Showing posts with label quality of care. Show all posts
Showing posts with label quality of care. Show all posts

Friday, November 21, 2014

Texas Medical Board disciplined 39 licensed physicians

At its November 7, 2014 meeting, the Texas Medical Board disciplined 39 licensed physicians and issued two cease and desist orders. The disciplinary actions included seven orders related to quality of care violations, three orders related to unprofessional conduct, three revocations, five voluntary surrenders, two suspensions, one order related to criminal activity, three orders related to peer review actions, one order related to inappropriate prescribing, three orders related to violation of prior Board order, five orders related to violation of Board rules, one order related to Texas Physician Health Program violations, and five orders related to inadequate medical records.
The Board issued 200 physician licenses at the November meeting, bringing the total number of physician licenses issued in FY15 to 660.


QUALITY OF CARE
Baumgartner, Teri Lynne, M.D., Lic. No. K6959, Athens
On November 7, 2014, the Board and Teri Lynne Baumgartner, M.D., entered into an Agreed Order requiring Dr. Baumgartner within one year complete at least 12 hours of CME, divided as follows: eight hours in medical recordkeeping and four hours in treating high risk pregnancy. The Board found Dr. Baumgartner failed to meet the standard of care in regards to one patient by failing to adequately assess and treat the patient's symptoms and failing to adequately document the medical records as to the patient's noncompliance with treatment.
Dave, Pramesh Chandrakant, M.D., Lic. No. K0014, Arlington
On November 7, 2014, the Board and Pramesh Chandrakant Dave, M.D., entered into an Agreed Order publicly reprimanding Dr. Dave and requiring Dr. Dave to within one year complete at least 8 hours of CME in liposuction procedures and complications, with at least four hours in risk management, and four hours in medical ethics; within one year complete the medical recordkeeping course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program; within one year and three attempts pass the Medical Jurisprudence Exam; and have his practice monitored by another physician for eight consecutive monitoring cycles. The Board found Dr. Dave's medical recordkeeping was inadequate, primarily in regard to anesthesia monitoring as well as patients' discharge criteria and post-discharge arrangements; and there was concern about the volume of aspirate removed from one patient, as well as the technical aspects of the procedure.
Mayo, Carlos O., M.D., Lic. No. K3329, Houston
On November 7, 2014, the Board and Carlos O. Mayo, M.D., entered into an Agreed Order requiring Dr. Mayo to have his practice monitored by another physician for four consecutive monitoring cycles; within one year complete the medical recordkeeping course offered by the University of California San Diego Physician Assessment and Clinical Education Program (PACE); and within one year complete at least eight hours of CME in obstetrical care. The Board found Dr. Mayo failed to use further laboratory analysis to confirm or rule out early pregnancy. Dr. Mayo should have at least used quantitative beta HCG testing, but he did not do so. The Board also found Dr. Mayo's medical records lacked sufficient documentation of the history and physicals he performed and his recommendation for treatment.
Medina, Marelyn, M.D., Lic. No. J9759, McAllen
On November 7, 2014, the Board entered a Final Order publicly reprimanding Marelyn Medina, M.D., and requiring Dr. Medina to within one year and three attempts pass the Medical Jurisprudence Exam; within one year complete at least 24 hours of CME, divided as follows: eight hours in ethics, eight hours in risk management and eight hours in endocrinology and diseases of the thyroid; and have her practice monitored by another physician for eight consecutive monitoring cycles. The Board found Dr. Medina failed to meet the standard of care in her diagnosing and treatment of hypothyroidism and iodine deficiency in a patient. The action was based on the findings of an administrative law judge at the State Office of Administrative Hearings. This order resolves a formal complaint filed at the State Office of Administrative Hearings. Dr. Medina has 20 days from the service of the order to file a motion for rehearing.
Moore, Robert Alan, M.D., Lic. No. E6533, Bellaire
On November 7, 2014, the Board and Robert Alan Moore, M.D., entered into an Agreed Order requiring Dr. Moore to within one year complete at least 12 hours of CME in risk management; and pay an administrative penalty of $5,000 within 60 days. The Board found Dr. Moore admitted to wrong-site lumbar area radiofrequency ablation to a patient's right lumbar region instead of the left region without the patient's consent. Although the patient needed ablation on both sides, Dr. Moore and the patient had agreed to the ablation on the left side first.
Rozenboom, Morgen Melinda, M.D., Lic. No. K2115, Texarkana
On November 7, 2014, the Board and Morgen Melinda Rozenboom, M.D., entered into an Agreed Order prohibiting Dr. Rozenboom from engaging in the practice of obstetrics, labor and delivery, or home births, and prohibiting her from supervising, delegating to, or associating with any midlevel providers including midwives in such practices until successfully completing the following requirements: within one year complete at least 24 hours of CME, divided as follows: eight hours in managing obstetrical emergencies, eight hours in risk management, including physician-patient communications and eight hours in medical recordkeeping; within one year obtain certification in neonatal resuscitation from the Neonatal Resuscitation Program offered by the American Medical Association of Pediatrics; and upon lifting the restriction, have her practice monitored by another physician for four consecutive monitoring cycles. The Board found Dr. Rozenboom failed to document her management of a patient's post-partum complications, including her assessment of the patient or what actions she took to stabilize the patient. The medical records demonstrate that the patient's vital signs were not monitored with appropriate frequency or regularity during the post-partum period, including when the patient exhibited signs of respiratory distress. The documentation that does exist contains errors and inaccuracies. Furthermore, Dr. Rozenboom did not honor the patient's request to be transferred to the hospital sooner.
