NBME Board Meeting Transcript March 4 2005

2 NEVADA STATE BOARD OF MEDICAL EXAMINERS

3 QUARTERLY BOARD MEETING

4 REPORTER'S TRANSCRIPT OF PROCEEDINGS

5 FRIDAY, MARCH 4, 2005

6 8:30 A.M. - 12:44 P.M.

9 Conference Room at the Offices of

10 the Nevada State Board of Medical Examiners

11 1105 Terminal Way, Suite 301

12 Reno, Nevada

24 REPORTED BY: CAPITOL REPORTERS

775-882-5322

25 Carrie Hewerdine, NV CCR 820

Capitol Reporters (775) 882-5322

1 A P P E A R A N C E S

3 PRESENT IN RENO:

4 STEPHEN K. MONTOYA, M.D., President

JOEL N. LUBRITZ, M.D., Vice-President

5 DONALD H. BAEPLER, Ph.D., D.Sc., Secretary-Treasurer

BONNIE S. BRAND, J.D., General Counsel

6 EDWARD O. COUSINEAU, J.D., Deputy General Counsel

CHARLOTTE M. BIBLE, J.D., Asst. Ch.,

7 Assistant Deputy Attorney General

DRENNAN A. CLARK, J.D., Executive Secretary,

8 Special Counsel

LAURIE L. MUNSON, Deputy Executive Secretary

9 DOUGLAS C. COOPER, Chief of Investigation

LYNETTE L. KROTKE, Chief of Licensing

10 MARLENE J. KIRCH, Public Member

CHARLES N. HELD, M.D.

11 CINDY LAMERSON, M.D.

JEAN STOESS, M.A.

12 SOHAIL U. ANJUM, M.D.

JAVAID ANWAR, M.D.

14 PRESENT IN LAS VEGAS:

15 MICHAEL J. GARCIA, R.R.T.

DAN HICKEY, P.A.-C, Advisory Committee Member

18 ALSO APPEARING:

19 LAWRENCE P. MATHEIS, M.D., Executive Director NSMA

PETER MANSKY, M.D. Director, NHPAF

20 ROGER BELCOURT, M.D.

MICHAEL L. HUSE, Investigator

21 GURPREET K. PADAM, M.D.

KAREN SELBACH, Residency Program Secretary

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1 I N D E X

3 AGENDA ITEMS: PAGE

5 1. Call to Order and Announcements 5

6 2. Approval of Minutes 5

7 3. Report on Status of the Board's Public

Service Announcement Program Through

8 Nevada Broadcasters Association 14

9 4. Amendments to Nevada Administrative

Code Chapter 630 18

5. Request for Approval to Practice Outside

11 of the University if Nevada School of

Medicine's Family Practice Residency

12 Program, Per NRS 630.265(4) 56

13 6. Board Website (www.medboard.nv.gov)

14 Report 33

15 7. Reports 75

16 8. Executive Staff Reports 125

17 9. Legal Reports 130

18 10. Adjudication in the Matter of the

Nevada State Board of Medical Examiners

19 vs. Scott R. Forrest, C.R.T., BME Case

No. 04-29264-1 134

11. Consideration of Stipulation for

21 Settlement in the Matter of the Nevada

State Board of Medical Examiners vs.

22 Suresh Khilnani, M.D., BME Case No.

04-6268-01 139

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1 I N D E X (Continued)

3 AGENDA ITEMS: PAGE

5 12. Consideration of Stipulation for

Settlement in the Matter of the Nevada

6 State Board of Medical Examiners vs.

Timothy Dyches, M.D., BME Case No.

7 04-9201-01 149, 156

8 13. Consideration of Dismissal of Complaint

in the Matter of the Nevada State Board

9 of Medical Examiners vs. Todd K. Malan,

M.D., BME Case No. 04-10433-1 155, 157

14. Licensure Ratification 161

15. Appearances for Consideration of

12 Acceptance of Applications for Licensure

(CLOSED SESSION - NOT REPORTED)

16. Matters for Future Agenda (NOT REPORTED)

17. Public Comment (NOT REPORTED)

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1 RENO, NEVADA, FRIDAY, MARCH 4, 2005, 8:30 A.M.

2 -o0o-

4 (1. CALL TO ORDER AND ANNOUNCEMENTS)

5 PRESIDENT MONTOYA: All right. Let's go ahead and

6 call to order. Can you hear us down south? Nod. Say "yes"

7 or "no." Waive your hand. Yeah.

8 MR. GARCIA: (Via teleconferencing) We can hear

9 you.

10 PRESIDENT MONTOYA: First, I'd like to welcome

11 Dr. Cindy Lamerson to the Board. She's sitting over here to

12 my left, and then she agreed to join this august party for the

13 duration. We appreciate you joining us. It's going to be a

14 lot of work, but I'm sure it's going to be a learning

15 experience.

16 I met Cindy a couple months ago, for the

17 orientation. She's a practicing dermatologist here in the

18 Greatest Little City on Earth. And welcome.

19 DR. LAMESON: Thank you.

21 (2. APPROVAL OF MINUTES)

22 PRESIDENT MONTOYA: Next we have approval of the

23 minutes. Dr. Lubritz had spotted some matters that he wants

24 to get corrected.

25 DR. BAEPLER: And I have one.

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1 PRESIDENT MONTOYA: And Dr. Baepler. So let's get

2 to it, and what should we correct?

3 DR. LUBRITZ: I don't know what page it is. Page 7

4 of 24, Stated Investigative Case Loads. It says Dr. Lubritz

5 presents a synopsis. That's Doug Cooper presented a synopsis.

6 That's at Status of Investigation, third paragraph from the

7 bottom, as per Dr. Baepler. We should change "Lubritz" to

8 "Baepler."

9 MS. MUNSON: Yes.

10 PRESIDENT MONTOYA: Anything else?

11 DR. LUBRITZ: How about we get to follow-up. If

12 something was supposed to have been done last time, and we

13 were supposed to find out about it this time.

14 PRESIDENT MONTOYA: Now we can ask.

15 DR. LUBRITZ: On page 19 of 24, what it says is that

16 upon returning to open session, Dr. Anjum moved to grant

17 Dr.`Takwa's M.D.'s application for licensure pending receipt

18 of a letter of recommendation from Yale.

19 Did we receive that?

20 MS. KROTKE: Yes.

21 PRESIDENT MONTOYA: Okay.

22 DR. LUBRITZ: We got that?

23 MS. KROTKE: Yes.

24 DR. LUBRITZ: There was one more.

25 MS. MUNSON: That one is okay then, as is.

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1 DR. LUBRITZ: If they got the letter, and if

2 somebody has read the letter, and they approve it, then they

3 would be okay.

4 MS. KROTKE: He passed with flying colors.

5 DR. BAEPLER: Mine is on page 9 of 24, to get Tony

6 off the hook in case the budget projections are wrong. You'll

7 recall that where the committee meets with the auditors and

8 they set the rates for licensure at that meeting, but none of

9 us had ever seen the figures before the outside team presented

10 them to us.

11 And when I got back and had a chance to model those

12 numbers on my own, I really felt they were too high. So I

13 recommended reducing them to the figure that you passed, and

14 in line 16 from the bottom, you refer to Mr. Clark, and then

15 the next reference, "he's been thinking about it and would

16 prefer not to go above the 600." That's me. So change the

17 "he" to my name, because it was not Tony's decision. In case

18 things go off the track, I should take the responsibility.

19 PRESIDENT MONTOYA: Not to go above the 600,

20 Dr. Baepler.

21 DR. BAEPLER: Yeah. That was my recommendation that

22 was adopted.

23 PRESIDENT MONTOYA: So it lands on Dr. Baepler's

24 hands. Okay.

25 DR. LUBRITZ: On page 6 of 24, top of page, it was

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1 asked whether or not there had been any complaints received

2 about not having information on education. It says

3 "Dr. Lubritz asked if staff could obtain about how frequently

4 people call for that information, and Ms. Munson said they

5 could."

6 So did we -- have we done any studies to see how

7 many people that have called in and have asked specifically

8 about education?

9 MS. MUNSON: Yes, I have them. We -- Julie and

10 Helen answer most of the phone calls, and I am the one who

11 receives the general email for the office.

12 And I've checked that, and we checked it for a

13 month, and in a month's time we received 59 requests or

14 comments as to why -- asking why it wasn't on the website and

15 stating they would have preferred that. Yes, they had to call

16 because it wasn't on the website.

17 DR. BAEPLER: I understand, but the statue doesn't

18 require it.

19 MS. MUNSON: So we are getting some calls. It's --

20 you know, that's less than two a day, but we have received

21 some.

22 PRESIDENT MONTOYA: 49 out of a couple thousand,

23 right?

24 MS. MUNSON: Oh, yes. We get a lot of phone calls,

25 and Julie handles a hundred a day, easily, fields calls, or

Capitol Reporters (775) 882-5322

1 close to that a lot of days, requesting information on

2 physicians. And so out of those --

3 DR. BAEPLER: The more pertinent question is not the

4 generic question as to why it's not on the website, but how

5 many calls did you get that want to know specifically Doctor

6 X, where did he go to school or something.

7 MS. MUNSON: We get a lot of calls asking for that.

8 In fact, most -- I would say the majority of the calls, when

9 callers call, they do want to know. They do care where their

10 physicians went to school.

11 DR. BAEPLER: Why do you think it is with every

12 doctor I've asked, I have yet to find a doctor who says that

13 the patient asks them where they went to school?

14 MS. MUNSON: They are -- when they call here, they

15 are asking -- they do want to know, but they are able to get

16 it from the phone, and they are satisfied with that.

17 DR. LUBRITZ: And that's not required in the regs?

18 DR. BAEPLER: No.

19 PRESIDENT MONTOYA: Anything else to the minutes?

20 Any follow-up there?

21 MR. COOPER: I would like to express to Dr. Baepler

22 that sometimes, as a patient, it's embarrassing to have to ask

23 a doctor where he went to school. When you call the Board,

24 you don't have to see anybody. You don't have to see the

25 physician. You can ask. If he's there, when the physician

Capitol Reporters (775) 882-5322

1 walks in the room and the first thing you ask him -- or the

2 first group of questions is: Where do you go to school? It

3 could be seen as offensive to some physicians and makes the

4 patient uncomfortable.

5 DR. LUBRITZ: Have you ever gotten any questions:

6 Has this doctor gone to school?

7 MS. KIRCH: Maybe after they went to them they

8 wonder.

9 MR. COOPER: You're forgetting where I work.

10 PRESIDENT MONTOYA: For the M.D.'s, my diploma is on

11 the wall. Yours also?

12 DR. HELD: I hand out an information sheet to all

13 patients.

14 PRESIDENT MONTOYA: You're the same, I'm sure.

15 DR. BAEPLER: Yes.

16 DR. LUBRITZ: Mine are so old, they're falling

17 apart.

18 PRESIDENT MONTOYA: I'll take a motion for the

19 minutes -- passage of the minutes.

20 MS. KIRCH: Move for approval as amended.

21 DR. LUBRITZ: I'll second.

22 PRESIDENT MONTOYA: All in favor?

23 Anyone opposed?

24 The Chair is in favor, so the minutes are passed as

25 amended.

Capitol Reporters (775) 882-5322

1 I was a little bit amiss, Dr. Lamerson. You don't

2 know people here like I do. So let me tell you what we have

3 here. You met the staff, but next to you is Dr. Held, a

4 pulmonologist from Gardnerville. I don't know if you've met

5 him or not, but he's there.

6 Next to you, of course, Jean Stoess. You met her at

7 the meeting. Dr. Anjum, a cardiologist from Las Vegas. And

8 the rest the staff you know. Marlene Kirch, the well-known

9 bankers face of the banking industry down in Las Vegas.

10 MS. KIRCH: The one that says no a lot.

11 PRESIDENT MONTOYA: Dr. Anwar, internal medicine

12 from the Las Vegas also. And Dr. Baepler, scientist

13 extraordinaire from the University of Reno. He's actually a

14 bird doctor. Yes, he's a bird doctor, an ornithologist.

15 And Dr. Joel Lubritz, the M.D. doctor from down

16 south, from Las Vegas.

17 MS. STROESS: I forgot about those that volunteered

18 by mistake.

19 PRESIDENT MONTOYA: The two on, actually, either

20 side of you volunteered for this job. You were hooked. The

21 two next to you all volunteered.

22 All right. You met all the rest of the staff.

23 Wait. You didn't meet the District Attorney, Charlotte Bible.

24 MS. BIBLE: Attorney General.

25 PRESIDENT MONTOYA: Attorney General, Assistant

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1 Deputy Chief. Right.

2 MS. BIBLE: Chief Deputy Attorney General.

3 DR. LAMESON: Okay.

4 PRESIDENT MONTOYA: She's been with us for a long

5 time. She keeps us straight and has bailed us out a few

6 times. And she's a valuable resource and makes sure we adhere

7 to the opening meeting laws, and she's good for a general fund

8 of knowledge in areas we get into.

9 All right. Now we're going to go on to the next

10 item.

11 So the December 28th, telephone call conference

12 meeting, which we had. It's under 2, right?

13 MS. MUNSON: Behind the blue sheet.

14 PRESIDENT MONTOYA: Behind the blue sheet.

15 MS. MUNSON: They're closed minutes, and then the

16 third one is the emergency meeting.

17 PRESIDENT MONTOYA: Blue sheet.

18 DR. BAEPLER: Blue section.

19 MS. MUNSON: We still have the closed minutes.

20 PRESIDENT MONTOYA: This is still in open session,

21 and this is confirmed regarding the matter of David Bloom

22 Evans.

23 DR. BAEPLER: Move to approve those minutes.

24 MS. KIRCH: Second.

25 PRESIDENT MONTOYA: Opposed? All in favor?

Capitol Reporters (775) 882-5322

1 Opposed?

2 MS. STROESS: I just have a question. Has anything

3 new happened since we had the meeting?

4 PRESIDENT MONTOYA: No. The laws of justice are so

5 slowly turning in this matter.

6 MS. KIRCH: He's also been charged in California.

7 There was an article in the newspaper. There's been some

8 additional charges in California, apparently.

9 DR. BAEPLER: You recall some of the photos they

10 recovered in Nevada were taken in California. So --

11 MS. KIRCH: There was an article that they charged

12 him.

13 DR. BAEPLER: California picked that up.

14 PRESIDENT MONTOYA: This doctor had no previous

15 record. He had not been picked up on any radar screen that

16 was currently available to mankind. So --

17 MS. BRAND: He is still incarcerated.

18 DR. BAEPLER: He is?

19 MS. BRAND: Yes.

20 PRESIDENT MONTOYA: Okay.

21 MS. KIRCH: Do we need to approve to close --

22 PRESIDENT MONTOYA: I don't think we have to do

23 anything. This has passed closed. I think we have to ratify

24 it.

25 MS. BIBLE: Yes.

Capitol Reporters (775) 882-5322

1 PRESIDENT MONTOYA: These minutes are already.

2 DR. BAEPLER: They've been approved.

3 PRESIDENT MONTOYA: They are already taken care of.

(3. REPORT ON STATUS OF THE BOARD'S PUBLIC SERVICE

5 ANNOUNCEMENT PROGRAM THROUGH NEVADA BROADCASTERS ASSOCIATION)

6 PRESIDENT MONTOYA: Okay. We go on to Number 3,

7 Report and Status of the Board's Public Service Announcement

8 Program through Nevada Broadcasting Association.

9 MR. CLARK: The Nevada Broadcaster's Association is

10 working on finalizing some additional scripts for radio and TV

11 spots, from those that our Board Committee approved, when it

12 was -- when it was functioning. They will send those scripts

13 to us when they have them finalized.

14 None will require Board members to appear on TV.

15 They will use actors and actresses to do that, but you recall

16 one of them was a -- a person goes into her doctor's office,

17 and the doctor is retiring. And she says something to the

18 effect, "Well, what am I going to do now? I don't have a

19 doctor. What's going to happen to me?" And the doctor tells

20 her that there are numerous great doctors in the State of

21 Nevada, and in her hometown, and all she has to do is check

22 with the Nevada Board of Medical Examiners to get some names,

23 and they'll give her some names and things like that.

24 They will send us those scripts, and we get to have

25 the opportunity to modify them, and then they will start

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1 working on them. But they are also waiting now. Have you had

2 the opportunity to go through that?

3 PRESIDENT MONTOYA: It is entirely my fault. I have

4 the script in my hands. I have it even memorized.

5 DR. BAEPLER: I have one question. Isn't it more

6 appropriate they call their county medical association if

7 they're looking for a new doctor?

8 MR. CLARK: I may have misspoken on that. Yeah. I

9 don't remember what the script said exactly.

10 PRESIDENT MONTOYA: What the script is trying to

11 imply is that we have a lot of good doctors here in Nevada.

12 DR. BAEPLER: Yes.

13 PRESIDENT MONTOYA: That you can find whatever

14 doctor you want.

15 DR. BAEPLER: Then you have people from Las Vegas or

16 Reno calling you to have you recommend a doctor.

17 PRESIDENT MONTOYA: That is not actually the intent

18 of this script, and the script doesn't say that. He misspoke

19 a little bit. But what we're trying to do is project a more

20 positive image about the doctors here in Nevada.

21 And it's not necessarily a recommendation or a

22 referral, but we are here to help if you have questions about

23 your doctor. We just want to get the message out there that

24 we have tons of good doctors, right here in Nevada.

25 DR. BAEPLER: That sounds good.

Capitol Reporters (775) 882-5322

1 MR. CLARK: I should have been more articulate.

2 PRESIDENT MONTOYA: Marlene and I also read these.

3 DR. HELD: How do they arrive at a dollar return?

4 What does that mean?

5 PRESIDENT MONTOYA: I wish he was here to explain

6 it, that they arrived -- they decide how much their

7 advertising dollar -- their advertising time is worth. And

8 then they broadcast this thing so many -- so many times, and

9 then they decide, okay, so it's worth that much money.

10 MR. CLARK: X dollars times 14 -- 14 radio spots a

11 month equals, whatever it is. That's --

12 DR. BAEPLER: At the commercial rates.

13 PRESIDENT MONTOYA: At the commercial rate.

14 MS. BRAND: There is a report given by Arbatron that

15 also estimates the number of viewers that they probably bring

16 that in.

17 PRESIDENT MONTOYA: That's where they get their

18 dollar amount.

19 DR. HELD: Have you ever seen one?

20 MS. KIRCH: Yes. We've seen a lot of them, and a

21 lot of people have seen it, because I've had calls and

22 comments when I go places. Even though I'm on there just a

23 brief period of time, I get a lot of comments, and I have seen

24 it.

25 DR. BAEPLER: Marlene and I were discussing the

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1 Oklahoma up-coming football game.

2 MS. KIRCH: That's very important business that was

3 being discussed.

4 PRESIDENT MONTOYA: I'm odd man out. I have no idea

5 what they're talking about.

6 DR. LUBRITZ: How much of a total budget -- I don't

7 even know what is the -- how much do the ads cost now? What

8 expenditure do we make yearly for our advertising?

9 PRESIDENT MONTOYA: We did go to a yearly plan.

10 Tony has that. Do you remember?

11 MR. CLARK: It's $15,000 a quarter. So $60,000 a

12 year, I believe.

13 DR. LUBRITZ: So that would be what percentage of

14 our total revenue?

15 MR. CLARK: I don't know.

16 DR. BAEPLER: 60,000, a hundred physicians' fees --

17 it's considerably less than one percent. It's no problem. I

18 don't know how much mileage they get out of them. They seem

19 to show them at 2:00 and 3:00 in the morning. That's the most

20 frequent time.

21 MR. CLARK: I've heard the ones on two or three of

22 the Reno radio stations during the day on the way to work and

23 on the way home. We're getting some daytime exposure up in

24 the north.

25 MS. KIRCH: The TV in Las Vegas has been on, like,

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1 various times that I would have been watching, which is in the

2 morning.

3 PRESIDENT MONTOYA: I've seen it.

4 DR. BAEPLER: I've seen it a couple of times.

5 DR. HELD: You're not an insomniac; are you?

6 MS. KIRCH: No, I'm not. I'm an early-to-bed

7 person.

8 DR. HELD: Like 2:30 in the morning.

9 PRESIDENT MONTOYA: I promised the next time we

10 meet, we'll have the Spanish version going.

11 DR. LUBRITZ: Si.

12 DR. HELD: Esta bien.

14 (4. AMENDMENTS TO NEVADA ADMINISTRATIVE CODE CHAPTER 630)

15 PRESIDENT MONTOYA: Number 4, Amendments to the

16 Nevada Code 630, Review Public Comments and Consideration of

17 Adoption Proposed Amounts. Ed?

18 MR. COUSINEAU: Yes, sir.

19 PRESIDENT MONTOYA: You've got something for us?

20 MR. COUSINEAU: You bet. Pursuant to the

21 Administrative Procedures Act, when an entity --

22 MR. GARCIA: (Via teleconferencing) Can we remind

23 you guys down -- up there in the north to turn on your mics,

24 please?

25 PRESIDENT MONTOYA: Consider us reminded.

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1 MR. COUSINEAU: -- consistent with the

2 Administrative Procedures Act --

3 DR. JAVAD ANWAR: Could I make a comment? It says

4 on the agenda -- so we are, time-wise, together on this,

5 Charolette?

6 MS. BIBLE: No.

7 PRESIDENT MONTOYA: Before we can actually talk

8 about this -- who is running this meeting? I swear, we're a

9 slave to the buck.

10 All right. We can't talk about it yet then, huh?

11 DR. BAEPLER: There is one item we could discuss,

12 relevant to it, however. In the minutes of the last meeting,

13 you'll note that we discussed what we would do about

14 applications in process. It's on page 4 of 24.

15 But we came to no conclusion, and we face that

16 problem now. For example, I have one doctor that I'm

17 reviewing. This is the one, passing the USMLE -- okay. It

18 took 11 attempts.

19 Now, if we pass this late in the agenda, we don't

20 have to grandfather him -- or how are we going to handle these

21 people in transit? The people that have applied under the old

22 rules and suddenly now we've changed the rules, what do we do

23 with the people in transit?

24 MS. KROTKE: We talked about that last month, I

25 think -- out of fairness, we grandfathered those in, all the

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1 applications that were in the pipeline, before we adopt this

2 one to be considered.

3 DR. BAEPLER: We can't have a person come here,

4 coming out of state, and then we say "Guess what? An hour ago

5 we changed the rules. Your application is invalid."

6 MS. KIRCH: What if they have a large number of

7 attempts and we don't think it's appropriate? We don't have

8 to license them.

9 DR. BAEPLER: We've passed them with 18 or 19

10 attempts. That's why we're -- you're right.

11 MS. KIRCH: I don't think we have to.

12 DR. BAEPLER: They're not violating any rule right

13 now, if they've taken 11 attempts. You see?

14 MR. COUSINEAU: First off, even if you will approve

15 the proposed regulation today, it's still going to take

16 probably about two months, approximately, assuming everything

17 goes as planned, for the materials to be forwarded to LCB.

18 They'll do their review, and once they've compiled all the

19 information necessary for -- according to the Administrative

20 Procedures Act, it will be filed with the Secretary of State.

21 That's actually when it's adopted.

22 DR. BAEPLER: That's the effective date.

23 MR. COUSINEAU: Unless we designate -- we can

24 designate the effective date subsequent, for a date certain.

25 DR. BAEPLER: Okay.

Capitol Reporters (775) 882-5322

1 MR. COUSINEAU: But as far as the individuals who

2 are in the pipeline right now, I think it would be bad

3 practice to try to imply that they are subject to the new reg.

