Board of Medical Examiners Newsletter and Report

www.albme.org January – March 2010 Volume 25, Number 1

Inside: Board discourages use of HCG for treatment of Board of Medical Examiners by George C. Smith Jr., MD* The Board has expressed concern about the use of human chorionic gonadotropin Executive Director Larry Dixon presents the annual (also sometimes referred to as gonadotrophin) hormone (HCG) report of the BME. for weight loss and wants to inform physicians of its current – page 2 view concerning this practice. HCG became of interest to the bariatric community after a Office-based surgery study was published in 1954 by Dr. Albert T. Simeons1. He Explore the definition of gave obese subjects a total dose of 5,000 IU of the hormone in “surgery” and the rules that daily injections of 125 IU. He reported significant decreases in apply in an office setting. measurements around the hips and waists of the subjects within – page 4 ten days, loss of appetite and very few side effects. Male and female patients on a 500 calorie diet who received daily injec- Use of lasers tions of HCG for 40 days lost significant amounts of weight. Refresh your knowledge of This study created quite a sensation, and over the next several the rules governing the use George C. Smith Jr., MD of lasers in a physician’s years, there were multiple attempts by scientists to reproduce *Dr. Smith practices family office. these results using double blind studies. The overwhelming evi- dence has been that there is no statistical difference in a control and emergency medicine in – page 5 Lineville and Anniston. He is group receiving placebo and the group receiving HCG. The fol- board certified in family med- Collaborative Practice lowing table2 summarizes six of these clinical trials. Note that icine and has been a member A Collaborative Practice five of them show no benefit, and the Asher and Harper study of the Board of Medical seminar will be presented has been criticized for its statistical and treatment methods. Examiners since 2005. at MASA’s Annual Session in Huntsville. Clinical trials of human chorionic gonadotropin (HCG) in the management of obesity – page 5 Investigators, year of report, no. of patients Study protocol Results Prescribing Asher and Harper3, Randomized, double-blind* Improvement, but HCG-treated Read the Board’s position 1973, n = 40 patients were given more on treating and prescribing doses to one’s self or family Young and colleagues4, Randomized, double-blind, No benefit members. 1976, n = 202 crossover* – page 6 Stein and associates5, Randomized, double-blind* No benefit 1976, n = 51 Controlled Substances Shetty and Kalkhoff6, Randomized, double-blind; No benefit MASA and BME present 1977, n = 6 in hospital† the 2010 series of the Miller and Schneiderman7, Prospective, double-blind, No benefit proper prescribing course. 1977, n = 19 cross-over* – page 6 Greenway and Bray8, Randomized, double-blind* No benefit 1977, n = 20 Public Actions *Deep intramuscular injections, 125 IU/d for 6 days a week for 6 weeks, combined with a diet supplying 500 to 550 Cal December 2009 – (2100 to 2310 kJ) daily. March 2010 †Deep intramuscular injections, 125 IU/d for 30 days, combined with a diet supplying 500 Cal daily. – page 7 see HCG treatment, page 3 Alabama BME Newsletter and Report

Alabama A Message from the Executive Director Board of Medical Annual report of the Alabama BME by Larry Dixon Examiners In 2009 there was a small decrease in the num- ber of newly licensed physicians in Alabama, with Kenneth Aldridge, MD, 594 approved applicants by endorsement and 136 Chairman approved applicants by examination, 49 fewer Tuscaloosa approved applicants than in 2008. We experienced Richard M. Freeman, MD an increase in collaborations with advanced prac- Vice Chairman tice nurses, with 734 collaborations approved, an Auburn increase over 2008 of 80. The Board of Medical Examiners and its staff have compiled the follow- Jorge A. Alsip, MD ing Annual Report for your information. Mobile

James G. Davis, MD Larry Dixon Birmingham A. APPLICANTS CERTIFIED TO MEDICAL LICENSURE Steven P. Furr, MD COMMISSION Jackson 1. Applicants by endorsement ...... 594 J. Daniel Gifford, MD a. Non-disciplinary Citation with Administrative Charge...... 13 Decatur 2. Applicants by examination ...... 136

