Primum Non Nocere
N C M E D I C A L B O A R D
No. 1, 2004 forumUsing IT to Improve Patient Care
and Communication — Page 3
In This Issue of the FORUM
President’s Message
The Medical Supervisor-Trainee Relationship and
the Wisdom of Dr Osler...............................................................1
New NCMB Position Statement ...................................................2
Using Information Technology to Improve Patient Care
and Communication: A Practical Guide—Part 1 .......................3
Now—File Complaints with Board by E-Mail ..............................8
Public Schools and Pregnant and Parenting Adolescents:
A Legal Guide ..........................................................................9
The Caring Lens .........................................................................11
NCMB Amends PA Rules ...........................................................12
George C. Barrett, MD, Receives FSMB Distinguished
Service Award .........................................................................12
Irregular Behavior in Sitting the USMLE
Can Put a Medical Career in Jeopardy ....................................12
Nighttime Is the Right Time: Night Shift Workers Keep the
Lights on After the Sun Goes Down ......................................13
USMLE Clinical Skills Examination to Debut June 2004 ...........15
Review:
Learning the Lessons That Will Make Us Uncomfortable.............16
Board Actions: 11/2003-1/2004 .................................................18
Board Calendar ...........................................................................24
Change of Address Form ............................................................24
Item Page Item Page
PrimumNon Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15, 1859
President’s Message
The Medical Supervisor-Trainee Relationship
and the Wisdom of Dr Osler
Following several months of discussion
on the subject, the North Carolina
Medical Board adopted a position state-ment
emphasizing the significance of the
relationship between teacher and student
in medical education at all levels and the
importance of that relationship being
understood and respected. That position
statement, The Medical Supervisor-
Trainee Relationship, appears at the end
of this article. Though brief, it carries a
vital message for all those engaged in the educational process.
As the Board considered this position statement, I couldn’t help
but pick up the Quotable Osler to review some appropriate words
of Dr William Osler (1849-1910), one of the finest medical edu-cators
of any era and a founder of The Johns Hopkins University
School of Medicine. His Principles and Practice of Medicine
(1892) was the leading medical text of its time and is still pub-lished
today. His comments pre-date antibiotics, the transistor,
space flight, and the desktop computer. They remind us of the
timeless nature of wisdom, and the great debt our profession
owes to those who choose careers as medical educators. They are
worth reading and rereading—particularly the last.
“That greatest of ignorance—the ignorance which is the conceit that a
man knows what he does not know.”
“The greater the ignorance the greater the dogmatism.”
“One special advantage of the skeptical attitude of mind is that a man
is never vexed to find that after all he has been in the wrong.”
“Common-sense nerve fibers are seldom medullated before forty—they
are never even seen with a microscope before twenty.”
“Perhaps no sin so easily besets us as a sense of self-satisfied superiori-ty
to others.”
“Keep a looking glass in your own heart, and the more carefully you
scan your own frailties, the more tender you are for those of your fel-low
creatures.”
“Silence is a powerful weapon.”
“Beware of words—they are dangerous things. They change colour
like the chameleon, and they return like a boomerang.”
“Care more particularly for the individual patient than for the special
features of the disease.”
“The practice of medicine is an art, not a trade; a calling, not a busi-ness;
a calling in which your heart will be exercised equally with your
head.”
“Errors in judgment must occur in the practice of an art which consists
largely of balancing probabilities.”
“Medicine is a science of uncertainty and an art of probability.”
“The practice of medicine is an art, based on science.”
“What is your duty in the manner of telling a patient that he is proba-bly
the subject of an incurable disease? . . . One thing is certain; it is
not for you to don the black cap, and, assuming the judicial function,
take hope from any patient—‘hope that comes to all.’ ”
“Gentlemen, if you want a profession in which everything is certain
you had better give up medicine.”
“You cannot afford to stand aloof from your professional colleagues in
any place.”
“A physician who treats himself has a fool for a patient.”
“In no relationship is the physician more often derelict than in his duty
Stephen M. Herring, MD
2 NCMB Forum
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 Medical Board, its members
or staff, or the institutions or organizations with which the authors
are affiliated. Official 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 tele-phone
number.
North Carolina Medical Board
Raleigh, NC
forum N C M E D I C A L B O A R D
Vol. IX, No. 1, 2004
PrimumNon Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15, 1859
Primum Non Nocere
Stephen M. Herring, MD
President
Fayetteville
Term expires
October 31, 2004
Charles L. Garrett, Jr, MD
President Elect
Jacksonville
Term expires
October 31, 2005
Robert C. Moffatt, MD
Secretary
Asheville
Term expires
October 31, 2004
H. Arthur McCulloch, MD
Treasurer
Charlotte
Term expires
October 31, 2005
E.K. Fretwell, Jr, PhD
Charlotte
Term expires
October 31, 2005
Robin N. Hunter-Buskey, PA-C
Raleigh
Term expires
October 31, 2006
Michael E. Norins, MD
Greensboro
Term expires
October 31, 2004
Janelle A. Rhyne, MD
Wilmington
Term expires
October 31, 2006
George L. Saunders, III, MD
Shallotte
Term expires
October 31, 2006
Shikha Sinha
Morrisville
Term expires
October 31, 2004
Edwin R. Swann, MD
Raleigh
Term expires
October 31, 2005
Aloysius P. Walsh
Greensboro
Term expires
October 31, 2006
R. David Henderson, JD
Executive Director
Bryant D. Paris, Jr
Executive Director Emeritus
Publisher
NC Medical Board
Editor
Dale G Breaden
Assistant Editor
Dena M. Marshall
Street Address
1203 Front Street
Raleigh, NC 27609
Mailing Address
PO Box 20007
Raleigh, NC 27619
Telephone
(919) 326-1100
(800) 253-9653
Fax
(919) 326-0036
Web Site:
www.ncmedboard.org
E-Mail:
info@ncmedboard.org
to himself.”
“Common sense in matters medical is rare, and is usually
in inverse ratio to the degree of education.”
“Longevity is a vascular question.”
“Humanity has but three great enemies: Fever, famine,
and war; of these by far the greatest, by far the most terri-ble,
is fever.”
“Soap and water and common sense are the best disinfec-tants.”
“The glutton digs his own grave with his teeth.”
“Remember how much you do not know. Do not pour
strange medicines into your patient.”
“It is astonishing with how little reading a doctor can prac-tice
medicine, but it is not astonishing how badly he may
do it.”
“It goes without saying that no man can teach successfully
who is not at the same time a student.”
“Superfluity of lecturing causes ischial bursitis.”
“Advice is sought to confirm a position already taken.”
“I desire no other epitaph . . . than the statement that I
taught medical students in the wards, as I regard this as by
far the most useful and important work that I have been
called upon to do.”
Thank you Dr Osler and educators alike.
New NCMB
Position Statement:
Medical Supervisor-
Trainee Relationship
It is the position of the North Carolina
Medical Board that the relationship between
medical supervisors and their trainees in med-ical
schools and other medical training pro-grams
is one of the most valuable aspects of
medical education. We note, however, that
this relationship involves inherent inequalities
in status and power that, if abused, may
adversely affect the educational experience
and, ultimately, patient care. Abusive behav-ior
in the medical supervisor-trainee relation-ship,
whether physical or verbal, is a form of
unprofessional conduct. However, criticism
and/or negative feedback that is offered with
the aim of improving the educational experi-ence
and patient care should not be construed
as abusive behavior.
(Adopted April 2004)
No. 1 2004 3
“Most prac-tices
don’t use
technology for
patient care
and communi-cation”
Using Information Technology to Improve Patient
Care and Communication:
A Practical Guide—Part 1
Marjorie A. Satinsky, MA, MBA
President, Satinsky Consulting, LLC
Information technology may
be able to help you improve the
efficiency of four aspects of your
practice: patient care and com-munication,
financial manage-ment,
clinical practice/opera-tions,
and professional growth.
Patient care and communication
is every physician’s priority, so
let’s start there. Future articles
will cover the application of technology to profession-al
growth and other topics.
Throughout North Carolina, practices of all sizes
already use information technology for pre-registra-tion,
appointment reminders and requests, on-line bill
payment, test reporting, patient education, on-line
physician-patient communication, and the coupling of
patient specific information with options for diagnosis
and treatment. The practices that are most satisfied
with these applications of technology to patient care
and communication have carefully analyzed their work
flow, identified specific problems that they want to
correct, looked at technological options, selected solu-tions
to meet their needs, and begun to document a
positive impact on patient satisfaction, operational
efficiency, and cost.
For many reasons, however, most practices don’t
use technology for patient care and communication.
Some practices are opposed in principle to any mech-anism
that changes their existing methods of care and
communication. Other practices have preconceived
notions about prohibitive costs, lack of time to inves-tigate
available options, and vendor inability to cus-tomize
available tools to meet their unique needs.
In Part 1 of this article, I hope to present a practical
guide to help you understand ways in which informa-tion
technology may be able to help you improve
patient care and communication in your practice. I
want to direct my comments particularly to those of
you who are in smaller and solo practices and who
may, for one reason or another, question the value of
technology for your patients and for yourselves. I
describe common applications and suggest steps you
can take to determine if information technology can
help you.
In Part 2 of this article, which will appear in the next
issue of the Forum, I will present several short profiles
of medical practices throughout the state that now use
technology to impact patient care and communica-tion.
Read these descriptions to learn what your col-leagues
are doing, what challenges they face, how they
make their decisions, and how they monitor their suc-cess
in meeting their goals. And, since patients come
first, I will also include comments from several
patients of physicians who have adopted the use of
technology to improve patient care and communica-tion.
The Value of Patient-Centered Care
and Communication
Most discussions of information technology as a
tool to improve patient care and communication focus
on the technology part of the phrase. Information
technology triggers a gut reaction related to the bells
and whistles of hardware and software. It’s easy to
ignore the underlying premise.
Dr Larry Weed, a well-respected medical educator
whose approach to patient-centered medicine has
influenced thousands of physicians, offers a relevant
perspective. “From both clinical and economic per-spectives,
patients and their families are the most neg-lected
and the most important actors in the healthcare
system.” (Weed and Weed, 1994, and Weed, 1997).
Dr Weed suggests that “properly designed informa-tion
tools” can enable patients to “engage in an
informed ‘conversation’ with providers and assume a
greater role in their own care than in the past.”
Following Dr Weed’s reasoning, physicians should
care about patient communication not only because
patients are better informed and more demanding
than they used to be, but because active patient
involvement in the delivery of medical care produces
better decision making.
Common Applications of Technology to
Patient Care and Communication
Let’s explore ways in which information technology
can enhance patient care and communication by look-ing
at some of the common applications: pre-registra-tion,
appointment reminders and requests, test report-ing,
patient education, on-line physician-patient com-munication,
and coupling patient information with
diagnosis and treatment options.
(1) Pre-registration
Most medical practices gather information about
patients both at the point of check in and again when
the patient goes to the examination room. Here’s a
Ms Satinsky
4 NCMB Forum
common scenario. Patients check in at the front desk
and fill out a paper form that includes a review of sys-tems,
a history of present illness, and insurance cover-age.
They then move to an examination room, where
a nurse or other clinical assistant takes vital signs and
asks questions about presenting symptoms. The physi-cian
then talks with patients, does appropriate exami-nations,
and if no further tests or services are needed,
suggests appropriate courses of treatment. Depending
on the office system, when the physician and patient
interact directly, the physician may or may not have
the information that has thus far been collected by the
front office staff and by the nurse or clinical assistant.
With computerized, on-line pre-registration, your
patients can have a very different experience. They use
a secure line to input information into your practice’s
system from a home terminal or from a terminal or
other device that is located in your office. They have
time to review and check what they have entered.
Elderly patients can ask family members to verify the
accuracy of their entries.
By the time your patients reach the examination
room, you already have their background and insur-ance
information. You request additional information
as needed. You enhance interactions with your
patients by focusing on possible causes and treatment
options. From your patients’ perspective, satisfaction
improves because you have more time to talk about
the information that has already been collected. The
practice saves the costs of dictation and transcription.
You and your colleagues reduce the length of time that
you spend with each patient without sacrificing quali-ty.
Because your staff validates insurance information
prior to the visit, your practice can reduce the volume
of claims denied because of incorrect payer data.
(2) Appointment Reminders and Requests
Many practices give patients the option of receiving
automatic telephone reminders of appointments
instead of personal reminder calls from staff. If the
practice already has a computerized scheduling sys-tem,
the automated reminder system can be linked
directly to it. Using either a computerized telephone
dialing and message system or an e-mail reminder, the
system alerts patients to upcoming appointments and
tells the practice which patients have not been con-tacted.
Patients receive their reminders on a timely
basis, and the practice can reduce the number of no-shows.
Another automated appointment feature allows
patients to request appointments. Patients call in or
use the practice Web site to request an appointment
for a particular time and date, and the practice
responds. Patient satisfaction increases because calls
about appointments are not mixed in with requests for
medical advice, prescription refills, and urgent care.
The practice retains its ability to control the schedule.
(3) On-line Bill Payment
On-line bill payment with a credit card can improve
both collections and patient communication.
Although the co-payment feature of managed care has
sensitized medical practices to the importance of col-lection
at the time of services, not all patients pay
when asked. As you know, many patients who have
outstanding balances don’t return for needed care
because they don’t want to experience the embarrass-ment
of again being asked to pay their outstanding
balances. On-line bill payment gives your patients a
convenient alternative.