4 And, conversely, even if -- you know, once the reg has been

5 enacted, that does not necessarily prescribe applicants from

6 applying if they don't meet the criteria. They can still you

7 go through the process.

8 DR. BAEPLER: Okay. That would resolve the problem.

9 We're not talking about a great number of people, obviously,

10 but we need to resolve it before we pass this.

11 MR. CLARK: One additional point that the Board

12 might wish to consider, and that is: The Board has an

13 obligation to the public not to license people who are

14 unqualified in the practice of medicine. And if for some

15 reason, whether it be 6,000 times taking the MLE -- MSLE or --

16 100 times, or 19 times, or whatever it is, if this Board feels

17 that the person is unqualified, you can vote not to give the

18 person a license.

19 That's the point Marlene was making earlier. You're

20 not locked in to giving a person a license just because he or

21 she didn't meet the regulation or did meet the regulation that

22 was in effect at that time.

23 DR. BAEPLER: In this instance, we need a hook to

24 hang our hat on. The person would have met every requirement

25 for licensure that we list.

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1 MR. CLARK: Except perhaps competence.

2 DR. BAEPLER: There is nothing in our regs that

3 would identify. That is my point. It's an argumentative

4 thing. If they were to take us to Court and -- the Court

5 would say, "What requirement have they not meet?" "They meet

6 every one of them, your Honor." Hmmm? It's why we're coming

7 in with this new reg.

8 DR. ANWAR: The point is that that application needs

9 to be considered on its merits and the whole application,

10 whether they felt the candidate is qualified for licensure or

11 not. And -- but going forward, if this reg is approved, then

12 we can say that a few did more than so many attempts, you are

13 not qualified. We can use that.

14 PRESIDENT MONTOYA: Administrative rejection is what

15 it would be, instead of having to come up here and --

16 DR. BAEPLER: Exactly.

17 PRESIDENT MONTOYA: -- and have a Board rejection,

18 just like we have an administrative reg licensures right now.

19 MR. CLARK: Have we tap danced around enough? Do

20 you have time now?

21 PRESIDENT MONTOYA: Two minutes.

22 DR. LUBRITZ: Do you know what we're going over?

23 DR. LAMESON: Yeah, I do.

24 DR. LUBRITZ: Because we've had applicants come

25 through that have taken the USMLE 10, 12, 13, 14 -- 19 times.

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1 We're trying to put some limit on it, and within what period

2 of time do they have to complete those.

3 DR. LAMESON: All right.

4 PRESIDENT MONTOYA: We've got a 22 right now in our

5 packet, at this time.

6 DR. BAEPLER: And I've got an 11.

7 MS. KROTKE: If the reg passes, how will the

8 applicant as of that time learn about the regulation? Does it

9 appear on forms that they have to fill out or how would that

10 be disseminated?

11 DR. ANJUM: It would be reviewed by the license

12 specialist. They would be informed of that. That would be an

13 administrative rejection, like you said before.

14 PRESIDENT MONTOYA: They have to fill out the

15 application first and send it in, and the license specialist

16 can say --

17 MS. KROTKE: Sorry.

18 PRESIDENT MONTOYA: -- sorry, but you've exceeded

19 the maximum number of times.

20 DR. BAEPLER: Do we refund their application fee at

21 that time?

22 MS. KROTKE: No.

23 PRESIDENT MONTOYA: We should either send them

24 something in advance that says that -- on the application, "If

25 you have taken the USMLE more than a certain number of times,

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1 then you would not meet the criteria for licensing in the

2 State of Nevada."

3 I don't think it's right to take their money then

4 give them the thing and not give them their money back. We

5 might avert some applications just by putting something

6 outside.

7 DR. BAEPLER: Any applicant ought to know what the

8 requirements are.

9 MR. CLARK: Once the regulation becomes applicable,

10 we will notify the Federation of State Medical Boards, which

11 keeps statistics on which each state requires and puts that

12 information out to USMLE, as well as all of the other boards,

13 and that is at least one fashion where the information comes

14 out to the public.

15 PRESIDENT MONTOYA: How would an applicant access

16 that information?

17 MR. CLARK: Say that again.

18 PRESIDENT MONTOYA: How would an applicant access

19 that information?

20 MR. COOPER: On the website.

21 DR. BAEPLER: The Federation website.

22 MR. CLARK: And they probably -- I don't know if

23 they have --

24 MS. MUNSON: Or we could update it with our

25 information about applications.

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1 PRESIDENT MONTOYA: Okay.

2 MS. MUNSON: Sure.

3 MS. KIRCH: Do you have other reasons you reject

4 these administratively? Do you refund the money?

5 MS. KROTKE: The only time that we give back money

6 is if we catch it before it's receipted. If they blatantly

7 don't meet the requirements on reviewing it -- before it's

8 sent for receiving, we'll send it back.

9 MR. GARCIA: (Via teleconference) Mics, please.

10 MS. KROTKE: Sorry. That's the only time we give

11 them we just send it back. Otherwise, by statute, we can't

12 give their money back for the application.

13 DR. BAEPLER: Okay.

14 MR. LUBRITZ: I have a problem with that. I think

15 if there is some reason that someone is not -- is going to be

16 administratively -- or can be administratively rejected, I

17 don't think we should take their money. I don't think that's

18 fair.

19 DR. HELD: I agree.

20 MS. STROESS: I agree, too.

21 DR. LUBRITZ: If we're going to do it, I think we

22 should have something that accompanies the application that

23 says, "Dear Doctor, if you can't pass these few things, please

24 don't send us the money, because we can't send it back to you,

25 but, no, you're not going to get a license."

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1 DR. BAEPLER: What about the --

2 MS. KIRCH: Isn't it incumbent upon anyone applying

3 for a license of any type to check and see if they meet the

4 requirements? And there are ways for them to do that.

5 DR. BAEPLER: I think this would be reflected on the

6 form they fill out.

7 MS. KIRCH: Well -- but if they still submit their

8 money and their application, there's ways for them to find

9 out. I don't know that we should refund the money. We still

10 are spending time looking at their application, processing it,

11 and I'm not sure that we should send the money back.

12 PRESIDENT MONTOYA: I'm afraid if we open this up to

13 refunding applications, that every time someone is rejected,

14 we're going to give the money back.

15 MS. KIRCH: Right, and that's not --

16 PRESIDENT MONTOYA: That's not too terribly wide

17 unless you make it very specific.

18 DR. ANWAR: I think that intent of the thing is that

19 before that application is even reviewed, if there is a way

20 for them to know the bullets: These are the things that won't

21 qualify your application, period, from an administrative

22 level.

23 MS. KROTKE: Even if they apply, and they're over

24 the limit on the USMLE, they can still apply by enforcement.

25 They may choose to go that route.

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1 DR. BAEPLER: A rough parallel might be applying at

2 professional schools. You make your application to law school

3 or whatever. You send in the forms with your application fee.

4 If you're rejected, you don't get that fee back.

5 PRESIDENT MONTOYA: It's now 9:00 o'clock. We can

6 go back and do this. We put the cart before the horse there

7 for a minute.

8 Mr. Cousineau, please go over the consideration of

9 dodging the Proposed Amendment to NAC 630.080.

10 MR. COUSINEAU: Yes, sir. Thank you.

11 Consistent with the Administrative Procedures Act,

12 two workshops at normal hearings were conducted to solicit

13 public input. The workshops were held in Reno on December

14 20th, 2004. In Las Vegas, on the 21st of December 2004, and

15 the formal hearing was held in Reno on February 4th of this

16 year.

17 The only input I received, either in person,

18 though -- I should say, the only input was in person. I

19 received no written correspondence or input from the general

20 public.

21 Mr. Matheis, who I believe is here with us today,

22 was the only one that spoke, and that was at the workshop on

23 the 20th of December in Reno.

24 I don't want to do him an injustice, but I'll try to

25 quote his comments generally. I think he believes that it

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1 was -- this is a step in the right direction and certainly is

2 a good idea.

3 He had concerns about the fact that international

4 medical graduates often times find the exams problematic, and

5 he was hoping that the Board would somehow be able -- or

6 contemplate putting a procedure in place to track and see if

7 there is a pattern as far as the individuals who apply that do

8 not meet the proposed regulation criteria.

9 Did I leave anything out, Mr. Matheis?

10 MR. MATHEIS: No.

11 MR. COUSINEAU: So that was, in essence, the only

12 input we received. I believe we have comported with all the

13 requirements under the Administrative Procedures Act to this

14 point. And, with that, I believe it needs to come to a vote

15 of the Board members.

16 PRESIDENT MONTOYA: Mr. Matheis, did you have

17 anything to add to --

18 MR. MATHEIS: No, Doctor.

19 PRESIDENT MONTOYA: Dr. Lubritz, you brought up a

20 good points about the possible refunding of the application

21 fee, should they not meet the requirements. Are you happy now

22 with the discussion we had before, that we put this on the

23 website? And what else could we do, Lynette, to get the

24 information to the applicant that --

25 MS. KROTKE: We can put on the check list where

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1 we're telling them to go get the USMLE verification -- we can

2 give them the new reg and let them know.

3 DR. BAEPLER: That would be good.

4 PRESIDENT MONTOYA: With the new reg in their hands

5 and the -- so they're fully informed, that these are the

6 minimum requirements, you'd be all right with that?

7 DR. LUBRITZ: Absolutely.

8 DR. BAEPLER: To put this in a perspective, what are

9 we talking about here? 1 or 2 percent of the applications?

10 This is not a common problem.

11 PRESIDENT MONTOYA: We don't want to be unfair to

12 anybody at all. So Doctor -- somebody on this side also had

13 an objection to it, and I can't remember --

14 DR. LAMESON: Just if they're informed, and they

15 decide to put their application forward, then they've been

16 informed, and they know that their application fee will not be

17 reimbursed.

18 PRESIDENT MONTOYA: You've heard what the Board

19 would like, Ms. Krotke. I don't think there is a problem with

20 that.

21 MS. KROTKE: No.

22 MR. COUSINEAU: The only thing I would ask

23 Dr. Montoya and Dr. Baepler, as far as the effective date.

24 Charolette, do you know? Is that something that needs to be

25 enunciated in the notice or is that discretionary on the part

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1 of the Board, to designate the effective date? We can just

2 leave it open-ended, and, obviously, it would be when it went

3 through the process formally. But I don't know if Dr. Baepler

4 your Board members wanted to get a date certain.

5 DR. BAEPLER: I just wanted the concept of --

6 grandfathering the ones that are in process is fine. That's

7 a`-- I'm perfectly satisfied with that, whenever the date

8 becomes available.

9 MR. COUSINEAU: Okay.

10 PRESIDENT MONTOYA: Objections anybody?

11 MS. KIRCH: Can you put a date in?

12 MS. BIBLE: You can. It's not before the Board.

13 DR. BAEPLER: You can't predict that.

14 MS. BIBLE: No.

15 PRESIDENT MONTOYA: We can just leave it as the

16 effective date then.

17 DR. BAEPLER: Whenever they finish it up in Carson

18 City, you can notify Licensing that it's now effective.

19 MR. COUSINEAU: Yes, sir.

20 PRESIDENT MONTOYA: So to move ahead with --

21 MR. CLARK: We can notify all of the licensees in

22 our newspapers that this new regulation has become effective

23 on X date because the L.C.E.B. has approved it and sent it to

24 the Secretary of State's Office.

25 PRESIDENT MONTOYA: Licensees are not worried about

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1 that. They're worried about the prospect that --

2 MR. CLARK: I understand, but at least it would be

3 public information.

4 DR. BAEPLER: Licensees also recruit new doctors.

5 PRESIDENT MONTOYA: They tell their friends. I

6 think we're going to need a motion to move forward.

7 DR. ANWAR: Motioned. Moved.

8 MS. KIRCH: Second.

9 PRESIDENT MONTOYA: Let's move to forward to this

10 amendment.

11 All in favor?

12 Opposed?

13 The Chair is in favor. So we move ahead with this

14 amendment.

15 The next one is a Status of Amendment of NAC

16 630.560, to increase the membership of the Practitioner of

17 Respiratory Care Advisory Committee to five members.

18 This is mostly because they're spread all over the

19 state, and it's hard to get a quorum. Mike, do I see you down

20 there?

21 MR. GARCIA: (Via teleconferencing) Yes,

22 Dr. Montoya.

23 CHAIRMAN MONTOYA: Okay.

24 MR. CLARK: I could respond to that, too. I've

25 already done the draft. I will have the notices out this

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1 month. We will hold the public hearing and the workshop this

2 month, and we will be prepared to go forward at the March

3 meeting -- strike that -- at the June meeting, with the

4 presentation to the Board of the proposed regulation change.

5 PRESIDENT MONTOYA: Mike, any --

6 MR. GARCIA: (Via teleconferencing) Yes.

7 PRESIDENT MONTOYA: Any comments on this?

8 MR. GARCIA: No. We appreciate your support, and

9 anything we need to do to help with those workshops, just let

10 me know.

11 PRESIDENT MONTOYA: Those of us that were not here,

12 in your words, would you tell us why we have to increase it to

13 five?

14 MR. GARCIA: Basically, we'd like to be able to

15 represent our constituency a little bit better. We're asking

16 that we add one additional member from the north, and we bring

17 in a respiratory therapist from our rural communities, so

18 we'll end up with two in the south, and two in the north, and

19 one from our rural facilities.

20 PRESIDENT MONTOYA: Okay. Thank you.

21 DR. LUBRITZ: Are you looking for a motion?

22 PRESIDENT MONTOYA: Yes.

23 DR. LUBRITZ: I move that we amend NAC 630.560 to

24 increase the membership of the Practitioner of Respiratory

25 Care Advisory Committee to five members.

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1 DR. HELD: Second.

2 PRESIDENT MONTOYA: Moved and seconded.

3 All in favor?

4 Opposed?

5 The Chair is in favor, so the amendment moves

6 forward.

7 All right. We can't start the next one until 9:20.

8 Request for Approval to Practice Outside Nevada.

9 DR. BAEPLER: We're slightly ahead.

10 PRESIDENT MONTOYA: For the Family Practice

11 Residents Program this is a case, in particular, that -- we

12 can discuss this concept in general.

13 MR. CLARK: Go to Item 6.

14 MS. KIRCH: Go on to the next item.

15 PRESIDENT MONTOYA: What is 6?

16 MS. KIRCH: The website.

18 (6. BOARD WEBSITE (www.medboard.nv.gov) REPORT)

19 PRESIDENT MONTOYA: Ah, Board website. Laurie, what

20 can you -- that's not a timed one. Yes. Great.

21 What can you can you tell us about the website?

22 MS. MUNSON: Well, we are continuing to increase our

23 hits every day on the website. Back when I reported, a little

24 over a year ago, we were getting about -- averaging 300 hits a

25 day. Now, we're up to around 500, so a lot of new hits, still

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1 the disciplinary page being the most popular. It remains that

2 way.

3 So we're getting word out there, and we've got --

4 received some good feedback lately on it, and we're still

5 continuing to work on that.

6 Under this item we also were going to discuss --

7 we've looked at a new product. We currently have License 2000

8 as our licensing and regulatory software system. And we

9 purchased that in 1999. So we've had it approximately five

10 years.

11 The Board expended about $153,000 on it at that

12 time. We've added some enhancements, anything from 5,000 to

13 $7500 every time we want to add a check box or something to

14 our module, so that we can, for instance, put down what the

15 primary specialty is, if it's a physician. So it's expensive

16 stuff.

17 We have a $21,000 maintenance contract per year.

18 It's currently 21,000. It started at 18 something, which was

19 based on 12 percent of the contract amount, the original

20 contract amount. The contract requires that it go up

21 3 percent a year. So now we're at 21. That's --

22 PRESIDENT MONTOYA: Excuse me. 3 percent a year and

23 infinitum?

24 MS. MUNSON: Under the current contract. We're due

25 to renegotiate that contract this year for the next three

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1 years. It's a three-year contract. They've been under that

2 contract for three years.

3 They haven't told me yet what the new contract fee

4 would be. They said it would be consistent. So it --

5 probably we'll be looking at another 3 percent on top of that.

6 That's for tech support and upgrades that they send out to us

7 that we download. We're doing that ourselves, but when we

8 call with a problem, where we have some people help with

9 something, that's what's included in that, the yearly fee. It

10 doesn't include these enhancements that cost us on top of

11 that, 5,000, 7,000.

12 On the other item under this, that we were looking

13 at, that we tabled until this meeting was as to the education

14 module. That one is over $12,000 to do that one thing.

15 Also we talked about on-line renewals. I checked

16 with them to add those. We would have to purchase another

17 program that works with License 2000, called My License, and

18 it -- we could do that two different ways.

19 One would be to pay $100,000, up-front, plus an

20 additional 30 percent on top of our maintenance agreement

21 every year, which would be approximately $6500 a year. Or we

22 can have them host the program, which would cost us $35,000,

23 up-front, and then ten to $15,000 a year for reconfigurations

24 for our renewals every year, plus $2,000 a month for -- every

25 month that we're on-line with our renewals. If we were on

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1 line for six months, it would be another $12,000 on top of

2 that.

3 So we're looking at $47,000 the first year to go

4 that way, and then twenty-two to 27,000 every year thereafter

5 for -- just for the on-line renewals, in addition to

6 everything else.

7 DR. BAEPLER: Even though we're on a biennial

8 system, so one year we don't have renewals?

9 MS. MUNSON: Actually, we do, because we have the

10 odd years where we have the physician's assistants and --

11 DR. BAEPLER: The big one comes every --

12 MS. MUNSON: We are biennial. You're correct, but

13 we are doing them every year because we've got some in the odd

14 years and some in the even. We're talking four to six months

15 for the respiratory therapist, minimum six months.

16 DR. BAEPLER: That's not cost effective.

17 MS. MUNSON: No, it's not cost effective.

18 Additionally, the other thing I wanted to mention, if we stay

19 with the system, most of the current staff of the Board was

20 not here when this was installed or upgraded and has never

21 received formal training.

22 To be able to utilize this system better we would

23 need, I believe, to spend some money for training. We've

24 talked about it with the other chiefs, and with Tony, and they

25 gave me a quote of $6,000 for forty hours of on-site training

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1 to get everybody up to speed.

2 We've also had upgrades, and when they upgrade, they

3 don't send out training. And they change things. So every

4 few years we're going to need training again on this system.

5 So there's another figure. And then that doesn't

6 guarantee it's going to do everything we need to it to do.

7 What we've found -- and Doug has a great frustration here with

8 this, especially in his area. The reports that we think we

9 should be able to use, simple reports, such as -- well, on my

10 side of things, someone asked the other day, "I would like to

11 know how many physicians licensed in Nevada graduated from the

12 University of Nevada Reno Medical School." We can't run that.

13 It's a simple report that we should be able to run, because

14 it's information contained in our database.

15 I called the tech people to say, "Hey, I'm having

16 difficulty with this." I had a tech person on the line. He

17 told me how to do it. It didn't work. Then when I asked

18 him -- I said, "Well, it didn't work," he gave me some --

19 "Well, you know, you know training." So there's our tech

20 support.

21 We send questions to them. We get answers back that

22 don't -- are non-responsive and they give us all this

23 technicality jargon that doesn't help us. They're nice people

24 to deal with, but we've just had a lot of frustration.

25 I asked -- sent him a list of ten questions that

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1 were on the Enforcement side of things. "Can you run this

2 report, such as complaints by complaints category,

3 investigator case loads," things that we also should be able

4 to pull on. We've tried to run, and we can't. They can't

5 even tell me, without doing this research, if our system will

6 allow for that, or if we're going to need another enhancement.

7 So there's what we're dealing with currently. And

8 along with this, the -- we were told about a system called

9 GL-Sweep. North Carolina Medical Board has just gone over to

10 them, and they've been working with them for 16 months on

11 this. They went on-line last week. Our Pharmacy Board, here

12 in Nevada, has it and has had it for approximately three

13 years. They're thrilled with it. They say it does everything

14 they need and then some.

15 North Carolina only been on there it a sort time.

16 They said they're great to work with. They are flexible.

17 They're working out the bugs now, because you're always going

18 to have that when you put a new system in place. But they are

19 working with them.

20 They stayed in the budget. They went a little over

21 on the time because of all the information that needs to be

22 collected, and working with the staff, and it became a big

23 deal, but they're happy with it. The Nursing Board there in

24 North Carolina has had it for a little while, and they're very

25 happy with it. These are big, big -- they have a lot of

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1 licensees. We're talking 30,000 licensees. And so it works

2 for them.

3 The Kansas Board is almost going on-line with them.

4 They've had the same experience. We have two other agencies

5 in Nevada, the Veterinary Board and Cosmetology that I'm aware

6 of that have it. It's out there. It's growing. It's --

7 PRESIDENT MONTOYA: Ms. Bible told me that D.O.

8 Board also uses its.

9 MS. MUNSON: And the D.O. Board. I'm sorry. Yeah,

10 and I talked to Tray over there, and he's been very satisfied

11 with it. We did hear one bad thing about it from the Texas

12 Board. They -- four years ago, they looked at an older

13 product. They spent over a half a million dollars on it.

14 Then they dumped it. They had difficulties with some

15 security. They had security issues, data conversion issues,

16 and response time issues.

17 However, it was a different product, and I also -- I

18 asked all of these other boards, that have this, that I could

19 talk to about these issues, and none of them have experienced

20 that. They're looking at the same product we are. It could

21 have been an anomaly. I don't know.

22 To go with them -- we've seen a demo, and I think

23 everyone was pretty please with what we've seen so for. They

24 looked very impressive. It's Microsoft-based. It's easy to

25 use. They use the same server, so we wouldn't have to buy any

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1 more servers. They use Crystal Report, which we already have.

2 They seem really great to work with. What they're

3 offering us is $53,000 for our licenses, which is 4,000 a

4 license for the first ten, and then a thousand a license for

5 all those thereafter. So that's -- the entire staff is 23

6 licenses. That's a one-time fee.

7 Then they've given us a quote of a 147,000 to

8 247,000 for configuration, putting -- you know, converting the

9 data, setting up our web -- they would change our website and

10 take it over, if we like, doing the on-line licensing. That

11 would all be included. On-line renewals would all be included

12 in that.

13 So for -- if we go with that, what that's based on

14 is 1500 hours of work, up to 2600 hours of week. It includes

15 training. It includes everything.

16 We customize our reports. We tell them what we

17 want. We get what we want out of this. Their maintenance

18 agreement is only -- or for their upgrades to this is 7950 per

19 year, currently. And their tech support is $95 an hour if you

20 buy it in bulk. The first year we'd probably need about a

21 100,000 to a 150,000 to be safe. That includes enhancements.

22 It includes everything. We're not going to have that in

23 addition.

24 And then it's going to go down there, because with

25 this system they'll teach us how to do our own thing. Every

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1 year we're going to know more and more, and be able to do more

2 of our own changes. If the Legislature us a new profession

3 for instance, we'll be able to add that, ourselves. We won't

4 have to do an enhancement to add these people, like we would

5 with the current system.

6 So we're looking at, for the first year or so,

7 probably the same amount, maintenance-wise, around $22,000, at

8 the -- at the upper end for them, which I believe will

9 decrease, as opposed to what we currently have, which

10 continues to increase in extra enhancements. No extra fees

11 and equipment needed for a line renewals.

12 DR. BAEPLER: We've mixed here a number of different

13 categories.

14 PRESIDENT MONTOYA: It sounds like we're being sold

15 a used car. You're very good at it. This new thing sounds

16 like you convert the baby back to before and change the

17 diapers.