William E. Goetter, MD B. APPLICANTS CERTIFIED FOR LIMITED LICENSE ...... 94 Fairhope

B. Jerome Harrison, MD C. APPLICANTS TAKING SPEX EXAMINATIONS Haleyville 1. Applicants passing examinations...... 5 2. Applicants failing examinations ...... 3 David P. Herrick, MD Montgomery D. APPLICANTS FOR OUT OF STATE ENDORSEMENT ...... 2 Juan Johnson, MD Birmingham E. ADVANCED PRACTICE NURSES (CRNP/CNM) 1. Certified Registered Nurse Practitioner Collaborations Approved ...... 731 John S. Meigs Jr., MD 2. Certified Nurse Midwife Collaborations Approved ...... 3 Centreville

Paul Nagrodzki, MD F. PHYSICIAN ASSISTANTS Birmingham 1. Physician Assistants Licensed ...... 44 2. Physician Assistants Registered to Physicians (new applications) ...... 194 George C. Smith, Jr., MD 3. Physician Assistants Granted Temporary Licensure ...... 23 Lineville 4. Temporary Licensure Converted to Full Licensure (after passing exam)... 23 Timothy Stewart, MD 5. Temporary Licensees Granted Registration...... 21 Huntsville 6. Anesthesiologist Assistants Licensed...... 1 7. Anesthesiologist Assistants Granted Temporary License ...... 0 Pamela D. Varner, MD 8. Anesthesia Assistants Registered to Physicians (new applications) ...... 1 Birmingham G. ACSC ISSUED / RENEWED ...... 11,818 Larry Dixon, Executive Director

Patricia Shaner, General Counsel H. DISCIPLINARY / CONFIDENTIAL ACTIONS 1. ACSC Surrender / Revocation / Restriction / Reinstatement ...... 6 2. Certificates of Qualification Denied / Surrendered...... 6 Carla Kruger, Staff Editor see BME Annual Report, page 4

2 Issue 1 • 2010 Alabama BME Newsletter and Report HCG treatment continued from page 1 www.albme.org HCG, marketed under the trade names A.P.L., Chorex, Pregnyl and Profasi, can be used for the treatment of prepubertal cryptocordism not due to anatomic obstruction and in The following selected cases of hypogonadotrophic hypogonadism secondary to pituitary deficiency in males. It is also occasionally used to induce ovulation. These are the only indications forms are shown in the current FDA drug labeling. In fact, the FDA labeling states: available on the HCG has not been demonstrated to be effective adjunctive therapy in the treatment BME’s Web site: of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” dis- • Retired Senior tribution of fat, or that it decreases the hunger and discomfort associated with calo- Volunteer license rie-restricted diets. application One non-label (and illegal) use of HCG is to stimulate the production of natural testos- terone in subjects who have been using anabolic steroids for muscle building. In other • CME worksheet words, it is often used to try to mask the side effects of exogenous steroids on the testos- • Request for waiver terone producing system. from CME due to HCG probably received its most widespread publicity from the of Kevin retirement Trudeau. His 2007 book, The Weight Loss Cure They Don’t Want You to Know About, claimed that “an absolute cure for obesity was discovered almost 50 years ago, but was • Address change form ‘suppressed’ by the AMA, FDA, and ‘other medical establishments throughout the world.’”9 In September 2007, the FTC charged Kevin Trudeau with violating a court order • Application for by misrepresenting the contents of the book and infomercials. Trudeau falsely claimed that replacement of lost or the book’s weight loss plan was easy to do, can be done at home, and ultimately allowed destroyed license readers to eat whatever they wanted. The use of HCG was the central tenet of that book. • Malpractice payment In summary, the use of HCG is extremely controversial and perhaps even harmful. It is report form for associated with illegal muscle-building steroid use and has never been proven in double- insurance companies blind studies to be an effective weight loss adjunct. Considering that the injections cost from $36 to $45 for three ampules of 5,000 IU each plus $12 to $15 for 5,000 IU of the • Dispensing physician compounds that are mixed with the HCG powder, its only proven weight loss is to registration form patients’ wallets. The Alabama Board of Medical Examiners views this practice as dubious medicine bordering on quackery and will take a dim view of its continued use. • Office based surgery registration form 1Simeons ATW. The action of chorionic gonadotrophin in the obese. Lancet 2:946-947, • Office based surgery 1954. adverse event 2 Birmingham CL, Smith, DC. Human chorionic gonadotropin is of no value in the reporting form management of obesity. Can Med Assoc J 1983; 128: 1156-1157. 3Asher WL, Harper H: Effect of human chorionic gonadotrophin on weight loss, hunger, • Laser/pulsed light and feeling of well-being. Am J Clin Nutr 1973; 26: 211-218. device procedures 4Young RL, Fuchs RJ, Woltjen MJ: Chorionic gonadotropin in weight control. A double- registration form blind crossover study. JAMA 1976; 236: 2495-2497. • Laser/pulsed light 5Stein MR, Julis RE, Peck CC, Hinshaw W, Sawicki JE, Deller JJ: Ineffectiveness of device procedure human chorionic gonadotropin in weight reduction: a double-blind study. Am J Clin Nutr adverse event 1976; 29: 940-948. reporting form 6Shetty KR, Kalkhoff RK: Human chorionic gonadotropin (HCG) treatment of obesity. Arch Intern Med 1977: 137: 151-155. • Notification of 7Miller, R, Schneiderman, LJ: A clinical study of the use of human chorionic commencement or gonadotrophin in weight reduction. J Fam Pract 1977; 4: 445-448. termination of 8Greenway FL, Bray GA: Human chorionic gonadotropin (HCG) in the treatment of collaborative practice obesity; a critical assessment of the Simeons method. West J Med 1977; 127: 461-463. • Collaborative practice 9 Trudeau K. The Weight Loss Cure They Don’t Want You to Know About. Alliance QA forms, chart review Publishing, 2007. audits

