July 2009 Volume 1, Issue 3 KANSAS STATE BOARD OF HEALING ARTS NEWS

“Your health and safety is our greatest purpose.” INSIDE THIS A KSBHA Annual Check-up ISSUE: uring the past mandates, adding staff, processes are becoming 12 months, to a new director which more streamlined thanks State medical 2 there have have created a year of to the work of records change D transition for been tremulous, exceptional staff. unexpected changes this agency. Board Actions 3 We’re still evolving but in the world. In July As president of I’m very pleased to see 2008, who could the Board, I’m the amount of work our FSMB News 5 have predicted the very agency has put in to collapse of many encouraged at moving forward. This A look back in 5 financial institutions, the amount of next year we will be history bankruptcy of work staff has launching a new web site General Motors, the been able to and continuing to work Anatomy and 6 budgetary accomplish to better communicate Physiology of a Dr. Michael Beezley problems of Board President thus far. At with our licensees as well KSBHA many state Disciplinary Action: the as the public. governments and the beginning of July 2008, Part 1 As always, if anyone worldwide impact of our we were looking at a has suggestions on what How the process 6 economy? significant backlog of they’d like to see or any begins cases. And, while we’re The Kansas Board of feedback, please do not still addressing a Healing Arts has hesitate to contact our backlog, it is experienced changes as agency. well from different considerably smaller and Amendments now in effect for Women’s-Right-to-Know Act everal new or other facility or clinic Notice: It is against contact any local or state amendments to in which abortions are the law for anyone, law enforcement agency S K.S.A. 65-6709, performed shall regardless of their to receive protection which is the Women’s conspicuously post a sign relationship to you, to from any actual or Right-to-Know Act, went in a location so as to be force you to have an threatened physical into effect July 1. clearly visible to patients. abortion. By law, we abuse or violence. You One of those The sign required cannot perform an have the right to change amendments involves the pursuant to this abortion on you unless your mind at any time requirement that a sign subsection shall be we have your freely given prior to the actual must be posted pursuant printed with lettering that and voluntary consent. It abortion and request that to K.S.A. 65-6709(k). It is legible and shall be at is against the law to the abortion procedure stipulates that any private least three quarters of an perform an abortion on cease. office, freestanding inch boldfaced type you against your will. The provisions of this surgical outpatient clinic which reads: You have the right to (Continued on page 5) Page 2 Volume 1, Issue 3 Dumpster diving changes state abandoned records law

by Jack Confer records custodians be that was introduced as believe that this appointed in both House Bill 2010 which legislation will be Executive Director cases. One was settled applies to the three helpful to our agency with the licensee’s healing arts and the healthcare dumpster diver attorney in February professions. It was profession and to the discovering a and we were awarded signed into law by public. A cache of custody in May on the Governor Mark If you are retiring or abandoned medical other one. This is simply Parkinson on June 4. leaving your practice, records and a little boy way too long for people This new legislation please remember that needing inoculation records to start kindergarten were the precursors for a change in state law regarding abandoned medical records this 2009 Legislative Session. It all started with two phone calls last summer concerning the patient records of two physicians; one of whom had his license revoked and whose patient files were found in a dumpster and another whose license was suspended and a mother subsequently unable to access her Board members, staff and legislators attended a bill signing of House Bill 2010 on June 4. Left to child’s inoculation right: Dr. Kimberly Templeton, Board Member; Senator Jim Barnett; Julia Mowers, Legislative records. Analyst; Jack Confer, Executive Director; Governor Mark Parkinson; Representative Mike Kiegerl; State law requires Dr. Myron Leinwetter, Board Member; and Scott Hesse, General Counsel. that doctors who are leaving the practice to be without their includes language that per K.A.R. 100-24-3, establish a custodian for records. There needed the district court shall our agency is to be their patient records as to be a quicker expedite an abandoned notified of who will be patient records must be resolution and the other records action brought maintaining your maintained for 10 question that surfaced forth by the Board. It records and where they years. It also requires was, who is financially also created the will be located. You that the doctors inform responsible for the medical records may contact Sandy at the Board who the maintenance of these maintenance trust fund, 785-296-2482. And, if custodian is and where patient records when which can allocate up you haven’t had a the records are stored. the former licensee’s to $10 from each chance to think that far In these two cases, that location is unknown? license renewal fee and ahead yet, now is did not happen. In January, our dedicate it to that trust. always a good time to Subsequently, we filed agency created This trust will be used to start planning. suits in Shawnee County legislation with the help maintain abandoned District Court that of Rep. Mike Kiegerl patient records. We Volume 1, Issue 3 Page 3 BOARD ACTIONS June and April 2009 Board Meetings

