The meeting was called to order at 11:00 a.m. by Dr. Robert Ferrell, President of the Board. Present at the roll call were Patrick Burchill, Bernie Christenson, Alex Falk, MD, Robert Ferrell, MD, Brent Lindbloom, DO, Milton Mutch, MD, and James Reynolds, MD. Board member Richard Porter, MD, was not present at the meeting. Also present at the meeting were Margaret Hansen, Executive Director, Donald Srstka, General Counsel, and Jane Phalen, Board Staff. In addition, members of the Physician Assistant Sub-Committee Rodney King, PA-C, and Jan Hines, PA-C, were present. James Cody, PA-C, member of the Physician Assistant Sub-Committee was not present.
Request for Modification for Scope of Practice and Submission of Training Protocol
The board met with Todd Nelson, PA-C, and Kathy Reynolds, MD, regarding their request for physician assistants Todd Nelson, PA-C and Dalaina Sievers, PA-C, currently practicing at the Avera McKennan Hospital Pediatric Critical Care Service, to perform Peripherally Inserted Central Catheter (PICC) Placement. The Board was informed that supervision is available 24/7 and that the physician assistant would be followed and monitored closely until they master the technique. Motion: Dr. Reynolds moved to accept this training protocol and approve subsequent performance of this procedure once the training is successfully completed, provided they submit an annual report to the Board regarding the number of PICC placements performed by the physician assistants and the performance outcomes, including any complications resulting from the performance of the procedure. The motion was seconded and passed.
South Dakota Academy of Physician Assistants (SDAPA)
The board met with Dan Palmer, PA-C and Kitty Kinsman regarding a draft of new language for the Physician Assistant Practice Act. The SDAPA submitted proposed changes to 36-4A.
a. Primary Physician Supervision Requirements: Discussion was held regarding supervision requirements. After discussion, the Board recommended that the new language mirror the language found in the Certified Nurse Practitioner Collaborative Agreement to state: A Physician Assistant who practices at multiple practice sites with the same primary supervising physician shall engage in the required direct personal contact at one of the practice sites. However, to assure quality patient care where multiple practice sites are utilized, the Board expects that the supervising physician will demonstrate that the physician supervision has occurred at each of the sites on a regular basis throughout the year. In addition, when the primary supervising physician is not in direct personal contact with the physician assistant, the physician must be available by telecommunication.
b. List of Approved Procedures in the Practice Agreement: Discussion was held regarding the list of approved procedures. The SDAPA presented information that all accredited physician assistant training programs in the United States provide a core curriculum that includes the procedures listed in the practice agreement. Therefore, the list of procedures could be removed. This would result in practice agreement procedures based on the core curriculum training. Additional procedures would be considered based on the specialized training and competency of the physician assistant and the specialty of the primary supervising physician. Any additions to the core curriculum procedures would be listed in the practice agreement and would be subject to approval by the Board.
Motion: Dr. Reynolds moved that based on the information that all accredited physician assistant programs are equal and all provide a core curriculum including training in the procedures listed in the practice agreement, that the listing of procedures be removed from the practice agreement and the physician assistant practice act. However, all modifications noted in the practice agreements must be approved by the Board based on the specialized training and competency of the physician assistant and the specialty of the primary supervising physician. The motion was seconded and passed.
c. The Board reaffirmed their position that a physician assistant may not engage in practice in South Dakota prior to submitting an original practice agreement to be filed in the Board office and receipt of a notice of approval of the practice agreement from the Board office. A request for a modification to the physician assistant scope of practice can be handled administratively with the input of a board member and a subsequent conference call to discuss and query the Board members for approval or denial.
d. The members were informed that some proposed changes were discarded. Therefore, the renewal date for the physician assistants will continue to be an annual renewal and payment of the renewal fee is required to maintain the physician assistant license even if the physician assistant is not currently practicing.
e. Discussion was held regarding the Good Samaritan Law and the opinion that the physician assistant is not protected by this law in the event of a disaster or emergency in which they may not have an approved primary supervising physician practice agreement in place to render medical assistance in healthcare facilities. Mr. Srstka referred to SDCL 20-9-3 which states that a physician assistant who in good faith renders emergency care at the scene of the emergency shall not be liable for any civil damages as a result of any acts or omissions for rendering the emergency care. He also stated that the Governor is granted broad emergency powers under the provisions of SDCL Chapter 33-15, including the power to suspend the provisions of any rules of any state agency in the event he deemed necessary. SDCL 33-15-8 lists the authority of the Governor in time of disaster. The Board recommended that language be developed that would allow a physician assistant to provide services, without an approved practice agreement in place, in a hospital or urgent care setting during a disaster or emergency situation.
