Primum Non Nocere
N C M E D I C A L B O A R D
No. 3, 2004 forumElectronic Medical Records
Page 4
In This Issue of the FORUM
President’s Message:
Consistency and Credibility .........................................................1
*Stephen M. Herring, MD
DEA Changing Style and Appearance of DEA
Controlled Substance Registration Certificate ...........................2
*Staff
Examination Notes .......................................................................3
*Staff
Electronic Medical Records and the Development of
Electronic Health Records and Electronic Patient Records........4
*Marjorie A. Satinsky, MA, MBA
Warning Signs...............................................................................9
*Staff
North Carolina National Guard Unit Starts
Adopt-a-Clinic Program in Iraq ..............................................10
*Major Henry E. Riley, PA-C, NCARNG
NC’s Allied Health Care Professionals: A Clarification................11
*Robin Hunter-Buskey, PA-C
Preparing for an Atypical Day: Are You Ready, Doctor? ............12
*Gale Adcock, FNP
A Dance with Technology...........................................................13
*Hayes Woollen, Jr, MD
Warren Pendergast, MD, New NCPHP Medical Director...........14
*Staff
Letters from Our Readers:
Patient Care Suffers Due to Computers ......................................15
Dr Yow Named Assistant Medical Director of NCMB................15
*Staff
The NCMB Presents Fondly, Carolyn:
Letters to a Young Physician ......................................................16
Board Actions: 5/2004-7/2004 ..................................................18
Board Calendar ...........................................................................24
Change of Address Form ............................................................24
Consistency is the steadfast adherence
to the same principles, course, or form.
It is an important sentinel in medical reg-ulation
because without consistency, by
definition, regulation cannot be optimal.
So important is it that some medical
boards have carefully assessed the consis-tency
of their regulatory processes in
order to best assure patient protection.
They have also presented the resulting
data at the annual meetings of the
Federation of State Medical Boards of
the United States. No two situations are identical in the world
of medical regulation, of course, but there are elements of some
situations that are generally similar to others. It is these similar-ities
that can be tracked throughout the regulatory process, not to
guarantee the same outcomes but to ensure consistency in
process itself. Needless to say, consistency simply for the sake of
consistency is not desirable, and, as Emerson said, “a foolish con-sistency
is the hobgoblin of little minds.” The North Carolina
Medical Board has considered the issue of consistency in regula-tion
and has drawn the conclusion that consistency in process is
essential to credible public protection and fairness, but seeking
consistency in outcomes would be futile due to the many vari-ables,
revealed through process, that attend each case coming
before it.
Regulation, that is to control or direct by rule, is the sole
responsibility and mandate of medical boards. They are, in fact,
the “courts of last resort,” and ultimately responsible for those
they license. However, they also depend on a complex system
and a team effort to assist in the process. The list of players is
long and includes, but is not limited to, the Federation of State
Medical Boards, accreditation organizations, medical schools,
graduate training programs, impaired physician programs, gener-al
medical societies, specialty societies and boards, hospital over-sight
systems, and peer review systems. These groups play an
important role by assisting medical boards in regulation. If they
do not perform their oversight functions effectively, the correc-tion
of problems will be delayed, threatening unnecessary harm
to patients.
Consistency and credibility throughout the entire system are
critical to best ensure meeting our common goals. If any organ-ization
has bylaws, rules, policies, resolutions, or codes in place,
irrespective of mission statement or mandate, consistency in
application must be pursued in order to earn and maintain cred-ibility.
One set of standards must be applied at all levels regard-less
of station or any other factor. As a hypothetical illustration,
if a chief of staff of a hospital demands that staff conform to a call
schedule, yet does not abide by that same schedule, there is a
credibility gap. If a surgery teacher throws instruments in the
operating room, but demands that students not throw instru-ments,
there is a credibility gap. To be credible, a professional
organization or accreditation body with established standards
must act if a member or accredited entity falls outside those stan-dards.
Not to do so is not to have standards. Fortunately, lack
of consistency in practice settings and in professional and accred-itation
groups is becoming more the exception than the rule,
which significantly enhances their credibility.
Item Page Item Page
President’s Message
Consistency and Credibility
Primum Non Nocere
NORTH CAROLINA
MEDICAL BOARD
April 15, 1859
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. 3, 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
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
We are all imperfect. That is inherent in the human
condition. In the field of medical licensure, we must
face that imperfection and work for consistent and
credible regulation in order to advance our quest for
the best in medical practice. We are indebted to those
medical boards and individuals that recognize the
importance of consistency and credibility for initiating
and pursuing a national discussion of those fundamen-tal
principles. I have no doubt that discussion will
remain a significant part of the regulatory agenda for
years to come.
During my service on the North Carolina Medical
Board over the past six years, it has made many posi-tive
changes to improve regulation. Those changes,
and the many improvements made over earlier years,
were not the result of any one person’s effort — they
were and are the product of the hard work and person-al
commitment of each and every past and present
Board member and of our dedicated and highly profes-sional
staff. Our Board, founded in 1859, is the oldest
continuously functioning medical board in the country.
It is recognized as a leader in medical regulation and
many of its members have provided outstanding
national leadership in the field. I am confident the spir-it
of this distinguished legacy will continue to generate
steady advances in the work of the Board because the
Board’s members, professional and public, and staff
will never accept the status quo. The determination to
provide effective public protection through consistent
and credible processes, ingrained in the Board’s culture
and tradition, will carry the Board another 150 years
and more. It has been a pleasure and an honor for me
to be a small part of all this.
DEA Changing Style and
Appearance of DEA Controlled
Substance Registration Certificate
The Drug Enforcement Administration (DEA) Office
of Diversion Control is in the process of changing the
style and appearance of the DEA Controlled Substance
Registration Certificate. As of October 1, 2004, the
revised Certificate of Registration will consist of two
parts: one that can be displayed on the wall and one
smaller, wallet-size version. The certificate will have an
imbedded watermark logo that will provide authentica-tion
of the certificate and also deter counterfeiting.
Registrants that are currently allowed to renew their
DEA registration via the Diversion Control Program’s
Web site (ie, retail pharmacies, hospitals, practitioners,
mid-level practitioners, and teaching institutions) may
print their Certificate of Registration on completion of
the registration renewal process as long as no changes
have been made to their registration since their last
renewal. The Diversion Control Program’s Web site
may be accessed at www.DEAdiversion.usdoj.gov. The
DEA will continue to send Certificates of Registration
via the U.S. Postal Service to all new registrants and all
other DEA registrants renewing their DEA registration.
No. 3 2004 3
Examination Notes
USMLE Clinical Skills Examination Underway
“Debriefing” USMLE Participants Can Lead to Sanctions Against Examinees
NBOME Begins Clinical Skills Testing at New Pennsylvania Center
Administration of the United States Medical
Licensing Examination (USMLE) Step 2 Clinical Skills
(CS) examination began in June in Philadelphia. There
are now five testing centers: Philadelphia, Atlanta, Los
Angeles, Chicago, and Houston.
More than 12,000 medical students and graduates of
LCME-accredited and international medical schools
have applied to take the examination since registration
began in January 2004. Of those, more than 7,000
have scheduled to take the examination at one of the
test sites.
“We’re very pleased with the successful roll-out of the
first test centers,” said James N. Thompson, MD, pres-ident
and CEO of the Federation of State Medical
Boards (FSMB). “This is a major step toward ensuring
that all physicians have the necessary clinical and com-munication
skills to practice medicine safely.”
The FSMB and the National Board of Medical
Examiners (NBME) are co-sponsors of the USMLE,
which is accepted by all allopathic and composite med-ical
boards as meeting their examination requirements
for licensure. The new Step 2 CS will assure the public
that all MDs who seek licensure in this country have the
same set of clinical and communications skills no mat-ter
where they have been educated or trained.
The one-day examination mirrors a physician’s typi-cal
workday in a clinic and other settings. Examinees
will examine 11 or 12 “standardized patients”—individ-uals
trained to portray real patients—for 15 minutes
each. The “patients” are hired actors, ranging from
teen-agers to retirees, who simulate various illnesses
that a physician is likely to encounter in common med-ical
practice. After each encounter, examinees record a
patient note, including pertinent history and physical
examination findings, diagnostic impressions, and plans
for further evaluation if necessary.
Examinees are evaluated on their ability to establish
rapport with the standardized patient, gather informa-tion,
perform focused physical examinations, communi-cate
effectively, and document findings and diagnostic
impressions.
Scores for the first group of Step 2 CS examinations
are expected to be released by mid-November, with
subsequent score releases taking place approximately six
weeks after test administration. Students who fail the
test can try again after 60 days, up to three times a year.
Because the actual date for release of scores is uncertain,
the FSMB and NBME have written to the directors of
all ACGME-accredited residency programs urging them
not to require applicants to their programs to complete
the Step 2 CS prior to the National Residents Matching
Program deadline in March 2005. A copy of that com-munication
and further information on the USMLE
Step 2 CS may be found on the USMLE Web site at
www.usmle.org.
The United States Medical Licensing Examination
(USMLE) Secretariat has issued a warning to medical
school faculty who may be “debriefing” students who
have taken the USMLE Step 2 Clinical Skills examina-tion,
then sharing information with students who have
not yet taken the test. While sponsors of the USMLE
Step 2 Clinical Skills examination have no objection to
examinees obtaining accurate, practical, and general
advice for taking the test, under USMLE rules, provid-ing
and/or disseminating information about case mate-rial
is viewed as “irregular behavior” and examinees run
serious risks if they disclose any test material. Sanctions
can include permanent annotation of their USMLE
records and being barred from taking any Step exami-nation
for a period of time.
For more information, contact the Federation of
State Medical Board’s vice president for Examination
and Post-Licensure Assessment Services at (817) 868-
4045.
The National Board of Osteopathic Medical
Examiners (NBOME) began testing at its new National
Center for Clinical Skills Testing in Conshoshocken,
PA, in September. The center will now conduct COM-LEX-
USA Level 2-PE (Performance Evaluation) clini-cal
skills examination on a continuous basis throughout
the year.
The purpose of the Level 2-PE is to measure doctor-patient
communication, history-taking, physical exami-nation,
osteopathic principles, manipulative treatment,
written communications skills, integrated differential
diagnosis, and the formulation of a therapeutic plan in
a simulated clinical environment. The DO candidates
see 12 patients during the seven-hour examination.
The test is similar to the USMLE Step 2 Clinical Skills
examination implemented at five sites this year.
Level 2-PE will be required for all DO candidates
graduating in 2005 and those who graduated before
July 1, 2004, and have not passed Level 2-CE
(Cognitive Evaluation) by June 30, 2005. Because
Level 2-PE is a separate component from Level 2-CE,
the examinations may be taken in any order.
For more information, visit the NBOME Web site at
www.nbome.org.
4 NCMB Forum
Electronic medical records
(EMRs) are high on most physi-cians’
lists of potential practice
enhancements. Currently, there
are many more interested physi-cians
than actual users, but I
expect the number of purchasers
to increase dramatically.
Interest in EMRs is increasing
for many compelling reasons. As
EMR technology evolves, new vendors are entering
the market and lowering their prices. (In fact, as I
write this article, EMRs, the current state-of-the-art,
are quickly moving toward more advanced technolo-gy,
such as electronic health records [EHRs] and elec-tronic
patient records [EPRs]. I’ll say more about this
evolution below.) Medical school graduates are very
comfortable with information technology and are like-ly
to set up their practices with EMRs, not paper med-ical
records.
Large private and public purchasers already set
expectations for health care providers and reward
those hospitals and physicians that can demonstrate a
high quality of care, practice efficiencies, and lower
costs. For example, General Electric, Verizon, IBM,
and CISCO, all national companies with North
Carolina locations, collaborate with other leading
employers to hold providers accountable for what they
do.
Like the private sector, the public sector is also inter-ested
in promoting the use of information technology.
At the federal level, Medicare’s e-prescribing initiative
is expected to accelerate electronic prescribing for all
patients. “Interoperability” in health care information
technology is a public priority for President Bush.
The Department of Health and Human Services
recently appointed its first national coordinator for
Health Information Technology to work with the
public and private sectors. In late July, that coordina-tor,
David Brailer, MD, PhD, announced federal sup-port
for community-based collaborations among
providers using IT products that are certified as hav-ing
a base-level of desirable features.
Here in North Carolina, the North Carolina
Healthcare Information and Communications
Alliance (NCHICA) has both public and private sup-port.