he Kansas State denied the initial request Board found actions that review. The Board Board of Healing for reinstatement at its constituted previously rejected an T Arts held its bi- April meeting. unprofessional and offer of a settlement at monthly meeting on Raymond E. Winger, dishonorable conduct. the February Board Friday, June 12 and took M.D., Wichita, was The order imposed a meeting. The petition various actions, granted an unrestricted 60-day suspension and filed alleges boundary including suspension license. Dr. Winger was practice limitations. The issues with four patients, and approval of consent first licensed in Kansas in Board voted to assess failure to adhere to orders. 1978 and continued costs associated with the applicable standard of In administrative practicing until he hearings of $20,421.93, care and failure to matters, the license of changed his license to which was later reduced maintain accurate Russell Reitz, M.D., exempt status in 1997 to $5,000. Dr. medical records, Manhattan, was brought and to inactive in 1998. Guindon’s license amongst other violations before the Board, as he In 2001, he applied for lapsed in August 2008. of Kansas Statutes. The was recently convicted of a status change from The Board entered terms of the consent a felony. Kansas law inactive to active which into several consent agreement include a requires the Board to was denied by the agreements. With chaperone in the room revoke licenses when the Board. In 2003, he was consent agreements, all times the doctor is licensee has been granted a restricted both the licensee and present with a female convicted of a felony license which required the Board agree to the patient; the chaperone regardless of whether it supervision by another conditions and the will maintain daily logs is related to the healing physician and limited his licensee waives his/her of patients seen and arts; unless 2/3 of the practice to family right to a hearing. report monthly to the Board finds that the medicine. A request to Ariana Powell, Board; and a fine. After licensee has been modify or terminate the Occupational Therapist three years and meeting rehabilitated and is not limitations was denied Assistant, Wichita, and all the terms, the a risk to the public. The by the Board in 2005 Matthew Britton, licensee may petition the Board converted this to before approval was Licensed Radiologic Board to terminate the an evidentiary hearing granted in the June Technologist, Lawrence, consent order. which means a presiding 2009 meeting. both entered into The Board accepted officer was appointed The Board suspended consent agreements with eight initial orders as and a hearing was held the license of Dana S. the Board. Adelbert final orders July 10. Gifford, Physical Reece, M.D., Leawood, which involved fines as a The Board voted to Therapist Assistant, entered into a consent result of failure to deny the request for Topeka, following a agreement following provide proof of reconsideration of failure to abide by the allegations of over continuing education reinstatement of the terms of a consent prescribing. The terms of and/or insurance. The license of Steven D. agreement previously the agreement include orders were Ringel, M.D., Shawnee entered. probation which consists issued to Jigar S. Patel, Mission. Dr. Ringel was Kurt M. Guindon, of further education. M.D., Lenexa; Mervin previously licensed in M.D., Arkansas, was The Board approved Hershberger, L.R.T., Kansas and had his granted reinstatement of entering into a consent Kansas City; Andrew license revoked in 2004 his Kansas medical agreement with John T. McGill Bowen, R.T., for prescribing license with limitations. Schroll, M.D., Overland Overland Park; Dustin violations. The Board In February 2009, the Park after a motion for (Continued on page 4) Page 4 Volume 1, Issue 3