Schrapps, Jerome Francis, M.D., Lic. No. J2907, Beaumont
On November 7, 2014, the Board and Jerome Francis Schrapps, M.D., entered into a Mediated Agreed Order requiring Dr. Schrapps to have his practice monitored for eight consecutive monitoring cycles by another physician; and within one year complete at least 24 hours of CME, divided as follows: 16 hours in identifying and treating post-operative complications and eight hours in ethics, with at least two of those hours in obtaining informed consent from patients. The Board found Dr. Schrapps failed to document any discussion with a patient regarding plans to conduct a sleeve gastrectomy, and failed to document written informed consent. Dr. Schrapps appropriately recognized that the patient's medical issues were possibly secondary to a gastric leak, but did not take the patient back to surgery to address the leak on a timely basis. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
UNPROFESSIONAL CONDUCT
Jolivet, David Anthony, M.D., Lic. No. G2160, Carlsbad
On November 7, 2014, the Board and David Anthony Jolivet, M.D., entered into an Agreed Order requiring Dr. Jolivet to submit to an evaluation by the Physician Health Program (PHP); and within one year complete at least 16 hours of CME, divided as follows: eight hours of risk management, four hours in ethics and four hours in medical recordkeeping. The Board found Dr. Jolivet admitted to prescribing controlled substances to his family members beyond the 72-hour period of immediate need and without maintaining adequate medical records, admitted to striking a family member in a dispute, and admitted to struggles with depression and alcohol consumption.
Miller, George Givens, M.D., Lic. No. G8286, Houston
On November 7, 2014, the Board and George Givens Miller, M.D., entered into a Mediated Agreed Order requiring Dr. Miller to within one year complete at least eight hours in CME, divided as follows: four hours in medical ethics and four hours in risk management. The Board found Dr. Miller failed to report a pending investigation by a health care entity to the Board when he filed his online renewal applications in 2006 and 2008. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Smith, Raleigh Arnold, M.D., Lic. No. F4547, Aransas Pass
On November 7, 2014, the Board and Raleigh Arnold Smith, M.D., entered into a Mediated Agreed Order requiring Dr. Smith to submit to and obtain an independent medical evaluation and follow all recommendations for care and treatment; within one year successfully complete the University of California San Diego Physician Assessment and Clinical Education (PACE) program; and within one year complete at least eight hours of CME, divided as follows: four hours in ethics and four hours in risk management. The Board found Dr. Smith engaged in inappropriate conduct and made unprofessional comments towards a co-worker in the presence of a patient and hospital staff and failed to notify the Board of actions by hospitals during the appropriate license renewal periods on his applications for renewal. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
REVOCATION
Gonzalez-Angulo, Ana Maria, M.D., Lic. No. L6917, Houston
On November 7, 2014, the Board and Ana Maria Gonzalez-Angulo, M.D., entered into an Agreed Order of Revocation, revoking Dr. Gonzalez-Angulo's Texas medical license and requiring her to immediately cease practicing in Texas. Dr. Gonzalez-Angulo agreed to the revocation of her license in lieu of further disciplinary proceedings. The Board found that on September 29, 2014, in the 248th District Court of Harris County, Texas, a jury found Dr. Gonzalez-Angulo guilty of one count of the first degree felony offense of Aggravated Assault of a Family Member. Dr. Gonzalez-Angulo was sentenced to serve 10 years in prison.
Hawkins, Willie James, M.D., Lic. No. G2147, Missouri City
On November 7, 2014, the Board entered a Final Order revoking Willie James Hawkins, M.D.'s Texas medical license. The Board found that Dr. Hawkins on November 19, 2012, in the 337th District Court, Harris County, Texas, pled guilty to a violation of the Medical Practice Act, a Class A Misdemeanor. The presiding judge found that the evidence substantiated Dr. Hawkins' guilt, but deferred making an adjudication of guilt and, instead, placed him on deferred adjudication community supervision for two years. The order of deferred adjudication issued against Dr. Hawkins stemmed from his September 2011 through February 2012 tenure as the operator, and supervising physician at the Wellness and Weightloss Clinic, located in Houston, Texas. Dr. Hawkins failed to exercise the proper diligence and oversight that those roles entail. The action was based on the findings of an administrative law judge at the State Office of Administrative Hearings. This order resolves a formal complaint filed at the State Office of Administrative Hearings. Dr. Hawkins has 20 days from the service of the order to file a motion for rehearing.
Johnson, Rahman C., M.D., Lic. No. BP10043418, Albuquerque, NM
On November 7, 2014, the Board entered a Default Order against Rahman C. Johnson, M.D., which revoked his Texas medical license. On March 28, 2014, the Board filed a Complaint with the State Office of Administrative Hearings (SOAH) in Docket No. 503-14-2947. The Complaint alleged Dr. Johnson was terminated from his residency program following an arrest for driving while intoxicated. Dr. Johnson was served notice of the Complaint but did not file an answer. All other deadlines passed without any response from Dr. Johnson, therefore the Board granted a Determination of Default and Dr. Johnson's Texas medical license was revoked by Default Order.
