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

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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

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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.

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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?

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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.

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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