and I see
0110
1 lots of them, for whatever the reason, have
a feeling that
2 maybe using your newsletter more, explaining
things to us
3 better, or whatever, opening the lines of
communication.
4 I know you are available, but yet like so
many other
5 things, you are busy, we're busy trying to
get to you
6 sometimes.
7 MEMBER LUBRITZ: I always answer my phone.
8 These doctors always answer their
phone. They would never
9 hide from a phone call from someone. Not because we're
10 busy. We're all busy.
11
MR. LESSLY: We have never
received a single
12 telephone call
from any licensee in this state about this
13 issue.
14
DR. COPPOLA: All I can say is
utilization
15 and better
communication. Maybe too much is better
than
16 not enough,
and maybe that might help the problem.
17
PRESIDENT HUG-ENGLISH: We can
certainly try
18 to clarify
this in our next newsletter, and I'm happy to
19 write
something about these regulations and to help
20 clarify
that. And I do think just as a reminder,
really
21 it was based
on the Medical Society's cooperation with us
22 to adopt these
guidelines. So I think we're all working
23 together here
for the same end point, and I think there is
24 just confusion
about the interpretation that I think we
25 can clarify.
0111
1 MEMBER LUBRITZ: I have one more thing.
2 PRESIDENT HUG-ENGLISH: Dr. Lubritz.
3 MEMBER LUBRITZ: We have someone here taking
4 these minutes. Can we be assured these minutes are going
5 to go back into the Clark County Medical
Society news just
6 like things from here come back?
7 DR. COPPOLA: Actually you get a copy to me,
8 I'll see that it gets to the State.
9 MEMBER LUBRITZ: I think that would be nice.
10
MR. LEGARZA: This isn't our
transcriber
11 here.
12
DR. COPPOLA: I'm sorry. That is
13 Dr. Havins'.
14
DR. HAVINS: These are paid for by
the Clark
15 County Society
and distributed to the Board.
16
PRESIDENT HUG-ENGLISH: Dr.
Stewart.
17
MEMBER LUBRITZ: I'm sorry, I
didn't mean to
18 speak.
19
PRESIDENT HUG-ENGLISH: I think
that maybe,
20 but I think
also that the newsletter may be -- I don't
21 think that
most physicians are going to want to sit down
22 and read
through the minutes of our whole meeting.
I
23 wouldn't want
to, I know that.
24
DR. COPPOLA: I will personally
get the
25 message out.
0112
1 MEMBER STEWART: If you could personally get
2 the message out. There seems to be a great deal of
3 paranoia from this side of the table against
"you's" guys.
4 There seems to be a great deal of paranoia
from your side
5 of the "you's" guys. We are all the same guys.
6 I don't believe that we have
regulations for
7 the control of acute pain. I do not believe that we have
8 regulations for control of pain in a hospice
situation,
9 whether it's an inpatient hospice or a
hospice without
10 walls. I don't believe that we have ever thought of
doing
11 that. I don't see the need to do that.
12
There was a need to deal with intractable
13 pain in the
previous unworkable problems and the doctors
14 that would
prescribe 200 Lortabs every three weeks ongoing
15 without a good
faith examination, without doing a back
16 X-ray, making
the people come in every two, three, four
17 weeks for
their prescription, please pay cash.
This
18 hopefully
eliminates that. But it also gives a
decent
19 practicing
physician, 99 percent of which we all are, the
20 safe
harbor. That's why we did it. If you can come close
21 to following
the guidelines, or explain why you deviated
22 from the
guidelines, you are in a safe harbor.
23
PRESIDENT HUG-ENGLISH: Okay. I think we
24 have about
covered this. I do need a motion that it
was
25 to consider a
requested change of NAC 630.230(1) and NAC
0113
1 630.230(m).
2 MEMBER STEWART: I would move that the Nevada
3 State Board of Medical Examiners in its next
newsletter to
4 the practicing physicians explain what we
have explained
5 today, and based on that I see no reason to
repeal that
6 NAC area.
7 MEMBER BAEPLER: I'll second it.
8 PRESIDENT HUG-ENGLISH: Discussion.
9 DR. HAVINS: If you would send me that letter
10 that you are
going to send, I'll see that it gets in the
11 Clark County
newsletter, your letter.
12
MEMBER LUBRITZ: Does that also
prevent a
13 trial lawyer
from getting up and saying, hey, you are
14 going to get
this guy now and it's pretty easy because he
15 didn't follow
the guidelines?
16
DR. HAVINS: That's up to the
courts. I
17 don't know.
18
MEMBER LUBRITZ: No, I'm talking
about you.
19 Do you feel
that now?
20
DR. HAVINS: I would feel a lot
better after
21 I get this
letter. As I read the law strictly
construed,
22 this law is as
written strictly, I have a concern about
23 that.
24
MEMBER LUBRITZ: Well, because I
think part
25 of the problem
also is you have said that letter has been
0114
1 circulated widely.
2 DR. HAVINS: I don't know what letter you are
3 referring to circulated widely.
4 MEMBER BAEPLER: The letter sent to the Clark
5 County Medical Association.
6 MEMBER LUBRITZ: A good trial lawyer would
7 love to see this on here because they can
say you haven't
8 applied the standards of care.
9 DR. HAVINS: Deviated from a regulation, yes.
10
MEMBER BAEPLER: You are liable.
11
MR. LEGARZA: Some unauthored
letter.
12
MEMBER LUBRITZ: What I'm saying,
I'd like
13 things to be
all unconfused when we get finished.
Since
14 you were the
one who promulgated that, if you feel that
15 this letter
explains to your satisfaction, maybe you could
16 also retract
that part about, hey, because I don't want a
17 trial lawyer
after me because I won't examine someone's
18 breasts
because I have otitis media. I don't
think that
19 is
necessary. So I'd like to get that
specter removed,
20 too, if it is
possible. If you feel that it is
21 appropriate.
22
DR. HAVINS: Right. I could give you my
23 opinion on
it. But that doesn't change what other
24 plaintiffs'
attorneys may want.
25
MEMBER LUBRITZ: You have the same
opinion,
0115
1 Don, to all these other doctors that have
seen that
2 letter.
So they are still going to be confused.
3 PRESIDENT HUG-ENGLISH: Why don't we take
4 this forward vote on it, and we will get a
letter sent
5 that hopefully will clarify this.
6 DR. HAVINS: That would be great.
7 PRESIDENT HUG-ENGLISH: There was a motion
8 that was seconded. All in favor?
Opposed? Chair votes
9 in favor of the motion. The motion carries.
10
(Whereupon, the motion was put to a vote
and carried unanimously.)
11
12
DR. COPPOLA: Thank you for your
time and
13 information.
14
PRESIDENT HUG-ENGLISH: Should we
take a
15 short break?
16
(Recess taken at 3:14 p.m.)
17
18
19
20
21
22
23
24
25
0116
1 RENO, NEVADA, SATURDAY, SEPTEMBER 8,
2001, 3:22 P.M.
2 -oOo-
3
4 PRESIDENT HUG-ENGLISH: We'll call this back
5 to order and move along. I think these next items should
6 be easier than the last few we have had.
7 19.
Ratification of Licenses Issued, and Reinstatements
of
Licensure and Changes of Licensure Status Approved
8 Since the June 1 & 2, 2001 Board
Meeting
9 PRESIDENT HUG-ENGLISH: Agenda Item No. 19,
10 Ratification
of licenses issued and reinstatements of
11 licensure and
changes of licensure status approved since
12 the June 1st
and 2nd, 2001 Board meeting.
13
DR. STEWART: Move to approve.
14
MEMBER LUBRITZ: Second.
15 PRESIDENT HUG-ENGLISH: Motion to approve and
16 second. Any discussion? All in favor of the motion?
17 Opposed? Chair votes in favor of the motion and the
18 motion
carries.
19
(Whereupon, the motion was put to a vote and
carried unanimously.)
20
17. Acceptance of Applications for Licensure
21
22
PRESIDENT HUG-ENGLISH: Agenda
Item No. 17,
23 this is an
acceptance of application for licensure from
24 Gary Seigel,
who is a nonappearance.
25
MR. LESSLY: This application is
under the
0117
1 underserved rural county exclusion where a
physician can
2 have one year of postgraduate training as
opposed to
3 three -- five years' experience and not
gotten in trouble
4 anywhere else and license restricted to that
county. They
5 told us there are two physicians who may
leave.
6 We wanted to get this in front
of you at this
7 meeting so that you could consider if you so
desire to
8 approve this application to be effective
upon the actual
9 departure of those two physicians, at which
time the
10 county would
be underserved.
11
MEMBER JONES: But they would have
to leave
12 first.
13
MR. LESSLY: Yes.
14
MEMBER JONES: I move we accept
the
15 application.
16
DR. STEWART: Second. Could I ask a question
17 about the
second page of this? Caroline Ford's
letter.
18 Are they still
doing this?
19
MR. LESSLY: Our regulation has
not been
20 adopted. It's in the package that is going out for
21 hearing. So we asked them to go ahead and do it, but
we
22 agree with it.
23
DR. STEWART: Fine. Thank you.
24
PRESIDENT HUG-ENGLISH: There was
a motion
25 and I believe
it was seconded? Any discussion? All in
0118
1 favor?
Opposed? The chair votes in favor
of the motion,
2 and the motion carries.
3 (Whereupon, the motion was put
to a vote and
carried unanimously.)
4
5 20.
Reports
6 PRESIDENT HUG-ENGLISH: Wasn't that easy?
7 All right.
We're moving on to agenda Item No. 20.
These
8 are our reports. We'll call on Carol, who has been very
9 patient, to give us our diversion program
report.
10
MS. BOWERS: You all have copies,
I assume.
11 So I'm going
to read some of it and not other parts of it.
12
Since the last Medical Board June 2nd, we now
13 have four
physicians in treatment, four evaluations at the
14 present
time. Three are at Talbot Recovery in
Atlanta,
15 and one is
either on his way to Talbot or Betty Ford.
16 He's not sure
yet which one he's going to do. In
addition
17 to the four in
treatment, we have two more that have
18 signed a
contract with the foundation.
19
Total number of participates is now 60, 30 in
20 Northern Nevada, 30 in Southern Nevada. Of the 30 in
21 Southern
Nevada, four are disruptive. I have
three that
22 we're still
investigating. We have 53 physicians or
PA's.
23 Of those 53,
three are unlicensed. We have four DO's,
two
24 RN's and one
dentist.
25
As I mentioned I think it was the last Board
0119
1 meeting, I have now started a group in Las
Vegas that I
2 facilitate, and right now we have six
participates in that
3 weekly group, and all new participants will
be going to my
4 group.
It is going very well. I'm very
pleased with that
5 part of it.
6 We had a Foundation Board
meeting in Las
7 Vegas on August 26th, and I enclosed the
minutes.
8 Significant part of that meeting was Dr. Vic
Rueckl has
9 been appointed as our clinical medical
director, and right
10 now his salary
is a dollar a month. We will see about
11 paying him
more based upon our financial status should it
12 improve.
13
He, Dr. Rueckl, assists me in every aspect of
14 this
program. He meets with all the
physicians that I
15 meet with, and
he does interventions with me, and that is
16 going
well. He also gives presentations, and
since June
17 we have spoken
at Valley Hospital, Desert Springs,
18 Sunrise,
Nellis Air Force Base, Washoe VA Hospital,
19 Columbia
Health Care System, and I have a presentation
20 coming up next
week at Mountain View Hospital, and I'll be
21 speaking at
the Federation meeting in Idaho on September
22 29th.
23
We have investigated and met with 12
24 physicians
since the last Medical Board meeting.
And as I
25 said, we still
have three that are still being
0120
1 investigated.
2 I want to speak to -- the
financial report is
3 enclosed, and I want to speak briefly about
the accounts
4 receivable.
When this -- I have also obtained a new
5 accountant who is a CPA, and she's been
wonderful compared
6 to the bookkeeper that we had
previously. Of the accounts
7 receivable, of the 83,000 -- this report was
made up on
8 July 31st.
On August 1st, she sent out the quarterly
9 statements to the participants, and the
amount billed was
10 $30,830. So that is part of those accounts receivable.
