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1 CODE: 4185
LISA A. YOUNG, CCR #353
2 Peggy Hoogs & Associates
345 Marsh Avenue
3 Reno, Nevada
COURT REPORTER
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9 NEVADA STATE BOARD OF MEDICAL EXAMINERS
10 BOARD MEETING
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12 Conference Room at the Offices of
13 the Nevada State Board of Medical Examiners
14 Friday, March 12, 2004
15 9:00 a.m. - 4:00 p.m.
16 Reno, Nevada
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25 Reported by: LISA A. YOUNG, CCR #353
PEGGY HOOGS & ASSOCIATES (775) 327-4460
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1 APPEARANCES
2 PRESENT IN RENO:
3 Cheryl Hug-English - President
Jaculine C. Jones - Vice President
4 Charolette Bible - Assistant Chief Deputy Attorney
Stephen D. Quinn, J.D. - Deputy General Counsel
5 Richard J. Legarza, J.D. - Deputy General Counsel
Donald Baepler, Ph.D., D.S.
6 Joel Lubritz, M.D.
Marlene J. Kirch, Public member
7 Sohail U. Anjum, M.D.
Robin Titus, M.D.
8 Stephen K. Montoya, M.D.
Javaid Anwar, M.D.
9 Laurie Munson - Deputy Executive Secretary
Larry D. Lessly, J.D. - Executive Secretary.
10 Special Counsel
Drennan A. Clark, J.D. - Deputy Executive Secretary
11 Special Counsel
Lynnette L. Krotke - Chief License Specialist
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13 PRESENT IN LAS VEGAS:
14 Edwin Kingsley, M.D. - President, Clark County Medical
Society
15 Don Havens, M.D. - Clark County Medical Society
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PEGGY HOOGS & ASSOCIATES (775) 327-4460
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1 RENO, NEVADA; FRIDAY, MARCH 12, 2004; 9:00 A.M.
2 -o0o-
3 PRESIDENT HUG-ENGLISH: I'd like to call this
4 meeting of the Nevada State Board of Medical Examiners
5 to order.
6 I just want to confirm that -- Are we on down
7 in Las Vegas? Can you hear us? No. My button is on.
8 Are we on in Las Vegas, Laurie?
9 MS. MUNSON: We just need to unmute. They are
10 not on, though. They can hear us.
11 PRESIDENT HUG-ENGLISH: Can you hear us down
12 in Vegas?
13 MR. LESSLY: They can't answer us.
14 PRESIDENT HUG-ENGLISH: Okay. Thank you. And
15 welcome.
16 Okay. We do have a very full agenda today and
17 tomorrow. And I see that we have lots of public members
18 here that when we get to certain agenda items please let
19 us know what you are going to comment about.
20 First thing is approval of the minutes from
21 our December meeting. Is there any discussion about the
22 minutes or additions or changes?
23 If not, I would accept a motion to approve the
24 minutes.
25 DR. LUBRITZ: So noted.
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1 MS. KIRCH: Second.
2 PRESIDENT HUG-ENGLISH: There is a motion and
3 a second to approve the minutes from our December board
4 meeting. All in favor?
5 THE BOARD: Aye.
6 PRESIDENT HUG-ENGLISH: Opposed? The minutes
7 are approved.
8 Next item on the agenda is under personnel and
9 consideration and discussion for additional staff
10 requirements.
11 And, Larry, I believe you are going to address
12 this.
13 MR. LESSLY: Thank you. There are two aspects
14 to this agenda item, one short-range and one long-range.
15 Let me address the short-range, and then I
16 will have Tony address the long-range.
17 We have added Mr. Quinn to the staff as deputy
18 attorney general -- deputy attorney counsel, not deputy
19 attorney general.
20 He and Mr. Legarza are both working full-time
21 and busy full-time. It is apparent when Mr. Legarza
22 retires we are going to need another attorney.
23 It is also apparent that we need to bring that
24 attorney in now. So we are asking for authority to hire
25 a deputy general counsel immediately to come on board as
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1 soon as possible.
