1
1 CODE:
4185
LISA
A. YOUNG, CCR #353
2 Peggy Hoogs & Associates
3
COURT REPORTER
4
5
6
7 BOARD MEETING
8
9
10
11 TRANSCRIPT OF PROCEEDINGS
Friday, December 5, 2003; 9:00
a.m.
12 Saturday, December 6, 2003; 8:30
a.m.
1105 Terminal Way, Suite 301,
13 Reno, Nevada 89502
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25 REPORTED BY: LISA A. YOUNG, CCR #353
PEGGY HOOGS & ASSOCIATES
(775) 327-4460
2
1
2
3 MEMBERS OF THE NEVADA STATE BOARD OF MEDICAL
EXAMINERS:
4 CHERYL A. HUG-ENGLISH, M.D.,
PRESIDENT
5
JACULINE C. JONES,
ED.D.,
6 PUBLIC MEMBER, VICE PRESIDENT
7 DONALD H. BAEPLER, PH.D.,
PUBLIC MEMBER,
SECRETARY
8
ROBIN L. TITUS,
M.D.
9
SOHAIL U. ANJUM,
M.D.
10
JAVAID ANWAR,
M.D.
11
STEPHEN K.
MONTOYA, M.D.
12
MARLENE J. KIRCH, PUBLIC MEMBER
13
JOEL N. LUBRITZ,
M.D.
14
15
STAFF OF THE NEVADA STATE BOARD OF MEDICAL EXAMINERS:
16
RICHARD J. LEGARZA, J.D.,
17 GENERAL COUNSEL
18 LARRY D. LESSLY, J.D.,
EXECUTIVE SECRETARY/SPECIAL COUNSEL
19
DRENNAN (TONY) A. CLARK, J.D.
20 DEPUTY EXECUTIVE
21 MAUREEN E. LYONS
DEPUTY EXECUTIVE SECRETARY/INFORMATION SYSTEMS
22 ADMINISTRATOR
23 LAURIE L. MUNSON
DEPUTY EXECUTIVE
SECRETARY
24
25
PEGGY HOOGS & ASSOCIATES
(775) 327-4460
3
1 ALSO PRESENT IN LAS VEGAS:
2 MICHAEL L. HUSE,
INVESTIGATOR
3
ROBERT J.
BARNET, M.D.
4 REVIEWER
5 MAX BRAVA, M.D.
6 DON HAVENS
CLARK COUNTY
MEDICAL SOCIETY
7
MIKE GARCIA
8 RESPIRATORY ADVISORY COMMITTEE
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PEGGY HOOGS & ASSOCIATES
(775) 327-4460
4
1 RENO, NEVADA; FRIDAY, DECEMBER 5, 2003;
9:00 A.M.
2 -o0o-
3 MADAM PRESIDENT: I'd like to call this
4 December 5th meeting of the Nevada State
Board of
5 Medical Examiners meeting to order.
6 This is our first meeting that we
have had
7 with our video conference equipment up and
running, and
8 I would just like to publically acknowledge
all the work
9 and the efforts that our staff have
undertaken to get
10 this up and running by our December meeting.
11 It took a tremendous amount of
effort. And,
12 Tony, I think under your leadership and your
discretion
13 this all happened. And a lot of effort from Maureen and
14 others who I know were here late last night
making sure
15 this is up and ready to go. And I appreciate the
16 effort, and I think hopefully we are set to
go.
17 Before we get started with our
agenda, I would
18
like to take just a moment. We
have some new employees,
19 and I would like to introduce those.
20 Larry, would you like to start
with those?
21 MR. LESSLY: I have a new employee.
22
Mr. Legarza has a new employee, and Tony Clark has a new
23 employee.
24 I would like to introduce to you
Debbie Swartz
25 who is sitting here in the front row who is
our new
PEGGY HOOGS & ASSOCIATES
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1 financial support assistant. She comes to us with a
2 number of years of experience doing the same
thing in
3 the private sector and has taken that
position about a
4 month or so ago and stepped right into
it. And we
5 welcome her here.
6 And I believe Mr. Legarza has an
employee to
7 introduce.
8 MR. LEGARZA: Jennifer Sloan. Jennifer is a
9 new investigator in the investigator
department.
10 Would you introduce yourself and
tell us a
11 little about your educational background and
experience.
12 MS. SLOAN: My name is Jennifer Sloan. I have
13 been here for a couple weeks now. I graduated from UNR
14 in psychology. And I come from a company called
15 Educare.
I was with them for almost six years.
I did
16 some program management, internal auditing,
and
17 investigation.
18 MR. LEGARZA: Thank you.
19 MR. CLARK: I would like to introduce Laurie
20 Munson who is the new assistant deputy
executive
21 secretary.
Laurie comes to us from the Attorney
22 General's Office where she had a lot of
experience. And
23 she will be replacing Maureen when Maureen
leaves on
24 January 23rd.
25 Maureen is the employee with the
board who has
PEGGY HOOGS & ASSOCIATES
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1 the most tenure at this point. She started in July of
2 1990.
And when she leaves on her last day,
3 January 23rd, she will have had thirteen and
a half
4 years of straight employment with the board.
5 And Laurie will be taking over all
of
6 Maureen's duties and those duties that Kasey
Miller
7 previously had as administrative support for
Stephen
8 Quinn and me.
9 And, also, one more thing about
Laurie, Laurie
10 is the guru of our video
teleconferencing. And I would
11 ask her to just take a minute and explain to
you how the
12 microphones operate, how the system operates,
and if you
13 have any questions, please don't look at
me. Look, at
14 Laurie.
15 MS. MUNSON: You can see how well it has gone
16 so far under my direction.
17 Basically, the microphones are
used basically
18 the same as the Contractors' Board, as I
understand.
19 Push the button to turn it on. Push it to turn it off.
20 If the mic has green, it means the mic is
live.
21 There are only seven. They are highly
22 sensitive so you don't need to be directly
in front of
23 them to be heard by Las Vegas.
24 Dan, at Voice Integration assures
us these are
25 sufficient for our needs. However, if we deem we need
PEGGY HOOGS & ASSOCIATES
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1 more, we can purchase them and set them on
the system.
2 We tested them a couple weeks ago and it
seemed to be
3 sufficient.
But we will know for sure after today, I
4 suppose.
5 Other than that, as you can see,
the camera on
6
the left as well as the camera at the end of the room
7 are showing the Las Vegas feed.
8 They have one camera so we can
only see it
9 from one direction. They can adjust it minorly, but it
10
will be the only one direction.
11 We have two cameras so we can show
it from
12 both sides of the room and make adjustments
with that.
13 We can control both the cameras
here and from
14
Las Vegas. So if they are not
seeing what they need to
15 see up here, we will always have an
investigator or
16 other staff member down there to help
operate the
17 equipment.
Today it is Mike Huse. So he can take
care
18 of it from that end.
19 When we go to closed session, what
we plan to
20 do is mute all the microphones in this room
which we can
21 do with just a touch of a button, hopefully,
and make
22 the screens go to blue as they were when you
came in.
23 And they will neither see nor hear what is
going on in
24 this room down in Las Vegas.
25 Mike will also mute the
microphones down there
PEGGY HOOGS & ASSOCIATES
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1 so we won't hear any noise from their end of
it.
2 When you come back to open session
we unmute
3 the microphone, camera is back on, and that
takes care
4 of that.
5 Two other things, we have the
capability now
6 of showing a video that includes Las Vegas
because there
7 is a camera attached to the VCR. And we can also put a
8 document on the camera screen with a
document camera if
9 you want to show that.
10 MADAM PRESIDENT: Great.
Thank you, Laurie,
11 and, again, thanks for all the effort in
getting this
12 together.
13 I would just like to take a moment
and have
14 those of you in Las Vegas introduce
yourselves so that
15 we know who is down there.
16 MS. LAURIE: He has his microphones muted.
17 MADAM PRESIDENT: Yes.
18 MR. GARCIA: Mike Garcia with the respiratory
19 advisory committee.
20 DR. BRAVA: This is Dr. Max Brava.
21 MR. HAVENS: Don Havens from the Clark County
22 Medical Society.
23 MADAM PRESIDENT: Hi, Don.
24 MR. HAVENS: We are having trouble hearing
25 you.
Mike is undoubtedly relating that up to you.
PEGGY HOOGS & ASSOCIATES
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1 MADAM PRESIDENT: You are having trouble
2 hearing us?
3 MR. HAVEN: Yes, it is garbled with electronic
4 screeches in it. Sounds like you are under water.
5 MADAM PRESIDENT: I don't think I am.
6 MR. GARCIA: It's getting better. It's
7 getting sharper.
8 MADAM PRESIDENT: Is the sound getting any
9 better?
10 MR. GARCIA: Yes.
And the picture is getting
11 better, also.
12 MADAM PRESIDENT: Bear with us.
Again, this
13 is the first time we are having this. Do give us
14 feedback as the day goes along if we are not
getting
15
through.
16 MR. HUSE: Dr. English, this is Mike. Can you
17 hear me okay?
18 MADAM PRESIDENT: Yes.
19 MR. HUSE: We have some technical problems and
20 Trent and I are trying to work it out. The voices are a
21 little garbled, and the picture is a little
bit fuzzy so
22 we will continue to work on it. But if you can hear us
23 okay, that's a step in the right direction.
24 MADAM PRESIDENT: Okay.
We want to make sure
25 you are hearing us okay as well.
PEGGY HOOGS & ASSOCIATES
(775) 327-4460
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1 Okay. Moving on to agenda item number two
2 which is the approval of our minutes from
September 4th
3 and 5th as well as September 26th. And is there any
4 discussion or changes proposed to the
minutes?
5 MS. JONES: I would move for approval.
6 MR. LEGARZA: Second.
7 MADAM PRESIDENT: There is a motion to accept
8 the minutes from both the September 4th and
5th and the
9 September 26th meetings. Any further discussion? All
10 in favor?
11 MEMBERS OF THE BOARD: Aye.
12 MADAM PRESIDENT: Opposed?
Chair votes in
13 favor of the motion. Motion carries, and the minutes
14 are approved.
15 Agenda item number three is our
personnel
16 section.
17 MR. LESSLY: Madam President, I would ask for
18 a closed session for the first portion of
that agenda
19 item to discuss professional competency of
board staff
20 only and diversion program for later on in
this agenda.
21 DR. TITUS: So noted.
22 MADAM PRESIDENT: There is a motion and second
23 to go into closed session. All in favor?
24 MEMBERS OF THE BOARD: Aye.
25 MADAM PRESIDENT: We are in closed session.
PEGGY HOOGS & ASSOCIATES (775) 327-4460
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1 We will return.
2 (Off the record -- Closed
session.)
3 MADAM PRESIDENT: We are in open session.
4 And, Mr. Legarza, do you have -- I'm sorry.
5 Mr. Lessly, do you have a recommendation to
the board
6 with regard to personnel and changes in
staff?
7 MR. LESSLY: I do.
Let me say that my
8 recommendation with respect to the licensing
specialist
9 and the chief licensing specialist will be
based upon
10 salary surveys we have done indicating that
they are
11 underpaid.
12 My recommendations with respect to
a number of
13 other employees are based upon their six
month --
14 completion of six months employment with the
board.
15 And, as you know, we sometimes
bring folks on
16 at a lower salary than the job would warrant
with the
17 understanding that if they perform well at
the end of
18 six months, we would look at that. A number of
19 employees are at that point at this time.
20 And the other recommendation I'm
going to make
21 to you and ask for in the form of a motion
is based upon
22 the increased work load that Dr. Barnet, our
medical
23 reviewer, is experiencing. He is on at .40 FTE at this
24 point.
25 So I would like to point out that
these are
PEGGY HOOGS & ASSOCIATES
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1 mid-stream increases in pay. They are not intended to
2 be two raises in any one year or putting
people out of
3 sink insofar as when the board normally
looks at
4
increased compensation for staff.
That is usually done
5 at the beginning of the fiscal year at the
June meeting.
6 However, what I would like to have
in a motion
7 is a motion that would accomplish the
following:
8 Increase the FTE on the medical reviewer
from .40 to .49
9 percent at the same base salary effective 1
10 December, 2003.
11 Increase the salary of license
specialist
12 Carolyn Castleman to $37,000 effective 1
December, 2003.
13 Annual increase of $3,000
effective 1
14 December, '03 for license specialist Misty
Dew, Kasey
15 Miller and Elizabeth Pawlikowski.
16 A $1,590 annual increase
performance bonus to
17 administrative assistance Angelia Donohoe
back in
18 investigations effective 1 January, 2004.
19 Six months evaluation increase of
$2,000
20 annual increase for Pam Gabica
administrative assistant
21 and investigations effective 1 January,
2004.
22 Four thousand dollar annual
increase to
23 investigator Trent Hiett who has completed
his six
24
months probationary term effective January, '04 and
25 should be raised to that entry level of an
investigator.
PEGGY HOOGS & ASSOCIATES
(775) 327-4460
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1 Two-thousand-five-hundred-dollar
longevity
2 bonus payable 1 January, 2004 payable to
Maureen Lyons
3 who has been with us thirteen and a half
years and who
4 will be leaving on January 23rd.
5 An increase in the salary of chief
licensing
6 specialist Lynnette Krotke who has been in
that position
7 for six months probationary period to
$55,000 annually
8 effective 1 December, 2003 and that is the
motion I do
9 request.
10 MADAM PRESIDENT: There is a motion and a
11 second to approve these changes as proposed
by
12 Mr. Lessly.
Any further suggestion? All in
favor?
13 MEMBERS OF THE BOARD: Aye.
14 MADAM PRESIDENT: Opposed?
Chair votes in
15 favor of the motion and the motion
carries. So those
16 changes have been approved.
17 I would just like to make a
comment that the
18 increased staff that we have had to hire and
the
19 increased workload that the current staff
have simply
20 reflects the fact that this board is working
very hard
21 and a lot of the changes that have come
legislatively,
22 the changes have not having the medical
legal screening
23 panel anymore has really increased the
workload, the
24 investigations, the licensing duties of this
board. And
25 I think these changes reflect the needs that
we have.
PEGGY HOOGS & ASSOCIATES
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1 I'd also like to personally thank
and
2 recognize Maureen Lyons for her years of
service to this
3 board since this is her last meeting with
us.
4 MS. LYONS: Thank you.
5
MADAM PRESIDENT: You have been a
tremendous
6 help in every way. The board couldn't do without you
7 and all that you do. Thank you.
8 MR. LESSLY: The only other things we need to
9
do under open session under personnel is, as I indicated
10 earlier to you, the administrative assistant
for
11 administration position has now been filled
again by
12 Helena Steples.
13 It ended up being an increase on
one position
14 on the amended document. We got the approval of the
15 president to do that which she is entitled
to do by job
16 description between meetings.
17 I guess we need a formal action to
approve
18 that administrative position and
administration to the
19 amended document.
20 MS. LYONS: I so move for approval.
21 MADAM PRESIDENT: Okay.
There is a motion and
22 a second.
23 Any suggestion about that? All in favor?
24 MEMBERS OF THE BOARD: Aye.
25 MADAM PRESIDENT: Opposed?
Chair votes in
PEGGY HOOGS & ASSOCIATES
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1 favor of the motion. Motion carries.
2 Okay. Moving on.
Agenda item number four is
3
consideration of new public service announcements. And
4 do we have Mr. Fisher with us?
5 MR. LESSLY: Mr. Fisher is with us.
6 MADAM PRESIDENT: Mr. Fisher, please join us
7 and tell us about public service
announcements.
8 MR. FISHER: Good morning and thank you for
9 the opportunity to be here.
10 I have four items on my agenda
that I would
11 like to do.
The first is I would like to report on the
12 data that we have through the end of October
of this
13 year.
14 Second of all, I want to answer
questions or
15 concerns that you may have with the goal to
try and make
16 you comfortable with what is being done and
to encourage
17 input from this board.
18 Number three, I'm here to propose
19 recommendations for 2004 based on what the
board of
20 directors of the Nevada Broadcaster's
Association feels
21 should be done in order to strengthen the
marketing of
22 the Nevada State Board of Medical Examiners.
23 And number four, if it can be
done, I would
24 like to show you three 30-second commercials
which are
25 an example of the productions that the
Nevada
PEGGY HOOGS & ASSOCIATES
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1 Broadcaster's Association is involved with.
2 So those are the four items that I
have.
3 First of all, beginning with
number one, and
4 at any point please, you know, certainly
interrupt.