Along with a number of its professional society
and association members, NCHICA has passed a res-olution
endorsing a secure, paperless, person-centered
health record by the year 2010. NCHICA is also
encouraging North Carolina employers to hold health
care providers accountable. I agree with NCHICA
and believe that within 10 years, EMRs (or their next
manifestations) will be in most physicians’ offices. In
those communities and practices that are particularly
forward-looking, the change will occur even sooner.
That said, I encourage you to work thoughtfully
rather than quickly so that you purchase systems that
suit your needs, that are standards-based, and that are
priced within your budget.
I encourage practices that are exploring EMRs to
address 10 important questions.
• What’s the philosophy behind EMRs?
• How has the technology of EMRs evolved, and
what is the future direction?
•What functions/capabilities can most EMRs
bring to medical practices?
• What are the potential benefits of EMRs and,
equally important, are they measurable?
• What’s the cost of introducing EMRs into your
practice?
• What steps should you take to get started?
• What are the keys to successful implementation?
• What are recommended resources for informa-tion
on vendors and their products?
• What questions should you ask vendors?
• What are good sources of additional informa-tion?
What’s the Philosophy Behind EMRs?
The philosophy of EMRs is straightforward. EMRs
capture data on the clinical status of individual
patients, and they allow users to view in new ways
data that have been previously stored. For example,
EMRs can capture data from within and outside a
physician’s practice. Visit notes, rationales for clinical
decision making, reports from physicians in other
practices, lab and X-ray results, information from hos-pitals,
pharmacies, and other health care institutions,
and information from state and national databases are
examples of the kinds of data that can be drawn into a
single database. Physicians and other users can then
view information on both individual patients and
groups of patients.
All EMRs have common building blocks (Carter,
2001). First, they have a database management sys-tem.
Second, they allow data input in a variety of
ways, such as pen, voice-based technology, and scan-
“NCHICA
has passed a
resolution
endorsing a
secure, paper-less,
person-centered
health
record by the
year 2010”
Ms Satinsky
Electronic Medical Records and the
Development of Electronic Health Records
and Electronic Patient Records
Marjorie A. Satinsky, MA, MBA
President, Satinsky Consulting, LLC
No. 3 2004 5
“As EMRs
evolve into
EHRs and
EPRs, one of
the challenges
that must be
addressed is
standards
for interoper-ability”
ning of paper records. Third, EMRs network through
a LAN, Internet, or wireless system. Fourth, they
offer security through a combination of one or more
mechanisms, including passwords, tokens, biometrics,
and/or encryption. Fifth, they allow messaging, and,
sixth, they store clinical information in a way that per-mits
movement from one system to another.
Evolution and Future Direction of EMRs:
CPRs to EMRs to EHRs and EPRs
As I noted earlier, the technology of EMRs is rapid-ly
evolving. Early work that began in the 1960s at
Massachusetts General Hospital, at Duke University
Medical Center, and at Indiana University set the
stage. By 1970, there was some capability to docu-ment
clinician-patient interactions and enable clinician
alerts. In 1991, the Institute of Medicine (IOM)
issued an important report called The Computer-Based
Patient Record: An Essential Technology for Healthcare.
The report grouped 180 features divided into 12
attributes of what was then called computer-based
patient records (CPRs). The IOM updated its report
in 1997. CPRs were longitudinal records that cap-tured
paper-based records for later use.
Further developments saw CPRs move toward the
current generation of electronic medical records
(EMRs). EMRs capture structured and unstructured
data from paper and from disparate computerized sys-tems,
including documentary imaging systems, and
then manage the information. Users can view the
information that has been captured by the EMR in a
variety of ways, depending on their needs. EMRs are
usually maintained by one organization such as a hos-pital
or medical practice. Although their interactivity
and access is superior to that of CPRs, EMRs are lim-ited
by both their organization or practice-centered
location and their focus on capturing information pri-marily
from a patient encounter.
EMRs are expected to evolve into electronic health
records (EHRs) that can capture information from
multiple sources and then into electronic patient
records (EPRs), lifetime records that patients, not
organizations or medical practices, control. EHRs
and EPRs will capture information from patients
themselves, from a wide variety of demographic and
clinical databases, and, with patient authorization,
from multiple providers. They will both have great
potential for enhanced clinical decision making, since
input won’t be limited to information obtained at the
time of a patient visit. Event-based triggers (eg, blood
pressure reaching a particular level) will facilitate clin-ical
decision support, and physicians will be able to
customize practice guidelines and protocols to meet
the needs of particular patients.
As EMRs evolve into EHRs and EPRs, one of the
challenges that must be addressed is standards for
interoperability. It’s all well and good to talk about
bringing data from multiple systems into a single data-base,
but only if different systems and vendors speak a
common language. At this year’s important annual
conference, Toward an Electronic Patient Record
(TEPR), several organizations that are working on the
continuity of care record, a potential clinical standard,
were well-received by vendors that took great interest
in the interoperability issue (Featherly, 2004).
Functions and Capabilities of EMRs
As you begin your investigation of EMRs, take an a
la carte approach to your decision making. You’ll be
looking at systems with multiple optional functions,
and you can select the features that you want and com-bine
them with other information technology applica-tions
in your practice.
Most EMRs allow physicians to perform up to 15
functions (Barrett, 2003) depending on user need. I
have listed the common EMR functions in an order
that I think makes sense for most physicians. If your
vendor allows you to phase-in the implementation of
the different functions, pick a sequence that best meets
your needs.
EMRs let you:
• view problem lists, medications, allergic reac-tions,
test results, and other information that is
related to a patient visit;
• document what happens during a patient visit
and the rationale for clinical decision making;
• identify clinical issues using red flags that alert
and remind physicians (eg, alerts can remind
physicians of drug allergies and reminders can
suggest age and sex specific prevention and
screening);
• decide clinical issues using comprehensive and
reliable databases and references (eg, an oncolo-gist
might want to check current information
from the American Cancer Society);
• manage prescriptions by accessing formularies,
consulting drug utilization databases, and e-pre-scribing
by routing new scripts and renewals
directly to pharmacies;
• order lab tests, imaging, and other procedures;
• communicate securely with medical colleagues
within and outside the practice, with patients in
a standard and structured way, and with public
health agencies;
• code by matching ICD and CPT codes with
details in the visit notes, by using an E & M cod-ing
tool, and by integrating SNOMED clinical
vocabulary;
• comply with privacy and security rules;
• aggregate data on individual patients into longi-tudinal
records;
• manage the chronic conditions and diseases of
individual patients;
• standardize disease management goals for sub-groups
of chronic disease patients (eg, pul-
6 NCMB Forum
monary physicians with asthma patients could
customize this module to include disease-specific
goals);
• query the system for reports on clinical issues for
both individuals and groups;
• conduct research, registry, and clinical trial activ-ities;
• incorporate information that comes from the
patient by direct input and/or by medical devices.
Potential Benefits of EMRs
Practices vary in specialty, size, and operations, so
EMRs don’t produce the same benefits for all users.
Studies of practices that have already implemented
EMRs identify three benefits that may result if, and
only if, the practice pays attention to factors other
than the technology itself. I’ll talk about keys to suc-cessful
implementation a bit later.
The three potential benefits of EMRs are improve-ments
in quality of patient care, in financial position,
and in practice operations. Let’s look at each benefit
separately.
Quality of Care:
EMRs can have a positive impact on the quality
of care you deliver to your patients. The software
eliminates illegible handwriting. It organizes notes
from patient visits and test results. You can
retrieve lists of patient problems, medications, and
preventive protocols more easily than when all
information is hand written and placed in paper
files in random order. You can also access patient
information from locations other than your main
office. For example, if you need patient informa-tion
when you are in a satellite office, the emer-gency
room, or your home, you can easily get
what you need. EMRs can facilitate the manage-ment
of patients with chronic health problems,
reduce medication errors, and eliminate duplicate
lab tests.
Financial Position:
Financial position depends on revenue and
expenses, and EMRs can impact both. With
respect to revenue enhancement, EMRs can reduce
the percentage and amount of erroneous claims
submitted by flagging erroneous codes or data
omissions. If you decrease the time spent on chart
documentation, you can see more patients per
hour and generate more revenue. Coding modules
can help you code more accurately and with more
confidence. EMRs can also provide information
on quality of care that you can use in negotiating
managed care contracts.
EMRs can also improve your practice’s financial
position by reducing operating expenses. For
example, practices that embrace EMRs as a
replacement for costly transcription can save on
that item. Other common cost savings can be the
reduction of staff time for chart pulls and prescrip-tion
renewals and a decrease in dollars spent on
paper supplies. Some malpractice carriers offer
reduced rates to practices with EMRs because the
new systems lower the risk of errors.
Don’t expect to see the financial benefits from
EMRs right away. Short-term financial gains are
offset by significant start-up costs that include not
only dollars paid to the vendor, but also the costs
of staff time and training. In some practices,
physicians reduce their patient loads — and there-fore
their revenue — while they focus on EMR
implementation. In other practices, administrators
that are heavily involved in EMR selection and
implementation require additional support while
they focus on the special project. Still other prac-tices
engage an external consultant to manage the
EMR project.
Practice Operations:
With respect to practice operations, think about
the processes that you now use to enter patient
information in a paper record. Your front desk
captures demographic information at patient regis-tration.
Your nurse interviews the patient and adds
clinical information, and then you have a face-to-face
visit with the patient. Results from laborato-ry
and other tests, hospital discharge notes, infor-mation
from other physicians and from public
health agencies come from other sources.
Requests for prescription renewals come directly
from patients. Let’s be honest: in most practices,
the processes for gathering and organizing all that
information may be cumbersome and error-prone,
and EMRs can make a big difference.
Measuring the quality, financial, and operational
improvements from EMRs is challenging. Practices
make many changes over time, and it’s hard to isolate
those that are a direct result of EMRs. The authors of
a 2003 study sponsored by the California HealthCare
Foundation found a wide variety of financial benefits
ranging from $0 to more than $20,000 a year (Miller,
Sim, and Newman, 2003). Quality improvement can
be easier to measure, since many practices go from no
measurement at all to very careful monitoring of
patient care. Physicians like the existence of monitor-ing
although they cannot always place a dollar value
on its worth.
What Do EMRs Cost?
I think the cost question is complex. I hesitate to
give you a specific dollar figure because you have so
many choices, but I am comfortable identifying the
cost items that you should consider. I’ll also give you
a word of advice: you should be making the first of
many decisions, not a final decision, so don’t assume
that once you purchase your first EMR you are fin-ished
forever. You should expect to revisit the EMR
question repeatedly.
You’ll need to know the cost of both the products
“Measuring
the quality,
financial, and
operational
improvements
from EMRs is
challenging”
No. 3 2004 7
“Information
technology is
only half the
picture; the
success or fail-ure
of any
technology
depends on
people”
and services you are buying from your vendor and
your internal start-up. Even when you have this infor-mation,
the cost can vary widely.
You have a choice between purchasing your own
server and selecting an application service provider
(ASP). Some practices presume that buying their
own server will give them control and reliability. In
my experience, these assumptions are not always valid.
The purchase approach means higher up-front capital
costs. The ASP approach costs less both at the outset
and for ongoing maintenance. Just as you might lease
a car, you can pay a fixed monthly rate to “rent” the
software that is hosted by the vendor or by a third-party
Internet provider. The practice also pays for net-work
communications that support data transmission.
(Rake Report, July 2002).
For a group of 20 surgical specialists in a single
practice with 11 locations that purchased its own serv-er,
the typical costs included the following.
• Software licenses: $200,000 — $300,000
• Electronic data interfaces (EDI priced at an
hourly rate): $10,000 — $40,000 for consulta-tion,
installation, and maintenance
• Conversion from paper to EMR: $5,000 —
$15,000
• Hardware, including on-site server and secure
virtual private network: $85,000 — $200,000
• Maintenance of EMRs and interfaces: $70,000
— $130,000 a year
• Implementation and training: $70,000 —
$220,000 (some vendors include training for the
first six months and then make it available as
needed at an hourly rate; some vendors vary the
costs for these items by the group size)
• Outside consultation to manage vendor selection
and implementation: paid on an hourly basis
•Total first year costs: $200,000 — $1 million
• Subsequent years: ongoing maintenance
• Customized programming: variable, at $100 —
$125 an hour
Getting Started with EMRs
I recommend you get started with EMRs by taking
the following steps in the order listed here.
• Set realistic expectations about your time frame
and process. Allow 18 months from the begin-ning
of your investigation to implementation.
The process will be long and hard.
• Start with your practice, not with the technolo-gy.
Set up an internal EMR task force that rep-resents
physicians, other clinicians, and adminis-trative
staff. Assign task force members to teams
that concentrate on particular aspects of EMR
implementation, such as capturing demographic
and clinical information, patient process, and
billing. You want to ensure buy-in for what you
are doing, not acceptance of a solution that a
handful of people crafted behind closed doors.
