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, Bernie Christenson, Alex Falk, MD, Brent Lindbloom, DO, Milton Mutch, MD, Richard Porter, MD, and James Reynolds, 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.
Dr. Robert Ferrell welcomed Dr. Alex Falk to the Board.
Mr. Srstka provided a review of SDCL 36-4-17 regarding the eligibility requirements for medical licensure in South Dakota. Mr. Srstka explained that the statute requires that an applicant shall complete the three (3) Steps of the USMLE within a seven (7) year period; with no more than three (3) attempts at each Step. If an applicant does not meet these eligibility requirements, the Board may consider making an exception if the applicant is board certified. The Board was informed that deviation from statute could result in litigation or other legal problems.
Discussion was held regarding Dr. Troy Nesbit. Dr Nesbit applied for a South Dakota medical license but he did not meet the eligibility requirements of SDCL 36-4-17 and he is not currently board certified. Dr. Falk stated for the record that it is a travesty that the Board cannot accommodate this physician. After preliminary discussion, the Board met with Dr. Troy Nesbit and his wife. Dr. Ferrell informed Dr. Nesbit that the Board must work within the confines of SDCL 36-4-17. Discussion in this matter continued. Dr. Porter moved that the Board investigate a way to allow it to consider applicants who do not meet SDCL 36-4-17 and explore potential legislative changes to this statute. The motion was seconded and passed. The Board directed the staff to prepare to open the Medical Practices Act for the purpose of proposing that the legislature modify SDCL 36-4-17. The Board then directed the staff to inform Dr. Nesbit that upon his obtaining a license in some other state the Board will issue him a locum tenens certificate.
Dr. Ferrell then recognized and congratulated Dr. James Reynolds on his recent induction into the South Dakota Hall of Fame.
The Board reviewed the minutes of the board meeting held March 15, 2006. Dr. Mutch 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 old business updates: 1) Dr. John Stransky was contacted and informed him that the Board did not grant a request to create a “retired” status for licensure; 2) a subpoena was issued for records regarding Brad Bussell, EMT, because of allegations of criminal activity. Mr. Bussell does not hold a current license in South Dakota and is under investigation by the Attorney General; 3) Dr. Gonzalo Sanchez signed his agreement with the Board and all reports have been sent to the national reporting entities. Dr. Sanchez has also paid the fine imposed by the Board and the Letter of Reprimand is ready to be signed by Dr. Robert Ferrell. He will continue to be monitored for compliance regarding the continuing medical education portion of the agreement.
The report on new business included the following: 1) 155 new licenses have been issued in the last three months; 2) The current renewal cycle for has been progressing rapidly and there has been much positive feedback now that the renewal forms are available on the Board website. The renewal rate has improved as 100% of the renewals for resident physicians, athletic trainers and licensed nutritionists received in the office have been processed and the physician assistants are 70% completed; 3) two new employees have been added to the office staff ; 4) Meetings have been held with the Occupational Therapist representatives, the Dietitians representatives, the executive director of the Board of Pharmacy. Further meetings are scheduled with representatives of other allied professional groups regarding streamlining the renewal forms, authorization for release of information forms, and initial applications for all the Board’s regulated professions; 5) Ms. Hansen has given several presentations to the credentialing personnel of local healthcare entities and has more scheduled in the future months.
The report on investigations included the following: 1) Michael Kuglitsch, MD, did not renew his medical license. Therefore, his license lapsed while he was under investigation by this Board; 2) Dr. Tassos Pappas will voluntarily surrender his license as a result of a plea agreement in a criminal case prosecuted by the United States Attorney for the district of South Dakota regarding his practice of misbranded TRI-Toxin into interstate commerce in violation of federal law; 3) A subpoena was issued regarding Suzanne Sachs, PA-C, and her alleged mental instability. Once the records are received, we will proceed accordingly.
Dr. Ferrell, Ms. Hansen, and Mr. Srstka attended the annual meeting of the Federation of State Medical Boards (FSMB) and provided the following information concerning: 1) the Hurricane Katrina disaster and the need to protect this Board’s records and have database and record back-up in place in the event of an emergency; 2) whether out-of-state physicians would be able to provide medical treatment if a disaster occurred in South Dakota. The Board assured the Governor that an incoming physician with an active license in another state would be able to practice in South Dakota for a certain period of time. Ms. Hansen added that through the FSMB, the Board may be able to check the credentials of an out-of-state physician in the event of an emergency. Dr. Ferrell encouraged other Board members to attend future FSMB meetings as valuable information and resources are provided.