11
Of the rest of the balance, there are nine
12 people that
owe us $44,000. Three of those are
DO's. One
13 is an RN who
declared bankruptcy. So I have to write
her
14 off. Three are unlicensed physicians. One is a physician
15 that made an
arrangement to pay us $350 a month a while
16 ago, and he
moved and has never paid us again. And
he
17 owes us still
$8,300.
18
MR. LEGARZA: Let's go repo his
Cadillac,
19 Carol.
20
MS. BOWERS: And the ninth one is
an elderly
21 physician in
Las Vegas who has had so many medical
22 problems that
we haven't done anything about his bill.
We
23 may write him
off too. I'm working on all those that
have
24 not paid us.
25
What the Diversion Committee has requested
0121
1 and the Board is that all of these problem
physicians,
2 whether it's finances or whatever, they will
meet with the
3 Diversion Committee either in the north or
the south
4 face-to-face, and we can determine the best
course of
5 action for what's happening.
6 I think the diversion program
is going very
7 well.
We're getting a lot of calls and a lot of requests
8 for speaking about what the diversion
program does. I'm
9 very pleased about that.
10
In the meeting in December, I'll have the
11 yearly
figures, but as of August 1st, we were already
12 ahead as far
as physician -- and I hate to call them
13 investigations
-- but physicians who we have seen or
14 looked
at. We are already ahead of August 1st
as of what
15 we had the
entire year of 2000. So I'm pleased with
what
16 we're doing.
17
MEMBER LUBRITZ: Carol, can I make
a
18
suggestion. On those, those
accounts receivable that you
19 don't receive,
rather than just writing off, other than
20 those that you
want written off, for the elderly physician
21 and whatever,
is we don't send them to collection because
22 our collection
rate is so low, it's not worth the trouble,
23 but we do send
it to a credit union so that means that
24 when they
apply for credit, wherever it is, they are going
25 to see on
here, wait a minute, no good credit record.
0122
1 They are going to be coming to you to say,
okay, I need to
2 go make another house loan or another loan
for a car, I
3 think I better pay you off so I can get that
off my credit
4 report.
5 MS. BOWERS: Good idea.
6 MEMBER STEWART: Is the gentleman from the
7 mid part of the state, the Cadillac driver,
is he still
8 practicing?
9 MS. BOWERS: He is practicing in Oklahoma.
10
MR. LEGARZA: He got out of Dodge
with his
11 Cadillac.
12
MEMBER STEWART: Well but he's not
in
13 compliance
with his agreement with the previous
14 investigation
committee.
15
MR. LEGARZA: That is correct.
16
MEMBER STEWART: So if the current
17 investigation
committee would want to, I guess they could
18 file upon him.
19
MR. LEGARZA: I agree with that.
20 MEMBER BAEPLER: Is he still licensed here?
21
MS. BOWERS: Yes, I believe so.
22
MEMBER BAEPLER: Then we have
jurisdiction.
23
MR. LEGARZA: Oh, yeah. Give me a memo, will
24 you?
25 MS. BOWERS: I'll give you a memo.
0123
1 MEMBER BAEPLER: Let's look at it.
2 MS. BOWERS: I wanted to mention one other
3 thing I don't think I mentioned the last
Board meeting
4 here, but we met with the Osteopathic Board
in Las Vegas,
5 and they have agreed to fund us again since
they have now
6 come into some funding of their own. So hopefully that
7 will be decided in October, and I need to
get with you
8 about helping with contracts.
9 MR. LESSLY: You mean they are going to fund
10 and we don't
have to?
11
MS. BOWERS: No, I didn't say
that.
12
MEMBER STEWART: How does the DO
Board do in
13 following your
recommendations and suspending licenses if
14 necessary?
15
MS. BOWERS: Well, we just had one
that he
16 had three
positive urines, and I sent a letter to the
17 Osteopathic
Board stating the fact that he had treatment
18 and he was
angry in the hospital. They immediately
19 suspended his
license. Immediately. It was excellent.
20
MEMBER STEWART: There is
something in here
21 about the
Simms lawsuit?
22
MS. BOWERS: That is still going
on. Our
23 insurance,
which is Travelers, still refuses to cover us.
24 Lionel and
Sawyer has been our attorney of record, and our
25 bill is quite
huge with them. So we have now been
turned
0124
1 over to a James Brown who is doing this pro bono
for us,
2 and then we will look at seeking Travelers
to pay for it.
3 MEMBER STEWART: Can you explain the genesis
4 of the suit?
5 MS. BOWERS: Basically it is that Jim Tracy
6 and the Nevada Health Foundation conspired
with the Dental
7 Board and Springbrook to falsely accuse him
of having a
8 drug problem in order to take all of his
money.
9 MEMBER BAEPLER: It is a dentist apparently.
10
MS. BOWERS: Yes. And Jim Tracy did this as
11 assistance to
John Hunt.
12
PRESIDENT HUG-ENGLISH: Any other
questions
13 for
Carol? Thank you very much. Sounds like it is going
14 very well.
15
MS. BOWERS: Thank you.
16 PRESIDENT HUG-ENGLISH: Okay.
Next is our
17 Physician
Assistant Advisory Committee. John, are
you
18 going to be
the spokesman today?
19
MR. LANZILOTTA: Yes. I looked at the agenda
20 and in Dr.
Titus' absence, I reviewed both the NAC and NRS
21 regulations
pertaining to PA's. Also the model,
American
22 Academy of
Physician Assistant guidelines for state boards
23 and a summary
of all state medical boards on PA practice,
24 and feel that
PA's in Nevada, we have an excellent
25 practice
climate. However, under a regulatory
board whose
0125
1 licensing and supervision standards protect
the public in
2 also an excellent manner are certainly
compatible and even
3 exceed like half of the other states.
4 I'll give you an example. In
5 recertification, half of the other states
will put
6 graduate of a program and NCCPA exam. Ours is current
7 certificate.
So that's a higher standard.
8 In the scope of practice, we're just
right on
9 with APA model guidelines and also the rest
of the states
10 as far as, to
give you an example, physician supervision
11 or physician
contact in person on the premises or by
12 telephone or
radio or communication, looking at the
13 guidelines,
the physician being present at a site one day
14 a month, and
then signing and reviewing selected charts, I
15 have checked
that out with the different summary of the
16 boards, and
like I said, we're compatible, even exceed
17 standards
there in what's written for us.
18
Really, I think as part -- we as PA advisors,
19 I have got
newsletter down here as a note, is really just
20 keeping our
colleagues and peers aware of what's going on.
21 Like the issue
that came up here with the practice
22 management for
standard pain guidelines, being in
23 substance
abuse, there is an opiate epidemic that I see
24 every
day. A lot of it is irresponsible
prescribing
25 actually. Keeping PA's like in meetings informed of
what
0126
1 we're doing up here and the guidelines, and
that's pretty
2 much our job here. But as far as any changes, of course,
3 would be up to the Board in what they would
want to do
4 with the regulations. But we like it the way it is.
5 PRESIDENT HUG-ENGLISH: That's good feedback.
6 Thank you.
7 Nancy, did you have anything to
add?
8 MS. MUNOZ: No, John and I already conspired.
9 So he speaks for both of us.
10
PRESIDENT HUG-ENGLISH: All
right. I think
11 that at the
last Board meeting we did have a subcommittee.
12 Don, were you
on that as well?
13 MEMBER BAEPLER: I don't recall, no.
14
MS. MUNOZ: That was Dr. Titus.
15
MEMBER BAEPLER: I'm embarrassed
to say the
16 PA's had the
impression somehow from the minutes, and I
17 can understand
that impression, because when I read them
18 now I get the
same impression, that we were going to look
19 into the
possibility of overhauling their regs and
20 thorough
examination. I don't know where that
came from.
21 I wish the
minutes had been worded a little bit
22 differently
because I forgot even why the issue came up.
23
PRESIDENT HUG-ENGLISH: I couldn't
remember
24 either,
Don. I think, though, that it's good
feedback. I
25 think it
always is good to take a look at what we're doing
0127
1 and to see where we should be and if things
need to be
2 changed.
I think the feedback we're getting from you and
3 the subcommittee is that we're really where
we should be
4 with the regs and that there really are not
any need for
5 revision or looking at them any further.
6 MR. LANZILOTTA: I looked at the Federation.
7 Well, there's really no guidelines for PA's
that I could
8 find.
I tried to do some searches there to see if
9 anything else, what their recommendations
would be. In
10 fact, I
couldn't even find as far as -- they have a whole
11 list of
physicians and the cases, state by state, and the
12 cases that are
represented and the various reasons, but I
13 couldn't find
anything on PA's. I was trying to gather
14 some data
there. I know there is. But it's not published
15 there.
16
PRESIDENT HUG-ENGLISH: Well, I
think it's
17 good. I know a couple years ago we did the same
thing,
18 and I was on
that committee for the nurse practitioners,
19 and I think we
also looked at PA's to sort of make us more
20 consistent
along both of those regs. So I think it
is
21 good once in a
while to take stock and take a look at it.
22 But I think
we're right where we need to be. Nancy.
23
MS. MUNOZ: I think the specific
issue that
24 was referred
to the committee, to which also Dr. Titus was
25 added, was
that letter from Dr. Scoverson that was
0128
1 requesting a waiver I think of the
registration fee, and
2 that was the original issue. And we have sort of been
3 corresponding about that but don't really
have an opinion
4 or recommendation at this time.
5 But somewhere along the line it
seemed to
6 kind of mushroom into this other issue as to
whether or
7 not we should -- I mean, our impression was
that we should
8 maybe look at the entire scope of practice
and revamp
9 things, and that was when I had e-mailed
John and I said,
10 I like things
the way they are.
11
MR. LANZILOTTA: Which actually is
positive,
12 I feel,
because it allowed me some research into it and
13 what other
states are doing. Don't get any ideas
but one
14 state even has
the PA's take an exam on their state laws.
15
MEMBER BAEPLER: I'm sorry the
minutes
16 reflected the
possibility of that, and indeed, that is not
17 the situation.
18 MS. MUNOZ: We will still research the issue
19 of the
registration from the original with Dr. Scoverson.
20
MR. LESSLY: We probably really
also ought to
21 thank Nancy
for taking time out of her schedule to be
22 interviewed by
the news media here in Northern Nevada last
23 few
weeks. She's been in the press quite
often.
24
PRESIDENT HUG-ENGLISH: I missed
it.
25
MS. MUNOZ: It's a good thing
because it was
0129
1 a very bad article and it was inaccurate,
and I called the
2 editor and suggested that they redo it
because it was --
3 the original article had a heading that
said, A good PA is
4 as good as an M.D. or something, and I
thought, oh, my
5 God, here we go. Then there was a quote in there, I don't
6 know where she got this, but it said that
nurse
7 practitioners and PA's have similar scopes
of practice
8 except that a PA has a wider scope of
practice, and that
9 was inaccurate. It was really bad. So please, I have
10 nothing to do
with it.
11
PRESIDENT HUG-ENGLISH: Okay. Well, we have
12 all been
there, for sure. Thank you both.
13
Next we have a committee report from our
14 newly appointed
respiratory care advisory committee.
15 Steve.
16
MR. KESSINGER: There is not a
whole lot to
17 talk
about. To give you a quick progress
report. We met
18 on July 20th
to begin the process of writing regulations,
19 and Mike
Garcia, Don Wright and I met with the staff here.
20 I think both
sides were very pleased we had already taken
21 the time to
put down our thoughts on what the regulations
22 should be, and
we're very close. So it didn't take a lot
23 of time to
hammer out those regulations.
24
We have two meetings scheduled next week on
25 the SB 91, on
the 12th and the 13th, and Don and Mike and
0130
1 myself are all in agreement that basically
we'll stand by
2 the regulations as they were written and
request that
3 whoever has a complaint or a concern about
it give us a
4 logical explanation as to why it should be
changed. We're
5 getting a lot of people phoning us either in
our
6 respective businesses or here to the
office. Maureen may
7 be able to speak more to the number of calls
that they
8 have received, and she thought maybe a
hundred or so since
9 all this began. Most of them are just inquisitive, very
10 small percentage
downright combative, concern with costs,
11 et
cetera. A few of them are just kind of
confused.
12 I
think the next four months we'll see a
13 variety of
people asking questions to us that we have
14 given the
answer to over and over and over again, and
15 we're just
going to have to get through this change.
