In November, I had the honor of
being sworn in as the North Carolina
Medical Board’s 119th President.
A little over five years ago, when I
was a new Board Member, it would
have been hard to believe I’d find
myself in the top leadership position.
Like many physicians, aside from
the direct experience renewing my
license each year, I had very little
understanding of NCMB’s role in
the practice of medicine. I became
interested in learning more through
my work as a partner in a large
emergency medicine practice in
Charlotte, where I am responsible
for responding to the occasional
complaints we receive from patients.
We are usually able to resolve
concerns without further escalation
but, from time to time, I’d receive a
letter from NCMB directing me to
respond to a complaint from a patient
seen by a provider in my group had
submitted.
I’ll admit to feeling somewhat
NCMB’s mission:
more than patient
protection
Timothy E. Lietz, MD
SPOTLIGHT
The burnout burden
According to the 2018 Medscape
National Physician Burnout &
Depression Report, 42 percent
of physicians in 29 specialties re-ported
symptoms of professional
burnout. Women report burnout
more frequently than men.
FROM THE PRESIDENT
FORUM North Carolina Medical Board
ISSUE NO. 4 | First Quarter 2018
afronted by having to answer to the
medical board. I happen to believe
that my practice, and the larger
community of physicians and other
medical professionals, hospitals
and others involved in the delivery
of medical care in Charlotte, do an
excellent job of holding one another
accountable, when necessary. In an
emergency department, we practice
in a fishbowl and everyone knows
what everyone else is doing. When
someone is not practicing up to
standard, everyone knows and that
behavior won’t be tolerated for long.
What additional value, I wondered,
could the medical board possibly
provide?
Serving on the Board – and
specifically, reviewing disciplinary
cases – quickly taught me that
the level of transparency and
accountability I take for granted isn’t
necessarily in place in every practice
environment. There are a lot of areas
in NC where the licensee practices in
his or her own bubble and no one is
watching. Who holds that physician
or PA responsible if patient care is
substandard? Who intervenes if the
licensee exploits patients sexually or
financially? Who will ensure that he
or she gets assistance with substance
Continued on pg 2
IN THIS ISSUE
STOP Act prescribing limits............ 3
2017 Position statement review.....5
NC CSRS adds multistate data.....7
Wellspring by NCPHP.....................8
Five questions: Shawn P. Parker, JD,
MPA...............................................11
Burnout rates reported, by sex
Source: Medscape 2018 National Phy-sician
Burnout & Depression Report
48% 38%
Female physicians Male physicians
use or mental
health
problems, if
needed?
In many cases
that come to
the Board’s
attention,
NCMB is the
patient’s only
means of
holding medical providers accountable, and the only
agency with the authority and imperative to act. I
should also say that inadequate oversight is not limited
to rural or less populous parts of North Carolina. No
part of the state or practice environment is perfect at
identifying and addressing problems with professional
misconduct or medical care.
When NCMB acts to address serious problems with
licensee conduct or care, we protect both the people
of North Carolina and the integrity of the medical
profession. Allowing misconduct or substandard care
to continue unchecked impugns the reputations of all
honorable and competent medical professionals. In
situations where impairment has eroded a physician
or PA’s professional and personal life, the Board’s
involvement is often the start of a process that literally
saves that licensee’s practice, not to mention life.
NCMB’s mission truly is to regulate medicine and
surgery for “the benefit and protection of the people
of North Carolina” – a group I have come to realize
includes the medical professionals it regulates.
Board Officers
President
Timothy E. Lietz, MD | Charlotte
President-elect
Barbara E. Walker, DO | Kure Beach
Secretary/Treasurer
Bryant A. Murphy, MD | Fayetteville
Immediate Past President
Eleanor E. Greene, MD | High Point
Board Members
Debra A. Bolick, MD | Hickory
A. Wayne Holloman | Greenville
Venkata Jonnalagadda, MD | Greenville
Michaux R. Kilpatrick, MD, PhD | High Point
Varnell McDonald-Fletcher, PA-C | Durham
Shawn P. Parker, JD, MPA | Raleigh
Jerri L. Patterson, NP | West End
John W. Rusher, MD | Raleigh
Ralph A. Walker, JD, LLB | Greensboro
Contact Us
Street Address:
1203 Front Street
Raleigh, NC 27609
Telephone:
(800) 253-9653
Fax:
(919) 326-1130
Website:
www.ncmedboard.org
Email:
info@ncmedboard.org
Have something for the editor?
forum@ncmedboard.org
Forum Staff
Publisher
NC Medical Board
Editor
Jean Fisher Brinkley
Designer
Sylvia French-Hodges
The Forum of the North Carolina Medical Board is published four times a year. Articles appearing in the Forum, including
letters and reviews, represent the opinions of the authors and do not necessarily reflect the views of the North Carolina Med-ical
Board, its members or staf, or the institutions or organizations with which the authors are afiliated. Oficial statements,
policies, positions, or reports of the Board are clearly identified.
We welcome letters to the editor addressing topics covered in the Forum. They will be published in edited form depending
on available space. A letter should include the writer’s full name, address, and telephone number.
FROM THE PRESIDENT
North Carolina Medical Board Forum Credits VOLUME XXI | No. 4
NCMB and Wake AHEC with support from Governor’s Institute have
collaborated on a new webinar and in person panel discussion series on
controlled substances prescribing and we may be coming near you. See full
details at www.ncmedboard.org/controlled-substances-cme-requirement
FREE IN PERSON CONTROLLED
SUBSTANCES CME NEAR YOU
3/31 Morehead City - Crystal Coast Civic Center
4/3 Concord - Carolinas Medical Center
4/19 Salisbury - Rowan Museum
5/8 Shelby - Carolinas Medical Center,
5/9 Clemmons - Village Inn Event Center
Be well,
Timothy E. Lietz, MD
Board President
Dr. Timothy E. Lietz was sworn in as NCMB’s
119th President on November 16, 2017
FORUM | First Quarter 2018 | 3
The prescribing limits contained in NC’s opioids law,
the STOP Act of 2017, took efect Jan. 1, imposing
new restrictions on initial prescriptions for acute
pain. This change to state law has generated many
questions from prescribers and patients.
The basics
The limits apply to initial prescriptions for acute
pain, including post-operative pain, when a Schedule
II or Schedule III opioid or narcotic is prescribed.
