Arizona Medical Board

9545 East Doubletree Ranch Road • Scottsdale, Arizona 85258

Home Page: http://www.azmd.gov
Telephone (480) 551-2700 • Fax (480) 551-2704 • In-State Toll Free (877) 255-2212

FINAL MINUTES FOR BOARD OFFSITE PLANNING MEETING

HELD AT 9:00 A.M. ON OCTOBER 14, 2010
Gainey Suites Hotel, 7300 Gainey Suites Drive, Scottsdale AZ 85258

Board Members
Douglas D. Lee, M.D., Chair
Paul M. Petelin Sr., M.D., Vice Chair
Amy J. Schneider, M.D., F.A.C.O.G., Secretary
Patricia R. J. Griffen, Member-at-Large
Andrea E. Ibáñez
Jodi L. Jenkins, M.D.
Gordi S. Khera, M.D.
Ram R. Krishna, M.D.
Germaine Proulx
William J. Thrift, M.D.

CALL TO ORDER
Douglas D. Lee, M.D. called the meeting to order at 9:00 a.m.

ROLL CALL
The following Board members were present:
Douglas D. Lee, M.D., Paul M. Petelin Sr., M.D., Amy J. Schneider, M.D., F.A.C.O.G., Patricia R. J. Griffen, Andrea E. Ibáñez,
Jodi L. Jenkins, M.D., Gordi S. Khera, M.D., Ram R. Krishna, M.D., Germaine Proulx, William J. Thrift, M.D.

Call to the Public

Jane Orient, M.D. spoke during the call to the public regarding Physician Assessment and Clinical Education (PACE). Scott
Forrer, M.D. spoke during the call to the public regarding the Board’s process. David Ruben, M.D. spoke during the call to the
public regarding system solutions and Affiliated Monitors. Darrel Jessop, M.D., spoke during the call to the public regarding
oversight of the adjudication process. David Quantz, spoke during the call to the public regarding statutory amendments.

Tips on Conducting Formal Interviews and Overview of the Formal Hearing Process
Jennifer Boucek, AAG presented parts two and three of a training series on the Arizona Medical Board’s Formal Interview and
Formal Hearing processes. Ms. Boucek explained that the Board may not take disciplinary action without providing a licensee
their due process rights. Ms. Boucek explained that all physicians facing discipline are afforded the option of Administrative
Hearing. Ms. Boucek summarized the due process steps and explained that there is the opportunity for a full evidentiary
hearing, including the right to cross examine the Board’s Medical Consultant during the Formal Hearing.

Dr. Lee commented that during the Board’s informal interview process, the Board’s chair asks the licensee to confirm that they
have chosen to waive the right to a full evidentiary hearing, including the right cross examine the Board’s Medical Consultant if
they do not choose a Formal Hearing. Dr. Lee also commented that if the licensee opts for the informal interview, they are given
a five minute opening statement to briefly summarize the case, which could be argued is not ample time for the licensee to
speak. Ms. Boucek explained that the standard procedure after the opening statement is for the presenting Board member to
ask questions of the licensee and have dialogue.

Ms. Boucek also answered questions regarding unprofessional conduct, standards of care and deviations and the Board’s role
of weighing the evidence. Ms Boucek stated the Board may consider their own personal expertise as physicians who understand
day-to-day practice, when adjudicating cases. Ms. Boucek answered questions about using the information obtained during the
course of the investigation to adjudicate the matter, regardless of whether they’ve done research on the side. Ms. Boucek
explained if they rely upon materials other, than the Board documents provided, the materials become part of the record.

Ms. Boucek reviewed the definitions of non disciplinary orders and Continuing Medical Education (CME) actions. Ms. Boucek
explained that a CME Order is an appealable agency action, and if the appeal takes place after a Formal Interview, the appeal
will go to Superior Court. Ms. Boucek also covered the limited disciplinary sanctions that the Board has the option to take. Dr.
Schneider noted that other states seem to regularly impose civil penalties and questioned why the Board rarely takes such
action. Ms. Boucek explained that the Arizona Medical Board may impose civil penalties as well, and if they do, the fine will go
into the State’s general fund, not to the Board.

The Litigator may attempt to settle the case prior to the scheduled Formal Hearing date. If the case proceeds to Formal Hearing,
the Administrative Law Judge (ALJ) has 20 days to complete the Order, after the record is closed and the Office of
Administrative Hearings provides the Board with the ALJ’s Recommended Order for the Board’s final decision on the matter.