VOLUNTARY SURRENDER
Dunegan, Gerald, M.D., Lic. No. D0856, Houston
On November 7, 2014, the Board and Gerald Dunegan, M.D., entered into an Agreed Voluntary Surrender Order in which Dr. Dunegan agreed to voluntarily surrender his Texas medical license in lieu of further disciplinary proceedings. Dr. Dunegan was under investigation for allegations related to his practice and prescribing habits. Dr. Dunegan reported to the Board that he has a physical condition that prevents him from continuing to practice medicine.
Gutierrez, Jaime Alberto, M.D., Lic. No. D2109, Houston
On November 7, 2014, the Board and Jaime Alberto Gutierrez, M.D., entered into an Agreed Voluntary Surrender Order on Formal Filing in which Dr. Gutierrez agreed to voluntarily surrender his Texas medical license effective 120 days from the date of this order in lieu of further disciplinary proceedings. Dr. Gutierrez's license is therefore permanently canceled on March 7, 2014. Dr. Gutierrez was the subject of a formal complaint at the State Office of Administrative Hearings related to the operation of unlicensed pain management clinics, improper supervision of midlevel providers, nontherapeutic prescribing and standard of care violations related to six patients. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Lewis, Billy Wayne, M.D., Lic. No. D7149, Bedford
On November 7, 2014, the Board and Billy Wayne Lewis, M.D., entered into an Agreed Voluntary Surrender Order in which Dr. Lewis agreed to voluntarily surrender his Texas medical license in lieu of further disciplinary proceedings. Dr. Lewis reported to the Board that he has a medical condition which precludes him from practicing medicine with reasonable skill and safety to patients.
Raben, Cyril Anthony, M.D., Lic. No. H6922, Fayetteville, AR
On November 7, 2014, the Board and Cyril Anthony Raben, M.D., entered into an Agreed Voluntary Surrender Order in which Dr. Raben agreed to voluntarily surrender his Texas medical license in lieu of further disciplinary proceedings. The Board found Dr. Raben surrendered his license to practice in Ohio, with consent to permanent revocation, after allegations of misconduct by the State Medical Board of Ohio. Dr. Raben was also denied application to renew his license by the state of Illinois based on the actions by the state of Ohio.
Salameh, Raja Nicolas, M.D., Lic. No. G9654, McAllen
On November 7, 2014, the Board and Raja Nicolas Salameh, M.D., entered into an Agreed Voluntary Surrender in which Dr. Salameh agreed to voluntarily surrender his Texas medical license in lieu of further disciplinary proceedings. The Board found Dr. Salameh is unable to practice medicine because of illness.
SUSPENSION
Sanjar, Mansour R., M.D., Lic. No. G3069, Baytown
On October 7, 2014, the Board entered an Order of Suspension By Operation of Law, suspending Mansour R. Sanjar, M.D.'s Texas medical license. The Board found that on March 12, 2014, in the U.S. District Court Southern District of Texas, Houston Division, a jury found Dr. Sanjar guilty of a felony, as follows: one count of Conspiracy to Commit Health Care Fraud, two counts of Health Care Fraud, one count of Conspiracy to Defraud the United States and to Pay Health Care Kickbacks, and two counts of Payment and Receipt of Healthcare Kickbacks. Dr. Sanjar's sentencing is scheduled for January 12, 2015. The Order remains in effect until superseded by a subsequent Order of the Board.
Ware, John Roscoe, M.D., Lic. No. G0260, Dallas
On November 7, 2014, the Board and John Roscoe Ware, M.D., entered into an Agreed Order of Suspension, suspending Dr. Ware's Texas medical license until such a time as he requests in writing to have the suspension stayed or lifted, and appears before the Board and provides clear and convincing evidence that he is physically, mentally, and otherwise competent to safely practice medicine. The Board found Dr. Ware underwent a neuropsychological examination in 2013 and was diagnosed with mild dementia and significant executive dysfunction. The weight of the clinical evidence indicates Dr. Ware is not currently safe to practice medicine.
CRIMINAL ACTIVITY
Khaznadar, Mohamedaouf A., M.D., Lic. No. K1504, Amarillo
On November 7, 2014, the Board and Mohamedaouf A. Khaznadar, M.D., entered into an Agreed Order publicly reprimanding Dr. Khaznadar and requiring Dr. Khaznadar to pay an administrative penalty of $2,000 within 60 days. The Board found Dr. Khaznadar entered a guilty plea and received deferred adjudication for a misdemeanor charge of offering to engage in sexual conduct on October 28, 2013.
PEER REVIEW ACTIONS
Davis, Jennifer Lee, M.D., Lic. No. J4070, Corpus Christi
On November 7, 2014, the Board and Jennifer Lee Davis, M.D., entered into an Agreed Order requiring Dr. Davis to within one year complete at least 16 hours of CME, divided as follows: four hours in risk management, four hours in medical recordkeeping and four hours in ethics; and comply with all terms and conditions imposed by the November 7, 2013, Medical Staff Performance Improvement Committee action requiring proctoring at Driscoll Children's Hospital. The Board found Dr. Davis was subject to disciplinary action by Driscoll Children's Hospital regarding her medical recordkeeping.