For post-operative pain, initial prescriptions must
be limited to no more than a 7-day supply. For non-postoperative
pain, initial prescriptions must be
limited to no more than a 5-day supply. The STOP
Act’s prescribing limits do not afect prescriptions
for chronic pain patients.
Learn more
NCMB has created an extensive list of FAQs
about the new prescribing limits to help licensees
understand what has and has not changed about
current acceptable clinical practices when treating
acute pain. The Board first distributed this content
to email readers of the Forum in January in the
digital supplement NCMB is testing in between full
issues of the newsletter.
The FAQs present basic information about the
prescribing limits, as well as specific scenarios in
which the limits do and do not apply.
What kinds of questions?
You’ll find this and other questions in our
prescribing limit FAQs:
Q: Are prescriptions for Tussionex subject
to the new prescribing limits?
A: No. Although Tussionex (hydrocodone syrup)
is a Schedule II drug, it is typically prescribed for
cough, not acute pain. The STOP Act prescribing
limits apply only when a Schedule II or Schedule
III opioid is prescribed for acute pain. That said,
Tussionex is frequently abused and prescribers
should exercise caution when writing for this
medication. Consider prescribing a short course
suficient to get the patient through the illness,
rather than authorizing whatever insurance will
cover (e.g. 30 days).
Find the STOP Act prescribing limits FAQs at
www.ncmedboard.org/STOP
NC’s new opioid prescribing limits
TRENDING AT NCMB
NCMB has
created a
Spanish
language
version of
its printable
patient
notice on the
acute pain
prescribing
limits that
took efect
Jan. 1. The
Board first
distributed
the notice
to email
readers of
the Forum
in January,
along with information about the limits, which are
imposed by the STOP Act of 2017.
Licensees are invited to download the notice, which
can be used to inform patients about the limits. The
idea for this resource originated with a request from
a medical practice that contacted NCMB to ask if
the Board had prepared anything to help licensees
explain the new prescribing limits to patients.
Find English and Spanish versions of the notice at
www.ncmedboard.org/safeopioids under “NC’s
new opioids law - the STOP Act”. NOTE: Licensees
who practice in settings that provide care on
demand (such as emergency rooms) are urged to
seek legal advice before posting the notice to ensure
compliance with federal EMTALA laws.
STOP Act notice now available
in Spanish!
Need a copy of your 2017
license renewal receipt?
Print one on demand at
www.ncmedboard.org/
PrintMyReceipt
BOARD NEWS
High Point neurosurgeon named to Board
Governor Roy Cooper recently appointed High Point neurosurgeon Dr. Michaux R. Kilpatrick, MD, PhD, to a three-year term on the Board. Kilpatrick will serve through October 31, 2020.
Michaux R. Kilpatrick, MD, PhD
Dr. Kilpatrick’s practice focuses on diagnosing, evaluating, and treating disorders of the spine, brain, and peripheral nervous center in adults. She currently practices with UNC Health Care Regional Physicians Neurosurgery in High Point.
Dr. Kilpatrick, a native of High Point, attended Hampton University in Virginia, where she earned a Bachelor’s degree in Chemistry, magna cum laude. She completed her medical degree at the UNC School of Medicine at the University of North Carolina, Chapel Hill, and a doctorate in neurobiology at the same institution. Dr. Kilpatrick completed postgraduate training in neurosurgery at UNC Hospitals and went on to complete a fellowship in stereotactic and functional neurosurgery at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Kilpatrick is certified by the American Board of Neurological Surgery.
Dr. Kilpatrick is a member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons and the National Medical Association. She serves on the Surgery Governance and Professional Improvement committees of the UNC Health Care High Point Regional Health System, where she was named the 2016-2017 Specialist of the Year.
Michaux R. Kilpatrick, MD, PhD
Beware of faxed “requests” for medicines and medical products
The NC Board of Pharmacy (NCBOP) took action in fall 2017 against several NC pharmacies involved in a national scam that resulted in unnecessary billing for diabetic pain creams and other products not prescribed by the patients’ medical providers. Physicians and PAs are advised to be wary of faxed requests seeking authorization for any treatments they have not personally recommended for their patients.
The pharmacy scam targeted patients with diabetes, often with advertisements promoting free or low cost diabetic testing supplies. According to NCBOP, patients who responded to these ads spoke by telephone with unlicensed, non-medically trained sales representatives who pitched additional products, such as non-narcotic topical pain treatments including lidocaine ointment and diclofenac sodium gel.
After patients provide billing and insurance information, prescription orders are then faxed to the patients’ medical providers for signatures, sometimes without the consent of the patient. Orders indicate that the patient has “requested” the items listed, prompting unsuspecting prescribers to authorize prescriptions and other items not prescribed by a licensed medical professional. This results in billing for items that may be unnecessary and unwanted by the patient. In some instances, patients never received items ordered on their behalf, according to NCBOP.
Bottom line: Be careful about automatically authorizing any order for medicine or medical supplies that you did not prescribe or recommend.FORUM | First Quarter 2018 | 5
New position statements
The Board adopted one new position statement in 2017, entitled Policy for the use of audio or visual recordings in patient care (see the full text of the new position statement on page 6).
Why was this position statement needed?
This position statement originated from the Board’s review of an enforcement case that involved a medi­cal practice’s use of video cameras for security, both in patient examination rooms and in public spaces such as the waiting and parking areas. A patient complained to the Board about this practice, stat­ing specific concerns that the practice did not pro­vide a private area for undressing and dressing. The Board’s primary goals in drafting the position state­ment were to ensure that 1. Patients are provided a place to disrobe or redress in private and 2. Files are stored in a secure manner that is compliant with HIPAA privacy rules.
Amended position statements
The Board approved revisions to the following posi­tion statements.
Drug overdose prevention
What changed? The Board added language to en­courage licensees to support the use of opioid an­tagonists (e.g. naloxone) as a means of preventing death from overdose; The Board also updated lan­guage that summarizes the Board’s efforts to ad­dress patient deaths and harm from opioid over­2017
position statement review
dose to include information about NCMB’s opioids investigative program, the Safe Opioid Prescribing Initiative and implementation of a CME require­ment for controlled substances prescribers.
Guidelines for avoiding misunderstandings during physical examinations
Revised to replace the word “sex” with “gender” in bullet point number two of the position statement.
Medical record documentation
Revised to include a substantial new section specific to Electronic Health Records. The new section is ex­cerpted in the box on page 6.
