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1 CODE: 4185

CECILIA A. VOHL, CCR #246

2 Peggy Hoogs & Associates

345 Marsh Avenue

3 Reno, Nevada

COURT REPORTER

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11 NEVADA STATE BOARD OF MEDICAL EXAMINERS

12 QUARTERLY BOARD MEETING

13 TRANSCRIPT OF PROCEEDINGS

14 FRIDAY, SEPTEMBER 10, 2004

15 8:30 A.M. to 2:25 P.M.

16 RENO, NEVADA

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25 REPORTED BY: CECILIA VOHL, NV CCR #246, CA CCR #5195, RPR, CRR

PEGGY HOOGS & ASSOCIATES (775) 327-4460

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

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MEMBERS OF THE BOARD:

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STEPHEN K. MONTOYA, M.D., PRESIDENT

5 JOEL N. LUBRITZ, M.D., VICE PRESIDENT

6 SOHAIL U. ANJUM, M.D., BOARD MEMBER

JAVAID ANWAR, M.D., BOARD MEMBER

7 CHARLES W. HELD, M.D., BOARD MEMBER

8 DONALD H. BAEPLER, Ph.D., D.Sc., SECRETARY-TREASURER,

CHAIRPERSON and PUBLIC MEMBER

9 JEAN STOESS, PUBLIC MEMBER

MARLENE J. KIRCH, PUBLIC MEMBER

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CHARLOTTE M. BIBLE, J.D.,

11 CHIEF DEPUTY ATTORNEY GENERAL

12 STEPHEN D. QUINN, J.D., GENERAL COUNSEL

13 EDWARD COUSINEAU, J.D., DEPUTY GENERAL COUNSEL

14 DRENNAN A. CLARK, J.D., SPECIAL COUNSEL

15 LAURIE MUNSON, EXECUTIVE SECRETARY

16 LYNNETTE KROTKE, CHIEF OF LICENSING

17 PRESENT IN LAS VEGAS:

DON HAVINS, M.D., CLARK COUNTY MEDICAL SOCIETY

18 TRENT HIETT, CLARK COUNTY MEDICAL SOCIETY

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PEGGY HOOGS & ASSOCIATES (775) 327-4460

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1 RENO, NEVADA, FRIDAY, SEPTEMBER 10, 2004, 8:30 A.M.

2 -oOo-

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4 PRESIDENT MONTOYA: Call the meeting to order. And

5 some new faces here with us. Make sure everybody knows who

6 everybody is.

7 Hi. Can you hear me down there in Las Vegas?

8 MR. CLARK: Come in, Las Vegas.

9 PRESIDENT MONTOYA: It's on? All right. So,

10 Laurie -- where is Laurie?

11 MS. KIRCH: Laurie is working on that.

12 PRESIDENT MONTOYA: We're going to introduce our new

13 members to get ourselves started, and the staff.

14 First of all, Dr. Held, if you'd please tell us

15 something about yourself, where you practice, what kind of guy

16 you are.

17 MR. CLARK: Great guy.

18 DR. HELD: I've been in Gardnerville for two years

19 after 22 years in Reno. I started a pulmonary group here in

20 Reno in 1981 and sort of got tired of the rat race and decided

21 I was going to go off on my own.

22 I do pulmonary medicine. I do pulmonary medicine,

23 and about 40 percent of what I do is sleep disorders medicine,

24 as well. And I sort of travel around. I go to Yerington,

25 Fallon, and South Lake Tahoe. Something different every day.

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1 PRESIDENT MONTOYA: Any particular interesting facts

2 we'd like to know about you? Former championship skier?

3 DR. HELD: No. I do ski. I'm a big into helicopter

4 skiing. Go almost every year off of British Columbia.

5 PRESIDENT MONTOYA: Oh, my God.

6 DR. HELD: Have five kids, plus -- including two

7 relatively young, nine and twelve. And it's an adventure.

8 PRESIDENT MONTOYA: Welcome to the Board, sir.

9 DR. LUBRITZ: He's going to be working for a long

10 time.

11 PRESIDENT MONTOYA: You're going to be working for a

12 while.