Ms. Boucek answered questions of the Board regarding the definition of the preponderance of evidence. Ms. Boucek explained
that preponderance of evidence is 51% evidence, which is not beyond a reasonable doubt, and is not clear and convincing
evidence. Ms. Boucek also explained that the quantity of the evidence does not determine the 51%, but rather the weight that is
given to each piece of evidence.

Dr. Khera asked what the time frame is for getting a case to Formal Hearing when a physician is suspended by a hospital. Ms.
Boucek explained there is no statutory time frame for cases that go to Formal Hearing, but the goal is within 90 days. However,
if the Board takes summary action on the matter, the case will go to Formal Hearing within 60 days. Dr. Lee said the Board has
cleared up a significant backlog for cases going to Formal Hearing and complimented staff and the Legal Advisors and litigators
on taking care to find the balance between making sure the physician has the due process rights, while at the same time moving
quickly to protect the public.

Investigations Manager, Patricia McSorley explained that the Board sends a notification to all hospitals in Arizona, upon
receiving information of the suspension of hospital privileges. Ms. McSorley also recognized that there are some cases involving
the suspension by a hospital that may result in dismissal, if after completion of an independent investigation by Board staff,
there is no preponderance of evidence to support a violation of the Medical Practice Act. The Board discussed the possibility
of again notifying the hospitals when a suspension has been lifted, although that is not required by statute.

Lisa Wynn, Executive Director said she had the opportunity to meet with Steve Nash, Executive Director of the Pima County
Medical Society, and members of the public in Tucson to create discussion and interviews and dialogue. Ms. Wynn explained
that, as a result, the Board has made improvements. The first change is providing the licensee with a redacted copy of the
anonymous complaints, rather than Board Staff’s summary of the complaint. Secondly, staff has made changes to the letter
noticing the licensee of the sustained allegation and the right to opt for either a formal interview or hearing. The revision
advises the physician a meeting can be scheduled to meet with staff to discuss the case prior to opting for a formal
hearing. Finally, when the physician receives a copy of complaint, staff has always granted an extension of time to respond;
however, the notice letter now also states to notify staff if they would like to request an extension.

Affiliated Monitors, Inc., Presentation

Vincent L. DiCianni, President of Affiliated Monitors spoke on the monitoring services they provide. They are an independent
entity that is neither an advocate for the Board or the physician. Affiliated Monitors takes instruction from the Board’s Order to
ensure that the physician is maintaining compliance with the terms and conditions of the required Order. Affiliated Monitors
oversees a broad range of monitoring cases including, boundary issues, chaperone requirements, record keeping, billing and
coding, insurance fraud and more.

Physician Assessment and Clinical Education (PACE) Presentation

Dr. David Bazzo, Director of Continuing Professional Development & Associate Director and Peter Boal, Administrative Director
spoke to the Board concerning PACE’s processes. PACE is an independent entity who gives an objective assessment. PACE
measures six core competencies for physicians that include: patient care, medical knowledge, practice-based learning and
improvement, interpersonal and communication skills, professionalism, and systems-based practice. The PACE evaluation
consists of Phase I (two-day assessment with multilevel testing) and Phase II (five-day off site) assessments. PACE also offers
a mentoring program and courses in anger management, medical record keeping, Physician Assistant Supervision, physician-
patient communication, prescribing, professional boundaries, wrong site surgery. PACE also offers a program called PACE Law
and Medicine for attorneys and Administrative Law Judges.

Physician’s Health Program (PHP) Overview and Performance Measures

Michel Sucher, M.D., of Greenberg & Sucher spoke about the contractual services that his company provides to the Board with
regard to the agency’s Physician Health Program. Dr. Sucher explained that the assessments that they perform include
substance abuse, drug testing, medical polygraph, psychological evaluations and psychiatric evaluations, when indicated, along
with review of collateral information. Dr. Sucher explained that their program can also help monitor conditions other than
substance abuse, such as boundary issues and disruptive behaviors. At the end of the assessment, Board staff receives their
report and recommendation for further evaluation and/or treatment. PHP also provides monitoring services for physicians and
physician assistants who are required to participate in the Board’s Monitored Aftercare Program for alcohol and substance
abuse. He stated that the drug testing has been enhanced by improvements in advanced drug tests that can detect substances
for longer periods of time.
Consideration and/or Approval of Potential Statutory Amendments and Initiatives
Lisa Wynn, Executive Director, discussed House Bill (HB) 2545 and that it was written in broad language for regulatory Boards.
The bill is scheduled to take effect on January 1, 2012. Ms. Wynn pointed out a conflict between sections “C” and “D” where it
states the Board “may not” and “may” have a physician’s non-disciplinary actions available on the Board’s website. The Board
discussed the matter of whether or not they wanted to continue listing non-disciplinary actions on the Board’s website and many
varying opinions were discussed at length. The Board determined they would wait for clarification on the Bill before making any
changes and instructed staff to gather information regarding this issue from stake holders and attempt to clarify and reconcile
discrepancy in the legislation.