Professional use of social media
Minor text change to second bulleted statement.
The treatment of obesity
Amended to add concerns about phentermine as an example.
Reviewed, no changes:
The Board reviewed the following position state­ments and determined that no changes are needed at this time.
Professional obligations pertaining to in­competence, impairment, and unethical conduct of healthcare providers
Unethical agreements in complaint settle­ments
What are the position statements of the Board and to whom do they apply?
What are position statements anyway?
Position statements provide guidance on a range of subjects, including direct clini­cal practice, professional ethics, legal and pol­icy matters and other practice related top­ics. All position statements may be accessed at
www.ncmedboard.org/PositionStatements.
A downloadable .pdf copy of the complete position statements is also available online.
The Board reviews position statements at least once every four years, or more frequently if new information or issues come to light that may necessitate reconsideration, expansion or revision of an existing NCMB position. Here’s what the Board worked on in 2017:
Position Statement ReviewNew Position Statement
Amended Position Statement
Electronic Health Records (excerpted from the position statement entitled, Medical record documentation)
The promise and potential of information technology in health care, particularly the use of electronic health re­cords (EHR), presents providers with distinct challenges. While the Board encourages the adoption and appropri­ate use of various forms of EHR there are some unique aspects and problems that have been repeatedly encoun­tered by the Board, some of which are discussed below. This subsection does not identify all of the issues and problems encountered by providers using EHR. Rather it is meant to identify issues which the Board has repeatedly found to be problematic in malpractice cases and com­plaints coming to the Board’s attention. It is important to recognize that this, and other Board position statements, are not comprehensive and do not describe exhaustively every standard that might apply in every circumstance. Basic, well-established principles of medical record docu­mentation, as outlined above, apply to all forms of medi­cal record documentation, including EHR.
The following guidelines are offered to assist licensees in meeting their ethical and legal obligations:
EHR Deficiencies. Providers, on occasion, attribute er­rors or lack of follow-up, such as missed or lost abnormal laboratory results or x-ray reports, to deficiencies in their EHR. This is not acceptable. Providers must be aware of the idiosyncrasies and weaknesses of the EHR system they are using and adjust their practice accordingly. Providers are ultimately responsible for the adequate oversight and monitoring of the EHR.
Responsibility of Licensees. EHR are becoming increasingly sophisticated and may provide flags for follow-up care or other clinical decision-making support, such as health maintenance recommendations. While an EHR system may assist in the clinical decision-making process, it is not responsible for decision making. For example, it is not acceptable to blame an EHR because it failed to recommend particular testing. Increasingly elaborate documentation, clinical management, and pro­ductivity tools may also result in increased opportunities for errors or omissions. These errors are a failure of the provider to assume appropriate responsibility for the care of the patient. In the end, decision-making responsibility rests solely with the provider; regardless of the informa­tion or notices provided by the EHR.
Use of Templates. The Board cautions against overuse of template content or reliance on EHR software which pre-populates, carries forward, or clones information from one encounter to the next, or from different provid­ers, without the provider carefully reviewing and updating all information. Documentation of clinical findings for each patient encounter must accurately and contempora­neously reflect the actual care provided.
Availability of, or Access to, Medical Records. Phy­sicians must be able to provide patient medical records in a timely manner for various situations, such as consulta­tions, transfer of care to another provider, or practice clo­sure. The Board has encountered situations where provid­ers were unable to access their patients’ medical records due to fee or other disputes with the EHR vendor. This is particularly true when the medical records are maintained off site (cloud storage). Providers must understand provi­sions of their contract with the EHR vendor in this regard. These principles of medical record access apply as well to telemedicine providers.
Breakdown of Patient-Provider Communication. Misunderstandings and miscommunications between patients, patient family members, practitioners, and office staff generate a substantial percentage of complaints received by the Board. Many EHR systems allow direct patient-provider communication (i.e. “patient portal”). While this form of communication can facilitate com­munication, such as follow-up of lab or x-ray results or medication refills, they also place a responsibility on the provider to provide timely responses to legitimate re­quests from patients for feedback or information.
Policy for the use of audio or visual recordings in patient care
The Board recognizes that there may be valid reasons for licensees to make audio or visual recordings of patients during a healthcare encounter. However, such recordings must be made for appropriate professional reasons and should employ safeguards that protect a patient’s auton­omy, privacy, confidentiality, and dignity. In instances where a patient may be asked to disrobe, the pa­tient should be provided an opportunity to disrobe beyond the view of any camera.
Prior to an audio or visual recording being made of a pa­tient, licensees should ensure that they have obtained the patient’s informed consent. The informed consent should be documented in the medical record and should allow the patient an opportunity to discuss any concerns before and after the recording.
Recordings that could lead to disclosure of the patient’s identity constitute protected health information and must be managed and transmitted in a manner that complies with HIPAA requirements.
Position Statement ReviewFORUM | First Quarter 2018 | 7
Prescribers registered with the NC Controlled Substances Reporting System (NC CSRS) can now obtain prescription drug histories from other states. The Forum asked the director of Duke Health’s Medical Pain Service, Steven D. Prakken, MD, his thoughts on how this new capability fits in to clinical practice.
What factors would cause you to look at a patient’s prescription history in an­other state?
If about 50 miles or less from the border then I would check it regularly. I would check at intake, then at least every 6-12 months. I would even suggest that anyone you give C2 meds to should have the neighboring states scanned once a year. If someone travels frequently to another state or if they have family in another state, I would check multi-state data regularly.
When would you not run out-of-state histories?
As I’ve indicated, there’s no reason to run multi-state queries for every patient, every visit. I don’t think there is anything that would make me “not” run out of state queries, if the situation fit the parameters stated above. Maybe if it was a script for someone in a nursing facility I could be convinced not to run one.
How do you see the availability of multistate prescription drug data fitting in to your practice and current NC CSRS use?
This is something I have looked forward to for a few years. There are situations every week where I wish I had easy access to surrounding state medication records. This is something I will check commonly for about 25% of my patients. This also is something that staff can be assigned to do.
Physicians and other controlled substances prescribers registered with the state’s prescription drug database now can see what medications their patients have received in other states.