The executive director’s report was approved.
Discussion was held concerning the VeriDoc License Verification System which would assist physicians and physician assistants in sending a primary source verification of their South Dakota license to another state board. Ms. Hansen demonstrated how the system works and explained how once the physician pays for the verification it is sent instantaneously from South Dakota to the state board(s) they indicate. VeriDoc is currently adding new state boards each day and hopes to be accepted in all states. After discussion, Dr. Lindbloom moved that the Board approve a contract with VeriDoc. The motion was seconded and passed.
Mr. Srstka informed the Board that the staff will begin writing Administrative Rules in the upcoming months. Rules Hearings will be scheduled during future board meetings. The applications for medical licensure will be updated and other licensure issues will be addressed in the new rules. The board staff will continue to meet and work with all interested parties concerning these issues.
The Board met with South Dakota Academy of Physician Assistant (SDAPA) representatives Dan Palmer, PA-C, Diane Weber, PA-C, Shelia Schweitzer, PA-C, Ann Davis, and Kitty Kinsman. Discussion was held regarding opening the Physician Assistant Medical Practice Act at the upcoming legislative session. The current practice act was written in 1973. The proposal seeks to modernize the language and streamline the licensure process. This proposal is not intended as a path to independent practice nor does it intend to diminish the role of the Board. The representatives, in attempting to clarify the physician/physician assistant relationship have borrowed language from thirty-two (32) states that would propose: 1) multiple supervision practice agreements under one license to improve the continuity of medical care coverage; 2) physician delegated and directed supervision practice agreements to replace the current checklist of procedures; 3) more efficient emergency and disaster care not protected by the “Good Samaritan Law”.
Mr. Srstka informed the Board members that: 1) SDCL 36-4A-20 indicates that all original signed and notarized supervisory practice agreements must be approved and on file with the Board office prior to the physician assistant commencing practice; 2) SDCL 36-4A-45 suggests that the locum tenens license for physician assistants was intended only for out-of-state physician assistants and not South Dakota licensed physician assistants; 3) SDCL 36-4A-37 could be changed to mirror SDCL 36-4-29, the corresponding statute of the Medical Practice Act, which would add the “preponderance of the evidence” standard. Discussion was also held regarding the physician delegated supervision proposal and defining the methods of supervision as well as Board receipt and review of all practice agreements for every location before the physician assistant commences practice.
After meeting with the SDAPA representatives, discussion was held with the physician assistant sub-committee members James Cody, PA-C, Rodney King, PA-C, and Jan Hines, PA-C. The Board requested that the sub-committee address the definitions of the frequency and modes of supervision which could potentially be specified in modifications to the supervision practice agreements.
Dr. Ferrell then adjourned the meeting for lunch at 12:00 noon.
At 12:30 p.m., Dr. Ferrell called the meeting to order.
The Board then discussed the issue of chest tube insertion. Dr. Alex Falk presented information and led discussion regarding the issue of whether to allow paramedics and flight nurses to insert chest tubes. Dr. Falk reviewed the chest tube protocols and guidelines provided by several regional hospitals and submitted the petition from Aberdeen Care Flight to allow this procedure as it would only be performed in a dire emergency. Dr. Reynolds moved to approve the introduction of chest tubes under the guidelines proposed by the hospital under direction of the medical director. The motion was seconded and passed with Dr. Falk abstaining from the vote.
The board reviewed the listing of new licenses. Mr. Burchill moved to accept as published. The motion was seconded and passed.
The Board considered the medical license application from Denise Crute, MD. At a prior meeting the board had considered letters of recommendation from the applicant’s patients, colleagues, and attorneys. The Board had also considered applicant’s letter of February 21, 2006, in rebuttal to the Colorado Board of Examiners proceedings ordering her medical license placed in an inactive status. The Board also took notice that the Colorado Order was reported to the Federation of State Medical Boards (FSMB) and the National Practitioner Data Bank/Healthcare Integrity and Protection Data Bank (NPDB/HIPDB), wherein the Colorado Board stated that the reasons for the reports were applicant’s failure to conform to minimal standard of acceptable medical practice, unprofessional conduct, and substandard or inadequate medical care.
