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BOARD MEETING
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Reported By: PEGGY BAKER HOOGS, CCR #160, RDR, CRR
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1 -oOo- APPEARANCES -oOo-
2
THE
BOARD: CHERYL A. HUG-ENGLISH,
M.D.
3 President
4 JACULINE C. JONES, Ed.D
Vice-President
5
DONALD H.
BAEPLER, Ph.D., DSc
6 Secretary-Treasurer
7 STEPHEN K. MONTOYO,
M.D.
8 SOHAIL U. ANJUM, M.D.
9 JOEL N. LUBRITZ,
M.D.
10 ROBIN L. TITUS,
M.D.
11 MARLENE J. KIRCH
12 JAVAID ANWAR, M.D.
13 CHARLOTTE M. BIBLE,
J.D.
Assistant
Chief Deputy
14 Attorney General
15 RICHARD J. LEGARZA,
J.D.
General
Counsel
16
ALSO
PRESENT: LARRY D. LESSLY, J.D.
17 Executive
Secretary/Special
Counsel
18
DRENNAN
A. CLARK
19 Deputy Executive Secretary/
Special
Counsel
20
MAUREEN
E. LYONS
21
Deputy Executive Secretary
22 PAM GABICA
Administrative Assistant
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2
1 INDEX
2 Agenda Items
3 1
Call to Order and Announcements
4
4 2
Approval of Minutes 7
5 3
Personnel 8
6 4
Consideration of Continuation of Contract
with
7 the Board's Public Service
Announcement
Program for October 1 through December 31,
8 2003 10
9 5
Consideration of Amendments to NAC Chapter 630 12
10 6
Consideration of Request by Washoe Medical
Center for Approval of Practitioner of
11 Respiratory Care Training Programs per
NRS 630.047(1)(e) and (f)(1) 25
12
7 Consideration of Request by
13 Hospital for Approval of Practitioner
of
Respiratory Care Training Programs per
14 NRS 630.047(1)(e)
and (f)(1) 25
15 8
Discussion of Standards for Licensure by
Endorsement and Setting of Application Fees
16 for Licensure By
Endorsement and
Administrative Physician License Types 26
17
9 Legal Reports
18
10 Reports 48
19
11 Executive Staff Reports 63
20
17 Ratification of Licenses
Issued and
21 Reinstatements of Licensure and
Changes of
Licensure Status Approved Since
the
22 May 30 & 31, 2003 Board
Meeting 93
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3
1 TRANSCRIPT OF
PROCEEDINGS
2 DR. HUG-ENGLISH: I'd like to call this
3 meeting of the Nevada State Board of
Medical Examiners --
4 this is September 4th's meeting -- to
order.
5 Can everybody hear me down in
6 Wave if you can hear.
7 (Waving.)
8 Thank you. Welcome to all of you up here
9 both on the Board and in our audience as
well as the
10 members that we have
in
11 problems with the system, I know there's
someone down
12 there at your end, but if you can let us
know as well so
13 that we can stop and take care of the
problem.
14 The first item on our agenda
today, I want to
15 just make note of the fact that at our
last meeting we
16 made some new appointments to our investigative
17 committee. We actually, for the first time on this
18 Board, have two investigative committees
because of our
19 increased caseload that we talked about at
our last
20 meeting, but we did -- I recognized after
the meeting
21 that we needed to revise the committee
appointments, and
22 so the new committees,
the first committee is headed by
23 Dr. Baepler, who
is also our secretary/treasurer, and the
24 members on that investigative committee
include Dr. Anjum
4
1 and Dr. Titus, and on the second
investigative committee,
2 Dr. Lubritz is
the chair of that committee, and
3 Dr. Montoya and Marlene Kirch serve on that as well. So
4 those are our two investigative
committees.
5 I can share with the Board
that one of those
6 committees has been hard at work since
early this morning
7 and has really not had much of a
break. It is very
8 intense, a lot of hard work to serve on
those committees,
9 and I appreciate the effort of, really,
six of our board
10 members now doing that, and as they know
well, there are
11 many cases to review, and it is a great
deal of work, so
12 I appreciate that.
13 Secondly, it's my pleasure to
announce that
14 we have a new board member joining us, and
we're thrilled
15 to have you here. Dr. Anwar is
joining us. He is a
16 physician from
17 the CEO of Quality Care Consultants, which
is a medical
18 quality and utilization company, and he
has served as the
19 chairman in the Department of Internal
Medicine at
20
21 hospital. We're thrilled to have you on the Board,
22 welcome, and I think you'll enjoy it.
23 Dr. Anwar,
as most of you know, succeeded
24 Dr. Stewart's position
on the Board.
5
1 And in addition, we have a new
person joining
2 us as the Deputy Executive Secretary and
Counsel, and
3 that is Mr. Tony Clark, and we are
thrilled to have you
4 as well, and Tony has been working with
us, really, the
5 last few months, but this is your first
official board
6 meeting, so welcome to
you. We're glad to have you on
7 board as well.
8 I think the fact that we have
seen the need
9 to both increase our investigative
committee members, it
10 is also meant that we have some additional
staff that the
11 Board has had to hire and will continue to
have to hire
12 because of the increased workload that
this Board finds
13 itself with the number -- increased number
of cases, a
14 lot of that relating to revisions in the
law with SB1 and
15
other changes through the Legislature, and so we're
16 trying to keep up with the curve, and so
we have made
17 some changes to our staff, and, Dick,
maybe you'd like to
18 talk about some of your additional staff
members.
19 MR. LEGARZA: Present in the room are
two new
20 employees in the
investigative department. First,
Pam
21 Gabica,
Administrative Assistant. Pam, would you
stand
22 and say hi to everyone.
23 MS. GABICA: Hi.
24 MR. LEGARZA: And sitting behind her is
6
1 Hyatt, who is a new investigator with the
investigative
2 department.
3 MR. HYATT: Hi, everyone.
4 DR. HUG-ENGLISH: Welcome.
And, again, we're
5 thrilled to have both of you with us, and
I know we will
6 keep
you busy.
7 Moving on, Agenda Item No. 2
is approval of
8 the minutes, and we have actually two
meetings that you
9 needed to look at. That was from the May 30th and 31st
10 board meeting as well as our July 11th
telephone
11 conference call, and I have a couple of
changes that I
12 think we need to look at.
13 One is on page 25 under Agenda
Item 14, which
14 involves the adjudication in the matter of
15 Board of Medical Examiners versus Renee
Claudia Bovell,
16 and in the minutes it indicates that we
found Dr. Bovell
17 guilty of one count of malpractice, and that,
from my
18 recollection,
is not correct. It was really the fact
19 that she was practicing with an inactive
license, so I
20 think we need to make that change to the
minutes.
21 And then secondly, in Agenda
Item No. 16,
22 which is the adjudication involving Dr.
Watson, it also
23 states that he was found guilty of one
count of
24 malpractice, and, again, he was basically
sanctioned for
7
1 not appearing before
the Board. It wasn't a
malpractice
2 issue.
So I'd like those changes made in the minutes.
3 Are there others that anyone
else has noted?
4 If not, I'd ask for a motion for approval
of the minutes
5 for both meetings.
6 DR. MONTOYO: So moved.
7 MS. KIRCH: Second.
8 DR. HUG-ENGLISH: There's a motion and a
9 second to approve the minutes from both
the May 30th-31st
10 meeting as well as our conference call on
July 11th.
11 All in favor?
12 (Ayes.)
13 Opposed?
14 Chair votes in favor of the
motion, motion
15 carries, and the minutes are approved.
16 Now we're moving on to our
personnel session,
17 and for this particular part of our
agenda, I do need a
18 motion to go into closed session.
19 DR. LUBRITZ: So moved.
20 MS. KIRCH: Second.
21 DR. HUG-ENGLISH: Motion and second. All in
22 favor?
23 (Ayes.)
24 We're in closed session.
8
1 MR. LESSLY: Could I ask that everyone be
2
excused other than Mr. Clark, Mr. Legarza and
Ms. Lyons.
3 (Closed session proceedings
not reported.)
4 DR. HUG-ENGLISH: We are back in open session
5 and we're experiencing our first technical
challenge. It
6 is -- and, please, we are trying to
maintain contact with
7 you down there so that if there are
glitches, we'll try
8 to work through them.
9 We're still in our personnel
session, and,
10 Larry, did you want to make a comment?
11 MR. LESSLY: Yes.
Thank you.
12 To my right is Stephen D.
Quinn, who is an
13 attorney with the
Attorney General's office. Mr. Quinn
14 has represented this Board in civil rights
litigation and
15 other litigation in
that capacity. I will tell you
that
16 I have appointed him the Deputy General
Counsel. He will
17 be coming on board with the staff in about
two weeks and
18 will be replacing Mr. Legarza
for Mr. Legarza's
19 retirement. So I'm very pleased to have Steve. I think
20 he's a good lawyer and will make a very
valuable
21 contribution to
the legal work of this Board.
22 DR. HUG-ENGLISH: We're all pleased to have
23 you on board, Steve. Welcome, and we all
look forward to
24 working with you. And, again, this is just one more
9
1 indicator of the Board's need to expand
our staff because
2 of the increased workload, so I know we
have plenty for
3 you to do.
4 Next we -- I do need a motion
or a discussion
5 about our continuation of our contract
with the Attorney
6 General's office.
7 MR. LESSLY: The only change in that contract
8 is the difference in the hourly rate, and
I think the new
9 hourly rate
simply incorporates the travel expenses.
I
10 would recommend that you authorize the
signing of that
11 contract.
12 MS. KIRCH: So moved.
13 DR. BAEPLER: Second.
14 DR. HUG-ENGLISH: There's a motion and a
15 second.
All in favor?
16 (Ayes.)
17 Opposed?
18 The chair votes in favor, and
the motion
19 carries, so that
contract will be continued.
20 Moving on, then, Agenda Item
No. 4 is
21 consideration of continuation of our contract
with the
22 Nevada Broadcasters
Association, and I think you have
23 some information on that under tab 4 about the costs.
24 MR. LESSLY: I had asked Mr. Fisher from the
10
1 Nevada Broadcasters
Association to be here, and I
2 understand his mother passed away and he
was unable to be
3 present.
We wanted to discuss with him increased
4 coverage for us and the production of some
additional
5 spots if we were going to go forward with
that contract
6 and have a general discussion with him
about the nature
7 of the contract and
relationship.
8 In view of the fact that he's
not here, I
9 would suggest we simply delay this
discussion until the
10 December meeting, and I would suggest we
go ahead and
11 authorize the contract for the next three
months to cover
12 the time until that
meeting.
13 DR. BAEPLER: Can you answer one question
14 just to clarify? If you look at the Agenda Item No. 4,
15
the handout, how is that dollar return calculated?
16 That's confusing.
17 MR. LESSLY: It's arbitrary. They put a
18 value on it.
19 DR. BAEPLER: This would be the equivalent
20 cost if we had to pay for all the spots?
21 MR. LESSLY: It probably would cost us more,
22 but he needs to tell you how that
organization -- that's
23 an internal thing that they do, and I
don't think there's
24 any standard.
11
1 DR. BAEPLER: Thank you.
2 MR. LESSLY: I'd suggest you authorize me to
3 continue the contract for the next three
months and ask
4 Mr. Fisher to be here
at the December board meeting.
5 DR. JONES: So moved.
6 MS. KIRCH: Second.
7 DR. HUG-ENGLISH: There's a motion and a
8 second to continue this agenda item until
December. All
9 in favor?
10 (Ayes.)
11 Opposed?
12 The chair votes in favor,
motion carries. So
13 we'll talk with him in our December
meeting.
14 Next, we have consideration of
the amendments
15 to the NAC Chapter
630, and I think Mr. Legarza and Tony
16
17 MR. LEGARZA: You've got -- under tab 5
18 you've got the proposed new
regulations. Everything --
19 everything that is in
Sections 1 through 7 you have
20 already adopted as temporary regulations
prior to --
21 during the last year
and a half.
22 During the period of time that
the
23 Legislature is in session and for six
months preceding
24 that period of time and for some period of
time after
12
1 they go out of session, the Legislative
Counsel Bureau is
2 unavailable to review regulations, so
administrative
3 agencies have to adopt temporary
regulations during those
4 periods of time, and then they have to
adopt permanent
5 regulations after the beginning -- the
first of November
6 of the year after the Legislature goes out of session
7 because the LCB is
unavailable to review them.
8 So everything in Sections 1
through 7 is
9 stuff that you have
already adopted that we have to
10 readopt as permanent regulations under the
law, and then
11 Sections 8 and 9 are new proposed
regulations, Section 8
12 being the requirement -- and it's a
requirement for all
13 physicians -- to take four hours of CME in
terrorism and
14 weapons of mass destruction was Section 8,
which was
15 required by the Nevada State Legislature
last session.
