Arizona Regulatory Board of Physician Assistants

Arizona Regulatory Board of Physician Assistants 9545 East Doubletree Ranch Road Scottsdale, Arizona 85258-5514 Telephone: 480-551-2700 Fax: 480-551-2705 www.azpa.gov Janice K. Brewer Governor Joan M. Reynolds, M.M.S., P.A.-C Chair DRAFT MINUTES FOR REGULAR SESSION MEETING Held on Wednesday, November 16, 2011 9535 E. Doubletree Ranch Road Scottsdale, Arizona 85258 CALL TO ORDER PA Reynolds called the meeting to order at 1:00 p.m. Board Members Joan M. Reynolds, M.M.S., P.A.-C, Chair Carole A. Crevier Michael E. Goodwin, P.A. Geoffrey W. Hoffa, M.S., P.A.-C Lesley A. Meng, M.D. Gary A. Smith, M.D., F.A.A.F.P. Patrick J. Van Zanen Peter C. Wagner, D.O. Kelli M. Ward, D.O., M.P.H., F.A.C.O.F.P. Myles A. Whitfield, P.A. ROLL CALL The following Board members were present: Ms. Crevier, PA Goodwin, Dr. Meng, PA Reynolds, Dr. Smith, Mr. Van Zanen, and PA Whitfield. The following Board members were CALL TO THE PUBLIC There were no individuals who spoke during the call to the public. EXECUTIVE DIRECTOR S REPORT Lisa S. Wynn, Executive Director, welcomed PA Whitfield to the Board. Ms. Wynn announced that Paul Parker has accepted the position of Licensing Manager. She stated that the Licensing Office has been undergoing process improvements in an effort to streamline initial licensure allowing staff to focus on the more complex applications. Ms. Wynn reported that she had the opportunity to meet with the Governor s Health Care Policy Advisor and the Executive Director of the Pharmacy Board to discuss prescription drug overdoses. Ms. Wynn reported that recent data from the CDC shows an alarming rate in which accidental prescription drug overdoses have increased nationwide. Ms. Wynn stated she is eager to work with the Governor s Office and the Pharmacy Board to promote the use of the prescription monitoring database, which according to the Pharmacy Board only 8% of physicians are utilizing. Ms. Wynn stated that the Board should be proactive in getting information out to its licensees who treat pain patients without reducing the availability of pain medication for patients who need it. APPROVAL OF ANNUAL FEES PA Reynolds observed that there have been no changes made to the Board s fees, and spoke in favor of approving the fees as they currently stand. MOTION: PA Goodwin moved to approve the Annual Fees as they currently stand. PA RULES UPDATE Kathleen Phillips, Rule Writer, provided the Board with an overview of the rule writing process. She explained that initially, the Board is required to open a docket to begin the rule writing process. She stated that the docket serves the purpose of providing notice and a summary of the Board s proposed rule writing. Ms. Phillips informed the Board that within one year, the final notice of proposed rulemaking shall be submitted to the Secretary of State s Office. She stated that the notice should include a notice of hearing, which is an oral proceeding that the Board will hold to obtain public comment from persons interested in the rulemaking. Ms. Phillips explained that within 120 days following the oral proceeding, the public comments shall be considered and addressed, and the notice of final rulemaking will be submitted to the Governor s Regulatory Review Council (GRRC). Ms. Phillips reported that GRRC will review the material to determine whether it is clear and understandable, and to ensure that the Board has not

exceeded its statutory authority. Ms. Phillips stated that once the Board receives GRRC s approval, the rules are then submitted to the Secretary of State s Office and become effective after sixty days. Ms. Phillips reported that she has been working with Ms. Wynn and her staff on the draft rules to meet the statutory authority that has been granted to the Board. She requested that the Board review the draft and submit any comments or concerns to Ms. Wynn within thirty days. Ms. Phillips also stated that the Board could form a Subcommittee to review the draft, or post the draft to the Board s website and invite public comment. Ms. Wynn stated that the Board has the option of expanding its audience with key stakeholders such as the Arizona State Association of Physician Assistants (ASAPA) or the hospital association. PA Reynolds questioned Board members as to whether the Board should form a Subcommittee or post the draft to the Board s website. Ms. Crevier spoke in favor of forming a Subcommittee to review the draft. PA Reynolds instructed Board members to review the draft rules and submit any comments or questions to Ms. Wynn via email. She stated that if there is a need for further clarification regarding a particular issue, the Board could form a Subcommittee. PA Reynolds recommended that the Board members review the draft simultaneously with stakeholders. APPROVAL OF MINUTES PA Reynolds stated that she noted a typographical error of a date within the August 24, 2011 Regular Session Meeting Minutes and spoke in favor of approving the minutes as amended. MOTION: PA Reynolds moved to approve the August 24, 2011 Regular Session Meeting Minutes, as amended. SECONDED: PA Goodwin ADVISORY LETTERS MOTION: Dr. Smith moved to issue an Advisory Letter in item numbers 1 and 2. 