The Board also considered documents sent by the Colorado Board of Examiners and the applicant including the Colorado Board’s formal complaint, the applicant’s answer, motions, and briefs of counsel, along with depositions of the witnesses, and pre-trial decisions made by the administrative law judge assigned to the Colorado proceedings. The Board incorporates all of these documents herein.
The Board gave great weight to the Stipulation and Agreement between the applicant and the Colorado Board of Examiners dated July 13, 2005, along with the Colorado Board’s Order. The Board found that applicant’s care of her patients C, N, O, and Q constituted unprofessional conduct as defined by SDCL 36-4-30.
Based upon examination of these documents, which are specifically incorporated herein, the Board concludes that applicant’s admitted unprofessionalism in caring for her patients C, N, O, and Q constitutes grounds for denial of her request for a South Dakota medical license under the provisions of SDCL 36-4-28 and SDCL 36-4-30.
Discussion was held regarding the medical license application from Barbara Schlager, MD. After discussion, Dr. Lindbloom moved to grant a South Dakota medical license to Dr. Schlager. The motion was seconded and passed.
Discussion was held regarding the medical license application from Bela Csaki, MD. After discussion, Mr. Christenson moved to deny the application on the grounds that there were too many incidents of medical malpractice. The motion was seconded and carried.
Discussion was held regarding Sharon Hermeling, PT, and her agreement with the Board to outline proper recording techniques for documenting treatments. After discussion, Dr. Falk moved to approve the agreement. The motion was seconded and carried.
The Board reviewed proposed changes to the Certified Nurse Practitioner (CNP) and Certified Nurse Midwife (CNM) collaborative agreement. After discussion, Dr. Lindbloom moved to approve the agreement as published. The motion was seconded and carried.
As is customary at the June meeting, the election of officers was held. Dr. Lindbloom moved to re-elect Dr. Robert Ferrell as President of the Board, Dr. James Reynolds as Vice-President of the Board, and Dr. Richard Porter as Secretary of the Board. The motion was seconded and passed.
The financial report was reviewed by the Board and accepted as presented.
At 1:30 p.m. the Board entered executive session to consult with legal counsel about proposed or pending litigation or contractual matters.
At 2:00 p.m. the Board came out of executive session. The Authorization for Release of Information Form was presented for board approval. The Board examined the Authorization of Release of Information Form and discussed releasing directory mailing contact information upon receipt of the signed Authorization for Release of Information Form and the appropriate fee. Mr. Burchill moved to accept the Authorization for Release of Information Form with directions to the staff that they could release the directory mailing contact information only after they were in receipt of the signed authorization and appropriate fee. The motion was seconded and passed.
The Board addressed the petition from Dr. Eric Luebbert. Dr. Luebbert applied for a medical license earlier this year but did not meet the eligibility portion of SDCL 36-4-17. In the meantime, Dr. Luebbert has recently obtained his specialty board certification in radiology and requested that the Board consider his application in light of his current status. Dr. Porter moved to grant him a license. The motion was seconded and passed.
Mr. Christenson moved to form a committee to address the possible modification of SDCL 36-4-17. The motion was seconded and carried. Dr. Ferrell and Dr. Reynolds were appointed to the committee.
Ms. Anita Kealy met with the Board and presented a proposal for the Board logo and offered five (5) examples for their consideration. The Board accepted the proposals for consideration and instructed board staff to choose a logo design.
The Board then held discussion regarding use of lasers and botox and acknowledged that the use of these procedures continues to expand and will require further policy definition and enforcement of statute. The board staff was directed to begin preparation for the consideration of this matter at the December meeting.
Transportation to the Board meetings was discussed. Mr. Christenson offered to coordinate future transportation. Dr. Mutch moved that the Board members use the most efficient means to travel to the Board meetings. The motion was seconded and carried.
The next board meeting will be held on Tuesday, September 12, 2006, at the Sioux Falls Holiday Inn City Centre in the Burgundy Room. This will be the annual joint meeting with the South Dakota Board of Nursing and will begin at 9:00 a.m.
As there was no further business, the meeting adjourned at 3:15 p.m.