5 The Nevada Broadcaster's
Association campaign
6 for the State Board of Medical Examiners
began in
7 January of this year. So what I'm reporting to you is
8
through the end of October. And
for those of you who
9 are not familiar with it, it is not a public
service
10 announcement. It shouldn't be labeled a public service
11 announcement. It is paid advertising. It is called a
12 noncommercial sustaining announcement, NCSA.
13 We didn't name it. The FCC did.
We don't
14 like the name, but there are a lot of things
the FCC
15 does that we are not happy with. But we don't want you
16 to make the mistake that it is a public
service
17 announcement.
18 Public service announcements are
not
19 necessarily tracked. They are not guaranteed. There
20
are no affidavits normally for public service
21 announcements. And our Washington attorney calls the
22 NCSA a strange duck. So that's the most professional
23 way I can say it to you.
24 At the end of October the State Board of
25 Medical Examiners has received $753,000
worth of
PEGGY HOOGS & ASSOCIATES
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1 advertising for the $50,000 that had been
expended at
2 that point which means that you are
receiving a 15.0
3 return for your money.
4 The guarantee by contract is three
to one.
5
You're receiving 15 to one. And
that is a composite of
6 the eight months. At the end of October you had
7 received 7,500 television and radio
commercials. That
8 is the data.
9 It is my understanding that my
office express
10 mailed Larry the formalized report that
should come
11 today.
We actually wanted it to come yesterday.
It may
12 be here now sitting at the front desk. So let me --
13 that's the raw data so let me share that
with you.
14 I don't know if anyone has any
questions with
15 regard to that, but those are the affidavit
statistics.
16 DR. LUBRITZ: You said we had how many?
17 MR. HUSE: Excuse me.
This is Las Vegas
18 calling.
Can we increase the volume on the speaker a
19 little bit please?
20 MR. FISHER: Is this better?
21 MR. HUSE: That's a lot better. Thank you,
22 Mr. Fisher.
23 MR. FISHER: I'm sorry.
I'm in radio. I
24 don't know to turn on the microphone.
25 MR. QUINN: Was that 1,000 spots that we had?
PEGGY HOOGS & ASSOCIATES
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1 MR. FISHER: No, you had 7,500 spots.
2 MR. QUINN: Roughly how many were north and
3 south?
Any idea on that?
4 MR. FISHER: That data can be -- I don't have
5 that in front of me. That can be broken down. It can
6 also be broken down north, south and rural.
7 MADAM PRESIDENT: We have it.
If you look in
8 the agenda book under tab four, it breaks it
down month
9 to month.
And it breaks it down radio, television north
10 and south and how many spots had aired for
each.
11 MR. LEGARZA: We have it through October.
12 MR. FISHER: You will have that information
13 today.
14 Let me move to the second item which
is
15 answering questions or concerns. I understand that some
16 of you had some concerns. And then I would like the
17 opportunity to make some proposals, as I
said, coming
18 from my board of directors board to board.
19 MADAM PRESIDENT: Any questions from board
20 members on what has been aired over the last
year or
21 formatted or any concerns?
22 MR. FISHER: Well then, the question will come
23 in the proposal. Is it possible to view this?
24 MADAM PRESIDENT: Let's test out our system to
25 see if we can do it. Where is Laurie?
PEGGY HOOGS & ASSOCIATES
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1 We are going to attempt to show a
couple of
2 30-second videos. We are hoping it gets down to you so
3 let us know.
4 Larry, can we find Laurie?
5 MR. FISHER: You know what, there is no plug
6 available.
You don't want to unplug what is already
7 plugged.
So that's fine. I will leave
them. We are
8 short an outlet so --
9 MADAM PRESIDENT: Do we have a power strip we
10 can get?
11 MR. FISHER: That's all right. You have a
12 very long agenda. If by the end of discussion there is
13 a way to do it, that's fine.
14 If there are no questions, then
let me make
15 some observations and share with you the
concerns that
16 the Broadcasters Association has.
17 Right now the procedure for 2003
has been that
18 this board of directors is approving a
contract
19 quarterly, every three months. It is possible to do it
20 that way.
21 We have been doing it that way
with you. I
22 will share that in our opinion it makes it
very, very
23 difficult.
Most of our, if not all, of our clients are
24 year contracts. Some are two-year contracts. And when
25
you have a year contract, then you also have a year
PEGGY HOOGS & ASSOCIATES
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1 strategy.
2 It is very difficult to do a strategy
when you
3 find out a few weeks or even a month before
that you
4 will be continuing a contract. And that does not give
5 an awful lot of continuity. It also doesn't give the
6 opportunity to really put together a
plan. And it is
7 more thrown together as opposed to marketing
an image
8 and marketing an action that you want a
telephone call
9 being made really requires, I think, so some
significant
10 planning saying this is what we want to do
for these
11 three months. This is what we want to do for this half
12 year.
This is what we would like to accomplish.
13 So the number one recommendation the Nevada
14 Broadcaster's would like to make is you
consider giving
15 an annual contract as opposed to a quarterly
contract
16 and it's actually to your benefit.
17 Will we continue to work with the board
on a
18 quarterly basis? We will.
19 I think you are doing yourselves a
disservice,
20 and I think more can be accomplished.
21 Number two, I think that you are
not spending
22 enough especially in comparison with our
other clients
23 and with our other state clients. And what I'm saying
24 is that it's just you are underpaying
especially for
25 what you are getting. And I think that one of the
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1 things --
2 We have two state contracts who
are now at the
3 point where they are receiving a million
dollars worth
4 of air play a year.
5 So I would recommend that one of
the things
6 you may want to consider is spending more
money means
7 having more spots on the air based upon our
experience.
8 The third recommendation is that
we would like
9 to play more of a role in the production and
the
10 marketing of this NCSA plan. We think there are things
11 that need to be done, for example, because
you will --
12 obviously if I'm going to make that kind of
comment, you
13 need some specifics.
14 I think it is wrong to do
one-size-fits-all
15 campaign for the State Board of Medical
Examiners. I
16 think that commercials need to be slanted
towards
17 northern Nevada. I think commercials need to be slanted
18
toward southern Nevada, and I definitely think
19 commercials need to be slanted towards rural
Nevada.
20 And we are not taking advantage of
the ability
21 to do that.
And if Nevada Broadcaster's takes the
22 production, it certainly can happen.
23 The other thing is too that I
think we don't
24 have enough variety of commercials that are
on the air.
25 And I also think -- I know it is tough sometimes to get
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1 the content of the commercials passed
through this board
2 because the board does approve all of the
ads which is
3 the way that it should be.
4 But, again, if we are doing three
months, six
5 months, nine months, twelve months --
6 I was talking in the hall
before. We do the
7 millennium scholarship marketing for the
state. And we
8 are already working on some of the filming
we are doing
9 in June because the first millennium
scholars are
10 graduating -- the first four years are
graduating and so
11 we are working on that.
12 I also think it would have been
very
13 appropriate to have a radio spot that was
running and
14 saying we want to wish everyone Happy
Holidays and Happy
15 New Years on behalf of the State Board of
Medical
16 Examiners, and we want you to know that we
are committed
17 to ABC or want you to know that your doctors
are ABC. I
18
think there are ways to follow the calendar. I think
19 there are ways to follow the certain events
that we have
20 here in Nevada that is unusual.
21 The other thing we have never
really done with
22
the state board is that there are added benefits that
23 can be done.
24 Nevada Broadcaster's is doing a
town hall
25 meeting in Ely on January 28, is doing a
town hall
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1 meeting in Elko on January 28. We are doing Winnemucca
2 and Fallon on January 29th. And these are open town
3 hall meetings to try and ascertain the
concerns of the
4 community.
5 Attorney General Sanoval is one of
the people
6 who will be among the people who are with
us. And it
7 would be wonderful if a representative from
this board
8 would also be there because there is no
doubt there may
9 be some concerns or some questions asked
with regards to
10 health care and with regards to medical
service in those
11 rural communities.
12 So those are my
recommendations. And we can
13 pick them a part and answer specifics.
14 DR. BAEPLER: I have a comment. There will be
15 an item on the agenda today or tomorrow
relating to our
16 performance audit that was conducted by the
federation.
17 And there is a recommendation in there, not
a mandate,
18 but a recommendation -- By the way, there is
a couple of
19 good ones in there -- that we go to a
full-time PR
20 person for the board. One that I don't necessarily
21 agree with by the way. But would take probably $100,000
22 a year to implement that program.
23 We can't possibly consider it
until the next
24 fiscal year anyway because of our salary
bubble this
25 year.
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1 But I noted, for example, Oklahoma
that just
2 came up with a $100,000 PR campaign. They are using
3 movie theaters which seems to me not to be a
very good
4 choice.
I don't know. People don't take
notes in a
5 movie theater and jot down numbers and
things.
6 And printed media -- I like print media
7 because the ad comes over the radio and on
TV and by the
8 time I realize I should take that number
down, it's
9 gone.
The print media people tend to peruse more
10 carefully and clip it out. There is certain advantages
11 to print media.
12 My basic question is it's hard to
think of
13 producing new commercials expanding the
contract unless
14 we know what kind of message we want to send
to the
15 public.
And I have never quite understood that.
16 It seems to me -- I never see the things on
17 TV. I
don't probably watch the right channels.
I have
18 seen them, but not in the last six or seven
months, let
19 me put it that way.
20 The message is kind of if you want
to know
21 some more about your doctor look at the home
page. That
22 seems to me to be the only message we get.
23 And, of course, our home page if
you go to
24 individual doctors to try and find out about
their
25 background, it's very, very limited
information, you
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1 know.
2 And certainly I would not spend
75,000 or
3 $100,000 if basically we want to tell them
you can get
4 information from the board by going to their
home page
5 or calling the office. We are very limited as to what
6 we can give them.
7 On the other hand, some states
such as Texas
8 they have, you know, placards in every
doctors' office
9 that simply says medical board if you have
questions and
10 number, et cetera, while you are sitting
there you can
11 be made aware of the medical board. The people who go
12 to doctors' office are the ones who most
likely ought to
13 have this.
14 We probably need more
visibility. But we
15 certainly --
And perhaps some of this is due to the
16 program you are putting on.
17 There is excellent evidence that the
people
18 living in this state now know there is a
medical board.
19 The number of complaints and contacts and so
on that we
20 get have increased significantly.
21 It's difficult for me to come to a
snap
22 decision today as to what we should do
because, I guess,
23 I don't quite understand the focus of the
program.
24 MADAM PRESIDENT: I think one of the things
25 that I see as valuable --
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1 MR. HUSE: Excuse me.
This is Las Vegas
2 again.
Are all the people turning on their microphones?
3 DR. BAEPLER: No, I have not.
4 MADAM PRESIDENT: I think we forgot.
5 MR. HUSE: That's fine.
Thank you.
6 MADAM PRESIDENT: I think one of the things I
7 see as valuable with this is and up until
this point
8 what we have had is an increased visibility
to the
9 board.
And I think one of the issues has been do we
10 provide enough information to the public
about ourselves
11 and what we do and what information the
public can
12 access.
And I see this as a way to do that.
13 And I think we have made some real
significant
14 progress.
And I certainly have had feedback who have
15 seen both the TV ads and the radio
spots. And I think
16 it's made a difference. I think we can and should go
17 forward and do better.
18 I think the commercials that we
have on the
19 air now are a little tired. They have been run for
20 quite a long time. I think they need to be updated and
21 redone.
I think they are of value.
22 And I think they are of particular
value to
23 the public who often, you know --
24 Different media approach different
people. I
25 think TV and radio are things that people
may listen to
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1 in their car on their way to work, late at
night. And I
2 do
think even if they may not be writing that number
3 down, it provides visibility for us that
they may then
4 look us up in the phonebook and say I need
to make a
5 call on this.
6 I personally think it is of value.
7 DR. TITUS: Let's review a little bit about --
8 we have some documentation -- I think we
have been
9 keeping records, Maureen. We started airing these
10 publicity or information pieces with the
number of
11 increased phone calls. Some of the members of the board
12 may not have been here when we started
taking them --
13 actually taking hard numbers and data about
how an
14
increase of number of contacts we had from the private
15 sector.
And I was curious, do you have any of that
16 information with you? It did seem like it made a
17 tremendous difference with the phone call contacts
and
18 contacts.
19 MS. LYONS: I don't have that information with
20 me. I
can tell you it has increased. We have
realized
21 by talking with people on the phone that
call in, we did
22
do a survey and asked them how did you hear about the
23 board.
And we did find that many of them were coming in
24 and saying, Well, I saw your TV ad or I
heard you on the
25 radio.
So we did see a significant increase.
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1 DR. TITUS: I thought it was fairly dramatic.
2 And it was pretty impressive how those calls
were made.
3 I agree with Cheryl and Don also. It's not clear what
4 our mission and goal is.
5 Certainly I think we are obligated
to make the
6 public aware we exist and we are here to
protect the
7 public and their interests. Not necessarily let them
8 know about any particular physician, but let
them know
9 we are here to protect them and deal with
concerns
10
regarding their physicians.
11 Not necessarily, in all due
respect, about
12 going to a public meeting about health care
services are
13 available in any rural town. As a rural person that's
14 not a role in particular to do that.
15 But we certainly do need some
availability to
16 the public.
Whatever means. I'm not so sure
limiting
17 it to radio and TV is appropriate. And maybe this would
18 be a good opportunity to rethink, number
one, what our
19 goals are, what we are trying to do, how
it's best to
20 serve those.
21 Certainly radio and TV was just a
-- my mind
22 we were doing it as a quarterly. This is just a trial
23 basis to see what came of this. And did we get the
24 public informed and it was a need because we
didn't have
25 anything.
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1 Maybe it's time to relook at all
the options
2 that are out there.
3 MS. KIRCH: If we went to an annual contract,
4 what type of input would we have or could we
have like a
5 planning session with you and say these are
the ones we
6 figured out exactly what we wanted to get
across. These
7 are the types of things we wanted to get
across the
8 public that we serve and then have you come
back with
9 some choices on how you do that or how you
develop the
10 spot.
11 MR. FISHER: We don't have to come back with a
12 proposal because we have already been
working together
13 for three years.
14 The fact is that your input is
critical. And
15 where you want to go, what you want to do,
and what you
16 want the message so that it's self evident.
17 If this is what you want, you want
A, B, C, D
18 and E, then we are going to do A, B, C, D,
and E. So
19 that what you want is input you already have
and you
20 should have.
21 And you should take more control
or more
22 input, more ideas. If it strengthens it, that's what it
23 is all about.
24 I do want to react on one thing to
help you
25 understand something. Advertising in movie theaters is
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1 significantly better than advertising in a
newspaper
2 which is extremely costly because in a movie
theater if
3 you are the Army National Guard and you are
interested
4 in getting high school students interested
in going to
5 the Guard, then you put that advertisement
in the movie
6 theater before it starts, especially for a
movie where
7 teenagers are going. It's targeted.
8 What you are asking is actually
reinforcement
9 my comment that I think the radio
commercials
10 specifically need to be targeted for the
rurals and the
11 radio commercials need to be targeted for
the north and
12 for the south.
13 And the movie theater example is a
great
14 example.
It's not just a general, let's put it in all.
15 It's targeted. That's what we can do, and that's what
16 we want to do. We want to target it better.
17 As far as exploring all the other
options, you
18 should always do that. And one of the things is that
19 the reason why the NCSA was attractive to
begin with and
20 I think the reason why Arnie brought it to
the attention
21 of this board and Larry originally you are
not paying
22 $50,000 and getting $50,000 worth of
advertising.
23 Ladies and gentlemen, you are
paying $50,000
24
and getting $750,000 worth of advertising.
25 So please when you do your
comparative
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1 shopping, which I encourage you should,
absolutely,
2 because we all do it, the bottom line is
going to be you
3 can do go downtown and you are not going to
get a 15 to
4 one return on your dollar.
5 DR. BAEPLER: One thing I cannot understand
6 you are talking about a subject I know
nothing about.
7 If I operated a business and spent three
quarters of a
8 million dollars over what span of time was
this?
9 MR. FISHER: Eight months.
10 DR. BAEPLER: If I spent three quarters of a
11 million dollars over eight months, I would
hope that the
12 advertising would be a little bit more
visible than what
13 we seem to get, from my personal
perspective.
14 MR. FISHER: You know what, I respect your
15 opinion, but the affidavits speaks for
themselves. And
16 I will tell you that the 7500 spots --
17 One of the things that we do with
Nevada
18 Broadcaster's which is why we have the
integrity we do.