Currently, NC prescribers who use the NC Controlled Substances Reporting System (NC CSRS) can get patient information from Virginia, South Carolina and over a dozen other states through the National Association of Boards of Pharmacy’s PMP InterConnect, which NC recently joined. More states are coming online regularly, as the NC Department of Health and Human Services works to enable additional two-way prescription data sharing agreements with individual states. In all, 45 states are connected to PMP.
To obtain information from another state NC CSRS users must select “Multiple State Query” from the left-hand side of the page, after logging in. Available states are in the field labeled, “Disclosing States.” It will be necessary to run a separate query for each state. In other words, to check a patient’s prescription histories in NC, SC and Virginia, a prescriber or registered delegate would have to run three queries.
CSRS Data Sharing
So, is mandatory NC CSRS in effect now?
Not yet. NC CSRS’s participation in PMP Interconnect is progress towards completion of NC CSRS improvements that are required before mandatory use can be in effect. However, NC DHHS must complete other technical improvements.
NCMB will continue to monitor progress and inform licensees when a specific effective date for mandatory NC CSRS use is established.
Dr. Prakken
NC CSRS captures all controlled substances prescriptions that are dispensed by outpatient pharmacies in North Carolina. Other states’ databases capture similar information. Prescribers can use prescription data to spot potentially harmful or contraindicated drug combinations and to better understand their patients’ habits and behaviors.
NC CSRS connects to multistate data sharing network
NC CSRS now provides multistate data. Now what?Collectively, too many healthcare professionals have a certain maladaptive mindset when it comes to their own health and healthcare. To varying degrees, the internal script goes something like this:
•
I’m too busy to see to my own healthcare needs.
•
My patients need me more than I need me.
•
I will always know when I need help.
•
My special knowledge will protect me.
•
I will always be well.
•
I am my own best doctor.
•
Illness is a sign of weakness.
•
Patient care always trumps self-care.
•
Sure, I’m depressed but I’ll just deal with it in my own way.
•
I know I’m sick but I have to go in to work.
•
All the good I do will protect me.
•
Any health problems I may develop are too far off into the future to worry about now.
These attitudes are inculcated into us throughout medical school and residency. They also come from the prevailing public notion of what a doctor is supposed to be, mostly driven by non-reality based Hollywood fiction.
So, dauntless, we put on our cloaks of invincibility, project the proper doctor persona, and carry on. Despite these attitudes, every provider currently training or in practice will one day take off the white coat and assume the role of patient.
This will happen, because all providers are human. Whether now or sometime in the future, we will experience the same medical maladies and infirmities as our patients. It can seem an especially cruel circumstance to a medical professional who has spent a lifetime seeing to the healthcare needs of others.
Doctors are great when it comes to caring for others, but they are not always so great at taking care of themselves. Far too many physicians and PAs get into trouble and end up before the Medical Board or at NCPHP because they chose to be their own providers and self-medicate rather than seek help from independent qualified professionals.
Burnout rates are extremely high and rising. When physicians burn out they will sometimes act out—with
Accepting role reversal: when the doctor becomes the patient
drugs, alcohol or maladaptive behaviors. Depression can develop or deepen. Of course, the most serious way providers act out is with self-harm. Suicide rates among healthcare providers are alarmingly higher than the in the general population, especially among women.
We must become humble enough and love ourselves enough to accept our own humanity. Self-care must become a priority for every provider. The following changes to attitude and that “internal script” are all that is required:
•
Asking for help when I need it is a sign of strength.
•
I need my own trusted healthcare provider and I will follow his or her advice.
•
Sometimes I need to listen to what those around me are noticing because I may not always be able to see what others see in me.
•
My own health comes first because I can’t be the best doctor for my patients if I’m not healthy and at my best.
•
I will never be so busy that I can’t see to my own needs.
•
I will never serve as my own healthcare provider.
•
If I get sick I’ll follow my provider’s prudent advice.
Everyone wants to achieve a state of wellness, and wellness begins with self-care. How can you determine where you are on the self-care scale? Ask yourself this one important question: Am I as great at taking care of myself as I am at caring for my patients? If the honest answer is no, it is time to turn away from the path of least resilience (pun intended) and make some changes. You, your patients, your family, and your community will be the better for it.
By Clark Gaither, MD
FROM NCPHP
Clark Gaither, MD
Dr. Clark Gaither currently serves as Medical Director for the North Caroli­na Physicians Health Program. He is a board-certified family physician who has dedicated much of his profession­al career to helping physicians and other medical professionals overcome job-related burnout. He is an author and frequent presenter on the topic of professional burnout.Physicians and physician assistants licensed by the Board contributed more than $172,000 to the NC Physicians Health Program Treatment Scholarship Fund during the 12-months ended Dec. 31, 2017. The Scholarship Fund provides financial assistance to licensees who may not otherwise be able to afford treatment. Licensees can contribute to the fund during the annual license renewal process.
Licensee donations support two types of scholarships. Gifts from the Treatment Scholarship Fund help cover the cost of alcohol and substance use treatment. In some cases, funds also may be used to pay for inpatient and outpatient assessments. A second fund, the Michael Wilkerson Family Fund, assists families of practitioners who are in treatment. Awards from this fund can be used to assist with family expenses that arise during the time when a licensee is unable to practice.
The Treatment Scholarship Fund awarded 60 scholarships in 2017, totaling about $170,000.
NCPHP is a not-for-profit organization that provides assessment, referral, monitoring, educational and support services for medical professionals with behavioral and substance use issues. Referrals to NCPHP are confidential. Licensees may remain anonymous, including to the Medical Board, if NCPHP can establish safety to practice or the licensee withdraws from practice while receiving treatment.
Q: What do you like to do in your leisure time?
A: I enjoy spending time with my fam­ily. I am a huge Carolina Panthers fan and I enjoy most, if not all, sports. I am also a bit of a foodie and enjoy watch­ing cooking demonstrations and at­tempting new recipes.
Q: What is the best les­son you have learned from your personal or professional life experiences?
A: “Be kind and try hard” is a mantra of­fered to me by a col­league and good friend, which has now become the expectation and unspoken rule within our family. I find it to be equally applicable professionally as well, and while I cannot quantify the number of successful outcomes from this approach, I fully believe it has im­proved the quality of the process.
BULLETIN BOARD
Q: Why did you want to serve on the Medical Board?
A: The Medical Board functions both as a quasi-judicial and quasi-executive body and it is truly fascinating to be involved in policy and process development in this capac­ity. I am quite proud to be part of such a prestigious insti­tution.