18 DR. BAEPLER: When we say mixing something though,

19 we have an agenda item that relates to the website. A lot of

20 what you're taking about here is not going to go on the

21 website for people to draw -- you know --

22 MS. MUNSON: No.

23 DR. BAEPLER: You're talking about institutional

24 research items, the types of things that would be useful to

25 staff. It's independent of the website. And the number of

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1 data points that you want to enter for the types of

2 information, like how many graduates from UNR, there are very

3 simple programs to handle this. It's just a bit of time to

4 enter it, but that -- these are not complex questions for a

5 computer to answer.

6 But the issue here -- if we want to talk about

7 Number 1, the relicensing, et cetera, on-line, seems not to be

8 cost effective. The website always has been a contentious

9 problem. The Legislature addresses this in NRS 630, and if

10 you read the NRS, there -- the Legislature defines for us

11 precisely what should go on that website.

12 Doctors generally are reluctant, for a whole variety

13 of reasons, which I think are valid in most cases, not to

14 endlessly expand this. And I -- I tend to agree with them.

15 But we're mixing a whole variety of things here, and I've

16 already lost track of what program is going to do what.

17 PRESIDENT MONTOYA: The first thing we're here to

18 consider is a new licensing regulatory software system. He's

19 talking about getting us a new system. Apparently the old

20 system is not working to keep up with what we need, and it

21 would be very expensive to keep applying band-aids, right?

22 MS. MUNSON: Right.

23 PRESIDENT MONTOYA: It sounds like ace bandages, not

24 band-aids.

25 You -- from what I'm hearing, would you like us to

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1 go with this new system. It sounds to me --

2 MS. MUNSON: Well, I'm hesitant to make a

3 recommendation, because there are a lot of considerations,

4 money being the first one. It's very expensive to switch

5 over. I think all -- I'm not -- I'm just saying it's a good

6 system, and it's something we might consider now or in the

7 future.

8 I think what we -- alternatively, we could expend

9 some money on training, which would be considerably less and

10 see if it will make a difference. It very well may. They

11 just can't give me any guarantees. They can't tell me, "Well,

12 we're going to do this, and now it's going to do what you

13 want." They're telling me they don't know. We still may have

14 to do some more enhancements that may cost more to run these

15 reports that we desperately need to have, especially on the

16 Enforcement side of things, but it very well may happen.

17 So it might be worth doing that now, with an eye

18 towards waiting another year until the -- revisiting this next

19 year or six months down the road.

20 PRESIDENT MONTOYA: We're deep into Licensing and

21 Relicensing right now. So this probably could change over

22 now, anyway, if we wanted to do it right.

23 MS. MUNSON: It would take -- even if we were to

24 say, yes, let's go with this, we'd have to get a contract.

25 That's going to be into April before we could possibly get

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1 one. It's going to take six months, minimum, to put it on

2 line. We still have our old system in the meantime.

3 But it would be a lot of extra work right now, which

4 we probably don't, frankly, have the time with the renewals

5 right now, to even begin. So it would -- we'd have to, you

6 know, put it off a couple of months, anyway.

7 DR. BAEPLER: Mr. President, we passed a budget at

8 the last meeting, based on financial projections, and we will

9 not know if those are accurate until at least July 1. At the

10 present time, you know, I think -- the training is great. We

11 have money for that.

12 But any significant expenditures before that, we

13 really need to defer until after July 1 to see if our

14 assumptions have held up correctly.

15 MS. MUNSON: I just wanted the Board to be aware of,

16 you know, what was going on, and that there is these other --

17 there are other systems, too. I'm not trying to sell you just

18 this one. It does seem to be one that most Boards, in

19 checking with other systems, have been looking at them, have

20 gone with.

21 But it's just something that I wanted you to know

22 what's available, what's going on with us currently.

23 DR. BAEPLER: My whole point of my earlier

24 comments -- I don't want to compound the problem by endlessly

25 adding things to the website that we're not required to put

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1 there in the first place. And then we get to the point that

2 now we've got to get a new system to accommodate it, when

3 it's -- it's not mandated by our statute to be there in the

4 first place.

5 PRESIDENT MONTOYA: What I'd like -- I think what we

6 would like to see, is get the numbers on paper so we can hand

7 them out to everybody, the advantages and disadvantageous of

8 both.

9 MS. MUNSON: Okay.

10 PRESIDENT MONTOYA: Give us time to look at those.

11 Give them to us kind of early-ish. I don't think we ought to

12 make a decision today, other than to say that it sounds like a

13 good idea that we go ahead with the training. Am I hearing

14 any objections for that?

15 DR. ANWAR: Not -- the training is all right, but

16 you mentioned that there is some other systems also. What

17 we'd like to -- I sense most of us, as far as this sort of

18 thing is concerned -- it seems like a good idea to have

19 everything on line. It streamlines functions and is

20 considered that you are up-to-date on things, so to say.

21 But if there are other systems, maybe you folks can

22 research them on that and come up with one system that you

23 think you can compare with what we have right now, the one

24 that you recommend, and then the financial accommodations of

25 all that -- and like what's been said, that you put in on a

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1 piece of paper that we can try to go -- in a language we can

2 try to assimilate and understand.

3 PRESIDENT MONTOYA: This would give us an

4 opportunity, just like when you buy a used car, you go home

5 and sleep on it before you buy it. So give us -- give us the

6 advantages, disadvantageous, and the costs, and let us know

7 what is going on, and I -- we can make a better informed

8 decision.

9 As a band-aid, I think that the Board would be

10 willing -- I'm not hearing anything different -- to go ahead

11 with the $6,000 in training. Ms. Bible just told me that's

12 not on the agenda today, but I am of the opinion that it's

13 kind of pertinent to the smooth running of the Board, so we

14 can go ahead and just say, okay, go ahead with the training.

15 Dr. Baepler says it's within on budget and we can do

16 that. Training is certainly part of what we do. So please

17 continue with that, and then we'll start looking at these

18 other systems, and we'll give it a good hard look when we come

19 back in June.

20 And we'll probably be much more able to make a

21 decision then, especially once we get out from under some of

22 this relicensure thing that we're in right now. Because I

23 think it's a bad idea to switch horses in the middle of the

24 stream.

25 DR. LUBRITZ: It would be appropriate for the Board

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1 to put out an RFP, to whatever software people that you would

2 be dealing with, so that they are giving specifically --

3 you're going to be able to compare apples to apples.

4 For instance, one system says, "I can do A, B, C, D,

5 E." Another one says, "We can do this." Again, as Dr. Anwar

6 said, we're kind of lay at this. But if you put out a Request

7 For Proposal and say, "I want my new system to be able to do

8 1, 2, 3, 4" down to 47 things, if that's what you want, then

9 all of them have to bid on that specific thing. We will say,

10 "how much are you charging for your maintenance?" Yes, this

11 is going out for others to bid on. Let them know that there

12 are others who would be bidding on this same thing.

13 And then that way I think you'll be better able --

14 we'll be better able, with your help, to say, "Here is what

15 we're getting, not -- that this has this accessory and that

16 has that accessory, and you can garner this information from

17 this system, but not that."

18 They have to give you specifically what you're

19 asking for. That way you can come up with a better idea.

20 MS. MUNSON: We can certainly do that.

21 PRESIDENT MONTOYA: You've got it. And the next

22 thing is consideration of additional licensees, educational

23 history, license research model. You touched on that.

24 MS. MUNSON: This is where we began speaking about

25 it at the last meeting, and we've got the same quote to add to

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1 the education module. That's just -- it's a decision if they

2 want that information on the website. We've done all the

3 clean-up work. It's ready to do if we so choose to put it on

4 there. It's -- it's your decision whether you actually want

5 to add that or go with what we've been doing. It's available

6 to the public by phone. They can access the information.

7 PRESIDENT MONTOYA: Board members?

8 DR. ANWAR: As far as the information on the website

9 is concerned, there's one area for any complaints against

10 doctors, especially if it goes to court, and if there are any

11 amounts, as to -- there is a cut-off line as to about which it

12 should go, and the idea of that is that we're trying to

13 protect the public from a bad doctor or a bad outcome from a

14 doctor, if possible, and let the public know, before they go

15 to a doctor, as to the -- some history, if there have been

16 complaints regarding the doctor.

17 DR. BAEPLER: Disciplinary history.

18 DR. ANWAR: Disciplinary history in that respect.

19 So when we consider a cut-off line, as far as

20 financial awards given against a doctor to a plaintiff, it has

21 to be in line with a problem -- it has to be reflective of a

22 problem with a doctor, like errors, or problems of that

23 nature, behavioral or whatever.

24 PRESIDENT MONTOYA: Excuse me, Dr. Anwar. You're

25 going down a different line. All we want to talk about here

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1 is the education. We want to be able to get on line and find

2 out the education of the doctor. That's -- that's what this

3 agenda item is about.

4 DR. ANWAR: This is not about other elements of the

5 website?

6 PRESIDENT MONTOYA: No, this is just -- we wanted to

7 see if we could -- it was under consideration to add an

8 education module, to see where the doctor went to medical

9 school, where he did his residencies, awards, and things like

10 that. That's what this question is actually about.

11 Your question is for a later item --

12 DR. ANWAR: All right.

13 PRESIDENT MONTOYA: -- for discussion.

14 DR. ANWAR: And I will hold the discussion on that.

15 DR. BAEPLER: A later item on this agenda or at a

16 later meeting?

17 PRESIDENT MONTOYA: It's for a later meeting.

18 DR. BAEPLER: Could we have that in June, please?

19 PRESIDENT MONTOYA: Okay. So will you put that --

20 Dr. Anwar's discussion in June. But this is the educational

21 module that we were talking about last time, so we could tell

22 the public where the doctor went to medical school, what

23 awards, academic awards. What else was --

24 MS. MUNSON: Actually, all that's on there is the

25 medical school, residencies, fellowships, and then it does

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1 have the original board certification on there, but that's not

2 public. What would be public is simply the medical school,

3 fellowships and internships.

4 PRESIDENT MONTOYA: Okay.

5 MR. CLARK: And residencies.

6 MS. MUNSON: Residencies.

7 MR. CLARK: Board certifications.

8 MS. MUNSON: There is a picture what would be on

9 there, under that item.

10 PRESIDENT MONTOYA: Dr. Lubritz?

11 MS. MUNSON: It's not 6. I'm sorry. I handed it

12 out.

13 MS. KROTKE: If they fail to pass that information

14 they may still think that physician is still Board certified,

15 and they're not. They may be expired.

16 MS. MUNSON: Second to the last page.

17 DR. ANJUM: Certification is for a limited period of

18 time, and then if it's elapsed --

19 MS. KROTKE: You have positions that have been

20 grandfathered into the --

21 DR. ANJUM: If they're grandfathered in, that's a

22 Board certification. That's how the Board accomplished that.

23 So the Board -- I think Board certification, on the part of

24 education -- I think education has to answer the question,

25 just like this question: Where did you go to school?

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1 Sometimes they ask for certification, too, and I think that is

2 part of education. My feeling is that should be on the

3 website, too.

4 PRESIDENT MONTOYA: Board certification? Does that

5 require another education module?

6 MS. MUNSON: Actually, no. What we did, when we

7 sent them for the proposal, was just -- we asked them to keep

8 that off. It's already in the database. So, no, it would be

9 the same. They would just add that to this list.

10 PRESIDENT MONTOYA: Okay.

11 MR. CLARK: You can see the form that would be

12 available on the website. It's the second to last page in

13 Laurie's handout, under Number 6.

14 MS. MUNSON: Number 6.

15 DR. ANWAR: What is the significance of medical

16 school? For us, it's important because we know which are the

17 ones that are approved by the Health Organization, but for a

18 patient, what is the significance of medical school? They

19 don't know from --

20 DR. LUBRITZ: Dr. Montoya?

21 PRESIDENT MONTOYA: Yes.

22 DR. LUBRITZ: Could we have someone read to us

23 specifically what the regs say of what needs to be posted on

24 the website? That may help us make some determination as

25 to --

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1 DR. BAEPLER: It's short.

2 MR. CLARK: NRS 630.144.

3 "Website. General requirements and restrictions

4 concerning posing of information.

5 "1: Board shall maintain a website on the Internet

6 or its successor.

7 "2: Except as otherwise provided in this section,

8 the Board, and its members, and employees shall not place any

9 information on the website maintained by the Board unless the

10 Board, at a regular meeting, approves the placement of the

11 information on the website.

12 "3: The Board shall place on the website without

13 having to approve the placement at a meeting.

14 "Subparagraph A: Each application form for the

15 issuance or renewal of a license issued by the Board pursuant

16 to this chapter.

17 "B: A list of questions that are frequently asked

18 concerning the processes of the Board and the answers to those

19 questions.

20 "C: An alphabetical listing, by name, of the each

21 physician and a brief description of each disciplinary area,

22 if any taken against a physician in this state and elsewhere

23 which relates to the practice of medicine and which is noted

24 in the records of the Board. The Board shall include, as part

25 of the list on the website, the name of each physician whose

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1 license has been revoked by the Board. The Board shall make

2 the list on the website easily accessible and user friendly

3 for the public.

4 "D: All financial reports received by the Board.

5 "E: All financial reports prepared by the Board.

6 "F: Any other information required to be placed on

7 the website by any other provision of law."

8 PRESIDENT MONTOYA: Very simple.

9 DR. LUBRITZ: Dr. Montoya, I'd like to put that in

10 the form of a motion, that we place on our website what is

11 required by regulation.

12 MR. CLARK: By statute.

13 DR. LUBRITZ: Pardon me. It's very straightforward

14 what we have. We're not going to be expending our personnel's

15 time putting in information that's not necessary. Other

16 information is available by calling the Board. We won't have

17 to go to the expense of adding things, having people look over

18 it to make sure that it's accurate.

19 I'd like to place what is required of us on the

20 website.

21 PRESIDENT MONTOYA: A motion has been made.

22 DR. HELD: I'll second that.

23 PRESIDENT MONTOYA: Seconded.

24 All in favor?

25 Opposed?

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1 MS. KIRCH: No.

2 PRESIDENT MONTOYA: The Chairman votes in favor. So

3 it looks like we go with what the statute requires to put on

4 there. So I don't think we have to pursue this educational

5 module.

6 MS. MUNSON: Just for clarification, everything

7 that's required of us under statute we are in compliance with.

8 PRESIDENT MONTOYA: Okay. Thank you.

9 MS. STROESS: Is there some place on the website now

10 that says, "If you want further information, call the office"

11 MS. MUNSON: I believe so, but I haven't looked at

12 that specific thing in a while. I'll make sure that there is.

13 I can --

14 MS. STROESS: Especially --

15 MS. MUNSON: Our number is there and all of that

16 information is available, but I'm not sure if it specifically

17 says that -- I don't recall, so I will check that. And I can

18 certainly do that if that's --

19 MS. STROESS: I think it's important, especially if

20 we're not including everything that a customer might want, and

21 they know they can call you and get the information.

22 DR. LUBRITZ: I'd accept that as an amendment.

23 MS. STROESS: Thank you.

24 PRESIDENT MONTOYA: They should be informed of that.

25 There has been an amendment to the motion. Any objections to

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1 that?

2 None heard.

3 All in favor of the motion?

4 Anybody opposed?

5 The Chairman is still in favor.

6 You're still opposed?

7 MS. KIRCH: No. I'll go along with that.

8 PRESIDENT MONTOYA: All in favor?

9 The Chairman is in favor. So that passes.

10 DR. LUBRITZ: I'd like to make a motion that we

11 approve the expenditure for training for our current system.

12 PRESIDENT MONTOYA: All in favor?

13 MS. STROESS: Second.

14 PRESIDENT MONTOYA: It's seconded.

15 Now, all in favor?

16 Nobody opposed?

17 The Chairman is in favor. So we'll go ahead and

18 spend the money for training.

19 MS. MUNSON: Thank you.

20 MR. CLARK: Mr. President, would you like me to go

21 down the hall and see if the resident is here?

22 PRESIDENT MONTOYA: Yes, please.

23 DR. BAEPLER: Could we have some discussion on that

24 before?

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1 (5. REQUEST FOR APPROVAL TO PRACTICE OUTSIDE OF THE

UNIVERSITY OF NEVADA SCHOOL OF MEDICINE'S FAMILY PRACTICE

2 RESIDENCY PROGRAM, PER NRS 630.265(4))

3 PRESIDENT MONTOYA: We'll start now. Let me tell

4 you what this is about first. It's a Request for approval to

5 practice outside the University of Nevada School of Medicine's

6 Family Practice Residency Program. This seems to be a problem

7 up here in Reno only, because we don't have very many

8 requested.

9 DR. BAEPLER: We have one. This does not demand a

10 closed session.

11 Years ago, the Medical School came to us when they

12 started the residency program and asked us to adopt the

13 limited -- the limited license for the residents that would

14 prohibit moonlighting.

15 Since we're a small state with one med school, we

16 can easily accommodate that request, and we did. You know,

17 we're not faced with multiple med schools, private and public.

18 There is more likely be an institutional decision rather than

19 a state-wide licensing decision.

20 That has worked well, and it would appear now as

21 though the med school has a different approach to this. The

22 deans and everybody that came forward with the original

23 proposal have left, and new people are in place.

24 Three meetings ago we had a request for an exception

25 to the policy for a resident in Reno to practice, in his third

Capitol Reporters (775) 882-5322

1 year of residency, in a small town in California where the

2 hospital was, and they were having extreme difficulties

3 getting ER coverage on weekends.

4 He wrote the letter and explained it was either one

5 weekend a more or at the most two. The Medical School

6 Professor, who was his mentor, highly approved it. It did a

7 service to the community, and the point was made that it's

8 also educationally valuable to the intern -- to the residents.

9 Okay. We really a little bit reluctant to do that,

10 but we did it.

11 It immediately followed that at the next meeting, by

12 residents in Las Vegas, same circumstances, third year

13 resident wanted to moonlight in the Mental Health Facility in

14 Las Vegas, and, of course, here in Reno and in Las Vegas,

15 they're both horribly understaffed.

16 And, again the same arguments. The school backed it

17 up. The resident's professor backed it up. He told us

18 exactly -- his limited involvement, and it wasn't very

19 extensive. And so, again, we changed it, but we also asked

20 Mr. Clark to contact the med school. We're performing an

21 administrative function for the med school by making these

22 exceptions, and I don't intend to get back into higher

23 administration again.

24 And it's almost a cop-out for the med school, who

25 should be making these decisions, to pass the buck to the

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1 Board, asking for an exception to a policy that the med school

2 requested in the first place. And if the Med School wants to

3 change their position on moonlighting, let us know, and we'll

4 change our licensing procedure.

5 It's a little bit of -- antithetical that nationally

6 they are reducing the hours required of residents, to counter

7 act the fatigue factor, and you might -- we're offsetting it

8 but saying: Now you can go moonlight.

9 I don't really know how common moonlighting is in

10 medical school these days. I don't know if Nevada is missing

11 some good residents' applications because they can't

12 moonlight. You know, we -- I think there is a need to upgrade

13 the overall quality of the residents' program in the medical

14 school. I hear that from a number of doctors.

15 I don't know whether this policy that we have is

16 inhibiting some very good people from applying. I don't --

17 you M.D.'s would have a much better sense of that than I.

18 This particular case, now, that we're being asked to

19 make an exception for, in a sense is an insult to the Board.

20 This letter of request is applicable to every single resident

21 in the program, the way it is written.

22 It's -- an educational experience. You know, it's

23 unlike the other two, where it's kind of met a special

24 community need. We don't have the slightest idea why this is

25 being requested. But, in my opinion, if we grant this, how

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1 can we say no ever again, based on what we have before us?

2 I still think we need to get a response from the

3 medical school and either enforce our policy or change it,

4 whatever they wish.

5 MR. CLARK: Mr. President, in response, I did

6 communicate with the medical school and talked to the former

7 Board member and Medical School Faculty Advisor, Dr. Cheryl

8 Huggins. She expressed the opinion that the Medical School

9 would like to maintain the current rule that we have and

10 allow, by exception, on application, individuals from the

11 program who pursue outside experiences in the residency

12 program.

13 But she didn't want to change -- or she felt the

14 school didn't want to change the rule that we had adopted.

15 DR. BAEPLER: Can we grant the authority to the

16 Medical School to make exceptions to what is in a sense their

17 own policy or do we have --

18 PRESIDENT MONTOYA: The Medical School ought to take

19 care of their own.

20 DR. BAEPLER: Yeah.

21 PRESIDENT MONTOYA: Let me hear from the --

22 particularly the resident, Dr. Padam, and Karen Selbach, the

23 Residency Program Secretary. You are here.

24 MS. SELBACH: Yes.

25 PRESIDENT MONTOYA: First, Dr. Padam, hi. I'm

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1 Dr. Montoya. Around me you see more Board members and staff.

2 We have name plates in front of us.

3 What do you have to say? You heard the argument.

4 DR. PADAM: Yes. Absolutely. First of all, the --

5 I'm requesting for permission to moonlight primarily for an

6 educational purpose. It would be a great adjunct to our

7 current residency training. We can experience the many facets

8 of ER medicine, and GI, internal medicine and so forth.

9 DR. BAEPLER: If it's so good, why did the Medical

10 School not want people to moonlight.

11 PRESIDENT MONTOYA: Dr. Baepler, let her finish.

12 DR. PADAM: However, personally, when I did my rural

13 rotation that was an aspect that I didn't have rotation was

14 the ER in a rural area. That is where we're going and

15 considering to work, and I think it's important to get the

16 experience, to know how an ER works in a rural area, and how

17 we are an important part of the community, and how we can

18 help, and it's something I have no experience in.

19 PRESIDENT MONTOYA: Are you saying that the

20 residency is deficient?

21 DR. PADAM: No. I'm saying it's -- it's an area I

22 don't have adequate experience in.

23 DR. ANJUM: Why don't they include that as part of

24 the training? They should rotate in the training. That

25 should be part the residency program instead of making

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1 exceptions, experiencing the issue.

2 DR. PADAM: Well, it is part of the rural rotation,

3 itself -- we are required to do a few shifts while we're on

4 the rural rotation, but certainly I don't think it's, by any

5 means, adequate for me.

6 DR. ANJUM: I think the amount of time that is spent

7 in any residency is determined by the Program Director to be

8 sufficient for any resident to get a proper training. And

9 anything outside that is moonlighting. I don't think it's

10 really training. That's my understanding of it.

11 PRESIDENT MONTOYA: Ms. Selbach?

12 MS. STROESS: Do you have a specific idea of where

13 you have you want to go?

14 DR. PADAM: Quincy, California. That's where I will

15 be moonlighting.

16 PRESIDENT MONTOYA: Ms. Selbach, do you have any

17 additional information?

18 MS. SELBACH: We have two ER rotations in the second

19 year, four weeks each, and a trauma surgery rotation in the

20 second year for four weeks. And then also the rural, which is

21 four weeks, depending which rule site they choose will

22 determine whether the preceptor provides the type of

23 experience that the resident is looking for.

24 There are standards that we have through Rural

25 Health, but some of the preceptors, I believe, don't have the

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1 interest to give the residents, sometimes, what the resident

2 is looking for, especially if they're going to go to a rural

3 facility after graduation. And so that is what Dr. Padam is

4 looking for.

5 PRESIDENT MONTOYA: Dr. Padam, you heard it

6 implied -- I'm going to ask the question directly: Are you

7 fulfilling some critical need in some underserved area, some

8 place around the -- either this state or in our attachment

9 area?

10 DR. PADAM: Currently as residents, no.

11 PRESIDENT MONTOYA: Would you be fulfilling such a

12 need by moonlighting?

13 DR. PADAM: I would like to, yes.

14 PRESIDENT MONTOYA: So, right now, you have no

15 ulterior motive to get out there and fill -- strike that.

16 Right now, you're not motivated to get out and serve

17 some underserved area or somebody who is in desperate need of

18 somebody of your talents out there in some rural area, or

19 emergency room, or something like that?