1. PA-11-0063A RICCI SILBERMAN, P.A. 1572 Issue an Advisory Letter for improper prescribing. This matter does not rise to the level of discipline. 2. PA-11-0094A MARK C. DE LA LAMA, P.A. 3073 Issue an Advisory Letter for sanction imposed by a federal agency, and for making an inaccurate statement on his 2004 license application. This matter does not rise to the level of discipline. REVIEW OF EXECUTIVE DIRECTOR DISMISSAL 1. PA-11-0056A BARRY D. MCMILLON, P.A. 2753 Uphold the dismissal. Elle Steger, Investigator, summarized that a complaint was filed by RT alleging that PA McMillon misstated the name of his supervising physician during a deposition for a malpractice case, and that he made false statements in RT s medical record regarding alcohol abuse. Ms. Steger reported that Board staff did not substantiate a violation of statute and noted that the malpractice case is pending. MOTION: PA Goodwin moved to uphold the dismissal. SECONDED: Mr. Van Zanen OTHER BUSINESS Accept the proposed Consent Agreement for a Letter of Reprimand and One Year Probation. Within six months, obtain 15-20 hours of Board staff preapproved 1. PA-11-0037A REBEKAH REINKE, P.A. 2329 Category l CME in an intensive, in-person prescribing course. The CME hours shall be in addition to the hours required for the renewal of licensure. The Probation shall terminate upon successful completion of the CME. Kathleen Coffer, M.D., Medical Consultant, summarized that a pharmacy survey revealed that PA Reinke prescribed multiple prescriptions of anabolic steroids for six different patients, and the prescriptions had been written in excess of PA Reinke s prescribing authority. Five patients charts were selected for review by a medical consultant, who observed that PA Reinke prescribed a schedule ll medication in excess of the 14-day limit of her scheduled medication prescribing authority, without obtaining co-signatures for the prescriptions. Dr. Coffer reported that multiple deviations from the standard of care were identified and that the Board s Staff Investigational Review Committee (SIRC) recommended a Letter of Reprimand with Probation requiring Page 2 of 5

the PA to obtain Category l CME in an intense, in person prescribing course. Dr. Smith complimented Board staff for investigating the matter. He agreed with SIRC s recommendation and spoke in favor of accepting the proposed Consent Agreement. MOTION: Dr. Smith moved to accept the proposed Consent Agreement for a Letter of Reprimand and One Year Probation. Within six months, obtain 15-20 hours of Board staff pre-approved Category l CME in an intensive, in-person prescribing course. The CME hours shall be in addition to the hours required for the renewal of licensure. The Probation shall terminate upon successful completion of the CME. 2. PA-07-0054A RUBEN A. DAMOUS, P.A. 1141 Grant the request for probation termination. Celina Shepherd, Investigator, summarized that on August 20, 2008, PA Damous entered into a Consent Agreement for a Decree of Censure and Five Year Probation. The Consent Agreement provided that after three years, PA Damous may petition the Board for termination of the remaining two years of probation. Ms. Shepherd informed the Board that PA Damous has been compliant with the terms and conditions of his Probation, and that Board staff determined that the request for termination is appropriate. MOTION: PA Goodwin moved to grant the request for probation termination. SECONDED: PA Whitfield 3. PA-11-0014A RACHEL A. PTAK, P.A. 4582 Accept the proposed Consent Agreement for a Letter of Reprimand. Ms. Shepherd summarized that the Medical Director of Emergency Services at Tucson Medical Center (TMC) alleged that in January 2011, PA Ptak wrote an antibiotic prescription for CK on a prescription form that did not contain the name of her supervising physician. The Medical Director pointed out that CK was not a patient of TMC and that PA Ptak had not been employed by TMC since May 2010. PA Ptak