2 We have someone in mind, without telling you
3 who that is at this point, but we would look for someone
4 with less experience than Mr. Quinn, someone who would
5 be with the board for a lengthy period of time and would
6 have an opportunity to practice in this field.
7 So we would request, first of all, for
8 authority to retain that person immediately.
9 And I will let Tony talk about the
10 investigators and the licensing specialists which are
11 more long-range.
12 MR. CLARK: At the present time our licensing
13 specialists are over-engaged. And they have currently
14 52 application files that they have not been able to
15 open and start working yet. And they are all carrying
16 40 or more applications that they are working actively.
17 They need another licensing specialist. What
18 we would anticipate is hiring someone as soon as
19 possible, bringing them on at an entry level salary of
20 $32,000 and then considering if that person works out
21 raising the salary at six months or considering raising
22 the salary at the six-month level.
23 We do not need new equipment and would not
24 need any additional office space to house that person.
25 It also appears because of an increase in
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1 complaints and in administrative work in handling
2 complaints and doing more notifications that we are
3 going to need a couple more investigators.
4 I would not propose that they come on board
5 until the beginning of the new fiscal year, July 1st.
6 They would start out essentially at $38,000 each and
7 then be reviewed at six months.
8 What we would like to do is get your approval
9 to hire on January -- excuse me on July 1st so that Doug
10 Cooper, head of investigations, can start advertising
11 and conduct some interviews.
12 That will require some additional space
13 because there is not space in the current office area
14 where investigators are located. And that would require
15 two additional computers as well, one for each of them.
16 I might add, somewhere down the line we should
17 probably upgrade the computers for the deputy general
18 counsel and for a new licensing person. We have
19 computers there, but they are old and slow and they need
20 to be upgraded at some point.
21 There is office space in the building
22 currently available down on the first floor right across
23 the hall from where the license specialists are working.
24 It would accommodate all of the investigators.
25 So if it is the board's feeling that we should consider
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1 and should hire two additional investigators commencing
2 July 1st, I would like authority to negotiate with the
3 building manager to take that space so it can be
4 converted and cleaned up and utilized by investigators.
5 PRESIDENT HUG-ENGLISH: Turn on your button.
6 DR. MONTOYA: For the need for licensing
7 specialist is it because of the increased number of
8 applicants that came into the State, or is it because of
9 the depth of the investigation you have to go through on
10 each applicant and that is slowing the process down?
11 MR. CLARK: It's a little of both, but more
12 because we are having more applicants. Tremendous
13 number of applicants are now applying for licensure in
14 Nevada.
15 They are doing a little more background
16 investigation, but primarily it's because of the number
17 of applications that are coming into the process.
18 DR. MONTOYA: On the investigator's side, it's
19 more or less the same question, are we getting more
20 complaints? Is it more complaints per capita, or is it
21 we are just getting more complaints because of the
22 number of people we have?
23 MR. CLARK: We are getting more complaints
24 because I think of the number of people we have. And
25 it's partially due to the legislature doing away with
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1 the medical dental processing panel. So that anybody
2 can just go file a malpractice suit. And in order that
3 none of those fall through the cracks, we have to have
4 the investigators take a look at them to see if there is
5 any validity to them.
6 So that has increased the case load of each of
7 the investigators.
8 Around the sister states most investigators
9 handle between 30 and 50 files at a time. And our
10 investigators are each handling more than 100.
11 DR. MONTOYA: That's currently why we have two
12 investigative committees instead of just one. And each
13 one has to read boxes and boxes of material each
14 session.
15 MR. CLARK: That's correct. And it's because
16 more complaints are coming in.
17 DR. MONTOYA: And it's because you have to
18 generate all this paperwork for us to see. So it takes
19 a lot of time. I understand that. Thank you.
20 DR. LUBRITZ: I'm sorry. May I ask some
21 questions of Doug Cooper?
22 MR. CLARK: Yeah, sure.
23 DR. LUBRITZ: Will two investigators assist
24 you in what you feel is adequate coverage for the
25 current case load?