Sokhon, Kozhaya Chehade, M.D., Lic. No. M9668, Houston
On November 7, 2014, the Board and Kozhaya Chehade Sokhon, M.D., entered into an Agreed Order publicly reprimanding Dr. Sokhon and requiring Dr. Sokhon to have his practice monitored by another physician for eight consecutive monitoring cycles; within one year complete at least 20 hours of CME, divided as follows: eight hours in cardiac catheterization, eight hours in risk management and four hours in ethics; within 180 days complete the competency course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program; and pay an administrative penalty of $5,000 within 120 days. The Board found Dr. Sokhon violated the standard of care regarding his care and treatment of the patient at issue. Dr. Sokhon was subject to discipline by peer review at Conroe Medical Center, and resigned from that facility while under investigation.
Wolffe, Eduardo Antonio, M.D., Lic. No. M0313, El Segundo, CA
On November 7, 2014, the Board and Eduardo Antonio Wolffe, M.D., entered into an Agreed Order publicly reprimanding Dr. Wolffe and requiring Dr. Wolffe to within one year and three attempts pass the Medical Jurisprudence Exam. The Board found Dr. Wolffe voluntarily resigned from a practice position with a hospital while under, or to avoid, an investigation based on his delivery of care and treatment for two patients.
INAPPROPRIATE PRESCRIBING
Cary, Adam Brian, D.O., Lic. No. M2581, Frisco
On November 7, 2014, the Board and Adam Brian Cary, D.O., entered into an Agreed Order requiring Dr. Cary to within one year complete at least 16 hours of CME, divided as follows: eight hours in risk management and eight hours in ethics; and within one year and three attempts pass the Medical Jurisprudence Exam. The Board found Dr. Cary prescribed to one patient with whom he had a close personal relationship without adequate documentation of a clinical diagnosis and for time periods exceeding the patient's immediate needs.
VIOLATION OF PRIOR ORDER
Brown, Forrest Carroll, M.D., Lic. No. D3169, Dallas
On November 7, 2014, the Board and Forrest Carroll Brown, M.D., entered into a Modified Agreed Order requiring Dr. Brown to within one month complete an independent medical evaluation and follow all recommendations for care and treatment. The Board found Dr. Brown has not complied with terms of his June 2013 Order. All other provisions of the Order, as modified, remain in full force.
Matthews, Jonathan Richard, D.O., Lic. No. L9803, Trophy Club
On November 7, 2014, the Board and Jonathan Richard Matthews, D.O., entered into an Agreed Order requiring Dr. Matthews to within 90 days complete all outstanding CME requirements as required by his June 2013 Orders. The Board found Dr. Matthews failed to complete all CME requirements of his June 2013 Orders by the deadlines set forth in the Orders.
Rousch, Daniel Eric, D.O., Lic. No. J4488, Bedford
On November 7, 2014, the Board and Daniel Eric Rousch, D.O., entered into an Agreed Order requiring Dr. Rousch to within one year and three attempts pass the Medical Jurisprudence Exam; and within 90 days complete all deficient CME hours ordered by the 2013 Order. The Board found Dr. Rousch violated his February 2013 order by failing to implement recommendations of his practice monitor and failing to complete any pre-approved CME hours at the time of his Informal Settlement Conference.
VIOLATION OF BOARD RULES
McWherter, Joseph Francis, M.D., Lic. No. E8713, Fort Worth
On November 7, 2014, the Board and Joseph Francis McWherter, M.D., entered into a Mediated Agreed Order requiring Dr. McWherter to remove the "while avoiding breast cancer" language from his website and provide proof to the Board of such removal within 30 days; within one year complete at least four hours of CME in risk management; and pay an administrative penalty of $1,000 within 60 days. The Board found the following statement on Dr. McWherter's website had the potential to be false, deceptive, and/or misleading if taken out of context, "[h]is program allows women to experience the life-enhancing benefits of hormonal replacement safely while avoiding breast cancer." This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Mercer, Lloyd Faust, Jr., M.D., Lic. No. G3610, Tyler
On November 7, 2014, the Board and Lloyd Faust Mercer, Jr., M.D., entered into an Agreed Order prohibiting Dr. Mercer from treating patients for chronic pain or engaging in the practice of pain management; shall not seek to reinstate DEA/DPS controlled substance registration certificates for Schedules II, III, IIIN, and IV; shall not treat or otherwise serve as a physician for immediate family, and shall not prescribe, dispense, administer or authorize controlled substances or dangerous drugs with addictive potential or potential for abuse to himself or his immediate family; and within one year and three attempts pass the Medical Jurisprudence Exam. The Board found Dr. Mercer failed to adhere to treatment, monitoring, and documentation requirements regarding six chronic pain patients, four of which were his family members. Dr. Mercer's treatment was not within the standard of care.
Shaw-Rice, Judi Ann, M.D., Lic. No. J1134, Houston
On November 7, 2014, the Board and Judi Ann Shaw-Rice, M.D., entered into a Mediated Agreed Order publicly reprimanding Dr. Shaw-Rice and requiring Dr. Shaw-Rice to not reregister or obtain DEA/DPS controlled substances certificates until authorized by the Board; within one year and three attempts pass the Medical Jurisprudence Exam; within one year complete at least 10 hours of CME, divided as follows: five hours in medical ethics and five hours in medical recordkeeping; within one year complete the prescribing course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program; not be permitted to delegate prescriptive authority for controlled drugs, but shall otherwise be authorized to supervise midlevel providers; and pay an administrative penalty of $5,000 within one year. The Board found Dr. Shaw-Rice submitted an application for a pain management clinic in which she inaccurately stated that she owned the clinic, which was actually owned by a non-physician; midlevels supervised by Dr. Shaw-Rice failed to follow the Board's guidelines for the treatment of chronic pain; and Dr. Shaw-Rice's midlevels failed to fully and properly follow protocols to monitor the patients for effectiveness of treatments, side effects, or abuse or diversion of medications.