BOARD ACTIONS June and April 2009 Board Meetings

(Continued from page 3) limitations previously hearings. The Board the Board as a placed on their licenses, voted in the April stipulation of being Kleekamp, Overland terminated. Dr. meeting to reduce the granted reinstatement of Park; Clifford Towle, Brockenbrough entered amount of costs owed by his Kansas license. His L.R.T., Hutchinson; into a consent Guindon to $5,000. license had previously Barbara Scritchfield, agreement in February Russell Etzenhouser III, been cancelled. The L.R.T., Carl Junction, 2007 as a condition of MD, Overland Park, consent order includes MO; Judy Lemasters, granting licensure in the asked the Board to public censure for Kansas City, MO; state. The terminations review a consent misrepresenting on his Michael Fish, L.R.T., lifted include monitoring agreement he entered licensure application that Texas. of his professional into with the Board he had not been subject April Board Meeting practice by a Kansas- placing limitations on the to malpractice actions. At the April 17 licensed, Board- practices he could Ronald L. Young, meeting the following approved physician. perform. The Board D.C., Salina, entered actions were taken: Akram entered into a tabled any further into a consent The license of Asghar consent agreement in consideration to the June agreement with the Chaudhary, M.D., February 2008 following meeting. Board. Audits of the Leawood, was allegations of boundary John Schroll, M.D., licensee’s medical suspended pending violations. Limitations Overland Park, records indicated successful passage of the implemented as part of requested the Board to deficiencies. Terms of the Federation of State the agreement included reconsider its decision consent order include Medical Board’s Special a chaperone present with from February to reject a probation for one year Purpose Examination female patients and settlement agreement. and follow-up education. and reinstatement of his documenting a daily log The Board tabled the James D. Hanna, license in another state. of female patients, request to the June M.D., Wisconsin, entered Chaudhary had his staff certifying the presence of meeting. into a consent appointment and a chaperone. Those The Board entered agreement with the privileges revoked at a limitations have now into several consent Board as a condition for Kansas health care been lifted. agreements. With licensure. The terms of facility and had his Kurt M. Guindon, consent agreements, the agreement fall under Missouri license M.D., Arkansas, both the licensee and the K.S.A. 45-221a(1) and revoked. appealed the Board’s Board agree to the are not permitted for The Board voted to assessment of conditions and the release. deny the reinstatement of $20,421.93 at the licensee waives his/her Margaret Eubank, the license of Steven D. February board meeting. right to a hearing. Physician Assistant, Ringel, M.D., Shawnee In February, the Board Carmen Steckline, Junction City, entered Mission. Dr. Ringel was concluded there were Licensed Radiologic into a consent previously licensed in actions that constituted Technologist, Hays, agreement with the Kansas and had his unprofessional and entered into a consent Board following failure to license revoked in 2004 dishonorable conduct. agreement with the maintain adequate for prescribing violations. The order issued Board for reasons which medical records and not Two licensees, James imposed a 60-day fall under K.S.A. 45- adhering to the standard A. Brockenbrough, M.D., suspension and practice 221a(1). of care. The terms of the Missouri, and limitations. The Board Paul Toma, D.O., agreement include Mohammad W. Akram, voted to assess Guindon Missouri, entered into a continuing education in P.A., Wichita, had costs associated with the consent agreement with medical record keeping. Page 5 Volume 1, Issue 3

NATIONAL NEWS From the Federation of State Medical Boards CME-Accredited version of responsible opioid prescribing

Continuing they prescribe for 1 Credits™ for reading • Informed consent Medical patients in pain. More the book and successfully and prescribing Education than 100,000 copies of completing an online test agreements A Responsible Opioid on the material. There (CME) accredited • Periodic review and version of Responsible Prescribing have been are no prerequisites for monitoring of Opioid Prescribing: A distributed across the participating in this patients Physician’s Guide is United States. activity. • Referral and patient now available at Jointly sponsored by Responsible Opioid management www.fsmb.org. Written the Federation of State Prescribing offers by pain medicine expert Medical Boards pragmatic steps for risk • Documentation Scott Fishman, M.D., Foundation, the reduction and improved • Compliance with this concise, University of Wisconsin patient care, including: state and federal authoritative book School of Medicine and • Patient evaluation, law offers physicians Public Health, and the including risk Responsible Opioid effective strategies for Alliance of State Pain assessment Prescribing: A Physician’s reducing the risk of Initiatives, this activity Guide is available at addiction, abuse and • Treatment plans offers participants up to www.fsmb.org for diversion of opioids 7.25 AMA PRA Category that incorporate functional goals $12.95. Bulk discounts are available.