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1 MR. COOPER: Yes, I believe so. Right now
2 after the March board we anticipate if we close the
3 amount of cases we are going to suggest we close, our
4 per investigator case load will be 107 cases.
5 If we took that figure which is, of course,
6 the most important figure and add two investigators, our
7 cases load would be 71 cases. I think that is
8 manageable.
9 DR. LUBRITZ: Roughly what would it cost us to
10 get the new computers and all that we need?
11 MR. CLARK: Computers are about $2,000 each.
12 We are going to need four.
13 MS. MUNSON: Four or five.
14 MR. CLARK: Four to plug the equipment in, but
15 that equipment costs $200. And then we can add up to 24
16 and we will have plenty of space for that. And the
17 floor space down there is about 1150 square feet, and
18 the price is about $1.10 per square foot so it's about
19 $1265 a month for additional space.
20 DR. LUBRITZ: Thank you.
21 DR. BAEPLER: What about the budget? The
22 budget is dwindling in terms of reserves. Ever since we
23 lowered the fees for licensing, the budget has -- the
24 reserve fund has shrunk considerably. There is enough
25 latitude in the budget to accommodate all of this, I
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1 assume.
2 MR. CLARK: There is enough in the budget to
3 accommodate both the purchase of some new computer
4 equipment in the equipment account and the personnel
5 account to cover one licensing specialist, deputy
6 general counsel, and at the first of the year when we go
7 or first of fiscal year when we go into the new fiscal
8 year to handle two more investigators so, yes.
9 DR. BAEPLER: I think, you know, whenever
10 there is space available, we have to grab it. It's not
11 always available. And I think the need for a new
12 licensing specialist is good news.
13 And I'm delighted to hear that people want to
14 move to the state to practice medicine. I hope it's not
15 just a momentary blip but it's reached a new plateau.
16 So I would move that we authorize the request
17 presented by both of you gentlemen.
18 MS. JONES: I second it.
19 PRESIDENT HUG-ENGLISH: There is a motion and
20 a second to approve the increased staff requirements of
21 a new deputy general counsel, two investigators and a
22 new licensing specialist. Any further discussion?
23 All in favor?
24 THE BOARD: Aye.
25 PRESIDENT HUG-ENGLISH: Opposed?
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1 Chair votes in favor of the motion. Motion
2 carries.
3 I think it is clear that those staff members
4 are really needed, and I just want to reemphasize how
5 hard the current staff members are working under very
6 difficult circumstances. And their case load is just
7 tremendous so I think this is definitely needed and will
8 hopefully be a help.
9 Okay. We are going to skip to agenda item
10 seven and that is our committee report to review the
11 public service announcement program. And, Dr. Montoya,
12 I think you are going to address that.
13 DR. MONTOYA: We met last month in Las Vegas
14 with the Nevada communications, and we are a
15 comprehensive campaign to get the word out about what
16 the State Board of Medical Examiners does, who we
17 represent, et cetera.
18 We met with the Nevada Broadcasters
19 Association. It was a very fruitful meeting. They
20 listened very carefully to what we had to offer. It was
21 myself, Marlene, Tony, were all there. And we came up
22 with several things that we wanted to accomplish.
23 We wanted to make sure that the public
24 understood what our mission was, that our doctors were
25 professional, honorable, and we had plenty of good
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1 doctors here in the state of Nevada. And we wanted to
2 keep them here in Nevada.
3 We wanted to come up with ways to make the
4 website more user friendly and more available.
5 What we came up with -- actually, we didn't
6 come up with. They took the ideas, and they came up
7 with these scripts for us. I was just given the scripts
8 today. And we are currently reviewing scripts for
9 television spots.
10 We are getting a lot of bang for the buck out
11 of the Nevada Broadcasters Association. They aired
12 these commercials quite a bit. And it seems to me it's
13 a money well spent in a particular endeavor.
14 We don't have anything concrete yet. As soon
15 as we review all of these scripts and narrow them down
16 and make sure they fulfill what we feel is the board's
17 mission, we will present it to the board and take it
18 from there.