16 And then Section 9 is, the
Legislature
17 required that the Board encourage
physicians who treat
18 persons of the age of more than 60 years
to take CMEs in
19 geriatrics and gerontology, including such
subjects --
20 you don't have to require it, but you are
required by the
21 Legislature to encourage it.
22 So what we have proposed in
Section 9 is that
23 you encourage them by offering them double
CME credit for
24 up to doubling of four hours of attendance
at those types
13
1 of CMEs where
they would get eight hours of credit for
2 four hours of
attendance at those types of CMEs.
3 So the ones you need to really
take a look at
4 as to whether or not the manner that
they're set out is
5 how much credit you want to give under
Section 9, how
6 much you want to encourage them to get,
and then Section
7 8, I think that's mandatory.
8 DR. BAEPLER: How much of all of this are we
9 locked into by legislative action?
10 MR. LEGARZA: All of it.
11 DR. HUG-ENGLISH: I'd like to emphasize that
12 point because I think there is some
misunderstanding from
13 community physicians that this is
something that the
14 Board wanted and that the Board
initiated. I think we
15 were caught as much off guard by this as
the community
16 physicians have been, but this is
something that clearly
17 was mandated by the Legislature in Section
8 that is a
18 requirement for everyone, the four hours
of CME regarding
19 antiterrorism and so forth, and as Dick
said, the
20 gerontology units of CME can be
recommended, not
21 required, but this is not something that
we initiated nor
22 something we really supported, but
nevertheless, this is
23 something that is now
required by our State Legislature,
24 and so these regs
simply reflect the requirement that --
14
1 this has already passed in the most recent
legislative
2 session, so I
don't think we have much of an option.
3 DR. BAEPLER: This is extremely unfortunate.
4 Take the antiterrorism. The Department of Homeland
5 Security is pouring already millions of
dollars into this
6 state and counties, and we've only seen
the tip of the
7 iceberg. All that type of thing is obviously going to
be
8 richly embellished by this federal agency,
and I hate to
9 see this whole topic come up at this time
because the
10 issue of license portability is on the
front burner, you
11 know, of the national scene, and to the
degree that this
12 in any way weakens our standards, I think
it is an
13 unfortunate move, but if we are, in fact,
locked in,
14 there's not much we can do.
15 MR. LESSLY: You're locked in on that one.
16 Tony drafted that regulation,
which was
17 pretty
straightforward. He also drafted
the one on
18 gerontology and did a little research on
this. This was
19 his idea about double credit, so if you
want to discuss
20 any other options with respect to that reg, you need to
21 talk with him.
22 DR. ANJUM: Does this mean you need a new
23 license or it
would be --
24 MR. LESSLY: It would be a requirement for
15
1 renewal.
2 DR. ANJUM: Renewal.
When you renew the
3 license, you
need to add four hours of --
4 MR. LEGARZA: One thing I need to explain to
5 you, this is a one-time thing. It isn't an annual thing,
6 it isn't a biannual thing. It's a one-time thing that
7 all physicians have to do within a certain
period of time
8 that is set out in the
legislation.
9 The proposed regulation makes
these four
10 hours an additional four hours over the 40
for the
11 biennium. In other words, I didn't think that I wanted
12 to put in here, well, if you get those
four hours, then
13 you only need to get 36 because the
regulations require
14 40 hours of CME. This is a one-time deal, so I just left
15 the 40 hours alone.
16 Now, some doctors may take
exception to that,
17 that sometime in the next two years
they're going to have
18 to
get a total of 44 hours of CME, but I didn't know
19 really how to cleanly add this four hours on because it's
20 not four hours every year, it's not four
hours every
21 other year, it's one time.
22 DR. BAEPLER: But this is -- doubling the
23 hours, then, would be irrelevant.
24 MR. LEGARZA: That has nothing to do with the
16
1 terrorism. That's the other one, that's the geriatrics
2 one.
3 DR. BAEPLER: But the geriatrics one is if
4 you have a patient 60 years or older.
5 MR. LEGARZA: Correct.
We're just
6 encouraging you -- we're not requiring you
to do it. The
7 legislation
didn't say physicians had to take that.
8 MR. LESSLY: It says you shall encourage
9 them.
10 MR. LEGARZA: How do you encourage them?
11 DR. BAEPLER: Is that within the 40?
12 MR. LEGARZA: Yes, that's within the 40.
13 Yes, that's within the 40, so if you had
four hours there
14 and you had four hours of terrorism, then you would only
15 need a total of 36 hours more.
16 DR. ANJUM: That's a good incentive.
17 MR. LEGARZA: To balance out, yeah.
18 DR. TITUS: Would you clarify, this having
19 been -- as a current county health officer
for
20 County, I've already been involved quite a
bit in
21 instructing the firemen and taking classes
myself since
22 September 11th of 2001, and just looking
at how -- will
23 it cover those of us who, since that
event, have already
24 been extremely involved in this so that we
don't have to
17
1 reinvent the
wheel and yet take another four-hour class
2 when we've been teaching classes?
3 MR. LEGARZA: This requires four hours of AMA
4 Category 1 CMEs. I looked on the Internet and found one
5 class that was
given.
6 DR. TITUS: One of the issues is the AMA -- I
7 mean, the whole
CME products aren't really geared towards
8 acts of terrorism at this point. It's been done through
9 the federal government, the Homeland
Security Act, our
10 local fire departments, and so the
physicians of us who
11 are on the front line have already been
thoroughly
12 involved in it, but yet have not received
any Category 1
13 CME for it. It's been something we've done because it's
14 the right thing to do.
15 The federal government has
given grants for
16 it already, the Homeland Security Act, and
it's not
17 through the CME
programs. Typically, in my mind,
the CME
18 programs, the companies are out there to
make money off
19 of physicians and charge incredible fees
for four hours,
20 and something like this, with all due
respect, the
21 intention is
good, but once again, it falls a little bit
22 flat of what I think it's intended to do.
23 We as physicians need to be
responsible
24 and -- but it's not going to come through
the CME program
18
1 where you sit down and have to pay big bucks
for it, and,
2 you know, I'm just feeling like it's
missing the mark a
3 little bit.
4 MR. LEGARZA: One, you've got to get four
5 hours.
Nobody has any choice; they've got to get them.
6 Two, if you can't get a Category 1 CME,
then we need to
7 put some other language in here that --
8 DR. TITUS: That's what I'm looking at.
9 MR. LEGARZA: You're not going to get out of
10 getting the four
hours. If you're licensed in this
11 state, you're going to have to get your
four hours
12 between now and
October.
13 DR. TITUS: What about those of us that
have
14 already got the four hours?
15 MR. CLARK: You may be able to petition the
16 Board to accept the courses that you've
taken by
17 furnishing some kind of a proof of what
the course was.
18 DR. TITUS: That's what I'm saying. Can we
19 modify this a little bit, because this is
going to be
20 hard to find that CME
Category 1.
21 MR. LEGARZA: You're going to have to have
22 some minimum qualifications for what the
people are
23 learning.
24 DR. TITUS: Right, I agree with that, but I
19
1 think if there's some wording that you could
-- to send
2 in, you know, a petition for acceptance of
programs that
3 have been, you know, recommended by the
federal
4 government or the Homeland Security or sponsored
by some
5 industry that's
regulated, I think we need to look at --
6 DR. BAEPLER: There's going to be a lot of
7 that.
8 DR. TITUS: Like No. 4, can we add to this?
9 Can we put a modification that you're
available to
10 petition or --
11 MR. LESSLY: You can't modify it. It's a
12 statutory requirement
that it has to include those
13 things.
14 MR. LEGARZA: We can modify the language of
15 this regulation. We can't -- everybody has to have it
16 within the times that are set out,
although -- has to
17 have it -- if you've been licensed after
October the 1st,
18 you have to get it within two years of
initial licensure,
19 and everyone else has to get it by
20 and it has to be four hours, and it has to
be in these
21 certain things that
are in three. That is in the
22 statute.
23 What are the qualifications
for this, who can
24 teach it, who says this is a good course,
that's a bad
20
1 course, this is a nothing course, this is
a great course,
2 whether it's AMA Category 1 or whatever it
is, I suppose
3 we would have to come up with some kind of a criteria.
4 DR. TITUS: I think so if you're already
5 saying there's only one course available.
6 MR. LEGARZA: All I'm saying is that's all
7 that I found.
8 DR. HUG-ENGLISH: I think this is a new --
9 just as we've seen a lot of federal
government things
10 coming out, this is new, and I think that
over the next,
11 probably, year you're going to see some
courses coming
12 out and that they will be available. I think that it is
13 a new requirement. I don't think we have much of an
14 option.
15 I think your comments, Robin,
are very
16
appropriate, but I don't think there's any way that you
17 can say -- and I, too, have been involved
in things with
18 the community and with the university with
antiterrorism
19 education, but
I think that to -- if we get too
20 nonspecific with it, it's going to be --
the board office
21 is going to be inundated with everybody
sending in
22 various things to petition to be
different, and I think
23 we need to be careful that we don't
overload from that
24 end of it, too.
21
1 I suspect that we'll see the
same kind of
2 thing as when the ethics requirement went
forward, and
3 that is that there will be a lot of
courses developed.
4 MR. CLARK: One thing you might consider
5 doing is looking at the course syllabus of
the courses
6 that you have taken and compare them to
the requirements
7 of the statute A through E, and I bet
you'll find that
8 all of those subjects are covered. You should then
9 submit the syllabus to the Board with the
request that
10 this be considered as equivalent to this
four hours of
11 training, and you certify, I took this
training, here's
12 the training I got, these are the subjects
I covered,
13 will you please consider this as meeting
the requirement.
14 MR. LEGARZA: Another thing, we're going to
15 have public hearings on this. We're going to have a
16 public hearing in
17 hearing in
18 people that may be attending those things
as to how to
19 define or get some definition or who does
the approval or
20 how you do the approval, whether it's AMA
Category 1 or
21 something else again.
22 DR. BAEPLER: Can we defer this until after
23 the public hearings?
24 MR. LEGARZA: There's nothing magic about the
22
1 language until, one, after the LCB takes a
look at it
2 and, two, until you have your hearings,
and then I come
3 back to you and say, this is the input,
this is the
4 input, and these are the recommendations
based upon the
5 input that we have, and it may -- it may
change. I mean,
6 you may change your minds between now and
then. You're
7 not going to adopt it until December at
the earliest, so
8 who knows what's going to happen in the
next three months
9 with regard to your
knowledge. Maybe even more --
10 MR. LESSLY: All you're doing here today is
11 telling Dick to go to
hearing on this.
12 MR. LEGARZA: You're just approving me to go
13 to public hearings and workshops, and then
I have to come
14 back to you to either adopt them or not
adopt them in
15 December.
16 DR. BAEPLER: There's one point here I think
17 we need to nail down.
18 Your reading of the language
of the statute
19 is that we would have the authority to
give an
20 equivalency of rather
than CMEs?
21 MR. CLARK: Yes, I believe that's true.
22 DR. BAEPLER: That opens up a lot of options.
23 DR. LUBRITZ: May I make a motion?
24 MR. GARCIA: Mike Garcia down in
23
1 Just as an FYI, the Clark County Health
Department put on
2 a six-hour training program on this very
subject at
3
4 and received nursing CEUs. I'm not sure if there were
5 CMEs, but the
program was actually titled "For
6 Physicians," so you might want to
check with the health
7 department.
8 DR. HUG-ENGLISH: That's a good suggestion.
9 Thank you, Mike.
10 And I do think there will be
others that are
11 going to come along, you know, very
shortly. I think
12 that, you know, we're seeing more in the
communities, and
13 I think the communities have really come
first with this
14
and have responded first in providing training, and so I
15 think at this point what we need, Dick, is
just a motion
16 to approve that you send these out for
workshops or
17 hearings to get
feedback on these.
18 DR. LUBRITZ: Motion.
19 MS. KIRCH: Second.
20 DR. HUG-ENGLISH: There's a motion and a
21 second to send the proposed revisions to
the NAC 630 out
22 for workshops. All in favor?
23 (Ayes.)
24 Opposed?
24
1 Chair votes in favor as
well. The motion
2 carries.
3 So we will bring this agenda
item back up in
4 December, and hopefully we'll have
feedback from those
5 hearings. Have you set dates for those yet?
6 MR. LEGARZA: Not yet.
I left it blank
7 because I've got to check with the
Legislative Counsel
8 Bureau as to how long they're going to
have to need them
9 to look at them, and then I will check
with the LCB in
10
11 accommodating with respect to that, but it
will be in
12 plenty of time before the next board
meeting, and I will
13 notice it for the hearing of the Board at
the December
14 meeting, which I guess will be here. I don't know.