(4) Test Reporting
Automated test reporting is not suitable for all prac-tices.
If a practice has a well-organized and effective
triage system that efficiently handles the reporting of
test results, it may not want to consider this particular
application of technology to patient care and commu-nication.
In practices that are comfortable with automated
test reporting, test results are returned to the physician
so he/she can add an interpretation to the raw scores.
For example, following an annual physical, you might
request cholesterol and colorectal screenings. If the
results are normal, your interpretation might be:
“Your results on both tests look good. Keep up the
good work and please use the practice’s automated
appointment system to make an appointment to
return for your annual checkup next year.” To get the
test results, the patient either calls an 800 telephone
number or accesses the practice Web site to enter a
secure pass code. Patients like the automated mecha-nism
because they can request results at their conven-ience.
From a practice perspective, the test-reporting
feature can reduce call volume and alert the practice
when a patient does not receive results.
(5) Patient Education
Several technology applications can improve patient
education. If your practice has a comprehensive and
easy-to-navigate Web site, patients can use it to
request information at any time of day or night. They
no longer have to call the practice during business
hours to get general information on services provided,
physicians in each specialty, office location and direc-tions,
and flu shots. You can use your Web site to pro-vide
even more information to your patients by listing
and responding to frequently asked questions, by writ-ing
and/or posting short articles on current topics of
interest, and by directing patients to reliable sources of
medical information.
You can also use technology to enhance patient edu-cation
while your patients are in your office. One
physician interviewed for this article engages his
patients in Web searches during their office visits. In
his opinion and mine, he’s simultaneously accom-
“Several
technology
applications
can improve
patient
education”
No. 1 2004 5
plishing two goals, both of which enhance the care
that he provides. He’s gathering as much current
information as he can so he can make the best possi-ble
diagnoses and recommendations. He’s also telling
his patients that he believes in reliable on-line sources
of medical information. By demonstrating the use of
specific on-line databases in which he has confidence,
he’s guiding his patients in their own use of the
Internet.
(6) On-line Care
A recent poll of physicians conducted by The
Boston Consulting Group (BCG) and Harris
Interactive (Physician Profiling and Behavior Change,
2002) documents patients’ desire to communicate
with their physicians on line. According to the physi-cians
who responded to the poll, almost 90 percent of
patients want to communicate with their physicians
on line, and more than one-third indicate a willingness
to pay for advice. More than half indicate that avail-ability
of on-line communication would impact their
choice of physicians.
Physicians who are comfortable with on-line care
and communication can provide different levels of
information. For example, you can direct patients
with general questions to educational material on your
own Web site or guide them to the Web sites of reli-able
organizations. Your practice can also participate
in one of the many on-line medical advice sites.
Another application of on-line care is prescription
refills. With prior patient consent, the system stores
patients’ prescription histories, possible drug interac-tions,
insurance coverage, and formularies. You can
use the Internet to fax prescriptions directly to phar-macies.
If you want to charge non-Medicare patients
for the service, you can do so. A potential benefit to
patients is reduced waiting time for the prescription.
Your practice may also save staff time and reduce its
operating costs (Ennis and Maus, 2001).
Going one step further, you can respond to patient-specific
questions on line, reserving the right to ask
the patient to come to the office for a visit.
Depending on your philosophy of billing for on-line
care and rules for Medicare patients, you can activate
a mechanism that lets you charge for services ren-dered,
provided that guidelines are established in
advance and that your patient signs a written waiver
allowing you to bill.
With all of these e-mail applications, “the key to suc-cessfully
integrating e-mail communications into med-ical
practices is to follow carefully thought out guide-lines
(Blumenfeld, 2002). Make sure you establish
rules in advance. The American Medical Association
offers guidelines for e-mailing that can help you define
parameters.
The provision of patient-specific on-line advice is
not attractive to all physicians. Many do not distin-guish
between secure on-line advice systems and tra-ditional
e-mail. The secure systems include firewalls,
encryption, and other protections; e-mail does not
have these features. Several of the physicians inter-viewed
for this article mentioned potential difficulties
in managing follow-up care and the increase in mal-practice
risk. HIPAA (Health Insurance Portability
and Accountability Act) compliance is another barrier
for some physicians; they would prefer not to imple-ment
on-line care at a time when new and complex
regulations are going into place.
(7) Coupling Patient Information with Diagnosis
and Treatment Options
Here’s yet another way in which technology can
improve patient care and communication. Let’s go
back to Dr Weed. He talks about the limitation of all
physicians, no matter how well trained or experienced,
to retrieve and organize relevant information and
apply logic and clinical judgment to arrive at a deci-sion
(Weed and Weed, 1994 and Weed, 1997). With
the exception of new patient visits, physicians spend
10-15 minutes, sometimes less, with most patients. If
technology can be used to couple each patient’s histo-ry,
including subjective information provided directly
by the patient, with all of the possible causes and treat-ment
options, the physician is in a position to make
the very best possible recommendation for each
unique patient.
A pediatric clinic in the Triangle already uses tech-nology
in just the way that Dr Weed suggests. The
clinic is a part of a not-for-profit organization devoted
to helping children and adolescents whose learning
differences present difficulties in school. A multidisci-plinary
team of pediatricians, psychologists, and learn-ing
specialists provides assessments and recommends
interventions. The homegrown technology that sup-ports
the clinicians combines information provided by
families, teachers, and the child with observations and
other results from a daylong assessment. The clini-cians
are specially trained to use the software to create
an individualized profile of each child. That profile is
matched against 1,000 possible interventions. The
interventions are categorized, reviewed, and improved
on an continuing basis. With the aid of this technol-ogy,
every family receives a description of clinical find-ings
and recommended interventions that is cus-tomized
to the individual child.
Getting Started
If these descriptions of ways in which technology
can improve patient care and communication in med-ical
practices interest you and you want to learn more,
here are six suggestions for starting your investigation:
(1) understand your problems and define your goals;
(2) identify an information technology team; (3) seek
facts from various sources; (4) select one or more ven-dors;
(5) implement the new system; and (6) measure
results.
“Understand
your problems
and define
your goals”
6 NCMB Forum
(1) Understand Your Problems and Goals
The first step is crucial, and you don’t have to leave
your office to do it. Information technology tools
help you solve problems. They don’t identify your
problems, determine goals for your practice, or tell
you what values are important to you and your col-leagues.
As I researched this article, I posed the same ques-tion
to physicians in many different practice settings:
“How do you use information technology to help you
with patient care and communication?” Most respon-dents
told me about their practice management sys-tems,
electronic medical record systems, and Web-based
systems. Very few told me what those systems
do for them and their patients.
Start by thoroughly understanding your existing
processes for patient care and communication.
Analyze your workflow and collect hard data to help
you understand the depth and impact of your prob-lems.
Review the results of your patient satisfaction
surveys. Your patients are your focus, and they will
tell you what they like and don’t like. Then think
about the direction in which you want to go. If you
understand your current status and desired goals, you
are ready to take the next step.
(2) Establish an Information Technology Team
More than one physician interviewed for this article
learned the hard way that no matter how much you
believe in the benefits of technology, IT decision mak-ing
is equally as challenging as organic chemistry. No
matter how small or large your practice may be, it’s
best to take a team approach to IT planning and
implementation. You need to choose the right group
of people to help you assess your practice, identify
problems, determine and review options, and make
good decisions.
If you’re a solo practitioner without an IT expert on
your staff, consider engaging outside help. If you
belong to an IPA, PHO, or other similar organization,
see how these organizations can help you evaluate
options and purchase hardware and software. Keep in
mind, however, that every practice is different. When
a large umbrella organization is involved in the inves-tigation
and selection process, you need to make sure
you get what you need, not just what is best for the
majority of medical practices in the group.
If your practice is larger, think carefully about the IT
team that you form. Physician involvement is essen-tial,
since physicians will be the primary users. It is
helpful to involve a physician who is interested in
technology, is willing to take the time necessary to
explore options, and has credibility with his/her physi-cian
colleagues. If your practice has multiple special-ties,
be sure they are appropriately represented, but
don’t form a working group that is too large to func-tion.
Include on your team your practice administra-tor,
information technology manager, and clinical and
administrative staff so you can begin to cultivate
involvement and cooperation by everyone. Be realis-tic
about time commitments.
(3) Seek Facts
Every medical practice is unique, and you are ulti-mately
seeking solutions that meet your practice’s
needs. Nonetheless, as you get started, you can obtain
comprehensive general information from a variety of
reliable resources. Use the Internet to find relevant
articles. Check with your state and local medical and
specialty societies to learn what others in your region
are doing. When you attend national meetings in
your specialty, talk with exhibitors and with colleagues
in other states.
Keep an open mind about the likelihood of finding
answers that work for your practice and that fit
within your budgetary constraints. Technological
advances now allow small practices to find practical
and affordable solutions (California HealthCare
Foundation, 2002). Some of these advances are:
• Improvements in Web-based technology and
Internet access that offer remote hosting and no
longer require expensive mainframes and PCs.
Practices that use Application Service Providers
(ASPs) pay a fixed monthly rate and can avoid
paying high up-front purchase costs.
• Availability of mobile computer devices that
accompany users as they move from place to
place.
• Modular product design that allows practices to
make incremental enhancements in their technology.
• Wireless computer linking that avoids bulky
cables.
• Advances in equipment design that include wire-less
laptop computers and handheld devices.
• Increased compatibility among applications creat-ed
by changes in industry standards.
(4) Selecting a Vendor
You have many choices of vendors. As you gather
information, learn to distinguish sales and marketing
hype from actual capability and track record. Talk
both with vendors that offer single applications as well
as with vendors that can add functions to their basic
packages. For example, many PMS and EMR systems
now have the capability to activate additional func-tions
that relate to patient care and communication.
The California HealthCare Foundation Report refer-enced
above includes a comprehensive list of applica-tions
and vendors categorized under three main head-ings:
financial, clinical, and patient-focused.
Lay out your specifications in a formal Request for
Proposal (RFP) so you can ask vendors to respond to
your specific needs and ensure that all vendors are
responding to the same set of questions. Make sure
you ask about impact on patient care and communica-tion,
physicians’ productivity, cost, ease of learning,
and interface with your current practice management
system. Check on 24-hour availability of technical
“Technological
advances
now allow
small practices
to find
practical and
affordable
solutions”
No. 1 2004 7
support so you can get help when you need it and
avoid having your operations come to a total stand-still.
Make site visits to vendors and to their other clients
so you can better understand the experiences of other
users. The vendors will want to accompany you on
some of these visits. Take time to make additional vis-its
on your own. During these less formal site visits,
ask if you can shadow a physician who is using the
technology so you can observe firsthand what happens
during a physician-patient interaction. Request per-mission
to talk directly with patients. It’s important
for you to get their opinions on the impact of tech-nology
on their care and on physician-patient com-munication.
Ask many questions about vendor training for you
and your staff. You want to make sure the trainer
assigned to you has the breadth of knowledge to
answer a variety of questions, and that the trainer
won’t be assigned to another client before your needs
are met.
Check vendor financial viability very carefully.
Some companies won’t be in business long enough to
let the ink dry on your contract. Other newcomers are
experiencing growing pains of their own and may
have difficulty providing you with the consistent good
service you want.
Finally, make sure your contract includes all the
items on which you and the vendor have agreed.
Read the fine print, and don’t rush to implement your
new systems before the details are in place.
(5) Implement the System
Once you have selected a vendor, plan the imple-mentation
down to the smallest detail. List each step
to be taken, expected time, and responsibility. Expect
disruption if you are converting from an existing sys-tem
to a new one, and plan accordingly. Pay attention
to the human side of implementation, and remember
that you are dealing with physicians and staff with
varying degrees of interest and ability in new tech-nologies.
Effective training programs may require
individualized attention in addition to group sessions.
(6) Measure Results
Measuring the impact of your technological change
is imperative. If you identified specific and clear goals
for your project, you’ll want to match progress against
them. You’re not just looking at technology, but
whether or not the technology you adopted helps you
solve problems in patient care and communication
without having unanticipated negative side effects like
lowering physician productivity and ability to gener-ate
revenue (Moore and Woodcock, 2002).
Conclusion
Information technology has great potential for
improving patient care and communication in your
practice. If you know what problems you want to
address, involve the right people in your decision
making, and are conscientious in vendor selection,
implementation, and measurement of results, you may
be able to improve patient satisfaction and simultane-ously
realize a positive impact on cost and operational
efficiency.
_____________________
References and Recommended Reading
Alexander, A. (1999). How to Get There from Here:
IT Project Management. MGM Update 38 (12), June 15,
1999.
Arena, J.K. (2000). Implementing an EMR with the
Humans in Your Practice. ACMPE Paper, June 2000.
Blumenfeld, J. (2002). To E-Mail or Not to E-Mail
Patients—That Will No Longer Be the Question. North
Carolina Medical Board Forum 2, 2002: 10.
Brandner, B. (2002). EMR ROI and Implementation:
Best Practices. Advance for Health Information Executives 6
(7) :30,32-35, July, 2002.
Ennis, K. and Maus, R. (2001). Kokomo Family Care:
Automating the Clinical Practice. MGM Journal 48 (4),
July/August, 2001.
