The meeting was called to order at 9:00 a.m. by Robert Ferrell, MD, President of the Board. Board members present for roll call were Patrick Burchill, Brent Lindbloom, DO, Milton Mutch, MD, Richard Porter, MD, and James Reynolds, MD. Board members not present for the meeting were Bernie Christenson and Alex Falk, MD. Staff members present were Margaret Hansen, Donald Srstka, and Jane Phalen. Physician assistant sub committee members present were James Cody, PA-C, Jan Hines, PA-C, and Rodney King, PA-C.
The board reviewed the minutes of the board meeting held December 5, 2005. Dr. Lindbloom moved to accept the minutes as published. The motion was seconded and passed.
Margaret Hansen presented the Executive Director Report. The report included the following updates: 1) Dr. Travis Sanger licensure information; 2) review of the information and status of the investigation into the collaborative agreement regarding two certified nurse practitioners (CNPs) and their advertised “independent” practice in Rapid City; 3) legislative results regarding DOH agency bills introduced during the recent session; 4) discussion on chest tube insertion in order to inform the board that after a national search we found that, due to liability issues, there is no national policy for chest tube insertion. Dr. Falk is currently studying the protocols for chest tube insertion from the hospitals in South Dakota; 5) additional training required prior to a physician returning to practice medicine in South Dakota after a period of inactivity. Ms. Hansen informed the board that the Federation of State Medical Boards (FSMB) does offer a post-licensure assessment program. In a related issue, the Board was informed that Sandro Visani, MD, was provided with information regarding urology residency programs available to him. The licensure fee was returned to Dr. Visani until such time as he completes a urology residency; 6) South Dakota is in keeping with the majority of the states that require an applicant for medical licensure to take and pass all three (3) steps of the USMLE examination within a seven (7) year period and with no more than three (3) attempts at each step. In a related issue, the Board discussed whether applicants in an MD/PHD program should be allowed to re-take step 1 of the USMLE in order to meet our state requirement of completion of the examination within a seven (7) year period.
The financial report was reviewed and accepted for information.
Discussion was held regarding a request from Dr. John Stransky. Dr. Stransky is currently retired and not actively practicing and he does not wish to pay the renewal fee. Dr. Stansky requested that the board to consider “inactive or retired” statues so that physicians who are not in practice could still renew their licenses without submitting the renewal fee. He also expressed concern that, if he did not renew his license due to the fee, he would not be in a position to administer medical care in a national emergency situation. After discussion concerning the “good Samaritan act” as it related to a national emergency, the board felt that the ability to provide medical care during a crisis situation would not necessitate an active license. The board members also indicated that any physician who has not practiced for an extended period of time must be required to prove educational training and competence prior to returning to active practice. In addition, creating a “retired” or “inactive” status would require a change to the Medical Practice Act 36-4. Dr. Mutch moved to not alter the current statutory definition at this time and Ms. Hansen was directed to inform Dr. Stransky of the board’s decision regarding his request. The motion was seconded and passed.
The board members were given an update as to the staffing issues at the board office. Currently, there are two permanent employees and two temporary employees. Ms. Hansen has written descriptions of the current open positions for a Business Manager/Accountant and a Verification/Renewal Coordinator and will begin scheduling interviews shortly.
Ms. Hansen provided information concerning a recent presentation that she and Dr. James Reynolds made to students at the Sanford University of South Dakota School of Medicine regarding medical licensure issues and questions. She also informed the board members that she met with representatives of the Sioux Valley Healthcare System, representatives of the Athletic Trainers Association, and representatives of the Medical Assistants Association. These meetings were held to open dialogue regarding licensure, and address their questions or concerns. The board members were updated on the visit Ms. Hansen took to Dallas, TX, to visit with representatives of the Federation of State Medical Boards (FSMB). She presented what she had learned about investigations and how they are handled in other states. She noted that many other states have a standard form for persons wishing to make complaints. The board members reviewed an example of a draft complaint form. They approved this form and directed that it be placed on the board website. Discussion was held as to whether a complainant may feel intimidated regarding possible retribution from a physician if they file a complaint and their name is released to the physician named in the complaint. After discussion, Mr. Srstka indicated that retribution in a complaint can be considered to be a separate act of unprofessional conduct. Dr. Lindbloom moved to accept the discussion for information purposes. The motion was seconded and passed.
Ms. Hansen also informed the board members that South Dakota is the only state that does not participate in the Federation Physician Data Center. Mr. Burchill moved that South Dakota become a participant in the Federation Physician Data Center. The motion was seconded and passed. The board members were reminded that Ms. Hansen, Mr.Srstka, and Dr. Ferrell were planning to attend the annual meeting of the FSMB in Boston, MA, in April. Ms. Hansen informed the board members that next year FSMB annual meeting will be held in San Francisco in May and encouraged any of the board members to attend.