Q: What do you find most rewarding about your service on the Board?
A: The people. There is a very human element to matters that come before the board. I have found my fellow Board Members to be extremely thoughtful and compassionate, and the staff of NCMB regularly demonstrate these same qualities. It is a real honor and very rewarding to serve and work among such dedicated and skilled individuals.
Q: What is the last book you read?
A: I recently read Humanity at Work, by Sandy Costa. It is a compilation of letters, learnings, and other musings con­nected with humor and historic context. I was first drawn in by a reference to [Italian psychologist Roberto] Assagioli’s quote, “There is no certainty, only adventure” and found myself wanting to apply the included wisdoms in my every­day life. Specifically, I like to repeat the following passage to my daughter as part of our tuck-in ritual: “You are a person on unimaginable worth and a treasure unique in all the uni­verse.” I highly recommend saying this to someone you love or even to yourself and see how well it resonates.
Five Questions: Shawn P. Parker, JD, MPA
GETTING TO KNOW THE PEOPLE OF THE NC MEDICAL BOARD
APPOINTED 2016 | ATTORNEY WITH SMITH ANDERSON | PUBLIC BOARD MEMBER| RALEIGH, NC
Supporting colleagues in a time of crisis
FORUM | First Quarter 2018 | 9
Want to donate?
•
Visit: www2.ncmedsoc.org/Donate
•
Complete the donation form
•
Be sure to select NC PHP Treatment Fund or NC PHP Wilkerson Family Fund to direct your gift
•
Donations may also be made through NCMB’s annual renewal processNorth Carolina Medical Board
Quarterly Board Actions Report |August 2017 - October 2017
The Board actions listed below are published in an abbreviated format. The report does not include non-prejudicial actions such as reentry agreements and non-disciplinary consent orders. A complete listing of recent Board actions is available at www.ncmedboard.org/BoardActions.
BOARD ACTIONS
Name/license #/location
Date of action
Cause of action
Board action
ANNULMENTS
GILLESPIE, Dorothy Lee, MD
(201500423) Hattiesburg, MS
10/02/2017
In her January 2015 application MD failed to disclose a pending disciplinary investigation by the Mississippi Board of Medical Licensure for improper prescribing practices. MD was issued a license in NC in March 2015; The same month, the Board discovered that MD had sur­rendered her Mississippi medical license. MD’s failure to disclose these circumstances on her application for a NC license violated the provi­sions of N.C. General Statute § 90-14(a)(3).
Annulment of NC medical license
SUMMARY SUSPENSIONS
SMITH, Michael Alson, MD
(000033467) Mount Holly, NC
10/24/2017
Board possesses information that indicates that MD engaged in forced or coerced sexual acts, sexual contact, and/or vaginal intercourse with patients in an examination room at his practice.
Summary suspension of NC medi­cal license; hearing set for December 2017
REVOCATIONS
NONE
SUSPENSIONS
BYRD, Elizabeth McNeill, MD
(009901257) Winterville, NC
08/08/2017
Alleged boundary violation; MD denies that she engaged in an inappropriate relationship with her patient. MD also denies patient’s allegation that MD requested the he share a portion of his narcotic medications, which MD prescribed, for her own inappropriate personal use.
Indefinite Suspension
FLOM, Jonathan Andrew, MD
(200400331) Fayetteville, NC
08/21/2017
Relapse of substance abuse disorder. MD voluntarily surrendered his license effective June 2017.
Indefinite Suspension
GYARTENG-DAKWA, Kwadwo, MD (200500050) Durham, NC
10/12/2017
In 2014, the Board received a complaint from a relative of one of MD’s patients concerning quality of care. After a records review by an independent physician expert who opined that
MD’s overall treatment failed to conform to the standards of care, MD was assessed for medi­cal competency by the Center for Personalized Education for Physicians. Their report found that MD was not practicing in a dangerous manner and his knowledge of pain manage­ment was mostly adequate, but that there were areas where MD would benefit from additional education and remediation. CPEP recom­mended a structured, individualized remedial medical education plan for MD.
Suspension for one-hundred eighty (180) days immediately stayed in its entirety. MD to begin his Center for Personalized Education for Physi­cians (CPEP) Educational Interven­tion Plan within 30 days from the date of consent order. This includes, and is not limited to, oversight, supervision and direction provided by an approved pain management educational preceptor physician.
LONG, James Randall, MD
(000033456) Lexington, NC
08/29/2017
MD entered into a plea agreement in October 2016 to one felony count of unlawful distribu­tion of Fentanyl. While MD was under federal indictment and was anticipating accepting the plea agreement where he would plead guilty to the charge, MD opened two additional medical practices. MD operated one of them by placing a physician in the practice after MD had surren­dered his license on December 2016. Although MD made a good faith effort to transfer owner­ship after surrendering, by continuing to own and operate the medical practice MD engaged in the corporate practice of medicine.
Indefinite suspension of NC medical license; MD may not apply for rein­statement for a period of two years from the date of the surrender of his license, which shall be December 1, 2018.
MCGRATH, Timothy John, MD
(200200571) Greensboro, NC
08/04/2017
Relapse of substance abuse disorder. MD vol­untarily surrendered his license in May 2017.
Indefinite Suspension of NC Medical LicenseBOARD ACTIONS
Name/license #/location
Date of action
Cause of action
Board action
SPERRAZZA, Robert Bruce, MD
(009401053) Panama City Beach, FL
09/26/2017
In April 2014, MD was convicted of a felony for Tax Evasion and Structuring Financial Trans­actions in United States of America v. Robert B. Sperrazza, 1:12-CR-00006-01. MD was sentenced to a period of imprisonment and released in February 2017. MD’s NC medical license became inactive in November 2014.
MD’s NC medical license suspended retroactively from April 2014 to Feb­ruary 2017. MD’s NC medical license shall remain inactive.
PROBATION/CONDITIONS
BAILEY, Scott Allen, MD
(200500604) Mebane, NC
10/03/2017
MD has a history of alcohol abuse and had pre­viously had his NC medical license indefinitely suspended. MD is an ongoing participant in NCPHP; NCPHP reports that MD is fully compliant with all its recommendations, and advocates for his return to practice.
MD shall maintain his NCPHP con­tract and complete 36 hours of Cate­gory 1 CME in pediatrics, including a pediatric advanced life support CME course approved in advance by the Board’s Office of Medical Director.