First Consulting Group (2002). Achieving Tangible IT
Benefits in Small Physician Practices. Prepared for California
HealthCare Foundation, September 2002.
Hodge, R. (2002). Myths and Realities of Electronic
Medical Records. The Physician Executive 28 (1): 14-19,
January-February, 2002.
Malik, S. (2003). Patients Want To Communicate With
You Online, Will Pay For It and It Influences Their
Decision On Which Doctor To Select. MD News, March
2003.
Moore, P.L. and Woodcock, E. (2002). E-Health:
Promise or Peril? How to Make Solid Business Decisions
about Investing in E-Health. MGMA Connexion 2 (5),
May/June, 2002.
Nelson, R. (2002). Information Management for the
Medical Practice Administrator. New York State MGMA,
June 27, 2002.
Rake Report (2000). Electronic Medical Record
Systems. 10-15. July 22, 2002.
Weed, L.L. (1997). New connections between medical
knowledge and patient care. British Medical Journal 315:
231-235, July 26, 1997.
Weed, L.L. and Weed, L. (1994). Reengineering
Medicine. Federation Bulletin: 81 (3), 1994: 147 - 183.
..........................................
The author wishes to thank the following for their suggestions
and for their review of this article: David Bullard, formerly
with Scott Medical Group; Stephen Malik, Medfusion;
Rosemarie Nelson, MGMA.
..........................................
Ms Satinsky is president of Satinsky Consulting, LLC.
She earned her BA in history from Brown University, her
MA in political science from the University of
Pennsylvania, and her MBA in health care administration
from the Wharton School of the University of
Pennsylvania. She is the author of two books: The
Foundation of Integrated Care: Facing the Challenges of
Change (American Hospital Publishing, 1997) and An
Executive Guide to Case Management Strategies (American
“Measuring
the impact
of your
technological
change is
imperative”
8 NCMB Forum
Organizations That Focus on IT
American Medical Informatics Association (AMIA) pub-lishes
a monthly informatics journal (www.amia.org).
Health Information and Management Systems Society
(HIMSS) publishes a quarterly journal (Journal of
Healthcare Information Management) and sponsors an
annual conference with a large vendor exhibition
(www.himss.org).
Magazines and Trade Journals
Healthcare Informatics is a monthly journal that frequently
features software comparison guides (www.healthcare-informatics.
com).
Health Data Management is a monthly trade magazine that
publishes an end-of-year resource guide on information
technology vendors (www.healthdatamanagement.com).
M.D. Computing is a monthly publication endorsed by
AMIA. It includes an annual Directory of Medical
Hardware and Software Companies (www.mdcomput-ing.
com).
Physician Practice Management Organizations
Medical Group Management Association (MGMA), the
professional organization for physician practice leaders,
offers reference books and a research service. It holds an
annual fall conference with a vendor exhibition focused on
physician practices (www.mgma.com).
PhysiciansPractice.com is a source for articles on IT for
physician practices. It lists selected vendors by product
type (www.PhysicianPractice.com).
Professional Organizations and Societies
American Academy of Family Physicians (AAFP) offers
various resources, including a vendor survey, vendor
requirements, FP Net (online computer information
source) and Fam-Med listserv (www/aafp.org).
American Medical Association (AMA) offers various
resources and publications (www.ama-assn.org).
American College of Physician Executives (ACPE) offers
resources, publications, and seminars (www.acpe.org).
Hospital Publishing, 1995). She is also author of an arti-cle
titled The Advanced Practice Nurse in a Managed Care
Environment, which appears in the book Advanced
Practice Nursing: Changing Roles and Clinical Applica-tions,
edited by J.V. Hickey, et al (Lippincott, 1996,
and Lippincott, 2000). The Forum has previously pub-lished
two articles by Ms Satinsky: Managing the
Implementation of HIPAA and the Privacy Rule, in #4,
2002; How to Determine If Your Practice Could Use a
Professional Practice Administrator, in #2, 2003. An
adjunct faculty member at the University of North
Carolina School of Public Health and the Duke University
School of Nursing, Ms Satinsky was a fellow of the
American College of Healthcare Executives (1991-2003)
and is currently a member of the Medical Group
Management Association. She may be reached at (919)
383-5998 or margie@satinskyconsulting.com.
The North Carolina Medical Board maintains a Web
site we hope the public finds easy to use. We also
hope it serves as a useful and informative tool for indi-viduals
accessing information, filing a complaint, and
generally learning about the Board and its work. In an
effort to enhance the site’s usefulness, the Board’s
Complaint Department has recently developed and
introduced a new, faster, and more efficient option for
submitting a complaint to the Department for
review—direct e-mail.
The Complaints section of the Web site can be
accessed by clicking on “Complaints” on the site’s
home page menu. The Complaints section offers a
link providing information about the overall com-plaint
process and a link presenting the two options
for filing a complaint with the Board.
Option one for filing a complaint, and the Board’s
preferred method, is to submit the complaint directly
to the Board by e-mail. When using this approach, it
is essential to include the complainant’s name, address,
and daytime telephone number. If the individual fil-ing
the complaint is the patient, it is necessary to also
include their date of birth. If the complainant is not
the patient, the patient’s name and date of birth must
also be provided. The full name and address of the
practitioner about whom the complaint is being filed
bust also be included. Filing by e-mail, though pre-ferred,
is not recommended for those filing a com-plaint
that must include the submission of various
attachments, such as letters, records, or other docu-ments.
Option two is to file a complaint form by mail,
sending it to the Complaint Department at the
Board’s address. The form is offered on the Web site
in two formats, one compatible with Adobe Acrobat
Reader (PDF) and one with Microsoft Word.
Individuals selecting this option may download the
complaint form, complete it, and mail it with any nec-essary
attachments.
Please visit the Board’s Web site at www.ncmed-board.
org for more information. For specific questions
regarding filing a complaint or about the process,
please call the Complaint Department between the
hours of 8:30 AM and 4:30 PM, at (919) 326-1100, ext
236 or 261.
Now—File Complaints with the Board by E-Mail
SUGGESTED RESOURCES
No. 1 2004 9
“Until the last
quarter of
the twentieth
century, U.S.
schools
routinely
expelled
pregnant and
parenting
youth”
The Institute of Government at
the University of North Carolina
Chapel Hill publishes legal
guides for North Carolina’s preg-nant
and parenting minors and
those who care for them, and an
article about each guide has
appeared in the Forum. The first
guide, on health care, was issued
in 2001, and the second, describ-ing
social services available for these young people,
was published the following year. The current article
describes the third guide, Public Schools and Pregnant
and Parenting Adolescents, which focuses on education
for pregnant and parenting teens and
pre-teens and will be available in May
2004. The last guide, for adolescents
and including a special chapter for their
parents, will follow within a year and
will be printed in Spanish as well as
English.
Each guide has been sent to nearly
10,000 professionals across the state. A
number of grants, chiefly from the Z.
Smith Reynolds Foundation, and
underwriting from the Institute make it
possible to distribute the books without
charge. In addition, anyone can read or
print the texts and accompanying
resource lists from http://www.adolescent
pregnancy.unc.edu. In its first two years,
the Web site has recorded more than
30,000 first-time visitors.
Arlene Davis, formerly a nurse, now a lawyer and
faculty member in UNC Chapel Hill’s Department of
Social Medicine, and I direct the adolescent pregnan-cy
project. Our goals for the project are that
• minors understand their legal choices;
• they have access to health care, education, and
social services while pregnant or parenting;
• adults recognize that teens are sometimes lawful
decision makers;
• caregivers not overlook the possibility that abuse,
neglect, or coercion may be implicated in minors’
sexual relationships; and
• the role of adult advisors, either family members
or professionals, is made easier.
Historical Context
The third legal guide, Public Schools and Pregnant
and Parenting Adolescents, reviews the legal status of
minors, explains education rights, and emphasizes the
importance of continuing in school. To understand
the barriers pregnant and parenting students often
face, it is helpful to consider historical context. Until
the last quarter of the twentieth century, U.S. schools
routinely expelled pregnant and parenting youth. For
example, forty years ago the deputy attorney general
of North Carolina assured a local school board that it
could legally refuse an unmarried girl re-entry after she
gave birth. He went beyond legal advice, however,
and counseled mercy. Because education is such an
important benefit for the public and the individual, he
recommended a compromise.
We suggest the person in question be
allowed to return to school on proba-tion
and then the school administra-tors
can observe the reaction and see
how the matter works out. If it
should turn out that because of this
situation too many problems are cre-ated,
then a permanent dismissal
would be in order but a trial should
be made of the pupil returning to
school. It is simply too great a
human responsibility to sit in judg-ment
and condemn a person entirely
or permanently from an educational
standpoint for one misstep.
Several years later, the North
Carolina General Assembly and
Congress gave these students legal protection. The
Assembly included pregnant students among the
newly designated group, “children with special
needs,” although when the federal government passed
similar legislation the next year, it did not. As a result,
the states receive no federal funds to provide special
education services to pregnant students. But Congress
insured educational rights for pregnant and, to a less-er
extent, parenting students in the ground-breaking
law that forbids gender discrimination, Title IX of the
Education Amendments of 1972.
Naturally, reality changes more slowly. Twenty years
ago, the National Institute of Education reported that
schools’ handling of student pregnancy and parent-hood
is “constrained by a number of factors, including
narrow (usually medical) definitions of the problem;
opposition to sex education, contraception and abor-tion;
disagreement about the appropriate school role;
Public Schools and Pregnant and Parenting
Adolescents: A Legal Guide
Anne Dellinger, JD
Professor, Public Law and Government, Institute of Government
The University of North Carolina Chapel Hill
Professor Dellinger
10 NCMB Forum
“Physicians
can serve these
patients by
counseling
them on
contraception
and pregnancy
options”
lack of expertise; and a lack of incentives to develop
programs.” Only last year, Wendy Luttrell, now an
education professor at Harvard, wrote of her work in
North Carolina: “Title IX may have ended de jure dis-crimination
but it did not end de facto discrimination
against pregnant school girls.”
Current Scene
Fortunately, some pregnant and parenting students
meet school counselors, social workers, nurses, teach-ers,
or administrators who expect them to continue
their education and help to make it possible. Many
such dedicated people work in North Carolina’s
schools. A high school graduate, former foster child,
and 19-year-old mother of three paid tribute to them.
When asked whether she had considered dropping
out, she exclaimed: “My teachers would never have let
me do that! They’d have come and gotten me.”
But support for these young women is a scarce
resource, as a school social worker explained.
My work is supposed to be with kids who’ve had
court involvement, but I take the pregnant girls as
extras because they’re not being served. We had 20
this year. One is 13 and too sick to stay in school any
longer. She’s 13- or 14-weeks pregnant and probably
won’t be back in school till the baby’s born. A DSS
report has been made about her. Our DSS takes any
report of this kind these days because in the past they
wouldn’t and things turned out badly.
School personnel, physicians and nurses I have
interviewed related the following incidents, among
others.
• One student, angry about another’s pregnancy,
threatened her in phone calls and pushed her at
school. When the pregnant girl’s parents, who
had tapes of the calls, contacted the school, they
were told that the school could do nothing but
offer homebound instruction.
• Near the beginning of a student’s pregnancy, her
doctor ordered bed rest. The principal told her
mother that no teacher was or would be available
for home instruction.
• Pregnant students could get optimal care at a hos-pital
teen clinic in an adjoining county. But most
refuse the opportunity because the school requires
time used for medical appointments be made up
and that would frequently extend the school day
to 5:00 p.m.
• A girl who gave birth in early August
asked to return September 1. Another, with
a Thanksgiving due date, who wanted to
breastfeed, asked to return after Christmas. Both
requests were denied under a policy that no stu-dent
receives semester credit if more than 10 days
are missed.
By all accounts, the youngest girls’ position is par-ticularly
difficult. Several school employees men-tioned
that girls who become pregnant in middle
school face greater discrimination and isolation than
older girls. A nurse described middle-school adminis-trators
as “very uptight about what they refer to as the
‘p’ word.” An administrator noted that these girls are
not well accepted by peers, which makes it hard for
them to stay in school. A nurse supervisor in a large
district observed that staff, fearing a bad influence on
other students, is even uncomfortable about letting a
new mother visit. A counselor pointed out how often
the youngest mothers soon become pregnant again
and that many programs for teen parents will not
accept anyone with more than one child.
Even older teens and those who do well academi-cally
face discrimination. Occasionally, school person-nel
single a girl out as a disgraceful example. For
example, half a dozen National Honor Society chap-ters
in other states have been sued for barring or
expelling pregnant or parenting girls on the basis of
character. In North Carolina, a teen who was elected
homecoming queen, then disqualified by school
authorities, charged that her unmarried motherhood
was the reason.
Counseling by Physicians
Physicians can help their young patients who
become pregnant and decide to parent by encouraging
them to return to school as soon as practicable and
stay until graduation. According to the Alan
Guttmacher Institute:
[D]ropping out of school, not having a baby, is the
key factor that sets adolescent mothers behind their
peers. If a pregnant teenager does drop out, it is
unlikely that she will return to school before her chil-dren
are in school. Adolescent mothers who stay in
school are almost as likely eventually to graduate
(73%) as women who do not become mothers while
in high school (77%). In contrast, only about 30% of
women who drop out of high school either before or
after their baby’s birth eventually graduates.