20 DR. PADAM: No. That is what I want to do.

21 However, I don't have any exposure to that, and I wanted to

22 get comfortable seeing how things work in a rural area and how

23 I would fit in after I graduated.

24 DR. BAEPLER: How much time would you spend?

25 DR. PADAM: Usually the shifts are one shift or

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1 maximum, two, depending on the resident and work hours, as

2 long as we don't exceed that.

3 DR. BAEPLER: Per what? Per month? Per week?

4 DR. PADAM: Per month.

5 PRESIDENT MONTOYA: Any further questions?

6 DR. ANJUM: I think this should be the jurisdiction

7 of program in the UNL or UNR, rather than the Board making

8 exceptions every time. We get one applicant practically every

9 meeting to do this.

10 DR. ANWAR: Why are we wasting time on these things?

11 These things should be made at the program level.

12 PRESIDENT MONTOYA: I'll entertain a motion.

13 DR. ANJUM: For residency, we are so strict now.

14 You know, even if you have a license in another state, you

15 cannot moonlight.

16 DR. BAEPLER: We've got a problem because of the

17 way -- is it a statute or regulation on our limited license?

18 Statute? That demands attention by the Board. We're asking

19 for a --

20 PRESIDENT MONTOYA: She comes up here for an

21 exception. It's our job to determine if we're going to grant

22 it or not. So to that end, I will entertain a motion.

23 DR. BAEPLER: Let me ask a legal question. Does

24 this Board -- and, again, I don't know if it's a statute or a

25 reg. But --

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1 MS. BIBLE: Statute.

2 DR. BAEPLER: Statute. Okay. It's a statute that

3 gives this Board the authority to do this, not the Medical

4 School. Can we delegate that authority to the Medical School?

5 PRESIDENT MONTOYA: Probably not, unless we --

6 DR. BAEPLER: The Statute defines our limited

7 licensed for -- a restricted license for a residency.

8 PRESIDENT MONTOYA: A limited license.

9 DR. BAEPLER: Okay. If we have a limited license --

10 or licensing defined by statute, can we delegate some

11 authority under that for exceptions to the Medical School or

12 must we do it? In other words, do we have to change the

13 statute?

14 DR. ANJUM: That schedule applies to us, not to any

15 school.

16 DR. BAEPLER: That's correct.

17 DR. ANJUM: We cannot delegate --

18 DR. BAEPLER: Well, we might be able to delegate it.

19 PRESIDENT MONTOYA: You're asking the bigger

20 question. I want to ask it in a particular -- because I have

21 a motion, and I -- on this particular case right in front of

22 us.

23 DR. BAEPLER: It's by statute.

24 DR. LUBRITZ: I'll make the motion that -- I'll make

25 the motion, and then I'll ask in a moment -- I'll make the

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1 motion that this not be granted, to allow Dr. Padam to go

2 outside of her residency program for training --

3 PRESIDENT MONTOYA: The motion is --

4 DR. ANJUM: Moonlighting.

5 PRESIDENT MONTOYA: Seconded?

6 DR. HELD: I didn't follow the motion.

7 PRESIDENT MONTOYA: Sorry.

8 DR. HELD: Could you restate it?

9 DR. LUBRITZ: I guess I could. We will -- I'll make

10 the motion that we deny this request to practice outside the

11 University of Nevada School of Medicine Family Practice

12 Residency Program, per NRS 630.265, open parenthesis, 4, close

13 parenthesis.

14 DR. BAEPLER: I'll second that.

15 PRESIDENT MONTOYA: Motion and second to deny the

16 request for moonlighting.

17 All in favor?

18 DR. LUBRITZ: May I have a moment?

19 PRESIDENT MONTOYA: A moment.

20 DR. LUBRITZ: Dr. Padam, this is not directed at

21 you. We don't want you to think that it is.

22 We think that you're doing the right thing in

23 requesting of your residency program the ability to be able to

24 make some decisions as to where you want to practice, and you

25 think you're deficient in that.

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1 So we're -- in no way does this Board want to

2 compromise your ability to learn, and we want to applaud you

3 for wanting to get more education. We feel this isn't the

4 venue, and that's why.

5 PRESIDENT MONTOYA: The motion is seconded to deny

6 the request for moonlighting.

7 MS. STROESS: I wanted to say that I'm going to vote

8 against the motion, because I believe that if we clarify our

9 stand, it should be after Dr. Padam has been dealt with,

10 because you didn't know when you applied that what our policy

11 was going to be.

12 PRESIDENT MONTOYA: Okay. So all in favor?

13 Opposed?

14 By hands. Opposed? One, two, three, four, five

15 opposed to the motion.

16 DR. ANJUM: Are you for the motion or opposed?

17 DR. LUBRITZ: I'm for the motion.

18 PRESIDENT MONTOYA: The motion is denied for

19 moonlighting.

20 DR. ANJUM: How many are for the motion?

21 PRESIDENT MONTOYA: So for the motion to deny

22 moonlighting is one, two, three, four.

23 DR. LUBRITZ: No. What? Denying this one in

24 particular?

25 PRESIDENT MONTOYA: This one particular instance,

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1 yes, is four, right?

2 DR. BAEPLER: Yes.

3 PRESIDENT MONTOYA: One, two, three, four. Motion

4 for -- to allow her to moonlight -- no.

5 DR. HELD: Against the motion.

6 PRESIDENT MONTOYA: Against the motion is who? One,

7 two, three, four.

8 The Chairman votes with the motion. So that makes

9 it five to four. So the motion will be denied.

10 So, Dr. Padam, take what Dr. Lubritz said to heart,

11 this is not anything reflecting upon you. It's just that the

12 Board does not want to get into the business of always

13 granting exceptions unless there is truly something out there

14 that you -- if you said there was one particular place out

15 there that really needs you, and that they contacted you, and

16 you're the only person that fits that, we probably wouldn't

17 have a problem with it.

18 We're not going to keep making exceptions for

19 everybody that wants to moonlight, but you heard also we're

20 probably going to work on the statute to maybe grant the power

21 to the Medical School to the residency to possibly let you do

22 that. We don't think this is the place to carry that out, and

23 I'm sorry.

24 MS. KROTKE: She did mention Quincy, California.

25 PRESIDENT MONTOYA: She did, and everybody else

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1 moonlighted there.

2 DR. ANJUM: We don't have any reason to worry about

3 any of the state jurisdiction, anyway, number one. Number

4 two, she's serving a special purpose if there is training

5 there. If there is room to get more training, this should be

6 a part of the training program for the Director to expand on

7 it rather than the -- if the training is deficient, we should

8 not have to make exceptions to that. That is what we're

9 trying to explain.

10 MS. SELBACH: The training is not deficient.

11 DR. ANJUM: Then why are we worried about more

12 training?

13 MS. SELBACH: She wants more training.

14 PRESIDENT MONTOYA: Okay.

15 DR. ANJUM: Let's extend the training to another

16 year or whatever. It's not against any person, but the

17 training is adequate. If it's adequate, there's no reason for

18 it.

19 PRESIDENT MONTOYA: Dr. Padam --

20 MS. SELBACH: I don't think it's just the training.

21 It's the experience after getting trained.

22 DR. ANJUM: Well, we do fellowships for that.

23 MS. SELBACH: We don't have the fellowships. We do

24 not have funding for that.

25 DR. ANJUM: That's what Dr. Lubritz was trying to

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1 explain, that this is not directed against, particularly, this

2 physician, but we cannot keep granting those exceptions every

3 meeting, as they're coming for these kinds of purposes, just

4 for the training purposes.

5 MR. CLARK: Doctor, are you licensed in California,

6 as well?

7 DR. PADAM: Yes.

8 PRESIDENT MONTOYA: Thank you for appearing. We

9 appreciate your time and effort.

10 DR. PADAM: Thank you, very much.

11 DR. BAEPLER: The other segment of this -- I think

12 it's within the open meeting law that we could discuss the

13 problem with the moonlighting, but I have a simple question.

14 Do we have to amend the statute or, under the statute, can we

15 delegate?

16 PRESIDENT MONTOYA: Ms. Bible has been looking this

17 up while we've been carrying on.

18 MS. BIBLE: Yes. Well, you have a regulation that

19 relates to limited license, and --

20 DR. BAEPLER: A regulation or a statute?

21 MS. BIBLE: Well, it first starts with a statute,

22 and then you also have a regulation. The statute provides

23 that the limited license -- under a limited license, the

24 licensee may only practice in connection with his duties as a

25 resident physician or under such conditions as approved by the

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1 Director of the Program and the Board.

2 DR. BAEPLER: And the Board.

3 MS. BIBLE: Then you do have a regulation that

4 relates to a limited license and the application that's

5 required, and it may be possible that you could amend to

6 provide further clarification of that statute in this

7 particular way. But it would require, I believe, a reg

8 change, and Ms. Brand agrees probably, you know, some language

9 might be able to be --

10 DR. BAEPLER: Okay. The reg change is not tied to

11 the legislature, so we could proceed with that.

12 MS. BIBLE: Right. And at this time it's

13 temporary -- or we're in temporary reg mode. So certainly

14 it's a lot easier to get those on.

15 DR. BAEPLER: Could we draft something.

16 DR. LUBRITZ: Could you draft that?

17 MS. BIBLE: We could, you know, direct --

18 DR. BAEPLER: I assume that the Board is quite

19 willing to grant that authority to the med school, rather than

20 have it constantly come here, right?

21 DR. ANWAR: This is wasting our time. There is no

22 reason we should be deliberating on something that should be a

23 part of the deliberation between the Chair of the Program or

24 whoever that person is, to see if it's appropriate within the

25 guidelines that they already have for the residents to be able

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1 to do that.

2 This is just one shift a month, which should be --

3 should not be a problem from a time point of view, because

4 they have those time constraints within which they work. And

5 I think the Board's deliberation on this matter is just a

6 waste of the Board's time.

7 DR. BAEPLER: We don't know the students.

8 MS. STROESS: Let's put it on the agenda for the

9 next meeting.

10 PRESIDENT MONTOYA: Yes. As a matter of fact, we'll

11 probably have reg drafted by then, and get them passed out.

12 They're already working on it, on either side of me.

13 MS. STROESS: I see that.

14 MS. KIRCH: But I take it, if we're going to do

15 that -- if there was a reason that we did not want full-out

16 moonlighting or if the school didn't want full-out

17 moonlighting, I think we need to know for sure what the school

18 is going to did about this.

19 PRESIDENT MONTOYA: Right. Right.

20 MS. KIRCH: And I think you can say, you know, the

21 medical school, the residency program is just going to do all

22 that. I think there needs to be clear guidelines if there is

23 concern about the moonlighting.

24 And maybe there are still instances they would need

25 to come before the Board, but I don't want to give carte

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1 blanche out there. If they have a regulation that says they

2 can't moonlight, there was a reason for that.

3 DR. BAEPLER: Because they requested it. That's the

4 reason.

5 MS. KIRCH: But still --

6 PRESIDENT MONTOYA: They took it off their hands is

7 what they did.

8 MS. KIRCH: Still there is a reason for it. I think

9 we need to look at that more carefully and see -- and develop

10 it in conjunction with the Medical School, the residency,

11 before you say we're not going to do that.

12 I think we need, in fairness to the students, as

13 well as in fairness to --

14 DR. BAEPLER: Right now the school is using us as a

15 cop-out. We're the bad guys.

16 PRESIDENT MONTOYA: Let me tell you where this

17 started, because this started a long -- some time ago, when

18 they really got heavy on the residents being overworked, and

19 they started limiting the number of hours residents could

20 spend at work or in the hospitals.

21 What residency programs did, some -- the one here

22 did, they came to the Board, and they said, "We just want a

23 law -- a regulation from the Board that says they can't

24 moonlight."

25 Then that made it easy for them to say, no, no, you

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1 stick to the -- that way they kept all the hours that they

2 worked under the maximum limit.

3 DR. BAEPLER: Within the school.

4 PRESIDENT MONTOYA: Within the school. Now -- now

5 they're coming to us asking for exceptions all the time to

6 allow these people to go out, which is kind of disingenuous to

7 me, because they're taking what they wanted, and now they're

8 shifting over on to us and saying, "Okay. You guys said that

9 they could do this."

10 But they still have got to keep track of these

11 hours, and it's kind of like fuzzy math, because they're --

12 they're at one time calling it experience and education, and

13 this, but at the same time they're saying, "Oh, it's not

14 education, because if it was education it would have to count

15 on their hours in, and they would get dinged for the hours

16 spent moonlighting."

17 So it's -- it's kind of a fuzzy math. They've got

18 to make up their mind what they want to do and how they're

19 going to count this. If they're going to call it education,

20 call it education and then include it in their education

21 tract. If it's a way to make an extra buck, then call it

22 that. If that's okay, then that's okay. That's their

23 business, as long as they keep the residency on the up-and-up

24 with the -- what, the Residency Review Committee -- is that --

25 or what they have to keep in line with?

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1 DR. MANSKY: I think there's a regulation with

2 national certification, a number of hours worked, and with

3 syllabus and basic syllabus, depending on the specialty.

4 PRESIDENT MONTOYA: Dr. Lubritz?

5 DR. LUBRITZ: What Marlene brought up was correct.

6 I think that when -- if we can get a draft, that we would want

7 to include what we would expect from them that, yes, if you're

8 going to allow them to do that on a limited license, the Board

9 needs to be notified of who those residents are, so that we

10 can appropriately put that in there.

11 PRESIDENT MONTOYA: And where they're going.

12 DR. LUBRITZ: And where they're going, and it also

13 might be reasonable to send a letter to Dr. Huggins to advise

14 her that we're working on something to allow the University to

15 make that decision.

16 DR. BAEPLER: Before the draft comes to the Board,

17 it ought to be run through the Med School to see if they agree

18 and can live with the draft.

19 PRESIDENT MONTOYA: Sounds fair.

20 MS. STROESS: I understand everything can't be

21 finished before our next meeting. So I'd like to see it on

22 the agenda after that, which is what, September something?

23 PRESIDENT MONTOYA: Okay.

24 MS. BRAND: Thanks.

25 PRESIDENT MONTOYA: All right. Let's take a break.

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1 We've been working for a while. It's 10:00 o'clock.

2 (Proceedings recess from 10:02 a.m. until 10:21 a.m.)

3 PRESIDENT MONTOYA: Back to order again. We even

4 have Dr. Baepler here back to start early.

6 (7. REPORTS)

7 PRESIDENT MONTOYA: We're ready for the reports from

8 Dr.`Mansky, Director of Nevada Health Professionals Financial

9 Assistance Foundation, and Dr. Belcourt.

10 PRESIDENT MONTOYA: Mike, can you hear us down

11 there?

12 MR. GARCIA: Yes, we can, sir.

13 DR. MANSKY: Mr. President, Board members, Staff

14 advisors, guests, I'm pleased to report on our program, and

15 first I want to recognize Dr. Roger Belcourt, who is our

16 President and has been very valuable in terms of his advice

17 and Counsel. So Roger, come up and join me, please.

18 I wanted to start out by giving you some data on our

19 program. I've got much of the data now on a database, and I

20 hope to get more on the database by the next meeting. I did

21 the geographic distribution so that you can have a sense of

22 what -- what we're doing up north and what we're doing in the

23 south, although we're one program.

24 As you can see, we have a total of 60 physicians,

25 respiratory therapists and physician assistants that we're

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1 monitoring primarily.

2 We have two alumni who volunteered to be monitored,

3 and this is for assurance and insurance. It's a valuable

4 thing to continue your monitoring and such things as an

5 adverse outcome which leads to a lawsuit. They're put in a

6 stronger position if they continue their monitoring. Plus

7 it's a safer thing to do in terms of their recovery. So we

8 are going to encourage more and more on this. We've got two

9 starting it right now.

10 We also have a contract with the osteopathic ward,

11 and we have three osteopathic physicians who are in our

12 program, one who left with that famous attorney that presented

13 the case at the first Board meeting I presented at.

14 We have some dentists in our program. One up north,

15 two south. And up north we have one chiropractor in the

16 program. We hope that we can get funding through the Boards

17 or organizations in the future so that we can grow as a

18 program.

19 We've also had eleven licensee candidates. We've

20 worked with eight physicians and three respiratory therapists,

21 and we have about five people pending -- pending in terms of

22 treatment pending, evaluation pending, not working right now,

23 and one disruptive physician who is not doing direct patient

24 harm, but is in trouble. And we're trying to have him go our

25 way rather than go -- the health and wellness track, rather

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1 than the legal track.

2 In general, we've continued to work with the

3 licensed specialists, and they've been very helpful in the

4 process of evaluation, and interactions have been quite

5 positive.

6 We've had interaction with the Board investigators

7 and I wanted to specifically thank Tony Clark for his help in

8 establishing things. We've had contact with the Pharmacy

9 Board, and we are going to rewrite our Board site description

10 of the Diversion Program, and that should be hopefully by the

11 next meeting.

12 We are -- we are following the health and wellness

13 track. We can often get physicians into treatment early, and

14 this is not only protecting public safety but preserving the

15 physician's career. And this is a real advantage, I think, of

16 going the health and wellness route. If we can convince a

17 physician that he or she needs treatment, we can get them in

18 very quickly.

19 Recovery is enhanced in our program with active

20 monitoring, and the data out shows about a 30 percent increase

21 in enhancements. So that the monitoring not only protects

22 public safety but also helps in recovery.

23 One of the things that have come up is some of the

24 physicians have chosen not to go in the diversion direction

25 and to the program for health and wellness, and they've chosen

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1 to approach matters from a legal point of view.

2 And we can be helpful to the Board in this, in that,

3 by regulations, the Board can send these people for an

4 evaluation. But there have been a lot of difficulties that

5 have come up, and I've been talking to the Counsel Office and

6 to the Attorney General's Office, and hopefully we can set

7 some standards. We can give a list of treatment centers, set

8 up an application for treatment centers, so there is a solid

9 standard there. And the anticipation is that this will save a

10 lot of time and heartache in terms of some cases that I've

11 been involved. They're just long and drawn out.

12 So I've enjoyed working with both offices, and

13 shared with them the standards that have come from the

14 Federation of State Medical Boards and the Federation of

15 Health Physicians Health Programs. Again, we hope to base our

16 guidelines on these programs and on our experience.

17 Our resources have been solid for what we're doing

18 at the present time. We have about a two- or three-month

19 operating reserve. We've continued to -- we've continued to

20 increase our interactions with hospitals, group practices. I

21 had the honor of presenting at the Nevada Branch of the

22 American College of Physicians, with about a 200 physicians

23 attending, and a real nice spin-off from that was I got to

24 meet a number of residents, both from the north and the south,

25 and the Director of Internal Medicine, about 20 or 30

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1 residents there.

2 I think when we can approach residents and

3 eventually medical students, developing programs such as the

4 AIMS program, AIDS Impaired Medical Students, we can perform

5 in many ways, a prevention role -- as our education hopefully

6 will perform a prevention role.

7 In our operation we continue to have our two active

8 Diversion Committees, both north and south, and we are also

9 continuing to examine our collection of urine. We've brought

10 up to the Board the use of Nyda drawing sites rather than

11 observed urines. We feel that we've negotiated with a couple

12 of labs, and we can decrease the price of each urine by

13 50 percent, thus increasing the frequency and the degree of

14 monitoring which I think really needs to be done.

15 We can also negotiate with labs so that we can

16 scholarship physicians in the program who are destitute or

17 don't have any money, but we also want to get out of the

18 business of -- we've been paying the lab and charging the

19 participants, and it's not working out very well, financially.

20 It's taking a lot of time and energy from us.

21 So the laboratory we're negotiating with is

22 agreeable to charging the physicians directly, and the way

23 they do this is they do this before they monitor. So they pay

24 for the month before, and this keeps them current and keeps

25 the system running.

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1 We hope to establish a pilot study, looking at

2 the -- gradually placing participants in the Nyda Drawing

3 Station Program, and to compare this with the rest of our

4 population as times goes on. And hopefully we can increase

5 this.

6 Finally, our contract is up for renewal, and we

7 respectfully request, from the Board renewal. We would also

8 like to increase or funding, and depending on -- obviously, on

9 the Board's budget, we're aiming high, and I think, in all

10 areas of the program, we have endeavored to aim high. And so

11 we'd like to have a funding of -- a possible increase of about

12 $40,000 to a $150,000.

13 We can submit budgets -- our income and expenses for

14 the last three years and a budget, if the Board so desires,

15 and I will get that up to Tony if you want that.

16 And I thank you for the opportunity. And, Roger,

17 did you have anything?

18 DR. BELCOURT: There are many enhancements to our

19 program here, and one of the things that we're putting into

20 place is a unique monitoring system for the progression of

21 physicians through the program It's a points system. And

22 we're actually looking to this to help us keep people in the

23 program who have not established the basics of compliance.

24 And so the standard is a five-year. That's a

25 minimum that people spend in the program. This can extend

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1 that out for some time if the compliance has been an issue.

2 Now, no one has ever quantified this, and so we're looking to

3 do this even with the eye of doing research on it, and

4 possibly at some point publishing general results on it in the

5 literature of addiction recovery.

6 So this will be rolling on line probably later this

7 summer, into the fall.

8 PRESIDENT MONTOYA: Dr. Mansky, just for

9 clarification, can I ask about your other sources of income?

10 DR. MANSKY: Certainly. We have -- we have about

11 ten to 11,000 coming from the Osteopathic Board. We've

12 approached other Boards but haven't been able to engage that

13 as of this time.

14 We have monitoring income. We charge the

15 participants 100 to $200 a month, depending on when they

16 entered the program and when their discipline is. So that,

17 essentially, at the present time, about half of our income

18 comes from the monitoring and half comes from the Board, and a

19 small amount comes from the Osteopathic Board.

20 In our data you'll see eventually -- we also have

21 income from urine testing, and we have expenses from urine

22 testing, but that's -- that's a real headache and, I think, a

23 money loser for us. So we'd like to get out of that business.

24 PRESIDENT MONTOYA: And does the Hospital

25 Association still contribute to your efforts?

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1 DR. MANSKY: Not at the present time.

2 PRESIDENT MONTOYA: Any reason that they stopped?

3 DR. MANSKY: Well, from my knowledge, we got a

4 considerable amount of money from Sunrise Hospital and their

5 system, and they have -- they have a new CEO there who's not

6 quite interested yet in supporting us, but. We've been

7 helpful in a couple of cases, and I hope, as time goes on, we

8 get support from them and from the other hospitals that we

9 work with.

10 PRESIDENT MONTOYA: Great.

11 MS. STROESSS: You don't have an office now?

12 DR. MANSKY: We don't.

13 MS. STROESSS: Where do you meet with your clients?

14 DR. MANSKY: My den.

15 MS. STROESSS: Your den?

16 DR. MANSKY: My den is my office, and I meet with

17 clients in physicians' offices in Nevada or sometimes for

18 coffee at Starbucks.

19 MS. STROESSS: Okay.

20 DR. MANSKY: But that really -- it's really quite a

21 pioneering, and I like that aspect of it, but it would be good

22 to have an office. It would be good to have some clerical

23 help. I am computer literate, thank God, and the work is not

24 below me at all, but it's just piling up. And really I need

25 to have some staff in our program.

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1 And we'd like to have growth. I think we can have

2 growth in terms of our program, in terms of getting

3 participants in our program, and growth in terms of education,

4 eventually.

5 PRESIDENT MONTOYA: Dr. Lubritz had a question.

6 DR. LUBRITZ: Have you thought about -- if I can use

7 the term and not be shot here -- going to the attorneys?