• Profile your practice operations. Identify what
works well and what needs improvement before
you delve into the solutions that EMRs offer.
• Begin your investigation of EMRs so you under-stand
what they can do. Talk with professional
organizations, colleagues in other practices, and
vendors themselves so you understand what’s on
the market.
•Achieve consensus on your practice’s priorities.
You want technology to help you, and you don’t
want to purchase technology for technology’s
sake.
• Invite several vendors into your practice to make
preliminary presentations.
• Convert a statement of your needs into a formal
request for a proposal (RFP) that you send to
vendors. At the same time you develop the RFP,
list the decision criteria and weighting that you
will use to evaluate responses.
•Review the proposals that you receive, shorten
your list of potential vendors, and make site vis-its
to those you think can meet your needs.
•Make more site visits — this time to other prac-tices
that are using the product. The vendors
generally accompany you on these trips, and I
encourage you to visit still other users without
the presence of vendors. Shadow the physicians
as they use the technology and observe how
EMRs impact the physician-patient communica-tion.
• Select the vendor.
• Incorporate the terms on which you have agreed
in a formal agreement. Be sure to include lan-guage
on termination and ownership of the data.
Include the vendor’s proposal as an attachment
to the contract.
• Develop an implementation plan that includes
the transition to EMR, interconnectivity, evalua-tion
of what you have done, and ongoing main-tenance.
Keys to Successful Implementation
Information technology is only half the picture; the
success or failure of any technology depends on peo-ple.
EMRs that are a phenomenal success in one prac-tice
may be a costly failure in another. Here are keys
to successful implementation.
• Identify a physician champion who is not only
interested in introducing EMRs, but who is able
and willing to coach his or her peers through the
transition process. The champion will test the
software on his or her own patients, work with
the EMR and other vendors, and then work with
colleagues and other staff to get it right.
• Enlist the commitment of all physicians in the prac-tice,
including those who are comfortable with
technology and those who are not. EMRs
should be a practice enhancement, not a tool that
8 NCMB Forum
one or two technologically savvy physicians use
while others retain their dependence on paper.
• Agree on timing that suits your practice. Some
vendors permit practices to purchase a compre-hensive
EMR software package and phase-in the
implementation of different modules. Others
allow the separate purchase of each module. Still
others are inflexible and require all clients to pur-chase
and implement in a way that meets vendor,
not purchaser, needs.
• Pay attention to the relationship between EMRs
and other systems. There are no current standards
governing the interconnectivity of EMRs and
practice management systems, Web-based com-munication,
lab, and other systems. Smooth
working relationships won’t be automatic. For
example, can the demographic and billing infor-mation
in your practice management system be
imported into your EMR? Can lab results from
an external vendor be linked to data that you
enter following a patient visit? You need to
know what interfaces are possible, who is imple-menting
them, and who will maintain them. Be
cautious about vendors that require you to pur-chase
all of their products and that are unwilling
to collaborate with other companies.
• Purchase the level of support that is suitable for
your practice. Even if you have your own infor-mation
technology specialists, you may need out-side
help from one or more vendors. Ask about
initial installation, availability of the help desk,
software fixes and upgrades, and deals on hard-ware,
software, and Internet connectivity.
Recommended Resources on Vendors
and Their Products
The question on EMRs that physicians ask the most
frequently is: “Which vendor should I select?” There
is no right answer, but there are good sources of infor-mation
on both vendors and their products. I recom-mend
that you look at the Web sites of the American
Academy of Family Physicians (www.aafp.org),
the California HealthCare Foundation (www.chcf.org),
Health Data Management (www.healthdataman
agement.com), CTS Software Selection (www.ct
sguides.com), and AC Group, Inc (www.acgroup.org),
for lists and reviews. The Medical Group Management
Association (www.mgma.com) and the North Carolina
Healthcare Information and Communications Alliance
(www.nchica.org) are also good resources.
Questions for Vendors
There are two parts to the vendor question: who do
you contact and what questions should you ask? The
resources that I’ve suggested above will give you guid-ance
on the vendors. Here are my suggestions of
questions to ask (Barrett, Holmes, and McAulay, 2003
and Rake Report 2002).
• How does each of the functions that the vendor
offers work? Request a demonstration for each
one and try it out.
•What is the method(s) by which information is
put into the system?
• What is the vendor’s approach to customization
and what are the accompanying costs?
• Do the menus, screens, and categories make
sense to you?
• How does the EMR integrate (or not!) with
your practice management system, Web-based
communication, and other systems?
• How do you access the EMR — remotely, by
mobile device, etc?
• How does the product process, exchange, and
store graphics and images?
• What customer support is available to the prac-tice
during transition from paper records, start-up,
implementation, and after that?
• What is the cost?
• What options for financing are available?
Conclusion
I think EMRs and their expected evolution into
EHRs and EPRs have great potential to improve the
clinical, financial, and operational aspects of your
practice. If you agree, approach the challenge with
knowledge and foresight, rather than with resistance
and fear.
_____________________
References
American Academy of Family Physicians. Press Release,
November 12, 2003.
American Academy of Family Physicians. AAFP This
Week. January 29, 2003.
Barrett, M.J., with Holmes, B.J., and McAulay, S.E.
Electronic Medical Records: A Buyer’s Guide for Small
Physician Practices. California HealthCare Foundation,
Oakland, CA. 2003.
Carter, J.H. Electronic Medical Records. A Guide for
Clinicians and Administrators. American College of
Physicians, Philadelphia. 2001.
Healthcare Informatics, Healthcare Information Programs.
Electronic Medical Records: Why Their Time Has
Come. 2003.
Featherly, K. TEPR ‘04, A Lot of Singing About
Interoperability. Healthcare Informatics. July 2004.
10-14.
Miller, R.H., Sim, I., and Newman, J. Electronic Medical
Records: Lessons from Smaller Physician Practices.
California HealthCare Foundation, Oakland,
CA. 2003.
Rake Report. Electronic Medical Record Systems. July 22,
2002. 10-15.
..........................................
The author gratefully acknowledges the assistance of W.
Holt Anderson, executive director of the North Carolina
Healthcare Information and Communications Alliance,
Inc, in Research Triangle Park, NC, and Franklin W.
“EMRs and
their expected
evolution into
EHRs and
EPRs have
great potential
to improve the
clinical,
financial, and
operational
aspects of your
practice”
No. 3 2004 9
Maddux, MD, chief executive officer of Gamewood, Inc,
in Danville, VA.
..........................................
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 Hospital Publishing,
1995). The Forum has published several articles by Ms
Satinsky, including 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; Using Information
Technology to Improve Patient Care and Communication:
A Practical Guide - Part 1, in #1, 2004; and Using
Information Technology to Improve Patient Care and
Communication: A Practical Guide — Part 2, in #2, 2004.
An adjunct faculty member at the University of North
Carolina School of Public Health, Ms Satinsky is a mem-ber
of the Medical Group Management Association. She
may be reached at (919) 383-5998 or margie@satinsky
consulting.com.
Over the years, a number of commentators,
medical and non-medical, have advised the public
on ways to evaluate and understand the world of
medicine, and all health care professionals would
benefit from considering their insights from time
to time. One of the best efforts of this kind we
have seen is by Thomas J. Scully, MD, a former
member of the Nevada State Board of Medical
Examiners and a former dean of the University of
Nevada School of Medicine, and his wife, Celia
G. Scully, a distinguished science writer. Their
book, Playing God: The New World of Medical
Choices (Simon and Schuster, 1988), was
designed to provide practical advice on how to
deal with the increasingly complex choices pre-sented
by medicine as the twentieth century
neared its end. What appears below is a snippet
from the book, a bit of advice for a patient that
should be equally valuable for any health care
professional open to self-examination.
Clues You’re Not Getting the Health
Care You Should
There are 12 warning signs that should raise a
red flag in alerting you to the fact that you may
not be getting proper health care or may be see-ing
a doctor who’s not right for you.
Your doctor:
1. Doesn’t seem to be listening to what you’re
saying.
2. Doesn’t answer your questions or take time
to ask if you have any. When there is an
answer, it’s in words you don’t understand.
3. Fails to take an adequate medical history or
give you a complete physical examination
when it’s called for. (Over a period of time,
of course, your doctor gets to know your
health history, and for certain types of ill-ness,
say a cold or “flu bug,” may forgo a
total-body-system physical and examine
only those areas where you have symp-toms.)
4. Doesn’t help you learn more about your
condition and what you can do about it, or
explain why the recommended tests, treat-ment,
or medications are necessary.
5. Neglects to inform you of potential risks,
benefits, and side effects of prescribed
drugs or suggested procedures and tests.
(Beware if you’ve said you’re “allergic” to a
certain medication and your doctor pre-scribes
it anyway.)
6. Doesn’t respect your modesty and makes
suggestive remarks while doing a pelvic
examination or examining your breasts.
7. Doesn’t make a follow-up appointment for
you or urge you to call the office to report
how you’re doing.
8. Seems forgetful, peculiar, or belligerent at
times, and may even have alcohol on the
breath.
9. Is hard to reach, doesn’t return phone calls,
and, when away, fails to arrange a replace-ment.
10. Is not on the staff of any community hos-pital
or medical center.
11. Is rigid, a know-it-all, and insists on an
“only” way to treat your condition.
12. Reacts defensively when you suggest a sec-ond
opinion.
A Bit of Advice
Warning Signs
10 NCMB Forum
“We have
encountered
several local
clinics and
hospitals that
are in dire
need of basic
medical sup-plies,
equip-ment,
and hos-pital
furnish-ings”
North Carolina National Guard Unit Starts
Adopt-a-Clinic Program in Iraq
Major Henry E. Riley, PA-C, NCARNG
In an effort to
strengthen interactions
between local Iraqi citi-zens
and North
Carolina’s Fayetteville-based
national guards-men
of the 1/252
Armor Battalion, an
A d o p t - a - C l i n i c
Program has been
established in the
Battalion’s area of oper-ation.
In addition to
maintaining a positive
relationship between guardsmen and local Iraqi citi-zens,
the program will become a meaningful symbol
of that relationship and of a caring commitment to the
medically impoverished citizens of Iraq.
During several medical assessment missions per-formed
in our area of
operation, we have
encountered several local
clinics and hospitals that
are in dire need of basic
medical supplies, equip-ment,
and hospital fur-nishings.
Many of these
clinics serve not only
their expected patients
but hundreds of newly
displaced refugees from
all over Iraq. The
patients seen in these
facilities present a wide
range of illnesses, includ-ing
thalassemia, typhoid,
and leishmoniasis, as well as blast injuries from land
mines and old traumatic injuries secondary to torture
at the hands of the Saddam regime.
The 1/252 Armor Battalion, an element of the
North Carolina National Guard’s 30th Heavy
Separate Brigade, has been activated in support of
Operation Iraqi Freedom since October 2003 and has
been serving in Iraq since February 2004. Our area of
operation is in Diyala province
and is approximately 100 miles
due east of Baghdad. It is the
size of Delaware. There are three
clinics and two hospitals that are
in the most serious need. The
people in the Diyala province are
a mixture of Khurdish, Arabic,
and Turcoman. While relatively
quiet in terms of anticoalition
activity, the potential for discon-tent
is quite high and occasional-ly
manifests itself by rocket
attacks, improvised explosive
devices, and attacks against Iraqis
assisting coalition forces.
Hopefully, a functional Iraqi
health care system will provide a sense of confidence
and well-being to the local Iraqi populace and assuage
any smoldering discontent and unrest.
The Adopt-a-Clinic Program’s ambition is to wed a
donating hospital, clinic, physician, or group with one
of the clinics in our area. The contributing party can
observe and nurture the growth and improvement of
the recipient Iraqi facility over time, long after the
1/252 Battalion’s mission has been completed. The
legacy of this relationship between the communities of
North Carolina and the Iraqi citizens can only foster a
greater understanding between the two countries and
provide long lasting stability and freedom from strife
for the newly liberated country of Iraq.
With the assistance of the state surgeon of the North
Major Riley Well-baby clinic in A-Sadeya, Iraq.
Iraqi girl who developed corneal ulceration and subse-quent
opacification following chemotherapy for non-
Hodgkins lymphoma in October 2003 in Baghdad. Her
family fled Baghdad for Jabarra in November 2000.
The only equipment in the emergency room in the clinic in
Jabarra.