A Look Back In History Women’s Right-to-Know Act Ever wonder what a doctor’s visit or prescription cost back in the day? Here’s a look at information reprinted in the May 7, 2009 issue of the Iola Register. (Continued from page 1)

subsection shall not apply to any private ay 1887 syphilis might cost as office, freestanding surgical outpatient little as $5 or as much The Allen clinic or other facility or clinic which as $100; chest County performs abortions only when necessary to M examination, $1 to $5; Medical Society prevent the death of the pregnant woman. obstetrics, ordinary published a fee bill in A courtesy copy of a sign is available for case, $10; visit in the download on our web site at this issue which listed a country under one mile, www.ksbha.org. range of fees physicians $1.30; over one mile, The Women’s Right-to-Know Act is part should charge for a long $2; add to charge, 50 of the Public Health Act which is list of medical cents for every mile over administered by the Kansas Department of procedures. Writing an one; amputation of leg, Health and Environment. Additional “ordinary” prescription arm, foot or forearm, information can be found on their web site, should cost 50 cents, for www.womansrighttoknow.org. each, $50, etc. Fifteen instance, but writing a county physicians prescription for a case of signed the publication. t h e

K PageVolume 6 1, Issue 3 Volume 1, Issue 3 Anatomy and Physiology of a KSBHA Disciplinary Action: Part 1 by Kelli J. Stevens, Associate Litigation Counsel How the process begins the preliminary work up hat happens Complaint when an of a case after a Board investigation investigator has omplaints regarding medical W professionals come to the Kansas State at the Board of Healing completed his or her Board of Healing Arts from a number of Arts has been completed? investigation. C sources including patients, patients’ families, If a case results in The direction an medical staff, employers, other health agencies a disciplinary investigation case and medical malpractice insurers. There are action against a takes upon several types of documents which function as a licensee of the completion depends “complaint,” but are not on a typical complaint Board, what is the first on what type of form. These include, but are not limited to, process? These case it is. If it reports of adverse findings from hospitals, are just a few of involves allegations notifications from other state licensing boards of the questions of practice below disciplinary action against a Kansas licensee, often asked of Board the standard of care, and malpractice complaints. staff. inappropriate Once the initial complaint is received, it is The answers are not prescribing, or other reviewed by the Board’s disciplinary counsel to simple ones. The clinical issues, the case determine whether an investigation needs to be different routes a case will likely be presented opened or if further information is needed. In can take may at times to a review committee of order for the agency to open an investigation, outside practitioners of resemble the body’s the complaint must pertain to the practice of the the same profession as arteries branching out in healing arts and must allege facts, which if the licensee being many directions. This accepted at face value, would constitute a investigated. three-part series of violation of the laws enforced by the Board. articles strives to explain Currently there are Occasionally, if the complaint contains basics of the process three Medical Doctor insufficient information, more information may involved in a disciplinary review committees, one be requested of the complainant. action against a Healing Doctor of Osteopathy Investigation Arts Act licensee (medical review committee, one doctor, doctor of Chiropractor review Board investigations are time-consuming and osteopathy, or committee, one may take several months or longer, depending Podiatrist review chiropractor). It is not committee, and the intended to provide the (Continued on page 7) respective councils which reader with an in-depth perform the case reviews analysis of every type of for each of the allied case, but to give a professions regulated by Trainers, Naturopathic of eyes to assist Board general overview of the the Board, Physician Doctors and Radiologic staff. The review path an investigation case Assistants, Physical Technoligists. committees meet on a takes through the Therapists, and PT They perform a regular schedule and disciplinary system at the Assistants, Occupational preliminary “peer often have a long Therapists and OT Board. review” of each case and agenda of several Assistants, Athletic This first part discusses provide a clinician’s set (Continued on page 7) Volume 1, Issue 3 Page 7 Anatomy and Physiology of a KSBHA Disciplinary Action: Part 1

