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10 REPORTER'S TRANSCRIPT
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12 BOARD MEETING
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15 Taken at the Las Vegas Embassy Suites
Hotel
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24
25 Reported by:
Gale Salerno, RMR, CCR No. 542
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1 APPEARANCES:
2 Stephen K. Montoya, M.D., President
3 Joel N. Lubritz,
M.D., Vice President
4 Dena L. James, Deputy Attorney General
5 Donald H. Baepler,
Ph.D., Secretary/Treasurer
6 Stephen D. Quinn, J.D.,
General Counsel
7 Sohail Anjum, M.D.
8 Jean Stoess, M.A.
9 Marlene J. Kirch,
Public Member
10 Edward Cousneau,
J.D.
11 Bonnie Brand, J.D.
12 Carolyn Castleman
13 Pam Gabica,
Administrative Assistant
14 Charles N. Held, M.D.
15 Javaid Anwar, M.D.
16 Robert J. Barnet, M.D., Medical Reviews
17 Pamela James
18 Douglas Cooper, Chief of Investigations
19 Lynnette L. Krotke,
Chief of Licensing
20 Drennan (Tony) A. Clark, J.D., Executive Secretary,
Special Counsel
21
Lori
L. Munson, Deputy Executive Secretary
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1 Also Present:
2 Roger Belcourt,
M.D.
3 Peter Mansky, M.D.
4 Max Doubrava, M.D.
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Janet Wheble, P.A.
6 John Lanzillotta,
P.A.
7 Larry Matheis
8 Michael Garcia
9 Don Wright
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1 P R O C E E
D I N G S
2 - - -
3 (
4 1. CALL TO ORDER
5 DR. MONTOYA: I would like to go ahead
6 and call the meeting to order.
7
8 2. APPROVAL OF MINUTES
9 DR. MONTOYA: Move to the second, to
10 approval of the
minutes.
11 MS. KIRCH: I would move for approval.
12 DR. MONTOYA: So all in favor?
13 Dr. Lubritz
just moved a second to
14 approve the minutes. Do you have any problem with
15 it?
16 All in favor? Opposes?
Passes.
17
18 3. PERSONNEL
19 DR. MONTOYA: Introduction of new
20 board staff.
21 DR. CLARK:
Mr. President, I would
22 like to introduce to the board Bonnie Brand,
deputy
23 general counsel. She has spent a number of years
24 with the attorney general's office with the
City of
25
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1 practice. We are pleased to have her on board.
2 DR. MONTOYA: So glad you came to join
3 us. Welcome aboard.
4 Anybody else?
5 DR. CLARK: That's it for right now.
6 DR. MONTOYA: Licensing division
7 staffing. Are there some changes there?
8 DR. CLARK: Let me give you a quick
9 update.
Barbara Daravanna decided that she would
10 leave our employment, and we have a new
lady, and
11 I'm sorry that I don't have her last name --
her
12 first name is
Brett, who will be starting on Monday
13 morning. Canady, C-a-n-a-d-y.
14 One other thing with respect
to the
15 licensing division. We have an entry-level
16 licensing specialist who has been with us
six
17 months, and who has met all of the
requirements to
18 be fully
trained. We have a policy that directs
19 that new people who come on board with the
board
20 start at a lower salary at 32,000 a year for
21 licensing specialist.
22 Since she has reached her six
months
23 gate, and has passed all of her
requirements, we
24 would like authority under our policy to
raise her
25 salary, technically the 15th of December, to
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1 $37,000, which is the mean salary for the
other
2 licensing specialists.
3 And this was the only exception
to
4 salary increases that would occur outside of
June,
5 and that is where you start low in the
training and
6 then come up to speed.
7 DR. MONTOYA: This goes along with the
8 policy we recently adopted that said
we would review
9 salaries once per year. This is the only exception
10 to that that Tony is
bringing up.
11 DR. CLARK: And her name is Jan Ross.
12 DR. MONTOYA: Any problems with this
13 anybody? Any discussions? This was a planned
14 exception.
15 We have a policy in
place. We don't
16 need to take any specific action. This is for
17 information purposes
only.
18 DR. CLARK: Then I have one other
19 thing for
licensing. Annette would like to be able
20 to designate one of her deputies as chief
deputy,
21
Carolyn Castleman, to be in control and in
charge
22 when she is away, and to train the other
licensing
23 experts and to help
license. This would not affect
24 salary increase at all.
25 DR. MONTOYA:
Vice president of the
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1 bank?
2 DR. CLARK: Yes.
3 DR. MONTOYA: The title, but nothing
4 more.
5 DR. CLARK: Yes.
The title and the
6 duties and the job, but
nothing more. She gets to
7 sweep the floors at night, too.
8 DR. MONTOYA: Any objections? Any
9 problems with that?
10 So we'll move on to that. All right.
11 Licensing configuration is straight
12 then?
13 MS. KROTKE: We have a new lady
14 starting Monday. She's replacing Barbara, and her
15 name is Brett
Canady.
16 DR. MONTOYA: Update on office
17 realignment.
18 DR. CLARK: We are finished with
19 office realignment. We're moving in and settling
20 in.
21 DR. MONTOYA: Those of you that don't
22 know, the office occupies the third floor of
that
23 building down there. Tony's office is essentially
24 at one end. There's an office for the executive
25 committee down there
also.
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1 Then we modified the board
room. And
2 then on the other end we have all the rest
of the
3 legal staff and the administrative staff and
1400
4 copy machines.
5
6 4. STATUS OF PUBLIC SERVICE ANNOUNCEMENT PROGRAM
7 DR. MONTOYA: Status on the public
8
service announcement program to the
9 Broadcasting Association. I'm sorry, I haven't
10 gotten it in Spanish yet. I have the script. I
11 have it memorized. I just haven't gotten my butt
12 down there.
13 DR. CLARK: We can show you the tape,
14 and I'll run that in just a second. But I want to
15 tell you also that I have heard the same ad
on the
16 radio in
17 will key up, Mike, we will get the tape
going.
18 MS. MUNSON: Mike, can you run the
19 tape, please?
20 DR. CLARK: Hello, Mike?
There he
21 is. There's his shoulder.
22 DR. MONTOYA: This ad was actually
23 filmed at the Channel 8 studios very close
over
24 here. And when the board members went down there we
25 were treated very well, professionally. They made
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1 it as painless as
possible.
2 - - -
3 (Whereupon, the following
television
4 ad was heard:)
5 "As members of the Nevada
State Board
6 of Medical Examiners, providing you with the
best
7 health care is our
top priority. Our job is to
8 worry about your doctor's credentials so you
don't
9 have to.
10 We check educational
background and
11 professional history on each
applicant for state
12 medical license.
13 licensing requirements of any jurisdiction
in the
14 country.
15 If you have any questions
about your
16 doctor, contact the Nevada State Board of
Medical
17 Examiners."
18 - -
-
19 MIKE: Run it again so that we can
20 point out -- you need to take a look at the
21 background because you can't tell on this
video,
22 it's got a lot of color, and it's got a lot
of stuff
23 in the background.
24 If there is any way they can
run it
25 again on the full
screen. And take a real good look
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1 at the back on that.
2 MS. MUNSON: Let me call him back.
3 DR. MONTOYA: Could you tell us what
4 stations are seeing this?
5 MIKE: They are statewide. You
6 have approximately 20 television stations
and
7 approximately 60 radio
stations.
8 Right now we're waiting for
the
9 Spanish, which is very important. For those of you
10 from the north we have nine Spanish stations
in
11
12 message out.
13 So we don't waste everybody's
time, if
14 they have any questions or comments, I don't
know
15 what else you're
reporting on.
16 DR. CLARK: That's the end of the
17 report.
I just wanted to show them the video and
18 advise them that I've already heard this on
the
19 radio, the radio stations in
20 the country and western
station. Don't say that.
21 DR. MONTOYA: This also helps, the
22 audit that we had a year and a half ago, in
fact,
23
it finished last year where they wanted more
24 information out there
about the state board. This
25 is an attempt to get the word out there that
they
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1 can call us and ask about doctors and their
2 credentials in a pretty
much nonthreatening manner.
3
4 5.
AMENDMENTS TO
5 DR. MONTOYA: Let's go on to
6 amendments to
7 stop to do this any time.
8 Are we connected to
9 Lori?
10 MS. MUNSON: I believe we are. We
11 have the blue screen. I think he was going to be
12 playing it again. I'm sorry.
13 DR. MONTOYA: Do we have something in
14 consideration of approval of minute
regulations for
15 completion of --
16 MS. MUNSON: Here it is, excuse me.
17 Well, I thought it was.
18 DR. QUINN: There are two items for
19 amendment that I
wish to present. The first item is
20 consideration of approval of an amendment to
the
21 regulation
applicable to testing that puts a time
22 limit for completion of the USMLE, and a
limit on
23 the number of attempts a person may make to
24 successfully complete the USMLE.
25 The regulation is NAC 630.080.
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1 The amendment changes the
regulation
2 by adding a provision to limit the time
within which
3 a person must successfully complete the
USMLE. And
4 also adds a limitation on the maximum number
of
5 attempts an applicant may make to complete
all three
6 steps.
7 The status of the regulation at this
8 point is the proposal is before you in the
9 brochure. It is on the second page. As written,
10 it adds a section or amends section five,
and
11 re-numbers section five and six as section
six.
12 And the proposal is that the
amendment
13 read for the purposes of subparagraph 3,
paragraph C
14 of subsection 2 of NRS 630.160: "A person must pass
15 steps one, two and three of the
16 medical licensing
examination within seven years
17 after the date on which the person first
took any
18 step of the United States Medical Licensing
19 Examination.
And the person is limited to a maximum
20 of two failures of each step, or a combined
maximum
21 of nine attempts to pass the United States
Medical
22 Licensing
Examination."
23 I sent this memorandum
out. And since
24 I sent it out, I
received response from one board
25 member, Dr. Anwar, who recommended that we modify
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1 that language to read basically to delete
the
2 reference to two failures, and just read
with
3 respect to the maximum with respect to the
number of
4 attempts that a person is limited to a
combined
5 maximum of nine attempts to pass steps one,
two and
6 three of the United States Medical Licensing
7 Examination.
8 DR. BAEPLER:
That was the intent of
9 the motion.
10 DR. QUINN: The status of this
11 proposed regulation
is a workshop is scheduled later
12 this month, I think on the 20th of December
in
13
14
15
16 the date is.
17 DR. BAEPLER: The next day.
They're a
18 day apart.
19 DR. QUINN: Thank you.
20 DR. BAEPLER: First in
21 in Vegas.
22 DR. QUINN: And the
23 be a combined workshop and public hearing on
the
24 proposed regulation.
25 DR. CLARK: Mr. President, one thing
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1 that needs to be included in this proposed
amendment
2 to the regulation is the exception for an
M.D.
3 who is also pursuing his Ph.D., and he has
ten
4 years -- he or she has ten years rather than
the
5 seven.
6 DR. BAEPLER: This has already been
7 posted as written. Are these changes to be
8
incorporated after the hearings?
9 DR. QUINN: My understanding is,
10 according to the provisions, we may make
that change
11 without changing the
schedule.
12 DR. BAEPLER: Okay.
13 DR. QUINN: These are simply the
14 workshops.
15 DR. BAEPLER: Because we have a
16 deadline proposing.
17 DR. QUINN: They are the workshops.
18 DR. BAEPLER: This is kind of
19 consistent with what
many other states do. We have
20 had some awkward moments when people have
had, what,
21 20 attempts or something
like that.
22 DR. QUINN: 15, 19.
23 DR. BAEPLER: Yeah.
Marginal people,
24 but technically meet all of our
requirements, and
25 this kind of cleans it up. It makes us pretty much
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1 like most states.
2 DR. QUINN: It does.
My memorandum
3 states that with respect to the seven-year
time
4 limit, the
overwhelming majority of states adopt
5 that, and the majority of 36 states adopt
some limit
6 on the number of attempts to successfully
complete
7 the USMLE.
8 DR. MONTOYA: What I'm hearing is
we
9 want to modify this in two ways. Is there any more
10 discussion on the
eliminating?
11 MS. STOESS: How does this affect an
12 applicant who has
made consideration attempts
13 already?
14 DR. MONTOYA: For consideration today
15 it's not going to affect them. For consideration in
16 three months it is going to affect them.
17 DR. BAEPLER: Her question is
18 pertinent though. The ones that are in the
19 pipeline, but not being considered today,
they send
20 in their application, so their application
is
21 received from this date forward.
22 MS. STOESS: That's good.
23 DR. QUINN: I don't think we should
24 put that in the regulation.
25 DR. MONTOYA: No, no.
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1 MS. CASTLEMAN: Does this mean if
2 someone doesn't meet that
criteria, that they can't
3 apply?
Or that they can apply, and then meet with
4 the board before they make a decision?
5 DR. MONTOYA: I think it means
6 administratively you wouldn't be given a
license.
7 DR. ANJUM: If they can apply, the
8 board can
consider.
9 DR. BAEPLER: If it's denied at the
10 staff level, for example, because then it's
not.
11 DR. QUINN: Administratively, if a
12 person were to insist that a board makes a
decision,
13 then I think these are reportable denials.
14 DR. BAEPLER: Yes.
15 DR. LUBRITZ: Where's Lynette?
16 MS. MUNSON: She stepped out for a
17 minute.
18 DR. BAEPLER: It's not indicated on
19 the application form, so people would have
no way of
20 knowing.
21 DR. LUBRITZ: It's their choice to
22 determine whether or not they want to go
through the
23 process, knowing that it's reportable to the
24 national.
25 DR. BAEPLER: Exactly.
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1 DR. MONTOYA: How about if we include
2 something in the
application packet that says --
3 DR. BAEPLER: Yeah.
4 DR. QUINN: I believe the
5 administrative process
is such that licensing
6 specialists clearly advise the person that
they
7 don't need to meet the requirements, and
then the
8 person can make
the decision. And at that point the
9 licensing specialist would say this is what
the
10 consequences are.
11 DR. BAEPLER: On the web site, they
12 can download everything off of the web. Note in
13 there that we have a new
reg.
14 DR. MONTOYA: Dr. Held?
15 DR. HELD: If someone chooses to take
16 that path, is the board going to allow them
to
17 withdraw their application once it's denied
so it's
18
not reported? Or if is it going
to be hard and
19 fast, if you come to the board with 15
attempts and
20 you are denied?
21 DR. MONTOYA: We have in the past
22 allowed people, under special circumstances,
to
23 withdraw their application and go away. But what
24 has happened in the past also is somebody
has
25 pursued this awfully hard, and said no, I
want you
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1 to consider me, and then they have to take
their
2 lumps.