Issue 1 • 2010 3 Alabama BME Newsletter and Report Office-based surgical procedures In 2003, the Board adopted rules Physicians performing office-based physician’s core curriculum must governing surgical procedures per- surgery using moderate or deep seda- be approved by the Alabama Board formed in a physician’s office or clin- tion/analgesia (as defined in the rules) of Medical Examiners after applica- ic (outside a hospital or outpatient must meet the requirements of the tion to the Board. The physician and facility licensed by the Department of rules, including registration with the at least one assistant must be trained Public Health). In this rule, “surgery” Board and maintaining certain equip- in and current in Advanced Cardiac is defined as “the revision, destruc- ment and supplies, and physicians Life Support (ACLS). tion, incision or structural alteration of must be able to document satisfactory On the Net: human tissue performed using a vari- completion of training, such as being Board’s web page concerning ety of methods and instruments.” If Board certified or being an active can- office based surgery: you perform such procedures in your didate for certification by a Board http://www.albme.org/index.cfm? office or clinic, you should thoroughly approved by the American Board of fuseaction=app.displayPage& read and comply with these adminis- Medical Specialties or comparable pageID=42 trative rules. See the Board’s Web formal training. Alternative creden- page concerning office-based surgery. tialing for procedures outside the BME Annual Report Meet the Staff continued from page 2 Kathy Burkett was employed by H. DISCIPLINARY / CONFIDENTIAL ACTIONS, cont. the Board in 2003 to provide assis- 3. Certificates of Qualification with Agreements / Restrictions ...... 2 tance to the investigative division. Certificate of Qualification Restrictions Terminated ...... 1 Her administrative skills were 4. Letters of Concern ...... 81 quickly recognized, and soon her 5. Complainant Inquiries Received ...... 748 duties included assisting Mr. Ed 6. Complainant Inquiries Resolved ...... 587 Munson, Senior Investigator, with 7. Complainant Inquiries Pending ...... 49 the complaints department, along 8. Complainant Formal Investigations...... 112 with her responsibilities of records Formal Investigations Completed...... 91 management and administrative sup- Formal Investigations Pending...... 21 port. Ms. Burkett is usually the first 9. Collaborative Practice Inspections ...... 108 person encountered by complainants 10. Collaborative Practice Compliance Seminars ...... 1 and may contact the physician for 11. Office Based Surgery Site Inspections...... 0 further information or clarification. 12. Interviews Conducted ...... 68 Cooperation and responsiveness in 13. Complaints filed with Medical Licensure Commission ...... 32 these instances can often avert the 14. Evaluations Ordered ...... 9 instigation of a full investigation. 15. Voluntary Agreements Entered Into ...... 5 Voluntary Agreements Removed...... 1 Your Medical 16. Voluntary Restrictions Entered Into ...... 0 Voluntary Restrictions Removed...... 0 License 17. Flag File for Reinstatement ...... 3 As a physician, your license to 18. Impaired Physician Coordinator Monitoring ...... 71 practice medicine in the Number monitored since 1990 ...... 890 State of Alabama is one of your 19. Requested CME Course Attendance ...... 12 most important assets. 20. Sent for Expert Review ...... 7 21. Assessments (MLC/BME)...... 34 It allows you to apply what you Administrative Fines...... 25 learned during years of school Administrative Costs ...... 9 and post-graduate training to 22. Summary Suspensions ...... 4 earn a livelihood to support Summary Suspension B Surrendered ...... 1 your family. Exercise care to Summary Suspension B Pending a Hearing before the MLC...... 3 protect this asset. 23. Voluntary Surrender of Alabama Medical License ...... 6