19 We don't over sell. We under sell.
20 Every time a television commercial
airs in
21 Reno, it also airs in Winnemucca or
Fallon. If you look
22 in your reporting, that's not given there.
23 So when I say that you have 7,500
advertising,
24 which is in the affidavit, that does not
consider the
25 ones that are rebroadcast. That also doesn't consider
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1 but --
2 I'm sorry that you have not seen
it or you
3 have not heard it, but someone has because
the telephone
4 calls speak for themselves.
5 MADAM PRESIDENT: Are we set up to show those
6 little video clips or can we do it?
7 MR. FISHER: What you are going to see is
8 three examples of commercials that we
produced.
9 DR. ANJUM: Do you we have any set time --
10 MR. FISHER: That's reported in the
11 affidavits.
12 DR. ANJUM: I have never seen those ads.
13 MS. LYONS: You don't know in advance.
14 DR. ANJUM: I watch TV, but I should be able
15 to catch those ads. Most people do watch TV. How many
16 people have seen those ads?
17 MADAM PRESIDENT: I have.
18 MS. JONES: I have.
19 MR. LUBRITZ: In the last six or eight months
20 I have seen them once or twice, Mr. Fisher.
21 MR. LUBRITZ: How many other state boards do
22 you represent and advertise for?
23 MR. FISHER: We are Nevada Broadcaster's.
24 MR. LUBRITZ: I guess I should rephrase this.
25 Are there any other boards that you,
Broadcasters --
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1 MR. FISHER: Are you talking about other
2 states that --
3 MADAM PRESIDENT: Boards in Nevada.
4 MR. LUBRITZ: Boards in Nevada that you
5 perform this service that you perform for
us?
6 DR. TITUS: How many other professional boards
7 in this state contract with you?
8 MR. FISHER: Majority of our clients are
9 through the office of the governor, through
the office
10 of the attorney general, through the office
of the state
11 treasurer, health division, consumer affairs.
12 You can go on our website which
lists in a
13 given month who the clients are.
14 But this is the only board that I
speak
15 before.
16 MR. LUBRITZ: Thank you.
17 MR. FISHER: There is an advantage and
18 disadvantage when it is board governed or
board driven.
19 Because of that it is important for us to
make sure,
20 which is why I'm here, that that -- the
questions are
21 flushed out, that the concerns are flushed
out, so that
22 everybody is comfortable with what they are
doing so
23 that we can make it better.
24 MR. LUBRITZ: Thank you.
25 MR. FISHER: These three commercials are for
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1 oral health.
2
MADAM PRESIDENT: In light of the
fact we are
3 having technical difficulties, we will go
ahead and move
4 on.
If we can get this going, we can come back to it.
5 We do have a really full day. So we are going to keep
6 going.
7 MR. HUSE: Thank you for that information. We
8 weren't sure what we were doing down here.
9 DR. TITUS: You send out a quarterly news
10 review.
11 MR. FISHER: Here you go.
12 (Videotape being shown of
commercials.)
13 MR. FISHER: These three commercials were
14 written by the Oral Health Board and they
were driven by
15 a board and the state approved of what the
content and
16 what exactly what the script was.
17 DR. BAEPLER: And the oral health board, is
18 that a state board as well?
19 MR. FISHER: Yes.
State Health Division.
20 The second one is similar but
different.
21 DR. TITUS: Did you bring any of our tapes?
22 MR. FISHER: No.
23 DR. ANJUM: I would be interested in seeing
24 our own.
25 DR. ANWAR: I'm aware of these. These are
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1 actual public health spots that are paid for
under
2 federal grants of the State Health Division
from the CEC
3 so I think it's a significantly different
model than
4 what you are talking about.
5 MR. FISHER: The point I wanted to make is
6 that these are scripts that were generated
by them, that
7 were reviewed, and that I'm interested in
the fact of
8 the script because the question that was
asked was
9 input.
10 MADAM PRESIDENT: I think the board is faced
11 with --
12 MR. FISHER: The difference is -- The reason
13 I showed this is so that there is no
misunderstanding
14 these are spots that we produce. You can see your ad.
15 We didn't produce it.
16 DR. TITUS: Why don't you put that on because
17 there are members of this board who have
never seen
18 that.
19 MR. FISHER: Fair.
Okay.
20 (Videotape of the board
commercials being
21 played.)
22 MADAM PRESIDENT: That's it.
23 MS. LYONS: It kind of started in the middle.
24 MADAM PRESIDENT: Okay.
So we have an idea
25 now.
And I apologize to you in Las Vegas who weren't
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1 able to see.
We were showing a couple examples of
2 commercials by the Nevada Broadcaster's for
the spot
3 that has been airing for the Board of
Medical Examiners.
4 What we are faced with now and
what the board
5 needs to decide is our contract expires the
end of
6 December.
And we need to make a decision whether we
7
want to renew that contract or whether you want to think
8 about it until the next meeting. But that's what we
9 need to decide at this point. As we go forward --
10 DR. MONTOYA: The next meeting is after the
11 contract?
12 DR. BAEPLER: There would be a break in
13 service?
14 MADAM PRESIDENT: There would be no
15 advertisements until our next meeting unless
we decide
16 something at this meeting, you are correct.
17 DR. BAEPLER: I'd just reiterate what we said
18 before.
If we are well advised under the terms of that
19 performance audit through the federation to
consider our
20 PR option, and it is PR, I don't quite know
how as a
21 board we would address that. There are options out
22 there.
But I do reiterate the fundamental point what is
23 it that --
24 MR. HUSE: Excuse me.
We are having trouble
25 hearing the speaker.
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1 DR. BAEPLER: I was just suggesting we need to
2 review our options as to how we want to
conduct our
3 public relations programs. But, most importantly, we
4 need to define just what is it we are trying
to convey
5 to the public. The ones you showed us as an example had
6 a very clear message. It was definitely focused.
7 I do not feel that ours are that
focused and
8 have never understood precisely what it is
that we wish
9 to convey to the public. That's my concern.
10 MS. KIRCH: I think as a board we have to
11 decide that because we can't give direction
to anybody
12 including the Nevada Broadcaster's
Association of what
13 we want to get out to the public unless we
know what it
14 is.
And I don't know that we have done that.
15 MADAM PRESIDENT: May I make a suggestion that
16 we maybe consider having a sub-committee of
the board
17 look at this and come back to us and perhaps
get with
18 you, Mr. Fisher, and look at some
possibilities and come
19 back to us in our March meeting?
20 I don't think there is a consensus
that I'm
21 hearing at this meeting, and perhaps that
would be
22 helpful.
But I would need some volunteers to do that.
23 DR. MONTOYA: I will volunteer. As part of
24 this I would like to say up front we need to
get
25 different information out there instead of
call the
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1 board and find out about your doctor.
2 Nevada doctors are good. And the board is
3 trying to help protect the public and make
sure that the
4 doctors are good. There is a lot of information out
5 there that is -- especially through the
legislative
6 process that we just have been through that
says all
7 doctors are bad, watch out for Nevada,
especially with
8
prominent people leaving the State for their cares.
9 We have to make sure that people
understand
10 that Nevada doctors are good. We have trained at good
11 places.
And that's going to be -- If I'm
going to be
12 on our sub-committee, if it's all right with
you, that's
13 going to be one of my thrusts.
14 DR. BAEPLER: That would be a good message.
15 MS. KIRCH: I would be happy to work on it as
16 well.
17 MADAM PRESIDENT: Is there anyone else who
18 would be willing to be -- I think it would be great to
19 have three.
Is there anyone from the north end that
20
would be willing to do that? I
know everybody is over
21 burdened.
22 Well, why don't we start with the
two of you
23 and if anybody else has interest in -- Tony,
you will
24 help with that as well?
25 MR. CLARK: Yes.
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1 MADAM PRESIDENT: Over the next couple of
2 months get some ideas together and come back
to the
3 board and come back to the March meeting and
we will
4 involve you in that process as well.
5 I appreciate you coming and sharing
your
6 advertisements.
7 MR. CLARK: Would the board consider going on
8 with the contract that is currently in place
until we
9 get to March so it's January, February,
March on the
10
current basis? Extend it for
another three months so we
11 don't run into a dead period where we have
nothing going
12 on advertising-wise for the board.
13 MADAM PRESIDENT: I think that's reasonable.
14 DR. MONTOYA: Will the broadcasters take
15 another quarterly contract?
16 MR. FISHER: We are going to work with you in
17 any way possible. I think the fact that there is a
18
sub-committee that will now, you know, take it and so
19 that we can --
20 The biggest problem is that there
are some
21 misconceptions and so if we can clear those
up and then
22 strength what we are doing, it's good.
23 But to answer your question,
absolutely. But
24 I would also suggest that one of the
possibilities is
25 that rather than having a presentation in
March and then
PEGGY HOOGS & ASSOCIATES (775) 327-4460
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1 talking at that, I would rather also, as
long as it's
2 just a sub-committee in place, have scripts
and have
3 tangibles that people can see so that we
don't lose even
4 more time.
5 MADAM PRESIDENT: No, I think that would be
6 great if we could get some things put
together for the
7
board to review in March. That
would be terrific. And
8 if people feel --
9 If the board members feel okay
about extending
10 the contract, then I would need a motion to
do that. So
11 we would continue the current structure that
we have in
12 place now for this next quarter, and then in
March
13 hopefully we will have something else to
build from.
14 MEMBER OF THE BOARD: So moved.
15 MEMBER OF THE BOARD: Second.
16 MADAM PRESIDENT: There is a motion and a
17 second.
Discussion?
18 MR. LUBRITZ: What will be the cost for this
19 coming quarter?
20 MR. FISHER: Same cost that it's been,
21 $15,000.
Five thousand dollars a month for three
22 months.
23 MR. LUBRITZ: Thank you.
24 MR. FISHER: You are already paid through
25 December so you still have advertising
taking place in
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1 the months of November and December.
2 MADAM PRESIDENT: All in favor?
3 MEMBERS OF THE BOARD: Aye.
4 MADAM PRESIDENT: Oppose?
Chair votes in
5 favor of the motion. Motion carries. So we will
6 continue in March and have our report in
March and
7 hopefully have some scripts to look at.
8 At this time I would like to take
a brief
9 recess, and we will come back in about 10 minutes.
10 (A recess was taken.)
11 MADAM PRESIDENT: We'll move to the agenda
12 item number five which is the amendments of
NAC chapter
13 630, and I'm going to turn that over to Mr.
Legarza.
14 MR. LEGARZA: We are missing Mr. Mathiesen.
15 We conducted the workshops on these proposed
16 regulations, the majority of which are
simply going to
17 permanent regulations from temporary
regulations with
18 the exception of section two on the first
page, which is
19 the act of terrorism required by the Nevada
State
20 Legislature, and the section three, the
requirement for
21 physicians and physicians assistants to have
-- to be
22 encouraged to take CMEs in geriatrics.
23 And we, of course, on those
regulations are to
24 give them extra credit for their attendance.
25 The rest of the things were simply getting
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1 into permanent form the temporary
regulations that we
2 had already adopted.
3 At the workshop in Reno no one
attended it.
4 At the workshop in Las Vegas Dr.
Brava, who is
5 in Las Vegas today, attended as well as Mr.
Mathiesen
6
attended.
7 Mr. Mathiesen didn't make any oral
8 presentations but he did hand me the Nevada
State
9 Medical Associations Physicians'
statement. And I know
10 he is here, and I don't know whether he
wants to be
11 heard on these proposed regulations.
12 MS. MUNSON: I did tell him we were going into
13 session, and he was on his way. He should be here any
14 second.
15
MADAM PRESIDENT: Okay.
16 MR. LEGARZA: As I read this input --
17 generally, the input of the Nevada State
Medical
18 Association with respect to the first set --
19 Well, maybe I better wait until he
gets here.
20 MADAM PRESIDENT: Why don't you review the
21 basic changes in the regs until he comes
back.
22 MR. LEGARZA: The legislature passed NRS
23 632.53 which said physicians had to get
these four hours
24 of CMEs within a certain period of time to
continue
25 their licensure in the state of Nevada.
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1 This is a one-time
requirement. It's not
2 something that has to be done annually. It's only one
3 time.
That's what section two is, that they are to have
4 this CME, only these four hours, on a one
time, one-shot
5 deal.
6 Section three is simply the
legislature
7 requested that we encourage physicians to
take -- that
8
are involved with geriatrics and gerontology to take
9 extra CMEs in those areas. And the proposed regulation
10 says they will get extra credit for CMEs
that they
11 attended in those areas.
12 MADAM PRESIDENT: And then if you would go
13 through the changes that are proposed as far
as the
14 competency that are --
15 MR. LEGARZA: Well, that's a completely
16 different.
That's a completely different one.
17 MADAM PRESIDENT: You would rather hold off on
18 that?
19 MR. LEGARZA: What you are doing today with
20 this first set of regulations -- proposed
regulations
21 for the board of medical examiners today you
are either
22 deciding to adopt these regulations or not
adopt these
23 regulations.
24 They have been through the whole
process. The
25 other set of regulations is something
completely
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1 different that you will be looking at with
respect to
2 which you may or may not do.
3 MADAM PRESIDENT: No.
No. I'm talking about
4 the proposed changes that you brought to us
last time
5 that changed the requirements for taking the
specs exam
6 that --
7 MR. LEGARZA: That's another new one, too.
8 I'm sorry.
9 MADAM PRESIDENT: Yeah.
That's included in
10 what we need to approve today. And I think we need to
11 talk about that.
12 MR. LEGARZA: Where is that?
13 MADAM PRESIDENT: That is section six at the
14 bottom of -- right after the
gerontology. And it talks
15 about the fact that we currently -- if you
have not
16 taken a major exam within ten years are
required, for
17 licensees or new licensees, to take the
specs.
18 But there has been some
changes. And if you
19
just want to address those or I think if you want --
20 MR. LEGARZA: The changes are that you can
21 take an examination. It used to be under the regulation
22 that you had to take -- under the NRS
chapter, section
23 E, the only examination that was available
to you if you
24 hadn't been tested within 10 years was
specs.
25 Now the change is acceptable
otherwise
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1 provided in section two. In Larry's comments that he
2 gave to me, the medical society was
concerned about this
3
language and lack of specific definition with respect to
4 the examinations and the types of tests that
would be
5 conducted.
6 I will represent to you that I
spent a lot of
7 time with the lawyers with the Legislative
Council
8 Bureau trying to get the message from me and
me trying
9 to get the message that the intent of the
board was to
10 have these options and that the board would
then give
11
the applicant, as I understood it, either the option to
12 take a different one or the board would
designate what
13 type of tests the applicant would have.
14 And Mr. Mathiesen was concerned
about lack of
15 specific definition. I don't think any more definition
16 needs to be put in this thing, but then Mr.
Mathiesen
17 had his presentation. And he is here, and he may have
18 something further to say with respect to
that.
19 With respect to the rest of the
regulations in
20 here, with the exception of the
anti-terrorism
21 regulation and some of the questions in that
that
22 Mr. Mathiesen had as I understand from the
presentation
23 that he gave at the workshop, everything
else is in
24 agreement with -- except for this language
here and with
25 maybe some alternate proposals for
consideration on the
PEGGY HOOGS &
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46
1 anti-terrorism, is that correct, Larry?
2 MR. MATHIESEN: Larry Mathiesen, Nevada State
3 Medical Association. Generally there were several areas
4 where we suggested expanding.
5 And in this particular section
either within
6 the regulation -- that's why we also offered
it as an
7 option.
You can do it in your newsletter -- is to
8 simply sort of indicate what the board has
in mind as
9 acceptable alternate tests. It's just that at some
10 point simply to have out there so that there
is a sense
11 of what the options are rather than leaving
it at just
12 the other options considered by the
board. So it doesnt
13 have to be in the regulation.
14 MR. LEGARZA: Got you.
And then you had some
15 suggestions for consideration on the
anti-terrorism one
16 with respect to giving credit for some
military service
17 training and maybe some other training. And I think
18 that was --
19 MR. MATHIESEN: I mean, the effort that you
20 got is really -- is to consider future CME
courses that
21 would comply with the anti-terrorism
act. And, as you
22 know, I think that the educational part of
that act, of
23 that legislation, was not very well thought
out.
24 It applies to EMTs, to your
licensees, to
25 nurses and to dentists. And why it doesn't apply to
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1 others, isn't clear. Why every physician or every
2 dentist should know about what this mas-destruction
is
3 unclear as well.
