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        10                   REPORTER'S TRANSCRIPT

 

        11          NEVADA STATE BOARD OF MEDICAL EXAMINERS

 

        12                       BOARD MEETING

 

        13

 

        14

 

        15        Taken at the Las Vegas Embassy Suites Hotel

 

        16                    4315 Swenson Street

 

        17                     Las Vegas, Nevada

 

        18

 

        19                 Friday, December 3, 2004

 

        20                         8:30 a.m.

 

        21

 

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        24

 

        25   Reported by:  Gale Salerno, RMR, CCR No. 542

 

 

 

                         ALL-AMERICAN COURT REPORTERS

                                (702) 240-4393


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         1   APPEARANCES:

 

         2   Stephen K. Montoya, M.D., President

 

         3   Joel N. Lubritz, M.D., Vice President

 

         4   Dena L. James, Deputy Attorney General

 

         5   Donald H. Baepler, Ph.D., Secretary/Treasurer

 

         6   Stephen D. Quinn, J.D., General Counsel

 

         7   Sohail Anjum, M.D.

 

         8   Jean Stoess, M.A.

 

         9   Marlene J. Kirch, Public Member

 

        10   Edward Cousneau, J.D.

 

        11   Bonnie Brand, J.D.

 

        12   Carolyn Castleman

 

        13   Pam Gabica, Administrative Assistant

 

        14   Charles N. Held, M.D.

 

        15   Javaid Anwar, M.D.

 

        16   Robert J. Barnet, M.D., Medical Reviews

 

        17   Pamela James

 

        18   Douglas Cooper, Chief of Investigations

 

        19   Lynnette L. Krotke, Chief of Licensing

 

        20   Drennan (Tony) A. Clark, J.D., Executive Secretary,

             Special Counsel

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             Lori L. Munson, Deputy Executive Secretary

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                         ALL-AMERICAN COURT REPORTERS

                                (702) 240-4393


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         1   Also Present:

 

         2   Roger Belcourt, M.D.

 

         3   Peter Mansky, M.D.

 

         4   Max Doubrava, M.D.

 

         5   Janet Wheble, P.A.

 

         6   John Lanzillotta, P.A.

 

         7   Larry Matheis

 

         8   Michael Garcia

 

         9   Don Wright

 

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                         ALL-AMERICAN COURT REPORTERS

                                (702) 240-4393


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         1                  P R O C E E D I N G S

 

         2                         -   -   -

 

         3                        (8:40 a.m.)

 

         4                     1.  CALL TO ORDER

 

         5                 DR. MONTOYA:  I would like to go ahead

 

         6   and call the meeting to order.

 

         7

 

         8                  2.  APPROVAL OF MINUTES

 

         9                 DR. MONTOYA:  Move to the second, to

 

        10   approval of the minutes.

 

        11                 MS. KIRCH:  I would move for approval.

 

        12                 DR. MONTOYA:  So all in favor?

 

        13                 Dr. Lubritz just moved a second to

 

        14   approve the minutes.  Do you have any problem with

 

        15   it?

 

        16                 All in favor?  Opposes?  Passes.

 

        17

 

        18                       3.  PERSONNEL

 

        19                 DR. MONTOYA:  Introduction of new

 

        20   board staff.

 

        21                 DR. CLARK:  Mr. President, I would

 

        22   like to introduce to the board Bonnie Brand, deputy

 

        23   general counsel.  She has spent a number of years

 

        24   with the attorney general's office with the City of

 

        25   Reno, the city attorney's office and in private

 

 

 

                         ALL-AMERICAN COURT REPORTERS

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         1   practice.  We are pleased to have her on board.

 

         2                 DR. MONTOYA:  So glad you came to join

 

         3   us.  Welcome aboard.

 

         4                 Anybody else?

 

         5                 DR. CLARK:  That's it for right now.

 

         6                 DR. MONTOYA:  Licensing division

 

         7   staffing.  Are there some changes there?

 

         8                 DR. CLARK:  Let me give you a quick

 

         9   update.  Barbara Daravanna decided that she would

 

        10   leave our employment, and we have a new lady, and

 

        11   I'm sorry that I don't have her last name -- her

 

        12   first name is Brett, who will be starting on Monday

 

        13   morning.  Canady, C-a-n-a-d-y.