later admitted that CK is her husband. A Medical Consultant reviewed the case and found that PA Ptak deviated from the standard of care for prescription writing, that she wrote multiple prescriptions for her husband without the delegated authority of her supervising physician and without appropriate documentation. Mr. Van Zanen noted that PA Ptak is currently awaiting licensure in Texas. Mr. Van Zanen stated that he is bothered by the PA s lack of candor and stated it seemed that she was willing to be forthcoming only when presented with evidence of unprofessional conduct. MOTION: Mr. Van Zanen moved to accept the proposed Consent Agreement for a Letter of Reprimand. SECONDED: Dr. Smith PA Goodwin questioned whether the Letter of Reprimand will be reported to other states. Ms. Wynn informed the Board that the disciplinary action will be reported to the National Practitioner s Data Bank (NPDB). Ms. Wynn explained that the NPDB is available for other state boards to query an applicant s disciplinary history. Ms. Shepherd informed the Board that PA Ptak indicated that the Texas Board will not make a decision regarding her license application until this case is resolved. LEGAL MATTERS 1. PA-09-0078A PA-10-0003A VALENTINE E. OKON, P.A. 2363 Deny the motion for rehearing/review. PA-10-0017A Mr. Van Zanen was recused from this case. Attorney Michael Denea was present on behalf of PA Okon. Mr. Denea stated that the motion for rehearing/review was filed due to a number of issues relative to irregularities in the Board s procedural history regarding his client s situation. Mr. Denea explained that based upon PA Okon s conduct during the course of a Formal Interview in November 2009, a new case was opened. Mr. Denea stated that the initiation of a new investigation was beyond the Board s statutory authority. Mr. Denea stated that the Interim Order for PACE that required PA Okon to enroll and pay for the evaluation within thirty days was deficient. He said that nevertheless, PA Okon gave every indication that he was willing to participate; Page 3 of 5

however, due to the substantial cost associated with PACE, he requested and was denied an extension to pay the costs of the evaluation. Mr. Denea stated that as a result of PA Okon s failure to pay for PACE within the required time, the Board opened a new investigation. Mr. Denea also claimed that individuals from PACE testified at the Hearing that there may have been racially biased aspects of the Microcog testing that was performed during PA Okon s evaluation. Mr. Denea further stated that he and his client believe that PA Okon entered into the Consent Agreement for a Practice Restriction because he was told by Board staff that he had no choice other than to do so. Anne Froedge, Assistant Attorney General, requested that the Board deny the request for rehearing/review as there were no irregularities in this matter. Ms. Froedge stated that this was a particularly egregious matter given that PA Okon has demonstrated that he will not abide by any Board Orders and that he cannot be regulated by this Board. Ms. Froedge addressed the statements made by Mr. Denea regarding the alleged irregularities in the Board s processes as they pertain to his client. She clarified that the Board was well within its right to open a new investigation to assess the PA s competency, pursuant to A.R.S. 32-2551.A. Ms. Froedge stated that although PA Okon did not participate timely in the PACE evaluation, his violation of the Order for PACE was not pursued at the Formal Hearing. Ms. Froedge pointed out that the evaluation results indicated that PA Okon performed poorly at PACE. She reported that one of the PACE evaluators testified at the Hearing that he was extremely concerned regarding PA Okon s Microcog testing and that he believed a neuropsychological evaluation was warranted based upon his behavior during the course of the evaluation. Additionally, Ms. Froedge informed the Board that PA Okon voluntarily signed the Consent Agreement for Practice Restriction without duress and while he was represented by an attorney. MOTION: PA Goodwin moved to deny the motion for rehearing/review. SECONDED: Dr. Meng PA Goodwin, Dr. Meng, PA Reynolds, Dr. Smith, and PA Whitfield. The following Board member was recused: Mr. Van Zanen. The following Board members were VOTE: 6-yay, 0-nay, 0-abstain, 1-recuse, 3-absent. FORMAL INTERVIEWS 1. PA-11-0006A ELIZABETH L. VITO, P.A. 3304 Draft Findings of Fact, Conclusions of Law and Order for a Letter of Reprimand and Five Year Probation to participate in PHP. PA Vito s PHP participation shall be