4 Issue 1 • 2010 Alabama BME Newsletter and Report Rules governing the use of lasers In 2007, the Board adopted rules physician being on-site and immedi- program for the facility where non-abla- governing the use of lasers in a physi- ately available. Electrocautery may be tive procedures are performed. The cian’s office. used by a Level 1 or Level 2 Delegate rules further specify what should be under direct physician supervision3. included in a quality assurance program. Who is affected Prior to any non-ablative initial treat- The rules affect physicians provid- ment, the physician must examine the 1Level 1 Delegate - a mid-level practi- ing ablative and non-ablative treat- patient, establish a treatment plan, and tioner (physician assistant or ments which utilize lasers/pulsed light sign the patient’s chart. advanced practice nurse) who is devices or any energy source, chemi- authorized in a written job description cal, or other modality that affects liv- Supervision or collaborative protocol to use a spe- ing tissue (when referring to the skin, The rules state what will be consid- cific laser/pulsed light device or other anything below the statum corneum), ered adequate supervision, which energy source, chemical or other whether applied for surgical, thera- includes (but is not limited to) the for- modality for non-ablative procedures, peutic or cosmetic purposes. mulation or approval of a written pro- as designated in the written job tocol, evaluating the technical skills of description or collaborative protocol Registration requirement the delegate and responding appropri- and who has met the educational Physicians who use or offer to use a ately to complications and untoward requirements for a Level 1 Delegate laser/pulsed light device in any facili- effects of the procedures. All physi- stated in the rules. ty other than a hospital must register cians subject to these rules should 2Level 2 Delegate - any person, other with the Board. carefully read and comply with this than a Level 1 Delegate, who has met (and every) section of the rules. the educational requirements for Who may perform what Level 2 Delegates stated in the rules. procedures Education requirements 3Direct supervision is defined as: “the The use of lasers/pulsed light or The rules state particular education physician is in the physical presence other energy devices for ablative pro- requirements for physicians, Level 1 of the patient being treated and is cedures may only be performed by a and Level 2 Delegates. Physicians are directly observing the use of the physician. responsible for ensuring they and any modality by a delegate.” The use of lasers/pulsed light or delegates meet these requirements ___ other energy devices for non-ablative prior to performing any of these pro- On the Net: procedures may be delegated to a cedures. Board’s web page about use of Level 1 Delegate1 or a Level 2 lasers (includes link to rules): Delegate2, but these procedures can- Quality assurance program http://www.albme.org/index. not be delegated to Level 2 Delegates The Board requires that physicians cfm?fuseaction=app.displayPage without the delegating/supervising ensure there is a quality assurance &pageID=48