No. 3 2004 11
Carolina National Guard, COL/MC Morton Meltzer,
and the North Carolina Air Guard and its state sur-geon,
LTC Jill Hendra, MD, we are attempting to
arrange transport of donated materials and supplies
from Raleigh, North Carolina, to Forward Operating
Base Cobra, our Battalion’s home here in Iraq. After
arriving in country, the supplies will be recorded and a
receipt will be issued to the donating group. At that
time, the supplies will be distributed to the clinics that
are in the greatest need. Specific donors will be
assigned a particular clinic so that, over time, a dia-logue
can be established between the donors and the
clinics through e-mail, pictures, and correspondence.
This will enable both parties to share in the rewards
inherent in a project such as this.
Generally, the Iraqi medical facilities in our area are
in deplorable condition. The previous regime neglect-ed
this area and left the health care system in disrepair.
Most of the clinics have no suitable furniture, there are
few examination tables, beds, and chairs. Windows
and doors are absent or broken from years of war and
neglect, as well as from looting that occurred immedi-ately
after the previous regime’s collapse. What few
medical supplies are issued from a central government
agency in Baquba are quickly exhausted and are woe-fully
inadequate to meet the needs of the families that
the clinics serve. In addition, the Iraqi Ministry of
Health was a Baathist party (Saddam Hussein’s polit-ical
party) affiliate and, according to several Iraqi
physicians I have talked to, issued supplies to those
areas that were politically like-minded and neglected
the more rural clinics that reside in our area of opera-tion.
Minor surgical instruments are rarely adequate-ly
sterilized, dressings are in short supply, and relative-ly
advanced equipment, such as aerosol nebulization
machines, is rare and generally damaged. Tubing is
reused multiple times if available at all. Patients often
wait for hours and are examined on the floor. Well-baby
clinics and immunizations are available, but stor-age
of vaccines, particularly in the smaller clinics, is
inadequate.
Although funds from the Coalition Provisional
Authority, the Iraqi government, and non-govern-mental
organizations such as the Admiral Nash Fund
have been used to refurbish health care facilities in
Iraq, they have been generally limited to larger facili-ties
and have rarely “trickled down” to the smaller
rural clinics. Virtually any item that is used in a hos-pital
or clinic in the United States would be gratefully
appreciated here.
The Adopt-a-Clinic Program is in its infancy and, as
of this writing, we are awaiting our first shipment of
donated supplies from Arlington Surgical Group, an
oral surgery group in Akron, Ohio. The 1/252 Armor
Battalion maintains a Web site with further details and
a link to initiate a donation. It also features informa-tion
on an Adopt-a-School Program that is similar in
form. If you, your group or clinic or hospital, would
like to help, please visit us at: www.tf252armor.com.
Baby getting out-patient antibiotics for tonsillitis at a better hos-pital
in Kifri, Iraq.
Patients waiting outside clinic in Sheik-Baba, Iraq.
“Patients often
wait for hours
and are exam-ined
on the
floor”
In the fifth paragraph of my article, North
Carolina’s Allied Health Care Professionals, in
Forum #2, 2004, I gave the impression that the
granting of the physician assistant’s license depends
on (1) completing appropriate PA education, (2)
passing the NCCPA examination, (3) receiving
acknowledgement of an intent to practice agreement
with a supervising physician, and (4) having a prac-tice
location approved by the Board. In fact, while
all four of those elements are required to receive per-mission
to practice as a PA in North Carolina, only
the first two are basic to the actual granting of the
PA license.
Robin Hunter-Buskey, PA-C, NCMB Member
North Carolina’s Allied Health Care Professionals:
A Clarification
12 NCMB Forum
Nurse Practitioner Notes
Preparing for an Atypical Day:
Are You Ready, Doctor?
Gale Adcock, FNP
3:00PM: A typically busy Friday
in the office; the waiting room
is half full but things are begin-ning
to wind down. A well-dressed
man approaches the
receptionist’s window and quiet-ly
announces: “I’m John Brown,
a staff member at the North
Carolina Medical Board. I’d like
to see Doctor Smith and Nurse
Practitioner Jones, please.”
It’s crunch time. Are you prepared, Doctor, for this
unannounced visit?
What You’re Required to Know
North Carolina Administrative Code 32M defines
the role and responsibilities of a physician working
with a nurse practitioner (NP) when designated as the
“primary supervising physician.” Commonly referred
to as NP “rules,” NCAC 32M establishes minimum
components for a physician/NP collaborative practice
agreement as well as a QA procedure referred to as the
“quality improvement process.”
The collaborative practice agreement (CPA) is the
signed and dated document summarizing mutual
understanding of the framework for your supervision
of the “medical acts” performed by an NP. The CPA
is not an employment contract, nor does it describe an
employer/employee or other business arrangement.
Rather, it contains details about an NP’s scope of
duties in your practice setting, a drug and device
agreement listing the categories of legend and con-trolled
drugs that you and the NP have agreed will be
prescribed for commonly encountered health prob-lems
in your patient population, a procedure for emer-gency
care of patients, arrangements for ongoing
physician/NP communication, and specification of
treatment protocols to be used in patient manage-ment.
The NP, the primary supervising physician, and any
back-up supervising physician(s) are equally account-able
for reading, understanding, and following all
requirements for collaborative practice as specified in
the NP rules.
What You’re Required to Have
Decrease your chances of a last-minute panic attack
when Board staff request to see documentation spec-ified
in NCAC 32M. The following items must be
maintained in the office and easily retrievable by you
and the NP.
• Proof of RN licensure.
•A copy of the NP’s approval to practice specify-ing
you as the NP’s primary supervising physi-cian.
•A copy of the NP’s current certificate of registra-tion
issued annually by the North Carolina
Medical Board.
•A copy of the collaborative practice agreement.
A signature page must be attached, including
documentation of an annual review of the CPA
itself and the protocols identified in it.
• Quality improvement process plan as well as doc-umentation
of every six-month “quality improve-ment
process” meeting with the NP for the pre-vious
five years.
•A list of all back-up supervising physicians pro-viding
consultation to the NP in your absence.
• CE documentation.
•DEA Registration and Pharmacy Permit, if held.
While not mandated in the rules, it is prudent to
have a current copy of the NP rules in the office to use
as a reference.
What About Medical Records?
After the first six months of your formal collabora-tive
relationship with the NP, there is no regulatory
requirement for routine review and co-signature of the
NP’s patient visits. It is generally accepted practice
that when you and the NP consult on a patient, this
consultation should be documented in the patient
record. NP rules require that whenever the NP wish-es
to prescribe a drug or device not included in the
drug and device agreement, the results of a consulta-tion
with you must be documented in the patient
record.
Anything Else?
Make the office staff aware that unscheduled visits
by a representative of the North Carolina Medical
Board or the North Carolina Board of Nursing are
possible (as authorized in NCAC 32M). You and the
NP will be expected to be available to meet with the
Board representative as quickly as possible; other staff
members are expected to cooperate with requests to
see medical records, make copies of documents, etc.
While some visits result from a complaint filed with
“The NP, the
primary super-vising
physi-cian,
and any
back-up super-vising
physi-cian(
s) are
equally
accountable
for reading,
understand-ing,
and fol-lowing
all
requirements”
Ms Adcock
No. 3 2004 13
either Board, the contents of this article pertain to
routine visits at randomly chosen practices intended to
ensure regulatory compliance.
PS: The nurse practitioner must wear a name tag
identifying her or him as an NP, whether the title is
spelled out or the initials “NP” are used.
If you’ve addressed all the issues above, relax.
You’re ready.
_____________________
Gale Adcock is an elected member of the North Carolina Board
of Nursing and a member of the Joint Subcommittee and the
Midwifery Joint Committee.
“We must con-tinue
to move
away from the
culture of
blame that
surrounds
medical errors
to create new,
proactive sys-tems
that spot
and prevent
potential
errors”
A Dance with Technology
Hayes Woollen, Jr, MD
President, Mecklenburg County Medical Society
“Sometimes we don’t recognize
the most significant events of our
lives when they are happening. . . .”
Dr Moonlight Graham
in “Field of Dreams”
We are changing. The health-care
industry, as we know it, is
reluctantly evolving, crawling
into the age of technology. We are transitioning to
electronic medical records, computerized physician
order entry, pharmaceutical bar coding, electronic pre-scriptions,
PDAs, and e-mails. The impact of tech-nology
is upon us, and for some, it is overwhelming.
Everyone — from patients and administrators to leg-islators
— is calling for an overhaul of the health-care
system, encouraging us to embrace the world of com-puters.
The premise is that digitalization will help us
reduce medical errors and improve quality of care.
Some would say that to keep pace with the com-plexities
of medicine and continue to improve quality
of care, we will have to make wise investments in new
technologies. The Institute of Medicine’s 2001 report
put this flatly: “. . .information technology must play
a central role in the redesign of the health-care system
if a substantial improvement in quality is to be
achieved over the coming decade.” In March 2003,
the U.S. House of Representatives’ Ways and Means
Committee passed the Patient Safety Improvement
Act. This legislation proposed to develop voluntary
national standards for the interoperability of health-care
information systems, specify medical terminolo-gy,
and evaluate technologies such as computerized
physician order entry and medication bar coding. The
ultimate goal was to reduce the medical error rate.
While we take apart every process, every communi-cation,
and every interaction in health care and put it
back together using digitalization and automation, we
have to ask ourselves fundamental questions: Will this
technology improve the quality of care for my patient?
Will it increase efficiencies in our medical system?
And most important, will this new technology reduce
medical errors? . . . Will it? . . . I don’t know. . . .
Maybe.
Because of our reluctance to change, the average
hospital or doctor’s office still uses paper records and
documentation that would have seemed familiar even
to Dr Moonlight Graham. But, with the increasing
complexity of medicine, it is becoming nearly impos-sible
to practice medicine without using electronic sys-tems.
In many instances, technology available today
can significantly reduce the incidence of adverse events
and enhance health care.
However, we must realize that adverse events are
most often system errors. More often than not, it’s
not about hardware or software; it’s about people and
processes. To capture the full benefits that the system
has to offer, health-care organizations need to redesign
many core processes. Otherwise, they will simply
automate inefficiencies.
Medical errors are a problem. They are a major
cause of preventable death in the U.S. Unfortunately,
a lot of denial about them exists in the medical indus-try.
A landmark study on medical errors indicated that
70 percent of adverse events were preventable. But
most medical errors are systems-related and not attrib-utable
to individual negligence or misconduct. The
key to reducing medical errors is to improve the sys-tems
of delivering care. We have to realize that tech-nology,
by itself, is not going to solve medication
errors, nor will throwing more money at the problem.
It will require a combination of approaches and imple-menting
a system of checks and balances. The airline
industry is a good example for health-care profession-als
to follow. A plane does not fly until its safety has
been checked and rechecked.
Most of you are aware of the report released July 28,
2003, from the U.S. General Accounting Office that
substantiates the fact that increasing malpractice
awards are driving the current medical-liability insur-ance
crisis. We need to continue lobbying for tort
reform. We must continue to move away from the
culture of blame that surrounds medical errors to cre-ate
new, proactive systems that spot and prevent
potential errors before they occur. Because of its
extraordinary complexity, the health-care system is
inherently risky, and mistakes will occur. The most
common response has been to blame individuals for
errors in health care. And, consequently, we some-
Dr Woollen
14 NCMB Forum
Warren Pendergast, MD, New Medical Director of North
Carolina Physicians Health Program (NCPHP)
times keep bad outcomes quiet. This deterrent model
isn’t working.
The U.S. health-care system must move beyond
blame to investigate why accidents happen and how
the risks of future accidents can be identified. The cul-ture
of blame surrounding medical error must be con-verted
into a culture of safety that flushes out infor-mation
and enables us to prevent or quickly recover
from mistakes before they become patient injuries.
We must work consistently to monitor ourselves and
the way we practice medicine. We need physician-run
peer review, and we need to be willing to open our-selves
up to criticism and self-evaluation.
Patient safety and reducing medical error should
always be our No. 1 concern. We need to enhance our
systems to reduce medical mistakes. We need to pro-vide
better education for our health-care workers-physicians,
nurses, staff, and administrators to avoid
the same mistakes in the future. Technology can help
us. But it cannot take the place of good decision-mak-ing.
Dr Jay R. Jackson said it best in the 2004
Handbook of Technology Management in Public
Administration: “What continually vanishes in our
quickening dance with technology is often the wisdom
of appropriate care, time spent listening to patients
and much that really can be called the human interac-tions,
that which is the best of the art of medicine.”
_____________________
Reprinted with permission from the July/August 2004
number of Mecklenburg Medicine, a publication of the
Mecklenburg County Medical Society.