3 DR. BAEPLER: I assume the person
4 would already have been rejected
administratively by
5 staff. So the person knows that they do not meet
6 the requirements.
7 If they still insist on appearing
8 before the board, I think they do it at
their risk.
9 DR. HELD: That's what I was
10 thinking.
11 DR. MONTOYA: And at the board meeting
12 we can say do you want this on your record,
and if
13 they say yes...
14 DR. BAEPLER: Before the board
15 meeting, tell them
on the phone.
16 DR. ANWAR: So there can be special
17 circumstances where they can argue before
the board,
18 then they can be specific with the board, as
we have
19 done in the past, we could give them that
choice, do
20 you want us to vote on this?
21 DR. MONTOYA:
What has happened
22 before, somebody has come in, the president
will
23 say, Doctor, you have a choice here, it
doesn't look
24 like you're probably going to get licensed
here;
25 just don't think you quite meet things. If you want
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1 to withdraw, you can withdraw. However, if you want
2 to pursue this, it is your right.
3 That's enough to scare off
most people
4 and wake them up. However, I can remember one where
5 it didn't.
Voted, they lost, they got reported.
6 Okay?
7 So they do absolutely have the
right
8 to come to the board. Nobody can deny that.
9 DR. ANWAR: The board member can look
10 at that application and apprise them that
their
11 chances of denial are pretty high?
12 DR. MONTOYA: Yes.
13 DR. BAEPLER: Since it's in the
14 administrative code,
we can make exceptions to it.
15 DR. MONTOYA: What I'm hearing, and
16 please correct me, a couple of things
here: One,
17 the seven years is okay, except for people
pursuing
18 a Ph.D., we give them
ten. Okay?
19 The second is that we take
away the
20 two failures per attempt, and just use a
combined
21 maximum of nine attempts
to pass all three.
22 Otherwise we can go with this.
23 MS. KIRCH: I move that we approve the
24 modifications.
25 DR. MONTOYA: Second it?
All in
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1 favor? So moved.
2 DR. QUINN: Second item on amendments
3 is a request from the -- pertains to a
request from
4 the respiratory care advisory committee to
increase
5 their membership from three to five members,
which
6 would require an amendment to NAC
630.560. This is
7 brought to your attention at this juncture
as a
8
request for authority to proceed with drafting an
9 amendment and
presenting it.
10 DR. MONTOYA: I don't want to engender
11 this, but please stand up and tell us.
12 MR. GARCIA: In short, our logic is
13 we're looking at close to 1,000
practitioners in the
14 state now.
Granted, the bulk of the weight of those
15 practitioners are in the south.
16 Right now we have two members,
myself
17 and Mr. Don Wright down
south on the committee. We
18 have one gentleman up north. We would like to
19 expand that to include a second person up
north, and
20 draw in a respiratory therapist from the
rural
21 communities so that we have a little better
22 representation of our
geographic mix.
23 DR. MONTOYA: I don't have any
24 problems with that.
25 Board members? Any problems with
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1 increasing to five?
2 MS. STOESS: Move for approval.
3 DR. MONTOYA: Moved?
Second it we go
4 to five members? All in favor? Opposed?
Okay.
5 Do we have that thing up yet?
6 MS. MUNSON: I believe he does. I
7 just need to tell him to play it.
8 Mike? Can you play that again, Mike,
9 the tape?
10
11 6. CONSIDERATION OF ELECTRONIC RENEWAL OF
12 LICENSURE
13 DR. MONTOYA: While he's getting that
14 number going --
15 MS. MUNSON: Can you show the video
16 again, please?
17 DR. MONTOYA: Consideration of
18 renewal.
19 DR. CLARK: Mr. President, we're
20 looking for direction
from the board. We can put
21 into practice the electronic re-registration
22
capability and payment by credit card for
23 physicians, physician assistants and
respiratory
24 therapists if the board directs us to do so.
25 We haven't done so yet. If the board
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1 wants us to provide that service to our
licensees,
2 we would not be able to have it available
for
3 physicians and physician assistants until
the 2007
4 registration period, but we would start
immediately
5 to try to implement it, and have it
operational for
6 the re-registration of the respiratory
therapists in
7 2006.
8 So we're asking for the board's
9 direction on this.
10 DR. MONTOYA: At the rate you're
11 going, it sure streamlines the process. And it sure
12 does it in a lot
bigger hurry.
13 You already have a package in
mind? A
14 company or
something?
15 DR. CLARK: We are looking at one.
16 And we're talking to several other states who are
17 implementing it now to make sure we have the
best
18 package with the fewest bugs, and then we
want to
19 try it out on Mike and his folks.
20 MR. GARCIA: We look forward to that.
21 DR. CLARK: Make sure it's
22 operational.
23 DR. MONTOYA: I think we're pretty
24 much in favor of this. Anybody have any?
25 MS. KIRCH: I think most of other
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1 state agencies are
doing that. It's just more
2 efficient.
3 DR. MONTOYA: It probably doesn't need
4 a motion, but let
me hear a motion.
5 All in favor to re-produce the
6 electronic licensing
business? Anybody opposed?
7 Any comments? All right.
8 So please, onward.
9 DR. CLARK: We'll get on it.
10
11 7. BOARD WEBSITE
12 DR. MONTOYA: Number 7, board website
13 report.
14 DR. CLARK: Let me give you a quick
15 rundown. Through November 30th, several days ago,
16 the board has issued licenses to 668
doctors, 496 of
17 those are regular licenses. The balance are
limited
18 licenses or special
licenses in other categories.
19 We have also licensed 67 new physician
20 assistants and 130 new
respiratory therapists.
21 At this time last year, the
board had
22 licensed 517 doctors compared to 668 this
year. And
23 at this time last year, those not including
limited
24
license, were 335 versus 496 this year.
25 So that indicates to me that
we will
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1 be over 700 licenses granted this year by
the time
2 December is over and we go into 2005.
3 DR. MONTOYA: So we've increased the
4 number of doctors that have licenses by
around 25
5 percent or so, and kept up with -- not quite
keeping
6 up with our population, in this part of the
state
7 anyway.
8 All right. We're going to watch the
9 commercial again. Watch for color in the
10 background.
11 MS. MUNSON: The tape, we've seen it,
12 it looks much better on the regular screen.
13 - - -
14 (Whereupon, the following
television
15 ad was heard:)
16 - - -
17 "As members of the Nevada
State Board
18 of Medical Examiners, providing you with the
best
19 health care is
our top priority. Our job is to
20 worry about your doctor's credentials so you
don't
21 have to.
22 We check educational
background and
23 professional history on each applicant
for state
24 medical license.
25 licensing requirements of any jurisdiction
in the
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1 country.
2 If you have any questions
about your
3 doctor, contact the Nevada State Board of
Medical
4 Examiners."
5 - - -
6 DR. MONTOYA: So it's a wrap.
7 MS. MUNSON: Finally.
8 DR. MONTOYA: The website report, we
9 have
a 668 doctor increase. Is there anything
else
10 we need to know?
11 MS. MUNSON: Yes.
And I don't know if
12 you want to see this, we have finished our
checking.
13 We went through all the files, we updated
all
14 the educational information and all the
other
15 information on all of
the licensees. So that is
16 completed now, and we are ready to put that
17 educational module
on-line and on the website.
18 I just received a quote from
them to
19 do that, though, and it is $12,538 to add
that
20 module.
21 And in considering that, we
are
22 actually in the process of working with a
company
23 called GL Suites to see a demo of their
program,
24 which would replace
License 2000. The reason being
25 we've been hearing from several states, and
the
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1 pharmacy board, Pamela has worked with them,
they
2 have it, everybody is really happy with this
3 program.
4 A lot of people -- we haven't
been
5 overly happy with License
2000. There's a lot of
6 things that we aren't able to do with it
that we
7 feel we should in the office. So we're entertaining
8 the idea of a new
program.
9 So my thought is we have these
things
10 getting ready to be set
up in January. We might
11 want to wait on this a little longer. I know it's
12 been a long time coming.
13 I don't know how the board
feels, but
14 rather than expend the money now, I don't
know if
15 you would rather wait, or if we want to go
ahead
16 with this. Of course, we'll come back to you with a
17 proposal if we
think that it looks like a good
18 program to see if the board wants to do
that.
19 DR. MONTOYA: Just so I understand
20 you, we can either buy the module that goes
with
21 License 2000 for 12,500. They help you mandate
22 things up a little bit better, right?
23 MS. MUNSON: This is system
24 automation. The current system that we have in
25 License 2000, it will cost us 12,500 to add
the
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1 module so we can have all the websites, all
the
2 information that we
currently have.
3 If we get a different system,
we would
4 have to reload everything. It's a different
5 company. We would have to scrap the system we have
6 and start over. But they can take the information,
7 if it is already on there, they will be able
to
8 transfer it.
9 DR. MONTOYA: How long to get it
10 transferred from our aged system?
11 MS. MUNSON: I wasn't there in the
12 beginning, but it's taken probably a year,
close to
13 a year. But we believe that part of the problem
14 with that was the system, the system that we
15 currently have.
16 And the support people are
back East.
17 They're pretty good to work with it, but
they didn't
18 have proper training. It's difficult to get a lot
19 of help with things.
20 And particularly with respect
to what
21 the investigations division needs, there are
a lot
22
of things in there that don't work the way they
23 should.
And we want to get a combined program
24 that's going to work for all the divisions
smoothly,
25 and doesn't have a lot of glitches.
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1 This system, we keep running
into
2 little glitches as well. We will come up with a
3 physician that's
not listed the same on there as
4 everybody else.
5 So we just haven't been overly
happy
6 with it. It serves the purpose, but we thought it
7 might be best to look at other systems.
8 This one in particular we've
been
9 hearing raves.
10
11
states mentioned it.
12 DR. MONTOYA: The pharmacy board?
13 MS. MUNSON: The pharmacy board has,
14 and I believe a couple of other boards in
15 think the nursing board is considering
it. I might
16 be wrong on that, but I was told they have
it or
17 were considering it.
18 So we thought we would take a
look at
19 it. It's just a demo. It's free.
Get an idea if
20 it might be worthwhile, and bring it back to
the
21 board, get some ideas of costs and see if
that's
22 something we want
to pursue.
23 DR. MONTOYA: I appreciate you keeping
24 us in the loop.
25 Nothing for us to do right now
from
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1 what I understand.
2 MS. MUNSON: Unless you want to
3 approve the education module to our current
system.
4 DR. ANWAR: Why would we want to do
5 that?
6 MS. MUNSON: My recommendation would
7 be to wait. We have waited this long, we're going
8 to see the demo in
January. From what the rep tells
9 me, they could get
us up and running really quickly
10 in just a few months. So that would be my
11 recommendation.
12 DR. MONTOYA: I recommend we wait
13 also.
14 MS. STOESS: So do I.
15 MS. KIRCH: Would we know something by
16 the March meeting?
17 MS. MUNSON: Absolutely.
18 DR. LUBRITZ: Specifically, what's
19 going to appear -- tell me why we need the
new
20 module. Specifically what's going to appear on the
21 website?
22 MS. MUNSON: I can actually show you.
23 I do have a sample of it. I'll pass it out. It did
24 show us how it will look. And it will be the
25 education, basic
education information. I think
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1 it's on the second to the last page.
2 DR. LUBRITZ: On the information that
3 you're looking to put on, tell me
specifically what
4 that is.
5 MS. MUNSON: It's the educational
6 background of the physicians.
7 DR. LUBRITZ: Okay.
Where they went
8 to medical school? College? High school? What are
9 you going to put on it?
10 MS. MUNSON: It has only medical
11 school. We don't go back that far. It's medical
12 school, and internship and residency and
13 fellowships.
14 We won't have the board
certifications
15 on there, because we can't control when
they're up
16 to date, so that will
not be included on there.
17 DR. LUBRITZ: And that is not
18 currently on the website
now?
19 MS. MUNSON: No, it's not.
The
20 reason it wasn't put on there, apparently
when they
21 converted to this License 2000 system, the
22 educational information
was found to be faulty, some
23 of it. In some of the cases when they took the
24 conversion, it
didn't convert correctly.
25 DR. LUBRITZ: Specifically, what is on
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1 the website? You have the name, you get the
2 address, you get
the specialty. What else?
3 MS. MUNSON: The disciplinary
4 records. We don't have a license number or the
5 issue or expiration dates on there currently
either.
6 DR. LUBRITZ: Are we lacking
7 something? And have we had any complaints about the
8 fact that we don't
list where the doctor went to
9 medical school?
10 MS. MUNSON: Yes.
11 DR. LUBRITZ: A lot?
A little?
12 MS. MUNSON:
A lot of people have
13 called, and they don't like the fact that
they have
14 to call us to get the
information. It's long
15 distance for a lot of people. That's usually the
16 complaint. Most states have that information on
17 there.
18 DR. LUBRITZ: If it's something that's
19 really important, maybe we want to track to
see how
20 many calls are we really getting, for
someone to
21 have to call up and say, gee, why didn't you
put
22 that on there? I mean, lots of people want lots of
23 things.
24 It doesn't mean that we have
to
25 acquiesce to someone who says I'm too lazy
to make a
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1 phone call because
I specifically want to know. I'm
2 not opposed to it, but my thought is if we
are going
3 to spend the money,
let's spend it and try to get
4 some data. How many people are really calling and
5 disappointed that we don't have it listed?
6 DR. MONTOYA: There's two options that
7 she's giving us. She's not recommending that we go
8 through this right now.
9 DR. LUBRITZ: I understand.
10 DR. MONTOYA: What she's actually
11 saying she wants to go to a new, better
system than
12 that we already have in
there anyway.
13 DR. LUBRITZ: I understand.
But is
14 there
any reason that we can't keep track of who's
15 really calling, how frequently do we get the
calls
16 and the requests?
17 MS. MUNSON: We can do that.
18 DR. LUBRITZ: The next thing, somebody
19 else is going to want some more information
and
20 we'll be providing more. Does he have any child
21 support history?
22 DR. CLARK: Marital history, child
23 support.
24 DR. MONTOYA: What I'm hearing is that
25 we would like to just wait on this. Let you do your
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1 research and review the other system, and you'll be
2 back with this in March?
3 MS. MUNSON: Yes.
4 DR. MONTOYA: So we'll table this
5 until then.
6 Do I have any motion to table this
7 until then?
8 MS. KIRCH: Motion.
9 DR. MONTOYA: Second?
All in favor?
10 So we'll put it off until
March and
11 consider it then, and see what we can come
up with.