(Continued from page 6) allegations, such as impairment, fraud, How the process begins investigations to consider sexual boundary (Continued from page 6) during a meeting. The violations and members receive the deceptive advertising on the seriousness and complexity of the alleged investigative materials in go directly to the complaints and the cooperation of the licensee, advance, which may disciplinary panel once health care facilities and witnesses involved. include thousands of the investigation is Once it is deemed that an investigation should be pages of medical complete. opened, an investigation case number and an records, investigative The Board’s investigator are assigned. Once assigned, the reports, and typically, a disciplinary panel is investigator will typically contact the complainant response from the comprised of either to advise them of the case’s status, where licensee regarding the four or five Board applicable. Many investigations require allegations. Based on members who serve for obtaining medical records from the their evaluation of all the one year on a rotating licensee/registrant and any health care facilities information, the review basis. The panel that are involved. It may also include interviewing committee makes a always has an M.D., witnesses, visiting facilities, obtaining drug recommendation as to D.O., D.C. and public prescription profiles from pharmacies and whether the licensee’s member serving at the requesting information from law enforcement or care and treatment was same time. The other regulatory agencies, in this state and outside the standard of function of the panel is elsewhere. During the course of the investigation, care or otherwise to review the the investigator documents their progress and deviated from accepted investigations where the findings in investigative reports. practices. review committee has Review The review committee’s recommended the Upon completion, the investigation case is recommendation triggers standard of care was forwarded to the Board’s disciplinary counsel to the next set of events for not met, as well as all determine the appropriate next step in the the case. If the the investigations process. If the investigation involves concerns recommendation is that alleging “conduct” about treatment below the acceptable standard the standard of care was violations. The purpose or other clinical issues, the investigative materials met, the investigation of the panel’s review is are forwarded to a review committee or council case will be routed to determine whether comprised of licensed/registered peers who through the Board’s or not to authorize determine if the information as presented processes for closure. If Board prosecution indicates a violation of the applicable standards. the recommendation is counsel to initiate that the standard of care disciplinary If the investigation involves no issues related to was not met, the case proceedings, make a treatment or the sufficiency of the care provided will proceed to the next formal offer of and involves only allegations related to the conduct or other “non-treatment” issues of the level of review by the settlement in the case, M.D., D.O., D.C. or D.P.M. licensee, the case Board’s disciplinary seek an informal goes directly to the Board’s disciplinary panel. panel. On the other remedy or close the hand, investigations that case with no action. In involve “conduct” (Continued on page 8)

PageVolume 8 1, Issue 3 Volume 1, Issue 3 Anatomy and Physiology of a KSBHA Disciplinary Action: Part 1

(Continued from page 7) carried over to their factors. A “conduct” commences the next meeting. Only case can often be disciplinary proceedings that way, the disciplinary after a thorough review prepared for a and outlines the facts and panel essentially serves does the Panel disciplinary hearing allegations supporting a as the “client” for Board determine whether to much faster, unless there request for discipline prosecution counsel. The authorize Board are issues requiring against a licensee. The panel is privy to counsel to pursue follow up investigation or petition is filed with the confidential investigative discipline, seek a an expert witness is Board’s Executive information and receives professional needed to review aspects Director, much like civil a legal analysis of each development plan, of the case that require pleadings are filed with a case from Board settle or recommend some sort of technical court clerk. At that point, attorneys. Because of closure of a case. expertise. For example, the matter is no longer an this, the panel members Additionally, since the billing fraud allegations investigation. Most do not participate in any disciplinary panel does may necessitate a coding pleadings are public decision-making for all not determine any final and billing expert’s records. Occasionally, future disciplinary outcomes for the cases review of the case. On there may be statutorily proceedings or other they review, the the other hand, a case protected information in Board actions which may licensee does not have containing allegations of the pleadings that is involve cases they have a right to appear when practice below the redacted if the document reviewed. It is of utmost their investigation is standard of care or is provided pursuant to a importance that the considered by the inappropriate prescribing request from the public. disciplinary panel avoid panel. Both the review will almost always need After a proceeding is the conflict of interest committee and an independent review initiated, the hearing which would exist if they disciplinary panel by an expert in the process is governed by made both prosecution processes take place particular field of the Kansas Administrative decisions and the final while the case is still at practice. The purpose of Procedures Act, or KAPA. decisions regarding the “investigative stage” an expert’s review is to While there can whether discipline is and the information is enable the presentation certainly be variations on imposed. confidential. Once a of opinion testimony on the disciplinary function of The disciplinary panel disciplinary action is the clinical care issues the Board depending on carefully evaluates the commenced, the involved. the subjective facts and licensee is entitled to investigative materials Upon completion of circumstances involved in due process in the and considers the the review, if the expert’s each investigation case, proceedings. licensee’s response to the opinions support the the basis structure and investigation, including If the disciplinary allegations, the next step process. The next article all supporting panel authorizes Board is for the prosecuting in this series will examine documents. Sometimes counsel to initiate a attorney to prepare a the various forms of they request additional disciplinary action, the disciplinary petition that disciplinary proceedings investigative information next step is again will be filed with the which take place at the and a case may be dependent on multiple Board. Filing the petition Board.

KANSAS STATE BOARD OF HEALING ARTS The Kansas State Board of Healing Arts is located at 235 S. Topeka Blvd, Topeka, KS 66603. Please visit us on the web at www.ksbha.org. Jack Confer, Executive Director, [email protected]; Editor: Kristi Pankratz, [email protected]; Layout: Patty Kostreles, [email protected].