4 But, of course, most physicians
who do need to
5 know about the issues of communicable
disease of
6 mas-injuries that may come as a result of an
act of
7
terrorism are already or in the process of getting that
8 education.
9 What we were suggesting was that
you could
10 also accept proof from the physician that
they have
11 complied already with training so they
didn't just have
12 to take a CME course that would be offered
in the next
13 two years.
14 Also, that you might want to
consider as an
15 alternative option a proof of training that
they have --
16 if they just come out of the military, they
have now had
17 significant training in this area.
18 Same thing with those who are
public health
19 officers who have been trained through the
public health
20 services.
They have had more than the minimum that is
21 in the law.
And you might want to deem that as
22 sufficient.
23 So it was just encouraging
flexibility in the
24 interpretation of how to comply with this
law because I
25 think there are many routes to do it.
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1 And what we really want, I think
the most, is
2 just an assurance that physicians and the
other health
3 professionals in the state are adequately
prepared to
4 deal with the possible ramifications of an
exposure to a
5 weapon of mas-destruction or other terrorist
acts.
6 DR. TITUS: To add on, when I read your
7 comments, Larry, for me as a rural county
health officer
8
since 911 we have been involved in a lot of extra
9 training on the whole bio-terrorism. I thought the fact
10 that you even made the comment about public
health
11 officers such as myself -- that would
certainly qualify
12 the amount of time I have already spent.
13 And, also, I disagree with you in
the sense
14 that I think the legislature is right in
asking any
15 public health professional or trying to --
not only to
16 public health people but people in primary
care, people
17 in dentistry because they may be the front
line to a
18 terrorist attack. They may be the ones that are needed
19 to see whether anything is out there.
20 It may be the dentist who looks in
your mouth
21 and sees an abnormality. It might be like the internal
22 medicine doctor in Florida who was astute
enough to
23 recognize that infection was a rare thing
that he was
24 dealing with something different. Just a primary care
25 and internal medicine doctor figured it
out. And so I
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1 think the legislature is right in looking at
anybody who
2 may be the person seeing it needs to do it.
3 MR. MATHIESEN: Larry Mathiesen. I certainly
4 agree with that. When the anthrax issue came up and
5 when small pox issue came up, it was really
primary care
6 physicians and physicians from the emergency
departments
7 who were the first with a deluge of
questions and
8 concerns.
9 And all of that the training needs
to go on.
10 It's just the particular package of the list
in the
11 statute is one person's idea of what is
proper.
12 I think overall our concern with
this as I
13 think the board's concern with this approach
is the
14 legislature should not be mandating the
contents of
15 continuing medical education. As things are
16 appropriate, that should be done.
17 They have done it here so we have
to find a
18 way to deal with that and comply with the
express wishes
19 of the legislature, but do it in a way that
doesn't
20 cause unnecessary complications, costs and
confusion
21 that we get physicians up to snuff as
quickly as
22 possible.
And that may mean a number of different
23 options.
24 MR. LEGARZA: I probably get at least five
25 maybe more calls a week from either
physicians or
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1 someone on their staff wanting to know what
this means
2 and how can I get it and where can I get it.
3 And when we first started this, I
went on the
4 Internet and I found one site. I was just in there not
5 more than two minutes, and it looks like --
and I have
6 been representing to physicians who have
been calling
7 that it looks like there are a bunch of
people. There
8 is Florida Medical Association. Here is American
9 Academy of Family Physicians. CME Anti-terrorism. And
10 here is just Yahoo search cme.com that has
-- I hit
11 about five of these. The U.S. Army Medical Research
12 Institute.
13 So it looks there is a whole bunch
of stuff so
14 people are getting on board making this
stuff available.
15 It doesn't look like availability for
category CMEs is
16 going to be an issue over the next two years
before
17 these people have to comply with this thing
for their
18 new continuing -- new licensure.
19 So that was the big concern about
all the docs
20 I have been talking to. Where is this? How can I get
21 this?
And I tell them get on the web, and you will be
22 able to find things. And you have certainly two years
23 to get it.
24 If you want to change and
implement some of
25 these other things, you can give credit for
other than
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1
category one CME. You can do
that. You can have the
2 input from the medical society. The language can be
3 changed.
I can work on that kind of language.
And it
4 will be maybe reworked by the legislative
council bureau
5 but if you want to have that portion amended
--
6 I think you have to leave alone
the
7 mandate-type language because it's been
mandated. We
8 can't promulgate a regulation that goes
against a state
9 mandate.
But if you want to make some stipulation for
10 the military or state officer that Larry has
suggested,
11 I can do that and do that quickly.
12 MR. LESSLY: Also, I'm aware that there is an
13 effort by the State Health Division the two
different --
14 Clark County and Washoe County District
Health
15 Department and AHAC through the school of
medicine to
16 actually put together a fully compliant CME
program.
17 We'll be working with them to maybe make
that available
18 on CDs and available to all the physicians
in the
19 states.
20 MR. LEGARZA: I think the doctors will be able
21 to comply.
22 MR. LESSLY: It's just that more paths you
23 provide seems to me more likely that these
physicians
24 will not feel that this is onerous and not
feel that
25
they are forced to do something that they otherwise
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1 won't do.
2 MADAM PRESIDENT: Dr. Brava, did you have a
3 comment as to that as well?
4 DR. BRAVA: Yes, I do, Cheryl. May I address
5 these three issues right now briefly?
6 MADAM PRESIDENT: Sure.
7 DR. BRAVA: First of all, I think all of the
8 three items need to be referred back to the
legislature.
9 These are merely products of
people thinking
10 they will be a good idea. And if the legislature
11 continues in this way we will all be driving
Chevrolets
12 and eating apple pie.
13 As far as the competency exam
goes, there has
14 been no demonstrated need for that. I'm unaware of any
15 information showing that there were fewer
complications,
16 incidents, or law suits among those people
who have not
17 been tested in the last 10 years.
18 There are a number of boards that
do have
19 optional testing on ten-year intervals now
and that
20 information should be available.
21 Secondly, the competency testing
places a
22 fairly large burden on the physician who
would then go
23 to take a review course.
24 MR. LEGARZA: We are talking about the regs
25 that we have the workshop on. We are not to the
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1 competency theme yet.
2 DR. BRAVA: I'm sorry.
I thought that was
3 already included.
4 MR. LEGARZA:
No, sir.
5 DR. BRAVA: All right.
I will switch to the
6 anti-terrorism speech.
7 Again, there has been no need
established for
8 this.
The anthrax problem was handled properly. The
9 west Nile problem has been handled properly.
10 We have the same burden of four
hours of
11 additional training and testing, time away
from the
12 practice.
And there is a negative financial affect on
13 those licensees out of state who don't
practice here and
14 may just give up the license rather than
paying a fee
15 every year that you use for the
Broadcaster's
16 Association.
17 And I think there are certainly
14th amendment
18 considerations in here. I don't claim that physicians
19 are discrete and insular minorities, but it
is fairly
20 obvious that this doesn't apply to
osteopathic
21 physicians, triage nurses, public health
nurses, school
22 teachers, food handlers and all sorts of
individuals who
23 might be the first line of encountering a
terrorism
24 attack.
25
I think the law was poorly designed.
It was
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1 passed almost in secret according to my
information.
2 There was no notice or opportunity for
hearing by those
3 who were aggrieved by the measure.
4 If the board does not wish to
refer this
5 matter back to the legislature in what I see
is a
6 stand-up position for physicians then I
suggest that the
7 course be provided at public expense on a CD
disk for
8 home-study purposes.
9 MADAM PRESIDENT: Thank you, Dr. Brava.
10 I just want ask to clarify that
the provisions
11 that were instituted by the legislature were
not brought
12 forward by the State board.
13 We were as surprised by this as
anybody else.
14 But be that as it may, the statute is in
place and we
15 are left to deal with that.
16 I think certainly it's an issue
that can be
17 raised at the next legislative session. But in the
18 meantime, we have to come up with ways to
ensure that we
19 meet this requirement.
20 And I think we have heard from Mr.
Mathiesen's
21 suggestions on how to perhaps moderate it
just a bit. I
22
think personally from my standpoint I think that is
23 reasonable certainly with the military and
to
24 incorporate some of their training seems
reasonable to
25 me.
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1 I think that all of the agencies
are working
2 towards developing CMEs that will be
available and not
3
very painful to comply with. And
that's what we are all
4 working towards I think.
5 But the requirement is in
place. I think
6 certainly we can go back and as Mr. Legarza
has stated
7 that we have the opportunity to moderate
what we are
8 accepting as the CME requirement. But the requirement
9 is there.
10 DR. BRAVA: I would like to request credit for
11 my medical education for national defense
that I took 50
12 years ago.
13 And I would like clarification on
how to give
14 extra credit for those who take courses in
geriatrics.
15 What does that mean?
16 MADAM PRESIDENT: Basically with the
17 geriatrics that is not a requirement but a
suggestion
18 made by the legislature that CMEs be
given. So for
19 people who take that suggestion and
incorporate that
20
part as part of their CME, they will be given double
21 credit hours up to a maximum of eight.
22 MR. LEGARZA: That's correct. It's not a
23 mandate.
The legislature has requested that we
24 encourage it.
25 The board felt one way to
encourage it was to
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1 give two for one for attendance up to a
maximum of eight
2 for four.
3 MADAM PRESIDENT: And the other thing that I
4 want to point out for the benefit of the
board members
5 because I think with all of these changes it
gets
6 confusing but with the passage of SB332 -- I
think that
7 gets into them or not -- you got distributed
this
8 morning just this summary.
9 And this was something I asked
Dick to do as a
10 reminder of the changes in licensure that
were passed by
11 332.
And, that is, there was a category created for
12 administrative physicians that again this is
from the
13 legislature that allows counties and public
agencies to
14 recruit physicians for administrative roles
only.
15 They would not be allowed to be
seeing
16 clinical patients.
17 Secondly, that there is a change
that allows
18 the governor to determine where there are
critically
19 unmet needs in this state with specific
specialties of
20 physicians who are practicing within this
state and
21 within those specific cases where the
governor
22 determines it's a critical need, the
three-year post
23 graduate training can be waived and that
with one year
24 post graduate training and five years of
clinical
25 experience they can be licensed.
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1 And then the third one is one that
we will see
2
later on today in some of our appearances and that is
3 the ability to grant licensure by
endorsement which
4 again allows discretion to this board to
waive one or
5 more of the requirements.
6 Now, I called your attention in the
different
7 section and that Dick has already discussed,
but one of
8 the things that is being proposed by the
change in
9 regulations today is that -- is to change
the specs
10 requirement.
11 In other words, give us more
options for
12 assessing competency for someone who has not
taken a
13 test within the last 10 years. And to clarify that,
14 again, it would be either taking the specs
exam or an
15 examination testing competence conducted by
physicians
16 or any other examinations that is approved
by the board
17 designed to test competence of the
applicant.
18 It's important that we talk about
this now
19 because I think it will be important for us
later in
20 some of our appearances for our applicants
that are
21 going to be applying for licensure by endorsement
which
22 I think that all of us as board members
since we talked
23 about last time gives us too much leeway and
it makes it
24 unclear as to what criterion we use by
licensure for
25 endorsement and when it's okay to waive
certain
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1 standards.
2 So our hope is that by changing
these
3 regulations and allowing a little more
flexibility with
4 requiring the specs exam and allowing other
methods to
5 assess competency, that we will in affect be
able to
6 have a separate way of evaluating people and
not having
7 them licensed by endorsement.
8 So I just wanted to clarify both
of these
9 things because I think it's confusing.
10 DR. MONTOYA: Are you ready for discussion on
11 the last one?
12 MADAM PRESIDENT: Yes.
13 DR. MONTOYA: I believe we are accepting
14 people who have recently passed their
boards,
15 recertified their boards, or who have just
finished the
16 residency for licensure, especially these
people who are
17 looking for license by endorsement. Those are all valid
18 tests.
19 Essentially residency is one long
test and at
20 the end they get a letter that says they
finished it or
21 didn't finish it completely. Otherwise, they wouldn't
22 be able to apply at all.
23 Board recertification I think we
have to
24 depend on the board because they are all
part of the
25 National Board of Examiners. They all meet the National
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1 Board of Examiners' criterion which I don't
think we
2 should quote ourselves too far above those
people.
3 And finish residency and reboard
4 recertification and completed board
certification, those
5 were the three things I think we had to
consider for
6 licensure.
7 We have had a lot of those by
endorsement,
8 people applying by endorsement. And I'm a little
9 dismayed to see people who have retaken
their boards and
10 have to reseek licensure by
endorsement. I don't
11 consider it a major exam. I get 35 CMEs every year when
12 I take mine and that's a lot of work.
13 MADAM PRESIDENT: I think, again, to clarify,
14 the way the proposal in the revision to the
statute
15 would allow us to accept those. It would allow us to
16 look at examinations that we feel test and
evaluate the
17 competence and that may include board
recertification or
18 pure review exams.
19 DR. MONTOYA: Or recertification.
20 MADAM PRESIDENT: Recertification.
21 MR. LEGARZA: This board has been down that
22 road before with the recertification. We used to have
23 that as one of the things that the board
would consider
24 specifically in the regulation.
25 And then the question came up,
What is the
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1 difference between the recertification of
the different
2 boards, whether they are proctored
examinations, whether
3 they are not proctored examinations, whether
it can
4 happen on line.
5 And the board engaged in looking
at these
6 examinations and discussions with the
national boards
7 and there was a hesitation and reluctance of
the people
8 on behalf of many of the boards to even give
us the
9 information as to the type of examination
that each
10 board gave.
11 And the information that was going
on back and
12 forth on the table between the medical
people were some
13 of them were really strange, some of them
were really
14 tough, and some were not anything. And they didn't
15 think there was any quality in the
recertification. So
16 the recertification was removed I think in
like 1999.
17 DR. TITUS: I can tell you that the American
18 Board of Medical Examiners has now changed
its position
19 on that.
And they now have come on board about this
20 whole issue about retraining and retesting.
21 And I have some concerns having
recently
22 retaken my family practice boards that the
family
23 practice boards have come on board and
looking at
24 changing how we do this and it's this
life-long learning
25 maintaining proficiency.
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1 One of the things we have to be
careful about
2 as I have said right from the beginning
about this
3 testing and relicensure issues is that we
can do all of
4 these tests and relicense and require that
they take all
5 these tests and we cannot promise the
citizens of this
6 state that their doctors are competent.
7 The American Board of Family
Practice is using
8 terms like they are going to look at
proficiency. They
9 have said and process a whole bunch of
things including
10 testing, including office charts, including
the fact
11 they are in the good standing in their state
to say that
12 yes that's a proficient physician. They know their
13 information that they know. Not using the word
14 competent physician.
15 Because if we say to the citizens
of this
16 state all the physicians that we license is
competent,
17 there should be zero lawsuits. There should be no
18 malpractice, but we all know there will be
-- we all
19 know there will be mistakes made.
20 I want to put it out there that
competency is
21 an issue that maybe we can't assure people.
22 DR. MONTOYA: Competency is a different issue
23 than what we were addressing here. That is a different
24 issue.
25 What we are talking about is
licensure by
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1 endorsement, and we were saying they had to
have taken a
2 major test in the last 10 years. And I'm saying
3 reupping your boards or finishing a
residency is a major
4 examination, not just for traditional
licensure.
5 DR. TITUS: It was only after 10 years that we
6
were looking at not giving --
7 DR. MONTOYA: That's why I said reupping the
8 boards.
9 MADAM PRESIDENT: I think perhaps it's time to
10 revisit that because I do agree with you
that in the
11 last couple of meetings I think that the
feelings have
12 been different as far as recertification.
13 And I think individual boards have
taken a
14 different approach to that as well. And some of the
15 boards that may have had more lacked
recertifications
16 have changed their policies. And so it may be time to
17 relook or resurvey some of the specialty
boards to see
18 what exactly they are doing for
recertification.
19 DR. TITUS: I want to agree with you, Steve, I
20 think now because the national boards have
come on board
21 with this concept that we should
accept. I agree that
22 recertification is one of the standards that
we can use
23 when somebody is applying. I agree with that
24 absolutely.
25 DR. BAEPLER: We have examined that issue and
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1 discussed it with several people at the
national
2 meetings and the federation. And I think there are some
3 generalizations that can be made that tend
to definitely
4 agree with your position.
5 Number one, of the 21 or 23 or
whatever boards
6 there is only a couple that don't have
recertification
7 possibilities and they have scheduled dates
in which
8 they will begin.