f. Further discussion was held regarding modifications to the practice agreements for procedures not included in the core curriculum at accredited physician assistant programs. The SDAPA provided information that the State of Iowa outlines a core base of procedures in their practice act and then lists specialty specific modifications. The Board directed that the SDAPA provide information regarding this modification procedure for the Board to consider. This may assist in developing a procedure to allow modifications to the South Dakota physician assistant practice agreements, provided the written request is submitted to the Board along with signed statement from the physician assistant to confirm completion of training.
g. Dr. Ferrell addressed the proposed new practice act and requested that several changes be made. He then encouraged the SDAPA to persist in their efforts to work with the SDSMA regarding this process.
Motion: Mr. Christenson moved that the Board adopt the proposed new physician assistant practice act, with the changes the Board made, in order to move forward with the legislation. The motion was seconded and passed.
Dr. Ferrell told the SDAPA to move forward with the support of the Board. Further discussion was held regarding writing administrative rules to allow future proposed modifications without requiring legislative action.
Grant Walker, MD – Application for South Dakota Medical License
The Board met with Dr. Grant Walker regarding his application for a license to practice medicine in South Dakota. Discussion focused on his post-graduate training programs and previous complaints. Dr. Walker stated that he has never been interviewed by another medical board and he has never had any complications or incidents in his medical practice. He applied for a license in Washington and withdrew the application. He applied for a license in Wyoming and that application is pending. He granted his permission for a Board representative to speak to the Wyoming and Washington medical boards regarding his applications. He also stated that he has never been denied licensure.
Motion: Mr. Christenson moved to grant an unrestricted license to practice in South Dakota. The motion was seconded by Dr. Lindbloom. Discussion was held. Mr. Christenson withdrew this motion and Dr. Lindbloom withdrew his second to this motion. Dr. Falk stated that the Board needed more information and that contact should be made with the training programs, references, and other medical boards.
Motion: Mr. Christenson moved that a representative of the Board contact the residency training programs as well as references and the medical boards in Wyoming and Washington for further information. The motion was seconded and passed.
The minutes of the meeting held June 27, 2006 were approved as published.
An election was held for the position of Secretary of the Board. The current secretary, Dr. Richard Porter, has retired from the Board. Dr. Milton Mutch was nominated for the Secretary position and was unanimously elected. Discussion was held regarding a social gathering before the December 5, 2006 meeting in order to welcome new board members and thank Dr. Richard Porter for his many years of service to the state as a member of the Board. Mr. Christenson moved that a social gathering be planned for the evening of December 4, 2006. The motion was seconded and passed.
Proceedings of the Joint Meeting with the South Dakota Board of Nursing. Due to weather conditions, the Board did not have a quorum for the Joint Meeting. Dr. James Reynolds and Dr. Milton Mutch represented the Board of Medical Examiners and voted based on the future ratification by the full Board. The Board addressed the items brought to the Joint Meeting and ratified the votes regarding: 1. Approval of the minutes of the Joint Meeting held September 15, 2005; 2. Approval of the Annual Report of Activity for FY 05-06 with the addition of the Motion: Dr. Mutch moved to pay the Board’s share of the expenses totaling $14, 242.94. The motion was seconded and passed; 3. Accepted reports on number of procedures on previously approved modifications to collaborative agreements; 4. Approval of Motion: Dr. Reynolds moved that the modification request submitted by Susan Johannsen, CNP, PA-C, be approved subject to submission of proof of educational competency and subsequent follow-up with results of 25 observed procedures. The motion was seconded and passed; 5. Approval of the new collaborative agreements for Certified Nurse Practitioners and Certified Nurse Midwives; 6. Discussion on the issue of Homebirth accepted for information; 7. Approval of election of Patrick Burchill as president of the joint board and election of Deb Soholt as secretary of the joint board.