8 There are lots of attorneys. I'd just like going there

9 because, Lord knows, number one, they're a lot more of them

10 than us. Number two, there are certainly attorneys that could

11 use the help of Diversion, and that might be a ready source

12 for you. And is the Dental Board not interested?

13 DR. MANSKY: The Dental Board is not interested at

14 this time, but I hope that we can -- we can get their

15 interest. We have -- we are monitoring one person, for

16 William Bush, who is -- who was their Executive Director --

17 isn't any more. They have a new Executive Director.

18 As to the attorneys, we have made initial contacts,

19 and I think this is very important for two points of view.

20 One is to be helpful with them and interact with our program,

21 and the second thing -- our participants need to consult

22 attorneys before they sign our agreements. They need the help

23 of attorneys, and they're not getting help of attorneys who

24 understand addictive illnesses and recovery.

25 And so if we can recruit among the recovering

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1 attorneys, who are doing well in their program or who are

2 graduates, someone who is interested in helping a physician

3 work through the legal issues of being in a program, like

4 ours, I think we'll be far ahead.

5 PRESIDENT MONTOYA: Any more questions?

6 From what I heard he's doing the -- everything by

7 himself, out of his den, on his computer, and he needs some

8 clerical help, and he actually probably needs, and an office

9 at some point.

10 DR. MANSKY: I -- I must say, some of the outreach

11 activities, especially in the north -- with the North

12 Diversion Committee, have been very helpful in terms of

13 getting people in the program, and monitoring, and in

14 education.

15 There's not as much activity down south. So we do

16 have that, but we really do need the clerical help.

17 DR. LUBRITZ: I have a question --

18 DR. BAEPLER: Is there -- yes.

19 DR. LUBRITZ: Is there money?

20 DR. BAEPLER: Yes, every time this contract comes

21 up, we used to get, you know, a philosophical discussion, not

22 about the need for the division program. It's obviously

23 needed, but the philosophical question as to whether a

24 regulatory board should sponsor one.

25 And I put it from the perspective -- if you look at

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1 that statute creating that Board, obviously there is a

2 reference to this kind of activity mandated by statute and

3 nothing that prohibits it, either.

4 And each time that we have entered into a

5 contract -- and, in particular, last time we entered into a

6 contract, we signaled our clear intent that the Medical Board

7 would reduce its level of support as they gathered support

8 from other agencies and sources of income, perhaps even

9 external foundations and so on. It's tough to get the money

10 from foundations to support doctors, you know. It depockets

11 people. So why do you need charity here? Nothing that I'm

12 saying is to be construed as negative about this, but we

13 really need to examine it.

14 Now, for the budget for the coming biennial, we did

15 set a $150,000 a year into that budget, mostly out of respect

16 for Dr.`Mansky. He's new, and we feel that he can move this

17 Diversion Program to a higher plateau. But you need to put

18 this in a total perspective.

19 First of all, you should not enter into a three-year

20 contract. We operate on a biennial system and our revenues

21 are projected for only two years. We really can't project

22 beyond our can current budget that we operate within for

23 everything you see. So the request for a three years should

24 be reduced to two years.

25 You also can't think of it as $150,000 a year,

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1 because we collect our money biennially. Think of it as

2 $300,000 for the biennial. That's the full-time license fees

3 of 500 physicians. That's 10 percent of the license fees you

4 take in from physicians. That's $60 per physician's license

5 fee. That's 10 percent of your license fees, serving less

6 than one percent of the doctors.

7 Just to put it in that kind of a perspective, it's a

8 philosophical question, independent of the value of your

9 organization, which is valuable.

10 Philosophically, I also question the 11 people in

11 the program that are licensed candidates. And I question it

12 from this perspective: When our only licensees get into

13 trouble with substance abuse, and dependency, and addiction,

14 this is a program designed to rehab them and salvage them for

15 a productive life.

16 I think it's pretty successful there, but I don't

17 know why we have to import people with the substance abuse

18 problem and then rehab them at our expense.

19 PRESIDENT MONTOYA: Well, Dr.`Mansky, to that end,

20 Dr. Baepler, you've been on the Board a long time, and you

21 know that we take many people in with problems, and we say,

22 "All right. You can come in, depending upon getting a

23 favorable letter from Dr.`Mansky plus participation in

24 diversion for however many years we have to.

25 DR. BAEPLER: I'd like to see it at their expense.

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1 PRESIDENT MONTOYA: That's what we have in the

2 statute. Those doctors do pay their fees.

3 DR. BAEPLER: They do pay the full fee?

4 PRESIDENT MONTOYA: They do pay the fee.

5 DR. BAEPLER: So they're not subsidized?

6 PRESIDENT MONTOYA: They're not subsidized. It pays

7 for the license. Their money is going to go take care of

8 things.

9 DR. BAEPLER: One final little minor point -- and,

10 you know, the money is budgeted, and I have no problem going

11 forward with it. There comes a question of advocacy, and

12 we're talking a little bit of a semantics problem here, but

13 historically the diversion program hasn't advocated for a

14 licensee. Tell us the facts.

15 DR. MANSKY: The facts of their --

16 DR. BAEPLER: Of their status in the program. It's

17 hard for you to advocate for a licensee, the expectation, when

18 you have --

19 DR. MANSKY: Oh, the licensee.

20 DR. BAEPLER: You don't have all the licensee

21 information, and it's really preferable not to use the word,

22 "We will advocate for this person," rather just tell us the

23 condition of the person with respect to the program they're

24 enrolled in.

25 PRESIDENT MONTOYA: I think we advocate them out of

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1 the perspective of their addiction problem. We don't say

2 anything else about his competency as a physician or anything,

3 just the addiction problem.

4 DR. BAEPLER: The context in which the word

5 "advocacy" is used has a broader implication. What they're

6 doing is appropriate. I have no problem with that. But I

7 would just personally -- we historically have tried to avoid

8 the word, "We will advocate for any person."

9 PRESIDENT MONTOYA: You read more into than I do.

10 DR. LUBRITZ: Agreed.

11 DR. MANSKY: If I can explain what we're doing, it

12 might clarify it. If a candidate comes and applies for a

13 license and has a history of drinking and driving, has a

14 history of another arrest related to drug or alcohol, a

15 history of being in a program in another state, maybe

16 progressing very well. We're asked to look at these

17 candidates and to decide which -- which of the candidates we

18 would recommend for evaluation, which we would recommend for

19 treatment, and which we would recommend for transfer from

20 their program in another state.

21 So in that way, hopefully, we are serving the Board

22 in being able to differentiate out the physician who is in

23 recovery and can come into the state and be a valuable

24 practitioner, versus some that can't. And we have been

25 working with the licensing specialist, actually on a couple of

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1 people, and we have not -- have not strongly supported.

2 PRESIDENT MONTOYA: Dr. Lubritz?

3 DR. LUBRITZ: Looking at some of the information

4 that Dr. Baepler just presented to us, I think that -- I think

5 we need to try to maximize our dollars spent -- for whatever

6 those dollars are, that we would be giving to diversion.

7 I, personally, have a problem, and it's merely my

8 feeling, on bringing doctors in -- my thought is we have a

9 certain number of doctors in the state already practicing --

10 physicians, P.A.'S, respiratory therapists that need your

11 assistance.

12 Well, we're looking for money from everyone. I

13 don't want to bring in another doctor who we're going to spend

14 money on. I would like to have that money spent on the people

15 who are currently in. I know what you just said about the

16 ones who do come in and pay. If they want to come into our

17 state, then my thought is they need to start paying more than

18 their share.

19 We're doing them a favor by getting them in here.

20 They could go back and practice wherever they're practicing.

21 So I would like to see them carry more than their prorata

22 share. And I -- I personally would like a commitment from

23 diversion that if someone comes in who doesn't currently have

24 a license, here's what it's going to cost you guys who are

25 already here.

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1 But here's what it's going to cost you guys who

2 we're going to bring in. And if they're not up to date, then

3 I expect them to be out of the program. Just my thought.

4 DR. BELCOURT: One of the things about the number,

5 we have a base cost, just to administer the program. And,

6 actually, the more participants we have in the program, that

7 defrays our cost and would defray our need to call upon Board

8 monies. So really, our best avenue is promotion of the

9 program and making the program available to people who will

10 contribute their monies.

11 This is not a free ride, and -- actually, we're

12 taking people who are already, you know, financially hit. I

13 mean, they've had -- especially people coming out of the

14 treatment centers. But people transferring in, those are

15 people who are going to be paying monitoring fees, and will

16 actually defray costs. So --

17 DR. LUBRITZ: I'd like to see them pay a significant

18 portion. My thought is: We are committed to diversion

19 because we -- we know that it has been a program that has

20 worked.

21 My thought is: When you think of the fact that all

22 the doctors who are out there, our only -- those of you who

23 don't know, we don't get money from the state. We get our

24 money from the money that we collect from physicians. We got

25 our money from the cost of investigations and that type of

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1 thing.

2 And yet we're expected to perform, to sometimes,

3 herculean kinds of tasks. So my thought is: We need to make

4 sure that money that we expend is very good. When you think

5 of ten percent of our money going to less than one percent of

6 physicians here in the state, my thought is: If you're going

7 to bring someone in, I want them to pay more than their share,

8 because somehow some of those physicians who we're bringing in

9 are going to be those who can't pay or whatever, just by

10 history, alone, and, therefore, I want them to do more than

11 their share. We're doing our share. I want them to do more.

12 DR. MANSKY: We are.

13 PRESIDENT MONTOYA: Dr. Lubritz, would some of your

14 worries be allayed if the hospital started pitching in a

15 little bit more?

16 DR. LUBRITZ: You bet.

17 PRESIDENT MONTOYA: It's time for me to start

18 hitting the hospitals, and you, too.

19 DR. MANSKY: It sounds like a good idea.

20 PRESIDENT MONTOYA: I'll start going on the

21 hospitals, and I'll start dragging people with me.

22 DR. MANSKY: Great. Thank you, very much. I just

23 wanted to comment. We're starting -- we have started to move

24 in that direction, in that the candidates who are coming in

25 used to be evaluated by us without fee. We are now charging a

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1 fee, which we presented to the Board at the last meeting.

2 DR. LUBRITZ: What is that fee?

3 PRESIDENT MONTOYA: Seriously, I hear exactly what

4 you're saying, and I would be pleased to take that back to our

5 Board for discussion and report back to you on it.

6 DR. LUBRITZ: What is the fee that you charge?

7 DR. MANSKY: We charge $250 for their evaluation,

8 and we charge for their urine sample, toxicology.

9 DR. LUBRITZ: Is that enough to cover your costs?

10 Is that enough to make a little profit?

11 DR. MANSKY: Not --

12 DR. LUBRITZ: If it's not, then you ought to charge

13 them what it's worth. They're coming here to get a license to

14 make their living here, perhaps to have the rest of their life

15 here.

16 So if they don't have the money to pay you what

17 you're worth, then why should we be paying for them? Because

18 they're not -- if they don't think you're worth it, why should

19 we think you're worth it? Don't sell your services short.

20 DR. MANSKY: Thank you.

21 PRESIDENT MONTOYA: You're a very valuable part to

22 this whole thing that we're doing, taking care of the citizens

23 of Nevada, and we don't want you to sell your services short.

24 We don't want you to be a bargain-basement person. We're

25 proud of you.

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1 DR. MANSKY: Thank you, Dr. Montoya.

2 PRESIDENT MONTOYA: And to that end -- the end of

3 the conversation, the end of his presentation, he asked for a

4 budget of $150,000. I think we can get the hospitals to start

5 pitching in. I know why some have stopped, and to be -- do

6 you want me to go over that, for those of you who don't know?

7 DR. LUBRITZ: I'd like to know.

8 PRESIDENT MONTOYA: There was a presentation done by

9 a former head of the diversion program at Sunrise Hospital,

10 and somewhere during that whole presentation he pretty much

11 mentioned that Sunrise is a bad hospital, that they treat

12 doctors bad, that -- he doesn't understand how people can

13 practice there, and then let me continue on with my

14 presentation.

15 And as a matter of fact, it's not the current

16 administrator that heard that. It's the former administrator

17 that was at that meeting. His face got red. He lost his

18 temper, almost, but he walked out of there and stopped

19 funding.

20 DR. LUBRITZ: I remember.

21 PRESIDENT MONTOYA: And we have a new CEO of Sunrise

22 in there that pretty much would be connected. He's

23 approachable. I've got an idea we can work with him. Plus we

24 can work with the other hospitals, with the exception of the

25 University Medical Center that doesn't give money to anybody

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1 in endeavors such as this.

2 We can work with the other hospitals, at least in

3 southern Nevada, and if you need me to come north every

4 Tuesday, I can come up here, and we can go see whoever you

5 want to up north.

6 But I've got an idea that the hospitals are going to

7 be working with us in this. So give me a little bit of time.

8 MS. STROESSS: Have you tried the Starbucks

9 Foundation?

10 DR. MANSKY: We do support them to some extent.

11 PRESIDENT MONTOYA: All right. Now, there is a

12 proposal for $150,000 budget, which is an increase of $40,000.

13 Dr. Baepler says the money is there.

14 DR. BAEPLER: It is in the budget.

15 PRESIDENT MONTOYA: It is in the budget. Do I hear

16 any modifications? Any suggestions? Any motions regarding

17 this?

18 DR. ANWAR: A two-year period with 300,000.

19 DR. BAEPLER: It was in the budget for each of the

20 next --

21 PRESIDENT MONTOYA: Let me hear what Dr. Anwar said.

22 DR. ANWAR: In line with what Dr. Baepler's comments

23 were, could we approve it for 300,000 for two years, and make

24 an amendment for there terms to be two years rather than three

25 years because of our biennial term?

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1 PRESIDENT MONTOYA: Fine.

2 MS. STROESSS: Second.

3 PRESIDENT MONTOYA: You heard the motion. All in

4 favor?

5 DR. LUBRITZ: Discussion.

6 PRESIDENT MONTOYA: Discussion.

7 DR. LUBRITZ: Thank you. I would like to make a

8 recommendation. I want to see Dr.`Mansky and Dr. Belcourt go

9 out and work. So I would like to say that we would give them

10 that amount, the additional $40,000, if they can match our

11 $40,000 with contributions from hospitals, other

12 organizations, self-funded plans, and whatever.

13 So we want you here, but I'd like to see you work a

14 little bit.

15 DR. BELCOURT: Actually, Dr.`Mansky's salary depends

16 on fund raising, and when we hired him here we knew that there

17 would be some Board support for his salary. But it was very

18 clearly understood that unless some fund raising occurred,

19 that he would not be able to stay here.

20 Now, he's kind of started to enjoy Nevada here. I

21 am not salaried. I'm strictly a volunteer. So --

22 DR. LUBRITZ: I think you ought to be paid.

23 DR. BELCOURT: Well, I appreciate that. It's a

24 labor of love, and I'm happy to continue it. We're not

25 operating extravagantly, by any means. I would just present

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1 that as an example. So I would -- I think you can,

2 retrospectively analyze and view a significant increase in

3 fund raising.

4 We have some pretty heady plans in mind, and a very

5 good group of thinkers assembled, both north and south, and

6 our foundation includes many former members of this Board who

7 are giving us some very, very good insight as to how the

8 foundation can proceed and thrive.

9 PRESIDENT MONTOYA: I was informed that the contract

10 is not actually on the agenda, so we can't pass it today, but

11 we've passed it in concept.

12 DR. BAEPLER: It was in here, in the handout

13 material. The request is in here. Yes, it is.

14 MS. BIBLE: I was asking --

15 DR. BAEPLER: It's in this handout. It's in this

16 handout that he gave us. It's in the last paragraph.

17 PRESIDENT MONTOYA: But it's not on the actual

18 noticed agenda.

19 MS. KIRCH: It's not an agenda item.

20 DR. BAEPLER: It was not sent out with the agenda,

21 no.

22 MS. BIBLE: What I told the Chairman is that if it's

23 something that -- a contract can be worked out with the staff,

24 the actual contract can come at the next meeting, because they

25 actually do have to approve the actual term of a contract, and

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1 the amount is one of those terms.

2 And, in concept, it appears there is some agreement

3 as to the amount that's requested, and if we could work with

4 staff to present a formal contract at the next agenda meeting,

5 that additional information -- maybe about progress, and it

6 can all be presented at the next meeting, and then it can

7 actually be approved at that particular meeting.

8 DR. MANSKY: We need some basis for funding until

9 that time, because I believe the contract ends in the middle

10 of the month, the middle of March, so that if we could extend

11 just for three months, the old contract, and then work out a

12 new one.

13 MS. BIBLE: The problem is that any contract

14 approved by this Board has to be approved by the Board of

15 Examiners unless it's less than $10,000. $10,000 needs to be

16 approved by the Budget Director and doesn't have to go through

17 a formal Board of Examiners.

18 DR. MANSKY: We would be very pleased to -- I'd be

19 very pleased to work with the staff on a new contract. What

20 I'm asking for is just funding until -- between the middle of

21 March and the beginning of June, when the Board meets again.

22 PRESIDENT MONTOYA: How can we --

23 DR. ANWAR: The way it can be done, maybe, is on a

24 monthly basis, so it stays within that 10,000.

25 DR. BAEPLER: That would be three consecutive

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1 contracts, each a little under $10,000. That probably

2 violates the intent of the statute.

3 MS. BIBLE: They look at it cumulatively.

4 DR. ANWAR: Oh.

5 MS. BIBLE: If you -- the thing is: Would you be

6 agreeable to doing a telephone meeting and you can get a

7 contract maybe for like $10,000 -- $9,999, so you can get it

8 approved, you know, do a -- an bridged kind of amount, and --

9 but it is limited to that unless you want to put it on -- if

10 you get it on for the next month's Board of Examiner's meeting

11 in April, then -- they meet the second Tuesday of the month,

12 and you can do a larger amount if you want to get it in.

13 DR. BAEPLER: What is preferable then? When do you

14 want -- the contract needs to come a little bit later. Do

15 you -- if we worked on interim financing, via conference call,

16 to cover you through the end of this fiscal year, do you want

17 any -- the new contract to be for two full years or do you

18 want it to -- be running for 21 months?

19 DR. MANSKY: I would -- I would think it should be

20 with the -- the fiscal year of the Board and cover the

21 two-year period.

22 DR. BAEPLER: Same for us also, because that's our

23 budget for us at 150,000, which begins July 1. So we can

24 probably work out the --

25 PRESIDENT MONTOYA: We'll get together with some

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1 interim financing, and, in concept, we have the contract

2 approved for $150,000 to carry on over. We will be looking

3 for you to go out and beat the bushes over this, so to speak,

4 to get some more funding to come in. And I'm willing to come

5 help you, and I especially can help you down south. And we'll

6 get going on this. All right?

7 DR. MANSKY: Thank you, very much, Dr. Montoya. I

8 appreciate your offer.

9 PRESIDENT MONTOYA: Thank you for coming up.

10 Dr. Lubritz?

11 DR. LUBRITZ: Could we do an advance in anticipation

12 of a new contract being done?

13 PRESIDENT MONTOYA: I have no idea.

14 MS. BIBLE: Well --

15 PRESIDENT MONTOYA: Tell you what, we'll just work

16 on this. Let them do their research with what we have.

17 MS. BIBLE: I think a conference call -- and you

18 only need a quorum of, like, six people.

19 DR. BAEPLER: It's, you know, the feeling of the

20 Board, so it's perfunctory.

21 PRESIDENT MONTOYA: We can handle it. Thanks.

22 DR. MANSKY: Thank you.

23 PRESIDENT MONTOYA: Physician Assistant Advisory

24 Committee, Dan Hickey. Is he around? North? No. Just you,

25 Mike, huh? Yes? Laurie?

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100

1 MS. MUNSON: Mr. Hickey was going to be here at

2 10:15 when we anticipated that, but we haven't seen him. He

3 must have gotten hung up. He had to -- he had some

4 appointment that he had to take care of.

5 PRESIDENT MONTOYA: Respiratory Care Advisory, Mike

6 Garcia, advisory members, down south. Do you have anything to

7 report, Mr. Garcia?

8 MR. GARCIA: (Via teleconferencing) Thank you,

9 Dr. Montoya. Two items, and I'll be brief. The first one, I

10 got a call from Mr. Clark this week, discussions with the

11 Department of Health regarding the regulation or NR -- the

12 Nevada Revised Statute change that we have requested regarding

13 our respiratory therapists not having to get a blood gas

14 license under the Department of Health, and that it's covered

15 under our scope of practice with this Board.

16 I'm conferencing with members from the Department of

17 Health this afternoon. It's their contention that they may be

18 able to create a waiver for therapists versus having to open

19 the law and the Legislature.

20 And I assume that the Board would be in approval of

21 that. I think that would save everybody a lot of extra work,

22 and our committee will report back to the Board the results of

23 that conference, once it's completed.

24 PRESIDENT MONTOYA: Hang on just a second, Mike.

25 MR. GARCIA: (Via teleconferencing) The second

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101

1 thing would be --

2 PRESIDENT MONTOYA: Hang on. Is there anybody that

3 has any discussion about this first item that he just went

4 over?

5 Okay. Mike, I'm sorry. Go ahead with the next one.

6 MR. GARCIA: (Via teleconferencing) Okay. Second

7 one is -- I will tell you that we're receiving calls,

8 particularly down south, from Respiratory Therapists who are

9 asking questions. Our law has a provision that a Respiratory

10 Therapist student may work in a hospital as long as they are

11 not caring for critically ill patients, but we really don't

12 spell out what they can or cannot do. We pretty much leave

13 that up to the employers.

14 There are therapists that are now beginning to call

15 our committee and say, "Well, what happens when we have, for

16 instance, a respiratory student who is being allowed to

17 deliver breathing treatments in a hospital, but they're in

18 their first year of school, and they haven't had pharmacology

19 and medication administration yet? What's other risk as the

20 supervising therapist?"

21 I will tell you that our committee is going to

22 prepare a recommendation for this Board, for their next

23 meeting. We would like to see, possibly, a regulation or NAC

24 adjustment that would somewhat clarify what a Respiratory

25 Therapy student can do, based upon their process and their

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102

1 curriculum.

2 We know that if you go to the Nursing Board, they

3 also allow nursing students to work in hospitals, but they

4 have pretty much spelled out what a nursing student can do

5 based on where they're at in their academic training.

6 So we would like the opportunity to present this

7 Board with some recommendations similar to that, down the

8 road. Those are the two things going on with our committee at

9 the moment, sir.

10 PRESIDENT MONTOYA: Thank you. Any questions?

11 Mr. Garcia, thanks for your presentation.

12 MR. GARCIA: Thank you.

13 PRESIDENT MONTOYA: Okay.

14 THE WITNESS: Next is the Investigative Committees.

15 I'm going to ask Dr. Baepler to present the findings of the

16 committee.

17 DR. BAEPLER: We considered 96 cases and filed two

18 complaints, requesting physicians' appearances for six

19 physicians at our next meeting. We are following up for

20 further investigation six additional cases and recommended 82

21 for closure. That list has been circulated.

22 PRESIDENT MONTOYA: I'm sorry. That was short.

23 Dr. Lubritz, maybe, Committee B.

24 DR. LUBRITZ: We had 12 cases considered of 80 total

25 cases for filing one. Total cases authorized for peer review

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103

1 one. Total cases requested for appearance, two. Total cases

2 authorized for further follow-up or investigation, seven.

3 Totality cases authorized for closure, was 69.

4 PRESIDENT MONTOYA: Thank you.

5 In consideration of closure by the committees, the

6 list has the two lists have circulated.

7 Do I have a motion for closure?

8 MS. STROESSS: Tell me what "closure" means.

9 PRESIDENT MONTOYA: That it's not to be considered

10 any longer, that the file is going to be stopped here. We're

11 not going to file on it. We're not going to bring them up for

12 more any more hearings. We're not --

13 DR. BAEPLER: The case is closed. There isn't going

14 to be any further action.