9 There is a general tendency among
all of these
10 boards to increase the examination to a more
meaningful
11
type of exam which some boards already have -- some are
12 non-proctored exams -- the tendency is to
increase the
13 standards for recertification. And several of the
14 boards are now even including pure review.
15 So they also you know used to
vehemently
16 oppose using their exams by boards such as
ours for
17 purposes of licensure and all of that.
18 They don't want to see their
specialists get
19 in a position where if they fail their
recertification
20 they are going to lose their license. No, they don't
21 want to see that. Neither do we.
22 I don't think they have any
objections
23
whatever though if we use their exams in order to
24 establish proficiency.
25 I don't see how we can ignore the
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1 recertification examinations in the
specialties,
2 particularly since they are getting more
rigorous.
3 DR. ANWAR: I have a comment on that. My
4
comment is that when somebody takes recertification
5 examinations, that really is the best
academic tool that
6 we have to allow them to practice that
specialty or a
7 sub-specialty --
8 MR. HUSE:
We cannot hear the speaker.
9 MR. ANWAR: My comment is that we really don't
10 have a better tool of academic assessment in
a specialty
11 or a sub-specialty other than certification
or
12
recertification in that specialty.
13 And to say from an academic point
of view that
14 there should be another standard to tie them
to practice
15 their specialty or subspecialty is not a
very good idea.
16 We need something more than just their
academic
17 proficiency.
18 We need other -- we have other
concerns, other
19 areas that we look into to determine if
somebody should
20 continue to practice medicine in this state.
21 But from a purely academic point
of view, I
22 don't think we have -- rather than to have
good
23 recertification and not so good training
programs,
24 recertification programs that we don't have
another
25 modality to use in lieu of that to determine
if
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1 academically they are fit to practice that
specialty or
2 subspecialty.
3 DR. BAEPLER: Exactly.
4 DR. TITUS: I can tell you that this is an
5 issue, this recertification issue, when I
took my boards
6 this summer down in San Francisco. And there were maybe
7 700 people.
And when we left that test we were handed
8 this document. I think of the 700 people I think I was
9
the only one that wasn't surprised at all that they have
10 said like a greetings of the American Board
of Family
11 Practice and board certification program
this is what we
12 have to do next time. It's not going to be good enough
13 to go every seven years and take this
test. We are
14 going to look at charts, a whole magnitude
of things.
15 And the boards are really changing how they
are viewing
16 this.
17 DR. BAEPLER: That's exactly what I found in
18 talking to them, yes.
19 MADAM PRESIDENT: I think that the way that
20 this is worded, and we'll ask our attorney
-- but I
21 think you could accept that based on the
fact that the
22 language that we have is any other
examination that is
23 approved by the board and designed to test
applicants,
24 if we decide as a board we can accept
recertification,
25 we can do that.
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1 Maybe what I'm hearing -- And maybe what I'm
2 hearing from you, Steve, is you would like
it more
3 clearly spelled out that that would be
acceptable that
4 we say initial certification or
recertification.
5 DR. MONTOYA: That's exactly what I was
6 looking for.
There was some doubt among us and among
7 the public as to what we were looking
for. And all of
8 these applications we have for licensure by
endorsement
9 also, I think a lot of these can be actually
approved
10 for a license administratively as they come
back to the
11 full boards.
12 MADAM PRESIDENT: The way I'm reading number
13 two it looks like we have it in there. It says we will
14 accept it.
We will consider an applicant to have
15 satisfied the requirements if within 10
years they have
16 passed part three of the boards and then the
other exams
17 and then the examination for primary
certification by a
18 specialty board and received primary
certification from
19 that board or the special purpose exam. So it didn't
20 have recertification.
21 MS. KIRCH: It doesn't have recertification so
22 if that was inserted --
23 MADAM PRESIDENT: So under E if we add
24 recertification.
25 DR. TITUS: While we are on this page, I read
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1 this and look at the very top of that
page. We are
2 looking at the top on that page when have we
been
3 required to take a written examination
concerning the
4 statutes and regulations related to the
practice of meds
5 in this state?
6 MR. LESSLY: About 15 years.
7 DR. TITUS: Where do we take that test? I
8 have been licensed 23 -- 25 years and have
never taken
9 that test.
10 MADAM PRESIDENT: It's for new licensees,
11 Lynn, so you would have done it. When you were
12 licensed, Robin, I think you had to come in
in person.
13 DR. TITUS: Yes. I
had a personal interview
14 here in this building.
15 MADAM PRESIDENT: When that was stopped it was
16 substituted basically. It's a written --
17 DR. MONTOYA: You have been around too long,
18 Dr. Titus.
19 DR. TITUS: I know.
Scary. When we don't
20 know what the law is, how do you give a test
to these
21 new applicants? What's the test?
22 MR. LESSLY: It's a written examination. Send
23 something to them in the mail with a copy of
the
24 statutes.
They have to answer the questions and send it
25 back.
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1 DR. TITUS: It's an open book. You send them
2 the statues.
They take the test and then mail it back.
3 DR. BAEPLER: It's a learning device.
4 DR. TITUS: That's fine.
I'm fine with that.
5 I was just reading going, Wow, I have never
taken one of
6 these.
7 MADAM PRESIDENT: What I'm hearing is
8 everybody is feeling the same way that we
want to add in
9 addition to primary certification,
recertification under
10 E.
11 MR. LUBRITZ: I would like to add something,
12 too.
There are some boards out there that are not
13 approved by the Board of Medical
Specialties. So I
14
would think that we would want to insert --
15 MR. LEGARZA: It's in there.
16 MADAM PRESIDENT: Good point, though.
17 DR. TITUS: We did deal with a license by
18 endorsement last time who had taken a
different board
19 that we had no way of knowing what the
criterion --
20 DR. ANJUM: Right.
A lady came in --
21 MADAM PRESIDENT: Okay.
And then we can
22 probably approve all of these at once, Dick,
can't we?
23 MR. LEGARZA: This is one regulation.
24 MADAM PRESIDENT: Okay.
So the other I'd like
25 to get a feeling for whether people want to
add what was
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1 suggested by Mr. Mathiesen allowing credit
for military
2 training to be incorporated --
3 DR. TITUS: Since 2001.
Not fifty years ago.
4 MADAM PRESIDENT: Right.
5 MR. LEGARZA: That is already in there I
6 think.
7 DR. TITUS: Since 2001.
8 MADAM PRESIDENT: So really when we are
9 talking about adding military training --
10 MR. LEGARZA: Military and public health
11 officer?
12 MADAM PRESIDENT: Right.
13 MR. LEGARZA: That's easy to do.
14 DR. LUBRITZ: Since 2001.
15 MR. LEGARZA: See, that's exactly what he has
16 in his proposal in the letter.
17 MADAM PRESIDENT: I think I need a motion to
18 incorporate that part of the statute which
would
19 incorporate the military training and the
public health
20 officer.
21 And, secondly, the change that was
proposed to
22 add recertification obviously by an approved
board of
23 medical specialty.
24 DR. BAEPLER: So moved.
25 DR. MONTOYA: Finishing up a residency.
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1 MADAM PRESIDENT: That would have been
2 incorporated because they would have taken
the boards.
3 MR. LUBRITZ: Just because you finished the
4 residency doesn't mean you have taken the
board.
5 MR. LEGARZA: You wouldn't be board eligible.
6 MADAM PRESIDENT: No, but you have to take
7 step one, two, and three during
residency. So unless
8 you are in a residency that's lasted longer
than 10
9 years or the residency has been going on for
10 years, I
10 guess you would not meet that. Okay.
11 So there was a motion. Was that seconded?
12 MS. KIRCH: I second.
13 MADAM PRESIDENT: All in favor?
14 MEMBERS OF BOARD: Aye.
15 MADAM PRESIDENT: Opposed?
Chair votes in
16 favor of the motion.
17 DR. TITUS: I'm going to go on record for
18 abstaining because that public health does
directly
19 pertain to me.
20 MADAM PRESIDENT: So noted.
21 Now I need a motion to approve the
changes in
22 the -- in this regulation as a whole. Is there any
23 other discussions, first of all, as far as
any of the
24 other items in here? I think those were the main ones.
25 Anything else you want to comment
on?
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1 MR. LEGARZA: Nothing.
2 MADAM PRESIDENT: There is a motion and a
3 second to approve the proposed changes in
the
4 regulation.
All in favor?
5 MEMBERS OF THE BOARD: Aye.
6 MADAM PRESIDENT: Opposed?
Chair votes in
7 favor of the motion. Motion carries.
8 MR. LEGARZA: Under the regulation under the
9 second section of it is this new revised
continuing
10 recertification of physicians every 10 years
which is
11 the last page under number five and then the
issue for
12 termination at this time is to whether or
not you want
13 me to -- instruct me to go back out and do
workshops on
14 this regulation.
15 DR. BAEPLER: I can bring you up to date on
16 this.
17 MADAM PRESIDENT: Okay.
Please do.
18 DR. BAEPLER: We were now in our third year on
19 deliberating on this and we have certainly
evolved quite
20 nicely.
21 We started out, as you are aware,
with the
22 search for the universal exam to examine
everyone for
23 competency.
24 Many states, by the way -- in
fact, most
25 states are now considering regulations. And many of
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1 them are still at that change where they are
still
2 trying to find the exam.
3 This is an unpalatable concept to
give
4 everyone the same exam to establish quote
competency.
5 Clearly, as many of the doctors
pointed out,
6 examinations don't examine for competency
but rather for
7 knowledge.
And the two are quite distinct.
8 Moreover, we had public workshops
on a
9 proposed set of regulations that began to
focus in a
10 different direction. Namely, wherever there is an
11 outside evaluation of the M.D. available
during that ten
12 year period, we need to accept that outside
evaluation
13 if that evaluation has any validity at all
because this
14 board is not staffed nor do we have the
money to give
15 each person a detailed going over, talk to
their
16 patients, talk to their colleagues --
17 The Canadian system where it cost
them seven,
18 eight, nine thousand dollars per doctor and
really is
19 not working that well.
20 Anecdotally, at least, the
information I get
21 on this is that our system in the United
States of
22 acting on those complaints and taking
disciplinary
23 action and so on is just as effective as the
Canadian
24 system and several of the provinces are
going to drop it
25 or very significantly reduce it.
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1 So we have a system that is
working.
2 The various states working on
these proposals,
3 however, want to be proactive because
legislators are
4 concerned that there should be some type of
validation
5 on a periodic basis.
6 And the problems with legislators
acting and
7 letting us react is the kind of problem we
just faced
8 here.
If we don't offer up something, in all
9 probability the legislators will. And they don't have
10 the time to work on it.
11 Mind you, the legislature is not
going to put
12 in three years. And we haven't worked in a vacuum. We
13 have been in contact with other states that
are working
14 on these.
15 At the last three federation
meetings this has
16 been a general point of discussion and
concern. And we
17 have all gotten ideas, those of us who have
attended
18 those sessions, as to what is going on in
the country.
19 We got voluminous response from
the medical
20 profession for our last set of suggested
regulations.
21 Not only were the workshops that we held
very well
22 attended but the transcripts of those
workshops are
23 voluminous.
And we had many M.D.s write us letters with
24 suggestions.
And many of the remarks at the workshops
25 and many of the comments in the letters were
extremely
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1 good.
2 What we did is categorize them to
see if we
3 could alleviate blocks of physicians who had
problems or
4 objections to that prior set of proposed
regs.
5 And I think we have been able to
hopefully
6 eliminate many of the objections by the
changes that we
7 are making.
For example, we have totally eliminated the
8 word competency, and came to the same
conclusion that
9 the group that Robin was reporting on would
use the word
10 proficiency.
11 Actually, I can't find the right
word.
12 Quality assurance might be better than even
proficiency,
13 but it's certainly not competency. We recognize that.
14 And somehow I like the idea of quality
assurance.
15 In the introductory paragraph,
even though we
16 called it a ten year review, the word
biennial appeared
17 in that several times. Many, many doctors objected that
18 they didn't want to do this every two
years. They
19 simply hadn't read the material.
20 This time we spell it out. 2007, 2017, 2027,
21 you see.
So it's clear. And we slipped the
dates from
22 2005 to 2007 for this to begin.
23 In the proposed recommendations
that you have
24 here there is a typo that has to be
corrected under 1a
25 where it says hold current certification and
it should
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1 read "and required to recertify by a
member board."
2 Not all the people are totally
grandfathered
3 in.
These people -- in other words, the physicians that
4 are
certified and have to recertify, they are home free.
5 Secondly in B, we used to
differentiate
6 between physicians who were grandfathered
and not board
7 certified by saying the ones that were not
certified had
8 to have hospital privileges at two
hospitals. Many
9 people are not in a position where that is
possible,
10 particularly in the rural communities.
11 Yet, we changed that to one
because it does
12 have a two-year review. And as in a couple other
13 instances here, the two-year review of
hospital
14 privileges can be quite vigorous. I don't care whether
15 you are working in a hospital with
privileges or if you
16 are working in a pathology laboratory that
is accredited
17 or a radiology facility that is
accredited. You have to
18 be proficient. You can't be a liability because it's
19 the hospital, it's the laboratories, is the
facilities
20 that are named in lawsuits as well as the
physicians.
21 They go after deep pockets.
22 You have a self-screening process
with
23 hospital privileges and with affiliation
with these
24 other types of operations that effectively
meets our
25 intended purpose of seeing that the
individual is
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1 proficient.
2 And this reduction to one such
affiliation
3 should, I think, take care of a large number
of
4 objections.
5 There were objections by several
groups of
6 physicians who typically don't have hospital
7 affiliations. The radiologists, the psychologists, or
8 psychiatrists rather, and the pathologists. Using their
9 own suggestions the pathologists have an
accrediting
10 organization which accredits the pathology
laboratory.
11 If you look that up on the
website, it's quite
12 vigorous.
And the pathologists, by the way, recommended
13 this both verbally and in writing. And upon checking,
14 it's just like hospital privileges because
you can't
15 accredit the group without looking at the
quality of the
16
individuals. And it's a rigorous
Q-A review of
17 individuals which collectively constitutes
the group.
18 The radiologists -- and there
should be a
19 change here from laboratory. They don't call them
20 laboratories. It should be a radiation facility rather
21 than a laboratory. A little less rigorous, but it meets
22 the same intent.
23 And lower on down the
psychiatrists. They
24
recommended that they have a self-assessment and review
25 examination offered by the American
Psychiatrist
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1 Association which has some rigor to it. And that would
2 be a decent way for the ones who do not have
to
3 recertify to meet their requirements.
4 We tried to diminish the concept
of taking a
5 test, and no one would have to take a test
under the
6 various options that are provided here.
7 We certainly allow them to. We run into the
8 same problem that we just discussed with
respect to the
9 prior one.
10 Certainly under 2D, we'll let them
take the
11 specs.
We will let them take a USMLE. We
will let them
12 take a specs test that relates to a specialty. The one
13 who handles the psychiatrist, any other
formal exam, and
14 there is a number of them out there. And they can
15 choose them at their options. For example, I didn't
16 know about the program for the psychiatrists
until it
17 was pointed out to me.
18 But I would rather have them take
that than
19 specs, you know.
20 But no one has to take an exam
because we will
21 accept
a pure review.
22 Now, there was a lot of questions
about what
23 was a pure review. Is it going to cost me eight, 10,000
24 dollars?
No. It's a pure review by a
couple other
25 doctors in your same area of
specialization. I would
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1 suggest it take couple, three hours. They would want to
2 look at some of your recent records to see
how you
3 handle and keep records of patients and so
on.
4 I know if I spend a couple hours
with a person
5 in my specialty, I can tell whether they are
proficient
6 or not.
I have no problem with that at all.
And I
7 assume M.D.s can do the same thing.
8 What we really tried to do here
without going
9 into all the details is try to remove many
of the
10 objections that were raised by the medical
profession at
11 the workshops and in written communication
with us.
12 Some will still remain. But the
13 recommendation to you today is certainly not
to accept
14 these, but to simply authorize legal counsel
to hold
15 additional workshops now in Reno and in Las
Vegas,
16 invite written comment. And I'm hoping we will have
17 taken care of the majority of the problems.
18 After those workshops have been
held and we
19 have had a chance to review the written
comments, we
20 might tweak this even further. But we are -- we can't
21
act on it today or until we have completed all of these
22 other processes.
23 I think the evolution of this
thing has been
24 dramatic over three years and starting off
with the
25 simplest concept, Give everybody an
exam. Well, we
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1 couldn't find the right exam, and there is
no right
2 exam.