15 DR. HUG-ENGLISH: Okay.
Thank you.
16 We'll move on, then, to Agenda
Item No. 6,
17 which is consideration of the request by
Washoe Medical
18 Center for approval of Practitioner of
Respiratory Care
19 training programs.
20 MR. LESSLY: At present I'd recommend you
21 simply take Agenda Item 6 and 7. Staff has reviewed this
22 and we recommend approval of those
programs.
23 DR. HUG-ENGLISH: We have a recommendation by
24 staff to approve the program. Is there a motion?
25
1 DR. TITUS: So moved.
2 DR. LUBRITZ: Second.
3 DR. HUG-ENGLISH: There's a motion and a
4 second.
All in favor of approval?
5 (Ayes.)
6 Opposed?
7 The chair votes in favor, and
the
8 Practitioner of Respiratory Care training
program is
9 approved.
10 MR. LESSLY: Same recommendation on No. 7.
11 DR. HUG-ENGLISH: This is a recommendation by
12
13 Practitioner of Respiratory Care training
program.
14 Is there a motion to approve?
15 DR. TITUS: So moved.
16 MS. KIRCH: Second.
17 DR. HUG-ENGLISH: All in favor?
18 (Ayes.)
19 The chair votes in favor as
well, and the
20 motion carries,
so that program has been approved as
21 well.
22 Agenda Item No. 8 is
discussion of standards
23 for Licensure By
Endorsement.
24 Now, this is another
legislative change that
26
1 was just -- just occurred in our last
legislative
2 session. I'm going to have Dick kind of go over that
for
3 us, and then we need to have a discussion
about it.
4 DR. BAEPLER: Can I interject one thing? I
5 got this item confused with 5 when I spoke
about license
6 portability and
standards and so on. I thought we
were
7 considering this one, so those remarks
that I made
8 reference to 5
really relate to 8.
9 MR. LESSLY: Let me make a comment before
10 Dick
starts in on that issue.
11 I have with me Lynette Krotke, who, as you
12 all know, is the chief of the Licensing
Division. This
13 licensure by endorsement legislation has
made a
14 significant impact on the
workload. I would tell you
15 that if you think having a meeting on
Thursday and Friday
16 is bad, considering December, it might
have to be
17 Wednesday, Thursday and Friday because we
already have 47
18 full board applicants to be heard and
seen, and we're
19 about 45 days away
from even closing out that agenda.
20 Of those, about 20 are
applications for
21 licensure by endorsement, so when Dick
gets into this
22 discussion
about licensure by endorsement, you need to
23 have Lynette tell you the nature of the
kind of
24 applicants you are going to be seeing in
December.
27
1 DR. HUG-ENGLISH: I think everybody got
2 Dick's memo passed out separate here, and
the first page
3 of that really goes through what the
legislation -- it
4
was under SB332, and it really allows a lot of leeway for
5 the Board and a lot of discretion in
licensing, and I
6 think that it also sets up some confusion
as to what the
7 requirements are for licensure, and I
think those are
8 some of the issues that Dick wants to
address with us.
9 Do you want to start?
10 MR. LEGARZA: Well, yeah.
11 The legislation, in my
opinion, is bad
12 legislation. We were given little, if any, opportunity
13 to comment on the proposed legislation in
the last
14 session. The licensure by endorsement thing basically
15 says you don't have to have any minimum
qualifications to
16 be licensed and/or you can require
whatever you want to
17 of anyone to give them a license, which I
guess the net
18 result of that, at least in my opinion, is
that the whole
19 thing seems
rather ridiculous.
20 It's
discretionary, totally discretionary.
21 The legislation says you may issue a
license, and my
22 question is -- and the memorandum, really,
the tone of
23 the memorandum is, why would you want
to? My
24 recommendation
is that you never issue a license by
28
1 endorsement. You don't have to; I don't think that you
2 should.
3 If you're going to be wanting
to change your
4 minimum qualifications for licensure, then
that's what
5 you should do. By issuing a license by endorsement, you
6 are admitting, I guess, that some of your
minimum
7 qualifications may or should not be
applicable, should
8 not be something that should be required
of licensees.
9 Once you start issuing licenses by
endorsement, you're
10 establishing
precedence. Are you going to
waive two
11 months of the thirty-six months'
progressive postgraduate
12 this month, three
months next month, a year? Are
you
13 going to waive not taking specs? What are you going to
14 waive with regard to the minimum
qualifications, and once
15 you set that, are
those then not your possible minimum
16 qualifications?
17 I don't think you should go
there. I think
18 it's bad.
If you go there, I think you would be causing
19 yourselves multitude of problems, and you
don't have to
20 go there.
I mean .332 also set up a whole bunch of other
21 things that gave the Board the ability to
license state
22 health officers, people working for the
State of
23 administrative
physicians, a whole bunch of things.
Now
24
the Governor has the ability to declare an emergency
29
1 situation.
2 Licensure by endorsement, bad
legislation. I
3 don't think you should go there. I know that you have a
4 lot of comments
about, well, I don't want to take specs,
5 specs isn't
applicable to me. Maybe -- you know,
going
6 out and talking about regulations, maybe
you change that,
7 if that's what you want to do. Maybe, okay, Doctor, you
8 don't want to take specs, then take a peer review.
But
9 your minimum qualifications are set up
both in law and in
10 regulations. If you want to change those or modify
11 those, do that, but my advice to you as
your general
12 counsel is
don't go here.
13 MR. LESSLY: And my advice to you as your
14 special counsel
is the same as his.
15 DR. HUG-ENGLISH: And I need to play devil's
16 advocate a
little bit, and I need to give you a little
17 bit of background about what happened in
this legislative
18 session with
this particular issue, and this, I believe,
19 has come from the Governor's office, and
part of it has
20 to do with the fact
that, if you remember, there have
21 been a couple of occasions wherein -- the
State Health
22 Officer issue was one in which some of our
requirements
23 precluded this person from accepting that
position.
24 I think that there are a few
occasions where
30
1 this might be applicable, and, for
example, I think that
2 one of the criticisms has been that
3 doors to a lot of very qualified
physicians who have
4 board certification in their specialty, who have
5 practiced in another state full-time for a
number of
6 years, who have been active in their specialty
7 affiliation groups, maybe have been
leaders on national
8
boards in their specialties and so forth, but to come
9 into
10 years, that they
have to take specs. Many of them don't
11 want to take specs, and so it precludes
them from coming.
12 I think we've had the
discussion about the
13 value of specs, but if you have a
specialist in ENT or
14 gastroenterology who's
been practicing for 15 or 20 years
15
in that particular specialty, to ask them to go back and
16 take specs -- and I think in repeated
appearances by
17 physicians, when we've asked them how long
it takes them
18 to study and review for specs, the answer
has been at
19 least two months, and I think we have to
ask ourselves,
20 is that really valuable enough to preclude
someone who
21 may be a leader in their field.
22 And I know for a fact, because
I've had phone
23 calls about a couple of these that will
come before us in
24 December, that we
have a few of those situations that are
31
1 asking for licensure by
endorsement. These are not
2 people that have not
met the criteria in other ways.
The
3 specs exam seems to be the holdup, and I
think that, too,
4 we need to be a little careful as the Board
here to shut
5 the door on this because I think that this
was a
6 compromise in the Legislature, to say that
there was a
7 move at one point -- we were very
concerned that the
8 Legislature might mandate we decrease our
requirements
9 altogether and eliminate, for example, the
three-year
10 training requirement or some of the other
things we have
11 in place. We were able to protect this, and in my mind,
12 to have this license by endorsement seems
sort of a
13 minimum of compromise. It does not say we have to do it.
14 It says that we can look at it and we can
have someone
15 appear before us and take their specific
situation into
16 account.
17 I agree with Dick's comments
that it opens
18 the door to a lot of people that I think
we would likely
19 say no to that don't meet criteria in
other ways, but
20 there are things that I think we could
require, and this
21 legislation
says we can require anything of that
22 applicant in
addition if they have not met -- say they
23 haven't taken specs. We could ask them and say, well,
24 you know, if you want licensure by
endorsement, you have
32
1 a choice; you can take specs or we can
submit you to a
2 peer review in your specialty, and maybe
that's an
3 adequate way to
assess for us that they're qualified.
4 MR. LESSLY: You can do that by simply
5 changing the reg,
and that's Dick's point. You change
6 the reg that
requires the specs exam to be a spec exams
7 or a peer review exam approved by this
Board, and you
8 never get to the issue of licensure by
endorsement.
9 That does seem to be -- you're
right, that
10 does seem to be
the hangup.
People don't want to take
11 specs. Specs has become
expensive. It's $800 now to
12 take the specs exam. It's going to cost more than that
13 for a doctor to come out here and have a
peer review at
14 his own expense,
though.
15 MR. LEGARZA: If the concern is specs, it is
16 a regulation. You can change the regulation. You can
17 change the regulation to require specs or
a peer review.
18 You can do that. That solves the problem that you're
19 talking about, Doctor.
20 DR. MONTOYA: Dick, that doesn't solve the
21 problem. We're married to this legislation. This is law
22 now.
23 MR. LEGARZA: No, we are not married to that
24 legislation. It is totally discretionary. It is whether
33
1 or not you want to do it.
2 DR. MONTOYA: It is on the books. It is
3 discretionary. We are going to have the discretion
4 whether we want to use this or not. We can change our
5 regulations and we can get around using it
another way,
6 but this is still going to be there.
7 MR. LEGARZA: Absolutely, absolutely, and my
8 advice is don't.
9 DR. MONTOYA: We can take that, but nothing
10 is materially
going to change what we do today. This
is
11 here.
12 MR. LEGARZA: But the concern that Cheryl's
13 addressing is -- and we hear it all the
time -- I don't
14 want to take specs, I'm a radiologist, I'm a pathologist,
15 I don't want to -- I'm good in my field, da-da-da-da-da.
16 Fine.
If you change the regulation and say, you can take
17 specs or you can take a peer review, then you're around
18 that; you're not giving up your 36 months'
progressive
19 postgraduate education,
you're not giving up anything.
20 Under the license by
endorsement, you can
21 give a license -- in my opinion, a DO and
an HMD can
22 apply for a license as an MD in the state
of
23 the license by endorsement.
24 DR. MONTOYA: We still can because the
34
1 legislation is
there. There's nothing this Board can
do.
2 We can change a regulation and make it easier
for us to
3 give them the license by peer review, a
regular license
4 by peer review or by
specs.
5 MR. LEGARZA: Correct.
6 DR. MONTOYA: We can go change the
7
legislation, but everything else, we are married to this.
8 We don't have to use it.
9 MR. LEGARZA: We're not married to it.
10 DR. ANJUM: We can't ignore it completely.
11 MS. KIRCH: I don't think we can ignore it,
12 so anyone that wants to apply for a
license could apply
13 under statute
whatever, and we're going to have to look
14 at it.
15 MR. LESSLY: And we are sending out
16 applications by the
dozens. Let Lynette tell you
17 something about what kind of applicants
you've got as a
18 result of this legislation.
19 MS. KROTKE: Well, Larry's right. The
20 applications are flying out the door at
this point, and
21 they're also coming right back.
22 Some of the things we're
looking at I'll just
23 briefly go over. Some of the things you're going to see
24 in December. We have a 61-year-old physician applying
35
1 for licensure by
endorsement. He has one year of
2 postgraduate education that cannot be
verified due to the
3 closure of his school, and he has two malpractice
4 settlements.
5 We have a 70-year-old applying
for licensure
6 by endorsement. He has taken and failed specs four
7 times. He has five years' postgraduate education,
but
8 three of the five cannot be verified. He has not
9 practiced since 9 of 2000, and he's in a
hurry to get a
10 license.
11 These are just all kinds of --
12 DR. BAEPLER: We could reject those
13 applications.
14 MS. KROTKE: You can, but you've also got
15
qualified people in here, too.
16 You know, we've got a
55-year-old
17 board-certified
urologist who was board certified in
18 1980, he's got an awesome education. He was sued for
19 malpractice, but he doesn't want to take
specs, so
20 that's --
21 DR. ANJUM: It's our selection to select
22 those or reject those.
23 MS. KROTKE: We have a 70-year-old physician
24 whose licensed in
36
1
2 gastroenterology -- in gastro, and he doesn't
want to
3 take specs.
4 We have a 54-year-old pain
management person
5 who's licensed in
6 affirmative answers on his
application. He's addicted to
7 Fentanyl. He had a board action in
8 away his license. He went in and out of treatment, and
9 he was given his license back in
10 manage people with drug problems. Okay.