Sorrels, William F., D.O., Lic. No. F7187, San Angelo
On November 7, 2014, the Board and William F. Sorrels, D.O., entered into an Agreed Order requiring Dr. Sorrels to within one year complete at least 21 hours of CME, divided as follows: eight hours in risk management, eight hours in medical recordkeeping, and five hours in doctor-patient communications; and pay an administrative penalty of $1,000 within 60 days. The Board found Dr. Sorrels prescribed naltrexone to a patient without obtaining a complete history and physical exam, and failed to maintain a medical record for the treatment of the patient.
Trevino, Jose De Jesus, M.D., Lic. No. F2074, Corpus Christi
On November 7, 2014, the Board and Jose De Jesus Trevino, M.D., entered into an Agreed Order requiring Dr. Trevino to have his practice monitored by another physician for eight consecutive monitoring cycles; and within one year complete at least eight hours of CME in the treatment of chronic pain. The Board found Dr. Trevino's record of clinical evaluation and documentation supporting prescribing were inadequate.
TEXAS PHYSICIANS HEALTH PROGRAM (PHP) VIOLATION
Ilich, Melanie Bivona, M.D., Lic. No. J2104, Waco
On November 7, 2014, the Board and Melanie Bivona Illich, M.D., entered into an Agreed Order requiring Dr. Illich to limit her practice to no more than 40 hours per week; prohibiting her from taking night or weekend call and shall arrange for call coverage; shall not treat or otherwise serve as a physician for her immediate family and shall not prescribe, dispense, administer or authorize controlled substances or dangerous drugs to herself or immediate family; undergo a 96-hour inpatient evaluation for substances abuse; continue to participate in Alcoholics Anonymous no less than five times a week; obtain a Board-approved treating psychiatrist and follow all recommendations for care and treatment; participate in activities of a county or state medical society committee on physician health and rehabilitation; abstain from the consumption of prohibited substances as defined in the Order; and participate in the Board's drug testing program. The Board found Dr. Illich failed to comply with the terms of her Physician Health Program (PHP) agreement related to the use of alcohol.
INADEQUATE MEDICAL RECORDS
Brimmer, Robert Alvah, II, M.D., Lic. No. K3110, Fort Worth
On November 7, 2014, the Board and Robert Alvah Brimmer, II, M.D., entered into a Mediated Agreed Order requiring Dr. Brimmer to pay an administrative penalty of $2,000 within 60 days. The Board found that the evidence was sufficient to support the entry of this Order due to the failure to document the rationale regarding the care of one inmate patient. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Gross, Robert Hadley, M.D., Lic. No. G5125, San Angelo
On November 7, 2014, the Board and Robert Hadley Gross, M.D., entered into an Agreed Order on Formal Filing requiring Dr. Gross to within 90 days submit an adequate written protocol to the Compliance Department of the Board; within one year complete the medical recordkeeping course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program; and within one year complete at least eight hours of CME in risk management. The Board found Dr. Gross did not adequately maintain adequate medical records with regard to seven patients. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
James, Kevin Bernard, M.D., Lic. No. M4201, Southlake
On November 7, 2014, the Board and Kevin Bernard James, M.D., entered into a Mediated Agreed Order requiring Dr. James to within one year complete the K-STAR risk management course; and pay an administrative penalty of $2,000 within 60 days. The Board found Dr. James inadequately documented his conversations with a patient as to the rationale for surgery. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Saqer, Rezik A., M.D., Lic. No. K2282, Houston
On November 7, 2014, the Board and Rezik A. Saqer, M.D., entered into a Mediated Agreed Order requiring Dr. Saqer to within one year complete the medical recordkeeping course offered by the University of California San Diego Physician Assessment and Clinical Education (PACE) program; and pay an administrative penalty of $500 within 60 days. The Board found Dr. Saqer's medical records did not fully comply with the Board's medical recordkeeping rules. This order resolves a formal complaint filed at the State Office of Administrative Hearings.
Ward, Gregory A., M.D., Lic. No. K1126, Fort Worth
On November 7, 2014, the Board and Gregory A. Ward, M.D., entered into an Agreed Order requiring Dr. Ward to within one year complete at least 8 hours of CME in medical recordkeeping. The Board found Dr. Ward incorrectly dictated and described a procedure that was different than the procedure he actually performed on the patient. Dr. Ward dictated the operative note several days after surgery and did not review the note before electronically signing it.
CEASE AND DESIST
Gogia, Prem P., No License, Sugar Land
On November 7, 2014, the Board and Prem P. Gogia entered into an Agreed Cease and Desist Order prohibiting Mr. Gogia from acting as, or holding himself out to be, a licensed physician in the state of Texas. Mr. Gogia shall not refer to himself as doctor; Dr. Gogia; or Prem P. Gogia, M.D., without clearly designating that he is not licensed to practice medicine in the state of Texas. The Board found Mr. Gogia improperly held himself out to the public using titles of "Dr." and "Doctor" and the suffix "M.D." in his business cards and within his advertisements.
