Arizona Medical Board 9545 East Doubletree Ranch Road Scottsdale, Arizona 85258

Home Page: http://www.azmd.gov Telephone (480) 551-2700 Fax (480) 551-2705 In-State Toll Free (877) 255-2212

DRAFT MINUTES FOR REGULAR SESSION MEETING

Held on Tuesday, October 3, 2017 and on Wednesday, October 4, 2017

9535 E. Doubletree Ranch Road Scottsdale, Arizona

Board Members James M. Gillard, M.D., M.S., F.A.C.E.P., F.A.A.E.M., Chair

R. Screven Farmer, M.D., Vice-Chair Jodi A. Bain, Esq., Secretary

Bruce A. Bethancourt, M.D., F.A.C.P. Teresa L. Connolly, D.N.P., R.N., N.E.A.-B.C.

Gary R. Figge, M.D. Pamela E. Jones

Lois E. Krahn, M.D. Edward G. Paul, M.D. Wanda J. Salter, R.N.

Tuesday, October 3, 2017 GENERAL BUSINESS

A. CALL TO ORDER Dr. Gillard called the meeting to order at 8:04 a.m.

B. ROLL CALL The following Board members were present: Dr. Gillard, Dr. Farmer, Dr. Bethancourt, Dr. Connolly, Dr. Figge, Ms. Jones and Dr. Paul. The following Board member participated telephonically: Ms. Bain. The following Board members were absent: Dr. Krahn and Ms. Salter. ALSO PRESENT Present among Board staff include: Anne Froedge, AAG; Mary Williams, AAG; Patricia E. McSorley, Executive Director; Kristina Fredericksen, Deputy Director; William Wolf, M.D., Chief Medical Consultant; Andrea Cisneros, Staff Investigational Review Committee (SIRC) Coordinator; Erinn Downey, Assistant Investigations Manager; Mary Bober, Board Operations Manager; and Michelle Robles, Board Coordinator.

C. PUBLIC STATEMENTS REGARDING MATTERS LISTED ON THE AGENDA Individuals who addressed the Board during the Public Statements portion of the meeting appear beneath the matter(s) referenced.

D. EXECUTIVE DIRECTORS REPORT

http://www.azmd.gov/

Agenda for the October 3-4, 2017 AMB Regular Session Meeting Page 2 of 24

Update on Relocation to 1740 W. Adams Street Ms. McSorley reported that the Board is scheduled to move January 4th and 5th of 2018 and that the IT department is working closely with Arizona Strategic Enterprise Technology (ASET) to facilitate the move.

Discussion Regarding Expansion of Licensing Options for Foreign Medical School Graduates

Update on Procurement Process for Physician Health Monitoring Services Ms. McSorley reported that the state procurement process is ongoing.

E. CHAIRS REPORT No report was given.

F. LEGAL ADVISORS REPORT No report was given.

G. REVIEW AND DISCUSSION REGARDING DRS. GREENBERG AND SUCHERS PHP PRESENTATION Dr. Greenberg and Dr. Sucher summarized the main points of their report regarding their program and their history in the field. Dr. Sucher noted that they are currently hiring two new addiction psychologists.

H. APPROVAL OF MINUTES MOTION: Dr. Figge moved to approve the August 2, 2017 Regular Session; including Executive Session; and the August 23, 2017 Special Teleconference; including Executive Session. SECOND: Dr. Paul. VOTE: 7-yay, 0-nay, 0-abstain, 0-recuse, 3-absent. MOTION PASSED.

LEGAL MATTERS

I. FORMAL INTERVIEWS 1. MD-16-1514A, STEPHEN J. GRAHAM, M.D., LIC. #19987

Dr. Graham was present without counsel. Board staff summarized that the Board initiated the case after the review of a related matter that resulted in the Board directing its staff to initiate the current investigation on the clinics Medical Director, Dr. Graham, for concerns regarding the clinics use of hormonal therapy. Dr. Graham stated that he was never the clinics Medical Director and that he was prescribing hormone therapy to his friends at his gym. Seven cases were reviewed by the Boards Medical Consultant (MC) who identified deviations from the standard of care in that the documented initial evaluations were inadequate, medications were prescribed based on vague symptoms, and appropriate follow up was not documented adequately. Further, the records provided were incomplete. Dr. Graham opined that an Advisory Letter would be appropriate in this case and referenced the evidence based studies that he provided for the Boards review. Dr. Graham commented that his license was never suspended in the past and that he has not established a pattern of inadequate medical records or inappropriate prescribing. Dr. Graham addressed his past disciplinary actions and what he has learned from his experience. Dr. Graham noted that of the seven cases reviewed two cases included very detailed past medical history.