11 A 50-year-old board-certified
in internal
12 medicine in '86, went to school in
13 Domingo, has three malpractice cases,
12,000, 60,000 and
14
110,000, and two pending malpractice cases, and a
15 Board letter of caution.
16 These are all things that are
coming at you.
17 DR. BAEPLER: I don't connect it up with our
18 problem, because since this is
discretionary, I would
19 assume that there isn't a single example
that you've
20 cited that we would grant a license to.
21 MS. KROTKE: Right, but I'm just saying, you
22 know, the amount of people that are
applying right now,
23 this is what we're getting.
24 MR. LESSLY: And the number of appearances
37
1
you're going to have.
2 DR. ANJUM: It will raise our workload,
3 that's very well accepted, but we can't
shut this motion
4 of legislation --
5 MR. LEGARZA: If the word gets out that
6 you're not granting these licenses,
they'll slow down.
7 DR. ANJUM: If we don't follow this, they may
8 make it mandatory next time. The Governor is after it
9 and
the Legislature is after it.
10 UNIDENTIFIED SPEAKER: We cannot hear.
11 DR. ANJUM: If we don't adopt this and follow
12 this, the Legislature may make it
mandatory next time,
13
which is not mandatory this time, so we can't totally
14 ignore it and --
15 MR. LESSLY: I think you let the Legislature
16 make it mandatory and take the heat for
it.
17 DR. ANJUM: I think it's our job -- anybody
18 who applies for a license, we have to look
at the
19 application anyway. Whether they are a good physician, a
20 bad physician,
that's our job to review, and it will just
21 increase our workload. That's what you're doing, you
22 know.
23 DR. LUBRITZ: I agree with Steve totally. I
24 think we're married to it, and if we're
not married to it
38
1 today, in two years we may be more married
to it if it's
2 not there. They've given us a perfect example of what
3 occurs at times of -- when things are
legislated because
4 they would rather mandate it, and this,
I'm going to
5 assume, was mandated, but they gave us a
wonderful
6 option, and that is the word
"may."
7 So if anyone applies for a license,
do we not
8 send them an application? So there's no difference
9 between what's happening now except we're
getting more.
10 We'll find a way, I think, of being able
to screen the
11 ones that we see because we may set up
some criteria
12 under the mays.
"May" gives us a wonderful opportunity.
13 It's going to increase everyone's
workload, but I would
14 really hate next Legislature for them to
say, aha, this
15 is exactly what we were talking about, so,
therefore, now
16 there's no may, it's must. So I see it as a reasonably
17 good thing to
have, given that we have a mandate.
18 DR. TITUS: Can you clarify for me, in the
19 past, if somebody wanted an application
that was not
20 qualified, you did not have to send them
one; is that not
21 correct?
22 MS. KROTKE: We did not send an application.
23 DR. TITUS: The bottom line for us is now you
24 are going to -- you're having requests for
applications.
39
1 In the past you could use your discretion
if they did not
2 meet the criteria and not send them an
application.
3 So what we're looking at --
the only thing
4 we're looking at here is an increase in
our workload
5 because we are forced now to look at these
applicants,
6 and we can do as we choose, and we would
hope that we
7 have enough knowledge, the people on this
Board, to bring
8 enough insight into this and we are not
going to award
9 people who are otherwise a danger to the
citizens of
10
11 We would hope that we would
look at these on
12 an individual case, but it will increase
our load, as
13 Dick was saying. We may have to meet for three days now
14 because we're going to be forced to look
at these
15 applications, and that's the bottom line.
16 DR. ANJUM: How many states do accept
17 licenses by
endorsement?
18 MR. LESSLY: Some do.
19 DR. HUG-ENGLISH: Actually, Tony gave me a
20 list of all, and I think I brought it with
me. There are
21 a lot of states that do specific, oh,
professorship
22 license or different licenses that may not
meet their
23 absolute criteria.
24 I think this is the bottom
line with this,
40
1 and I really agree with all of your
comments, that this
2 is legislation, and it does say, "may," it does not say,
3 "must." It gives this Board the discretion, and I
really
4 trust the judgment of this Board. I think that it does
5 mean that we're going to have to review
more
6 applications, but my guess is that that
probably will
7
happen maybe the first couple of meetings, and
that then,
8 when people figure out that, you know,
there's some basic
9 standards here, that
we're not just going to grant
10 anybody a license just
because, that that will fall off.
11 I don't think that we're going
to get 50, you
12 know, applications each meeting. I think, Lynette, you
13 said right now we have 19 that would be
licensures by
14
endorsement for December, but I think it's sort of a
15 similar thing that we saw with the respiratory
16 therapists. Initially it was a lot of workload for a
17 couple of meetings, and now that's kind of
balanced out.
18 I think that probably we will
do very few of
19 these, and I think Dick's comments about
the fact that we
20 need to consider and be consistent in our
own standards
21 of
what we do grant licensure by endorsement for is very
22 valid, but I think there are a select few
circumstances
23 where we might use this, and I think that
it gives us an
24 opportunity to
use our judgment and our discretion in
41
1 those very few situations where I think it
makes sense.
2 DR. MONTOYA: At the same time, we can still
3 revisit that regulation with peer review.
4 MR. LESSLY: Now is the time to tell Dick to
5 add that to the hearing, and I gather what
we're talking
6 about here is you will take the specs exam
or you will
7 pass a peer review in your specialty.
8 DR. BAEPLER: Or an alternative that the
9 Board would recommend.
10 DR. LUBRITZ: See, I don't want to limit it
11 to -- I would prefer not to limit it to
those two
12 alternatives because we have a host of
others that we
13 haven't even explored at this point, so I
would hate to
14 limit it to two. I would like to put "or another
15 alternative
appropriate with the Board."
16 MR. LESSLY: Why don't you just do the reg
17 and either take the specs exam or another
approved
18 examination approved
by the Board, period.
19 DR. HUG-ENGLISH: And understand we're
20 talking about two separate issues here,
because if we're
21 changing that regulation, that's changing
the requirement
22 for a regular license,
not licensure by endorsement.
23 MR. LESSLY: Which will impact on this
24 endorsement problem.
42
1 DR. HUG-ENGLISH: But it will make a
2 difference, I think, in the number that we
will get
3 applying for licensure by endorsement if
there's another
4 option in addition to specs that they
could take, and
5 they would then prefer to just get a
regular license
6 because it also is much
easier on them. Understand that
7 it slows their process down for getting a
license to do
8 this because it means they have to appear
before the
9 Board, and then we have to make a
decision, and then it's
10 going to take another
month or so. So it slows them
down
11 as well, so I think if we have that other
option for our
12 regular license, to say specs or another
exam as approved
13 by the Board, that
might limit the numbers we get.
14 DR. LUBRITZ: I would hate to even add
15 another exam because that's also limiting
what we can do,
16 or other
determinations.
17 DR. BAEPLER: Other alternatives.
18 DR. LUBRITZ: Other alternatives suggested or
19 demanded by the Board. That leaves you wide open. It
20 does not limit
you at all. I'm afraid of limiting us to
21 one or two or three
things.
22 DR. BAEPLER: Let me give you one example
23 here. If we ever get to the competency proficiency
24 recommendations -- and I think we're going
to increase
43
1 that to about nine options from the old
five -- one of
2 them was that if you're board certified
and not
3 grandfathered and you get recertified, we
can take a look
4 at your board specialties; they're
increasing regularly
5 with these board recertification exams and
often
6 involving now peer reviews and so on. We might consider
7 that to be a perfect
alternative to the specs.
8 I think a more important
question is, let's
9 take that health officer, for
example. I forget what the
10 exact deficiency was, why he could not get
a license, but
11 from a legal perspective, if you have a
person that you
12 grant a license by exception, and then at
the next board
13 meeting or one after you have another one
that is in the
14 identical circumstances by virtue of their background, do
15 you feel legally comfortable granting one
the license and
16 not the other?
17 MR. LEGARZA: Absolutely not.
18 MR. LESSLY: The issue here is what Don has
19 just said, proof
of competency. That's why you have the
20 specs exam
administered on initial licensure.
So if you
21 write the reg
and draft the reg to say you take the specs
22 exam or provide other proof of competency
acceptable to
23 the Board, you've covered the issue.
24 DR. BAEPLER: I don't think we'd allow many
44
1
in, but every time we did allow someone in, we'd be
2 essentially saying anybody else that is in
this same
3 circumstance is
going to be permitted in.
4 DR. LUBRITZ: Could you say that again?
5 MR. LESSLY: You either take the specs exam
6 or you provide such other proof of
competency acceptable
7 to the Board.
8 DR. BAEPLER: That's not a bad thing,
9
though, because if we base these things as an uncommon
10 exception and for valid reasons, we
probably ought to
11 grant a license to the next person under
identical
12 circumstances.
13 DR. LUBRITZ: That would, I assume, take in
14 those new types of examinations that will
be coming up,
15 be it specs or
whatever else may come up in the way of
16 modules or --
17 MR. LESSLY:
It's unfortunate that the
18 modules have not been fully developed by
the federation
19 to cover the specialties, but you could
use that when
20 they came.
21 DR. LUBRITZ: So --
22 MR. LESSLY: I would think if you drafted it
23 that way, you could do anything you want
to.
24 DR. LUBRITZ: Say it exactly as you want
45
1 to --
2 MR. LESSLY: Pass the specs exam or provide
3 such other proof of competency as
acceptable to the
4 Board.
5 DR. ANWAR: That sounds good.
6 DR. ANJUM: It's exactly what we would do
7 anyway.
8 DR. HUG-ENGLISH: So I think we need to, if
9 that's the feeling of the Board, maybe
instruct Dick to
10 include that in the last agenda item that
we approve to
11 take to hearings on proposed changes in
regulations.
12 Is everybody okay with
that? We need a
13 motion.
14 DR. BAEPLER: I would so move.
15 DR. LUBRITZ: Second.
16 DR. HUG-ENGLISH: There is a motion, then, to
17 include and, again, to modify the
regulation of taking
18 specs or --
19 MR. LESSLY: By proof of competency as
20 acceptable to the
Board.
21 DR. HUG-ENGLISH: As acceptable by the Board.
22 DR. LUBRITZ: That's reasonable.
23 MR. LESSLY: Look at it on a case-by-case
24 basis in that
situation.
46
1 DR. HUG-ENGLISH: All in favor?
2 (Ayes.)
3 Opposed?
4 DR. LUBRITZ: You know what? Would it be a
5 good idea to add, "and will be looked
at on a
6 case-by-case
basis"? Is that acceptable,
unacceptable?
7 MR. LESSLY: There's the drafter.
8 DR. HUG-ENGLISH: We'll work on that
9 language.
10 The motion carries, and so
we'll have
11 feedback on
that as well in December.
12 MR. LESSLY: There's one other matter under
13 No. 8, application fees for licensure by
endorsement and
14 administrative physician license fees need
to be set.
15 I would recommend that you leave
the
16 application fee for administrative
physician license at
17 $400. I recommend that you increase the application
fee
18 for licensure by
endorsement from 400 to $600.
This
19 takes a tremendous
amount of additional time to process
20 those applications, and every last one of
them is a full
21 board appearance.
22 DR. LUBRITZ: Eight hundred.
23 MR. LESSLY: Six hundred is sufficient.
24 DR. HUG-ENGLISH: I think it's reasonable.
47
1 In talking to Lynette and learning what
they really are
2 having to do, you know, with her staffing,
really
3 verifying credentials, and it's a lot more
work than just
4 the routine application, so I think that
additional $200
5 is reasonable.
6 MS. KIRCH: I so move.
7 DR. BAEPLER: Second.
8 DR. HUG-ENGLISH: Motion and second to raise
9 the cost of licensure by endorsement from
400 to $600
10 biennium. All in favor?
11 (Ayes.)
12 Opposed?
13 The chair votes in favor and
the motion
14 carries.
15 MR. LESSLY: And set the fee for the
16 administrative license
at 400. That was in the motion.
17 DR. HUG-ENGLISH: That was in the motion.
18 We're going to skip Agenda
Item No. 9 for now
19 and go on to Agenda Item No. 10, our
reports, and the
20 first up on that is our diversion program,
and we have
21 Carol Bowers here to
tell us about that.
22 MS. BOWERS: Since the last board meeting in
23 May, we've added two new physicians to the
program. One
24 is still in treatment at
48
1
2 contract, and we had another respiratory
therapist pass
3 away from chronic severe (inaudible) --
4 UNIDENTIFIED SPEAKER: Excuse me.
We can't
5 hear the speaker.
6 DR. HUG-ENGLISH: Thank you.
7 MS. BOWERS: Can you hear me now?
8 DR. HUG-ENGLISH: Go ahead and start over,
9 Carol.
10 MS. BOWERS: Since the last board meeting in
11 May, we've added two new physicians. One remains in
12 recovery at
Talbot Recovery in
13 participants complete their monitoring
contract, and we
14 had another respiratory therapist pass
away from severe
15 liver damage due to his disease.