16
PRESIDENT HUG-ENGLISH: We
appreciate your
17 efforts, and
welcome you as a representative of that
18 group. Thank you.
19 MEMBER STEWART: Cheryl, may I ask a
20 question?
21
PRESIDENT HUG-ENGLISH: Yes.
22
MEMBER STEWART: On our conference
call, the
23 union
representative in Southern Nevada was unhappy with
24 the way that
this had been undertaken. Do you
understand
25 what her
concerns were other than the fact that she was
0131
1 not involved and Mr. Lessly wrote the
regulation?
2 MR. KESSINGER: I have heard that they are
3 circulating a letter down there now with
five points on
4 it. I
don't know all five. The one that comes
to mind is
5 they are concerned with the $5,000 --
6 MR. LESSLY: Fine.
7 MR. KESSINGER: -- fine being too excessive
8 for the amount of pay that respiratory
therapists receive
9 in comparison with PA's and physicians. They have
10 concerns over
some of the disciplinary actions as well.
I
11 don't know
which ones they are.
12
After the August 17th meeting they cornered
13 me for about
45 minutes in the front hall and were upset
14 that their
rank and file wasn't able to participate in the
15 writing of the
regulations. I know that letters have
gone
16 back and forth
about that, and one of our advisory board
17 members is a
member of that union. At least he was at
the
18 time of his
appointment. I understand he's taken a
19 supervisor's
job and therefore is no longer a member of
20 the union.
21 But other than that, I think they
are just
22 trying to flex
some muscle, and I think we pretty much
23 told them that
they are more than welcome to come to the
24 workshop and
give public comment, but they hold no more
25 standing than
a staff therapist or anybody else does.
0132
1 MR. LESSLY: It is our intention next week to
2 send out letters under your signature to all
the list of
3 respiratory therapists we have explaining
the licensing
4 process, the time table involved, sending an
application
5 and get the ball rolling so that they are
out before the
6 first of October. That will give them October, November
7 and December to get an application in and
processed. So
8 hopefully before the end of next week and
certainly before
9 the end of September all those will be out
so they have 90
10 days to react
to it.
11
MEMBER BAEPLER: What percentage
of the
12 respiratory
therapists will you reach, do you think?
13
MR. LESSLY: You have given us a
listing we
14 think is
fairly accurate. Looks like about 700 in
the
15 state.
16
MEMBER BAEPLER: Do you think that
is most of
17 them?
18
MR. KESSINGER: I believe so. I think we
19 also discussed
sending a letter to known businesses,
20 hospitals,
departments.
21
MR. LESSLY: We will probably run
a newspaper
22 ad in Southern
Nevada and Northern Nevada, attention
23 respiratory
therapists, you commit a felony if you
24 practice after
January the 1st without a license.
25
MR. KESSINGER: And quite frankly,
the
0133
1 communication, I have been in touch with
every manager in
2 the north state over the last five months
about the whole
3 situation.
So if there is a downfall in communications,
4 it is between the managers and their staff.
5 MEMBER BAEPLER: It's been in the paper, too,
6 you know.
7 MR. KESSINGER: Absolutely.
8 MEMBER LUBRITZ: Just one thing that you
9 happened to bring up, and I can certainly
see that it may
10 be
appropriate, is if you think about $5,000 fine for
11 physicians and
their level of income, compared to
12 respiratory
therapists, that might be certainly one thing
13 that they are
requesting that might be very reasonable.
14
MR. LESSLY: Or you look at it if
a $5,000
15 fine is really
too much to them, it would really be a
16 prohibition
against misconduct.
17
MR. KESSINGER: The point I'm
trying to get
18 across to most
people, if your daily practice doesn't
19 include
anything that goes against the regulations, then
20 you are never
going to incur that. 98 percent of the
21 people are
never going to come across that at all.
They
22 are going to
walk the straight and narrow and not be an
23 issue.
24 I
think at this point, and we have been
25 trying to do
this for 16 years, and I can tell you that
0134
1 less than 30 people have been involved in
the process for
2 that entire period of time out of 700
practitioners.
3 MEMBER BAEPLER: I don't want them to read
4 that that is going to be a fine. It could be a $500
5 maybe.
6 MR. KESSINGER: It says "may be."
7 MR. LESSLY: The track record of this Board
8 on levying fines is pretty sparse in the
last 15 years.
9 Fines don't accomplish much other than
punish. Most of
10 our attitudes
have been solve the problem, don't punish
11 the person.
12
MEMBER BAEPLER: We don't get to
keep the
13 money anyway.
14
MR. KESSINGER: You can appreciate
the
15
mentality. Up until 1995 when we
passed the legislation
16 requiring
national board certification as a minimum,
17 somebody in
this state could use the term respiratory care
18 practitioner
having never gone to any schooling of any
19 kind.
20
MEMBER BAEPLER: It was totally
unregulated.
21
MR. KESSINGER: Trained on the job
working in
22 the hospital
having 20 years of service and never ever set
23 for any form
of competency exam ever. So that was a
24 change that
they swallowed because they had no choice, and
25 this one I
think they are just trying to throw up fences.
0135
1 PRESIDENT HUG-ENGLISH: May I just make a
2 comment about the fine, the language I
believe that's
3 consistent with our other language says
impose a fine not
4 to exceed $5,000. It doesn't say it would be $5,000.
5 MR. KESSINGER: Not to exceed.
6 PRESIDENT HUG-ENGLISH: I think that is
7 something to point out, too, to people who
have complaints
8 about that.
It doesn't say it's going to be $5,000.
9 MR. LESSLY: I don't think we have ever fined
10 anyone $5,000,
that I can recall.
11
MEMBER BAEPLER: Not even an M.D.
12
MR. LESSLY: No, I don't remember.
13
MR. LEGARZA: I think since I have
been here
14 we only fined
one, and I can't remember who it was.
15
MS. LYONS: That $1,000.
16
MR. LEGARZA: It was two $1,000
fines. We
17 had two
counts. It was a thousand dollar fine on
each
18 count I think
on someone. We make them pay the fines.
19
MS. LYONS: We fined one guy a hundred
20 dollars and he
appealed it.
21
PRESIDENT HUG-ENGLISH: Okay. Anything else?
22 Thank you very
much.
23
Next is our committee report on the committee
24 to study
post-licensure continuing competency, and Don,
25 were you going
to make some comments?
0136
1 MEMBER BAEPLER: Very briefly for the new
2 members, we're aware of the fact that around
the country
3 there is more and more talk about some kind
of competency
4 testing they call it, and we're well aware of
the fact
5 that no professional group eagerly accepts
this. I don't
6 care whether you are a teacher or lawyer or
CPA or doctor
7 or whatever, it is resisted.
8 Nonetheless, we see that in the
field of
9 medicine that is so rapidly changing, and
given the aging
10 of the
population, to which I can attest and no mandatory
11 retirement
age, we will be increasingly faced with the
12 older and
older MD's, and there is some concern of course
13 that there
will be perhaps federal legislation and even
14 more probable
that there will be state legislators
15 legislating
this, which is a terrifying thought, if boards
16 are not
proactive and begin to come up with some solutions
17 and
recommendations for this.
18
We actually by bringing this up and having a
19 committee have
received national attention. We're the
20 only state
that's addressing it at this point.
Although
21 since other
states know we're addressing it, they are
22 looking at us.
23
And it's not as simple as putting forward one
24 vehicle, a
mechanism like take an exam. We're
trying to
25 give doctors
four or five alternative routes, some of
0137
1 which don't involve an examination, where
one of these or
2 perhaps two in combination will achieve the
purpose.
3 One of the avenues might be a
modified and
4 somewhat abbreviated specs exam that is tailor
made for
5 this to give some indication of a person's
general medical
6 ability, but the nature of the specs data
bank is such
7 that it can be tailored for every specialty
that exists
8 and it could emphasize a specialty.
9 Again, you have to put into
context that we
10 might be
talking about one percent of the doctors out
11 there that
might have some competency problem.
We're
12 going to be
meeting in October on the 24th with people
13 from the
Federation and the specs and other -- it's a very
14 interesting
group that is assembling to use Nevada as a
15 guinea pig to
see if such an approach can be developed.
16 So everything
is tentative. We don't have a proposal
yet.
17 But we feel
compelled to move in that direction.
18
MR. LESSLY: I would tell you that
that
19 meeting Don
and Arne Rosencrantz attended at the
20 Federation
annual meeting certainly got the attention of
21 the Federation
and the National Board of Medical Examiners
22 who jointly
own the exam. The people who are coming
are
23 Dale Austin,
chief executive officer of the Federation,
24 vice president
of the Federation, and some extremely high
25 ranking people
from the National Board of Medical
0138
1 Examiners.
So they are coming out here to do something
2 with us.
3 I would encourage any of you
and all of you
4 who want to come to that meeting, it will be
here on the
5 24th of October at 10:00 o'clock in the
morning. I would
6 guess that it might be over by lunchtime,
and it might not
7 be over by lunchtime. We'll arrange to have luncheon out.
8 We will not have sandwiches. We're going to take everyone
9 out
for lunch somewhere, and I assume they will get back
10 on airplanes
heading back to Dallas and Philadelphia late
11 that
afternoon. If you can make that meeting,
I would
12 strongly urge
you to do so. The more attendance we
have,
13 the better I think.
14
MEMBER BAEPLER: I got word the
meeting I
15 attended in
San Diego, we contacted a number of the
16 specialty
boards thinking that the recertification in the
17 specialty
might meet this particular thing, and in some
18 specialties
the exam is quite rigorous and in others it's
19 not. But in contacting the specialty boards, they
resist
20 having their
recertification used as a competency exam for
21 the retention
of the M.D. license.
22
I'm told now that that is beginning to change
23 and there is a
change in the attitude. If that change
is
24 sufficient,
then your specialty is all we need to
25 establish
competencies. We don't want this
threatening to
0139
1 the medical community that somehow they
totally fight us
2 on this.
3 PRESIDENT HUG-ENGLISH: Okay.
Well, it will
4 be interesting to hear in October.
5 MEMBER ANJUM: I hope it doesn't get in the
6 hands
of Dr. Havins.
7 PRESIDENT HUG-ENGLISH: Our Investigative
8 Committee, Joel.
9 MEMBER LUBRITZ: We had 53 cases that we
10 closed. There were no complaints filed against
11
physicians. I'm not sure there is
a lot more to say other
12 than that.
13
MR. LESSLY: Are all of you
looking for your
14 names on the
list?
15
MEMBER STEWART: Gee, it's not
there. Must
16 be doing more
on investigation.
17 PRESIDENT HUG-ENGLISH: We will circulate
18 those
around. After we get those circulated, I
guess we
19 need a vote to
close those cases.
20
MR. LEGARZA: Dr. Lubritz and I
need all
21 three of those
back as soon as everybody has had the
22 opportunity to
look at them.
23
PRESIDENT HUG-ENGLISH: In the
meantime we'll
24 move on while
you are reviewing those. The
25
Secretary-Treasurer report, and that is Joel also. Bob,
0140
1 are you going to do that?
2 MR. FRANTZ: I assist Dr. Lubritz. I'm
3 passing out the audit from our auditor and
also included
4 in the insert there is the current financial
statement.
5 MEMBER BAEPLER: We did pick up a little bit.
6 MR. FRANTZ: The green of course are the
7 audited financial statements here from our
accountant CPA
8 firm that we utilize. There wasn't anything significant
9 in the report. They found all the money accordingly, and
10 they knew
where it all went to. Basically that's
what
11 we're
primarily interested in, and everything looked fine
12 as far as they
were concerned. You can read it.
13 I
would like to call your attention for a
14 minute to page
5 of the audit report and point out we have
15 a total
expenditures for last fiscal year of a million
16 440,000
dollars. We always kind of project our
reserves
17 based on the
expenses that we incur per year. We try
to
18 have at least
two years of reserve.
19 I
have talked to Dr. Lubritz a little bit
20 earlier. I expect a change in that figure someplace
21 between a
hundred thousand dollars for next year based on
22 what's going on
on the additional respiratory therapists.
23 That is also
offset by the revenue coming in. That
also,
24 we added that
additional in the licensing area.