13 Ms. Stoess, welcome to the Board. There's one

14 interesting fact I would like everyone to know about

15 Ms. Stoess is that she volunteered for the job, and that lends

16 something in there. I think that takes a lot of guts to do

17 this, especially with the press we've been getting. Would you

18 please tell us about yourself.

19 MS. STOESS: Well, I wondered why I got the letter

20 from the governor's office that kept saying thank you for

21 volunteering.

22 I did read about the recent series in the

23 Gazette-Journal. And like most Nevadans, I didn't know

24 anything about the Board. I was surprised to find out that

25 there are public members. So I sent a letter to the governor

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1 offering to serve, should there be a vacancy. And here I am.

2 I have background in public policy. I've served on

3 the Washoe County Board of Commissioners. I was the first

4 Washoe County commissioner woman. And I've been on the

5 Regional Transportation Commission, Airport Authority, Tahoe

6 Regional Planning Agency, and that kind of thing.

7 And I guess the most interesting thing right now for

8 me is I have a book coming out in February that I co-authored

9 with Geoff Sher in Las Vegas. And if you know Geoff, you'll

10 know that the book is only about one subject: It's about

11 in-vitro fertilization, and it's about reproductive

12 techniques.

13 PRESIDENT MONTOYA: Marlene Kirch -- which we know

14 Laurie. Go ahead. You don't have to go like new people.

15 MS. KIRCH: I'm one of the public members. I am a

16 trust officer with Wells Fargo Bank, and I've been on the

17 Board for three years.

18 PRESIDENT MONTOYA: Dr. Anwar?

19 DR. ANWAR: That's it?

20 MS. KIRCH: That's it.

21 DR. ANWAR: I'm Javaid Anwar. I'm a practicing

22 internist. Very quickly, I practice internal medicine with a

23 group, with Internal Medicine Associates. There are 20 in our

24 group, and we also have a consulting operation called Quality

25 Care Consultants, myself and Dr. Kahn. We've been doing that

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1 work for about 15 years, with quality assurance utilization

2 management, case management, risk management. And here I am.

3 PRESIDENT MONTOYA: Mr. Quinn, our attorney, please

4 say what your deal is.

5 MR. QUINN: I'm Stephen Quinn, general counsel for

6 the Board. I've been general counsel for the Board for just

7 about a year. Previous to that, I was deputy attorney general

8 in handling complex litigation in the Attorney General's

9 Office for about seven years. Did some insurance defense.

10 Been practicing law for 30 years, mostly in litigation.

11 Started out as assistant U.S. attorney and was in private

12 practice for several years.

13 I'm pleased to be here, and I'm representing the

14 Board here as general counsel.

15 PRESIDENT MONTOYA: Thank you. I'm Steve Montoya,

16 and I'm the current president of the Board. This is

17 essentially my first meeting. I'm replacing Dr. Cheryl Hug.

18 I'm a practicing gynecologist both in Las Vegas and Nevada.

19 Next to me is Ms. Bible.

20 MS. BIBLE: Thank you. I'm Charlotte Bible. I'm the

21 chief deputy attorney general. I serve as commission counsel

22 to the Board, conflict counsel, and help the Board whenever

23 they need assistance, in addition to Steve and Ed.

24 I've been with the Attorney General's Office for 13

25 years. I've practiced law for 18 years, and I've been with

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1 the Board for four years.

2 THE COURT: Dr. Lubritz?

3 DR. LUBRITZ: Joe Lubritz from Las Vegas. I'm an

4 ear, nose, and throat physician. I've practiced in Las Vegas

5 for 30 years. I've been with the Board for seven years and

6 just recently elected vice president.

7 MR. COUSINEAU: Good morning. My name is Ed

8 Cousineau. I've been with the Board about five months now as

9 deputy general counsel. Precedent to that, I was a deputy

10 attorney general with the Medicaid Fraud Control Unit in

11 Carson City and licensed for going on eight years now.

12 PRESIDENT MONTOYA: Dr. Baepler?

13 DR. BAEPLER: Don Baepler. I just retired July 1

14 from 36 years of service in the University of Nevada system,

15 mostly at UNLV. Spent the entire 36 years in administration.