Agenda for the October 3-4, 2017 AMB Regular Session Meeting Page 3 of 24

During questioning, Dr. Graham explained how he became involved in prescribing hormone therapy and how it relates to preventative medicine. Dr. Graham noted that the prescribing of hormones does not take place at his current place of employment and confirmed that, since 2014, he no longer has any relationship with the clinic. Dr. Graham admitted that his medical records could be better and that the seven cases were his friends who he knew very well which resulted in his lack of detailed medical records. Dr. Graham expressed his understanding of FDA approval for testosterone and human growth hormone. Dr. Graham noted that he had each person sign a consent regarding the associated risks. Dr. Graham informed the Board that the gym in which he saw the patients no longer exists and that he practices preventative medicine. Board staff confirmed that there were signed consents regarding the risks and benefits in five out of the seven cases. MOTION: Dr. Paul moved for a finding of unprofessional conduct in violation of A.R.S. 32-1401(27)(e) and (q) for reasons as stated by SIRC. SECOND: Dr. Farmer VOTE: 7-yay, 0-nay, 0-abstain, 0-recuse, 3-absent. MOTION PASSED. MOTION: Dr. Paul moved for a draft Findings of Fact, Conclusions of Law and Order for a Letter of Reprimand and Three Year Probation. Within twelve months, enroll in and successfully complete PRoBE and enroll in PRoBE Plus. Also within twelve months, enroll in and complete the CPEP medical recordkeeping seminar, and enroll in CPEPs follow up program. The CME hours shall be in addition to the hours required for renewal. The chart reviews shall include private care patients only. Once the licensee has complied with the Probation, he shall request that the Board terminate the Probation. SECOND: Dr. Connolly. Dr. Farmer commented that this is an evolving practice where there are those who are prescribing for profit and those who take it seriously. Dr. Farmer opined that these medications are serious and should not be prescribed in a gym and should be carefully documented and reviewed. ROLL CALL: Roll call vote was taken and the following Board members voted in favor of the motion: Dr. Gillard, Dr. Bethancourt, Dr. Connolly, Dr. Figge, Ms. Jones and Dr. Paul. The following Board member voted against the motion: Dr. Farmer. The following Board members were absent: Ms. Bain, Dr. Krahn and Ms. Salter. VOTE: 6-yay, 1-nay, 0-abstain, 0-recuse, 3-absent. MOTION PASSED.

2. MD-16-1321A, ROMEN K. JHA, M.D., LIC. #33212 Dr. Jha was present without counsel. Board staff summarized that MB presented to the hospitals Emergency Department (ED) with complaints of right sided abdominal and pelvic pain with nausea and vomiting. MB underwent three imaging studies, but refused a transvaginal ultrasound. The MC indicated that Dr. Jha deviated from the standard of care by failing to check for a positive Murphys sign, by failing to arrange for a pelvic exam and by failing to consider further investigation into possible gallbladder disease. The case was reviewed at the August 2, 2017 Board meeting for consideration of an Advisory Letter; however, the Board voted to invite the physician in for a formal interview. Dr. Jha summarized his treatment of MB stating that she did not appear to be in distress. Dr. Jha noted that all of her tests were normal and that he informed the patient she had a urinary tract infection. Dr. Jha opined that a pelvic exam was not appropriate based on his exam and treatment plan.

Agenda for the October 3-4, 2017 AMB Regular Session Meeting Page 4 of 24

During questioning, Dr. Jha stated that he was not aware that the patient was on an antiemetic and explained the reasoning behind the patients discharge medication. Dr. Jha explained that when the nursing staff informed him that the patient and her mother did not want to leave at discharge he felt that he had already addressed the situation with them. Dr. Jha noted that he was not informed of the patient and her mother being escorted out of the hospital by security until after it had occurred. Dr. Jha opined that a pelvic exam was not needed at the time and would not have prompted a diagnosis of chronic cholecystitis. Dr. Jha opined that this case does not rise to the level of discipline and that he thought he was doing the right thing. During deliberation, Dr. Bethancourt stated he agreed with the physician that her test results were normal which could cause confusion. Dr. Bethancourt opined that the fact that a patient was discharged in pain and having to go to another hospital for a diagnosis was concerning. Dr. Gillard agreed with the physician that a pelvic exam would not have been appropriate. MOTION: Dr. Bethancourt moved for a finding of unprofessional conduct in violation of A.R.S. 32-1401(27)(q) for reasons as stated by SIRC. SECOND: Dr. Figge. VOTE: 7-yay, 0-nay, 0-abstain, 0-recuse, 3-absent. MOTION PASSED. Dr. Figge requested that the hospital be referred to ADHS. MOTION: Dr. Bethancourt moved to Issue an Advisory Letter and Order for Non-Disciplinary CME for inadequate evaluation of persistent abdominal pain and for inadequate medical records. There is insufficient evidence to support disciplinary action. Within six months, complete no less than 2 hours o