19 DR. BAEPLER: The current TV or ads would be
20 phased out?
21 DR. MONTOYA: Yes, absolutely.
22 MR. CLARK: And each of the board members has
23 a copy of the scripts proposed and the proposed campaign
24 and cost furnished by Nevada Broadcasters Association in
25 the papers that were handed out this morning.
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1 So perhaps at your leisure or on breaks you
2 could take a look at some of those and give Dr. Montoya
3 and Marlene and me some feedback on what you think.
4 PRESIDENT HUG-ENGLISH: I think that that's a
5 great idea. I think also we have later this morning
6 Mr. Fisher. I don't think he is here yet.
7 MR. CLARK: He is going to be in Las Vegas.
8 PRESIDENT HUG-ENGLISH: Okay. We have
9 consideration of the continuation of the Broadcasters
10 Association contract. And so he will have a little
11 report for us, I think, later this morning.
12 But I appreciate, Steve, you and Marlene being
13 willing to look at this. And I think that it's great to
14 see that we have already gotten some scripts to review.
15 And I think that we don't really have to -- well, Tony
16 or Larry, correct me, when does our current contract
17 expire with the Broadcasters Association?
18 MR. LESSLY: March 31st.
19 PRESIDENT HUG-ENGLISH: So we really do need
20 to take action in this meeting in some way to continue
21 that.
22 MR. LESSLY: Yes.
23 PRESIDENT HUG-ENGLISH: Okay. Now these
24 scripts that have been presented, would this be what
25 they see to go forward if we continue the contract?
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1 These are new scripts that would be incorporated into
2 those public service announcements?
3 MR. CLARK: Yes. And those scripts, and they
4 would have people like Senator Richard Bryan, Senator
5 Bill Raggio, Joel Crowley in the north. Dr. Montoya had
6 a recommendation for a doctor in the south who would
7 probably do those in Spanish who is the chief at one of
8 the hospitals.
9 DR. MONTOYA: Yes, Dr. Tony Alamo.
10 MR. CLARK: So we would use particularly
11 people who are known in the north for the northern
12 campaign and people who are known in the south for the
13 southern campaign and hopefully some of the people who
14 are known in the other 15 counties for people in the
15 outlying cow counties would know them. That was a term
16 of art, Robin.
17 PRESIDENT HUG-ENGLISH: So I guess we really
18 have two decisions to make as a board at this meeting.
19 One would be whether or not we want to continue the
20 contract with the Broadcasters Association and then the
21 second is whether or not -- and I know that all of us
22 are seeing this for the first time -- but whether these
23 are scripts we want to go forward with right now because
24 our contract does expire at the end of this month.
25 I would suggest that during our first break
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1 that the board members kind of take a look at these
2 scripts and certainly we could make a decision to go
3 forward with the contract and also make provisions for
4 this. I don't think we necessarily have to commit to
5 these exact formats but --
6 MR. CLARK: And this is only the first shot at
7 the scripts.
8 DR. MONTOYA: I wanted to re-emphasize that we
9 are not married to these scripts. This is just the
10 first shot. There will be multiple modifications I'm
11 sure.
12 MS. KIRCH: When we had the meeting, they had
13 their creative people there too. We gave them some
14 ideas, agreed we would look at the preliminary scripts.
15 If we had other suggestions, we could go back to them.
16 So they are very willing to work with us.
17 DR. LUBRITZ: Cheryl, I notice it says the
18 Nevada Broadcasters Association with board approval and
19 support for doing a 12 month campaign for $72,000 for 12
20 months worth of production for 15,000 for a total of
21 87,000. Do you know what we are currently paying?
22 MR. LESSLY: Five thousand dollars a month.
23 DR. LUBRITZ: That's the number that stuck in
24 my mind. So we are increasing that by $12,000 for the
25 annual budget in addition to a $15,000 production.
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1 I personally at a time when we are having a
2 decrease in reserve -- when we are having a decrease in
3 our reserve to take on more. My question is is that
4 also a negotiable figure on the increase which would be
5 $12,000 and, of course, there is production fees and I
6 understand that. And that was my only comment.