So hopefully this will be more acceptable.
3 MADAM PRESIDENT: Okay.
So are there other
4 comments by board members about the revised
5 recommendations that would again, just to clarify,
be
6 going to workshops?
7 DR. LUBRITZ: Have we included in here -- I'm
8 not sure it's in here. Have we included the possibility
9 since more boards are going towards
continuing
10
proficiency that if they are a particular board that's a
11 recognized board by the board of medical
specialists
12 that those may also be incorporated in here?
13 MS. KIRCH: It's in here.
14 DR. MONTOYA: As long as we maintain your
15 certification, you are considered competent.
16 DR. TITUS: I would like to make a few
17 comments that as you guys probably know I'm
on the
18 federation national subcommittee on
maintenance of
19 licensure.
They are not talking about necessarily
20 competency.
It's a special committee on a maintenance
21 of licensure.
22 We have met once in
September. And we are
23 meeting again a week from today.
24 When we first started this three
years ago, it
25 was in its infancy and we were one the few
states that
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1 was looking at that. And we were slammed by our doctors
2 in our state because they wanted to know why
does Nevada
3 have to be -- why do we have to be
first? Why don't we
4 get more information. Let other states show we need to
5 do that, et cetera. Just to assure the other physicians
6 in the state it is an international issue,
not a
7 national issue, not just a state issue on
the whole idea
8 of maintenance of licensure and proficiency.
9 So everybody is looking at
it. I would like
10 to say that we are leaps and bounds ahead of
some of the
11 other states. But also a few states have actually, I
12 think, presented some ideas that I would
like to put
13 forth here because I think in all due
respect, Don, in
14
your attempt to include everybody, it's become rather
15 cumbersome and to then use say the
radiologist can do
16 this and the pathologist can do that and
then the
17 psychologist can do this, it does become
cumbersome.
18 And I want to submit New Jersey,
believe it or
19 not, New Jersey has come up with a very
short statement
20 with this that is pending in their
legislature. Just
21 briefly.
Humor me for a second.
22 They are talking about an
unaffiliated
23 physician would be subject to a biennial
quality
24 assurance review. Quality assurance review is all as a
25 condition to relicensure.
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1 The bill defines unaffiliated
physicians as
2 those who maintain an office and meet all
the following:
3 They don't have privileges at a health care
facility.
4 They don't say J-H or whatever, not
participating in an
5 HMO or manage care facility. And those of you who are
6 --
you have to go through a reup every two years to be
7 on a HMO.
8 Is not participating in a federal
Medicare
9 program.
Is not accredited by certain recognized
10 accrediting bodies such as boards, et
cetera. And that
11 physicians would be subject to pay the
charge for the
12 cost of that inspection.
13 DR. BAEPLER: Pure review.
14 DR. TITUS: I think we do need to rework this
15 concept.
16 MADAM PRESIDENT: I think what we need to
17 decide today and move this along a little
bit about what
18 we have here is a draft that I think the
committee has
19 worked
on. And we need to decide whether we
want to
20 send this out in this format to workshops.
21 DR. BAEPLER: I think one advantage in
22 spelling it out -- and, by the way, point
two there are
23
some M.D.s out there with some unusual and unique
24 circumstances and we are willing to make
exceptions to
25 accommodate them so that they just don't fit
the mold.
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1 I think one way to look at this,
and we can
2 certainly streamline the language and keep
the intent,
3 if I was an M.D. and knew I had to do this
every 10
4 years, I would look at this and see how it
affects me.
5 I'm hoping that the majority of
the M.D.s will
6 find a place in here that fits them ideally
at virtually
7
no convenience to them because we are not asking them to
8 do any more than they are already doing.
9 And I think it spells it out
because we are
10 trying to meet the stated objections of
specific groups
11 that offered a good alternative and now we
are going to
12 include them.
13 I think it can be streamlined as
we get
14 experience.
15 DR. ANWAR: I recommend we move forward with
16 workshops taking this language and see what
the
17 physician comments are and bring it back and
the
18 language that has been pointed out can be
reworked as
19 long as the intent is there.
20 DR. MONTOYA: I second that.
21 MADAM PRESIDENT: There is a motion and a
22 second to then take these requirements as
proposed to
23 workshops.
All in favor?
24 MEMBERS OF THE BOARD: Aye.
25 MADAM PRESIDENT: Opposed?
Chair votes in
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1
favor of the motion. Motion
carries.
2 MR. LEGARZA: I want to make one little
3 comment.
I intend with your permission and Larry has
4 instructed me to do so. We sent the other proposed
5 regulations by mail to every licensed
physician. We
6 intend to do that again. Is that okay?
It will cost us
7 about five thousand bucks.
8 MADAM PRESIDENT: That will be really good.
9 DR. BAEPLER: But the workshops will probably
10 be after the holidays?
11 MR. LEGARZA: Yes.
We will set the workshops,
12 and I'll meet with you and anybody else on
the committee
13 to get the times. And we will have the workshops set in
14 Reno and in Las Vegas.
15 DR. BAEPLER: Right.
Good.
16 MR. LEGARZA: Okay.
17 MADAM PRESIDENT: Okay.
Moving on to agenda
18 item number six. There is a discussion of our diversion
19 program, and we have with us our former
president
20 Mr. Rosenkranz. Hi.
Come and join us please.
21 On your agenda it does say Dr.
Coughlin was
22 going to join us, and Dr. Rosenkranz has
agreed to make
23 his presentation and tell us a little bit
about what's
24 going on with diversion.
25 DR. ROSENKRANZ: Good afternoon. I'm Arty
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1 Rosenkranz.
It's nice to be here.
2 I think I will defer to Carol and
let her make
3 the regular report about diversion, and I
will give mine
4 and answer any questions.
5 MS. BOWERS: Hi.
I'm Carol Bowers. Over the
6 course of 2003 we have had 18 individuals
evaluated or
7 treated.
8 We investigated over who were
involved a total
9 of 73 individuals.
10 We had two respiratory therapists
die this
11 year.
12 We had 22 participants complete their
13 contracts with the state.
14 We have given presentations to the
medical
15 students of Reno, at Valley Hospital, Family
Practice
16 Residence, Medical Executive Committee at
Valley
17 Hospital at Sunrise Hospital and at Washoe
Medical
18 Center.
19 I attended the federation health
programs in
20 April in Illinois and the western region
meeting in
21 Oregon in September.
22 I continued to attend Reno on a
monthly basis,
23 and I tried to spend some time with the
medical board at
24 each visit.
25 November 22nd I attended the
annual meeting at
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1 the osteopathic board and discussed the
renewal of our
2
contract and give my annual report.
They are very
3 pleased with my work and unanimously voted
to contract
4 with us for another year. So I was pleased with that.
5 We did not receive any money from
the hospital
6 association this year. So I believe that needs to be
7 number one on the list of goals for 2004.
8 The foundation has taken over as
the wellness
9 committee for many of the hospitals in Las
Vegas and in
10 Reno.
I think soliciting them for funding is a good
11 idea and certainly should be done.
12 We had a significant problem with
the
13 presentation that Dr. Rubin gave at Sunrise
Hospital.
14 And hopefully that has been corrected. And Mr. Stype
15 may continue to support our efforts.
16 I have a brochure that is ready to
go. It is
17 all set up and it looks really good. I need some input
18 from the board as to the contents of that
brochure. I
19 would hope to discuss that at the last
meeting but there
20 were more pressing topics at that meeting.
21 Doctor Rutherford has resigned as
medical
22 director and it will be effective December
1st.
23 The board seems to be able and
willing to take
24 a more active role in the future. And as I have been
25 over there, I don't have it with me, I have
come up with
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1 things that they requested Dr. Coughlin
would like
2 before I say that I'm -- obviously most of
you by now
3 know I have resigned effective December
31st. And I
4 have given some suggestions as to possible
replacements
5 for me that I hope will be appropriate.
6 Dr. Coughlin would like to see a
physician
7 replace me along with secretary support
because he does
8 not feel I have been capable in my position
as an
9 effective director.
10 I have 64 participants. It varies between 62
11 and 66 and that depends on who comes in and
who leaves
12 at the time but it general stays in the
60s. They have
13 21 in the north and 23 in the south. The south has
14 really blossomed. I don't know whether that's a good
15 thing or a bad thing. I think it's a good thing because
16 we are getting lots of calls and a lot of
people seem to
17 see that we are helping physicians.
18 And I think more work needs to be
done in
19 Reno, and I think that will happen over the
next year.
20 Our finances have certainly
improved in four
21 years.
When I took over this position at the first
22 board meeting I wondered what I was doing
here. When I
23 took over the checkbook, I think we had a
thousand
24 dollars in the checkbook. We now have $57,821 in the
25 checkbook.
And all of your bills are paid on time.
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1 We have all the licenses we
need. All the
2 taxes are paid. Everything is paid at the time and has
3 been.
4 So I leave here or I will leave
here feeling
5 like I have accomplished what I told the board
I hoped
6 to accomplish. I feel good about what I have done here.
7 I want to thank specifically this
board
8 because I have received nothing but support
and good
9 feelings from this board. And I appreciate that, and I
10 leave with a saddened heart over leaving
this.
11 But in the long run, I think it
many be a good
12 move for me, and I certainly hope that the
board will
13 continue to support the foundation as you
have supported
14 me.
15 MADAM PRESIDENT: Carol, I know that I speak
16 for the board when we say that we appreciate
you and the
17 work that you have done. And you are absolutely correct
18 and that when you came on board it was a
mess. And
19 there was no money. And you have taken that and created
20 a wonderful program. And it is in large part due to you
21 that it is as successful as it has
been. And we
22 recognize that and we appreciate you. And I know that
23 all of us are saddened that you are leaving.
24 And, you know, we wish you only
the best, but
25 I
think it is definitely our loss and the foundation's
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1 loss that you are leaving us. What I would like to do
2 is Arnie let you give your report. And if anyone would
3 like to go into closed session for just a
moment to
4 address some personnel issues with Carol, we
can do that
5 as well.
6 DR. ROSENKRANZ: I'm sure Carol feels the same
7 way I did when I left this board a couple
years ago.
8 She feels how is this foundation going to
continue
9 without her.
I felt the same way when I left this
10 board.
And I think we all feel greatly of ourselves and
11 our work.
And she has done wonderful work, and I am
12 happy to be associated with the foundation
for the last
13 couple of years.
14 Things are going to happen. We have appointed
15 a new medical director as Carol said, Brad
Thompson. I
16 don't know Brad very well, but Carol gives
him high
17 marks.
She thinks a lot of him, and I think the other
18 foundation and board members feel the same
way that he
19 will be a good medical director.
20 We only found out -- the
foundation found out
21 through Carol's letter that she was
resigning just a
22 couple days ago so she has put out the word
that we are
23 looking for a new director. And through her
24 association, I believe, and we will look in
Las Vegas
25 and nationally. It may take us a little while to find
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1 somebody, but we will find somebody.
2
A little history about the board.
I think
3 over the last few years Carol has done a
very good job
4 of running the foundation. And the board was sort of a
5 figurehead board and didn't do very much
work. But over
6 the last six months I think that the board
felt some
7 conflict and some problems with Dr. Rueckl
and maybe
8 with Carol and the team and decided that we
really need
9 to dig in and do work.
10 So we have -- we are
committed. I think the
11 whole board is committed to do that. We were meeting
12 twice a year. We are going to meet four times a year,
13 and I think that is a big improvement. We didn't have
14 job descriptions. Carol didn't even have a contract,
15 okay.
We didn't have a job description for the
16 executive director of northern Nevada. We didn't have
17 contracts for those people.
18 A lot of things we assumed
happened as a board
19 and didn't happen. But they are going to happen.
20 The board members that were
present on
21 November 16th are willing to do the work.
22 And I'm sure that the people that
we have
23 committed -- the chairman of the committee
for job
24 descriptions, we have Dr. Thompson as the
medical doctor
25 and December 31st and Dr. Rueckl will be
finished.
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1 We are meeting more often. We are going now
2 to evaluate the job performances of our
employees which
3 we haven't done or didn't do for a number of
years.
4 We have some new officers. And Carol talked
5 about that, and we have room for a new board
member. We
6 are looking for a new board member. We are going to get
7 monthly financial reports which we didn't do
a very good
8 job of keeping track of before.
9 I think of my history on this
foundation board
10 we let it run very loosely. We have a problem. This
11 was decided before Carol was leaving. We knew we had a
12 problem, but I think the foundation feels
competent that
13 we can
handle the situation.
14 Carol is going to help us find
somebody. She
15 will be around until the end of the month,
and we will
16 still do the work that the foundation
does. That's the
17 end of
my report.
18 MADAM PRESIDENT: Thanks, Arnie.
19 DR. MONTOYA: May we go into closed session?
20 MADAM PRESIDENT: We'll go into closed
21 session.
22 (Off the record -- closed session.)
23 MADAM PRESIDENT: Is there a motion?
24 DR. TITUS: I move we give our president,
25 Cheryl Hug, the authority in regards to the
current
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1 situation with our diversion program. I move that we
2 give Dr. Cheryl Hug permission or authority
to notify
3 them in January if actions that they have
taken are not
4 to the satisfaction of this board.
5 MEMBERS OF THE BOARD: Second.
6 MADAM PRESIDENT: Okay.
There is a motion and
7 a second to give me the authority to send a
letter to
8 terminate our relationship with the
diversion program if
9 progress has not been made for replacement
of Carol
10 Bowers.
All in favor?
11 MEMBERS OF THE BOARD: Aye.
12 MADAM PRESIDENT: Chair votes in favor of the
13 motion.
Motion carries. Thank you both
for your
14 presentations.
15 I know that we are really running
late. Can
16 we just do agenda item number seven, and
then we can
17 maybe take a break.
18 I think this is a relatively short
one. This
19 is agenda number seven, consideration of
submission of
20 request to participate in the federation's
poster
21 session at the next meeting.
22 Larry, you want to talk about
that?
23 MR. LESSLY: I wasn't at the last meeting.
24
Apparently the federation utilized a poster session.
25 There is an invitation out for boards to
request to
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1 participate.
2 MR. HUSE: We cannot hear you in Las Vegas.
3 MR. LESSLY: There is a request out for
4 submission to participate in the poster
session along
5 with abstract -- as well as abstract. What we would be
6 doing in that poster session is supposed to
be inviting
7 of ideas and things that are occurring with
your board.
8 I have discussed it with
Cheryl. I have
9 discussed it with Don. It would seem to me if we want
10 to participate in something like that,
perhaps our
11 continuance of public announcements, for
lack of a
12 better descriptive term, if, in fact, this
board adopts
13 a regulation on post licensure competency
proficiency, a
14 background on that regulation and
distribution of that
15 regulation at that booth might be
appropriate.
16 Those were things I thought of, I
guess. The
17 first thing you would need to do if you are
interested
18 in doing it is what would you like to do?
19 DR. TITUS: I was back at the last board
20
meeting. I was disappointed at
our federation meeting.
21 I was disappointed that our board didn't
participate in
22 a poster session. I thought the ones that were
23 represented were good.
24 I think our board is very progressive,
and we
25 have things to share with other states. And we were
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1 asked, those us that were there, where is
your poster?
2 And I came back saying, Why didn't we do a
poster
3 session?
And I would be in favor of something like that
4 and be happy to help to participate.
5 DR. BAEPLER: Not very expensive to create.
6 And looking at the agenda for the spring
meeting, there
7 is a very limited amount of time. And we have to man
8 it.
Can it be an unmanned poster for the entire
9 session?
10 DR. TITUS: Fifty minutes maybe.
11 DR. BAEPLER: Yeah.
12 DR. TITUS: I don't know how many of us are
13 planning to go to the meeting, but I would
be
14 encouraging this board in looking into doing
that.
15 DR. BAEPLER: Yeah.
16 MADAM PRESIDENT: Okay.
There is a motion to
17 that affect?
18 DR. MONTOYA: Second.
19 MADAM PRESIDENT: Okay.
There is a motion and
20 a second.
All in favor?
21 MEMBERS OF THE BOARD: Aye.
Opposed? Chair
22 votes in favor of the motion. Motion carries.
23 MR. LESSLY: What do you want us to look into?
24 MADAM PRESIDENT: I think both of those things
25 would be appropriate depending on what
happens in the
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1 next meeting.
2 MR. LESSLY: I think I need some assistance
3 from the board members -- probably have to
be Don -- to
4 talk about a poster.
5 DR. BAEPLER: I can begin to put something
6 together.