16 So that makes two deaths of
respiratory
17 therapists who were in the diversion
program, and it
18 really made an impact on the group of
respiratory
19 therapists that I deal with because they
were -- one was
20 pretty sudden death, and the other one,
every week we
21 watched him slowly die. So that little group of
22 respiratory therapists is
doing very well. They're very
23 committed to their recovery, and I enjoy
doing work with
24 them.
49
1 The foundation continues to
give
2 presentations to various
hospitals. Dr. Belcourt is
3 presenting at Saint Mary's in September,
Dr. Ruekel at
4
5 disruptive physician. I will be speaking at Mountain
6 View in October.
7 I'm very grateful that the
medical board
8 increased our funding because we did not
receive any
9 money this year from
the hospital association. I did
10 call Alan Stipes, and I found out there was a severe car
11 accident and several of the hospital
association people
12 were badly injured and one was killed, so
Alan's going to
13 check on the funding to see if the hospitals
have
14 continued to do that, and I'm going to
call some of the
15 ones that have donated in the past and see
if they care
16 to donate again.
17 I think I said the last time
that we put a
18 new point system in for monitoring our
participants, and
19 everything that they did gave them certain
points, and
20 they needed 500 points in order to
complete their
21 contract. It actually is going very well. I've had very
22 few complaints, which is surprising from
physicians who
23 now are required to do even more work than
they were
24 before, but they seem actually pleased to
have a more
50
1 subjective way to monitor them as opposed
to -- I mean,
2 an objective way as
opposed to subjective.
3 One thing that has surprised
me tremendously,
4 last time I changed the format of what I
wrote in the
5 newsletter, and I put in -- I had a
physician write a
6 personal story, and the first time I did
that, I got a
7 thousand dollars
donation as a result of that one story.
8 So this last time I did another story,
personal story. I
9 have received -- yesterday was the fifth
referral as a
10 direct result of that newsletter because
they said it was
11 so -- made it feel so real and so
personal, and I know a
12 doctor that needs your help, and I got
calls from two
13 wives who read this who were so grateful
to have
14 something so
meaningful in the newsletter.
15 I mean, I have been blown away
by that, so I
16 think changing that format has in fact
made this more
17 real, at least to some
people. I mean, I can lecture on
18 addiction from now until the cows come
home, but when you
19 read something and it's actually happened
to a person and
20 actually happened to a physician in the
state, it makes
21 it more real, so I'm
very pleased with that part of it.
22 The foundation continues to
make progress via
23 serving the needs of the physician in the
state of
24
51
1 being in this position,
and the finances seem to be in
2 order.
I don't have any problems. We
have usually 45 to
3 $50,000 in the checkbook, which is a
miracle compared to
4 what it was a few years
ago.
5 So any questions, I will try
and answer them.
6 DR. HUG-ENGLISH: Does anybody have any
7 questions for Carol?
8 Well, thank you for that report,
and it
9 sounds like things are going well.
10 MS. BOWERS: Thank you.
11 MR. LEGARZA: I have one comment, if I may.
12 Every time I call Carol when I
think there's
13 a problem, she's on top of it, she takes
care of it, and
14 if it isn't taken care of in a manner that
she believes
15 or we believe or the investigative
committee believes it
16 should be taken care of,
it is taken care of in the long
17 run, and she doesn't ignore us at all, and
when we have a
18 problem we tell
her about it, and she's right on.
19 MS. BOWERS: Thank you.
20 DR. HUG-ENGLISH: I would agree with that. I
21 think you're doing a great job, and we all
appreciate the
22 effort and the
hard work you do. So thank you.
23 MS. BOWERS: Thank you very much.
24 DR. HUG-ENGLISH: John, why don't you come up
52
1 and give us the Physician Assistant
Advisory Committee
2 report.
3 MR. LANZILLOTTA: First of all, excuse me,
4 I've got laryngitis. I'd like to commend Carol on that.
5 That was a great article, and working in
the field now,
6 it's just amazing the work that she's
doing.
7 The Board received the
resignation of Brian
8 Loff. He was appointed by the Board in March of
2002,
9 and as a replacement I would like the
Board to consider
10 the nomination of
Daniel Hickey. Dan has been a PA
in
11
12 He is a retired officer in the Air Force
where he served
13 in critical management
and administrative physicians.
14 A longstanding member of the
15 for 20 years, he's done a lot to advance
and guide our
16 profession in
the state. He's served in the
17 Academy as president and past president
and is involved
18 with the
19 national level. He's also a director for the Society of
20 dermatologic PAs.
21 Dan brings years of experience
as a
22 clinician, administrator and leader in the
PA profession,
23 and I appreciate your consideration as a
replacement.
24 I'll have to see Dr. Lubritz
after this.
53
1 DR. HUG-ENGLISH: Thank you, John. You know,
2 we have some water for you in there.
3 Well, that certainly is quite
a CV, and I
4 would open it up for discussion for board
members to
5 consider.
6 DR. MONTOYA: I move for his acceptance.
7 DR. LUBRITZ: Second.
8 DR. MONTOYA: I move for his acceptance as a
9 new member.
10 DR. TITUS: Discussion?
11 DR. HUG-ENGLISH: Yes, discussion.
12 DR. TITUS: Along those same lines, though,
13 it may be needed a separate motion to send
Brian a letter
14 of thanks.
15 DR. HUG-ENGLISH: I think we can do that. I
16 don't think we even need a motion for
that, but I think
17 we can send Brian a thank you for his time
served.
18 MR. LANZILLOTTA: Thank you.
19 DR. HUG-ENGLISH: So there was a motion and a
20 second to approve Daniel Hickey's
appointment to the
21 Physician Assistant Committee. Any further discussion?
22 All in favor?
23 (Ayes.)
24 Opposed?
54
1 Chair votes in favor of the
motion and the
2 motion
carries. Welcome.
3 MR. HICKEY: Thank you very much.
4 DR. HUG-ENGLISH: Do you have any comments
5 you'd like to make?
6 MR. HICKEY: Only that I've been here -- I've
7 been in
8 civilian since 1990. Every contact that I've had with
9 this Board has been absolutely positive in
support of
10 members of my profession. I hope that I can serve the
11 Board as well as my profession as well as
the Board has
12 served it.
13 DR. HUG-ENGLISH: Thank you very much.
14 Okay.
Next we have our Respiratory Care
15 Advisory Committee, and Mike Garcia is in
16 MR. GARCIA: Our committee has no report for
17 this meeting. Thank you.
18 DR. HUG-ENGLISH: That's short and to the
19 point. Thank you, Mike.
20 All right. We now have our investigative
21 committees, and, Dr. Baepler,
why don't you talk first
22 about your committee.
23 DR. BAEPLER: My committee, which consists of
24 Dr. Titus, Dr. Anjum
and myself, met on August 22nd. Of
55
1 the cases that we considered, we closed 52
of them, which
2 would be distributed to you. Of those 52, four of them
3 were based on physicians'
appearances. Several cases we
4 kept open for more information and for
future appearances
5
by physicians, but I recommend that you accept the
6 closure of the
52 listed on this sheet.
7 DR. HUG-ENGLISH: Thank you, Don.
8 And Dr. Lubritz.
9 DR. LUBRITZ:
Our committee consists of Steve
10 Montoya, Marlene Kirch
and myself. We also have a few --
11 we have a few which we have not
closed. We're needing
12 more information. We did close 66, and there are several
13 that we still need information from, so I
just want to
14 thank the members for a lot of hard work
and it was -- I
15 enjoyed working with them.
16 DR. BAEPLER: If I could make one comment.
17 You can tell from the numbers,
creating that
18 second committee was absolutely necessary,
and I'm
19 delighted we moved in that direction.
20 DR. HUG-ENGLISH: Absolutely.
And I again
21 thank you to all the members who served on
both those
22 committees, and
we will circulate the case closures
23 around, and later I will ask for a motion
to approve
24 those, but, again, thank you for all your
work.
56
1 And then, Dr. Baepler, as your other hat, you
2 are secretary/treasurer, so if you want to
give us your
3 report on that.
4 DR. BAEPLER: The first item is the
5 consideration of the board audit for the
fiscal year just
6 ended.
7 I met with the auditors this
morning, three
8 representatives of Solari
& Sturmer, and the audit report
9 is in your
hands. I might point out one significant
10 difference from prior audits. To bring our accounting
11 standards up to the accepted norm today,
we had to figure
12 in the fixed assets, which are nonliquid assets such as
13 furniture and computers and all of that,
and they
14 computed that for fiscal '03, and they
compared fiscal
15
03 with fiscal '02 and by including retroactively fixed
16 nonliquid
assets for both years.
17 The very last page, page 21,
of the audit
18 report gives
you a good comparison between the two fiscal
19 years.
I think the most important thing is that the
20 Audit Committee was very pleased with the
way that we
21 managed fiscal control on the funds. They did not have
22 any recommendations for improvement nor
did they find any
23 fault with the figures and the procedures
that they
24 analyzed, so it was a short meeting. So I'm very pleased
57
1 to recommend to you
that you accept this audit report.
2 MR. LESSLY: And instruct us to file it.
3 DR. BAEPLER: And I would ask also, as part
4 of that motion, that you instruct the
Executive Director
5 to use the established avenues and
mechanisms to bring
6 this to the appropriate
state agencies that we report to.
7 DR. LUBRITZ: So moved.
8 MS. KIRCH: Second.
9 DR. HUG-ENGLISH: There is a motion and a
10 second to approve the audit. All in favor?
11 (Ayes.)
12 Opposed?
13 Chair votes in favor and the motion
carries.
14 DR. BAEPLER: The second item is the approval
15 of the budget for the fiscal year that
started July 1,
16 and I believe this has been distributed to
you. This can
17 be very brief.
18 Let me just point out that on
the balance
19 sheet, which is page 1, you'll note that
the fixed assets
20 are figured in there for the first time
under assets.
21 All of the other assets are liquid or
liquid equivalents
22 in that they're almost instantly
equivalent or
23 convertible to assets, and as usual, by
some coincidence,
24 the assets and the liabilities balance out
to the penny.
58
1 What we need to really address
is page 2,
2 which is the actual
budget itself. The first column
of
3 numbers is the expenditures -- it's almost
irrelevant to
4 the budget -- showing
us where we are. The important
one
5 is the second column, which is the actual
budget, and
6 then the third column shows you where
we're over budget
7 or under budget
relative to receipts.
8 Very simply, remember that we
get the
9 majority of our fees every other year, and
that's the
10 majority of our
revenue, and the fees we collect in that
11 year
carry us for two years, but we show our budgets on a
12 fiscal year basis, so we're always going
to alternate
13 between a fat year, the year that revenues
come in and we
14 show a surplus, and if you look at it just
in that
15 context, that's
when people say, my, you're too fat, you
16 need to reduce fees, but the second year
we always show a
17 huge deficit because we don't collect that
much revenue
18 in the second year.
19 I had one of my budget people
pencil out a
20 biennial budget showing two years of
receipts and two
21 years of anticipated expenses, and it
looks pretty good.
22 However, projecting out this budget for this
coming year,
23 there's absolutely no problem. We have some
24 extraordinary expenses and some duplicate
salaries that
59
1 will
not reoccur, but it assumes a present level of
2 operation, and that's important to
remember when we
3 consider the possibility of opening up an
office in Las
4 Vegas.
This does not accommodate an office in
5 but that's a different agenda item which
we can address
6 when its time comes.
7 I feel comfortable with it,
but it is really
8 and in all probability a little bit short
of meeting our
9 expenses for the next fiscal year, and it
is possible
10 that we would have to reconsider an
increase in fees,
11 although I hope it would not come to
that. There's just
12 too many unknowns. This year we're great.
13 I recommend that you approve
the budget.
14 There's nothing significant or new in this
budget that
15 has not been in previous budgets, and as a
matter of
16 fact, any increases in this budget
are because of
17 personnel items and so forth that you've
already approved
18 as a board.
19 DR. HUG-ENGLISH: Thank you, Dr. Baepler.
20 Any discussion about the budget?
21 MR. GARCIA: Dr. English, I have a question.
22 Mike Garcia. Does the revenue in that budget
23 include projected revenues from
respiratory license
24 renewals that will occur in fiscal '04?
60
1 DR. BAEPLER: It includes all projected
2 license fees that will be collected from
respiratory
3 therapists, MDs, PAs,
based on the historical record of
4 what happens here. Yes, all of that has been projected.
5 MS. GARCIA: And I guess the further question
6 would be, are the respiratories'
specific renewal
7 licensure fees based upon the minimum
value that was set
8 in the bill, counselor?