 

        14                 One other thing with respect to the

 

        15   licensing division.  We have an entry-level

 

        16   licensing specialist who has been with us six

 

        17   months, and who has met all of the requirements to

 

        18   be fully trained.  We have a policy that directs

 

        19   that new people who come on board with the board

 

        20   start at a lower salary at 32,000 a year for

 

        21   licensing specialist.

 

        22                 Since she has reached her six months

 

        23   gate, and has passed all of her requirements, we

 

        24   would like authority under our policy to raise her

 

        25   salary, technically the 15th of December, to

 

 

 

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         1   $37,000, which is the mean salary for the other

 

         2   licensing specialists.

 

         3                 And this was the only exception to

 

         4   salary increases that would occur outside of June,

 

         5   and that is where you start low in the training and

 

         6   then come up to speed.

 

         7                 DR. MONTOYA:  This goes along with the

 

         8   policy we recently adopted that said we would review

 

         9   salaries once per year.  This is the only exception

 

        10   to that that Tony is bringing up.

 

        11                 DR. CLARK:  And her name is Jan Ross.

 

        12                 DR. MONTOYA:  Any problems with this

 

        13   anybody?  Any discussions?  This was a planned

 

        14   exception.

 

        15                 We have a policy in place.  We don't

 

        16   need to take any specific action.  This is for

 

        17   information purposes only.

 

        18                 DR. CLARK:  Then I have one other

 

        19   thing for licensing.  Annette would like to be able

 

        20   to designate one of her deputies as chief deputy,

 

        21   Carolyn Castleman, to be in control and in charge

 

        22   when she is away, and to train the other licensing

 

        23   experts and to help license.  This would not affect

 

        24   salary increase at all.

 

        25                 DR. MONTOYA:  Vice president of the

 

 

 

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         1   bank?

 

         2                 DR. CLARK:  Yes.

 

         3                 DR. MONTOYA:  The title, but nothing

 

         4   more.

 

         5                 DR. CLARK:  Yes.  The title and the

 

         6   duties and the job, but nothing more.  She gets to

 

         7   sweep the floors at night, too.

 

         8                 DR. MONTOYA:  Any objections?  Any

 

         9   problems with that?

 

        10                 So we'll move on to that.  All right.

 

        11                 Licensing configuration is straight

 

        12   then?

 

        13                 MS. KROTKE:  We have a new lady

 

        14   starting Monday.  She's replacing Barbara, and her

 

        15   name is Brett Canady.

 

        16                 DR. MONTOYA:  Update on office

 

        17   realignment.

 

        18                 DR. CLARK:  We are finished with

 

        19   office realignment.  We're moving in and settling

 

        20   in.

 

        21                 DR. MONTOYA:  Those of you that don't

 

        22   know, the office occupies the third floor of that

 

        23   building down there.  Tony's office is essentially

 

        24   at one end.  There's an office for the executive

 

        25   committee down there also.

 

 

 

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         1                 Then we modified the board room.  And

 

         2   then on the other end we have all the rest of the

 

         3   legal staff and the administrative staff and 1400

 

         4   copy machines.

 

         5

 

         6     4.  STATUS OF PUBLIC SERVICE ANNOUNCEMENT PROGRAM

 

         7                 DR. MONTOYA:  Status on the public

 

         8   service announcement program to the Nevada

 

         9   Broadcasting Association.  I'm sorry, I haven't

 

        10   gotten it in Spanish yet.  I have the script.  I

 

        11   have it memorized.  I just haven't gotten my butt

 

        12   down there.

 

        13                 DR. CLARK:  We can show you the tape,

 

        14   and I'll run that in just a second.  But I want to

 

        15   tell you also that I have heard the same ad on the

 

        16   radio in Reno already.  It sounds good, but if you

 

        17   will key up, Mike, we will get the tape going.

 

        18                 MS. MUNSON:  Mike, can you run the

 

        19   tape, please?

 

        20                 DR. CLARK:  Hello, Mike?  There he

 

        21   is.  There's his shoulder.

 

        22                 DR. MONTOYA:  This ad was actually

 

        23   filmed at the Channel 8 studios very close over

 

        24   here.  And when the board members went down there we

 

        25   were treated very well, professionally.  They made

 

 

 

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         1   it as painless as possible.