7 MR. CLARK: I'm sure it is, Dr. Lubritz. I'm
8 sure it is negotiable. The first time that any of us
9 saw this proposal was when it came on e-mail yesterday.
10 We were laboring under the idea that we would
11 continue on at 5,000 a month or 60,000 a year. And this
12 was an upgrade in their proposal to us.
13 MR. LESSLY: If you are going to decide to
14 renew this contract effective April 1st, for three more
15 months, renew it at the $5,000 figure. We have some
16 lead time involved to have these scripts and develop
17 this new program.
18 MR. BAEPLER: My own opinion is I would vote
19 to continue the program only if those old ones were
20 going to be scrapped and we had some new ones in there.
21 I'm really getting tired of the old ones.
22 MR. LESSLY: We are going to have to look at
23 the old ones for three more months.
24 MR. BAEPLER: No, I realize that.
25 PRESIDENT HUG-ENGLISH: We will get more
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1 information, I think, later this morning when Mr. Fisher
2 is here to give his presentation. But I think that's a
3 good point, Joel.
4 I'm going to skip again to agenda item 15
5 under our reports and I would like -- we have some
6 members of the diversion program here. And I guess we
7 have some spare chairs up here to have you come forward.
8 Mr. Rosencrantz is here and others. So we
9 will go ahead.
10 MR. ROSENCRANTZ: I'm Arne Rosencrantz with
11 the Nevada Health Professionals Assistance Foundation.
12 I was here in December, and there was some
13 questions about our continuity and how we were going to
14 continue. But we have made some great strides, and I'm
15 really proud and happy to be here today.
16 First, I would like to introduce our
17 president, Tim Coughlin. Dr. Coughlin from Reno, Roger
18 Belcourt is a board member. Dr. Belcourt is from Reno
19 as well.
20 Our medical director and executive director
21 who took over after Dr. Rueckl and Carol Bowers left,
22 and he is doing this on an interim basis. He has been
23 terrific. He has volunteered his time and worked really
24 hard to put our records and get this organization
25 straight. He has done a great job. Dr. Bradley
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1 Thompson from Las Vegas. I'm really glad to have Brad
2 on board.
3 And our special guest is Dr. Peter Manski and
4 I think the CVs have been passed out already.
5 Dr. Manski we are in negotiation and contract
6 with him now and I will just turn this meeting over Tom
7 Brad -- Dr. Thompson and let him tell you about what the
8 foundation has done.
9 DR. THOMPSON: Thank you for having us here
10 today. We are now in our ninth year and Nevada Health
11 Professionals Assistance Foundation is going to serve
12 Nevada, I think, as well as any of the states doing a
13 comparable fashion.
14 As you know or many of you know, Dr. Rueckl
15 resigned last year effective at the end of '03 due to a
16 personality conflict with Sunrise Hospital.
17 And Carol Bowers who was the executive
18 director for the last four years also resigned to take a
19 position back at Talbot Recovery Center in Atlanta.
20 Everybody else took two steps back. And I
21 sort of ended up doing this to keep the foundation
22 together while we are looking for a new director. And I
23 think hopefully we have found one.
24 And after we went through about six different
25 states -- And really we did a national search -- we
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1 unanimously selected Dr. Peter Manski who is the current
2 medical director of the entire New York program.
3 Our target date for the assumption of duties
4 given plus or minus -- you know, it's our target date is
5 May 17th for his assumption of duties.
6 At that time it is our plan to combine both
7 the executive and the medical directorships because
8 Dr. Manski is a psychiatrist.
9 And I think it's redundant to have a medical
10 director. Plus, we can combine the fees of both Carol
11 and Victor to one salary. That made us more marketable.
12 That's how we were able to do this.
13 However, Dr. Manski, however, will not be able
14 to practice medicine until he gets his license. I'm
15 sure you will all agree.
16 So I will continue to be the medical director,
17 I guess, until Dr. Manski's license goes through. And
18 then we only need one position. So that will be
19 helpful.