12 MS. MUNSON: Thank you
13
14 8. REPORTS
15 DR. MONTOYA: Reports.
Diversion
16 program come
through? Peter Mansky?
17 Congratulations.
18 DR. CLARK: Don't you take this
19 chair.
20 DR. MANSKY: Is it possible for us to
21 wait for our president, Roger. I think his plane is
22 late. I hate to put it off.
23 DR. MONTOYA: There's other people
24 that can talk. You're here, and have a foot in the
25 door.
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1 John?
2 DR. MANSKY: Thank you very much.
3 DR. MONTOYA: Sure.
4 DR. MONTOYA: This is John
5 Lanzillotta, the
advisory committee member.
6 MR. LANZILLOTTA: Good morning.
7 The resignation of Nancy Munoz
leaves
8 a vacancy in the PA
advisory committee. We
9 currently usually have three members. And I'm here
10 this morning to make a nomination of Janet Wheble
11 for that position.
12 Janet has practiced as a
physician's
13 assistant in
14 and well-respected officer in the
15 Physician Assistants. Her background is extensive
16 in a number of medical specialities,
including
17 emergency medicine, and she works in
18 now.
19 Janet has been a clinical
advisor for
20 the
21 Studies, the
22 Studies.
She was a clinical instructor; clinical
23 instructor at the
24 UMC.
25 She's also an administrator of
our
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1 corporation and provides for recruitment of PAs for
2 individual physicians and groups, and also
does
3 medical legal
consultation.
4 Janet really maintains and
exemplifies
5 a high standard for our profession, and I
feel that
6 she would be an asset on our committee.
7 And if the board would ever
require us
8 to have a more expanded role in serving the
board,
9 then she would certainly be a very qualified
10 candidate with
her background.
11 DR. MONTOYA: I wondered why this was
12 included in the packet. I figured somebody had gone
13 someplace because this
showed up. I didn't know
14 about the resignation.
15 Is Janet here?
16 MR. LANZILLOTTA: Yes.
17 DR. MONTOYA: I would like to talk to
18 her.
19 MS. WHEBLE: I'm Janet Wheble. I've
20 been in
21 we were some of the very first PAs in
22
feels like it anyway.
23 I would think this would be an
honor
24 and privilege to serve the advisory
committee for
25 the state.
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1 DR. MONTOYA: Your paper looks great.
2 I think we would be honored to have you
around. We
3 have to do this as an individual agenda item
later
4 apparently, because you weren't on our
schedule to
5 consider you as a replacement. Okay?
6 But I'm glad you came. I don't
7 foresee any problems. Thank you for taking the time
8 to come down.
9 John, thank you. Is that it, John?
10 MR. LANZILLOTTA: Yes, thank you.
11 DR. MONTOYA: The respiratory care
12 committee?
13 MR. GARCIA: The gentlemen of our
14 advisory committee
wants to thank you. The only
15 thing that has been at all an issue with the
16 respiratory profession in the state of
17 last few months had been related to the
weapons of
18 mass destruction, the continuing education
required
19 for physicians and
physician assistants.
20 We have a large majority of
the
21 facilities, particularly the hospitals in
the state,
22 are telling respiratory therapists that that
law
23 applies to them, too, and that they need to
take
24 it.
25 Our professional society,
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1 Society of Respiratory Therapists, has
recommended
2 to all therapists that
they take that education.
3 Many of the outcomes, clinical outcomes for
people
4 who might be involved in such a problem end
up in
5 the respiratory court.
6 But Mr. Cousneau
helped me research
7 the law, and, indeed, we were not mandated
to take
8 that education.
9 The board has been answering
questions
10 when people call appropriately to the office
telling
11 our practitioners that, no, you do not have
to take
12 that by law.
13 For a while there was a little
bit of
14 confusion, but I
certainly appreciate your help.
15 We've gotten out the word, and once again we
thank
16 the board for their
guidance and support.
17 DR. MONTOYA: Any questions? Michael
18 Garcia, respiratory therapist.
19 MR. GARCIA: Thank you.
20 DR. MONTOYA: Investigative
21 committees, we have Dr. Baepler.
22 DR. BAEPLER: We completed our work
23 yesterday. Angie is now putting the results in
24 printed form and will fax them back, and
we'll have
25 them a little bit later. We have don't have the
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1 report back from Angie yet.
2 DR. MONTOYA: How many cases did you
3 consider?
4 DR. BAEPLER: 117.
Over 40 discussion
5 cases, four appearances.
6 DR. MONTOYA: How many boxes of
7 material? Bilateral hernia boxes?
8 DR. BAEPLER: 113 cases.
9 DR. MONTOYA: You overstated your
10 workload.
11 DR. BAEPLER: This was quick work.
12 Thank you.
This should be circulated as the cases.
13 DR. BAEPLER: In brief then: 113
14 cases considered,
we filed on six of them. Sent out
15 for a peer review, an extra peer review on
one of
16 them. Calling for five appearances at our next
17 meeting, and need further followup investigation on
18 nine, and closed 92.
19 DR. MONTOYA: Closed 92?
20 MS. KIRCH: What do you mean by
21 closed?
22 DR. BAEPLER: No further action. No
23 disciplinary action. The doctor is informed that
24 the complaint is closed. Just advised the level of
25 any action over.
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1 DR. MONTOYA: The head of ICP,
2 Dr. Lubritz. For the nice statistics in front of
3 him.
4 DR. LUBRITZ: If Doug's calculations
5 are correct, we
have a total number of cases 63;
6 total cases authorized for filing were
eight. Total
7 cases authorized for peer review one. Total cases
8 requested for appearances is
five. Total cases
9 authorized for further followup
or investigations
10 were four.
Total cases closed were 45. So I
guess
11 that means that I'm
a little low next time.
12 I have some numbers here in front of
13 me. I want the new board members to know and the
14 public to know that the real work of all this whole
15 stuff goes on to
the investigative committees. They
16 work the hardest of anybody here. And it's tough
17 reading all those files. They put in long hours,
18 and they have to meet twice as often as just
a
19 general board
does. And I do appreciate all the
20 effort all these
investigative committee people go
21 through, and I know you're working
hard. That 117,
22 I'm glad --
23 DR. BAEPLER: 113.
24 DR. LUBRITZ: I'm glad I got off your
25 committee in time.
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1 Doug Cooper, Douglas Cooper,
chief of
2 investigations is sitting right there, gave
me some
3 statistics for the total open investigations
that we
4 have going on now. Of complaints 632. Average for
5 investigator is 90
cases. Civil court cases pending
6 opening 112. In other words, these aren't in open
7 court yet.
8 The last pool of civil court
cases is
9 in July of 2004. Investigators went and looked at
10 the civil court cases to see if there were
any
11 malpractice cases going on there; complaints
against
12 doctors. And they had to call through all these
13 court things, because sometimes the court, or
the
14 lawyers or the doctor doesn't report them.
15 And this means that in
addition to the
16 112 cases opening, civil court cases filed
are also
17 pending opening, but
there's an amount unknown.
18 DR. BARNET: Can you give a ballpark?
19 DR. LUBRITZ: About 11 or 12. About
20 60 to 70 in July to
probably December. That might
21 be a little
high. It seems to have slowed down a
22 little bit.
We're up to July. We're a couple
of
23 months behind. We're looking at maybe 60 more to
24 add to the 112.
25 DR. BAEPLER: The numbers are big.
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1 But they're comfortable with these numbers.
2 DR. MONTOYA: Who's comfortable?
3 DR. BAEPLER: The investigators.
4 They're comfortable with it. The medical reviews.
5 DR. MONTOYA: Peer reviews currently
6 being conducted are 69. And peer reviews pending,
7 peer reviewers is
61.
8 Part of the problem we're
running into
9 it's hard to find peer reviewers. And if anybody
10 has anybody that will volunteer to be a peer
11 reviewer, that would be really appreciated
by the
12 board. Because we need it in all
walks. We need
13 radiologists, family practitioners,
neurologists,
14 ophthalmologists. We need them all to come up and
15 help us because it is hard to find them.
16 DR. BAEPLER: There's a budgetary
17 impact, too.
Obviously, the case load has
18 practically doubled, and the peer review
fees used
19 to be incidental. There's now a significant budget
20 item that we need to be aware of.
21 DR. MONTOYA: So the consideration of
22 cases recommended for closure, did that make
it all
23 the way around yet? So I can't consider that yet.
24 Where is it?
25 All right. As soon as that gets
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1 around, we can vote on that.
2 Meanwhile, the status of
investigative
3 case load.
You just heard 90, and you're
4 comfortable.
5 I want to hear from Mr.
Cooper. What
6 do you think about that?
7 MR. COOPER: What do I need think
8 about 90?
9 DR. MONTOYA: What do you think about
10 the case load?
11 MR. COOPER: Historically, we were
12 always running behind. We have adequate personnel
13 now not to be running
behind. So we can handle the
14 investigators that we
have. We're running at about
15 an average of
90. We can handle that.
16 We do hit a bump whenever we
get on a
17 project that the people go out of town for a
few
18 days, and we, under Mr. Clark's direction,
we
19 prioritize cases. There's a priority system now.
20 So we will get behind on some when other
cases take
21 a priority.
22 We didn't do that in the past. We
23 worked them as we got them, but now we do
that. But
24 I think with the staff that we have at this
point,
25 notwithstanding an increase in civil court
cases,
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1 findings statewide or exceptionally hard
cases that
2 need more than one peer reviewer or need
peripheral
3 investigation, I
think we can handle with the staff
4 that we have at this
time.
5 DR. LUBRITZ: How does your case load
6 compare to other states?
7 MR. COOPER: Last time I did that
8 survey, the other
states were running between --
9 this is from memory now, so if you look that
up I
10 might be off a little bit. But they were running
11 from 45 to 52 per investigator.
12 DR. LUBRITZ: So you have twice the
13 number of cases?
14 MR. COOPER: We're a little bit higher
15 than our surrounding
states. But you have to
16 consider in those numbers, too, the way
things are
17 done in other states compared to our
state. We're
18 pretty much
straightforward. The investigator
works
19 for the board of medical examiners, and we
do all
20 the medical or other
cases.
21 In some of the other states,
they
22 come under umbrella organizations. They do all
23 professional licensing. So an investigator might
24 have -- in
25 cases and three contractor board cases and
two
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1 cosmetology cases.
2 So they're a little bit askewed. I
3 think those cases are a little bit easier to
work.
4 More cut and dried than medical cases. So the
5 numbers don't always show a fair
representation of
6 what's going on.
7 I can only say with the staff
we have
8 now, with these numbers we're doing
fine. We do
9 need to catch up on the
10 civil court filings,
and we do need to catch up on
11 our peer reviews. We're a little bit sluggish in
12 those areas. Historically, it's just tough to do
13 that.
14 DR. LUBRITZ: Because we can't get
15 them a peer review because they're --
16 MR. COOPER: We're at the mercy of the
17 peer reviewer. It's good when people call and
18 volunteer to be a peer reviewer. If someone calls
19 and they're not board certified in their
specialty,
20 and you have 27 complaints on them, and we
can't use
21 them.
22 A lot of the calls that we get
we have
23 to slough off because
they don't qualify. They
24 don't meet the legal standard were they to
testify
25 at a hearing. So that limits the number.
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1 The other part is once we turn
the
2 case over for peer
review, we don't want to be
3 pests. We'll check in at 30 days, but we have peer
4 reviews that have taken
six months to get completed.
5 And it's almost better to wait for that than
to
6 confront the physician and say we have to
have
7 this. You can't do it? Give it back to me and
8 start the search all over again.
9 So that's a variable there
that we
10 can't control. So it's a combination of once we
11 give it to them, get it back to them and
then
12 finding appropriate peer reviewers who are
board
13 certified in their specialty. No formal complaints,
14 no heavy confidential
complaints. We look at that
15 also.
16 And just recently we've gone
out of
17 state on a couple pediatric
cardiologists. We
18 started at the
19 School and went all the way to
20
couldn't find anybody. And low
and behold, one of
21 the new investigators had graduated from UC
Davis,
22 had a friend that worked in the hospital
there that
23 knew the chief of pediatric cardiology,
someone we
24 hadn't got the name of. And called him, and he is
25 doing a case now.
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1 That took six months. Six months we
2 were actively looking for a peer
reviewer. We went
3 to
4 someone that didn't know
the physician involved.
5 Because the physician involved was popular
and knew
6 a lot of people.
7 DR. MONTOYA: Another wrinkle we threw
8 in the investigator, they have to give progress
9 reports to the individual
that filed the action. I
10 can't remember what is --
11 MR. COOPER: The first thing we do is
12 we send a letter telling the complainant
that we
13 received it, and that we're working the
case. And
14 we encourage any phone calls or any
communication
15 that that complainant
has at any time. And believe
16 me they do
call. So you have almost continual
17 updates by telephone.
18 And then we send a 45-day
letter. If
19 the case continues for more than one IC
cycle, that
20 45-day letter
automatically becomes a 90-day letter.
21 And phone calls continue.
22 So there's three written
23 correspondences in 90
days plus phone calls. And
24 then when an action does take place, if
there's a
25 filing of a formal complaint or a closure of
the
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1 case, a letter is written to the
complainant, too.
2 So that cycle involves a lot
more
3 correspondence
with each complainant than it used
4 to.
5 DR. HELD: Would it be valuable when
6 you have particular difficulty finding a
peer
7 reviewer to circulate a question, because a
lot of
8 us have connections all over the country,
and could
9 potentially call somebody and say, hey,
John, we're
10 having trouble, could you help me out.
11 PAMELA: I have started doing that.
12 In fact, I think the last time I called and
asked
13 for several referrals -- and I need to talk
to
14 Dr. Montoya about OB/GYN
in
15 But I have been doing
that. And plus
16 the list of peer reviewers, qualified peer
reviewers
17 grows every
month. And so the list is much bigger
18 than it was, you know, two or three months
ago.
19 Because I got a response from the newsletter
that
20 was sent out, and I'm still making my way
through
21 that list of people interested in being peer
22 reviewers.
23 But also you have to realize,
too,
24 that when we receive a peer review from a
peer
25 reviewer, Dr. Barnet reviews it, and/or
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1 Dr. Calvanese, and they render their opinion on
2 quality of the peer
review. If it's a peer review
3 that doesn't address appropriate questions
and
4 appears to be of poor quality, then that
peer
5 reviewer's name is removed from the list.
6 So it's not necessarily
consistent all
7 the time, or they
decide they don't want to do it,
8 or they have obligations and say, you know,
I can't
9 do it for the next six months because of my
10 schedule.