And depending on where we are, it will be
7 either regs or proposed or under
consideration.
8 MADAM PRESIDENT: Right.
9 DR. BAEPLER: Hopefully regs.
10 DR. TITUS: I will be happy to help you with
11 it when we are there.
12 MR. LESSLY: Both of them at the same booth
13 and we'll work on that.
14 MADAM PRESIDENT: Okay.
And you guys want to
15 wait?
Is that going to take a little bit to talk about?
16 MS. LYONS:
I would like you to just read --
17 we received an e-mail from Assemblyman
Maybe. And I
18 just want to quickly read what this says
particularly
19 the circled paragraph.
20 DR. BAEPLER: Who is this from?
21 MS. LYONS: Assemblyman Maybe.
22 The board now decides in open
session what
23 goes on the website. You see that Assemblyman Maybe is
24 interested in how that all works. So at this point it
25 is -- the legislature deemed that the board
make a
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1
decision in open session about what goes on there.
2 Well, right now all the
information on our
3 licensees are available over-the-phone and
on our
4 website.
The only difference is the education about the
5 licensee is not on the website yet. That's something we
6 discussed in the past. One of the main reasons that the
7 education --
8 MR. HUSE: Excuse me.
We are having
9 difficulty hearing in Las Vegas.
10 MS. LYONS: One of the reasons the education
11 is not in the website right now is due to
the conversion
12 over the last three years. The data has -- every time
13 you do a data conversion you have to clean
up the data.
14 And in doing about three to four conversions
you can
15 imagine some data on the education has
become jumbled.
16 And it's -- I don't feel that it is absolutely
accurate
17 what we have in our data base right now.
18 And that's why we have been
putting off
19 putting the education on the website because
we were
20 going to get that cleaned up. And that's a big project.
21 And we really don't have anyone on staff to
do it.
22 So what I would propose if you
want to
23 consider putting the education on the
website is, first
24 of all, there is two costs involved. One, to hire a
25 full-time person who has a lot of experience
in data
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1
input because this person has to take each hard copy
2 file, pull it, put the education on it.
3 I got a quote from Kelly
Services. A person
4 for a six-month period of time would cost
$14,500. And
5 I think in a six-month period of time they
could take
6 and clean up all of the active status
licensees that we
7 have.
8 On top of that I received a quote
from System
9 Imaging to enhance our website to allow the
education to
10 be put on there and that would be
$10,580. So we are
11 talking about $25,000 to get the education
on there.
12 Besides the education, some other
information
13 you can consider to go on the website would
be
14 disciplinary actions taken by other states
against our
15 licensees, any criminal convictions,
malpractices that
16 have occurred prior to the issuance of a
Nevada license,
17 things like that.
18 DR. MONTOYA: How about things like awards,
19 monetary things? How about putting those things in
20 there concerning the physician?
21 MS. LYONS:
That would have to come under what
22 Assemblyman Maybe suggests is can a
physician make
23 remarks.
So what we would have to do is send out
24 questionnaires to everyone and tell us what
awards you
25
have one or --
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1 DR. TITUS: I would -- I have a wall full of
2
awards. I mean, how would you
know that they are even
3 legitimate?
I just would be, you know, a reward from
4 the physicians state of Nevada from
medical. I mean,
5 that doesn't necessarily need to be on there. The boy
6 scouts could give us --
7 DR. MONTOYA: I would say give us the top
8 three awards.
9 DR. TITUS: I don't know.
10 MS. LYONS: You could do this thing where the
11 licensee could actually submit things that
they would
12 like you to put on for them on there by
their name.
13 DR. TITUS: I'm concerned that we are not
14 addressing what the assemblyman is concerned
about. And
15 I'm concerned about this. If there is some inaccurate
16 information about a physician on this
website, why
17 hasn't he been able to get it changed? That's what I'm
18 more concerned about than any award.
19 MR. LESSLY: It's all been taken care of.
20 DR. TITUS: He has --
21 MR. LESSLY: It's all been taken care of.
22 DR. ANWAR: So why do we need to take any
23 additional information? What is the value of that since
24 we have looked into all that information to
approve
25 somebody to practice in this state? What is the value
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1 of the negative information on somebody's
CV?
2 DR. BAEPLER: We already approved the guy
3 knowing all of that.
4 DR. ANJUM: That is a complete information.
5 MS. LYONS: Keep it as a Nevada site.
6 DR. ANJUM: It is negative information.
7 DR. ANWAR:
That is somewhere --
8 MR. LESSLY: If we tell you what disciplinary
9 actions have been taken in Nevada, we tell
you about
10 malpractice against the physician in
Nevada. We don't
11
tell you about malpractice that occurred in some other
12 state before you came here.
13 DR. BAEPLER: What about settlements?
14 MR. LESSLY: Not in another state.
15 DR. BAEPLER: Settlements are so
16 misunderstood.
17 MR. LESSLY: We don't tell you about their
18 education on the website, but we do tell you
about their
19 education if you call in by telephone and
ask us.
20 DR. TITUS: Is that available? Do you say
21 that on the website if you want more
information about
22 education you can call us?
23 DR. BAEPLER: There is a phone number.
24 MS. LYONS: We do say if you would like more
25 information, you can call the office. We don't
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1 particularly say about information.
2 DR. TITUS: I think in was generated because
3 this physician couldn't get his information
changed. It
4 was enacted, and you are saying it was taken
care of?
5 DR. BAEPLER: It probably happened when we
6 were converting too.
7 DR. TITUS: It may not.
8 MR. LESSLY: We have taken care of this.
9 MR. CLARK: I talked to him personally.
10 MS. LYONS: The reason I brought this up,
11 though, is the education is something that
needs to go
12 on the website.
13 Other sites offer it. It's just a piece of
14 information that really needs to go on
there. And what
15 I'm telling you is that I feel we need to --
prior to
16 getting it on there we need to have it
cleaned up so we
17
feel confident. So we don't
receive e-mails such as
18 this one saying this information is
inaccurate.
19 I would prefer taking a six month
time frame,
20 hiring somebody, get it cleaned up to the
point -- you
21 are never going to feel it's 100 percent
confident.
22 Nobody is perfect -- and then put it on the
website.
23 And I think at that point I think
these other
24 suggestions I made were something to think
about. But I
25 think we are there, I think, when we compare
our website
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1
to other state medical board websites.
2 DR. TITUS: When we reapply every other year,
3 are we not obligated to keep our educational
information
4 -- is that not all -- Do we check that? Is that what
5 we have on you?
6 MS. LYONS: We don't ask for the educational
7 information on the registration forms. We used to do
8 that.
And we did a little survey and found that what
9
the physician filled out on his registration was not
10 always correct. They sort of relied on their memory,
11 and you are not going to get the accurate
dates and all
12 that stuff.
13 DR. BAEPLER: Can you tell how many hits you
14 get a day or month or anything?
15 MS. LYONS: I don't keep track of that.
16 That's something you can on a website. I'm currently
17 working on the website.
18 MADAM PRESIDENT: That would be good to know.
19 DR. BAEPLER: I don't have -- I would like to
20 know if it's heavily used.
21 DR. TITUS: That would be something to
22
address, because the one we do now is tell them to call
23 in the future to look at, you know --
looking at the
24 website.
25 MS. LYONS: Didn't our website come up?
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1 DR. MONTOYA: It did come up when I did the
2 Spanish language, though, I have seen it
someplace.
3 MADAM PRESIDENT: I guess the question to
4 address today is do we want to add the
educational
5 background on the website?
6 MS. KIRCH: Yes, it is.
7 MADAM PRESIDENT: There is a motion to do so.
8 I so move.
9 MEMBERS OF THE BOARD: Second.
10 MADAM PRESIDENT: There is a motion to add the
11 educational background. All in favor?
12
MEMBERS OF THE BOARD: Aye.
13 MADAM PRESIDENT: All oppose?
Chair votes in
14 favor of the motion. Motion carries.
15 I think by doing so, Maureen, I
think we have
16 authorized you to go ahead and do what you
need to do to
17 get somebody place.
18 MS. LYONS: I will get started on that right
19 away.
20 DR. TITUS: We will not open it to where they
21
can make personal comments there.
22 DR. MONTOYA: I think that's next.
23 MADAM PRESIDENT: I think that opens you up to
24 all kinds of other questions. Then it is not a -- it's
25 a
site that is not a board site. It's a
physicians'
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1 site where they can put what they want on
it. And I
2 think having comments on their information
isn't really
3 appropriate.
There is a lot of other -- many places
4 they can do that. They can put it in other places.
5 They can put it in their office. I don't think it
6 should be on the website.
7 MS. KIRCH: What can they do the national data
8 bank?
9 MS. LYONS: They can respond to an action that
10 is recorded on them. They can fill out a form and
11 respond to that action that was taken
against them.
12 MS. KIRCH: Does it go on the website?
13 MS. LYONS: The response?
14 MR. KIRCH: Oh, yeah.
The whole national data
15 bank does.
16 MS. LYONS: I do have another part to my
17 agenda item.
18 MADAM PRESIDENT: Okay.
19 MS. LYONS: If I can keep my voice. I'm in
20 the process of trying to do a major overhaul
on the
21 site, and mostly it's due to the status that
the
22 legislature that is put in place scattered
around in
23 different areas about what needs to go on an
agency's
24 website.
We are going to have a frequently asked
25 questions page.
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1 We are also going to have a
listing of any
2 doctor that has had a disciplinary action
against them.
3 There will be a list in alphabetical order
and from that
4
list you can see who they all are and you can look them
5 up and read what that disciplinary action
is. We will
6 have a link to the inspector general's
office, a link to
7 the D.O. website. That was at their request.
8 One suggestion that the federation
made in
9 their audit was that right now what our
staff does is
10 whenever a disciplinary action is
adjudicated, the
11 investigative staff goes in and types a
summary of what
12 occurred.
That's put into the comments which appears on
13 the website.
14 The federation recommended in
their audit that
15 what we do is rather than to do that is to
actually take
16 the actual documents and turn it into a, you
know, file
17 on the website so that it could be
electronically
18 downloaded by anyone what would want it at
no charge.
19 People can write in and request
and pay 60
20 cents a page for copies. The federation felt that by
21 allowing -- rather than summarizing it,
which is whoever
22 the investigator is that is doing the
summaries
23 interpretation of it, take that away and
just let the
24 person who wants the whole document take it
and then
25 they can read it for what they think it
needs which I
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1 thought was a good idea too because it leads
to less
2 liability on ours and of interpreting
documentation.
3 And that's something we could do. That's about it.
4 I'm also working on getting --
another thing I
5 have to do is get every single form that we
have has to
6 go on line.
We purchased Adobe Acrobat program so that
7 anyone
can access it. It's just user friendly
by any
8 computer.
So I'm doing that.
9 I'm taking all the forms I have
typeset them.
10 I'm trying to make them really consistent
which is very
11 time
consuming and getting them into the Adobe format
12 and that is something that was required by
the
13 legislature.
I don't know whether that's good or bad
14 thing for us, but it will be there.
15 And that's it.
16 MR. LESSLY: And the deadline for all of this
17 is January the 23rd?
18 MS. LYONS: Yes.
19 MADAM PRESIDENT: Thank you, Maureen.
20 With that we are in recess for lunch.
21 DR. TITUS: You want to give a time?
22 MADAM PRESIDENT: Half an hour.
23 MR. HUSE: How long are you in recess for?
24 MADAM PRESIDENT: Half an hour.
25 (A recess was taken.)
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1 MADAM PRESIDENT: We are going to continue on.
2 And we are going to skip a little bit in our
agenda
3 under agenda item thirteen. We have just a couple of
4 those to get through.
5 (Off the record -- Closed
session.)
6 (Back on the record.)
7 MADAM PRESIDENT: That takes us to our
8 investigative committee.
9 DR. BAEPLER: I ask that be deferred to
10 tomorrow.
11 MADAM PRESIDENT: Okay.
Do you want to do
12 your secretary treasurer report?
13 DR. BAEPLER: We have already examined parts
14 of it indirectly this morning. Do you have all copies
15 of this?
There is nothing to act on. I can
report it
16 just as easily, Maureen.
17 DR. ANWAR: Is there anything we need to know?
18 DR. BAEPLER: You need to know that everything
19 is all right.
20 DR. TITUS: Basically we need to know that we
21 haven't spent more money than we have.
22 DR. BAEPLER: I'm really interested in the
23 chair support. If you want to take two of these, let me
24 get start with this. The top page is from July 1
25 through December 4th as are both of these
pages
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1 approximately five months.
2 This is simply a balancing of
assets against
3 liabilities and it doesn't tell you very
much because
4
you are always going to have assets match liabilities.
5 The second page is of more
interest because
6 this actually shows the expenditures versus
anticipated
7 expenditures versus budget and it relates to
income.
8 How well we are in target or where we might
miss it.
9 Expenses, we are on target. We may be over or
10 a little under. I can just generalize by saying we
11 appear to be in good shape.
12 There are some areas that are over
budgeted to
13 give us flexibility such as we discussed
this morning.
14 And the cash flow is coming in pretty much
as
15 anticipated.
So since this is the first year of
16 basically biennial approach to this, I was
able to get
17 this yesterday. I have examined it in some detail,
18 asked some questions for clarification, and
I can give
19 you assurance that everything is on target.
20 There are no surprises in here.
21 DR. TITUS: We need a motion to accept this or
22 no?
23 DR. BAEPLER: I think it's just a report for
24
your information.
25 DR. TITUS: Okay.
Thanks.
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1 MADAM PRESIDENT: Thank you, Don. The
2 committee of post licensure competency
meeting, Robin,
3 you were going to talk to us about that.
4 DR. TITUS: I already did earlier, and I don't
5 need to go down that road. We are meeting again this
6 next week, and we will be interested to take
back our
7 proposal and changes.
8 We are leaps and bounds -- I would say two
9 thirds --
There are still people on that committee when
10 we showed up there in September asking Why
are we doing
11 this.
And where is this coming from. So
there are
12 states that are behind on that issue.
13 I think everybody left that
meeting
14 recognizing it's out there. We're committed on a
15 nationwide basis and an international basis.
16 MADAM PRESIDENT: Okay.
And the
17 administrators in workshop, Tony, you
attended that.
18 MR. CLARK: I was in the seat on the 16th and
19 17th for the administrators in medicine on
the 16th and
20 federation seminar on the 17th. Certainly a good
21 meeting.
The folks discussed several states which have
22 started into the criminal --
23 MR. HUSE: We are having trouble hearing in
24 Las Vegas.
25 MR. CLARK: Criminal background investigations
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1 for licensure.
2 They talked about managing the
malpractice
3
mess proceedings to discipline the correlation of
4 malpractice to competency.
5 There was a letter of physicians
health
6 presentation and a common verification
initiative that
7 is out there to try to assist doctors who
want to apply
8 in more than one state and make it easier to
get them
9 their licenses.
10 During the seminar the next day
put on by the
11 federation they discussed legal
implications, the
12 Internet for medical boards, and primarily
talked about
13 physicians practicing medicine by the
Internet.
14 Internet medical education, Internet board
meetings and
15 things of that nature. It was a worth while meeting for
16 both days.
17 MADAM PRESIDENT: Okay.
Thank you. And the
18 federation of association of regulatory
boards, Steve,
19 you want to do that one?
20 MR. QUINN: I attended this seminar in
21 Portland, Oregon for regulatory
attorneys. It was
22 basically a two and a half day seminar or
three day
23 seminar.
Three day, four days, two full days and a half
24 day.
Thursday through Sunday.
25 It was very interesting to me
having come from
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1 the area of general practice and litigation
and going to
2 the area of administrative law dealing with
boards. It
3 was very interesting to me dealing with
administrative
4 law learning the intricacies of
administrative law.
5 It went over the areas of
discovery in
6 disciplinary proceedings, licensure
disciplinary
7 actions, testing, and issues involving the
integrity of
8
the testing procedure or breaches of the testing
9 procedures, enforcement, post activity
litigation.
10 And I'm pleased to tell you it
appears that by
11 reason of this teleconferencing equipment,
Nevada
12 appears to be head and shoulders in be front
of
13 everybody in the nation, at least, everybody
represented
14 at the conference. Nobody has this sort of equipment
15 even though they have to deal with the
geographical
16 discrepancies or disparities that we have to
deal with.
17 And it was -- I thought it was an excellent
seminar for
18 me.
19 MADAM PRESIDENT: Well, great.
Thank you.
20 MR. LEGARZA: Does this tell you what two guys
21 have been staying home and working.