16 The most notable achievement as an administrator was

17 hiring Jerry Tarkanian as basketball coach. I'm up at 6:00

18 every morning, including Saturdays and Sundays. I have a

19 beautiful DNA lab and specialize in the genetic differences

20 between Asian populations and Central and South America, so

21 I'm finally doing what I was trained to do 45 years ago.

22 PRESIDENT MONTOYA: He's a public member.

23 DR. BAEPLER: Public member, yes.

24 PRESIDENT MONTOYA: Now we come to Dr. Anjum.

25 DR. ANJUM: Sohail Anjum, physician from Las Vegas,

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1 Nevada. I've been practicing in an office for 26 years. I've

2 been on the Board for three years and happy to be here. Thank

3 you.

4 PRESIDENT MONTOYA: Mr. Clark?

5 MR. CLARK: Tony Clark. I'm the executive secretary

6 and special counsel to the Board. I've been with the Board a

7 little over a year, about a year and three months. Prior to

8 that, I spent two and a half years with the Attorney General's

9 Office as the solicitor general of Nevada, and prior to that

10 for 14 years, I was the acting general commander of the Nevada

11 National Guard. And before that, I was in private practice in

12 Reno as a litigation attorney and defense lawyer for 21 years

13 with Clark, Guild and now Judge David Hagen.

14 PRESIDENT MONTOYA: Thank you. Over in the corner,

15 we have Mr. Cooper. And would you introduce your staff.

16 MR. COOPER: Good morning. We've been fortunate

17 enough to add some new investigators. One I introduced in the

18 June IC, and we've got two more on board now in full training.

19 First is Heather Higgins.

20 Heather, get up and introduce yourself.

21 MS. HIGGINS: I'm Heather Higgins. I've been with

22 the Board since -- I've been an investigator since July 1.

23 Previous to that, I was a claims adjuster with Progressive

24 Insurance. Went to UC Davis, majored in communications and in

25 Spanish and been in Reno for a little over a year, and I look

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1 forward to working with all of you.

2 MR. COOPER: Heather brings to us our Spanish

3 capability, which we haven't had before, except for Dr.

4 Montoya, but we couldn't use Dr. Montoya, to call on him to

5 act as translator if we needed, so this is a good thing on our

6 part.

7 And secondly, we have Terry Ward.

8 MS. WARD: I, like Heather, have been with the Board

9 since July 1st. I have medical history, law enforcement and

10 juvenile corrections. I got my degree from the University of

11 Phoenix in human resources management.

12 PRESIDENT MONTOYA: Thank you. Did you introduce

13 everybody?

14 MR. COOPER: Oh, I'm sorry. And this is the lead

15 investigator, Pamela Casteagnola. She's been with us since 15

16 December 2001.

17 PRESIDENT MONTOYA: And Doug is our investigator --

18 he's the chief of Investigations.

19 MR. COOPER: I'm chief of Investigations, correct.

20 And I've been here since July 1st, 2001.

21 PRESIDENT MONTOYA: Okay. Laurie, you came back.

22 MS. MUNSON: I'm Laurie Munson. I have been with the

23 Board since November. I'm the deputy executive secretary. I

24 hate to admit it, but I'm the information systems

25 administrator. I'm saying that only because we're having

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1 technical difficulties again.

2 And I'm chief of Administration. Formerly, I was

3 with the Attorney General's Office for six and a half years.

4 I worked in the litigation and civil divisions there. And

5 prior to that, I was in private practice as a paralegal and

6 legal secretary for about 11 years.

7 PRESIDENT MONTOYA: Anybody who I missed that's

8 behind me who is sitting in this room?

9 Oh, there's Mr. Matheis, Clark County -- Nevada state

10 medical association.

11 MR. KESSINGER: Steve Kessinger, Respiratory Advisory

12 Committee.

13 PRESIDENT MONTOYA: Thank you. And we're going to

14 have auditors that are going to be introduced in just a

15 minute, thank you very much.

16 We'll go ahead and get started. The approval of the

17 minutes of the emergency telephone conference, in the open

18 session, we tabled it for the June 4th meeting.

19 MS. KIRCH: Move for approval.

20 DR. ANWAR: Second.

21 PRESIDENT MONTOYA: Moved and seconded. Any -- all

22 in favor?