25
MR. LESSLY: We have close to two
years in
0141
1 reserve at this point, two years operating
expenses in
2 reserve.
3 MR. FRANTZ: What I have done here, there is
4 a financial statement, current financial
statement in
5 here.
The auditor has not gotten back to me with the
6 adjustments yet to move the balances around
to the exact
7 figure.
We're going to have a little bit of deviation
8 from the figures. If you were to take a look at the
9 balance sheet down on the equity side,
retained earnings
10 of $590,000,
that should be approximately $578,000.
11
The reason why is that under current
12 liability we
have vacation. This is the amount of
annual
13 leave that we
have on the books. What we do is take
each
14 employee's
hourly rate times annual leave that comes up
15 with that
figure. So that figure will be adjusted
$11,000
16
difference. So we have moved the
578,000 that we
17 currently show
in the retained earnings up into the
18 capital
accounts 305 account. We will have $2.83
million
19 in reserve,
which as of this time based on last year's
20 income is
about 50 percent our two years reserve.
21
MEMBER BAEPLER: Question
here. Recognizing
22 the State of
Nevada, it's not appropriated money but it is
23 by
technicality in law state money. It
becomes the
24 property of
the state when we receive it and deposit it, I
25 would
assume. It has to be.
0142
1 Do we run a liability in
getting this reserve
2 too large?
3 MR. LESSLY: Sure.
4 MEMBER BAEPLER: A liability in the sense
5 that the state might grab it.
6 MR. LESSLY: Sure, and we're about there.
7 When we started -- well, when I took this
job, we had less
8 than 300,000.
9 MR. FRANTZ: 350,000.
10
MR. LESSLY: In reserve. We have said that
11 it's not
appropriate. We need at least a
year. We got a
12 year, and we
decided really that's not appropriate either
13 because we
spend money on computers like mad because we
14 don't have any
choice about it. We decided we needed at
15 least two
years' operating expenses in reserve.
16
Now I would assume that our operating
17 expenses are
going to continue to go up. I don't
think
18 they are going
to go down in this age of technology.
19 Assuming
salaries continue to go up and the cost of
20 computer
programs go up, we're going to spend a little
21 more, not significant. So we're probably in the ballpark
22 of where by
the next biennium registration period we're
23 going to be
looking at a possible reduction in licensing
24 fee to the
physicians.
25
MEMBER BAEPLER: That is what I
thought we
0143
1 might get to.
2 MR. LESSLY: That may be a token reduction,
3 that may be a politically expedient thing to
do. We're to
4 the point that I don't think that there is
any intent to
5 capture these funds or to put us into an
umbrella agency
6 statewide.
However, you can simply, as has happened in
7 California, California has an independent
Medical Board.
8 However, what they do is they set the fee
for their
9 physicians, and I believe it is the same as
ours now, they
10 collect their
money, and they have someone put a bill in
11 the
Legislature that says it goes to the general fund.
12 Well, when it
gets in the general fund, you can't get it
13 back out unless
the Legislature props it. So they give
14 them 40
percent of what they collect back to operate on
15 and 60 percent
goes for some other purpose.
16
Someone could introduce a bill to do that to
17 us, but I
don't think there is any intent on the part of
18 this governor
or this state administration to do some
19 umbrella
agency to take over our funds. At one
time that
20 was a problem,
and there was serious concern on the part
21 of the Board
years ago that someone was trying to capture
22 our reserve,
and we went in and reduced the fee and spent
23 the money.
24
MEMBER BAEPLER: I agree, a
two-year reserve
25 is fine, but
if you project it out for another year, you
0144
1 suddenly have five million dollars for
surplus, it can't
2 go on forever.
3 MR. LESSLY: The reserve provides for some
4 contingency on some horrendous lawsuit. It's not really
5 happening right now that we're making a lot of
money off
6 of our investments because of our economic
situation.
7 However, the more money you have in reserve
and you
8 generate funds from that, the less the funds
have to be to
9 the physicians and respiratory therapists,
the PA's to be
10 licensed. It's not big enough yet to be really
11 significant.
12
So I agree, Don, I don't think that we would
13 ever put
ourselves in a posture of wanting to have $10
14 million in
reserve.
15 MEMBER BAEPLER: No, it is not an immediate
16 problem.
17
MR. LESSLY: You are right, within
the next
18 four years it
could become a problem.
19
MEMBER LUBRITZ: Could we not
designate a
20 certain
portion to be a reserve for expenses and another
21 to be a
reserve for malpractice suits?
22
MR. LESSLY: You can do anything
you want to
23 with it. You could put any accounting designation you
24 want on it
because we're not subject to the budget act.
25 It would
strictly be your decision. It wouldn't
be
0145
1 binding on anyone.
2 MEMBER BAEPLER: I would love to see us
3 consider a building fund.
4 MR. LESSLY: Yes. I
have even looked at
5 contribution of a building or whatever. The Alabama Board
6 of Medical Examiners owns its own
building. We would have
7 to have legislative authority to do
that. But that's one
8 thing.
9 MEMBER LUBRITZ: Can we seek that so that we
10 have --
11
MR. LESSLY: We could.
12
MEMBER LUBRITZ: -- another area
to
13 sequester?
14
MEMBER BAEPLER: It hides a nice
chunk.
15
PRESIDENT HUG-ENGLISH: I also
think that the
16 idea presented
that if we really are getting too much in
17 reserves, that
we look at a possible reduction in fees.
I
18 think that
that would be a nice thing to do and I think
19 would
certainly send a message to the licensees.
The
20 other thing
I'd like to add is that if we have some extra
21 money, I love
California's laminated cards.
22
MEMBER BAEPLER: Business cards?
23
PRESIDENT HUG-ENGLISH: No, when
you get a
24 license from
California, instead of the little tearout,
25 correct me if
I'm wrong, but at the end of two years,
0146
1 those are looking pretty ragged.
2 MR. LESSLY: I thought about proposing that
3 this time, but we're overdrawn from the
meeting you went
4 to.
5 MR. LEGARZA: Can't we blame that on Dee?
6 He's gone.
Let's blame it on Dee.
7 MEMBER LUBRITZ: Is it out of order to --
8 MR. LESSLY: We don't need to do that. You
9 mean as far as the ID card? We'll just do it.
10
MEMBER LUBRITZ: Not the ID
card. A building
11 fund.
12
MR. LESSLY: To give some
consideration to
13 that? That would have to happen in the next
legislative
14 session.
15
MEMBER BAEPLER: We could create
the fund.
16 We need
legislative authority to go ahead and hire an
17 architect and
build one.
18
MR. LESSLY: We have got the
fund. It is the
19 reserve right
now.
20
MEMBER LUBRITZ: Can we instruct
in-house to
21 label it as
such?
22
MR. LESSLY: You can label it
anything you
23 want. It's not going to make any difference because
if
24 the
legislature decided they want to take it, they could
25 take it
anyway.
0147
1 MEMBER BAEPLER: There is one psychological
2 difference I found. If you label it, a portion of it,
3 just start off with half a million in the
building fund,
4 it hides the real surplus because it looks
like you have
5 an intent.
6 MR. LESSLY: Facilities fund.
7 MR. LEGARZA: Of course, you can't have the
8 intent if you don't have statutory
authority.
9 PRESIDENT HUG-ENGLISH: It is something to
10 think about
for the next legislative session if we want to
11 bring it
up. I think it is premature now.
12
MR. LESSLY: We spend a
substantial amount on
13 rent every
year, as you can see, and it's not going to go
14 down. We're in pretty good shape here. We have a lease
15 on this place
for a six-year period of time, and I don't
16 think based on
what we have done on the move here that
17 we're looking
at having to have any substantial more
18 square
footage.
19
MEMBER BAEPLER: How many square
feet do you
20 have right
now?
21
MR. LESSLY: Bob can tell you
that.
22
MR. FRANTZ: Around about 3500
feet.
23
MEMBER BAEPLER: Let's call it
4,000.
24
MR. LESSLY: That is probably
closer.
25
MR. FRANTZ: I would have to look
at the
0148
1 lease.
2 MR. LESSLY: We have all of this, we go all
3 the way to the hallway, and we have
downstairs.
4 MEMBER BAEPLER: At 4,000 square feet
5 replacement value is about $600,000 based on
Las Vegas
6 building costs for a 4,000 square foot
office building.
7 You are not talking -- if you wanted to
ultimately
8 accumulate a million dollars, you can have a
very
9 significant nice building, unless Reno is
significantly
10 more expensive
than Las Vegas. I'm figuring $150 a
square
11 foot, which is
what we use for our average office type
12 building.
13
MR. FRANTZ: Construction costs
$150?
14
MEMBER BAEPLER: Yes.
15
MR. LESSLY: Don is right. If you label it,
16 went in and
got the legislative authority to do it, the
17 risk there is
they will say no and take your money, once
18 they realize
you have it. So I don't think they read
19 these
reports. I don't think anybody did. Our auditor
20 made a change
to one last year, wasn't it oops, we did
21 something we
shouldn't have done here and make a change to
22 it. Send it down to there, they never caught it
or never
23 read it.
24
PRESIDENT HUG-ENGLISH: At any
rate, we have
25 two years to
think about it.
0149
1 MR. FRANTZ: Do you have any questions about
2 it real quickly here? I know we need approval for the
3 audited financial statements.
4 MR. LESSLY: We need a motion to approve the
5 audit and instruct us to file it pursuant to
statute.
6 MEMBER KIRCH: I so move.
7 MEMBER STEWART: Second.
8 PRESIDENT HUG-ENGLISH: There is a motion to
9 approve the audit. All in favor.
Opposed? Chair votes
10 in favor. The motion passes.
11
(Whereupon, the motion was put to a vote
and carried unanimously.)
12
13
MEMBER STEWART: The important
thing about
14 the audit is
there are no recommendations.
15
MR. LESSLY: None whatsoever this
year. Also
16 means that
once this audit is approved by the Board, last
17 year's
secretary is off the hook.
18
MR. FRANTZ: If you don't need
your audit
19 report, just
leave it on the counter here and I'll pick
20 them up later.
21
PRESIDENT HUG-ENGLISH: Thank you,
Bob.
22 Okay. Now that everybody has had a chance to look
at the
23 Investigative
Committee report, I do need a motion.
24
MEMBER STEWART: Move to accept
the report.
25
MEMBER JONES: Second.
0150
1 PRESIDENT HUG-ENGLISH: There is a motion to
2 accept the Investigative Committee
report. All in favor.
3 Opposed?
Chair votes in favor. Motion
passes.
4 (Whereupon, the motion was put
to a vote
and carried unanimously.)
5
6 PRESIDENT HUG-ENGLISH: Paul, did you have
7 anything further about the Colorado program,
or do you
8 think we talked about it enough?
9 MEMBER STEWART: We probably talked about it
10 more than
enough. This is a package of what I
brought
11 back from Denver. It is actually in Aurora, Colorado,
12 which is 30
miles north of Colorado, a little suburban
13 town. The office is probably a thousand square feet
where
14 they do this
in an office building. The office was so
15 small that
they rented a hotel conference room to talk
16 about what
they were doing.
17
You'll see here that they list what they do.
18 They have a
simulated patient training outline. They
have
19 a bunch of
slides talking about the history.
20
This organization has been in existence for
21 11 years. They are currently averaging 60 evaluations a
22 year. Remember there are probably 600,000 licensed
23 physicians in
the United States.
24 They want this to become successful, but
they
25 believe that
they must get to 150 or preferably 200
0151
1 evaluations a year for it to become
self-standing.
2 Currently the Federation is supporting the
underfunding of
3 this.
It sounds like more than $150,000.
4 There are some case studies
that you could
5 look at, the kind of things that they think
they can do.
6 In the overall of the referral process,
anybody can refer.
7 Medical boards refer because, page 2, half
way through,
8 alternative investigation, by stipulation,
prior to
9 license reactivation, practice and career
transitions,
10 recovery from
disabling illness or injury, prior to
11 license
reinstatement due to prior suspension or
12
revocation. The physicians
apparently come because they
13 are mandated
to do so by the state licensing Board, a
14 managed care
organization to continue to be on the list,
15 or a hospital
or medical group that will not bring the
16 doctor back
into clinical practice without knowing that he
17 is okay to do
so.