BECERRA, Gonzalo Daniel, MD
(201101599) Winterville, NC
10/13/2017
MD has a history of alcohol abuse and had previously entered into a consent order in
November 2016 with the Board, in which his license to practice medicine was indefinitely suspended. NCPHP reports that MD has fully complied with his monitoring contract and advocates for MD licensure reinstatement.
License reinstated; MD to maintain his current contract with North Car­olina Physicians Health Program and abide by its terms.
REPRIMANDS
HINES, Marcono Raymond, MD
(000022578) New Bern, NC
08/03/2017
In September 2016, the Board received infor­mation from the NC Department of Health and Human Services (“DHHS”) related to MD’s controlled substance prescribing. Four patients’ records were reviewed by an expert pain management physician and each record showed that MD significantly departed from standards of acceptable and prevailing medical practice. Areas of concern included inadequate record keeping, inadequate drug screening and failure to appropriately respond to aberrant drug test results, poor evaluation of patient risk factors and potential drug interactions, opioid prescribing in the absence of a docu­mented and justifiable diagnosis, and inade­quate pharmacovigilance.
Reprimand; MD agrees to refrain from prescribing Schedule II and III controlled substance within 60 days following date of this order. MD’s records shall be monitored by a Board approved physician monitor for six months, with regular face-to-face meetings. MD is ordered to complete 10 hours of Category 1 CME in medical record keeping and controlled substance prescribing. MD shall query the NC Controlled Substances Reporting System for ev­ery prescription for Schedule IV and V controlled substances he issues. MD shall read the Board’s Position Statement entitled Policy for the use of opiates for the treatment of pain and submit a written attestation that he has. After completing all require­ments, MD may petition the Board to modify this order to allow him to pre­scribe Schedule II and III controlled substances; the Board is under no obligation to approve such a request.
KWIATKOWSKI, Timothy Carl, MD
(009701443) Charlotte, NC
09/19/2017
The Board received a complaint in March 2016 from a patient’s family regarding MD’s care and treatment of their family member in Jan­uary 2015. MD had failed to attend to patient’s low oxygen saturation levels, and the patient suffered a cardiac arrest and died. In February 2016, the Board received a report of a Change in Staff Privileges (“CISP”) from Carolinas Healthcare System and the Board opened an investigation addressing MD’s care of three ad­ditional patients. The reviewing medical expert found several quality of care issues with MD’s diagnoses and treatments.
Reprimand; MD shall maintain his current two-year contract with NCPHP.
DENIALS OF LICENSE/APPROVAL
SHANTON, Gregory Damon, PA
(000101943) Newport, NC
08/31/2017
The Board denied PA’s application for reinstatement of his license based on PA’s prior history of substance abuse, diversion of controlled substances for personal use and his­tory of failing to comply with the terms of his September 2007 consent order, which ordered that PA refrain from the use of alcohol. In addition, PA did not actively practice medi­cine during the two-year period immediately preceding the submission of his application to reactivate his suspended license.
Denial of request to reinstate PA license
FORUM | First Quarter 2018 | 11Name/license #/location
Date of action
Cause of action
Board action
SURRENDERS
MCCUTCHEN, William, DO (200501619) Aiken, SC
10/23/2017
Voluntary Surrender of License
TESFAYE, Daniel, MD
(009901623) Lithonia, GA
08/23/2017
Voluntary Surrender of License
WADDELL, Roger Dale, MD
(000030105) Aberdeen, NC
08/18/2017
Voluntary Surrender of License
PUBLIC LETTERS OF CONCERN
BERNDTSON, Keith Robert, MD
(201701889) Park Ridge, IL
08/02/2017
Upon review of MD’s application for a license to practice medicine in North Carolina, the Board was concerned about a Consent Order with the Illinois Board issued in June 2012, in which the Illinois Board found that MD inappropriately prescribed controlled substances to family members and prescribed excessive quantities of controlled substances to a patient. MD’s Illinois medical license was placed on probation for one year and MD agreed to several conditions, including obtaining continuing medical educa­tion related to pain management and controlled substance prescribing.
Public Letter of Concern
BRILL, (II), Louis Beverly, MD
(201200499) Fairfax, VA
09/14/2017
The Board is concerned about a Consent Order that MD entered into with the Virginia Board in February 2017, in which MD was reprimand­ed for failing to identify Patient A’s tumor, resulting in a fourteen (14) month delay in the diagnosis and treatment of Patient A’s cancer.
Public Letter of Concern
CONKWRIGHT, Caroline Elizabeth, PA-C (001005703) Elizabeth City, NC
09/20/2017
The Board is concerned that PA failed to file the required Intent to Practice form with the Board prior to commencing practice and this failure persisted for ~two years until PA was notified by the Board. Additionally, PA failed to conduct and document the required quality improvement meetings with her supervising MD for her first six months of practice.
Public Letter of Concern
DANIEL, Myriam Marie-Jude, MD
(009401167) Greenville, NC
09/13/2017
The Board is concerned that MD co-signed approximately 15 controlled substance prescrip­tions in 2016 for patients she had not seen or treated. The prescriptions were then issued by a PA under MD’s supervision that MD knew had an expired Drug Enforcement Administration registration. MD did this in an attempt to assist PA while he was in the process of renewing his registration. This is an unacceptable practice.
Public Letter of Concern
FULBRIGHT, Renee Annette, MD
(200300619) Gastonia, NC
09/19/2017
The Board is concerned MD may have failed to conform to current accepted standards of care when MD discharged a patient who came to the Emergency Department (ED) complaining of chest pain and shortness of breath. MD ordered and reviewed tests, with the exception of the troponin test results, and discharged the patient before recognizing that her troponin levels were elevated and abnormal. An elevated troponin lev­el is a marker for acute cardiac disease. Patient returned to the ED 10 hours later experiencing acute myocardial infarction and underwent an angiography and stent placement.
Public Letter of Concern
HOLM, Richard Philip, MD
(200401073) Roanoke Rapids, NC
10/20/2017
MD was scheduled to perform trigger finger release surgery on a patient’s right thumb. Prior to surgery and after consent documents had been reviewed, a nurse mistakenly com­bined the patient’s signed consent form with the documents of another patient who was scheduled for carpal tunnel release surgery. MD subsequently performed carpal tunnel release surgery on the incorrect patient. Board acknowledges that while the nurse mistakenly indicated to MD that Patient A was to receive carpal tunnel release surgery, the MD has the ultimate responsibility to do all he can to ensure that the correct operation is performed even in the presence of mistakes by others.