23 THE BOARD: Aye.

24 PRESIDENT MONTOYA: All opposed?

25 DR. STOESS: I will abstain since I wasn't here.

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1 PRESIDENT MONTOYA: Dr. Stoess will abstain. Chair

2 votes in favor, so it passes.

3 Let's see. Open session. We took care of that.

4 And now this is an audit by Solari & Sturmer. With

5 us we have Elisa Lasa and Mary Martini, and then -- from our

6 staff, who is going to present the audit, which you should

7 have in front of you. It's the green book.

8 And any questions? Do you have any comments to make

9 about it in our meeting here?

10 We have the audit in front of us. Does anybody have

11 any comments on it?

12 DR. BAEPLER: I had the opportunity to read the

13 document last evening, and I realize the rest of you just got

14 it right now, and I got it last evening as secretary-treasurer

15 so that I could review it.

16 And the audit is a good audit. It has no surprises

17 in it, and it points out that our revenues are not quite

18 keeping up with expenses, so to speak. We are using up some

19 of our reserves, which was our intent when we lowered the

20 licensing fee from $600 to $400. And I have to re-examine

21 that for action by the Board in December to see if we need to

22 increase it.

23 We'll have some various projections to show you, but

24 it's a good audit, and I feel that our reserves are adequate

25 for an operation of this size.

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1 And I've turned out to be really pleased with the

2 audit.

3 PRESIDENT MONTOYA: Any questions for the auditors?

4 The recommendations that they made to us will be

5 implemented sometime in the next few months. There is nothing

6 shocking, nothing hard to implement.

7 We're looking forward to working with them. And

8 thank you very much for your efforts and wonderful

9 suggestions.

10 MS. LASA: Thank you.

11 MS. MARTINI: Thank you.

12 PRESIDENT MONTOYA: Okay. Thank you very much. Glad

13 to approve the audit.

14 DR. BAEPLER: So moved.

15 DR. ANJUM: Seconded.

16 PRESIDENT MONTOYA: So moved and seconded the

17 approved audit. Any objections? Any comments?

18 The Board votes in favor. It's passed.

19 The public service announcement --

20 DR. LUBRITZ: One moment.

21 PRESIDENT MONTOYA: We'll go back one moment to

22 the --

23 DR. LUBRITZ: To the minutes. I thought you were

24 talking about the emergency session, but we had the other

25 minutes.

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1 PRESIDENT MONTOYA: I was including both.

2 DR. LUBRITZ: I'm sorry, can we go back?

3 PRESIDENT MONTOYA: We can go back, if you wish.

4 DR. LUBRITZ: And I made a note that we need to add

5 to the minutes, who's licensed -- who received licenses on

6 those. Unless I read it incorrectly, it shows where we all

7 voted -- let me find specifically where that is, and I think

8 it was pretty much on all of them, unless I read it wrong. I

9 believe, if we go to the minutes of June 4, 5 -- I'll just

10 turn to the first one, Herschel Martin-Schwartz. It says --

11 PRESIDENT MONTOYA: Are you looking at the open

12 session or the closed session?

13 DR. LUBRITZ: This is an open -- beg your pardon,

14 closed session. But it doesn't show where we went to open

15 session. And then we gave him his license, and that's the

16 same for all of these, unless I'm just missing something.

17 MS. MUNSON: Dr. Lubritz, what's been done in the

18 past, in the closed session, it shows where you go back to

19 open session, because -- it's not actually voted on in closed

20 session, so that's why it's not reflected in the closed

21 session. So you have to go back to the open session where the

22 Board actually made the motion and voted on it.

23 DR. BAEPLER: You put all the open session in a

24 separate section, don't you?

25 MS. MUNSON: Correct. Everything that happens in the

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1 open is in the open minutes; everything that happens in the

2 closed is solely in the closed minutes, because the closed

3 minutes are not distributed to the public, so it remains

4 separate.

5 DR. LUBRITZ: Okay. So we would have to reference,

6 go from closed and then go find the open session, and then

7 that's where it passes.

8 PRESIDENT MONTOYA: Do you understand? That's where

9 the votes actually take place.

10 DR. LUBRITZ: Because I looked.

11 PRESIDENT MONTOYA: He didn't get his license. I see

12 it here.