11 MS. STOESS: How much of a peer
12 reviewer's time does it take to do one peer
review?
13 PAMELA JAMES: The average I would say
14 is two or three hours, is what they're
submitting.
15 We have some that have gone, you know, six,
eight,
16 ten. But depending on the volume of the charts,
the
17 length of the
charts and sometimes the peer
18 reviewers on the same doctors have to review
four or
19 five charts, but the average time is
probably about
20 three hours.
21 DR. MONTOYA: Thank you very much. I
22 appreciate it.
23 DR. MONTOYA: Consideration of Cases
24 recommended for closure. We saw A.
We don't have
25 B's list.
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1 MR. COOPER: Do we have B's list?
2 DR. MONTOYA: Recommended for closure
3 until we see B's list.
4 MR. COOPER: That was compiled shortly
5 after --
6 DR. MONTOYA: Oh, we have A. The list
7 of closures. We don't have B.
8 Do you have it?
9 MR. COOPER: I don't have it with me.
10 I thought it was faxed to Dr. Lubritz several weeks
11 ago.
12 DR. CLARK: We will get that and have
13 it for you by this
afternoon.
14 DR. MONTOYA: I may just wait for this
15 and we'll come back and check that. Can you put a
16 particular letter
in the system to come back to it?
17 And
18 Liaison Report. That would be me. I missed their
19 November meeting. I had a delivery at the same
20 time. But I would say we're getting along well.
21 And what happened at the
November
22 meeting? Did I miss something? What they were
23 fairly excited about was passage of Question
3, and
24 the failure of Question
4 and 5. So they were
25 pretty happy about that, and so was I, and
so were
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1 most of the people on
board.
2 DR. HAVINS: If there's any questions,
3 the next meeting of the board is on January
15th.
4 And that will be looking at the legislature
at
5 issue.
That may come up there. So I'm
sure we will
6 want to make sure we are coordinated on
that.
7 DR. LUBRITZ: Are you proffering any
8 legislative person?
9 MR. MATHEIS: There are several issues
10 that are continuation issues on managed care
and
11 some other items that we'll be supporting
that are
12 actually coming through
the regulatory agencies.
13 At this point we don't have
specific
14 legislation. We are working with others on the
15 issue that you also support, and that is
16 reestablishment of the
medical screening panel. And
17 I'm not sure exactly how that will be
proceeding,
18 negotiating with the
legislature on that.
19 DR. BAEPLER: But if they don't fund
20 it, it's not worth having.
21 MR. MATHEIS: There's a lot of
things
22 if they don't do it it's not worth
having. That's
23 why it's going to take
some discussions.
24 DR. MONTOYA: Thank you very much.
25 This is the diversion program.
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1 Dr. Mansky,
executive director.
2 DR. MANSKY: Thank you very much for
3 distributing our report. And glad to be here.
4 And let me summarize some of
the
5 report.
We have 65 active participants, along with
6 14 candidates for licensure who the program
is
7 dealing with.
8 Three participants have been
9 inactivated, five have been activated. Fortunately,
10 two of the inactivated were for
noncompliance.
11 We interviewed eight
candidates, one
12 in the previous quarter
in person. And I want to
13 say that working with Lynnette, the license
14 specialist, it's been a pleasure and very
helpful,
15 and it's been a pleasure to coordinate our
efforts
16 in reviewing the new
candidates coming in.
17 We've continued to work with
the board
18 investigators, with Doug
and Pam. And we've done a
19 couple reports for them. And, again, it's a
20 pleasure working with them, along with Steve
and
21 Tony, and I
appreciate their help in the operation
22 of our program. And we want to continue to
23 strengthen our relationships with the board
staff.
24 It's been a good few months, and I hope that
it's a
25 good few years.
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1 We're financially solvent with
a two
2 or three-month operating
reserve. But we still want
3 to increase our fund raising,
and we've approached,
4 along with the officers from our board, the
dental
5 and pharmacy board, the nursing board, and
the
6 osteopathic board.
7 We do need to establish a
full-time
8
office and a staff, I think, to accomplish all our
9 goals. And that's one reason why we want to
10 increase our fund raising efforts.
11 We do have candidates for
licensure to
12 pay for their urine testing, or chemical
toxicology
13 testing. The board -- at the board meeting, it was
14 decided that we would like to establish a
fee of
15 $250.
16 We ran this by the board
staff, and
17 with your blessing, we will do that for each
18 candidate that comes by and charges them for
the
19 person-to-person
interview, for the report, and for
20 the urine testing.
21 DR. LUBRITZ: Dr. Mansky, you're
22 requesting that your board
pay, or our board pay?
23 DR. MANSKY: Our board, the foundation
24 board, decided that we would like to explore
the
25 possibility of charging $250 to each
candidate
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1 directly that comes in who has to be --
2 DR.
LUBRITZ: I mean, you're not
3 asking the Nevada State Board of Medical
Examiners
4 to pay that bill?
5 DR. MANSKY: No, not at all.
6 DR. BAEPLER: Would you explain to me
7 the terminology, what is a candidate for
licensure?
8 When you say you have 14 candidates for
licensure,
9 people that are trying to
get a license from us?
10 DR. MANSKY: We are working with the
11 license specialists for people who are
applying for
12 a license in
13 drinking and driving arrest, known problems,
or are
14 in recovery with another physician's health
15 program.
16 DR. LUBRITZ: Does that also take in
17 abusive physicians? Disruptive?
18 DR. MANSKY: It would be if they've
19 answered the question on the board
questionnaire
20 that they've had such a
history.
21 DR. LUBRITZ: That would also be in
22 your purview?
23 DR. MANSKY: It would.
We have in
24 this round of applicants had someone who has
gone
25 through disruptive. Almost all of them that have
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1 come through have had a substance or a
suspected
2 substance abuse disorder.
3 DR. BAEPLER: Candidates for licensure
4 which
are not presently licensed in
5 subsidize any kind of a treatment for them,
or do
6 they pay their way?
7 DR. MANSKY: They pay their way.
8 And they were really getting
an
9 evaluation service for
free from our group. And we
10 felt we are charging them for urine. It is actually
11 a fairly significant expenditure of time to
contact
12 these people and arrange. So we think that this is
13 a very fair fee, and many other states do
that.
14 DR. LUBRITZ: I would expect it
15 actually.
16 DR. MANSKY: We have, by the way, been
17
referred a couple who have had boundary issues, and
18 we have had people calling us up, usually
through
19 the licensing specialists, asking our
opinion of
20 should they apply for a
license or not.
21 So we have really -- this has
really
22 been an effort of ours working with a
license
23 specialist.
24 We've increased our
networking. We've
25 met with administrators of several hospitals
and
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1 private groups. We have at least three
outreach
2 lecturers, and one just recently -- and this
is why
3 Roger had to come down from
4 Roger gave a lecture up in Elko for the
University
5 of
6 center, and this was telecasted to
Winnemucca and
7
8 presentation.
9 We are going to give a
lecture, or
10 I've been asked to give a lecture for the
American
11
12 January.
And this is not only an honor, but we hope
13 to be able to talk about our program with
about 200
14 physicians that will be
at that meeting.
15 We would like to increase with
our
16 outreach our referral base, and we would
like to be
17 able to give referrals of physicians early
on in
18 their disease before they have had
impairment at the
19 work site.
And we hope that through our outreach
20 efforts we can do that.
21 It may take quite a while
before we
22 become an entrusted place for them to go,
but I
23 think that this may well help increase our
ability
24 to protect the public.
25 We also want to establish some
local
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1 treatment resources utilizing clinicians in
2 and we've done site visits, and educated
selective
3 clinicians concerning evaluation and
treatment needs
4 of the foundation. And most of the initial
5 evaluation and treatment, however, still
remain at
6 national centers, which are approved by the
7 foundation.
8 We continue with our two
active
9 diversion committees,
and each committee now meets
10 monthly. I attend the meeting. There is one
11 meeting in
12 We review cases, discuss cases, and the
committees
13 have also addressed areas of operation and
concern
14 for operational improvement and issues that
we need
15 to refer to our foundation board for
discussion.
16 Along with that, under the
leadership
17 of Roger, we've approved conditions for
18 participation, because it clearly reflects
the
19 choice of coming into
the diversion program.
20 And, additionally, it is not
21 officially a contract, so that this can
avoid some
22 difficulties which we've
had in the past.
23 There are legal implications
about
24 mandating 12-step meeting attendance. And our board
25 has come up with the fact that we would like
to
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1 mandate attendance at mutual help groups
which
2 consists of recovering addicts and
alcoholics, and
3 it requires that the group of recovering
addicts or
4 alcoholics help to establish a lifestyle
which
5 promotes abstinence
and recovery.
6 There are other groups that do
12-step
7 groups, so that this avoids the mandate into
12-step
8 groups which some of the
courts have criticized.
9 Both of these requirements
really
10 help combat the isolation of the addict, and
11 non-effective lifestyles
that they have developed.
12 Finally, we have a very costly
13 collection of urine. We have collectors go out for
14 urine, and in the outlying districts this
can be
15 costly. So we've explored other possibilities. And
16 some of the states have now worked with NIDA
17 certified centers for collection. These are not
18 observed urines, but they're collected in a
room
19 without a water source, which has a toilet,
which
20 has blue fluid in
it. They are asked to remove
21 outer garments before they go in. The person from
22 the laboratory stands outside the room. The sample
23 is measured for
temperature.
24 And so far, I've talked to one
state,
25
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1 found it very successful, and they found
that after
2 they did it, that some of their staff, who
was
3 supposed to observe the individuals, after
they got
4 used to them for a while, weren't observing
urine.
5 Other states do use volunteer
6 physicians in the area where the physician
is to
7 observe and collect the urine and start the
chain of
8 custody.
9 And that's another
possibility. Those
10 physicians are usually asked to sign a
contract and
11 an agreement that
they will observe the urines. And
12 some of them have been tougher than our
collectors.
13 We are also looking into
laboratories
14 to getting a quality
panel at a lower cost. We
15 would like to get lower costs so we can
increase the
16 frequency of testing, of the physicians, PAs and
17 various therapists.
18 Finally, we are looking into
utilizing
19 a new test called TGT, ethylglucobromide. It can be
20 picked up in two or three days, and it
avoids
21 something that happens
with measuring alcohol.
22 Alcohol can be produced in the urine outside
the
23 body if there's sugar and yeast or bacteria
in the
24 urine, whereas the ethylglucobromide
is only
25 produced in the body.
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1 It can also be measured up to
two or
2 three days after ingestion of alcohol, so
that our
3 tests really only pick up, I think, a number
of
4 hours after ingestion, but it depends upon
the dose
5 of ingestion.
6 So I respectfully submit this
report,
7 and am open to any questions you may have.
8 DR. MONTOYA: Nicely done.
Any
9 questions?
10 DR. BELCOURT: One other informational
11 thing. I have reduced the board requirement of two
12 ethics credits per year to attach to this
foundation
13 presentation. And what that does is when you go out
14 and tell a group of rural physicians that
you're
15 going to give them two ethics credits for
sitting
16 down and listening to me for an hour and a
half, you
17 get excellent attendance.
18 So I think that's an
unanticipated
19 benefit.
20 DR. MONTOYA: We don't need any action
21 on that. It's happened already. It's going on.
22 DR. BELCOURT: I guess I'm asking for
23 forgiveness.
24 DR. MONTOYA: I would go to your
25 lecture.
It's hit and miss whether you get a good
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1 ethics lecture or not. Sometimes I do it through
2 the mail or on-line.
3 Any questions? Thank you very much.
4 MR. GARCIA: Dr. Montoya, I have a
5 question for Dr. Mansky.
6 DR. MONTOYA: Sure.
7 MR. GARCIA: The amount of respiratory
8 therapists in your program, do you have a
feel for
9 that?
10 DR. MANSKY:
I do. We have a group
11 that meets once a week,
and we have about 20 in that
12 group. That's phase one.
13 DR. MONTOYA: Thank you very much.
14 Dr. Baepler,
do we have any money
15 left?
16 DR. BAEPLER: I'm going to do the
17 second item here first. This is the current status
18 requiring no action. And as is usual, is
19 incomprehensible.
20 Remember, once again, that the
21 reason -- anybody
else require one? The reason that
22 this is so difficult to understand is that
we
23 operate on a biannual basis for
collections. Once
24 every two years we get in most of our money
when
25 people renew their licenses. But we operate on a
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1 fiscal year by state law
and mandate.
2 It would be very easy if we
had a
3 biannual budget rather than two annual
budgets
4 because of the way in
which we get revenue.
5 In the first year of biannum, we
6 always show lots more revenue than we will
have
7 expenditures. And in the second year, that we are
8 in now, we will always
show much lower expenditures
9 than revenues because we're living off the
money we
10 collected a year ago last June.
11 I can simply assure you that
the
12 situation, as indicated in the status
report, is
13 exactly as planned. There are no surprises in
14 revenues or
expenditures. Which
is kind of amazing
15 because we're in the second year, and we
projected
16 these things over -- well, about two years
right now
17 we've projected these and they wound up
quite well.
18 DR. ANWAR: The financial statement is
19 how assets and
liabilities always match up.
20 DR. BAEPLER: An accountant will force
21 that.
The best answer is you force the balance.
22 MS. KIRCH: Yeah.
23 DR. BAEPLER: This is shown as profit
24 and loss, which is a
standard accounting term. It's
25 actually expenditures versus -- income
versus
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1 expenditures.
2 DR. ANJUM: Projections of
3 expenditures.
4 DR. BAEPLER: As of December 4th, or
5 whatever the closing date is on the
top. So
6 everything is
fine. We're well within our budget,
7 and everything is quite right.
8 DR. MONTOYA: Do I have a motion to
9 approve the budget? Second?
All in favor?
Anybody
10 opposed? Passes. Thank you very much.
11 DR. BAEPLER: The big item now is the
12 next biannual budget. Do you want to take it up at
13 this time? It includes setting the fees, the
14 licensing fee.
15 DR. MONTOYA: Doesn't that come up
16 later on, something
about setting fees.
17 DR. CLARK: I think it essentially
18 comes up now.
19 DR. BAEPLER: This is listed here as
20 consideration of approval of biannual budget
for the
21 next two fiscal years, which is the next biannum.
22 And you can't do that item unless you know
what your
23 income is.
24 DR. MONTOYA: You're absolutely
25 right. I thought it was a separate agenda item.
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1 Please.
2 DR. BAEPLER: Two years ago, a little
3 bit over, we had a large balance reserve
fund. We
4 contemplated, perhaps even to the point
where we
5 could build a building or buy a building
rather than
6 lease and rent,
and a variety of options. But there
7 was some criticism, and probably justified,
the
8 reserve was
getting to be too large.