9 MR. LESSLY: I can answer that. The budget
10 is based upon no
increase. The fees have not been set
11 and will not be set until the December
board meeting, so
12 we are not -- so we will not be
recommending that your
13 fees go up.
14 MS. GARCIA: Thank you, sir. Thank you,
15 Dr. Baepler.
16 DR. TITUS: Could you clarify for me, in this
17 budget under
"Equipment Expense" and "Projected," have we
18 budgeted for equipment so that we could do
our own
19 broadcasting from within our facility?
20 DR. BAEPLER: That kind of ties into the
21 question of the office in
22 answer to that.
23 MR. LESSLY: No.
24 DR. BAEPLER: No, they have not.
61
1 DR. TITUS: I was just looking under the
2 difference in budget under equipment lease
and just
3 wondered if that's been factored in.
4 MR. GARCIA: Excuse me.
We're having a hard
5 time hearing the
speaker.
6 DR. TITUS: I'm just curious about whether or
7
not we've budgeted for the expense of hosting our friends
8 in
9 DR. BAEPLER: The answer is no, but that
10 would have to be done -- if we open an
office in Las
11 Vegas that would accommodate this kind of
a function,
12 that would be an expense related to
opening a new office.
13 MR. LESSLY: When we get to that agenda
14 item -- and Tony has that project --
you'll see we can't
15 come up with a figure until you make that
decision.
16 DR. BAEPLER: This is based on an as-is
17 operation.
18 DR. HUG-ENGLISH: Any further questions? If
19 not, I need a motion to approve the
budget.
20 DR. TITUS: So moved.
21 MS. KIRCH: Second.
22 DR. HUG-ENGLISH: There's a motion and a
23 second to approve the budget for fiscal
year 2003-2004.
24 Any further discussion?
62
1 All in favor?
2 (Ayes.)
3 Opposed?
4 The chair votes in favor and
the motion
5 carries.
6 And, again, thank you, Don.
7 Has everybody has an
opportunity to look at
8 all the investigative committee cases,
both committees
9 have circulated each way? Okay.
We're still going
10 around.
11 I'll let that continue around,
then, and
12 we'll go on to Agenda Item No. 11, and
that is our
13 executive staff reports, and, Larry, do
you want to start
14 those off?
15 MR. LESSLY: Under the consideration of
16 request for staff attendance at
educational meetings, I
17 would point out to you the Citizens
Advocacy Centers
18 meeting on the 13th of November in D.C.,
which is
19 primarily for public members, but for
other members also,
20 I think you all got individual mailings on
that. If you
21 didn't, we have that information. If you want to go, we
22 need to know.
23 Requesting authority to send
Tony Clark to
24
63
1 meeting and the Federation Executive
Management Seminar,
2 and that is when, Tony, in September?
3 MR. CLARK: 14th, 15th, 16th of September.
4 MR. LESSLY: And I'm requesting that you send
5 me to the Medem
meeting on the 9th and 10th of October in
6
7 prescribing and treatment, and I went to
that last year,
8 and I'm on that steering committee, and we
need to send
9
10 on those three.
11 DR. LUBRITZ: So moved.
12 MS. KIRCH: Second.
13 DR. HUG-ENGLISH: There is a motion and a
14 second to approve sending staff to various
educational
15 meetings. Any further discussion?
16 All in favor?
17 (Ayes.)
18 Opposed?
19 Chair votes in favor of the
motion, and the
20 motion carries.
21 MR. LESSLY: And then the Federation is
22 having a board member workshop in
23 of November on
impaired physicians. I would
encourage
24 those of you who wish to go to let us know
so we can get
64
1 you registered for that.
2 DR. LUBRITZ: When is that?
3 MR. LESSLY: That is the 15th of November in
4
5 available for attending
that.
6 DR. TITUS: Is it a repeat of the one they
7 presented last year, which was a very good
one, but we
8 did
attend it, the impaired physician?
9 MR. LESSLY: It's on impaired physicians
10 again. I don't know that it will be the same thing,
but
11 it is on the same topic.
12 DR. LUBRITZ: Would you check on the agenda
13 for us ?
14 DR. TITUS: It's a very good workshop, but if
15 they're going to use that same formula, it
would seem a
16 little bit of duplication.
17 MR. LESSLY: I'll get that for you, and those
18 of you who want
to go, let me know.
19 And those are the only travel
requests I
20 have.
Under the 2003-2005 biennial registration
21 statistics, as of yesterday, the 3rd of
September, we
22 have 4,375 active M.D.s
licensed; we have 897 inactive;
23 we have a total of 255 Physician
Assistants; we have a
24 total of 871 Practitioners of Respiratory
Care; and we
65
1 have a total of
174 limited license resident physicians.
2 DR. BAEPLER: Larry, off the top of your
3 head, does this show an increase or a
decrease from a
4 year ago?
5 MR. LESSLY: A little increase, not much. It
6 shows a pretty significant increase in the
number of
7 Licensed Respiratory Care Practitioners,
but that's as of
8 yesterday, and registration has been
completed, and
9 everyone who was put
out of business has been restored to
10 business, and
Dick handled all of that, so these should
11 be the stable
figures for the balancing of this biennium.
12 Under status of staff
additions and changes,
13 I've told you about Mr. Quinn coming on
Board. Dick has
14 added two people that you met this morning
back in his
15 section. I'm going to, I think, be requesting of the
16 president
between meetings authority to hire another
17 investigator
and another Licensing Specialist. The
18 president has the authority to act
for the Board between
19 meetings in those types of matters, and
I'm not certain
20 I'm there yet, but I'm pretty certain I
will be before we
21 meet in December. So I will be asking Cheryl for
22 authority to
make those hires.
23 I think you've been handed out
a copy of the
24 organizational manual
and job description changes. Is
66
1 that correct, Maureen?
2 MS. LYONS: I didn't hand them out yet.
3 MR. LESSLY: They're coming. Why don't we
4 wait just a moment until you have those in
front of you.
5 DR. HUG-ENGLISH: While we have just a
6 moment, can I
ask for a motion on the investigative
7 committee approval
of the cases closed?
8 DR. TITUS: Motion made on A and B.
9 DR. JONES: Second.
10 DR. HUG-ENGLISH: There's a motion and a
11 second to approve the investigative
committees reports on
12 cases closed. All in favor?
13 (Ayes.)
14 Opposed?
15 Chair votes in favor of the
motion, motion
16 carried.
17 MR. LESSLY: Has everyone seen that? The
18 organizational chart changes reflect the
addition of the
19 Deputy Executive Secretary/Special
Counsel, reflect the
20 addition of a Deputy General Counsel,
remove the
21 Financial Support Assistant under the
Executive
22 Secretary.
That is the replacement for Mr. Frantz.
23 Remember, he was the Financial
Manager. That position
24 now will become a Financial Support
Assistant because
67
1 there's not going to be very much
financial management
2 occurring since we're
going to spend our reserve funds.
3 And the Chief Licensing
Specialist, the three
4 Licensing Specialists, and over under the
General
5 Counsel's office, the Medical Reviewer
works for the
6 General Counsel; the Chief Investigator
and those who
7 report to the Chief Investigator. I would move that you
8
approve this organizational chart.
9 MS. KIRCH: So moved.
10 DR. BAEPLER: Second.
11 DR. HUG-ENGLISH: Motion and a second to
12 approve the organizational chart. Any discussion on it?
13 I have to say it looks really very nice.
14 All in favor?
15 (Ayes.)
16 Opposed?
17 Chair votes in favor, motion
carried.
18 MR. LESSLY: Under the changes in the manual,
19 the personnel policy simply adds the two
new positions to
20 the executive staff and redefines the
administrative
21 professional staff. There's a change in my job
22 description. My title, at the request of the Medical
23 Association in the Legislature, was
changed to Executive
24 Secretary from Executive Director. I think that was an
68
1 effort to attempt to
downgrade the position. However,
2 I'd like to thank you for that change
because, as I've
3 pointed out to Dr. Baepler,
that he is merely the
4 Secretary and I'm the Executive Secretary,
so now he is
5 working directly for me
on some projects. That's the
6 change in mine.
7 The change in -- well, the new
Deputy
8
Executive Secretary/Special Counsel position simply
9 reflects that
that person does my duties when assigned.
10 Same is true with the new Deputy General
Counsel job
11 description and the Deputy Executive
Secretary/
12 Information Systems Administrator change.
13 It takes some of the
provisions that Maureen
14 had been doing out and goes over to the
Administrative
15 Assistant to the Executive Secretary, and
then I believe
16 the ultimate change was the Financial
Manager is deleted
17 in its entirety since we
no longer have a Financial
18 Manager, and then the Medical Reviewer job
description
19 was cleaned up to reflect reporting to the
general
20 counsel.
And those are the changes, and I'd be happy to
21 answer any questions with respect to those job
22 descriptions.
23 DR. BAEPLER: The auditors are complimentary
24 in that we are beginning to -- the
auditors are
69
1 complimentary in that we are beginning to
achieve a
2 separation of
powers in the alteration of expenditures
3 and checks and
everything under this system.
Sometimes
4 that's difficult to achieve in a small
staff, but they're
5 pleased that we've essentially arrived at that
point.
6 MR. LESSLY: So I need a motion to approve
7 those job description
changes.
8 DR. TITUS: So moved.
9 MS. KIRCH: Second.
10 DR. HUG-ENGLISH: There's a motion and a
11 second to approve the proposed job
description changes.
12 All in favor?
13 (Ayes.)
14 Opposed?
15 Chair votes in favor as well.
16 MR. LESSLY: I'd point out to you that we
17 always in December traditionally approved
the job
18 descriptions and this
policy manual. There will be some
19 cleanup in the policy manual. I don't expect any change
20 in the organizational chart other than the
possible --
21 UNIDENTIFIED SPEAKER: Excuse me.
We cannot
22 hear the speaker.
23 MR. LESSLY: It probably would help if I
24 turned the microphone on.
70
1 I said we have traditionally
reviewed the
2 operational chart and the job descriptions
in the
3 December board meeting. I don't anticipate that there
4 will be any changes other than some
cleanup and the
5 possibility of the two additional staff
members I
6 mentioned earlier being added to that chart.
7 What doesn't appear on there,
as you all
8 know, we have a
legislative counsel, Keith Lee. He is on
9 our payroll. He doesn't appear on the staff, but he's
10 still working with us between the sessions
with respect
11 to legislation we may be seeking for next
session of the
12 Legislature. And that's all I have to say about the
13 organizational chart.
14 And the next item is
videoconferencing
15 equipment for the
Board conference room, and Mr. Clark
16 has that item.
17 MR. CLARK: Madam President, members of the
18
Board, in order to assist the Board in considering an
19 office in
20 for the
21
22 some bids for equipment for video
teleconferencing. One
23 was from Data and Voice Integration, a
private company in
24
71
1 services at the university, UCCSN.
2 In order
to put in a full-up video
3 teleconferencing capability at the Board's
conference
4 room in
5 to Friday/Saturday meetings, the cost
would be
6 $39,148.26, and there are two add-ons to
that which are
7 potentials, and
they are, for $2500 additional, you can
8 have a video camera that can put up on the
screen a
9 document so that people in
10 to people in
11 people in
12 the screens. For an additional $7,000, you can get two
13 plasma screens, which are state of the
art, probably more
14 advanced than the screens you're looking
at right now,
15 but those are items that are available.
16 If you stay with the private
system, then you
17 have the capability of having meetings any
days you want
18 because you would have your own T-1 line
and you would be
19 able to utilize that
at your convenience. If you go
with
20 the university system, you would be on the
State's T-1
21 line, and it
has iffy capability on Saturdays.
They're
22 available some Saturdays, some Saturdays
they're not, so
23 you really couldn't schedule ahead of time
on your own
24 schedule to have Friday/Saturday meetings.
72
1 And in addition, the State's quote
for the
2 equipment for both
offices is $54,600, which is
3 considerably more than the 39,100 that the
private
4 organization was
quoting for us, and with the State
5 system you have an annual fee of $7500 to
utilize their
6 line, an access fee. That access fee would not be
7 required utilizing your own system on a
T-1 line.
8 Let me go from that to a
9 and this is as a result -- this
consideration is as a
10 result of directions that were given to
the Board by
11 committees of the State Legislature at the
recently
12 concluded session, and in looking into the
potential for
13 office space in
14 Buildings and Grounds to see if there was
some space
15 available in the
16 At the time that we had our
discussion, there
17 was 1200 square feet available in the
18 and they charge a $1.15 per square foot,
but I was
19 cautioned at that time that the space was
right next to
20 the governor's ombudsman's office, which
wanted to
21 expand, and that we -- if we even took the
space, we
22 could get kicked out of it if an agency
that was already
23 in the building wanted to expand into that
area.