The Board also discussed page 7 of the Omnibus Bill, which proposes that physicians may give immunizations and vaccinations
to members of their house hold and to patients whom they have not performed a physical for. Ms. Wynn explained that she has
preliminarily spoken to stake holders such as the Department of Health Services who approve of the language.

Ms. Wynn discussed the Board’s website and queried what information the Board would like to maintain on the site. Dr. Petelin
asked if the public would have access if the Board performed a criminal back ground check for licensees. Dr. Lee said that the
licensee must note in his application whether or not he/she were convicted of a felony. Ms. Wynn commented that the licensee’s
application is public record, which the public could request.

Dr. Petelin said he felt we could serve the public best by maintaining pertinent information on the Board’s website. Dr Lee noted
that website information that is not pertinent may make new physicians hesitant to practice in Arizona. Ms. Boucek stated that
under HB 2545, the Board would be required to place a comment on the website that additional information is available upon
request to the public. The Board did not make a decision on the matter, but determined to discuss this matter further at a future
meeting.

The Board discussed the revisions to the Arizona Revised Statutes contained in the Medical Board’s Omnibus Bill that propose
amendments to several statutes that govern healthcare. Ms. Wynn said that under section §32-1436, the Board is currently
permitted to charge physicians up to $200 for an initial dispensing license and $150 for renewal of that license. However, Ms.
Wynn stated that some physicians mistakenly think they must have the dispensing license in order to write prescriptions. Ms.
Wynn explained that the dispensing license is not necessary in order for physicians to prescribe and if the board were to
eliminate the requirement, the financial impact to the board would not be significant.

Ms. Wynn also explained that section §32-1452, requires that the Board receive quarterly reports for compliance with substance
abuse monitoring. However, the Board is currently notified immediately if a physician is non compliant and; therefore, there is no
benefit in receiving the quarterly reports.

Ms. Wynn then spoke on Section §32-2842 concerning the requirements for a physician licensed to read or interpret
mammograms and said it appears to be a potentially unnecessary legislation as many of the requirements are listed to be a
hold-over of requirements. Additionally, Ms Wynn pointed out that federal law addresses this issue. Dr. Petelin, said he
considered the legislation to be significant in that it was written cover non-radiologists, such as general surgeons, who perform
stereotactic biopsy procedures or an orthopedic surgeon who has the responsibility to look at a magnetic resonance imaging
(MRI) study. Dr. Petelin said there is an overlap of specialists who need to look at images.

Ms. Wynn said that section 7 is new language proposed to address the issue of the shortage of general practice and family
practice physicians in Arizona. Ms. Wynn explained that this would be a pilot program, where applicants of this specialty could
apply for an Arizona initial license at no charge. Evangeline Webster, Business Office Manager said that the Board’s revenue
reduction may be offset within one to two years. Dr. Petelin stated that physicians may not stay in practice in Arizona just
because they didn’t have to pay the initial license fee. Dr. Lee said the pilot program is a good attempt to resolve the issue of
family practice and general practice specialty shortage in Arizona.

Ms. Wynn also covered information in a handout titled “An Act” which seeks to amend §36-2604 that refers to the prescription
database available to health care providers. Ms. Wynn explained that the Board would like to utilize the prescription monitoring
program to help monitor licensees who are under existing Board Orders The proposed language would clarify the Board’s
authority to utilize the database for this purpose. Ms. Wynn also pointed out that there would be a fee for the database services
going forward, both for the Board and the individual practitioners.

Ms. Boucek informed the Board of the proposed legislation governing the medical use of marijuana. The proposed legislation
states the physician shall not be subject to any penalty for the prescribing of marijuana, if the physician believes it is therapeutic
to the treatment of a patient and the Board would not be able to take disciplinary action against a physician for this diagnosis.
The Board formed a subcommittee to address the issues related to the medical use of marijuana. The Board named Dr. Petelin
as the chairman and Ms. Griffen and Dr. Thrift as subcommittee members.
The meeting adjourned at 4:08 p.m.

___________________________
Lisa S. Wynn, Executive Director