 

         2                            - - -

 

         3                 (Whereupon, the following television

 

         4                 ad was heard:)

 

         5                 "As members of the Nevada State Board

 

         6   of Medical Examiners, providing you with the best

 

         7   health care is our top priority.  Our job is to

 

         8   worry about your doctor's credentials so you don't

 

         9   have to.

 

        10                 We check educational background and

 

        11   professional history on each applicant for state

 

        12   medical license.  Nevada has among the strictest

 

        13   licensing requirements of any jurisdiction in the

 

        14   country.

 

        15                 If you have any questions about your

 

        16   doctor, contact the Nevada State Board of Medical

 

        17   Examiners."

 

        18                           -  -  -

 

        19                 MIKE:  Run it again so that we can

 

        20   point out -- you need to take a look at the

 

        21   background because you can't tell on this video,

 

        22   it's got a lot of color, and it's got a lot of stuff

 

        23   in the background.

 

        24                 If there is any way they can run it

 

        25   again on the full screen.  And take a real good look

 

 

 

                         ALL-AMERICAN COURT REPORTERS

                                (702) 240-4393


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         1   at the back on that.

 

         2                 MS. MUNSON:  Let me call him back.

 

         3                 DR. MONTOYA:  Could you tell us what

 

         4   stations are seeing this?

 

         5                 MIKE:  They are statewide.  You

 

         6   have approximately 20 television stations and

 

         7   approximately 60 radio stations.

 

         8                 Right now we're waiting for the

 

         9   Spanish, which is very important.  For those of you

 

        10   from the north we have nine Spanish stations in

 

        11   Las Vegas, and it is critical that we get the

 

        12   message out.

 

        13                 So we don't waste everybody's time, if

 

        14   they have any questions or comments, I don't know

 

        15   what else you're reporting on.

 

        16                 DR. CLARK:  That's the end of the

 

        17   report.  I just wanted to show them the video and

 

        18   advise them that I've already heard this on the

 

        19   radio, the radio stations in Reno.  Don't say it's

 

        20   the country and western station.  Don't say that.

 

        21                 DR. MONTOYA:  This also helps, the

 

        22   audit that we had a year and a half ago, in fact,

 

        23   it finished last year where they wanted more

 

        24   information out there about the state board.  This

 

        25   is an attempt to get the word out there that they

 

 

 

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         1   can call us and ask about doctors and their

 

         2   credentials in a pretty much nonthreatening manner.

 

         3

 

         4     5.  AMENDMENTS TO NEVADA ADMINISTRATIVE CODE 630

 

         5                 DR. MONTOYA:  Let's go on to

 

         6   amendments to Nevada administrative code.  We can

 

         7   stop to do this any time.

 

         8                 Are we connected to Reno audio-wise,

 

         9   Lori?

 

        10                 MS. MUNSON:  I believe we are.  We

 

        11   have the blue screen.  I think he was going to be

 

        12   playing it again.  I'm sorry.

 

        13                 DR. MONTOYA:  Do we have something in

 

        14   consideration of approval of minute regulations for

 

        15   completion of --

 

        16                 MS. MUNSON:  Here it is, excuse me.

 

        17   Well, I thought it was.

 

        18                 DR. QUINN:  There are two items for

 

        19   amendment that I wish to present.  The first item is

 

        20   consideration of approval of an amendment to the

 

        21   regulation applicable to testing that puts a time

 

        22   limit for completion of the USMLE, and a limit on

 

        23   the number of attempts a person may make to

 

        24   successfully complete the USMLE.

 

        25                 The regulation is NAC 630.080.

 

 

 

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         1                 The amendment changes the regulation

 

         2   by adding a provision to limit the time within which

 

         3   a person must successfully complete the USMLE.  And

 

         4   also adds a limitation on the maximum number of

 

         5   attempts an applicant may make to complete all three

 

         6   steps.

 

         7                 The status of the regulation at this

 

         8   point is the proposal is before you in the

 

         9   brochure.  It is on the second page.  As written,

 

        10   it adds a section or amends section five, and

 

        11   re-numbers section five and six as section six.