To maintain a girl’s school status, a physician should
inform the school when she must be absent due to
medical necessity. (For a condition likely to last more
than four to six weeks, the student, with a physician’s
certification, is entitled to homebound instruction.)
On the other hand, a physician does not help a patient
by providing an excuse for absences that are marginal
or unnecessary. Although North Carolina lacks data
on educational outcomes for these students, many
school personnel think that steady attendance during
pregnancy and returning soon after delivery is best
academically and socially, ensuring that the girl
remains connected to school.
Above all, physicians can serve these patients by
counseling them on contraception and pregnancy
No. 1 2004 11
options. In North Carolina in 2002, 76.6 percent of
new mothers under age 20 reported that their preg-nancy
was unintended—and the percentage was very
likely higher for mothers under 18. Since 1995, when
North Carolina adopted and required an abstinence-based
curriculum, very few adolescents have heard
complete information about reproductive health at
school. Only 12 or so school districts supplement the
curriculum required by statute. In these circum-stances,
information offered by physicians and other
health providers can change lives.
_____________________
Nota Bene
About the Legal Guide Series
Health Care for Pregnant Adolescents: A Legal Guide,
the first title in this series, was published by the
Institute of Government, University of North
Carolina at Chapel Hill, in the fall of 2001 and was
introduced to the Board’s licensees in Forum #3,
2001. The second title, Social Services for Pregnant and
Parenting Adolescents: A Legal Guide, was published in
2002 and presented in Forum #3, 2002. Public Schools
and Pregnant and Parenting Adolescents: A Legal Guide,
discussed above, is the third volume in the series. The
final volume in the series, for adolescents themselves,
with a special chapter for their parents, will follow in
the coming year and will appear in Spanish as well as
English. It will be announced in the Forum when
available.
..........................................
Professor Dellinger has been a faculty member at the
Institute of Government at UNC Chapel Hill since 1974.
She was formerly counsel with Hogan & Hartson,
Washington, DC, and is author of numerous publications
on health and hospital law, including an article, How We
Die in North Carolina, in Forum #2, 1999. Her articles
on the first two titles in the Legal Guide series appeared in
Forum #3, 2001, and Forum #3, 2002.
John Wills Moses, Jr, MD, is a
primary care pediatrician and
a documentary photographer
based at Duke University. It is
his distinctive work that appears
on the covers of the Legal Guide
series. A native of New York, he
is a graduate of the Medical
University of South Carolina and
did his residency training at
Boston City Hospital and Yale-New Haven Hospital.
He is board certified in pediatrics.
While maintaining a busy clinical practice, Dr
Moses teaches photography at Duke’s Center for
Documentary Studies. This spring semester, he is
again teaching Children and the Experience of Illness,
a course that incorporates teaching photography to
children faced with chronic disease. His personal doc-umentary
projects have included a study of adolescent
parents and innovative primary care clinicians. In
addition to contributing images to the Legal Guide
series, he has recently published his photographs in
The Youngest Parents by Robert Coles, MD (Norton
Press), and Big Doctoring by Fitzhugh Mullan, MD
(University of California Press).
Dr Moses
The Caring Lens
12 NCMB Forum
George C. Barrett, MD, of
Charlotte, a former member and
president of the North Carolina
Medical Board, was presented
the Federation of State Medical
Board’s Distinguished Service
Award on April 30 in Arlington,
VA, at the Federation’s 2004
Annual Meeting. The award rec-ognizes
his outstanding service
to and leadership of the Federation and the field of
medical licensure and discipline.
Dr Barrett served as president of the Federation in
2000-2001. His leadership helped stimulate signifi-cant
progress by state medical boards in the areas of
license portability and continuing competency. In
2002, he chaired the Search Committee that selected
James N. Thompson, MD, former dean of Wake
Forest University School of Medicine, to be the new
CEO of the Federation.
Additionally, Dr Barrett served the Federation in an
array of other capacities, including service on the
Special Committee on Strategic Planning and the
Post-Licensure Assessment System/Assessment Center
Program Committee. He is also a Federation repre-sentative
to the Educational Commission for Foreign
Medical Graduates.
George C. Barrett, MD, Receives FSMB
Distinguished Service Award
Dr Barrett
On October 31, 2003, the United States Medical
Licensing Examination Committee on Irregular
Behavior made determinations in 27 instances that
USMLE examinees had engaged in irregular behavior.
The transcripts of those examinees were annotated to
reflect those determinations. That means anyone
receiving those examinees’ USMLE transcripts in the
future will be aware of the findings. In some cases, the
examinees were also barred from USMLE for a period
of time.
A determination of irregular behavior can put an
examinee’s medical career in jeopardy! Third parties,
such as residency program directors and state licensing
boards, receive annotated transcripts and make deci-sions
that could adversely affect an examinee’s future.
The conduct involved included bringing unautho-rized
material into the testing room (including cellular
telephones, pagers, etc), falsification of information
on USMLE documents (such as applications and
score reports), making notes while in the testing
room, and not adhering to proctor’s instructions.
In 2003, seven examinees were found guilty of post-ing
examination content in Internet chat rooms, and
this led to sanctions as noted above. The posting of
examination content in a public forum such as the
Internet may provide unfair advantage to future test
takers and is strictly prohibited.
Examinees are expected to be familiar with the
USMLE Bulletin of Information and the rules of con-duct.
The USMLE program will use any means nec-essary
and appropriate to protect the integrity of the
examination program.
The North Carolina Medical Board has recently
amended subchapter 32S, Physician Assistant
Regulations, of the North Carolina Administrative
Code. A copy of the rules is posted on the North
Carolina Medical Board’s Web site at www.ncme
dboard.org, or you may access a copy through
the Rules Division of the North Carolina
Office of Administrative Hearing’s Web site at
http://www.oah.state.nc.us.
The amended rules include: 21 NCAC 32S .0106,
Continuing Medical Education, which removes speci-fications
for the continuing medical education of
PAs who prescribe controlled substances; 21 NCAC
32S .0109, Prescriptive Authority, which no longer
requires the supervising physician’s co-signature on
prescriptions written by the PA; and 21 NCAC 32S
.0110, Supervision of Physician Assistants, removing
the supervising physician’s co-signature requirement
of PA charts. [Note: Entries by a PA into patient charts
of inpatients (hospitals, long term care institutions)
must comply with the rules and regulations of the
institution.]
The amendment of 21 NCAC 32S .0106 became
effective April 1, 2004, and the amendments to both
21 NCAC 32S .0109 and 21 NCAC 32S .0110
became effective May 1, 2004.
NCMB Amends PA Rules
Irregular Behavior in Sitting the USMLE Can
Put a Medical Career in Jeopardy
No. 1 2004 13
Nighttime Is the Right Time:
Night Shift Workers at Pitt County Memorial Hospital
Keep the Lights on After the Sun Goes Down
Doug Boyd and Dena Marshall
The night shift. Sometimes
dark and quiet, sometimes wild
and raucous, depending, some
say, on the phase of the moon
and whether it’s a “pay-day
Friday.”
One thing is certain: night
shift workers consider themselves
just a little different from their
daytime counterparts.
“Night nurses are a different
breed. I’m a night person,” said
Family Birth Center nurse
Frances Hamilton.
Clinician Bobby Jones put it a
little more rhythmically: “We
keep vampire hours and get none
of the powers.”
Several hundred people are
needed to keep Pitt County
Memorial Hospital and the
Brody School of Medicine at East Carolina University
working through the night. Patients need 24-hour
care. Research experiments sometimes conclude at
midnight. A car crash can happen at any time.
“Night shift employees are a critical link and impor-tant
to the system,” said Tyree Walker, PCMH vice
president of human resources. “These employees are
highly skilled, work as a cohesive interdisciplinary
team and meet the health care challenges every single
night of the week.”
Advantages, such as being off during the day and
taking home shift-differential pay, attract people to the
night shift. For others, it’s just a way of life.
“It takes a quirky group of people to work nights,”
said nurse Nikki Dickinson. “You’ve got to be a little
crazy.”
Darkness Settles, but Not Sarah Beth
One recent summer night at PCMH, 2-West—the
pediatric floor—had 24 patients, most of them babies.
Six-week-old Sarah Beth White was spending her first
night in the hospital due to an infection. She drank
from a bottle as she lay in her dad’s arms.
“She woke up this morning with a temperature of
104,” Sarah’s mother, Winnie White, said at 9:30 p.m.
“We think it’s a urinary tract infection, but the doctor
wanted us to stay a few days to rule out other infec-tions.”
The Whites were among many families spending
the night, some on 2-West and others elsewhere in the
hospital.
“We encourage family members to stay overnight
with younger children. They are allowed to bring
items from home: blankets, stuffed toys. We try to
follow their home routine as much as possible,” said
2-West charge nurse Judy Holley.
Holley, a nurse for 35 years, hasn’t always worked
the night shift; she chose a day schedule when her
children were young. She now prefers nights.
“There are fewer extra people on the floor,” she said.
“There is also a lot of teamwork on this floor that is
excellent at night. It’s just a whole different world.”
With 35 babies in the Neonatal Intensive Care Unit
and no windows, day and night meld amid a non-stop
flurry of critically ill infants and hard-working clini-cians.
Karen Michaels, assistant nurse manager, has
been working nights for nearly 20 years. She has no
problem staying awake, but has found the shift takes
some getting used to for some new nurses.
“As long as I stay busy, I’m fine,” Michaels said.
“We are pretty much doing stuff all night, but at three
or four in the morning the new girls are usually tired,
so we get them to walk the hallways to stay awake.
New nurses still have to rotate days and nights, so I
suggest coffee, caffeine, Tylenol® and to keep on their
routine as much as possible.”
Not only do new nurses have to adjust to the night
shift, but also the environment inside the NICU takes
a toll on them, Michaels said.
“We have highly critical babies in this unit,” she
said. “We see a lot. The babies suffer, and the parents
have a hard time stopping life support. We lost two
babies today so it was a bad day, but we sit and talk
about it. We tell the new nurses they did everything
Mr Boyd
Ms Marshall
Neonatal nurse Jennifer Callicut has worked nights for 12 years
at PCMH.
“ ‘We keep
vampire
hours and
get none of
the powers’ ’’
14 NCMB Forum
they could, everything right.”
For nearly 12 years, Jennifer Callicut has worked the
night shift in the NICU. She said the schedule allows
her more family time.
“I worked days for a little while, but found nights
were a lot easier on my family,” Callicut said. “I am
able to see my children in the morning and also spend
more time with them.”
Callicut admitted, however, the worst thing about
working the night shift was jumping back into the
routine after going on vacation. For Michaels, the
downside is that the cafeteria is only open from 1 a.m.
to 3 a.m.
Lorrie Pipkin, a nurse in the Family Birth Center,
agreed with Callicut’s view on the night shift and chil-dren.
After getting off work, she said, “you take them
to school, you go to bed, then you get up in time to
go pick them up, then you go to work.” If she worked
days, she said, she would leave home before the chil-dren
awoke and get home just in time for them to fin-ish
their homework and go to bed.
PCMH employees who work at night may be on a
3 to 11 p.m. shift, an 11 p.m. to 7 a.m. shift, or the
long 7 p.m. to 7 a.m. shift. Some have variations of
those hours.
One of those working from 7 p.m. to 7 a.m.
was charge respiratory therapist Brian White. He
guessed he and his co-workers walk five miles or
more, day or night. He might walk from the
Emergency Department to the Cardiac Intensive Care
Unit almost 20 times in one night. He said the
patient load for a respiratory therapist remains steady
for day and night shifts. “It may fluctuate depending
on new patients and patients who go home,” he said.
“It can get crazy”
Nights in the Emergency Department can fluctuate,
too. On this night, following a day with five traumas,
it was busy.
“Right now, it’s packed in here like it is two in the
afternoon,” said Dr Skip Robey, ECU associate clini-cal
professor of emergency medicine. “Because this is
a tertiary care center, patients come from all regions.
There’s a constant flow of patients, so it’s rare if we are
not busy.”
Robey said patients at night may come in for a vari-ety
of reasons ranging from violent crimes, to knife
and gun incidents, to motor vehicle crashes involving
alcohol.
According to Dr Ron Landry, assistant clinical pro-fessor
of emergency medicine, the ED operates as it
does during the day, prioritizing patients, taking care
of the sickest ones first.
“It can get crazy at night,” Landry said. “You end
up having to ‘put your finger in the dam’ so to speak,
stabilizing your patients. It’s easier to get behind at
night because of a decrease in staff and more odd
patients coming in. It’s rare to have trouble staying
awake, and it’s even more difficult just to sit down and
feel tired.”
Dr Clarence Dunagan, a third-year emergency med-icine
resident, always works the night shift. During
his first year, he rotated between days and nights, but
said he prefers nights and has no trouble staying
awake.
“I went to the Air Force Academy,” Dunagan said.
“I can pretty much fall asleep on command.”
Meanwhile under a crescent moon, radiologic tech-nologists
Amy Ayers and Crystal Stalls sipped soft
drinks during a break from duty in the Emergency
Department. “It’s been a rough night,” Ayers said,
citing a number of minor traumas in the ED. She said
the night shift “suits my lifestyle. I’m not a morning
person. I’d rather sleep all morning, then get up at
noon.”
Usually after work, she goes to workout at ViQuest
or to get breakfast with co-workers. “The lady at
Bojangles knows me,” she said with a smile. On this
particular morning, she had to attend a cardiopul-monary
resuscitation class after work.