22 MADAM PRESIDENT: I think it's nice that we
23 have had such involvement in various
workshops.
24 And one more I think, Tony, you
attended the
25 federation workshop on the impaired
physician in Las
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1 Vegas.
2 MR. CLARK: I did on the 15th of November.
3 They talked about the history of physicians'
health
4 programs, and potentially impairing
conditions and some
5 of the treatments for them.
6 They talked about intervention
evaluation and
7 treatment, monitoring and guidelines and
standards for
8 the physicians' health programs and the
effective
9
interface that the physicians held programs that need to
10 develop with the state medical boards in the
various
11 states.
It was a worth while day. It was
very
12 interesting.
13 MADAM PRESIDENT: Okay.
Thank you. Should we
14 move on to do a few of the reports? I still think we
15 are okay on time.
16 Agenda number ten our executive
staff reports
17 and, Larry, I will start off with --
18 MR. LESSLY: In your agenda book you have
19 information on the international meeting to
be held in
20 April, I believe. If, in fact, anyone from this board
21 planned to attend that meeting as a
delegate, we need to
22 do that.
23 I would like to see Tony go to
that meeting as
24 a delegate.
In addition, I would like to see Tony go to
25 the administers and medicine meeting as far
as the
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1 federation's annual meeting is
concerned. Probably the
2 four lawyers, chief license specialist
Laurie the new
3 deputy executive director from the
staff. We do need to
4 know who of you want to go so we can take
care of the
5 early registration reports. It's in Washington, D.C.
6 DR. TITUS: I'm going to go.
7 MS. JONES: I'm going.
8 MADAM PRESIDENT: I think I'm a delegate, and
9 I'm going.
10 MR. LESSLY: You are going. So we will name
11 you our delegate. My way and Cheryl's way is paid so we
12 are a free as far as travel is concerned.
13 MADAM PRESIDENT: The date again is in April?
14 MS. LYONS: It starts on the 29th. So just
15 four of you so far?
16 MS. KIRCH: When do you have to register?
17 MS. LYONS: We have time.
18 MS. KIRCH: I'm still kind of looking. I was
19
just curious.
20 MS. LYONS: We can still register.
21 DR. TITUS: You went to San Diego, correct?
22 Did you go to Chicago? I will tell you after how
23 disgusted I was with the San Diego meeting
going to the
24 Chicago meeting was a tremendous
improvement.
25 I was just commenting on this
federation
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1 meetings nationally the one in San Diego
needed a lot to
2 be desired and many of us who attended --
that meeting
3 was not adequative representatives of the
states
4 involved.
And they improved it dramatically in Chicago,
5 and I encourage anybody on this board to go
to the one
6 in Washington D.C.
7 MR. LESSLY: I was on the program committee
8 for
this upcoming event.
9 MADAM PRESIDENT: Do we need a motion for
10 that?
11 MS. LESSLY: I have one more. I need Laurie
12 Munson be authorized to go back to the east
coast --
13 MS. LYONS: No.
That's me. I'm supposed to
14 say that.
System Automation puts on a users conference
15 each year, and it's held at their offices in
Maryland.
16 Laurie should go to that so she can be more
familiar
17 with System Automation. They are the software people
18 that write the licensing 2000 program.
19 And in part of the federation's
audit they
20 recommended that we consider starting to use
the
21 accounting module our license 2000 for
accounting rather
22 than using Quick Books to keep track of
registration
23 fees versus deferred registration fees, et
cetera.
24 We are not using a module that's
available to
25 us because we never started doing it. It's never been
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1 done.
It would make a lot of sense because it would
2 have everything immediately tie in rather
than having to
3 reconcile.
4 I would like Debbie to also go to
this meeting
5 in
Maryland with Laurie because they are going to have a
6 half-day session on the accounting
module. So it will
7 be perfect for her to learn.
8 MS. LESSLY: Can we do that in one motion?
9
DR. TITUS: So moved.
10 MS. JONES: Second.
11 MADAM PRESIDENT: There is a motion to
12 approve.
All in favor?
13 MEMBERS OF THE BOARD: Aye.
14 MADAM PRESIDENT: Chair votes in favor as
15 well.
Motion carries.
16 MR. LESSLY: In your agenda booklet with the
17 federation materials there is correspondence
with
18 respect to committee payments and if you
wish to serve
19 on a committee? I would suggest we get a letter in to
20 the committee about -- to our in-coming
president about
21 your desire to do so.
22 In addition, there is a call for
candidate
23 nominations which has been included. I believe we have
24 a person on this board who might be a nice
available
25 candidate for election of the board of
directors.
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1 And I would like to nominate Dr.
Baepler as
2 our candidate for the board of directors,
and I guess
3 that would be our request that he be placed
in
4 nomination.
5 We would need a motion that the
board nominate
6 him or the board present his name to the
nominating
7 committee with the position of a member of
the board of
8 directors.
And he needs to express on the record his
9 intention of accepting that position if so
elected.
10 DR. BAEPLER: I would be pleased to accept it.
11 It never occurred to me and certainly was
not my idea to
12 run.
It came from an external, two sources, I guess,
13 outside of this board. But I think it would be
14 interesting to run. It won't be easy. But we will give
15 it a little campaign. And worst that can happen is I
16 will try again next year.
17 MR. LESSLY: I guess we need a motion to
18 nominate.
19 MADAM PRESIDENT: Okay.
All in favor?
20 MEMBERS OF THE BOARD: Aye.
21 MADAM PRESIDENT: Opposed?
Motion carries.
22 MR. LESSLY: I ask that the audit discussion
23 be deferred until tomorrow.
24 I would -- there is a suggestion
that the next
25 item on consideration of hiring the
federation to do the
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1 audit of the licensing procedures and policy
be
2 deferred.
3 The audit that was recently
concluded
4 developed into that aspect of our operations
and found
5 us on the forefront nationwide of
licensing. So I would
6 question whether we really need to consider
that audit
7 at this point.
8 So I ask we defer that which,
assuming you are
9 willing to do that, would bring us to the
consideration
10 of approval of revised organizational and
operational
11 charts, personnel policies and officer
committee and job
12 transcription manual for 2004. That is Maureen's item.
13 DR. BAEPLER: While she is passing this out
14 when will we get an updated copy of NRS 630?
15 MR. LESSLY: This is the one I asked her to
16 make, at least, a thirty minutes
presentation on.
17 MADAM PRESIDENT: Our booklet.
18 MS. LYONS: Please hold these for your
19 reference.
Don't leave them behind.
Okay. Take them
20 home.
Put them under your pillows so at night you have
21 something to read.
22 MR. LESSLY: If you open the book to the
23 organizational chart, that explains
everything that the
24 -- in the book job description have all been
cleaned up
25 to address changes in the titles. You will note that we
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1
now reflect two investigative committees, one chaired by
2 the secretary, one board member required to
be a public
3 member, one consisting of three members, at
least, one
4 to be a public member.
5 We are showing the deputy executive
secretary
6 special counsel did the same personnel block
with my
7 position.
8 Likewise, with the general counsel
and deputy
9 general counsel. Likewise, with the deputy executive
10 secretary administrator. Those reflect the three
11 persons who have been brought on board to
replace us.
12 The license specialists number has
been
13 increased to four which you did last
meeting.
14 Investigators are increased to
four and the
15 job descriptions have been amended to
reflect all of
16 those new titles in an update.
17 MADAM PRESIDENT: Larry, is the new
18 malpractice review committee on this
organization there
19 at this time?
20 MR. LESSLY: No, it is not.
21 MADAM PRESIDENT: Can we make that addition?
22 MR. LESSLY: I was waiting to see if any of
23 you would be willing to come back to a
second meeting.
24 We can add that. We certainly can. We can add that
25 above the internal affairs committee. Same command
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1 line.
I assume we will continue with that.
2 DR. BAEPLER: I think we have to, yeah.
3 MR. LESSLY: Any questions? I guess I need a
4 motion to accept the manual.
5 MS. JONES: So noted.
6 MS. KIRCH: Second.
7 MADAM PRESIDENT: There is a motion with the
8 addition of the malpractice committee. All in favor?
9 MEMBERS OF THE BOARD: Aye.
10 MADAM PRESIDENT: Chair votes in favor. And
11 motion carries.
12 MS. LYONS: Under tab ten you have proposed
13 dates for meetings of this board for
calendar year 2004.
14 Those dates are not something we are
recommending be
15 carved in stone. We simply took dates that seemed to
16 parallel with the same period of time
between the
17 meetings we used for 2003. So you do need to decide on
18 which dates you have meetings.
19 MADAM PRESIDENT: I ask we would change the
20 March from the 5th and 6th to either the
weekend before
21 or weekend after. The weekend after would be the 12th
22 and 13th of March.
23 MS. JONES: I think that's a wonderful idea.
24 DR. TITUS: That works better for me.
25 DR. ANJUM: We are going to change it?
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1 MADAM PRESIDENT: So it will be March 13th,
2 14th rather than the 5th and 6th with the
investigative
3 committee meeting on the 11th.
4 DR. TITUS: March 11th with investigative
5 committee?
Okay.
6 MR. LESSLY: Are the rest of the dates
7 acceptable?
8 MS. KIRCH: How are you doing the
9 investigative committees? Are you having both of them
10 come up?
11 MR. LESSLY: Don't worry about that.
12 DR. BAEPLER: We came up this time. You did
13 not come up this time. It's up to the chair.
14 MR. LESSLY: It's up to the chair.
15 MS. KIRCH: I was just curious so that --
16 MR. LESSLY: Actually, Cheryl and I don't care
17 what you do in September.
18 MS. JONES: I don't either.
19 MS. LYONS: We are okay with that? So I think
20 we are okay.
That's the date we always seem to have a
21 conflict.
22 MADAM PRESIDENT: So do I have a motion to
23 approve this schedule as presented with that
one
24 revision?
25 MS. KIRCH: So moved.
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1 MADAM PRESIDENT: Is there a second?
2 MEMBER OF THE BOARD: Second.
3 MADAM PRESIDENT: All in favor?
4 MEMBERS OF THE BOARD: Aye.
5 MADAM PRESIDENT: Getting tired.
6 MR. LESSLY: The next issue is the status of
7 board office space. Tony Clark will talk to you about
8 that.
9 MR. CLARK: Let me show you a little layout of
10 the first floor downstairs. We have taken an additional
11 540 square feet. This shows you how it's been laid out
12 for use by the licensure folks.
13 And the room has already been
reconfigured. A
14 hole cut in the wall, a doorway cut into the
wall
15 between the two offices. It's been repainted. It is
16 being recarpeted.
17 The desks will be set up in there
Thursday and
18 Friday of this coming week, and the
licensing folks will
19 be ready to start a week from Monday in
their new
20 facilities downstairs.
21 DR. TITUS: Can we look back at the meeting
22 schedules?
I was thinking in September that's Labor Day
23 weekend.
I don't know if it's a conflict.
24 MS. LYONS: Labor Day weekend is the 6th.
25 DR. TITUS: That will be the Labor Day
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1 weekend, and that will be a conflict for me.
2 MS. LYONS: No.
That's bad. That's a good
3 point.
Sorry, Tony.
4 MR. CLARK: That's okay.
5 DR. TITUS: I'm usually on a river unavailable
6 by cell phone.
7
MS. LYONS: September 10th and
11th.
8 MS. KIRCH: Thank you.
9 DR. TITUS: Do we need a new motion or just
10 revise it?
11 MADAM PRESIDENT: We'll just revise it.
12 MS. LYONS: We'll revise that and add that in.
13 MADAM PRESIDENT: Carry on, Tony.
14 MR. CLARK: That concludes my presentation of
15 the office space. Unless you have questions.
16 You will note that there is room
for an
17 additional desk to be put in if we need an
additional
18 licensing specialist. So we have plenty of room down
19 there.
20 MADAM PRESIDENT: Looks good.
21 MR. LESSLY: The next item is the item that
22 was labeled September 4th and 5th
consideration of the
23 board office to be located in Las Vegas.
24 DR. BAEPLER: We have an experimental program
25 now that the Clark County Medical
Association has
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1 indicated to us is --
2 MR. HUSE: We cannot hear in Las Vegas.
3 DR. BAEPLER: We have this experimental set up
4 that occasionally we forget to turn our
buttons on.
5 However, it's been indicated to us
that this
6 will meet the needs of the people in Las
Vegas. Before
7 we take that item off the table to discuss
whether we
8 need office space in Las Vegas, I would like
to give
9 this a chance.
10 Budget considerations are such
that we
11 shouldn't even attempt it before the next
fiscal year,
12 in any event, and by then we will have some
experience
13 with it.
I will suggest we just leave it on the table.
14 MADAM PRESIDENT: Okay.
15 MR. LESSLY: That is the end of that agenda.
16 DR. TITUS: Should we go back to --
17 DR. BAEPLER: Interviews.
18 MADAM PRESIDENT: So that concludes agenda
19 number ten.
And I think we will move back now to our
20 appearances.
21 And we, I believe, left off -- our
next one
22 was Dr. Bernstein and that is in book two.
23 DR. TITUS: I move to close the meeting.
24 (Whereupon the meeting entered into closed
session for
25 the remainder of the day, 3:45
p.m.)
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1 RENO, NEVADA; SATURDAY, DECEMBER 6, 2003;
9:00 A.M.
2 -o0o-
3 THE COURT: Okay.
I'm going to call the
4 continuation of Nevada State Board of
Medical Examiners
5 meeting to order.
6 Can you hear us down there?
7 MR. HUSE: Yes.
We can hear you now, and we
8 have a picture now. We just got it. Thank you.
9 THE COURT: Great.
Okay. This morning we
10 really have the remainder of our appearances
so the
11 majority of this meeting will be going back
and forth
12 between open and closed session to let our
audience
13 members know there will be times when we are
in closed
14 session.
15 And we left off late last night. Our next
16 appearance would -- No. We
can't do your investigative
17 because Joel isn't here. We'll wait.
18 So Dr. Barnet is in book two under
E.
19 MS. KIRCH:
I move we go into closed session.
20 MADAM PRESIDENT: Okay.
We'll go into closed
21 session.
22 (Closed session.)
23 (Two matters were heard off the record due
to the court
24 reporter not having notice of open
session.)
25 MADAM PRESIDENT: Anything else?
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1 DR. BAEPLER: Move we adjourn.
2 DR. ANJUM: Second.
3 THE COURT: There is a motion to adjourn, and
4 we are now adjourned.
5 (Whereupon the proceedings were concluded at
12:45 p.m.)
6 -o0o-
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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1 STATE OF NEVADA, )
) ss.
2 COUNTY OF WASHOE. )
3
4 I, LISA A. YOUNG, a Certified
Court
5 Reporter in and for the state of Nevada, do
hereby
6 certify:
7 That the foregoing proceedings
were taken by
8 me at the time and place therein set forth;
that the
9 proceedings were recorded stenographically
by me and
10 thereafter transcribed via computer under my
11 supervision; that the foregoing is a full,
true and
12 correct transcription of the proceedings to
the best of
13 my knowledge, skill and ability.
14 I further certify that I am not a
relative nor
15 an employee of any attorney or any of the
parties, nor
16 am I financially or otherwise interested in
this action.
17 I declare under penalty of perjury
under the
18 laws of the state of Nevada that the
foregoing
19 statements are true and correct.
20 Dated in Reno, Nevada this 20th
day of
21 December 2003.
22
___________________________
LISA A.
YOUNG, CCR #353
23
24
25
PEGGY HOOGS & ASSOCIATES
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1
STATE OF NEVADA, )
) ss.
2 COUNTY OF WASHOE. )
3
4 I, LISA A. YOUNG, a Certified
Court
5 Reporter in and for the state of Nevada, do
hereby
6
certify:
7 That the foregoing proceedings
were taken by
8 me at the time and place therein set forth;
that the
9 proceedings were recorded stenographically
by me and
10 thereafter transcribed via computer under my
11 supervision; that the foregoing is a full,
true and
12 correct transcription of the proceedings to
the best of
13 my knowledge, skill and ability.
14 I further certify that I am not a
relative nor
15 an employee of any attorney or any of the
parties, nor
16 am I financially or otherwise interested in
this action.
17 I declare under penalty of perjury
under the
18 laws of the state of Nevada that the
foregoing
19 statements are true and correct.
20 Dated in Reno, Nevada this 20th
day of
21 December 2003.
22
___________________________
LISA
A. YOUNG, CCR #353
23
24
25
PEGGY HOOGS & ASSOCIATES
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