9 At the start of this biannum, for
10 example, the
reserve was almost 3.7 million
11 dollars. Remember that that's a biannual reserve.
12 You divide that in half to see what your annual
13 potential reserve
would be.
14 And it was decided that we
would
15 whittle that reserve down so that we would
16 ultimately end up with something in the
vicinity of
17 maybe a million and a half, which is
something like
18 500 to 700,000 per year
annual reserve.
19 And so we intentionally set up
a
20 licensing fee schedule to where we would
operate at
21 a loss. And we went from $600 to $400.
22 Now, that was a pretty sizable
chunk
23 and we have, in fact, operated at a loss.
24 At the end of this biannum, June 30,
25 2006, we are going to be well under two and
a half
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1 million. In other words, we whittled about 600,000
2 a year out of the reserves, reduced it by
1.2
3 million.
4 So we haven't reached our
target. We
5 can still operate at a slight loss in the
next
6 biannum. But we are going to have to raise our
7 fees.
8 Unbeknownst to us, due to
legislative
9 changes, we suddenly got a whole new set of
10 circumstances to contend
with. For example, the
11
number of investigative cases with all these things
12 coming from the court have doubled. The budgetary
13 implications of that, we have two IC
committees now
14 rather than one. We had an to add another medical
15 advisor. We had to add more legal staff. We added
16 three more investigative
staff.
17 You begin to add these up, and
it's a
18 very significant budgetary item to double
the
19 number of investigations and staff and
everything
20 associated with it. It's largely unanticipated.
21 On the bright side of the
ledger, we
22 had a significant increase in license
applications.
23
And we've added two people to the licensing group,
24 if I remember correctly, since the start of
the
25 biannum.
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1 That's why we're taking up so
much of
2 our space in the building,
and all of this has to be
3 reflected in the budgeting.
4 Now, Tony did a fine job of
getting
5 together figures. And he also put in a new twist,
6 which was quite right and
appropriate.
7 He went to our outside
auditors and
8 gave them a number of assumptions, which all
make
9 common sense. The type of thing that you have to
10 know to build a budget. You can review these at
11 your leisure.
12 Now, what we did was we
actually asked
13 the outside auditors and accountants to do
some
14 modeling for us. And the next pages -- so we tried
15 an experiment here, which I'm not sure was
16 successful or not.
17 They first presented it, just like
we
18 classically have, as a biannual budget
divided into
19 two fiscal year budgets. And we said just for fun,
20 break it down into something that might be
more
21
understandable into two fiscal years, taking the
22 money that we get at the
beginning of the biannum
23 and artificially cutting it in half and
showing it
24 as coming in on June
30th of each year.
25 So you can kind of equate revenue
to
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1 expenditures on an
annual basis. And that's what
2 these next pages do. The first page is for the
3 first fiscal year. The second page is for the
4 second fiscal year, with the fees at the top
5 projected on an annual basis.
6 Like MD 300. Well, that's a $600
7 fee.
8 MD 312.50, that's a $625 fee
and so
9 on.
10 We show that on an annual
basis, too.
11 I'm not sure that this is successful. But you just
12 have to double those numbers to get the
actual fee.
13 Now, the recommendation from
the group
14 was to increase the doctors' fees from the
400 to
15 650. Comes to 89 cents a day, by
the way.
16 And at $650, we still will be
17 operating -- and by the way, the PAs to go from 300
18 to 350, and to leave the respiratory
therapists
19 where they are.
20 This is still projected to
operate at
21 a loss, so that we would
decrease our reserves.
22 In looking at the projected
23 expenditures and revenue, we have been
conservative
24 in our estimates of
revenue. We have been a little
25 bit cautious in the approach to the
budgeting.
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1 Probably the expenditures here are a little
bit more
2 than they will be, and the revenues are a
little bit
3 less than they will be.
4 I've been thinking about it,
Tony, and
5 I haven't had a chance to talk with you
about it but
6 I did a little modeling myself. I really don't like
7 to go above the $600 figure that we used to
have,
8 and I don't like to increase the PAs.
9 The difference in that is that
going
10 back to the $600 fee for the MDs would cost
us
11 approximately $240,000 of lost revenue from
our 650
12 projection, and keeping the PAs where they are is
13 about a $25,000 figure.
14 Which means we will get into
the
15 reserves a little bit more. And projected that we
16 could finish up the biannum
with less than a million
17 and a half in reserves. But I think that's the
18 worst possible case.
19 Buried in here is the
possibility of
20 adding one or two
positions. I really think we're
21 staffed up now for the biannum,
but we can
22 accommodate, without going off budget, two
more
23 people at the level of an investigator and a
24 licensed person, if it gets to a level. That's kind
25 of programmed in here in an item that is
just
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1 professional salaries
without applying it to
2 existing physician's
positions.
3 And there's
a few other cushions in
4 there, too.
5 So it just depends how fast
you want
6 to
eat up your reserves and get down to a level
7 where the auditors and accountants think it
is
8 acceptable. And which kind of meets the unofficial
9 guidelines of the federation for an
operation with a
10
budget of our size.
11 DR. MONTOYA: What would be the number
12 we have to reach? What would be the minimal amount
13 of reserve we have to reach?
14 DR. BAEPLER: I think to feel very
15 comfortable, a million
to million and a quarter. I
16 think when you're operating a budget the
size we
17 are, and remember again, it's a biannual
figure that
18 reserve.
The fees that we set and which will be
19 collected by next June 30th, we get into the
next
20 fiscal year and have problems, we can't go
back to
21 all of the licensees and say we have to hit
you up
22 for another 100 bucks, we're not going to
make it.
23 So you're stuck with what you
assess
24 today for the next licensing man who's going
to
25 carry us through to
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1 That's the problem with these
2 projections. We don't anticipate anything like we
3 got this last biannum,
which caused us to just
4 double this and double that, you know, the
5 tremendous growth. We think we're in very good
6 comfortable shape
now. And it is with some
7 reluctance, by the way, that you go back to
the $600
8 figure.
9 DR. MONTOYA: Could I ask at this
10 stage, and I think we've got the information
we
11 want, what are the financial numbers we are
asking
12 for?
13 DR. BAEPLER: I'm recommending $600
14 for MDs, 300 for PAs. That's
where you are now,
15 right? And keeping respiratory therapists where
16 they are now.
17 DR. ANWAR: PAs is what figure?
18 DR. BAEPLER: Right now, I don't feel
19 comfortable that the PAs
are -- doctors are only
20 charged $100 more than PAs. That's a little bit
21 disproportionate.
22 DR. MONTOYA: Respiratory therapists
23 keeping the same?
24 DR. BAEPLER: Keep them the same.
25 DR. MONTOYA: 150?
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1 DR. BAEPLER: Yeah.
Respiratory
2 therapists are 150 now?
3 MR. GARCIA: 200.
And $100
4 application fee on the
initial.
5 DR. BAEPLER: And we recommend keeping
6 the application fees and
all of that the same.
7 DR. MONTOYA: Any discussion board
8 members?
9 DR. BAEPLER: Again, I would point out
10 that we still will be operating at a loss,
but it's
11 a planned loss to get us
to our target.
12 DR. MONTOYA: Discussion from
13 outside?
14 DR. DOUBRAVA: Is the only source of
15 our income the licensing fees and
applications?
16 DR. BAEPLER: No. We
have income from
17 other investments and reserve money, but
they're
18 getting less than 2
percent off CDs.
19 DR. DOUBRAVA: The state provides no
20 space for personnel?
21 DR. BAEPLER: No.
22 DR. MONTOYA: A motion is made to
23 accept the proposed fees? Second it?
Any
24 objections? All in favor? Opposed?
Passes.
25 DR. BAEPLER: I really think, again,
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1 Tony, it was a very bright idea to bring the
2 auditors in on the model. They're going to feel
3 very comfortable when they audit us because
they
4 were in on the planning.
5 DR. MONTOYA: The rest of these are
6 going to go pretty fast, so I want to take a
break
7 right now. We've been sitting for quite a while.
8 Bladder capacity is only so much, so let's
take ten
9 minutes.
10 (A recess was taken from
12 DR. MONTOYA: Back to order. The next
13 report is going
to be Tony. Can you give us the
14 update on his trip to the regional meeting
in
15
16 DR. CLARK: Lori Munson and I attended
17 the Administrators of American Western
Regional
18 meeting in
19 beneficial.
20 The principal thing that was
discussed
21 was the
22 and the
23 physician's problems that are outside of
discipline;
24 that is, a problem with sexual boundaries,
problems
25 with alcohol abuse, problems with
temperament.
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1 They have developed three day,
four
2 day, six day, ten day in-residence programs
for
3 physicians to help them deal with these
problems and
4 to resolve those.
5 And I frankly was unaware that
a lot
6 of those programs were available out there,
7 especially for things like recordkeeping, bad
8 temper, and things
of that nature. Of course, we're
9 familiar with the drug and alcohol, but not
some of
10 the others. And so we found that very interesting.
11 And the other thing that
happened
12 there was I was elected to the board of
directors
13 for the Western Region to represent the
western
14 regions.
15 DR. MONTOYA: Congratulations.
16 Great.
17 DR. CLARK: So we will continue on
18 that way. And that's the report.
19 DR. MONTOYA: Valuable resource to get
20 those programs under our
belt.
21 DR. LUBRITZ: Where were those?
22 DR. CLARK: One was University of
23 California San Diego, and the other was in
24 state. And we just had a brochure, we were talking
25 about physicians at the
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1 Western Reserve Medical School in
2 that will help doctors keep better records,
teach
3 them how to do that, how to control temper
and
4 things of that nature.
5 So there are things out there
that the
6 board can
recommend for physicians that are less
7 than a suspension or a
revocation of license. You
8 go for four days to learn how to keep
records and
9 pay for it yourself.
10 DR. LUBRITZ: Can you send all of us a
11 copy of those? That way we can keep in mind when
12 we're sitting here, investigative
committees,
13 whatever.
14 DR. CLARK: I will do that.
15 DR. LUBRITZ: Thank you.
16 DR. MONTOYA: Next would be Federation
17 of State Medical Boards Promoting Balance
and
18 Consistency in the Regulatory Oversight of
Pain Care
19 Workshop down in
20 Mr. Quinn, please.
21 DR. QUINN: I also had the pleasure of
22 attending a seminar put on by the Federation
of
23 State Medical Boards on the promotion of
balance and
24 consistency in
the regulatory oversight of pain
25 care.
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1 This was an excellent and very
current
2 overview of the use of controlled substances
for
3 chronic or intractable
pain. They were great
4 speakers. It was a two-day seminar. The first day
5 was devoted mostly
to philosophical approaches. The
6 second day was divided up into two
tracks: The
7 board track or the investigation track.
8 I went on the investigation
track
9 because that's kind of what
I do.
10 I don't want to take away the
thunder
11 because I know several of our staff are
going to
12 attend this seminar, as it comes up in
different
13 locations. But the interesting things that I came
14 away with is there is an equal or greater
problem
15 with the under-medication of pain and the
16 over-medication
or the over-prescribing problem.
17 And a second thing I came away
with
18 from the seminar is that quantity of
medication
19 alone is never
grounds for an investigation. There
20 were cases, one case, an example, a patient
was
21 receiving 1600
milligrams of morphine a day. And
22 the record was this patient is titrated up to the
23 point where it took 1600 to relieve the pain
so this
24 patient could
function, and she did function.
25 But that's an extreme example,
of
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1 course. But if you look at the chart, when you look
2 at the chart, it's exactly what happened and
it's
3 okay.
4 So the quantity alone is never
enough,
5 and under-medication is just as bad as
6 over-medication.
7 DR. ANJUM: Do we have an institution
8 to bring the dose down in any way, or just titrate
9 it up?
10 DR. QUINN: As you're going through
11 the treatment of pain, you have to consider
all the
12 alternatives. But as you're considering -- in
13 addition to
considering all the alternatives, like
14 what's the cause and what can I do to
relieve the
15 cause, if you're putting pressure on
somebody, you
16 put the -- you give them medication
analgesics to
17 eliminate the pain and the pressure. Well, if you
18 can relieve the pressure,
that will take care of
19 it.
20 You're doing both of these things at
21 once. But you keep going up until the patient can
22 function, until you relieve the pain. Just go until
23 you relieve the pain. And then you can try to back
24 off, too, and then you can explore other
things.
25 The other side of the tragedy
of this
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1 patient is they tried to wean her off
morphine onto
2 methadone, and in the transition they messed
up and
3 she died.
She either died or serious brain injury.
4 I don't know what.
5 DR. ANWAR: Chronic pain management is
6 a very difficult disease to treat, and
generally is
7 treated very poorly in the
8 to
9 DR. QUINN: It's the paranoia,
10 prosecution for
over-prescribing.
11 DR. BAEPLER: The whole point of the
12 model guidelines that we adopted was to
encourage
13 doctors to prescribe enough, not to under
14 prescribe.
It was to be a protective device for
15 doctors.
16 DR. ANJUM: And to use all the tools
17 available to
investigate.
18 DR. LUBRITZ: And to not just give
19 pain medication, but to chart acceptable,
when was
20 the last time that they had a consultation
for their
21 specific area.
22 DR. ANWAR: It may not be available
23 but usually it ends up with one doctor, a
pain
24 management doctor or the primary care
doctor, and
25 that's just not good enough for total care
of that
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1 chronic pain management
patient. There is
2 neurological, orthopedic
intervention and a private
3 care doctor and anesthesiologist, put
together a
4 pain management team,
and those are just not
5 available here very
often. They are in some areas,
6 but not in most areas.
7 DR. QUINN: So as you can see from the
8 discussion, it's a very current
program. It's a
9 very current seminar, and legal staff and
10 investigative staff will be attending.
11 DR. MONTOYA: Thank you very much.
12 The Council of Licensure
Enforcement
13 and Regulations Natural Certified
Investigators'
14 Training in
15 Pam, couldn't you want find
someplace
16 a little picturesque?
17 PAMELA JAMES: Actually, that's my
18 home town.
And it's picturesque, thank you.
I
19 enjoyed visiting my family. Thank you for sending
20 me.
21 Actually, we attended the
conference
22 of Licensure,
Enforcement and Regulation. It's
an
23 organization that
was created to train investigators
24 in regulatory agencies, all state regulatory
25 agencies and not just medical boards, so
they cover
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1 the contractors boards, all kinds of state
and
2 nursing boards,
accounting boards.
3 And so we met a lot of people
from
4 other different boards, and got an agenda
with their
5 names and phone numbers. Made some good contacts.