For PCMH police, the night can also be busy.
Seven officers patrol the hospital, inside and out,
rotating posts every three hours. Officer Houston
Randolph, who’s been at the hospital for almost four
years, said he receives numerous calls during his 12-
hour shift.
“On a typical night, we can get calls for morgue
releases, assault victims in the ED, and for families
who may be emotional if a member has passed,”
Randolph said. As part of his patrol at night, he also
includes regular tours through the hospital and park-ing
lots.
Vernon Lane, another PCMH patrol officer,
described the patient calls: “They’re out of it. They’re
having some kind of reaction to drugs. Patients can be
violent.”
Inside the PCMH visitor lobby, Cynthia Ellis, lead
visitor control receptionist, arrived at work dark and
early at 4:30 a.m. Part of her job is to assist surgery
patients and their families as they arrive for their pro-
Amy Ayers, left, and Crystal Stalls take a break from their jobs as
X-ray technicians near the end of their night shift at PCMH.
“ ‘I worked
days for a
little while,
but found
nights were a
lot easier on
my family’ ’’
No. 1 2004 15
“ ‘It’s easier
to get behind
at night
because of a
decrease in
staff and more
odd patients
coming in’ ’’
cedures. “Most of the time when I get here at 4:30,
there are people sitting in the lobby waiting for me,”
she said.
On the Medical Intermediate Unit, hospitalist
Anthony Smith was completing his shift. Hospitalists
work seven days, then have seven days off. They alter-nate
between a week on the day shift and a week on
the night shift. As a fire alarm went off on the Medical
Intensive Care unit, he talked about which shift he
prefers.
“As a married guy, days,” he said. “I don’t see that
much of (my wife) when I work nights.” Dr Smith
also pointed out that while the hospital is much less
active at night, that doesn’t mean patients get a lot of
rest. “Patients for the large part are up because of
noises and nurses checking on them. And the fire
alarms.”
With the shift drawing to a close, Family Birth
Center nurse Debra Wright summed up her feelings of
working at PCMH after dark: “It’s awesome.”
_____________________
Reprinted with permission from the July/August 2003
number of People, the newsletter of University Health
Systems of Eastern Carolina and the East Carolina
University Division of Health Sciences. Photos by Cliff
Hollis.
..........................................
Doug Boyd is editor of People. Dena Marshall is a former
staff assistant of People and now serves as assistant in the
NCMB’s Department of Public Affairs and as assistant edi-tor
of the Forum.
PCMH police officer Freddie Bowen raises the flags in front of the
hospital as the sun rises behind him.
After years of development and the investment
of millions of dollars, the United States Medical
Licensing Examination Step 2 Clinical Skills
examination (Step 2-CS)—the first such testing
of medical graduates in 40 years—will debut in
Philadelphia in June.
The examination assesses whether an examinee
can demonstrate the fundamental clinical skills
essential to safe and effective patient care under
supervision. It is a one-day test that mirrors a
physician’s typical workday in a clinic and other
settings. Examinees will examine 11 or 12 “stan-dardized
patients”—people trained to portray
real patients.
More than 3,000 students have registered
for the examination since registration began
in January. Following the opening of the
Philadelphia examination center, additional cen-ters
will be opened in Atlanta in July, in Los
Angeles in August, and in Chicago and Houston
in September.
A wide-ranging effort to educate the profes-sion
about the new examination continues. The
National Board of Medical Examiners, which co-sponsors
the USMLE with the Federation of
State Medical Boards, has invited the deans from
all LCME-accredited medical schools to partici-pate
in “learning labs” to learn first hand about
the examination. Deans from more than 85
schools are expected to participate. Additionally,
the Federation and the NBME will bring a dele-gation
from the American Medical Association
to visit a testing center and discuss the examina-tion.
_____________________
NewsLine, Federation of State Medical Boards
USMLE Clinical Skills Examination
to Debut in June 2004
16 NCMB Forum
REVIEW
Learning the Lessons That Will Make
Us Uncomfortable
George C. Barrett, MD
Former President, NCMB
Former President, Federation of State Medical Boards
“They avoided
what might be
considered the
‘real’ issue, the
issue of the
morality of
assisted sui-cide”
For 2,500 years, the Hippocratic
oath has proscribed giving a deadly
drug to a patient or making a sug-gestion
to this effect. As we have
developed both mechanical and
chemical means of prolonging the
labor of death, there has been an
increasing concern regarding the
role physicians should play, if any, in
assisting in the suicide of patients
who are terminally ill and who have
felt that they can no longer endure
their life.
In 1997, anticipating that physician-assisted suicide
would become legal as it did in Oregon, the editors of this
book, Assisted Suicide: Finding Common Ground and
Guidance for Real-World Implementation, organized a proj-ect
at the University of Pennsylvania Center for Bioethics,
convening a national panel of experts on the subject of
assisted suicide. The panel membership was multidiscipli-nary—
with representatives from medicine, nursing, psy-chology,
Hospice, patient advocacy, law, philosophy, the
clergy, and bioethics. The panel was deliberately com-posed
of individuals with diverse viewpoints on assisted
suicide—some for, some against. The goal assigned this
panel was not to argue the pros or cons but, rather, start-ing
from the assumption that legalization was coming, to
seek common ground in examining how to guide practices
and determine safeguards that would keep assisted suicide
voluntary, regulated, and an option of last resort.
They acknowledge that they avoided what might be
considered the “real” issue, the issue of the morality of
assisted suicide. They further acknowledge that it is an
important question, but it is not the only question. That
assisted suicide is going on does not make it right, but it
does require some guidance for the practice. They decid-ed
morality was not the urgent question to be addressed.
The panel, which was named “The Assisted Suicide
Consensus Panel of the Finding Common Ground
Project,” debated many questions: What is assisted sui-cide?
Is physician-assisted suicide different from refusal of
treatment? Are there alternatives to assisted suicide? How
useful are currently available guidelines for physician-assisted
suicide? Who should have access to what? Does
assisted suicide necessarily mean physician-assisted suicide?
Can it be effectively and meaningfully regulated? How
should physicians respond to requests for assisted suicide?
The book provides expanded versions of the consensus
papers, with additional chapters developed by different
members of the panel.
Following is the editors’ chapter-by-chapter summary of
questions addressed, with my occasional comments for
clarity.
Chapter One
Some context on early implementation of the Oregon
law is provided and the implications for end of life care in
that state.
Chapter Two
“Assisted Suicide and Refusal of Treatment: Valid
Distinction or Distinction Without a Difference?” initiates
a policy debate at the beginning with an examination of
definitions and first principles. This chapter deals with the
distinction between refusal of treatment and assisted sui-cide.
It also cites the issue of causation to account for the
distinction between withdrawing life sustaining treatment
and assisted suicide. The panel clearly distinguishes
between assisted suicide and refusal of treatment.
Chapter Three
“The Role of Guidelines in the Practice of Physician-
Assisted Suicide” asks several key questions: “what goals
do guidelines serve, who should formulate them, what bar-riers
are there to the creation and implementation of guide-lines,
and, fundamentally, is dying a process that is
amenable to direction under guidelines by physicians?”
The panel notes a concern that the debate about guidelines
to regulate the practice of physician-assisted suicide has
been shaped more by overall attitudes about the desirabil-ity
or undesirability of legalization than by any particular
set of guidelines and their merit.
Chapter Four
The question: “Ought Assisted Suicide Be Only
Physician-Assisted?” The assumption has been inherent in
many discussions that assistance with suicide generally
means physician-assisted suicide. This chapter seeks to
define both the necessity and limits of the physician’s role
in assisted suicide. It concludes that assisted suicide
requires physician involvement, but physicians’ limited
competence in performing the full range of tasks is too nar-row
a construct. This leaves open the possibility of other
professionals expanding their authority in this area.
Chapter Five
In many respects, this chapter poses a seminal question.
The authors examine the assumption that, if there are
times when assisted suicide is morally safe, can this be
Dr Barrett
No. 1 2004 17
implemented in practice? The counter question becomes,
if regulation is so difficult, is it preferable to rely on alter-natives
currently permitted?
Chapter Six
“Palliative Treatments of Last Resort: Choosing the
Least Harmful Alternative” looks at how physicians, nurs-es,
patients, families, and loved ones still can face clinically,
ethically, morally, and legally challenging decisions
throughout the dying process even when palliative care is
effective. This chapter illustrates, with summaries of real
clinical cases, how each of these practices might be a
response to patients in particular clinical circumstances,
keeping in focus the patients’ values, as well as those of the
families, other loved ones, and health care providers.
Chapter Seven
“Responding to Legal Requests for Physician-Assisted
Suicide” focuses on how physicians can respond to
requests in an era of legalization. When legal physician-assisted
suicide does become one of the many options to be
freely considered for terminally ill patients with extreme
suffering, some patients will view it as a right to expect on
demand. The chapter considers the ethical implications of
disclosing to patients assisted suicide as an option of last
resort. When practicing in
jurisdictions that permit
assisted suicide, physicians
should not encourage
patients to hasten death.
They remind physicians of
the responsibility to focus
on broader biopsychosocial
concerns. This will require
empathic listening and emo-tional
support. This chapter
also provides a context and
vocabulary for physicians when responding to requests for
assisted suicide.
Chapter Eight
“Lesson from the Dying” describes the death of the
author’s twenty-six-year-old son who died as the result of
carcinoma of the colon. The author reminds us that labor
is the term applied when a woman is giving birth, and
indeed it is a laborious process. The experience the father
had with his son suggested that dying should also be
termed labor, and he felt that his son had labored with con-siderable
difficulty in the process of dying. The author
poses the question: “What’s wrong with assisted suicide?”
He notes that terminal illness obviously involves the feel-ings
and experience of others, but dying belongs to the
patient and no one can it do for us. Suicide, however,
directly affects others besides the person who has died in
ways that can be uniquely damaging. Suicide is particular-ly
damaging precisely because the death was self-inflicted.
Those closest to the person who has committed suicide
invariably feel particularly guilty. The author says that in
addition to its professional, ethical, spiritual, and legal dif-ficulties,
assisted suicide therefore carries with it an added
burden, one that is not often considered: a serious and last-ing
social and emotional price among the survivors.
I believe the Consensus Panel was well composed and
the papers resulting from its deliberations are scholarly,
readable, and focused on the questions addressed in an
objective manner. The editors believe the papers will
advance the policy dialogue and assist those who will be
dealing with these issues in practice. I would add that for
some dealing with these issues the questions will focus
thinking and practices at the bedside, which should have
the potential to cause physicians to alter their approach to
management in a more compassionate manner. For exam-ple,
Tulsky, Clampa, and Rosen make a clear statement that
physicians are ethically obligated to explore in a meaning-ful
way a request for assisted suicide. This includes dis-cussion
of what is permitted under the law if the patient
persists. Although in no way obligated to accede to a
request that violates the physician’s moral code, he or she
must avoid dismissal out of hand.
I find no evidence to suggest the editors or the panel
members attempted to provide support for or against
physician-assisted suicide.
Attention to these questions during clinical training may
have a very positive impact on patient management, and
opportunities for dialogue should be created during train-ing.
I do believe including discussion of the moral issue
related to physician-assisted suicide would have been inter-esting
and where the panel
“came down” on that issue
would have been of some
value. However, it is evi-dent
that what appears
moral in this decade may
not be so clear in the next.
We cannot address the
moral issue today and
assure our conclusion will
be the same when reviewed
a decade hence.
Frank Davidoff, MD, the author whose son died from
carcinoma of the colon, recalls that when he was a resident
his chief of medicine kept reminding the residents that if a
patient signed out of the hospital against advice, it was
really the resident’s problem. If a patient had to ask for
barbiturates, the resident had not been doing his job. Dr
Davidoff points out that today assisted suicide is no longer
taboo and that we cannot be shocked or surprised when
some doctors agree to assist the rare patient with ending
life. Public discussion has provided the opportunity to
understand the extent to which assisted suicide may violate
the physician’s deepest professional codes.
Dr Davidoff, however, cautions that the lessons learned
leave us with “an unresolved, and irresolvable, tension.” In
my view, that’s exactly where we should be. The only real
tragedy would be if we were to become comfortable with
the choices we face in caring for patients whose illness has
made the work of living—and dying—-intolerable.
This book will assist physicians in meeting their respon-sibility
to learn all the lessons that will make us uncom-fortable
when we are confronted with a patient wanting
“out against advice.” It has the potential to assure that this
generation of physicians and those following will under-stand
and accept death as a part of life. If so, patients
dying in pain will be a problem of the past and we may not
fear patients seeking the good death.
“Attention to
these questions
during clini-cal
training
may have a
very positive
impact on
patient man-agement,
and
opportunities
for dialogue
should be cre-ated
during
training”
Assisted Suicide: Finding Common Ground and Guidance for
Real-World Implementation
Lois Snyder, JD, and Arthur L. Caplan, PhD, eds
Indiana University Press, Bloomington and Indianapolis, 2002
232 pages, $35 (hardback)
[Includes: annotated bibliography on assisted suicide; Oregon
Death with Dignity Act;
texts of 1997 U. S. Supreme Court decisions on Washington et al.
V. Glucksberg
and on Vacco, Attorney General of New York, et al V Quill et al.]
18 NCMB Forum
Annulment:
Retrospective and prospective cancellation of the
authorization to practice.