Dr Warren Pendergast has
been selected as the new
medical director of the
North Carolina Physicians
Health Program (NCPHP).
The Board of Directors of
the NCPHP selected Dr
Pendergast following a national
search. He becomes only the
third person to lead the
NCPHP since its inception in
1988. He succeeds Dr Mike Wilkerson, who left the
NCPHP in April to become medical director of the
Talbott Recovery Campus in Atlanta, Georgia.
“Serving the NCPHP as associate medical director
has been a privilege. It has been personally reward-ing
to help physicians, physician assistants, and now
veterinarians and veterinarian technicians through
periods of difficult change to find the promises of
recovery,” says Dr Pendergast of his career with the
NCPHP.
Dr Pendergast, 44, joined the NCPHP as associate
medical director in 1999. Before coming to the
NCPHP, he served as director of consultation psychi-atry
at Carolinas Medical Center in Charlotte, NC,
and associate medical director for the Carolinas
HealthCare System Department of Psychiatry.
Dr Clark Gaither, chairman of the NCPHP Board
of Directors and Search Committee, states: “Dr
Pendergast has proven himself to be the caring pro-fessional
that this position demands. He has the
experience, empathy, compassion, and training neces-sary
to propel the NCPHP forward with the same
goals and ideals set forth since its inception.”
“Warren Pendergast has developed evaluation and
treatment resources nationally and has maintained
himself on the cutting edge of physician health issues.
It is obvious he believes in the recovery process, the
recovering physician, and the work of physician
health programs. I believe the NCPHP is fortunate
to have Dr Pendergast available to step into Dr
Wilkerson’s shoes. Under his leadership and capable
stewardship, I believe the NCPHP will continue to
be recognized nationally as a leading program in
physician health matters,” notes a colleague from the
Mississippi Professionals Health Program.
Dr Pendergast is board certified in addiction psy-chiatry
by the American Board of Psychiatry and
Neurology. He is also a member of the American
Society of Addiction Medicine. He completed his
psychiatry residency at the University of North
Carolina.
In addition to his varied responsibilities at the
NCPHP, Dr Pendergast volunteers at the Mental
Health Clinic for Wake County, providing psychiatric
care to indigent patients. Dr Pendergast also serves
on the Board of Directors of the Federation of State
Physicians Health Programs. He is currently serving
as chair of the Consortium of Professional Recovery
Programs.
The NCPHP originated as a physicians health
committee of the North Carolina Medical Society.
Established as a formal program by the Medical
Society in 1988 and administered by the NCMS
Foundation, the program subsequently evolved into a
not-for-profit, independent organization. The
NCPHP is available to aid any physician, physician
assistant, veterinarian or veterinarian technician
whose health and/or effectiveness has been signifi-cantly
impaired by alcohol, chemical dependency,
behavior issues, aging, or illness.
Dr Pendergast
No. 3 2004 15
Dear Ms Satinsky: I write concerning your article
(Using Information Technology to Improve Patient
Care and Communication: A Practical Guide — Part
2) in the NCMB’s Forum, No. 2, 2004.
Except for medical students and practitioners to
impress themselves and try to impress others with
their computers, I submit that “Patient Care and
Communication” continue to suffer due to comput-ers!
I practiced for 30 years — general surgery. Retired
nine years ago. Everything I hear from patients in
today’s population is the rush they observe /“suffer” as
practitioners look at their computers and use mobile
(cell) phones.
Looking a patient in the eyes, listening as the
patient talks — telling their story, then examining the
patient has gone by the board! No wonder medi-cine/
surgery finds itself in the situation it is in today!
God bless!
Charles P. Nicholson, Jr, MD, FACS
Concord, North Carolina
Ms Satinsky Responds
Dear Dr Nicholson: I share your opinion that the most
important aspect of physician-patient communication is
looking a patient in the eyes, listening carefully, and then
doing an examination. I suggest, however, that computers,
cell phones, and other new technology are not the problem;
people are the problem.
In Part 2 of my two-part series on Using Information
Technology to Improve Patient Care and Communication:
A Practical Guide, I identify physicians throughout the
state who believe that information technology has helped
them provide better care. Philip Singer, MD, of
Hillsborough Medical Group, PA, demonstrated to me the
way in which he looks patients directly in the eye while cap-turing
information that he gathers during a visit.
Michael Norins, MD, of LeBauer HealthCare in
Greensboro, showed me how he engages his patients in his
Web-based searches for information on a particular disease
or medication. In other practices, physicians who are less
adept at using technology than are Drs Singer and Norins
ask a nurse or other assistant to enter the information in
their electronic health records so they can maintain eye
contact at all times.
There is an art to using information technology in a way
that has a positive, not a negative, impact on physician-patient
interactions; and for those who lack this skill, there
are alternatives.
Sincerely,
Margie Satinsky, President
Satinsky Consulting, Durham, North Carolina
Patient Care Suffers Due to Computers
Letters from Our Readers
Dr Kevin Yow Named Assistant Medical Director
of the NCMB
Kevin Brewer Yow, MD,
has joined the staff of the
North Carolina Medical
Board on a part-time basis
as assistant medical director.
He works with Jesse E.
Roberts, MD, the Board’s
medical director, in evaluat-ing
the medical records and
performance of practitioners
about whom questions have been raised. Dr Yow
is board certified in family medicine and is in the
active practice of family and emergency medicine.
A native of North Carolina, Dr Yow is a gradu-ate
of UNC-Chapel Hill School of Medicine. He
completed internship at Pitt County Memorial
Hospital in Greenville and residency at Duke
University Medical Center. Dr Yow also holds
degrees in law and public health. Prior to enter-ing
medical school, Dr Yow served as general
counsel for the North Carolina Hospital
Association and as staff attorney for health care
issues for the North Carolina General Assembly.
Commenting on his position with the Board, he
said: “I look forward to providing clinical input at
the staff level to support the Board in its mission
to license, educate, and regulate physicians for the
betterment of medical care in North Carolina.”
Kevin B. Yow, MD
16 NCMB Forum
THE NORTH CAROLINA MEDICAL BOARD Presents a
Caring, On-Line Primer About the Humanity Essential to
Medical Practice
Fondly, Carolyn: Letters to a Young Physician
On its Web site, the North Carolina Medical Board proudly offers Fondly, Carolyn: Letters to a Young
Physician, by Carolyn E. Hart, MD, of Charlotte, NC, as a service to all medical students, residents, facul-ty,
mentors, and other physicians and health care professionals concerned about the humanity essential to
professionalism and the practice of medicine.
As director of medical education at Charlotte Memorial Hospital and Medical Center (now
Carolinas Medical Center) from 1962 to 1984, I would have made Dr Hart’s series of letters to a
young physician mandatory reading for all interns and residents on a yearly basis. This require-ment
would have served to enhance and guide their efforts in becoming complete (or, as Izaak
Walton said, Compleat) practicing physicians. Thank you, Dr Hart! And, I have mailed copies of
the Fondly, Carolyn series to my eldest grandson, who is currently in an orthopedic surgery resi-dency.
Bryant L. Galusha, MD
Former President, Federation of State Medical Boards
Former Executive Vice President, Federation of State Medical Boards
Former Member, National Board of Medical Examiners
Former President, North Carolina Medical Board
This correspondence should be required reading for medical students and residents in all spe-cialties.
They incorporate the concepts of professionalism, how to be a caring and culturally com-petent
physician, and how to advocate for your patients and your profession. As medicine has
become more complex, it has become increasingly more difficult for the mentors and teachers
involved in medical education to have the opportunities to pass these values on to their trainees.
These letters could be an invaluable resource.
Barbara S. Schneidman, MD, MPH
Former Associate Vice President, American Board of Medical Specialties
Former President, Federation of State Medical Boards
Former Member, Accreditation Council for Continuing Medical Education
Former Chair, Washington State Board of Medical Examiners
Many of us professionals on today’s fast track may think we have all the answers to life’s chal-lenges.
And we don’t like to be preached to. But deep inside, we quietly yearn for new insights
about ourselves and a better understanding of our values and relationships. Dr Carolyn Hart’s
intimate Fondly, Carolyn letters come as a breath of fresh air for us all. Each of the letters in the
series is filled with friendly suggestions, which, while ostensibly addressed to a new physician,
bring thoughtful advice and guidance to us all. She asks: Do you really desire a truly fulfilling,
happy, and healthy life? Consider the five cornerstones of that life she shares with us in her let-ters:
trust in a higher power, a calling, a loving relationship with another adult, an avocation, and
physical exercise. I urge you to read the Fondly, Carolyn letters — read and act!
E.K. Fretwell, PhD
Member, North Carolina Medical Board
Chancellor Emeritus, University of North Carolina, Charlotte
Former Interim President, University of Massachusetts System
To access Fondly, Carolyn, simply go to the Board’s Web site: www.ncmedboard.org. The text can be easi-ly
downloaded and printed out in the free Adobe format.
We owe special thanks to Dr Hart for preparing a revised version of the Letters to a Young Physician series,
which appeared in its original form in the Mecklenburg County Medical Society’s publication, Mecklenburg
Medicine, in 2002. We also thank her and Mecklenburg Medicine for graciously permitting publication of
the revised version in the Forum in 2002 and, now, its publication on the NCMB’s Web site.
Please let us know if you have any questions. Telephone Dale Breaden, NCMB Department of Public
Affairs, at (919)326-1109, ext 230, or Dena Marshall at (919)326-1109, ext 271. E-mail: dale.brea
den@ncmedboard.org.
No. 3 2004 17
Fondly, Carolyn:
Letters to a Young Physician
Carolyn E. Hart, MD, practices neurology in Charlotte, North Carolina. She earned her medical
degree from Emory University School of Medicine in Atlanta and did her postgraduate specialty train-ing
at the Johns Hopkins University Hospital in Baltimore. In 2002, she served as president of the
Mecklenburg County Medical Society and decided to take the opportunity of preparing the monthly
president’s message for the Society’s publication, Mecklenburg Medicine, to present a series of letters
to a medical student, W, one of whose parents is a physician and both of whom are friends of hers.
Her thoughts, so clearly and simply expressed, unfold as a thoughtful and caring primer of sorts, laced
with wisdom, a gentle and conversational guide for health care professionals at any point in their
careers.
Dr Hart and Mecklenburg Medicine were kind enough to allow publication of the letters, slightly
revised and titled Fondly, Carolyn, in the Forum, the quarterly publication of the North Carolina
Medical Board, soon after their appearance in Mecklenburg Medicine. The series was so well received
that the Board’s Public Affairs Department asked permission to publish it on line as a permanent part
of the Board’s Web site, making it available to members of health care professions and students nation-wide.
Dr Hart and Mecklenburg Medicine graciously agreed. What appears here has been further
revised by Dr Hart for on-line publication.
We thank Dr Hart and Mecklenburg Medicine for the opportunity to offer the Fondly, Carolyn series
to the widest possible audience.
❖ Take Time to Comfort
❖Take Time to Volunteer
❖ Take Time to Continue Learning
❖ Take Time to Relax with Your Family
❖ Take Time to Run Your Business
❖ Take Time to Use Your Manners
❖ Take Time to Be Culturally Competent
❖ Take Time to Live Healthily
❖ Take Time to Advocate
❖ Take Time to Notice Beauty
❖ A Note to Readers from Dr Carolyn Hart
Letters to a Young Physician:
Dr Carolyn E. Hart
Primum Non Nocere
NORTH CAROLINA
MEDICAL BOARD
April15, 1859
NCMB 2004
[Introductory page for the Fondly Carolyn series as it appears on the NCMB Web site]
18 NCMB Forum
ANNULMENTS
NONE
REVOCATIONS
AMSELLEM, David, MD
Location: Goldsboro, NC (Wayne Co)
DOB: 6/06/1946
License #: 0000-20869
Specialty: PYM/N
Medical Ed: University Montpellier, France (1973)
Cause: The Board summarily suspended Dr Amsellem’s license in March
2004 due to his mental impairment. At a hearing in May 2004, the
Board concluded Dr Amsellem was unable to practice with reason-able
skill and safety by reason of illness and/or a physical or mental
abnormality.
Action: 7/29/2004. Findings of Fact, Conclusions of Law, and Order
issued: Dr Amsellem’s license is revoked.