6 I did there.
So in that respect alone, it was
7 beneficial.
8 But during the three-day
conference,
9 which I attended along with Trent Hyatt,
Angela
10
Canary, and Terry and Heather, we attended the
11 conference, the five of us, and they covered
three
12 different days.
13 The first day, basically they
went
14 over professional conduct and inter-agency
15 regulations. Principals of administrative law and
16 the investigative
process. It was an overview of
17 investigations in
different areas.
18 It included inspections, which
some of
19 that information is very
specific to other boards.
20 But it kind of falls in with us inspecting
doctors'
21 offices.
22 The second day covered
principals of
23 evidence, evidence collection, tagging and
storage,
24 as well as interviewing techniques of
doctors,
25 witnesses on cases, what have you.
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1 And the final day covered
report
2 writing and the similarities and differences
between
3 administrative and
criminal proceedings.
4 And we ended the last day,
there was
5 a 110-question exam, which all the
investigators
6 took.
And their scores -- assuming they had 80
7 percent or above, and we all did -- their scores
8 will be sent to the conference, and they
will get a
9 certificate saying
they passed, and they're
10 certified as a basic investigator for the
first
11 course.
12 There's an advanced course
that they
13 offer, too, which I think Doug will be
requesting
14 training on.
15 DR. MONTOYA: This is a conference you
16 had to pay attention and take a test at the
end?
17 PAMELA JAMES: I know.
It was pretty
18 intense.
19 DR. MONTOYA: Tough.
Congratulations
20 for putting up with all
that. I'm sorry, I don't
21 mean to interrupt you, but I'm impressed.
22 PAMELA JAMES: And it was
23 informative. And from talking to the investigators,
24 they enjoyed it.
25 DR. MONTOYA: Is that it?
Thank you
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1 very much.
2 Request
For Authority to Provide
3
Medical Training in Cosmetic Injection Techniques.
4 MS. KROTKE: I have a group of
5 physicians that would like to come to a
local
6
7 patients with Botox. And
this is something that
8 needs board approval. I don't know if you're
9 comfortable with it or
not. It's just something
10 that we do have to run
through the board.
11 DR. MONTOYA:
Do you want to hear from
12 me now? I don't like it. I don't like it one bit.
13 I don't like people coming in and taking a
bunch of
14 patients and injecting them with Botox, with the
15 same form letter from the same company
saying I'm a
16 wonderful doctor from wherever they are,
17 something, and they
want to come here and recruit
18 our patients. No.
Recruit local people to put on
19 this conference. It's sales.
20 DR. BAEPLER: If it was some kind of a
21 CHE program?
22 DR. MONTOYA: That's under number 8.
23 And you can see towards the back, they have
all the
24 same damned form letter in there.
25 MS. KROTKE: Yes.
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1 DR. MONTOYA: I'm not comfortable with
2 this at all. I'm only one vote.
3 MS. KROTKE: I have a letter from the
4 company that they sent right before we came
down.
5 And these are the letters that they want
these
6 physicians to come in.
7 DR. HELD: Is there any reason a video
8 wouldn't do?
9 DR. MONTOYA: There are local doctors
10 that can inject Botox;
that can teach you how to do
11 this.
12 I'm not impressed with this at
all.
13 Let's call for a vote. I know how I feel.
14 MS. KIRCH: I was going to volunteer.
15 DR. HELD: I would like to move to
16 reject that request.
17 DR. MONTOYA: Thank you.
18 And second
it?
19 DR. COUSNEAU: I want to make sure the
20 board members are clear. I have received several
21 calls about it, and I'm not sure if this is
one of
22 the people I spoke to and forwarded that to
23
Lynette. But I just want to make
sure there is
24 consistency
across the board. We can't one time do
25 it and one time not. If we're going to do this, we
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1 have to make sure it's going to be pretty
much not
2 allowed throughout consistently.
3 DR. BAEPLER: I think we have a
4 condition here,
and I agree with what you said.
5 If it's part of a CME program, continuing
medical
6 education, a
doctor wants to demonstrate a certain
7 technique, we've always
cooperated with that.
8 This is a commercial
promotion.
9 DR. BAEPLER: I think we're all
10 amenable to an expert coming in and
demonstrating
11 something, but this is not the case.
12 DR. MONTOYA: I'm not comfortable with
13 it.
14 DR. QUINN: I would like to add there
15 are several categories of licensure
requirement, and
16 there is also an exception to a requirement
for a
17 licensure. I just want to bring to your attention,
18 an out-of-state doctor, the statute provides
that
19 the requirement to be licensed does not
apply to an
20 out-of-state doctor that comes to
21 on a regular basis to assist a
22 providing care. It basically says other than on a
23 regular basis.
24 DR. BAEPLER: This is not to assist a
25 local doctor.
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1 DR. QUINN:
I'm not saying that. I'm
2 only making this -- I'm only advising that
these are
3 the requirements. You either have to be licensed,
4 or you fall within one of those categories
that is
5 an exception to
licensure, one of which is what I
6 just said.
There are several others, like military
7 doctors and so forth.
8 DR. ANWAR: This is a little
9 confusing. It's an advanced training program for
10 plastic surgeons.
11 DR. QUINN: One of the exceptions that
12 I'm speaking about, and I don't have it
before me,
13 is where it's 630.047(c), where a physician
legally
14
qualified to practice in another state were to come
15 into the state on an irregular basis, and
then
16 subsection 2, provide medical instruction or
17 training approved by the board physicians
licensed
18 in this state.
19 So there's
two aspects to that
20 exception. And one of which has come to my
21 attention, and I
don't know if it's on this agenda
22 or how it was, but you know, that's where
the
23 seminar submits
their training with their curriculum
24 in advance, and
all their training materials in
25 advance, and asks
for board approval. All of this
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1 training.
2 And the other limitation is
that it is
3 for training to
4 DR. ANWAR: This is a natural thing.
5 DR. QUINN: These are the exceptions.
6 DR. ANWAR: It's not just another
7 doctor.
8 DR. QUINN: So this question appears
9 to fall into the category of persons who
need to
10 obtain a license. Which it sounds like that's what
11 they're doing.
12 But they're simply asking to
give me
13 one so I can do this. It sounds like what they're
14 doing.
15 DR. MONTOYA: License for a day.
16 Any more discussion?
17 DR. ANJUM: I believe the impression
18 that any specialty that comes on one time
does not
19 require a license. If they do more than once, you
20 require a license.
21 DR. MONTOYA: What they're asking is
22 to give a license to a
whole group.
23 DR. ANJUM: Even a group.
24 DR. BAEPLER: Give them a license,
25 exempt them from getting a license.
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1 DR. MONTOYA: These people are going
2 to be working on live patients. We have to
3 investigate all these people to make sure
that
4 they're --
5 DR. ANJUM: Physicians coming to teach
6 a procedure, teaching
7 only one time to come
here and train and go back.
8 DR. MONTOYA: But this is a national
9 seminar. This is a little different. This is not
10 to come down and teach Dr. Anwar how to put in a
11 stent
or something. This is to come
down by this
12 company,
sponsored by this company, make a profit,
13 to get a bunch of people in there, and to
inject
14 them, to operate on live patients.
15 DR. ANJUM: They're demonstrating to
16 the patients of
17 DR. MONTOYA: Yeah.
Not only
18 it's a national.
19 They can hire local people
that are
20 already trained. Take them, train them.
21 I don't like this method.
22 DR. BAEPLER: This is a commercial
23 venture.
24 DR. MONTOYA: I had a motion before.
25
Did I have a second to reject this licensure? All
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1 in favor? All opposed?
2 MS. KROTKE: This isn't on the agenda,
3 but this is something that's coming up in
licensing
4 that I need some board input on.
5 We have a teleradiology
license, or a
6 telemedicine license. And I'm seeing a new wrinkle
7 in this, and I have psychiatrists that want
to have
8 a teleradiology
license, and a neonatologist that
9 wants the license,
a special purpose license.
10 And I don't think the license
was
11 designed for psychiatry or neonatology, and
I've
12 kind of stalled these people.
13 Is that something you're
comfortable
14 with?
Giving them a special purpose license so they
15 can, you know, diagnose via video
conferencing? I'm
16 not comfortable with it.
17 DR. MONTOYA: They have to come to the
18 board.
19 DR. BAEPLER: We're going to be forced
20 into setting some policy
for telemedicine. We
21 simply are.
Telemedicine is going to be a
22 continuing problem until
we address it.
23 DR. MONTOYA: It's very well outlined
24 in radiology where they can get digital
scanners,
25 they can see a picture just as well in Ely
as they
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1 can right here in
2 DR. BAEPLER: Or in
3 DR. MONTOYA: Yeah.
However, some of
4 this other stuff, pretty good for in-state
stuff, if
5 there's a shortage of doctors in Fallon
where they
6 need to look at somebody and teleconference,
maybe
7 that will work.
8 But I don't think the board
wants to
9 start licensing people all over the country.
10 MS. KROTKE: Thank you.
11
12 9. EXECUTIVE STAFF REPORTS
13 DR. MONTOYA: The executive staff
14 reports. Mr. Clark?
15 DR. CLARK: Mr. President, I would
16 like to request the board's authority for
some
17 additional staff to attend the pain
management
18 course that Steve attended. You have already
19 approved Lori and my attendance, Doug's
attendance
20 and Lynnette's
attendance.
21 I would like Bonnie to be able
to
22
attend, and the other investigators, Pamela and all
23 of the investigative staff, because there's
an
24 investigative training
session there.
25 So with your approval, I'm
asking that
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1 those other staff members be allowed to
attend the
2 federation pain
management course.
3 DR. BAEPLER: I'm attending the one to
4 be held in
5 accommodate our staff? Or are we going to have to
6 go across the country for this?
7 MS. MUNSON: I can check to see if
8 there's any more
openings. I don't know.
9 Some of the investigative
staff is
10 set to go to
11
12 was pretty much
full. But there may be some opening
13 that could have come up. We'll check.
14 DR. MONTOYA: I don't think the board
15 is going to have
any trouble going.
16 All in favor of them
continuing the
17 pain management seminar? All in favor? Passed.
18 Next?
19 DR. CLARK: I would ask for authority
20 to attend the AIM board of directors meeting
in
21
22 DR. MONTOYA: Are we paying for that?
23 Or is that part of the western regional
presidency
24 thing?
25 DR. BAEPLER: What meeting is that?
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1 DR. CLARK: The administrators of
2 medicine board of
directors meeting.
3 DR. MONTOYA: Any motion to let them
4 go?
5 MS. KIRCH:
Move for approval.
6 DR. MONTOYA: All in favor?
Opposed?
7 So moved.
8 Approval for Dr. Baepler, Board of
9 Directors Federation of State Medical Boards
of the
10
11 DR. BAEPLER: As I pointed out, I have
12 less enthusiasm this
year than last year. This is
13 not a commitment, but I would like to have
the
14 option available.
15 DR. HELD: Let the force be with you.
16 DR. MONTOYA: All in favor of letting
17 Dr. Baepler run?
18 DR. BAEPLER: That would be at my own
19 expense.
20 MR. COUSNEAU: Do you need a campaign
21 manager?
22 DR. BAEPLER: I have a campaign
23 manager in
24 DR. MONTOYA: Consideration of a
25 Proposed 2005 Board Meeting Schedule. Is that
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1 next?
2 DR. ANWAR: Did we skip something?
3 Number two?
4 DR. MONTOYA: There's also
5 Consideration of Approval of Committee
Description
6 and Duties. Do you all have this list in there?
7 The executive committee
currently
8 consists of this
corner of the table. And it just
9 makes it
handy. It just makes it easy. You don't
10
have this president making decisions.
He's at least
11 taking up with two other people, and he can
get good
12 input, and it doesn't necessitate calling
the whole
13 board together to
get some kind of input. I'm not
14 going to make any decision like to give this
guy a
15 license or
something like that, but it's more other
16 things. Mostly administrative
things. Other kind
17 of authority things that come up where I can
use
18 some extra input.
19 DR. BAEPLER: Item number two should
20 streamline future meetings. Should cut down on some
21 of the appearances where the appearance is
totally
22 predictable.
23 DR. MONTOYA: Moved.
Seconded? All
24 in favor? All opposed?
25 DR. CLARK: I have one thing. I
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1 would like to ask the board's approval to
amend
2 the organizational chart to take the medical
3 interviewers out from under the general
counsel and
4 put them directly under the executive
secretary for
5 supervision.
6 DR. MONTOYA: Action item.
7 DR. CLARK: It doesn't really require
8 action, I
guess. I wanted the board to be aware of
9 that.
And if you have an objection, let me know and
10 we'll make it.
11 DR. MONTOYA: Okay.
Not an action
12 item. Information only.
13 MS. MUNSON: The board meeting
14 schedule.
15 DR. CLARK: If possible, we would like
16 to move the proposed June board meetings
from the
17 10th and 11th of June to
the 3rd and 4th of June.
18 That will make it available for Dr. Barnet
to attend
19 both of the IC meetings for that board
meeting.
20 DR. MONTOYA: Meetings as scheduled
21 are for when, March 4th and 5th?
22 DR. CLARK: March 11th and 12th.
23 Could you move it?
24 DR. HELD: I can't do that same
25 weekend of June. I cannot.
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1 DR. BAEPLER: 11th and 12th.
2 DR. HELD: I cannot to the 11th and
3 12th.
4 DR. MONTOYA: Two people down. March
5 4th and 5th works better? How about we go to March
6 4th and 5th then? June 3rd and 4th? Is that right?
7 DR. CLARK: Yes.
September 9th and
8 10th?
9 DR. MONTOYA: What are the notes,
10 Lori, on June 4th?
11 DR. BAEPLER: Gets sent home early for
12 the 50th wedding
anniversary. Sounds more like a
13 sentence.
14 DR. ANWAR: What happens in June?
15 DR. CLARK: June 3rd and 4th.
16 DR. MONTOYA: September 2nd and 3rd.
17 DR. CLARK: No, 9th and 10th.
18 DR. MONTOYA: Why 9th and 10th?
19 DR. CLARK: So you don't interrupt
20 with Labor Day.
21 DR. MONTOYA: Oh, okay.
And
22 December?
23 DR. CLARK: 2nd and 3rd.
24 DR. HELD: 2nd and 3rd is okay, if you
25 have a party.
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1 DR. MONTOYA: We will.
We'll have a
2 birthday cake delivered to the conference.
3 Which meeting is going to be held back
4 down here?
5 DR. CLARK: We haven't decided yet.
6 I'll wait for the executive committee to
wait for
7 that.