Paletta, Antonio Giovanni, No License, Round Rock

On October 27, 2014, a Board panel directed the Executive Director to enter a Cease and Desist Order against Antonio Giovanni Paletta requiring him to immediately cease from engaging in the practice of medicine without a license and from referring to himself as a doctor or physician in any manner, including by referring to himself as "doctor," "Dr.," or "M.D.," unless he also designates the authority under which the title is used or the college or honorary degree that gives rise to the use of the title. The Board panel found that Mr. Paletta engaged in the unlicensed practice of medicine and held himself out as a doctor during the airing of a local radio show.

Saturday, May 24, 2014

In-Depth: 12 HHS Funded Health Care Innovation Award Projects to Watch

On Thursday of this week, the HHS announced the twelve recipients of the second round of Health Care Innovation Awards program to test innovative models designed to deliver better care outcomes and lower costs. Twelve awards range in value from an expected $2 million to $18 million over a three-year period, with an average award size of $9 million. Each project will be monitored for measurable improvements in quality of care and savings generated.
Health Care Innovation Award Program Overview
The second round of the awards program will support public and private organizations that have a high likelihood of driving health care system transformation and delivering better outcomes. The four defined areas include:
  • Models that are designed to rapidly reduce Medicare, Medicaid, and/or CHIP costs in outpatient and/or post-acute settings.
  • Models that improve care for populations with specialized needs.
  • Models that test approaches for specific types of providers to transform their financial and clinical models.
  • Models that improve the health of populations – defined geographically (health of a community), clinically (health of those with specific diseases), or by socioeconomic class – through activities focused on engaging beneficiaries, prevention (for example, a diabetes prevention program or a hypertension prevention program), wellness, and comprehensive care that extend beyond the clinical service delivery setting.
An in-depth look at the awards are listed below: 

1. Altarum Institute

Project Title: “Reducing the Burden of Childhood Dental Disease”
Geographic Reach: Michigan
Estimated Funding Amount: $9,383,762
The Altarum Institute project will test a service delivery model with multiple components that involves direct work with primary care providers and dentists and the development and enhancement of supporting health information technology components. The model targets children enrolled in Medicaid or CHIP, ages 0 to 17.  Specific intervention activities include: 1) improving Identification of Children at high risk of dental disease by developing and deploying oral health risk screening tools, leveraging an existing statewide registry to document screenings and risk status, and delivering technical assistance/training to providers on the use of these tools in primary care and non-traditional settings; 2) linking to appropriate care providers through existing state and regional health information exchange infrastructure to establish electronic referral pathways between medical and dental providers, connecting dentists to the referral system, and monitoring the process, providing following-up on incomplete referrals; 3) promoting evidence-based preventive care by educating and preparing primary care providers and dentists to follow standards of care for preventive services such as fluoride varnish, sealants, and cleanings, providing outreach and education to families of high-risk children, coordinating with existing oral health promotion programs, and better aligning provider incentives to increase provision of preventive care; and 4) enabling care management and monitoring by developing and implementing a statewide dental quality monitoring system using recently validated American Dental Association measure sets.
2. American College of Cardiology Foundation
Project Title: “SMARTCare”
Geographic Reach: Florida, Wisconsin
Estimated Funding Amount: $15,871,245
The American College of Cardiology Foundation project will test the implementation of SMARTCare, which is a combination of clinical decision support, shared decision-making, patient engagement, and provider feedback tools designed to improve care for patients with stable ischemic heart disease. SMARTCare aims to achieve the following goals: 1) a reduction of imaging procedures not meeting appropriate use criteria, 2) a reduction in the percentage of percutaneous coronary interventions not meeting appropriate use criteria while achieving high levels of patient engagement and lower rates of complications, and 3) an increase in the percentage of stable ischemic heart disease patients with optimal risk factor modification. While many of these solutions have been studied and proven effective in isolation, this project will test them in combination.  The model will be tested at five sites in Wisconsin and five sites in Florida.
3. The Association of American Medical Colleges 
Project Title: “eConsults/eReferrals: Controlling Costs and Improving Quality at the Interface of Primary Care and Specialty Care”
Geographic Reach: California, Iowa, New Hampshire, Virginia, Wisconsin
Estimated Funding Amount: $7,125,770
The Association of American Medical Colleges project will test the scalability of an eConsult/eReferral model for implementation in five partner academic medical centers.  The eConsults model, developed by the University of California San Francisco (UCSF), is an electronic consultation and referral (eCR) platform for access to specialty input to address several well-documented gaps in primary care-specialty care communication and coordination and provide a foundation for non-face-to-face, asynchronous electronic consultation.  The proposed model has two components, both fully integrated into the Epic electronic health record.  The first being implementation of a standardized set of condition-specific referral templates across 12 medical specialties, with additional surgical specialties nearing completion. These templates, developed at UCSF and refined at each academic medical center by a consensus of primary care/specialist clinicians, provide immediate decision support to the primary care provider (appropriateness of referral, recommended pre-referral tests, etc.) and ensure that all necessary information is provided to the appropriate specialist. The second component of the model is the eConsult, an asynchronous exchange initiated by the primary care provider to seek guidance from the specialist, who is expected to respond in less than 72 hours. eConsults are completed in lieu of an in-person specialist visit, though the specialist can convert an eConsult to a referral if the situation warrants and the patients will still have the option to seek care with that specialist, if desired. The eConsult system integrates into current care-delivery practices and supports the work of both the primary care provider and the specialist involved in an eConsult exchange.