Conditions:
A term used for this report to indicate restrictions
or requirements placed on the licensee/license.
Consent Order:
An order of the Board and an agreement between
the Board and the practitioner regarding the
annulment, revocation, or suspension of the
authorization to practice or the conditions and/or
limitations placed on the authorization to practice.
(A method for resolving disputes through infor-mal
procedures.)
Denial:
Final decision denying an application for practice
authorization or a motion/request for reconsider-ation/
modification of a previous Board action.
NA:
Information not available.
NCPHP:
North Carolina Physicians Health Program.
RTL:
Resident Training License.
Revocation:
Cancellation of the authorization to practice.
Summary Suspension:
Immediate temporary withdrawal of the authori-zation
to practice pending prompt commence-ment
and determination of further proceedings.
(Ordered when the Board finds the public health,
safety, or welfare requires emergency action.)
NORTH CAROLINA MEDICAL BOARD
Board Orders/Consent Orders/Other Board Actions
November - December 2003 — January 2004
DEFINITIONS
Suspension:
Temporary withdrawal of the authorization to
practice.
Temporary/Dated License:
License to practice medicine for a specific period
of time. Often accompanied by conditions con-tained
in a Consent Order. May be issued as an
element of a Board or Consent Order or subse-quent
to the expiration of a previously issued tem-porary
license.
Voluntary Dismissal:
Board action dismissing a contested case.
Voluntary Surrender:
The practitioner’s relinquishing of the authoriza-tion
to practice pending or during an investiga-tion.
Surrender does not preclude the Board
bringing charges against the practitioner.
ANNULMENTS
NONE
REVOCATIONS
BANERJEE, Haradhan, MD
Location: Cleveland, OH
DOB: 4/03/1935
License #: 0000-22674
Specialty: FP/IM (as reported by physician)
Medical Ed: Nilratan Sircar, India (1957)
Cause: Conviction of a felony in State of Ohio v. Haradhan Banerjee,
case number 384747.
Action: 12/09/2003. Entry of Revocation issued: Dr Banerjee’s
license is revoked by operation of law as of 10/08/2003.
FINNEY, Patrick Curtis, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 10/25/1969
License #: 0098-00247
Specialty: IM (as reported by physician)
Medical Ed: University of Tennessee, Memphis (1996)
Cause: Conviction of a felony in McCracken Circuit Court,
Commonwealth of Kentucky, on 9/14/2000.
Action: 12/17/2003. Entry of Revocation issued: Dr Finney’s license
is revoked by operation of law as of 12/17/2003.
NELSON, David Stephen, MD
Location: Winston-Salem, NC (Forsyth Co)
DOB: 12/16/1935
License #: 0000-13186
Specialty: EM/GS (as reported by physician)
Medical Ed: Bowman Gray School of Medicine (1961)
Cause: Conviction of a felony in U.S. v. David S. Nelson, case num-ber
1:01CR319-1.
Action: 12/9/2003. Entry of Revocation issued: Dr Nelson’s license is
revoked by operation of law as of 11/26/2003.
PULIVARTHI, Venkataramanaiah, MD
Location: Gastonia, NC (Gaston Co)
DOB: 5/30/1960
License #: 0096-00114
Specialty: IM (as reported by physician)
Medical Ed: Guntur Medical College, India (1983)
Cause: Conviction of a felony in U.S. v. Venkata R. Pulivarthi, case
number 4:02-673.
Action: 12/18/2003. Entry of Revocation issued: Dr Pulivarthi’s
license is revoked by operation of law as of 7/11/2003.
TAYLOR, Carolyn Rose, MD
Location: Clinton, NC (Sampson Co)
DOB: 1/18/1948
License #: 0000-24876
Specialty: GP (as reported by physician)
Medical Ed: New Jersey College of Medicine (1976)
Cause: In January 2003, Dr Taylor was convicted in Onslow County
Superior Court of felony Uttering a Forged Instrument.
Action: 11/04/2003. Dr Taylor’s North Carolina medical license is
revoked.
SUSPENSIONS
See Consent Orders:
GALYON, Ronald Curtis, MD
LESZCZYNSKI, Donald Brian, MD
LOCK, George Joseph, Physician Assistant
MILES, Martha Cope, MD
TAUB, Harry Evan, MD
THOMPSON, Jill Ellen, MD
TUCKER, Peter Loren, MD
WHITE, Steven William, Physician Assistant
SUMMARY SUSPENSIONS
LUTZ, Robert Paul, MD
Location: Chapel Hill, NC (Orange Co)
DOB: 5/05/1948
License #: 0000-27387
Specialty: FP (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1982)
Cause: Dr Lutz may be unable to practice medicine with reasonable
skill and safety to patients as shown by the Notice of Charges
and Allegations filed by the Board October 24, 2003 [see entry
for this physician on the Board’s Web site at www.ncmed-board.
org].
Action: 10/24/2003. Order of Summary Suspension of License issued:
Dr Lutz’s medical license is suspended effective 12/17/2003.
No. 1 2004 19
CONSENT ORDERS
BUZZANELL, Charles Anton, MD
Location: Asheville, NC (Buncombe Co)
DOB: 9/23/1956
License #: 0098-00481
Specialty: AN/APM (as reported by physician)
Medical Ed: Georgetown University School of Medicine (1984)
Cause: To amend the Consent Order of September 2003 that reissued
Dr Buzzanell’s medical license, which he surrendered on
11/01/2002. In September 2002, Patient A, who has a physi-cian-
patient relationship with Dr Buzzanell presented to the
ER at Pardee Hospital in Hendersonville with suicidal
ideations. Dr Buzzanell authorized the ER physician to admit
Patient A, but later failed to remember, and denied, he had
authorized admission of Patient A. He prescribed his memory
loss to his failure to take his prescribed medication. Patient B,
who had a patient-physician relationship with Dr Buzzanell,
had a history of lung cancer and, in September 2002, Dr
Buzzanell performed an intrathecal pump revision on Patient B
at Pardee Hospital. Patient B died the following day, leading to
a conversation between Dr Buzzanell and the medical examin-er,
Dr Rholl. Dr Rholl believed Dr Buzzanell was less than
forthcoming in discussing Patient B’s surgery and said she
would have ordered an autopsy had she obtained information
she now believes she has regarding the surgery. Dr Buzzanell
surrendered his license on 11/01/2002. He has now success-fully
completed evaluation and treatment at Ridgeview
Institute for attention-deficit/hyperactivity disorder NOS and
has continued his treatment on an outpatient basis. He has a
contract with the NCPHP and the NCPHP reports he is com-pliant.
Action: 1/10/2004. Consent Order executed: Dr Buzzanell’s license is
reissued to expire on the date shown on the license; he shall
limit his practice to no more than 40 hours a week; he shall
restrict privileges to one local hospital; he shall not implant
intrathecal pumps or spinal column stimulators and tunneled
catheter systems; he shall continue his treatment with his
health care providers, therapists, and support groups; he shall
maintain and abide by a contract with the NCPHP; must com-ply
with other conditions.
DAVIS, Tracy Denise, Physician Assistant
Location: Durham, NC (Durham Co)
DOB: 5/22/1973
License #: 0001-03924
PA Education: Medical College of Georgia (2000)
Cause: On application for a PA license. In August 2003, Ms Davis
informed the Board on her application that she had practiced
as a PA in Georgia from November 2000 through August 2003
without being licensed. On learning she was not properly
licensed, she quit her job, but she never informed her employ-er
she had practiced without a license.
Action: 11/05/2003. Consent Order executed: Ms Davis is issued a PA
license and is reprimanded; must comply with other condi-tions.
DONDIEGO, Richard Michael, MD
Location: High Point, NC (Guilford Co)
DOB: 1/15/1955
License #: 0095-01225
Specialty: IM/C (as reported by physician)
Medical Ed: Universidad Central del Caribe School of Medicine, Puerto
Rico (1981)
Cause: On the request of Dr DonDiego for reinstatement of his
license. Dr DonDiego failed to register his license by the
required date in 2003 and, therefore, his license was placed on
inactive status in May 2003. He now appreciates the impor-tance
of registering his license annually in a timely manner.
Action: 11/03/2003. Consent Order executed: Dr DonDiego’s license
is reinstated effective on the date of the Consent Order and is
to expire on the date shown on the license [5/03/2004]; he
shall submit documentation of his CME to the Board on an
annual basis, beginning on or before 9/01/2004; he shall main-tain
and abide by a contract with the NCPHP; must comply
with other conditions.
GALYON, Ronald Curtis, MD
Location: Ellijay, GA
DOB: 8/12/1953
License #: 2003-01531
Specialty: ORS (as reported by physician)
Medical Ed: Eastern Virginia Medical School (1986)
Cause: On application for a North Carolina license. In 1992, Dr
Galyon was diagnosed with alcohol abuse. In 1998, he tested
positive for alcohol when reporting for work at a hospital in
Georgia and was terminated from his employment at the hos-pital.
In that same year, he was diagnosed with alcohol
dependence. In June 1999, he entered into a Consent Order
with the Georgia Board restricting his Georgia medical license
as a result of substance abuse. In August 1999, he admitted to
the Georgia Board that he had consumed alcohol and had been
charged with DUI. He voluntarily entered substance abuse
treatment in that same month. In October 1999, he entered
into another Consent Order with the Georgia Board suspend-ing
his license. In August 2001, the Georgia Board issued a
public Consent Order lifting Dr Galyon’s suspension and rein-stating
his Georgia license subject to terms and conditions. In
June 2003, he submitted a license application to the North
Carolina Medical Board and disclosed his Georgia public
Consent Order. The North Carolina Board requested he be
assessed by the NCPHP. The NCPHP found Dr Galyon suf-fers
from alcohol dependence and depressive disorder, but that
he can practice safely under certain conditions and limitations
paralleling those in his Georgia Consent Order. Dr Galyon
admits his situation and the importance of proper treatment.
Action: 12/18/2003. Consent Order executed: Dr Galyon is issued a
license to practice medicine and surgery; that license is imme-diately
suspended; suspension is stayed on specific terms and
conditions; he shall provide the Board a copy of his continuing
aftercare contract and he shall abide by all the terms of that
contract; he shall designate an acceptable supervising physician
who will supervise his work and an acceptable treating physi-cian
with whom he will continue therapy; he shall provide a
copy of this Consent Order to both physicians; the supervising
and monitoring physicians will be in communication with each
other and will report to the Board quarterly; they will immedi-ately
report any change in Dr Galyon’s condition; Dr Galyon
shall use triplicate prescription forms for all controlled sub-stances
he prescribes, with copies coming to the Board; he shall
make a copy of his dispensing record available to the Board on
request; he shall keep for the Board’s inspection a prescrib-ing/
dispensing log for all controlled substances; unless lawful-ly
prescribed for him by someone else, he shall not possess or
use mind- or mood-altering substances or alcohol; he shall
notify the Board within 10 days of such use and shall include
the name of the prescriber and the pharmacy filling the pre-scription;
he shall supply bodily tissue and/or fluid samples at
the Board’s request for testing to determine if he has consumed
any of the substances cited; he shall maintain and abide by a
contract with the NCPHP; he shall regularly attend AA and/or
Caduceus meetings; must comply with other conditions.
HSIEH, Stephen Szu-heng, MD
Location: Lexington, NC (Davidson Co)
DOB: 9/09/1968
License #: 0097-00075
Specialty: IM (as reported by physician)
Medical Ed: Bowman Gray School of Medicine (1995)
Cause: On the Notice of Charges and Allegations filed 8/07/2003. In
January 2003, the Medical Staff Executive Committee of
Lexington Memorial Hospital concluded Dr Hsieh had com-mitted
unethical and inappropriate medical acts in reading
EKGs and telemetry of other physicians’ patients without a
consultation order and billing for those services. The
Committee recommended his clinical privileges be revoked.
Dr Hsieh requested a hearing on this matter. As a result of that
hearing and the explanation of the misunderstandings that led
to the problem, the Committee stated it could not conclude
that Dr Hsieh had any intent to mislead or defraud any patient
or third-party payor. It also concluded Dr Hsieh had done all
he could to rectify his mistakes by refunding the moneys he had
received from his billings to patients and third-party payors.
The Committee also noted his regret and remorse and con-cluded
he was not likely to again make the mistakes that had led
to this situation. As a result of the hearing, the Committee’s
20 NCMB Forum
recommendation was modified and a formal reprimand was
issued to Dr Hseih. His privileges were suspended for 30 days
and he was placed on probation for a year. He was also
required to do at least 50 hours of community service, which
he has completed.
Action: 11/20/2003. Consent Order executed: Dr Hsieh is repri-manded.
JOHNSON, Maxwell Kenneth, MD
Location: Sisseton, SD
DOB: 4/22/1939
License #: 0000-28226
Specialty: IM/ID (as reported by physician)
Medical Ed: University Otago, New Zealand (1965)
Cause: On the request of Dr Johnson for reinstatement of his license.
In July 2001, Dr Johnson was reprimanded and fined by the
Michigan Board of Medicine for failing to obtain adequate
CME as required by Michigan law. In 2002, Dr Johnson failed
to register his North Carolina license as required by North
Carolina law and his license was placed on inactive status on
1/03/2003. He now appreciates the importance of registering
his North Carolina license annually in a timely manner.