8
9 10. LEGAL REPORTS
10 DR. MONTOYA: Legal reports. It's up
11 to Steve Quinn.
12 DR. QUINN: Consistent with the
13 increase in
investigation cases, we presently have
14 the following cases: Two cases are pending
15 adjudication. Eighteen cases are scheduled for
16 hearing. We have hearings pending. Nine cases are
17 in a phase where they have gone through the
18 investigative process because of
legal counsel for
19 the purposes of preparing investigative
committee
20 summaries for legal counsel, because
investigative
21 committees have approved the filing. And this does
22 not include the actions taken yesterday,
which would
23 add another six cases to that category.
24 There are seven cases pending
25 further -- with legal counsel, seven cases
with
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1 legal counsel that are back for further
2 investigation, and this also does not
include any
3 cases that fall into that category
considered by
4 yesterday's
meeting.
5 There is one case pending a
6 settlement, and general counsel and deputy
general
7
counsels have a total of 37 cases.
8 I would comment that it
appears that
9 there's about a nine to twelve-month delay
between
10 the authorization of the filing of a formal
11 disciplinary action
by an investigative committee,
12 and when that case gets before the board for
13 adjudication. There's several
reasons for that, if
14 anybody has any
questions.
15 The present projection, based
on the
16 way cases are coming out, is that legal
staff will
17 be carrying the burden of somewhere in the
18 neighborhood of
48 to 50 formal hearings per year,
19 or approximately one a
week. And this could result
20 in a scheduled adjudication, approximately
12
21 adjudications per board needed.
22 MS. STOESS: What are some of the
23 reasons?
24 DR. QUINN: Once the investigative
25 committee authorizes filing of a complaint,
the
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1 complaint get
dropped. It's just an inherent delay
2 in the time.
3 The scheduled statutory delays
are
4 30-day delay, required delay between the
filing of
5 the complaint and the setting of the prehearing
6 conference. And then another 30-day delay between
7 the setting of the prehearing
conference and the
8 hearing. And that's a quick 60 right there.
9 And then after the hearing, in the
10 past, my experience, which is relatively
limited,
11 has been that the next step, once these
hearings --
12 the board doesn't know -- the statute
provides that
13 the board has authority to either conduct a
hearing
14 as a board, so that the board conducts the
hearing,
15 or to assign it to a
hearing officer. And the
16 practice has
been, almost in all cases, to assign it
17 to a hearing officer.
18 The hearing officer hears the
case and
19 basically conducts
the hearing. And then he must do
20 a synopsis. There's a delay in production of a
21 transcript of the
hearing, giving that transcript.
22 Once that's done, the hearing
officer
23 then produces a synopsis. That creates another
24 delay.
And from that point on, then there is the
25 delay of putting together the packet in time
for the
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1 board to get a sufficiently advanced -- in
advance
2 of the next scheduled board meeting, to give
the
3 board members a full opportunity to read the
case.
4 MS. STOESS: Thank you.
5 DR. QUINN: You're welcome.
6 DR. MONTOYA: There's one item that I
7 would like to go back to under section
8. It's on
8 the investigative
committees.
9 Investigative committee B's
list is
10 now circulated? Yes?
11 So I would like to have a
motion for
12 these cases recommended for closure.
13 MS. KIRCH: Vote for approval.
14 DR. MONTOYA: Motion for approval of
15 closed cases. All in favor? Passes.
16 So thank you for that.
17 And now we'll go back.
18 DR. QUINN: There's an agenda item
19 here under legal
reports. I don't have anything to
20 report on terms and conditions of probation
status.
21 Board litigation status. We still
22 have -- we don't have any significant cases
in
23 litigation. We've got about five cases. The one
24 significant case
in litigation is the Nishler case.
25 My understanding of the Nishler case
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1 is I happen to -- the 9th Circuit said the
case is
2 over. The next technical step is that the 9th
3 District Court has to enter an order saying
that the
4 9th Circuit's decision is now adopted as the
ruling
5 of the District Court to
end the case.
6 For some reason that just
hasn't
7 happened, Dr. Nishler filed an application for
8 involuntary review,
which the 9th Circuit has never
9 entered an order.
10 I talked to counsel for the
one board
11 member who had
outside counsel. And we don't want
12 to stir up anything with the courts, but she
told
13 me -- I saw her at the
airport flying up here --
14 that she had her secretary review the file,
and she
15 thinks that an
order has come in.
16 I haven't seen it yet. But I'll get
17 in touch with her when I get back in
18 may be the end of that.
19 The other cases are -- one
case is a
20 case where a man filed an action, and he did
nothing
21 more. And he doesn't have a lawyer.
22 It's my discretion to just let
the
23 thing lie
there. Because when a guy goes to court
24 without a lawyer, the judge is going to give
him any
25 and every break. And I use my legal tools to kind
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1 of just dismiss this case; the judge is not
going to
2 do it.
I'm going to just let it go until time
3 requires it to be
terminated.
4 DR. ANWAR: What is that?
5 DR. QUINN: Five years, actually.
6 And that's really all there is
for
7 litigation.
8 I would like to ask Ed Cousneau to
9 address the issue of the letters of concern.
10 DR. COUSNEAU: As the board members
11 are aware, in 2003 the legislature
authorized the
12 medical board to
issue letters of concern, letters
13 of warning or nonpunitive admonishments. And have
14 already -- obviously the IC members are
aware -- put
15 into action.
16 There was, however, some
ambiguity in
17 the statute as to who had the authority to
issue
18 those letters.
19 The statute itself says the
board may
20 issue, and the definition in Chapter 630 of
the
21 board is simply
just the word medical examiners. So
22 there's ambiguity there.
23 We asked for an advisory
opinion from
24 the attorney general's office, Charlotte
Bible. We
25 received one two months ago, and it is
consistent
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1 with our hopes and
understanding.
2 But what we do need, I
believe, at
3
this point, to recommend in any advisory opinion is
4 to have the full board move or make a motion
to
5 grant the authority of the IC to again
administrator
6 these letters of concern.
7 I guess the point, the pertinent point
8 that came out of the opinion is the letters
of
9 concern are
obviously not a final adjudication.
10 Since the IC's are the investigative slash
11 persecutorial
end of the process, and the other
12 board members are the adjudicated body, we
need to
13 separate the two. So we need to make that clear
14 distinction.
15 And so by the board now
authorizing
16 the IC committee to issue the letters that
have been
17 issued and subsequently will be issued,
we're going
18 to firm up the statute.
19 MR. BAEPLER: We used to do this until
20 about four years ago. And it says a very convenient
21 way to advise the
physician that we are concerned
22 without calling it a
disciplinary action. It
23 doesn't advise to
that letter. And it's
24 confidential. It's not reported.
25 But it kind of puts the
physician on
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1 guard that he really needs to do something
here and
2 improve there.
3 And so another complaint comes
in on
4 that, and we've already sent the letter of
concern
5 around on that very thing. Now, you know, the
6 accumulative effects of these complaints can
lead to
7 a disciplinary action
perhaps.
8 So it's frustrating not to be
able to
9 send these letters because these cases now
are
10 typically just closed, period.
11 DR. ANWAR: So these letters could go
12 out without even the
knowledge of the president?
13 DR. COUSNEAU: You mean president of
14 the board? That's what we do, is we do want to
15 keep the IC separate and investigate it from
the
16 adjudicative end. Because although we send a letter
17 out, it doesn't mean that we can't act
subsequent,
18 based on that. So that's why we wanted to
19 differentiate, separate that.
20 DR. MONTOYA: If I find out about it.
21 DR. COUSNEAU: I guess we probably do
22 need some kind of motion.
23 DR. QUINN: I think what we need to do
24 is have a motion
that has two parts. One motion
25 that would authorize the investigative
committees to
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1 issue Section 630.299
letters of concern.
2 And the second part of the motion
3 would be for the board to ratify and approve
and
4 adopt whatever letters of concern, those
letters of
5 concern that have previously been sent by
the
6 investigative committees.
7 DR. ANWAR: Can you modify that to
8 explain as to who signed the letter?
9 DR. QUINN: As part of the motion,
10 that the authority is delegated to the chair
of the
11 investigative committee.
12 MS. KIRCH: The authority to the
13 committee to be assigned
by the chairman.
14 DR. BAEPLER: The way committee A
15 proposed to handle it, the letter will be
drafted
16 and sent to the three
members. The two members that
17 are not the chair will communicate with the
chair
18 whether it's all right or they want any
changes.
19 The chair will communicate with the
20 staff, who will use the rubber stamp to use
for the
21 committee.
22 MS. KIRCH: To the committee
23 authorizing it, and I believe same thing on
the
24 other committee.
25 DR. LUBRITZ: That having been said,
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1 we have not
discussed who should sign that. And my
2 personal thought is if it's the desire of
the
3 members of the investigative committee that
their
4 names be signed as
well. I think it's perfectly
5 appropriate either way.
6 MS. KIRCH: I so move.
7 DR. BAEPLER: You're moving what Steve
8 said?
9 DR. MONTOYA: And this is a motion to
10 authorize the investigative committee,
chairperson
11 send letters of concern,
and it's an amendment to
12 Statute 630.299, right?
13 DR. QUINN: It's pursuant to.
14 DR. MONTOYA: Pursuant to.
15 MS. KIRCH: It's still the committee
16 that authorizes it, not
just the chairman. It's the
17 committee that
authorizes it.
18 DR. MONTOYA: He just signs it. And
19 the board ratifies and
adopt letters that have
20 previously been sent.
21 Moved and seconded. All in favor?
22 Opposed?
23 DR. BAEPLER: That, by the way, is a
24 matter of written record. The staff taking the
25 record for the IC mediation. It's all on record
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1 that the committee did
this.
2 MS. KIRCH: Just so everyone
3 understands, not one person saying okay,
we're going
4 to do this. I think it's appropriate for the
5 committee.
6 DR. MONTOYA: Licenses at issue, the
7 changes of licensure status approved since
the
8 September 10th meeting.
9 Moved? Second?
All in favor?
10 Anybody opposed?
11 So all those licenses are now
ratified
12 changes.
13
14 12. DISCUSSION, CONSIDERATION AND APPROVAL OF
15 SETTLEMENT
16 DR. MONTOYA: Okay, item number 12.
17 Discussion, approval, settlement and
agreement for
18 the Rajiv Budden versus
19 Medical Examiners by the Supreme Court. Closed
20 session for a
bit.
21 MR. TAYLOR: Hal Taylor.
If the board
22 goes into closed session, may I be allowed
to be in
23 the room? Can we waive closed session?
24 MS. JAMES: What the board wishes to
25 do is go into an executive session where
they advise
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1 on a pending litigation matter, which would
include
2 you and your client.
3 They will not be discussing
any
4 matters that will be required to be in open
session
5 for this board. Just the legal advice that would be
6 privileged.
7 MR. TAYLOR: I understand.
We would
8 waive closure of the meeting of the board.
9 DR. MONTOYA: At this time we are in
10 closed session.
11 (A discussion was held off the
12 record from
13 DR. MONTOYA: We're back in open
14 session, and
considering the indication of the Rajiv
15 Budden, M.D., and
the compromised settlement and
16 release agreement.
17 DR. BAEPLER: Mr. Chairman, I move
18 this board accept the settlement.
19 DR. ANWAR: Second.
20 DR. MONTOYA: It's been moved and
21 seconded that we accept the settlement. All in
22 favor?
All opposed?
23 Chairman is in favor. We accept this
24 settlement.
25 Dr. Budden,
do you have anything to
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1 tell us?
2 MR. TAYLOR: Yes, we do.
3 DR. MONTOYA: Do you have anything,
4 Mr. Budden?
5 DR. BUDDEN: Not at this time.
6 MR. TAYLOR: I missed the question.
7 DR. MONTOYA: We generally listen to
8 the doctor, not the
attorney.
9 MR. TAYLOR: I'm sorry.
Well, at this
10 point, however, you have my presentations
exhibited.
11 MR. TAYLOR: I did, in fact, present a
12 written discussion of
the issues in the case. All I
13
would really like to do is take the board through
14 that because there are some medical issues
there.
15 Normally -- I've been doing
16 professional licensing
law since 1985; those
17 umbrella agencies back in
18 are allowed to do a brief presentation.
19 DR. MONTOYA: A brief presentation
20 would be appreciated.
21 MR. TAYLOR: I understand.
And I
22 understand a brief presentation from an
attorney is
23 somewhat suspect, but I will, in fact, be
brief.
24 DR. MONTOYA: Before you go on,
25 Mr. Taylor, let me state for the record so
it's
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1 clear that you provided me with a packet,
which is
2 headed as a statement of applicant, and you
provided
3 me with several copies. And I have distributed that
4 copy to each
member of the board here present today;
5 distributed a copy to each member of the
board
6 today.
7 MR. TAYLOR: Thank you very much. And
8 I will be using that as my reference
point. I will
9 try to keep it short.
10 I spent most of my professional
career
11 actually working where
Mr. Quinn does. I'm
12 extremely sensitive to the fact that every
licensing
13 board, this
licensing board particularly, is not
14 going to license someone who should not be
licensed
15 and is not qualified for the state.
16 And I really understand that,
and I
17 under the public
concerns with regards to that.
18 I have an 800-pound gorilla in
the
19 corner. That's the earlier denial. What I'm going
20 to try to do is quickly go through the
issues in the
21 case, and ask the board to look at the
background
22 that it saw the last time in a somewhat
different
23 light.
24 If you would take a look at
the
25 doctor's statement of applicant, on the
second page
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1 you will see what amounts to a time line
with
2 regards to Dr. Budden's
training.
3 The
4 will see that goes from January of '94 to
May of
5 '94. The reason he left Nassau County Medical
6 Center was because -- and I've got the
illness of
7 his brother, it's actually the illness of his
8 father, he had
cancer. That is, there was nothing
9 with regards to his work there.
10 He went to Medical College of
Georgia
11 because that was to be
close to his family.
12 This is the instance where we
have him
13 there for a year. In fact, his contract was not
14 renewed.
15 Those of you who were present
at the
16 previous matter
will recall that there was great
17 concern about the fact that Dr. Budden said that he
18 was not
terminated. He, in fact, was not
renewed.
19 What you will see within the
documents
20 is a statement which I quote, or within this
21 statement, I have talked with counsel for
the
22
23 say -- and I had hoped to have an affidavit
today to
24 give to you, we don't have it yet.
25 What they will say is for him
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1 termination, not renewal. They were talking about
2 the same thing. There was no majority input with
3 regards to use of
the term termination.