20 I don't know if you are interested currently,
21 let me know if you are, in the competition of who our
22 clients and participants are. If you are interested in
23 that data right now -- I'm going to make this report
24 available if anybody wants a break down of north and
25 south physicians, PAs and RTs, or whether you want to
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1 look that way. I know there is a time --
2 DR. LUBRITZ: Just, quickly, how many do you
3 have in the program just --
4 DR. THOMPSON: Sixty-three active.
5 DR. LUBRITZ: North and south?
6 DR. THOMPSON: Yeah, that's everybody total.
7 DR. LUBRITZ: What is the mix on that,
8 Dr. Thompson?
9 DR. TITUS: I think we are interested.
10 DR. THOMPSON: I will be happy to do that.
11 There are 49 physicians. This is both north and south.
12 Fifteen from the north and 29 from the south.
13 There are five who are out of state. Meaning
14 they are either doing local tenants here or their
15 applications are pending. I see one of them on the
16 agenda for later today. Actually, we are starting a
17 contract already. So that's where the other five come
18 from.
19 There are 10 respiratory therapists, two in
20 the north and eight in the south.
21 There are two physicians assistants both in
22 the south. Now these are just the active contracts.
23 All right. That doesn't include the -- we are still
24 advocating for -- they have completed their six months,
25 two year or five year contracts which is the majority of
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1 it. So there are lots and lots of others currently
2 being monitored.
3 We are pleased to report that we are
4 financially solvent. We have in reserve about two and a
5 half months of operating expenses and liquid reserve.
6 Though, we are not exactly living paycheck to
7 paycheck, we are going to have some start-up costs for
8 Dr. Manski. And we have had some costs with the
9 interviews but we are doing okay. I have already taken
10 steps to increase our reserve.
11 We are getting a little tougher with the
12 clients. We are also increasing the client fees a
13 little bit. We are having -- I have already put in
14 requests and have verbal commitments from Sunrise
15 Hospital. And also the Nevada Hospital Association has
16 given us a verbal commitment, but they haven't specified
17 an amount yet. In the past it has been usually in the
18 range of 30 to $50,000.
19 We currently have a verbal commitment which
20 will be firmed up next month from the osteopathic boards
21 who contracts with us. I did not include that in the
22 stats you have heard.
23 And then we may even at some point get support
24 from the medical societies that will be if we get a
25 strong relationship going with the medical societies
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1 they might even help us as well.
2 Further possibilities include, you know, we
3 may approach the dental board for some contracts with
4 them.
5 We have already received an individual
6 donation. And we may consider formalized contracts with
7 the hospitals themselves because we do a lot of work
8 that doesn't come through this. You know, it comes from
9 the hospital programs themselves with mostly behavior
10 and chemical problems.
11 And we have Dr. Manski, should our contract
12 come through, who has had a lot of fund-raising
13 experience in his years in New York state.
14 I think that in the brief tenure since Carol
15 left I have been very happy with the relationship with
16 you folks and your availability for questions and
17 comments and I hope that that continues to be strong. I
18 mean, your staff has been fantastic.
19 Less secure is our relations with the
20 individual hospital staffs. They tend to be a little
21 more maverick and independent. Carol did some great
22 work in forging ties that are particularly in the south.
23 And I -- my plan is to go in and introduce Dr. Manski to
24 the individual hospital staffs, the executive
25 committees, and administrations and provide him -- he
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1 doesn't know this yet -- and provide him with the
2 availability to speak to staffs as they deem it
3 necessary.
4 Also, Dr. Manski we would like to encourage
5 him to join the University of Nevada at Reno and that
6 will go to strengthen our program.
7 We continue to have strong diversion
8 committees in both the north and the south. I'm
9 particularly pleased with the southern committee which I
10 have just recently revamped which includes members from
11 the old medical society committees when they were run.
12 And there is some valuable experience there, but also
13 from the individual hospital and also from the, you
14 know, current diversion program. So I think it's
15 bridging committees down there.
16 Doctors Coughlin and Belcourt continue to run
17 a very tightly run diversion committee in the north. At
&