18
They figure that it takes them two, three or
19 four weeks to
schedule a time. You're there for three,
20 perhaps four
days. And it takes them six weeks to
finish
21 and generate
and deliver a report.
22 A
little more than half way through they talk
23 about what
they do. They make a practice
profile. They
24 interview the
physician. They give him a multiple
choice
25 examination
like a specs. They interview him. They give
0152
1 him simulated patients. They do personality cognitive
2 functioning, computer-based stimulation,
transaction
3 simulated recall, whatever that is, which I
think is can
4 you type the same numbers in the computer
that the
5 computer screen shows you, and then they
might do a
6 psychiatric or a medical evaluation.
7 They are nice people. They are associated
8 with the University of Colorado. They say that they are
9 able to find almost any specialty,
subspecialty or sub
10 subspecialty
doctor to talk to the physician candidate in
11 his field of
knowledge.
12
PRESIDENT HUG-ENGLISH: Thank
you. I think
13 it's helpful
to know a little bit about the program since
14 we have had an
occasion to use it today, and I appreciate
15 you going to
that program to find out about it. It's
16 helpful.
17 21. Legal Reports
18 PRESIDENT HUG-ENGLISH: Okay.
We'll move on
19 to our legal
reports from Dick and Charlotte. Which
one
20 of you want to
go first?
21
MS. BIBLE: I can be very
quick. There's
22 only one
outstanding petition for judicial review, Dr. Mel
23 Graham, and in
fact, his attorney was Rosenberger, and he
24 never filed --
he filed a petition but he did not file any
25 points and
authorities. So it's my intention to
file a
0153
1 motion to dismiss based that he didn't file
his points and
2 authorities.
Another deputy is handling the other
3 litigation, and I'm not that familiar with
it. I don't
4 think anything is going on with that case.
5 PRESIDENT HUG-ENGLISH: Okay.
That's good
6 news.
7 MS. BIBLE: One other thing is the last time
8 I was here, the Cohen case, they have been
remanded back
9 from the Supreme Court, and the attorney had
filed a
10 motion to have
the order implemented and the sanctions on
11 the one count
dismissed. But it's never been set for
12 hearing. We haven't had a determination as to what the
13 court will do
and whether it will come back to you. It
14 should come
back to you for reconsideration of the
15 penalties on
the one remaining count, since one of them
16 got
dismissed. So I'll keep you advised if
it is and when
17 it will come
back to you.
18
PRESIDENT HUG-ENGLISH: Dick.
19
MR. LEGARZA: We have nothing in
federal
20 court that I'm
aware of other than the one that Charlotte
21 indicated the
AG is handling. We have three cases on
22 appeal for
judicial review. Two of them the
appellants's
23 briefs have
been filed, my briefs are due in about 20
24 days. Third one has been on file with the court for
a
25 year
and-a-half, and there's been no decision on that one.
0154
1 Everybody seems to be current with their
terms and
2 conditions of their probation.
3 I need some input from the
folks from Las
4 Vegas.
On the 11th of October we have our hearing set on
5 adopting, telephone conference call, for the
adoption of
6 the regulations, which are the respiratory
care
7 regulations that Steve has been talking about,
the
8 integrative and complementary medicine
regulations and all
9 of the other regulations that were the
temporary
10 regulations
plus complete change in that whole big package
11 as you recall
of changing physicians assistant to
12 physician
assistant, that cleanup thing we did in the
13 legislation.
14
We have word, and I think we talked about it
15 a little bit,
that homeopathic doctor indicated there's
16 been a substantial change, and they may be
there making a
17 bunch of noise
at our workshop. Steve has talked to the
18 people from
the union, and I talked to them for quite a
19 while. Obviously, they are going to show up. So the
20 hearing on the
workshops are going to be probably
21 lengthier than
I thought they were going to be. There
may
22 or may not be
people who would be looking for a physical
23 location down
south.
24
Now in the past we have had a location, we
25 located a
location at the Bridger Building, and the
0155
1 members of the Board from down there have
met at that
2 location, and we had one telephone call with
the people
3 from up here, and I'm thinking about
attempting to set
4 that up.
I think it maybe would be more convenient for
5 the people from the South to go to one spot,
it would be
6 more convenient for anyone interested in
appearing where
7 we don't have to worry about having a whole
bunch of
8 people on the telephone conference calls and
everybody has
9 a better reaction.
10 I
need your feeling about -- we have done it
11 in the
past. It's worked pretty good, I
think. Don't you
12 think? I'm thinking about trying to get a location
either
13 at the -- I
think it is the Bridger Building.
14
MEMBER BAEPLER: Or was it
Sawyer?
15
MEMBER KIRCH: The Bridger
Building is
16 closed, unless
they reopened it. The Bridger Building
is
17 the bank
building.
18
MEMBER STEWART: You are talking
about that
19 manufactured
housing building on 26 and Sahara.
Bradley.
20
MR. LEGARZA: Bradley. The Bradley Building,
21 or the Sawyer
Building. I mean the legislative counsel
22 bureau is real
good, that is where we're having our
23 workshop
hearings, and I think they would let us have an
24 office there
in their building at the Grant Sawyer
25 Building. I want to do that. I want to put that together
0156
1 so that there would be a physical place
there where all
2 you people can come to, and we can have a
meeting, just
3 telephone call with the ones from up here
rather than
4 being scattered all over the place, be a
location for
5 folks to go to.
6 MEMBER KIRCH: How many people do you think
7 you will have?
8 MR. LEGARZA: Who knows.
I'll bet we'll
9 probably have three or four union people at
least at the
10 workshop. There may be some general practitioners, I
mean
11 some
practitioners, respiratory therapy practitioners that
12 will be
interested in it. If Dr. Murthoil is
there, the
13 last time he
was there I think he had about 25 of his
14 patients with
him.
15
MEMBER BAEPLER: Why would he be
at this?
16
MR. LEGARZA: Because the
integrative and
17 complementary
medicine regulations are part of this
18 regulation
package to adopt them permanently. They
were
19 only adopted
as temporary regulations because the
20 legislature
was in session and couldn't go to the LCB.
21
If it is okay, unless I hear somebody say I
22 don't want you
to do that, that is what I plan to do is
23 get a physical
site. What was the name of that
place?
24 Either the
Bradley Building or Grant Sawyer.
25
MEMBER KIRCH: The community
college library
0157
1 have various facilities available. Some other thoughts.
2 MS. BIBLE: The Sawyer Building, I'm sure you
3 can get a room.
4 MR. LEGARZA: LCB is real good about it.
5 MEMBER STEWART: That is Thursday, the 11th
6 of October, afternoon?
7 MR. LEGARZA: Yes, sir.
If I find a spot,
8 I'll send everyone a letter saying where it
is, reminding
9 you.
Is that fair enough? That's all I
have.
10
MEMBER BAEPLER: The hearing is on
Wednesday?
11 MR. LEGARZA:
No, October the 11th is a
12 Thursday.
13
MEMBER BAEPLER: We have a hearing
coming up
14 this
Wednesday, don't we?
15
MR. LEGARZA: That is just the
workshop.
16
MEMBER KIRCH: That is at the
Bradley
17 Building.
18
MR. LEGARZA: No, the Sawyer
Building. You
19 guys don't
have to be at that one, but you certainly can
20 be.
21
MR. LESSLY: It certainly will be
22 educational,
if you want to.
23
MR. LEGARZA: It is not a Board
meeting.
24
MEMBER KIRCH: I realize
that. But I think
25 that if you
are there and you hear the input of the
0158
1 people.
2 MR. LEGARZA: You sat through one one time
3 before, didn't you?
4 MEMBER STEWART: Yes, sir.
5 MR. LEGARZA: You bet.
Please.
6 PRESIDENT HUG-ENGLISH: Okay.
Thanks, Dick.
7 22.
Executive Director's Report.
8 PRESIDENT HUG-ENGLISH: Moving on to the
9 Executive Director's report, Larry.
10
MR. LESSLY: First item under my
report is
11 staff
attendance at educational meetings. I
will tell you
12 we have not
attend any because we just haven't had time.
13 I am not going
to the executive management seminar, nor am
14 I sending any
staff to the executive management seminar in
15 Dallas. It is a one-day thing on how to deal with the
16 press. We let our President deal with the
press. So I
17 don't think I
need to be trained or have my staff trained
18 to do
that. I say no comment. That is the only way you
19 can deal with
them anyway.
20 I
would tell you that I am going next weekend
21 and next
Monday, I'll be in Philadelphia at the USMLE
22 committee on
irregular behavior to look at problem
23 patients, of
individuals who have taken the USMLE exam,
24 and I'm also
probably going to get on the airplane after
25 the meeting on
the 24th on the post-licensure competency,
0159
1 I'm probably going back to Dallas with them
that night
2 because there is an executive directors
advisory council
3 that I'm still on the next day in Dallas.
4 We don't have any other planned
educational
5 events or trips for staff at this time. If you look in
6 the section of your booklet on travel, you
notice the
7 Federation is holding its regional workshop
in Las Vegas.
8 I would certainly like to see some Board
members appear at
9 that workshop. Joel and Jackie and Dick and I went to the
10 one in
Phoenix, Arizona, and it was absolutely remarkable.
11 There was no
one from the Arizona Medical Board or the
12 Arizona
Osteopathic Board there. It was right
there in
13 their
jurisdiction.
14
MEMBER LUBRITZ: What is that
date?
15
MR. LESSLY: It is the 10th of
November.
16
MEMBER BAEPLER: At the Embassy
Suites.
17
MR. LESSLY: Embassy Suites in Las
Vegas.
18
PRESIDENT HUG-ENGLISH: What is
the topic
19 going to be
this time?
20
MR. LESSLY: E medicine and
Medical Board
21 oversight.
22
MEMBER BAEPLER: I would be quite
willing to
23 go to that.
24
MEMBER JONES: I would, too.
25
PRESIDENT HUG-ENGLISH: Me, too.
0160
1 MR. LESSLY: Give me your name and we'll
2 register you for it and get information to
you. Looks
3 like we have four already.
4 MEMBER ANJUM: I'll go.
5 PRESIDENT HUG-ENGLISH: Five.
6 MEMBER BAEPLER: Kind of fascinating topic.
7 MR. LESSLY: I would also tell you that the
8 administrators in medicine is having a
conference in Las
9 Vegas I believe the 27th of September. They wanted me to
10 give welcoming
remarks, and Dr. Baepler is giving opening
11 remarks.
12 MEMBER BAEPLER: I have never heard from
13 them.
14
MR. LESSLY: If you don't hear,
don't go.
15
MEMBER BAEPLER: September 27th?
16
MR. LESSLY: I'll check it for
you.
17
MEMBER BAEPLER: I have never
heard from
18 them.
19
MR. LESSLY: Also in the booklet
-- any
20 questions
about that workshop? That is a one-day
thing,
21 all day
Saturday. I think they give you CME for
it. We
22 pay your
registration fee if there is any, and it's
23 usually fairly
interesting. It's on a timely topic, and
24 they staff it
fairly well.
25
We have a Board investigator workshop series.
0161
1 It's being conducted in Las Vegas at the
Embassy Suites on
2 November 8th and 9th. I guess I need authority for Dick
3 to send anybody to that if he deems that
appropriate.
4 MEMBER STEWART: So move.
5 MEMBER KIRCH: Second.
6 PRESIDENT HUG-ENGLISH: All in favor.
All
7 opposed?
Passes.
8 (Whereupon, the motion was put
to a vote
and carried unanimously.)
9
10
MR. LESSLY: You also notice
Citizen Advocacy
11 Center has a program announcement for
Wednesday, November
12 the 14th, and
Friday, November the 16th, for their 2001
13 annual meeting
in Philadelphia. This organization
14 primarily for
Maureen's information is an organization
15 that is
designed to assist public members of licensing
16 boards and the
medical field. They do have a bit of
their
17 own agenda,
but they also present some very good
18 information.
19
And it's not restricted to public members.
20 Any member can
go to it. They invite staff of medical
21 boards to go
to it. If anyone wants to go to that,
you
22 need to let us
know, and we'll register you for it.
23 I
believe that that is all of the educational
24 events. I have no requests for staff to attend
anything
25 discussed.
0162
1 The next thing on the agenda is
the
2 consideration of proposed 2002 Board meeting
schedule.