Public Letter of Concern
BOARD ACTIONSName/license #/location
Date of action
Cause of action
Board action
JENSEN, Larry Jay, PA-C
(000102963) Tarboro, NC
09/21/2017
Board is concerned that PA’s examination of patient neglected to include areas relevant to the patient’s presenting complaints. Conse­quently, PA’s patient was released only to return two days later, to be referred to the hospital with ultimately fatal sepsis, thought due to a large necrotic sacral decubitus ulcer which PA failed to diagnose.
Public Letter of Concern, PA to com­plete Category I CME pre-approved by Board’s Office of the Medical Di­rector on the evaluation and manage­ment of decubitus ulcers and sepsis six months from the effective date of this public letter of concern.
MENON, Padman Achutha, MD
(200301017) Virginia Beach, VA
09/12/2017
Board is concerned that MD allowed a PA to begin practicing under his supervision without first submitting the required Intent to Practice form with the Board. As the PA’s primary super­vising physician, MD is required to ensure her compliance with the Board’s rules. Additionally, MD and PA failed to conduct and document quality improvement meetings for PA’s first six months of practice, as required by rule.
Public Letter of Concern
PATTERSON, David Read, MD
(000018696) Greensboro, NC
10/23/2017
Board is concerned that MD inappropriately obtained and prescribed controlled substances for himself and wrote controlled substance prescriptions for an immediate family mem­ber. Prescribing controlled substances to one­self or to close family members is prohibited by Rule 21 NCAC 32B .1001.
Public Letter of Concern; MD inac­tivated his license in February 2017 with no plans to return to practice. Board has provided MD a copy of Rule 21 NCAC 32B .1001 and the Position Statement titled “Self-Treatment and Treatment of Family Members”.
SCALES, John Socrates, MD
(201502423) Ocala, FL
08/28/2017
Action taken by Florida Department of Health (FL Board); The Board is concerned that MD performed a kyphoplasty on patient’s T11 ver­tebrae, which was the wrong site. MD resolved this matter with the FL Board via a June 2017 Final Order and Settlement Agreement. Board urges MD to take steps to ensure the conduct does not happen again.
Public Letter of Concern
SIROIS, Cindy Nguyen, MD
(200601680) Hudson, OH
09/18/2017
The Board is concerned that, when reviewing a patient’s MRI, MD failed to recognize or report the presence of an intraspinal fluid collec­tion that progressed to an epidural abscess compressing the cervical spinal cord. Patient underwent surgical drainage of the epidural abscess but was left with significant long term neurologic injury that might have been less had MD reported condition sooner.
Public Letter of Concern
SMITH, Tracey, PA-C
(000102582) Greenville, NC
09/20/2017
Board received a quality of care complaint from a patient under PA’s care and requested a review be conducted by an external expert specializing in pain management. Upon completion of review, the expert found four significant problems with care: (1) PA failed to use the NC Controlled Substance Reporting System query to determine patient suitability for initiating controlled substances; (2) PA failed to adequately monitor the signs of abuse, misuse, diversion or tampering; (3) PA failed to act on aberrant monitoring findings; and (4) PA’s prescribed Suboxone® (buprenorphine) for opioid use disorder prior to receiving a DATA Waiver to lawfully do so.
Public Letter of Concern; Board requests PA take targeted CME to ad­dress quality of care issues outlined in investigation. Specifically, PA is directed to take four hours of CME in controlled substance management and two hours in urine drug screen interpretation and use.
YAKES, Wayne Francis, MD
(200401355) Englewood, CO
08/01/2017
MD was arrested and charged with Driving While Impaired (DWI) in August 2010, but the charges were dropped. MD was arrested and charged with DWI in June 2015 and MD pled guilty to that charge. The Board is concerned that the MD did not report the August 2010 charge and arrest on his annual renewal appli­cations until March 5, 2016. The 2015 DWI led MD to enter into a July 2016 Stipulation and Final Agency Order with the Colorado Medical Board, which placed MD’s Colorado medical license on probation for five years and required MD to be monitored by the Colorado Physi­cians Health Program.
Public Letter of Concern; MD entered a contract with the North Carolina Physicians Health Program (“NCPHP”) on February 20, 2017. The Board advises MD to comply with all recommendations.
BOARD ACTIONS
FORUM | First Quarter 2018 | 13Name/license #/location
Date of action
Cause of action
Board action
MISCELLANEOUS ACTIONS
FERGUSON, (Jr.), Robert Lee, MD
(000034310) Hope Mills, NC
09/14/2017
Alleged inappropriate prescribing of narcotics; The Board has evidence from which it could conclude that MD’s care failed to conform to current accepted standards of care.
MD’s license is made inactive, in lieu of any further action by the Board.
JAYARAMAN, Arun Laxminarayan, MD (201200668) Phoenix, AZ
09/26/2017
In April 2017, MD submitted a license inacti­vation request to the North Carolina Medical Board. Additionally, in May 2017, MD entered into an Order for Probation; and Consent to the Same with the medical board in Arizona. In the Arizona Consent Order, MD admitted that he had presented for a scheduled shift while impaired by alcohol. The Arizona Consent Order indicated that while MD did not see any patients on that shift, MD’s actions constituted unprofessional conduct; the order placed MD’s Arizona license on probation. MD is required to participate in the Arizona Physician Health Program for one year.
NC medical license made inactive.
CONSENT ORDERS AMENDED
LEWIS, Marvin, MD
(000033542) Spring Lake, NC
10/04/2017
MD requested to be relieved of two conditions contained in his October 2014 Consent Order that 1) Restricted him from prescribing all controlled substances classified as Schedule II, III, and Schedule IV and 2) Restricted MD from supervising any advanced practice prac­titioners, including physician assistants and nurse practitioners. After meeting with MD, the Board decided to grant MD’s request to lift these restrictions, subject to MD’s completion of certain CME.
Amended Consent Order; MD is relieved of the obligations stated in paragraphs three and four of his October 2014 order; Within four months of the date of this amended order, MD shall complete continuing medical education (“CME”) relat­ed to medical record keeping and controlled substance prescribing that has been approved in advance by the Board’ s Office of the Medical Director.