HODA, Syed Tanweerul, MD
Location: Inner Grove Heights, MN
DOB: 2/05/1966
License #: 0097-00590
Specialty: IM/FP (as reported by physician)
Medical Ed: Dow Medical College, Karachi, Pakistan (1991)
Cause: In charges filed in March 2004, it was alleged by the Board that Dr
Hoda had violated his Consent Order with the Board and had had
action taken against his license by Minnesota. He did not appear
for the scheduled hearing on these matters on 6/16/2004. The
Board found he had violated the Consent Order of January 2002
by which his license was suspended, the suspension being stayed if
he complied with conditions, including not prescribing via the
Internet for anyone he had not examined unless he had a previous
physician-patient relationship with them. This Consent Order was
based on his work with Virtual Medical Group. In September
2002, Dr Hoda entered into a Consent Order with the Minnesota
Board due to his approving a prescription in March 2002 via the
Internet for a person he had not examined. This latter prescription
was done within the 60-day stayed suspension period of his North
Carolina Consent Order.
Action: 6/22/2004. Findings of Fact, Conclusions of Law, and Order of
Discipline issued: Dr Hoda’s North Carolina medical license is
revoked.
JONES, Miles James, MD
Location: Clayton, GA
DOB: 11/22/1952
License #: 0099-00557
Specialty: PTH (as reported by physician)
Medical Ed: Howard University (1977)
Cause: Dr Jones’ license has been revoked or suspended by several states
and he has been excluded from participating in Medicare and
Medicaid for prescribing via the Internet in an inappropriate man-ner.
He did not examine patients for whom prescriptions were
written and to whom medications were sent and he had no physi-cian-
patient relationship with them.
Action: 5/28/2004. Final Agency Decision issued: Acting on the Proposal
for Decision by Administrative Law Judge A.B. Elkins, who heard
the matter and who issued his Proposal in March 2004, and fol-lowing
arguments by Dr Jones and the attorney for the Board, the
Board ordered the revocation of Dr Jones’ license. He may not
apply for reinstatement for two years.
KELL, Michael Jon, MD
Location: Atlanta, GA
DOB: 11/01/1949
License #: 0000-35005
Specialty: OS/ADD (as reported by physician)
Medical Ed: Emory University (1985)
Cause: Dr Kell was convicted in Georgia of one count of felony
Conspiracy to Defraud the State, one count of felony Medicaid
Fraud, one count of felony False Writings, and three counts of
felony Tax Evasion.
Action: 7/02/2004. Findings of Fact, Conclusions of Law, and Order of
Discipline issued: Following a hearing on 6/16/2004, the Board
revoked Dr Kell’s license based on the felony convictions in
Georgia.
SUSPENSIONS
MURNANE, John Eugene, III, MD
Location: Phoenix, AZ
DOB: 11/16/1951
License #: 0000-25733
Specialty: AI/EM (as reported by physician)
Medical Ed: Medical College of Virginia (1979)
Cause: Dr Murnane has action taken against his licenses in Arizona and
Virginia. In 2000, he entered an agreement with the Arizona
Board to abstain from alcohol but in March 2002 a random screen-ing
test found him positive for alcohol use. As a result, Arizona
suspended his license in May 2002. He surrendered his license in
Arizona in December 2002. In June 2002, Virginia suspended his
Virginia license due to the action in Arizona. In March 2003, his
request for reinstatement of his Virginia license was denied.
Action: 6/30/2004. Findings of Fact, Conclusions of Law, and Order of
Discipline issued: Dr Murnane’s North Carolina license is indefi-nitely
suspended.
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.)
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.
NORTH CAROLINA MEDICAL BOARD
Board Orders/Consent Orders/Other Board Actions
May - June 2004
DEFINITIONS
No. 3 2004 19
BOX, James Brent, MD
Location: Calhoun, GA
DOB: 7/24/1959
License #: 0000-33622
Specialty: IM (as reported by physician)
Medical Ed: Mercer University (1986)
Cause: In October 2003, Dr Box was fined $1,000 by the Georgia Board
for employing a physician assistant for a period of three years dur-ing
which the physician assistant has allowed her license to lapse.
Action: 7/02/2004. Consent Order executed: Dr Box is reprimanded.
CIRILLO, Robert L. Jr, MD
Location: Chapel Hill, NC (Orange Co)
DOB: 1/25/1967
License #: 0099-00187
Specialty: VIR/DR (as reported by physician)
Medical Ed: Georgetown University (1994)
Cause: In submitting his license application to the North Carolina Medical
Board in January 1999, Dr Cirillo failed to reveal on the applica-tion
form that he had attempted to withdraw his application for a
Florida license in September 1998 following an interview with the
Florida Credentials Committee, and that, in November 1998, the
Florida Board filed notice of its intent to deny his application. The
North Carolina application form asked specifically for such infor-mation.
Action: 6/16/2004. Consent Order executed: Dr Cirillo is reprimanded.
CROSS, Harry Giles, Jr, Physician Assistant
Location: Southern Pines, NC (Moore Co)
DOB: 3/11/1960
License #: 0001-01139
Specialty: IM/GER (as reported by physician)
PA Education: Wake Forest University School of Medicine PA Program (1989)
Cause: In May 2001, Mr Cross pled guilty to one count of conspiracy to
submit false claims and two counts of making false claims. All of
these were felonies. He was sentenced to 27 months imprison-ment
and three years of supervised probation by the U.S. District
Court for the Middle District of North Carolina. He was also
assessed a fine of $200,000. In December 2001, he surrendered
his PA license. He has now completed his term of imprisonment
and paid all fines and restitution.
Action: 6/17/2004. Consent Order executed: Mr Cross’ PA license was
suspended from December 1, 200l, until the date of issuance
shown on the license issued pursuant to this Consent Order
[6/17/2004]; his license is reissued to expire on the date shown on
the license [12/17/2004]; he shall practice only in a setting first
approved by the president of the Board; must comply with other
requirements.
EDGE, Kendra Dian, Physician Assistant
Location: Winston-Salem, NC (Forsyth Co)
DOB: 10/15/1975
License #: 0001-02842
PA Education: NA
Cause: Ms Edge practiced under the supervision of Dr James Spencer
from October 1999 through November 2003 without submitting
the required Intent to Practice form with the Board. She then
practiced from December 2003 to February 2004 under the super-vision
of Dr David Smull prior to submitting the required Intent
to Practice form. On 2/19/2004, she submitted the proper Intent
to Practice form.
Action: 6/18/2004. Consent Order executed: Ms Edge is reprimanded.
ENGLISH, Thaddeus David, Physician Assistant
Location: Elizabeth City, NC (Pasquotank Co)
DOB: 8/01/1972
License #: 0001-03217
PA Education: University of Pennsylvania, Lock Haven, PA Program (2000)
Cause: Between January 2002 and February 2004, Mr English prescribed
controlled substances to a physician co-worker suffering from back
pain. He failed to document the prescriptions, failed to keep a
chart on the co-worker, and failed to inform his supervising physi-cian
of his action.
Action: 5/20/2004. Consent Order executed: Mr English is reprimanded;
he must provide a copy of the Consent Order to all current and
prospective employers; must abide by all laws, rules, and regula-tions
in future.
FOLKERTS, AnnaMaria, Physician Assistant
Location: Elon, NC (Alamance Co)
DOB: 8/24/1961
License #: 0001-02206
PA Education: College of West Virginia (1996)
Cause: In December 2002, the Board issued a finding that Ms Folkerts
engaged in unprofessional conduct by providing false and mislead-
See Consent Orders:
AARON, Maureen Margaret, MD
CROSS, Harry Giles, Jr, Physician Assistant
HAMBLETON, Scott Lewis, MD
HOOPER, Jeffrey Curtis, MD
JOHNSON, Welburne Dewitt, II, MD
MILTON, Bernard Gerald, MD
NIEMEYER, Meindert, MD
PATEL, Rakesh Dahyabhai, MD
POLLACK, Sheldon Victor, MD
SKIPPER, Michelle Taylor, Nurse Practitioner
SUMMARY SUSPENSIONS
ECHOLS, Everett Raphael, II, MD
Location: Rockingham, NC (Richmond Co)
DOB: 6/12/1954
License #: 0095-00562
Specialty: FP/P (as reported by physician)
Medical Ed: Meharry Medical School (1981)
Cause: The Board has information that Dr Echols is prescribing danger-ous
drugs to individuals over the Internet without first examining
those individuals to determine if the drugs are medically indicated
and are safe for use by the individuals. Dr Echols’ offending con-duct
is described in detail in the Notice of Charges and Allegations
filed by the Board on 6/16/2004.
Action: 6/16/2004. Order of Summary Suspension of License issued: Dr
Echols’ North Carolina medical license is summarily suspended
effective on service of the Board’s Order.
CONSENT ORDERS
AARON, Maureen Margaret, MD
Location: Martinsville, VA
DOB: 6/11/1945
License #: 0000-25685
Specialty: FP (as reported by physician)
Medical Ed: University of Saskatchewan (1968)
Cause: In January 2004, the Virginia Board of Medicine placed Dr
Aaron’s medical license on indefinite probation subject to condi-tions,
including her completion of a comprehensive course of med-ical
record keeping within six months, her keeping of complete and
accurate medical records, and unannounced review of her con-trolled
substance records by the Board.
Action: 7/02/2004. Consent Order executed: Dr Aaron’s North Carolina
license is indefinitely suspended, said suspension being stayed on
condition she comply with the Virginia Order and other require-ments.
ALLEN, Aaron Russell, MD
Location: Anaheim, CA
DOB: 1/22/1942
License #: 0000-35576
Specialty: N/CN (as reported by physician)
Medical Ed: University of Southern California, Los Angeles (1971)
Cause: In April 2001, while working in Lumberton, NC, and Myrtle
Beach, SC, Dr Allen pre-signed three prescription pads that were
delivered to the Myrtle Beach Medical Center to allow two physi-cians
there who did not have valid DEA registrations to issue pre-scriptions.
He mistakenly believed it was lawful to do this after
being erroneously advised by the MBMC facility manager that the
DEA had approved the pre-signing. Approximately 13 patients
and two employees were issued Dr Allen’s pre-signed prescriptions
by two physicians at MBMC. Dr Allen never completed a physi-cal
on these persons to determine a diagnosis and treatment prior
to pre-signing the prescription blanks. Dr Allen says he checked by
telephone with the physicians before they issued the prescriptions
and later reviewed and co-signed the records. Dr Allen cooperat-ed
with the Board’s investigation. In late 2002, Dr Allen relocat-ed
to California and does not plan to return to North Carolina to
practice.
Action: 5/21/2004. Consent Order executed: Dr Allen is reprimanded,
must comply with other conditions.
BOVELLE, Renee Claudia, MD
Location: Bowie, MD
DOB: 12/30/1963
License #: 2001-01177
Specialty: OPH (as reported by physician)
Medical Ed: UCLA Drew School of Medicine (1992)
Cause: Dr Bovelle was reprimanded by the Nevada Board of Medicine for
engaging in medical practice in Nevada with an inactive license on
three occasions.
Action: 7/01/2004. Consent Order executed: Dr Bovelle is reprimanded.
20 NCMB Forum
ing responses on her application for a PA license by not disclosing
she has been disciplined by the New Jersey Board of Medical
Examiners. The Board suspended her license indefinitely, holding
Ms Folkerts could not reapply for reinstatement until December
2003. She applied for reinstatement in April 2004.
Action: 5/20/2004. Consent Order executed: Ms Folkerts is issued a PA
license to expire on the date shown on the license [12/31/2004];
she shall meet with Board members in November 2004; before
that meeting, she shall obtain 20 hours of Category 1 CME and
she shall provide an evaluation of her performance by her super-vising
physician; must comply with other conditions.
GEORGE, Pazhayidathe K., MD
Location: Zebulon, NC (Wake Co)
DOB: 5/16/1939
License #: 0000-27457
Specialty: IM/GE (as reported by physician)
Medical Ed: Trivandrum, India (1964)
Cause: Relative to testimony given at the time, Charges and Allegations
that Dr George committed boundary violations with three female
patients were dismissed in October 2003. Dr George testified at
the hearing that, from 1992 to 2003, he did breast examinations
on female patients outside their bra or outer clothing and these
examinations were below the minimum standard of care. He fur-ther
testified he had recorded these examinations in the medical
record without noting how they were conducted. He admitted any
physician reviewing these records would assume an appropriate
breast examination had been conducted. Those actions of Dr
George constitute unprofessional conduct. He has agreed to stop
performing breast examinations and to complete 10 hour of CME
about breast examination so he may better recognize symptoms
that require referral for a proper breast examination.
Action: 5/04/2004. Consent Order executed: Dr George is reprimanded;
he shall obtain 10 hours of Category I CME on breast examina-tions;
must comply with other conditions.