 

        12                 And the proposal is that the amendment

 

        13   read for the purposes of subparagraph 3, paragraph C

 

        14   of subsection 2 of NRS 630.160:  "A person must pass

 

        15   steps one, two and three of the United States

 

        16   medical licensing examination within seven years

 

        17   after the date on which the person first took any

 

        18   step of the United States Medical Licensing

 

        19   Examination.  And the person is limited to a maximum

 

        20   of two failures of each step, or a combined maximum

 

        21   of nine attempts to pass the United States Medical

 

        22   Licensing Examination."

 

        23                 I sent this memorandum out.  And since

 

        24   I sent it out, I received response from one board

 

        25   member, Dr. Anwar, who recommended that we modify

 

 

 

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         1   that language to read basically to delete the

 

         2   reference to two failures, and just read with

 

         3   respect to the maximum with respect to the number of

 

         4   attempts that a person is limited to a combined

 

         5   maximum of nine attempts to pass steps one, two and

 

         6   three of the United States Medical Licensing

 

         7   Examination.

 

         8                 DR. BAEPLER:  That was the intent of

 

         9   the motion.

 

        10                 DR. QUINN:  The status of this

 

        11   proposed regulation is a workshop is scheduled later

 

        12   this month, I think on the 20th of December in

 

        13   Las Vegas.  I think another workshop is scheduled in

 

        14   Reno.  I know another workshop is scheduled in

 

        15   Reno.  I can't remember off the top of my head when

 

        16   the date is.

 

        17                 DR. BAEPLER:  The next day.  They're a

 

        18   day apart.

 

        19                 DR. QUINN:  Thank you.

 

        20                 DR. BAEPLER:  First in Reno.  Second

 

        21   in Vegas.

 

        22                 DR. QUINN:  And the Reno workshop will

 

        23   be a combined workshop and public hearing on the

 

        24   proposed regulation.

 

        25                 DR. CLARK:  Mr. President, one thing

 

 

 

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         1   that needs to be included in this proposed amendment

 

         2   to the regulation is the exception for an M.D.

 

         3   who is also pursuing his Ph.D., and he has ten

 

         4   years -- he or she has ten years rather than the

 

         5   seven.

 

         6                 DR. BAEPLER:  This has already been

 

         7   posted as written.  Are these changes to be

 

         8   incorporated after the hearings?

 

         9                 DR. QUINN:  My understanding is,

 

        10   according to the provisions, we may make that change

 

        11   without changing the schedule.

 

        12                 DR. BAEPLER:  Okay.

 

        13                 DR. QUINN:  These are simply the

 

        14   workshops.

 

        15                 DR. BAEPLER:  Because we have a

 

        16   deadline proposing.

 

        17                 DR. QUINN:  They are the workshops.

 

        18                 DR. BAEPLER:  This is kind of

 

        19   consistent with what many other states do.  We have

 

        20   had some awkward moments when people have had, what,

 

        21   20 attempts or something like that.

 

        22                 DR. QUINN:  15, 19.

 

        23                 DR. BAEPLER:  Yeah.  Marginal people,

 

        24   but technically meet all of our requirements, and

 

        25   this kind of cleans it up.  It makes us pretty much

 

 

 

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         1   like most states.

 

         2                 DR. QUINN:  It does.  My memorandum

 

         3   states that with respect to the seven-year time

 

         4   limit, the overwhelming majority of states adopt

 

         5   that, and the majority of 36 states adopt some limit

 

         6   on the number of attempts to successfully complete

 

         7   the USMLE.

 

         8                 DR. MONTOYA:  What I'm hearing is we

 

         9   want to modify this in two ways.  Is there any more

 

        10   discussion on the eliminating?

 

        11                 MS. STOESS:  How does this affect an

 

        12   applicant who has made consideration attempts

 

        13   already?

 

        14                 DR. MONTOYA:  For consideration today

 

        15   it's not going to affect them.  For consideration in

 

        16   three months it is going to affect them.

 

        17                 DR. BAEPLER:  Her question is

 

        18   pertinent though.  The ones that are in the

 

        19   pipeline, but not being considered today, they send

 

        20   in their application, so their application is

 

        21   received from this date forward.

 

        22                 MS. STOESS:  That's good.

 

        23                 DR. QUINN:  I don't think we should

 

        24   put that in the regulation.

 

        25                 DR. MONTOYA:  No, no.

 

 

 

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         1                 MS. CASTLEMAN:  Does this mean if

 

         2   someone doesn't meet that criteria, that they can't

 

         3   apply?  Or that they can apply,