15 DR. ANJUM: No further action.

16 PRESIDENT MONTOYA: No further action. Thank you.

17 MS. STROESSS: I'll ask him next time.

18 DR. BAEPLER: Yes, they beat the rap.

19 PRESIDENT MONTOYA: Don't ask the blabber mouth.

20 Okay. Consideration for this, do I have a motion for closure

21 or those two listed items?

22 MS. STROESSS: So moved.

23 DR. ANWAR: Second.

24 PRESIDENT MONTOYA: All in favor?

25 Opposed?

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104

1 The Chairman is in favor.

2 Status of Investigative case load. You just heard

3 from Doug. What are you going to tell us, Mr. Cooper?

4 MR. COOPER: Doug Cooper, Chief of Investigations.

5 The two committees considered a total of 176 cases, this going

6 back through the last eight IC meetings. We're turning around

7 about 175 cases is the average in that 10-week period between

8 the two Investigative Committee meeting dates.

9 We have 21 -- excuse me -- in February, we hit a

10 high of 90 peer reviews in the field. It's the highest I've

11 seen it since I've been here. A lot of those were done and

12 came in this in the last three weeks.

13 So we currently have, right now, 69 peer reviews out

14 in the field, and 69 peer reviews pending assignment to a peer

15 reviewer.

16 Other statistics that we have, to let you know

17 what's going on is: We have 21 hearings scheduled. And from

18 the activity of just the last week, we have three more formal

19 complaints, which will give us 24 files.

20 That's pretty much it, in a nut shell, except for

21 the fact -- I would like to state that in June, Investigator

22 Terry Ward is going to be on the agenda to present to the

23 Board the findings of our Compliance Overview.

24 We've gone through and looked at all the legal files

25 that exist at the Board of Medicine. Those legal files

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105

1 contain orders that were issued as a result of a guilty

2 verdict, based on a formal complaint, and we've audited

3 100 percent of them. And she's going to have the figures for

4 you, but we do know that, as of right now, we have 44 of those

5 240 files where the physicians were -- or other practitioners

6 were not in compliance. I don't have any more specifics to it

7 now, but since we are growing as rapidly as we're growing and

8 we're having more legal cases to look at, and those cases

9 obviously are going to be coming to a conclusion, we've had an

10 additional duty assigned, Investigator Terry Ward, and as the

11 Compliance Officer, and that will be our Probation and

12 Compliance and will require the extra work of two

13 investigators keeping up with it.

14 And what that means is that after a finding from

15 the -- of hearing based on a formal complaint is announced,

16 and the punishment -- for lack of better word -- is decided

17 upon by the Board, the Probation Compliance Enforcement Unit

18 will monitor and collect from the licensee involved the CME if

19 there are CME's, to make sure that the public reprimand, if

20 there is one, is done, that it's recorded, to make sure that

21 the payment is paid in full, and make sure that that order,

22 based on that finding, is in complete compliance. Then we'll

23 close the file.

24 But it was a great accomplishment for those -- for

25 Terry and Angela Canary, who assisted here a little bit on it,

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106

1 to get those 240 cases done, and there will be a full

2 report -- it's quite interesting -- and the explanation of how

3 the program is going to work, at the June meeting.

4 We're running 645 open cases as of today. So the

5 last time we reported that I had 90 per investigator. Three

6 months later we have 92 per investigator. So we're being

7 pretty consistent.

8 Also I'd like to add that with the issuance of that

9 spectacular ad that Marlene, Dr. Baepler, and Dr. Montoya

10 appeared in last fall, we have the heaviest December and

11 January intake of citizen complaints that we've ever had.

12 So despite closing 176 cases this last ten weeks,

13 we've also taken in about 101 citizen complaints in 60 days.

14 So congratulations on your ad.

15 MS. STROESSS: Was that mostly in southern Nevada?

16 MR. COOPER: It was about the same ratio as always,

17 about 80 in south, and 20 in the north.

18 MS. STROESS: I haven't seen anything on -- I guess

19 I'll just keep watching.

20 MR. COOPER: Stay up for Conan if you want to see

21 that.

22 PRESIDENT MONTOYA: Dr. Lamerson, I think

23 Ms. Stroess has also seen this. These Investigative

24 Committees give you an idea of what they do. When you receive

25 your box of materials, and there is a lot of reading -- those

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107

1 two guys have two more boxes to read, each of reading. About

2 right?

3 DR. BAEPLER: Yeah.

4 PRESIDENT MONTOYA: About two more boxes.

5 DR. BAEPLER: And they have to be read.

6 MS. STROESS: And a meeting that lasts all day,

7 generally.

8 PRESIDENT MONTOYA: And most of the time it takes

9 all day.

10 MS. STROESS: Yeah.

11 PRESIDENT MONTOYA: Okay. Just to give you an idea

12 of their work load. So if you get appointed to an

13 Investigative Committee, I'm not doing you any favors.

14 Request to Place Hearing Schedule on the Board

15 Website. Doug, what do you think?

16 MR. COOPER: I'm sorry. I'm actually a little gun

17 shy of even approaching the website, because did we pass a

18 motion that we're not going to do anything that isn't

19 delineated in the NRS.

20 PRESIDENT MONTOYA: Lock and load, Dr. Lubritz.

21 MR. COOPER: What I was going to request -- what I

22 had in mind --

23 DR. BAEPLER: I'm probably the only one that

24 understood that.

25 MR. COOPER: Well, see, the hearing scheduled since

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108

1 last June, since -- it went from four in the past -- and soon

2 to be 25 to 30 days, it's proven to be a really dynamic

3 document. Because of the lawyering that goes on mostly by the

4 defense, it changes every week.

5 In fact, my boss told me not to deliver it to him

6 unless it was a really serious change. He gets tired of

7 opening up the emails and reading it. The fact that we are

8 charged with notifying the patient when the hearing is to take

9 place and inviting them to come at their own expense, of

10 course, and the fact that the medical staff officers review

11 this constantly and call me -- or I have to call them for

12 updates, I just thought it would be a good idea if we could

13 publish the schedule, which is, my understanding, public

14 information, on the website, and just refer the patient and

15 the medical staff officers of all the hospitals to the

16 website, to verify that the hearing is going to take place

17 when it does take place.

18 DR. BAEPLER: A recent survey showed that 60 percent

19 of the homes in Las Vegas have computers, so you're going to

20 miss 40 percent.

21 MR. COOPER: Well, we've got to shoot for something.

22 PRESIDENT MONTOYA: I like the current system,

23 personally.

24 MS. BRAND: Also, the District Attorney's Office,

25 when they send a witness subpoena out, they tell the witness

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109

1 to call the day of trial to make sure it's still going that

2 day. Maybe our letter could be used to --

3 MR. COOPER: Well, we're still notifying them.

4 MS. BRAND: You can notify them once.

5 MR. COOPER: Hopefully we can refer them to call if

6 they have questions or to use the information that would be on

7 the website. That was my idea.

8 MS. BRAND: They could call our switch board, too,

9 for changes. The switch board has the most current hearing

10 schedule.

11 PRESIDENT MONTOYA: We will currently keep the

12 website as to the what statute reflects.

13 MR. COOPER: I anticipated that.

14 MR. CLARK: Nice try, Doug.

15 MR. COOPER: Had I been first, maybe.

16 MS. MUNSON: Blame it on me.

17 PRESIDENT MONTOYA: Nevada State Medical Association

18 Liaison Report. That would be me and Mr. Matheis.

19 I don't have a lot to say except that the Clark

20 County Medical Society and the Nevada State Medical

21 Association report that they pretty much are in line with us,

22 and legislative initiatives that are going through right now

23 in the current Legislatures. That's about all I have to

24 report. Mr. Matheis?

25 DR. MATHEIS: Thank you, Doctor. The Council Board

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110

1 of NSMA meets next Saturday going over issues -- major issues,

2 and Dr. Montoya will get all the background material and

3 everything.

4 And Scott Crafee (phonetic), who is the lobbyist,

5 and I talked with Keith Lee, the lobbyist M.D. in the

6 Legislature. Every week I do an e-update on Legislation going

7 on over in Carson City, and I think most of the physicians get

8 that.

9 I'll send that to Tony, and he can -- if you're

10 interested, then he can pass that along.

11 DR. LAMERSON: Great.

12 DR. MATHEIS: This is kind of an ongoing thing.

13 There are several bills -- I don't know if you've not an

14 Legislative update with you of what they're trying to do.

15 Several bills do affect the Board, that have come out that

16 affect us.

17 And one of them is a bill that would require a

18 report to you of every office-based surgery that's done in the

19 state, and the -- while the intent is laudable, as they

20 usually are, that's probably the -- we have some problems with

21 that as an approach and will be trying to amend the bill to

22 make it more reasonable, where information that you need,

23 information about problems that may result from office-based

24 surgeries, like other problems --

25 PRESIDENT MONTOYA: What do you mean other problems?

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1 DR. BAEPLER: Even the ones that went well would be

2 recorded?

3 DR. MATHEIS: Yes.

4 DR. BAEPLER: Oh, my.

5 DR. MATHEIS: So I think that is -- that sort of

6 thing does occur. I think the bill is still in the process of

7 being drafted. There have been a lot of problems with getting

8 bills being drafted, technically, this session. So there is a

9 real delay. What's likely to happen is that they'll all get

10 scheduled in a cluster, here, in early April or mid-April,

11 right before the first deadline. So some of you may get

12 panicked calls to do some testimony just because it's very

13 hard to predict what's going on over there.

14 But we have -- again, on behalf of the Nevada State

15 Medical Association, we appreciate Dr. Montoya's availability

16 and the communication. At the staff level, communication has

17 been very good, very productive over the past months, and I

18 think that's the best way to avoid any unnecessary problems.

19 Thank you.

20 DR. ANJUM: I want to ask you one question. What is

21 the definition of an office-based surgery.

22 DR. MATHEIS: It is literally any -- they don't do

23 it by procedure. Rather, it's whether or not any of the three

24 levels of sedation is involved. So it's essentially -- it's

25 an odd approach.

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1 Normally, in the past, when they want to limit

2 procedures that are done, they'll define the procedures of

3 when they're with the limitations on ambulatory surgeries,

4 what they had to have as backup. That was the approach taken.

5 This one starts from an anesthesia-based assumption

6 that the problem is -- it has to do with the sedation levels.

7 So it is -- I mean, it goes -- that's a pretty extensive

8 number of --

9 DR. ANJUM: It would include a laparoscopy or

10 something that --

11 DR. MATHEIS: It could be. I think part of the

12 problem is that, as wide as the definition is in the proposed

13 bill, it would go beyond what we would formally --

14 DR. ANJUM: Nothing under local anesthetic doesn't

15 count?

16 DR. MATHEIS: Not necessarily.

17 DR. ANJUM: If they have a procedure that --

18 DR. MATHEIS: The lowest level is -- is where there

19 is localized sedation. So I'll get to all of you that

20 definition. It's -- it is rather --

21 DR. ANWAR: It's easier to understand the issue with

22 the bill, the way it's being proposed, if you understand the

23 genesis of the bill, where is it coming from, and what is the

24 intent of that.

25 It's probably coming from anesthesiologists who

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1 would want a piece of the pie. They are promoting their

2 business, that they should be doing in those private offices

3 when procedures are being done, so that they can bill for

4 their services.

5 DR. ANJUM: It's not only that. A lot of people are

6 doing eye surgeries in the office, and that's -- you know,

7 minor surgery. I don't know if that would be reported, but

8 the dermatologists do a lot of skin biopsies. People do

9 endoscopies and --

10 DR. MATHEIS: Yes.

11 PRESIDENT MONTOYA: Some of this was brought in from

12 out of state.

13 DR. MATHEIS: All of it is. This is a really a

14 result of some national news stories during the summer that

15 had to do with allergic reactions to anesthetics, and to

16 anesthesia in some cases. And the Las Vegas Review Journal, I

17 believe, picked up the national story, and they found an

18 anecdote of a case where some patient had to be taken to an

19 emergency department because they had an unknown allergy to a

20 particular anesthetic that was used, and it was about that.

21 So that was the genesis of the legislation, but it's

22 grown into something that I think is -- is incredibly larger,

23 and in -- the original story was one that said, in order to

24 avoid those circumstances, the presence of an

25 anesthesiologist, when there are certain procedures done, is

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1 appropriate.

2 And so I think that's how these things started.

3 They were always created --

4 DR. ANJUM: Who is going to end up monitoring that?

5 DR. MATHEIS: Well, the good news, for you, the

6 writer of the bill volunteered you all to do that. All of

7 this would be reported to the Board.

8 MS. STROESS: Who wrote the bill?

9 MR. CLARK: Susan Gerhardt, who is a new assembly

10 woman from Henderson.

11 MS. STROESSS: Okay.

12 DR. ANJUM: That's a full-time job in itself,

13 monitoring.

14 DR. MATHEIS: I think it would be more than a

15 full-time job.

16 DR. ANJUM: Surgeries being done and procedures

17 being done under anesthesia, that's --

18 DR. BAEPLER: We could take over the second floor of

19 the building.

20 DR. MATHEIS: And among the things that we'll be

21 coordinating with Mr. Lee -- but one of the things that we'll

22 be saying is that that's not a normal function for this Board.

23 That kind of information is studied by the Health Division,

24 by, you know, Sentinel Reporting, events reporting, but this

25 is really a new idea and a new way of trying to do things, and

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1 perhaps looking at reporting of the specific events that were

2 unplanned that --

3 PRESIDENT MONTOYA: And have the Board do it.

4 DR. MATHEIS: There is also a bill draft, that's not

5 yet a bill, that would also apply to the Board, and that -- I

6 think you had a report on an issue that came up as regarding

7 behavior of a resident, and the reaction was to draft -- at

8 least request a bill -- it hasn't yet come out -- that would

9 require criminal background checks on all new applicants.

10 Now, of course, the problem is that the particular

11 case that was the genesis for this bill draft wouldn't have

12 been, in any way, found out by that particular brevity. There

13 was no criminal background. So the -- the criminal background

14 check wouldn't have changed the outcome of the case.

15 But legislation isn't always drafted rationally.

16 Something has to be done. This is something. This has to be

17 done. And that's the process it goes through, but that one is

18 likely to come up, and would -- I think the Board has looked

19 into the issue of criminal background checks. I think -- we

20 have no objection to it, but we think that it's something that

21 rather -- a more prudent approach would be -- the Board should

22 be authorized to conduct criminal background checks when there

23 is any reason you think that you need that information.

24 And doing it on every applicant -- since virtually

25 every applicant will have had background checks in order to

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1 get through medical school, residency programs, training

2 programs, or being licensed in other states, there's more

3 extensive background information that you have on, certainly,

4 M.D. applicants than probably any other licensing board in the

5 State would have on their applicants.

6 It's just -- so it is a reaction to a very negative

7 news story, and, again, the reaction is not quite on point to

8 what they were perhaps trying to do, but I will -- I will send

9 to Tony, the weekly updates and background material that I'm

10 provided to our Board on the legislation, and you can ask for

11 anything else that I can help.

12 MS. STROESS: That would be real helpful. I'd like

13 to get information from Tony and whoever, in case we have to

14 do an email or go down to Carson or whatever.

15 PRESIDENT MONTOYA: All right. Thank you, Larry. I

16 appreciate it.

17 Now, Dr. Baepler is going to tell us the state of

18 our finances.

19 DR. BAEPLER: This is, of course, an interim

20 statement for our fiscal year, which began July 1 and ends

21 June 30. And for the second year of the biennium, which we're

22 now in, is the year in which we don't collect much money. And

23 so we would always show a deficit, which is planned.

24 The first year of the biennium, which is starting

25 July 1, we show a huge surplus, and we project spending about

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1 half of it. So we have a deficit. You have to think of it in

2 terms of two years. This is simply a reflection of the status

3 of our projected budget as of March for a fiscal year that

4 ends June 30.

5 The -- we're well on target. We're comfortable in

6 all our parameters, in operating. The only area where we're

7 over expended so far is furniture for some reason. All of the

8 other things are in the ballpark or less than we had

9 projected.

10 It appears as though we will meet our target that we

11 set up at the beginning of this biennium. I'm not concerned.

12 The second page shows you the magic of our

13 accountants, who always get the assets to balance the

14 liabilities to the penny, and the fact that their rules of

15 accounting demand that is incidental. It always works out

16 that way.

17 So the status of our budget is in good shape.

18 PRESIDENT MONTOYA: All right. Federation of State

19 Medical Boards and Pain Care Workshops in Vegas, third and

20 fourth. Dr. Baepler and Mr. Clark will speak on that.

21 DR. ANWAR: Was this for our information on that?

22 PRESIDENT MONTOYA: Yes.

23 DR. BAEPLER: This report, real quickly, that we had

24 a good turn out at the Las Vegas session, and we have a number

25 of people going to the Seattle session, and we were

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1 particularly pleased to see a wide involvement of staff.

2 The first day of the session was a general

3 background information session. The second day they broke it

4 up into a session for staff and a section for Board members

5 and administrators.

6 I think everyone that attended really found it very

7 useful. Pain management is, of course, a very timely thing

8 that people are discussing around the country.

9 PRESIDENT MONTOYA: Thank you. Administrators and

10 Medicine Board meeting.

11 MR. CLARK: I might ask, Mr. President, if you would

12 like Mike Huse, one of our investigators who attended the Las

13 Vegas training, to give the investigator's view.

14 PRESIDENT MONTOYA: Okay.

15 MR. HUSE: Good morning. First I'd like to offer,

16 on behalf of myself and of the other members of this staff of

17 the Investigating staff, certainly a thank you for allowing us

18 to attend this Pain Management Conference, as it was very

19 informative and actually eye opening.

20 There was an impressive list of speakers that

21 attended the meeting. They ranged everywhere from the legal

22 profession, to the medical profession, and also to the

23 pharmaceutical industry, as well as family therapists and

24 social workers.

25 Research data across the nation indicates -- has

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1 pointed out that over-prescribing of pain medications, in

2 fact, is not the issue. The issue is under-prescribing of

3 pain medications across the nation. And this leads to the

4 subject of pain management and patient care.

5 There were several areas of discussion that led to

6 the investigative procedures that go on, on a particular case

7 regarding prescription medication. And the attorney that gave

8 this presentation, Arthur Fexton (phonetic), who was

9 Prosecuting Attorney for the Division of Enforcement, State of

10 Wisconsin, he recommended the four D's when we look at

11 physicians and how they operate their procedures.

12 One of those is: Are they dated? Have they

13 increased their educational background and knowledge of what

14 they are -- what they are doing in -- according to pain

15 management?

16 The second D is: Are they being duped by their

17 patients? If so, why is this happening? Are they not aware

18 of the naivete that can happen with their patients?

19 The third is being disabled or dysfunctional due to

20 mental illnesses or drug problems on their own.

21 And the fourth, of course, is the dishonest

22 category, which means that the physician has basically become

23 greedy, desperate, and we have criminal activities.

24 The second area -- and this is a major area for

25 those of us investigations that daily have activities

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1 accumulating information, resources and data regarding a

2 particular complaint, and this is the issue of documenting and

3 charts for the patients.

4 It's recommended that the physicians, in dealing

5 with pain management, can increase their credibility by the

6 three D's once again. Document, document, document.

7 In the case of cancer and other terminal cases, are

8 they doing palliation? Research? Is that the only goal?

9 In the case of non-terminal cases, is function the

10 major goal? And, of course, what to look for in this category

11 is the adequate described pain, the adequacy of the charts,

12 classified and measuring lab tests, functional objectives,

13 including daily living or occupational.

14 Alternatives to opiates, referrals to consultations,

15 reports and documents, med sheet in the chart and -- used and

16 checked frequently.

17 Now, I'm stressing this particular area of chart

18 issues because that's the area that us investigators deal with

19 most often, when we're asking for records and patient charts

20 from the perspective physicians and hospitals, whatnot.

21 Now, we have -- those of us that attended the

22 conference have a good idea of what to look for with all these

23 records that come in, and we can fixate, in our own mind, what

24 kind of a case do we have here, which is helpful to our

25 medical reviewers when we send the files on up to

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1 Investigation.

2 The third area was, of course, a very interesting

3 area, and it's something that's going across the nation in

4 abundance, and that's the ability for investigators to get

5 into a task force situation, where we're sharing information

6 and receiving information from other agencies across the

7 nation.

8 Those would include, of course, the Pharmacy Board,

9 State Medical Boards, the DEA, FBI, and so on. Doctor -- not

10 Doctor, but Keith McDonald, who is the Executive Secretary of

11 the local Pharmacy Board, gave a presentation at this

12 workshop, and he indicated that they have set up a new on-line

13 software program with the Pharmacy Board that allows for

14 immediate -- well, almost immediate transfer of information to

15 qualified end users of their database for pharmaceuticals,

16 prescription profiles.

17 This program, I understand, is a pilot program.

18 They're the first ones to get it, and it looks like it's going

19 to go nation-wide. We, the State Board of Medical Examiners

20 and the Investigation staff have implemented our staff with

21 theirs, and we all have passwords to go into this secured

22 database and down load all the prescription information we

23 need, not only on patients but on the physicians, too.

24 I ordered one yesterday. I got it this morning. So

25 the -- the program is very good, and it's something that I

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1 guess is going nation-wide.

2 MR. COOPER: Also there is -- this task force

3 phenomenon -- I can't indicate the name of physician, but it

4 went to the Investigative Committee A, in December. The Board

5 meeting -- while we were in the Board meeting in Vegas, we did

6 have one of those task force situations where those agencies

7 that Mike indicated did go in together and not raid but -- the

8 AG likes to call it a raid, but we don't -- but went in and

9 took the evidence that we needed to take, in the task force

10 situation, on a major prescribing case, that we're going to be

11 presenting, I'm sure, to the Board when the investigation is

12 completely finished.

13 It was quite interesting.

14 MR. HUSE: As you can see, the workshop program was

15 very extensive and really very informative. I wish that maybe

16 some other members of the Board could have been there.

17 With that having said, there is so much information

18 here, I don't want to take up a lot of your time. I just want

19 to say thank you again for allowing the Investigating team to

20 attend the workshop. The information was just really

21 valuable.

22 PRESIDENT MONTOYA: Well, thank you for your report,

23 Mr. Huse. We do appreciate it.

24 MR. GARCIA: If I could interrupt for one minute.

25 Dan Hickey is here for the P.A. Report.

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1 PRESIDENT MONTOYA: All right. We'll get to it. I

2 was on a roll with Tony. You have something about the

3 Federation of State Boards -- no?

4 MR. CLARK: No, nothing yet.

5 PRESIDENT MONTOYA: Administration of the Winter

6 Board Meeting.

7 MR. CLARK: The Administrators in Medicine, Board of

8 Directors met, set the agenda and program for it's annual

9 meeting in Dallas in May, and also is pursuing attempts to set

10 up an Internet program for all Board Counsel, and a separate

11 one for all investigators, so that if a particular Board

12 Counsel has a problem, they can put it on the Internet to all

13 other Board Counsel and see how other Boards have dealt with

14 the same problem, and the same with the availability of this

15 sharing of information for investigators.

16 And the aim for the Directors is working on that

17 right now, and I would just point out one further thing with

18 respect to Mike's report, and Dr. Baepler's report on the Pain

19 Management Program, there are seats available if any Board

20 members want to attend the Seattle iteration, which is two

21 days. And I don't remember when it is, but if you could find

22 some time available, Laurie has the dates, and she can make a

23 reservation for any Board members that would like to attend.