Action: 11/12/2003. Consent Order executed: Dr Johnson’s license is
reinstated effective the date of the Consent Order; he shall
obtain CME as required by North Carolina law and shall doc-ument
his CME to the Board beginning on or before
9/01/2004; must comply with other conditions.
KLING, Timothy George, MD
Location: Nags Head, NC (Dare Co)
DOB: 4/08/1944
License #: 0096-00591
Specialty: OBG (as reported by physician)
Medical Ed: University of Iowa (1971)
Cause: Dr Kling was reprimanded under a Consent Order issued by
the Illinois Board in 2003 and he was ordered to complete 30
hours of Category I CME in fetal emergencies. This action was
based on information that Dr Kling allegedly failed to perform
a timely caesarian section, resulting in injuries to a newborn
infant.
Action: 1/22/2004. Consent Order executed: Dr Kling is reprimand-ed;
he shall comply in all respects with the Illinois Consent
Order; must comply with other conditions.
LEMAIRE, Pierre-Arnaud Paul, MD
Location: Wilson, NC (Wilson Co)
DOB: 3/24/1960
License #: 0000-39440
Specialty: GS/VS (as reported by physician)
Medical Ed: University of Medicine and Dentistry of New Jersey R.W.
Johnson Medical School (1985)
Cause: On the request of Dr Lemaire for reissuance of his license. In
February 2002, Dr Lemaire was referred by his wife to the
NCPHP for alcohol problems. He met with the staff of the
NCPHP and admitted he was an alcoholic. He signed a con-tract
with the NCPHP and agreed to enter a 28-day inpatient
treatment program. He had also tested positive for canna-banoids.
However, Dr Lemaire did not enter the treatment
program because he was under subpoena in a malpractice case.
The NCPHP agreed for him to undergo outpatient treatment,
which he began promptly. In May 2002, he tested positive on
drug screens and agreed to undergo assessment by a substance
addiction treatment center. He was diagnosed with alcohol
dependence and cannabis abuse. Residential treatment was
recommended and it was recommended he not return to prac-tice
until he successfully completed the treatment program. In
consultation with the NCPHP, he was given several options
regarding his future. In July 2002, Dr Lemaire decided to sur-render
his license and did so on July 12. On 9/14/2002, the
Board preferred Charges and Allegations against him related to
his being unable to practice with reasonable skill and safety due
to excessive use of alcohol and or other substances. On
3/31/2003, Dr Lemaire and the Board entered into a Consent
Order in which Dr Lemaire agreed to leave his license in a sur-rendered
status until he could demonstrate his ability to prac-tice
with reasonable skill and safety unaffected by alcohol or
other substances. He has now shown the Board he completed
a 28-day inpatient addiction treatment program and attends
four to six AA meetings a week and meets weekly with his AA
sponsor. He continues to work with and be monitored by the
NCPHP, which reports he continues to show signs of recovery
and asserts he is safe to return to practice with a temporary
license under certain conditions. He admits to the Board that
when he consumes alcohol or marijuana he is unable to prac-tice
medicine with reasonable skill and safety.
Action: 11/05/2003. Consent Order executed: Dr Lemaire is issued a
license to expire on the date shown on the license [3/31/2004];
unless lawfully prescribed for him by someone other than him-self,
he shall refrain from use of all mind-or mood-altering sub-stances
and from alcohol; he shall notify the Board within 10
days of any such use and shall include in that notice the identi-ty
of the prescriber and the pharmacy filling the prescription;
on the request of the Board, he shall supply bodily fluids or tis-sues
for screening purposes; he shall maintain and abide by a
contract with the NCPHP; he shall attend AA, NA, and/or
Caduceus meetings as recommended by the NCPHP; prior to
resuming practice, he must obtain practice site approval from
the president of the Board; he agrees his practice, if allowed to
resume, should be limited to Wilson, NC, and the adjoining
area; must comply with other conditions.
LESZCZYNSKI, Donald Brian, MD
Location: Calabash, NC (Brunswick Co)
DOB: 4/14/1960
License #: 2001-00257
Specialty: IM (as reported by physician)
Medical Ed: Pennsylvania State University (1986)
Cause: Dr Leszczynski surrendered his license on 8/13/2001 after he
was arrested and charged with obtaining a controlled substance
by fraud in South Carolina. He was convicted on that charge
in March 2002 and placed on two years probation.
Action: 1/22/2004. Consent Order executed: Dr Leszczynski’s med-ical
license is suspended indefinitely retroactive to 8/13/2001.
LOCK, George Joseph, Physician Assistant
Location: Princeton, NC (Johnston Co)
DOB: 8/26/1958
License #: 0001-01050
PA Education: Bowman Gray (1987)
Cause: In November 2000, Mr Lock signed a contract with the
NCPHP in which he agreed to abstain from mood changing
chemicals unless prescribed by his primary care physician or
psychiatrist and approved by the NCPHP. However, Mr Lock
did ingest such a chemical for shoulder pain without informing
the NCPHP until asked for a urine sample. After being
warned that he must completely abstain, within two weeks Mr
Lock again used such a chemical for pain related to kidney
stones without informing the NCPHP. When confronted, he
admitted his action. In June 2002, he signed a Consent Order
with the Board in which he agreed to abstain the use of mind-or
mood-altering chemicals and alcohol unless lawfully pre-scribed
by someone other than himself. He also agreed to sup-ply
bodily tissues or fluids to allow testing for such use. On
April 24, 2003, he refused to provide a urine sample for test-ing.
The next day, he supplied the sample to the NCPHP and
it proved positive for codeine. In May, he provided another
urine sample that proved positive for opiates. Mr Lock also
admitted he forged his supervising physician’s signature on a
prescription for several Schedule III drugs. Mr Lock surren-dered
his PA license on May 20, 2003.
Action: 11/20/2003. Consent Order executed: Mr Lock’s PA license
is suspended indefinitely effective May 20, 2003.
MILES, Martha Cope, MD
Location: Sanford, NC (Lee Co)
DOB: 8/12/1953
License #: 0000-35989
Specialty: N (as reported by physician)
Medical Ed: University of Oklahoma (1988)
Cause: Relative to the Notice of Charges and Allegations of
9/17/2003. Dr Miles has not always kept accurate inventories
of controlled substances she purchased for administration to
patients in her office. On rare occasion, Dr Miles has left pre-signed
prescriptions with her nurse so that, in Dr Miles’
absence and after checking with her or her record of the
patient’s care, the nurse could reauthorize prescriptions. On
one occasion, Dr Miles prescribed for her husband and daugh-ter
without keeping a record and without coordinating the pre-
No. 1 2004 21
scribing with their regular physicians. These actions constitute
unprofessional conduct. Dr Miles has signed a contract with
the NCPHP and the NCPHP reports she has complied with
that contract.
Action: 1/15/2004. Consent Order executed: Dr Miles’ license is sus-pended
for 12 months; suspension is stayed immediately on
conditions: she shall maintain and abide by a contract with the
NCPHP, she shall successfully complete the Vanderbilt
University Prescribing for Controlled Substances course, she
shall continue treatment with a psychiatrist approved by the
NCPHP and shall authorize that psychiatrist to share informa-tion
about her with the Board, she shall continue in the care of
the Duke or UNC pain centers, she shall practice no more than
eight hours a day and no more than 30 hours a week, and she
shall completely abstain from prescription medicine unless law-fully
prescribed by her primary physician or psychiatrist and
approved by the NCPHP; must comply with other conditions.
RODINE, Mary Kim, MD
Location: Weaverville, NC (Buncombe Co)
DOB: 11/30/1954
License #: 0000-27295
Specialty: IM (as reported by physician)
Medical Ed: University of Illinois (1980)
Cause: On the request of Dr Rodine for reinstatement of her license.
On 9/04/1991, Florida granted Dr Rodine a license pursuant
to an Order that stated the license was contingent on her enter-ing
into a contract with the Physician’s Recovery Network
based on her history of psychiatric treatment for depression.
On 1/15/1997, Illinois placed her license on indefinite proba-tion
for a minimum of five years, suspended her controlled
substance registration, and ordered she attend meetings of AA
or NA at least three times a week and undergo random urine
screens at least once a month. Dr Rodine failed to register her
North Carolina license in 1986 and her license was placed on
inactive status as a result. In October 2003, she asked that her
North Carolina license be reinstated. She now appreciates the
importance of registering her license in a timely manner.
Action: 11/14/2003. Consent Order executed: Dr Rodine’s license is
reinstated effective 11/14/2003; she shall maintain and abide
by a contract with the NCPHP; she shall obtain required
CME; must comply with other conditions.
TAUB, Harry Evan, MD
Location: Chapel Hill, NC (Orange Co)
DOB: 11/24/1970
License #: Resident Training License
Specialty: P (as reported by physician)
Medical Ed: Dartmouth Medical School (2001)
Cause: Relative to the Notice of Charges and Allegations of
9/10/2003. After issuance of his RTL, Dr Taub became addict-ed
to controlled substances legitimately prescribed for his wife.
In April 2003, Durham County Sheriff ’s Department officers
and agents from the DEA searched Dr Taub’s residence after
obtaining information from a pharmacist that Dr Taub had
obtained controlled substances under a false name. During the
search of his residence, Dr Taub admitted to the officers and
agents that he had been writing prescriptions for himself for
about a year. As a result of his candid admission, formal
charges were delayed pending Dr Taub’s hospitalization for
addiction. When he was released from treatment, he contact-ed
Durham law enforcement authorities and accepted service of
one felony count. On July 17, 2003, he was arrested and
charged. In September, Dr Taub entered into a deferral agree-ment
in Durham County District Court that placed him on
supervised probation. The Court agreed that if he followed his
treatment plan and submitted to drug testing for a year, charges
would be dismissed and his record expunged. The NCPHP
advocates for Dr Taub.
Action: 1/22/2004. Consent Order executed: Dr Taub’s medical
license is suspended indefinitely; such suspension is stayed sub-ject
to conditions and terms stated in the Consent Order; Dr
Taub shall abide by all laws and rules; he shall maintain and
abide by a five-year contract with the NCPHP; at the Board’s
request, he shall supply bodily fluids and tissues for drug test-ing;
he shall give a copy of the Consent Order to all current and
prospective employers; unless lawfully prescribed for him by
someone else, he shall refrain from the use or possession of
mind- or mood-altering substances and all controlled sub-stances;
he shall notify the Board within 10 days of his use of
such medication and shall identify the prescribing physician
and the pharmacy filling the prescription; must comply with
other conditions.
THOMPSON, Jill Ellen, MD
Location: Gastonia, NC (Gaston Co)
DOB: 3/31/1957
License #: 0093-00608
Specialty: R/RNR (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1991)
Cause: On inappropriate prescribing of medications. From April
through June 2002, Dr Thompson wrote prescription refills to
a close relative for hydrocodone and other medications without
keeping a medical record. In June and July 2002, Dr
Thompson wrote prescriptions to another family member for
hydrocodone and other medications without examining him or
keeping a medical record. Several other instances of similarly
inappropriate prescribing for relatives and friends occurred in
2002. These prescriptions were all written outside the scope of
Dr Thompson’s practice as a diagnostic radiologist. The fore-going
constitutes unprofessional conduct.
Action: 1/22/2004. Consent Order executed: Dr Thompson’s license
is suspended for 60 days, which suspension is immediately
stayed. Dr Thompson agrees not to prescribe to family mem-bers
or others with whom she has a close personal relationship
and shall not prescribe outside the scope of her medical prac-tice.
TUCKER, Peter Loren, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 4/07/1955
License #: 0000-31213
Specialty: PS (as reported by physician)
Medical Ed: Bowman Gray School of Medicine (1981)
Cause: Relating to Charges and Allegations filed against Dr Tucker on
May 1, 2003. During an in-office face lift and related proce-dures
performed on Patient A by Dr Tucker, anesthesia servic-es
were provided by an independent contractor, a certified reg-istered
nurse anesthetist. The patient was observed by Dr
Tucker and his staff to be awake and alert in the recovery room,
and her care was assumed by the nurse anesthetist. While in
the recovery room, the patient received an injection of fentanyl
citrate IV from the nurse anesthetist without authorization
from Dr Tucker. The administration of fentanyl caused the
patient to suffer respiratory depression and arrest and required
resuscitative measures. Initially, the nurse anesthetist attempt-ed
to deal with the situation on her own and without consult-ing
Dr Tucker, declining offers of assistance from other staff
members. Dr Tucker then resuscitated the patient and accom-panied
her to the hospital. The nurse anesthetist did not go to
the hospital. The nurse anesthetist was grossly negligent in her
failure to alert Dr Tucker to the patient’s condition and, given
the facts and circumstances of the patient’s care, in giving the
patient the fentanyl injection in the recovery room. Though
Dr Tucker is responsible for the supervision of his staff, includ-ing
his nurse anesthetist, he is not required to foresee or antic-ipate
all acts of gross negligence, nor is he responsible for those
acts. The nurse anesthetist was practicing outside her scope of
practice and performing medical acts without supervision by a
licensed physician. Three days later, the patient died from the
effects of the fentanyl injection. Dr Tucker’s care of the patient
fell below the standards of medical practice in that he failed to
supervise the nurse anesthetist sufficiently and that he should
have discovered that his nurse anesthetist was practicing medi-cine
in the recovery room without physician supervision. Dr
Tucker ended the work relationship he had with the nurse anes-thetist
and implemented policies to supervise his remaining
nurse anesthetists with more scrutiny to prevent similar inci-dents.