GOODWIN, William Pierce, MD
Location: Jacksonville, NC (Onslow Co)
DOB: 9/18/1949
License #: 0099-00849
Specialty: FP (as reported by physician)
Medical Ed: Meharry Medical College (1976)
Cause: Relative to the Charges and Allegations dated 5/19/2004. In
November 2002, the Georgia State Board of Medical Examiners
and Dr Goodwin entered a Consent Order in which Dr Goodwin
agreed to attend and successfully complete a mini-residency in
appropriate prescribing. In July, 2002, the Georgia Board repri-manded
and fined him for failing to complete the required mini-residency.
He was also ordered to attend the program as original-ly
required. Dr Goodwin completed the program, however, only
after the deadline to which he agreed in his second Consent Order
with the Georgia Board. In September 2003, he was reprimanded
and fined again by the Georgia Board.
Action: 7/27/2004. Consent Order executed: Dr Goodwin is reprimand-ed.
GRAU, Gerard Dean, MD
Location: Fort Lauderdale, FL
DOB: 12/15/1945
License #: 0000-25299
Specialty: PS (as reported by physician)
Medical Ed: University of Virginia (1971)
Cause: In 2001, Dr Grau entered into a Consent Agreement with the
Florida Board that assessed a $5,000 fine against him based on
allegations involving deficiencies relating to paperwork required in
managing the stock of office medications at his plastic surgery cen-ter.
He neither admitted nor denied the allegations.
Action: 5/07/2004. Consent Order executed: Dr Grau is reprimanded.
HALL, Bruce Parker, MD
Location: Orchard, NY
DOB: 6/10/1953
License #: 0094-00516
Specialty: DR (as reported by physician)
Medical Ed: University of Rochester (1981)
Cause: Dr Hall was placed on probation for two years by the New York
Board to resolve allegations he practiced below the standard of
care. He was required to practice under supervision and to com-plete
a specific CME course.
Action: 6/09/2004. Consent Order executed: Dr Hall is reprimanded and
must submit a complete application for a license before resuming
practice in North Carolina.
HAMBLETON, Scott Lewis, MD
Location: Shelby, NC (Cleveland Co)
DOB: 4/15/1963
License #: 2000-00444
Specialty: FP/EM (as reported by physician)
Medical Ed: University of Tennessee (1994)
Cause: Dr Hambleton has a history of substance abuse. In December
2002, he signed a Consent Order with the Board admitting his
attempt in February 2002 to obtain controlled substances for his
own use in by writing a prescription to a fictitious name. He sur-rendered
his license in February 2002. He was then reissued a
license under the December 2002 Consent Order, which required
he refrain from all use of mind- or mood-altering substances or
alcohol unless lawfully prescribed. In March 2004, a bodily fluid
sample was collected from Dr Hambleton by an NCMB investiga-tor
and Dr Hambleton subsequently admitted he had been ingest-ing
hydrocodone for at least two months in violation of his
Consent Order. He surrendered his license on 3/18/2004.
Action: 6/02/2004. Consent Order executed: Dr Hambleton’s license is
suspended indefinitely.
HATCHER, James Jackson, MD
Location: Virginia Beach, VA
DOB: 3/02/1951
License #: 0000-21961
Specialty: IM/PCC (as reported by physician)
Medical Ed: University of Virginia (1976)
Cause: In June 2003, Dr Hatcher was formally reprimanded by the
Virginia Board of Medicine for improper prescribing.
Action: 5/26/2004. Consent Order executed: Dr Hatcher is reprimanded.
HOOPER, Jeffrey Curtis, MD
Location: Greensboro, NC (Guilford Co)
DOB: 9/21/1964
License #: 0097-00286
Specialty: FP (as reported by physician)
Medical Ed: Vanderbilt School of Medicine (1995)
Cause: Dr Hooper has been an anonymous participant in the NCPHP
since 1997 due to alcohol abuse. In early 2004, he tested positive
for alcohol and at the direction of the NCPHP he entered a treat-ment
program. At this point, the Board gave Dr Hooper the
choice of surrendering his license or having it summarily suspend-ed.
He surrendered his license in March 2004 and remains in a res-idential
treatment program.
Action: 5/27/2004. Consent Order executed: Dr Hooper’s license is
indefinitely suspended from this date.
HOWARD, Jerome, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 3/01/1944
License #: 0000-18523
Specialty: FP (as reported by physician)
Medical Ed: State University of New York Upstate, Syracuse (1970)
Cause: From October 2001 to July 2002, Dr Howard wrote prescriptions
for several controlled substances for a close relative. He has acted
as the primary care physician for that relative for over 20 years and
prescribed numerous medications, including controlled substances,
to that person. In November 2002, Dr Howard prescribed
Ritalin(r) to another close relative, for whom he has also acted as
the primary treating physician. He admits this is unprofessional
conduct.
Action: 5/06/2004. Consent Order executed: Dr Howard is reprimand-ed;
he shall comply with the Board’s Position Statements on pre-scribing
and on treating family members.
JOHNSON, Welburne Dewitt, II, MD
Location: Cookeville, TN
DOB: 5/18/1956
License #: 0000-29126
Specialty: EM/FP (as reported by physician)
Medical Ed: Northwestern University (1980)
Cause: In November 2003, following previous action on Dr Johnson’s
case, the Tennessee Board of Medical Examiners suspended Dr
Johnson’s license for three years by Consent Order based on alle-gations
that he engaged in inappropriate behavior with patients
and staff and was diagnosed with sexual addiction and narcissistic
personality disorder. Dr Johnson neither admitted nor denied the
allegations but agreed to the Consent Order. In October 2003, he
surrendered his Kentucky license in lieu of revocation based on
actions of the Tennessee Board.
Action: 6/16/2004. Consent Order executed: Dr Johnson’s license is sus-pended
indefinitely and he shall not be eligible to reapply for at
least two years; he shall comply with the orders of both Tennessee
and Kentucky; must comply with other conditions.
MacCARTHY, Justin Daniel, MD
Location: Jacksonville, NC (Onslow Co)
No. 3 2004 21
DOB: 4/10/1942
License #: 0094-00908
Specialty: OTO (as reported by physician)
Medical Ed: National University of Ireland (1966)
Cause: On 8/26/2002, Dr MacCarthy pled guilty to four counts of failure
to pay/file income tax and was sentenced to 36 months of super-vised
probation, including supervised community service, and to
pay restitution of $2,679. This conduct occurred when Dr
MacCarthy was experiencing significant personal and financial
problems.
Action: 6/02/2004. Consent Order executed: Dr MacCarthy is repri-manded.
MARTIN, Wayne Robert, MD
Location: Newland, NC (Avery Co)
DOB: 7/08/1940
License #: 0000-18277
Specialty: FSM/OS (as reported by physician)
Medical Ed: University of Colorado (1968)
Cause: When practicing in Montana in 2003, Dr Martin was censured by
the Montana Board and ordered to pay a fine of $1,000. They
found his conduct not to be within the standard of care when he
sutured a patient’s self-inflicted lacerations without the use of anes-thesia
in an effort to dissuade the patient from injuring himself in
future
Action: 6/16/2004. Consent Order executed: Dr Martin is reprimanded
for his conduct in the referenced case and for having his license
acted against by Montana.
MILTON, Bernard Gerald, MD
Location: Braidwood, IL
DOB: 11/30/1944
License #: 0000-33098
Specialty: FP (as reported by physician)
Medical Ed: University of Maryland (1973)
Cause: Under a Consent Order dated 3/21/2003, Dr Milton’s license in
Illinois was suspended indefinitely by the Illinois Board for a min-imum
of two years based on information he suffers from mental ill-ness,
including bipolar disease, that impairs his ability to practice.
As a result of his illness, he failed to appear at his office for appoint-ments
for some three months, yet he continued to authorize med-ical
treatments and new prescriptions for patients. He failed to
keep dispensing logs and he allowed unlicensed persons to work as
nurses.
Action: 6/03/2004. Consent Order executed: Dr Milton’s North Carolina
license is suspended indefinitely and he shall not be eligible to reap-ply
for at least two years.
NIEMEYER, Meindert Albert, MD
Location: Elon, NC (Alamance Co)
DOB: 6/16/1956
License #: 0000-30440
Specialty: FP (as reported by physician)
Medical Ed: Faculty of Medicine, National University of Utrecht (1981)
Cause: Regarding the Charges and Allegations against Dr Niemeyer filed
1/13/2004. Dr Niemeyer has been prosecuted criminally in the
District Court of Alamance County on substantially the same alle-gations
as contained in the Board’s Charges labeled “Boundary
Violation.” Dr Niemeyer was convicted of six counts of misde-meanor
assault on a female and one count of misdemeanor false
imprisonment. He was acquitted of two counts of misdemeanor
assault on a female. Dr Niemeyer has also sold Juice Plus+® from
his medical office to patients and has encouraged them to become
distributors of the product. He surrendered his license in March
2003.
Action: 5/20/2004. Consent Order executed: Dr Niemeyer’s license is
suspended indefinitely effective March 20, 2003, the date of his
license surrender.
PATEL, Rakesh Dahyabhai, MD
Location: Schiller Park, IL
DOB: 9/30/1966
License #: 0095-00177
Specialty: IM/PD (as reported by physician)
Medical Ed: Boston University (1990)
Cause: In 2003, Dr Patel was placed on probation for one year by the
Arizona Medical Board for inappropriate sexual intimacies with
patients. Arizona found that a patient alleged Dr Patel rubbed her
shoulders and back, asked her how her marriage was going, then
began to touch and rub her breasts and became aroused; that the
patient later sued Dr Patel for malpractice; that Dr Patel denied the
allegations and settled the lawsuit; and that a second patient made
similar allegations against Dr Patel. As a result of its investigations
and proceedings, Arizona placed Dr Patel on probation and
required he obtain 20 hours of approved CME on sexual intima-cy/
boundary issues.
Action: 5/20/2004. Consent Order executed: Dr Patel’s license is sus-pended
for 12 months; suspension is stayed on terms and condi-tions,
including that he obtain 20 hours of CME on sexual intima-cy/
boundary issues within 90 days (which may be the same CME
completed pursuant to his Arizona discipline) and that he obtain
practice site approval by the Board’s president before resuming
practice in North Carolina. [Site approval has been granted under
the Consent Order for Dr Patel to practice at the Rocky Mount
Family Medical Center in Rocky Mount, NC.]
PEISEL, Francis James, MD
Location: Wilmette, IL
DOB: 7/11/1950
License #: 0000-21096
Specialty: AN (as reported by physician)
Medical Ed: University of Kentucky (1975)
Cause: In 2001, the Kentucky Board of Medicine entered an Order deny-ing
Dr Peisel’s application for a license due to his providing false
information on his application.
Action: 5/06/2004. Consent Order executed: Dr Peisel is reprimanded;
must comply with other conditions.
PHILIPS, Sherif Antoun, MD
Location: Greenville, NC (Pitt Co)
DOB: 6/24/1958
License #: 0095-01056
Specialty: NEP/IM (as reported by physician)
Medical Ed: Ain Shams Medical School, Egypt (1981)
Cause: In May 2000, Dr Philips was medical director of Total Renal Care
in New Bern, NC. He was not Patient A’s attending physician, but
was on duty as medical director when Patient A received hemodial-ysis.
The procedure was begun on Patient A and he was left unat-tended
by a technician. Later, an employee noticed a pool of blood
under Patient A’s chair and, after examination, found Patient A was
in cardiac arrest. The employee called for aid and a nurse practi-tioner
began CPR until an EMT arrived. Dr Philips subsequently
learned Patient A was in cardio-respiratory arrest and needed help,
but he did not attempt to aid the patient in any way prior to the
arrival of the EMT. The patient was moved to Craven County
Hospital, where he died of blood loss.
Action: 5/21/2004. Consent Order executed: Dr Philips is reprimanded.
POLLACK, Sheldon Victor, MD
Location: Toronto, Canada
DOB: 5/01/1949
License #: 0000-23641
Specialty: D (as reported by physician)
Medical Ed: University of Toronto (1974)
Cause: Dr Pollack was disciplined by the College of Physicians and
Surgeons of Ontario for injecting non-approved injectable grade
liquid silicone into patients for lip augmentations after informing
the Ontario College he would not do so. In September 2003, the
Ontario College suspended Dr Pollack’s license for six months;
placed terms, conditions, and limitations on his license; and fined
him $2,500.
Action: 5/21/2004. Consent Order executed: Dr Pollack’s license is sus-pended
for six months from the date of the Consent Order; prior
to resuming practice in North Carolina, he must demonstrate com-pliance
with the Order of Discipline of the Ontario College and his
good standing with the College.