The board then addressed requests for modifications to the scope of practice for certified nurse practitioners (CNPs) to perform joint injections and joint aspirations. One of the modification requests was tabled by the South Dakota Board of Nursing (SDBON) and the board members also tabled this request. Three (3) of the requests were approved by the SDBON. Discussion was held regarding the conditions that ideally this procedure should be performed in an orthopedic setting under the supervision of an orthopedic physician. However, this would not address the problems of practice in a rural setting where there is a need to perform this procedure but there may be no orthopedic physicians to provide collaboration. The Board considered the premise that the supervising physician is more qualified to determine if a mid-level is able and competent to perform this procedure. The Board indicated a need for some type monitoring and reporting of the number of these procedures performed by the mid-level. After discussion, Dr. Reynolds moved that the board approve these three (3) modification requests with the requirement that this approval is only valid for their practice with their current collaborating physician and that the CNP will submit annual documentation on the number of joint aspirations and joint injections they perform. This annual documentation will be provided in writing each year prior to the September Joint Board Meeting between the SDBON and the SDBMOE. The motion was seconded and passed.
The board members met with the physician assistant subcommittee members. Discussion was held concerning a letter the board received from a South Dakota ophthalmologist requesting that physician assistants be approved to perform eye injections. Dr. Ferrell queried six (6) ophthalmologists and the consensus from these physicians was that they would not recommend that physician assistants perform this type of procedure. Dr. Lindbloom moved that the board deny this request for physician assistants to perform eye injections. The motion was seconded and carried.
The subcommittee informed the board members that there is discussion regarding possible legislative changes to the antiquated laws and rules governing the practice of the physician assistants in South Dakota, specifically, the issue of a physician assistant performing rounds in a hospital setting. The board requested that the subcommittee begin gathering information regarding this issue and other possible changes to update the practice act for physician assistant practice. Mr. Cody also will obtain a model physician assistant practice act to assist the board in reviewing this issue.
Discussion was held concerning Brad Bussell and the status of his license as an emergency medical technician (EMT). Mr. Bussell was being investigated for taking narcotics from an ambulance in Mitchell. Mr. Bussell stated he would surrender his license but we have received nothing from him to date. Discussion was held regarding the need to send a letter stating he must cease practice pending the outcome of an investigation by the Department of Criminal Investigations (DCI). Mr. Srstka contacted the DCI and is awaiting an update as to their findings. This was accepted for information purposes.
The board members discussed the disciplinary actions related to the South Dakota medical license for Gonzalo Sanchez, MD. After discussing modifications dealing with the issue of the release of the agreement, the board determined that the agreement is a public document and, as such, will be reported to the appropriate agencies and will be posted on the disciplinary section of the board website. Also, parties requesting a copy of this agreement in writing will receive a copy from the board office. Dr. Mutch moved to approve the modifications. The motion was seconded and passed with Dr. Ferrell and Dr. Lindbloom abstaining. Mr. Srstka was instructed to send the agreement to Mr. McMahon with instructions to have Dr. Sanchez sign the agreement and return it to the board office.
Information regarding the number of license issued since the last board meeting was reviewed and accepted for information.
The board members discussed the application for medical licensure submitted by Dr. Denise Crute. Dr. Crute’s application has areas of concern especially in the area of malpractice, not only the number of incidents but the type of incidents. After discussion, Dr. Porter moved to issue a medical license with stipulations to Dr. Crute. The motion was seconded but defeated. After further discussion, Dr. Reynolds moved to employ a consultant to review her application and materials and to offer an opinion. The motion was seconded and passed. Mr. Srstka was to investigate the matter further.
Discussion was held regarding a complaint that, during a recent rodeo, the Professional Rodeo Cowboys Association (PRCA) contracted with athletic trainers employed by Mobile Sports Medicine System of Dallas to provide services to the PRCA riders. These athletic trainers were not licensed in South Dakota. After discussion, the board determined that this situation does not differ from other sports teams who travel and bring their own trainers to treat their athletes. Dr. Mutch moved that a letter be sent stating that athletic trainers provided by Mobile Sports Medicine System of Dallas are contracted to the PRCA and only treat PRCA riders. In addition, the letter must state that the Board requires and expects that a crew of South Dakota licensed emergency medical technicians (EMTs), a volunteer licensed South Dakota physician, an ambulance, and resuscitation equipment must be located onsite. The motion was seconded and passed.
The board reviewed a letter from a newly graduated physical therapist assistant who has taken the national physical therapist assistant examination five (5) times and has failed at those attempts. This physical therapist assistant requests the board’s approval to take the examination for the sixth time. Dr. Mutch moved that the board advise her to take a refresher course or additional training and then request approval from the board to retake the national examination. The motion was seconded and passed.
The board entered executive session at 12:10 p.m. to discuss personnel matters. Executive session ended at 12:45 p.m.
The date for the next board meeting is set for Tuesday, June 27, 2006, in Sioux Falls at the Board office beginning at 9:00 a.m. There being no further business, the meeting was adjourned at 12:50 p.m.