4. The Avera Virtual Care Center
Project Title: “Avera Virtual Care Center: Improving Care & Reducing Costs for the Vulnerable Elderly Population”
Geographic Reach: Iowa, Minnesota, Nebraska, South Dakota
Estimated Funding Amount: $8,827,573
The Avera Virtual Care Center project will test the virtual wrapping of a set of comprehensive, resident-centered, geriatric care services around the long term care population. The project will operate in facilities located in South Dakota, Minnesota, Iowa and Nebraska. The three primary drivers of this project include: building the assessment capability and toolkits of the long term care team of care providers; providing long term care facility residents with routine and early access to appropriate goal-directed care; and improving management of care transitions. A Virtual Care Team will host INTERACT II training sessions and skill building workshops for long term care staff and will facilitate widespread implementation of INTERACT II tools and treatment algorithms to support earlier identification of urgent issues. The INTERACT II implementation will be further supported by high-quality care planning resources and training to promote alignment of resident care goals and treatment plans. To address the geriatric care access gap, the Virtual Care Team will offer daily rounds, comprehensive geriatric assessments and urgent care visits to address resident health needs in a timely manner. These services will be provided out of a centrally staffed telemedicine hub, spreading the expertise of one team over 30 long term care centers. To maximize safety and continuity across transitional points in care, the Virtual Care Center team will promote the adoption of standardized tools and processes.
5. The Children’s Home Society of Florida 
Project Title: “Improving child well-being through integrating care in a community school setting”
Geographic Reach: Florida
Estimated Funding Amount: $2,078,295
The Children’s Home Society of Florida project will implement a medical home for students, families, teachers and the community at the Wellness Cottage at Evans High School, which aims to reduce Emergency Department and inpatient utilization, increase sexually transmitted disease awareness, and address food insecurities and traumatic stress. Four community partners including Children’s Home Society of Florida (child welfare/behavioral health), the University of Central Florida, Orange County Public Schools and Central Florida Family Health Center will operate the Wellness Cottage, a hub for health, social, behavioral health, parental support, and after-school activities. The Central Florida Family Health Center will provide onsite primary care. Health risk assessments will inform health promotion activities. Student health ambassadors will promote healthy lifestyles. Community health workers will help parents remove barriers to care. The University of Central Florida will provide social work, nursing, and medical interns. Primary Health Maintenance Organizations will facilitate access to the clinic and assist in evaluating health costs. Programs and services targeting wellness will be available in the school and community. It is predicted that the services provided at Evans Wellness Cottage will improve both the physical health and behavioral health of students, staff, and adults living in the targeted area. The model is designed to create a safe environment where students can learn better health care seeking behaviors and personal health management. In addition, informal and formal connections will help facilitate the development of trust and establish critical lines of communication to improve access to care at the Evans Wellness Cottage.
6. Clifford W. Beers Guidance Clinic, Inc.
Project Title: “New Haven WrapAround”
Geographic Reach: Connecticut
Estimated Funding Amount: $9,739,427
The Clifford W. Beers Guidance Clinic, Inc. project will deliver evidence-based, culturally-appropriate integrated medical, behavioral health, and community-based services coordinated by a multidisciplinary Wraparound Team. Services include: 1) family engagement, recruitment, and education provided by trained community health workers in community-based settings; 2) multidisciplinary triage, screening, and assessment conducted by the Wraparound Team and including assessments of each family’s physical, behavioral, and psychosocial risks, needs, and strengths; 3) family-focused care plans developed with the family, family supports, and the Wraparound Team and used to guide care and interventions; 4) care coordination provided by a Wraparound Team and focused on coordinating the provision of appropriate care across multiple care settings, managing care transitions, reconciling and managing medications, and coordinating access to crisis support and wellness and social support services; and 5) wellness and social support services provided at the hubs and at community-based organizations to address chronic and toxic stress (e.g., smoking cessation, parenting courses, diabetes prevention, meditation). The model focuses on high-need families, addresses medical and behavioral health care needs, integrates services across multiple health care institutions, and addresses the “chronic and toxic stress” experienced by the target population families. This project integrates care for families and integrates care delivery across multiple health care and community-based institutions, which will reduce the fragmentation that currently puts families at risk for poor care, poor outcomes, and excessive costs.
7.  Four Seasons Compassion for Life 
Project Title: “Increasing patient and system value with community based palliative care”
Geographic Reach: North Carolina
Estimated Funding Amount: $9,596,123
The Four Seasons Compassion for Life project will test a new model for community-based palliative care (in conjunction with Duke University), which spans inpatient and outpatient settings. The model features interdisciplinary collaboration and the integration of palliative care into the health care system, continuity of care across transitions, and longitudinal, individualized support for patients and families. This expands upon a successful program in four Western North Carolina counties to include an additional ten counties.  With community-based palliative care, care coordination ensures clinical follow-up of patients as they transition across settings. Standardized assessments and data infrastructure facilitate quality monitoring/improvement and high-quality patient care leading to decreased hospital readmissions.