24 MS. BRAND: It's around June 22nd. I think it's a

25 Monday-Tuesday.

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1 DR. BAEPLER: That isn't sold out, and they expanded

2 it. They do have room.

3 MR. CLARK: The last we knew, they still had a few

4 seats available.

5 DR. BAEPLER: Okay.

6 PRESIDENT MONTOYA: All right. Mr. Hickey, the

7 Physician Assistant Advisory Committee. Do you have anything

8 to report?

9 MR. HICKEY: Yes. Good morning. Please excuse my

10 tardiness. Primarily the reason why I'm speaking to you this

11 morning is to recommend your favorable consideration for an

12 appointment to the Physician Assistant Advisory Committee of

13 Janet Weavel of Las Vegas.

14 Ms. Weavel has been practicing in Las Vegas and

15 licensed by the Board since 1986. She's got an extraordinary

16 record involvement, both in academic and clinical issues, and

17 I would certainly, on behalf of the other members of the

18 committee, recommend that you favorably consider this

19 appointment.

20 PRESIDENT MONTOYA: To that end, we met Ms. Weavel

21 at our last meeting. She presented herself and said, "Hi," to

22 us. She looks like she's got a great resume. Do you have a

23 motion?

24 MS. STROESS: So moved.

25 DR. HELD: Second.

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1 PRESIDENT MONTOYA: Moved and second that Ms. Weavel

2 get appointed to the Physician Assistant Advisory Committee.

3 All in favor?

4 Opposed?

5 The Chairman is in favor.

6 So moved.

7 Mr. Hickey, do you have any other reports?

8 MR. HICKEY: I have no other reports at the current

9 time. Thank you, very much for your time.

10 PRESIDENT MONTOYA: Thank you for coming to talk to

11 us. See you.

13 (8. EXECUTIVE STAFF REPORTS)

14 PRESIDENT MONTOYA: Executive Staff Reports?

15 Mr. Clark?

16 MR. CLARK: Mr. President, as the handout for Agenda

17 Item 8, are eight Staff Training Requests, and rather than

18 read them all, you have them in front of you, and I would

19 request approval for staff identified to attend those training

20 courses, and also to encourage Board members to attend the

21 Federation Annual meeting which will be in Dallas this year

22 from May 12th through May 14th.

23 DR. BAEPLER: I going to move that we approve the

24 staff attendance.

25 MS. KIRCH: Second.

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1 PRESIDENT MONTOYA: All in favor?

2 Anybody opposed?

3 The Chairman is in favor, especially since he's

4 going. So passed.

5 MR. CLARK: One other thing, and it has to do with

6 office space. For those of you who didn't know, or hadn't

7 seen it, immediately to the west of -- or the next room, next

8 to the kitchen, there is a new Board lounge for Board members

9 to make their phone calls in private, and have coffee together

10 if they want.

11 And on the far side, over here, is an office for the

12 Executive Members of the Board, the President, Vice-President

13 and Secretary and Treasurer.

14 Dr. Montoya and I have talked to the Investigators,

15 and currently, when they were meeting with witnesses or

16 complainants in Las Vegas, they end up meeting with them in

17 coffee shops and/or when they are copying medical records,

18 which are confidential, they have to go to Kinko's, a public

19 place, to do that.

20 They have been talking with the Pharmacy Board. The

21 Pharmacy Board has taken some new office space on South

22 Maryland Parkway in an office complex across the street from

23 UNLV. There is an office available in that complex that they

24 would be willing to sublet to the Board.

25 We have sufficient furniture and computers to put

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1 into that office, so we don't have to get any new furniture or

2 computers. We would to have to lease a copy machine, fax

3 machine. The cost would be, for this year, for rent for the

4 facility, $262.50 a month, for the calendar year of '06, $273

5 a month, for '07, $283.50 a month, and for leasing of the

6 equipment that's necessary, 217 per month, plus tax, for the

7 copy fax machine.

8 This would provide a secure and private place where

9 our investigators can meet with witnesses and complainants to

10 take confidential statements, to copy medical records,

11 confidentially, and I'm asking for the Board's approval to

12 enter into a sublease or lease agreement with the Pharmacy

13 Board and to obtain the equipment. The item of equipment

14 necessary to operate for our investigative staff in southern

15 Nevada.

16 DR. BAEPLER: Is that in the La Plaza Office

17 Complex?

18 MR. CLARK: Yes.

19 DR. BAEPLER: The Research Center I used to direct

20 rented a large place there, and parking is available, too.

21 MS. STROESS: How large is the office? Do you have

22 the square footage?

23 MR. CLARK: It is 150 square feet.

24 PRESIDENT MONTOYA: All right. Any discussion?

25 MS. STROESS: It's going to be cozy.

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1 PRESIDENT MONTOYA: It doesn't have to be much. It

2 just needs to be a place to meet. I know the investigators

3 especially don't want to go to these people's house and have

4 to do this at those locations.

5 MR. CLARK: That or meet in the coffee shop at the

6 hospital.

7 DR. BAEPLER: At Starbucks.

8 MR. COOPER: Or at Starbucks, across the table from

9 Mr. Mansky.

10 PRESIDENT MONTOYA: So any discussion?

11 DR. BAEPLER: Excuse me. This is in the suite of

12 space that they rent?

13 MR. CLARK: Yes, this is in the Pharmacy Board's

14 suite.

15 DR. BAEPLER: They're subleasing to us under it?

16 MR. CLARK: Yes. They have receptionist coverage

17 and all of that available.

18 DR. BAEPLER: It sounds like a bargain.

19 PRESIDENT MONTOYA: By your motion?

20 MS. KIRCH: So move.

21 DR. BAEPLER: Excuse me. Do they have an conference

22 room that they could use on an ad-hoc basis?

23 MR. CLARK: I'm not aware if they have a conference

24 room. I don't believe so.

25 PRESIDENT MONTOYA: It's been moved that we approve

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1 the lease.

2 DR. ANJUM: Second.

3 PRESIDENT MONTOYA: All in favor?

4 Opposed?

5 The Chairman is in favor. So moved.

6 They don't have a conference room, huh?

7 DR. BAEPLER: I don't know.

8 PRESIDENT MONTOYA: I don't know, either.

9 DR. MATHEIS: I think there is one.

10 DR. ANWAR: My assumption was that they can use

11 their facility on an ad-hoc basis and use their coffee and

12 phone and pay them whatever on an as-needed basis instead of

13 leasing the basis permanently from them.

14 PRESIDENT MONTOYA: Once we get our --

15 DR. BAEPLER: Yes, once --

16 PRESIDENT MONTOYA: Once we get our feet in there,

17 maybe we can expand.

18 MR. COOPER: We when do, if we take a normal case

19 and we go to Kinko's, it can cost us, on one -- just done, one

20 trip down there $180 for copies. That's more than 50 percent

21 of what the rent is for a month. When we do that, it takes a

22 few hours to do that. So we can't use their copy machine for

23 a few hours at a time and basically lock them out.

24 DR. BAEPLER: Also it's a space you can lock?

25 MR. COOPER: We could lock it up and spread the

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1 stuff out and not worry about losing someone confidential

2 materials.

4 (9. LEGAL REPORTS)

5 PRESIDENT MONTOYA: Thank you. To that extent we're

6 up to legal reports. Ms. Brand?

7 MS. BRAND: Yes. Some statistics. We have two

8 cases pending adjudication. One case with the synopsis being

9 prepared for submission at the next Board meeting. We have 31

10 cases schedule and pending hearings; nine cases where the IC's

11 have authorized filing of additional complaints. That's

12 including the recent ones. Two cases pending settlement.

13 Fourteen cases needing IC summaries prepared by legal.

14 We're pretty well booked up. Ed and I are booked

15 through, I think, July. Ed has got another case in October

16 set for hearing. So it won't be long before these hearings

17 will be set into the next year, and they're at a pretty fast

18 clip.

19 In addition, I think Ed has three hearings, and I

20 have two or three. It's moving along. We're pretty busy, and

21 you might have noticed one of the workshops that we asked for

22 permission to attend is on managing our time. So we're

23 wondering if maybe we could manage our time a little bit

24 better to squeeze a little more work into our day.

25 For information, the Michler case has been

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1 concluded. I don't know too much about it, but maybe Tony can

2 comment a little bit on that. We're still awaiting the

3 final -- the copy of the final order.

4 MR. CLARK: I don't know too much about it, either.

5 Michler who was a doctor whose license was denied, and he sued

6 the Board. And I think he lost at the District Court level,

7 went up to the Ninth Circuit, lost, asked for a hearing, lost,

8 and it was now then pushed back to the District Court for

9 entry of the final dismissal order.

10 And we apparently have received that, and it's done

11 and over with, and we're now ready to get rid of 14 boxes full

12 of files.

13 MS. BRAND: It's pretty nice, since we have 4,000

14 more. And the Mower case, Ed and I just completed the Nevada

15 Supreme Court brief, and that got filed yesterday. So we're

16 hoping for a good decision on that.

17 The next thing that will happen on that will be the

18 other side will have an opportunity to reply brief. There may

19 or may not be an oral hearing in the Nevada Supreme Court, and

20 we have no idea when the Court would make a decision, but it

21 will be coming, and we'll keep you posted on that.

22 PRESIDENT MONTOYA: Is the work load as expected?

23 Is it too much? Is it all right. Are we taxing the system?

24 MS. BRAND: It feels like too much right now, but as

25 you all know, I'm new. We're just going to buckle down and

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1 see what we can do, and attend this seminar and see if we can

2 organization ourselves a little bit better and go forward the

3 best we can.

4 PRESIDENT MONTOYA: You'll let us know, I assume.

5 MS. BRAND: Yes. Thank you for asking.

6 PRESIDENT MONTOYA: Mr. Cousineau, anything to

7 report?

8 MR. COUSINEAU: Nothing additionally. I -- as

9 Bonnie said, the last couple weeks we have been engrossed in

10 that Mower matter, getting that out of the way. I think we're

11 back to the business that we had stalled for a little bit.

12 But we've got quite a few hearings coming up in the next

13 couple months, and that will be, I think, not just keep us but

14 the investigators busy, and you have, of course, all the

15 ancillary matters that come from that, and the filing, IC's.

16 We have plenty to do.

17 PRESIDENT MONTOYA: Okay. And Chief Deputy Attorney

18 General, Charlotte Bible. What's up?

19 MS. BIBLE: Thank you. Actually, I don't have any

20 cases that I'm handling.

21 PRESIDENT MONTOYA: You've got to give us something.

22 MS. BIBLE: All I can say is that the Michler case

23 was a 14-year-old case, and it is an bad example of what a

24 litigious licensee can do and how long a case can take to get

25 resolved. And luckily, it's been finally resolved now.

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1 That's all I have.

2 MS. BRAND: What about the U.S. Supreme Court,

3 Charolette? Can they still go there?

4 MS. BIBLE: They could, if they make a case for a

5 federal constitutional violation, but a case like that is not

6 likely -- they could take it on a writ of certiorari.

7 However, the Supreme Court won't even consider a case that

8 doesn't have some national appeal, and things that are split

9 in the Circuit. Since this is not an issue about a split in

10 the Circuit, it would not likely end up there.

11 MR. CLARK: And sometimes the money well runs dry.

12 MS. BIBLE: That is right. If they did file a

13 petition for certiorari, there is no requirement that you have

14 to answer and file. You wait for the Supreme Court to ask you

15 to file an answer, and usually they're denied.

16 DR. BAEPLER: There is no constitutional question;

17 is there?

18 MS. BIBLE: I think they did raise some due process

19 issues, but I don't know if those were all the issues that

20 have been previously -- they did bring a few process issues.

21 So that definitely was brought into the case, but I don't

22 know, you know.

23 DR. BAEPLER: Okay.

24 PRESIDENT MONTOYA: All right. Ladies and

25 gentlemen, it's now a quarter to 12:00. We're about 45

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1 minutes behind.

2 What I'd like to propose -- we have to get through a

3 couple of cases that are here. Let's take a quick break so

4 everyone can get some fresh air, so we can be fresh when you

5 consider these people who have sat here for an hour and a

6 half. So a real quick break.

7 (Proceedings recess from 11:46 a.m. until 11:57 a.m.)

9 (10. ADJUDICATION IN THE MATTER OF THE NEVADA STATE BOARD OF

MEDICAL EXAMINERS VS. SCOTT R. FORREST, C.R.T., BME CASE NO.

10 04-29264-1)

11 PRESIDENT MONTOYA: Okay. This is an Adjudication

12 of a Complaint against Scott Forrest, a Respiratory Therapist.

13 The adjudicating Board members are Marlene Kirch, Jean Stoess,

14 Joe Lubritz, Charles Held, Cindy Lamerson, and Montoya.

15 Have each of you received the packet of information

16 about this case, including copy of the Complaint and

17 transcript of the hearing, a synopsis of the hearing officer,

18 and exhibits?

19 (Affirmative responses)

20 PRESIDENT MONTOYA: Are you ready to make an

21 adjudication?

22 (Affirmative responses)

23 PRESIDENT MONTOYA: Okay. Ms. Brand will give a

24 brief statement of the facts of the case.

25 MS. BRAND: This was a case where Mr. Forrest filled

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1 out an application for licensure and checked "no" on Question

2 Number 12 which asked if he had ever been convicted of a

3 violation of law, misdemeanor gross or felony. And he checked

4 "no" on another question with regard to whether he had used

5 any chemical substances or had any problems with chemical

6 substances.

7 Then in May, about two weeks later, he filled out an

8 initial registration form, and he answered "yes" to the

9 question if he had ever violated a law, and he admitted that

10 been convicted of a DUI. He also answered "not applicable" to

11 the question about chemical substances.

12 So he answered inconsistently on those two

13 documents.

14 Then on May 19th, he was working for Washoe Med, and

15 he tested positive for cocaine, and he was dismissed.

16 In this case, we never actually heard from

17 Mr. Forrest. However, we have clear information that he did,

18 in fact, receive notice of the hearing, notice of the dates.

19 He received a full copy of the Complaint, and a full copy of

20 our pre-hearing statement, which included copies of all of the

21 evidence against him.

22 He was noticed at the adjudication would take place

23 today, and that notice did return, but that doesn't have any

24 effect on your ability to go ahead and adjudicate, because

25 notice has been complete.

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1 PRESIDENT MONTOYA: You're saying that's because we

2 don't have him out here? Are you making one last check?

3 MS. MUNSON: Yes.

4 PRESIDENT MONTOYA: Just to make sure. All right.

5 I think it's pretty much cut and dry that he got caught on

6 drugs, on the job, and it's not the first time.

7 MS. BRAND: You are allowed to go into closed

8 session at this time if you'd like.

9 PRESIDENT MONTOYA: We're still in open.

10 MS. KIRCH: So moved.

11 MS. STROESS: Second.

12 PRESIDENT MONTOYA: Sorry. We have to ask you to

13 leave.

14 THE REPORTER: All right.

15 (Closed session proceedings followed;

16 not reported and not transcribed herein)

17 MR. GARCIA: (Via teleconferencing) If you guys are

18 coming back into open session, please turn on your mics.

19 PRESIDENT MONTOYA: We're coming back to open. Do I

20 have that motion for that?

21 MS. KIRCH: So moved.

22 DR. BAEPLER: Second. Yes.

23 PRESIDENT MONTOYA: Is there any input?

24 DR. ANJUM: On the doctor --

25 PRESIDENT MONTOYA: No, not on --

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1 DR. ANJUM: Not on future --

2 PRESIDENT MONTOYA: The last item.

3 DR. ANJUM: If you've been a participant in a

4 particular case, you can still participate in the discussion

5 part of it in closed session, or open session, or where?

6 MS. BIBLE: Normally you're not here in closed

7 session.

8 DR. ANJUM: I see.

9 DR. LUBRITZ: If you've investigated. You're

10 generally not here for the adjudication.

11 DR. ANJUM: If we're now adjudicating this case, I

12 should leave the room for closed session.

13 MS. BIBLE: When they come back into open session,

14 if you want to make a recommendation regarding penalty, then

15 that would be that -- I think that's acceptable to do when

16 we're in open session. Because it's the same as when you've

17 seen in other cases. We might have opposing Counsel here that

18 may have made -- wanted to make a comment and really limited

19 their comments as well. So we played it both sides in the

20 past and have pretty much not had the investigative Board

21 members or their Counsel participate when we do the

22 adjudication.

23 But if you'd like to make a recommendation after

24 they take the vote, that would be -- it's acceptable.

25 DR. ANJUM: Afterward?

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1 MS. BIBLE: Yes.

2 DR. ANJUM: All right.

3 PRESIDENT MONTOYA: Do I have a motion on this

4 particular case?

5 DR. HELD: I make a motion that Scott Forrest's

6 license to practice respiratory --

7 PRESIDENT MONTOYA: Do we find him --

8 DR. HELD: Guilty.

9 PRESIDENT MONTOYA: Two things. Failed the drug

10 test and lied on the application.

11 MS. BRAND: He had two counts of lying on the

12 application.

13 PRESIDENT MONTOYA: Yeah.

14 DR. HELD: I would make the motion to find him

15 guilty --

16 MS. KIRCH: Second.

17 DR. HELD: -- of the charges.

18 DR. LUBRITZ: Both charges.

19 MS. BIBLE: Three charges.

20 MS. BRAND: All.

21 DR. HELD: All charges.

22 PRESIDENT MONTOYA: Okay. Motion made and seconded

23 by Doctor -- who was that? You, Marlene? Marlene seconded

24 it.

25 And all in favor?

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1 Opposed?

2 The Chairman is in favor. The motion carries. He

3 was convicted in all three counts.

4 DR. LUBRITZ: This was a unanimous decision?

5 PRESIDENT MONTOYA: Yes.

6 Now, the second motion.

7 DR. HELD: Motion that Scott Forrest's license to

8 practice medicine in the State of Nevada be revoked.

9 MS. KIRCH: Second.

10 PRESIDENT MONTOYA: Second by Ms. Kirch.

11 All in favor?

12 Opposed?

13 The Chairman is in favor. So moved. His license is

14 revoked in the State of Nevada.

15 DR. LUBRITZ: Unanimous.

16 PRESIDENT MONTOYA: Unanimously. None opposed.

18 (11. CONSIDERATION OF STIPULATION FOR SETTLEMENT IN THE

MATTER OF THE NEVADA STATE BOARD OF MEDICAL EXAMINERS VS.

19 SURESH KHILNANI, M.D., BME CASE NO. 04-6268-01)

20 PRESIDENT MONTOYA: Consideration of Stipulation of

21 Settlement in the Matter -- we're still in open -- of Medical

22 Examiners versus Suresh Khilnani. Adjudicating members on

23 this particular case are: Montoya, Dr. Lubritz, Marlene

24 Kirch, Dr. Anwar, Ms. Stroess, and Ms. Lamerson --

25 Dr. Lamerson.

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1 DR. BAEPLER: Would you like the non-adjudicating

2 members to leave?

3 PRESIDENT MONTOYA: I will ask them to step out for

4 just a minute.

5 DR. BAEPLER: A settlement is not the --

6 MS. BIBLE: Actually, settlements are okay, because

7 it's -- it's actually in -- just so you understand, it's the

8 due -- really a due process issue, because the investigating

9 Board members are the prosecuting body. They had their

10 opportunity and they had a hearing. They present their

11 evidence, and they make a recommendation to the Hearing

12 Officer. So we get that transcript.

13 Then when it comes to this Board, they're looking at

14 the transcript, and they make a decision. On a settlement --

15 and so that's -- so they don't get an opportunity to make

16 further argument, and you don't any further opportunity to

17 make argument. So it's fairness on both sides.

18 DR. BAEPLER: Double jeopardy, huh?

19 MS. BIBLE: Well, on the settlement, they've

20 actually waived that right for, you know, discussion of the

21 facts of the investigation, and it's an agreement by the

22 parties. So it's a little different, that you could add your

23 input, because now you can just add information. And that's

24 been agreed to by the party when he signs this settlement

25 agreement. So that's the difference between a settlement and

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1 an adjudication.

2 PRESIDENT MONTOYA: All right. And --

3 DR. BAEPLER: What about a dismissal, just to cover

4 the third?

5 MS. BIBLE: So that's a motion for dismissal?

6 DR. BAEPLER: Yes.

7 MS. BIBLE: I think it's the same.

8 DR. BAEPLER: As a settlement?

9 MS. BIBLE: As a settlement, yes.

10 PRESIDENT MONTOYA: Okay. Regarding Dr. Khilnani,

11 Dr. Khilnani was somebody who was alleged that he failed to

12 meet the standard of care by failing to monitor cuff pressures

13 and ET tube, and the second one was that he should performed a

14 tracheotomy when he was transferred to him by Dr. Lambert,

15 months later. To this end, I'm going to ask Dr. Held to give

16 his opinion on both, and we have it in front of us. If there

17 is any further discussion on what you presented to us, I would

18 like to hear it.

19 DR. HELD: No. I don't think there's any further

20 discussion. The main issue about monitoring cuff pressures

21 was that he didn't know what the policies were for the

22 department. He thought it was occurring, but it was not part

23 of the policies.

24 So he was unaware of something he should have, as a

25 pulmonary physician, been aware of. And the second issue was

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1 documentation in which there was no documentation in the chart

2 that he gave consideration to further evaluation of the lady's

3 airway, which ultimately led to her demise.

4 PRESIDENT MONTOYA: I've read the case. You

5 probably know it better than I do. Can you give us a synopsis

6 of what went on?

7 DR. HELD: I haven't reviewed it lately, but a lady

8 with some neuromuscular problem that had a very prolonged

9 illness -- she was quite sick and had a -- an endotracheal

10 tube, a tube through her nose, down the back of her airway,

11 into her trachea for a period of time, not an excessive period

12 of time.

13 She subsequently was discharged from the hospital to

14 some sort of care facility and she developed respiratory

15 problems that suggested an airway problem. And she came in

16 with the recommendation from a doctor at the care facility

17 that she have a tracheostomy. This was not performed, and --

18 and there was no documentation of either an adequate

19 evaluation or the thought process of why further evaluation

20 was not done, and she subsequently expired from airway

21 problems.

22 PRESIDENT MONTOYA: A phlegmatic mass, right?

23 DR. HELD: She developed a mass -- a narrowing of

24 her trachea, quite a ways down. A tracheostomy would not have

25 been appropriate therapy. That wasn't the real issue. The

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1 real issue was: She came in with an airway problem. They did

2 a superficial evaluation, and then it seemed that no other

3 thought was given to why she was having problem.

4 PRESIDENT MONTOYA: He could explain himself to

5 other people, but after the fact. That's what I thought --

6 DR. HELD: He explained himself to us after the

7 fact. He and I met face-to-face here quite a while ago. I

8 can't remember exactly when, and he explained himself, but

9 nothing was documented.

10 PRESIDENT MONTOYA: Dr. Lubritz, you had questions?

11 DR. LUBRITZ: I think he had actually had a

12 consultant, an otolaryngologist consult, and, as I recall,

13 there was no recommendation from the otolaryngologist that he

14 get, for instance, a CT of the trachea to see if there was any

15 narrowing or whatever.

16 So it may be one of those cases, again, where you

17 call for an consultant. You rely upon that consultant, as you

18 do a radiologist or whatever, with their opinion, because

19 that's why you ask them in the first place.

20 If you don't get the -- if you don't -- if you don't

21 get a good answer from the consultant, or one that is

22 reasonable, then you're led right down the path from what the

23 consultant has recommended. So it can be from a lack of

24 getting information, a lack of getting good information, or

25 getting poor information, or bad information from a

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1 consultant.

2 DR. HELD: I think he got good information from his

3 ENT consultant but just within limits. The narrowing in the

4 trachea was just above the division between the right and left

5 main stem bronchus, and the ENT physician would not be able to

6 visualize that area in an evaluation. So they -- you know,

7 they sort of looked at the problem from here to here and

8 missed it down here.