3 We'd like to set the dates for Board
meetings over a year
4 in advance so that we make sure we don't
have any
5 conflicts.
Hopefully this will meet your schedule.
We
6 have attempted to do them approximately
quarterly. So we
7 do four meetings a year.
8 We have also -- I understand
Dr. Lubritz has
9 decided he wishes to continue with the
investigative
10 committees in
conjunction with Board meetings. We have
11 also scheduled
the Investigative Committee meeting for the
12 day, the
Friday before the Saturday full day Board
13 meeting, with
the understanding that we probably will
14 continue, if
this President wishes to do so, the meeting
15 starting late
Friday afternoon after the Investigative
16 Committee is
over so that we get some things out of the
17 way. Had you not had that meeting last night, you
would
18 be here at
least until seven or eight tonight. The
only
19 way we can
avoid an extremely long Saturday with the
20 agendas the
way they have been coming in is to do the
21 Friday evening
thing, too.
22
MEMBER KIRCH: Is there any
flexibility on
23 the March
date? I do have a conflict.
24
MR LESSLY: Anybody else have a
conflict in
25 march?
0163
1 PRESIDENT HUG-ENGLISH: I will have a
2 conflict if we change it to the next
weekend.
3 MEMBER JONES: Don't change it.
4 MR. LESSLY: The Vice President doesn't want
5 it changed.
6 MEMBER STEWART: The December meeting, are
7 you going to not have meetings once a year
in Las Vegas?
8 MR. LESSLY: That is entirely up to you. I
9 have listed it in Reno because I have run
analysis of the
10 cost to do the
meeting in Las Vegas, and I find that we
11 spend, and
this is not significant, we spend approximately
12 $4600 more to
hold a meeting in Las Vegas than we do here.
13 We have the
meeting room here. We have to fly an
awful
14 lot of staff
and take an awful lot of material to Las
15 Vegas.
16
I'm uncomfortable with the last meeting we
17 had in Las
Vegas, I was uncomfortable with the situation
18 where we had a
license application, we didn't have the
19 files all
there because they were in Reno and weren't
20 readily
available. Licensing specialist
available to come
21 in on a
part-time basis today on the one issue on the
22 mental health.
23
My feeling is we don't accomplish anything
24 other than
maybe your convenience to hold that meeting in
25 Las
Vegas. It's much easier for us to pick
you up at the
0164
1 airport and do what we do and get you home
than it is for
2 us to get to Las Vegas to hold a meeting.
3 We had a comment one time I
believe from
4 Dr. Havins about having meetings down there,
this is where
5 most of the doctors are. That is true.
But they don't
6 come to meetings. The only people in December who
7 appeared at our meeting on the agenda were
physicians from
8 Reno from diversion who had to fly down to
the meeting.
9 So I mean, it is entirely up to
you. I would
10 simply tell
you it costs us more, it is extremely -- it's
11 a logistical
nightmare for us to do it down there. So
I
12 simply propose
that you do it in Reno.
13
MEMBER BAEPLER: It's difficult to
hold
14 meetings with
the university system, we move them all over
15 the state, and
we ended up with Vegas and Reno for the
16 Board of
Regents meeting having everything physically
17 duplicated at
each end of the state. It got to be a
18 nightmare when
we would hold a meeting like in Elko.
Then
19 we faced the
same kind of problem we do when we meet here
20 in Las
Vegas. Everything had to be transported,
from the
21 name signs on
over. And then your reference material
22 isn't
available to you.
23 I
have found as we discussed various things,
24 particularly
with respect to the investigations, it helps
25 to have these
records handy and available. There is no
0165
1 way you can transport records. There is no way you know
2 what you need.
3 MEMBER STEWART: I agree with all that. All
4 that said and done, is it important that
there is one
5 meeting a year in Las Vegas?
6 MR. LESSLY: We don't hold one in Elko.
7 Don't hold one in Carson. We held one in Carson City in
8 1999.
9 MEMBER STEWART: I don't have a good answer
10 to that
question.
11
MR. LESSLY: I know what you are
saying,
12 Paul. I guess I would say of all the meetings we
have
13 held in Las
Vegas, we have an empty auditorium or empty
14 meeting room
when we do it. People don't come to
these
15 hearings.
16
MEMBER STEWART: That was a
hearing; that
17 wasn't a
meeting.
18
PRESIDENT HUG-ENGLISH: It was a
meeting.
19 MS. LYONS: They would have come up here just
20 as easily.
21
MEMBER STEWART: I just don't know
if it
22 makes a
statement good, bad or indifferent. I
just don't
23 know. I'm just raising the question.
24 MEMBER BAEPLER: Have we ever been
25 criticized?
0166
1 MR. LESSLY: Is it inconvenient for you to do
2 it this way?
I mean, I would think that it's much more
3 convenient for you to, with the hotel
location, the office
4 location, and the airport location, to come
here than it
5 is for me to fly 12 people down south.
6 MEMBER MONTOYA: I enjoy the break. I enjoy
7 coming up here. I don't care.
8 MEMBER KIRCH: One of the things to consider
9 if we have like our telephonic conference
calls, if we are
10 voting or
something, perhaps do something like that, make
11 them available
at a central place where other people can
12 come, and
we'll say we don't always go to Reno, you can
13 always
participate on some of these by coming to a central
14 location. Maybe that would -- I don't know.
15
MEMBER BAEPLER: Have we ever
received any
16 criticism for
not meeting, say, more in Vegas? Right
now
17 it is three to
one.
18
MR. LESSLY: It used to be half
and half.
19 Used to be
like the Regents, every other meeting.
20
MEMBER BAEPLER: If we are not
getting any
21 criticism for
that shift, maybe probably nobody cares
22 where we meet.
23
MR. LESSLY: From a logistical
standpoint, it
24 is a nightmare
for Maureen with meal arrangements, we have
25 got to rent a
room. Well, it's just more convenient
here.
0167
1 PRESIDENT HUG-ENGLISH: We are having our
2 December meeting -- which remind me of the
date coming up
3 this year.
4 MS. LYONS: November 30th, December 1st.
5 PRESIDENT HUG-ENGLISH: -- in Las Vegas.
6 That one is in Las Vegas. Perhaps we could try this for a
7 year and see if people object or we get
criticized for it,
8 and people have an issue with it, nothing is
set in stone.
9 This is a one-year schedule. We can certainly revise it
10 the following
year.
11
MS. LYONS: This gets published in
our
12 newsletter and
people call in and say, oh, I just saw that
13 we have a
whole year to change it. It's not like
we can't
14 change the
schedule.
15
MEMBER BAEPLER: Given the fact
that no one
16 will attend
the meeting in Las Vegas, it never occurred to
17 me that we met
there for any reason other than to make it
18 a little more
convenient once a year for those of us from
19 Las
Vegas. It is a minor inconvenience to
fly up here
20 compared to
the alternative.
21
MR. LESSLY: I guess if you from
Las Vegas
22 say that it's
a major problem with you, we will change it.
23 I'll change
the schedule.
24
MEMBER BAEPLER: It is not a major
problem.
25
MEMBER STEWART: No, it's not a
major thing.
0168
1 We had offices down there. We decided that we did not
2 need to have a satellite office down
there. When we made
3 that decision, you went from
alternating. I guess you did
4 alternating to three and one.
5 MR. LESSLY: It used to be five, and we went
6 to four, and it was three and one.
7 MEMBER STEWART: I have no idea. I'm just
8 raising the question. If we believe Dr. Havins,
9 two-thirds of the doctors are in the
southern part of the
10 state, should
one meeting be there, with the realization
11 that nobody
comes to our party.
12
MR. LESSLY: I understand there
are going to
13 be some at the
December meeting because we're going to
14 encourage the
Medical Association to be there. Maybe
we
15 will have some
at this particular meeting. We'll see.
16
MR. LEGARZA: I think you might
get
17 criticized for
not having the meeting in Las Vegas, but I
18 don't know
what the legitimacy of that criticism would be.
19
MEMBER BAEPLER: We could always
change it.
20
MS. LYONS: This will be published
in the
21 October
newsletter. That is a chance for all
licensees to
22 notice it is
going to be in Reno.
23
MEMBER KIRCH: When we're doing
our votes,
24 when we had
our last call as opposed to having us in our
25 offices or
wherever we were, have us in one spot where
0169
1 everybody can come and say there are
opportunities.
2 There's always availability for general
comment. So maybe
3 we adjust the way we do any of our
telephonic giving them
4 the opportunity to be present or something
like that.
5 MR. LESSLY: We do meetings where you have
6 gone to a central location in Las Vegas, and
you have met
7 up here.
But quite frankly, I think telephone conference
8 calls are the most dangerous kind of meeting
you can have
9 because you don't have the interchange that
you have. You
10 don't get to
look each other in the face and discuss the
11 issues. And it seems like there's always some problem
12 with them.
13
MEMBER KIRCH: I'm just saying
when we have
14 these, not
that we are going to have them on a regular
15 basis, we're
having one to vote on the regs. Make
sure
16 we're all in
that. When we had our last call, instead
of
17 those of us
being in our offices, perhaps have us in a
18 central
location, publish that and say you do have the
19 availability
that periodically we have these. Even
though
20 it is a
limited agenda and maybe only one or two items,
21 they still
have the opportunity for public comment.
22
MEMBER BAEPLER: It can be a
posted meeting.
23
MEMBER KIRCH: I think they have
to be
24 anyway. If we just post it and if there is someplace
we
25 can meet like
the Sawyer Building or something like that,
0170
1 then that gives them that opportunity under
public
2 comment, they can make their comments. Maybe that is one
3 way to say that we he have tried to
accommodates you
4 somehow.
5 I'm not saying that we should
do our full or
6 regular meetings that way. I'm just saying on certain, if
7 we have a single agenda item or one or two
items that
8 we're going to deal with telephonically, put
us all
9 together.
10
MR. LESSLY: We don't have any
requirement
11 legally, as I
understand it, to -- correct me if I'm
12 wrong -- to
hold hearings, workshops over the State of
13 Nevada.
14
MR. LEGARZA: There is no
requirement that
15 you hold two
workshops. There is no requirement that
you
16 hold a
workshop anywhere. Since I have been
general
17 counsel I have
always held the workshop in Las Vegas and a
18 workshop in
Reno.
19
MR. LESSLY: I did it when I was
general
20 counsel.
21
MEMBER LUBRITZ: That is because
you like to
22 visit Las
Vegas.
23
MR. LEGARZA: I like Las
Vegas. I always
24 have.
25
PRESIDENT HUG-ENGLISH: I don't
think we need
0171
1 a motion on that, do we?
2 MR. LESSLY: I think you need to set your
3 schedule.
4 MEMBER BAEPLER: I move we adopt the schedule
5 as presented.
6 MEMBER JONES: Second.
7 PRESIDENT HUG-ENGLISH: All in favor.
8 Opposed?
Chair votes in favor and motion carries.
9 (Whereupon, the motion was put
to a vote
and carried unanimously.)
10
11
MR. LESSLY: The next agenda item
is the
12 Nevada
Broadcasters Association contract. This
is the
13 contract for
the organization that runs our public service
14 announcements
on radio and TV. And we have been doing
15 this on a
quarterly basis. So we need to decide
whether
16 we're going to
continue it for the months of October,
17 November and
December.
18 I
will tell you that the statistics are down
19 on the number
of spots that have been aired. And I'm
20 trying to
gather from the report whether it's a question
21 of the
stations not actually reporting it or whether it is
22 fewer spots
simply being run. I would tell you that
I
23 have finally
seen the TV ad. It was like 10:00
o'clock in
24 the
morning. It wasn't at 3:00 o'clock in
the morning as
25 many of them
are.
0172
1 But if we are going to continue
this, we need
2 a motion to do that for three months. I would urge you to
3 do it for three more months simply because
you need to
4 look at what we have done here. We have spent in excess
5 of $50,000 to develop two TV adds. One is no longer
6 running.
The current one the Board was very pleased with,
7 I believe, and has been running for -- it's
less than a
8 year.
I think since last summer. Maybe
it's nine months
9 that it's been running.
10 I
don't think you have gotten your money's
11 worth out of
that investment in that ad at this point.