NAVARRO-MCGUINNESS, Cheryl Tan, DO (200601750) Mooresville, NC
09/14/2017
Amendment stems from August 2014 Consent Order wherein DO was reprimanded and fined $1,000 for inappropriate and excessive pre­scribing of controlled substances. DO signed a Memorandum of Understanding (MOU) with DEA in May 2017.
Amendment to August 2014 Consent Order; DO must comply fully with the Memorandum of Understanding (MOU) with DEA signed May 2017 prohibiting DO from handling sched­ule II, IIN, III and IIIN controlled substances for two years and agreeing to prescribe only schedule IV and V controlled substances within the scope of DO’s practice for patients with an established doctor-patient relationship. DO must also continue to adhere to all terms and conditions contained in her 2014 Consent Order with the Board.
WARONSKY, Roy George, PA-C
(000102512) Charlotte, NC
10/18/2017
In June 2017, the Board and PA entered a con­sent order wherein PA agreed not to prescribe controlled substances. After accepting the con­sent order, PA completed 34 category I CME hours on the subject of prescribing controlled substances. Furthermore, PA is now practicing under different supervising physicians than those during the relevant times giving rise to the consent order. PA requested that he be allowed to prescribe Schedule IV and V con­trolled substances under a plan of increased supervision.
Amended Consent Order, PA may prescribe Schedule IV and V con­trolled substances under the fol­lowing conditions: A) Whenever PA prescribes a controlled substance, a supervising physician must be onsite and available for consultation. B) PA’s supervising physician(s) must review 25% of PA’s patient charts in which PA prescribed a controlled substance, and document the review in the patient chart. C) PA and his primary supervising physician shall conduct and document monthly qual­ity assurance meetings. D) PA shall, upon request, provide the Board patient charts so that the Board may review his care. All other terms and conditions of the June 9, 2017 Con­sent Order remain in effect.
BOARD ACTIONSFORUM | First Quarter 2018 | 15
Annulment: Retrospective and prospective cancellation of the practitioner’s authorization to practice.
Conditions: Actions or requirements a licensee must complete and/or comply with as a condition of licensure.
Consent Order: An order of the Board that states the terms of a negotiated settlement to an enforcement case; A method for resolving a dispute without a formal hearing.
Denial: Decision denying an application for licensure, re­instatement, or reconsideration of a Board action.
Dismissal: Board action dismissing a contested case.
Inactive Medical License: Licenses must be renewed annually in NC. The Board may negotiate a provider’s agreement to go inactive as part of the resolution of a dis­ciplinary case.
Public Letter of Concern (PubLOC): A public record expressing the Board’s concern about a practitioner’s be­havior or performance. A public letter of concern is not considered disciplinary in nature; similar to a warning.
Revocation: Cancellation of authorization to practice. Authorization may not be reissued for at least two years.
Glossary of Terms
Stay: Full or partial stopping or halting of a legal action, such as suspension, on certain stipulated grounds.
Summary Suspension: Immediate cancellation of authorization to practice; Ordered when the Board finds the public health, safety, or welfare requires emergency action.
Suspension: Withdrawal of authorization to practice, ei­ther indefinitely or for a stipulated period of time.
Temporary/Dated License: A License to practice for a specific period of time. Often accompanied by conditions contained in a Consent Order.
Voluntary Surrender: The practitioner’s relinquishing of authorization to practice pending or during an investi­gation. Surrender does not preclude the Board bringing charges against the practitioner.
Limitation: A restriction placed on a licensee’s practice. When practicing under a restriction, it is not lawful for the licensee to engage in the prohibited activity. Example: Dr. Smith is restricted from prescribing Schedule II and III medications.
Name/license #/location
Date of action
Cause of action
Board action
TEMPORARY/DATED LICENSES: ISSUED, EXTENDED, EXPIRED, OR REPLACED BY FULL LICENSES
NONE
COURT APPEALS/STAYS
NONE
DISMISSALS
NONE
One of the most frequent inquiries NCMB gets is how a physician can remove a nurse practitioner or PA the physician no longer su­pervises from his or her licensee information page on the Board’s website. Former PA supervisees can be removed by emailing a request to pa@ncmedboard.org.
NPs are licensed by the NC Board of Nursing and can only be removed by that agency. If you see a former NP still listed on your online NCMB licensee information page, teresaw@ncbon.org to let them know you no longer supervise the NP and would like them removed as an active supervisee. NCBON will notify the Board, which can then delete the NP from the physician’s NCMB page.
TIP: It is the responsibility of the PA or NP to remove former supervisors by notifying the appropriate licensing board when they change supervisors. When ending a supervisory relationship, remind the PA or NP of this. PAs can remove old supervisors by going to www.ncmedboard.org/ITP and submitting an Intent to Practice form.
Wait a minute, I don’t supervise that NP or PA anymore…
BOARD ACTIONS1203 Front Street
Raleigh, NC 27609
Prsrt Std
US Postage
PAID
Permit No. 2172
Raleigh, NC
BOARD MEETING DATES
March 14-15, 2018 (Full Board)
May 16-18, 2018 (Full Board)
June 21-22, 2018 (Hearing)
July 18-19, 2018 (Full Board)
Sept. 19-21, 2018 (Full Board)
Meeting agendas, minutes and a full list of meeting dates can be found on the Board’s website:
www.ncmedboard.org
CONNECT WITH NCMB ON SOCIAL MEDIA
Facebook.com/ncmedboard | Twitter: @NCMedBoard
Attention: Register with HealthConnex by June 1
NC DHHS recently announced that all providers who treat patients in­sured through Medicaid, NC Health Choice or the State Health Plan must register for the state’s Health Information Exchange, HealthConnex, by June 1, 2018.
A health information exchange (HIE) is a secure electronic network that enables authorized health care providers to access and share health-re­lated information. Its purpose is to improve health care quality, enhance patient safety, improve health outcomes, and reduce overall health care costs by enabling health information to be available securely whenever doctors, nurses and patients need it.
State law (NCGS 90-414.4) requires NC providers who participate with the state insurance programs listed above to register with HealthConnex no later than June 1 to continue receiving payments.
Visit www.hiea.nc.gov/ for more information. NC DHHS holds free monthly “How to Connect” conference calls that providers are welcome to join – check the website for upcoming dates.
Read FAQs about NC HealthConnex at:
www.hiea.nc.gov/frequently-asked-questions