9 DR. LUBRITZ: All right.

10 DR. HELD: When he discussed it with me, it sounded

11 like that he had thought of the appropriate process but had

12 made a judgment that that was not necessary in this particular

13 patient, and he was wrong.

14 DR. LUBRITZ: Did he do a fiberoptic endoscopy?

15 DR. HELD: No.

16 DR. LUBRITZ: Would you have?

17 DR. HELD: Yes. Well, knowing all the facts,

18 absolutely. Have I ever not done a bronchoscopy and wish I

19 had? Oh, you bet.

20 PRESIDENT MONTOYA: In this particular case, could I

21 ask: Who worked this out?

22 MR. COUSINEAU: Actually Doug Montoya -- this was

23 prepared by Steve Quinn, and the case was assigned to me. So

24 when I opened the file, the settlement agreement was one of

25 the top items. I have spoke when Counsel, John Cotton, and

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1 explained to him it was coming in front of the Board, but I

2 made no representations except I was going to present it at

3 the next Board meeting.

4 PRESIDENT MONTOYA: What are we consenting to do

5 by -- this is a settlement? What is our settlement?

6 MR. COUSINEAU: We're going to be settling the --

7 Dr. Khilnani, basically, if we agree to this, would be

8 performing ten hours of CME in addition to the regular CME

9 requirement, relating to the documentation. I guess, CME

10 documentation of the medical record, and also he would

11 reimbursing the Board for the costs. An amount was set in

12 advance, in this instance, for $2500.

13 I don't think that's past practice, but whatever the

14 case, that was the agreement that was worked out. So it's

15 certainly not bound by that, but if we do want to deviate from

16 it, we'd have to go back and start the process kind of fresh,

17 if we're going to accomplish another settlement. So it's

18 really a CME -- ten hours that the doctor would be responsible

19 for and $2500 in costs.

20 PRESIDENT MONTOYA: A reprimand in our newspaper?

21 DR. BAEPLER: No.

22 MR. COUSINEAU: You mean the newsletter?

23 PRESIDENT MONTOYA: The newsletter.

24 MR. COUSINEAU: No.

25 DR. BAEPLER: It's Item 5 here.

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1 PRESIDENT MONTOYA: Yes, I can see it down. It's

2 sufficient.

3 Any more -- Mr. Cousineau presented what the

4 settlement is. It's on page 4 of the settlement agreement,

5 and so, he has to take the ten hours and pay us $2500. This

6 is a discipline. So it does go on his record with the State

7 and -- that he was disciplined.

8 DR. ANWAR: The bottom line, the way I see it, is

9 that there was a pathology that was missed, really. He didn't

10 make an effort to look at what the problem is, and there was

11 something they didn't considered that they should have

12 considered. So that was something that should have been

13 considered but it was missed.

14 And so how do you tell a doctor so that the chances

15 of it happening again are decreased to protect the citizens of

16 Nevada?

17 And I think the fact that all that has gone on

18 through this stage is -- is reason enough for a doctor to be

19 more mindful of the types of diagnoses and definitive, and in

20 a similar case present in the future, how to prevent such a

21 negative outcome as was the result in this case.

22 So I think that component, from a medical point of

23 view, has been covered.

24 PRESIDENT MONTOYA: You're considering him educated

25 at this point?

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1 DR. ANWAR: Right.

2 PRESIDENT MONTOYA: I don't mean to interrupt you.

3 I was just --

4 DR. ANWAR: Yes, that was my comment, basically.

5 PRESIDENT MONTOYA: Okay.

6 MS. KIRCH: Wait.

7 PRESIDENT MONTOYA: We never went to closed. We're

8 still in open.

9 MS. KIRCH: So you're saying that he was educated on

10 the medical error part or whatever.

11 PRESIDENT MONTOYA: The medical error and pursuing

12 another diagnosis instead of -- plus we're asking him to take

13 ten more CME's.

14 MS. KIRCH: That's on --

15 PRESIDENT MONTOYA: The endotracheal tube care.

16 MS. KIRCH: No. On documentation.

17 DR. HELD: He knows how to care -- from our

18 conversations, he knows how to take care with the ET tube and

19 that kind of stuff. What he didn't do was document at any

20 point in time. I think it was partly related to accounting on

21 a resident doing it. Most of the notes were by a resident,

22 and -- and it was a clear documentation problem.

23 PRESIDENT MONTOYA: All right.

24 MS. KIRCH: Because the CME is on documentation. It

25 has nothing to do with --

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1 DR. HELD: He's going to do a lot more bronchoscopes

2 for a long time, because this is a legal case I think.

3 MS. BIBLE: Just to clarify this. What they're

4 doing, by the settlement is -- it's sort of like a

5 lesser-included violation in failing to maintain medical

6 records, as opposed to being found guilty of malpractice. And

7 part of the settlement is dismissing the malpractice claims

8 and replacing them with failure to maintain medical records.

9 So it definitely would be reflected as a

10 disciplinary action, but it would be reflected as failure to

11 maintain medical records and not a malpractice issue.

12 And then, as you discussed, the penalty for that is

13 the CME and costs.

14 MR. COUSINEAU: Is that something we do when we

15 publish in our --

16 MS. BIBLE: It would be -- the settlements are, I

17 believe, published. So it will get -- it's public, and the

18 settlement is a public document, and because this is a -- it

19 is a settlement for a violation, it would be reported to the

20 national data bank.

21 DR. BAEPLER: Are we doing it in open session?

22 PRESIDENT MONTOYA: We're still in open session. Do

23 I hear a motion?

24 DR. LUBRITZ: I move that we accept the settlement

25 agreement proposed by our previous Counsel with opposing

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1 Counsel for the Doctor -- settlement with Dr. Suresh Khilnani,

2 Board Case Number 04-6268-01.

3 MS. KIRCH: Second.

4 PRESIDENT MONTOYA: Motion and seconded.

5 All in favor?

6 Opposed?

7 The Chairman is in favor. The motion carries.

8 DR. ANWAR: Are we in closed session or open?

9 PRESIDENT MONTOYA: We're open.

10 MS. BRAND: Open.

11 PRESIDENT MONTOYA: Any time we take a vote, we have

12 to do it in open.

14 (12. CONSIDERATION OF STIPULATION FOR SETTLEMENT IN THE

MATTER OF THE NEVADA STATE BOARD OF MEDICAL EXAMINERS VS.

15 TIMOTHY DYCHES, M.D., BME CASE NO. 04-9201-01)

16 PRESIDENT MONTOYA: Okay. This is also

17 consideration of stipulation for settlement in the matter of

18 the State of Nevada versus Timothy Dyches, M.D. The Case

19 Number is 04-9201-01.

20 The adjudicating members are Dr. Baepler, Dr. Anjum,

21 Dr. Anwar, Dr. Held, Jean Stoess, and Dr. Lamerson.

22 This is another stipulation for settlement, so

23 nobody has to leave. And it's Number 12, and this is the --

24 well, who -- who knows this case? Joel, you know this case

25 the best? You can probably summarize it the quickest.

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1 DR. LUBRITZ: Dr. Dyches, as I recall, has practiced

2 in the State of Nevada over 20 years. He practices here in

3 Reno. And to my knowledge, I think, this is his first case.

4 I can't remember that exactly, but it's a very clean record.

5 He's a very well respected physician.

6 There was -- this was a case of a medical error. He

7 is -- his practice manager made a change in the way pathology

8 reports would be handled.

9 Prior to this time, pathology reports were presented

10 to the physician. He would sign off on them, and they would

11 be placed in the patient's chart. She made a change, without

12 notifying him, that the pathology reports would no longer pass

13 the physician, but would just be filed in the chart.

14 This was a patient who had a tonsil -- history of

15 recurrent tonsil infections, had a tonsil -- one that was

16 larger were the other. He had a tonsillectomy and saw the

17 patient for a post-op visit. There was no pathology report

18 available.

19 And on a subsequent visit -- then she missed an

20 appointment. I think, on a subsequent visit, it was found,

21 eight months later, that she had a lymphoma of the tonsil.

22 She was staged, as I recall, had a radiation, and has done

23 well since that time.

24 The doctor, when he presented to us, very

25 forthrightly said that a mistake was made, a medical error was

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1 made. "I can't lay it off on anybody else but me. It's my

2 practice. I didn't see the pathology report. I have to

3 accept responsibility for it. Yes, there was a mistake, and,

4 yes, I made it."

5 He has gone to back and fired the person who -- his

6 practice manager, and they have put up different types of

7 layers of protection for filing records. They've gone back to

8 the old thing. Made stamps and whatever. He's changed back

9 to the way things used to be done. He was unaware that it had

10 been changed until this case came up.

11 And we, therefore -- his attorney, I think,

12 presented to one of our attorneys a settlement. I will assure

13 you that the doctor was, number one, very sorry that it

14 happened. Number two, agreed that it shouldn't have happened.

15 Number three, the patient at this point has had a good

16 outcome, and I think that he has suffered as much as any

17 individual can.

18 PRESIDENT MONTOYA: He remedied the problem.

19 DR. LUBRITZ: He remedied the problem so that it

20 won't occur again. I would be unlikely to occur again.

21 PRESIDENT MONTOYA: Mr. Cousineau, you were the one

22 who proposed this.

23 MR. COUSINEAU: There was another case that was

24 given to me, and I was fairly familiar with the facts

25 surrounding it. Dr. Lubritz indicated that Dr. Dyches

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1 appeared as -- I think it was June IC, and explained his

2 position. I think the IC was satiated for the most part, but

3 Mr. Quinn was under the belief and kind of went back and

4 forth.

5 It was ultimately decided that filing a complaint

6 would be appropriate, in order to make a record of the

7 wrongdoing. Therefore, when the public would inquire as to:

8 Is there any improprieties? It would show there had been a

9 filing of a complaint, so there is some documentation of it.

10 Conversely, that we would essentially dismiss that,

11 and that would also be part the record. So, again, it was --

12 that was the thinking, I believe, that, you know, initiated

13 this.

14 Knowing that -- we spoke to Dr. Barnett about this

15 at the time. Subsequent, he was kind of more of a -- thought

16 it was a medical error, and I felt this was probably the most

17 appropriate way to dispose of it, because if we went to a full

18 hearing and go through it all, I think we're going to come to

19 the same conclusion, I think.

20 So it was my thoughts -- I contacted Dr. Dyches, who

21 did not have an attorney, and I had to rely on the previous

22 correspondence between Mr. Quinn and Dr. Dyches. And based on

23 that, I prepared this settlement agreement, just to get to try

24 to dispose of it.

25 I thought this was the most expeditious way to go

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1 about it. Dr. Dyches has been very decent about it. He's

2 been very understanding.

3 DR. BAEPLER: The settlement is to dismiss the case

4 now?

5 MR. COUSINEAU: I know that's not the normal

6 protocol.

7 DR. BAEPLER: It's rationale. I would move that we

8 do so, based -- I don't think you have a legal case to pursue

9 it here. This is a system error and not even a medical error.

10 This is a system failure, and they've taken corrective action

11 to ensure that this system error will not reoccur.

12 PRESIDENT MONTOYA: We've handled systems errors

13 much like this in the past, before, Dr. Anwar.

14 DR. ANWAR: I second that, and I have a comment.

15 This is the best possible outcome that we could expect from a

16 physician's office. We couldn't have done it any better or

17 recommended any better -- made any better recommendations for

18 the physician to act on the problem in that office that he has

19 done as a result.

20 PRESIDENT MONTOYA: Thanks. Anybody else?

21 MR. COOPER: Can I ask Ms. Bible a question?

22 PRESIDENT MONTOYA: No. Sure. Go ahead.

23 MR. COOPER: Now, I report to the data bank. This

24 is a complaint, and it's listed a settlement agreement, both

25 of which are reportable. Yet the settlement agreement says

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1 that we're dismissing the action. If it's a dismissal --

2 MS. BIBLE: It's dismissed now. It's been, by

3 settlement agreement, that it's dismissed. So there is no

4 action that was --

5 MR. COOPER: Well, that's my dilemma.

6 DR. BAEPLER: The action is dismissed.

7 MS. BIBLE: I'm sorry?

8 MR. COOPER: I said that's my dilemma. It's a

9 dismissal but it's by settlement. I've got to report

10 settlement agreements, but this is not --

11 DR. BAEPLER: I move --

12 DR. ANJUM: It's a recommendation of the Counsel to

13 dismiss the case.

14 DR. BAEPLER: I move to dismiss, not settle.

15 DR. ANJUM: It's the decision of the Board here to

16 dismiss. It may come in for any purpose, but it's to dismiss.

17 So you can report the final outcome.

18 MR. COOPER: Number 13, that's -- what's going on

19 with Number 13?

20 MS. BIBLE: Wait. Can we --

21 PRESIDENT MONTOYA: Hold on.

22 MS. BIBLE: Let me explain the differences. Just

23 because it's by settlement agreement doesn't -- settlement

24 agreements, in and of themselves, doesn't necessarily mean

25 disciplinary action. It's the finding of a violation. It's

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1 an action by the Board.

2 So the settlement, in and itself, is not something

3 that needs to be reported. It's what's in the settlement

4 agreement, and in this case it's a settlement agreement of

5 those complaints, that there is no violations found by this

6 Board.

7 DR. BAEPLER: So use your judgment.

8 PRESIDENT MONTOYA: Don't report it.

9 MR. COOPER: I'm not going to report something that

10 shouldn't go forward.

11 PRESIDENT MONTOYA: It's been moved and second --

12 are we -- that we accept the dismissal. All in favor?

13 Anybody opposed?

14 The Chairman is in favor. This is dismissed.

16 (13. CONSIDERATION OF DISMISSAL OF COMPLAINT IN THE MATTER OF

THE NEVADA STATE BOARD OF MEDICAL EXAMINERS VS. TODD K. MALAN,

17 M.D., BME CASE NO. 04-10433-1)

18 PRESIDENT MONTOYA: Onward and upward.

19 Consideration of dismissals of complaints in the matter of

20 Nevada versus Todd K. Malan, M.D. The adjudicating members

21 are Dr. Baepler --

22 MS. KIRCH: I think those are wrong; aren't they?

23 Or are they right?

24 MS. MUNSON: Dr. Baephler, Dr. Anwar, and Dr. Held

25 are not adjudicating.

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1 DR. BAEPLER: Thank you.

2 MS. KIRCH: Because they were --

3 PRESIDENT MONTOYA: Oh.

4 MS. MUNSON: It's a misprint. My apologies.

5 PRESIDENT MONTOYA: The adjudicating members are

6 myself --

8 (12. CONSIDERATION OF STIPULATION FOR SETTLEMENT IN THE

MATTER OF THE NEVADA STATE BOARD OF MEDICAL EXAMINERS VS.

9 TIMOTHY DYCHES, M.D., BME CASE NO. 04-9201-01)

10 MR. COUSINEAU: Sorry to interrupt. I want to bring

11 this up to clarify the record. The Complaint that was

12 originally filed against Dr. Dyches is -- can we go back to

13 that real quick? The Complaint, itself, lists the IC members

14 in error. It lists Dr. Anwar as one of the committee members.

15 Actually it was you as well as Dr. Lubritz and Ms. Kirch.

16 So what I would -- the only reason I'm pointing that

17 out is because Dr. Anwar did take part in the adjudicative

18 process. I wanted to be clear that he was entitled to be on

19 the adjudicative body, and it was actually you that --

20 PRESIDENT MONTOYA: My vote doesn't count?

21 MR. COUSINEAU: Maybe can we just take that back to

22 make sure we have the record clear and vote once again. I

23 apologize for that.

24 PRESIDENT MONTOYA: In the matter of Medical

25 Examiners versus Dr. Dyches, the adjudicating members were

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1 Dr. Baepler, Dr. Anjum, Doctor -- not Dr. Anwar -- okay --

2 Dr. Anwar, Dr. Held, Ms. Stroess, and Dr. Lamerson.

3 MR. COOPER: Yes, sir.

4 PRESIDENT MONTOYA: Okay. All those that were in

5 favor of the dismissal, again?

6 Opposed?

7 And the Chairman does not have a vote, so it

8 carries.

9 MR. COUSINEAU: Thank you. Sorry about that.

10 Now onward. I wonder why that case sounded

11 familiar. I thought I had read it so many times in here.

12 MS. STROESS: When I read that I thought that must

13 be the kind of issues that keep all the doctors awake at

14 night, having to deal with humans on your staff.

16 (13. CONSIDERATION OF DISMISSAL OF COMPLAINT IN THE MATTER OF

THE NEVADA STATE BOARD OF MEDICAL EXAMINERS VS. TODD K. MALAN,

17 M.D., BME CASE NO. 04-10433-1)

18 PRESIDENT MONTOYA: Yes. Consideration of

19 complaints in the State of Nevada versus Todd K. Malan. And

20 now the adjudicating members are going to be, again:

21 Dr. Anwar, Jean Stroess, Dr. Lamerson, myself, Dr. Held, and

22 Dr. Lubritz. Did I catch them all?

23 DR. MANSKY: Not Dr. Held.

24 PRESIDENT MONTOYA: Not Dr. Held. Dr. Lubritz?

25 MS. KIRCH: And me.

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1 PRESIDENT MONTOYA: Marlene Kirch, you brought it

2 up. I thought you were getting out of it. Okay. And you.

3 We've got that straight.

4 All right. This is the case of a patient getting

5 shipped to another hospital and the accepting -- well, the

6 non-accepting doctor was very irritated at this circumstance,

7 and filed a case against the first doctor. It turns out the

8 patient could not be taken care of by the doctor -- Dr. Malan

9 in any of his hospitals, anyway, because of her insurance

10 situation.

11 So she was shipped to another hospital where

12 Dr. Malan could not take care of her, although she was

13 problems and needing to be induced, the doctor that had to

14 take her was not happy with this. The case turned out to be

15 all right. It was called patient abandonment. So any

16 discussion?

17 DR. LUBRITZ: At this point it was made clear that

18 the patient knew that Dr. Malan could not go to UNC and she,

19 on her own volition, went there and, she had no problem with

20 the fact -- she made a decision, based on insurance, that

21 Dr. Malan could not go there. She was unsure about her

22 insurance, and, therefore, she made the decision, and,

23 therefore, was not abandoned.

24 DR. HELD: Right.

25 PRESIDENT MONTOYA: That's one view. My view is

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1 should -- sorry. Do we want to go in closed? We can keep

2 this open?

3 MS. BRAND: If you're going to talk about his

4 conduct --

5 MS. BIBLE: If you want to.

6 PRESIDENT MONTOYA: Is there a motion to go in

7 closed session?

8 DR. LUBRITZ: Yes.

9 MS. KIRCH: Second.

10 PRESIDENT MONTOYA: We're in closed.

11 (Closed session proceedings followed;

12 not reported and not transcribed herein)

13 PRESIDENT MONTOYA: There has been a recommendation

14 by the staff to dismiss this complaint.

15 MS. KIRCH: I move we dismiss the formal complaint

16 against Dr. Malan on Number 04-10433-01.

17 DR. BAEPLER: Second.

18 PRESIDENT MONTOYA: Moved and seconded.

19 All in favor?

20 All opposed?

21 Chairman is in favor.

22 MS. BRAND: Thank you.

23 DR. LUBRITZ: Are these cases that -- whatever they

24 are, that we vote upon -- should we put the reason that we are

25 recommending dismissal, filing, whatever, or does it just

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1 stand on its own that someone would go read the record and --

2 MS. BRAND: Right.

3 DR. LUBRITZ: We don't really -- as in the cases

4 with others, where we're accepting or denying licenses, we

5 don't have to list the reasons for that.

6 MS. BIBLE: You bring up a good point. You do

7 discuss it. You know, obviously we came out of closed

8 session, and it was for a decision, because other people who

9 have case aren't going to see those.

10 DR. LUBRITZ: That's the reason I'm asking the

11 question.

12 MS. BIBLE: Right. They aren't going to see those

13 reasons. I guess from a -- you don't need findings of fact,

14 where you definitely have reasons. Like when you have to

15 write findings of a factual basis and conclusions of law, and

16 in order where we deny somebody or find them in violation.

17 When we're dismissing, there is not that

18 requirement, because all we do is do an order of dismissal.

19 DR. BAEPLER: No one is going to challenge it.

20 MS. BIBLE: Except that I think what your probably

21 talking about is in the future, if somebody comes and --

22 DR. LUBRITZ: And somebody is going to come and say,

23 "Wait a minute. If you dismissed this case" --

24 MS. BIBLE: Right.

25 DR. LUBRITZ: My question is: What should we do?

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1 MS. BIBLE: Well I think that --

2 DR. LUBRITZ: Not this one, but in --

3 MS. BIBLE: Right. It's probably a good idea,

4 except that sometimes, like in a dismissal like this, you're

5 talking about some legal aspects that maybe aren't

6 necessarily, you know -- they're not appropriate to really --

7 DR. LUBRITZ: What's your recommendation?

8 PRESIDENT MONTOYA: What I'm hearing is she's

9 saying: Keep it simple.

10 MS. BIBLE: I think simple on a dismissal is better.

11 DR. BAEPLER: Simple is good.

12 MS. BIBLE: If we don't really need -- I mean, if we

13 were to ever been challenged, you could say "These are taken

14 on case-by-case basis."

15 DR. LUBRITZ: You will tell us at the appropriate

16 time -- one of you will tell us, "I think you need to put into

17 the record why you're doing this"?

18 MS. BIBLE: Sure.

19 DR. BAEPLER: That's good.

21 (14. LICENSURE RATIFICATION)

22 PRESIDENT MONTOYA: The next item is the Licensure

23 Ratification under Number 14. There is a few dozen licenses.

24 DR. BAEPLER: Move we approve them.

25 MS. KIRCH: Second.

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1 PRESIDENT MONTOYA: Moved and second.

2 All in favor?

3 Opposed?

4 None. The Chairman is in favor. So licenses are so

5 ratified.

6 It's lunchtime, folks.

7 MS. BRAND: Before you take a break, I have some --

8 some prepared questions, six sets for you to have licensees

9 appearing in front of you, and they're just preliminary. And

10 I would like to pass them out to each of you now, to take a

11 quick look, and you can make your own suggestions and changes,

12 but if you have to question somebody about their prior --

13 taking exams too many times, there is a little suggestive list

14 for you.

15 We talked about this at the last Board meeting, and

16 if somebody has a question about prior substance abuse, that's

17 where they are. I'll give them to you now. I almost forgot.

18 (Proceedings recess at 12:44 p.m.)

19 (Afternoon proceedings not reported

20 and not transcribed herein)

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1 REPORTER'S CERTIFICATE

3 STATE OF NEVADA )

) ss

4 CARSON CITY )

6 I, CARRIE HEWERDINE, a Notary Public in and for

7 Carson City, Nevada, do hereby certify:

8 That on Friday, the 4th day of march, 2005, at 8:30

9 a.m. of said day, at the Nevada State Board of Medical

10 Examiners, 1105 Terminal Way, Suite 301, Reno, Nevada, said

11 proceedings ere taken in verbatim stenotype notes by me, a

12 Certified Shorthand Reporter, and thereafter transcribed to

13 the best of my knowledge, skill and ability, as herein

14 appears;

15 I further certify that I am not a relative nor an

16 employee of any attorney or any of the parties, nor am I

17 financially or otherwise interested in this action.

18 I declare under penalty of perjury under the laws of

19 the State of Nevada that the foregoing statements are true and

20 correct.

21 Dated in Carson City, Nevada this 11th day of March,

22 2005.

_____________________________________

24 CARRIE HEWERDINE, CCR #820

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