I
12 would not want
to see you stop that. But I'm not real
13 pleased with
the statistics either. They are not as
good
14 as they have
been in the past. They guarantee us a
15 three-to-one
cost ratio here. But they set the cost
16 figure, the
value on the spots, which may or may not be
17 correct.
18
MEMBER LUBRITZ: Hasn't Arne been
working
19 with them
pretty much?
20
MR. LESSLY: He's argued with them
about for
21 the value of
your spots, we're really not getting that
22 much money's
worth. The ads are not being run at good
23 times of the
day.
24
That's probably more true up here than it is
25 in Las
Vegas. We're not truly a 24-hour city
here, I
0173
1 don't think.
We are as far as downtown Reno is concerned.
2 Las Vegas is a 24-hour city. So probably running an ad in
3 Las Vegas at 3:00 o'clock in the morning is
more effective
4 than it is in running it in Washoe County at
3:00 o'clock
5 in the morning.
6 He's argued with them, and they
have been
7 cooperative about it. But I think their figures are just
8 down this time.
9 PRESIDENT HUG-ENGLISH: Would it be
10 appropriate,
Larry, to continue it through December but
11 with the
stipulation that we'd like to see some changes,
12 that we don't
really feel we're getting our money's worth?
13
MR. LESSLY: If you approve this I
can
14 certainly
write Mr. Fisher and say it is approved.
The
15 Board had some
reservations about the figures, and we
16 would
certainly want to see those figures increased
17 hopefully
between now and the end of December. And
we
18 will be
looking at those figures before we make another
19 decision to
continue the contract after this quarter.
20
MEMBER MONTOYA: Make a motion we
continue
21 with that
stipulation.
22 MEMBER JONES:
Second.
23
PRESIDENT HUG-ENGLISH: There is a
motion and
24 a second. All in favor.
Opposed? Chair votes in favor
25 and motion
passes.
0174
1 (Whereupon, the motion was put
to a vote
and passed unanimously.)
2
3 MR. LESSLY: The next item under my portion
4 of the agenda is the public service
announcement -- I'm
5 sorry -- is consideration of draft policy
statements for
6 Internet continuing medical education
accreditation, so
7 forth.
I put this on here because the committee on
8 post-licensure competency, and in
particular, Dr. Baepler
9 had reservations about the quality of life
of
10
standardization in continuing medical education. This
11 policy
statement is on there for any comments we might
12 want to make.
13 I
don't think we have to come to any
14 conclusion
here today, but if any of you want comments,
15 individual
Board members want comments made, if you will
16 get them to
me, I'll be happy to send them to the
17 Federation.
18
That would be also true with the other
19 document that
I handed out to you, the Federation of State
20 Medical Board
model policy guidelines for opiate addiction
21 treatment in
medical offices. Those are sent out for
22 comment
also. If you have comment on those, I
would be
23 happy to
forward them to the Federation.
24
The Board office staff and space update, I
25 think I pretty
well explained to you last night and today
0175
1 what's happened with staff. We have had some changes. We
2 have had more turnover in the last six
months than we have
3 had in ten years. We think things are stabilized.
4 Mr. Legarza is actively recruiting for
another
5 investigator at this point.
6 As far as the office space is
concerned, we
7 are fully moved at this point. We now run from here to
8 the far end of the building on the third
floor. The space
9 next door, I think we took all of you
through it, the
10 orientation
session for the new Board members. It's
now
11 fully
occupied. They have closed a wall off at
the far
12 end of the
office. You can tell they are doing a
13 tremendous
amount of construction and rehab work here in
14 the building,
which we hope is going to be over before too
15 much longer.
16
Any questions about staff or space at this
17 point?
18
Last thing are informational items.
Speak
19 for
themselves. Unless you have a
question. That's the
20 end of my
report.
21
PRESIDENT HUG-ENGLISH: Thank you,
sir.
22 MEMBER STEWART: Cheryl, could I ask Larry to
23 discuss Dr.
Wack's letter?
24
MR. LESSLY: I still haven't seen
it.
25 I
gather the gist of the letter from the
0176
1 first page.
Dr. Wax is apparently concerned about
2 limitations on practice for those physicians
who are
3 required to practice in medically
underserved areas as
4 designated by the federal government for a
period of two
5 years in order to avoid the requirement that
they go home
6 after completing postgraduate training in
the United
7 States.
We have had this same issue come up a number of
8 times about what are they entitled to do,
what are they
9 required to do.
10 I
wish Elizabeth were here. She can
probably
11 answer these
better than I can.
12
Let me say what we do on issuing a license to
13 those
physicians is we put on the license exactly what the
14 federal
government tells us is going to be put on the
15 license. If they are restricted to working at
16 Dr. Stewart's
clinic, we put that on there. If they
are
17 restricted to
working for Dr. Paul Stuart, we put that on
18 there. That would give them greater latitude
obviously if
19 you have got
15 locations.
20
We're not in a position to second guess where
21 they are
allowed to work. It is not our
responsibility to
22 monitor
that. It is the responsibility of the
State
23 Health
Department who runs the program to ensure that they
24 comply with
the requirements that are imposed by the
25 federal
government.
0177
1 I guess there's been concern in
Las Vegas
2 that these physicians practice beyond the
scope of their
3 authority.
That is simply a matter for the Health
4 Department to make a determination.
5 Do you have other questions
about that,
6 Dr. Stewart?
7 MEMBER STEWART: No, sir.
8 MEMBER LUBRITZ: I know I got asked about a
9 couple recent articles in the paper about
it. I keep
10 getting, what
are you all doing about it? I said we
who?
11
MR. LESSLY: Good response.
12
MEMBER LUBRITZ: I said, as far as
I know,
13 that comes
through the Governor's office and not through
14 our office.
15
MR. LESSLY: State of Nevada could
stop
16 participating
in that program if there is a problem with
17 it any time
they wanted to. That selection process
of who
18 gets those
positions is done by the state government.
19 We're not
involved in it. The only thing we do is
process
20 an application
of that physician and issue the license
21 based upon who
the petitioner for the physician is.
22
MEMBER LUBRITZ: Since it is a
question I get
23 asked a lot
since they had several articles in the paper,
24 what's a good
answer to give?
25
MR. LESSLY: Contact the
Department of
0178
1 Health.
2 MEMBER LUBRITZ: Department of Health. Okay.
3 MEMBER ANJUM: The Board only gives licenses.
4 They don't restrict licenses. The Department of Health
5 tells them where to work and where not to work. I think
6 it is five years, not two years any
more. You have to
7 work for five years to get an exemption for
the card. It
8 used to be two years and went to three
years, and now it
9 is five years.
10
MR. LESSLY: We have had a lot of
complaints
11 about the
situation of physicians feel they are slave
12 labor,
contracts being broken, all kinds of things
13 happening in
their work environment that we're not in the
14 position to
become involved in. Certainly not within
our
15 jurisdiction.
16
Again, our only jurisdiction is to issue them
17 a license and
issue it in accordance with the restriction
18 of the
Department of Immigration -- I guess it is the
19 Labor Department
that finally issues the thing, puts on
20 the petition.
21
MEMBER LUBRITZ: But they have to
come in
22 with all the
requirements of any other physician coming
23 in, except
they're special in the sense that the
24 Department of Health tells them where they can
work.
25
MR. LESSLY: They meet every
requirement for
0179
1 licensure, three years progressive
postgraduate, major
2 exam, the works. All of them are fresh out of residence
3 training anyway.
4 MEMBER ANJUM: The Board doesn't tell them
5 where they can and cannot work.
6 MR. LESSLY: If the petition of that
7 physician that is approved says you are
going to work for
8 Dr. Paul Stewart, we'll put you are to work
for Dr. Paul
9 Stewart, whatever the government tells
us. We don't go
10 out and say
we're going to look to see if you are working
11 someplace else
other than for Dr. Paul Stewart.
12
PRESIDENT HUG-ENGLISH: Have we
ever had any
13 conversation
with the State Board of Health about this?
I
14 mean,
obviously, this letter.
15
MR. LESSLY: Not more than a
couple hundred.
16
PRESIDENT HUG-ENGLISH: That's
what I
17 figured. What's their response?
18
MR. LESSLY: I think their
response is they
19 are reluctant
to do very much about it at all. I don't
20 think they are
staffed or interested in monitoring it, and
21 I doubt very
seriously they ever check on it.
22
MEMBER BAEPLER: How many people
are we
23 talking about?
24
MR. LESSLY: Twenty a year.
25
MEMBER LUBRITZ: They stay for
five years. A
0180
1 hundred physicians.
2 MR. LESSLY: Uh-huh.
States have an election
3 to make whether they want to participate in
it or not.
4 Nevada elected to do so.
5 MEMBER LUBRITZ: Are they all in Las Vegas?
6 MR. LESSLY: Majority of them. I take that
7 back.
There's one in Gerlach, Nevada.
8 The program has done some good
for rural
9 Nevada because they will go to these
underserved areas
10 that no other
physician will go to simply because they are
11 required to do
so in order to have that license and the
12 opportunity to
practice in the United States. So I'm
not
13 saying it's a
bad program from any standpoint. But I
14 think majority
of them are in Las Vegas.
15
MEMBER LUBRITZ: But when they
serve their
16 time, are they
then allowed to stay here?
17
MR. LESSLY: Yes, and petition for
18 unrestricted
license.
19
MEMBER ANJUM: I think that two
type of
20 programming,
the limit of 20 for the underserved area,
21 plus some for
the rural area is separate. That's a
22 separate quota
for that. So there is more than 20 per
23 year that can
come to the state.
24
MEMBER STEWART: The issue
currently is the
25 I20 program
which deals with the HS -- HPSA underserved
0181
1 area which is the census track of North Las
Vegas. That's
2 what Dr. Wax's worries are about.
3 MEMBER LUBRITZ: What it says is they don't
4 work in that particular area but can work.
5 MEMBER ANJUM: They don't work there?
6 MEMBER LUBRITZ: The articles in the paper
7 said that they work not just there, but they
can work
8 anywhere.
9 MEMBER ANJUM: I may be wrong, but what I
10 heard is that
as long as they do the required number of
11 hours, which
is generally 40 hours a week in that area,
12 they can do
some additional work somewhere else, too.
I
13 don't know the
rules. That is what I heard from
14
conversations. The major burden
of the work is in Las
15 Vegas. They can work somewhere else, too, but that's
16 where they
have their main location.
17
MEMBER STEWART: Larry, we are not
the police
18 of this issue.
19
MR. LESSLY: No, sir.
20
PRESIDENT HUG-ENGLISH: So I guess
if you get
21 further
comments, refer them on to the State Board of
22 Health.
23 MEMBER LUBRITZ: Do we answer him by saying
24 send this
letter to the State Board of Health?
25
MR. LESSLY: He doesn't really ask
us. Does
0182
1 he ask us for an opinion?
2 MEMBER STEWART: I got a fax'd copy. It's
3 addressed to Cheryl at this office.
4 MR. LESSLY: We haven't seen it.
5 MEMBER STEWART: He just fax'd it to me and
6 mailed it to her. That's why I thought when we talked a
7 couple days ago, that I thought you had seen
it.
8 MR. LESSLY: No.
9 MEMBER ANJUM: It doesn't say copy to her.
10
PRESIDENT HUG-ENGLISH: Isn't this
the one I
11 told you about
that was fax'd over? So when I called
you
12 about it a
couple days ago that I had gotten it.
13
MR. LESSLY: Maybe I had a senior
moment.
14
PRESIDENT HUG-ENGLISH: I did get
it. It
15 came to my
office, though, not here.
16 MEMBER
LUBRITZ: It says in the third
17 paragraph,
"At this point I would request that the State
18 Board of
Medical Examiners take a careful review of what
19 is occurring
in this city as, obviously, that what is
20 happening is
not what is supposed to be happening. I
21 regret that I
won't be there." So I think it's
reasonable
22 to send him
back a letter and say thank you for your
23 letter but
that's governed by.
24
MR. LESSLY: Be happy to prepare
that letter.
25
MEMBER LUBRITZ: Is that
reasonable?
0183
1 MEMBER ANJUM: Sure.
2 PRESIDENT HUG-ENGLISH: Yes.
3 MEMBER LUBRITZ: Rather than not answering?
4 MEMBER STEWART: I guess under his signature
5 is the question, and I don't know that we
have a position,
6 what is the Board's position on physicians
who willfully
7 and knowingly violate a federal statute?