Collaborative Ensuring Quality in the Collaborative Practice Agreements in Working together to deliver quality healthcare. Alabama Friday, April 9, 2010 – 9:00 a.m. until 12:15 p.m. Currently, there are more than Von Braun Center – Huntsville, Alabama 2,000 active collaborative Presented by: The Medical Association of the State of Alabama, The Alabama Board of Medical agreements between Examiners, and The Alabama Board of Nursing physicians and Certified A Collaborative Practice Seminar will be presented during the Registered Nurse Practitioners/ Medical Association of the State of Alabama’s Annual Session. Certified Nurse Midwives. The seminar is open to both members and non-members of MASA About 70 to 100 new for a registration fee of $100. agreements are approved For more information, contact the MASA Education on a bi-monthly basis. Department at (334) 954-2500 or [email protected].

Issue 1 • 2010 5 Alabama BME Newsletter and Report

Treating and The Medical Association of the State of Alabama and prescribing to The Alabama Board of Medical Examiners present: family members Prescribing and Pharmacology The Board frequently receives inquiries from licensees, pharmacists and others con- of Controlled Drugs: cerning the Board’s position on treating and prescribing to one’s self or family members. Critical Issues and Common The Board looks to the ethical opinion of the American Medical Association’s Council on Pitfalls Ethical and Judicial Affairs when considering unprofessional conduct issues. The 2010 Series AMA opinion E-8.19, Self Treatment or Treatment of Immediate Family Members, states that physicians generally should not treat Controlled substances are prescribed and dispensed today themselves or members of their immediate at an increasing rate to help patients cope with pain, insomnia, families except in emergency settings or isolat- anxiety, depression, obesity and myriad other disorders. ed settings where there is no other qualified Studies show that most practitioners are rather conservative physician available and only until another when prescribing controlled drugs while a small number are at physician becomes available. Except in emer- times overly aggressive. In addition, controlled prescription gencies, it is not appropriate for physicians to medications are falling into the hands of increasing numbers of write prescriptions for controlled substances prescription drug abusers. for themselves or immediate family members. This Intensive Course in Prescribing Controlled Drugs is In addition, in Administrative Rule 545-X- designed for physicians and physician assistants in all special- 4-.06, the Medical Licensure Commission ties who need or wish to increase their knowledge and ability includes in its definition of unprofessional to effectively prescribe and control medications without the conduct “prescribing or dispensing a con- potential for abuse. trolled substance to oneself or to one’s APRIL 10 - 11 NOVEMBER 20 - 21, 2010 spouse, child, or parent, unless such pre- Embassy Suites, Huntsville Renaissance Hotel & Spa at the scribing or dispensing is necessitated by Registration: $250 Convention Center, Montgomery emergency or other exceptional circum- Registration Deadline: March 22 Registration: $375 stances.” The April Prescribing Seminar Registration Deadline: Nov. 1 The Board has requested that pharmacists WILL NOT include the 4-hour Accommodations: contact the Board if they experience physi- Pharmacology Class. Call the Embassy Suites Accommodations: Montgomery at (334) 269-5055 cians writing controlled substances to family Call (800) EMBASSY or visit members, or especially to themselves. It can or visit www.embassysuiteshuntsville.com www.embassysuitesmontgomery. avert future problems for the physician who is Room Code: MAS com simply acting out of ignorance or be the cata- Group Code: MED lyst for help for an impairment issue. Very few JULY 30 - AUGUST 1 Room Block Cutoff: October 20 physicians lose their license on a first time Sandestin Golf and Beach impairment issue. Physicians should always Resort, Destin, Florida Registration forms and interact with pharmacists with professionalism, Registration: $375 particularly when a pharmacist questions or Registration Deadline: July 12 agenda are posted in needs clarification on a prescription. Accommodations: the Education section Call (800) 320-8115 or visit ___ www.sandestin.com of MASA’s Web site, On the Net: Group Code: 22E65S www.masalink.org. AMA web site: http://www.ama-assn.org Room Block Cutoff: June 13 MLC Administrative Rules: http://www.alabamaadministrativecode. For more information, contact the MASA Education state.al.us/docs/mlic/index.html Department at (334) 954-2500.