retroactive to July 6, 2011. PA Vito shall continue treatment with a Board approved psychiatrist. PA Vito was present without legal counsel. Kathleen Coffer, M.D., Medical Consultant, summarized that PA Vito admitted to diverting scheduled ll narcotics from her office. She underwent an assessment and entered into an Interim Practice Restriction in January 2011. PA Vito self-reported a DUI later that month, and the Board s Physician Health Program (PHP) Monitor recommended inpatient treatment, which she successfully completed in March 2011. Prior to entering into PHP, PA Vito tested positive for alcohol and she subsequently underwent long-term treatment that she successfully completed in June 2011. The PHP Monitor assessed PA Vito and deemed her safe to practice while participating in PHP. PA Vito subsequently entered into an Interim Consent Agreement for PHP participation and the Interim Practice Restriction was terminated. Board members questioned whether PA Vito had adequate support to assist her through recovery. PA Vito assured the Board that she has developed a support system and network of friends through her treatment program. PA Vito informed the Board that she has been sober for 262 days, and that she is currently working part time performing physical examinations. PA Vito reported that she has a pending position at United Surgical Assist, and that she is currently awaiting the credentialing process. She explained that her new position will consist of assisting different surgeons in the operating room. She stated that the required work hours will be dramatically less than before. Ms. Crevier questioned whether the PA had a system in place to prevent a future occurrence of the events that have transpired. PA Vito stated that she has developed coping mechanisms to prevent stressors from overwhelming her. PA Vito stated that she is confident that she will continue to progress in her recovery and rehabilitation. MOTION: PA Reynolds moved for a finding of unprofessional conduct in violation of A.R.S. 32-2501(18)(d) Habitual intemperance in the use of alcohol or habitual substance abuse; and A.R.S. 32-2501(18)(s) Prescribing, dispensing, or administering any controlled substance or prescription-only drug for other than accepted therapeutic purposes. PA Goodwin observed that PA Vito s current supervising physician is her treating psychiatrist and questioned whether a conflict exists that may violate professionalism standards. PA Goodwin expressed concern regarding the type of practice PA Vito is entering regarding direct physician supervision. Ms. Crevier noted that surgical assisting includes pre and postoperative evaluations of patients, which will require the PA to meet with her supervising physician on a weekly basis to review patient charts. Jennifer Boucek, Assistant Attorney General, stated that concern regarding possible violation of professionalism standards was not an issue investigated under the current case. She proposed that the Board either return the case for further investigation or adjudicate the current case and open a new investigation to address the Board s concerns. Page 4 of 5

PA Reynolds stated she believed this matter rises to the level of discipline and agreed with SIRC s recommendation for a Letter of Reprimand and PHP Probation with psychiatric monitoring. MOTION: PA Reynolds moved for a draft Findings of Fact, Conclusions of Law and Order for a Letter of Reprimand and Five Year Probation to participate in PHP. PA Vito s PHP participation shall be retroactive to July 6, 2011. PA Vito shall continue treatment with a Board approved psychiatrist. SECONDED: Dr. Smith PA Goodwin spoke against the motion and reiterated his concerns regarding PA Vito entering into a practice without direct physician supervision. Dr. Meng, PA Reynolds, Dr. Smith, Mr. Van Zanen, and PA Whitfield. The following Board member voted against the motion: PA Goodwin. The following Board members were VOTE: 6-yay, 1-nay, 0-abstain, 0-recuse, 3-absent. PA Reynolds questioned whether the Board had the ability to conduct chart reviews to ensure that PA Vito is performing according to what is expected of a PA in this kind of situation. Ms. Boucek pointed out that an assessment was performed by the PHP Monitor, who found that PA Vito is safe to perform healthcare tasks while participating in PHP. Ms. Boucek further stated that the Board has not received evidence to support that the PA has committed unprofessional conduct regarding her performance of healthcare tasks. The meeting adjourned at 2:48 p.m. Lisa S. Wynn, Executive Director Page 5 of 5