13 MR. CLARK: Dr. Lubritz, if you look at page 13 of

14 32, and it does say "closed session," but referring to

15 Dr. Herschel Martin-Schwartz, it says, "Dr. Lubritz moved that

16 the Board approve Dr. Herschel Martin-Schwartz, M.D.'s

17 application for licensure. Dr. Baepler seconded the motion.

18 It was passed unanimously with the Chair voting in favor."

19 DR. LUBRITZ: Okay. So all of this first part is

20 just the closed session. Got it. Okay. Because I found the

21 same on all these, and now I'm understanding why, because it

22 was all closed session. Got it. Thank you.

23 PRESIDENT MONTOYA: All right. Moving on. We got

24 that cleared up. Let's go to the Nevada Broadcast

25 Association. Tony, Marlene, and I served on this.

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1 Marlene, do you have anything new to say?

2 MS. KIRCH: No.

3 PRESIDENT MONTOYA: The biggest part of this is that

4 we're going to get some -- some of it is going to include some

5 of the members of the current board to let people know that

6 we're here, we are there to help them, let the doctors know

7 we're also here to not necessarily work against them, because

8 we're doctors also, and that's by letting them also be on this

9 message. These are really going to be, if I'm correct,

10 filming sometime over this next quarter, from what I

11 understand.

12 MR. CLARK: Yes, Doctor. If I might give you an

13 overview. Your contract was approved by the State Board of

14 Examiners, so we have a one-year contract with the Nevada

15 Broadcasters Association.

16 I spoke with Nevada Broadcasters within the last

17 week. They have asked the three TV stations in Las Vegas for

18 studio time so they can film and do the television commercials

19 that we're going to do, one of which will have, hopefully, all

20 of the Las Vegas board members there present to participate in

21 it, and they should have the new radio ads on within the next

22 two weeks. And the television ads should be on before the

23 middle of October.

24 Interestingly enough, I got a telephone call

25 yesterday from a lady at Lake Tahoe who identified herself as

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1 the wife of a doctor who saw our television ad that had the

2 African-American doctor in it, the old television ad, and she

3 was very incensed about it, said it was a racial slur and we

4 shouldn't be using that kind of advertising.

5 And I assured her that we were in the process of

6 upgrading our advertising, and we would be giving a positive

7 message about the Board and the medical profession in the

8 State of Nevada, and she was pleased with that.

9 PRESIDENT MONTOYA: Thank you. Any questions?

10 One of the recommendations that came out of the

11 federal audit was that we do something to get better -- we

12 hire a PR man. This is our attempt to take care of our PR,

13 public relations, effort. And -- one of our attempts. And

14 through the other attempts, Tony getting out to some of the

15 places. And I'm going to the Clark County meetings and some

16 of the Nevada State Medical meetings to represent the Board.

17 So we're trying to take care of our public relations

18 responsibility in that manner.

19 All right. Going on to Item Number 7, "Request for

20 Approval to Practice Outside the University of the Nevada

21 School of Medicine's Family Practice Residency Program," we've

22 filed this appeal before with other people.

23 Basically, we've let -- in my experience in the past

24 three years on the Board, we've let people do it with their

25 insurance approval, and they can only practice in California

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1 where, after two years, they can get a full license. They're

2 not eligible to practice and admitted here in Nevada yet.

3 Most of these people go practice in some of the ERs or urgent

4 care centers out in nearby California.

5 So with that said, shall we --

6 MR. CLARK: Doctor, we have this doctor and his

7 residency program director scheduled for 10 o'clock to make a

8 personal appearance and request to the Board.

9 We got a little ahead of ourselves on this, so if we

10 could put this matter out -- off until they arrive at 10:00,

11 that would be good.

12 DR. BAEPLER: Could I make one comment here? The

13 moonlighting policy that the Board adopted was at the request

14 of the medical school, that they did not want their residents

15 moonlighting. And it reinforced their administrative policy

16 to have the Board simply declare that it was not possible,

17 under our policy. So we really adopted that as the request of

18 the medical school.

19 Now there seems to be a change in attitude. Lately,

20 we've been getting these classified exceptions to the medical

21 school's policy; in effect, moonlighting.

22 I wonder if the medical school ought to re-examine

23 their policy. I'm sure it's not a great issue to this Board

24 as to whether they moonlight. It's an educational decision.