6 Issue 1 • 2010 Alabama BME Newsletter and Report Report of Public Actions of the Medical Licensure Commission and Board of Medical Examiners MLC – December 2009 MLC – February 2010 MLC – March 2010  On Dec. 7, 2009, the Commission  On Feb. 4, the Commission  On March 10, the Commisison entered an Order reprimanding the entered an Order denying the request entered an Order indefinitely suspend- license to practice medicine in of Bryant H. Hudson III, MD, ing the license to practice medicine in Alabama of Dan S. Hollis, MD, license number MD.4228, Alabama of Oscar V. Fadul, MD, license number MD.8278, Auburn, Montgomery, AL, for reinstatement of license number MD.9585, Huntsville, AL, and assessing an administrative his Alabama Controlled Substances AL. fine. Certificate.  On March 10, the Commission  On Dec. 29, 2009, the Commission  On Feb. 4, the Commission entered an Order denying the applica- entered an Order placing on indefinite entered an Order suspending the tion of Pascual Herrera, Jr., MD, probation the license to practice medi- license to practice medicine in license number MD.13663, Leesburg, cine in Alabama of Oliver Wilson Alabama of Gilberto Sanchez, MD, AL, to lift the probationary status of Crawford Jr., MD, license number license number MD.17969, his license to practice medicine in MD.28100, Ozark, AL. Montgomery, AL, for a period of six Alabama. months.  On March 10, the Commission MLC – January 2010 entered an Order granting the applica-  Upon the stipulation of the parties, BME – February 2010 tion for a license to practice medicine on Jan. 27, the Commission entered  On Feb. 17, the Board revoked the in Alabama of Rock Navarkal, MD, an Order reprimanding the license to Alabama Controlled Substances license number MD.30114, practice medicine in Alabama of Certificate of Eldred Mattatha Birmingham, AL, subject to indefinite JuDonn T. Adams, MD, license Brunson, MD, ACSC number probation. number MD.14027, Fayeteville, GA, ACSC.11237, Pelham, AL. Dr. assessing an administrative fine, and Brunson is no longer authorized to  On March 10, the Commission requiring compliance with the provi- write prescriptions for controlled sub- entered an Order approving the prac- sions of the Consent Order entered stances. tice plan filed by Ervin Wells, MD, into with the state of Georgia on license number MD.28241, Calera, May 20, 2009.  Upon the stipulation of the parties, AL, for his practice of medicine in on Feb. 17, the Board assessed an Alabama. administrative fine against Bret L. BME – January 2010 Fisher, MD, license number  On March 10, the Commission  On Jan. 20, the Board accepted the MD.25887, Panama City, FL, for issu- entered an Order denying the applica- Voluntary Restriction on the certifi- ing controlled substances prescrip- tion for reinstatement of the license to cate of qualification and license to tions without having obtained an practice medicine in Alabama of practice medicine of Adolfo Robledo, Alabama Controlled Substances Michael David Williams, DO, MD, license number MD.13102, Certificate. license number DO.426, Riverview, Troy, AL. FL.  On Feb. 22, the Board issued an  On Jan. 20, the Board accepted the Order deferring consideration of the voluntary surrender of the certificate application for reinstatement of cer- BME – March 2010 of qualification and license to practice tificate of qualification of Ricky Joe None to date. medicine in Alabama of Jason M. Nelson, MD, license number Hunt, MD, license number MD.12557, Hanceville, AL, until he MD.29076, Guntersville, AL. sits for and passes the Special Purpose Examination, at which time the Board will again consider the matter.

Issue 1 • 2010 7 PRESORTED Alabama State Board of Medical Examiners STANDARD Newsletter and Report U.S. POSTAGE PAID Montgomery, AL Alabama Board of Medical Examiners Permit No. 417 P.O. Box 946 Montgomery, AL 36102-0946

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