24 In the interim, between then
and now, that
73
1 area has been taken and is no longer
available. Because
2 the State Pharmacy Board and the State
Board of Nursing
3 and the Division of Child and Family
Services are located
4 in an office complex by the name of LaPlaza Business
5 Center on
6 and across the street on the east from
UNLV, I went and
7 met with the property manager there.
8 They have a number of office
configurations
9 that are available. They charge $1.53 a square foot, and
10 they include air conditioning and water
and electricity
11 in their charge. I found out from the State Pharmacy
12 Board that if you lease outside of a state
building, then
13 you have to go to Buildings and Grounds
and they
14 negotiate your lease for you for a small
four percent of
15 the total lease price, which you add on to
your rental
16 price, which
the Department of Administration takes so
17 that Perry Comeaux can take vacations periodically. He
18 likes to go out
of the country.
19 And so we would be stuck
paying an extra four
20 percent in a private facility, but these
are pretty nice
21 facilities, and
I think that we can accommodate the Board
22 very well there depending on how much
space the Board
23 wants.
24 Now, in pursuing this a little
bit further,
74
1 one of our licensing specialists has
expressed an
2 interest in moving to
3 position there, so if we were to run -- if
the Board were
4 to run a full-up office there, we would be
proposing a
5 licensing specialist, an investigator and
a
6
receptionist/administrative support person. That would
7 require reception area, two offices, a
kitchen and a
8 conference room. That's probably about 1600 square feet,
9 and that would be $1836 a month or 22 --
about 22,100 a
10 year, plus the four percent, which would
run it up to
11 22,900 and change per year.
12 In addition to that, you would
need
13 telephones, which would be about 400 a
month; you would
14 need three computers, which are 2300 each;
a fax; copying
15 and scanning machine; and that's about 550
a month from
16 Xerox.
And so if you were to put people down there,
17 giving an investigator a $45,000-a-year
salary, and
18 figuring in 33 percent for the perks,
insurance and
19 retirement, a licensing specialist at
$40,000, figuring
20 in the perks and an admin receptionist at
30,000 plus the
21 perks, you would be looking at about
163,000 a year in
22 personnel expenses to
do that.
23 Overall, at a minimum, you
would be looking
24 at about $275,000 a year, and there may be
some
75
1 additional expenses that we didn't consider
in the
2 initial -- oh, furniture for three offices
-- two
3 offices, a reception area and a conference
room, about
4 25,000 from Machabee Office.
5 DR. BAEPLER: Does that include a Xerox and a
6 fax machine?
7 MR. CLARK: Yes.
It's a single machine,
8 Xerox, copying and fax machine.
9 And I did not figure in
kitchen costs, which
10 would be a refrigerator and things of that
nature, but
11 you're looking at probably, in round
figures, $300,000 a
12 year to operate that facility in the
south.
13 One other thing that you could consider, if
14 you wanted to go that route and you wanted
to pay for the
15 document-copying capability, is you could
hold IC
16 meetings with some of the members in
17 of the members here in
18 mean, that makes
a logistical nightmare, and it's not
19 quite as easy to have the meeting go
forward as well as
20 the meeting today and the meeting that Dr.
Baepler ran a
21 week or so ago, but it is at least a
possibility when one
22 of the members of the Board just can't
possibly come up
23 to the northern part
of the state.
24 And one final thing. If the Board decides
76
1 that it should have one or more meetings a
year in the
2 southern part of the state, you would have
facilities to
3
accommodate that.
4 DR. BAEPLER: If I may just make a couple of
5 comments. By the way, the Plaza, I had no idea we were
6 looking there, but the research center I'm
associated
7 with
at the university, until relatively recently we
8 rented a whole floor from them, and it was
very
9 satisfactory. You have ample and easy parking, it's
10 close to the airport, et cetera, et
cetera.
11 It may be due to political
expediency that we
12 have to open an office in
13 can't go to our old module. We had a small office with a
14 single-staff-type operation. If we went to that, I would
15 recommend that we hire a retired Maytag
repairman to
16 staff it because that office had no
equipment and we need
17 someone trained
just to sit there.
18 In reality, if you examine the operation
up
19 here, doctors, physician assistants and
respiratory
20 therapists do not stop by our office, you
see. They just
21 don't unless they're summoned because
we're investigating
22 them, but the day-to-day, week-to-week,
month-to-month
23 traffic is nil,
zero.
24 I think the staff has worked
out a practical
77
1 solution to have a larger office down
there that would
2 have some functions associated with it
assigned to the
3 two staff people, functions related to
licensure and
4 other things, which can easily be done
from here, but
5 also can easily be done down there, and,
of course, the
6 main reason
would be to have the conference room for
7 teleconferencing whenever we required it,
you know.
8 I would point out that the $300,000 figure is
9 minimal. When you think in terms of total revenue,
make
10 that 600,000 because I think in biennial
terms rather
11 than annual terms. We would have to have a very
12 significant increase in licensing fees to
accommodate a
13 $600,000 additional
expense on a biennial basis.
Perhaps
14 this is worth it. It's certainly something to consider.
15 DR. TITUS: Did the Legislature mandate that
16 we open or we're to consider an office?
17 DR. HUG-ENGLISH: Let me give a little
18 background on that.
19 Initially in the committee,
there was a big
20 push to move the entire operation to
21 the discussion proceeded, I agreed that we
would look at
22 opening an additional office instead of
moving the entire
23 office and operation to
24 a legislative -- there's no bill that says
we have to do
78
1 this, but it certainly was very strongly
communicated to
2
us in the session that we should have a visible office
3 open in
4 MR. CLARK: One thing I might add for your
5 edification, and that is, the licensing
specialist, if we
6
were to open an office in
7 respiratory therapists' and the physician
assistants'
8 files down there and handle the licensing
of those two
9 professions from that office rather than
try to split the
10 physicians out. They would all stay in the north with
11 the four licensing
specialists that will be there.
12 DR. BAEPLER: Let me emphasize there once
13 again that when people apply for licenses,
they don't
14 come to the office.
15 DR. TITUS: I have some real concerns about
16 where the documents would be, and I
appreciate saying the
17 idea already of not having to split --
there would be
18 some files and some physicians in
19 I mean, that seems to me would be total
chaos. If we
20 have an IC committee meeting and we need a
file, to me it
21 just would not work, and it would be very
cumbersome to
22 have good control of documents that are
very sensitive if
23 we have split offices, and I least
appreciate the thought
24 that you would take a set group of files
there as opposed
79
1 to trying to have some M.D.s there and some not.
2 I really would have to
question at this time
3 if
it's economically viable to consider an office there,
4 and I think that by hosting an -- I am for
5 teleconferencing, I am for getting some
setup so we can
6 broadcast these to
7 would at this time think that it's
economically not
8 advisable for us to do
that.
9 DR. BAEPLER: The figures clearly show it is
10 not economically
advisable. However, it may be
11 politically advisable.
12 MR. CLARK: I would adjust one thing, and
13 that is, even if the Board agrees and
directs us to
14 purchase the video teleconferencing
capabilities for the
15
16
17 which is probably not going to be
available to us on
18 Saturday, and so in order to accomplish
going back to
19 Friday/Saturday meetings, we probably have
to have a
20 place of our own with which to have our
own equipment on
21 our own T-1 line in
order to accommodate that facility.
22 DR. LUBRITZ: How portable is that equipment?
23 MR. CLARK: I don't think it's portable at
24 all. I think once you install it, it's installed
as far
80
1 as the screens are concerned and the
speakers and things
2 of that nature. And there would be two cameras in each
3 of the conference rooms looking at --
facing the Board
4 and facing speakers, and then two large
screens, one
5 showing you what's going on down there and
one showing
6 you what's going on up here, but the
equipment itself is
7 not portable.
8 DR. LUBRITZ: It would seem far more
9 reasonable, given the expense of $600,000
per biennium,
10 to have an office just for the
videoconferencing and buy
11 the videoconferencing equipment than it
would be to staff
12 a new office there. We all know where that came from,
13 we're not going to be shy about it, and my
personal
14 thought is it's an expense that we
probably have to go
15 to, one that's really unnecessary, but if
we have to do
16 it, a lot more economic to do it by just
having an office
17 that we use just for videoconferencing for
the very few
18 people who show up
there, and that's it.
19 DR. BAEPLER: And for an occasional IC
20 committee meeting.
21 DR. LUBRITZ: And for an occasional whatever.
22 DR. ANWAR: The expenses, the bulk of the
23 expenses seem to be in personnel and their
benefits and
24 salaries. Now, do we need to have a decent personnel
81
1 down there, that like we have up here, or
would some of
2 the people up north move down south?
3 MR. CLARK: They would be additional
4 personnel to what we have here. One of the License
5 Specialists has agreed to move down south,
so she is
6 already well trained. We were -- we are considering, as
7 a result of the Chief License Specialist's
request,
8 hiring an additional License Specialist
for the north to
9 cover all of the additional work that is
coming in here.
10 We would hire an additional
investigator for
11 the south who would have to be trained
before he or she
12 were turned loose there, and we would hire
an
13 administrative support person in the south
as well, but
14 those would be new positions essentially.
15 DR. BAEPLER: If I understand this, however,
16 if we did not have the office manned down
there, you
17 would still add at least one additional
position here in
18 all probability?
19 MR. LESSLY: I think we may be talking about
20 two positions.
21 DR. BAEPLER: The net additional cost is the
22 secretarial-type
position?
23 MR. LESSLY: The net additional cost is in
24 the facility, the
equipment, the secretarial cost.
I
82
1 believe that before this next meeting
occurs, I'm going
2 to be asking for authority for a Licensing
Specialist and
3 an investigator.
4 If this happens, just as Tony
indicated, we
5 would transfer the respiratory therapy and
PA licensure
6 function to
7 they can have an investigative person
assigned there and
8 keep that person busy with the full scope
of an
9 investigation, but we're going to be
looking, I believe,
10 at two more people
whether we do the office or not.
11 DR. ANWAR: My question really would be, what
12 are the true additional costs of having an
office down
13 south if you don't take those two people
who we were
14 planning to have up north anyway, whether
they're located
15 physically up north or
down south?
16 DR. BAEPLER: About 440,000 biennially off
17 the top of my head. Maybe more on that.
18 MR. CLARK: That's about right. Under
19 $500,000 for the
biennium.
20 DR. HUG-ENGLISH: One of the -- Joel, your
21 comment was a
good one. One of the problems, though,
22 that we would have is that one of the
criticisms of the
23 Board at the Legislature was lack of
availability or lack
24 of capability of people to come and be at
the meetings
83
1 and so forth.
2 It's clear that we need to
have at least, I
3 think, one meeting a year down in
4 to do this, we not only need to have an
office that would
5 house videoconferencing equipment; we need
to have enough
6 space that would house the Board for
meetings and so that
7 we can go from
8 this that we need to consider, I think,
that we need to
9 have the capability of having meetings
there as well.
10 DR. HUG-ENGLISH: Is there someone that wants
11 to make a comment down
in Vegas?
12 DR. KINGSLEY: Yes.
Dr. English, this is
13 Dr. Ed Kingsley, the president of Clark
County Medical
14 Society, and we
were discussing the option of the Board
15 setting up the teleconferencing equipment
in your own
16 office, and then we would be willing to
offer our
17
18 putting the equipment
in there, and we won't even charge
19 you.
20 DR. BAEPLER: How large is the area?
21 DR. KINGSLEY: I don't know if it would be
22 large enough for the meetings you're
speaking of, but it
23 would certainly be large enough for the
teleconferencing.
24 DR. HUG-ENGLISH: That's a very nice offer.
84
1 I'm a little confused. Do you have teleconferencing
2 equipment now or are you just offering --
3 DR. KINGSLEY: No, we don't have the
4 equipment. We just offered the space.
5 DR. HUG-ENGLISH: Is the space -- I'm sorry,
6 I probably am having difficulty hearing
you, but did you
7 say that the space would accommodate
enough for a Board
8 meeting or would just accommodate the
equipment?
9 DR. KINGSLEY: The conference room we use for
10 our meetings probably holds 25 or 30
people at the most,
11 so I don't know if that would be
sufficiently large for
12 your needs, but it would be large enough
for
13 teleconferencing, I think, in most cases
in terms of the
14 meetings you were talking about having.
15 If you were going to hold the meetings
down
16 here, I don't know if that would be large
enough for you,
17 but it should be large enough for the
teleconferencing
18 purposes.
19 DR. MONTOYA: That's a generous offer.
20 DR. HUG-ENGLISH: That's a very nice offer
21 and I appreciate that. That's certainly something to
22 consider.
Thank you for that suggestion.