SKIPPER, Michelle Taylor, Nurse Practitioner
Location: Laurinburg, NC (Scotland Co)
DOB: 10/27/1967
Approval #: NP 0002.00849
NP Education: NA
Cause: In a Settlement Agreement with Ms Taylor signed on 2/01/2004,
the NC Board of Nursing found that Ms Taylor violated the
Nursing Practice Act by prescribing medications for a co-worker
without her supervising physician’s knowledge. The Nursing
Board suspended Ms Taylor’s license for three months and will
reinstate it thereafter on probationary conditions.
Action: 6/03/2004. Consent Order executed: Ms Taylor’s approval as an
NP is suspended for three months (2/01/2004-5/01/2004) and she
must reapply with the NCMB for approval as an NP after rein-statement
by the Nursing Board; she must comply with all the
terms of her probation with the Nursing Board.
TAYLOR, David Howarth, MD
Location: Searcy, AR
DOB: 8/31/1953
License #: 0000-28814
Specialty: GE/IM (as reported by physician)
Medical Ed: University of Arkansas (1981)
Cause: In March 2003, Dr Taylor entered into an agreement with the
22 NCMB Forum
Texas State Board of Medical Examiners to restrict his license due
to complications/adverse outcomes with two patients undergoing
endoscopic procedures.
Action: 6/16/2004. Consent Order executed: Dr Taylor is reprimanded.
THOMPSON, Robert Bruce, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 2/29/1956
License #: 0000-40006
Specialty: N/APM (as reported by physician)
Medical Ed: University of Miami School of Medicine (1987)
Cause: Amendment to Consent Order of7/25/2003. The Board voted to
allow Dr Thompson to engage in clinical practice under certain
terms and conditions.
Action: 6/19/2004. Consent Order Amendment executed: Dr Thompson
shall practice with R. L. Follmer, MD, at Carolinas Medical Center
for a two-month mini-fellowship; Dr Follmer shall supervise and
monitor Dr Thompson’s clinical practice; Dr Thompson shall not
practice more than 40 hours per week; Dr Follmer must submit a
letter to the Board indicating he has read the Consent Order of July
2003 and this Amendment; all other provisions of the July 2003
Consent Order remain in effect.
WADDELL, Roger Dale, MD
Location: Apex, NC (Wake Co)
DOB: 11/17/1954
License #: 0000-30105
Specialty: GP (as reported by physician)
Medical Ed: University of Colorado School of Medicine (1981)
Cause: In 1999, Dr Waddell met with the NCPHP after being convicted
for the second time of DWI. He admitted he had a history of alco-holism
and entered an inpatient treatment program. Between May
2000 and November 2001, he continued to consume alcohol
despite his work with the NCPHP and additional treatment. In
May 2000, the NCPHP broke Dr Waddell’s anonymity and report-ed
his problems to the Board. After several meetings with the
Board, he surrendered his license in November 2001. In August
2002, he entered treatment at Metro Atlanta Recovery Residences
and stayed in residence there for 15 months. He has continued to
maintain and abide by a contract with the NCPHP.
Action: 6/23/2004. Consent Order executed: Dr Waddell’s license is reis-sued
to expire on the date shown on the license [10/31/2004];
unless lawfully prescribed by someone else, he shall refrain from
the use of all mind- or mood-altering substances, including alco-hol;
on request, he shall supply bodily fluids or tissues for
drug/alcohol screening; he shall maintain and abide by a contract
with the NCPHP; he shall practice no more than 20 hours a week;
must comply with other conditions.
MISCELLANEOUS ACTIONS
ROSNER, Michael John, MD
Location: Hendersonville, NC (Henderson Co)
DOB: 12/04/1946
License #: 0000-26865
Specialty: NS/NCC (as reported by physician)
Medical Ed: Virginia Commonwealth University School of Medicine (1972)
Cause: The Board summarily suspended Dr Rosner’s license in November
2002. Following a hearing in January 2003, at which the Board
determined Dr Rosner had performed surgery that was not med-ically
indicated on eight patients, the Board indefinitely suspended
his license on 2/05/2003. An initial request for reinstatement of
Dr Rosner’s license was denied in February 2004. A hearing was
requested by Dr Rosner and was held on 6/16-17, 2004. As a
result of that hearing, the Board determined Dr Rosner is qualified
for a license.
Action: 7/23/2004. Findings of Fact, Conclusions of Law, and Order
issued: The Board issues Dr Rosner a license to expire on the date
shown on the license [1/31/2005]; whenever Dr Rosner proposes
to perform surgery for hypoplastic posterior fossa (HPF), he shall
ensure the patient has first obtained a second opinion from anoth-er
licensed North Carolina neurosurgeon approved by the Board;
the second opinion does not have to agree that surgery is indicat-ed
for Dr Rosner to operate; Dr Rosner may perform the HPF
surgery only when included in a formal research project under the
oversight of an institutional review board.
DENIALS OF RECONSIDERATION/MODIFICATION
NONE
DENIALS OF LICENSE/APPROVAL
MACKEY, William Frederick, Jr, MD
Location: Wilmington, NC (New Hanover Co)
DOB: 10/20/1944
License: 0000-19801
Specialty: CHP/P (as reported by physician)
Medical Ed: University of Tennessee, Memphis, College of Medicine (1969)
Cause: At the scheduled hearing on 5/21/2004 on Dr Mackey’s request for
reinstatement of his license, summarily suspended in March 2000
and indefinitely suspended in April 2000, the Board found Dr
Mackey unable to practice medicine with reasonable skill and safe-ty
by reason of illness, drunkenness, excessive use of alcohol, or any
other type of material or by reason of a physical or mental abnor-mality.
It also found Dr Mackey did not present sufficient cause in
his last minute motion for continuance of the hearing to excuse his
absence from the hearing.
Action: 5/28/2004. Order issued: Dr Mackey’s appeal is dismissed for
lack of prosecution and his application for reinstatement is denied.
STANTON, Eugene Stefan, MD
Location: Cocoa Beach, FL
DOB: 3/04/1922
License #: 0000-34744
Specialty: GS/GYN (as reported by physician)
Medical Ed: Institute of Medicine, Cluj, Romania (1946)
Cause: License has been inactive since March 1998 and Dr Stanton has
not satisfied the Board that he has maintained his skills.
Action: 4/13/2004. Application for reinstatement of license denied.
SURRENDERS
AUSTERMEHLE, Paul Edward, Physician Assistant
Location: Asheville, NC (Buncombe Co)
DOB: 8/04/1966
License #: 0001-02541
PA Education: Philadelphia College Textile (1997)
Action: 7/23/2004. Voluntary surrender of North Carolina PA license.
CYNN, Steven Jae, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 11/12/1936
License #: 0000-19592
Specialty: FP/NTR (as reported by physician)
Medical Ed: Yonsei University, Korea (1961)
Action: 6/23/2004. Voluntary surrender of medical license.
GILMER, Vince Donald, MD
Location: Fletcher, NC (Henderson Co)
DOB: 9/05/1962
License #: 2000-01139
Specialty: FP (as reported by physician)
Medical Ed: University of South Alabama (1997)
Action: 7/06/2004. Voluntary surrender of North Carolina medical
license.
WHITMER, Gilbert Gomer, Jr, MD
Location: Rocky Mount, NC (Edgecombe Co)
DOB: 9/04/1961
License #: 0000-36854
Specialty: ORS/SOH (as reported by physician)
Medical Ed: The Johns Hopkins University School of Medicine (1987)
Action: 7/08/2004. Voluntary surrender of North Carolina medical
license.
CONSENT ORDERS LIFTED
FORD, Angela B., Physician Assistant
Location: Oak Ridge, NC (Guilford Co)
DOB: 9/08/1969
License #: 0001-02891
PA Education: NA
Action: 7/02/2004. Order issued lifting Consent Order of 7/31/2002.
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)
Action: 6/14/2004. Order issued lifting Consent Order of 11/14/2003.
TATE, Denny Cook, MD
Location: Graham, NC (Alamance Co)
DOB: 9/07/1958
License #: 0000-29427
Specialty: IM (as reported by physician)
Medical Ed: University of North Carolina School of Medicine (1984)
Action: 5/06/2004. Order issued lifting Consent Order of 8/30/1999.
No. 3 2004 23
WODECKI, Tadeusz K., 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)
Action: 6/30/2004. Order issued lifting Consent Order of 11/25/2003.
WOLEBEN, Martyn Dean, MD
Location: Goldsboro, NC (Wayne Co)
DOB: 11/13/1956
License #: 0097-00428
Specialty: OBG (as reported by physician)
Medical Ed: University of Mississippi School of Medicine (1988)
Action: 5/10/2004. Order issued lifting Consent Order of 11/03/2003.
TEMPORARY/DATED LICENSES:
ISSUED, EXTENDED, EXPIRED, OR REPLACED BY FULL LICENSES
BREWER, Thomas Edmund, Jr, MD
Location: Denton, NC (Davidson Co)
DOB: 11/04/1956
License #: 0000-28141
Specialty: EM/OM (as reported by physician)
Medical Ed: Wake Forest University School of Medicine (1983)
Action: 5/20/2004. Temporary/dated license extended to expire
1/31/2005.
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: 5/20/2004. Temporary/dated license extended to expire
1/31/2005.
CARLSON, James Lennart, MD
Location: Cerro Gordo, NC (Columbus Co)
DOB: 11/20/1959
License #: 2002-00010
Specialty: FP (as reported by physician)
Medical Ed: Medical College of Wisconsin (1991)
Action: 7/22/2004. Temporary/dated license extended to expire
11/30/2004.
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 School of Medicine (1981)
Action: 722/2004. Temporary/dated license extended to expire
3/31/2005.
HEINER, Daniel Edward, MD
Location: Charlotte, NC (Mecklenburg Co)
DOB: 7/06/1964
License #: Resident Training License
Specialty: ORS (as reported by physician)
Medical Ed: University of Kansas (1997)
Action: 7/22/2004. Undated RTL issued.
LAVINE, Gary Harold, MD
Location: New Bern, NC (Craven Co)
DOB: 11/04/1964
License #: 2001-00403
Specialty: EM (as reported by physician)
Medical Ed: University of Southern Alabama (1983)
Action: 5/20/2004. Temporary/dated license extended to expire
2/28/2005.
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 NJ, RW Johnson Medical
School (1985)
Action: 7/22/2004. Temporary/dated license extended to expire
11/30/2004.
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: 5/20/2004. Temporary/dated license extended to expire
11/30/2004.
McClelland, Scott Richard, DO
Location: Wilmington, NC (New Hanover Co)
DOB: 7/19/1948
License #: 0000-29064
Specialty: P (as reported by physician)
Medical Ed: Kirksville Osteopathic (1980)
Action: 7/22/2004. Temporary/dated license extended to expire
1/31/2005.
MOIR, Ronald Jeffrey, MD
Location: Morganton, NC (Burke Co)
DOB: 12/30/1956
License #: 0000-31176
Specialty: AN (as reported by physician)
Medical Ed: East Carolina University School of Medicine (1984)
Action: 5/20/2004. Temporary/dated license extended to expire
9/30/2004.
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: 5/20/2004. Temporary/dated license extended to expire
11/30/2004.
STROUD, Joan Marie, Physician Assistant
Location: Gastonia, NC (Gaston Co)
DOB: 4/24/1956
License #: 0001-01476
PA Education: Pennsylvania State University PA Program (1980)
Action: 7/22/2004. Temporary/dated license extended to expire
1/31/2005.
THOMPSON, Robert Bruce, MD
Loction: Charlotte, NC (Mecklenburg Co)
DOB: 2/29/1956
License #: 0000-40006
Specialty: N/APM (as reported by physician)
Medical Ed: University of Miami School of Medicine (1987)
Action: 5/20/2004. Temporary/dated license extended to expire
7/31/2004.
7/22/2004. Full and unrestricted license issued.
WHITE, Steven William, Physician Assistant
Location: Cameron, NC (Moore Co)
DOB: 12/19/1962
License #: 0001-02116
PA Education: Midwestern University (1996)
Action: 5/20/2004. Temporary/dated license extended to expire
1/31/2005.
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)
Action: 5/20/2004. Full and unrestricted license issued.
See Consent Orders:
CROSS, Harry Giles, Jr, Physician Assistant
FOLKERTS, AnnaMaria, Physician Assistant
WADDELL, Roger Dale, 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
US Postage
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: September 22-24, 2004; October 20-22, 2004; November 17-19, 2004
January 19-21, 2005; February 16-17, 2005
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
Federation of State Medical Board’s web site at www.fsmb.org. If you have additional questions, please
e-mail Kelli Singleton, the Board’s GME Coordinator, at kelli.singletom@ncmedboard.org or visit the
Board’s web site at http://www.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.