8. Icahn School of Medicine at Mount Sinai 
Project Title: “Bundled Payment for Mobile Acute Care Team Services”
Geographic Reach: New York
Estimated Funding Amount: $9,619,517
The Icahn School of Medicine at Mount Sinai project will test Mobile Acute Care Team (MACT) Services, which will utilize the expertise of multiple providers and services already in existence in most parts of the United States but will transform their roles to address acute care needs in an outpatient setting. MACT is based on the hospital-at-home model, which has proven successful in a variety of settings.  MACT will treat patients requiring hospital admission for selected conditions at home. The core MACT team will involve physicians, nurse practitioners, registered nurses, social work, community paramedics, care coaches, physical therapy, occupational therapy and speech therapy, and home health aides. The core MACT team will provide essential ancillary services such as community-based radiology, lab services (including point of care testing), nursing services, durable medical equipment, pharmacy and infusion services, telemedicine, and interdisciplinary post-acute care services for 30 days after admission. After 30 days, the team will ensure a safe transition back to community providers and provide referrals to appropriate services.
9. New York City Health and Hospitals Corporation
Project Title: “ED Care Management Initiative: Preventing Avoidable ED/Inpatient Use”
Geographic Reach: New York
Estimated Funding Amount: $17,916,663
The New York City Health and Hospitals Corporation project will test an Emergency Department Care Management model, which expands and enhances a current successful pilot program. This model utilizes a multi-disciplinary team that will comprehensively assess patients who present in the emergency department for an ambulatory-care sensitive condition (ACSC), create a care plan that would avoid an unnecessary hospitalization, and provide ongoing support after discharge, including medication management, education, and linkages with primary care providers.  The program will operate in 6 hospitals.
10. North Shore-LIJ Health System, Inc.
Project Title: “Healthy Transitions in Late Stage Kidney Disease”
Geographic Reach: New York
Estimated Funding Amount: $2,453,742
The North Shore-LIJ Health System, Inc. project will implement the Healthy Transitions (HT) Program, which aims to improve late stage chronic kidney disease costs and outcomes. The model is based on a successful pilot and aims to integrate and coordinate aspects of chronic kidney disease care. The primary interventions center on improving patient education and preparation for renal replacement treatment, increasing home dialysis and preemptive transplantation, home safety, dietary counseling, depression screening, advanced directive counseling, detecting medication errors, identifying hospitalization risk and intervening to reduce risk. Nurse care managers will work in close collaboration with treating nephrologists. The HT chronic kidney disease informatics system creates a daily report with alerts that drives key care processes.
11. Regents of the University of California San Francisco
Project Title: “The UCSF and UNMC Dementia Care Ecosystem: Using Innovative Technologies to Personalize and Deliver Coordinated Dementia Care”
Geographic Reach: California, Nebraska
Estimated Funding Amount: $9,990,848
The Regents of the University of California San Francisco project will implement Care Ecosystem, an innovative clinical program that builds on the UCSF Memory and Aging Center’s 15-year history of offering high-quality dementia care, while incorporating the University of Nebraska Medical Center’s specialized expertise in functional monitoring and rural dementia care. Whereas most dementia care today is crisis-oriented and reactive, this model emphasizes continuous and personalized care. The target population is Medicare beneficiaries and persons dually eligible for Medicare and Medicaid.  By supporting family caregivers, keeping patients healthy, and helping them prepare together for advancing illness, this model aims to improve satisfaction with care, prevent emergency-related health care costs, and keep patients in the home longer. The primary point of contact for patients and families will be a Care Team Navigator (CTN) with 24/7 availability. An innovative “dashboard” with both CTN and patient portals will drive efficient and personalized communication between the CTN, care team, and the patient and family. The 4 modules of Care Ecosystem are as follows. The Caregiver Module will include educational forums and connect families with community resources. The Decision-Making Module will facilitate proactive medical, financial, and safety decisions. The Medication Module will track and reduce inappropriate medications or doses and trigger a pharmacist review when indicated. The Functional Monitoring module will use smartphones and sensors to rapidly detect and respond to changes in functional status, which is particularly important for patients living remotely, alone, or who are at-risk for acute declines.
12  Regents of the University of Michigan
Project Title: “Michigan Surgical and Health Optimization Program (MSHOP): A Multiplex Patient Risk Stratification and Intervention Program”
Geographic Reach: Michigan
Estimated Funding Amount: $6,389,850
The Regents of the University of Michigan project will implement the Michigan Surgical and Health Optimization Program (MSHOP), which focuses on- real-time risk stratification and peri-operative optimization for patients undergoing abdominal surgery. The model aims to improve surgical outcomes in two ways. (1) Real-time risk stratification aims to improve the appropriateness of surgery—in certain high-risk cases, patients and surgeons will avoid prohibitively high-risk surgical care, focusing on medical and palliative management. Further, real-time risk stratification can identify patients who would be good candidates for the peri-operative prehabilitation program. (2) This peri-operative program aims to enable patients to train for surgery, improving their physiology and mindset through an established outpatient program, leading to better outcomes and reduced costs by preventing complications and reducing length of stay.   Over the 3-year period MSHOP will be implemented in 40 Michigan hospitals.
The second and final batch for round two will be announced in the coming months.