Homebirth
The Board continued earlier discussion held with the Board of Nursing regarding the issue of Homebirth. A request from a Certified Nurse Midwife to provide this service without an approved collaborative agreement has been submitted. At the earlier joint meeting, the Board of Nursing and the Board of Medical Examiners recommended that a task force research this issue and gather documentation to provide in the event that legislation is initiated in the future.
Motion: Dr. Mutch moved that a committee, chaired by Dr. Brent Lindbloom, be formed to address this topic. He further moved that Dr. Lindbloom select the members of the committee. The motion was seconded and passed.
Executive Director Report
Margaret Hansen presented the Executive Director Report and updated the Board.
Old Business including the following: 1. Troy Nesbit, MD, and the issuance of his locum tenens certificate; 2. Dr. Gonzalo Sanchez and his registration for a continuing medical education course as part of his agreement with the Board; 3. Dr. Anastasios Pappas and the voluntary surrender of his medical license effective July 21, 2006; 4. Dr. Michael Kuglitsch and his letter stating that he did not intend to reinstate his license to practice medicine in South Dakota; 5. Two subpoenas issued regarding Brad Bussell, EMT, and Suzanne Sachs, PA and the receipt of the information. Mr. Bussell and Ms. Sachs did not renew their licenses to practice in South Dakota and their licenses are lapsed; 6. Information on the recent renewal cycle; 7. Report on the VeriDoc License Verification Service; 8. Report on Board Statistics and report on primary source verifications and due diligence.
New Business including the following: 1. Report of staff vacancies; 2. Report on new Board Investigator Consultant, Mr. Adrian Mohr and new Special Case Attorney, Mr. Craig Kennedy; 3. Emergency suspension of medical license – Dr. Jason Ostby for alleged possession of a controlled substance; 4. Meetings held with representatives from the professions we license regarding streamlining the applications, the renewal forms, and updating the authorization and release statements, including HIPPA releases – future meetings are scheduled; 5. Ms. Hansen’s presentations to the Medical Group Management Association and three future presentations scheduled; 6. Staff attendance at AIM workshops to be held in September and October 2006; 7. Future plans to write Administrative Rules and dovetail the rules hearings to coincide with board meetings. The Executive Director’s Report was approved.
Financial Report and Board Audit for the Year Ended June 30, 2006.
The Board reviewed the financial report and accepted it for information. The Board then reviewed the Audit for the year ended June 30, 2006.
Motion: Mr. Burchill moved to approve the Audit. The motion was seconded and passed.
The Board reviewed and discussed the listing of new licenses issued since the last meeting totaling 189 new licenses. The listing was approved as published.
The Board addressed the request from Dr. Lucy Modahl to be granted a medical license in South Dakota. She did not meet the examination requirements in statute but is board certified.
Motion: Mr. Christenson moved to grant Dr. Modahl a medical license. The motion was seconded and passed.
The Board addressed the request from Dr. Sylvanus Ayeni to be granted a medical license in South Dakota. He did not meet the examination requirements in statute but is board certified.
Motion: Dr. Mutch moved to grant Dr. Ayeni a medical license. The motion was seconded and passed.
Further discussion was held regarding administrative handling of physicians who do not meet the examination requirements listed in statute but are board certified. The Board instructed the staff to review such board certified applicant’s file with Dr. Ferrell for approval; however, such applicants with derogatory information or other concerns must be reviewed by the entire Board at a Board meeting.
Bela Csaki, MD
Dr. Bela Csaki applied for a medical license at the June 27, 2006 meeting and his application was denied. The Board, however, decided to reconsider its decision after reviewing additional letters from the applicant and Drs. Ben Henderson, Travis Henderson, and Robert Marciano of the Mobridge Clinic.
Motion: Dr. Falk moved that the Board grant Dr. Csaki a locum tenens certificate to allow him to practice in Mobridge for a period of 60 consecutive days with renewals. At the conclusion of the 60 day period, Drs. Robert Marciano, Ben Henderson and Travis Henderson must submit a detailed report listing the number and type of surgical procedures performed by Dr. Csaki and the outcomes of these procedures. The motion was seconded and passed.
Discussion was held regarding the recent passage of the law regarding emergency contraception.
Discussion was held regarding a complaint concerning Dr. Reuben Setliff and Dr. Robert Akins. Both physicians practice in the Ear/Nose & Throat (ENT) specialty. The Board took this discussion under advisement.
There being no further business, the meeting was adjourned at 4:15 p.m.