8 MR. LESSLY: We don't enforce federal
9 statutes.
We don't have the authority to enforce federal
10
authority. If somebody is
convicted of a crime under
11 federal
statute, it goes to the Investigative Committee.
12
MEMBER ANJUM: Do we know what the
federal
13 statute is,
number one?
14
MR. LESSLY: It really doesn't
make any
15 difference to
us because we don't have any jurisdiction.
16 24. Discussion and Consideration of
Correspondence
17
PRESIDENT HUG-ENGLISH: Okay. Moving on
18 then to agenda
Item No. 24, we really are getting close,
19 guys. Discussion and consideration of
correspondence.
20 It's a letter
from the Clark County OBGYN Society. I
21 don't know
specifically if you have had an opportunity to
22 read that.
23
MEMBER MONTOYA: Going through
this, they are
24 taking a lot
of things out of context, explanatory kind of
25 mode trying to
drum up anything under the influence of
0184
1 Mr. Havins over here. And he's an angry middle-aged man.
2 PRESIDENT HUG-ENGLISH: Do you know him,
3 Steve?
4 MEMBER MONTOYA: Yes, I do.
It was more or
5 less a quasi social thing and something that
we could use
6 to disseminate information to our members,
something to
7 control.
They have all these meetings. Now
he's making
8 it into a politically active entity. That is his
9 prerogative.
He is trying to drum up more and more fodder
10 for his
thoughts.
11
Now he got started on that pain control
12 thing. He did have some stuff going with that. That got
13 a little bit
taken on by somebody else. Then he just
14 turned on some
other thing. He took the whole book and
15 decided to go
to town.
16
MEMBER LUBRITZ: I don't think
this was on
17 his own. I think it was in part due to Dr. Havins.
18
My personal thought is on this, this letter
19 got copied to
A, B, C, D, E, F, G. I think we should
20 answer this
letter and send copies to A, B, C, D, E, F, G
21 that they know
the President is not a lawyer, that the
22 pain control
issue has been discussed specifically with
23 Dr. Havins who
now understands that he was not correct -
24
MEMBER ANJUM: I don't think he
does.
25
MEMBER LUBRITZ: -- in
promulgating those
0185
1 kind of things. I think --
2 PRESIDENT HUG-ENGLISH: We heard Dr. Coppola
3 say that communication is key. And I think I agree with
4 you, Joel, that when we get a letter like
this or find out
5 about a letter like this, that the best
response is to
6 send back a letter basically stating the
facts as the
7 facts really are.
8 MEMBER LUBRITZ: Exactly.
9 MEMBER STEWART: So perhaps the letter that
10 you or the
doctors are going to write to the State Medical
11 Society and
State Medical Association could also be sent
12 to the OBGYN group.
13
MEMBER LUBRITZ: So long as it
answers all
14 these
questions.
15
MEMBER BAEPLER: You want to
address all of
16 them.
17
PRESIDENT HUG-ENGLISH: We could
do a
18 separate
letter to answer this.
19
MEMBER BAEPLER: Include the other
letters to
20 answer that
one section but the other topics in there.
21
PRESIDENT HUG-ENGLISH: How does
everybody
22 feel about
that?
23 John.
24
MR. LANZILOTTA: Some of these
things, does
25 the AMA have
like a set of ethical guidelines?
Because
0186
1 like the APA or physicians assistants
do. Some of these
2 issues are in ethical guidelines of practice. I mean not
3 only are they regulations, but they are also
ethical
4 guidelines for physicians and PA's to
practice by. Like
5 the sexual misconduct and a few of these
other things for
6 personal gain, that I'm reading through this.
7 I'm just wondering what the
awareness is
8 there of people that are bringing these
issues up. There
9 are standards of ethical guidelines of
medical practice
10 also. And I see that they cross over into the
regulation,
11 or the
regulation crosses over into them. I'm
looking at
12 this as in
amazement, part of this, myself.
13
MEMBER MONTOYA: He sent this up
here?
14
PRESIDENT HUG-ENGLISH: No, I
don't think so.
15 MR. LESSLY: We obtained a copy of it.
16
MEMBER MONTOYA: You obtained a
copy of it.
17 I could have
given you mine. I didn't think you would
18 read it.
19
MEMBER LUBRITZ: I think when a
letter like
20 this goes out,
a derogatory letter like this goes out to
21 all of these
people, I think that to not answer it is
22 admitting that
it's all correct.
23
MEMBER BAEPLER: It becomes a
public
24 document.
25
MEMBER ANJUM: It is not addressed
to the
0187
1 Board.
2 MEMBER BAEPLER: It becomes a public comment
3 because it was addressed to public
officials, and
4 everything they receive is public.
5 PRESIDENT HUG-ENGLISH: Let's ask our legal
6 advisers here, since it truly was not
addressed to us and
7 we just obtained a copy, would it be
appropriate for us to
8 respond to it?
9 MR. LEGARZA: I don't think it would be
10 inappropriate
for you to respond to it. Whether or not
11 you want to
respond to it I think it is up to you. I
12 think Joel
says he wants to respond to it. I don't
know.
13
MEMBER MONTOYA: It seems to me it
would be
14 best to respond
to it. I'm not sure if by doing so we
15 don't send a
message down there that says, hey, he's got
16 our ear, so to
speak.
17
MEMBER BAEPLER: If the response
can show
18 the factual
errors and that this approach is totally
19 groundless,
then it also weakens his position, if you can
20 word it that
way.
21
MEMBER MONTOYA: That is true.
22
MEMBER STEWART: He has
disseminated
23 information
that is not true and specifically told his
24 confers that
they cannot prescribe pain medicine to
25 someone in
pain, which is in error. So if
communication
0188
1 is key, then however we obtained the
document, I think we
2 have to set the record straight with the
physicians that
3 listen to other people other than read the
Board
4 regulations themselves.
5 MR. LEGARZA: Who are you going to send it to
6 on this concerned physicians of Nevada? Easy to come up
7 with Ensign's and Gwinn's address.
8 MEMBER JONES: It is going out to the
9 newsletter that Cheryl is writing.
10
MEMBER MONTOYA: Concerns of
physicians in
11 Nevada is a
few physicians in Las Vegas that have gotten
12 together and
developing some kind of a committee to start
13 funding a
lobbyist up here.
14
MEMBER BAEPLER: We don't know
what they are
15 concerned
about.
16
MR. LESSLY: Separate and apart
from the
17 medical
association?
18
MEMBER MONTOYA: Yes.
19
MEMBER BAEPLER: We don't know
what they are
20 concerned
about at this point?
21
MEMBER MONTOYA: They are
concerned about
22 tort reform,
is one of the big concerns.
23
MEMBER ANJUM: Is this not like
putting an
24 allegation on
the Board?
25
MEMBER STEWART: Do you want to go
that he's
0189
1 disseminated false information and that is
unprofessional?
2 MEMBER ANJUM: It is.
3 MEMBER STEWART: Yes, it is.
4 MEMBER ANJUM: If he didn't understand it.
5 He is telling the Board is doing something
wrong.
6 MEMBER LUBRITZ: Why don't you correct it and
7 send the information and ask the
Investigative Committee
8 to investigate it. Answer the letter.
9 MEMBER ANJUM: Let's send a message to
10 somebody.
11
MEMBER BAEPLER: Can you tie it to
him? By
12 Dr. Nowins.
13
MS. BIBLE: Why don't you send him
the
14 history and a
copy of the letter.
15
MEMBER LUBRITZ: The reason I know
it is from
16 Dr. Nowins is
because Dr. Comeau stopped me at the
17 hospital and
he said, well, what do you think about the
18 letter? I said, I have no idea what you are talking
19 about. He said, oh, let me get you a copy of what
20 Dr. Nowins
sent out.
21
MEMBER KIRCH: I think we should
address it
22 and say it's
come to our attention that there was
23 communication
with and we would like to set the record
24 straight.
25
MR. LESSLY: Who are you going to
address it
0190
1 to?
2 MEMBER KIRCH: The people.
3 MEMBER STEWART: Dr. Nowins with a copy to
4 Clark County OBGYNers.
5 MR. LESSLY: Do you know who those members
6 are?
7 MEMBER LUBRITZ: He is a member.
8 MEMBER STEWART: You probably do by your
9 files.
10
MR. LESSLY: I can do that, yes.
11
MEMBER LUBRITZ: Steve, do you
have a
12 membership
list?
13
MEMBER MONTOYA: Yes, I can get
one.
14
MEMBER LUBRITZ: That is pretty
easy.
15
MEMBER MONTOYA: I was looking at
that OBGYN
16 network. If he is willing to put out that document,
then
17 Dr. Comeau
ought to be able to put out whatever document
18 he gave.
19 MEMBER LUBRITZ: Dr. Comeau didn't put this
20 out. Dr. Comeau sent to it me. So then I said, hey, can
21 you get me a
letter so I can send it to the Board. He
22 said sure.
23
MEMBER MONTOYA: Dr. Comeau is the
fax
24 network.
25
MEMBER STEWART: Just give him a
copy and use
0191
1 his dissemination machine. I think it's important. Larry
2 spent a lot of money sending us to an
international
3 meeting where we are supposed to learn, and
the one thing
4 that I learned, other than knowing that
Oxford is a
5 wonderful place, is our job is to protect
the public and
6 to guide doctors. We have done very well with number one.
7 We have tried to do number two, but other
people
8 disseminate our information for us. I think we need to
9 disseminate our information for ourselves.
10
PRESIDENT HUG-ENGLISH: We'll
generate a
11 letter. A lot of writing.
12
MEMBER STEWART: Same letter.
13
MEMBER ANJUM: Should we send it
to the next
14 meeting of the
OBGYN Society and say something there?
If
15 that's not out
of line.
16
MEMBER MONTOYA: I didn't hear the
first part
17 of what you
said.
18
MEMBER ANJUM: Maybe this letter
should be
19 sent to the
OBGYN and should be read in the next OBGYN
20 Clark County
meeting, whenever that is.
21
MEMBER MONTOYA: They are held
monthly. The
22 last one was
two days ago.
23
PRESIDENT HUG-ENGLISH: I think we
can make
24 our
point.
25 25. Matters for Future Agenda
0192
1 PRESIDENT HUG-ENGLISH: Okay.
Matters for
2 future agenda. Since we seemed to have run out of things
3 to talk about today.
4 26.
Public Comment.
5 PRESIDENT HUG-ENGLISH: Okay.
Then hearing
6 none, we'll take time to address public
comments.
7 Although our public seems to have left. I'll read the
8 public comment. This is required by NRS 24.241.(c)(3) of
9 Nevada's Open Meeting Law.
10
Under this item members of the general public
11 may bring
matters not appearing on this agenda to the
12 attention of
the Board. The Board may discuss the
matters
13 but may not
act on the matters at this meeting. If
the
14 Board desires,
the matters may be placed on a future
15 agenda for
action. Comment on any topic is to be
limited
16 to not more
than two minutes in order to accommodate the
17 Board's
schedule and other speakers. Please
address your
18 comments to
the Chair and not to individual Board members.
19
Hearing no public comment, this meeting is
20 now adjourned.
21 (Meeting adjourned at 5:13 p.m.)
22
23
24
25
0193
1 STATE OF NEVADA, )
2 ) ss.
3 COUNTY OF WASHOE. )
4 I, ERIC V. NELSON, Certified
Court Reporter
5 and a notary public in and for the County of
Washoe, State
6 of Nevada, do hereby certify:
7 That I was present at the
meeting of the
8 NEVADA STATE BOARD OF Medical Examiners on
SATURDAY,
9 SEPTEMBER 8, 2001, and thereafter took
stenotype notes of
10 the
proceedings, and thereafter transcribed the same into
11 typewriting as
herein appears;
12
That the foregoing transcript is a full, true
13 and correct
transcription of my stenotype notes of said
14 proceedings.
15
Dated at Reno, Nevada, this 14th day of
16 October, 2001.
17
18
19
___________________________
20 ERIC V. NELSON,
CCR #57
21
22
23
24 SIERRA NEVADA REPORTERS (775)
329-6560
25