Since these events, Dr Tucker has not experienced any
problems with patient care involving anesthesia or post-opera-tive
recovery and he has fully cooperated with the Board.
Action: 11/20/2003. Consent Order executed: Dr Tucker’s license is
suspended for 12 months. Suspension is stayed subject to the
following terms: he shall abide by all laws, rules, and regula-tions;
he shall supervise his nurse anesthetists more closely and
shall submit the relevant procedures and protocols to the
Board, along with a random selection of patient charts, for
review by the Board at times requested by the Board; and he
shall meet with the Board or members of the Board as request-ed.
22 NCMB Forum
WHITE, Steven William, Physician Assistant
Location: Cameron, NC (Moore Co)
DOB: 12/19/1962
License #: 0001-02116
PA Education: Midwestern University (1996)
Cause: Mr White was the only licensed medical care provider on site
at the Spout Springs Medical Center from June 2001 to
December 2, 2002 under the supervision of Linda M.
Robinson, MD. At that point, Mr White took a leave from
practice due to illness. He recommenced practice under the
supervision of Robert L. Ferguson, MD, on March 20, 2003.
On May 25, 2003, Dr Ferguson notified the Board and Mr
White that he would no longer serve as Mr White’s supervisor.
However, in the hope he would contract with another super-vising
physician, Mr White kept the clinic personnel in place
and hired part-time physicians to care for patients through
mid-June 2003. After May 25, when his approval to practice
had lapsed, Mr White continued to treat patients at least four
times and did lab work, drew blood, and wrote prescriptions
backdated to before May 25. The Board performed a review of
Mr White’s practice and found problems relating to disposal of
hazardous waste, maintenance of medical records, supervision,
and physician support of practice activities. On June 19, 2003,
Mr White closed the clinic and voluntarily surrendered his PA
license. He has now taken and passed the PA National
Recertifying Examination and he recognizes that, despite the
conduct of others, PAs have an individual obligation to ensure
timely compliance with Board rules.
Action: 12/03/2003. Consent Order executed: Mr White’s PA license
is suspended indefinitely effective June 19, 2003; such suspen-sion
is stayed effective December 18, 2003, subject to certain
conditions and he is issued a temporary license to expire on the
date shown on the license [6/30/2004]; he shall abide by all
laws, rules, and regulations related to medical practice; he shall
provide a copy of this Consent Order to all current and
prospective employers; when he returns to practice, he shall
practice with a supervising physician on site no less than three
days a week; he shall maintain appropriate medical records
countersigned by his supervisor; he shall cooperate with the
Board’s Investigative Department in monitoring his practice;
must comply with other conditions.
WODECKI, Tadeusz Kazimierz, MD
Location: Stone Mountain, GA
DOB: 3/04/1954
License #: 2003-01312
Specialty: IM/GP (as reported by physician)
Medical Ed: Silesian Academy of Medicine, Zabrze, Poland (1979)
Cause: On Dr Wodecki’s application for a medical license. In March
1999, the Georgia Board entered into a Consent Order with
Dr Wodecki by which his license was suspended for 45 days
and placed on probation for three years following suspension.
Restrictions were placed on his authority to prescribe con-trolled
substances. In June 1999, the New York Board charged
Dr Wodecki with professional misconduct by reason of the
action taken by the Georgia Board. He surrendered his New
York license in October 1999.
Action: 11/25/2003. Consent Order executed: Dr Wodecki is repri-manded;
he is issued a license to expire on the date shown on
the license [6/04/2004]; must inform the Board of any change
in residence or practice address within 10 days of the change.
MISCELLANEOUS ACTIONS
NONE
DENIALS OF RECONSIDERATION/MODIFICATION
AMIR, Guy J., MD
Location: Royal Palm Beach, FL
DOB: 6/24/1971
License #: NA
Specialty: NA
Medical Ed: Fatima, Philippines (1997)
Cause: In July 2003, the Board voted to deny Dr Amir’s request to
withdraw his application for a license and to deny his applica-tion
for a license. At a hearing on 11/20/2003, the Board again
considered the issues at Dr Amir’s request. It found that sub-stantial
evidence exists to support the Board’s denial of Dr
Amir’s application for a license based on his failure to provide
the Board evaluations of his postgraduate training within a
reasonable time and in a reasonable manner.
Action: 1/13/2004. Findings of Fact, Conclusions of Law, and Order
issued: the Board’s previous denial of Dr Amir’s application
for a medical license was proper and shall remain in effect.
DENIALS OF LICENSE/APPROVAL
DEBNAM, George Clyde, MD
Location: Raleigh, NC (Wake Co)
DOB: 11/05/1927
License #: 0000-8749
Specialty: FP/OBG (as reported by physician)
Medical Ed: Meharry Medical College (1951)
Cause: Dr Debnam failed to satisfy the Board of his qualifications for
a license.
Action: 1/06/2004. Letter issued denying Dr Debnam’s application
for a medical license.
SURRENDERS
BARBER, Robert Anthony, DO
Location: Morehead City, NC (Carteret Co)
DOB: 9/30/1954
License #: 2003-00222
Specialty: FP (as reported by physician)
Medical Ed: University of Health Sciences College of Osteopathic Medicine
(1989)
Action: 12/22/2003. Voluntary surrender of medical license.
BRANSFORD, Paris, MD
Location: Houston, TX
DOB: 1/01/1930
License #: 0000-14435
Specialty: [not indicated]
Medical Ed: Meharry Medical College (1963)
Action: 12/16/2003. Voluntary surrender of medical license.
GILLILAND, Corey William, DO
Location: Ft. Bragg, NC (Cumberland Co)
DOB: 5/02/1967
License #: 2000-01486
Specialty: GP/AM (as reported by physician)
Medical Ed: University of Health Sciences College of Osteopathic
Medicine, Kansas City (1999)
Action: 11/26/2003. Voluntary surrender of medical license.
GRODER, Martin Gary, MD
Location: Chapel Hill, NC (Orange Co)
DOB: 11/15/1939
License #: 0000-18262
Specialty: P (as reported by physician)
Medical Ed: Columbia University (1964)
Action: 1/28/2004. Voluntary surrender of medical license.
PABST, Mark Dell, MD
Location: Dunn, NC (Harnett Co)
DOB: 6/01/1936
License #: 0000-27835
Specialty: PD (as reported by physician)
Medical Ed: University of Iowa (1962)
Action: 11/24/2003. Voluntary surrender of medical license.
ROWE, Theodore Charles, III, MD
Location: Pilot Mountain, NC (Surry Co)
DOB: 9/30/1942
License #: 0000-16300
Specialty: FP/PH (as reported by physician)
Medical Ed: Medical College of Virginia (1968)
Action: 12/15/2003. Voluntary surrender of medical license.
TYLER, Brent Joseph, MD
Location: Durham, NC (Durham Co)
DOB: 10/01/1975
License #: RTL
Specialty: AN (as reported by physician)
Medical Ed: University of Illinois College of Medicine (2003)
Action: 1/15/2004. Voluntary surrender of resident training license.
No. 1 2004 23
COURT APPEALS/STAYS
NONE
CONSENT ORDERS LIFTED
NEWTON, Jimmie Isaac, MD
Location: Winston-Salem, NC (Forsyth Co)
DOB: 11/29/1938
License #: 0000-14269
Specialty: OBG (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1964)
Action: 11/04/2003. Order issued lifting Consent Order of
2/19/2003.
SHAFTNER, Kimberly K., MD
Location: Princeton, NC (Johnston Co)
DOB: 12/09/1954
License #: 0000-25426
Specialty: FP/ABS (as reported by physician)
Medical Ed: Ohio State University (1980)
Action: 1/06/2004. Order issued lifting Consent Order of
10/04/2000.
TEMPORARY/DATED LICENSES:
ISSUED, EXTENDED, EXPIRED, OR REPLACED BY FULL LICENSES
BUZZANELL, Charles Anton, MD
Location: Asheville, NC (Buncombe Co)
DOB: 9/23/1956
License #: 0098-00481
Specialty: AN/APM (as reported by physician)
Medical Ed: Georgetown University School of Medicine (1984)
Action: 12/18/2003. Temporary/dated license extended to expire
6/30/2004.
CONNINE, Tad Robert, MD
Location: Hopkinsville, GA
DOB: 1/19/1964
License #: 0099-00193
Specialty: RO (as reported by physician)
Medical Ed: University of Southern Florida (1992)
Action: 12/18/2003. Temporary/dated license extended to expire
12/31/2004.
GOTTSCHALK, Bernard Joseph, MD
Location: Wilmington, NC (New Hanover Co)
DOB: 5/10/1955
License #: 0000-30162
Specialty: IM/ON (as reported by physician)
Medical Ed: University of Pittsburgh (1981)
Action: 1/22/2004. Temporary/dated license extended to expire
7/31/2004.
GUALTEROS, Oscar Mauricio, MD
Location: Aberdeen, NC (Moore Co)
DOB: 5/11/1964
License #: 0099-00236
Specialty: IM (as reported by physician)
Medical Ed: University of Navarra, Spain (1991)
Action: 1/22/2004. Temporary/dated license extended to expire
1/31/2005.
KEEVER, Richard Alan, MD
Location: Greensboro, NC (Guilford Co)
DOB: 6/11/1941
License #: 0000-16400
Specialty: OTO (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1969)
Action: 1/22/2004. Temporary/dated license extended to expire
1/31/2005.
LAVINE, Gary Harold, MD
Location: Winterville, NC (Pitt Co)
DOB: 11/04/1964
License #: 2001-00403
Specialty: EM (as reported by physician)
Medical Ed: University of South Alabama (1989)
Action: 12/18/2003. Temporary/dated license extended to expire
6/30/2004.
MASSENBURG, O’Laf Sorento, Physician Assistant
Location: Winston-Salem, NC (Forsyth Co)
DOB: 2/10/1960
License #: 0001-01117
PA Education: Bowman Gray (1988)
Action: 1/22/2004. Full and unrestricted PA license issued.
MATTHEWS, Charles Joseph, MD
Location: Raleigh, NC (Wake Co)
DOB: 2/03/1955
License #: 0000-27245
Specialty: N (as reported by physician)
Medical Ed: University of Virginia (1978)
Action: 12/18/2003. Temporary/dated license extended to expire
6/30/2004.
PRESSLY, Margaret Rose, MD
Location: Boone, NC (Watauga Co)
DOB: 5/05/1956
License #: 0000-34548
Specialty: FP (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1990)
Action: 12/18/2003. Temporary/dated license extended to expire
6/30/2004.
SHAFTNER, Kimberly K., MD
Location: Princeton, NC (Johnston Co)
DOB: 12/09/1954
License #: 0000-25426
Specialty: FP/ABS (as reported by physician)
Medical Ed: Ohio State University (1980)
Action: 12/18/2003. Full and unrestricted license reissued.
SINGH, Prachee, Physician Assistant
Location: Charlotte, NC (Mecklenburg Co)
DOB: 8/16/1976
License #: 0001-03694
PA Education: University of Texas, Pan American (2001)
Action: 12/18/2003. Temporary/dated license extended to expire
12/31/2004.
See Consent Orders:
BUZZANELL, Charles Anton, MD
DONDIEGO, Richard Michael, MD
LEMAIRE, Pierre-Arnaud Paul, MD
WHITE, Steven William, Physician Assistant
WODECKI, Tadeusz Kazimierz, MD
DISMISSALS
NONE
Mail Completed form to: North Carolina Medical Board
PO Box 20007, Raleigh, NC 27619
Please print or type. Date:______________
Full Legal Name of Licensee:_____________________________________________________
Social Security #:_______________________License/Approval #:______________________
(Check preferred mailing address)
❏ Business:_____________________________________________________________________
❏ Business:_____________________________________________________________________
❏ Business:_____________________________________________________________________
Phone:(______)_________________________Fax:(_______)____________________________
❏ Home: ______________________________________________________________________
❏ Business_____________________________________________________________________
❏ Home: ______________________________________________________________________
Phone:(______)_________________________Fax:(_______)____________________________
The Board requests all licensees maintain a current address on file with the Board office. Changes of
address should be submitted to the Board within 60 days of a move.
✁
Prsrt Std
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PAID
Permit No. 1486
Raleigh, NC
North Carolina Medical Board
1203 Front Street
Raleigh, NC 27609
CHANGE OF ADDRESS FORM
North Carolina Medical Board Meeting Calendar,
Examinations
Meeting Dates: May 19-21, 2004; June 16-17, 2004; July 21-23, 2004
August 18-19, 2004; September 22-24, 2004
Residents Please Note USMLE Information
United States Medical Licensing Examination Information (USMLE Step 3)
Computer-based testing for Step 3 is available on a daily basis. Applications are available on the
North Carolina Medical Board’s Web site at http://www.ncmedboard.org/exam.htm. If you have
additional questions, please e-mail Kelli Singleton, GME/Examination Coordinator, at
kelli.singleton@ncmedboard.org.
Special Purpose Examination (SPEX)
The Special Purpose Examination (or SPEX) of the Federation of State Medical Boards of the United
States is available year-round. For additional information, contact the Federation of State Medical
Boards at PO Box 619850, Dallas, TX 75261-9850, or telephone (817) 868-4000.