23 DR. KINGSLEY: You're welcome.
24 DR. HUG-ENGLISH: Well, I'm not quite sure
85
1 what to do. This is not something that I suppose we have
2 to decide at this meeting, but I think
this obviously has
3 some significant
financial impact for the Board.
It also
4 is clear from public comment as well as
legislative
5 comment that we somehow, I think, need to
improve our
6 accessibility to people in
7 another, whether it involves the office or
it involves
8 something that was just suggested, we need
to look at the
9 capability of videoconferencing and the
capability of
10 allowing us to have a place that's
accessible to have
11 meetings down there as
well.
12 DR. TITUS: I would encourage the lines of
13 communication
to stay open and continue to research this
14 new offer and
different options. I think it's
also a
15 generous offer and would table this and
give them
16 Godspeed for this time around and rediscuss it in
17 December.
18 DR. BAEPLER: Madam Chair, I agree with that.
19 Someone needs to look at the space, of
course. It's a
20 very generous offer. It, of course, does not include a
21 physical presence there by any staff, so
it would be a
22 relatively inexpensive option, but I don't
know if it
23 meets legislative
concerns. I can't assess that.
24 MS. KIRCH: What about -- if you're looking
86
1 at that, the pharmacy Board, do they have
a facility
2 where they have like
a conference room that we could
3 pursue possibly renting some space from
them as well if
4 the Clark County Medical doesn't work out?
5 MR. CLARK: I don't believe they have a
6 conference room. I know they have office space down
7 there, but I don't believe they have a
conference room,
8 and I don't know what the nursing Board or
Child and
9 Family Services has.
10 MS. KIRCH: You know, it was just a thought
11 if there was some way to work with another
Board or share
12 even some expenses on the
teleconferencing, if it got to
13 the point where they
needed to teleconference also.
14 MAUREEN: Right now we are also sharing
15 Contractors Board offices, but the problem
is they are
16 closed on Saturday.
17 MS. KIRCH: I realize that, but perhaps if we
18 went into some of the other facilities,
they would give
19 us access on Saturdays where they're not
in a state
20 building or something
like that.
21 MR. MATHIAS: Larry Mathias,
22 Medical Association.
23 The Board of Pharmacy does
have a conference
24 room, but it
doesn't have video-casting capability.
It
87
1 is large enough for the Board
meetings. They alternate
2 their Board meetings between north and south,
so -- but
3 they don't have videoconferencing
capability. The
4 nursing Board also doesn't have
conferencing
5 capabilities.
6 DR. HUG-ENGLISH: Thank you.
Okay. I think
7
that there was -- was that a motion, Robin, to table this
8 agenda item, and we will gather some
information and
9 maybe take a look at the space that was
generously
10 offered, and then we'll bring this back
again in
11 December?
So is there a second to that motion?
12 MS. KIRCH: I second that.
13 DR. HUG-ENGLISH: Any further discussion?
14 All in favor?
15 (Ayes.)
16 Opposed?
17 Chair votes in favor of the
motion; the
18 motion carries.
19 MR. CLARK: Madam President, is there a
20 motion or does that motion include a stay
on the video
21 teleconferencing
equipment as well or just the space?
22 DR. HUG-ENGLISH: That's a very good point.
23 I think that we in some manner need to proceed
with the
24 videoconferencing
equipment, and I think that
88
1 irregardless of whether we do an office
down there, we're
2 going to need to do the videoconferencing,
so I think
3 that -- is that everybody else's --
4 DR. TITUS: On a second motion, I would move
5 that we seek more negotiation with the
private sector for
6 videoconferencing.
7 DR. LUBRITZ: Second it.
8 DR. HUG-ENGLISH: All in favor?
9 (Ayes.)
10 Chair votes in favor.
11 So we'll pursue that part of
it.
12 MR. CLARK: And I will check out both the
13 conference room at the Clark County
Medical Society and
14 the pharmacy board's conference room and
check the
15 availability there as
well.
16 DR. HUG-ENGLISH: Great.
Thank you.
17 DR. TITUS: I think that our Legislature in
18 good faith want
us to communicate with everybody
19 throughout our State, and keeping the
lines of
20 communication
open, I think it's good faith if we show
21 them the costs and what we're trying to
do, and keeping
22 us available to our peers in
23 the intent of this, and I think that's --
they would be
24 encouraged that we're making progress.
89
1 DR. HUG-ENGLISH: Thank you, Robin.
2 MAUREEN: Excuse me.
Can we have
3 clarification? Are we tabling until December the
4 purchase of video equipment also?
5 DR. HUG-ENGLISH: No.
There were two
6 separate motions. We're tabling the office, and we're
7 moving ahead with the
videoconferencing.
8 MR. LEGARZA: Can I say something? I'm not
9 so sure you can move ahead with the
purchase of video
10 equipment until you make a decision as to,
one, whether
11 or not you're going to have a facility
that is going to
12 allow you, for instance, to have meetings
in
13 well as videoconferencing, because not
only must you have
14 videoconferencing from
15 have videoconferencing from
16 think you should buy your equipment until
you find out
17 what it is that you're going to do with
respect to a
18 physical plant
in
19 a big conference room where you can have
meetings and
20 where you can videoconference to
21 to have offices or not
have offices.
22 DR. BAEPLER: If we had our own
23 videoconferencing, could we
videoconference with the
24 current facility
that we're using today in Vegas?
90
1 MAUREEN: They're not open on Saturdays.
2 DR. TITUS: But yes, yes.
3 DR. HUG-ENGLISH: Tony, let me ask you this:
4
I guess the question that Dick brings up is a good one in
5 that if we purchase the equipment, does it -- you brought
6 up a couple of different options, whether
we go with the
7 State or whether we go with the private
sector, and if we
8 purchase the equipment, say, for the
9 we're not sure yet where we're going to be
located, is
10 that going to be a
problem?
11 MR. CLARK: I don't know, and I'll have to
12 find out from the video teleconferencing
people. I know
13 that if we bought the private sector
equipment, it is
14 compatible with the equipment that the
Department of
15
Health and Human Services for the State has, and we
16 could -- you could piggyback to
17 equipment or to
18 that's a distinct possibility, but I'll
have to find out
19 for sure and find out whether that
equipment is
20 compatible with the equipment in this
building and the
21
22 that.
23 DR. LUBRITZ: I think that it's reasonable to
24 proceed along the lines,
you'll have a bid and the bid
91
1 will allow you X number of months -- you
can explain to
2 them what we're trying to do -- so that we
can have
3 everything available to
us, knowing what the cost is,
4 knowing what the delivery time is, knowing
what the
5 installation time
is, and certainly we can proceed on
6 that.
7 We think we know what we're
going to need,
8 you know the scenarios
that we need, and you can have
9 bids for those, and then it's just finding
how are we
10 going to and where are we going to install
it. I think
11 it's foregone that we're going to need it,
so I don't
12 think one needs to be waiting upon the
other.
13 MR. HUGHES: Excuse me.
May I add something?
14 This is Mike Hughes.
15 Tony and I have discussed the
16 videoconferencing
arrangements with the video people.
17 One thing I think is being overlooked in
this discussion
18 is the fact that, regardless of where you
put the
19 equipment both in
20 have to have a technician available on the
days that you
21 want to link up the equipment, in order to
set up the
22 equipment, and so that might be a person
that comes in
23 from the outside that helps us or somebody
internally
24 that's trained to do
that.
92
1 DR. HUG-ENGLISH: I think that's a very good
2 point, Mike. Thank you for bringing that up.
3 Are we clear on what we're
doing?
4 DR. TITUS: Clear as mud.
5 DR. HUG-ENGLISH: I'm going to skip ahead to
6 Agenda Item No. 17, and that is
ratification of licenses
7 issued and reinstatement of licensures,
and I just need a
8 motion to approve those.
9 DR. MONTOYA: So moved.
10 MS. KIRCH: Second.
11 DR. HUG-ENGLISH: There's a motion and a
12 second to approve the ratification of
licenses. Any
13 discussion?
14 All in favor?
15 (Ayes.)
16 Opposed?
17 Chair votes in favor, and the
motion carries.
18 And believe it or not, I think
-- Larry says
19 not.
20 MR. LESSLY: There are informational items
21 under Item No. 11. Maureen has a report on the website
22 additions.
23 DR. BAEPLER: We skipped No. 9, too.
24 DR. HUG-ENGLISH: Dick wants to do that.
93
1 Maureen.
2 MS. LYONS: Larry has been searching and
3 searching the statute since the
legislative session ended
4 to find lots of work
for me to do on our website.
Every
5 day he says, "I found something else,
and this other
6 statute that is requiring that we do this,
that and the
7 other."
8 So I'm going to have to go
through and make
9 major modifications to
our website. I've purchased Adobe
10 Acrobat, which allows you to translate any
document into
11 a readable,
downloadable file. So I will be
able to put
12 our -- all of our applications for
licensure on line, our
13 registration forms. The Legislature requires that all of
14 our forms go on line, so I will be
starting this project
15 as soon as I can following
this board meeting, and I hope
16 to have it completed by --
17 MR. LESSLY: She will have it completed
18 before she leaves.
19 MS. LYONS: -- by January. Thank you.
20 DR. HUG-ENGLISH: I know that's a lot of
21 work, updating that and adding
information, and I know
22 you'll do just a great job, Maureen.
23 Okay. I believe that we have completed all
24 the agenda items that we can today. We have the legal
94
1 reports which Dick and Charlotte will do
tomorrow, and
2 tomorrow, just for the benefit of all our
audience
3 members both here and in
4 adjudications and
appearances all day.
5 So just point of information,
you're
6 certainly welcome. There will be a lot of those
7 appearances that will bounce back between
open and closed
8 session, but just so that you know what is
on the agenda
9 for tomorrow.
10 At this point, before we
adjourn or recess
11 for today, if there's any public comment
from either Las
12 Vegas or
13 Okay. Hearing none from either place --
14 DR. HAVENS: Don Havens,
15 Society.
I think in consideration of the Senate, at
16 least Commerce and Labor Committee, that access would be
17 satisfied if we just had
videoconferencing. Personally,
18 the physicians that I know I don't think
would be --
19 would be fully satisfied if we had videoconferencing
20 without you all having to trek down here
to a meeting in
21
22 videoconferencing
capability is there.
23 So I know that you feel that
it's good to be
24 down here once a year, perhaps in
December, but I'm not
95
1 sure it would be necessary if we had the
2 videoconferencing.
3 DR. BAEPLER: Dr. Havens, what is your
4 personal opinion on the --
5 DR. HAVENS: Sorry.
Can you turn your mic
6 on?
7 DR. BAEPLER: What's your personal opinion on
8 the necessity to have full-time staff
located in Vegas?
9 DR. HAVENS: My personal feeling is that's
10 not necessary. If you have access to the Board from the
11 public and physicians at the meetings,
that that is
12 satisfactory.
13 DR. BAEPLER: Thank you.
I just wanted
14 clarification
of that.
15 DR. HAVENS: The physicians here, I don't
16
think, are interested in creating unnecessary expenses
17 for the Board because we know where the
source of the
18 income comes
from for those expenses. So if there's
19 videoconferencing,
I think that's adequate.
20 I think the emphasis about
putting an office
21 down here came from one source in
particular, and I don't
22 think, again, if there's
videoconferencing, that there's
23 going to be an
objection to that.
24 DR. HUG-ENGLISH: Thank you for those
96
1 comments. I appreciate that.
2 MR. LEGARZA: Don, hey Don.
What's that one
3 source in particular?
4 DR. HAVENS: It slips my mind, but Cheryl
5 might recall.
6 MR. LEGARZA: Was it a legislator or an
7 individual?
8 DR. HAVENS: I think it was a legislator.
9 MR. LEGARZA: From the north or the south?
10 DR. HAVENS: I think it might have been from
11 the north.
12 MR. LEGARZA: Thank you.
13 DR. HUG-ENGLISH: Okay.
Any other public
14 comments? If not, we will recess until tomorrow morning
15 at
16 (Proceedings adjourned at
17
18
19
20
21
22
23
24
97
1 STATE of
2 )
ss.
3
4
5 I, PEGGY B. HOOGS, a notary
public in and
6 for the
7 certify:
8 That on Thursday, the 4th day of
September,
9 2003, I was personally present for the
purpose of acting
10 as a Certified Court Reporter in the
matter entitled
11 herein;
12 That said transcript which appears
13 hereinbefore was taken in verbatim
stenotype notes by me
14 and thereafter transcribed into
typewriting as herein
15 appears;
16 That the foregoing transcript,
consisting of
17 pages 1 through 97, is a full, true and
correct
18 transcription of my stenotype notes of
said hearing to
19 the best of my
knowledge, skill and ability.
20 Dated at
22
Peggy B. Hoogs, CCR #160, RDR5
23
24
98