4 And, therefore, the statement
by
5 Dr. Budden on his
application that made that
6 distinction, he apparently felt was the
majority,
7 and obviously the board did. But the reality is
8 that the attorney for the Medical College of
Georgia
9 said we meant renewal of his license, so,
therefore,
10 it was not a misrepresentation.
11 DR. LUBRITZ: Would you say that
12 again, please?
13 MR. TAYLOR: Yes.
The critical issue
14
in the first case: The board
looked at it and said
15 they know that at the end of one year at the
Medical
16
17 year.
That there is a termination, a nonrenewal,
18 whatever terminology he wants to use.
19 Dr. Budden,
in his application, says I
20 wasn't
terminated. Contract wasn't renewed.
21 The board looked at that. The order
22
is attached, and said wait a minute, you're
23 misrepresenting this. You were terminated. It's
24 not a nonrenewal.
25 When I talked to the attorney
for the
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1
2 meant.
We meant the nonrenewal for the second
3 year.
So it was not a misrepresentation.
4 But I think the thought that
that was
5 a misrepresentation, in fact, colored the
way the
6 board looked at
everything else in the case.
7 He was nonrenewed. He was nonrenewed
8 because of unsatisfactory
performance. He then went
9 on to the UCON, University of
10 Medicine.
11 He did a complete first rotation at
12 UCON, did
fine. And in the second rotation he
13 begins to have
problems. He goes on probation
14 twice.
15 Now, part of what happened was
he was
16 allowed to come on
to UCON without a certificate
17 from the
18 that UCON should not have allowed him into
their
19 program without that certificate. Or certainly when
20 there was a change, a political change, they
felt
21 uncomfortable with that.
22 That's when he started having
23 problems. I'm not going to go into a lot of detail
24 on that. We believe there was a connection.
25 Bottom line, he then goes to
King Drew
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1
2 does 18 months
there. He's at Cedar Sinai Medical
3 Center for a clinical subspecialty in
cardiac
4 anesthesiology.
5 He finishes up in December of
1999.
6 He's given full credit for 18 months at
UCON. He's
7 given full credit for 18 months at King Drew
Medical
8 Center.
He's licensed to practice in
9
10 And he applies for licensure
here and
11 is denied based upon the board's feeling
that, first
12 of all, there were problems with his work
when he
13 was a resident, and there were problems with
his
14 work and internship in Medical College of
Georgia,
15 which, as you see, occurs almost ten years
ago.
16 And there was another problem.
17
18 late documentation in
the hospital. There's a
19 record in the file that he, in fact, was
never
20 suspended because of that.
21 He certainly had some problems
with
22 regards to Medical College of Georgia. You will see
23 the letter from Dr.
Stein. Dr. Stein is, in fact,
24 the person who is identified as the person
who, in
25 fact, was
responsible for him not being renewed.
It
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1 was a letter to the program director at
UCON.
2 That's Exhibit F to your documents. And I'll simply
3 read it:
4 "I'm writing in support
of Dr. Rajiv
5 Budden's
consideration for your anesthesiology
6 residency program. Dr. Budden was an
intern at the
7
8 July '94 through June 1995. He rotated through ICU,
9 CCU, general medicine, and subspecialty
services
10 during that period. And, hence, received training,
11 experience in broad areas of internal
medicine. In
12 general, he worked hard and I believe has
the
13 potential for a solid
performance."
14 Take a look, there's another letter
15 which shows the evaluation showed that out
of
16 eleven months, he had satisfactory -- not
stellar
17 performance, satisfactory performance
through nine
18 of those months. Two of those months unsatisfactory
19 performance.
20 They felt he needed to repeat
the
21 program or do something else. He needed to make
22 some progress. But this is all back in '95, '96,
23 '97.
24 He then goes in. He has a clean
25 rotation
initially at UCON. He then does 18
months
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1 at King Drew. No problems whatsoever. And he's
2 been practicing ever since.
3 So what I'm asking the board
to do is
4 to recognize that, first of all, the board,
when it
5 considers his application initially, didn't
have all
6 the right information. For instance, the board
7 initially thought he had been terminated from
three
8 programs. That's not true. The first program he
9 left because of illness in the family.
10 But he was terminated, nonrenewed,
11 whatever term you want to use with regards
to the
12 two programs.
13 Then plowed through, proceeds
with his
14 education,
proceeded with his training, proceeded
15 with his practice without problems from that
point
16 forward.
17 What we're really talking
about is
18
19 time and the
second rotation at UCON, the other
20 rotations are good. And subsequently he's had a
21 clean record, and has
had additional training.
22 He hasn't taken the board
tests yet.
23 He's board eligible. I would suggest to the board,
24 and I'm going to let Dr. Budden
talk then, because
25 obviously I've gone beyond the brief time I
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1 promised, I think when the board felt that
he was
2 making misrepresentation, I think it
somewhat
3 colored the board's view of the other
problems he
4 had had previously, which are admitted. I think
5 UCON is somewhat political.
6 But having said all of that,
take a
7 look at what the doctor has done since that
point,
8 and I believe that he has -- and all he
needs to be
9 after all, is minimally
qualified. I say, in fact,
10 qualified to practice medicine safely for
the
11 health, safety and
welfare of the public in
12 And nothing since UCON really demonstrates
that he's
13 not qualified.
14 We would ask the board to, in
fact,
15 recognize that there was some language
confusion
16 initially. Take a look at his record, recognize
17 that these are old
problems. Recognize that he has
18 addressed them.
19 And I'm even suggesting if the
board
20 is really, really concerned, and I've done
this with
21 other boards, board of nursing
whatever. If the
22 board is really
concerned about competency, then we
23 can, in fact, put some sort of monitoring
program in
24 place for reports given to the board to make
sure
25 that everything was, in fact, going as it
should
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1 be.
2 If that would provide the
board with
3
some level of comfort with regards to this
4 applicant,
certainly he would be willing to do that.
5 So we would ask the board to
take all
6 this into consideration. And I'm sorry if the
7 legalese offends anybody. That's what we do. But I
8 think that -- I would hope the board would,
in fact,
9 grant licensure with whatever bells and
whistles and
10 monitoring it wishes
to do.
11 Dr. Budden
is, of course, available.
12 DR. MONTOYA: Dr. Budden, do you
have
13 anything to say?
14 DR. BUDDEN: No, sir.
15 DR. BAEPLER: What was your experience
16 with the USMLE? Did you have to repeat those?
17 DR. BUDDEN: I believe I repeated the
18 first one, but I can't recall at this time,
but I
19 did not repeat the third. It was during the time
20 when NBME was transferring me to USMLE. I believe I
21 repeated the second USMLE once.
22 DR. MONTOYA: Thank you for your
23 presentation.
24 Does the board have any
questions?
25 MS. STOESS: Where are you practicing
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1 now?
2 DR. BUDDEN: Up to this point in
3
4 DR. ANJUM: How long have you had a
5
6 DR. BUDDEN: Since 1998.
I obtained
7 that license one week prior to starting my
residency
8 in
9 licensed in the State of
10 proceed after the second year of internship.
11 DR. ANJUM: Anywhere else you have a
12 license?
13 DR. BUDDEN: In
14 license in
15 last seven or eight years.
16 DR. BAEPLER: What is the nature of
17 your practice in
18 DR. BUDDEN: I'm an anesthesiologist.
19 DR. ANWAR: Have you had any problems,
20 issues in your practice
in
21 DR. BUDDEN: Not that I can recall.
22 DR. ANWAR: Have you been continually
23 practicing anesthesiology in
24 time?
25 DR. BUDDEN: Yes.
Once I finished my
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1 residency at
2 heart surgery for six months at Cedars
Sinai.
3 Cedars Sinai, they hired me after they saw
my
4 performance. And as well I continued with King Drew
5
6 three years after I
completed my residency.
7 I was a junior attending and I
was
8 teaching the residents
coming in and doing trauma.
9 And I was in private practice in
10 as well.
11 DR. ANWAR: If the board needs, would
12 you be able to provide some reference letters
as to
13 where you worked and
people that we can contact?
14 DR. BUDDEN: Yes, of course.
15 DR. LUBRITZ: Do you have a job offer
16 here? Is there a reason that you're seeking a
17 license in the State of
18 DR. BUDDEN: I wanted to expand my
19 practice.
And actually I wanted to move my family
20 closer to me. My family currently is in
21 And
my mother is retiring, and she has her heart set
22 on
23 get to see her. So that's the reason I want to
24 apply for a
25 to practice and be close
to my family.
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1 DR. BAEPLER: But do you have an offer
2 in
3 DR. BUDDEN: I had an offer in the
4 past but I couldn't practice because I was
denied
5 the license so I lost that offer.
6 DR. LUBRITZ: What?
7 DR. BUDDEN: I had an offer to
8 practice, when I initially applied for the
license,
9 but I lost that offer because I was denied
the
10 license at that time.
11 DR. ANWAR: Who was that offer from?
12 DR. BUDDEN: I don't recall the
13 doctor's name. It was two years ago.
14 DR. BAEPLER:
15 DR. BUDDEN: In the Las Vegas area.
16 DR. BAEPLER:
17 DR. MONTOYA: Any further questions?
18 Motions?
19 DR. ANJUM: Discussion?
20 DR. MONTOYA: Do you want to go to
21 close?
22 DR. QUINN: Let me say this before we
23 go:
The issue here is whether to basically rescind
24 revocation? That's the only issue.
25 DR. BAEPLER: I would move that we
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1 rescind it. But this is not the equivalent of
2 granting license?
3 DR. QUINN: That's correct.
4 DR. BAEPLER: It will open the
5 door, but we would be open to that. So if my
6 understanding is correct, I would move to
rescind.
7 DR. ANJUM: That doesn't grant him a
8 license.
9 DR. BAEPLER: No, it does not.
10 MS. KIRCH: I'll second it.
11 DR. MONTOYA: I would like to go to
12 closed session also.
13 DR. ANWAR: There's a motion for a
14 second.
15 MS. KIRCH: There was a motion for a
16 second.
17 DR. MONTOYA: The motion was to
18 rescind.
19 DR. BAEPLER: Rescind.
20 MS. STOESS: I second.
21 DR. LUBRITZ: I vote we go to closed
22 session at this
time. I move that we table the
23 motion.
24 DR. COUSNEAU: I want to bring it up,
25 but can we rescind a previous order or
finding of
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1 adjudicated body when the adjudicated body
is not
2 the same as it was previous?
3 DR. MONTOYA: I think we're
4 functioning as the same
board.
5 DR. COUSNEAU: Yes, sir.
But I just
6 want to make sure.
7 DR. ANJUM: The members are
8 different. The body is the same.
9 MR. TAYLOR: There are some members I
10 believe who were here on the previous.
11 DR. BAEPLER:
There's some carry
12 over. One board cannot bind future boards. One
13 legislative session
cannot bind further
14 legislation.
15 DR. COUSNEAU: There was legislation
16 by that body. There is a different body. I mean
17 the nine board members.
18 DR. BAEPLER: Okay.
Could we
19 constitute the old board?
20 DR. COUSNEAU: I don't believe that
21 comes up to rescind
decisions either.
22 DR. ANJUM: Boards change. Members
23 change.
24 MS. KIRCH: I think perhaps there's
25 another action other than rescinding that we
need to
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1 take.
2 DR. BAEPLER: I will withdraw my
3 motion. Withdraw the motion so there is no motion.
4 DR. MONTOYA: Let's go for closed
5 session for a
minute.
6 (Off the record from
8 DR. MONTOYA: Back in open session.
9 Dr. Budden
and Mr. Taylor, we accept
10 your settlement.
11 MR. TAYLOR: Thank you.
12 DR. BUDDEN: Thank you.
13 DR. MONTOYA: All in favor of
14 accepting the
settlement? Oh, we already did
that.
15 MS. JAMES: That's why we listened to
16 his presentation.
17 MR. TAYLOR: Did I sign the dismissal,
18 Steve?
I did? Thank you, very, very
much.
19
20 13. REQUEST FOR
REMOVAL OF RESTRICTION FROM LICENSE
21 DR. MONTOYA: We are now going to
22 consider the matter of Dr. Chancellor.
23 Dr. Chancellor presents to us asking us to
remove
24 restrictions from his
license.
25 DR. QUINN: I received a telephone
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1 call yesterday, a message that he called the
board
2 office. He is not going to be here.
3 DR. MONTOYA: Remove restrictions
4 from license. Would anybody like a review of
5 Dr. Chancellor?
6 DR. BAEPLER: Was the reference in the
7 phone call that he
wanted withdrawn from the agenda
8 and have a later appearance?
9 DR. QUINN: Nothing of that nature.
10 DR. BAEPLER: Just that he won't be
11 here?
12 DR. MONTOYA: Dr. Chancellor is the
13 ENT doctor.
Does anybody want the presentation?
14 Nobody wants it?
15 DR. LUBRITZ: Why do we even have
16 this? Doesn't he have to petition the board?
17 DR. BAEPLER: He wants to do something
18 other than ENT work.
19 DR. LUBRITZ: Is there something that
20 he has written to us that has him here on
the
21 agenda?
22 DR. QUINN: That's it.
Remove the
23 restriction.
24 DR. ANWAR: Anything that we need to
25 take action on?
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1 DR. HELD: Could I make a motion to
2 table that?
3 DR. QUINN: No.
4 MS. JAMES: You can, but...
5 DR. ANWAR: Motion to continue on the
6 restrictions as placed before since there is
no
7 further evidence
represented to change that.
8 DR. BAEPLER: Second it.
9 DR. MONTOYA: Second.
It will
10 continue the restriction as done before.
11 All in favor? Opposed?
Chair is in
12 favor.
So moved.
13 And if I'm not mistaken --
14 DR. ANWAR: He has to figure it out
15 himself.
16 DR. MONTOYA: I think that takes us to
17 lunch, doesn't
it? We'll go ahead and shut down for
18 the time being and have
lunch. Start again in
19 40 minutes.
20 (Off the
record at
21
22
23
24
25
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1 REPORTER'S CERTIFICATION
2
3 I, GALE SALERNO, a certified
court
4 reporter and notary public within and for
the State
5 of
6 shorthand the proceedings in the
above-entitled
7 matter at the time and place indicated, and
that
8 thereafter said shorthand notes were
transcribed
9 into typewriting at and under my direction,
and the
10 foregoing transcript constitutes a full,
true, and
11 accurate record
of the proceedings.
12 IN WITNESS WHEREOF, I have
hereunto
13 set my hand this day of , 2004.
14
15
16
17
GALE
18 NOTARY PUBLIC
19
20
21
22
23
24
25
ALL-AMERICAN COURT REPORTERS
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